Investigation of Project Delays: Towards a Sustainable Construction Industry

The construction industry is one of the key industries for any country. It has been observed that this industry is suffering from sustainable solutions during project execution. It is evident from the literature that most of the construction projects are seriously affected by delays. Pakistan's construction industry also suffers similar challenges. After the COVID-19 pandemic, the construction industry is experiencing several challenges which have resulted in project delays. Thus, this study investigates the key challenges affecting the timely completion of construction projects. The challenges were discovered from the literature and investigated to analyze their significance towards a sustainable construction project. This study also observes the relationships between the key challenges using Partial Least Squares Structural Equation Modeling (PLS-SEM). A structural model was developed based on the 55 common challenges identified from literature. Data collection was administered through a structured questionnaire survey using a 5-point Likert-scale. The challenges were grouped into six constructs. The outcome reported 20 critical challenges, with information and communication-related factors being the most important challenge in the construction industry. Contract management also significantly affects project time overrun. The created model served as a starting point for academics, researchers, and practitioners to create an effective system for regulating time overrun challenges.

The mental health of staff working in UK prisons during the Covid-19 pandemic

This article presents the results of an opportunistic, cross-sectional, self-report survey of the well-being of staff working in prisons throughout the UK. The survey was completed by 594 participants in the early part of 2021 at the height of the Covid-19 pandemic. Self-report measures indicated concerning levels of burnout and 43.4% of participants were above the established cut-offs on the Generalised Anxiety Disorder (GAD-7) scale. Eighty-one per cent reported that their mental and physical health had deteriorated and many said emotional support was lacking. Further research is required to establish how typical and persistent these concerns are. © 2023 The Authors. The Howard Journal of Crime and Justice published by Howard League and John Wiley & Sons Ltd.

CFD Analysis to Minimize the Spread of COVID-19 Virus in Air-Conditioned Classroom

The COVID-19 which is a respiratory disease spread by a virus of the coronavirus family has become a big problem leading to the closure of all academic as well as economic activities due to its capability to spread fast. In this study, we have investigated the effect to mix a disinfectant in aerosol form with air coming out from the air conditioning machine so it can reach all parts of the room to remove the virus and prevent the closure of certain necessary teaching–learning activities in the classroom. For this, the k-ε model which consists of two equations is used to numerically model the turbulent flow in the classroom. From the analysis, it can be found that high turbulent zones are formed in the room which can be an effective way of distributing the aerosol-based disinfectant in the classroom and from the particle tracker we can see the aerosol-based disinfectant reaching every corner. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Ravulizumab for COVID-19 Kidney Injury

Background: The evidence suggests that the primary events in AKI occur on the luminal surface of the endothelial cells in the microvasculature of kidney. These findings can be explained by the activation of the complement resulting in endothelial injury. Ravulizumab inhibits the cleavage of C5 into C5a and C5b thus preventing endothelial dysfunction. In this study, we report the use of ravulizumab to treat AKI in the setting of COVID-19 infection with focus on a primary follow-up period of 30 days. Method(s): Patients were randomized in a placebo-controlled fashion. One group received placebo and standard care (SOC) while the second group received SOC and ravulizumab. Outcomes were rigorously assessed for 30 days after enrollment. Result(s): 13 (11.4% of screened) patients identified to have COVID-19 infection were enrolled in the study. Six patients were randomized to receive ravulizumab in addition to standard of care (SOC+R) and seven patients were randomized to SOC. Three patients randomized to the SOC group died after enrollment. Mean number of hospital free days after enrollment was 290+/-47 (SOC+R) vs 164+/-144 (SOC) respectively. Free C5 levels increased over 30 days following ravulizumab infusion and corresponded with decreasing ravulizumab blood levels over the same time interval (p=0.001). During this same time period there was a decreased number of anuric days observed in the SOC+R compared to SOC (p=0.009). There was a reduced frequency of dialysis events in the SOC+R for ten days after enrollment (p=0.001). Conclusion(s): Due to the recurrent impact of COVID-19 infection throughout the world, targeted therapies for concomitant kidney injury merit future investigations to reduce incidence of AKI and potentially reduce future prevalence of CKD.

COVID-19 AS A CONFOUNDER IN A CASE OF HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS

SESSION TITLE: Pulmonary Involvement in Critical Care Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Hemophagocytic Lymphohistiocytosis (HLH) is a condition in which the body's natural ability to end an immune or inflammatory response is defective1. COVID-19 also presents with severe inflammation, and like HLH, leads to significantly elevated ferritin2. We present a case that was initially thought to be COVID-19, but the patient was diagnosed with HLH in the setting of S. aureus endocarditis. CASE PRESENTATION: A 62-year-old male with a history of atrial fibrillation, mechanical mitral valve on warfarin, type II diabetes, chronic obstructive pulmonary disease, and recently diagnosed COVID-19 presented to the hospital with progressive dyspnea. In the emergency department, he was found to be hypoxemic and in atrial fibrillation with rapid ventricular response. He had a fever of 39.3°C and his initial laboratory workup revealed hemoglobin of 11.9 g/dL, leukocytes of 5,700, platelets of 83,000, AST 35 U/L, ALT 34 U/L, CRP of 31.89 mg/dL, and ferritin of 1994 ug/L. The patient was admitted and started on dexamethasone 6 mg daily. The following day, the patient's blood work revealed a significant worsening of AST and ALT to 7280 U/L and 3319 U/L, respectively. D-dimer increased to 11861 ng/mL (DDU) and ferritin to 36,470 ug/L. On the third day of admission, his clinical status declined acutely as he became significantly bradycardic, progressing to a cardiac arrest after which he required cardiopulmonary resuscitation, intubation, and was transferred to the intensive care unit. A CT scan obtained revealed hepatomegaly of 22 cm and blood cultures were positive for S. aureus requiring vancomycin treatment. The patient was kept on dexamethasone due to concerns for HLH. Ferritin continued to worsen, reaching 50,749 ug/L. His sCD25 came back positive. Unfortunately, the patient expired on his fifth day of hospitalization after discussing with his family their goals for his care and switching his care to comfort only. DISCUSSION: HLH is a challenging condition since diagnosis is difficult and mortality is high. There are a few methods used to diagnose HLH. Usually, 5 of 8 criteria must be met, which was achieved with this patient. However, often the patient only fulfills 4 of 8 since many criteria are difficult to obtain such as bone marrow biopsy, sCD25, and CXCL9. A useful tool is the H-calculator3. Our patient scored a 180 indicating a 50-75% likelihood of HLH. Assessing the likelihood of disease is important since sCD25 and CXCL9 take time and if the patient is clinically deteriorating treatment should not be delayed. CONCLUSIONS: HLH is catastrophic and rare. Physicians should always have it as a differential diagnosis in patients with severe inflammatory states and elevated ferritins to avoid anchoring bias. If suspicion is high based on clinical evaluation and scores, treatment should not be delayed. Reference #1: Filipovich A, McClain K, Grom A. Histiocytic disorders: recent insights into pathophysiology and practical guidelines. Biol Blood Marrow Transplant. 2010;16(1 Suppl):S82-S89. doi:10.1016/j.bbmt.2009.11.014 Reference #2: Cheng L, Li H, Li L, et al. Ferritin in the coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. J Clin Lab Anal. 2020;34(10):e23618. doi:10.1002/jcla.23618 Reference #3: Fardet L, Galicier L, Lambotte O, et al. Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome. Arthritis Rheumatol. 2014;66(9):2613-2620. doi:10.1002/art.38690 DISCLOSURES: No relevant relationships by Areeka Memon No relevant relationships by Carissa Monterroso No relevant relationships by Carson Oprysko No relevant relationships by Eduardo Padrao No relevant relationships by Mouna Penmetsa

Seeing is believing? A systematic review of credibility perceptions of live and remote video-mediated communication in legal settings

There has been a dramatic increase in use of remote communication via audio-visual technology since the COVID-19 pandemic. This includes use in complex legal hearings where decisions rely heavily on credibility assessments of an individual and their interview statement. This is particularly relevant in legal settings where negative assessments can have adverse outcomes such as asylum applications which can result in deportation. Increasing use of remote communication technology raises the question of what research can tell us about how someone is perceived when interviewed live (in-person) compared with via video-mediation. A systematic review of the literature resulted in the selection of nine papers. Four themes were identified;decision-maker's assumptions, frame of the camera, demeanour and detecting truth and lies. The results are discussed within the context of credibility judgements in asylum proceedings together with implications for further research and practice. Copyright © 2022 The Authors. Applied Cognitive Psychology published by John Wiley & Sons Ltd.

COVID-19 and Autoimmune Demyelinating Diseases

This chapter addresses COVID-19 in the context of patients with demyelinating disorders of the central nervous system (CNS). Multiple sclerosis (MS) is the most common CNS demyelinating disease, and SARS-CoV-2 infection in patients with MS and other autoimmune demyelinating CNS disorders causes numerous concerns. As with other infectious diseases, COVID-19 may exacerbate pathology in patients with MS. Standard therapies for MS and immunosuppressive treatments for other CNS autoimmune disorders may pose unique risks during severe COVID-19. However, preliminary findings on SARS-CoV-2 infection suggest that some MS therapies may limit the aggressive immune response underlying severe COVID-19 complications. Furthermore, infection with SARS-CoV-2 may have the potential to trigger postinfection autoimmune disorders. Here we review the current understanding of COVID-19 in patients with MS and other CNS disorders and the impact of immunomodulatory therapies on these patients. © 2021 Elsevier Inc. All rights reserved.

Assessment of pregnant females' anxiety and health concerns during COVID-19 pandemic

Objective: To determine level of anxiety in pregnant females during covid-19 using CAS scale and to determine pregnant women's maternal and fetal health concerns during COVID-19. Study Design: Descriptive Cross sectional study Place and Duration of Study: This study was conducted at the Outpatient department of Obstetrics and Gynaecology Isra University Hospital Hyderabad from January 2021 to March 2021 for a period of 03 months. Materials and Methods: A convenience sampling technique was used to collect data from 180 pregnant women who had no previous psychiatric, missed abortion, or ectopic pregnancy history. A standardized CAS scale was used to assess each participant's level of anxiety about COVID-19, followed by a self-structured questionnaire to assess women's concerns about foetal and maternal health in the context of COVID-19. Frequency was calculated for all variables. Results: The bulk of our patients were over 35 years old and multigravida, according to our results. Corona related anxiety was found in 63.8% of patients, and it had an impact (58%) on their lives, both in terms of their health (41.3%) and the health of their unborn child (53.8%). Conclusion: Anxiety was shown to be present in majority of pregnant females with most of them being worried about the health of their unborn child. © 2021 Medical Forum Monthly. All rights reserved.

Online Teaching in an Un-prepared Country during COVID-19: An Interview Study on Final Year Medical and Dental Students

Aims: To assess medical students' perception of online teaching to suggest transforming the future curriculum in low-economic countries. Study Design: Cross-sectional online interview study. Place and Duration of Study: A team of collaborators interviewed final year medical and dental students of Pakistan from 07/08/2020 till 17/09/2020. Methodology: A questionnaire was developed based on open and close-ended questions in Google forms;focusing on institutional preparedness, views on online education, the institute's closure and COVID-19, and long-term effects of closure of the institute. Independent fellow researchers systematically analyzed the unaltered transcripts of the responses, and themes were then identified and coded to conclude the results. SPSS version 23 used for analysis. As this study was based on final year students. Results: In response to an invitation email, 2442/2661 (91.77%) students voluntarily participate in this qualitative study. Most participants were females (1614, 66.10%). Closing down institutes was directly linked to a lack of motivation and feel of helplessness. As most showed dissatisfaction with online teaching compounded by psychological effects, students feared losing clinical skills and life during the pandemic. Conclusion: The psychological impact of the crisis led to resistance to accepting the change for a better outcome. Incorporating telemedicine, different interactive learning style to online teaching, and resilience training would result in fruitful outcomes. Developed countries may also guide build infrastructure in developing countries to develop a more robust online teaching methodology in the long-run.

Safety of B cell depleting effects of ocrelizumab in patients with multiple sclerosis in clinical practice

Introduction: Ocrelizumab is a humanized monoclonal antibody that targets CD20 expressing cells. It rapidly depletes circulating B-cells that express CD20. However, it has a prolonged peripheral B-cell depleting effect, relatively less well-understood effect on tissue compartment B-cell population, and complex cross-talk with T-cells. Therefore, there is considerable interest in the short and long-term safety of ocrelizumab, mainly regarding severe infections and malignancies. Objective: To investigate the safety of ocrelizumab therapy in relapsing-remitting (RRMS), secondary-progressive (SPMS) and primary progressive multiple sclerosis (PPMS) patients including the incidence of infections and malignancies. Methods: This retrospective study included MS patients receiving ocrelizumab therapy for up to 46 months. Patients' demographic, duration of disease, phenotype, expanded disability status scale(EDSS), course of treatment, number of infusions, infusion site reactions, infection, and laboratory data were recorded. Wilcoxon two-sample tests were used to compare patient with and without infections. Results: Of the 187 patients, 67% were female, 66% were White, 21% were Black, median EDSS was 6 (range 0-8.5), and the mean age was 50.7 years. RRMS(55%) was the most common type of MS with an equal number of both PPMS and SPMS(22%), and the median duration of MS was ten years. Twenty-seven(14%) patients had infusion site reactions primarily mild, with only 2 patients having an anaphylactic reaction. Fifty-two(28%) patients had an infection, the most common being recurrent UTI , 9 with URI, 7 with COVID-19 infection, and 7 with pneumonia, out of which 5 were severe. 6(3%) patients had a cancer diagnosis after the start of treatment. In contrast, 13(7%) had a cancer diagnosis before starting treatment. Infections were associated with older age(p=0.01), higher EDSS at last clinic visit(p=0.046) and more infusions(p=0.031). Conclusion: The rate of infections in clinical settings seems similar to reports from clinical trials, but cancer rates were slightly higher. Advanced age and higher disability status increased the risk of infections.

Adoption of E-Learning at Higher Education Institutions: A Systematic Literature Review

The concept of e-learning offers several benefits;however, the effective adoption of e-learning systems at higher education institutes (HEIs) is a relatively new concept and thus a challenging task. The current paper provides a comprehensive review of the extant literature on adopting e-learning systems at HEIs. Using the PRISMA search technique, owing to the widespread adoption of e-learning since 2005, the relevant articles published from 2005 to 2020 are selected. The paper identifies and puts forward the level of compatibility and readiness of students and teachers in adopting e-learning, factors that motivate and hinder the adoption of e-learning respectively, benefits of adopting an e-learning system, and the strategies for implementing e-learning at HEIs. In this realm of COVID-19 and e-learning, this paper also envisages different strategies, policies, and recommendations for effectively implementing e-learning at HEIs.

Impact of cough etiquettes in compliance with preventive measures from airborne disease: A cross-sectional study among symptomatic respiratory patients

Objective: To evaluate the impact of knowledge regarding cough etiquettes among the symptomatic respiratory patients as a preventive measure from airborne disease. Study Design: A cross-sectional study Place and Duration of Study: This study was conducted at the Al-Tibri Medical College between the duration of December 2019 to February 2020. Materials and Methods: A total of 200 admitted and non-admitted respiratory symptomatic patients of both genders with the age of 18 years and above were included in the study through a non-probability convenience sampling technique after taking ethical approval from concerned authorities. The researcher filled a valid questionnaire after taken verbal consent from the patients. The data were evaluated in the form of frequency and percentage through SPSS version 22.0. Results: 100% of patient's responses the coughing, sneezing, and spitting are the source of transmission. The majority of the respondent knew the preventive method and media was the principal source of information. The number of patients was unaware of respiratory hygiene and cough etiquette. To some extent, they practice cough etiquettes in their daily lives while they cannot practice these measures due to insufficient knowledge and resources. Conclusion: According to the current requirement of health sensibility among the community due to running pandemic situations of the coronavirus worldwide, the study revealed the hidden aspects of community orientation regarding the prevention form air born disease. Following the study results, they need proper education about respiratory hygiene, and by adopting which measures they can incorporate the appropriate care and cope with any health situation.

Awareness and compliance of paramedics towards airborne infection control in sindh

Objective: To evaluate the knowledge and compliance of paramedics regarding preventive measures in Sindh. Study Design: Cross Sectional Study Place and Duration of Study: This study was conducted at the Naz Memorial Hospital, Karachi from January 2020 to May 2020. Materials and Methods: 100 numbers of paramedics from different medical institutes through snow ball sampling selected. The valid questionnaire was filled by the paramedics and received via email with the ethical approval from concerned ethical bodies. Both gender with 18 years and above age were included, no medical professional other than paramedics were included in present study. Both questionnaires were filled by the participant, who voluntarily participates in the study. The data was expressed in the form of frequency and percentage through SPSS version 21.0 Results: 100% of paramedic's well response the knowledge at higher level of appreciation regarding preventive measures and their application at their work places. They are well trained and excellent skills in their field of health care, the deficit area if the availability of resources for both the workers and patients. Conclusion: In fighting a battle against the corona virus team of paramedics are generally highly equipped with knowledge, skills and attitude. The only barriers at their work place are the availability of recourses that can make hazards in management of illness and meanwhile cure the patients and self-protection are at high risk. If the ministry involved and make sure the proper accessibility of all protective maneuvers at the site of health management, the outcomes will be more than the thought.

Demographics, clinical profile and outcomes of severe coronavirus patients

Objective: Aim of this study is to determine the frequency, demographics and clinical profile and outcomes of corona virus in patients with symptoms of corona virus such as fever, sore throat, respiratory problem, diarrhea, cough and abdominal pain. Study Design: Cross-sectional study Place and Duration: Study was conducted at Liaquat University Hospital, Hyderabad for duration of six months from July 2020 to December, 2020. Methods: Total 320 patients of both genders with ages 18 to 75 years suspected to have corona virus were enrolled in this study. Demographically details of patients including age, sex, residence and co-morbidities were recorded after taking informed consent. Real time PCR was done to confirm the cases. Complete clinical profile of corona virus patients was examined. Complete data was analyzed by SPSS 22.0. Results: Among 320 patients 60 (18.75%) were diagnosed positive for corona virus disease while 260 (71.25%) had negative for corona virus. Out of 60 patients 45 (75%) were male patients and the rest were females 15 (25%). Mean age of patients was 53.54±11.68 years. Majority of patients 52 (85%) were asymptomatic, 5 (8.33%) patients were critically ill and 4 (6.67%) patients were symptomatic. Mean time to recovery was 14.11±4.55 days. Mortality found in 2 (3.33%) patients and all were critically ill. Conclusion: Majority of corona virus patients were male, older age group and asymptomatic. Only 8.33% patients were critically ill. Majority of patients were recovered while only 3.33% patients were died.

Incidence and distribution of findings of chest radiographic in patients positive for COVID-19

Background:The radiologic parameters of covid-19 (corona virus disease-2019) is displayed mainly by CT but the detail report of chest radiographs in accordance with the time period of the disease is absent. Purpose:The objective of this study was to analyze the severity of Covid-19 findings on the chest radiographs and to evaluate the disease time course. The aim of the study also included the evaluation of relation between these findings on chest radiograph and RT-PCR(real-time reverse transcription polymerase chain reaction) test for SARS COV-2 nucleic acid. Methodology:This study was retrospective in which admitted Covid-19 patients (during April-June 2020) inCivil Hospital and Khairpur Medical College, Khairpurwere analyzed through chest radiographs and RT-PCR and was approved by institutional review boards. Consents from all participants included in this study was taken. 74 patients were taken from Civil Hospital Khairpur. The positive covid-19 was evaluated through RT-PCR test done on swabs taken from nasopharynx and throat. 42 patients possessed serial results of RT-PCR. The chest radiography was done on all patients except one. The time course of symptoms was acquired from epidemiological data of public given by the Health department. In a-symptomatic patients (11 out of 74 concluding the date of positive RT-PCR test result was added to analyze onset of symptoms. The radiologists scored the radiographs of chest on the basis of ground-glass opacity, consolidation, pleural fluid as well as the location. Severity index of each lung was analyzed, and scores were added to obtain the final severity score. Results:The clinical presentations of 74 patients in which 31 (42%) were males and 43 (58%) were females included in this study. (the mean value of age was 61 years and the range of age was 18 to 80 years). Fever (44 patients;59.4% as well as cough (30 patients;41%) were commonly present in the patients. About 11 patients (15%) presented as asymptomatic. The comorbidities like hypertension were present in 16 patients (22%) and diabetes was present in 10 patients (14%). 49 patients displayed abnormal chest radiographs during their course disease. The baseline radiograph of chest reveals consolidation as commonest presentation in about 34 patients (46%), and ground glass opacity in 25 patients (34%). The common locations were peripheral distribution in 30 patients (41%) and lower zone involvement in 36 patients (49%). 36 out of 74 (49%) patients had bilateral involvement of lungs. Only three patients (4%) presented with pleural effusion. All patients were evaluated through baseline chest radiographs in which 25 patients (34%) presented with normal results. Conclusion:The radiographic examinations of Covid-19 patients revealed bilateral consolidation in lower zones of lungs reaching at peak within 10 to 12 days from the time of onset of the symptoms.

Association of mortality and raised inflammatory markers such as serum LDH, serum ferritin and CRP in hospitalized patient with COVID-19 infection

Objective: The objective of the study was to analyze correlation of serum ferritin, CRP (c-reactive protein) and lactate dehydrogenase with mortality in hospital due to infection caused by covid-19. Also, the aim was to evaluate the best cut off values. Study Design: It was a cross-sectional study carried out in themedicine department ofCivil Hospital and Khairpur Medical College, Khairpur. The study was done between June to September 2020. Methodology: Patients that were admitted due to SARS COV-2 which was positive after PCR testing were the part of this study. Patients that had suggestive findings on radiograph but negative PCR test for SARS COV-2, patients with incomplete data or patients that left hospital against medical advice were not included in this study. At the time of admission, serum levels of ferritin, CRP and LDH were tested. The viral load of SARS COV-2 was analyzed through nasopharyngeal swab. WHO guidelines were used to evaluate the disease severity. Results: In this study, 248 participants were taken with mean age 42.28± 17.84years. 163 patients (65.7%) showed up with mild symptoms, 38 patients (15.32%) revealed moderate while 47 patients (18.95%) were severe cases. 27 patients (10.8%) expired in the hospital. The serum levels of ferritin (124 patients;50%), CRP (86 patients;34.67%) and LDH (179 patients;72.17%) were elevated which was more frequent in patients with moderate or severe conditions and mortality.The 95% confidence interval and the areas in curves associated with receiver operating characteristics for serum levels of ferritin, CRP and LDH were 0.920 (0.840-0.98), 0.91 (0.84-0.95) and 0.87 (0.75-0.92) respectively. CRP (≥45.5 mg/L) had 87.46% sensitivity and 89.10% specificity;ferritin (≥723 ng/ml) had 94.22% sensitivity and 87.60% specificity and the LDH (≥428.5 U/L) had 91.50% sensitivity and 81.65% specificity to predict the mortality. Conclusion: The levels of inflammatory markers at the time of admission will help predict mortality in Covid-19 patients.

Innovation in the pandemic: A pilot study of improvised cpap for COVID-19 respiratory failure

INTRODUCTION: Increasing functional residual capacity with positive pressure improves ventilation perfusion mismatch and relieves hypoxemia. However, most noninvasive interfaces must be tightly applied for prolonged periods and may lead to facial decubiti and delirium. High flow O2 systems with wide bore nasal cannulas are not widely available in resource-limited settings. We hypothesized that applying CPAP through a high flow nasal cannula (improvised nasal CPAP or iCPAP) may provide sufficient alveolar recruitment and greater patient comfort. The objective of this study was to describe the use of a respiratory support strategy using iCPAP in COVID-19 respiratory failure. METHODS: In a prospective, observational design, hemodynamically stable, non-hypercapnic patients, admitted with COVID-19 hypoxic respiratory failure and on iCPAP, were included. For iCPAP ResMed LumisTM 150 VPAP ST-A was used with Respicare High-flow nasal cannula. iCPAP failure was characterized as advancement to conventional BiPAP or endotracheal intubation. Data on ROX index, iCPAP failure, organ failure, survival to discharge was collected. RESULTS: 113 patients were admitted;improvised CPAP (iCPAP) was applied in 45 (49%), 6 (13%) alternated between bilevel positive pressure and iCPAP. Mean APACHE II score was 19.3 ±4.7, 37 (82%) were male, mean age was 52±12.9 years. Systemic steroids were given to 45 (100%), 41 (91%) patients underwent awake proning, 8 (18%) and 7 (16%) were given concurrent tocilizumab and convalescent plasma. Mean PaO2/FiO2 ratio at admission was 129 ±63 (range 43,380). Mean CPAP applied was 12 ±2.7 cmH20. For patients receiving concurrent BiPAP, mean IPAP was 15 ±3.7 cmH20, EPAP 11 ±4 cmH20 were applied. Mean ROX index 2 hours after iCPAP application was 10.9 ±5.5. iCPAP failure occurred in 3 (6.6%) patients;1 required intubation and invasive ventilation and 2 were advanced to only BiPAP support. 39 (87%) patients were discharged alive from the ICU;2 (4.4%) developed acute kidney injury, 5 (11%) had deranged liver function tests. One patient (2%) had a cerebrovascular event. 1 patient (2%) had a cardiac arrest. CONCLUSIONS: iCPAP application in carefully selected patients and with intensive care monitoring, may represent a valid form of respiratory support in COVID-19 hypoxic respiratory failure.