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As the coronavirus disease 2019 (COVID-19) pandemic continues, a new disease, COVID-19-associated pulmonary aspergillosis (CAPA), is on the rise. CAPA is a secondary fungal infection in patients with critical COVID-19 receiving mechanical ventilation in intensive care units (ICUs). Although the incidence rate of CAPA is estimated to be 10.2% in ICU patients, CAPA appears to be associated with an increase in overall mortality. CAPA is like classical invasive pulmonary aspergillosis (IPA) but has an ambiguous clinical manifestation and occurs without typical host factors. It is also like influenza-associated pulmonary aspergillosis but differs in clinical characteristics. For research and clinical practice, the European Confederation for Medical Mycology and the International Society for Human and Animal Mycology proposed novel case definition criteria for CAPA. Although CAPA management is not much different from typical IPA, areas of uncertainty remain that require further investigation. Copyright © 2022 by The Korean Society for Medical Mycology. All right reserved.
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Background: Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a life-threatening invasive fungal infection in critically ill patients with COVID-19. However, only a few studies have reported CAPA in the Republic of Korea. Objective: To describe clinical characteristics of CAPA in patients at a tertiary care hospital in the Republic of Korea. Methods: This retrospective, observational consecutive case series study was conducted by reviewing the electronic medical records of patients who developed CAPA at Seoul National University Hospital from January 1, 2020, to August 31, 2021. CAPA was defined by European Confederation of Medical Mycology/International Society for Human and Animal Mycology (ECMM/ISHAM) consensus criteria. Patient demographics, comorbidities, corticosteroid use, clinical presentation, treatment, and outcomes were investigated. Results: Eleven patients were diagnosed with probable CAPA according to the ECMM/ISHAM criteria. One patient had classical host factor for invasive pulmonary aspergillosis before admission. All patients received corticosteroid therapy before CAPA diagnosis. The mean total corticosteroid administered before CAPA diagnosis was 220 mg of dexamethasone equivalent dose (range, 80~572 mg), and the mean duration of steroid therapy was 15 days (range, 4~34 days). The median time from intensive care unit admission to CAPA diagnosis was 12 days (range, 5~36 days). All individuals showed aggravation on chest X-rays. Ten patients were diagnosed with positive serum galactomannan (GM), and one was diagnosed with positive GM in a bronchoalveolar lavage specimen. Of the 11 patients, 8 received voriconazole-based antifungal therapy for a median of 30.5 days. Only two patients survived after antifungal treatment. Conclusion: These cases illustrate CAPA complicated in critically ill COVID-19 patients. The challenges in diagnosis and poor outcomes of CAPA emphasize the clinical suspicion and needs for further investigation. Copyright@2022 by The Korean Society for Medical Mycology. All right reserved.
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Background: The recent novel coronavirus disease (COVID-19) pandemic has led to restrictions in physical activity. We evaluated the impact of risk perception on physical activity, and its impact on kidney function in chronic kidney disease (CKD) patients during the pandemic. Method(s): A population of CKD patients registered in a SKETCH (Study on Kidney disease and EnvironmenTal Chemicals, Clinical Trial No. NCT04679168) cohort recruited from June 2020 to October 2020 was included in the study. Patients were followed-up every 3 months for a year. We obtained risk perception and physical activity information by a questionnaire survey. Physical exercise, 3-times/week, was categorized into three groups according to the frequency of positive response during 5 visits: group 1, 0-2;group 2, 3-4;group 3, 5. We used Logistic regression analysis to identify the significance of risk perception to physical activity. The cox-proportional hazard model was used to identify the significance of physical activity for kidney function. Result(s): A total of 262 patients were included, and the mean age was 60.5+/-12.8 years old. Mean eGFR was 43.4+/-20.9 mL/min/1.73 m2, and there were 220 (84.0%) with eGFR <60 mL/min/1.73m2. There were 122 (46.6%) of patients who showed higher risk perception for COVID-19 infection. After adjustment with age, sex, comorbidities, and laboratory results, higher risk perception was significantly associated with decreased physical activity (adjusted OR 0.44, 95% CI, 0.23, 0.84). During 364.8+/-38.6 days, 52 (19.8%) patients showed decreased kidney function with decreasing eGFR >=30%. Group 1 showed a significantly increased risk for kidney dysfunction (adjusted HR 3.36, 95% CI 1.23, 9.20). This result was prominent in age over 60, male sex, patients with hypertension. Conclusion(s): Decreased physical activity related to higher risk-perception, and that was significantly increased risk for kidney dysfunction. Healthcare provider needs to consider a new strategy to encourage physical activity irrespective of risk perception.
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Background: Low total CO2 (tCO2) levels are significantly associated with allcause mortality. Lots of factors are related to the poor prognosis of COVID-19, it was a lack of data to evaluate the impact of tCO2. We evaluated the impact of metabolic acidosis on all-cause mortality in patients with COVID-19. Method(s): We retrospectively reviewed the data from two independent hospitals that care for admitted patients with COVID-19 between February 2020 and September 2021. We excluded subjects with underlying end-stage kidney disease, no data of tCO2 value, and age under 18 years old. The primary outcome was in-hospital mortality. We evaluate the impact of tCO2 as a continuous variable on mortality using the Cox-proportional hazard model. In addition, we tried to find the relative value of tCO2 to increase the risk of mortality using a generalized additive model. We also evaluated the impact of such a value of tCO2 and 22mEq/L of tCO2 on mortality. Result(s): A total of 4,423 patients were included, and the mean age was 54.7+/-18.3 years old. Mean tCO2 was 26.2+/-3.6 mEq/L, and there were 792 (17.9%) with tCO2 <22 mEq/L. Increased in 1 mEq/L of tCO2 significantly decreased risk for all-cause mortality after adjustment with age, sex, history of hypertension, diabetes, and laboratory results such as serum white blood count, hemoglobin, platelet, calcium, phosphate, albumin, and eGFR (adjusted HR 0.95, 95% CI 0.91, 0.99). We found that the level of 24 mEq/L of tCO2 as a cut-off value to increase risk of mortality. In the Cox-proportional hazard model, the risk of all-cause mortality was significantly increased by around 1.6 times in subjects with lower tCO2 irrespective of the cut-off value of 22 or 24 mEq/L. Conclusion(s): Decreased tCO2 significantly increased the risk of all-cause mortality in patients with COVID-19. Monitoring of tCO2 could be a good indicator to predict prognosis, and it needs to be considered to encourage in patients with a specific condition.
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The corona virus is currently in a pandemic. At this point, the most pressing challenge in the health care field is the coronavirus disease (COVID-19) epidemic. "In Korea, the first laboratory confirmed case was confirmed on January 20, 2020[1]". One way to identify these diseases is building the computational model. And then it needs a way to check whether the model worked or not. In this paper, We explain how to check the model using several programs.
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Email is an essential communication tool for modern people and offers a variety of functions. After the outbreak of COVID-19, the importance of emails enhanced further as non-face-to-face work increased. However, with the spread and dissemination of emails, cybercrime that abused emails has also increased. The number of cases of stealing or damaging email users by impersonating public institutions such as the National Police Agency, the Prosecutor’s Office, or the WHO. This study proposes an advanced algorithm of email classification using an SMTP response code to strengthen the level of email security. The proposed system is located on the side of the recipient’s email server and operates upon receipt of the email. When an email is received, it automatically verifies whether the domain of the email sender is normally registered in DNS. Thereafter, MX, SPF, and PTR records are extracted and combined to determine the state of the sending server. When additional verification is required, a proposed algorithm automatically connects the communication session to the sender to request the SMTP response code. The proposed algorithm was applied to two organizations and succeeded in classifying received emails into various categories. This study contributes to the literature on email classification by presenting new ideas in the process of sender verification. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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For the last couple years, governments and health authorities worldwide have been focused on addressing the Covid-19 pandemic;for example, governments have implemented countermeasures, such as quarantining, pushing vaccine shots to minimize local spread, investigating and analyzing the virus??? characteristics, and conducting epidemiological investigations through patient management and tracers. Therefore, researchers worldwide require funding to achieve these goals. Furthermore, there is a need for documentation to investigate and trace disease characteristics. However, it is time consuming and resource intensive to work with documents comprising many types of unstructured data. Therefore, in this study, natural language processing technology is used to automatically classify these documents. Currently used statistical methods include data cleansing, query modification, sentiment analysis, and clustering. However, owing to limitations with respect to the data, it is necessary to understand how to perform data analysis suitable for medical documents. To solve this problem, this study proposes a robust in-depth mixed with subject and emotion model comprising three modules. The first is a subject and non-linear emotional module, which extracts topics from the data and supplements them with emotional figures. The second is a subject with singular value decomposition in the emotion model, which is a dimensional decomposition module that uses subject analysis and an emotion model. The third involves embedding with singular value decomposition using an emotion module, which is a dimensional decomposition method that uses emotion learning. The accuracy and other model measurements, such as the F1, area under the curve, and recall are evaluated based on an article on Middle East respiratory syndrome. A high F1 score of approximately 91% is achieved. The proposed joint analysis method is expected to provide a better synergistic effect in the dataset.
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The COVID-19 pandemic has forced workers around the world to switch their working paradigms from on-site to video-mediated communication. Despite the advantages of videoconferencing, diverse circumstances have prevented people from focusing on their work. One of the most typical problems they face is that various surrounding factors distract them during their meetings. This study focuses on conditions in which remote workers are distracted by factors that disturb, interrupt, or restrict them during their meetings. We aim to explore the various problem situations and user needs. To understand users' pain points and needs, focus group interviews and participatory design workshops were conducted to learn about participants' troubled working experiences over the past two years and the solutions they expected. Our study provides a unified framework of distracting factors by which to understand causes of poor user experience and reveals valuable implications to improve videoconferencing experiences. © 2022 ACM.
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We examine whether the impacts of COVID-19 on labor supply differ across women with different degrees of childcare burden during the initial stage of the pandemic in South Korea. To identify the effect of the outbreak, we exploit the fact that the first wave of the outbreak in South Korea was concentrated in a specific region due to a largescale religious gathering. Utilizing the Local Area Labour Force Survey, we find that the negative impact was larger for women with young children than for women without young children. Specifically, our preferred specification suggests the employment rate of women with young children decreased by 3.9 percentage points more than that of women without young children due to the COVID-19 outbreak. Women with young children also reduced weekly working hours more than their counterparts without young children. Unlike women, the impacts of COVID-19 on the labor supply among men with and without young children were not different.
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Background: The recent novel coronavirus disease (COVID-19) pandemic has led to unprecedented changes in behavior. We evaluated the current status of precautionary behavior and physical activity in chronic kidney disease (CKD) patients during the COVID-19 pandemic. Methods: A population of CKD patients (n=306) registered in a SKETCH (Study on Kidney disease and EnvironmenTal Chemicals, Clinical Trial No. NCT04679168) cohort recruited from June 2020 to October 2020 was included in the study. We conducted a questionnaire survey related to (1) risk perception of COVID-19, (2) hygienic behavior, (3) social distancing, and (4) physical activity during the past year (before the pandemic) and during the pandemic. To compare behaviors before and during the COVID-19 pandemic, the Wilcoxon-signed rank test was used. Logistic regression analysis was conducted to identify the relative factors related to risk recognition or behavior changes. Results: There were 187 (61.1%) patients with eGFR <45 mL/min/1.73 m2. This population showed a higher degree of risk perception for COVID-19 than the general population. During the pandemic, social distancing and hygiene-related behavior was significantly increased (P <0.001). The frequency of exercise was decreased only among those with regular exercise, without diabetes, or with a lower Charlson comorbidity index (CCI) (P <0.001), with no change among the other groups. Socioeconomic status and comorbidities significantly affected behavioral characteristics regardless of the category. Age was the most significant determinant of risk perception among CKD patients. Education and income were significantly associated with precautionary behaviors such as staying at home and hand sanitizer use. Also, patients with higher CCI status significantly increased their frequency of exercise (adjusted OR 2.10, 95% CI 1.01-4.38). Conclusions: CKD patients showed higher risk-perception with active precautionary behavioral changes than the general population. Healthcare providers should be aware of the characteristics to comprise precautionary behavior without reducing the physical activity.
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Background: There are few data about long-term respiratory complications following Middle East Respiratory Syndrome coronavirus (MERS-CoV) infection. This study aimed to evaluate respiratory functions and radiologic sequelae according to the severity of infection one year after the patients experienced MERS-CoV infection. Methods: A total of 73 patients undergoing MERS-CoV infection during the 2015 MERS outbreak in South Korea were enrolled in this prospective multicenter study. Pulmonary function tests and 6-minute walking tests were performed 1 year after infection. Radiologic sequelae was defined as fibrosis or atelectasis on chest computer tomography and severe pneumonia was defined as that requiring oxygen therapy. Multivariate linear regression tests were used to evaluate the effect of infection severity on respiratory function. Results: At the time of MERS-CoV infection, 18 patients had no pneumonia, 35 experienced mild pneumonia, and 20 did severe pneumonia. The median age was not different between groups (P = 0.942). Forced vital capacity (FVC) was 102.6%, 94.9%, and 88.7% in the no, mild, and severe pneumonia group, respectively (P = 0.010) and forced expiratory volume in 1 second was 105.3%, 95.7%, and 91.7% (P = 0.057). Diffusing capacity (DLCO) was significantly lower in the severe pneumonia group than in the no or mild pneumonia group (78.3% vs. 89.4% or 88.6%, P = 0.035). In multivariate analyses, FVC and DLCO were significantly correlated with infection severity after adjustment with age, sex, underlying lung disease, and smoking. There was no difference in the walking distance of 6 minute tests between groups. Radiologic sequelae were shown in 18.8%, 65.6%, and 100% in the no, mild, and severe pneumonia group, respectively (P < 0.001). Conclusion: The patients with more severe pneumonia by MERS-CoV had more impaired respiratory function in one year follow-up, which was compatible with radiologic sequelae. Disclosures: All authors: No reported disclosures. FAU - Il Jun, Kang
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The emergence and reemergence of coronavirus epidemics sparked renewed concerns from global epidemiology researchers and public health administrators. Mathematical models that represented how contact tracing and follow-up may control Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) transmissions were developed for evaluating different infection control interventions, estimating likely number of infections as well as facilitating understanding of their likely epidemiology. We reviewed mathematical models for contact tracing and follow-up control measures of SARS and MERS transmission. Model characteristics, epidemiological parameters and intervention parameters used in the mathematical models from seven studies were summarized. A major concern identified in future epidemics is whether public health administrators can collect all the required data for building epidemiological models in a short period of time during the early phase of an outbreak. Also, currently available models do not explicitly model constrained resources. We urge for closed-loop communication between public health administrators and modelling researchers to come up with guidelines to delineate the collection of the required data in the midst of an outbreak and the inclusion of additional logistical details in future similar models. FAU - Kwok, Kin On
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The reported incidence rate of venous and arterial thrombotic events in critically ill patients with COVID-19 infections is high, ranging from 20% to 60%. We adopted a patient-tailored thromboprophylaxis protocol based on clinical and laboratory presentations for these patients in our institution. We hypothesised that patients who received high-intensity thromboprophylaxis treatment would experience fewer thrombotic events. The aims of our study were to explore the incidence of thrombotic events in this population; to assess independent factors associated with thrombotic events and to evaluate the incidence of haemorrhagic events. A retrospective review of all adult patients with confirmed SARS-CoV-2 infection admitted to the intensive care unit (ICU) between 1 March and 29 May 2020 was performed. The primary outcome was a composite of venous and arterial thrombotic events diagnosed during the ICU stay. Multivariable logistic regression was used to identify the independent factors associated with thrombotic events. A total of 188 patients met the inclusion criteria. All received some type of thromboprophylaxis treatment except for six patients who did not receive any prophylaxis. Of the 182 patients who received thromboprophylaxis, 75 (40%) received high-intensity thromboprophylaxis and 24 (12.8%) were treated with therapeutic anticoagulation. Twenty-one patients (11.2%) experienced 23 thrombotic events (incidence rate of 12.2% (95%CI 7.9-17.8)), including 12 deep venous thromboses, 9 pulmonary emboli and 2 peripheral arterial thromboses. The multivariable logistic regression analysis showed that only D-dimer (OR 2.80, p = 0.002) and high-intensity thromboprophylaxis regimen (OR 0.20, p = 0.01) were independently associated with thrombotic events. Thirty-one patients (16.5%) experienced haemorrhagic events; among them, 13 were classified as major bleeding according to the International Society on Thrombosis and Haemostasis criteria. Therapeutic anticoagulation, but not the high-intensity thromboprophylaxis regimen, was associated with major bleeding. A proactive approach to the management of thromboembolism in critically ill COVID-19 patients utilising a high-intensity thromboprophylaxis regimen in appropriately selected patients may result in lower thrombotic events without increasing the risk of bleeding.