Ginger ring compounds as an inhibitor of spike binding protein of alpha, beta, gamma and delta variants of SARS-CoV-2: An in-silico study

The available drugs against coronavirus disease 2019 (COVOD-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are limited. This study aimed to identify ginger-derived compounds that might neutralize SARS-CoV-2 and prevent its entry into host cells. Ring compounds of ginger were screened against spike (S) protein of alpha, beta, gamma, and delta variants of SARS-CoV-2. The S protein FASTA sequence was retrieved from Global Initiative on Sharing Avian Influenza Data (GISAID) and converted into ".pdb” format using Open Babel tool. A total of 306 compounds were identified from ginger through food and phyto-databases. Out of those, 38 ring compounds were subjected to docking analysis using CB Dock online program which implies AutoDock Vina for docking. The Vina score was recorded, which reflects the affinity between ligands and receptors. Further, the Protein Ligand Interaction Profiler (PLIP) program for detecting the type of interaction between ligand-receptor was used. SwissADME was used to compute druglikeness parameters and pharmacokinetics characteristics. Furthermore, energy minimization was performed by using Swiss PDB Viewer (SPDBV) and energy after minimization was recorded. Molecular dynamic simulation was performed to find the stability of protein-ligand complex and root-mean-square deviation (RMSD) as well as root-mean-square fluctuation (RMSF) were calculated and recorded by using myPresto v5.0. Our study suggested that 17 out of 38 ring compounds of ginger were very likely to bind the S protein of SARS-CoV-2. Seventeen out of 38 ring compounds showed high affinity of binding with S protein of alpha, beta, gamma, and delta variants of SARS-CoV-2. The RMSD showed the stability of the complex was parallel to the S protein monomer. These computer-aided predictions give an insight into the possibility of ginger ring compounds as potential anti-SARS-CoV-2 worthy of in vitro investigations. © 2023, School of Medicine, Universitas Syiah Kuala. All rights reserved.

Nutritional assessment of COVID-19 patients admitted in intensive care units in Pakistan

Coronavirus disease 2019 (COVID-19) can be life threating if untreated. Early diagnosis and effective nutritional management can save life. To assess the nutritional status and predict possible outcomes of critical patients Sequential Organ Failure Assessment (SOFA), nutrition risk in critically ill patients (NUTRIC), and acute physiology and chronic health evaluation (APACHE) score has been used. This retrospective observational study was conducted on confirmed COVID-19 cases in Intensive Care Unit (ICU) of Shifa hospital between November 24, 2020 to May 31, 2021. The demographic, clinical and laboratory information was obtained from hospital records. Risk factors for COVID-19 were identified and compared using multivariate logistic regression analysis. The nutritional risk for each patient was assessed. In this study 162 COVID-19 patients with median age of 64 years (IQR: 56-74) were included. Hypertension (59.2%) was found to be the most common comorbidity and the most prevalent symptoms upon admission were fever (54.9%). The patients in critical condition were supplied nutrients through nasogastric route (61.7%) while 37.7% and 0.6% were assisted through oral and total parenteral nutrition (TPN) route. The Glasgow comma score was found to be mild (72.2%) (GCS>12) with increased creatinine, white blood cell count, C-reactive protein (CRP C), and glycosylated haemoglobin HbA1c level were present. Interestingly based on SOFA, APACHE and NUTRIC score low insignificant malnutrition risk was observed. Our study found different demographic factors and comorbidities have a substantial impact on COVID-19 patients, as evidenced by demographic, laboratory, clinical, and nutritional risk factors.

Among COVID-19 Hospitalized Patients Does D-Dimer Value at the Time of Admission Predict Future Outcome

Background: COVID-19 is still going on with lots of uncertainties. There is a need for early and effective marker for prognostication of COVID-19 patients. Coagulation dysfunction and increased D-dimer levels are seen in this disease. Thus, present study was aimed to compare D-dimer value in relation to disease severity and disease mortality, and to evaluate prognostic significance of D-dimer. Method(s): All symptomatic SARS-CoV-2 RT-PCR confirmed COVID-19 patients admitted in Hospital from March 31, 2021, to May 31, 2021 were evaluated and clinical, demographical and laboratory findings were collected and analysed. According to disease severity patients were grouped and death events and D-dimer value were assessed. Optimal D-dimer cut off point in all groups were evaluated. Result(s): 388 patients were included in the study out of which 142 (36.5%) died during hospital stay. Mean D-dimer value in mild disease was 1.17+/-0.21, moderate disease was 1.47+/-0.17 and in severe disease was 2.92+/-0.23 FEUmicrog/ml. Mean D-dimer value in non-survivors were significantly (P<0.001) different and higher (59.3%) as compared to survivors. ROC curve analysis showed a prognostic value of D-dimer in mild (AUC=0.755, Z=3.30, P=0.001), moderate (AUC=0.762, Z=4.65, P<0.001) and severe (AUC=0.694, Z=5.08, P<0.001) patients. Optimal cut off of D-dimer between survivor and non survivors was >0.78 in mild cases, >1.05 in moderate patients and >2.11 in severe cases. Conclusion(s): Mean D-dimer value showing increasing trend with increase disease severity and prognostic significance was found highest in moderate patients followed by mild patients and least in severe patients in terms of mortality.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Azole resistance screening in Aspergillus species isolated from patients with COVID-associated pulmonary aspergillosis from Pakistan

Background: COVID-19 associated pulmonary aspergillosis (CAPA) complicates the course of critically ill COVID-19 patients. Delay in diagnosis and reports of azole resistance in CAPA patients lead to adverse outcome. We had previously reported CAPA rates of 21.7% from our center with high mortality. To detect azole resistance in Aspergillus species isolated from CAPA patients, we performed azole resistance screening. Material(s) and Method(s): Aspergillus species isolated from tracheal aspirates of CAPA patients admitted in Aga Khan University Hospital, Karachi, Pakistan during July 2020- January 2022, were screened for azole resistance as per CDC protocol. Minimum inhibitory concentration of screening positive strains were determined using YeastOne Sensititre plate. Result(s): 92 Aspergillus isolates were screened from 73 CAPA patients for azole resistance. Only 2 (2.17%) A. flavus isolates showed growth on voriconazole well, while other 90 (97%) isolates were screened negative for resistance (Table. 1). MICs of these two strains against posaconazole, voriconazole and itraconazole were 0.5 ug/mL, 1 ug/mL and 0.25ug/mL respectively. Table. 1: Aspergillus species distribution and growth on azole resistance screen agar Conclusion(s): We also did not find any azole resistance in this study. Periodic surveillance for the emergence of azole-resistant clinical isolates using molecular approaches is essential.

The nexus of environmental, social, and governance practices with the financial performance of banks: A comparative analysis for the pre and COVID-19 periods

This study aims to examine the impact of ESG practices on the financial performance of the banking industry of Pakistan during the pre and COVID-19 periods. The data were collected from the annual reports of selected banks for the pre-COVID-19 period (2018) and the COVID-19 period (2020). Results of the t-test show that there is a significant difference in ESG disclosures between the pre and during-COVID-19 periods. The regression analysis shows that the formative ESG factor positively affected the financial performance of the banking industry during the pre-COVID-19 period. While the reflective factors (environmental and social) positively affected the financial performance of the banking industry in the pre-COVID-19 period. During the COVID-19 period, the formative factor of ESG was found to have a significant positive impact on the financial performance of the banking industry. Similarly, in this period, the reflective factors (social and governance) were also found to have a significant positive impact on the financial performance of the banking industry. Interestingly, environmental sustainability negatively impacted the financial performance during the COVID-19 period. It indicates that the banking industry ignored environmental sustainability practices during the COVID −19 period, negatively affecting their financial performance. It suggests that ignoring environmental sustainability practices will deteriorate financial performance following the COVID-19 period. These results have profound policy implications for practitioners and policymakers in the banking industry, which are discussed. © 2023 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.

New cardiovascular events in the convalescent period among survivors of SARS-CoV-2 infection.

BACKGROUND: Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may have an increased risk of acute cardiovascular events in the convalescent period. AIMS: To determine whether patients with SARS-CoV-2 infection have an increased risk of cardiovascular events during the convalescent period. METHODS: We analyzed 10,691 hospitalized adult pneumonia patients with SARS-CoV-2 infection and contemporary matched controls of pneumonia patients without SARS-CoV-2 infection. The risk of new cardiovascular events following >30 days pneumonia admission (convalescent period) was ascertained using Cox proportional hazards regression analysis to adjust for potential confounders. RESULTS: Among 10,691 pneumonia patients with SARS-CoV-2 infection, 697 patients (5.8%; 95% CI, 5.4-6.2%) developed new cardiovascular events (median time interval of 218 days post pneumonia admission; interquartile range Q1 = 117 days, Q3 = 313 days). The risk of new cardiovascular events was not significantly higher among pneumonia patients with SARS-CoV-2 infection compared with those with pneumonia without SARS-CoV-2 infection (hazard ratio (HR), 0.90, 95% CI, 0.80-1.02) after adjustment for potential confounders. In addition, no significant difference in the rate of a new ischemic stroke (HR, 0.84; 95% CI, 0.70-1.02) or ischemic heart disease (HR, 1.00; 95% CI, 0.87-1.15) was observed between the pneumonia patients with and without SARS-CoV-2 infection. CONCLUSION: Our study suggests that new cardiovascular events rate in the convalescent period among pneumonia patients with SARS-CoV-2 infection was not significantly higher than the rate seen with other pneumonias.

Frequency of Respiratory Complications in Post COVID-19 Patients After Coronary Artery Bypass Grafting

Objective: To determine the frequency of post-operative pulmonary complications after (coronary artery bypass grafting) CABG surgery and to compare the respiratory complications of post COVID and comparison group Study Design: Analytical Cross-sectional study Study Place and Duration: Study was conducted in Adult Intensive Care Unit, Armed Forces Institute of Cardiology, Rawalpindi Pakistan, from Sep 2021 to Mar 2022. Methodology: 40 patients were selected, and divided into two groups using non-Probability consecutive sampling. Group-A had history of COVID-19 infection and Group-B was a comparison group and had no history of COVID-19 infection. Patients presenting for elective On-Pump (coronary artery bypass grafting) CABG surgery and known history of COVID-19 were included in our study. Patients of age ranging 30 to 70 years irrespective of gender were included in the study. Any patient who had cardiopulmonary bypass time of more than 120 min, respiratory illness like asthma or Chronic Obstructive Pulmonary Disease (COPD), history of smoking, or requiring post-operative re-ventilation due to cardiac or neurological complication, were excluded from the study. After patients were received from Operation theatre, they were monitored for the respiratory complications and both groups were compared. Results: A total of 40 patients were included in this study having mean age 57.9±7.62 years. Most of the patient population was male 31(77.5%) and only 09(22.5%) were female patients. Study population was equally divided into two groups i.e., 20(50%) in comparison group and 20(50%) in post COVID-19 group. There was no significant difference in age (p=0.714), ventilation time (p=0.068), gender (p=1.000), and re-ventilation (p=0.451) of both groups. While Intensive Care Unit stay (p=<0.0001) and non-invasive ventilation (NIV) were found to be significant (p=0.007). © 2022, Army Medical College. All rights reserved.

Chronic Anticoagulant Use Prior to Covid-19 Diagnosis: A Systematic Review and Meta-Analysis

INTRODUCTION: Coagulopathy and thromboembolic events are poor prognostic indicators of COVID-19 disease. There is a discrepancy in the results of different studies regarding the effects of chronic anticoagulation on clinical outcomes. This systematic review aims to summarize the evidence on the impact of chronic anticoagulation on clinical outcomes in COVID-19. METHOD(S): A Literature search was performed on LitCovid PubMed, WHO, and Embase databases from inception (December 2019) till May 2022. Our eligibility criteria included original studies that reported the association between prior use of anticoagulants for unrelated indications at the time of COVID-19 diagnosis and the patient outcomes in adults suffering from COVID-19. The risk of thromboembolic events in COVID-19 infected patients on chronic anticoagulation is the primary outcome and severity of COVID-19 disease in terms of ICU admission or invasive mechanical ventilation/intubation requirements, and all-cause mortality were the secondary outcomes. Random effects models were used to compute crude ODDs ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs). RESULT(S): A total of 44 observational studies met our inclusion criteria. In unadjusted analysis, prior anticoagulation was not associated with reduced risk of thromboembolic events in COVID-19 patients (N=43851, 9 studies, OR 0.67 [0.22, 2.07];p= 0.49;I2= 95%). However, pre-hospital use of anticoagulants significantly increase the risk of allcause mortality in COVID-19 patients (N= 580601;37 studies, OR 1.56 [1.22, 2.01];p=0.0005;I2= 97%). There was no statistically significant association between prehospital anticoagulants usage and COVID-19 disease severity (N=186239;20 studies, OR 0.96 [0.70, 1.33];p= 0.82;I2= 88%). Pooling adjusted estimates revealed no statistically significant association between pre-hospital use of anticoagulants and risk of Thromboembolic events in COVID-19 patients (aOR= 0.85 [0.34, 2.12];p= 0.72), COVID-19 related mortality (aOR= 0.93 [0.82, 1.07];p= 0.32), and the severity of COVID-19 infection (aOR= 0.96 [0.72, 1.30];p= 0.81). CONCLUSION(S): Prehospital use of anticoagulation was not significantly associated with reduced risk of thromboembolic events, improved survival, and lower severity of disease in COVID-19 patients.

E-learning for business resilience: A qualitative study in a mega MNC

As of 2020, COVID-19 has impacted nearly all countries and about half of the world's population. C'OVID-19 will have driven over half of the world's population into a strict confinement lockdown by 2020. For the sake of the overall mental health of humanity, organizations have developed various coping strategies for mindfulness, such as e-learning. Genpact was the subject of a case-based inquiry for the study using secondary data. The study's conclusion reveals that Genpact's strategy for building organizational resilience in the face of a pandemic. The study adds to the literature in a novel way by performing a qualitative survey of Genpact, providing essential insights to HR policymakers, academics, and top management on how to create professional resilience.

Detection of SARS-CoV-2 Eta VOI among international travelers using COVIDSeq-NGS

Rationale: SARS-CoV-2 has been identified as a highly infective and contagious viral infection. The SARS-CoV-2 pandemic has been spread worldwide and affected more than 210 countries. Globally, the fast spread of novel SARS-CoV-2 variants has been mostly attributed to international travel. Patient concerns: We are reporting the genomic evidence of SARS-CoV-2 Eta VOI among two international travelers. Both travelers were males from Nigeria aged 24 and 34 years and both were asymptomatic. Diagnosis: The nasopharyngeal swab samples were in both travelers positive by real-time RT-PCR followed by COVIDSeq-NGS. Interventions: Paracetamol 3 times daily for 5 days. Outcomes: Patient recovered completely within 10 days and discharged after 14 days of quarantine duration. Lessons: This report highlights genomic variation of SARS-CoV-2 among the travelers. For managing the present health crisis, molecular identification of viral variants present in different geographical locations will be very helpful.

Covid-19 and Intensive Care Unit: Infection, Contact Time & Procedures Performed

Background: Safety of front-line health care workers dealing with critically ill patients is of prime importance during COVID-19 pandemic. We have limited skilled workforce and intensive care units (ICU). Aim(s): To determine the frequency of COVID 19 among ICU staff and find association with contact time and procedure performed. Method(s): A comparative cross-sectional study was conducted on 95 subjects working in ICU settings of tertiary care hospitals of Lahore. Data was collected about COVID-19 infection, prevention practices, contact time & procedures performed through google forms. Data was entered & analyzed by SPSS v23 while performing descriptive statistics, T Test, Chi square test & binary logistic regression. Result(s): Among 95(100%) subjects 25(26.31%) had covid-19 infection whereas 70(73.68%) did not had infection. Age> 30(p=.041), female gender (p=.022), use of re-useable personal protective equipment PPE(p=.009), contact time (p=.020), performing procedures: Nebulization(p=.023) & non-invasive positive pressure ventilation (p=.011) were significantly associated with COVID-19 infection among ICU staff. Conclusion(s): There was high frequency of COVID-19 infection among ICU staff. Age> 30, female gender, re-useable PPE, contact time, performing procedures: Nebulization & non-invasive positive pressure ventilation were significantly associated with COVID-19 infection among ICU staff. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

Development of Potent SARS-CoV 3CL Protease Inhibitors: In silico Analogues Designing of Darunavir, Molecular Modelling and Molecular Dynamic Simulation

COVID pandemic initiated in early 2019 and the origin from where it initiated was Wuhan city of China. It changed the whole world. A huge population died due to COVID-19 in spite of taking precautions. New treatments and vaccines are introduced for the treatment and prevention. Among successful treatments, antivirals were found effective against COVID-19. But there is a need to find derivatives, which could be more effective for the treatment of COVID-19. The current research is focused on computational studies on one of the antiviral, darunavir. A computational strategy, molecular docking and molecular dynamic simulation techniques is presented to discover the potent analogues of darunavir for inhibiting protease 3CLpro of SARS-CoV2. The newly discovered X-ray structure (PDB ID: 6LU7) was selected for docking study and generated analogues were docked. The docking results showed that the compounds were bound in the active site of receptor with good binding affinity. It was concluded that compounds D8 and D15 were have good binding affinity value of -9.85 and -8.95 kcal/mol, respectively and these compounds were selected for molecular dynamic simulation (MDS) study to check their stability in pocket of receptor. © 2022 Chemical Publishing Co.. All rights reserved.

Emerging concerns of infectious diseases and drug delivery challenges

Emerging infectious diseases are the infections that could be newly appeared or have existed demographic area with rapidly increasing in some geographic range. Among various types of emerging infectious diseases like Ebola, chikungunya, tuberculosis, SARS, MERS, avian flu, swine flu, Zika, and so on, very recently we have witnessed the emergence of recently recognized coronavirus infection as Covid-19 pandemic caused by SARS-CoV-2, which rapidly spread around the world. Various emerging factors precipitating disease emergence include environmental, demographic, or ecological that increase the contact of people with unfamiliar microbial agents or their host or promote dissemination. Here in this chapter, we reviewed the various emerging considerations of infectious diseases including factors responsible for emerging and re-emerging infectious diseases as well as drug delivery challenges to treat infectious diseases and various strategies to deal with these challenges including nanotheranostics. Nanotheranostics are showing potential toward real-time understanding, diagnosis, and monitoring the response of the chemotherapy during treatment with reduced nontarget toxicity and enhanced safety level in the recent research studies. © 2022 Elsevier Inc. All rights reserved.

Mental health and its association with changes in quality of life due to COVID-19 pandemic among undergraduate students in Islamabad

Background: Corona virus is caused by Severe Acute Respiratory Syndrome Coronavirus 2;it has spread in 216 countries including Pakistan. It has been noted in the past that disease outbreaks have significant effects on mental health of the population. With previous evidence of anxiety and depression among student populations, we aimed to investigate frequency of Mental Health and its association with changes in Quality of Life due To Covid-19 Pandemic among undergraduate students in Islamabad.

Emergence of Candida auris-A Human Isolate with Atorvastatin as a Growth Promoter

Background and Objective: The fungal infection, caused by the newly discovered highly resistant Candida auris was a major health threat before COVID-19. The concept of drug repurposing not only addresses the issue of microbial resistance, but also is an easy way to bypass costly and time-consuming novel drug development. Rationale: Statins which are therapeutically used for the treatment of atherosclerosis, have exhibited some antifungal actions against various fungal spp. Although, no such study was conducted on C. auris. Based on the anti-HMG-CoA reductase activity on ergosterol synthesis, we elucidated the effect of Atorvastatin at the clinically administered human dose (0.055g), on Candida auris. Materials and Methods: Candida auris was isolated from an adult male diabetic patient and was identified on the VITEK system and confirmed on MALDI-TOF MS with 99% accuracy. It was cultured on 24 g potato Dextrose Agar (PDA). Pure atorvastatin was incorporated in culture plates, incubated at 37∘C observed for fungal growth. Results: Initially no growth was observed in the first twenty-four hours, but an unexpected growth was observed after 48 hours, and the colonization further doubled in 96 hours. Conclusion: Atorvastatin was repurposed in C. auris due to its anti-HMGCoA reductase activity on ergosterol synthesis. The observation raises cautions among the patients on atorvastatin therapy at the clinically administered human dose (0.055 g), on a clinical isolate of C. auris isolate. Our investigation provides an awareness that the patients on a statin-therapy should be highly cautious about C. auris infection and must take appropriate measures to prevent the infection.

Assessing Rapid On-Site Evaluation (ROSE) for Adequacy of Endobronchial Ultrasound Transbronchial Needle Aspiration (EBUS-TBNA) Procedures Compared to A Direct-to- Cellblock Approach As a Response to COVID-19 Pandemic

Background: Rapid on-site evaluation (ROSE) of endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) has been used as standard to improve diagnostic yield and to triage samples for additional testing. A method has been prompted to leveraging the expertise of cytotechnologists only or the utility of tele cytology. However, due to the COVID-19 pandemic, our institution had to discontinue ROSE for EBUS-TBNA, and instead adopted a direct-to-cellblock approach. This study aims to determine if removing ROSE affected the adequacy of samples obtained from the EBUS-TBNA cases, and if this new approach should be employed continuously for an extended period without jeopardizing the standard of care to the patient since we are still in the pandemic. Design: We collected data of total 1903 EBUS-TBNA cases from 734 patients. 1097 cases were performed from 1/2019 to 3/2020 with ROSE on 452 patients;806 cases were performed between 4/2020 to 12/2020 without ROSE on 282 patients, and the sample was sent directly to be processed as a cell block. Data variables collected included patient's age and gender, specimen sites and frequencies, and final cytopathological diagnosis. Calculated standardized residuals and fitted multivariate generalized linear model were performed at Moffitt Cancer Center & Research Institute Biostats Core using software SAS 9.4. Results: On average, holding specimen site variable constant, a biopsy from a patient with ROSE is 0.936 (=exp -0.066) times less likely to be reported as 'Satisfactory' as compared to a biopsy taken from a patient without ROSE, and this difference is not statistically significant (p = 0.785). Among all 6 categories of diagnosis, biopsies reported as 'Diagnostic for malignancy' are significantly different between ROSE and no ROSE groups with the standardized residual of 1.80 (p = 0.036) & only other significantly different category was 'Other';however, a very small number of biopsies were reported in this category (3.5%). Conclusions: The inadequacy rate of EBUS-TBNA was 6.4% higher on average in cases with ROSE when compared to a directto- cell block approach in this data set, however this difference was not statistically significant. This suggests that ROSE could be discontinued in favor of a direct-to-cell block approach. Although additional studies are needed, the discontinuation of ROSE for EBUS-TBNA would decrease the time and cost burden on cytopathology service while providing the same quality of care to the patient. (Table Presented).

Quality Improvement Project on Trauma and Orthopaedic Junior Doctor Knowledge and Assessment/Management of Common Peri/Post-Operative Complications

Introduction: Foundation doctors knowledge of common peri/post-operative complications can be hugely variable when commencing Trauma and Orthopaedic rotations. This can result in reduced awareness and confidence in the assessment and initial management of surgical complications. A quality improvement project was therefore designed with the following objectives: 1. To assess the confidence of foundation doctors on the assessment and management of common peri and post-operative complications on starting and finishing their T&O placement;2. To offer regular orthogeriatric teaching on assessment and management of common peri and post-operative complications;3. To review and produce a booklet on assessment and management of common peri and post-operative complications and deliver to all T&O foundation doctors and possibly expand to all surgical specialties;4. To review if the above methods were successful in improving doctors' knowledge of assessment and management of common peri and post-operative complications. Methods: PDSA cycle. Anonymous survey pre and post rotation sent out to all F1 and F2 doctors. This assessed their confidence before and after their rotation in seven different common complications. We also asked for feedback regarding how they felt their confidence would be improved (formal teaching, sim sessions, producing a guide, etc.). This was repeated over the course of the year covering three sets of four month rotations. Results: The QIP illustrated that foundation doctors improved confidence in managing complications with a combination of regular formal teaching, receiving a complications handbook/guide and through informal feedback on ward rounds. The audit illustrated areas where confidence was low and did not improve (wound healing) or the guide lacked information (diabetes management and COVID). Through improvements in teaching and the guide we were able to see increasing confidence levels throughout the subsequent cycles of the QIP. Conclusion: (1) F1 and F2 doctors often have low confidence when starting a T&O rotation in dealing with common peri/post-operative complications. (2) By offering formal teaching, producing a booklet and feedback and assessing F1s and F2s regularly during their rotation we were able to see an increase in confidence. (3) Further QIP cycles should be undertaken to further pursue ways of engaging and improving junior doctor confidence.

Deep Learning Based Intelligent Classification of Covid-19 Pneumonia Using Cough Auscultations

The World Health Organization has designated COVID-19 a pandemic because its emergence has influenced more than 50 million world's population. Around 14 million deaths have been reported worldwide from COVID-19. In this research work, we have presented a method for autonomous screening of COVID-19 and Pneumonia subjects from cough auscultation analysis. Deep learning-based model (MobileNet v2) is used to analyze a 6757 self-collected cough dataset. The experimentation has demonstrated the efficiency of the proposed technique in distinguishing between COVID-19 and Pneumonia. The results have demonstrated the cumulative accuracy of 99.98%, learning rate of 0.0005 and validation loss of 0.0028. Furthermore, cough analysis can be performed for other patients screening of other pulmonary abnormalities. © 2021 IEEE.

New-Onset Dementia Among Survivors of Pneumonia Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection.

Background: Case series without control groups suggest that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may result in cognitive deficits and dementia in the postinfectious period. Methods: Adult pneumonia patients with SARS-CoV-2 infection (index hospitalization) and age-, gender-, and race/ethnicity-matched contemporary control pneumonia patients without SARS-CoV-2 infection were identified from 110 healthcare facilities in United States. The risk of new diagnosis of dementia following >30 days after the index hospitalization event without any previous history of dementia was identified using logistic regression analysis to adjust for potential confounders. Results: Among 10 403 patients with pneumonia associated with SARS-CoV-2 infection, 312 patients (3% [95% confidence interval {CI}, 2.7%-3.4%]) developed new-onset dementia over a median period of 182 days (quartile 1 = 113 days, quartile 3 = 277 days). After adjustment for age, gender, race/ethnicity, hypertension, diabetes mellitus, hyperlipidemia, nicotine dependence/tobacco use, alcohol use/abuse, atrial fibrillation, previous stroke, and congestive heart failure, the risk of new-onset dementia was significantly higher with pneumonia associated with SARS-CoV-2 infection compared with pneumonia unrelated to SARS-CoV-2 infection (odds ratio [OR], 1.3 [95% CI, 1.1-1.5]). The association remained significant after further adjustment for occurrence of stroke, septic shock, and intubation/mechanical ventilation during index hospitalization (OR, 1.3 [95% CI, 1.1-1.5]). Conclusions: Approximately 3% of patients with pneumonia associated with SARS-CoV-2 infection developed new-onset dementia, which was significantly higher than the rate seen with other pneumonias.