Outcomes of patients with COVID-19 in the setting of chronic opioid use disorder.

BACKGROUND: There are limited studies regarding the effects of COVID-19 in patients with a concurrent diagnosis of opioid use disorder (OUD). Due to the rapidly developing nature and consequences of this disease, it is important to identify patients at an increased risk for serious illness. The aim of this study was to identify whether COVID-19 patients with OUD are at an increased risk of hospitalization and other adverse outcomes. METHODS: This retrospective chart review compared clinical parameters from patients with positive COVID-19 status as identified by a positive SARS-CoV-2 PCR test and diagnosed OUD at the University of Utah Health. The primary outcome variables were hospitalization for COVID-19, length of hospital stay, and the presence of comorbidities in the OUD patient population. Descriptive statistics and prevalence ratios (PRs) were generated. Log binomial models generated PRs adjusted by age, sex, and race, and comorbidities of asthma, pneumonia, hypertension, cardiovascular disease, and diabetes. RESULTS: COVID-19 patients with OUD were significantly more likely than patients without OUD to have asthma (p < 0.01), diabetes (p < 0.01), hypertension (p < 0.01), cardiovascular disease (p < 0.01), and chronic pneumonia (p < 0.01), and to be hospitalized (27.9 percent vs 3.6 percent; p < 0.01), admitted to the intensive care unit (11.5 percent vs 1.5 percent; p < 0.01), and receive mechanical ventilation (30.5 percent vs 0.1 percent; p < 0.01). After adjusting for age, sex, race, asthma, pneumonia, cardiovascular disease, hypertension, and diabetes, patients with OUD continued to be at increased risk for inpatient hospitalization (aPR = 4.27, 95 percent confidence interval [CI] = 1.66-10.94). Patients with OUD also averaged longer stays in the hospital than those without OUD (9.53 days vs 0.70 days, p < 0.001). CONCLUSION: Patients with a diagnosis of OUD in the presence of COVID-19 are more likely to be hospitalized, have underlying health issues, and have longer hospital inpatient stays compared to patients without OUD.

The Cancer Genomics Cloud enables bioinformatics training in a hybrid educational world

The Cancer Genomics Cloud (CGC), powered by Seven Bridges, is an NCI-funded platform that streamlines access to large cancer datasets, bioinformatic tools, and cloud computation for cancer researchers. The attributes of the CGC designed to democratize data analysis also make it ideal for training the next generation of data scientists. During the Covid-19 pandemic, it has become clear that remote/virtual learning is of great importance for workforce development, and that reducing barriers to high quality educational resources is critical for many populations. Here we present our best practices for education of bioinformatics using the CGC, taking advantage of both distributed cloud networks and platform features to enhance learning. Our best practices methods are focused on a systematic approach that takes the instructor and students through a typical bioinformatics workflow in their field of research. Briefly, the organizational structure of the CGC, known as “projects,” contains all aspects of an analysis, including data files, tools, and tool settings. Projects have fine-grained permission settings, which allow the owner to securely share their project for viewing or editing. An instructor can generate an example analysis from start to finish then share an entire project with trainees. Both students and instructors have access to the same data on the cloud, so the teacher can pre-populate the projects with specific files, ensuring the same starting point. All members within the project can communicate, including adding notes directly on the results, allowing students to troubleshoot in real time with the teacher. Instructors can manage costs for the whole class through the CGC's billing system. The CGC also provides Public Projects for self-guided training, where a researcher can learn by example using the data, tools, and completed tasks within the project, including detailed instructions embedded in markdown language. We have successfully used these methods to train masters students in bioinformatics at Georgetown University for three years, as well as high school students, college students, and current cancer researchers. This approach to virtual learning of bioinformatics can democratize training for the next generation of data scientists. The FAIR practices built into the CGC enables education across all levels of expertise, empowering users to drive cancer research from any stage of their career.

COVID-19 epidemic: analysis and prediction

“Novel Coronavirus”, commonly known as COVID-19 has spread nearly to the entire world. The number of impacted cases and deaths has increased significantly in each country, posing a challenge for the world’s health organizations. The goal of this paper was to better comprehend and analyze the growth of the disease in India, including confirmed, recovered, fatalities, and active cases of COVID-19. Data analysis affects an organization’s decision-making process with interactive visual representation. The proposed model was an ensemble model that was built using linear regression, polynomial regression, and support vector machine (SVM) regression models. The model predicted the number of confirmed cases from 30th May 2021 to 15th June 2021 based on the data available from 22 January 2020 to 29 May 2021 and improved accuracy was obtained when compared with the actual data. Forecasting the confirmed cases might assist health organizations in planning medical facilities. Following that, an appropriate machine leraning (ML) model must be found that can predict the number of new cases in the future. © 2022, Institute of Advanced Engineering and Science. All rights reserved.

Chronic Disease Burden - Nutrition and Lifestyle affecting Lives and Livelihoods in the Covid-19 Pandemic

Introduction: The covid-19 pandemic had widened the health gap, further exposing the challenges that workers face. These individuals are often marginalised by job role, geographical location changes due to migration or societal stigma in terms of ethnic origin, gender and disability. This paper further explores the challenges that vulnerable workers face in terms of nutrition and lifestyle factors (as defined by the United Nations Sustainable Development Goals) that play an important role in dis-ease. Materials and Methods: A case series of workers globally affected by the above factors were researched and nutritionally relevant health factors analysed. This series covers all continents and was able to cover the burden of poor nutritional status as a contributing factor to covid 19 related mortality and morbidity. In particular, the effects nutrition being of relevance in the management of Long Covid was also flagged. Results: Poor nutritional status, in particular micronutrient deficiency and the double edged effects of both under and over nutrition have had direct and indirect effects on the susceptibility and recovery from covid-19. The findings further support that prevention and disease management is noted to be a key variable in the vulnerable worker population. Conclusions: The implementation of key nutritional parameters as part of the health and economic ecosystem is a significant factor in the saving of Lives and Livelihoods !

Special Session 36 Unemployment, Job Insecurity and Health for Vulnerable Workers Pre, During and Post Pandemic

Session introduction Workers can be more vulnerable because of their social conditions, their health, and disabilities, and/or being in higher-risk jobs. The Covid-19 pandemic has brought about an unprecedented level of uncertainty with loss to lives and livelihoods. This has impacted the health and wellbeing of populations directly through infection, as well as through societal factors made worse by chronic disease and economic factors. Furthermore, there is evidence that vulnerable populations are disproportionately affected in terms of both their health and the socio-economic impact. UJIH-SC aims to share the evaluation of the effects of this pandemic on vulnerable workers in the context of health and work. We explore the challenges facing the global workforce during the COVID-19 pandemic.

AKI and collapsing focal segmental glomerulosclerosis in an immunocompetent patient with cytomegalovirus and COVID-19 infection

Introduction: Collapsing Glomerulopathy is a morphological variant of focal segmental glomerulosclerosis (FSGS) characterized by rapidly progressive renal failure and nephrotic range proteinuria. CMV-associated renal infections are usually seen in post-transplant and immunocompromised patients. We present a case of severe collapsing FSGS and acute CMV infection in an immunocompetent host. Case Description: A 19-year-old woman with HbSS sickle cell disease and infrequent vaso occlusive crisis was hospitalized with febrile illness. During hospitalization she developed non-oliguric acute kidney injury (AKI) and volume overload and started on intermittent hemodialysis. Chest x-ray showed cardiomegaly, pulmonary venous congestion, infiltrates and bilateral pleural effusions. 24h Urine protein was 17,291 mg/24h. Urine and serum myoglobin were elevated. Relevant investigations include positive CMV IgM, CMV PCR 7000 international unit(s)/ml, positive mycoplasma IgM. SARS-CoV-2 RT-PCR & NAT were negative but antibodies were positive. A diagnosis of COVID associated Multisystem inflammatory syndrome in children (MIS-C) was made and she received methylprednisolone. She received piperacillin/tazobactam, azithromycin, ganciclovir, meropenem, and linezolid for CMV infection and pneumonia. Renal biopsy revealed collapsing FSGS, moderate and acute tubular injury, interstitial edema, focal tubular microcysts and podocyte effacement. Renal function improved after ganciclovir therapy and hemodialysis was discontinued. Prednisone and losartan were started for persistent proteinuria. Discussion: Active CMV infection in immunocompetent hosts is uncommon. The mechanism of CMV associated with collapsing FSGS is unclear as direct viral infection is not always seen on biopsy. CMV is not routinely tested for in immunocompetent patients and should be considered in AKI and nephrotic syndrome with multi-system involvement. Our patient had lung infiltrates and rhabdomyolysis which could be explained by CMV infection. Anti-viral therapy may be effective. As opposed to primary collapsing FSGS steroids are not routinely needed. Some patients have persistent proteinuria and nephrotic syndrome may respond to steroids, with tacrolimus in refractory cases. It is unclear if prior COVID infection or MIS-C contributed to activation of CMV infection and FSGS.

Complex and Challenging Surgery like CRS with HIPEC is Easible Midst the COVID 19 Pandemic: Experience from Tertiary Care Center in India.

BACKGROUND: Amidst the COVID pandemic, most guidelines have recommended delaying surgery and giving chemotherapy for with peritoneal surface malignancies. However, when all options are exhausted, complex surgery like CRS with HIPEC can be performed in select patients. METHOD: To facilitate these complex surgeries with maximum safety, RT-PCR test for COVID-19 was performed for each patient. Personal protective equipment including N95 masks and face shields was used. A number of OT personals were limited. Taking these steps minimized the risk of COVID-19 infections among healthcare workers and patients. CONCLUSION: After implementing these steps, we were able to perform complex CRS and HIPEC procedure during the pandemic and thus improve oncological outcomes.

Perception of the Indians regarding the sudden outbreak of COVID-19: A Rapid Online Cross-sectional Survey

India is the second most populated country in the world having a rapidly growing population which is currently increasing at the rate of 16 million each year. At that situation to estimate the knowledge and prevalence of contraception among people an online randomized survey has been done among 126 volunteer. An anonymous online questionnaire has been developed and circulated among general public to assess the knowledge, attitude and practices regarding contraception and related factors. Majority of people around 92.9% were aware of the existence of contraceptive methods. The most commonly used contraceptive was condom 26.2%. Majority of 65.1% did not use any kind of contraceptive methods. About 26.2% used Condoms, minimum 15.1% used pills, and 5.6% used withdrawal method. Around 34.9% participants felt different types of issues after using any contraceptive tools. The study highlights that awareness does not always lead to use of contraceptives. A lot of educational and motivational activities and improvement in family planning services are needed to promote the use of contraceptive and reduce the high fertility rate & also to reduce the fatality due to sexually transmitted diseases.

Management options for gynecological cancers in low- To middle-income countries amidst COVID-19 pandemic

Objective: Due to Covid-19 pandemic, the oncologists and cancer patients are in a dilemma, whether they should continue with the planned treatment or wait till the pandemic is over. This review is intended to explore the management options for gynaecological cancers during the pandemic. Data sources: We searched for literature from Pubmed database and oncological socities pertaining to the management of gynaecological cancers and Covid-19 pandemic. Study Selection: For such once in a century pandemic, there is a paucity of evidence based literature. Therefore, to address this issue all the available relevant studies were reviewed. Results: Definitely, a deviation from a standard care for a longer period i.e. beyond 4-6 weeks may lead to a significant impact on over all outcomes. As this current scenario is one of the first after the advent of modern medicine, there are no clear-cut evidence based suggestions to adopt for clinicians. Various organizations like NCCN, ACS, SGO, ESMO have suggested few recommendations for present situation. Here again, a role of multidisciplinary team is of pivotal importance and every case merits discussion by multi-disciplinary team (MDT) before finalizing a strategy. We share our perspective on the issue, which is based on currently available evidences as well as the practices we intend to follow at our centre. We agree that the quality of evidence remains of low grade and are mostly based on expert recommendations with an aim to tide over this period of around 4-12 weeks. Conclusion: Precise triage of patients will play a pivotal role in preserving resources and protecting health care workers and patients. The expertise at the respective oncology centres, prevalence/incidence of COVID-19 cases in that area, the support system of the hospital and the patient profile should direct the changes in practices. We also recommend that the standard therapy should be resumed as soon as the situation improves.

Outcomes of Patients with COVID-19 in the Setting of Chronic Opioid Use Disorder (preprint)

Background: There are no known studies regarding the effects of COVID-19 in patients with a concurrent diagnosis of opioid use disorder (OUD). Due to the rapidly developing nature and consequences of this disease, it is important to identify patients at an increased risk for serious illness. The aim of this study was to understand the disease burden of COVID-19 on patients with OUD by looking at their rates of hospitalization, admission to the intensive care unit (ICU), and receipt of mechanical ventilator support.Methods: This retrospective chart review compared clinical parameters from patients with positive COVID-19 status as identified by a positive SARS-CoV-2 PCR test and diagnosed OUD at the University of Utah Health. Descriptive statistics and prevalence ratios (PRs) were generated. Log binomial models generated PRs adjusted by age, sex, race, and comorbidities of asthma, pneumonia, and diabetes.Results: COVID-19 patients with OUD were significantly more likely than patients without OUD to have asthma (p<0.01), diabetes (p<0.01), and chronic pneumonia (p<0.01), to be hospitalized (23% vs 4%; p<0.01), to be admitted to the ICU (11% vs 2%; p<0.01), and to receive mechanical ventilation (7% vs 1%; p<0.01). After adjusting for age, sex, race, asthma, pneumonia, and diabetes, patients with OUD continued to be at increased risk for inpatient hospitalization (aPR=5.65, 95% confidence interval [CI]=2.29-13.92), intensive care unit (ICU) admission (aPR=0.69, 95% CI = 0.19-2.45), and mechanical ventilation (aPR=1.25, 95% CI =0.27-5.75). Patients with OUD averaged longer stays in the hospital than those without OUD (9.53 days vs 0.70 days, p<.001).Conclusion: Patients that have a diagnosis of OUD in the presence of COVID-19 are more likely to be hospitalized, admitted to the ICU, receive mechanical ventilation and have longer hospital inpatient stays compared to patients without OUD.