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1.
Frontiers in Dental Medicine ; 2, 2021.
Article in English | Scopus | ID: covidwho-2323337

ABSTRACT

The coronavirus disease-2019 (COVID-19) pandemic has imposed a situation where all healthcare facilities except emergency services remain suspended. These times generated the necessity for the implementation of a healthcare delivery system that can be accessed digitally and, thus, benefit the majority of children as well as healthcare professionals. This review aims to propose a sound model of less technique sensitive, safe and handy strategies for dental traumatic injuries, endodontic and restorative concerns, and orthodontic urgencies until complete clinical help can be sought. Five hundred thirty articles were obtained from the PubMed, Google Scholar, Embase, Lilacs, and Cochrane databases published from 2011 to 2021. Nineteen articles that described teledentistry in the COVID-19 era were included. Teledentistry can serve as a vital patient management strategy that can aid in triaging urgent and elective patient treatment needs, ultimately easing the burden of clinics and at the same time providing a safer means of consultation. Copyright © 2021 Goswami, Nangia, Saxena, Chawla, Mushtaq, Singh and Jain.

2.
Journal of Investigative Dermatology ; 143(5 Supplement):S39, 2023.
Article in English | EMBASE | ID: covidwho-2293213

ABSTRACT

Introduction: The crucial role of infection control measures has been emphasized in controlling the spread of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). More rigorous hand hygiene and face mask practices have led to increased reports of skin problems of the hand and face. A retrospective survey was conducted to investigate the incidence and severity of occupational skin disease in healthcare workers (HCWs). Method(s): An electronic survey was circulated to HCWs working in two London hospital sites between January 2021 to May 2021. Demographics, details on hand washing, alcohol gel, emollient and face mask use was recorded alongside details of skin disease. Result(s): 75 responses were recorded from doctors (57%), nurses (20%), healthcare students (12%), therapists (7%) and students (4%). 19 people (25%) washed their hands more than 30 times a day, 37 (49%) people 10-30 times, and 12 people (16%) washed between 5-10. Similar results were found for alcohol gel use. 34 (47%) did not apply emollient once during a shift. Common hand symptoms included dryness (89%, n=67) and erythema (65%, n= 49). 73 (97%) HCWs wore face masks more than 4 hours/day, with common facial symptoms being acneiform lesions (71%, n=43) and erythema (62%, n=37). 61 participants were unsure who to contact regarding occupational skin disease. Discussion and conclusion: Our results illustrate high levels of occupational skin disease in HCWs, including symptoms of xerosis and dermatitis. Campaigns to improve knowledge and adherence regarding emollient application may help to substantially minimize the prevalence of occupational skin disease among HCWsCopyright © 2023

3.
Value in Health ; 25(12 Supplement):S474, 2022.
Article in English | EMBASE | ID: covidwho-2211010

ABSTRACT

Objectives: This study aimed to explore the impact of COVID-19 on patients with PTSD and the burden of resource utilization in the pre- and during the COVID-19 pandemic. Method(s): This retrospective observational study included patients diagnosed with PTSD between 1st January 2018 to 31st December 2020 using ICD-10-CM codes from Optum's de-identified Clinformatics Data Mart database. In the study duration, distinct patients were identified and further classified by age, gender, and location of service. To determine the influence in pre- and during COVID-19 for each of the stratification variables, a year-wise comparison was done. Chi-square was performed as test of significance for categorical variables. Result(s): Overall we observed the number of PTSD patients increased by 7% (n=206,741) during the pandemic (1st January 2020 - 31st December 2020) vs pre-pandemic (1st January 2019 - 31st December 2019). A significant increase was seen across all age groups (p<.05). In the case of teenagers, PTSD was found to have increased by 22% whereas in adults and the elderly an 8% and 3% increase was seen respectively. When broken down by gender, a significant increase was observed. Females (+9% [n=143,032]) were seen to have been affected more compared to males (+4% [n=63,625]) during the pandemic vs pre-pandemic. In healthcare resources utilization overall, there was an observed 24% increase. For both inpatients and office, PTSD decreased significantly (-3% and -4% respectively) (p<.05);while ER visits, increased only by 1% (p<.05). A significant increase in outpatient and telehealth services was observed (122% and 454% respectively) (p<.05). Conclusion(s): An increased exacerbation in PTSD was observed during the pandemic with respect to burden across various stratification and resource utilization;especially in outpatient and telehealth services. Better treatment, psychotherapy and alternative care programs may be required to curb this impact and decrease the overall burden across various care setting. Copyright © 2022

4.
Critical Care Medicine ; 51(1 Supplement):554, 2023.
Article in English | EMBASE | ID: covidwho-2190670

ABSTRACT

INTRODUCTION: Since the start of the COVID-19 pandemic there has been an evolution of variant strains that have spread throughout the world. As time has passed, clinicians have appreciated that these variants have different symptomology and clinical course. As our understanding of the disease process has progressed, medical management has evolved. Throughout, cancer patients have represented a uniquely at-risk population. We sought to compare the characteristics of critically ill cancer patients with Omicron variant to those infected with the ancestral strain. METHOD(S): Single-center retrospective cohort study analyzed all cancer patients >=18 years of age with current or past (< 2 years) diagnosis of cancer, who were admitted to ICU with COVID-19. The ancestral strain period was defined as March 1 to June 30, 2020, and the Omicron variant period was December 15, 2021 to April 1, 2022. Demographics, clinical and laboratory data of critically ill cancer patients were extracted from electronic health record and an ICU database. RESULT(S): A total of 127 patients were analyzed (38 Omicron and 89 ancestral strain). Median age was similar (67 years Omicron, 65 ancestral) and slightly higher male (47% Omicron, 58% ancestral). There was a higher number of hematologic malignancy (53% Omicron, 43% ancestral). Mechanical ventilation and vasopressors were less commonly used (58% and 53% Omicron, 67% and 71% ancestral), respectively. Prone positioning was utilized less frequently (47% Omicron, 56% ancestral) as was tracheostomy (11% omicron, 34% ancestral). ICU mortality was similar in both groups, (39% vs 37% however, hospital mortality was higher (55% Omicron group, 45% ancestral). CONCLUSION(S): Critically ill cancer patients infected with the Omicron variant may be less likely to undergo tracheostomy however, they are more likely to die during their hospitalization. Even with higher hospital mortality Omicron patients also seemed to be less acutely ill as their requirement for mechanical ventilation, vasopressors and prone positioning was lower. This should be considered as we counsel patients and set expectations about what might happen during a COVID admission to the ICU.

5.
Journal of Information & Optimization Sciences ; 43(6):1353-1361, 2022.
Article in English | Web of Science | ID: covidwho-2160522

ABSTRACT

The pandemic situation caused by COVID-19 has forced most IT companies in India to conduct work from home until 2021. Organizations have thought that by shifting the workspace from office to home, they would be able to combat the pandemic situation. The shift of the workplace during the pandemic has augmented employee anxiety, stress and burnout, which have further resulted in employee disengagement. The regression analysis has been used to study the impact of COVID-19 and identify the key drivers that largely impacted employee engagement during the pandemic. The present study has tried to lay a foundation for investigating employee engagement amid the pandemic and post-pandemic mainly in the IT sector.

8.
1st International Conference on Technologies for Smart Green Connected Society 2021, ICTSGS 2021 ; 107:3505-3521, 2022.
Article in English | Scopus | ID: covidwho-1874767

ABSTRACT

Employee Wellness Programs play a very significant role in the holistic development of an employee. Wellness Programs in the wake of COVID 19 have become an essential requirement for all employees. Living and working during a pandemic coupled with higher stress levels and a time-compressed schedule exemplifies the need for wellness programs as a predominant technique for employee engagement. The present study reviews the theoretical literature about wellness programs, an employee engagement technique, pre and during pandemic between 2017 - 2021 from refereed journals (Web of Science, Science Direct, SCOPUS, JSTOR, ERIC, DOAJ). To address employee issues through wellness programs, a comprehensive systematic review of literature has been done to redesign wellness programs in unprecedented times. The study aims to assess four key dimensions of wellness programs: emotional, intellectual, social, and financial that can help an employee live the best life possibly - mentally, emotionally, and professionally. The present study highlights that a good employee wellness program boosts organizations productivity. © The Electrochemical Society

9.
Endocrine Practice ; 27(6):S68-S69, 2021.
Article in English | EMBASE | ID: covidwho-1859543

ABSTRACT

Objective: Flash Continuous Glucose Monitoring (flash CGM) has been rapidly accepted in real life clinical setting. Methods: We conducted a cross sectional study across two centres, delivering the similar standard of care, over three years (n=362), in patients who utilised FreeStyle Libre Pro CGM to understand glycemic metrics and variability. The key glycemic metrics;TIR, Time Below Range (TBR), Time Above Range (TAR), estimated HbA1c, average glucose was analysed. Descriptive statistics, Pearson r and ANOVA were utilised for analysis. Results: Overall, in total 24.8% (90/362) were in TIR >70%, with 14.7% (18/122) patients in 2018, 17.6% (30/170) in 2019 and 60% (42/70) in 2020. In total 37% (134/362) were in TAR < 25%, 29.5% (36/122) in 2018, 28.2% (48/170) in 2019 and 71.4% (50/70) in 2020. In total 45.3% (164/362) were in TBR < 4%, 44.2% (54/122) in 2018, 46.4% (79/170) in 2019 and 44.2% (31/70) in 2020. Overall, 9.3% (34/362) achieved all three metrices (TIR >70%, TAR < 25%, TBR < 4%), with 4.9% (6/122) in 2018, 7.6% (13/170) in 2019, 24.2 (17/70) in 2020. There was a significant negative correlation between the eHbA1c and TIR (Pearson r – 0.74, 95% CI -0.79 to -0.69, p < 0.0001). There was significant improvement in TIR and TAR over three years. The eHbA1c (6.5%) and average glucose (139.7mg/dl) were lowest in the year 2020, which were comparable with values in previous years. Lesser hypoglycaemic events were noticed in CGM. (figure). [Formula presented] Discussion/Conclusion: There was a significant change in the glycemic metrics. We attribute the remarkable improvement, over three years, to the better awareness in the patients to manage diabetes, greater adoption of guideline directed, contemporary therapeutics including SGLT2 inhibitors, advanced insulins. This coincided with the COVID-19 induced fear of mortality and lockdown led better metabolic health, that resulted in better self-care of diabetes.

10.
Endocrine Practice ; 27(6):S60-S61, 2021.
Article in English | EMBASE | ID: covidwho-1859541

ABSTRACT

Objective: Continuity of care has demonstrated positive outcomes from the advanced countries with insurance care model. There is limited evidence for the benefits from developing countries, in limited resource setting where the patients directly pay from the pocket for the diabetes care. Methods: We retrospectively analysed the relationship between the continuity of care and the glycemic control in patients who atleast had a biannual visit to our comprehensive care centre from 2016 to 2020 (n=1160). Results: The mean number of visits in the year 2016, 2017, 2018, 2019 and 2020 were 3.6 (±1.6, max 11, 95% CI 3.38 to 3.98), 5 (±2.5, max 16, 95% CI 4.5 to 5.5), 4.8 (±2.1, max 12, 95% CI 4.4 to 5.2), 4.7 (±2.2, max 14, 95% CI 4.3 to 5.1), 3.4 (±1.6, max 12, 95% CI 3 to 3.7) (p< 0.0001), respectively. The mean number of visits cumulatively for the continuous five years for each patient was 22 (±7.9, min 11, max 56, 95% CI 20 to 23). The mean number of HbA1c readings done cumulatively for the continuous five years for each patient was 22 (±3.8, min 1, max 17, 95% CI 3.3 to 4.4). The mean interval (days) between the two consecutive visits was 85 (±26, min 33, max 155, 95% CI 81 to 90). The mean number of HbA1c tests were 3.8 (±2.8, min 1, max 17, 95% CI 3.3 to 4.4). The mean number of visits were 4.3 (±1.6, min 2.2, max 11, 95% CI 4 to 4.6). There was a non-significant positive correlation between the mean number of visits and the mean HbA1c readings (Pearson r 0.113, p= 0.22). The baseline value of HbA1c (%) was 8.0 (±1.5, min 5.3, max 13.3, 95% CI 7.7 to 8.3), which reduced by 0.7 when compared for the minimum value of HbA1c achieved at any point of time as mean 7.2 (±7.2, min 4.8, max 10.9, 95% CI 7 to 7.5), (p< 0.0001). There were 360 patients who had atleast one visit in 3 months and achieved HbA1c < 7, as compared to 250 patients with more than 3 months interval for consecutive visits and with HbA1c ≥ 7 (p=0.0404, OR 1.2 95% CI 1.01 to 1.62). COVID-19 induced lockdown led to the decrease in the patient visits in the year 2020. There were 55 all cause hospitalizations. Discussion/Conclusion: The results of our study demonstrate that comprehensive diabetes care have a potential positive implication, even in out-of-pocket ecosystem, which can drive the demand for a continuous follow up visits. We attribute long continuity of care for the smaller number of hospitalizations.

11.
Endocrine Practice ; 28(5):S47, 2022.
Article in English | EMBASE | ID: covidwho-1851057

ABSTRACT

Objective: Uncontrolled hyperglycaemia is associated with poor clinical outcomes in patients with COVID-19. Basal-bolus (BB) insulin regimen is recommended for intensification and is safe and effective. However, this is complex in COVID era, especially for initiation with challenges in deployment of healthcare personnel with gaps in required expertise. Hence, implementation of an effective insulin therapy is challenging. Methods: We evaluated the impact of initiating premix analog insulin regimen (PA) in T2D patients diagnosed with COVID-19 during the second wave of the pandemic (n=434), who consulted virtually. Insulin initiation was based on random blood sugar (RBS) as reported through SMBG by the patients who were already under regular care, across two dedicated diabetes management centres. Patients were advised to contact over Whatsapp in case self-reported RBS was above 300 mg/dL Results: The mean age of the patients was 59 years (SD±13, 95% CI 58 to 60). 256 were male. 48 patients (11%) were started with basal insulin (43 glargine, 5 degludec) and were optimally managed by dose uptitration. There were 92 patients (21.1%) who were initiated on PA twice daily to achieve glycemic control. Of these, 56 patients (12.9%) were diagnosed as moderate COVID-19 and required corticosteroids. Among these, 42 patients (75%), on PA regimen reported post lunch and dinner glycemic spikes which necessitated additional pre-lunch dose of premix analogue. 36 patients with mild COVID-19, were continued on PA twice daily and doses were uptitrated based on the SMBG reports. The rest 378 (87%) mild COVID-19 cases, were managed by standard care approach for diabetes care, including oral drugs. The mean RBS at the first consultation at insulin initiation was 211 mg/dL (SD±98, 95% CI 192 to 230). On first follow up teleconsultation;mean RBS in mild COVID-19 was 178 mg/dL (SD±50, 95% CI 138 to 195), while those who progressed to moderate COVID-19, RBS was 267 mg/dL (SD±101, 95% CI 210 to 298). On second follow up;mean RBS in mild COVID-19 was 168 mg/dL (SD±54, 95% CI 148 to 183) and in moderate COVID-19 was 203 mg/dL (SD±88, 95% CI 174 to 258). 138 patients (31.7%) needed uptitration of insulin regimen Discussion/Conclusion: Simplified insulin regimen based on premix analog insulin has the potential for timely initiation of insulin, titration and intensification to third dose of PA to optimise the management of T2D in COVID-19. Our study did not account for the compliance to beyond the second teleconsultation and the pandemic prevented the estimation of A1C and did not account for patients who transformed as severe COVID-19 patients who needed hospitalisation

12.
EAI Endorsed Transactions on Scalable Information Systems ; 9(35), 2022.
Article in English | Scopus | ID: covidwho-1744789

ABSTRACT

INTRODUCTION: Contact tracing is a method to track the victims, which have been infected from the host with any particular disease. Therefore, clustering based machine learning techniques can be employed for contact tracing. Contact tracing can be automated by using technology and thus helps us in producing much more accurate and efficient results. OBJECTIVES: This work aims at finding usefulness of clustering techniques for contact tracing. Two different clustering techniques namely density-based clustering and partitioning-based clustering have been used to analyse corresponding results for COVID-19 infected cases. The dataset is generated from a mock data generator with certain assumptions. RESULTS: The paper compares DBSCAN and K-means for contact tracing for COVID-19 Pandemic. The comparative analysis of two algorithms is presented. CONCLUSION: The effectiveness of certain clustering algorithms in COVID-19 contact tracing is analysed. DBSCAN performs well for clustering tasks. This work only focuses on possible techniques useful for contact tracing and does not claim any medical accuracy © 2021. Meenu Gupta et al., licensed to EAI. This is an open access article distributed under the terms of the Creative Commons Attribution license, which permits unlimited use, distribution and reproduction in any medium so long as the original work is properly cited

13.
Critical Care Medicine ; 50(1 SUPPL):571, 2022.
Article in English | EMBASE | ID: covidwho-1691818

ABSTRACT

INTRODUCTION: AS is an autoimmune condition, characterized by antibodies directed against an aminoacyl transfer RNA synthetase. AS has a highly heterogenous disease pattern due to different organ involvement. The initial clinical presentation can be variable. We present an atypical case of AS with ARDS. DESCRIPTION: A 72-year-old female, retired teacher, with no significant past medical history presented to the emergency department with complaints of progressively worsening shortness of breath for 3 to 4 weeks, associated with fever, nausea, vomiting, and diarrhea. Otherwise review of symptoms was negative. Patient was hypotensive, tachycardic and hypoxic requiring hi-flow nasal canula (FiO2 90%). A chest CT was negative for thromboembolic disease but did show bilateral patchy ground glass opacities with traction bronchiectasis and confluent consolidation in both upper lobes. Patient was admitted to the medical intensive care unit and initiated on antibiotics, but her hypoxemia progressively worsened requiring mechanical ventilation for ARDS. She required multiple proning sessions. Her bronchoscopy with bronchoalveolar lavage was negative for infectious etiology including COVID test. Given her persistent hypoxia, patient was started on methylprednisolone due to concerns for interstitial lung disease (ILD). Patient's oxygenation significantly improved, and she was extubated 10 days later. Further investigations revealed positive anti-PL-7 directed against threonyl t-RNA synthetase. Case was discussed in the ILD multidisciplinary conference with pulmonary and thoracic surgery. In the light of her ongoing oxygen requirements, there was high suspicion of rapidly progressive form of antisynthetase syndrome. Therefore, she was started on 60 mg prednisone, tacrolimus, and cyclophosphamide. Patient was discharged to a skilled-nursing facility. DISCUSSION: AS can be a challenging diagnosis, especially in patients without any muscular or rheumatological symptoms that present with ARDS. It is critical to have a broad differential for patients with non-resolving ARDS. ILD as the initial presentation of AS is a major cause of mortality. Currently there is limited evidence-based recommendations to guide therapy. Additional randomized clinical trials would be needed to support guidelines directing the management of AS ILD flare.

14.
Journal of Pharmaceutical Research International ; 33(45B):30-39, 2021.
Article in English | Web of Science | ID: covidwho-1497877

ABSTRACT

Aims: To assess medical students' perception of online teaching to suggest transforming the future curriculum in low-economic countries. Study Design: Cross-sectional online interview study. Place and Duration of Study: A team of collaborators interviewed final year medical and dental students of Pakistan from 07/08/2020 till 17/09/2020. Methodology: A questionnaire was developed based on open and close-ended questions in Google forms;focusing on institutional preparedness, views on online education, the institute's closure and COVID-19, and long-term effects of closure of the institute. Independent fellow researchers systematically analyzed the unaltered transcripts of the responses, and themes were then identified and coded to conclude the results. SPSS version 23 used for analysis. As this study was based on final year students. Results: In response to an invitation email, 2442/2661 (91.77%) students voluntarily participate in this qualitative study. Most participants were females (1614, 66.10%). Closing down institutes was directly linked to a lack of motivation and feel of helplessness. As most showed dissatisfaction with online teaching compounded by psychological effects, students feared losing clinical skills and life during the pandemic. Conclusion: The psychological impact of the crisis led to resistance to accepting the change for a better outcome. Incorporating telemedicine, different interactive learning style to online teaching, and resilience training would result in fruitful outcomes. Developed countries may also guide build infrastructure in developing countries to develop a more robust online teaching methodology in the long-run.

15.
Transfus Clin Biol ; 29(1): 60-64, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1322364

ABSTRACT

BACKGROUND AND OBJECTIVES: Seroprevalence estimation of COVID-19 is quite necessary for controlling the transmission of SARS-CoV-2 infection. Seroprevalence rate in recovered COVID-19 patients help us to identify individual with anti-SARS-CoV-2 antibodies and its protective nature. The objective of present study was to evaluate seroprevalence of SARS-CoV-2 among potential convalescent plasma donors and analysis of their deferral reasons. MATERIALS AND METHODS: A total 400 potential convalescent plasma donors were enrolled over five-month period for this prospective study. Inclusion criteria were lab confirmed COVID-19 recovered patients and 14 days of symptoms free period. All prospective plasmapheresis donors were tested for IgG SARS-CoV-2 antibody through chemiluminescent microparticle immunoassay, CBC, serum protein, blood grouping along with other required test for normal blood donation as per Drugs & Cosmetics Act. After pre donation testing and medical examination if donor was found to be ineligible for plasmapheresis was deferred. Seroprevalence rate was calculated by positive IgG antibody test results among the potential plasma donors. RESULTS: Seroprevalence rate was 87% for IgG SARS-CoV-2 antibodies in prospective convalescent plasma donors (recovered COVID-19 patients). There was no significant difference in seroprevalence rate between different sub-groups with respect to gender, age, blood groups, Rh factor, mode of treatment, day of Ab testing and repeat plasma donation. Most common reason for their deferral was absent IgG SARS-CoV-2 antibodies (13%) followed by absenteeism of eligible screen donors (6.7%), low Hb (1.7%) and poor veins for plasmapheresis (1.7%). Till five-month study period none of the plasmapheresis develop symptoms of reinfection with COVID-19. CONCLUSION: In all, 13% recovered patients did not develop IgG antibodies after SARS-CoV-2 infection. SARS-CoV-2 IgG antibodies persist for quite some time and are protective against reinfection. More long-term serology studies are needed to understand better antibody response kinetics and duration of persistence of IgG antibodies.


Subject(s)
COVID-19 , SARS-CoV-2 , Antibodies, Viral , Blood Donors , COVID-19/therapy , Humans , Immunization, Passive , Prospective Studies , Seroepidemiologic Studies , Tertiary Care Centers , COVID-19 Serotherapy
18.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277459

ABSTRACT

Rationale:Acute respiratory failure (ARF) is the leading cause of intensive care admission for patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Noninvasive respiratory support devices assist select patients with worsening ARF. However, delaying intubation may be associated with an increased mortality rate which stems from cardiovascular complications and volume induced lung injury.Prior research has shown correlations between point of care ultrasound measurements and success or failure of weaning intubated patients. There is a paucity of data analyzing the relationship between ultrasound measurements and the requirement of intubation in patients on non-invasive respiratory support. This study evaluates whether ultrasound measurements of diaphragm movement (diaphragm inspiratory time (TI), diaphragm excursion time index (E-t index)) and lung ultrasound score (LUS) among SAR-CoV-2 patients on non-invasive respiratory support would identify those at risk for failure necessitating intubation. Method: Prospective single center observational study. Recruitment was considered for patients with SAR-CoV-2 on noninvasive respiratory support: non-rebreather face mask (NRB), high flow nasal cannula (HFNC), or noninvasive positive pressure ventilation (NIPPV). Independent observers measured E-t index, TI and LUS. The clinical care team was blinded to the involvement of the patient in the study. Welch's two-sample t-tests detected differences in the lung ultrasound parameters distribution between the intubated and non-intubated groups. Association between lung ultrasound parameters and intubation events were evaluated by using a multivariable logistic regression analysis and fitting the lung ultrasound parameters and time component on the likelihood of intubation. Results were statistically significant if p<0.05. Result: 89 LUS and diaphragm measurements were performed from March 2020 to May 2020. Patients requiring intubation had higher mean LUS but lower mean inspiratory time (TI) and lower mean E-T index. (Table 1). Higher LUS was associated with higher odds of being intubated by a factor of 1.17. Conversely, a higher TI was associated with lower odds of intubation. Area under curve for a receiver operator curve of 0.85 with a sensitivity of 86% and specificity of 75% for TI and LUS. Conclusion: Our data shows that among SAR-CoV-2 infected patients with ARF, a reduced E-t index and TI and an elevated LUS are associated with intubation. A lower TI is independently associated with intubation. Among the intubated, the mean LUS was higher than those who were not. LUS more than or equal to15 predicted receipt of invasive ventilation with a sensitivity of 92% and a specificity of 45 % (AUC = 0.72).

19.
Indian Journal of Community Health ; 32(3):564-568, 2020.
Article in English | ProQuest Central | ID: covidwho-908457

ABSTRACT

On 31st December 2019, China informed local WHO office of "cases of pneumonia of unknown etiology detected in Wuhan. As of 6th May 2020, there are nearly 3.6 million cases of corona virus infection and approximately 0.25 million deaths worldwide. The real-time data regarding the actual number of cases, as it originates from the epicenter is the key to the estimation of the case fatality rate, hospitalization rates, expected timeline of arrival of contagion, and other epidemiological data. The novel virus has no available literature pertaining to its epidemiological parameters, on which experts can base their estimates and hence the challenge in planning for epidemic management. Bolstering this challenge are the reports alleging under-reporting by Chinese authorities. Alleged toned down numbers could have led to erroneously low estimates contributing to inadequate public health response globally. We conducted a simulation on epidemiological model of COVID-19 to find out expected time off arrival of infections and mortality in different countries and compared this to actual data. © 2020, Indian Association of Preventive and Social Medicine. All rights reserved.

20.
Chest ; 158(4):A350, 2020.
Article in English | EMBASE | ID: covidwho-866530

ABSTRACT

SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Bacterial and fungal infections in COVID-19 patients have been inadequately studied and reported. The purpose of this study is to determine the incidence and outcomes of superinfections in patients with COVID-19. METHODS: A retrospective observational study of all patients diagnosed with COVID-19 at Fairview Hospital-Cleveland Clinic. Main outcomes were incidence of bacterial, viral and fungal infections among COVID-19 patients and in-hospital mortality. RESULTS: There were 82 patients diagnosed with COVID-19. Fifty-one (62.2%) were male and median age was 64.5 years. On admission, 48 (58.5%) patients were admitted to ICU and 13 (15.9%) required mechanical ventilation. Of all patients, 22 (26.8%) developed superinfection during admission. Only three had positive PCR for other viruses;two had respiratory syncytial virus and one had influenza A. Methicillin resistant staphylococcus aureus (MRSA) was detected in 5 (6.1%) patients. Superimposed bacterial pneumonia were detected in 13 (12.2%) patients;2 MRSA, 2 methicillin sensitive staphylococcus aureus, 2 Corynebacterium striatum, 2 pseudomonas aeruginosa, 2 mycoplasma pneumoniae, 1 legionella, 1 serratia marcescens and 1 klebsiella pneumoniae. Only one patient had aspergillus fumigatus lung infection. Positive blood cultures were detected in 4 (4.9%) patients and included a case of candidemia. Urinary tract infection was diagnosed in 10 (72%) patients, and only 2 had a foley’s catheter. Corticosteroids were used in the treatment of 37 (45.1%) patients, with only 8 of the 22 patients who developed superinfections. Compared to the no superinfection cohort, patients who developed superinfection were more likely to require ICU admission (77.3% vs 53.3%, p 0.05), develop circulatory shock (59.1% vs 30.0%, p 0.016), require mechanical ventilation (63.6% vs 33.3%, p 0.014) and had lower median absolute lymphocytes count (1455/mm3 vs 5700/mm3, p 0.006). In multivariate analysis, circulatory shock (p 0.046) and need for mechanical ventilation (p 0.037) remained significantly associated with superinfection. Median time to superinfection development was 5 days with an overall mortality of 19.5%. The mean overall survival time among patients who developed superinfections was not significantly different compared to no superinfection group, 53.5 days (95% CI: 46.7-60.3) and 48.5 days (95% CI: 42.6-54.5) respectively, (p 0.278). CONCLUSIONS: In our COVID-19 cohort the rate of superinfection was 26.8%. Superinfection was associated with higher rates of circulatory shock and mechanical ventilation. The use of corticosteroids was not associated with higher rates of infections. CLINICAL IMPLICATIONS: This study will help in identifying frequent infections among COVID-19 patients in an attempt to predict and treat superinfections early in the course of the disease. DISCLOSURES: No relevant relationships by Saira Afzal, source=Web Response No relevant relationships by Sura Alqaisi, source=Web Response No relevant relationships by Sanchit Chawla, source=Web Response No relevant relationships by Tariq Kewan, source=Web Response No relevant relationships by Aisha Saand, source=Web Response No relevant relationships by Talha Saleem, source=Web Response

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