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1.
Chest ; 162(4):A2006-A2007, 2022.
Article in English | EMBASE | ID: covidwho-2060886

ABSTRACT

SESSION TITLE: Occupational and Environmental Lung Disease Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: We describe a case of acute progression of chronic hypersensitivity pneumonitis (HP) in an adult, previously misdiagnosed as COPD for 13 years due to severe emphysematous changes seen on imaging. He was also found to have acutely worsened disease as a result of Covid-19. CASE PRESENTATION: A 64-year-old male presented to the pulmonary clinic with dyspnea on minimal exertion. He reported respiratory complaints for 13 years, treated with 2 L/min of oxygen overnight, and budesonide-formoterol and tiotropium inhalers. These complaints were previously associated with brief occupational mold exposure and possible COPD. His respiratory distress worsened one year ago when he was hospitalized for Covid-19. On discharge, his oxygen requirement had increased to 6 L/min. CT chest showed air-trapping in the mid-zones bilaterally, mosaic attenuation, and peri-bronchial thickening. PFTs showed an FEV1 33% and FVC 55% of predicted, consistent with severe obstruction and reduction in lung volume. As the patient was a lifetime non-smoker, alternative diagnoses were pursued. Alpha-1 antitrypsin levels and immunologic testing, including scleroderma and myositis panels, were within normal limits. Positive findings included CCP IgG/IgA antibodies at 96 units and HP panel positive for pigeon serum antibodies. Prompted by this testing, the patient revealed that he had parakeets in his home for the past 15 years. He also reported significant symptom improvement on occasions that he took a course of steroids. Based on these findings, a diagnosis of chronic fibrotic hypersensitivity pneumonitis with bronchiolitis obliterans was considered. The patient's severe airflow obstruction and respiratory failure precluded surgical lung biopsy. Empiric management was initiated with 30 mg of prednisone daily with a slow taper and instruction to eliminate exposure to exotic birds. DISCUSSION: HP is commonly caused by inhalation of and sensitization to an aerosolized environmental antigen;a common subtype is bird fancier's lung due to repetitive exposure of avian antigen. Continuous antigen exposure increases the risk for development of fibrosis, which was also seen in our patient. The most commonly described radiologic findings in HP are ground-glass opacities, ill-defined centrilobular nodules, and focal areas of air trapping resulting in mosaic attenuation and fibrosis. More than 20% lymphocytosis on bronchoalveolar lavage is also a sensitive tool in detecting alveolitis. The relationship between Covid-19 and disease progression in HP is not well studied. CONCLUSIONS: Chronic hypersensitivity pneumonitis from avian antigens, or Bird fancier's lung, can present with severe emphysematous changes on CT imaging, along with obstructive pattern of PFTs. This should be an important differential, especially in patients who are non-smokers. Covid-19 causes disease progression in HP, this relationship needs to be further explored. Reference #1: Funke M., Fellrath J.-M. Hypersensitivity pneumonitis secondary to lovebirds: a new cause of bird fancier's disease. Eur. Respir. J. 2008;32:517–521. DOI: 10.1183/09031936.00108507 Reference #2: Pereira C., Gimenez A., Kuranishi L., Storrer K. Chronic hypersensitivity pneumonitis. J. Asthma Allergy. 2016;9:171–181. DOI: 10.2147/JAA.S81540 Reference #3: C.S. Glazer, C.S. Rose, D.A. Lynch Clinical and radiologic manifestations of hypersensitivity pneumonitis J. Thorac. Imag., 17 (4) (2002), pp. 261-272. DOI: 10.1097/00005382-200210000-00003 Morell F, Roger A, Reyes L, Cruz MJ, Murio C, Muñoz X Bird fancier's lung: a series of 86 patients. Medicine (Baltimore). 2008;87(2):110-130. DOI: 10.1097/MD.0b013e31816d1dda DISCLOSURES: No relevant relationships by Momina Amjad No relevant relationships by Amit Chopra No relevant relationships by Rafeh Safdar

2.
Journal of General Internal Medicine ; 37:S438-S439, 2022.
Article in English | EMBASE | ID: covidwho-1995585

ABSTRACT

CASE: A 83-year-old male with a history of non-insulin dependent diabetes mellitus, and coronary artery disease presented with four days of worsening myalgias, subjective fevers, and abdominal distention. He had no history of abdominal surgery, sick contacts or medication changes. He had a temperature of 99.2°F, a heart rate of 80 beats per minute, a respiratory rate of 18 breaths per minute, a blood pressure of 105/80 mmHg, and an oxygen saturation of 96% on room air. On examination, the abdomen was distended but without tenderness or guarding. Abdomen Computed Tomography (CT) scan revealed pancolonic severe gaseous dilatation with no transition point. COVID 19 polymerase chain reaction was noted to be positive, along with an elevated D-dimer of 2.58, ESR of 60 mm/h and CRP 40 mg/l;otherwise the laboratory workup including a respiratory and gastrointestinal panel, blood and sputum culture were negative. Following multidisciplinary and shared decisionmaking, a rectal tube was placed and the patient was given neostigmine with resolution of symptoms and subsequent radiographic demonstration of improvement in the colonic distention within 48 hours. Unfortunately, the patient suffered a cardiac arrest on day 5 of his hospitalization and per the family's request, aggressive treatment was aborted in favor of comfort measures. IMPACT/DISCUSSION: While COVID-19 is primarily an airborne infection, widespread expression of its receptor, Angiotensin Converting Enzyme type 2 (ACE2), throughout the gastrointestinal (GI) tract causes GI tract-related clinical symptoms in the absence of respiratory symptoms, leading to a delay in COVID-19 infection diagnosis. While anorexia (50.2%) and diarrhea (49.5%) are the most common gastrointestinal symptoms of COVID 19, our patient presented with abdominal discomfort (2%). Acute colonic pseudo-obstruction or Ogilvie syndrome is a functional disorder characterized by profound dilatation of the colon without a true mechanical obstruction. An association between certain viral infections (Herpes) and intestinal pseudo-obstruction has been demonstrated previously. The mechanism of such a development is hypothesized to be due to the viral invasion of the myenteric plexus. Similarly, COVID-19 has demonstrated neurotropic potential leading to the development of Ogilvie syndrome. Treatment modalities available for the treatment include bowel rest, nasogastric and rectal tube placement, electrolyte correction, neostigmine and possible endoscopic/surgical intervention with a preferably good prognosis. CONCLUSION: 1. The full range of effects of the COVID 19 virus are yet to be discovered. Loss of parasympathetic spinal control of bowel motility may be one possible manifestation of this disease. 2. Gastrointestinal sequelae of COVID 19 respond well to conservative management and should warrant a low threshold for the investigation and implementation of such treatment.

3.
Mol Biol Rep ; 49(6): 5325-5340, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1955989

ABSTRACT

Saffron is a unique plant in many aspects, and its cellular processes are regulated at multiple levels. The genetic makeup in the form of eight chromosome triplets (2n = 3x = 24) with a haploid genetic content (genome size) of 3.45 Gbp is decoded into different types of RNA by transcription. The RNA then translates into peptides and functional proteins, sometimes involving post-translational modifications too. The interactions of the genome, transcriptome, proteome and other regulatory molecules ultimately result in the complex set of primary and secondary metabolites of saffron metabolome. These complex interactions manifest in the form of a set of traits 'phenome' peculiar to saffron. The phenome responds to the environmental changes occurring in and around saffron and modify its response in respect of growth, development, disease response, stigma quality, apocarotenoid biosynthesis, and other processes. Understanding these complex relations between different yet interconnected biological activities is quite challenging in saffron where classical genetics has a very limited role owing to its sterility, and the absence of a whole-genome sequence. Omics-based technologies are immensely helpful in overcoming these limitations and developing a better understanding of saffron biology. In addition to creating a comprehensive picture of the molecular mechanisms involved in apocarotenoid synthesis, stigma biogenesis, corm activity, and flower development, omics-technologies will ultimately lead to the engineering of saffron plants with improved phenome.


Subject(s)
Crocus , Computational Biology/methods , Crocus/metabolism , RNA/metabolism , Transcriptome/genetics
4.
Pakistan Journal of Zoology ; 54(4):1899-1904, 2022.
Article in English | CAB Abstracts | ID: covidwho-1904009

ABSTRACT

Coronavirus consists of single-stranded, enveloped and RNA virus, largest genome among all RNA viruses and has 4 proteins i.e. envelope, spike, nucleocapsid and membrane. Coronaviruses are classified into 4 genera: Alphacoronavirus, Betacoronavirus, Gammacoronavirus and Deltacoronavirus. Betacoronavirus most probably originated from bats and the virus may have jumped to avian species and evolved as Deltacoronavirus group. The avian coronaviruses jumped among other avian species, giving rise to Gammacoronavirus from Deltacoronavirus, while Betacoronavirus may have given rise to Alphacoronavirus. It is known that SARS-CoV-2 belongs to Betacoronavirus. This most similar virus is verified in bat and Malayan Pangolin. Analysis showed that SARS-CoV-2 most probably originated by recombination of both bat and pangolin viruses. Viral protein seroconversion and viral specific nucleotide positive documented in all COVID-19 patients tested provides confirmation of a link between the presence of this virus and the disease.

5.
Pakistan Journal of Zoology ; 54(4):1899-1904, 2022.
Article in English | Scopus | ID: covidwho-1847887

ABSTRACT

Coronavirus consists of single-stranded, enveloped and RNA virus, largest genome among all RNA viruses and has 4 proteins i.e. envelope, spike, nucleocapsid and membrane. Coronaviruses are classified into 4 genera: Alphacoronavirus, Betacoronavirus, Gammacoronavirus and Deltacoronavirus. Betacoronavirus most probably originated from bats and the virus may have jumped to avian species and evolved as Deltacoronavirus group. The avian coronaviruses jumped among other avian species, giving rise to Gammacoronavirus from Deltacoronavirus, while Betacoronavirus may have given rise to Alphacoronavirus. It is known that SARS-CoV-2 belongs to Betacoronavirus. This most similar virus is verified in bat and Malayan Pangolin. Analysis showed that SARS-CoV-2 most probably originated by recombination of both bat and pangolin viruses. Viral protein seroconversion and viral specific nucleotide positive documented in all COVID-19 patients tested provides confirmation of a link between the presence of this virus and the disease. Copyright 2022 by the authors.

6.
Acta Neuropsychiatr ; 34(6): 318-329, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1839468

ABSTRACT

BACKGROUND: Long haulers have been recently reported after contracting coronavirus disease (COVID-19). In the present study, we aimed to screen for the neuropsychiatric signs detected <1 to >6 months after infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to determine whether vaccination has an effect on them. METHODS: An online survey was conducted among participants who had been diagnosed with laboratory-confirmed SARS-CoV-2 infection. The clinical signs and durations of neuropsychiatric complaints and their correlations to sex, age, severity of COVID-19 signs, and vaccination status were screened. RESULTS: A total of 2218 individuals, including 1358 females and 860 males, with an age range of 12-70 years, submitted their responses. The respondents experienced cognitive dysfunction, mood alteration, depression, tinnitus, sleep disorders, and loss of taste and smell, with prevalence rates ranging from 18.9% (tinnitus) to 63.9% (loss of taste and smell). Of the respondents, 2.2-7.7% confirmed the persistence of symptoms for >6 months. Tinnitus was the least common complaint, and only 2.2% of the study participants had tinnitus for >6 months. Meanwhile, mood alteration persisted for >6 months in 7.6% of the study participants. More respondents who received two doses of BNT162b2 vaccine showed persistent symptoms than those in the other groups. Disease severity and female sex were identified as potential determinants of the development and persistency of such symptoms. CONCLUSION: Post-COVID neuropsychiatric symptoms were present in considerable percentages of the study participants with SARS-CoV-2 infection, persisting for >6 months in up to 7.6% of the participants.


Subject(s)
Ageusia , COVID-19 , Tinnitus , Male , Female , Humans , Child , Adolescent , Young Adult , Adult , Middle Aged , Aged , COVID-19/epidemiology , SARS-CoV-2 , BNT162 Vaccine
7.
Curr Pharm Teach Learn ; 14(4): 521-525, 2022 04.
Article in English | MEDLINE | ID: covidwho-1814295

ABSTRACT

PURPOSE: This wisdom of experience commentary, from peer academic reviewers serving on accreditation teams, will discuss benefits and challenges of international and national virtual accreditation visits (VAVs) using a "What? So What? Now What?" reflective model. DESCRIPTION: Onsite accreditation reviews for health professional education programs require investments in time, effort, and money to maintain program alignment with accreditation standards and continuously generate quality practitioners. When COVID-19 entered the accreditation world, reviewers had to pivot modalities to a VAV format. ANALYSIS/INTERPRETATION: Adaptation and expectations of VAVs present several challenges. Barriers and advantages will be discussed as well as implications for the future. While medical and pharmacy education standardization has long been established, the authors propose national and international accrediting bodies will utilize the ingenuity of emergency COVID-19-driven onsite accreditation alternatives to develop protocols for novel accreditation methodology. CONCLUSIONS: Whether the continued mutation of COVID-19 prevents the return to previous accreditation visits or not, the experiences gained from the emergency-driven VAV, can inform and enrich accrediting bodies knowledge, theories, and practices of future VAVs. IMPLICATIONS: Higher-education institutions, accreditation bodies, and government entities will use experiences during COVID-19 to transform and improve academic requirements and future practices. Even if there is a full return to onsite reviews, such guidelines or improved versions of them can be applied to situations where immobility or restricted mobility is an issue, such as in illness, pregnancy, travel, war, etc. It is crucial for educators and accrediting bodies to evolve as we navigate these unprecedented times.


Subject(s)
COVID-19 , Pharmacies , Pharmacy , Accreditation/methods , Humans , Pandemics
8.
Currents in pharmacy teaching & learning ; 2022.
Article in English | EuropePMC | ID: covidwho-1728411

ABSTRACT

Purpose This wisdom of experience commentary, from peer academic reviewers serving on accreditation teams, will discuss benefits and challenges of international and national virtual accreditation visits (VAVs) using a “What? So What? Now What?” reflective model. Description Onsite accreditation reviews for health professional education programs require investments in time, effort, and money to maintain program alignment with accreditation standards and continuously generate quality practitioners. When COVID-19 entered the accreditation world, reviewers had to pivot modalities to a VAV format. Analysis/interpretation Adaptation and expectations of VAVs present several challenges. Barriers and advantages will be discussed as well as implications for the future. While medical and pharmacy education standardization has long been established, the authors propose national and international accrediting bodies will utilize the ingenuity of emergency COVID-19-driven onsite accreditation alternatives to develop protocols for novel accreditation methodology. Conclusions Whether the continued mutation of COVID-19 prevents the return to previous accreditation visits or not, the experiences gained from the emergency-driven VAV, can inform and enrich accrediting bodies knowledge, theories, and practices of future VAVs. Implications Higher-education institutions, accreditation bodies, and government entities will use experiences during COVID-19 to transform and improve academic requirements and future practices. Even if there is a full return to onsite reviews, such guidelines or improved versions of them can be applied to situations where immobility or restricted mobility is an issue, such as in illness, pregnancy, travel, war, etc. It is crucial for educators and accrediting bodies to evolve as we navigate these unprecedented times.

9.
Pakistan Journal of Medical and Health Sciences ; 15(10):3076-3079, 2021.
Article in English | EMBASE | ID: covidwho-1573199

ABSTRACT

The Covid-19 pandemic has wreaked havoc throughout the world, with 150 million cases to date and over 3 million lives claimed worldwide Objectives: To assess the immediate side effects of Covid-19 vaccination among the people of Pakistan Study Design: Randomized, descriptive cross-sectional study Methodology: Present study was carried out using an online questionnaire by enrolling 17040 subjects. Inclusion/Exclusion criteria: All citizens of Pakistan over the age of 12, who were eligible for the COVID-19 vaccination were enrolled. Statistical analysis: Data was analyzed by SPSS software, version 25 in terms of frequencies and percentages. Results: In present study, results showed that 76% subjects were vaccinated. Among them 64% received Sinopharm, 30% Sinovac, 0.7% Pfizer, 0.5% Astrazeneca, 2.8% Moderna, 0.8% Cansino, 0.3% PakVac and 0.1% Sputnik V. Most participants (66%) suffered no symptoms post vaccination. Only 15% developed fever, 7% dizziness, 5% vomiting, 4% pain at injection site, 2% headache and 1% fatigue. After vaccination, 1% had a reinfection and 99% so far have not caught Covid-19. Among all participants, 87% found the vaccine safe, 7% were neutral and 5% found it unsafe. Conclusion: We concluded that most Pakistanis have received the Chinese vaccine i.e. Sinopharm. Majority individuals have experienced either no to mild or few moderate type of adverse effects following immunization irrespective of the age and gender that can be easily managed at home.

10.
Chest ; 160(4):A14, 2021.
Article in English | EMBASE | ID: covidwho-1458330

ABSTRACT

TOPIC: Allergy and Airway TYPE: Medical Student/Resident Case Reports INTRODUCTION: Acute eosinophilic pneumonia/pneumonitis (AEP) is a rare respiratory illness characterized by eosinophil accumulation in the pulmonary interstitium and airspaces.Due to limited research done in older population, there is delayed and underdiagnosis in patients above age 40.Here we present a unique case of a 96-year-old man with AEP. CASE PRESENTATION: A 96-year-old lifetime non-smoker male with a history of hypertension, DVT on therapeutic enoxaparin presented to the hospital from a nursing home with a productive cough and increasing shortness of breath.He was found to be saturating at 80% on 4 liters of oxygen. Patient had a fever of 100.1F.Physical exam was significant for bilateral diminished breath sounds.His chest x-ray revealed worsening bilateral pulmonary infiltrates since his last admission with pneumonia last month.He was started on empiric antibiotics and High flow oxygen.CT chest showed bilateral ground glass opacities with increased interstitial thickening.Blood cultures, respiratory pathogen panel, SARS-COV2 PCR were negative. The patient's eosinophils increased to 11.7% with a progressive decline in neutrophil count. The bronchoalveolar lavage showed presence of numerous clumps of eosinophils. Patient was diagnosed with AEP and started on methylprednisolone 80 mg twice daily. Antibiotics were stopped and patient's status improved with continuous steroid treatment. Patient improved and was discharged on steroid taper. DISCUSSION: AEP is an idiopathic entity commonly associated with smoking, medications, allergic diathesis and parasitic infections. Furthermore, individuals between 20-40 years of age are most commonly affected. It causes IL-5 release and eosinophils accumulation, resulting in the release of toxic proteins and lipid mediators that promote a pro inflammatory reaction. Eosinophil counts may be normal on presentation, as seen in this case. Symptomatic AEP resembles pneumonia and While diagnosing AEP, it is important to exclude other disorders such as asthma or other atopic illnesses as these also respond to corticosteroids. Gold standard diagnosis of AEP is bronchoscopy with BAL which reveals eosinophilia (>25%). Treatment of AEP requires eliminating the inciting factor and initiating corticosteroids. While there are no clear guidelines on the optimal dosing of corticosteroids, there is evidence to suggest that high-dose IV steroids is effective in patients requiring mechanical intubation, whereas low dose oral prednisone is efficient in patients with minimal hypoxia. CONCLUSIONS: Our case here is unique as it highlights the occurrence of AEP in old age in the absence of associated factors. It is prudent to be vigilant of leukocyte trends in patients with recent history of pneumonia as not to misdiagnose and to consider other possible etiologies, such as AEP.If identified and treated appropriately, the disease has favorable outcomes with no long term sequalae. REFERENCE #1: Rhee CK, Min KH, Yim NY, Lee JE, Lee NR, Chung MP, Jeon K. Clinical characteristics and corticosteroid treatment of acute eosinophilic pneumonia. Eur Respir J. 2013 Feb;41(2):402-9. doi: 10.1183/09031936.00221811. Epub 2012 May 17. PMID: 22599359. REFERENCE #2: Pope-Harman, Amy L.;Davis, Bruce W.;Allen, Elizabeth D.;Christoforidis, John A.;Allen, James N. Acute Eosinophilic Pneumonia A Summary of 15 Cases and Review of the Literature, Medicine: November 1996 - Volume 75 - Issue 6 - p 334-342 DISCLOSURES: No relevant relationships by MohammadAsim Amjad, source=Web Response No relevant relationships by Ajinkya Buradkar, source=Web Response No relevant relationships by Kashyap Kela, source=Web Response No relevant relationships by Pooja Kharbanda, source=Web Response No relevant relationships by jacob miller, source=Web Response No relevant relationships by Princy Shah, source=Web Response

11.
World Dev ; 147: 105629, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1313492

ABSTRACT

Since COVID-19 broke out, there has been renewed interest in understanding the economic and social dynamics of historical and more recent epidemics and pandemics, from the plagues of Antiquity to modern-day outbreaks like Ebola. These events can have significant impacts on the interplay between poverty and social cohesion, i.e. how different groups in society interact and cooperate to survive and prosper. To that effect, this paper provides a theory-driven overview of how social responses to past epidemics and pandemics were determined by the epidemiological and non-epidemiological characteristics of these outbreaks, with a particular focus on the conditions giving rise to scapegoating and persecution of minority groups, including migrants. We discuss existing theories as well as historical and quantitative studies, and highlight the cases where epidemics and pandemics may lead to milder or more severe forms of scapegoating. Finally, we conclude with a summary of priorities for future research on epidemics, pandemics and social conflict and discuss the possible effects and policy implications of COVID-19.

12.
Pakistan Journal of Medical and Health Sciences ; 15(5):1196-1199, 2021.
Article in English | EMBASE | ID: covidwho-1315209

ABSTRACT

Aim: To assess the results of chest x ray radiographs of patients positive for Covid-19, presented at the tertiary care hospital according to the classification by the British Society of Thoracic Imaging (BSTI. Place and Duration: In COVID-19 Ward (Department of Medicine) Sheikh Zayed Hospital, Lahore for three months duration from January 2021 to March 2021. Methods: A total of 96 patients were selected. In this observational study, positive COVID-19 patient determined by the reverse transcriptase polymerase chain reaction (RT-PCR) were enrolled for this study above the age of 14 years. CXR results were classified conferring to BSTI documentation and classification in terms of percentage and frequency. Results: Chest rays of 96 patients who tested positive for Covid-19 by RT-PCR over the age of 14 years were examined. Chest X-rays are classified according to the BSTI Covid-19 X-ray classification. Out of 96 patients, 10 patients (10.41%) had normal chest x-rays, 19 (19.80%) patients had classic bilateral, peripheral and basal consolidation / ground glass opacity (GMO), 60 (62.5%) had unspecified group,7(7.29%) patients have poor quality X-ray film. The unilateral involvement was noticed in 15 and bilateral in 49 patients, 12 of the patients had diffuse involvement on chest radiograph and peripheral involvement in 39 patients. According to regional dominance, 41 of the unspecified (42.70%) had middle and lower lung involvement, 7 (7.29%) had only the middle zone, and 8 (8.33%) had involvement of lower zone. Conclusions: In this study, Covid-19 chest X-rays are usually presented as ground glass opacity, mixed consolidation with GGOs in the middle and lower peripheral areas of the bilateral lung. Chest X-ray BSTI classification is used to classify Covid-19 severity in our patients, thus differentiating in the classic Covid-19 of the middle zone versus low zone involvement.

13.
J Ayub Med Coll Abbottabad ; 33(2):283-288, 2021.
Article in English | PubMed | ID: covidwho-1303063

ABSTRACT

BACKGROUND: During the pandemic, disruption of work schedule and constant health risks causes physician burnout. This study aims to identify Burnout in physicians working in COVID ICU and isolation Ward. METHODS: A cross-sectional study was conducted on 200 physicians who had worked in either COVID ICU or Isolation ward. A survey of 23 questions was designed to assess the work-related Burnout using the Copenhagen burnout inventory and the implementation of NIH guidelines. RESULTS: Among the 200 physicians, 151 (75.5%) were well informed of the guidelines, of which 52 (34.4%) participants believed the guidelines were not sufficient. These 34.4% of individuals showed a mean burnout score of 70.05% (p-value 0.001). Medical registrars and Medical Officers suffered the highest burnout mean percentage score of 76% and 72.42%, respectively. 89 (44.5%) individuals arranged PPE suits on their own and suffered a burnout score of 71.3% ±14.35 (p-value <0.001). Seventy-two (36%) claimed their administration was not cooperative in resolve safety issues. These individuals showed a mean burnout score of 74.3% ±13.82 (p-value <0.001). CONCLUSIONS: Lack of physician's faith in the adequacy of the NIH guidelines has been found to be a significant factor in contributing to work-related Burnout. Due to the shortage of PPE, a majority of physicians have to reuse their PPE multiple times and even have to personally arrange their PPE suits, which further compounds the burnout. Increase administrative cooperation in resolving issues related to safety measures should help elevate work-related burnout in physicians working in the ICU and isolation ward.

14.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277803

ABSTRACT

Small cell lung cancer (SCLC) can be complicated by paraneoplastic syndromes including ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS). Early recognition is vital, given the poor prognosis noted in this subset of patients. We present a case of EAS due to SCLC manifesting as acute anxiety. A 55-year-old male former smoker with a history of recently diagnosed diabetes mellitus, hypertension, and anxiety presented with complaints of worsening anxiety and confusion, which he attributed to the ongoing COVID-19 pandemic. Initial examination revealed hypertension (177/73 mmHg), anxious affect, and mild confusion. Laboratory work-up was notable for leukocytosis (18,510/mm3), hypokalemia (2.4 mg/dL, and metabolic alkalosis (33 mmol/L). Workup for refractory hypokalemia revealed elevated serum cortisol level (91.3 μ g/dL), elevated 24-hour urinary free cortisol level of (18,965 mcg/hour), and elevated serum adrenocorticotropic hormone (ACTH) (294 pg/mL). Magnetic resonance imaging (MRI) of the brain was unremarkable. Computed tomography (CT) scan of the chest, abdomen, and pelvis revealed a 2.8 cm soft tissue mass in the right paratracheal mediastinum with lymphadenopathy, suggestive of malignancy. Bronchoscopy with transbronchial needle aspiration of a mediastinal lymph node was performed, and histopathology confirmed the diagnosis of small cell carcinoma complicated by ectopic ACTH production. Progressive hyperactive delirium and metabolic derangements prompted the initiation of ketoconazole and continuous infusion of etomidate in the intensive care setting, with improvement in symptoms. Concurrent radiotherapy and a chemotherapy regimen of etoposide and cisplatin was initiated. Mitotane was administered given persistently elevated cortisol levels. His subsequent hospital course was complicated by septic shock, diverticulitis, and multi-organ failure, leading to a change in goals of care to comfort measures only. EAS is an uncommon manifestation of SCLC, affecting about 1% of these patients. EAS is typified by high levels of cortisol and ACTH which are not suppressed by high dose dexamethasone. EAS portends a poor prognosis in patients with SCLC, with a median survival ranging from 3.5 to 5.5 months. Given the broad range of symptomatology of hypercortisolism, the identification of EAS is often delayed, with a mean duration of 14 months from symptom onset to diagnosis. Our case uniquely presented with the deceptively benign symptom of acute anxiety without any associated respiratory symptoms that would suggest lung cancer. Hormonal suppression was challenging, requiring concurrent use of etomidate, ketoconazole, and mitotane, apart from chemotherapy.

15.
Heliyon ; 7(5): e07068, 2021 May.
Article in English | MEDLINE | ID: covidwho-1230506

ABSTRACT

Severe acute respiratory syndrome coronavirus 2, SARS-CoV-2 (COVID-19), came as a significant health care challenge for humans in 2019-20. Based on recent laboratory and epidemiological studies, a growing list of mutations in the virus has the potential to enhance its transmission or help it evade the immune response. To further compound the problems, there are considerable challenges to the availability of effective, affordable, safe vaccines on a mass scale. These impediments have led some to explore additional options available in traditional medicines, especially immune-boosting natural products. Saffron has been used for centuries to treat fever, bronchitis, cold and other immune, respiratory disorders. Herein, we discuss the potential role of saffron during and after COVID-19 infection, focusing on immunomodulation, respiratory, renal, and cardiovascular functions. As a nutraceutical or drug supplement, it can alleviate the magnitude of COVID-19 symptoms in patients. The anti-inflammatory, antioxidant, and other medicinal properties attributed to saffron bioactive compounds can help in both pre-and post-infection management strategies. The abnormalities associated with COVID-19 survivors include anxiety, depression, sleep disturbances, and post-traumatic stress disorder. Saffron can help manage these post-hospitalization abnormalities (sub-acute and chronic) too, owing to its anti-depressant property. It can help common people boost immunity and manage depression, stress and anxiety caused due to prolonged lockdown, isolation or quarantine.

16.
19th Mexican International Conference on Artificial Intelligence, MICAI 2020 ; 12469 LNAI:65-73, 2020.
Article in English | Scopus | ID: covidwho-891230

ABSTRACT

The emerging issue of COVID-19, which is caused by the coronavirus SARS-CoV-2 is a significant problematic issue. This disease has impacted worldwide and covered the globe in its threat. Scientists and physicians have been investigating pathophysiological aspects of this pandemic to understand the virus structure for the treatment development. In this mini review, we briefly discuss the characteristics of SARS-CoV-2, its origin, diagnosis, and treatment. This study will provide an understanding of the role of artificial intelligence in this emerging COVID-19 pandemic along with the impact in our society, economy, health, and industrial level. © 2020, Springer Nature Switzerland AG.

17.
J Med Educ Curric Dev ; 7: 2382120520963039, 2020.
Article in English | MEDLINE | ID: covidwho-890054

ABSTRACT

INTRODUCTION: The COVID-19 pandemic imposed dramatic changes on educational practices worldwide. Many universities and schools have moved into the delivery of their courses and educational programs utilizing fully electronic online modes. This study aims to evaluate the pharmacy student distance online learning experience during the COVID-19 pandemic. METHODS: A cross-sectional survey was utilized where a 3-domain survey questionnaire focused on preparedness, attitude and barriers was distributed to students at the time of conclusion of the semester. Each domain consists of multiple questions that made up a score that reflects their preparedness, attitude as well as barriers relevant to distance online learning experience. The survey was voluntarily, and all data were collected and recorded via google forms with maintaining anonymity. RESULTS: The response rate was about 75% (n = 309). The results' analysis revealed no gender differences in any of these domains. However, there were some variable responses among different educational levels. The average preparedness score was 32.8 ± 7.2 (Max 45), the average attitude score was 66.8 ± 16.6 (Max 105), and the average barrier score was 43.6 ± 12.0 (Max 75). There was statistical significance difference in both preparedness score and attitude scores between different professional years (P-value <.05). However, there was no difference in barrier scores among all professional years. The results indicated that about 61.4% of the students agreed on that college of pharmacy was well-prepared and ready for the online education during the emerging COVID-19 pandemic with complete transition into online education. The results also indicated that 49.2% of the students showed positive attitude toward the provided online learning. The results indicated that about 34% of the students identify some barriers toward the provided online learning. Finally, there were strong association between the need for training on how to receive online courses and preparedness and barriers scores. DISCUSSION AND CONCLUSION: E-learning experience pose challenges and presents opportunities during emergency situations. The need for training for students and faculty was highly associated with the preparedness and barriers domains rather than the infrastructure or computer literacy, so the school can improve their experience by addressing these needs.

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