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1.
Chest ; 162(4):A1117, 2022.
Article in English | EMBASE | ID: covidwho-2060772

ABSTRACT

SESSION TITLE: SESSION TYPE: PRESENTED ON: PURPOSE: Critical Care Medicine (CCM) patients admitted to the Intensive Care Unit (ICU) but receiving ongoing care in the Emergency Department (ED) while awaiting an Intensive Care Unit (ICU) bed has been a growing area of concern. This has occurred more frequently during the COVID-19 global pandemic and resultant surge conditions at many hospitals. METHODS: This project presents a retrospective chart review and analysis, inclusive of 455 patients admitted to the medical ICU but receiving initial care while in the ED at Cleveland Clinic Akron General between October 1st 2020 and January 1st 2022. Linear regression analysis was performed to compare the association of boarding time (in total minutes after CCM assumed care,) ICU length of stay, and total ventilator days. Logistical regression analysis was used to investigate the association between boarding time and in-hospital mortality. Patients were further stratified into a subset of those with a diagnosis of Acute Respiratory Failure (ARF) in the setting of COVID-19 positivity. RESULTS: The total number of patients admitted under the ICU service was 454 (n=454). The total number of patients in a subset with ARF in the setting of COVID-19 positivity was 275 (n=275). Median age was 62.8 +/- 16.9 years. Mean ED boarding time was 462 +/- 1108 minutes. There was a statistically significant association between boarding time and ICU length of stay and boarding time and ventilator days. Linear regression analysis showed the variance between the ED boarding time and length of stay to be 0.024% (p-value 0.0116) and with ventilator days to be 0.023% (p-value 0.0401). Logistical regression analysis investigating an association between boarding time and in-hospital mortality did not reveal any significant relationship between these two variables. For the sub-group of ARF and COVID-19 positivity, there were no statistically significant associations. CONCLUSIONS: The overall impact of boarding time on ICU length of stay and in-hospital mortality was rather small, yet statistically significant: for every one additional minute of boarding time, ICU length of stay increased by 0.024% and ventilator days increased by 0.023%. Forthcoming analysis will stratify patients based on acuity and risk-adjustment metrics, in order to further eliminate confounding factors which may influence boarding time. CLINICAL IMPLICATIONS: The question of ED-CCM boarding is worthy of further examination in the setting of new and increased demands and strain on the national Critical Care Medicine infrastructure, as a result of the COVID-19 pandemic. This project aims to characterize the problem further and explore associated outcomes. This may provide the basis for further investigations, or targeted interventions, around the issue of EM-CCM boarding. DISCLOSURES: No relevant relationships by Amit Diwakar No relevant relationships by Zachary Jerusalem No relevant relationships by Palak Rath No relevant relationships by Sterling Shriber

2.
13th International Conference on Intelligent Human Computer Interaction, IHCI 2021 ; 13184 LNCS:229-241, 2022.
Article in English | Scopus | ID: covidwho-1782735

ABSTRACT

Deep learning models have demonstrated state of the art performance in varied domains, however there is still room for improvement when it comes to learning new concepts from little data. Learning relevant features from a few training samples remains a challenge in machine learning applications. In this study, we propose an automated approach for the classification of Viral, Bacterial, and Fungal pneumonia using chest X-rays on a publicly available dataset. We employ distance learning based Siamese Networks with visual explanations for pneumonia detection. Our results demonstrate remarkable improvement in performance over conventional deep convolutional models with just a few training samples. We exhibit the powerful generalization capability of our model which once trained, effectively predicts new unseen data in the test set. Furthermore, we also illustrate the effectiveness of our model by classifying diseases from the same genus like COVID-19 and SARS. © 2022, Springer Nature Switzerland AG.

3.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277676

ABSTRACT

Introduction: Immune-related adverse events occur in 20% of cases of treated with checkpoint inhibitor agents and require immunosuppressive agents depending upon the severity. This leads to increased vulnerability to opportunistic infections such as Pneumocystis Jiroveci pneumonia (PJP). Here we present a patient with stage four Non small cell lung cancer (NSCLC) who underwent 4 cycles of chemoimmunotherapy with Carboplatin, Pemetrexed and Pembrolizumab. Subsequently, the patient was found to have PJP pneumonia. Case presentation: A 71-year-old Caucasian male, known to have hypertension, T2DM and stage 4 NSCLC (s/p right lower lobectomy) was being treated with palliative chemoimmunotherapy: carboplatin, pembrolizumab and pemetrexed. He completed 4 cycles. Pembrolizumab was discontinued in March 2020 due to concern for myositis. However, Pemetrexed maintenance was continued and he received his last and sixth dose in October 2020. He presented with worsening dyspnea and nonproductive cough for 1 month without any h/o fever, sweats or chills. CT chest showed new diffuse bilateral ground-glass infiltrates with no pleural effusion or consolidation compared to a negative CT PE study one month earlier. COVID 19 testing was negative. He was given Solu-Medrol 1 g for 3 days, however he didn't improve. Initial differentials were checkpoint inhibitor pneumonitis, drug-induced pneumonitis, pulmonary alveolar proteinosis, unrecognized hypersensitivity pneumonitis, cryptogenic organizing pneumonia, and unlikely pneumocystis pneumonia or diffuse alveolar hemorrhage. The respiratory array test was negative. Sputum PCR was positive for Pneumocystis Jiroveci and he was started on Trimethoprim-Sulfamethoxazole (TMP-SMX) and Prednisone. TMP-SMX was continued for 21 days. The patient improved but required readmission, more steroids, and underwent bronchoscopy with BAL which confirmed the resolution of PJP infection. He was then treated for HAP and subsequently was discharged. Discussion: Immune suppression is very well known with standard chemotherapeutic agents.PJP infection is rarely encountered in patients with NSCLC and has a low incidence of 2.6 per 100,000 person-years. Sputum PCR has increased sensitivity to conventional stain approximately 100%. However, specificity varies depending upon the population: 20% colonization rate in healthy adults. The risk of this infection is associated with chemoradiotherapy, corticosteroids, and immunosuppression. Multiple similar case presentations have been reported in literature, with similar occurrence in lung cancer patients being treated with pemetrexed, pembrolizumab and methotrexate containing regimen. Although rare, we must keep PJP as a differential in NSCLC patients undergoing treatment with chemoimmunotherapy and presenting with pneumonia.

4.
2020 IEEE Bombay Section Signature Conference, IBSSC 2020 ; : 251-255, 2020.
Article in English | Scopus | ID: covidwho-1105132

ABSTRACT

The world is going through a very tough time due to the pandemic, and people are only leaving their houses if it's unavoidable. As the lockdown restrictions begin to ease slowly, wearing masks, sanitization and social distancing has become a priority. Safety workers are putting their lives on the line to ensure the safety of the citizens. This paper presents a product in the form of an automated kiosk that aims to reduce the load on the safety workers, while efficiently screening people entering any premises. The kiosk was deployed in a real commercial environment, and thousands of people have used it. The goal of the research paper is to answer this research question - What can be the best solution in this situation in order to safeguard the premises? © 2020 IEEE.

5.
2020 IEEE Bombay Section Signature Conference, IBSSC 2020 ; : 186-191, 2020.
Article in English | Scopus | ID: covidwho-1105130

ABSTRACT

COVID-19 is considered as threat to mankind, the educational technologists and academicians are considering it as an opportunity to develop and carve out new horizons as far as online teaching - learning is concerned. Thus developed technologies and methodologies during this pandemic situation will continue to be in existence and impact the world even though the so called pandemic situation remains in existence or not. An inter-institute faculty student peer collaboration has been initiated and is ongoing between an premium institute Indian Institute of Technology Bombay and another premier self-financing autonomous institute G. H. Raisoni College of Engineering Nagpur with involvement of NPTEL for the development of MOOC of Digital Signal Processing course. Philosophy of this novel initiative for noble cause is to make best teaching standards in the country accessible to a large number of student and other stakeholders and to provide them with an experience of learning at par with live interaction as student peers from IIT Bombay have. The implementation methodology, results, current status and future scope of ongoing endeavor is presented in this paper. The paper is having six sections. The outcomes in the form of takeaways for partnering institutes are presented with the current status of the ongoing inter-institute student - faculty peer collaboration. The future plans are presented in the last section with proposed involvement of another institute PVG's College of Engineering, Pune in the collaboration to expand its reach, scope and horizon leading toward exploring the other avenues of joining hands to serve the society in the best possible way. © 2020 IEEE.

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