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Background: Confinement and economic uncertainty, along with disease-specific issues such as pain and suffering may uniquely impact rheumatology patients, putting non-COVID morbidity at par with COVID-related losses.Methods: We conducted a review of records to explore the clinical profile and interventions in rheumatology patients at a tertiary care center in Northern India to identify the potential problems and propose direction for the future.Results: In our experience spanning 5 weeks, among 508 rheumatology patients who sought teleconsultations, rheumatoid arthritis was the most common diagnosis (35.2'), and 43' were asked to continue the same treatment over tele consults, whereas investigations were awaited for another 16'. Nearly one-third (29.9') required an intervention, though this largely consisted of dose titrations (104 of 152, 68.4'). Certain diseases such as myositis were under-represented among consults (1.2') but over-represented (33.3') among admissions. Among the 54 patients who were asked to rate their teleconsultation experience, the voice and consultation quality were rated and average of 9.9 each, and 88.9' (48/54) said they would prefer teleconsultations until the pandemic is over.Conclusion: A sizeable proportion of rheumatology patients can be managed with teleconsultations, with some requiring greater assistance, calling for a triage protocol for the times ahead. With propositions for a deliberate transition into the realm of virtual consulting, chronic caregivers can hope to reach an optimal balance between e-consults and in-person visits.
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Publication metrics enable the assessment of the performance of citations or utilization of published work. Journal-level metrics depend on the database whose citations are analyzed. Publication metrics from the Web of Science include the widely-used journal impact factor (JIF) and other indices such as Journal Citation Impact, Eigenfactor, normalized Eigenfactor, and Article Influence Score. Metrics from Scopus include the CiteScore, Source Normalized Impact Factor, and SCImago Journal Rank. Author-level metrics such as total citations, h-index, i10-index, and g-index inevitably increase with time and can be inflated by self-citations. Article-level metrics such as total citations and online attention scores derived from Scopus (PlumX Metrics) or Altmetric indicate the extent of utilization and discussion in scientific circles of a particular article. Publication metrics are useful to provide a bird's eye view of how well an individual journal or article has been cited or used. They do not necessarily reflect article quality. As an example, some of the articles with the highest Altmetric Attention Scores are actually retracted publications that attained high scores due to the negative debate that they elicited. Journal-level metrics such as the JIF are fluid and prone to historical fluctuations from year to year, most recently observed by increases in the JIF of journals which published a lot of coronavirus disease 19-related content. Research assessment of individual scientists often misuses publication metrics such as the JIF, when they should instead rely on a critical appraisal of research articles by assessors.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Aim/Introduction: COVID-19 can cause lung dysfunction postinfection. Respiratory complications are critical sequelae of severe COVID-19 infection and several patients suffer from PCLD after testing RT-PCR negative. Interleukin-6 (IL-6) acts as a key cytokine playing a role in inflammation in lung and other tissues in COVID-19. IL-6 level is increased in patients with non-specific interstitial pneumonia/fibrosis. Injured lungs are major source of IL- 6. Studies have shown association between IL-6 and development of lung injury evaluated by CT scan. Persistent 18F-FDG uptake in lung parenchyma is seen in PCLD patients indicating residual inflammation. Thus the study aimed to evaluate the metabolic activity of lung disease on FDG PET/CT and correlate it with IL-6 in PCLD patients. Material(s) and Method(s): The study was approved by Institutional Review Board and Ethics committee. 32 patients having persistent (>4 weeks) respiratory symptoms post-acute COVID-19 infection after testing RTPCR negative (PCLD) underwent 18F-FDG PET/CT. Simultaneously blood sample was collected on the day of the FDG PET/CT scan in EDTA vial before FDG injection. Serum level of IL-6 was measured by ELISA. FDG PET/CT images were analyzed and SUVmax of metabolic active lung lesions were calculated. The FDG PET/CT findings were correlated with IL-6 using PSM correlation test. Result(s): The mean age of patients (n = 32) was 55.7 years (range 36-71 years) of which 25 were males. 13 (41%) patients had dyspnoea at rest while the remaining had dyspnoea on exertion (59%). Similar age and gender-matched healthy controls were included in our study. All patients had bilateral ground-glass opacities (GGO) in the lung parenchyma. Out of 32 patients, 30 (94%) had a metabolically active lesion in the bilateral lung parenchyma. The mean SUVmax was 3.6 (range 2 - 12.7) and the median was 2.7. Corresponding CT had extensive lung disease including bilateral GGO seen in all patients, consolidation (n=14), and interstitial thickening (n = 20), with more than one feature in some. The Median IL-6 level was significantly higher in patients suffering from PCLD compared to healthy control (326.96 vs 281.5, p=0.0023). Serum IL-6 strongly correlated with SUVmax score of PCLD (r=0.675). The patients were treated with steroids and antifibrotic as per institute's protocol. Conclusion(s): PCLD with ongoing active inflammation as detected by 18F-FDG PET/CT is noted in patients with persistent pulmonary symptoms and it correlates strongly with elevated IL-6 levels. This may play a role in future to monitor the patient with prolonged disease.
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Background: Confinement and economic uncertainty, along with disease-specific issues such as pain and suffering may uniquely impact rheumatology patients, putting non-COVID morbidity at par with COVID-related losses. Method(s): We conducted a review of records to explore the clinical profile and interventions in rheumatology patients at a tertiary care center in Northern India to identify the potential problems and propose direction for the future. Result(s): In our experience spanning 5 weeks, among 508 rheumatology patients who sought teleconsultations, rheumatoid arthritis was the most common diagnosis (35.2'), and 43' were asked to continue the same treatment over tele consults, whereas investigations were awaited for another 16'. Nearly one-third (29.9') required an intervention, though this largely consisted of dose titrations (104 of 152, 68.4'). Certain diseases such as myositis were under-represented among consults (1.2') but over-represented (33.3') among admissions. Among the 54 patients who were asked to rate their teleconsultation experience, the voice and consultation quality were rated and average of 9.9 each, and 88.9' (48/54) said they would prefer teleconsultations until the pandemic is over. Conclusion(s): A sizeable proportion of rheumatology patients can be managed with teleconsultations, with some requiring greater assistance, calling for a triage protocol for the times ahead. With propositions for a deliberate transition into the realm of virtual consulting, chronic caregivers can hope to reach an optimal balance between e-consults and in-person visits. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a contagious viral pathogen, creating a public health emergency, and affecting lives and livelihood of millions of populations globally. Good knowledge, attitude, and practice are essential to prevent and stop the widespread transmission. Aims and Objectives: The aim of the study was to assess the knowledge, attitude, and practices regarding COVID-19 among health-care workers (HCWs) in tertiary care hospitals of Odisha. Material(s) and Method(s): The present study is an observational, cross-sectional, and question-based online research. Questions were created on Google forms. Link was generated and given through social media apps. The questionnaire consists of four sections. First section comprised demographic characteristics. Second, third, and fourth sections contain questions on knowledge, attitude, and practice related to COVID-19, respectively. Descriptive and inferential statistical procedures were done through IBM SPSS statistics version 24.0. The research was granted approval by Institute Ethics Committee of IMS and SUM Hospital. Result(s): Data were analyzed in 430 subjects, 205 females and 225 males. The majority of HCWs have good knowledge score 86.5%, attitude score 80.9%, and practice score 91.2%. The mean knowledge score was 6.6 +/- 0.84 and mean attitude score was 28.5 +/- 1.89. Knowledge and attitude score was found to be significantly different among age groups and gender, p<0.001. Mean attitude score had a significant difference with working status, P = 0.025. Mean knowledge and attitude score was significantly higher across professions and work experience, P < 0.001. Good practice score varies significantly across professions, P < 0.001. Conclusion(s): The most of HCWs had good knowledge, positive attitude, and adopted appropriate practices regarding COVID-19. Periodic educational interventions are strongly recommended for HCWs to upgrade their knowledge, attitude, and practices regarding coronavirus diseases. Copyright © 2022 Debasish Misra, et al.
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Background: COVID-19, an unprecedented pandemic significantly affects psychologically healthcare workers (HCWs). The World Health Organization has also announced the pandemic as a Global Public Health Crisis. Priority to observe psychological effects was critical to understanding the various factors and delivering a tailored approach to treatment. This study aims to analyse the prevalence and severity of depression, anxiety, and stress amongst HCWs in Odisha during the pandemic. Materials and methods: A cross-sectional, observational, questionnaire-based online study was conducted. A total of 300 HCWs participated. The collection of data was done online through a self-administered validated depression, anxiety, and stress (DASS-21) questionnaire designed in Google form. The questionnaire has three sections, consent form, demographic characteristics, and DASS-21. For analysis of categorical variables descriptive statistics, Chi-square test, and Binomial test were used, and for continuous variables, Kruskal Wallis test & Mann-Whitney test were used and ‘p’<0.05 was considered significant. Results: In this study, respondents were young (63.7%) and the majority were females (61.7%). Doctors constitute 57%, nurses 35%, dentist 17.7% and pharmacists 7% (p<0.001). The majority work in non-government sectors (p<0.001), having 1-5 years of experience (p<0.001). As many as 42.7% of HCWs have depression, 53.7% anxiety, and 13.3% stress. The professional category has a significant association with depression, anxiety, stress, and overall, DAS score (p<0.01). Doctors have the highest level of depression, anxiety, stress, and overall, DAS score, followed by nurses, dentists, and pharmacists. Gender played a significant association with anxiety and stress. Females have a significantly higher level of anxiety and stress (p<0.05). Conclusion: The present study revealed a higher proportion of depression, anxiety, and stress in HCWs. Early screening for detecting mental health issues should be initiated for HCWs who are being exposed repeatedly. Hence, group-specific need-based psychotherapy is critical during the pandemic. © 2023, Faculty of Associated Medical Sciences, Chiang Mai University. All rights reserved.
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Coronavirus disease 2019 (COVID-19) is a global pandemic where several comorbidities have been shown to have a significant effect on mortality. Patients with diabetes mellitus (DM) have a higher mortality rate than non-DM patients if they get COVID-19. Recent studies have indicated that patients with a history of diabetes can increase the risk of severe acute respiratory syndrome coronavirus 2 infection. Additionally, patients without any history of diabetes can acquire new-onset DM when infected with COVID-19. Thus, there is a need to explore the bidirectional link between these two conditions, confirming the vicious loop between “DM/COVID-19”. This narrative review presents (1) the bidirectional association between the DM and COVID-19, (2) the manifestations of the DM/COVID-19 loop leading to cardiovascular disease, (3) an understanding of primary and secondary factors that influence mortality due to the DM/COVID-19 loop, (4) the role of vitamin-D in DM patients during COVID-19, and finally, (5) the monitoring tools for tracking atherosclerosis burden in DM patients during COVID-19 and “COVID-triggered DM” patients. We conclude that the bidirectional nature of DM/COVID-19 causes acceleration towards cardiovascular events. Due to this alarming condition, early monitoring of atherosclerotic burden is required in “Diabetes patients during COVID-19” or “new-onset Diabetes triggered by COVID-19 in non-Diabetes patients”.
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Background: Stroke misdiagnosis is estimated to occur in 9% of all stroke patients and is associated with poor outcomes. We hypothesized that machine learning (ML) could be used to detect ischemic stroke at the point of care in emergency departments (ED). Methods: Clinical data from 13 hospitals of a large health system in Pennsylvania, United States, from September 2003 to May 2019 were used for model development. Data from June 2019 to December 2020 were prospectively collected and divided into pre- and post-COVID cohorts for validation. We simulated three clinical settings by enrollment with different inclusion/exclusion criteria and created two ML pipelines: ML applied to pre-event clinical data, and natural language processing (NLP) with ML applied to clinical notes during triaging. Misdiagnosed stroke in ED was a case study to show the discriminative power. Results: We included a total of 49,155 patient encounters (8,900 consecutive ischemic stroke patients and 40,255 controls). The best model, based on the patient's pre-event information, was XGBoost (AUROC=0.91). Using NLP+ML pipeline, we collected 2,070 notes during the triage process and 9,607 notes (non-stroke) for modeling. For independent validation, we identified 2,989 notes for stroke and 4,303 notes for non-stroke. We identified nine models that reached a balanced performance in terms of AUROC, sensitivity, and specificity. Model performance, in terms of AUROC, ranged from 0.876 to 0.985. Model sensitivity and specificity reached 0.993 and 0.975, respectively. There was no performance difference between models tested on pre- and post-COVID. Three out of four models correctly identified a separate case series of five misdiagnosed strokes. Conclusion: Available clinical information can be used to reduce stroke misdiagnosis in real-time. In addition, this study serves as a foundation for prospective trials to establish how pre-event clinical data and triage information can be used to improve care.
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Background/Objectives: The use of hydroxychloroquine (HCQ) for COVID-19 has raised concerns for adverse effects. We aimed to understand the practice, perceptions, and experience of adverse drug reactions (ADRs) with HCQ use for COVID-19 and other indications. Methods: A validated e-survey with 30 questions was circulated among rheumatologists and other specialists using SurveyMonkey. Responses from rheumatologists were compared with other doctors (odds ratio [OR], median, interquartile range), and ADRs encountered based on their indications. Results: Among 410 respondents (71.2% rheumatologists, 27% academicians) with a lifetime experience of 17886 (4884-52074) patients over 12 (7-20) years, and 148 (48-349) prescription of HCQ per month, one-third (135) were managing COVID-19 with 10 (0-60) prescriptions per physician. Electrocardiograms were seldom ordered preprescription (5%), but visual scans were requested by one-thirds, especially by rheumatologists (OR-1.9). Agreement on the safety of HCQ for non-COVID indications was nearly unanimous (99%), but only two-third (64%) perceived it to be safe for COVID-19, with most (72%) being uncomfortable using HCQ with macrolides. ADRs were most often encountered after middle-age with skin pigmentation (554 [123-2063]) being the most frequent, followed by gastrointestinal intolerance (222 [42-980] per million prescriptions). Cardiac toxicity was rarely reported. ADRs other than cutaneous and visual were noted more frequently by nonrheumatologists. Rheumatologists were less likely to consider HCQ unsafe (OR-0.04) and reportedly faced a greater challenge in drug procurance (OR-2.6) during the pandemic. Conclusions: Most ADRs are rare with HCQ use in our respondent population with a large user experience. HCQ use was considered unsafe by one-thirds in the setting of COVID-19 but not outside it, lesser so by rheumatologists. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.