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2.
Palliative Medicine ; 36(1 SUPPL):11-12, 2022.
Article in English | EMBASE | ID: covidwho-1916744

ABSTRACT

Background: The COVID-19 pandemic hampered the palliative care services due to the policies of nationwide lockdown, social distancing and patient triaging. Telemedicine can be a possible solution to overcome the hurdles of providing holistic care to cancer patients by minimising the visit of patients to the healthcare facility. Aim: The objective of the study was to evaluate and assess the feasibility of telemedicine as a tool to provide palliative care during the COVID-19 pandemic in resource limited setting. Design/Participants: A retrospective study was conducted to analyse the telemedicine service from 25 March 2020 to 30 June 2020. Patients who availed the teleconsultation services during this period were recruited. A smartphone-based 24/7 model for conducting audio-visual consultations was created whereby patients could interact with a trained palliative medicine physician. The study explored the reason for teleconsultation, main barriers for hospital visit, and patient satisfaction. Results: Out of the 547 patients, 462 (84.46%) utilised voice calling service. The major reason for not visiting the hospital was issues with transportation (48.8%) followed by fear of contracting COVID-19 (37.3%). The majority of the calls (63.62%) were regarding uncontrolled symptoms related to primary disease. 402 (73.49%) patients were very satisfied, and 399 (72.94%) decided to use telemedicine in future as well. Conclusion: Telemedicine is a helpful tool to provide integrated palliative care to cancer patients who are unable to visit hospitals regularly. This was observed to be especially useful during the pandemic in a resource limited setting.

3.
Asian Journal of Pharmaceutical and Clinical Research ; 15(5):94-98, 2022.
Article in English | EMBASE | ID: covidwho-1863542

ABSTRACT

Objective: Rhinocereberal mucormycosis is an acute, fulminant, and often lethal opportunistic infection typically affecting diabetic or immunocompromised patients. Early diagnosis is vital in these infections because delay in initiation of the treatment can be life-threatening. Computed tomography (CT) with axial and coronal sections is a highly accurate and non-invasive modality to accurately image sinonasal mycosis. The aim of the study was to describe the imaging findings in suspected cases of mucormycosis on CT. Methods: This study was conducted in Radiodiagnosis Department of Rajindra Hospital, Patiala. The data of 22 patients who were referred for CT with a clinical suspicion of mucormycosis were collected and all these patients were followed up to know about the prognosis of the disease. Results: In our study, there were 54.60% females and 45.40% males. Maximum number of patients (45.45%) belonged to 40-49 year age group. Diabetes mellitus was found to be the most commonly (90.90%) found comorbidity followed by hypertension (36.36%). In our study, involvement of unilateral nasal cavity was observed in 36.36% cases. Among the paranasal sinuses, maxillary and ethmoid sinuses were the most commonly involved in 95.45% and 77.27% cases. Conclusion: Prompt diagnosis and treatment of rhino-orbital mucormycosis are the sine qua non as antifungal drugs and surgical debridement can successfully control the infection and thus reduce the high mortality and morbidity associated with mucormycosis.

5.
Indian Journal of Hematology and Blood Transfusion ; 37(SUPPL 1):S120-S121, 2021.
Article in English | EMBASE | ID: covidwho-1631896

ABSTRACT

Introduction: COVID-19 pandemic has placed the health systemworldwide in unprecedented stress, therefore, prompt identification and management of patients having severe disease is essential fortriaging of patients at the time of admission.Aims &Objectives: To identify hematological biomarkers ofCOVID-19 disease severity in patients admitted in a tertiary carehospital.Materials &Methods: A retrospective study was conducted over aperiod of 17 months (20th March 2020-19 August 2021) on 7416COVID-19 patients. Patients with cancers, pregnancy and chronichematological diseases were excluded from the study. Patients wereclassified clinically as per severity of disease as non-severe (asymptomatic, mild, moderate) or severe and their hematological parameterswere analyzed.Mann-Whitney test was used to compare between the groups. Optimal predictive cut off points for the variables were defined by receiveroperating characteristic (AUC) curve to dichotomize the variables.Univariate analysis was performed to screen out independent variables to be used in the binary logistic regression (BLR). A p valueof< = 0.05 was considered as statistically significant.Result: Age, duration of hospital stay, RBC count, WBC, Plateletcount, RDW, Neutrophils %, Absolute neutrophil count (ANC),Absolute monocyte count (AMC), NLR, PLR, NMR were statisticallyhigher whereas hemoglobin, hematocrit, MCHC, lymphocyte %,Absolute lymphocyte count (ALC), Eosinophils %, Absolute eosinophil count (AEC), Monocytes %, Basophils %, Absolute Basophilcount (ABC) and Lymphocyte Monocyte ratio (LMR) were lower insevere group. MCV and MCHC were not significant, so wereexcluded from the logistic regression model. All variables were significant in univariate analysis. Age (>42 yrs), duration of hospitalstay (>10 days), RBC count (B 4.33 106/lL),WBC count (> 7.73103/lL), RDW (>14.8%), Neutrophils (>71.7%), Eosinophils(B 0.3%), Monocytes (B 5%), ALC (B 1.01 103/lL), LMR(B 3.125) with adjusted odd ratio of 1.8, 1.5, 1.3,1.3, 1.4, 2.0, 2.1, 1.5,2.0 and 1.3 respectively were found to be significant predictors ofseverity.Conclusions: Age, duration of hospital stay, RBC count, WBC,RDW, Neutrophils %, Eosinophils %, Monocytes %, ALC, LMRshould be assessed and monitor at the earliest to halt unfavorableoutcome of mortality or morbidity.

8.
Anesthesia and Analgesia ; 133(3 SUPPL 2):465, 2021.
Article in English | EMBASE | ID: covidwho-1445062

ABSTRACT

Background: Intubation is a highly aerosol generating procedure. Recent airway management guidelines advocate the use of appropriate personal protective equipment, a video laryngoscope and 'intubation box' while intubating a suspected or an infected COVID patient.1 We undertook a study to compare CMAC Videolaryngoscope with Mc Grath Videolaryngoscope for tracheal intubation using an intubation box along with PPE. Methods: The patients were randomly allocated to two groups by computer-generated random numbers, depending upon the Video laryngoscope used: Group C (n=30) where C-MAC VL was used and Group M (n=30) where Mc Grath VL was used. The primary outcome was total time required for successful intubation. The secondary outcomes included number of attempts required, CL grade, POGO score, difficulty faced while using the device and user's preference. Results: The time to intubation was 57.17± 19.98 seconds with C-MAC laryngoscope as compared to 57.93 ± 14.92 seconds with McGrath laryngoscope (p=0.134). The POGO score and CL grade were comparable. Both the devices had a good POGO score. Twelve patients in each group were found to have a CL grade of 1. The time to glottis visualization was more with Mc Grath than with C-MAC although not significant (23.8±14.03 vs 20.10±10.78). Both the devices were easy to use. Conclusions: Both C-MAC and McGrath video laryngoscopes, are equally effective devices for intubation by a donned anaesthesiologist using an intubation box but McGrath with a disposable blade is better suited in these conditions.

9.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277788

ABSTRACT

Rationale: Thoracic computed tomography (CT) is an integral part of diagnosis and classification of interstitial lung diseases (ILD). However, recommended interpretative guidelines for ILD are often difficult to follow and radiological diagnosis of ILD frequently relies on subjective interpretation (gestalt) by the thoracic radiologist. Moreover distinguishing ILD from numerous other diagnoses that mimic the radiological appearance of ILD can at times be extremely challenging to non-specialized radiologists. Here we applied an image analysis technique of CT scans to explore automated discrimination between different forms of clinico-radiologically diagnosed ILD, various ILD mimickers and normal controls. This technique is based on the concept of mean curvature of isophotes (MCI), a computer vision technique recently shown to perform well at detecting COPD on CT scans. Here, we apply it for the first time to detection and classification of ILD. Methods: Our convenience sample of patients was divided in four categories: 25 ILD patients with definite or probable usual interstitial pneumonia (UIP), 26 ILD patients indeterminate for UIP or with an ILD diagnosis other than UIP, 31 normal controls, and 36 ILD mimickers. The latter category included CTs featuring pulmonary edema, lymphangitic carcinomatosis, multifocal pneumonia, multifocal minimally invasive adenocarcinoma, pulmonary alveolar proteinosis, atelectasis, pulmonary sarcoidosis, pneumocystis jiroveci pneumonia, Kaposi sarcoma, and COVID19. From each patient's CT scan we computed MCI at a fine (1mm) and coarse (4mm) scale over a segmentation of the lungs performed with open-source software [http://chestimagingplatform.org]. We then quantified both MCI results with a probability density estimate (PDE). We subsequently performed a functional principal component analysis (FPCA) on the PDEs for each subject to capture the largest modes of variation. A multinomial logistic regression with the top 5 principal components from each scale as predictors was used to classify patient status. Results: Our method had excellent discriminative ability with a multi-class area under the operating characteristic curve of 0.976. The sensitivities and specificities ranged from 0.81-0.97 and 0.94-0.99, respectively (Table 1). Conclusion: The MCI technique showed good ability in differentiating definite and probable UIP from other categories of ILD, normal controls and various ILD mimickers. While the unsupervised nature of our predictors makes our method less susceptible to overfitting, external validation will be needed to provide an unbiased estimate of performance. The proposed method could ultimately be a valuable screening algorithm for incidental findings and/or decision support mechanism in contexts where specialized radiology expertise may not be readily available.

10.
Journal of the American Geriatrics Society ; 69(SUPPL 1):S168, 2021.
Article in English | EMBASE | ID: covidwho-1214819

ABSTRACT

INTRO: Hemophagocytic lymphohistiocytosis (HLH) is an uncommon type of hemophagocytic syndrome characterized by systemic inflammation and overactivation of the immune system leading to multisystem failure.1 Most common in pediatrics1, it's a rare, challenging diagnosis often missed in older adults. CASE: A 67 year-old male with a PMH of COPD, CKD3a, and lung nodules presented to his PCP for dyspnea and cough. COVID19 test was negative, CXR showed irregular opacities but no consolidation, so he was treated for COPD exacerbation. One month prior, he saw Pulmonology and completed a 10 day course of Augmentin. After 3 days, family noted the patient was jaundiced with dark urine. Labs showed normocytic anemia, acute on chronic kidney injury, and elevated LFTs. His PCP had him admitted for further workup and treated for community-acquired pneumonia;dyspnea improved. But, the patient's acute kidney injury worsened, so he was transferred from an outside facility to U of M Hospital. Nephrology was consulted and urine studies were consistent with ATN. Liver function worsened and drug-induced liver injury with cholestasis was suspected, given recent Augmentin. Acute hepatitis panel, infectious and autoimmune workups were negative. The patient's hgb declined, requiring multiple transfusions despite no source for an active bleed. Abdominal ultrasound showed an enlarged liver with diffusely coarse echogenicity. Liver biopsy showed diffuse granulomatous hepatitis with necrosis and cholestasis. Finally, soluble IL-2R was ordered and was quite elevated at 35,150 U/mL (normal 137-838 U/mL). Lab findings and clinical presentation led to a diagnosis of HLH. At the end, the patient decompensated requiring transfer to ICU for multi-organ failure. Following goals of care discussions with family, he was transitioned to comfort care and passed away soon afterward. DISCUSSION: This case shows the importance of considering HLH as a diagnosis in older adults with characteristic findings. Early diagnosis is often hard due to low suspicion, limitations of diagnostic criteria in adults, and inaccessibility to specialized lab tests (like soluble IL-2 assay). Adult HLH is usually fatal with median survival of about 2 months.

11.
Indian Journal of Hematology and Blood Transfusion ; 36(1 SUPPL):S129-S130, 2020.
Article in English | EMBASE | ID: covidwho-1092789

ABSTRACT

Aims & Objectives: The present study was undertaken to evaluate prognostic relevance of hematological parameters in COVID-19 infected patients for early identification of critical patients for early management. Patients/Materials & Methods: A retrospective study was conducted over a period of 2 months (01st July 2020 to 1st September 2020) on 912 admitted COVID-19 positive patients. 2 ml venous blood was aseptically collected in EDTA vaccutainer and processed in automated hematology analyser (ADVIA 2120i). Patients with hematological malignancy were excluded from the study. Patients were assigned into three groups according to the severity of disease (mild/asymptomatic, moderate and severe) as well as on the basis of clinical outcome (discharged ordeath). Results: To talleucocyte count, absolute neutrophil count, neutrophillymphocyte ratio, plateletlymphocyte ratio, reddistribution width were significantly higher (p<0.05) is the decreased patients and in severe disease group where as hemoglobin and hematocr it was significant lower in these patients. Lymphopenia was recorded in decreased patient but was not statically significant. Discussion & Conclusion: COVID-19 patients with severe disease and poor outcome showed significant difference in ther outine hematological parameter such as total leucocyte count, absolute neutrophil count, absolute monocyte count, neutrophillymphocyte ratio, plateletlymphocyte ratio, reddistribution width and hematocrit which are readily available and can be helpful in the prediction of COVID-19 patien toutcome.

12.
Acta Medica International ; 7(2):143-147, 2020.
Article in English | EMBASE | ID: covidwho-1024705

ABSTRACT

Introduction: In this paper, we consider a fundamental problem of testing faced by the health staff on testing COVID 19 patients. In general, the number of testing kits or testing capabilities is limited, and the number of COVID 19 patients is much larger than that. This paper tries to answer this fundamental question that how to perform COVID 19 testing to reduce the death rate. Materials and Methods: We consider that the survival rate of patients is dependent over two parameters: their age and severity of symptoms at a time. Based on these observations, we propose a survival rate function. Using the survival rates, the death rate for an individual is obtained. MATLAB was used for plotting the graphs. Results: It is shown by numerical results that by using the proposed mechanism, the average death rate can be significantly reduced. Conclusion: It is proposed to conduct the testing for those patients who lie in the high death rate regimen.

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