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Background: Patients with SARS-CoV-2 infection are at an increased risk of cardiovascular and thrombotic complications portending an extremely poor prognosis. COVID-19 infection is known to be an independent risk factor for acute ischemic stroke (AIS) and myocardial infarction (MI). Aim(s): We propose to develop risk assessment model (RAM) that can risk stratify hospitalized COVID-19 patients for arterial thromboembolism (ATE). Method(s): This multicenter, retrospective study included adult patients admitted with PCR proven SARS-CoV-2 infection between 3/1/2020 and 9/5/2021. The composite outcome was in-hospital ATE events, including AIS, MI, and other ATE identified by ICD-10 codes. 49 variables, including baseline demographics, past medical history, presenting vitals and laboratory values, were categorized with multiple imputation to impute missing values. Variables selected by LASSO regression were used to build the final RAM. Result(s): Among 3531 patients from training cohort (admitted before 12/31/2020), 548 (15.5%) patients developed acute ATE, compared to 285 of 2508 (11.4%) in the validation cohort (admitted after 12/31/2020). The final score included 16 items: Male gender (1);Non-African American race (1);Age 40-59 (2), Age 60+ (4);Systolic blood pressure > = 160mmHg (1);History of cerebrovascular accident (1), Coronary artery disease (1), Smoking (1);Leukocytes > 11 K/uL (1), B-type natriuretic peptide > 100 pg/ mL (1), Lactate dehydrogenase > 192 U/L (1), Creatinine > 1.4 mg/ dL (1), Aspartate aminotransferase > 41 U/L (1), Troponin-I > 0.03 ng/mL (1), Troponin-I > 0.09 ng/mL (3), Interleukin-6 > 5 pg/mL(1), Potassium < 3.5 mEq/L(1), Magnesium < 1.8 mg/mL (1). RAM had a good discrimination for ATE (training AUC 0.777, 95% CI 0.756-0.797;validation AUC 0.749, 95% CI 0.721-0.778). The validation cohort was stratified as low-risk (score 0-8), intermediate-risk (score 9-13) and high-risk groups (score 14+), with the incidence of ATE 2.1%, 11.3%, and 31.1%, respectively. Conclusion(s): Our prediction model based on 16 parameters commonly available at hospital admission showed moderate performance in identifying hospitalized COVID-19 patients at low and high risk for ATE.
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Background: TB and COVID 19 have similar presentation. This study Aims to identify the problems and difficulties faced by TB patients during COVID 19 pandemic and Lockdown. Methods: A 35 Questionnaire based study where a total of 100 diagnosed TB cases in DOTS OPD were asked regarding the difficulties faced by TB patients for Diagnosis of TB and starting treatment, and also the ease of availability of consultation, anti TB drugs, Investigations and counselling during the period of pandemic and lockdown. Results: Out of 100 patients diagnosed with TB, 42% were COVID 19 suspects, 38% had symptoms for <1month which helped in early diagnosis of TB. 6% patients had symptoms for > 6 months. 27% patients faced problems getting diagnosed, of which 51.8% had travel difficulty, 29.6 % - financial, 18.5 % - lack of health care access, 19% of the patients had no access to high protein diet during lockdown. 31% of patients had side effects due to AKT, Vomiting 74%, 16% Itching, 9.6% Joint pains. 57% patients required admission. All patients were satisfied about counselling regarding disease and treatment course. Patients reported for follow up after 6.7 days on average. Conclusion: TB patients faced difficulties during COVID 19 pandemic.
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With the onset of lockdown in the COVID-19 scenario, people were forced to confine themselves within the four walls of their rooms which in the meantime invited mood disorders like depression, anxiety etc. Music has proven to be a potential empathetic companion in this tough time for all. The proposed emotion-based music recommendation system uses aser emotion as an input to recommend songs that are-ascertained using faciai expression or using direct inputs from the user. The model uses a Random Forest classifier and XGBoost algorithm to identify the song's emotion considering various features like instruineiitainess, energy, acoustics, liveness, etc, and lyrical similarity among songs with the help of Term-Frequency times Inverse Document-Frequency (TF-IBF). The results of comprehensive experiments on reai data confirm the accuracy of the proposed emotion classification system that can be integrated into any recommendation engine. © 2021 IEEE.
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Coronavirus disease, also referred to as COVID-19, is a contagious illness generated by a respiratory virus. There has been an exponential increase with the amount of patients affected with COVID-19 that has put an exceptional burden on the medical care frameworks across the world. Analysis of COVID-19 disease from the images of Chest X-ray may help isolate high-risk patients, while test results are anticipated upon. With most X-ray frameworks currently digitized, there is no transportation time required for the samples, hence making it easier for the health care workers to analyze it. In this work, we demonstrate the potential of ResNet, which is a CNN, to diagnose Chest X-ray images. These images can be classified into Normal, COVID, or Viral Pneumonia efficiently using ResNet. As a result, the probability of detecting patients with COVID-19 is maximized through higher accuracy. Empirical analysis exhibits that the proposed neural network strategy is better than Support Vector Machine, Naive Bayes algorithm, Logistic Regression, and k-NN. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Introduction: Vaccines against SARS-CoV-2 have been approved rapidly. Pivotal studies were conducted in healthy volunteers. Data in allo- HCT patients (pts) are lacking. Here, we examined antibody (AB) titers to COVID-19 vaccination with BNT162b (Comirnaty®) or mRNA-1273 (Moderna Covid-19 Vaccine®) in allo-HCT pts. Methods: Serial AB titers (IgG, IgA, IgM: prior to;1m after dose 1;1, 3, 6m post 2. vaccine) against 4 SARS-CoV-2 antigens (receptor-binding domain, spike glycoprotein subunit S1/S2, and nucleocapsid protein) were recorded with a multiplex AntiBody CORonavirus Assay (ABCORA) in allo-HCT pts and healthy controls. Results: So far 99 pts (median age 55y (range 18y-74y)) have been enrolled. Currently, AB responses for the 1m after dose 1 and dose 2 are available for 74 and 57 pts, respectively. Pts were grouped into those (A) 3-6m post-HCT (n=14 after 1. dose, n=11 after 2. dose);(B) 6-12m post- HCT (n=11 after 1. dose, n=10 after 2. dose);and (C) >12m post-HCT (n=49 after 1. dose, n=36 after 2. dose). In addition, AB responses are available for n=32 healthy controls (median age 38y) after the 1. dose, and n=10 after 2. dose. There was a statistically significant difference of the S1 AB levels (IgG, IgA, IgM) between the 4 groups after both the 1. and the 2. dose (ANOVA p-value< 0.001 and 0.003, respectively, Fig.1). After the 1. dose, median values of sum of S1 signals were 0.97 (1Q-3Q=0.82-1.14) in (A), 0.92 (0.78-1.27) in (B), 2.35 (0.90-33.7) in (C);and 57.1 (14.6-69.7) in the healthy group. After the 2.dose, median values were 3.84 (1Q- 3Q=1.32-15.3) in (A), 20.9 (1.28-69.9) in (B), 118 (8.74-313) in (C);and 195 (150-238) in the healthy group. Values >9.3 are considered to represent protective immunity according to ancillary studies. Conclusion: Allo-HCT pts early post-HCT displayed only low/no AB formation to vaccination. Such knowledge is of critical importance to allo- HCT pts and transplant physicians to guide treatment decisions regarding re-vaccination and social behavior during this pandemic. Analyses on the impact of pharmacological immunosuppression and graft-vs-host disease on immune responses to the vaccine are underway. (Figure Presented).
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Background: Long-term data in allo-HCT patients after SARS-CoV-2 vaccination are lacking. We examined antibody (Ab) titers to the vaccination with BNT162b (BioNTech Pfizer) or mRNA-1273 (Moderna) Covid-19 vaccine in allo-HCT patients. Methods: Serial Ab titers (prior to;1m after 1. dose (T1);1m (T2), 3m (T3) post 2. dose) against SARS-CoV-2 antigens (receptor binding domain (RBD), spike glycoprotein subunit S1/S2, nucleocapsid) were recorded with the AntiBody CORonavirus Assay (ABCORA) in allo-HCT patients and healthy controls. Results: We enrolled 110 allo-HCT patients (median age 57y) and 86 healthy controls (median age 37y). Patients were grouped into: (A) 3-6m, (B) 6-12m and (C) >12m post-HCT. The sum of IgG, IgA and IgM S1 activities (cS1) >17 is considered to represent protective immunity. cS1 Ab levels were statistically different between the 4 groups both after the 1. and the 2. dose (ANOVA p-values<0.001, Fig.1) with the lowest antibody response in group A (S1 median value 0.959 at T1, 6.26 at T2, 1.24 at T3) and B (S1 median value 0.973 at T1, 4.76 at T2, 11.9 at T3) compared to group C (S1 median value 6.57 at T1, 179 at T2, 69.3 at T3) and healthy controls (S1 median value 54.9 at T1, 228 at T2, 91.1 at T3). Conclusion: Allo-HCT patients early post-HCT displayed only low or no Ab formation to vaccination with a decline in AB response after T2. We conclude that Ab response in allo-HCT patients should be measured regularly to guide treatment decisions regarding re-vaccination and social behavior.
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Background: The COVID-19 pandemic changed the way Americans live and behave. Social isolation, financial crisis, and loss of loved ones add to the stressors. Research has shown increased alcohol consumption as a coping mechanism. Several reports indicate an increase in alcohol sales during the pandemic. Short term and long-term complications of this are unknown currently. We sought to determine the number of hospitalizations for alcoholic hepatitis during the COVID-19 pandemic in the United States. Method: This is a retrospective cohort study comparing hospitalizations for alcoholic hepatitis/ alcoholic hepatic failure during February 2019 to September 2019 and from February 2020 to September 2020. We analyzed HCA Healthcare’s Physician Services clinical data warehouse which aggregates data from 185 hospitals in the US. Patients were identified retrospectively using ICD-10 codes. Patient characteristics, labs, and discharge information were also collected. Categorical variables were compared using the Chi-square test and continuous variables were compared using the t-test. Results: The total number of hospitalizations for alcoholic hepatitis and alcoholic liver failure in February through September was 57,171 in 2020 vs 61,356 in 2019. This represented 7.4 % of all admissions in 2020 vs 6.5% in 2019. Admissions in Q1 (excluding January), Q2, and Q3 were 6.02%, 8.55%, and 7.74% respectively in 2020, and 6.63%, 7.05%, and 6.08% respectively in 2019. The mortality rate in 2019 was 1.35%, it increased to 2.04% in 2020 (p=0.01). There is also a 7% increase in cases among women in 2020. Conclusions: This study shows that there is a relative increase in hospitalizations for alcoholic hepatitis and alcoholic hepatic failure during the COVID-19 pandemic compared to the year before, especially in the second and third quarters of the year. Interestingly at the beginning of the pandemic when many states issued stay-at-home orders there was a 10% decrease in alcoholic hepatitis hospitalizations versus the previous year. As the prolonged uncertainty and chaos continued the hospitalizations increased by 21% in the second quarter and by 27% in the third quarter versus the prior year. We assume that as uncertainties prevailed, alcohol use increased, resulting in alcohol-related liver injuries. Additionally, the COVID-19 pandemic has seen increased alcoholic hepatitis mortality and an increase in female patients. The results shed light on a different public health aspect of the pandemic which has gone unnoticed and needs to be addressed.
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Introduction: Arterial and venous thromboembolism are common complications in COVID-19. Micro-macro thrombosis-related organ dysfunction can confer an increased risk for mortality. The optimal dosage of anticoagulation (AC) in COVID-19 patients remains unclear. Interim data from adaptive randomized control trials (ATTACC, REMAP-CAP, and ACTIV-4a) showed divergent results of therapeutic AC (TAC) versus usual care AC for the primary outcome of organ support free days in hospitalized COVID-19 patients. Components of CHA 2DS 2-VASc, a model originally built for predicting ischemic stroke in atrial fibrillation, are consistent with independent risk factors for COVID-19 severity and mortality. Herein, we analyzed the performance of the CHA 2DS 2-VASc model in hospitalized COVID-19 patients for predicting arterial and venous thromboembolic events, which could potentially aid in risk stratification of hospitalized patients and guide AC dosing. Methods: This is a large, retrospective, multicenter cohort study that included all adult patients from one tertiary care and five community hospitals with PCR-proven SARS-CoV-2 infection between 3/1/2020 and 12/1/2020. The primary composite outcome was acute arterial thromboembolism (ATE) and venous thromboembolism (VTE). We identified patients with ATE [cerebrovascular accident (CVA), myocardial infarction (MI) including both ST-segment elevation MI and non-ST-segment elevation MI], and VTE [deep vein thrombosis (DVT) and pulmonary embolism (PE)] using ICD -10 codes. Mean and standard deviation were reported for continuous variables;proportions were reported for categorical variables. To compare the groups, the Chi-square test was used for categorical variables, and the t-test was used for continuous variables. CHA 2DS 2-VASc scores were calculated on admission and were used as a measure of the predictive accuracy of the scoring system. Sensitivity and specificity with different cut-offs of CHA 2DS 2-VASc scores were calculated. All statistical tests were 2-sided with an α (significance) level of 0.05. All data were analyzed using R version 4.0.5. Results: Among 3526 patients, a total of 619 patients had thromboembolic events: 383 had ATE and 236 had VTE. Of 383 patients who had ATE, 350 patients were found to have acute MI, 48 had CVA, and 15 had both MI and CVA. In patients with VTE, 134 had DVT, 168 had PE, and 66 had both DVT and PE (Figure 1). We analyzed the primary composite outcome of ATE and VTE (group 1) vs no ATE and VTE (group 2). Baseline characteristics are included in Table 1. The in-patient all-cause mortality rate was 28.4% in group 1 vs 12.6% in group 2 (p<0.001). The mean hospital length of stay was 12.3 days in group 1 vs 8.8 days in group 2 (p<0.001). Group 1 had a mean CHA 2DS 2-VASc score of 3.3 ±1.6. vs 2.7±1.7 in group 2 (p<0.001) (Figure 2). At CHA 2DS 2-VASc scores of 3 and 4, the model had a specificity of 46% and 67% and sensitivity of 68% and 42% respectively for predicting ATE/VTE. The CHA 2DS 2-VASc score of 5 had a specificity of 86% and sensitivity of 25%. The score of 7 had 98% specificity but 3% sensitivity (Table 2). Conclusion: Our results suggest that the CHA 2DS 2-VASc model for arterial and venous thromboembolism has a moderate performance. The CHA 2DS 2-VASc score of 5 has a high specificity, though low sensitivity, for predicting thromboembolism. The CHA 2DS 2-VASc score can be used as an adjunct risk stratification tool to initiate TAC. [Formula presented] Disclosures: No relevant conflicts of interest to declare.
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Background: Vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been approved rapidly. However, pivotal studies have been conducted in healthy volunteers, while recipients of allogeneic hematopoietic cell transplantations (allo-HCT) may have different dynamics and patterns of response to the vaccine and data in this cohort is lacking. Methods: Here, we examined longitudinal antibody (AB) titers to SARS-CoV-2 vaccination with BNT162b (Comirnaty ®) or mRNA-1273 (Moderna Covid-19 Vaccine ®) in allo-HCT recipients who had undergone allo-HCT >3months (m) ago and in healthy controls (hospital employers). Serial AB titers (prior to (T0);1m after 1 st dose (T1);1m (T2), 3m (T3), 6m (T4) post 2 nd dose) were measured with an in-house developed multiplex Antibody CORonavirus Assay (ABCORA) that measures SARS-CoV-2 IgG, IgA, and IgM reactivities against RBD (receptor binding domain), S1 (subunit 1 of the spike protein), S2 (subunit 2 of the spike protein) and N (nucleoprotein), thereby allowing to differentiate immunity after vaccination versus immunity after infection. As neutralization activity correlates well with S1 AB binding, the potency of the AB response was defined as the sum of S1 IgG, IgA and IgM reactivities (cumulative S1 (cS1)). Based on computational methods high neutralization potency was predicted above a cS1 threshold of 17. Results: We enrolled 114 allo-HCT patients (median age 57y (range 18y-74y)) between March 9th 2021 and May 31st 2021 at the University Hospital Zurich, Switzerland. Currently, AB responses at T1, T2, and T3 are available for 99, 95 and 89 patients, respectively. Patients were grouped into those (A) 3-6m post-HCT (T1: n=25 at, T2: n=23, T3: n=20);(B) 6-12m post-HCT (T1: n=13, T2: n=13, T3: n=12);and (C) >12m post-HCT (T1: n=61, T2: n=59, T3: n=57). In addition, AB responses are available for healthy controls (median age 35y (range 23y-64y)) (T1: n=75, T2: n=69, T3: n=48). There were 10 patients and 5 healthy subjects with a reported or detected SARS-CoV-2 infection. There was a statistically significant difference of cS1 AB levels between the 4 groups at T1, T2, and T3 (ANOVA p-values (p) <0.001, respectively, Fig 1) with the lowest AB response in group A (cS1 median value 0.957 at T1, 5.22 at T2, 1.90 at T3) and B (cS1 median value 0.973 at T1, 4.76 at T2, 11.9 at T3) compared to group C (cS1 median value 6.21 at T1, 199 at T2, 76.4 at T3) and healthy controls (cS1 median value 54.9 at T1, 228 at T2, 91.1 at T3). Using a multivariate linear regression analysis adjusted on age and gender, we found that patients in groups A and B had significantly lower cS1 levels than groups C and healthy subjects (p<0.001, p<0.001, p=0.034 of healthy versus groups A, B, C respectively at T2, and p<0.001, p=0.004, p=0.12 at T3), and that preinfected patients had higher cS1 levels at T2 and T3 respectively (p=0.003 and 0.006). The dynamics of the AB response were more diverse in allo-HCT recipients. In a multivariate linear regression analysis (Fig 2) assessing factors associated with humoral immune responses in allo-HCT recipients, we found consistently lower cS1 responses in patients early post-HCT (group A+B (p=0.002)) and higher cS1 levels in those who had been preinfected with SARS-CoV-2 (p=0.012). Patients under immunosuppressive treatment (IST) and those who had relapsed disease post-HCT showed significantly lower cS1 immune responses (p=0.028 and 0.005, respectively). The presence of moderate or severe chronic GVHD was not a statistically significant factor influencing AB levels. This may be explained by (i) the heterogeneity of the condition of chronic GVHD and low patient numbers;(ii) the late time point >12m post-HCT with generally higher AB levels. Consistent with other reports age >65y was also associated with lower cS1 responses (p=0.03). Conclusion: Allo-HCT recipients early post-transplant, those of older age, and those given IST displayed insufficient AB titers to the vaccine. Such knowledge is of critical importance to transplant recipients and th ir physicians to guide treatment decisions regarding re-vaccination, and social behavior during this pandemic. Monitoring AB development in all allo-HCT recipients and vulnerable patients with other immunocompromising conditions may be crucial to determine those at increased risk for infection and for the timing of booster vaccines. [Formula presented] Disclosures: Manz: CDR-Life Inc: Consultancy, Current holder of stock options in a privately-held company;University of Zurich: Patents & Royalties: CD117xCD3 TEA.