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Medical Journal of Malaysia ; 77(Supplement 5):20, 2022.
Article in English | EMBASE | ID: covidwho-2313954


Introduction: Nirmatrelvir/ritonavir (Paxlovid) was approved in December 2021 for infected individuals at high risk of progressing to severe COVID-19 and require hospitalization. A scoring was established in the local COVID-19 treatment guideline to select those infected and at high risk at primary care setting for Paxlovid therapy. The scoring quantified risk based on age, comorbidities, vaccine doses, body mass index (BMI), and chest radiograph changes. This study aimed to assess the performance of the scoring and parameters. Method(s): A case was an infected individual who progressed and being hospitalized. A total 551 patients (98.7% symptomatic infections without pneumonia and 1.3% with mild pneumonia) were recruited including 260 (47.2%) cases and 291 (52.8%) controls between January and February 2022. Receiver-operating-characteristic (ROC) was applied to investigate performance and optimal cut-points for the scoring, as well as individual parameter. Result(s): The existing scoring presented a poor accuracy of 65.0% with 3 as the cut point score. The accuracy can be improved to 70.0% when using 2 as the cut point score. The accuracy would improve further to 74% by modifying the age cut point from 60 to 35 years, BMI from 30.0 to 35.0 kg/m2 and applying 100 days as the cut point for duration from the last vaccine dose. Hypertension, cardiovascular diseases, and chronic lung diseases presented a relatively high risk for disease progression and hospitalization, therefore should be assigned more points. Conclusion(s): The existing scoring was suboptimal and should be optimized by incorporating new cut points for age, BMI and vaccine duration, and giving more weightage to more significant comorbidities.

International Journal of Rheumatic Diseases ; 26(Supplement 1):132.0, 2023.
Article in English | EMBASE | ID: covidwho-2229293


Background: Covid-19 infection has caused a global pandemic in the recent years and although initially it was considered mainly a respiratory ailment it has proven over time to cause a constellation of complications across various systems such as hematological, immune, cardiovascular, gastrointestinal, and neurological. Method(s): We report a case of a lupus patient with Covid-19 infection who presented initially with fever and gum bleeding with a negative dengue serology and negative HIV serology. Result(s): A 45-year- old lady with a 30-year history of SLE was admitted to our hospital with Covid 19 infection. She had relatively stable disease over the past few years but was admitted to the hospital with complaints of fever, gum bleeding and shortness of breath with no chest x-ray changes. Her oxygen saturations were 95% under room air and her vital signs were stable. Laboratory examinations revealed raised white cell count (11.63) with neutrophilia and elevated C-reactive protein (2.84mg/dl). Her platelet count was low at 113 when compared to her baseline of 549. An urgent peripheral blood film showed an incidental finding of Stomato-ovalocytosis with mild anaemia however there was no features of haemolysis. She was initially treated as acquired Immune thrombocytopenia provoked by Covid-19 infection and was started on IV hydrocortisone. She had a lack of response as evident of a further decline in her platelet counts and the following day, she developed rapid decline in her renal function wherein her creatinine increased from 83 to 207. An urgent ultrasound doppler of the kidneys to rule out acute renal vein thrombosis was organised however it showed normal patent renal vessels. Peripheral blood films were repeated which showed minimal schistocytes and the diagnosis was clinched with the Adamst13 activity levels being less than 0.2%. She was started on 20g IVIG per day with plasma exchange however succumbed to the illness. Conclusion(s): The diagnosis of TTP classically involves the recognition of the pentad of fever, microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure, and neurological abnormalities however 60% of patients do not fulfil the pentad. It is essential to recognize that Covid-19 is an acquired cause of TTP, and a high index of suspicion must be maintained for early treatment institution.

Wearable Telemedicine Technology for the Healthcare Industry: Product Design and Development ; : 33-52, 2021.
Article in English | Scopus | ID: covidwho-1797350


Blockchain has three main features-decentralization, immutability, and encryption-that can cover multiple fields of use in the healthcare industry. Telemedicine, a relatively new field, stems from telecommunications' contribution to healthcare services' remote delivery. This area has observed many benefits of Blockchain technology. However, innovative techniques for secured and authenticated data transfers still need to be put forward in this new digitization era. Healthcare professions use the opportunities provided by the Blockchain technology (BCT) in accessing the patient's information in a decentralized format. Though the decentralization aspect improves the overall robustness of current healthcare systems, trust and traceability are the key action points that need to be focused on. BCT paired with smart contracts automates operations and services of telehealth and telemedicine in an efficient and trustful way. Several case studies and models have been discussed and proposed, demonstrating the practicality of secured data transfers using BCT in the telehealth and telemedicine domain. BCT has hopefully assisted in the safe sharing of data information, from cryptographic record keeping of a person's information to easy access and access everywhere. Telemedicine has had significant security issues, but Blockchain's ability to develop and maintain a secure network when exchanging data has allowed easy information flow. This chapter presents various models and frameworks proposed in the state-of-the-art and discusses their implications for patient engagement and empowerment. These models are discussed in terms of their performance and cost in providing secured and private data sharing. Cost, lack of awareness on how to implement it, and lack of standardization are obstacles preventing Blockchain's adoption in telemedicine. The COVID-19 pandemic has boosted telehealth and telemedicine technology uptake, where BCT could be a prevailing solution. The interest in providing hospital care in the patient's home is also growing, an approach where multiple investors are pouring money into companies working on remote monitoring of different health and telemedicine parameters. There is currently limited research on Blockchain applications for telemedicine, but more research is available every day. Blockchain is now one of the most active fields of software science, and by restoring authority over medical records and health data to the patient, it will shift the hierarchy of healthcare. © 2022 Elsevier Inc. All rights reserved.