Safety, Feasibility, and Outcome of Percutaneous Dilatational Tracheostomy in Critically Ill COVID-19 Patients ABS0009)

Aim and background: Percutaneous dilatational tracheostomy (PDT) may improve outcomes in critically ill COVID-19 patients on mechanical ventilation. However, the timing of performing tracheostomy may be controversial and it is an aerosol-generating procedure with potential risk for viral exposure to the healthcare workers. Materials and methods: An operational protocol for performing PDT was made and subsequently followed in a designated COVID-19 ICU. Critically ill adult patients on a mechanical ventilator who underwent PDT were included in this retrospective cohort study. Case files were retrospectively reviewed and patient characteristics, clinical outcome, and procedure-related details were noted. Results: Forty-one patients were included in the analysis. The median age was 49 years, and 41.5% of patients were females. The median duration of mechanical ventilation before tracheostomy was 10 (8-16) days and the median (IQR) PaO2/FiO2 ratio on the day of PDT was 155 [125-180] mm Hg. 48.8% of patients had transient desaturation to SpO2 <90%. 41.5% survived ICU discharge. None of the health care providers involved developed any symptoms of COVID-19. Conclusion: Early PDT may improve outcomes in critically ill COVID-19 patients and should be considered safe for health care providers. .

Prognostic Role of Different Severity Indexes in COVID-19 Pneumonia: A Retrospective Study

Aim and background: Approximately 50% of the COVID-19 patients require intensive care due to pneumonia and respiratory failure. The CURB-65,3 CRB-654, A-DROP5 score, and Pneumonia Severity Index (PSI) scoring systems are established prognostic tools for community-acquired pneumonia (CAP). Similarly, the qSOFA score is a prognostic tool for critically ill patients. However, the utility of these scoring systems in the context of COVID-19 is yet to be established as a predictive tool for triage by means of rapid decision-making and preventive measures to combat the ongoing pandemic. Materials and methods: This observational, retrospective cohort study was conducted AIIMS, New Delhi during May to June, 2021 after obtaining institutional ethical committee approval (IEC-860/4.9.2020). Only the RT-PCR-proven patients >18 years among the institutionalized patients with severe acute respiratory infections (SARI) were included. Results: Out of the 235 included patients, 27.2% of patients required mechanical ventilation, and the overall period of hospital stay was 9 (5-13) days. While the SMART COP score with an AUC of 0.812 (95% CI 0.752-0.871), the PSI score with an AUC of 0.819 (95% CI 0.762- 0.877) obtained significant results for mortality, the A drop score with an AUC of 0.92 (0.897-0.954), and both the PSI (AUC of 0.964;95% CI 0.928-1.000), and the SMART COP (AUC of 0.925;95% CI 0.887-0.962) acquired the best result for intubation and thereby requirement of mechanical ventilation. Conclusion: Although the outcome of COVID-19 depends upon multiple factors the SMART COP, PSI, and A-drop scoring systems seem to be promising predictive tools for morbidity and mortality.

Beyond the Pandemic: Masking-Behaviour, Practices, Skin problems and Attitude among Healthcare workers and Medical students of South India

Background Mask-related dermatoses among health-care workers can impact their quality of life, work and the safety afforded by the mask. Hence their prompt recognition and remedial measures assume importance during the pandemic. To collect data about-types of masks used, facial skin problems encountered and factors involved, skin care practices followed and attitude to mask-wearing among medical students and healthcare workers of South India, a cross-sectional survey was conducted using an online structured questionnaire filled by the respondents after informed consent.Data was analysed using appropriate statistical tests. Results and Conclusion Of the 576 respondents, majority used unscientific combinations of masks. Most common mask-related dermatosis was new-onset acne. Female gender, younger age, oily skin and longer hours of mask-wearing were predisposing factors. Improper care of skin and mask and reluctance to seek medical advice was observed. Majority had a positive attitude to wearing mask during the pandemic and found several other benefits to mask-wearing. Information about scientific mask-wearing practices and common mask-related skin problems must be disseminated among the medical fraternity and remedial measures offered. A general positive attitude to mask-wearing gives assurance of adherence to mask wearing even during the trough phase of pandemic.

Vaccine hesitancy among communities in ten countries in Asia, Africa, and South America during the COVID-19 pandemic.

Vaccine hesitancy is considered one of the greatest threats to the ongoing coronavirus disease 2019 (COVID-19) vaccination programs. Lack of trust in vaccine benefits, along with concerns about side effects of the newly developed COVID-19 vaccine, might significantly contribute to COVID-19 vaccine hesitancy. The objective of this study was to determine the level of vaccine hesitancy among communities in particular their belief in vaccination benefits and perceived risks of new vaccines. An online cross-sectional study was conducted in 10 countries in Asia, Africa, and South America from February to May 2021. Seven items from the WHO SAGE Vaccine Hesitancy Scale were used to measure a construct of belief in vaccination benefit, and one item measured perceived riskiness of new vaccines. A logistic regression was used to determine which sociodemographic factors were associated with both vaccine hesitancy constructs. A total of 1,832 respondents were included in the final analysis of which 36.2% (range 5.6-52.2%) and 77.6% (range 38.3-91.2%) of them were classified as vaccine hesitant in terms of beliefs in vaccination benefits and concerns about new vaccines, respectively. Respondents from Pakistan had the highest vaccine hesitancy while those from Chile had the lowest. Being females, Muslim, having a non-healthcare-related job and not receiving a flu vaccination during the past 12 months were associated with poor beliefs of vaccination benefits. Those who were living in rural areas, Muslim, and those who did not received a flu vaccination during the past 12 months had relatively higher beliefs that new vaccines are riskier. High prevalence of vaccine hesitancy in some countries during the COVID-19 pandemic might hamper COVID-19 vaccination programs worldwide. Programs should be developed to promote vaccination in those sociodemographic groups with relatively high vaccine hesitancy.

Impact of COVID-19 on cancer care in India: a cohort study.

BACKGROUND: The COVID-19 pandemic has disrupted health-care systems, leading to concerns about its subsequent impact on non-COVID disease conditions. The diagnosis and management of cancer is time sensitive and is likely to be substantially affected by these disruptions. We aimed to assess the impact of the COVID-19 pandemic on cancer care in India. METHODS: We did an ambidirectional cohort study at 41 cancer centres across India that were members of the National Cancer Grid of India to compare provision of oncology services between March 1 and May 31, 2020, with the same time period in 2019. We collected data on new patient registrations, number of patients visiting outpatient clinics, hospital admissions, day care admissions for chemotherapy, minor and major surgeries, patients accessing radiotherapy, diagnostic tests done (pathology reports, CT scans, MRI scans), and palliative care referrals. We also obtained estimates from participating centres on cancer screening, research, and educational activities (teaching of postgraduate students and trainees). We calculated proportional reductions in the provision of oncology services in 2020, compared with 2019. FINDINGS: Between March 1 and May 31, 2020, the number of new patients registered decreased from 112 270 to 51 760 (54% reduction), patients who had follow-up visits decreased from 634 745 to 340 984 (46% reduction), hospital admissions decreased from 88 801 to 56 885 (36% reduction), outpatient chemotherapy decreased from 173634 to 109 107 (37% reduction), the number of major surgeries decreased from 17 120 to 8677 (49% reduction), minor surgeries from 18 004 to 8630 (52% reduction), patients accessing radiotherapy from 51 142 to 39 365 (23% reduction), pathological diagnostic tests from 398 373 to 246 616 (38% reduction), number of radiological diagnostic tests from 93 449 to 53 560 (43% reduction), and palliative care referrals from 19 474 to 13 890 (29% reduction). These reductions were even more marked between April and May, 2020. Cancer screening was stopped completely or was functioning at less than 25% of usual capacity at more than 70% of centres during these months. Reductions in the provision of oncology services were higher for centres in tier 1 cities (larger cities) than tier 2 and 3 cities (smaller cities). INTERPRETATION: The COVID-19 pandemic has had considerable impact on the delivery of oncology services in India. The long-term impact of cessation of cancer screening and delayed hospital visits on cancer stage migration and outcomes are likely to be substantial. FUNDING: None. TRANSLATION: For the Hindi translation of the abstract see Supplementary Materials section.

Understanding the implications of FinTech Peer-to-Peer (P2P) lending during the COVID-19 pandemic

This study examines the impact of the COVID-19 pandemic on the determinants of FinTech Peer-to-Peer (P2P) lending. The issue is significant because P2P lending platforms have attracted borrowers with little to no access to the credit facilities offered by conventional banks during the pandemic. Although many banks and financial institutions have offered online loan application services during the COVID-19 pandemic, few have developed verification of loan applications submitted online. The results of this study show that the COVID-19 has brought a drastic change in the key determinants of P2P lending. The results imply that FinTech P2P lending has become the most viable alternative credit option available to borrowers. The findings are significant and likely to be of interest to borrowers, investors, practitioners, academics, and policymakers because they highlight the usefulness of P2P lending platforms and their potential to augment or replace lending provided by traditional or conventional banking institutions. © 2021 Informa UK Limited, trading as Taylor & Francis Group.