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1.
LANCET ; 399(10342):2171-2173, 2022.
Article in English | Web of Science | ID: covidwho-1935277
2.
Infect Dis Now ; 52(5): 286-293, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1930875

ABSTRACT

OBJECTIVES: We aimed to compare the outcomes of COVID-19 Renal Transplant Recipients (RTRs) managed on an ambulatory basis to that of inpatient management. DESIGN, SETTING, MATERIALS, AND METHODS: We performed a retrospective study in Lucknow, India, comparing the ambulatory management with the historical cohort managed in the hospital.R RTRs with mild COVID-19 were managed by supervised home-based self-monitoring (HBSM), a strategy to manage this high-risk group on an outpatient basis during the second wave of the pandemic. The primary outcome was the clinical deterioration to a higher severity category among RTRs with mild COVID-19 managed by HBSM compared to hospitalized patients within two weeks of disease onset. RESULTS: Of the 149 RTRs with mild COVID-19, 94 (63%) and 55 (37%) were managed by HBSM and in the hospital, respectively. The proportion of RTRs who clinically deteriorated to a higher severity category (moderate or severe category) was similar among both groups (28.7% versus 27.2%, P=0.849). Among RTRs with clinical deterioration, COVID-19-related death was reported in two patients of the HBSM group and in none of the patients of the hospitalized group. Graft dysfunction was higher in the hospitalized group (7.4% versus 27.2%, P=0.002). Median time to complete clinical recovery (7 days in both groups), secondary bacterial infections (25% versus 33.3%, P=0.41), and the mean decline in EQ-5D score from baseline at six weeks (-6.6 versus-4.3, P=0.105) were found to be similar in both groups.


Subject(s)
COVID-19 , Clinical Deterioration , Kidney Transplantation , COVID-19/epidemiology , Humans , Retrospective Studies , SARS-CoV-2
3.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927819

ABSTRACT

Post-intubation tracheal stenosis (PiTS) is a complication that occurs in 10-22% of patients after prolonged intubation or tracheostomy. Predisposing factors include localized infection, soft tissue trauma, granulation at the site of stoma, hypotension, tracheal cartilage damage, and metabolic disorders. Despite advances in the design of endotracheal tubes and cuffs, PiTS continues to remain an undesired consequence that warrants increased attention, especially in the COVID pandemic, which has led to increased number of tracheostomies and intubations. Consequently, prompt diagnosis and management is imperative to improve patient survival and quality of life. Herein, we present a 52-year-old male with history of tracheostomy in the setting of prolonged intubation from intraparenchymal hemorrhage with subsequent decannulation who was admitted for the management of pulmonary embolism. His course was complicated by encephalopathy and acute hypercapnic respiratory failure requiring intubation. In the intensive care unit, the patient was extubated after improvement in his respiratory and mental status, however developed shortness of breath and the feeling of impending doom a few hours after extubation. Chest radiograph was obtained and suggested tracheal stenosis (Image-1A). Given this finding, follow-up urgent chest computed tomography demonstrated severe lateral collapse of the subglottic space with critical tracheal stenosis (Image-1B). There was >90% cross sectional area reduction at the site of greatest stenosis (Image-1C). The measured area at the site of greatest stenosis was noted at 0.32 cm2 (average tracheal area is 2.8-3.4 cm2). His tracheal stenosis was suspected to be secondary to his history of tracheostomy. Given these findings, patient was reintubated for airway protection and urgently underwent rigid bronchoscopy. Initially, argon plasma coagulation was used in between stenotic areas, however there was minimal improvement in the airway, requiring a silicone 18 x 14 x 14 cm Y-stent to be placed. Since stent placement, patient has required frequent bronchoscopies to assist with mucus and secretion clearing. The remainder of his hospital course was benign. PiTS is an infrequent yet important complication that clinicians must consider in individuals with a history of prolonged intubation who have sudden difficulty breathing postextubation. Prompt recognition is required to manage these patients effectively. Factors considered in the management include location, length, and the severity of the stenosis. Therefore, if 1) critical stenosis is suspected, 2) the facility is capable of resection and reconstruction, and 3) the patient has minimal comorbidities, surgery should be considered. Otherwise, bronchoscopy with stent placement can be performed.

4.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927723

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a newly emergent coronavirus, that was first recognized in Wuhan, Hubei province, China, in December 2019. SARS-CoV-2 is a positive-sense singlestranded RNA virus that is contagious in humans. E-cigarette or vaping product use-associated lung injury (EVALI) is a type of acute lung injury of unclear pathogenesis. The two pathologies present with overlapping clinical symptoms, and imaging, making them difficult to distinguish, especially in global COVID-19 pandemic. Case report: 27-year-old female with past medical history of IBS, Diverticulitis, and anxiety presented with cough, shortness of breath, fever and fatigue. She also reported headaches and abdominal pain, she denies sick contact and recent travel but admit that she uses E cigarette more than usual due to anxiety attack. Patients initially discharge from ED but subsequently admit to hospital for worsening of symptoms possible COVID pneumonia vs community acquired pneumonia. She was persistently hypoxic and transfer to ICU for acute hypoxic respiratory failure. Labs was significant for elevated WBC while serum chemistries were unremarkable, Chest x-ray was not significant for any acute pathology. CT scan show revealed parenchymal changes consistent with bilateral upper and lower lobe ground-glass opacities. No septal change was noted, helping us rule out causes such as organizing pneumonia, lipoid pneumonia, and diffuse alveolar damage. Extensive testing for viral and bacterial infections was all negative. she has Covid19 PCR negative twice. Bronchoalveolar lavage testing was not done as patient refuse for invasive intervention. Patient started on steroids. Discussion: EVALI is thought to be a type of acute lung injury with an unknown pathogenesis. E-cigarette use, especially those containing THC and/or vitamin E acetate, is a key risk factor for developing the disease process. COVID 19 pneumonitis and EVALI have same clinical presentation, laboratory studies and images, and make challenge for physician to differentiate both pathologies. Both disease present with similar initial symptoms, including cough, shortness of breath, fevers, vomiting, diarrhea and headache. Similarly, laboratory studies may be unremarkable or elevated in both presentations and do not help distinguish between them. Furthermore, Chest X-ray and CT have very similar findings in both presentations, including diffuse hazy or consolidative opacities and ground-glass opacities, respectively. As well, both COVID-19 and EVALI are associated with worse outcomes in older adults or those with underlying chronic conditions, including cardiac and pulmonary disease.

5.
Obstetrics and Gynecology ; 139(SUPPL 1):58S, 2022.
Article in English | EMBASE | ID: covidwho-1925434

ABSTRACT

INTRODUCTION: Available data on the association between COVID- 19 and adverse pregnancy outcomes is limited by ascertainment bias. Our objective was to assess the impact of COVID-19 on pregnancy outcomes in a propensity score matching (PSM) study. This allows for balancing of observed baseline covariates and decreases the effect of confounding factors. METHODS: We conducted a retrospective, multicenter, case-control study to understand the association between COVID-19 and pregnancy outcomes. We reviewed all consecutive charts of adult females aged 18-45 years with SARS-CoV-2 infection betweenMarch 1, 2020, and August 31, 2020. Cases were patients diagnosed with COVID-19 during pregnancy (COVID+), whereas controls were pregnant patients who tested negative for COVID-19 (COVID-). We excluded cases with multiple gestation or incomplete data. PSM was performed using age, race/ethnicity, body mass index, and past medical history. The primary outcome was a compound score of pregnancy complications (pregnancy loss, neonatal demise, fetal growth restriction, hypertensive disorders of pregnancy, preterm premature rupture of membranes, preterm delivery, and placental abruption). Analyses were performed with SAS software. RESULTS: A total of 2,474 patients were identified, of which 2,374 were COVID- and 100 COVID+. There was a trend toward higher rate of adverse pregnancy outcomes in the COVID+ group (48 [48%] versus 917 [38.7%], P=.06). The results remained unchanged after optimal oneto- four PSM was applied (48 [48%] versus 151 [37.8%], P=.06). CONCLUSION: COVID-19 in pregnancy appears to be associated with an increased risk for adverse pregnancy outcomes. Although our study had a trend toward statistical significance, further research with a large sample size is required.

6.
International Journal of Pharmaceutical and Clinical Research ; 14(6):331-341, 2022.
Article in English | EMBASE | ID: covidwho-1925198

ABSTRACT

Introduction: Consequent upon continued nationwide lockdown to check the spread of COVID-19 pandemic, online teaching and learning has emerged as a new mode to continue the regular educational programs in India. It is vital to assess the perception of this new method by various stakeholders of educational sector. Objectives: The objectives included identification of the problems and benefits felt by medical students and college teachers about online classes and to assess its effectiveness on attendance and academic performance of students. Methods: The cross-sectional study was conducted during March-October 2021 among 150 first MBBS students admitted in 2020 in a medical college at Udaipur, Rajasthan. The participants who gave informed consent and attended three online and offline monthly tests were included and the rest were excluded. The quantitative techniques included frequency tables, mean, standard deviation and ‘t-test’. Results: Among 100 respondents, 48% were male and 52% were female. The major problems faced by students included lack of space at home to attend class (71%), interrupted internet connectivity (42%), missing interaction with stakeholders (>70%) and mismatch in theory and practicals (69%). The benefits included homemade food, family care, risk minimization of COVID-19 and regular parental monitoring. The major advantages felt by teachers included continued teaching (90.90%) and saving time (100%) in taking attendance in online mode. The average attendance for online classes was significantly higher over offline classes (p<0.0001), whereas the average retention of knowledge level as evidenced by average marks was significantly lower for online class tests compared to offline class tests (p<0.0001). Conclusion: The higher attendance does not reveal higher knowledge retention during online mode of classes.

7.
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research ; 25(7):S442-S442, 2022.
Article in English | EuropePMC | ID: covidwho-1905440
8.
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY ; 129:154-154, 2022.
Article in English | Web of Science | ID: covidwho-1905139
9.
1st International Conference on Computing, Communication and Green Engineering, CCGE 2021 ; 2021.
Article in English | Scopus | ID: covidwho-1901430

ABSTRACT

The whole world is completely upset because of the unexpected ejection of a lethal disease called Covid-19. Every single region is absolutely closed because of the effect of Covid. To prevent the unfold of this unwellness, everybody needs to maintain social distancing. Students are considered as the eventual fate of the country. To save the understudies from this infection the academic institute has begun internet educating and learning. Yet, giving information in online mode has become a testing task for understudies similarly as a tutor. Because of e-learning, customize learning has become vanish. To help intelligent instructing and learning systems an upgraded model is needed to boost the academic activities. This paper presents a style of projected model utilizing Reinforcement learning. The reinforcement learning (RL) approach provides effective pedagogical strategies for educating the learners with their interest in the subject. With the assistance of RL, the introduced model chooses the training difficulty level of scholars and recommends the student's understanding level to access the reading content. The proposed structure is planned in such a manner with the goal that the educator isn't needed to continually screen the understudy. Experimental results show that these approaches scale back the number of attentions needed from the teacher and enhance the training capability of understudy. The presented framework enhances personalized learning. © 2021 IEEE.

10.
Medical Science ; 26(122):8, 2022.
Article in English | Web of Science | ID: covidwho-1887480

ABSTRACT

COVID-19 (Coronavirus infectious disease 2019) denotes an ever changing and varied disease which has crippled the health care systems throughout the world. There have been studies conducted across the globe to establish the important factors for severity and mortality associated with COVID-19. We tried to study the effect of chronic obstructive pulmonary disease (COPD) on the severity as well as outcome of COVID-19. Material and methods: A total of 180 patients with COVID-19 were enrolled in this study and were then screened for history of COPD. There were 49 patients with history of COPD and 131 patients with no history of COPD. Inflammatory markers and HRCT scores were assessed for all the patients and they were followed up to study the outcome. Result: COPD was significantly associated HRCT Score, inflammatory markers and outcome. The mean HRCT Score for patients with COPD was more in COPD group (15.39 +/- 4.65) when compared with Non-COPD group (9.39 +/- 3.98). Mortality was also significantly higher in patients with COPD (67.3%) when compared to the patients without COPD (3.3%). Conclusion: We conclude that COPD is an important factor which has to be considered while treating the patients of COVID-19 especially in the rural India where lockdown restrictions and lack of knowledge have provided hinderance in achieving optimal follow up as there is increased severity and mortality associated with it.

12.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880136
13.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880009
14.
Journal of Developmental and Behavioral Pediatrics ; 43(2):E136-E136, 2022.
Article in English | Web of Science | ID: covidwho-1866074
15.
16.
Pediatric Blood & Cancer ; 69:1, 2022.
Article in English | Web of Science | ID: covidwho-1849389
17.
Pediatric Blood & Cancer ; 69:1, 2022.
Article in English | Web of Science | ID: covidwho-1849388
18.
Journal of the American College of Cardiology ; 79(9):898-898, 2022.
Article in English | Web of Science | ID: covidwho-1849101
19.
Annals of Behavioral Medicine ; 56(SUPP 1):S186-S186, 2022.
Article in English | Web of Science | ID: covidwho-1848865
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