ABSTRACT
Corona virus disease-2019 (COVID-2019) has impacted on many social behaviours and has put forth some cautiousness in day-to-today life. Therefore, to remove the barrier of fearful life, it is essential to monitor the preventive guidelines suggested by the world health organization. The very first guideline to be followed is to wear a mask and maintain social distance. In order to implement this in a super populous country like India, the administration used very coercive steps. To aid the administration, this paper provides a simple and easy to implement deep learning technique for the detection and recognition of COVID norm violators. Given an unconstrained/ constrained real-time video, the proposed framework uses YOLOv4 model for person localization, height-width comparison for evaluating social distance, and a customized YOLOv4 model for face mask detection. Once the proposed algorithm localizes the violators, it identifies them using convolutional neural network-based face recognition library. The evaluation metrics on benchmark datasets as well as real-time data are obtained. The proposed framework outperforms existing solutions with mAP (mAP @ 0.50 i.e. Mean Average Precision) of 0.9395 on YOLOv4. Comparison of proposed technique with the existing literature illustrates the better trade-off between accuracy and complexity. © 2022, Ismail Saritas. All rights reserved.
ABSTRACT
SESSION TITLE: Medical Student/Resident Disorders of the Mediastinum Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Tracheoesophageal fistula (TEF) is a rare condition that can be congenital or acquired. Patients of the novel Corona Virus Disease 2019 (COVID-19) remain intubated for prolonged periods that can give rise to a multitude of complications. Here we present a case of a 53-year-old female who got intubated after developing COVID pneumonitis, complicated by acute respiratory distress syndrome (ARDS). She developed TEF at the end of the third week of intubation. CASE PRESENTATION: A 53-year-old female presented to the hospital with hypoxemic respiratory failure caused by COVID pneumonitis. She got intubated and her hospital course was complicated by ARDS. She got extubated by the end of the third week but reintubated for persistent hypoxemia two days later. She was on the pressure control mode of ventilation with positive end-expiratory pressure (PEEP) of 16, Inspiratory Pressure ( Pi) of 19 and peak pressure of 35. Suddenly, she developed hypoxemia and gastric distension on the same ventilator settings and her peak pressure dropped to 22. The X-ray of the abdomen was normal. Sudden dropping of peak pressure prompted the clinician to get computerized tomography (CT) scan of the neck which revealed trachea-esophageal fistula. (Figure 1,2,3). She was treated with tocilizumab, Flolan, and broad-spectrum antibiotics. The fistula was bypassed temporarily with a tracheostomy tube and a plan was made to follow up with the surgery team for possible surgical intervention. DISCUSSION: COVID-19 patients who develop severe respiratory disease remain on mechanical ventilation for a prolonged time period. In addition to the lack of specific guidelines to treat this disease, the severity of illness, heavy sedation, and significantly long time period of intubation add to poor outcomes in these patients. Complications of prolonged intubation include ventilator-dependent respiratory failure, ulceration, granulation tissue formation, tracheal or laryngeal stenosis, and rarely tracheoesophageal fistula to name a few. [1] The sudden deterioration of respiratory status, dropping peak pressures, and gastric distension are a few signs of fistulous opening in the trachea. The commonest site of TEF is at the bifurcation of the trachea. [2] These patients should be extubated as early as their respiratory status allows but should not be delayed for more than two weeks to avoid these complications. CONCLUSIONS: Patients with severe COVID-19 disease remained intubated for a prolonged period. Tracheostomy tube placement should not be delayed or they can develop multiple complications. If a patient develops sudden desaturation, gastric distension, or drops peak pressures without changing the baseline ventilator settings, TEF should always be in the differentials, and management should proceed with either immediate surgical intervention or supportive care temporarily and surgical intervention later in course Reference #1: Surgery and perioperative management for post-intubation tracheoesophageal fistula: case series analysis.Puma F, Vannucci J, Santoprete S, Urbani M, Cagini L, Andolfi M, Potenza R, Daddi NJ Thorac Dis. 2017 Feb;9(2):278-286. Reference #2: Moersch HJ, Tinney WS. A fistula between the esophagus and the tracheobronchial tree. Medical Clinics of North America. 1944 Jan 1;28(4):1001-7. DISCLOSURES: no disclosure on file for Asad Chohan;No relevant relationships by Soban Farooq, source=Web Response no disclosure on file for Rajesh Kumar;No relevant relationships by S Roomi, source=Web Response No relevant relationships by Rehan Saeed, source=Web Response no disclosure on file for Maryam Siddique;No relevant relationships by Usama Talib, source=Web Response
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SESSION TITLE: Medical Student/Resident Pulmonary Vascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Coronavirus disease 2019 (CVOD-19) is presumed to be a prothrombotic state however, there is no concrete evidence supporting therapeutic anticoagulation in this disease. Here, we present a case of a 67-year old male diagnosed with COVID-19 who developed an acute pulmonary embolism and right ventricular strain pattern during hospitalization and was treated with therapeutic Lovenox. CASE PRESENTATION: A 67-year-old male who had tested positive for COVID-19 one week ago presented to the hospital with shortness of breath, fever (T 102.8), and generalized body aches. His oxygen saturation worsened, and he was put on the nasal cannula, later transitioning to non-rebreather, and finally intubation for not maintaining saturation. Computerized tomography (CT) scan of the chest on admission revealed bilateral, bibasilar and sub-pleural ground-glass opacities. (Figure 1) One week later, he became hypotensive, tachycardiac, and hypoxic on the same ventilator settings. Bedside echocardiogram revealed right ventricular dilatation and akinesis of the mid free wall. (Figure 2) A provisional diagnosis of pulmonary embolism was made and he was treated with therapeutic Lovenox. CT scan of the chest with contrast confirmed the diagnosis of pulmonary embolism. (Figure 3) His hospital course was complicated by pneumonia treated which was treated with antibiotics. He was discharged to a nursing home with a tracheostomy tube and Eliquis on the third week of hospitalization. DISCUSSION: Emerging as a cluster of pneumonia cases in Wuhan, China in December 2019, COVID-19 has spread across the world. It attaches to angiotensin-converting enzyme 2 expressed in the lungs, heart, and gastrointestinal tract. [1] Widespread microvascular thrombi in the pulmonary circulation as evidenced by autopsy studies cause profound hypoxia by a ventilation-perfusion mismatch in the lungs. The proposed mechanism of COVID-19 thrombosis includes hypercoagulable state and cytokine-mediated damage. [2] It is believed that 50 % of these patients have elevated D-dimer levels that in combination with elevated prothrombin time and reduction in fibrinogen level have been associated with increased mortality.[3] Some enterprises are therapeutically anticoagulating these patients based on these coagulation parameters while others are not. CONCLUSIONS: COVID-19 increases the incidence of microvascular and microvascular thrombotic complications. Worsening respiratory status not explained by radiological changes in the lung fields, and especially in conjunction with high titers of D-dimers, should raise the suspicion for pulmonary embolism. More studies are needed to evaluate the need for therapeutic anticoagulation in these patients without objective evidence of thrombosis. Reference #1: Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020. https://doi.org/10.1038/s41586-020-2012-7. Reference #2: Mei H., Hu Y. (2020) Characteristics, causes, diagnosis and treatment of coagulation dysfunction in patients with COVID-19. Zhonghua Xue Ye Xue Za Zhi 41:E002. Reference #3: ang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Journal of Thrombosis and Haemostasis. 2020 Apr 1. DISCLOSURES: No relevant relationships by John Madara, source=Web Response No relevant relationships by Sohaib Roomi, source=Web Response