ABSTRACT
We developed a pandemic telephone outreach protocol to identify risk for social isolation, health destabilization, medication issues, inadequate services and supports, and caregiver stress among older adults at high risk of destabilization. Screening, conducted between April 1, 2020, and May 8, 2020, was targeted to those who had previously been screened as frail or who were identified as vulnerable by their family physician. This study describes the implementation and results of this risk screening protocol and describes patient, caregiver, and health professional perceptions of this outreach initiative. Mixed methods included satisfaction surveys and interviews completed by patients/caregivers (N = 300 and N = 26, respectively) and health professionals (N = 18 and N = 9, respectively). A medical record audit collected information on patient characteristics and screening outcomes. A total of 335 patients were screened in the early weeks of the pandemic, of whom 23% were identified with at least one risk factor, most commonly related to the potential for health destabilization and medication risk. Follow-up referrals were made most frequently to physicians, a pharmacist, and a social worker. The outreach calls were very well received by patients and caregivers who described feeling cared for and valued at a time when they were socially isolated and lonely. The outreach calls provided access to trusted COVID-19 information and reassurance that health care was still available. The majority of health professionals (>86%) were "very" or "extremely" satisfied with the ease of completing the screening via telephone and value for time spent;for 79% the protocol was "very" or "extremely" feasible to implement. Health professional interviews revealed that patients were unaware they could access care during the pandemic lockdown but were reassured that care was available, potential crises were averted, and they supported future implementation. Risk screening provides a significant opportunity to provide information, support, and mitigate potential risks and is an important and feasible component of pandemic planning in primary care.
ABSTRACT
This paper explores the relationship between weight loss, sex and beauty by analysing a corpus of 285 articles about celebrity weight loss published in the UK national press between 23 March 2020 and 6 July 2020. Taking a corpus-assisted critical discourse analysis approach, we examine the use of the statistically salient lemma flaunt*. Ninety-seven per cent of the instances of flaunt* in our corpus are attributed to female celebrities, and the respective protagonists are reported by the UK press to flaunt their bodies and their weight loss on their social media pages. By critically analysing the use of flaunt*, we are able to demonstrate the manner in which celebrity social media posts are repackaged to sexualise female celebrities and to sexualise the process of weight loss in general. We argue that describing social media images shared by female celebrities as flaunting could at best, misrepresent their intentions, and at worst contribute towards the pervasive unsolicited sexualisation of women, and exacerbate adverse body image and mental health issues during the COVID-19 pandemic which in and of itself has exacerbated these issues. © 2023, equinox publishing.
ABSTRACT
Background. During the coronavirus disease 2019 (COVID-19) pandemic, healthcare facilities (HCFs) were overwhelmed with increasing patient volumes and limited resources. Reports of disruptions in routine practices at HCFs have emerged. We evaluated changes in policies, practices, and programs for antimicrobial stewardship (AMS), infection prevention and control (IPC), and clinical microbiology across six HCF in South America following the onset of the COVID-19 pandemic. Methods. We conducted a survey in 6 HCFs in Argentina, Brazil, and Chile;2 HCFs in each country. Data on 5 components (facility characteristics, antibiotic procurement and distribution, AMS activities, IPC activities, and clinical microbiology) were collected from designated specialists within each HCF from March 2018 - February 2021. We compared observations within these 5 components pre-pandemic (March 2018 - February 2020) to during pandemic (March 2020 - February 2021.) Results. During the pandemic, the number of ICU beds increased across all the 6 HCFs by 57-633%, and the number of ventilators increased by 15-317% in 5 out of the 6 HCFs. Healthcare personnel shortages were observed in all 6 HCFs, notably common for nurses and laboratory personnel (Table 1). Extended use of N95 respirators was reported across all 6 HCFs with 2 doing extended use of gowns and medical masks. The only PPE reused was N95 respirators in 2 HCFs. Difficulties in cohorting patients with multi-drug resistance organism (MDRO) was reported by one of the HCFs. Three HCFs reported shortages in drugs with coverage for MRSA, gramnegative bacteria, and fungal pathogens despite no reports of interruption in AMS activities in these HCFs. Two hospitals reported delays on microbiology results. Facility characteristics and reported changes during COVID-19 pandemic (March 2020-February 2021) Conclusion. The COVID-19 pandemic led to substantial increases in ICU beds, number of ventilators, and extended use of PPE suggesting increases in admission of severe patients and suboptimal IPC practices in HCFs in South America. It is unclear if shortages in agents commonly used to treat MDRO was related to overuse or access difficulties. Additional evaluation is needed to determine the impact of these findings on antimicrobial resistance and antimicrobial use.
ABSTRACT
Background. Reports showing high rates of antibiotic use (AU) in patients with coronavirus disease 2019 (COVID-19) despite low rates of secondary bacterial infection have emerged from various countries across the globe. We evaluated the impact of the COVID-19 pandemic on AU in healthcare facilities (HCFs) in Argentina, Brazil, and Chile. Methods. We conducted an ecologic evaluation of AU in inpatient adult acute care wards (excluding maternity wards) in 6 HCFs in Argentina, Brazil, and Chile;2 HCFs per country. AU data for intravenously administered antibiotics commonly used to treat respiratory infections were collected from pharmacy dispensing records and aggregated to monthly defined daily dose (DDD)/1000 patient days. Graphs were created to depict AU and COVID-19 discharges over time throughout the 36-month study period (03/2018-02/2021). Relative changes in AU for all antibiotics combined and specific classes were calculated by comparing median AU for the 24-month prepandemic period (3/2018-2/2020) with the 12-month pandemic period (3/2020-2/ 2021). Only statistically significant differences (P< 0.05) determined by the Wilcoxon signed-rank test are reported. Results. Compared to the pre-pandemic period, the use of all included antibiotics combined increased in 4/6 HCFs (6.7-35.1%). In the 4 HCFs that experienced increases in AU, Figure 1 shows that use was high during months when COVID-19 patient surges occurred. In 3/4 of these HCFs, AU remained high despite significant decreases in COVID-19 discharges. Ceftriaxone use increased in 2/6 HCFs (27.1- 51.6%). Use of beta-lactam antibiotics with activity against Pseudomonas aeruginosa increased in 3/6 HCFs (31.3-82.5%) and decreased in 1/6 HCFs (-18.9%). Vancomycin and linezolid use increased in 3/6 HCFs (36.9-77.1%). Conclusion. Increases in AU among hospitalized adults were observed in 4 of 6 South American HCFs included in this study. The high rates of broad-spectrum antibiotic use in the HCFs may impact further emergence of antibiotic resistance. Understanding how this increase in antibiotic use compares to rates of bacterial infections during this time period is critical. (Figure Presented).
ABSTRACT
Background: SARS-CoV 2 virus infection present as varying degree of severity with many post viral complications.Although initial research was focused on the epidemiology, risk factors, clinical syndrome and treatment options;sufficient data is needed on sequelae of the patients who got discharged. The present study aimed to identify long term outcomes of COVID 19 recovered patients to safeguard their life in future. Methods: The present longitudinal study included all 443 COVID 19 recovered patients who were admitted during the second wave at our tertiary care hospital from 1stApril to 25th May, 2021 and interviewed telephonically with series of questionnaire. Baseline demographic profile, comorbidities, clinical characteristics and investigatory findings were obtained from the hospital records and analysed for the long term symptoms and outcomes. Results: Over a mean follow up period of 152 days, around 6% of the patients who recovered after acute COVID 19 infection died after the discharge. More than two third of patients were male. Diabetes and hypertension were most common comorbidities among the study population. Most common persistent symptoms was fatigue among the recovered population at follow up. Multivariate logistic regression analysis against the odds of post discharge mortality revealed patients receiving advanced respiratory support (AOR 5.2, 95% CI 1.8-15.1) and ICU stay during the hospitalisation (AOR 6.67, 95% CI 1.18-37.7) were predictors of post discharge mortality. Conclusion: Fatigue was the most common symptoms observed after 5 months of discharge from acute COVID 19 infection. Overall post discharge mortality was 6% and admission in ICU and use of advanced respiratory support were associated mortality among recovered patients.
ABSTRACT
Background: Vedolizumab (VDZ) is effective in inducing and maintaining remission in patients with Inflammatory bowel disease (IBD), but limited data exists in the youngest patients diagnosed <6, known as very early onset (VEO)-IBD. We aimed to evaluate the efficacy and safety of VDZ in this cohort. Methods: This was a retrospective study of patients with VEO-IBD followed at the Children's Hospital of Philadelphia, treated with VDZ for >6 months. Data collected included demographics, disease characteristics, medications, hospitalizations, growth, surgeries, and labs. Disease activity was measured using the Pediatric Ulcerative Colitis Activity Index (PUCAI) and Pediatric Crohn Disease Activity Index (PCDAI) at baseline and 6 months. Primary outcome was clinical response defined as a decrease in PUCAI>20 or PCDAI>15 at 6 months. Secondary outcomes included improvement in growth, labs, steroid use and hospitalizations. Continuous variables were analyzed using the Friedman test followed by the Wilcoxon signed-rank test. Nominal data was analyzed using McNemar's test. Results: Thirty-three children with VEO-IBD, 66% male, treated with VDZ were included. Median age of diagnosis was 3.7 years (range 1.2-6 years), with a median baseline disease duration of 3 years (range 0.1-18.5 years). IBDU was classified in 61%, and CD in 39%. Disease location was 70% colonic, 27% ileocolonic and 3% small bowel. Seven patients had prior surgeries, including diverting ileostomies (n=6) and subtotal colectomy (n=1). Nineteen (58%) patients were biologic naïve. VDZ was used as combination therapy in 6 (18%) patients (methotrexate n=4, rapamycin n=1, tacrolimus n=1). Bridge therapy was initiated in 78% of patients, with steroids (n=8) and antibiotics (n=18). Clinical response at 6 months was achieved in 19 patients (58%) with improvement in median PUCAI from 25 to 5 (p<0.01) and median PCDAI from 18.75 to 5 (p<0.05). BMI for age Z-score improved from -0.325 to 0.65 (p<0.001). Steroids and antibiotics were tapered off in 6/8 (75%) and 14/18 (78%, p<0.001) respectively. Hospital length of stay decreased significantly during the 12 months after initiating VDZ compared to 3 months prior to initiation (p<0.05). 2 patients underwent surgery including a subtotal colectomy for colonic stricture and diverting ileostomy within 2 months of starting VDZ. Adverse effects included COVID-19 infection (n=2), influenza (n=2), upper respiratory infection (n=2), pneumonia (n=1), tracheitis (n= 1), cellulitis (n=1), molluscum (n=1), and pityriasis rosea (n=1). Conclusion: VDZ is effective at inducing clinical remission in a subset of children with VEO-IBD primarily with colonic disease. It has a favorable safety profile with minimal reported adverse events observed in this study. This study is limited by small sample size and retrospective design. Larger prospective studies are warranted.
ABSTRACT
Background: Adults with Parkinson's Disease are often faced with complex medication regimens and physical limitations affecting their ability to self-manage medications. Limited information is available on how older Ontarians with Parkinson's Disease manage their medications in their homes. The purpose of this study was to explore medication management capacity, beliefs and behaviours related to medication taking, and knowledge of adherence aids or technologies in this population. Methods: A cross-sectional survey, informed by the Theory of Planned Behavior, was developed. It comprised of 36 items, divided into: demographics;medication information;beliefs about medication intake;other's impact on medication intake;experience managing medications;system of organizing medications;and effect of the COVID-19 pandemic on access to medications, and health care providers. Adults aged 65 and older living in Ontario and diagnosed with Parkinson's Disease were recruited. Participants completed the survey independently online through Qualtrics or over the phone with the research team. A sample size of 11 was calculated using Cochran's Formula for Sample Size. Results: Twelve participants completed the survey, of which 58% were females, with an average age of 75 years (range 65-89). Most participants lived independently with their spouse or partner (92%). Participants described their health as below average (25%), average (33%), above average (33%), or excellent (8%). On average participants took 9.2 medications (range 4-15), of which 3.8 were oral (range 1-6), 0.9 were non-oral (range 0-3), 1.2 were over the counter (range 0-3) and 3.3 were natural health products (range 0-6). Participants felt that their health depended on their medications (92%) and would never not fill medications because they are not covered by their insurance (92%). Eleven participants had systems to help take their medications, including visual reminders (N=9), someone remining them (N=2) phone alarms (N=6) or diaries (N=1). Two participants changed how often they visited their pharmacy or how their medications were provided because of the COVID-19 pandemic. Conclusion: Patients with Parkinson's disease use many medications, believe they must take their medications to stay well, and have strategies for managing medications. Further research is needed to identify the effectiveness of their management strategies.
ABSTRACT
Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection enters human body through respiratory tract and then rapidly spread to involve lungs and multiply swiftly leading to severe hypoxic pneumonia. Clinically, Coronavirus disease 2019 (COVID-19) infection is identified by three stages based on viral infection, lung involvement with inflammation and pulmonary fibrosis. High resolution Computed Tomography (HRCT) lung play an important role in diagnosis and management of lung fibrosis in coronavirus disease patients. Aim: To study association between inflammatory markers and development of lung fibrosis in post COVID-19 patients. Study also aimed at assessment of chest Computed Tomography (CT) Involvement Score (CT-IS) and COVID-19 Reporting and Data System (CO-RADS) for chest CT in post COVID patients presented with lung fibrosis. Materials and Methods: This retrospective study included elaborate evaluation of HRCT findings and inflammatory markers of 54 patients presented with pulmonary fibrosis at tertiary care centre for duration of six months from 1st June to 30th November 2020. Only those patients were included in which both HRCT findings and clinical laboratory parameters were available. Interleukin-6 (IL-6), C-Reactive Protein (CRP), serum ferritin, Lactate Dehydrogenase (LDH), Erythrocyte Sedimentation Rate (ESR) and Procalcitonin (PCT) markers were studied. Statistical analysis was conducted using chi-square test to compare the inflammatory markers with CT-IS score with p-value <0.05 was considered significant. Results: Total 536 corona positive patients were admitted in hospital and underwent HRCT lung from June 2020 to November 2020. Out of 536, 54 (10.07%) patients showed findings of lung fibrosis on follow-up CT scan. Among 54 patients with lung fibrosis, CRP, serum ferritin and IL-6 levels were high in 46 (85.19%), 42 (77.77%) and 48 (88.89%) patients respectively. Lactate dehydrogenase, ESR and PCT were increased in 12 (22.22%), 15 (27.78%) and 06 (11.11%) patients respectively. These levels were higher in Fibrotic phase compared to prefibrotic phase. Erythrocyte sedimentation rate was significantly associated with the severity of lung fibrosis, having significant p-value=0.004. Conclusion: Among all inflammatory markers, ESR value may be useful as a surrogate marker to predict the pulmonary fibrosis in COVID-19 patients. C-reactive protein, IL-6, LDH, serum ferritin and PCT levels do not show significant association with lung fibrosis on HRCT scan.
ABSTRACT
The objective of the study was to evaluate knowledge and attitude regarding immuno-nutrition in Indians residing in different parts of the world and to evaluate practices adopted during lockdown to boost immunity. A rapid assessment survey was conducted using Goog le Forms which was circulated amongst Indian community residing in different countries using various social media platforms. Data was collected from 325 Indians from 11 different countries. Participants were regrouped into 4 groups: South Asia, Europe, East Africa and Western Asia based on geographical location. About 85% participants identified most factors that either boost or suppress immunity. More than 90% participants reported vitamin C, vitamin D, vitamin B12, proteins and iron as the nutrients that boost immunity. Higher percentage of Indians from South and Western Asia reported that holy basil, asafoetida, cardamom, nuts and Chawanprash helped boost immunity as compared to Indians from Europe and East Africa (p<0.05). The overall minimum knowledge score obtained by participants was 45% and maximum was 100%. Highest marks were obtained by Indians from Western Asia followed by Indians from South Asia then Europe and lastly East Africa. However, there was no significant difference marks obtained by participants of 4 regions (p>0.05). Almost 1/3rd participants had misconception that immunity can be boosted in short amount of time. There was a significant difference in practices adopted by participants across different regions (p<0.001). Indians from Western Asia and South Asia adopted supplement and food based approaches to boost immunity as compared to Indians from other 2 regions. Though the overall knowledge regarding immuno-nutrition was similar in Indians from all 4 regions, the attitude and strategies adopted to boost immunity varied from region to region. There is a need to conduct educational programs to help improve the attitude and strategies adopted to boost immunity in Indians staying across the globe.
ABSTRACT
TOPIC: Occupational and Environmental Lung Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: E-cigarette or vaping product use-associated lung injury (EVALI) encompass a host of pulmonary complications including diffuse alveolar hemorrhage, lipoid pneumonia, hypersensitivity pneumonitis, and rarely, acute eosinophilic pneumonia (AEP) [1]. AEP presents as an acute febrile illness with hypoxemia, diffuse pulmonary infiltrates, and eosinophilia on bronchoalveolar lavage (BAL) without evidence of prior infection or atopic illness [2]. Presented is a young adult patient with a history of continuous vaping and extended exposure to kitchen smoke who developed acute hypoxemic respiratory failure later diagnosed as AEP. CASE PRESENTATION: An 18-year-old male with no significant past medical history presented to the emergency department with acute onset malaise, fever, non-productive cough, and shortness of breath over 12 hours. Social history revealed 3-week workplace exposure to smoke as a barbeque cook and a 5-year history of daily vaping with reported cessation 3 weeks prior. Vitals were notable for hypoxemia which was corrected with administration of 8L of oxygen via nasal cannula. Quickly after admission, he had worsening respiratory status: tachypnea, increased oxygen requirement, use of accessory muscles, and bilaterally diminished breath sounds. He was transferred to the medical intensive care unit for emergent endotracheal intubation. Laboratory testing revealed a neutrophil predominant leukocytosis of 19.3x109/L. COVID-19, rapid influenza A and B, and urine antigens for streptococcus and legionella were negative as were autoimmune serologies. A computed tomography (CT) scan of the chest revealed diffuse bilateral consolidative opacities [Figure 1] with worsening over the next 24 hours [Figure 2]. Further investigation was undertaken with bronchoscopy. A BAL was obtained, and cell count and cultures were sent. BAL cell count was remarkable for 33% eosinophilia. The diagnosis of AEP was made, and the patient was started on systemic glucocorticoids, with significant improvement within 24 hours. DISCUSSION: The modified Philit criteria is used to make the diagnosis of AEP, which the patient satisfied [3]. Although a 5-year vaping history was present, no previous significant respiratory symptoms were reported. Prior studies have demonstrated a relationship between workplace smoke exposure and AEP [3]. Based on the modified Philit criteria, we suspect that the patient had acute respiratory failure from AEP as a result of chronic EVALI acutely exacerbated by workplace smoke exposure. The treatment of AEP treatment involves high-dose intravenous glucocorticoids followed by a prolonged oral steroid taper. CONCLUSIONS: Obtaining occupation history as well as smoke exposure is as important as obtaining vaping history in an otherwise healthy young patient who presents with acute hypoxemic respiratory failure with bilateral diffuse opacities on imaging. REFERENCE #1: Winnicka L, Shenoy MA. EVALI and the Pulmonary Toxicity of Electronic Cigarettes: A Review. J Gen Intern Med. 2020;35(7):2130-2135. doi:10.1007/s11606-020-05813-2 REFERENCE #2: Allen JN, Pacht ER, Gadek JE, Davis WB. Acute Eosinophilic Pneumonia as a Reversible Cause of Noninfectious Respiratory Failure. N Engl J Med. 1989;321(9):569-574. doi:10.1056/nejm198908313210903 REFERENCE #3: Philit F, Etienne-Mastroïanni B, Parrot A, Guérin C, Robert D, Cordier JF. Idiopathic acute eosinophilic pneumonia: A study of 22 patients. Am J Respir Crit Care Med. 2002;166(9):1235-1239. doi:10.1164/rccm.2112056 DISCLOSURES: No relevant relationships by Nurjahan Khatun, source=Web Response No relevant relationships by Parth Patel, source=Web Response No relevant relationships by Naleen Patel, source=Web Response No relevant relationships by Tarang Patel, source=Web Response No relevant relationships by SACHIN PATIL, source=Web Response No relevant relationships by Shyam Shankar, source=Web Response No relevant relationships by Rodger Wilhite, source=Web Response
ABSTRACT
Amid rise in Covid-19 cases throughout the world including India. So study was initiated to find out the impact on different domains of health. A self-administered questionnaire was prepared, which consist of questions per-taining to the change in physical and mental health along with the quality of life during the lockdown period and was distributed through Google forms. During the survey, a total of 663 responses were collected, of which 604 responses were analyzed. Out of responses that were calculated, the physical health of 370 participants (61.30%) was improved, physical health of 111 (-18.40%) participants has deteriorated and the remaining 123 (20.30%) participants barely changed. The mental health of 274 (-45.30%) participants was declined, 201 (33.20 %) respondents tried to maintain a healthy mental state while 129 (29.30%) members maintained a peaceful state of mind. The quality of life of 290(48%) was adversely affected, 218 (36%) participants were able to maintain a healthier lifestyle, and their quality of life increased, while 96 (15.8%) remained unchanged. Quality of life is most negatively ham-pered whereas there is improved physical health status in the adult popula-tion. All the 3 components are Physical and Mental health along with Quality of life was affected due to Covid-19 related lockdown but out of these, physical health was 61.3% positively affected while mental health and QOL were deteriorated by 45% and 48% respectively.
ABSTRACT
Background: In response to the COVID-19 pandemic, telehealth has emerged as a key strategy to ensure the safety of patients and healthcare workers and minimize disease spread. Lyndon B. Johnson Hospital (LBJ) is a safety-net hospital that mainly serves low income and uninsured patients (pts), and MD Anderson Medical Oncology faculty and fellows diagnose and treat over 800 new cancer cases per year in the LBJ Oncology Clinic. We piloted a teleoncology (TO) program to replace inperson visits for pts with clinic appointments (appts) during the COVID-19 pandemic. Methods: A multidisciplinary team was formed to implement TO in the LBJ Oncology Clinic. Fellows and APPs screened their appts in advance and used guidelines to determine pts appropriate for TO. Clinic visits were prioritized for new pts, treatment consents, and symptomatic pts;stable pts on treatment and surveillance had appts changed to TO. Pts were notified when their appts were converted, with integrated video visits preferred over telephone visits. To limit disease exposure, 3 fellows rotated in clinic for one week at a time and cared for the pooled clinic pts;the other 16 fellows and 2 APPs conducted TO and remotely staffed their pts with faculty on their assigned clinic day. We reviewed TO visits during the initial 1-month pilot period and survey results from involved personnel. Results: From 4/13/2020-5/8/2020, we identified 251 pts that utilized TO. Median age was 57 years (range, 20-88) and 66% were female;63% were Hispanic and 21% were African American;52% spoke Spanish and 46% spoke English. 57% of TO visits were conducted via telephone and 43% via video. 48% of the TO visits were for pts on active treatment, including IV therapy (35%) and oral targeted agents (13%);15% were surveillance pts with (9%) or without (6%) restaging imaging, 8% were pts on endocrine therapy, and 16% had transitioned to the Survivorship Clinic staffed with APPs. Survey response rate was 100% (5/5) for faculty, 74% (14/19) for fellows, and 100% (2/2) for APPs. 80% of faculty, 57% of fellows, and 100% of APPs were generally satisfied (agree/strongly agree) with the patient care delivered via TO;100% of faculty, 64% of fellows, and 100% of APPs believe patients were generally satisfied with TO. Conclusions: This study demonstrates that implementing TO in a fellows' teaching clinic at a safety-net hospital is feasible and effective. Nearly half of the TO visits conducted during this pilot period were for pts on active cancer treatment and the majority of caregivers were satisfied with TO. Pt care via TO is ongoing and pt survey data is currently being collected.
ABSTRACT
Purpose - The latest 2019 coronavirus (COVID-2019), which first appeared in December 2019 in Wuhan's city in China, rapidly spread around the world and became a pandemic. It has had a devastating impact on daily lives, the public's health and the global economy. The positive cases must be identified as soon as possible to avoid further dissemination of this disease and swift care of patients affected. The need for supportive diagnostic instruments increased, as no specific automated toolkits are available. The latest results from radiology imaging techniques indicate that these photos provide valuable details on the virus COVID-19. User advanced artificial intelligence (AI) technologies and radiological imagery can help diagnose this condition accurately and help resolve the lack of specialist doctors in isolated areas. In this research, a new paradigm for automatic detection of COVID-19 with bare chest X-ray images is displayed. Images are presented. The proposed model DarkCovidNet is designed to provide correct binary classification diagnostics (COVID vs no detection) and multi-class (COVID vs no results vs pneumonia) classification. The implemented model computed the average precision for the binary and multi-class classification of 98.46% and 91.352%, respectively, and an average accuracy of 98.97% and 87.868%. The DarkNet model was used in this research as a classifier for a real-time object detection method only once. A total of 17 convolutionary layers and different filters on each layer have been implemented. This platform can be used by the radiologists to verify their initial application screening and can also be used for screening patients through the cloud. Design/methodology/approach - This study also uses the CNN-based model named Darknet-19 model, and this model will act as a platform for the real-time object detection system. The architecture of this system is designed in such a way that they can be able to detect real-time objects. This study has developed the DarkCovidNet model based on Darknet architecture with few layers and filters. So before discussing the DarkCovidNet model, look at the concept of Darknet architecture with their functionality. Typically, the DarkNet architecture consists of 5 pool layers though the max pool and 19 convolution layers. Assume as a convolution layer, and as a pooling layer. Findings - The work discussed in this paper is used to diagnose the various radiology images and to develop a model that can accurately predict or classify the disease. The data set used in this work is the images bases on COVID-19 and non-COVID-19 taken from the various sources. The deep learning model named DarkCovidNet is applied to the data set, and these have shown signification performance in the case of binary classification and multi-class classification. During the multi-class classification, the model has shown an average accuracy 98.97% for the detection of COVID-19, whereas in a multi-class classification model has achieved an average accuracy of 87.868% during the classification of COVID-19, no detection and Pneumonia. Research limitations/implications - One of the significant limitations of this work is that a limited number of chest X-ray images were used. It is observed that patients related to COVID-19 are increasing rapidly. In the future, the model on the larger data set which can be generated from the local hospitals will be implemented, and how the model is performing on the same will be checked. Originality/value - Deep learning technology has made significant changes in the field of AI by generating good results, especially in pattern recognition. A conventional CNN structure includes a convolution layer that extracts characteristics from the input using the filters it applies, a pooling layer that reduces calculation efficiency and the neural network's completely connected layer. A CNN model is created by integrating one or more of these layers, and its internal parameters are modified to accomplish a specific mission, such as classification or object recognition. A typical CNN structure has a convolution layer that extracts features from the input with the filters it applies, a pooling layer to reduce the size for computational performance and a fully connected layer, which is a neural network. A CNN model is created by combining one or more such layers, and its internal parameters are adjusted to accomplish a particular task, such as classification or object recognition.
ABSTRACT
Background: The use of optical coherence tomography−angio co-registration (OCT-ACR) in routine clinical practice is evolving with limited reporting of clinical outcomes. We conducted this study to evaluate the impact of OCT-ACR on clinician decision making during percutaneous coronary intervention (PCI). Methods: Patients with clinically significant stenosis of >70% in at least 1 coronary artery were enrolled in the study. The pre- and post-PCI procedural strategies were prospectively assessed after angiography, OCT, and ACR with data analyzed by an independent core lab. We enrolled 500 patients from 9 centers in south Asia. Twenty-eight patients had inadequate imaging, whereas data from 75 patients are yet to be analyzed by core lab due to COVID-19. Results: The interim results included 397 patients with a mean age of 57.8 ± 10.8 years. Pre-procedural OCT resulted in a change in PCI strategy in 76% of lesions including change in stent length (57%), diameter (34%), strategy (10%), and landing zone (57%) (Figure). The use of ACR additionally altered treatment strategy in 23% lesions. Postprocedural OCT demonstrated edge dissections (3%), underexpansion (18%), malapposition (17%), tissue/thrombus prolapse (8%), and incomplete coverage (1%), thereby requiring additional interventions for optimization in 36% lesions. No change in strategy was observed with post-procedural ACR. [Formula presented] Conclusion: This is the first South Asian study reporting outcomes of OCT-ACR−guided PCI in patients with coronary artery disease. The use of OCT resulted in overall pre-procedural change of PCI strategy in 76% lesions compared with angiography. Real-time ACR had an additional significant impact with change in strategy in 23% of lesions. Categories: IMAGING: Imaging: Intravascular