Factors influencing turnover intention among healthcare employees during the COVID-19 pandemic in the private hospitals of Bahrain

PurposeThis study aims to examine the relationship between polychronicity, job autonomy, perceived workload, work-family conflict and high work demand on the health-care employee turnover intention during the COVID-19 pandemic. Design/methodology/approachThe authors conducted quantitative research in private hospitals using a self-administered questionnaire, and 264 respondents participated. The authors also used an analysis of moment structures to determine the relationship between independent and moderating variables. FindingsThe results show a significant positive relationship between polychronicity, job autonomy, perceived workload, work-family conflict and high work demand, affecting turnover intention. This study also found the moderating effect of high work demand on work-family conflict and turnover intention. Research limitations/implicationsThis research was limited to hospitals in Bahrain during the COVID-19 pandemic. Nevertheless, the findings highlight the factors associated with health-care employee turnover intention and only five factors were identified. Practical implicationsThis study enhances the theoretical and practical effects of turnover intention. The results provide a competitive benchmark for hospital managers, administrators and governing bodies of employee retention. Social implicationsIt advances economics and management theory by enhancing the understanding of health-care employees' turnover intention in Bahrain. It serves as a basis for future large-scale studies to test or refine existing theories. Originality/valueTo the best of the authors' knowledge, this study is the first to adopt extrinsic variables in self-determination theory to measure the turnover intention of health-care employees. However, using resources in a crisis can be applied to any disaster.

Face Mask Detection Using Multi-Task Cascaded Convolutional Neural Networks

Detecting faces is a prevalent and substantial technology in current ages. It became interesting with the use of diverse masks and facial variations. The proposed method concentrates on detecting the facial regions in the digital images from real world which contains noisy, occluded faces and finally classification of images. Multi-task cascaded convolutional neural network (MTCNN)—a hybrid model with deep learning and machine learning to facial region detection is proposed. MTCNN has been applied on face detection dataset with mask and without mask images to perform real-time face detection and to build a face mask detector with OpenCV, convolutional neural networks, TensorFlow and Keras. The proposed system can be used as an application in the recent COVID-19 pandemic situations for detecting a person wears mask or not in controlling the spread of COVID-19. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Real-Time Face Mask Detection from CCTV Video Frames using Deep Neural Networks

The coronavirus, commonly known as SARS COVID-19, is causing a pandemic that is affecting individuals all over the world. The spread of the virus compelled the authorities to impose a rigorous lockdown on its citizens. Every person in society may experience a variety of issues as a result of this. According to WHO (World Health Organization) regulations, the sole method to halt the virus's spread is to wear a face mask. Therefore, the suggested approach makes sure that everyone appropriately wears a face mask in public locations. The objective of this approach is to detect people without face masks and people who wear facemasks incorrectly in social environments. This system consists of multiple face detection modules to find the area of interest within the video frames. In the next level, using the trained Deep Learning model, the presence of a mask is detected and faces without mask and faces wearing masks incorrectly are highlighted. The dataset for face mask identification comprises of 8190 photos with unique facial annotations from the Kaggle and RMFD datasets that come into two categories: "with mask” and "without mask”. © 2022 IEEE

Prevalence of Internet Addiction and Its Association with Depression, Anxiety and Stress in Medical Students during the Covid-19 Pandemic

Introduction: The use of the internet has become an integral part of everyday life in these modern times of digitalization, especially the lives of adolescents. At the same time, excessive use of the internet has emerged as a significant affliction. However, the impact of Internet addiction has not been well studied in India on these crucial years of life. The objective of this study was to evaluate the prevalence of internet addiction and its association with depression, anxiety and stress among medical students during the COVID -19 pandemic. Methodology: A cross-sectional study was conducted among medical students of Saveetha Medical College, Chennai during the covid-19 pandemic. A pretested, predesigned questionnaire, Young's Internet Addiction Scale, and Depression Anxiety Stress Scale (DASS21) are used in the study. Chi-square test, Fisher's exact test were used to assess the association between internet addiction and depression, anxiety and stress. Result(s): A very high prevalence (72.04%) of internet addiction was observed among the respondents. The primary purposes of using the internet were entertainment (21.30%) and social media (20.80%) followed by academics (18.07%), and a majority (40.13%) reported spending 3-5 hours a day followed by more than 5 hours a day (38.49%). There was a significant association between Internet addiction and depression (odds ratio =8), anxiety (odds ratio=8) and stress (odds ratio=7). Conclusion(s): Internet addiction is a serious issue with huge impacts on mental health. Early intervention therefore is crucial. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Biomedical advances in the treatment of COVID-19: An Indo-Canadian perspective

This white paper summarizes the key outcomes, topics, and recommendations from the Canada-India Healthcare Summit 2021 Conference, Biotechnology Session, held on May 20-21, 2021. In particular, the authors have focused their attention on topics ranging from research and development into the etiology and treatment of COVID-19 to novel approaches, such as ultraviolet-C disinfection and cell and gene therapy. The paper also deals with important topics around the effects of food distribution and nutrition on COVID-19 and vice versa, as well as key considerations around research and development, innovation, policy, grants, and incentives, and finally, summarizes the ways in which Canada and India, being close allies, have already begun to partner to fight the pandemic (as well as future strategies to continue this excellent progress). We also include key points raised during the summit and summarize them as part of this white paper.

Role of NOX4 in Modulating Alveolar Type II (AT2) Epithelial Cell Phenotype and Mitochondrial Dynamics in Hyperoxic Acute Lung Injury

Introduction: Management of acute respiratory distress including COVID-19 pneumonia involves O2 supplementation, which is lifesaving, but causes severe hyperoxic acute lung injury (HALI). AT2 cells are the most affected cell type in hyperoxia (HO). NADPH oxidase (NOX) is a major source of reactive oxygen species (ROS) in HO. NOX4, the only functionally active NOX present in mitochondria, and primarily produces H2O2 as well as mtROS has been shown to be involved in several human pathologies. Not much is known about NOX4-induced mitochondrial injury in HALI. The current study aims to determine the role of AT2 epithelial cell NOX4 in HALI and the impact of HO on the modulation of mtROS and mitochondrial dynamics in HALI. Methods: Nox4-/-Spc-Cre animals were generated using tamoxifen induction and the knockdown was validated. The Nox4- /-Spc-Cre knockout (KO) and wild type (WT) mice were exposed to room air (NO) or 95% O2 (HO) for 66h to study the structural and functional changes in the lung. Transmission Electron Microscopy (TEM) was used to study the HO-induced changes in mitochondria. Isolated primary AT2 and/ mouse lung epithelial (MLE) cell line was investigated for mtROS, mt dynamics and apoptosis. Mitochondrial injury was assessed in Nox4 WT and Nox4 silenced cells. Results: C57BL/6J WT animals subjected to HO for 66h showed increased expression of NOX4, determining the role of NOX4 in HALI. The H&E staining demonstrated significant HALI in Nox4 WT animals exposed to HO compared to Nox4 KO as determined by increased infiltration of neutrophils, alveolar wall thickening and presence of proteinaceous debris in the alveolar space. Further, increased BAL cell count and protein levels, increased AT2 cell death and elevation of the proinflammatory cytokine IL- 6 and the chemokine KC was seen in WT animals compared to Nox4 KO. Analysis of lung tissues by TEM showed mitochondrial swelling, cristae damage and mitophagy in AT2 cells due to HO. Changes in mt injury markers were also observed. HO-induced NOX4 increase in primary AT2/ MLE-12 cells resulted in increased mtROS production and apoptosis, which was reduced with Nox4 siRNA silencing. Conclusion: This study suggests that the HO induced NOX4 expression in mouse lung, and deletion of Nox4 gene in AT2 cells reduced mtROS production and apoptosis and protected the lungs from severe hyperoxic lung injury. These results suggest NOX4 as a potential target for the treatment of HALI.

PROSTATE ABSCESS: CLINICAL FEATURES, MANAGEMENT, AND OUTCOMES OF A MASKED INFECTION IN COVID 19 PERIOD: A CASE SERIES

INTRODUCTION AND OBJECTIVE: Prostate abscess (PA) is uncommon and the diagnosis is often delayed or missed. Traditionally, PA has resulted from acute prostatitis or ascending genitourinary (GU) infection due to gram-negative bacilli but S. aureus is an emerging cause. The objective is to study the clinical features, management and outcomes of PA in COVID 19 period. METHODS: A prospective review of all adult patients admitted with a diagnosis of PA between April 2020 and July 2021(in COVID period) were conducted. Inclusion criteria included age ≥18 years, a GU infection syndrome, and imaging consistent with PA. RESULTS: Fifteen patients with PA were identified. The median age was 54 years. Four patients (22.7%) were immunosuppressed and 11 (50%) had diabetes. Fever (66.6%), dysuria (60%), and urinary retention (20%) were the most common presenting symptoms. Pelvic CT revealed PAs in all patients with 8/15 (53.3%) were >2 cm in greatest diameter. Urine cultures were positive in 13/15 (86.6%) patients with 4/13 (30.7%) growing S. aureus (MRSA). Fourteen patients (93.3%) were managed with antibiotics alone whereas 1 (6.6%) underwent abscess drainage. The median duration of antibiotic therapy was 32 days. CONCLUSIONS: PA is relatively uncommon and may be difficult to distinguish clinically from conditions like acute prostatitis. Optimal management usually requires both antibiotics and drainage. With the advancement in the field of radiology, newer antibiotics and early diagnosis, effective conservative management of PA has become possible. Noticing the trend of frequent occurrence of S. aureus as a cause, coverage for MRSA should be a component of empiric treatment for PA.

Role of web-based programs in heart disease prevention and rehabilitation in the covid-19 era

Objectives: Cardiovascular disease (CVD) is the leading noncommunicable cause of mortality and morbidity globally. In-person education and awareness programs conducted as part of the CVD prevention efforts have either come to a standstill or have been replaced by web-based programs in the COVID-19 era. This study describes the design and execution of web-based programs to improve awareness and educate cardiac patients during the pandemic. Methods: All web-based education/awareness sessions conducted since the start of the government-enforced lockdown in India till date (23 March-10 September 2020) were included. A multidisciplinary team consisting of Physician, Physiotherapist and Dietician worked completely online to maintain continuity of service to previously enrolled patients and to develop comprehensive web-based programs for newly enrolling patients. Patient education sessions were incorporated into the homebased CVD prevention/rehabilitation programs, which also consisted of supervised exercise sessions. Web-based awareness programs about CVD prevention strategies during the pandemic were provided to corporate employees, paying special attention to the psychosocial challenges of working from home, and to the general public. Google Meet or Zoom was used for the audiovisual presentation followed by discussion. Results: Our team provided 28 web-based education sessions and 6 awareness webinars for a total of 185 individuals during this period. The topics covered are provided in the Table. The enrolees and their family members actively participated in the sessions and interacted during the discussion. The feedback was that the communication was clear and that the online sessions were effective. The only barrier was the occasional technical snag or connectivity issue, which hindered the continuity of the session briefly. Conclusion: There has been a huge sea change in the way healthcare has been delivered during the COVID-19 pandemic and CVD prevention services are no exception. Web-based programs with online sessions replacing inperson sessions are proving to be effective in patient education and awareness creation and might be the way forward even after the pandemic in resourcelimited settings like India.

Home-based cardiac rehabilitation to address evolving patient needs during the covid-19 pandemic

Objectives: Home-based cardiac rehabilitation (HBCR) and prevention programs (HBPP) which occupied a small proportion of the overall Preventive Cardiology work in the past have become mainstream during the COVID-19 pandemic. This study aims to analyse the design and delivery of HBCR/HBPP pre and during the pandemic to address evolving patient needs. Methods: All patients who had undergone HBCR/HBPP at our Preventive Cardiology centre in Chennai, India till 22 March 2020 (pre-pandemic enrolees) and from 23 March-10 September 2020 (during-pandemic enrolees) were included. Hybrid programs had some in-person and some online/phone sessions;completely home-based programs had only online/phone sessions. Intake evaluation consisted of physician consultation, review of medical records, health-related lifestyle questionnaire, quality of life questionnaire, 24-hour diet recall and body mass index and functional capacity (FC) assessment. The sixminute walk test (6MWT) or the 2-minute step test (2MST) was used for FC assessment. A multidisciplinary team consisting of Physician, Physiotherapist and Dietician provided 1-2 sessions per week for 3-6 months. HBCR was offered to low/medium risk patients. Results: Of the 29 subjects (57±13 years, 69% male), 16 (55%) were prepandemic enrolees and 13 (45%) during-pandemic enrolees. Completely homebased programs were provided to 4 (25%) of the pre-pandemic enrolees and to 13 (100%) of the during-pandemic enrolees (p=0.0002). Almost all pre-pandemic enrolees resided outside Chennai and travelled by air/train/road for in-person sessions in the hybrid program;an elderly woman residing in Chennai preferred the hybrid program, as she needed a caregiver to accompany her. Majority of pre-pandemic home-based sessions were phone calls whereas majority of during-pandemic sessions were online video sessions with supervised exercise and/or audiovisual presentation. FC was assessed using 6MWT in 17 (59%) and 2MST in 9 (31%) subjects;FC was not assessed in 3 pre-pandemic enrolees. No adverse events were reported. Conclusion: Multidisciplinary HBCR/HBPP is an effective and safer alternative to traditional programs. There is potential to expand these services post-pandemic to all patients irrespective of place of residence and risk profile.

Effectiveness of a home-based cardiovascular disease prevention program during the COVID-19 pandemic

Background: Home-based cardiovascular disease (CVD) primary prevention (HBPP) and cardiac rehabilitation (HBCR) programs which occupied a small proportion of the overall Preventive Cardiology work in the past have become mainstream during the COVID-19 pandemic. Purpose: This study aims to analyse the effectiveness of a home-based CVD prevention program implemented during the pandemic in India. Methods: A retrospective study was conducted on pre-pandemic and pandemic enrolees. Health behaviour, CVD risk factors, physical and mental component score (PCS, MCS) from SF-12 questionnaire, body mass index (BMI), 6-minute walk distance (6MWD), and clinical and biochemical parameters were assessed. A multidisciplinary team consisting of Physician, Physiotherapist, Dietician and Counselling Psychologist provided the program using tele-health platforms. Results: Of the 66 subjects (55 ± 13 years, 73% male), 17 (26%) enrolled pre-pandemic and 49 (74%) enrolled during-pandemic, 28 (42%) were HBPP and 38 (58%) were HBCR participants. Majority of the subjects (n = 51, 77%), with significantly more HBCR than HBPP participants, harboured 4 or more risk factors (p = 0.04). In the 60 (91%) program completers, BMI, 6MWD, PCS and MCS had improved significantly. SBP, DBP, LVEF, HbA1c, total cholesterol and LDL had improved significantly in affected subjects. Completely home-based participants (n = 44, 67%) who never had any in-person contact with the team during the program also showed significant improvement. No adverse events were reported. Conclusion: Comprehensive home-based CVD prevention programs are effective in improving anthropometric, clinical, biochemical and psychosocial parameters, are a safe alternative to conventional programs and could potentially become the standard-of-care in the post-pandemic era. (Figure Presented).

MYOSITIS AND RESPIRATORY FAILURE WITH PEMBROLIZUMAB

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Pembrolizumab, an anti-programmed death 1 receptor monoclonal antibody, increases survival in non-small cell lung cancer (NSCLC). It causes less toxicity than traditional chemotherapy, however it can induce autoimmune adverse events including pneumonitis and colitis. There have been a limited number of case reports chronicling myositis with respiratory distress as an adverse effect of pembrolizumab. We present a case of a patient with NSCLC being treated with pembrolizumab, which induced respiratory failure secondary to myositis. CASE PRESENTATION: A 77-year-old man with metastatic NSCLC status post right upper lobectomy on carboplatin/paclitaxel/pembrolizumab started 10/26/20, with recent hepatitis diagnosed one week prior to admission and identified as secondary to pembrolizumab, on treatment with prednisone (1 mg/kg), presented with proximal weakness and progressive exertional dyspnea over the last three weeks. Vital signs were remarkable for tachypnea and tachycardia. Physical exam showed 2/5 proximal muscle strength in upper and lower extremities, absent deep tendon reflexes, and no skin rash. Labs revealed CK 1567, LDH 889, SARS-CoV2 PCR negative. CT pulmonary arteries was negative for acute lung processes. The patient required noninvasive positive pressure ventilation (NIPPV) for respiratory distress. Treatment was initiated with pyridostigmine (60mg QID PO) and pulsed glucocorticoids (methylprednisolone 1 g daily). He remained NIPPV dependent so pyridostigmine was increased to 90mg QID PO and IV immunoglobulin (IVIG) 85 g QD was added for refractory respiratory failure and muscle weakness. Acetylcholine receptor antibodies, ANA, anti SSA/SSB, anti-Jo1 were negative. Lumbar puncture was performed with normal opening pressure, CSF cell count, and chemistry. The clinical diagnosis was myositis attributed to pembrolizumab. The patient responded to a week of continued IVIG (30 g QD for 5 more days) and tapering steroids, with improvement in proximal muscle strength and was weaned off NIPPV. DISCUSSION: Pembrolizumab works as an immune checkpoint inhibitor, which may cause an autoimmune effect. One study identified 5 patients with pembrolizumab induced myositis. Our patient, presented with proximal muscle weakness and respiratory distress requiring NIPPV, two months after starting pembrolizumab. His respiratory distress was not due to lung disease. Autoimmune workup was negative. He underwent a lumbar puncture which ruled out Guillain-Barre syndrome. He was diagnosed with pembrolizumab induced myositis. A limitation in our case was that a biopsy never confirmed the diagnosis as he responded to pulsed steroids and IVIG. In other cases, the myositis has been treated by plasma exchange or immunosuppression. CONCLUSIONS: Pembrolizumab can induce potentially fatal myositis. It is crucial that clinicians are aware of this so prompt treatment can be initiated. REFERENCE #1: Claus J, Van Den Bergh A, Verbeek S, Wauters E, Nackaerts K. Pembrolizumab-induced necrotizing myositis in a patient with metastatic non-small-cell lung cancer: a case report. Lung Cancer Manag. 2019 May 8;8(2):LMT10. doi: 10.2217/lmt-2018-0017. PMID: 31645893;PMCID: PMC6802710. REFERENCE #2: Liewluck T, Kao JC, Mauermann ML. PD-1 Inhibitor-associated Myopathies: Emerging Immune-mediated Myopathies. J Immunother. 2018 May;41(4):208-211. doi: 10.1097/CJI.0000000000000196. PMID: 29200081. REFERENCE #3: Robinson SD, Lai C, Hotton G, Anand G. Life threatening pembrolizumabinduced myositis in a patient treated for advanced adenocarcinoma of the lung. Acute Med. 2019;18(3):197-199. PMID: 31536059. DISCLOSURES: No relevant relationships by Shlomo Greenberg, source=Web Response No relevant relationships by Daniel Kurbanov, source=Web Response No relevant relationships by Visala Natarajan, source=Web Response

39-YEAR-OLD WITH LEGIONELLA MYOCARDITIS

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Myocarditis is an inflammatory condition of the myocardium. Legionella is a known rare infectious cause of myocarditis. Additionally, it has been implicated with pericarditis and prosthetic valve endocarditis. We present a case of a 39-year-old male with legionella pneumonia with myocarditis, acute renal failure, and rhabdomyolysis. CASE PRESENTATION: A 39-year-old male with no known past medical history presented to the emergency department with worsening dyspnea after a viral syndrome for 3 weeks. He was intubated in the emergency department for respiratory failure. Chest x-ray showed multifocal atypical infiltrates. Electrocardiogram significant for diffuse ST depressions. Echocardiogram revealed severe left ventricular systolic dysfunction with ejection fraction of 30% with no valvular abnormalities. Lab analysis revealed hyponatremia, elevated troponins and acute renal failure with rhabdomyolysis requiring hemodialysis. Atypical serology was positive for Legionella which was treated with levofloxacin and azithromycin. SARS-CoV-2 PCR was negative and urine drug screen was negative. He was diagnosed with myocarditis given the legionella culture, elevated troponins, significant for electrocardiogram and echocardiogram findings. DISCUSSION: The first case of Legionella myocarditis was reported in 1981 by Gross [1]. Symptoms of myocarditis can range from a mild flu-like illness to cardiogenic shock or sudden death. Myocarditis is the cause of 12% of sudden deaths in young adults [2]. Diagnosis is typically made clinically with non-diagnostic exams, as endomyocardial biopsy is only used for special circumstances when other testing are non-diagnostic. A literature review of Legionella myocarditis as of 2017 portrayed ten patients with positive Legionella urine antigens, with eight having reduced left ventricular ejection fraction on echocardiogram. Only two of those cases were based on cardiac biopsy [3]. CONCLUSIONS: Extrapulmonary manifestations of Legionella such as myocarditis have been reported even in the absence of overt pneumonia, and most often in immunocompromised patients. Clinicians should be aware of Legionella in the setting of unexplained myocarditis with findings as above. Treatment should be initiated for this reversible cause of myocarditis without delay, resulting in favorable prognosis. REFERENCE #1: Armengol, S., Domingo, C., Messales, E., (1992). Myocarditis: a rare complication during Legionella infection. DOI: 10.1016/0167-5273(92)90276-9 REFERENCE #2: Damasio, A.F, Rodriguez, L., Miranda, L/, Coelho, P., Banazol, N., Colaco, J., Fragata, J. (2014). Fulminant myocarditis caused by Legionella pneumophila: Case report. Revista Portuguesa de Cardiologia. Vol 33, Issue 3. https://doi.org/10.1016/j.repce.2013.09.015 REFERENCE #3: Erdogan, Haluk & Eldem, Halil. (2017). A Patient with Suspected Myocarditis Associated with Legionnaires' Disease: A Case Report and Review of the Literature. Mediterr J Infect Microb Antimicrob. 6. 10.4274/mjima.2017.2. DISCLOSURES: No relevant relationships by James McGee, source=Web Response No relevant relationships by Visala Natarajan, source=Web Response no disclosure on file for Ben Shamian;

BAMLANIVIMAB-INDUCED GUILLAIN-BARRÉ SYNDROME

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Guillain-Barre syndrome (GBS) is an autoimmune post-infectious neuropathy resulting in acute ascending flaccid paralysis 1. To the best of our knowledge and review of literature, this is the first reported case of GBS after receiving bamlanivimab a monoclonal antibody immunotherapy, now authorized for use in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. CASE PRESENTATION: A 61-year-old male presented with acute progressive ascending bilateral lower extremity weakness and fever. Previous medical history included Chronic obstructive pulmonary disease and a recent diagnosis of SARS-CoV-2 for which he received monoclonal antibody (Bamlanivimab) one week prior to admission. On admission, neurological exam was remarkable for decreased bilateral lower and upper extremity strength with poor hand grip strength. Patient was being monitored in the intensive care unit for respiratory failure using negative inspiratory force and vital capacity. Lumbar puncture results were remarkable for normal glucose (62 mg/dL), elevated protein (122.4 mg/dL) without an elevated white blood count. The patient was diagnosed with GBS and initially treated with Intravenous Immunoglobin (IVIG) for five days. However, he continued to be symptomatic and developed mild dysarthria and facial weakness. He was subsequently treated with plasmapheresis for five days. Neurological and respiratory function improved after plasmapheresis therapy. DISCUSSION: The case illustrates GBS presentation after treatment with monoclonal antibody therapy in the setting of SARS-CoV-2. Bamlanivimab is an IgG1κ monoclonal antibody that targets the spike protein of SARS-CoV-2 and prevents the attachment and entry of the virus into human cells. In mild-moderate cases, Bamlanivimab was authorized to treat mild-moderate SARS-CoV-2 in patients above 12 years old, weight more than 40 kg, and high risk of disease progression and/or hospitalization.2,3 In this case report, the patient developed GBS within a short time period after receiving Bamlanivimab. Other case studies have also reported subsequent development of GBS after treatment with monoclonal antibodies.4,5,6 Ipilimumab, an IgG1 monoclonal antibody that inhibits cytotoxic T lymphocyte-associated antigen 4 (CTLA-4), was associated with GBS development after its use as an adjuvant therapy for patients with melanoma. 4,5 Adalimumab (a tumor necrosis factor alpha inhibitor) was also reported with GBS development when used as therapy for psoriasis and psoriatic arthritis. 6 These monoclonal antibodies have different mechanisms of action and were used in other disorders. CONCLUSIONS: This case report demonstrates that monoclonal antibodies may develop an autoimmune response. This case report is important in highlighting GBS as a potential side effect of Bamlanivimab given its potential for respiratory compromise and its current use in mild to moderate SARS-CoV-2.1,3 REFERENCE #1: Leonhard, S.E., Mandarakas, M.R., Gondim, F.A.A. et al. Diagnosis and management of Guillain–Barré syndrome in ten steps. Nat Rev Neurol 2019;15:671–683. REFERENCE #2: Chen, P., Nirula, A., Heller B. et al. SARS-CoV-2 Neutralizing Antibody LY-CoV555 in Outpatients with Covid-19. N Engl J Med 2021;384:229-237 REFERENCE #3: U.S. Food and Drug Administration. (2021, March 31). Coronavirus (COVID-19) Update: FDA Authorizes Monoclonal Antibody for Treatment of COVID-19. Retrieved from https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-monoclonal-antibody-treatment-covid-19 DISCLOSURES: no disclosure on file for Nia Jagroop;No relevant relationships by Visala Natarajan, source=Web Response No relevant relationships by Gladys Palaguachi, source=Web Response no disclosure on file for Benhoor Shamian;

Characteristics of COVID-19 patients admitted to a tertiary care hospital in Pune, India and predictors of requirement for intensive care treatment

Objectives: 1. To study associations of severity of COVID-19 disease with clinical features and laboratory markers. 2. To develop a model to predict the need for ICU treatment. Methods: This is an analysis of clinical course in 800 consecutive patients from a dedicated COVID-19 tertiary care hospital in Pune, India (8th April to 15th June 2020). We obtained clinical and laboratory information, severity grading and progress from hospital records. We studied associations of these characteristics with need for ICU management. We developed a predictive model of need for ICU treatment among first 500 patients and tested its sensitivity and specificity in the following 300 patients. Results: Average age was 41 years, 16% were <20 years of age, 55% were male, 50% were asymptomatic and 16% had at least one comorbidity. Using MoHFW India severity guidelines, 73% patients had mild, 6% moderate and 20% severe disease. Severity was associated with higher age, symptomatic presentation, elevated neutrophil and reduced lymphocyte counts and elevated inflammatory markers. Seventy-seven patients needed ICU treatment: they were older (56 years), more symptomatic and had lower SpO2 and abnormal chest X-ray and deranged hematology and biochemistry at admission. A model trained on the first 500 patients, using above variables predicted need for ICU treatment with sensitivity 80%, specificity 88% in subsequent 300 patients;exclusion of expensive laboratory tests (Ferritin, C- Reactive Protein) did not affect accuracy. Conclusion: In the early phase of COVID- 19 pendemic, a significant proportion of hospitalized patients were young and asymptomatic. Need for ICU treatment was predicted by simple measures including higher age, symptomatic onset, low SpO2 and abnormal chest X-ray. We propose a simple model for referring patients for treatment at specialized COVID-19 hospitals. © 2021 Journal of Association of Physicians of India. All rights reserved.

Prevalence of depression, anxiety and stress symptoms and their association with quality of sleep and loneliness in the general population during the covid-19 pandemic in India

The impact of mental health due to coronavirus infection caused by SARS-2 COVID-19 is severe. The spread of the virus has been reported not only in India but also in many countries worldwide. The lockdown amid the recent COVID-19 widespread has brought about a change in the way of life in most people. The self-isolation and social distancing measures may result in individuals becoming more anxious, angry, stressed, disturbed and depressed. The aim of our study is to assess the prevalence of depression, anxiety and stress and their association with quality of sleep and loneliness in the general population during the Covid 19 pandemic. The study design was a cross-sectional study, and information and data were collected through an online questionnaire using Google forms. A total of 726 participants had completed the online questionnaire from which socio-demographic details, Depression, Anxiety & Stress (DASS 21), Insomnia (ISI) and Loneliness (UCLA) were assessed. The overall prevalence rate of depression, anxiety, stress, insomnia and loneliness was 27%, 24.9%, 12.1, 16.9% and 8.8%, respectively. Age, edu-cation, occupation and living status had a strong association with depression. Concerning anxiety, age, marital status, living status and past history of medical illness were positively correlated. Stress had a strong association with edu-cation. Insomnia was significantly associated with depression, anxiety, stress and loneliness. Anxiety, stress and insomnia had a strong association with loneliness. This study shows that the psychological impact of the COVID-19 pandemic in the general population is very high. Since loneliness and insomnia have been shown to be associated with psychological symptoms, screen-ing for and addressing them can help in reducing the psychological impact of COVID-19.

THE SCARS OF WAR: A CASE OF COVID-19-INDUCED PULMONARY FIBROSIS

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Approximately 6 million people have been diagnosed with severe acute respiratory syndrome coronavirus-2 (SARSCoV-2) and close to 400,000 people have died from this deadly disease worldwide (COVID-19, 2020). Almost all of the complications include pneumonia. The pulmonary symptoms associated with SARSCoV-2 vary from mild respiratory symptoms to severe respiratory failure. Of those infected with SARSCoV-2, 40% will progress to acute respiratory distress syndrome (ARDS) and of those, 20% will go on to develop pulmonary fibrosis (Spagnolo, 2020). We present a case of a middle-aged female with SARSCoV-2 with unusually rapid progressing pulmonary fibrosis. CASE PRESENTATION: 53 year old female with history of hypertension and obesity, found to be SARSCoV-2 positive. The patient was treated with hydroxychloroquine, azithromycin, intravenous corticosteroids, tocilizumab, and convalescent plasma. She was successfully extubated after a prolonged course and discharged to rehabilitation facility after a length of stay of 15 days. Five days post-discharge the patient presented with sudden-onset shortness of breath secondary to large right-sided tension pneumothorax requiring pigtail and large bore chest tube insertion. Despite this, due to severe hypoxemia, the patient required immediate intubation. Repeat SARSCoV-2 testing was positive. Computed tomography (CT) of chest was significant for diffuse ground glass opacification with no fibrosis. Repeat CT chest just four days later showed severe diffuse bilateral fibrotic changes. DISCUSSION: A large study of SARSCoV-2 patients based in Wuhan, China featured 138 hospitalized patients wherein 61% of patients developed ARDS. Pulmonary fibrosis is a known consequence of ARDS. It is characterized by epithelial cell damage and activation, fibroproliferation, and abnormal accumulation of extracellular matrix (ECM) in lung parenchyma. The pathogenesis of how this disease causes lung damage is still speculative. Diffuse alveolar damage occurs with cellular fibromyxoid exudates, desquamation of pneumocytes, and hyaline membrane formation typical of ARDS. This is similar to findings seen in pathology reports of post-mortem lung biopsies of SARS and Middle Eastern Respiratory Syndrome coronavirus’ and is likely similar to what is occurring in SARSCoV-2 patients (Spagnolo, 2020). CT findings of these cases showed areas of advanced fibrosis with bullae formation. Multiple factors that may contribute are virus-induced cytokine release syndrome, drug effects and increased airway pressure with hyperoxia-related lung injury secondary to mechanical ventilation. CONCLUSIONS: Statistics reveal 2-3 million people recovered from SARSCoV-2 worldwide (COVID-19, 2020). This recovery is not always without consequences such as pulmonary fibrosis seen in this patient. Therefore, it is necessary to evaluate long-term ramifications and treatment options in surviving SARSCoV-2 patients. Reference #1: COVID-19 dashboard by the center for systems science and engineering at Johns Hopkins University. Retrieved from https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 Reference #2: King TE Jr, Pardo A, Selman M. Idiopathic pulmonary fibrosis. Lancet. 2011;378(9807):1949-1961. doi:10.1016/S0140-6736(11)60052-4 Reference #3: Spagnolo et al., Pulmonary fibrosis secondary to COVID-19: a call to arms? Lancet Respiratory Medicine. 2020;doi: https://doi.org/10.1016/S2213-2600(20)30222-8 DISCLOSURES: No relevant relationships by Blessen George, source=Web Response No relevant relationships by Michael Megally, source=Web Response No relevant relationships by Visala Natarajan, source=Web Response no disclosure on file for Benhoor Shamian;