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1.
Open Respiratory Medicine Journal ; 16(1), 2022.
Article in English | Scopus | ID: covidwho-2079931

ABSTRACT

Background: Better delineation of COVID-19 presentations in different climatological conditions might assist with prompt diagnosis and isolation of patients. Objectives: To study the association of latitude and altitude with COVID-19 symptomatology. Methods: This observational cohort study included 12267 adult COVID-19 patients hospitalized between 03/2020 and 01/2021 at 181 hospitals in 24 countries within the SCCM Discovery VIRUS: COVID-19 Registry. The outcome was symptoms at admission, categorized as respiratory, gastrointestinal, neurological, mucocutaneous, cardiovascular, and constitutional. Other symptoms were grouped as atypical. Multivariable regression modeling was performed, adjusting for baseline characteristics. Models were fitted using generalized estimating equations to account for the clustering. Results: The median age was 62 years, with 57% males. The median age and percentage of patients with comorbidities increased with higher latitude. Conversely, patients with comorbidities decreased with elevated altitudes. The most common symptoms were respiratory (80%), followed by constitutional (75%). Presentation with respiratory symptoms was not associated with the location. After adjustment, at lower latitudes (<30º), patients presented less commonly with gastrointestinal symptoms (p<.001, odds ratios for 15º, 25º, and 30º: 0.32, 0.81, and 0.98, respectively). Atypical symptoms were present in 21% of the patients and showed an association with altitude (p=.026, odds ratios for 75, 125, 400, and 600 meters above sea level: 0.44, 0.60, 0.84, and 0.77, respectively). Conclusions: We observed geographic variability in symptoms of COVID-19 patients. Respiratory symptoms were most common but were not associated with the location. Gastrointestinal symptoms were less frequent in lower latitudes. Atypical symptoms were associated with higher altitude. © 2022 Tekin et al.

2.
Asian Journal of Social Health and Behavior ; 5(2):68-74, 2022.
Article in English | Web of Science | ID: covidwho-2033315

ABSTRACT

Introduction: World Health Organization declared coronavirus disease-2019 (COVID-19) as global pandemic on March 20, 2020. Highly contagious nature of this new virus and high propensity for human-to-human transmission led to various challenges, one of them is stigma and discrimination. This led to ill-treatment, devaluation of affected individuals, termination of employment, abandonment, and physical violence. The current study attempts to assess the magnitude of social stigma and discrimination among COVID-19 survivors. Methods: Longitudinal study was conducted among COVID-19 survivors from June 2020 to February 2021 at tertiary care center, Jamnagar, Gujarat, India. Participants were contacted through telephone, interview was conducted at 1 and 6 months, using pro forma containing demographic details, "Stigma questionnaire " and "Discrimination questionnaire. " Results: A total of 420 participants of age 18-60 years participated in the study. Participants experienced personalized stigma had concerns regarding disclosure of illness and public attitudes. Discrimination at their respective workplace was also observed. Stigma was statistically significant related to gender and geographical area (F = 3.879, P < 0.05, R-2 = 0.45), while discrimination statistically significant related to geographical area (F = 2.407, P < 0.05, R-2 = 0.028). The stigma and discrimination was still prevalent after 6 months;however, there was a reduction in overall stigmatization which was statistically significant (P < 0.05). Conclusion: The large cohort of participants faced significant social stigma and discrimination in terms of personalized stigma, negative self-image, and workplace discrimination. Increasing awareness, knowledge about illness, and availability of treatment facilities can contribute in lowering the stigma.

3.
The British journal of surgery ; 109(Suppl 6), 2022.
Article in English | EuropePMC | ID: covidwho-2012477

ABSTRACT

Aim Extramedullary plasmacytoma are rare neoplasms, which mainly occur in the head and neck, the most common site being the nasal cavity or septum. Patients may present with epistaxis, nasal obstruction, or rhinorrhoea. Extension into the orbit is rare but can lead to visual disturbances. Method This case report pertains to a 69-year-old female patient who initially presented with a 6-week history of recurrent sinusitis, with left sided cheek pain and diplopia. Results A CT and MRI scan was performed, which showed opacification of the left maxillary, ethmoid and sphenoid sinuses with bony destruction of the medial and anterior maxillary walls and into the anterior soft tissues. The mass was completely obstructing the left nasal cavity extending into the inferomedial orbit. Staging CT scans also showed nodal disease in the neck. Biopsy with histology was positive for CD138, with diffuse proliferation of plasma cells of varying maturity and atypia. Additionally, mono IgG kappa was also positive as was CD45 suggestive of a lymphoid neoplasm. Bone marrow biopsy and PET scan confirmed there was no systemic involvement. Radiotherapy was initiated after the patient recovered from COVID -19. A repeat MRI scan 6 weeks post radiotherapy showed a partial response with reduction in the size of the tumour, resolution of the intra-orbital extension and disappearance of paraprotein. Conclusions This case report illustrates need for earlier consideration of EMP diagnostically to reduce the risk of conversion of the plasmacytoma to multiple myeloma, which is a known possibility and to ensure minimal delay in the commencement of treatment.

4.
Stem Cells Transl Med ; 11(Suppl 1):S15, 2022.
Article in English | PMC | ID: covidwho-2008612

ABSTRACT

Introduction: Stroke is the fifth leading cause of death in the United States. Tissue plasminogen activator and mechanical thrombectomy are the only effective treatments, but many patients are ineligible for these treatments. Objective: The objective of this study was to determine whether an intravenous infusion of a non-HLA matched, unrelated donor umbilical cord blood (UCB) would improve functional outcomes. Methods: We conducted a phase II multicenter, randomized (2:1), placebo controlled, double-blinded trial of UCB in adults with acute ischemic stroke. Patients had to have adequate immune function. Cord blood units were selected from U.S. public cord banks based on blood type, race, and cell dose. Study product was infused 3-10 days post stroke. Participants were randomized within strata of National Institutes of Health Stroke Scale Score (NIHSS) (<12 vs ≥12), and study center. The primary endpoint was change in Modified Rankin Scale (mRS) (baseline minus day 90). The study was powered at 80% (odds ratio of 2). Key secondary outcomes included functional independence at day 90 (mRS <2), NIHSS, the Barthel Index, infusion reactions, and adverse events. Results: Seventy-nine participants were enrolled at 6 centers when the trial was closed early due to slow accrual related to COVID19;73 participants (47 randomized to UCB) were included in the safety and efficacy analyses. The median (range) of the change in mRS was 1 (–2, 3) in UCB and 1 (–1, 4) in placebo. A shift analysis based on the proportional odds model showed an odds ratio of 0.9 (95% CI: 0.4, 2.3) after adjustment for baseline mRS and randomization strata. No differences were observed on the key secondary outcomes. There were 17 mild infusion reactions (27.6% UCB;15.4% placebo). The distribution of serious and non-serious adverse events was similar between arms. Discussion: This study demonstrated the safety of infusing non-HLA matched UCB to adults with acute ischemic stroke. Feasibility and logistics were challenging. The primary efficacy endpoint did not demonstrate benefit in this underpowered sample size. In a secondary ad hoc analysis, a trend of improved functional outcomes at day 90 in recipients of UCB more than 5 days post stroke (Figure 1) could be explored in future trials.Figure 1.Cord blood versus placebo odds ratio by treatment latency (days).

5.
Global Advances in Health and Medicine ; 11:39-40, 2022.
Article in English | EMBASE | ID: covidwho-1916543

ABSTRACT

Methods: Semi-structured interviews were conducted with 51 providers and 30 Veterans across 12 VHA Medical Centers (VAMCs). Interviewees included staff delivering and patients participating in tele WH coaching, tele WH educational classes, and tele-complementary and integrative therapies (e.g., acupuncture, chiropractic, yoga, Tai Chi, mindfulness or meditation). Interviews were transcribed and a content analysis was performed using a rapid approach. Results: Participants described a broad range of benefits associated with Veteran participation in teleWH services. These included: 1) Improved access to services that previously were not widely offered in-person;2) Increased comfort engaging in services, especially for specific Veteran populations (e.g., Veterans with PTSD, LGBTQ, women, and younger Veterans);3) Greater convenience, including less stress related to travel, length of time required to use services, and integration with workday;and 4) Increased engagement in self-care outside of classes or services. Disadvantages included: 1) Decreased socialization and opportunities for group interaction;2) Decreased access to touch-based services (e.g., acupuncture);3) Technological challenges with approved virtual platforms. Facilitator skill and tele health etiquette mattered greatly for satisfaction with tele WH. Background: The Veterans Health Administration (VHA) quickly responded to the COVID-19 pandemic by providing access to care via tele health. This rapid pivot occurred simultaneously with VHA's Whole Health transformation, which includes the integration of complementary and integrative health services, education, and coaching to develop self-care skills. This qualitative study explored providers' and patients' perspectives on the implementation and advantages/ disadvantages of tele-Whole Health services (tele WH). Conclusion: Tele WH is perceived to be a strong complement to in-person services and poses many physical and mental health benefits for patients. Attention to facilitator skills training and ease of virtual platform use is needed to increase engagement and make tele WH a viable patient centered option for care.

6.
Journal of Urology ; 207(SUPPL 5):e169, 2022.
Article in English | EMBASE | ID: covidwho-1886483

ABSTRACT

INTRODUCTION AND OBJECTIVE: Nephrectomy and venous thrombectomy is a challenging procedure with potential morbidity and mortality. Despite the increasing use of immune checkpoint inhibitors (ICI) in the management of advanced renal cell carcinoma (RCC), data regarding the outcomes of venous thrombectomy following ICI is limited. We evaluated the feasibility and perioperative outcomes of nephrectomy and venous thrombectomy following ICIs. METHODS: Patients with locally advanced or metastatic RCC with venous thrombus undergoing nephrectomy following ICI therapy were evaluated in four high-volume US academic centers between June 2017 and June 2021. Clinical data, perioperative outcomes, and 90-day complications were recorded. RESULTS: Out of 79 patients who received post-ICI nephrectomy, 27 had venous thrombus. Median (IQR) age was 64 (55-71) years. ICI regimens were Nivolumab ± Ipilimumab (n=19), and Pembrolizumab± Axitinib (n=8). Nephrectomy was indicated following either a good clinical response to ICI (n=24) or as a palliative surgery (n=3). Venous thrombi levels are shown in Table-1. Among all patients, 26 (96%) underwent radical and 1 (4%) partial nephrectomy;12 (44.5%) open, 12 (44.5%) robotic and 3 (11%) laparoscopic. One robotic case converted electively to open. Vascular procedures included renal vein thrombectomy (n=6), IVC thrombectomy and primary repair (n=19), IVC patch repair (n=1), and suprarenal cavectomy (n=1). No intraoperative complications were reported. Nine patients showed no viable tumor in the thrombus, of whom 2 had complete response in the primary tumor as well (ypT0N0). 90-day complication rate was 33% (n=9), with 8 patients (30%) requiring readmission (Table-2). One death was reported within 90 days due to COVID-19 infection. CONCLUSIONS: Nephrectomy and venous thrombectomy following systemic immune checkpoint inhibitor therapy is feasible. One third of patients show no viable tumor in the thrombus. Larger studies are needed to predict pathological response.

7.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880486
8.
Data Science for COVID-19: Volume 2: Societal and Medical Perspectives ; : 1-776, 2021.
Article in English | Scopus | ID: covidwho-1872878

ABSTRACT

Data Science for COVID-19, Volume 2: Societal and Medical Perspectives presents the most current and leading-edge research into the applications of a variety of data science techniques for the detection, mitigation, treatment and elimination of the COVID-19 virus. At this point, Cognitive Data Science is the most powerful tool for researchers to fight COVID-19. Thanks to instant data-analysis and predictive techniques, including Artificial Intelligence, Machine Learning, Deep Learning, Data Mining, and computational modeling for processing large amounts of data, recognizing patterns, modeling new techniques, and improving both research and treatment outcomes is now possible. © 2022 Elsevier Inc.

9.
Journal of the American College of Cardiology ; 79(9):2196-2196, 2022.
Article in English | Web of Science | ID: covidwho-1848389
11.
Pharmaceutical and Biomedical Research ; 7(2):97-104, 2021.
Article in English | EMBASE | ID: covidwho-1357931

ABSTRACT

Background: The National Task force constituted by the Indian Council of Medical Research (ICMR) and various International agencies has recommended the use of Hydroxychloroquine (HCQ) as prophylaxis for Coronavirus Disease 2019 (COVID-19). This measure was taken because of the urgent need to protect high-risk individuals like Health Care Workers (HCW) from contracting COVID-19. Objectives: This study aimed to assess the awareness, attitudes, and practices on using HCQ as prophylaxis to prevent COVID-19 infection. Methods: A cross-sectional study was conducted among the doctors working in Dr RML Hospital, New Delhi, India, a tertiary care public hospital involved in the care of COVID-19 patients. The invitation to participate was electronically circulated, and the consenting participants were allowed to access an online survey. The survey had a total of 23 questions that were designed to understand the awareness, perception, and practices of doctors regarding the use of HCQ as prophylaxis in COVID-19. Results: About 147 doctors participated in this survey. The major source of knowledge regarding HCQ prophylaxis was quoted as regulatory agencies (44%), particularly ICMR, and the main indication was reported as being a healthcare worker (60%). Most of the participants (91%) believed that the HCQ effect is not clear and felt more scientific data regarding the use of HCQ as prophylaxis for COVID-19. But many doctors (51%) still recommend using HCQ to their colleagues. Conclusion: In this study, we observed that most doctors were aware of the recommendations regarding the HCQ prophylaxis in COVID-19 and had good adherence to therapy but felt the need for more concrete scientific evidence for using HCQ.

12.
The Spine Journal ; 21(9, Supplement):S178, 2021.
Article in English | ScienceDirect | ID: covidwho-1347832

ABSTRACT

BACKGROUND CONTEXT During the COVID-19 pandemic, surgeons found ways to provide appropriate care while conserving inpatient resources and limiting potential exposure. For patients with adult spinal deformity (ASD), spine surgery often requires extended LOS and non-routine discharge. Given resource limitations during the COVID-19 pandemic and caution regarding hospital stays, surgeons have modified standard postoperative protocols to minimize patient exposure. PURPOSE The primary aim of this study was to compare LOS and discharge disposition of ASD patients undergoing surgery before and during the pandemic. Secondary aims were to compare the rates of 30-day complications, readmissions, and ED visits. STUDY DESIGN/SETTING Retrospective review of an institutional surgical registry. PATIENT SAMPLE A total of 117 patients with adult thoracolumbar deformity. OUTCOME MEASURES Outcome measures included LOS and discharge disposition (home vs non-home), as well as 30-day major complications, reoperations, readmissions and ED visits. METHODS We identified all patients who underwent elective thoracolumbar ASD surgery with ≥5 levels fusion at a tertiary care center during two distinct time intervals: Jul-Dec 2019 (Pre-COVID, N=60) and Jul-Dec 2020 (During-COVID, N=57). Outcome measures included LOS and discharge disposition (home vs non-home), as well as 30-day major complications, reoperations, readmissions, and ED visits. Regression analyses controlled for demographic and surgical factors. RESULTS Patients who underwent ASD surgery during the pandemic were younger (61 vs 67 years) and had longer fusion constructs (9 vs 8 levels) compared to before pandemic (p<0.05 for both). On bivariate analysis, patients undergoing surgery during the pandemic had significantly lower LOS (6 vs 8 days) and were more likely to be discharged home (70% vs 28%) (p<0.05 for both). After controlling for age and levels fused on multivariable regression, patients who had surgery during the pandemic continued to demonstrate a significantly lower LOS (IRR=0.83, p=0.015) and greater odds of home discharge (OR=7.2, p<0.001). Notably, there were no significant differences in reoperations, readmissions, ED visits, or major complications between the two groups (p>0.05 for all). CONCLUSIONS During the COVID-19 pandemic, the LOS for patients undergoing thoracolumbar ASD surgery decreased, and more patients were discharged home without adversely affecting complication or readmission rates. Lessons learned during the pandemic may help improve resource utilization without negatively influencing outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

13.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-290083

ABSTRACT

Bam-readcount is a utility for generating low-level information about sequencing data at specific nucleotide positions. Originally designed to help filter genomic mutation calls, the metrics it outputs are useful as input for variant detection tools and for resolving ambiguity between variant callers . In addition, it has found broad applicability in diverse fields including tumor evolution, single-cell genomics, climate change ecology, and tracking community spread of SARS-CoV-2. Here we report on the release of version 1.0 of this tool, which adds CRAM support, among other improvements. It is released under a permissive MIT license and available at https://github.com/genome/bam-readcount.

14.
16.
British Journal of Diabetes ; 21(1):8, 2021.
Article in English | EMBASE | ID: covidwho-1285583

ABSTRACT

Background: Diabetes mellitus has been considered a significant risk factor for morbidity and mortality for COVID-19.1 HbA1c levels are often used as a marker of poor glycaemic control and are one way of diagnosing pre-diabetes as well as diabetes.2,3 We tried to explore whether HbA1c levels could be an independent risk factor for mortality and morbidity in patients with positive coronavirus (SARS-COv-2) swabs. Methods: This was a retrospective multicentre study of coronavirus swab positive patients who had a recent HbA1c test. Their demographic data, medical history, COVID-19 swab and laboratory results, and final outcomes were analysed. Patients were divided into three groups;HbA1c in normal (group 1), pre-diabetic (group 2) and diabetic (group 3) ranges. Data were analysed using JASP and statistical computation using a χ2 test. Results: A total of 1,226 patients had SARS-CoV-2 RNA identification swabs between 10 February 2020 and 1 May 2020. A cohort of 120 of these patients had positive swab results and recent HbA1c results. Mortality rates for group 1 (normal HbA1c) and 3 (diabetic HbA1c) were relatively higher than group 2 (pre-diabetic HbA1c). Among group 2, female patients had greater mortality, perhaps because of fewer male patients, although overall co-morbidity was less (4/120 (3.33%) in group 2 compared with 18/120 (15%) in group 1 and 14/120 (11.66%) in group 3. Overall, 36/120 (30%) patients died and 84/120 (70%) survived. Survival curves after analysis of data showed that increasing HbA1c levels were associated with poorer outcomes across all groups. Analysis was significant with p=0.003. Conclusions: HbA1c levels in this study were an independent marker of increased risk of mortality in COVID-19 swab positive patients. The findings are statistically significant (p=0.003). Increased co-morbidities at normal HbA1c seem to have a contributing role in enhanced mortality.

17.
Computing ; : 21, 2021.
Article in English | Web of Science | ID: covidwho-1220479

ABSTRACT

COVID - 19 affected severely worldwide. The pandemic has caused many causalities in a very short span. The IoT-cloud-based healthcare model requirement is utmost in this situation to provide a better decision in the covid-19 pandemic. In this paper, an attempt has been made to perform predictive analytics regarding the disease using a machine learning classifier. This research proposed an enhanced KNN (k NearestNeighbor) algorithm eKNN, which did not randomly choose the value of k. However, it used a mathematical function of the dataset's sample size while determining the k value. The enhanced KNN algorithm eKNN has experimented on 7 benchmark COVID-19 datasets of different size, which has been gathered from standard data cloud of different countries (Brazil, Mexico, etc.). It appeared that the enhanced KNN classifier performs significantly better than ordinary KNN. The second research question augmented the enhanced KNN algorithm with feature selection using ACO (Ant Colony Optimization). Results indicated that the enhanced KNN classifier along with the feature selection mechanism performed way better than enhanced KNN without feature selection. This paper involves proposing an improved KNN attempting to find an optimal value of k and studying IoT-cloud-based COVID - 19 detection.

18.
Applied and Computational Mathematics ; 20(1):124-139, 2021.
Article in English | Web of Science | ID: covidwho-1220293

ABSTRACT

Artificial Intelligence has revolutionized medical sciences by providing effective ways of diagnosing various diseases. The main objective of this paper is to design a system which is able to diagnose possible presence of COVID-19 in a patient using Adaptive neuro fuzzy inference system (ANFIS). ANFIS is an approach which can be considered as a amalga-mation of artificial neural networks and fuzzy systems and hence providing advantages of both of them. Our proposed system functions with 5 variables as input and 1 variable as output. A comparative performance analysis of results obtained from ANFIS and fuzzy systems is also done which clearly depicts that ANFIS model outperforms fuzzy systems by achieving better accuracy than fuzzy systems for the diagnosis of COVID-19.

19.
IEEE Int. Conf. E-Health Netw., Appl. Serv., HEALTHCOM ; 2021.
Article in English | Scopus | ID: covidwho-1214726

ABSTRACT

The COVID-19 pandemic has wreaked havoc all over the world. The rising number of cases have overburdened healthcare systems even in the most developed countries. To ease the burden on healthcare systems a quick and efficient testing technique is needed. Currently, the RT-PCR testing is done with time consuming and laborious an alternative is a detection from Chest X-Ray images. It has been discovered in published studies that Chest X-Rays of COVID-19 patients have specific malformations that can be used to identify a positive case. Inspired by the work done on 'COVID-Net' by Linda Wang, Zhong Qiu Lin and Alexander Wong, a Deep Learning approach to detect coronavirus from Chest X-Ray images is used in this study. To surpass previous results the EfficientNet Convolutional Neural Network (CNN) model is proposed. This model not only achieves +2% accuracy, but it also attains higher sensitivity and Positive Predictive Values. The study uses the open source COVIDx dataset. It has approximately 14, 000 X-Ray images. To the best of authors' knowledge, this dataset contains the largest number of COVID-19 positive cases. The study offers a Deep Learning approach contributing to create an efficient COVID-19 detector that can be used in the real world. © 2021 IEEE.

20.
Critical Care Medicine ; 49(1 SUPPL 1):70, 2021.
Article in English | EMBASE | ID: covidwho-1193857

ABSTRACT

INTRODUCTION: With the SARS-CoV2 adversely affecting outcomes in obese patients, extracorporeal membrane oxygenation (ECMO) as a therapeutic option is increasingly being considered and used, however, no cutoff value for body mass index (BMI) has been identified. We present a unique case of acute respiratory distress syndrome (ARDS) successfully treated with veno-venous (VV) ECMO in a young patient with body mass index (BMI) 73.9 kg/m2 with COVID-19 infection. To our best knowledge this represents the highest BMI patient with COVID-19 successfully managed with VV ECMO to date. METHODS: An 18-year-old male with history of asthma, obstructive sleep apnea, and super morbid obesity, weighing 540 pounds presented with complaints of dyspnea. On admission he was afebrile, conscious and in mild respiratory distress. Initial laboratory findings showed troponinemia with peak levels 66.45ng/ml with signs of inferior wall ST elevation myocardial infarction in electrocardiogram for which thrombolytics were administered. Later COVID-19 test returned positive. Within less than 24 hours of admission, patient developed worsening hypoxic respiratory failure necessitating emergent endotracheal intubation. The patient continued to have hypoxia on 85% FIO2, positive end expiratory pressure (PEEP) 16 cm H2O. Neuromuscular blockade was initiated and the ECMO team was consulted. Patient was cannulated via the right internal jugular vein using a 32-French Crescent VV double-lumen bicaval ECMO cannula by the cardiac critical care team. During the course, patient encountered many challenges particularly with a difficult airway while maintaining infection control precautions, loss of airway pre- and post- cannulation while positioning, refractory hypoxemia owing to shunting due to high endogenous CO up to 20 liters/minute (treated with beta blockers) and septic shock after successful decannulation on day 20 of ECMO needing catecholamine, vasopressin and angiotensin II support. After few days on high ventilatory support post decannulation, he underwent tracheostomy and after 95 days of total hospital stay, was discharged home. RESULTS: Our multi-disciplinary critical care team along with anesthesiology, hospital medicine and nursing played an integral and crucial role in a good outcome for this super morbidly obese patient.

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