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Background: Health-care providers, particularly pediatric dentists, highly depend on electronic media. This survey attempts to assess how they have taken to e-media to keep themselves abreast of the current situation and use it efficiently. Objectives: To determine attitudes, awareness, and practices of e-media usage among pediatric dental professionals and postgraduate students in pediatric dentistry during the COVID-19. Materials and Methods: A convenience sample of 958 pediatric dental practitioners and postgraduate students in pediatric dentistry from throughout India participated in a descriptive cross-sectional survey. An investigator-designed questionnaire comprising 23 close-ended questions related to the usage and various aspects of e-media before and during the COVID-19 pandemic. Results: Younger generations of pediatric dentistry are more active in the use of e-media. Dentists between the ages of 30 and 50 years are more likely to utilize social media in their profession than dentists above the age of 50 years. For academic purposes and patient communication, e-media was the most popular choice. Conclusion: The Indian pediatric dentistry profession has grown significantly with the use of e-media. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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The effects of climate change can be seen immediately in ecosystems. Recent events have resulted in a commitment to the Paris Agreement for the reduction of carbon emissions by a significant amount by the year 2030. Rapid urbanisation is taking place to provide room for an increasing number of people's residences. Increasing the size of a city and the number of people living there creates a daily need for consumable resources. In the areas of transportation, supply chains, and the utilisation of renewable energy sources, deliver on pledges that promote the accomplishment of the Sustainable Development Goals established by the United Nations. As a result, the supply chain needs to be handled effectively to meet the requirements of growing cities. Management of the supply chain should be in harmony with the environment;nevertheless, the question of how to manage a sustainable supply chain without having an impact on the environment is still mostly understood. The purpose of this study is to present a conceptual model that may be used to maintain a sustainable supply chain with electric vehicles in such a way that caters to both environmental concerns and human requirements. As part of the continual process of achieving sustainability, interrelationships between the various aspects that are being investigated, comprehended, and applied are provided by the model that was developed. It is self-evident that governmental and international organisations that are concerned with supply-demand side information will benefit from such a model, and these organisations will locate viable solutions in accordance with the model's recommendations. Beneficiaries consist of individuals who are active in the supply chain and are concerned with supply-demand side information. These individuals also need to understand how to effectively manage this information.
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Background The relationship between smoking and COVID-19 disease severity is uncertain;one meta-analysis found smoking increases the risk of developing severe COVID-19 two-fold.1 No previous study has reported whether smokers have worse outcomes at follow-up. We hypothesised that smokers admitted to hospital with COVID-19 would have a greater symptom and radiological severity at follow-up. Methods We prospectively followed up swab-positive COVID-19 patients in two hospitals discharged between 03.05.20 and 19.06.20. Telephone calls were conducted 8-10 weeks post discharge. Demographics, co-morbidities, smoking history and symptom burden data were collected. Symptom burden was quantified using a numerical rating scale for breathlessness, cough and fatigue. Patients were offered a follow-up chest radiograph (CXR) if abnormal on discharge Results 782 patients were reviewed post-discharge, median (IQR) time to review: 63 (54-79) days. Smoking history was obtained for 537 patients. Outcomes for 181 (34%) current/ex-smokers were compared to 356 (66%) never-smokers. Table 1 demonstrates baseline characteristics and symptom burden between groups at follow-up. Never-smokers were significantly younger (59.5±16.3 vs. 65.1±15.5 years, p<0.001) and more likely to be from ethnic minority groups (51.4% vs 34.8%, p<0.001). Ex/current smokers had significantly increased self-reported breathlessness (1 (0-3) vs 0 (0-2);p=0.037) and higher Medical Research Council (MRC) dyspnoea score (2 (1-3) vs 1(1-2);p=0.013). They were less likely to have returned to work (30% vs 51%;p=0.013). Regression analyses demonstrated no significant impact of age and ethnicity on self-reported breathlessness (p=0.317) but demonstrated a significant impact of age on the MRC score (p<0.001). There were no significant differences in CXR findings at follow-up. Conclusion In this large clinical cohort, ex/current smokers had significantly increased self-reported breathlessness at follow-up. These results should be interpreted with caution as the burden of breathlessness prior to admission is unknown. Interestingly, there were no significant differences in other symptoms, nor any differences in radiology findings. Further work is required to understand the mechanisms underlying these findings in order to mitigate the effect of COVID-19 in current/ex smokers. We should continue to routinely and optimally treat current smokers for their tobacco dependence.
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The World Health Organization has recorded over 8 Million cases of COVID19 as of October 2020. Despite receiving appropriate lung protective ventilation and medical treatment, some of these patients develop refractory hypoxemia and acute respiratory distress syndrome. Extracorporeal membrane oxygenation has been recognized as a lifesaving therapy for patients with ARDS secondary to COVID19. There are few centers in the United States equipped with the necessary staff and the experience to take care of such critically ill patients. Some patients are too ill to be transferred with conventional mechanical ventilation, and they require interhospital transport while on ECMO. We have developed a highly specialized ECMO Deployment Team dedicated to the cannulation and transport of COVID19 patients while on venous-venous (VV) ECMO or venous-arterial (VA) ECMO. We use routine bedside ECMO cannulation via bilateral femoral vessels configuration at the outside hospital. The patient is stabilized and transported by air or ground to one of our affiliated hospitals.Here we present a series of five patients who were cannulated by our team at an outside institution and transported while on ECMO support to one of our three system hospitals. Patient ages ranged between 49-64 years old. Four patients required VV ECMO for severe hypoxemia secondary to COVID19 ARDS. One patient required VA ECMO due to viral myocarditis secondary to COVID19. Time on ECMO ranged from 9-33 days. Three of the five patients recovered successfully and were discharged home, rehab or LTAC. One patient is still currently on ECMO and one patient is deceased. There were no reported or documented transmission of COVID19 to the members of the ECMO deployment team. The potential for survival of the critically ill due to COVID19 often demands a higher level of care. However, stable transport to an appropriate institution presents a limiting factor. Our method of a dedicated ECMO Deployment Team appears to provide favorable outcome for these patients. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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Introduction: Pneumothorax and pneumomediastinum have both been noted to complicate cases of coronavirus disease 2019 (COVID-19) requiring hospital admission. We report the largest case series yet described of patients with both these pathologies (including nonventilated patients). Methods: Cases were collected retrospectively from UK hospitals with inclusion criteria limited to a diagnosis of COVID-19 and the presence of either pneumothorax or pneumomediastinum. Patients included in the study presented between March and June 2020. Details obtained from the medical record included demographics, radiology, laboratory investigations, clinical management and survival. Results: 71 patients from 16 centres were included in the study, of whom 60 had pneumothoraces (six with pneumomediastinum in addition) and 11 had pneumomediastinum alone. Two of these patients had two distinct episodes of pneumothorax, occurring bilaterally in sequential fashion, bringing the total number of pneumothoraces included to 62. Clinical scenarios included patients who had presented to hospital with pneumothorax, patients who had developed pneumothorax or pneumomediastinum during their inpatient admission with COVID-19 and patients who developed their complication while intubated and ventilated, either with or without concurrent extracorporeal membrane oxygenation. Survival at 28 days was not significantly different following pneumothorax (63.1 +/- 6.5%) or isolated pneumomediastinum (53.0 +/- 18.7%;p=0.854). The incidence of pneumothorax was higher in males. 28-day survival was not different between the sexes (males 62.5 +/- 7.7% versus females 68.4 +/- 10.7%;p=0.619). Patients aged >= 70 years had a significantly lower 28-day survival than younger individuals (>= 70 years 41.7 +/- 13.5% survival versus <70 years 70.9 +/- 6.8% survival;p=0.018 log-rank). Conclusion: These cases suggest that pneumothorax is a complication of COVID-19. Pneumothorax does not seem to be an independent marker of poor prognosis and we encourage continuation of active treatment where clinically possible.
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S58 Table 1Patient characteristics for smokers and never smokers with follow up dataVariable (%)Never-smokersEx/current SmokersP - valueN356181-DemographicsAge *(years)60 ± 1665 ± 16<0.0001Male Sex (%)212 (60)122 (67)0.076Black, Asian, Minority Ethnic (BAME) (%)183 (51)63 (35)<.0001ComorbiditiesHypertension155 (44)68 (38)0.382Ischaemic Heart Disease32 (9)25 (14)0.088Diabetes93 (26)41 (23)0.392Respiratory Background65 (18)45 (25)0.073Hospital AdmissionAdmission NEWS2 Score4 (2–6)5 (2–6.25)0.838Intensive Care Admission39 (11)24 (13.3)0.462Symptom Burden at follow upBreathlessness rating 0–100 (0–2)1 (0–3)0.037Cough rating 0–100 (0–1)0 (0–1)0.594Fatigue rating 0–102 (0–5)2 (0–5)0.933How close to 100% do they feel90 (75–100)90 (75–100)0.969Returned to Work92/179 (51)40/133 (30)0.013MRC Dyspnoea scale (1–5)1 (1–2)2 (1–3)0.005CXR at follow upNormal (%)86/120 (72)43/69 (62)0.184Significantly improved (%)25/120 (21)19/69 (28)0.294Unchanged (%)01/69 (2)0.186Significantly Worsened (%)9/120 (8)6/69 (5)0.770*normally distributed parametric data with mean and standard deviationAll other scale data was non-parametric with median and interquartile ranges shownAbbreviations: NEWS2 (National Early Warning Score 2);MRC (Medical Research Council)ConclusionIn this large clinical cohort, ex/current smokers had significantly increased self-reported breathlessness at follow-up. These results should be interpreted with caution as the burden of breathlessness prior to admission is unknown. Interestingly, there were no significant differences in other symptoms, nor any differences in radiology findings. Further work is required to understand the mechanisms underlying these findings in order to mitigate the effect of COVID-19 in current/ex smokers. We should continue to routinely and optimally treat current smokers for their tobacco dependence.ReferenceZhao Q., et al. J Med Virol 2020 Apr 15.