Comparison of in-class learning engagement of PGY-1 interns during online and in-person teachings using a modified classroom observational tool

Introduction: In-class engagement enhances learning and can be measured using observational tools. As the COVID-19 pandemic shifted teaching online, we modified a tool to measure the engagement of instructors and students, comparing in-person with online teaching and different class types. Methods: Video recordings of in-person and online teachings of six identical topics each were evaluated using our ‘In-class Engagement Measure’ (IEM). There were three topics each of case-based learning (CBL) and lecture-based instruction (LLC). Student IEM scores were: (1) no response, (2) answers when directly questioned, (3) answers spontaneously, (4) questions spontaneously, (5) initiates group discussions. Instructor IEM scores were: (1) addressing passive listeners, (2) asking ≥1 students, (3) initiates discussions, (4) monitors small group discussion, (5) monitoring whole class discussions. Results: Twelve video recorded sessions were analysed. For instructors, there were no significant differences in percentage time of no engagement or IEM scores when comparing in-person with online teaching. For students, there was a significantly higher percentage time of no engagement for the online teaching of two topics. For class type, there was overall less percentage time of no engagement and higher IEM scores for CBL than LLC. Conclusion: Our modified IEM tool demonstrated that instructors’ engagement remained similar, but students’ engagement reduced with online teaching. Additionally, more in-class engagement was observed in CBL. “Presenteeism”, where learners were online but disengaged was common. More effort is needed to engage students during online teaching. © 2022 TAPS. All rights reserved.

SARS-CoV-2 PROTEINS AND BIOTOXIN DETECTION USING PHOTONIC RESONATOR SENSOR

The great advances in silicon photonic-sensing technology have made it an attractive platform for wide sensing applications. The small size of chip and detection system makes photonic microring resonator can be used in clinic for quick detection of disease. Here, we employ the high sensitivity of the photonic sensor toward the change of refractive index for the detection of SARS-CoV-2 virus spike proteins and botulinum toxin in water. The system require very small amount of sample 50uL with high sensitivity, in short 1hr without pre-treatment required. The measurement can be automatic with minimum manpower involved. Moreover, the system can be multiplexed to detect a few target analytes at the same time in one sample. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.

ACUTE KIDNEY INJURY AND COLLAPSING GLOMERULOPATHY IN PATIENT WITH COVID-19 AND HOMOZYGOUS FOR APOL1 GENE VARIANT

African Americans (AAs) with high-risk APOL1 alleles are at an increased risk of developing early onset focal segmental glomerulosclerosis (FSGS) and rapid progression of chronic kidney disease. In some cases, severe COVID-19 pneumonia is associated with kidney injury known as COVID-19-Associated Nephropathy, the exact mechanisms of which are unclear. A 25-year-old AA female presented with mild respiratory symptoms and positive for SARS-CoV-2 and was admitted to Emergency in March 2020. Her serum creatinine (sCr) was 1.4 mg/dL, albumin 2.92 g/dL;she recovered clinically and was discharged. She returned to hospital 25 days later with severe kidney failure, sCr of 28 mg/dL, potassium of 5.6 mmol/L and urine protein/creatinine (uPCR) of 10355 mg/g. She was initiated on hemodialysis. Kidney biopsy showed CG with acute tubular necrosis with direct invasion of the glomerular cells by particles resembling coronavirus. Hemodialysis was discontinued and she was discharged home on oral prednisone at 1mg/kg/day. After 5 months, she was tapered off of prednisone and her sCr improved to 2.6 mg/dL with uPCR of 3133 mg/g. Genetic testing with Renasight, a 382 renal gene panel was performed, yielding homozygosity for the APOL1 risk allele (c.[1024A>G;1152T>G] (p. [Ser342Gly;Ile384Met]) (G1 allele). High-risk APOL1 risk variants occur in 13% of AAs.These individuals have an estimated 4% lifetime risk for incurring FSGS. However, a ‘2nd hit' is necessary for kidney disease to develop. COVID-19 may lead to kidney injury due to tissue ischemia, cytokine storm, hypercoagulability or direct viral-mediated mechanisms. In COVID-19 related kidney biopsies, CG is often described. Although glucocorticoid sensitivity in such patients is not well-defined, our patient showed response to oral prednisone. This case adds to growing evidence that SARS-CoV-2 infection contributes to CG. The dual effect of high-risk APOL1 variants and SARS-CoV-2 in effecting CG remains to be elucidated. Testing with a broad renal genetic panel could help define genetic variants that promote complications from SARS-CoV-2 infection.

Identifying Human Factors for Remote Guidance on Physical Tasks

Remote collaboration is becoming increasingly crucial, especially currently when travel is restricted because of the Covid-19 pandemic. People are looking for real-time and no-travel solutions to enable remote collaboration with colleagues and experts. A lot of research has been conducted on how to support remote guidance on physical tasks. However, these studies have mainly focused on development of technical components to support collaboration, while less attention has been paid into exploring and evaluating human factors that could influence remote collaboration. The aim of this paper is to identify human factors including culture, language, trust and social status for their possible effects on remote collaboration by reviewing their effects on computer-supported collaboration. This review adds more critical views of human perspectives into the current research mostly-focused on the technical side of remote guidance. © 2021, Springer Nature Switzerland AG.

COVID-19 and ischemic stroke: A systematic review and meta-summary of the literature

Background: Acute ischemic stroke (AIS) is a life-threatening complication of coronavirus disease 2019 (COVID-19) infection. Increasing reports suggest an association between COVID-19 and AIS, although the underlying mechanism remains uncertain. Objectives: We performed a systematic review to characterize the clinical characteristics, neuroimaging findings, and outcomes of AIS in COVID-19 patients. Methods: A literature search was performed in PubMed and Embase using a suitable keyword search strategy from 1st December 2019 to 29th May 2020. All studies reporting AIS occurrence in COVID-19 patients were included. Results: A total of 39 studies comprising 135 patients were studied. The pooled incidence of AIS in COVID-19 patients from observational studies was 1.2% (54/4466) with a mean age of 63.4 ± 13.1 years. The mean duration of AIS from COVID-19 symptoms onset was 10 ± 8 days, and the mean NIHSS score was 19 ± 8. Laboratory investigations revealed an elevated mean D-dimer (9.2 ± 14.8 mg/L) and fibrinogen (5.8 ± 2.0 g/L). Antiphospholipid antibodies were detected in a significant number of cases. The majority of AIS neuroimaging patterns observed was large vessel thrombosis, embolism or stenosis (62.1%, 64/103), followed by multiple vascular territory (26.2%, 27/103). A high mortality rate was reported (38.0%, 49/129). Conclusion: We report the pooled incidence of AIS in COVID-19 patients to be 1.2%, with a high mortality rate. Elevated D-dimer, fibrinogen and the presence of antiphospholipid antibodies appear to be prominent in COVID-19 patients with concomitant AIS, but further mechanistic studies are required to elucidate their role in pathogenesis.

Fever as a predictor of adverse outcomes in COVID-19.

BACKGROUND/INTRODUCTION: There are little data on outcomes of COVID-19 patients with the presence of fever compared to the presence of symptoms. AIM: We examined the associations between symptomology, presence of fever and outcomes of a COVID-19 cohort. DESIGN AND METHODS: Between 23 January and 30 April 2020, 554 COVID-19 patients were admitted to a tertiary hospital in Singapore. They were allocated into four groups based on symptomology and fever-Group 1: asymptomatic and afebrile, Group 2: symptomatic but afebrile, Group 3: febrile but asymptomatic and Group 4: symptomatic and febrile. The primary outcomes were intensive care unit (ICU) admissions and mortality. The composite end-point included ICU admissions, mortality or any COVID-19 related end-organ involvement. RESULTS: There were differences in ferritin (P=0.003), C-reactive protein (CRP) levels (P<0.001) and lymphopenia (P=0.033) across all groups, with the most favourable biochemical profile in Group 1, and the least in Group 4. Symptomatic groups (Groups 2 and 4) had higher ICU admissions (1.9% and 6.0%, respectively, P=0.003) than asymptomatic groups (Groups 1 and 3). Composite end-point was highest in Group 4 (24.0%), followed by Group 3 (8.6%), Group 2 (4.8%) and Group 1 (2.4%) (P<0.001). The presence of fever (OR 4.096, 95% CI 1.737-9.656, P=0.001) was associated with the composite end-point after adjusting for age, pulse rate, comorbidities, lymphocyte, ferritin and CRP. Presence of symptoms was not associated with the composite end-point. DISCUSSION/CONCLUSION: In this COVID-19 cohort, presence of fever was a predictor of adverse outcomes. This has implications on the management of febrile but asymptomatic COVID-19 patients.

Photonic sensor to detect of SARS-COV-2

To target the detection of intact SARS-COV-2 and its protein, research is focused on developing other diagnostic methods besides the molecular detection methods. Here, we employ the high sensitivity of the photonic sensor toward the change of refractive index for the detection of SARS-COV-2 virus spike proteins. The system require very small amount of sample 100uL with high sensitivity of 0.08 pM virus in short 60 min without pretreatment required. The measurement can be automatic with minimum manpower involved. Moreover, the system can be multiplexed to detect a few target analytes at the same time in one sample. © 2020 CBMS-0001

Collapsing/sclerosing glomerulopathy (CSG) and acute tubular injury (ATI) in patients with COVID-19

Introduction: AKI in patients with COVID-19 may be due to ATI from hemodynamic instability or inflammatory responses. We present two cases of CSG and ATI in patients admitted for COVID-19 Case Description: Case 1 25-year-old black obese female admitted with fever, cough, dyspnea and serum creatinine of 1.4 mg/dL, discharged next day with home quarantine. Re-admitted 26 days later due to nausea, fatigue, and bilateral foot swelling. Serum creatinine 28 mg/dl and urine protein to creatinine ratio (uPCR) of 10.4 g/g Case 2 42-year-old black female with hypertension, diabetes mellitus admitted with fever, dyspnea, cough, and diarrhea. Patient found to have diabetic ketoacidosis, serum creatinine 12.7 mg/dl. She developed deep vein thrombosis and pulmonary embolism and uPCR 15.4 g/g. She was started on hemodialysis Kidney biopsy showed global and segmental capillary collapse with a variable degree of sclerosis and severe renal tubules injury. Electron microscopy showed spherical structures in the podocytes, endothelial cells, and tubular epithelium similar to Coronavirus particles Discussion: Our experience above is part of a growing literature describing the direct visualization of SARS-CoV-2 in causing ATI and CSG. Pathogenetic pathways remain to be elucidated.

Mortality of AKI in human immunodeficiency virus with and without co-infection with COVID-19

Background: Since the start of COVID-19 pandemic, concerns have been raised about specific populations being at potential higher risk for developing more severe diseases, and patients living with HIV (PLWH) are among them. SARS-CoV-2, a newly isolated virus from the Corona Virus family, is enveloped, positive-sense single-stranded RNA virus that causes multi-organ failure, especially acute kidney injury (AKI) which is proved to be associated with significantly elevated mortality rate. It dysregulates human immunity especially on T lymphocytes which is shared by HIV as the mechanism of causing related diseases. We reviewed our hospital data to examine if HIV infection resulted in worse outcomes in COVID-19 patients who developed AKI. Methods: Retrospective chart review of all admitted patients to Kings County Hospital (KCH), a municipal hospital in Brooklyn, New York City between 3/1 to 5/15, 2020, from the electronic medical record. Patients were reviewed in groups of COVID infection without history of HIV, HIV patients admitted without COVID infection and patients with history of HIV who were admitted because of COVID infection. The rate of AKI and mortality were extracted and analyzed suing Chi-squared test in SPSS. Results: A total of 1092 patients with confirmed COVID-19 diagnosis were admitted in the above time period, out of which 22 were diagnosed with COVID-19 and HIV. In the COIVD-19 without HIV diagnosis group, 450 patients developed AKI and 213 patients died, with a mortality rate of 47.3%;in the COVID-19 with HIV group, 9 patients developed AKI and 4 expired, mortality rate is 44.4%. There's no significant difference between these two groups (p=0.86). Compared to these two groups, 21 out of 93 PLWH without COVID infection had AKI during hospitalization with 2 patients deceased, and a mortality rate of 9.5% which is significantly lower (p=0.03). Conclusions: Data from our hospital bewtween 3/1 and 5/15/2020 shows the mortality rates of patients with HIV and COVID-19 co-infection with AKI and COVID patients without HIV who developed AKI are not statiscally different, but significantly higher than patients with HIV who developed AKI.

Clotting of hemodialysis catheters in patients with renal failure with COVID-19

Background: We are an inner-city hospital in New York that had a surge of patients diagnosed with COVID-19. Many of these patients had acute kidney injury (AKI) and required renal replacement therapy (RRT). NYC Health + Hospitals/Kings County has 40 adult intensive care unit (ICU) beds. ICU capacity expanded to a potential of 150 beds during the COVID-19 surge. The surge included patients transferred from other NY innercity hospitals for critical care and RRT. Sequential obstacles were faced in providing hemodialysis (HD) to this expanded pool of AKI patients. Additional machines, supplies, staffing and organization were helpful. Clinicians noted that COVID-19 complications included hypercoaguability and we observed an increased frequency of clotting of hemodialysis catheters (HDC). Methods: We examined the percentage COVID-19 tested renal failure patients with clotting of HDC access during the period March 1, 2020 to May 15, 2020. We collected data on 146 patients during the above period who had HD. We then compared those who were COVID-19+ positive confirmed by testing to those who were not COVID-19+ by testing. HDC clotting was identified by the use of alteplase. We compared our findings of the two groups to historical controls during a similar time period prior to the COVID-19 surge, between January 1 to February 29, 2020. Results: We had 3,665 admissions between March 1 and May 15, 2020, of which 1,075 patients had a confirmed COVID + test during the admission. Of these, 773 patients were noted to have AKI from diagnosis codes in the electronic medical record. Of the146 patients who needed HD (including patients with AKI and CKD) 97 were COVID-19+ and 49 were negative. HDC clotting identified by the use of alteplase was noted in 27% of those who were COVID-19 + compared to 10% of those who were COVID-19 negative. (P value= 0.02 by Chi-square using SPSS Version 24). The percentage of patients with clotting of catheters in the non-COVID-19 group was comparable to historical controls. Conclusions: Significantly more COVID-19+ patients had HD catheter clotting compared to non-COVID-19 patients. Increased clotting was noted as a barrier to providing optimal HD therapy. For this and other reasons, we initiated an urgent start acute peritoneal dialysis program to mitigate the challenges in delivering HD to COVID-19 patients.