Racial and Ethnic Disparities in the Use of Live Video Telemedicine

Purpose of Study As a result of the coronavirus disease 2019 (COVID-19) pandemic and physical distancing, telehealth has been scaled up as a key strategy to address the need for virtual access to medical services. Previous studies have examined use of web-portals for accessing health information, but data on the use of live video telemedicine for disease management across different ethnicities is limited. The objective of this study is to determine if disparities exist among different ethnic groups in accessing live video telemedicine services. Methods Used A literature review was conducted using databases such as PubMed and Google Scholar. Key search terms included: telehealth, telemedicine, ethnicity, and disparities. Studies were included if a) they were conducted in the United States, b) patients used a live video telehealth service with a provider, c) focused on telemedicine use across different racial and ethnic groups, and d) investigated completed access to live video telemedicine at the individual level, and not potential access at the aggregate level. Summary of Results Of 25 articles found, 5 met our inclusion criteria. Overall, white patients had higher rates of telehealth visit completion and video telehealth use than non-white patients. Studies that used telehealth visits for diabetes education and glycemic control showed that self-care improved in all ethnic groups, but despite tailored intervention, minority groups never achieved the same level of self-care as whites. Conclusions Our review suggests that overall white patients have better access to live video telemedicine, and use the services at higher rates compared to non-white patients. However, since this trend was not seen in every study, it is likely that other factors beyond race and ethnicity play a role in access to telemedicine. Effective strategies are needed to mitigate disparities to ensure equitable telemedicine access.

Smoking and COVID-19 in patients with cancer: Novel analysis from CCC19 registry

Background: Patients (pts) with thoracic cancers have a high rate of hospitalization and death from COVID-19. Smoking has been associated with increased risk for severe COVID-19. However, there is limited data evaluating the impact of smoking recency on COVID-19 severity in pts with cancer. We aimed to characterize the clinical outcomes of COVID-19 based on the recency of smoking in pts with thoracic cancers (TC) and all other cancers (OC). Methods: Adult pts with cancer and lab-confirmed SARS-CoV-2 and smoking history recorded in the CCC19 registry (NCT0435470) were included. Pts were stratified by cancer type (TC or OC) and further stratified into subgroups based on the recency of smoking cessation: current smoker;former smokers who quit < 1 yr. ago;1-5 yr. ago;6-10 yr. ago;quit > 10 yr. ago;and never smoker. 30-day all-cause mortality was the primary endpoint. Secondary endpoints were any hospitalization;hospitalization with supplemental O2;ICU admission;and mechanical ventilation. Results: From January 2020 to December 2021, 752 pts from TC group and 8,291 pts from OC group met the inclusion criteria. 78% of patients in TC group ever smoked compared to 36% patients in the OC group. In both groups, the majority of never-smokers were females (70% and 60% in TC and OC respectively). The burden of smoking and the rate of pulmonary comorbidities (PC) was higher in the TC group (PC 22-69%) compared to OC group (PC 12-26%) across all smoking strata. Overall, 30-day all-cause mortality was 21% and 11% in pts with TC and OC respectively. Former smokers who quit < 1 year ago in TC group had the highest rate of mortality and severe COVID-19 outcomes. However, in the OC group, there was no consistent trend of higher mortality or severe COVID-19 outcomes in specific subgroups based on smoking recency. Conclusions: To our knowledge this is the largest study evaluating the effect of granular phenotypes of smoking recency on COVID-19 outcomes in pts with cancer. Recent smokers who quit < 1 year ago in TC group had the highest rate of mortality and severe COVID-19. Further analysis exploring the factors (e.g., smoking pack years) associated with severe outcomes in this subgroup is planned.

NOTTO guidelines for vaccine-induced thrombotic thrombocytopenia in organ donation and transplantation

From the context of organ donation, COVID-19 vaccine-induced thrombotic thrombocytopenia (VITT) is important as there is an ethical dilemma in utilizing versus discarding organs from potential donors succumbing to VITT. This consensus statement is an attempt by the National Organ and Tissue Transplant Organization (NOTTO) apex technical committees, India, to formulate the guidelines for deceased organ donation and transplantation in relation to VITT to help in appropriate decision-making. VITT is a rare entity, but a meticulous approach should be taken by the organ procurement organization's (OPO) team in screening such cases. All such cases must be strictly notified to the national authorities (NOTTO) as a resource for data collection and ensuring compliance with protocols in the management of adverse events following immunization. Organs from any patient who developed thrombotic events up to 4 weeks after adenoviral vector-based vaccination should be considered to be linked to VITT and investigated appropriately. The viability of the organs must be thoroughly checked by the OPO, and the final decision in relation to organ use should be decided by the expert committee of the OPO team consisting of a virologist, a hematologist, and a treating team. Considering the organ shortage, in case of suspected/confirmed VITT, both clinicians and patients should consider the riskbenefit equation based on limited experience. An appropriate written informed consent of potential recipients and family members should be obtained before the transplantation of organs from suspected or proven VITT donors.

Pulmonary Embolism as Post-COVID-19 Sequelae: Role of Lung Perfusion Scintigraphy.

We present the case of a 41-year-old male, suspected to have pulmonary thromboembolism with a history of coronavirus disease 2019 (COVID-19) infection 1 month ago. He presented with dyspnea and dry cough for 2 weeks. D-dimer was >776.70 mcg/L. Lung perfusion scan with Tc-99m macroaggregated albumin revealed multiple bilateral segmental perfusion defects with no mass lesion/consolidation on high-resolution computed tomography (CT) of lungs suggestive of pulmonary embolism (PE) present according to perfusion only modified PIOPED II criteria. CT pulmonary angiogram showed a large filling defect in the right pulmonary artery. The case emphasizes the prolonged sequelae following COVID-19 after recovery from the acute phase of the illness. Lung perfusion scintigraphy can play an important role in the screening of such patients who may be at risk for developing PE as post-COVID-19 sequelae.

Colon capsule endoscopy versus computed tomographic colonography for identifying colorectal cancer and polyps: A systemic review and meta-analysis

Aim: Early diagnosis and treatment of Colorectal Cancer can improve outcomes. Polypectomy with colonoscopy has failure and incompletion rates with risk of aerosol-generation. Computed Tomographic Colonography, second investigation, is limited by radiation exposure and aerosol generation. Colon Capsule endoscopy is a novel technique without gas insufflation, therefore avoiding the discomfort and aerosol- generation. Our aim is to compare the yield of the CCE with CTC in CRC and polyps in patients with positive stool tests or diagnosed colorectal lesions. Methods: Review followed PRISMA standards. Electronic database (EMBASE, MEDLINE, PubMed, CINAHL) searched for RCTs and Observational studies. MedCalc Statistical Software used for the synthesis of results. Primary (Per-Lesion and Per-Patient sensitivity analysis) and secondary (Other lesion and completion rate sensitivity analysis) outcomes measured using a random-effect model. Results: We found one RCT and three observational studies. Per-Lesion Sensitivity Analysis of CCE versus CTC showed overall effect of 1.903 (0.990- 1.937), p-value-0.057. Per-Patient Sensitivity Analysis of showed overall effect of 1.928 (0.995-1.892), p-value-0.054. Other lesions Sensitivity Analysis showed overall effect of 0.810 (0.121-161.995), pvalue- 0.418. Completion Rate Sensitivity Analysis showed overall effect of -0.419 (0.526-1.516), p-value-0.676. Conclusion: CCE had a better detection rate for colorectal cancer and polyp than the CTC, but this was not statistically significant. Therefore, this study failed to prove CCE's superiority over CTC. A careful decision can be made in current COVID-19 pandemic since its advantage of zero aerosolisation. Researchers should focus on innovation in techniques and simultaneous high-quality studies to evaluate them.

Colon capsule endoscopy versus computed tomographic colonography for identifying colorectal cancer and polyps: A systemic review and meta-analysis

Introduction: Colorectal Cancer is the third commonest cancer and ranks second in cancer-related deaths worldwide1. It is imperative to diagnose the condition in the initial stages for early treatment and improved outcomes. Colonoscopy is a gold standard investigation, but it is an invasive procedure and has failure and incompletion rates with risk of aerosol-generation2,3. Computed Tomographic Colonography, the second investigation, is limited by radiation exposure and aerosol generation3. Colon Capsule endoscopy is a novel technique without gas insufflation, therefore avoiding discomfort and aerosol generation. Current evidence favoured the CCE use, but the literature behind this is still in the infancy stages. Aims & Methods: This review aims to compare the yield of the CCE with CTC in CRC and polyps in patients with positive stool tests or diagnosed colorectal lesions. Review followed PRISMA standards. The electronic database searched for RCTs and observational studies. MedCalc Statistical Software version 17.2.1 used for the synthesis of results4. Primary (Per-Lesion and Per-Patient sensitivity analysis) and secondary (Other lesion and completion rate sensitivity analysis) outcomes measured using a random-effect model. Results: We found one RCT and three prospective observational studies (Fig 1), enrolling a total of 237 patients. Per-Lesion Sensitivity Analysis of CCE versus CTC showed overall effect of 1.903 (0.990- 1.937), p-value-0.057 (Fig 2). Per-Patient Sensitivity Analysis showed overall effect of 1.928 (0.995-1.892), p-value-0.054 (Fig 3). Other lesions Sensitivity Analysis showed overall effect of 0.810 (0.121-161.995), p-value-0.418. Completion Rate Sensitivity Analysis showed overall effect of -0.419 (0.526-1.516), p-value-0.676. None of the primary and secondary outcomes showed significant results between CCE and CTC. Conclusion: CCE had a better detection rate for colorectal cancer and polyp than the CTC, but this was not statistically significant. Therefore, this study failed to prove CCE's superiority over CTC. Considerable variability noted in the included studies with the inadequate quality and lacunae in the data. Initial studies revealed promising results of CCE, but they had a low level of evidence. A careful decision must be taken in the current COVID-19 pandemic since its advantage of zero aerosolisation. Researchers should focus on innovation in techniques and simultaneous high-quality studies to evaluate them.

Colon Capsule Endoscopy versus Computed Tomographic Colonography for identifying Colorectal Cancer and Polyps: A systemic review and Meta-analysis

Introduction: Early diagnosis and treatment of Colorectal Cancer can improve outcomes. Polypectomy with colonoscopy has failure and incompletion rates with risk of aerosol-generation (Uraoka, Hosoe and Yahagi, 2015). Computed Tomographic Colonography, second investigation, is limited by radiation exposure and aerosol generation. Colon Capsule endoscopy is a novel technique without gas insufflation, therefore avoiding the discomfort and aerosol-generation. Objective: To compare the yield of the CCE with CTC in CRC and polyps in patients with positive stool tests or diagnosed colorectal lesions. Method: Review followed PRISMA standards. Electronic database searched for RCTs and observational studies. MedCalc Statistical Software used for the synthesis of results. Primary (Per-Lesion and Per-Patient sensitivity analysis) and secondary (Other lesion and completion rate sensitivity analysis) outcomes measured using a random-effect model. Results: We found one RCT and three observational studies. Per-Lesion Sensitivity Analysis of CCE versus CTC showed overall effect of 1.903 (0.990-1.937), p-value- 0.057. Per-Patient Sensitivity Analysis of showed overall effect of 1.928 (0.995-1.892), p-value- 0.054. Other lesions Sensitivity Analysis showed overall effect of 0.810 (0.121-161.995), p-value- 0.418. Completion Rate Sensitivity Analysis showed overall effect of -0.419 (0.526-1.516), p-value- 0.676. Conclusions: CCE had a better detection rate for colorectal cancer and polyp than the CTC, but this was not statistically significant. Therefore, this study failed to prove CCE's superiority over CTC. A careful decision can be made in current COVID-19 pandemic since its advantage of zero aerosolisation. Researchers should focus on innovation in techniques and simultaneous high-quality studies to evaluate them.

Notto covid-19 vaccine guidelines for transplant recipients

In December 2019, novel coronavirus (SARS-CoV-2) infection started in Wuhan and resulted in a pandemic within a few weeks' time. Organ transplant recipients being at a risk for more severe COVID-19 if they get SARS CoV-2 viral infection, COVID-19 vaccine has a significant role in these patients. The vaccine is a safer way to help build protection and would either prevent COVID-19 infection or at least diminish the severity of the disease. It would also reduce the risk of the continuing transmission and enhance herd immunity. Immuno-compromised patients should not receive live vaccines as they can cause vaccine-related disease and hence the guidelines suggest that all transplant recipients should receive age-appropriate 'inactivated vaccine' as recommended for general population. Though trials have not been undertaken on transplant recipients, efficacy and safety of COVID-19 vaccine have been scientifically documented for few vaccines among the general population.

NOTTO COVID-19 vaccine guidelines for transplant recipients

In December 2019 Novel corona virus (SARS-CoV-2) infection started in Wuhan and resulted in a pandemic within few weeks' time. Organ transplant recipients being at a risk for more severe COVID-19 if they get SARS CoV-2 viral infection, COVID 19 Vaccine has a significant role in these patients. The vaccine is a safer way to help build protection and would either prevent COVID -19 infection or atleast diminish the severity of the disease. It would also reduce the risk of the continuing transmission and enhance herd immunity. Immuno compromised patients should not receive live vaccines as they can cause vaccine related disease and hence the guidelines suggest that all transplant recipients should receive age appropriate 'inactivated vaccine' as recommended for general population. Though trials have not been undertaken on transplant recipients, efficacy and safety of COVID-19 vaccine have been scientifically documented for few vaccines among the general population. © 2021 Indian Journal of Transplantation ;Published by Wolters Kluwer - Medknow.

Tongue image analysis for COVID-19 diagnosis and disease detection

Tongue analysis is an effective indicative strategy for assessing the state of the internal organs and to detect associated diseases. In this paper, we propose a disease detection method with the use of a regular smartphone and to track disease on the go. Colour, texture and geometric features are extracted from the images of the tongue captured and are used to train classification models to detect associated diseases. The primary objective of this paper is to classify images of tongues which are healthy or are diagnosed with either thyroid, heart disease or gastritis. The secondary objective is to perform comparative analysis of machine learning algorithms to find the best performing models and their differences in hope to achieve better performance than those which have been achieved till date. In addition, this paper also takes into consideration the recent breakout, COVID-19, and aims to identify features which potentially help to classify tongues of patients who have been diagnosed with this pandemic. © 2020, World Academy of Research in Science and Engineering. All rights reserved.