To assess the diagnostic and prognostic ability of CXRs in COVID-19 pneumonitis

Rationale: The COVID-19 pandemic has led to the deaths of millions with its ability to cause severe pneumonia. Diagnosis is based on PCR testing which has many limitations: lengthy turnaround times, lack of universal availability and variance in sensitivity. Imaging such as CXR could be a valuable and faster aid in diagnosing COVID-19 compared to PCR. It is widely available, cheap and can be performed at the bedside- enabling a rapid turnover of patients whilst minimising cross-link infection. However only a few studies have assessed its prognostic value. We aim to analyse the diagnostic accuracy of CXR in COVID-19 and to assess if severity of COVID pneumonitis on CXR correlated with mortality. Method(s): A retrospective study of all in-patients aged >= 18 years with a confirmed diagnosis of COVID-19 during the first and second waves of the pandemic. Admission CXRs and in-patient CT Thorax scans were analysed. Statistical analysis was performed using the Chi-Squared Test for independence. Result(s): 999 COVID-19 patients were included in the study. Severity of COVID pneumonitis on CXR correlated with mortality when patients were grouped into the following categories: normal (n=161, mortality=42%), mild (n=220,mortality=33%) moderate, (n=328, mortality=42%) and severe (n=290, mortality=58%) (P<0.001). 251 patients had both CT and CXRs. CT scans were superior in diagnosing COVID pneumonitis (63%) compared to CXR (47%) (P<0.001). Conclusion(s): Our study showed a positive correlation between the severity of COVID pneumonitis on CXR and mortality, supporting the use of CXR in the ED to help rapidly identify and treat patients at high risk of death.

Comparing the mortality of COPD and non-COPD patients with COVID-19 in a UK hospital

Rationale: Initial reports during the pandemic have shown that COPD patients with COVID-19 have a poorer prognosis due to an increased risk of respiratory failure. It is well known that in COPD, there is an increased expression of angiotensin converting enzyme-2 (ACE2), the receptor which plays a role in SARS-CoV-2 entry into cells. In the absence of infection, ACE2 converts angiotensin-2 (AngII) to angiotensin-1-7- helping regulate inflammation. During COVID-19 infection, ACE2 activity is reduced due to receptor occupancy, resulting in greater levels of AngII- leading to a pro-inflammatory state. We aim to investigate the impact of COPD and COVID-19 on mortality, length of in-patient stay and gender. Method(s): A retrospective study of all in-patients aged >= 18 years with a confirmed diagnosis of COVID-19 during the first wave of the pandemic. Statistical analysis was performed using the Chi-Squared Test for independence. Result(s): 445 COVID-19 patients were included in the study, out of whom 52 (12%) had COPD. Mortality in COPD patients (65%) was found to be significantly higher than non-COPD patients (49%) (P=0.03) There were no significant differences in mortality between COPD and non-COPD patients when grouped for male and female (P=0.68). Furthermore, there were no significant differences in length of in-patient stays of >7 days between COPD and non-COPD patients (P=0.79). Conclusion(s): Our study demonstrated how COPD increases mortality in COVID-19. This data should be considered when highlighting at risk groups- prioritising them for treatment, isolation, and preventative public health measures such as the COVID-19 vaccination programme.

Integrative Medicine in the Treatment of COVID-19: An Indian Perspective

Background: Over recent years, evidence-based modern medicine has overshadowed the use and efficacy of natural and traditional medicines. However, in the wake of the pandemic, the in-terest in the quest for therapeutic resources linked to traditional, complementary, and integrative medicine has substantially increased. This has further facilitated the research and development of potential therapeutic crude drugs or their formulations in the management of COVID-19 and the symptoms associated with the latter. This article attempts to provide a comprehensive review of the various traditional medicines used as integrative medicines in alleviating symptoms attributed to the COVID-19 infection. Method(s): The literature was thoroughly browsed for recent research articles, systematic reviews, case studies, and review articles on ScienceDirect, PubMed, and Google Scholar using keywords like complementary medicine, alternative medicine, and holistic approach to enlist a few. Subse-quently, they were thoroughly screened to include only recent studies and evidence. Additionally, the official guidelines published by the Government and other regulatory bodies were also sought to be included in the article. Study Design: The review article follows the narrative literature review method. However, the pri-mary data was skimm ed for relevance, and only recent shreds of evidence pertinent to the review were included. Result(s): The review elucidated the pharmacological activity of various treatment regimens in different systems of medicine, with available supportive clinical evidence. Additionally, it also under-scored the importance of holistic health interventions, and how these traditional and integrative systems of medicine cater to the same. Conclusion(s): The recent evidence presents a broad-spectrum effect of these therapeutic interven-tions, primarily in the fields of mental health, mild to moderate, and even severe forms of the infec-tion, employing various pharmacological pathways. These studies primarily include studies and sta-tistics pertaining to the SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona Virus 2) but may include supporting evidence from other respiratory viruses. This information may prove imper-ative in guiding new research, and also in designing and supporting an integrative treatment regi-men. Conclusively, any suspicion pertaining to the COVID-19 infection should be sought by follow-ing the protocols recommended by the concerned health authorities of the respective region/country. Copyright © 2023 Bentham Science Publishers.

Cov-Verhindern: A versatile device to limit the rapid spreading of COVID-19

The number of people infected with COVID-19 is skyrocketing all over the world. It causes symptoms such as fever, shortness of breath, and other breathing difficulties and it affects people differently. Elevated heart rate (above 90 beats per minute), increase in body temperature (above 37 degree Celsius), lower oxygen saturation (less than 94 percent) are serious symptoms. To detect the virus early and restrict its spread, Cov-Verhindern is a versatile device that can be used anywhere such as shops, malls and educational institutions. 'Verhindern' is a German term that means 'Try to avoid'. We're attempting to stop the spread of COVID-19 here, hence the term 'Cov-Verhindern'. This system includes sanitizing session, temperature sensing, oxygen saturation and heart beat monitoring through an IoT-based program along with a gate mechanism and interaction process. © 2022 Author(s).

Handle with Care: Regulatory Easing in Times of COVID-19

The policy response to the COVID-19 shock included regulatory easing across many jurisdictions to facilitate the flow of credit to the economy and mitigate a further amplification of the shock through tighter financial conditions. Using an intraday event study, this paper examines how stock prices - a key driver of financial conditions - reacted to regulatory easing announcements in a sample of 18 advanced economies and 8 emerging markets. It finds that regulatory easing announcements contributed to looser financial conditions but effects varied across sectors and tools. News about regulatory easing led to lower valuations for financial sector stocks, mainly in jurisdictions with relatively lower capital buffers. These results stand in stark contrast with valuations of non-financial sector stocks, which increased in response to regulatory relief announcements, particularly in industries that are more dependent on bank financing. The effects also differed across tools. Valuations declined and financial conditions tightened following announcements related to easier bank capital regulation while equity valuation rose and financial conditions loosened after those about liquidity regulation.

Paediatric multisystem inflammatory syndrome associated with COVID-19 infection: A case series

Multisystem Inflammatory Syndrome (MIS) is a newer, rarer and dangerous childhood disease that require early attention and is associated with Coronavirus Disease-2019 (COVID-19) infection. This article reports four clinically ill children of age 6-15 years admitted to Aster CMI hospital, Bengaluru, Karnataka, India, during October and November 2020. The diagnosis was based on elevated laboratory values (D-Dimer, C-reactive Protein (CRP), and Ferritin) and positive COVID-19 antibody test. No infectious aetiologies were identified. All patients presented at Emergency Room (ER) with hypotensive shock and were treated with inotropic support, Intravenous Immunoglobulin (IV-Ig), and steroids. Children responded well to treatment and were discharged within a period of 8-11 days. Clinical characteristics are necessary for understanding more about newly identified paediatric illness.

MedRobo Medicine Delivering and Patient Parameter Monitoring Robot

In this paper, we propose a robot named MedRobo with some functionality of providing medicine as well as to measure the vital parameters (Heart rate, Pressure, Temperature and SpO2) of the patient. During the current scenario, reducing the human to human contact in hospitals is required. In a bid to prevent doctors and medical staff from getting affected by Coronavirus the role of medicine delivering robots are evolving. We can attain the locomotion procedure of the robot using the principle of Radio-frequency identification (RFID) that automatically identifies and tracks tags attached to the objects. The movement and finding the path to patient location is done through a line follower and with RFID tag. Line following method is used to identify the path with help of two infrared sensors. The robot will move towards the patient's room by following a non reflective line and use RFID cards to identify the patient's room number. Using the vending machine the medicine delivery is made possible to the patients. All the measured parameters will be stored to the cloud using the application of the Internet of Thinking (IoT). All the data will successfully be sent to the cloud through the Node MCU. If the read values varied from threshold then a message will be sent to doctors through GSM Module. © 2021 IEEE.

COVID-19 post-discharge mortality rate in a London district general hospital

Introduction Due to the novelty of COVID-19, uncertainty about the factors contributing to mortality, unavailability of definitive treatment options, limited access to medical, social support and rehabilitation in the community during the COVID-19 peak;compounded with anxiety and reluctance to seek medical help in timely manner, it was anticipated that vulnerable patients would be affected the worst. We report post-discharge mortality and the associated risk factors. Method This is a retrospective study of all the patients admitted at a busy district general hospital during the peak period of the COVID-19 pandemic i.e. 1st March to 20 June 2020. We included all patients aged 18 and above in data analysis. Results A total of 628 patients were admitted during the study period with 481 having positive swab PCR. Of these, 389 (62%) patients had two or more comorbidities, 311 (49.5%) hypertensive and 166 (26.4%) diabetic. In-hospital mortality: 226/628 (35.9%) patient died in hospital, of which 194 (85.8%) had a positive Coronavirus nasopharyngeal swab. This was statistically significant with p-value of 0.001. Post-discharge mortality of patients: 54/402 (13.4%) of those patients discharged home following hospitalisation died within 28 days of discharge. 42/54 (77.7%) were swab positive. Swab positive patients 42/54 (77.8%) had a higher risk of death. Two thirds of swab positive patient were older than 75 years and 81% had two or more pre-existing comorbidities. There was no difference in length of stay between the survivors and non-survivors. Conclusion As expected, age, male gender, COVID-19 PCRpositivity, multiple comorbidities, high BMI and raised CRP were associated with higher in-hospital and post-discharge mortality. It is unsurprising that antibiotic treatment without bacterial infection was associated with higher but statistically insignificant mortality rate, while therapeutic anticoagulation and steroids were associated with better outcomes. There is an urgent need for further analysis of root cause to mitigate the modifiable factors and devise a robust post-discharge management plan in collaboration with all stakeholders.

Staving off intubation: Characteristics of outcomes in early versus delayed intubation in COVID-19

INTRODUCTION: Early in the COVID-19 pandemic, hypoxic patients were immediately intubated for fear of decompensation and aerosolizing the virus with non-invasive ventilation (NIV). Reports revealed a high mortality for intubated patients, prompting NIV such as high flow nasal cannula (HFNC) or noninvasive positive pressure ventilation (NIPPV). The literature lacks description of the outcomes between patients who were intubated immediately versus only after failing NIV. We describe the characteristics of patients who were intubated ?early,? defined as being intubated without NIV attempts, versus ?delayed?, defined as intubated after failed initial NIV use. METHODS: A prospective registry was created of all COVID-19 patients admitted to our urban academic medical center from March 2020 to July 2020. We analyzed this database to investigate escalation of respiratory support. Variables of interest included intubation, use of HFNC, NIPPV, and mortality. Logistic regression explored associations with mortality. RESULTS: A total of 109 patients were initiated on NIV. 102 began on HFNC and 7 on NIPPV. A total of 47 patients were intubated early. Of those started on HFNC, 24 (23.5%) were escalated directly to intubation. 23 (22.5%) received NIPPV, of which 16 (69.6%) required intubation. Of those started on NIPPV initially, 5 required intubation and 2 were downgraded to HFNC. Comparing early versus delayed intubation, the odds ratio for surviving intubation, adjusted for age and BMI, with a trial of NIV prior to intubation was 0.057 (0.002 - 0.562). For NIPPV, 94.4% (17 of 18) of patients intubated ?delayed? died, while 69.2% (27 of 39) patients intubated ?early? died. Unadjusted odds ratio for surviving intubation when having HFNC prior to intubation was 0.289 (0.081- 0.923), but lost statistical significance when adjusted for age and BMI. 64 patients (58.7%) who were started on NIV were never intubated during admission. CONCLUSIONS: This study suggests that NIV may be useful in the treatment of hypoxemia secondary to COVID-19 to prevent intubation, however the likelihood of survival decreases in those who fail NIV. Delayed intubations are associated with mortality when adjusted for age and BMI. Further research is needed to investigate who may benefit most from NIV as a supportive measure to prevent intubation.

Outcomes of low tidal volume ventilation in COVID-19 intubated patients

INTRODUCTION: Low tidal volume ventilation (LTVV), defined as 6 to 8cc of tidal volume per kilogram of ideal body weight (IBW), has been shown to reduce mortality and days requiring invasive ventilation when utilized in the acute respiratory distress syndrome (ARDS). The degree of hypoxemia in respiratory failure experienced in the SARSCOV2 infection (COVID-19) is similar to ARDS from other respiratory pathologies;however, there appears to be notable heterogeneity in lung compliance of COVID-19 patients as well as higher rate of mortality for ARDS supported with invasive mechanical ventilation in COVID-19. It remains unknown if lung protective tidal volume strategies confer a significant benefit for COVID-19 ARDS as they do for ARDS due to other etiologies. We aim to determine if LTVV was associated with decreased mortality, ventilator days, ICU length of stay, or decreased length of hospital stay. METHODS: A prospective observational study was performed with inclusion criteria of a positive COVID-19 test and intubation for non-operative indications. Ideal body weight was calculated to determine whether or not each patient ever exceeded or achieved LTVV, here defined as less than 6cc/kg of ideal body weight. The primary outcome was mortality. The secondary outcomes were length of stay in the hospital, ICU days, and ventilator days. RESULTS: A total of 75 COVID positive patients were intubated at our facility. 60 (80%) of these patients died. Exceeding 6cc/kg IBW LTVV trended towards more days in the ICU (p=.089) and number of days intubated (p=.148), but only increased hospital length of stay was statistically significant (p=.025). Patients who did maintain LTVV at least one day did have decreased crude odds of mortality at 0.281 (95% CI .0482-1.6395). LTVV was not correlated with fewer ICU days (p=.846), number of days intubated (p=.709), or length of hospital stay (p=.699). CONCLUSIONS: Failure to maintain LTVV was associated with increased mortality and hospital LOS. It also trended toward an increase in ICU days days of mechanical ventilation. Further prospective studies are required.