POST COVID NEUROPATHIC PAIN: A CASE REPORT

COVID-19 has been reported to be associated with various neurological manifestations involving both the central and peripheral nervous system. Somatic and visceral pain, as well as headache, are all widely recognised in association with COVID-19, however, there is a comparative paucity of reports of neuropathic pain. We present a case of COVID-19 associated neuropathic pain in a 61-year-old male. He developed acute severe burning pain affecting all four limbs distally, one week following confirmed COVID-19 infection. There was no ataxia or autonomic failure. Neurological examination was unremarkable. Electrophysiologi-cal tests revealed delayed SSEP in the lower limbs, however, skin biopsy and MRI of the neuroaxis was unremarkable. His pain was inadequately controlled with gabapentin but improved significantly after a short course of steroids. This case adds to the various neurological manifestations of COVID-19 infection, highlighting the possible variability of symptoms in patients with nervous system involvement of SARS-CoV-2 infection. This report provides additional evidence that COVID-19 disease can trigger autoimmunity which is consistent with previous reports of several autoimmune neurological diseases.

SENTIMENT ATTRIBUTION ANALYSIS WITH HIERARCHICAL CLASSIFICATION AND AUTOMATIC ASPECT CATEGORIZATION ON ONLINE USER REVIEWS

Due to COVID-19 pandemic, most physical business transactions were pushed online. Online reviews became an excellent source for sentiment analysis to determine a customer's sentiment about a business. This insight is valuable asset for businesses, especially for tourism sector, to be harnessed for business intelligence and craft new marketing strategies. However, traditional sentiment analysis with flat classification and manual aspect categorization technique imposes challenges with non-opinionated reviews and outdated pre-defined aspect categories which limits businesses to filter relevant opinionated reviews and learn new aspects from reviews itself for aspect-based sentiment analysis. Therefore, this paper proposes sentiment attribution analysis with hierarchical classification and automatic aspect categorization to improve the social listening for diligent marketing and recommend potential business optimization to revive the business from surviving to thriving after this pandemic. Hierarchical classification is proposed using hybrid approach. While automatic aspect categorization is constructed with semantic similarity clustering and applied enhanced topic modelling on opinionated reviews. Experimental results on two real-world datasets from two different industries, Airline and Hotel, shows that the sentiment analysis with hierarchical classification outperforms the classification accuracy with a good F1-score compared to baseline papers. Automatic aspect categorization was found to be able to unhide the sentiment of the aspects which was not recognized in manual aspect categorization. Although it is accepted that the effectiveness of aspect-based sentiment analysis on flat classification and manual aspect categorization, none have assessed the effectiveness while using hierarchical classification with a hybrid approach and automatic aspect categorization.

Improving the skills and safety at workplace: Training on the use of the airseal insufflation system in laparoscopic surgery

Aims: According to Good Surgical Practice set by the RCS England, surgeons need to keep themselves up to date and maintain the competence in all areas of their practice. Literature and guidelines recommended the use of AirSeal insufflation in laparoscopic surgery for the safety during the first surge of Covid-19. Our objectives were to measure the level of knowledge and confidence of surgical trainees in using the AirSeal insufflation system in laparoscopic surgery at our institution and to help trainees achieve competence. Method: Multiple small group training sessions were delivered to 14 surgical doctors adhering to safety protocols. The concept of the AirSeal insufflation system, its benefits, limitations, set up and troubleshooting were delivered using lectures, videos and hands-on training. The change in level of knowledge and confidence in practical skills were assessed by analyzing the responses to the questionnaire completed before and after the course. Results: • 60% reported increase in knowledge of the AirSeal system • 50% reported increase in confidence of the practical skills • The mean rating for usefulness and satisfaction of the advanced training sessions was 9 out of 10. Conclusion: The dramatic improvement in self-perceived confidence of practical skills and knowledge of the AirSeal system was achieved among surgical doctors. Adaptation to the situation and introduction of this advanced technology to the trainees in elective and emergency settings helped promote the skills and safety at workplace during this pandemic especially with the support of flexible training sessions.

Review of diabetes control before and during COVID era at District General Hospital

Introduction: In Paediatrics, there was a significant reduction and delays in patients presenting to the emergency department during the COVID-19 pandemic (1,2). Diabetes Service provision was affected during the pandemic with a move towards virtual clinics and fewer face to face appointments. We studied the nature and severity of presentation of TIDM, the impact of the pandemic on diabetes control in newly diagnosed TIDM patients. Objectives: To evaluate presentation at diagnosis and effect on subsequent diabetes control due to COVID 19 pandemic's impact on health care provision. Methods: This retrospective study involved case notes review of 65 newly diagnosed T1DM patients up to the age of 16 years over two years (March 2019 to March 2020: Pre-pandemic cohort, March 2020 to March 2021: Pandemic cohort). Results: The percentage of patients presenting in severe diabetic ketoacidosis at diagnosis was higher in the pandemic year by 10%. The data showed no differences between the two groups regarding mean age at presentation, antibody status, vitamin D level at the diagnosis and frequency of diabetes-related hospital attendances. In contrast, in the pandemic group, 12% (3) newly diagnosed patients spent more than 72 hours during their first diabetes-related admission compared to 5% (2) in the pre-pandemic year. Interestingly, the HbA1C control over one year period was similar in the pre-pandemic and pandemic cohorts (figure 1). Conclusions: Our study suggests that during the pandemic year, more patients presented with severe DKA, higher HbA1C and had a longer length of stay in the hospital during the initial admission. A longitudinal review of HbA1C level over one year suggests that the diabetes control was not adversely affected during the pandemic. (Table Presented).

Use of angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers in COVID-19 infection does not adversely affect clinical outcomes including need for non-invasive and invasive ventilation

IntroductionIt has been hypothesized that use of Angiotensin-Converting-Enzyme Inhibitors (ACE-I) and Angiotensin Receptor Blockers (ARB) are associated with worse outcomes in COVID-19 through upregulation of ACE2 receptors.1 Recent studies have shown no association between ACE-I/ARB use and increased mortality but there is limited information on other markers of disease severity such as Continuous Positive Airway Pressure (CPAP) requirement and need for intubation. We assessed the effect of ACE-I/ARB on the outcomes of COVID-19 patients.MethodsA retrospective observational study of patients with suspected or confirmed COVID-19 admitted to the respiratory units during a 1-year period. Patient demographics, clinical and medication history and clinical outcomes were extracted from written and electronic records. Primary outcomes – LOS, CPAP requirement, intensive care (ICU) admission, intubation and death – were compared between those who received ACE-I/ARB concurrently with their COVID-19 treatment and those who did not. Statistical analysis was performed using chi-squared test and odds ratio (OR).ResultsOf 521 patients with suspected or confirmed COVID-19 (median age 59 years, 62.6% male), 183 (35.1%) required CPAP, 108 (20.7%) were admitted to ICU, 60 (11.5%) were intubated and 41 (7.9%) died. In total, 151 (29%) were on ACE-I/ARB treatment, most commonly for hypertension. There was no difference in median LOS between those on ACE-I/ARB treatment and those not (11 and 10 days respectively, p=0.20). There was no difference between CPAP requirement (OR 1.13, 95% CI 0.71–1.56), admission to intensive care (OR 0.64, 95% CI 0.50–1.36), intubation (OR 0.65, 95% CI 0.43–1.58) and death (OR 1.15, 95% CI 0.53–2.11) between the two groups (p>0.05).ConclusionThere was no difference in clinical outcomes between COVID-19 patients on ACE-I/ARB and those who were not, in particular with regards to need for non-invasive and invasive ventilation. Our findings support current recommendations for continued use of ACE-I/ARB in COVID-19 infection.ReferenceFang L, et al. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? The Lancet. Respiratory medicine 2020;8(4):e21. doi:10.1016/S2213-2600(20)30116-8