Impact of COVID-19 on electroconvulsive therapy practice across Canadian provinces during the first wave of the pandemic.

BACKGROUND: Electroconvulsive therapy (ECT) is a procedural treatment that is potentially life-saving for some patients with severe psychiatric illness. At the start of the global coronavirus disease 2019 (COVID-19) pandemic, ECT practice was remarkably disrupted, putting vulnerable individuals at increased risk of symptom exacerbation and death by suicide. This study aimed to capture the self-reported experiences of psychiatrists based at healthcare facilities across Canadian provinces who were delivering ECT treatments during the first phase of the COVID-19 pandemic (i.e., from mid-March 2020 to mid-May 2020). METHODS: A multidisciplinary team of experts developed a survey focusing on five domains: ECT unit operations, decision-making, hospital resources, ECT procedure, and mitigating patient impact. Responses were collected from psychiatrists providing ECT at 67 ECT centres in Canada, grouped by four geographical regions (Ontario, Quebec, Atlantic Canada, and Western Canada). RESULTS: Clinical operations of ECT programs were disrupted across all four regions - however, centres in Atlantic Canada were able to best preserve outpatient and maintenance care, while centres in Western Canada were able to best preserve inpatient and acute care. Similarly, Atlantic and Western Canada demonstrated the best decision-making practices of involving the ECT team and clinical ethicists in the development of pandemic-related guidelines. Across all four regions, ECT practice was affected by the redeployment of professionals, the shortage of personal protective equipment, and the need to enforce social distancing. Attempts to introduce modifications to the ECT delivery room and minimize bag-valve-mask ventilation were consistently reported. All four regions developed a new patient prioritization framework, and Western Canada, notably, aimed to provide ECT to only the most severe cases. CONCLUSIONS: The results suggest that ECT provision was disproportionately affected across different parts of Canada. Possible factors that could explain these interregional differences include population, distribution of urban vs. rural areas, pre-pandemic barriers in access to ECT, number of cases, ability to control the spread of infection, and the general reduction in physicians' activities across different areas of health care. Studying these factors in the future will inform how medical centres should respond to public health emergencies and pandemic-related circumstances in the context of procedural treatments.

Post Pandemic Cyber Attacks Impacts and Countermeasures: A Systematic Review

COVID-19 is one of the deadliest pandemics of this century's that affected the whole world. As the COVID-19 spread the government had to impose lockdown that pushed the people to follow some new lifestyle like social distancing, work from home, hand washing, and the country have to shut down industries, businesses and public transport. At the same time, doctors were occupied in saving life's and on other side cyber criminals were busy taking this situation as advantage, which creates an another silent pandemic i.e. cyber-security pandemic. During this pandemic with overloaded ICT infrastructure, cyber space was gaining attention of more cyber attacker and number of attacks/threats increased exponentially. This is one of the rapidly growing global challenges for industry as well as for human life. In this paper a systematic surveys and review is done on recent trends of cyber security attacks during and post COVID-19 pandemic and their countermeasures. The relevant information has been collected from different trusted sources and impact landscape discussed with importance of cyber security education and future research challenges highlights. © 2023 IEEE.

Hospital-Acquired Achromobacter Denitrificans Bacteremia: Case Report and Review of Literature

INTRODUCTION: Achromobacter denitrificans bacteremia is a rare condition and generally affects adults with multiple comorbidities and is usually a hospital acquired infection. We report a case of hospital acquired Achromobacter denitrificans bacteremia in a young female without any comorbidities, who presented to the hospital with severe viral pneumonia. DESCRIPTION: A 33-year-old female was presented to the ER with increasing difficulty in breathing. On examination, she had labored breathing. Her oxygen saturation was 80% at room air. With oxygen support via face mask, her saturation increased to 83% with 15 L/min. Then non-invasive ventilation via BiPAP it improved to 90% and she was admitted to the medical ICU. Meanwhile, as per history from the husband, she had a cough and coryza for the past one week and was taking over the counter medications. Lab investigations at the time of admission reported WBC count as 7500/ cumm. She was tested negative for COVID-19. HR CT-scan showed bilateral ground glass opacities with bilateral patchy consolidations. For worsening hypoxia, she was intubated and placed on ventilator support (FiO2:60%). Her blood and urine culture reports were negative. The Liver function tests showed elevated SGOT/SGPT, suggesting acute hypoxic liver injury. Supportive care with IV steroids, and broad-spectrum antibiotics Pipercillin and Tazobactam was provided. In the second week, the patient's WBC started rising and peaked at 40,000/cumm on Day-10. Her condition worsened further despite being on 100% FiO2. The tracheal sample grew a colony of Acinetobacter Baumannii, while her blood cultures reported positive for A. Denitrificans sensitive to Pipercillin and Tazobactum. Chest X-Ray suggested features of acute respiratory distress syndrome with no signs of a cavitary lesion or abscess. Ultrasound abdomen and Echocardiography ruled out other sources of infection. Despite ventilatory support and medications, the patient deteriorated, and passed away after cardiorespiratory arrest. DISCUSSION: Achromobacter denitrificans cause opportunistic nosocomial infections, which has been recovered from ventilators, humidifiers, "sterile" saline, and IV fluids. A. denitrificans is associated with pneumonia, peritonitis, bacteremia, endocarditis, empyema, renal abscess, and pancreatic pseudocysts.

FUT2 gene as a genetic susceptible marker of infectious diseases: A Review

Some blood group antigens are reported as a susceptibility marker for some diseases. For instance, HBGA (Histo-blood group antigen) which is controlled by gene FUT2 also considered as a susceptible marker. The FUT2 gene which exhibits the expression of alpha-1, 2-L-fucosyltransferase enzyme also leads to HBGA expression for the gut, and it provides a composition of the phenotypical profile that exists in some populations with unique histories of evolution and it can be considered as a marker of the genetic population. It is found to have an association with many diseases which is discussed in this review. Polymorphic mutations are known to inhibit and reduce its function which are population specific. Detailed understanding and deeper knowledge of its role in the pathogenesis and prevention of many diseases is required. FUT2 may also have a potential role in the case of COVID-19 as a susceptible marker due to its association with respiratory diseases and the ABO blood group. There is an utmost need for this kind of review knowing its importance and owing to limited collective information.

Association of serum ferritin with COVID-19 in a cross-sectional study of 200 intensive care unit patients in a rural hospital: Is ferritin the forgotten biomarker of mortality in severe COVID-19?

Background: The COVID-19 disease caused by the SARS-CoV-2 virus, has toppled the world since first case noted in 2019, and the cases have been increasing there after. This grave effect is caused by the cytokine storm induced inflammation produced by the noxious virus. As it is an inflammatory state, various acute phase reactants are expected to raise; thus serum ferritin is contemplated to increase. Here we aim to anchor serum ferritin as a way marker for diagnosis and management of COVID-19 patients and study its role as a prognostic marker. Another aspect is the association of COVID-19 with the N: L ratio; observation has stated that higher N: L ratio results in more severe outcome. The study aimed to establish a correlation of COVID-19 severity with serum ferritin in the form of HRCT Score, N: L Ratio and Clinical Outcome in the patients admitted in Intensive Care Unit. Result: Out of 200 patients who were admitted in the intensive care unit with COVID-19, the association of serum ferritin with N: L Ratio and HRCT Score was significant, and the association of serum ferritin with clinical outcome in terms of discharged and expired was found to be statistically significant. Conclusion: Serum ferritin was found to be a potent marker for clinical outcome in intensive care unit patients in terms of death versus treated. HRCT Score and N:L ratio were found to be correlated with serum ferritin. Therefore, we conclude that serum ferritin may determine the severity of COVID-19 infection and it can be used as a marker for Clinical Outcome thereby making it an often neglected biomarker for predicting prognosis in COVID-19 with most of the physicians focusing mostly on interleukin 6, C Reactive protein and d dimer as a marker of severe COVID infection.

Proton pump inhibitor therapy usage and associated hospitalization rates and critical care outcomes of COVID-19 patients.

Proton Pump Inhibitors (PPI) are one of the most prescribed medications in the United States. However, PPIs have been shown to increase the risk of enteric infections. Our study aims to evaluate the correlation between PPI and COVID-19 severity. We performed a retrospective cohort study on patients who tested positive for SARS-CoV-2 from March to August 2020. Patients were categorized based on PPI user status. Primary outcomes included need for hospital or ICU admission and 30-day mortality. Secondary outcomes looked to determine the severity of COVID-19 infection and effect of comorbid conditions. 2,594 patients were reviewed. The primary outcomes of our study found that neither active nor past PPI use was associated with increased hospital admission or 30-day mortality following completion of multivariate analysis. Additionally, there was no association between COVID-19 infection and the strength of PPI dosing (low, standard, high). However, the following covariates were independently and significantly associated with increased admission: age, male gender, diabetes, COPD, composite cardiovascular disease, kidney disease, and obesity. The following covariates were associated with increased mortality: age, male gender, COPD, and kidney disease. In conclusion, the high risk features and comorbidities of PPI users were found to have a stronger correlation to severe COVID-19 infection and poor outcomes as opposed to the use of PPI therapy.

TREND ANALYSIS AND COMPARISON OF COVID - 19 CASES BEFORE AND AFTER ADMINISTRATION OF VACCINE USING MACHINE LEARNING

In this study we draw a comparison between the trends in the growing cases of novel coronavirus after the administration of vaccine doses. We compare two scenarios where how the trends have changed after the vaccine has been administered and how the trend would have looked if there were no vaccines present. This study can be used to determine the early changes that the vaccines have brought about in the trends and how much reliability do they show in preventing the cases from rising further. The predictions are made using a Weibull based Long-Short-Term-Memory approach which is also being used by the National Health Service of the UK on a dataset that takes into account features like age groups, air traffic, developmental index of the country, average temperatures of a country, which are detrimental in determining the rate of infection and deaths accurately. The model is tested on data gathered from multiple countries and the results are drawn after analyzing the result for each country as an individual entity for the conclusion to be reliable. With an increasing market competition and not so long testing period given to these vaccines which have made it to the common masses we feel this study can help predict how effectively the vaccines will be able to improve immunity against this virus and is it a viable option to invest such large capital in development and purchase of these vaccines preferring it over the organically decreasing curve following the traditional methods and natural processes. © 2021 IEEE.

Evaluating the Clinical Feasibility of an Artificial Intelligence-Powered, Web-Based Clinical Decision Support System for the Treatment of Depression in Adults: Longitudinal Feasibility Study.

BACKGROUND: Approximately two-thirds of patients with major depressive disorder do not achieve remission during their first treatment. There has been increasing interest in the use of digital, artificial intelligence-powered clinical decision support systems (CDSSs) to assist physicians in their treatment selection and management, improving the personalization and use of best practices such as measurement-based care. Previous literature shows that for digital mental health tools to be successful, the tool must be easy for patients and physicians to use and feasible within existing clinical workflows. OBJECTIVE: This study aims to examine the feasibility of an artificial intelligence-powered CDSS, which combines the operationalized 2016 Canadian Network for Mood and Anxiety Treatments guidelines with a neural network-based individualized treatment remission prediction. METHODS: Owing to the COVID-19 pandemic, the study was adapted to be completed entirely remotely. A total of 7 physicians recruited outpatients diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Patients completed a minimum of one visit without the CDSS (baseline) and 2 subsequent visits where the CDSS was used by the physician (visits 1 and 2). The primary outcome of interest was change in appointment length after the introduction of the CDSS as a proxy for feasibility. Feasibility and acceptability data were collected through self-report questionnaires and semistructured interviews. RESULTS: Data were collected between January and November 2020. A total of 17 patients were enrolled in the study; of the 17 patients, 14 (82%) completed the study. There was no significant difference in appointment length between visits (introduction of the tool did not increase appointment length; F2,24=0.805; mean squared error 58.08; P=.46). In total, 92% (12/13) of patients and 71% (5/7) of physicians felt that the tool was easy to use; 62% (8/13) of patients and 71% (5/7) of physicians rated that they trusted the CDSS. Of the 13 patients, 6 (46%) felt that the patient-clinician relationship significantly or somewhat improved, whereas 7 (54%) felt that it did not change. CONCLUSIONS: Our findings confirm that the integration of the tool does not significantly increase appointment length and suggest that the CDSS is easy to use and may have positive effects on the patient-physician relationship for some patients. The CDSS is feasible and ready for effectiveness studies. TRIAL REGISTRATION: ClinicalTrials.gov NCT04061642; http://clinicaltrials.gov/ct2/show/NCT04061642.

Electroconvulsive Therapy in Canada During the First Wave of COVID-19: Results of the "What Happened" National Survey.

OBJECTIVES: The COVID-19 pandemic has disrupted the provision of essential and potentially life-saving procedural treatments such as electroconvulsive therapy (ECT). We surveyed ECT providers across Canada to understand how the first wave of the pandemic affected ECT delivery between mid-March 2020 and mid-May 2020. METHODS: The survey was administered to ECT team members and decision makers at 107 Canadian health care centers with a focus on 5 domains: operations, decision-making, hospital resources, ECT procedure, and patient impact. Responses were obtained from 72 institutions, and collected answers were used to derive representative responses reflecting the situation at each ECT center. For specific domains, responses were split into 2 databases representing the perspective of psychiatrists (n = 67 centers) and anesthesiologists (n = 24 centers). RESULTS: Provision of ECT decreased in 64% centers and was completely suspended in 27% of centers after the onset of the pandemic. Outpatient and maintenance ECT were more affected than inpatient and acute ECT. Programs reported a high level of collaboration between psychiatry and hospital leadership (59%) but a limited input from clinical ethicists (18%). Decisions were mostly made ad hoc leading to variability across institutions in adopted resource allocation, physical location of ECT delivery, and triaging frameworks. The majority of centers considered ECT to be aerosol-generating and incorporated changes to airway management. CONCLUSIONS: Electroconvulsive therapy services in Canada were markedly disrupted by the COVID-19 pandemic. The variability in decision-making across centers warrants the development of a rational approach toward offering ECT in pandemic contexts.

Clinico-epidemiological profile of early cases of Covid-19 in state of Haryana, India

Background: Covid-19 disease is caused by novel coronavirus known as SARS CoV 2. Coronaviruses are known to cause disease in humans which can be a common cold or a serious pneumonia. SARS Cov 2 is a new variant of coronavirus which was never reported in humans before detection of cluster of cases of pneumonia in Wuhan on 31st December, 2019.Objective: The study was conducted with the objective to find out clinico-epidemiological profiles of early Covid-19 patients in state of Haryana, India and to find out knowledge about covid appropriate behaviors among covid 19 patients. Methods: All the covid-19 cases in the five districts of Haryana were enumerated from March 2020 to May 2020. These Covid-19 cases were contacted telephonically and those who gave their consent to participate in the study were asked to fill interview schedule. Observations: There were 356 covid cases reported in five districts attached to PGIMS, Rohtak. Out of total,254 subjects participated in the study, there were 60.6 % males and 39.4% females who participated in the study. Blood groups of all the participants were also enquired and it was observed that B +ve was most common (19.7%) blood group followed by A+ve (16.5%) and O +ve (15.7%). Conclusion: It can be concluded by the study that majority of the subjects were males, overweight and blood group A & B were the most common blood groups. It was observed that 75.2 % participants were aware about the use of mask, social distancing, hand hygiene and cough etiquettes.

Going Virtual During a Pandemic: An Academic Psychiatry Department's Experience with Telepsychiatry.

Background: The novel coronavirus pandemic (COVID-19) led healthcare providers, including mental health providers, across the U.S. to swiftly shift to telemedicine. Objectives: This shift gave our Department of Psychiatry a chance to better understand key challenges and opportunities vis-à-vis virtual mental healthcare. We aimed to obtain provider feedback on the use of telepsychiatry and to learn from the provider perspective about patient experiences with video visits. This information will be used to inform the telemedicine strategy at a systems level within our psychiatry department, our academic health system, as well as the field of telemedicine as a whole. Design and Sample: A 22-item online questionnaire comprising 16 quantitative and six qualitative items was distributed to providers currently using video visits to provide care. Results: A total of 89 mental health providers completed the questionnaire. Outcomes demonstrated that while providers perceive challenges associated with virtual care (e.g., fatigue, technology-related issues, and age-related concerns), they also recognize a number of benefits to themselves and their patients (e.g., convenience and increased access). Overall, provider satisfaction, comfort, and willingness to use telepsychiatry was high. Conclusions: The vast majority of providers adapted quickly to the use of virtual platforms; many endorse advantages that suggest virtual care will continue to be a modality they provide in the future, post-COVID-19. It will be important to continue to evaluate aspects of virtual care that may limit clinical assessments and to optimize use to improve access, convenience, and cost-efficiency of mental healthcare delivery.