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Objective: The aim of the present study was to investigate the psychiatric distress, including stress, anxiety, and depression levels, among COVID-19 positive patients who were admitted between 01 July 2020 to 31 August 2020 to the COVID-19 isolation ward of the Uttar Pradesh University of Medical Sciences, Saifai, Etawah India. Participants included 100 patients, with 55 males and 45 females. The majority of admitted patients (81%) were illiterate. Out of 100 patients, 83 were married, 16 were unmarried, and only 1 was a widow. Method(s): Levels of anxiety, depression, and stress level were noted in admitted patients using Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-9) depression assessment, and Perceived Stress Scale 4 (PSS-4) assessment techniques, respectively. Result(s): Patient Health Questionnaire (PHQ-9) depression assessment results showed minimal, mild, and moderate depression in 9, 25, and 66 patients, respectively, with a 10.6 median score of PHQ-9. Mild, moderate, and severe anxiety (GAD-7 score) was present in 22, 28, and 50 of the patients surveyed. The mean Perceived Stress Scale 4 (PSS-4) was also analyzed, and it reported 6.1 values. The results of the study demonstrated that the patients had a high label of psychiatric distress, but still, admitted patients believe that they will come out from this pandemic condition. Conclusion(s): Although patients claimed psychiatric distress and mental health illness, they still denied the requirement of any mental health professionals to minimize stress levels and were satisfied with the medical facilities available in a hospital located in a rural area.Copyright © 2022 Bentham Science Publishers.
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Background: It has been more than year of beginning of COVID-19 outbreak, the most serious complication of COVID infection is excessive increase in inflammatory mediators also known as cytokine storm which leads to formation of pneumonia in some patients. After resolution of pneumonia some amount of fibrosis develops which leads to decrease in quality of life and increased mortality. Nevertheless, in elderly patients a small % of fibrosis can be fatal. Therefore, as corona virus has affected several millions of people even though pulmonary fibrosis being a rare complication can cause huge no. of cases of pulmonary fibrosis, Several randomized control trials has been carried out till now for treatment of fibrosis, Perfenidone and nintedanib are approved as a treatment modality of idiopathic pulmonary fibrosis, it has been also useful in non-idiopathic pulmonary fibrotic diseases like interstitial idiopathic fibrosis studies are going out for effectiveness in post COVID pulmonary fibrosis. Several other modalities are also being tested, drugs which help in decreasing the severity of cytokine storm such as steroids. Viral load can be decreased by using antiviral agents. Certain novel drugs are also being researched upon, so in this review article considering the impact of fibrosis on the covid population, cause of pulmonary fibrosis, prevention and treatment modalities has been discussed.
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Background: Patients with paraganglioma/pheochromocytoma (PPGL) or hereditary predisposition to PPGL often need screening with biochemical labs, imaging and physical exam. Given the rarity of PPGL and hereditary PPGL, care is often provided through specialty centers. Subsequently, patients may have experienced restrictions on travel and delayed scheduling of non-elective procedures due to COVID-19. This study aimed to analyze the impact of COVID-19 on seeking PPGL management. Methods: Patients with a personal history of PPGL or hereditary PPGL risk from the University of Michigan, Brigham Women's Hospital, and Huntsman Cancer Institute were sent a survey in 2021. The survey included questions regarding tumor history (Y/N), gene status, demographics, and experience with COVID. The survey assessed whether they missed any exams related to PPGL diagnosis or screening. Comparative analyses utilized regression and chi-square tests. Patient factors measured in analyses evaluated COVID surveillance (labs, imaging, doctor visit) as the primary outcome and age, institution, gene status, sex, and PPGL history as predicting variables. Results: In total, 241 respondents across three institutions completed the survey. The cohort was primarily female (n = 158, 65.6%). A majority of the cohort identified as White (n = 222, 92%) and non-Hispanic (n = 226, 93.8%). PPGL history was reported in 158 patients (65.6%), 43 of which were pheochromocytoma and 113 were paraganglioma, primarily in the head and neck (n = 78). At time of survey completion, 209 (87%) respondents answered COVID-related questions. Thirty-nine respondents (19.2%) reported missing doctor visits, while 31 (15.3%) report missing HPPGL imaging and 33 (16.3%) report missing lab tests. There were no differences by institution (p > 0.05) on patient reported missed visits. Logistic regression analysis showed no difference in missing visits based on having a hereditary PPGL predisposition gene or sex of respondent (all p-values > 0.05). There was no difference based on PPGL history, though it is unknown if patients missed PGL follow-up or screening. Individuals who missed imaging (Y/N) were more likely to report missing their lab tests (OR = 1.8, p < 0.01) and doctor visit (OR = 1.25, p < 0.01). Age was a significant predictor for missing doctor visits (p = 0.02) with an odds ratio of 1.002 per 1 year increase in age. Conclusions: Though institutions had different COVID-19 restrictions and guidelines by state, there was no difference on missing surveillance or screening. Over 15% of respondents reported missing at least one aspect of PPGL care, indicating a need to re-engage those with PPGL and hereditary PPGL to return to typical screening and surveillance. Patients who miss one aspect of surveillance are likely to have missed other aspects of surveillance and will require evaluation of all aspects of screening to return up to date on needed visits and procedures.
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One of the most significant threats to today's global society is COVID-19. Due to the fear of the nCoV-19 virus and increasing infection and death rates, complete lockdowns are enforced in the whole world. Due to this contagious disease, physical communication is very difficult and risky, so the best option for communication is connection via digital media. With the constantly growing number of media platforms, India has shrunk due to the increasing communication and exchange of information. These digital platforms turned out to be most effective as regards quicker communication during the pandemic. The present study on the usage of social media during a time of pandemic addresses effective ways of usage of social media for public communication with emergency organizations, such as police, during lockdown. This information will help to identify people who are careless, cautious, and neutral towards this situation. Moreover, we discuss how to identify various emotions of people before, during, and after this crisis situation using naive Bayes and K-means clustering for clustering of tweets or comments on Twitter and Facebook and find trends using social media analytics. © 2022 Elsevier Inc. All rights reserved.
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Purpose: In today’s dynamic situation, innumerable challenges are posited in the education sector because of the COVID-19 pandemic. Higher educational institutes (HEIs) are compelled to adopt digital technologies and technology-mediated learning in the teaching-learning processes. The purpose of this paper is to understand the factors affecting learning effectiveness, learning satisfaction and the mediating role of prerecorded videos from the learners’ perspective. Design/methodology/approach: A self-designed structured questionnaire based on previous similar studies is adopted as a survey instrument. It consists of 22 questions to address the five constructs of the proposed hypothesized conceptual model, developed for the study. Data of 311 students from HEIs of Maharashtra state in India were collected. Confirmatory factor analysis is carried out to test the model fitness, reliability and validity, and structural equation modeling is applied to conduct path analysis and hypotheses testing of the model. Findings: Hypotheses testing reveals that perceived usefulness (PU) significantly affects the perceived learning effectiveness, which again affects the learning satisfaction of the students. In addition, perceived ease of use affects the PU as suggested in the technology acceptance model. The prerecorded videos have a moderating role to play in the computer self-efficacy and the perceived learning effectiveness of the students. This research will provide meaningful acumen to enhance the overall learning process among students in urban as well as rural India. Originality/value: This study explores the technology-mediated learning during the unexpected and dynamic situations of the COVID-19 pandemic in the context of higher education in India. For sustainable use of technology-assisted learning, educators must understand the key factors that influence students’ learning effectiveness and satisfaction. The research outcomes will lead toward developing the human capacities, as the prerecorded videos at the HEIs of India will provide new approaches for effectively adopting digital technologies and technology-mediated learning. © 2022, Emerald Publishing Limited.
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Introduction: Coronary artery calcium score (CACS) is a known predictor of cardiac events, however its association with inpatient mortality in COVID-19 infection remains unknown. Hypothesis: We hypothesized that elevated CACS is associated with increased mortality in inpatient patients with COVID-19. Methods: Inpatients with COVID-19 between March and May, 2020 at a single center were identified. All patients had a non-contrast chest CT during admission, and CACS and Multi-Ethnic Study of Atherosclerosis (MESA) percentile were retrospectively measured. Patients were grouped in quartiles: no CACS (0 AU), mild CACS (1-99 AU), moderate CACS (100-399 AU), and severe (> 400 AU). Inpatient mortality was compared between groups using logistic regression adjusted for age and troponin level. Results: One hundred thirty-nine patients were included with 107 (80%) surviving to discharge. Eighty-two patients self-identified as black or African American (59%) and 66 were female sex at birth (47%). The mean CACS for the survivors was 319 AU and 406 AU for non-survivors (p = 0.02). The mean MESA percentile for survivors and non-survivors was 41% and 60%, respectively (p = 0.03). Fifty-nine patients had no CACS, 19 had mild CACS, 28 had moderate CACS, and 33 had severe CACS. Fifty-three of the no CACS group survived (89%), 13 of the mild group survived (68%), 17 of the moderate group survived (60%), and 24 of the severe group survived (73%). After adjustment for age and troponin level, CACS > 0 AU versus those with CACS of 0 AU had 4-fold higher odds of mortality (OR 4.0, 95%CI 1.3-12, p= 0.02). However, there was no significant increased odds of death within higher quartiles of CACS (OR 1.4, 95%CI 1.0-2.1, p=0.08). Conclusion: The presence of coronary artery calcium positively correlates with inpatient COVID-19 mortality, even after accounting for age and myocardial injury. Severity of CACS, however, is not associated with mortality.
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Introduction: Coagulopathy in COVID-19 progresses from initialpulmonary microthrombi without systemic coagulation activation to asystemic hypercoagulable stage with widespread activation of coagulation and then to a hypocoagulable picture seen in later phases ofthe disease.Aims &Objectives: We decided to conduct this study because of thesevere infections in 2021 compared to 2020 to understand theCoagulopathy in COVID-19 among our population using Thromboelastography (TEG) and V curve.Materials &Methods: All adult patients with a confirmed COVID-19 and TEG report were recruited in the study and followed up fortwo months. Citrated Kaolin TEG parameters included were R and Ktime, alpha angle, maximum amplitude, clotting index, lysis 30. Thefirst-degree velocity curve of (V curve) TEG which extrapolatesthrombin generation potential with maximum rate of thrombin generation and time as well as thrombin generated. Comparison betweensurvivors and thromboembolisms were made with TEG parameters.Result: Study included 43 patients after excluding three patients.Average age was 58.34 (± 15.35) and majority of them were males(34/43). TEG as well as V-curve were hypercoagulable compared toage matched reference range. Systemic hypercoagulable stage (34/43)and interestingly 13/34 patients had secondary fibrinolysis activity.Mortality rate and thrombotic incidents was 32.56% and 30.23%respectively. Risk factors for mortality were MA, LY 30, TG,Hypercoagulable TEG (OR-7.36), D Dimer (OR-1.40) and Thrombosis (OR-1.37). Incidents of Thrombosis in decreasing order wasacute coronary syndrome (n = 10), DVT with PTE (n = 2) and MCAinfarction (n-1). LY 30 was associated with an increased thromboticrisk (OR-15.3, r = 0.122, Correlation-0.40, P = 0.02). Repeat TEGwas performed in 11 patients which was consistent with a hypercoagulable picture even after 5 days of thromboprophylaxis.Conclusions: TEG is useful in diagnosing and categorizing Coagulopathy associated with COVID-19.
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Background: Heart transplant recipients may be at increased risk for infection and adverse outcomes from infection with COVID-19. Management of these patients is complex, with limited data and no standard of care. Purpose:We sought to describe the incidence and outcomes of COVID-19 infection in patients with a history of heart transplant. Methods: Retrospective review of 235 heart transplant patients at a large academic medical center identified 31 patients with laboratory confirmed COVID-19 infection. Laboratory and clinical data were collected from our institution as well as other local hospitals patients had been treated at. Outcomes were followed from March 15, 2020 to March 15, 2021. All data was deidentified. Results: In a cohort of 235 heart transplant patients, 31 patients were identified after testing positive for COVID-19 infection. The mean and median age of patients was 51.9 and 56.0 years respectively. 71% of patients were male and 29% of patients were female. The mean and median time from transplant to diagnosis was 6.54 and 6.50 years. Average ejection fraction prior to infection was 60.4%. Seventeen patients (55%) had atherosclerosis, ten patients (32%) had diabetes, fifteen patients (48%) had hypertension, and twelve patients (39%) had a history of smoking. 84% of patients were on three types of immunosuppression and 16% were on two. Eight patients (26%) were asymptomatic, six patients (19%) had acute hypoxic respiratory failure, and two patients (7%) had GI symptoms. Two patients had evidence of graft injury with mean AlloSure (donor derived cell free DNA) levels of 0.61%. Immunosuppressive regimens were decreased in 32% of patients and COVID-19 directed therapies were given in 32% of patients. The most common treatments were remdesevir (5 patients), steroids (3 patients), and bamlanivimab (2 patients). Thirteen patients (42%) were hospitalized and two patients (7%) died. Conclusions: In a single center case series 31 patients were identified with COVID-19 infection. Nearly half of the patients required hospitalization, with one third of patients decreasing their immunosuppressive regimen and 7% mortality. Further investigation is needed to determine long term outcomes and optimal therapeutic regimen for COVID-19 in this unique population.
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The global pandemic of COVID-19, has impacted various sectors around the globe, including education sector. It has compelled the educators and learners to go for the teaching/learning activities in online mode, rather than traditional face to face teaching. The technology-enabled interactions can be effective only when the student teacher bonding is created and the sentiments of the learners are understood fully. To be prepared for such outbreaks in future is the need of hour. The study imbibes the role of sentiment analysis with the introduction of what it means and how it can help in such outbreaks in an online learning environment. Recently few studies are being contributed for covering the various aspects of this evolving area of sentiment analysis. The literature however is scattered and unorganized, therefore there is a need to conduct a systematic literature review to compile all the relevant studies together and to arrange it in a framework. This paper attempts towards this to provide better insight on the usage of sentiment analysis for education sector. The outcome of this paper is a step towards proposal of future areas of the research in this emerging field. © 2021, Springer Nature Switzerland AG.
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The sudden outbreak of 2019 novel coronavirus (2019-nCoV), brings numerous challenges not only for general population, but also to health care workers (HCWs) who are serving in numerous hospitals worldwide. These health care workers have dual impacts of COVID-19 pandemic, facing not only the overload of infected patients in hospitals but also dealing with psychiatric distress among them. The aim of the present study was to investigate the psychiatric distress in 98 HCWs, working in Uttar Pradesh University of Medical Sciences, Saifai, Etawah India. In all recruited HCWs measures depression, anxiety and stress level and also raised questioning related to stress level from these HCWs. Results showed that nursing staff had highest level of depression, anxiety and stress level followed by doctors and paramedical staff. Majority of HCWs had positive response from their family members, society and infected patients. Almost HCWs believed that PPE kit is able to protect them and meeting with their family members/loved ones helps to reduce stress levels. HCWs who came in direct contact with COVID positive patients or infected ones had higher psychiatric distress over the HCWs who did not came in direct contact. Most of the HCWs denied requisition of mental health professionals to minimize stress levels and believed that working in rural area hospital is comparatively safe to working in urban area hospital. © 2021 MEDIC SCIENTIFIC. All right reserved.
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Introduction: Coronavirus disease 2019 (COVID-19) outbreak posed unique challenges for immunosuppressed patients. Little is known about the clinical course and immunosuppression management of this novel infection in intestinal transplant recipients. Methods: We experienced 6 adult intestinal transplant recipients who had a positive swab test of COVID-19 and symptoms. Baseline characteristics, clinical presentation, management of immunosuppressive therapy and outcomes were collected. Results: Median age was 53 years (range 30-71). They had 3 liver-free composite allografts, 2 isolated intestine, and 1 intestine-kidney with median time from transplant of 8 years (range 4-12). Maintenance immunosuppressive therapy was tacrolimus/steroid in 4, and tacrolimus monotherapy in 2 patients. The most common symptom was cough (n=5) followed by fever (n=3) and dyspnea (n=3). All had ground glass opacities on computed tomography. Four patients were admitted to our institution but two were managed at local hospital due to difficulty of transportation. Immunosuppression therapy was never suspended and was reduced for one patient. Pharmacological therapy consisted in remdesivir and steroids for 4 recipients (67%) associated with convalescent plasma in 2 cases (33%) plus tocilizumab in 1 case (17%), and steroids for 2 patients (33%) associated with convalescent plasma in 1 case (17%). Two patients required intubation for acute respiratory distress syndrome. One patient received antibiotics for superimposed bacterial pneumonia. Mean white blood cells and lymphocyte count were 4.72±0.6 k/uL and 0.96±0.65 k/uL at presentation, respectively. Mean D-Dimer, C-reactive protein and ferritin were 740±160 ng/ml, 4.1±5 mg/dl and 249±149 ng/ml, respectively at presentation, with a peak of 1255±785 mg/ml, 10.9±8 mg/dl and 630±318 ng/ml, respectively. No significant changes were noted in liver and renal function. Before discharge, all patients underwent ileoscopy and allograft biopsies with no evidence of inflammation/rejection. Mean hospital stay was 36±21 days. Death occurred in 2 patients (33%) who were managed at local hospital. No recurrence was noted with mean follow up of 90 days. Conclusions: We treated intestinal transplant recipients symptomatic for COVID-19 without immunosuppression interruption. No increased inflammation or rejection was noted in the intestinal grafts. Aggressive treatment of COVID-19 infection should be granted under expertise of intestinal transplant and transplant infectious disease team.
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With the sudden outbreak of coronavirus disease of 2019 (COVID-19) pandemic, the Health Care Workers (HCWs) have claimed varying echelons of stress, anxiety and insomnia. This is the first write up ever reported describing the numerous studies conducted globally to determine the mental health issues in HCWs throughout in COVID-19 pandemic. Herein we compile the studies conducted in different countries worldwide. All these studies alleged high pervasiveness of stress, anxiety, depression, insomnia, somatization, obsessive-compulsive symptoms and other mental disorders in HCWs. Female medical staff showed high occurrence of mental distress over male medical staff. Transmission of infection from HCWs to their family members further increases fear and distress. Ample education, training, psychosocial services and social support have improve mental health of HCWs. © 2021 MEDIC SCIENTIFIC. All rights reserved.