One-Year Long-Term Follow up for Post-Acute Sequelae of Covid-19 Pots Patients

Background: Persistence of orthostatic tachycardia, palpitations, and fatigue beyond 4 weeks of an acute COVID-19 infection has been termed Post-Acute Sequelae of COVID-19 (PASC) POTS. We have previously reported 6-month outcomes of PASC POTS. Long-term management and outcomes of these patients is unknown. Objective(s): To examine the long-term management and outcomes of PASC POTS patients. Method(s): We conducted a retrospective study of all patients who were diagnosed with POTS at Cardiology, Neurology, and Rehabilitation Post-COVID clinic after a COVID-19 infection between March 1, 2020, and November 1, 2022, at the University of Texas Health San Antonio. We examined COVID history, POTS diagnosis, management, and one-year outcomes of post-COVID POTS patients. Result(s): In 42 patients that were diagnosed with PASC POTS, 33 had a one-year follow-up. 100% were female, 60.6% were Caucasian. Average age was 40.6 + 11 years while the average BMI was 31.9 + 10.4 kg/m2. The most common symptoms were fatigue (87.9%), palpitations (75.7%), brain fog (72.7%), orthostatic tachycardia, exercise intolerance, and dyspnea (70%). The mean heart rate change with 10-minute standing test was 42.68 + 26.73 beats per minute. At 12-months follow-up, the most common symptom was still fatigue (66.7%), palpitations (45.5%), orthostatic tachycardia, and orthostatic intolerance (42.4%). All patients were managed with increased salt and fluid intake, lower compression stockings and rehabilitation. Fifty five percent of patients were treated with Enhanced External Counter Pulsation (EECP), 42% were treated with beta blockers, 18% with fludrocortisone, 15% with midodrine, and 15% with Pyridostigmine. At 1 year follow-up, 33% of patients reported improvement in their symptoms, 33% reported worsening of symptoms, 24% reported stable symptoms, and 9% had resolution. Conclusion(s): PASC POTS patients continue to experience adverse symptoms even at one year. Physical therapy and rehabilitation and pharmacological therapy appear improve symptoms in a minority of patients.Copyright © 2023

Excess Mortality during the First Ten Months of Covid-19 Epidemic at Jakarta, Indonesia

Excess mortality during the COVID-19 epidemic is a crucial indicator of the health effects. We examined mortality records from government sources in Jakarta, Indonesia, from January 2015 to October 2020: 1) burials in public cemeteries;2) civil registration of deaths;and 3) registration of deaths by health authorities. During 2015-2019, there were an average of 26,342 burials per year between January and October. During the same time frame in 2020, there were 42,460 burials, a 61% increase. Two months before the first official laboratory confirmation of SARS-CoV-2 infection in Indonesia in March 2020, a surge in burials began in early January 2020. In 2020, an examination of civil death registrations or health authority death registrations revealed insensitive trends. Both the characterization and management of the health crisis in Jakarta are clouded by insufficient laboratory diagnostic and death surveillance capabilities. The public burials data described may serve as a useful indicator of mortality impacts and the efficacy of epidemic interventions.Copyright © 2023

The impact of COVID-19 on heart failure admissions in Suriname-A call for action.

INTRODUCTION: During the height of the COVID-19 pandemic, there was a worldwide reorganization of healthcare systems focusing on limiting the spread of the virus. The impact of these measures on heart failure (HF) admissions is scarcely reported in Low and Middle Income Countries (LMICs) including Suriname. We therefore assessed HF hospitalizations before and during the pandemic and call for action to improve healthcare access in Suriname through the development and implementation of telehealth strategies. METHODS: Retrospectively collected clinical (# hospitalizations per patient, in hospital mortality, comorbidities) and demographic (sex, age, ethnicity) data of people hospitalized with a primary or secondary HF discharge ICD10 code in the Academic Hospital Paramaribo (AZP) from February to December 2019 (pre-pandemic) and February to December 2020 (during the pandemic) were used for analysis. Data are presented as frequencies with corresponding percentages. T-tests were used to analyze continuous variables and the two-sample test for proportions for categorical variables. RESULTS: There was an overall slight decrease of 9.1% HF admissions (N pre-pandemic:417 vs N during the pandemic: 383). Significantly less patients (18.3%, p-value<0.00) were hospitalized during the pandemic (N: 249 (65.0%)) compared to pre-pandemic (N: 348 (83.3%)), while readmissions increased statistically significantly for both readmissions within 90 days (75 (19.6%) vs 55 (13.2%), p-value = 0.01) and readmissions within 365 days (122 (31.9%) vs 70 (16.7%), p-value = 0.00) in 2020 compared to 2019. Patients admitted during the pandemic also had significantly more of the following comorbidities: hypertension (46.2% vs 30.6%, p-value = 0.00), diabetes (31.9% vs 24.9%, p-value = 0.03) anemia (12.8% vs 3.1%, p-value = 0.00), and atrial fibrillation (22.7% vs 15.1%, p-value = 0.00). CONCLUSION: HF admissions were reduced during the pandemic while HF readmissions increased compared to the pre-pandemic period. Due to in-person consultation restrictions, the HF clinic was inactive during the pandemic period. Distance monitoring of HF patients via telehealth tools could help in reducing these adverse effects. This call for action identifies key elements (digital and health literacy, telehealth legislation, integration of telehealth tools within the current healthcare sector) needed for the successful development and implementation of these tools in LMICs.

New insights from nanotechnology in SARS-CoV-2 detection, treatment strategy, and prevention.

The recent outbreak of SARS-CoV-2 resulted into the deadly COVID-19 pandemic, which has made a profound impact on mankind and the world health care system. SARS-CoV-2 is mainly transmitted within the population via symptomatic carriers, enters the host cell via ACE2 and TMPSSR2 receptors and damages the organs. The standard diagnostic tests and treatment methods implemented lack required efficiency to beat SARS-CoV-2 in the race of its spreading. The most prominently used diagnostic test,reverse transcription-polymerase chain reaction (a nucleic acid-based method), has limitations including a prolonged time taken to reveal results, limited sensitivity, a high rate of false negative results, and lacking specificity due to a homology with other viruses. Furthermore, as part of the treatment, antiviral drugs such as remdesivir, favipiravir, lopinavir/ritonavir, chloroquine, daclatasvir, atazanavir, and many more have been tested clinically to check their potency for the treatment of SARS-CoV-2 but none of these antiviral drugs are the definitive cure or suitable prophylaxis. Thus, it is always required to combat SARS-CoV-2 spread and infection for a better and precise prognosis. This review answers the above mentioned challenges by employing nanomedicine for the development of improved detection, treatment, and prevention strategies for SARS-CoV-2. In this review, nanotechnology-based detection methods such as colorimetric assays, photothermal biosensors, molecularly imprinted nanoparticles sensors, electrochemical nanoimmunosensors, aptamer-based biosensors have been discussed. Furthermore, nanotechnology-based treatment strategies involving polymeric nanoparticles, metallic nanoparticles, lipid nanoparticles, and nanocarrier-based antiviral siRNA delivery have been depicted. Moreover, SARS-CoV-2 prevention strategies, which include the nanotechnology for upgrading personal protective equipment, facemasks, ocular protection gears, and nanopolymer-based disinfectants, have been also reviewed. This review will provide a one-site informative platform for researchers to explore the crucial role of nanomedicine in managing the COVID-19 curse more effectively.

Introduction to the special section: Tribal marketing after Covid

This article introduces the special section, "Tribal Marketing After Covid: Consuming Together in an Age of Social Distance.” The authors trace the history of tribal marketing theory up until the present, ‘post-Covid' era, outlining each wave and some trajectories for future research. © The Author(s) 2023.

IDF21-0236 Prevalence of Breakthrough Covid Infections and Its Severity among Vaccinated Individuals

Background: COVID vaccines (Covishield and Covaxin) are critical in controlling the ongoing global pandemic, COVID-19. Several vaccines are now available in the market that already proved their efficacy. Aim: We assessed the breakthrough infection rate of COVID-19 and the severity of the infection among vaccinated individuals. Method: A structured survey questionnaire was circulated among the general public, via WhatsApp and email during April- June 2021, containing questions on vaccination, the prevalence of COVID after vaccination and the severity of the infection. The results were analyzed statistically. Results: 175 individuals participated in the survey, out of which 165 were vaccinated. 64.8% (107) were infected with COVID-19 after vaccination, out of which 64 were infected after two doses of vaccine. 50% of the individuals infected were asymptomatic or with mild symptoms (Table 1). Discussion: The risk of severity in COVID19 infection after having two doses of vaccination remains very low. A larger percentage of patients had mild-moderate symptoms and recovered quickly. It is imperative to administer a safe and effective vaccine to reduce morbidity and mortality associated with COVID-19. The findings here, though in a small population, are important regarding vaccine hesitancy and confidence in vaccine decision-making.

Low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope: Monte Carlo treatment planning and dose measurements in a postmortem subject.

Objective.The goal of this study was to use Monte Carlo (MC) simulations and measurements to investigate the dosimetric suitability of an interventional radiology (IR) c-arm fluoroscope to deliver low-dose radiotherapy to the lungs.Approach.A previously-validated MC model of an IR fluoroscope was used to calculate the dose distributions in a COVID-19-infected patient, 20 non-infected patients of varying sizes, and a postmortem subject. Dose distributions for PA, AP/PA, 3-field and 4-field treatments irradiating 95% of the lungs to a 0.5 Gy dose were calculated. An algorithm was created to calculate skin entrance dose as a function of patient thickness for treatment planning purposes. Treatments were experimentally validated in a postmortem subject by using implanted dosimeters to capture organ doses.Main results.Mean doses to the left/right lungs for the COVID-19 CT data were 1.2/1.3 Gy, 0.8/0.9 Gy, 0.8/0.8 Gy and 0.6/0.6 Gy for the PA, AP/PA, 3-field, and 4-field configurations, respectively. Skin dose toxicity was the highest probability for the PA and lowest for the 4-field configuration. Dose to the heart slightly exceeded the ICRP tolerance; all other organ doses were below published tolerances. The AP/PA configuration provided the best fit for entrance skin dose as a function of patient thickness (R2 = 0.8). The average dose difference between simulation and measurement in the postmortem subject was 5%.Significance.An IR fluoroscope should be capable of delivering low-dose radiotherapy to the lungs with tolerable collateral dose to nearby organs.

Public attitude towards Covid-19 booster dose vaccination, Vijayawada, Andhra Pradesh, India

This study aimed to explore the attitude of the public towards COVID-19 booster vaccination inVijayawada, Andhra Pradesh, India. Materials and methods: A study was conducted in urban and rural areas of Vijayawada Andhra Pradesh. A -structured questionnaire was used to interview around 700 respondents who took two doses of the covid-19 vaccine. Finally, the data were analyzed with 456 respondents, who filled out the questionnaire. The questionnaire included three parts socio-demographic characteristics, selected factors, and beliefs about COVID-19 booster vaccination. The data collected was analyzed using Microsoft excel software and using SPSS. Results: About the Covid-19 booster vaccination, 80.7% of the public in the age group of 20-40 are ready to take the booster dose without hesitation, followed by 87.5% of the public in the age group of 40-60 are ready to take booster dose without hesitation, followed by 100% respondents in the age group60-80 are ready to take booster dose without hesitation, followed by100% respondents in the age group80 and above are ready to take booster dose without hesitation take covid-19 booster dose in the study areaout of 390 respondents under the age group of 20-40, majority, 80.76% respondents' are expressing that Govt. should supply covid-19 booster dose at free of cost. Out of 48 respondents, under the age group of 40-60, majority83.51% of respondents are expressing that Govt. should supply covid-1 9 booster dose free of cost, followed by 100% of respondents under the age group of 60-80 expressing that Govt. should supply covid-19 booster dose at free of cost, followed by 50% respondents under the age group of 80 and above are expressing that Govt. should supply covid-19 booster dose at free of cost Conclusion: Most of the publicis ready to take the booster covid-19 vaccine. They believe that preventive mechanisms like social distance, wearing the mask, and sanitizers will be better than taking a booster dose vaccination. So the government has to create awareness about the covid-19 booster dose and should eliminate apprehensions about the covid-19 vaccine. The sportspersons and movie stars have to take initiation to curtail apprehensions in the minds of the public. The colleges have to conduct awareness programs to educate the public with the help of healthcare warriors.

Social, demographic and behavioural determinants of SARS-CoV-2 infection: a case-control study carried out during mass community testing of asymptomatic individuals in South Wales, December 2020.

Between 21 November and 22 December 2020, a SARS-CoV-2 community testing pilot took place in the South Wales Valleys. We conducted a case-control study in adults taking part in the pilot using an anonymous online questionnaire. Social, demographic and behavioural factors were compared in people with a positive lateral flow test (cases) and a sample of negatives (controls). A total of 199 cases and 2621 controls completed a questionnaire (response rates: 27.1 and 37.6% respectively). Following adjustment, cases were more likely to work in the hospitality sector (aOR 3.39, 95% CI 1.43-8.03), social care (aOR 2.63, 1.22-5.67) or healthcare (aOR 2.31, 1.29-4.13), live with someone self-isolating due to contact with a case (aOR 3.07, 2.03-4.62), visit a pub (aOR 2.87, 1.11-7.37) and smoke or vape (aOR 1.54, 1.02-2.32). In this community, and at this point in the epidemic, reducing transmission from a household contact who is self-isolating would have the biggest public health impact (population-attributable fraction: 0.2). As restrictions on social mixing are relaxed, hospitality venues will become of greater public health importance, and those working in this sector should be adequately protected. Smoking or vaping may be an important modifiable risk factor.

CAN PHYSICAL ACTIVITY AS AN INDEPENDENT PARAMETER INFLUENCE TIR?

Background and Aims: A large subset of PWD assume that physical activity alone can bring glycemic control irrespective of the stage of diabetes. During Covid, there was an increased emphasis on physical activity in PWD. People with uncontrolled diabetes were avoiding physical visits to hospitals due to the fear of contracting the disease. In this scenario, we analysed the effects of physical activity on glycemic control as measured by CGM in terms of TIR. Methods: We analysed the EMR of T2D patients who performed CGM atleast once from March 2021 - June 2021 after the lockdown period and extracted data on exercise (type, frequency and duration of exercise), BMI and TIR. Out of 603 T2D, 332 (those who performed at least one kind of physical activity) were categorised into the study group (SG) and 271 (those without any physical activity) into the control group (CG). Results: TIR was compared between SG and CG using analysis of covariance model with TIR as the dependent variable, treatment as a fixed effect and BMI as a cofactor. There was no significant difference (p = 0.7305) in TIR between the groups. When taken together, 16.3% achieved a TIR >70% and 6.5% achieved a TIR >90% irrespective of physical activity. Percentage of patients in various TIR categories is shown(Fig.1) Conclusions: Physical activity alone as an independent parameter may not have a significant role in improving TIR. The findings emphasize the fact that physical acvity should be combined with medical nutrition therapy and therapeutic interventions for better optimal outcomes in the management of diabetes. (Figure Presented).

Averting Complications and Improving Quality of Life (QOL) in T2D Adhering to a Telemedicine Program for 15 Years

Background: Pros and cons of telemedicine (TM) in different specialties, haves been highly debated during the COVID pandemic. With Diabetes Tele Management System (DTMS®), TM-based treatment follow-up and integrated EMR in our centre since 1997, changes in dosages, diet and exercise are carried out via telephone/email by a multidisciplinary diabetes team 24*7, based on reported structured glucose values and remote monitoring. Aim: We assessed long-term outcomes of DTMS® along with QoL in patients adhering to DTMS® compared with non-adherent patients (NAP). Method: T2D (n = 495, age = 62.91 + 11.64) with a follow-up via DTMS® for ≥15 years were de-identified and clinical characteristics were extracted from EMR. Validated questionnaire was administered to capture QoL (Eq-5D) from June to Aug 2020. Treatment group (TG) comprised 267 subjects who have had a minimum of 3 physical consultations, 5 TM consultations and attended at least one patient education session per year. Control group (CG) (n = 184) comprised of NAP, who did not fit the above criteria. The scores were analysed statistically and compared using an independent sample “t” test. Results: From a total of 495 (61.2% male) screened, 451 complemented the data. Significant reductions in glycemic and non-glycemic parameters and complications were observed in TG when compared to CG (Table 1). [Formula presented] Discussion: The results indicate that greater adherence to a cost-effective and structured TM system (DTMS®) can help prevent diabetes complications and achieve and sustain the targets in diabetes and significantly improve QoL.

Role of a multidisciplinary team assisted, technology enabled education program in empowering people with type 1 diabetes

Introduction: Carbohydrate counting (CC)-a meal planning tool is an integral part of type 1 diabetes (T1D) management. CC have been evidenced to have positive effects on glycemic control. Objectives: We investigated and analyzed the effect of a multidisciplinary team (MDT) assisted, technology enabled education program in empowering T1D to meticulously use carb counting. Methods: T1D (n=50;age: 5-35 years;HbA1c>8 % at baseline;55% females) during their initial visit to the center were invited to participate in a MDT assisted technology enabled program. Group I (G1) received continuous assistance from a MDT along with trimonthly education and the use of technologies (n=25) and Group II (G2) opted for performing CC on their own based on the trimonthly education and used technologies at their convenience. Both the groups were trained on CC trimonthly and virtually during the Covid pandemic. Individual WhatsApp group was created for G1 comprising of the patient/caretaker and the MDT, for reporting their BG values, and sharing photos of their meals so that MDT can assist them continuously. Patients were encouraged to use a connected glucometer to monitor the BG values to improve MDT engagement. 66% of the patients were on MDI and 34% were on CSII. 8% of the participants belong to the 5-9 age group and rest of them were 10-35 years of age. Results: A significant improvement in HbA1c (Baseline 9.53 ± 1.65 to 7.50 ± 0.68) was observed in G1 Compared to G2. CC in Indian foods is challenging given the hidden carbs in the traditional meals. The greater ability to count carbs accurately led to better A1c reduction. Conclusions: Counting carbohydrates with the help of a MDT assisted technology enabled education program was found to be of significant benefit in the management of T1D.

Image-based Social Sensing: Combining AI and the Crowd to Mine Policy-Adherence Indicators from Twitter

Social Media provides a trove of information that, if aggregated and analysed appropriately can provide important statistical indicators to policy makers. In some situations these indicators are not available through other mechanisms. For example, given the ongoing COVID-19 outbreak, it is essential for governments to have access to reliable data on policy-adherence with regards to mask wearing, social distancing, and other hard-to-measure quantities. In this paper we investigate whether it is possible to obtain such data by aggregating information from images posted to social media. The paper presents VisualCit, a pipeline for image-based social sensing combining recent advances in image recognition technology with geocoding and crowdsourcing techniques. Our aim is to discover in which countries, and to what extent, people are following COVID-19 related policy directives. We compared the results with the indicators produced within the CovidDataHub behavior tracker initiative. Preliminary results shows that social media images can produce reliable indicators for policy makers.

Chatbot on COVID-19 for Sustaining Good Health During the Pandemic

This paper throws light on the JAVA-based platform whereby the user converses with the machine based on artificial intelligence. The machine behaves so smartly that the user is unable to detect his/her conversations with the machine and feels to be communicating with human itself. The paper also reflects the evolution of chatbot from ELIZA to WOEBOT and emphasizes the essential attributes that any chatbot should possess. This chatbot tackles the queries related to the current pandemic COVID-19. This chatbot is developed such that it is user friendly and is aesthetically appealing to the user. © 2021, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

The psychological impact of COVID-19 on socially isolated individuals – a systematic review

Purpose: This study aims to assess the various psychological effects of the Coronavirus on those in isolation, the factors that cause these effects during the pandemic, as well as to discuss the recommendations and strategies that can be implemented to help reduce the negative psychological impact. Design/methodology/approach: Databases such as MEDLINE (Ovid), excerpta medica dataBASE (Ovid) and cumulative index of nursing and allied health literature (Elton B. Stephens Company), as well as grey literature, were used as a part of the search design to locate articles published on this subject. The search design was formatted in a way that aided in locating articles concerning a variety of mental health effects. Title and abstract screening and full text screening were conducted by two reviewers. The risk of bias assessment was conducted using AMSTAR2. Data extraction was performed by one reviewer and was confirmed by the other. Findings: A total of 28 articles were obtained, and of those, 11 were included in the review. From the data that was reviewed, the majority of the isolated individuals felt depressed and anxious. This negative psychological distress contributes to deteriorating health and quality of life in many people. Research limitations/implications: Few limitations include limited published research papers pertaining to the subject of the mental health effects of COVID-19 on individuals in social isolation. Therefore, this suggests the need for higher quality studies to be performed on this topic. Originality/value: This review provides a unique viewpoint on the effects of COVID-19, allowing for others to have a better understanding of the wide range of psychological impacts the pandemic has brought on. © 2021, Emerald Publishing Limited.