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1.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-316210

ABSTRACT

COVID-19 has fundamentally disrupted the way we live. Government bodies, universities, and companies worldwide are rapidly developing technologies to combat the COVID-19 pandemic and safely reopen society. Essential analytics tools such as contact tracing, super-spreader event detection, and exposure mapping require collecting and analyzing sensitive user information. The increasing use of such powerful data-driven applications necessitates a secure, privacy-preserving infrastructure for computation on personal data. In this paper, we analyze two such computing infrastructures under development at the University of Illinois at Urbana-Champaign to track and mitigate the spread of COVID-19. First, we present Safer Illinois, a system for decentralized health analytics supporting two applications currently deployed with widespread adoption: digital contact tracing and COVID-19 status cards. Second, we introduce the RokWall architecture for privacy-preserving centralized data analytics on sensitive user data. We discuss the architecture of these systems, design choices, threat models considered, and the challenges we experienced in developing production-ready systems for sensitive data analysis.

2.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-321692

ABSTRACT

Background: Vascular access support teams have been set up to help offload procedural tasks from critical care teams during the coronavirus disease 2019 (COVID-19) global pandemic. However, the impact of VAST on clinical outcomes and on workload has not been shown previously with no reports to date from the UK. Our aim was to evaluate clinical outcomes of a multidisciplinary vascular access support team (VAST) and the value of the service to critical care teams. Methods: Prospectively collected data on all patients requiring vascular access at St Thomas’ Hospital, London over a 5-week period during the first wave of the pandemic in the UK. At the end of study period, online anonymised questionnaire administered to critical care team members, including nursing and medical professionals, to evaluate their experience of the service. We report access-related complication until discharge from centre and description of results of online survey. Results: 122 patients aged 52.1 ± 13 years with high rate of pre-existing co-morbidities, underwent line insertion including 190 catheters (central venous n=182, arterial n=8). Median (range) number of 5 (0-17) lines were placed per day in patients of whom 90% tested positive for Severe Acute Respiratory Syndrome Coronavirus-type 2 pathogen (SARS-CoV-2). A single line (n=146) was inserted in 96 out of 122 patients (78.7%) and n=18 patients (14.7%) ‘double puncture’ technique used. 45 line insertions (24%) had complications with minor [bleeding (n=19), line infection (n=10)] and 2 lines (1%) with major complication. The survey respondents, n=54 professionals, highlighted ease of referral and timely access placement (>90% responses);with agreement that VAST service saved them precious time and allow them to focus on other jobs. Conclusions: We describe the successful deployment of a multidisciplinary vascular access team with low complication rates and high rates of satisfaction. We recommend similar models can be considered by health services to optimise patient care and ICU management.

4.
Ann Vasc Surg ; 80: 104-112, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1596282

ABSTRACT

BACKGROUND: The aim of this study was to examine the COVID-19 pandemic and its associated impact on the provision of vascular services, and the pattern of presentation and practice in a tertiary referral vascular unit. METHODS: This is a retrospective observational study from a prospectively maintained data-base comparing two time frames, Period 1(15th March-30th May 2019-P1) and Period 2(15th March-30th May 2020-P2)All the patients who presented for a vascular review in the 2 timeframes were included. Metrics of service and patient care episodes were collected and compared including, the number of emergency referrals, patient encounters, consultations, emergency admissions and interventions. Impact on key hospital resources such as critical care and imaging facilities during the two time periods were also examined. RESULTS: There was an absolute reduction of 44% in the number of patients who required urgent or emergency treatment from P1 to P2 (141 vs 79). We noted a non-significant trend towards an increase in the proportion of patients presenting with Chronic Limb Threatening Ischaemia (CLTI) Rutherford 5&6 (P=0.09) as well as a reduction in the proportion of admissions related to Aortic Aneurysm (P=0.21). There was a significant absolute reduction of 77% in all vascular interventions from P1 to P2 with the greatest reductions noted in Carotid (P=0.02), Deep Venous (P=0.003) and Aortic interventions (P=0.016). The number of lower limb interventions also decreased though there was a significant increase as a relative proportion of all vascular interventions in P2 (P=0.001). There was an absolute reduction in the number of scans performed for vascular pathology; Duplex scans reduced by 86%(P<0.002), CT scans by 68%(P<0.003) and MRIs by 74%(P<0.009). CONCLUSION: We report a decrease in urgent and emergency vascular presentations, admissions and interventions. The reduction in patients presenting with lower limb pathology was not as significant as other vascular conditions, resulting in a significant rise in interventions for CLTI and DFI as a proportion of all vascular interventions. These observations will help guide the provision of vascular services during future pandemics.


Subject(s)
COVID-19/epidemiology , Hospital Units/statistics & numerical data , Hospitalization/statistics & numerical data , Tertiary Healthcare/statistics & numerical data , Vascular Surgical Procedures/statistics & numerical data , Workload/statistics & numerical data , Ambulatory Care/statistics & numerical data , COVID-19/complications , COVID-19/therapy , Critical Care/statistics & numerical data , Facilities and Services Utilization , Humans , Magnetic Resonance Imaging/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Tomography, X-Ray Computed/statistics & numerical data , United Kingdom
5.
Infection ; 50(2): 309-325, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1588678

ABSTRACT

The coronavirus disease-19 has left a permanent mark on the history of the human race. Severe acute respiratory syndrome coronavirus-2 is a positive-sense single-stranded RNA virus, first reported in Wuhan, China, in December 2019 and from there took over the world. Being highly susceptible to mutations, the virus's numerous variants started to appear, and some were more lethal and infectious than the parent. The effectiveness of the vaccine is also affected severely against the new variant. In this study, the infectious mechanism of the coronavirus is explained with a focus on different variants and their respective mutations, which play a critical role in the increased transmissibility, infectivity, and immune escape of the virus. As India has already faced the second wave of the pandemic, the future outlook on the likeliness of a third wave with respect to the Indian variants such as kappa, delta, and Delta Plus is also discussed. This review article aims to reflect the catastrophe of the variants of SARS-CoV-2 and the possibility of developing even more severe variants in the near future.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19 Vaccines , Humans , Mutation , Pandemics , SARS-CoV-2/genetics
6.
Archives of Disease in Childhood ; 106(Suppl 1):A328, 2021.
Article in English | ProQuest Central | ID: covidwho-1443494

ABSTRACT

BackgroundAntimicrobial resistance (AMR) poses a major threat to human health. Although rates of AMR have risen significantly in adults over the past few years, increasing rates of AMR are now being seen in children. Antimicrobial stewardship (AMS) is a highly effective approach to tackling AMR;however few paediatric AMS initiatives have focused on antibiotic prescribing in an Emergency Department (ED) setting. There are data to suggest that rates of antibiotic prescribing for respiratory tract infections (RTIs) is higher in children presenting to emergency departments than in those presenting with comparable disease severity to primary care.ObjectivesThe focus of this study was to evaluate the impact of two sequential antimicrobial stewardship interventions on antibiotic prescribing for children aged <16 years presenting with upper and lower respiratory tract infections to the Paediatric Emergency Department (PED) at Southampton Children’s Hospital.MethodsAntibiotic prescribing data were collected over a 16 week period (03/08/2020–22/11/20). All children with a discharge diagnosis of upper respiratory tract infection (URTI), otitis media, tonsillitis, pneumonia and lower respiratory tract infection (LRTI) were included. Baseline data were collected between weeks 1–7. The 1st AMS intervention was a 15-minute educational session delivered either face to face or virtually to all PED clinicians by a PED consultant (DJ). The educational intervention used informational slide sets to reinforce the principles of judicious antibiotic use and appropriate antibiotic guideline adherence for RTI’s through case-based learning scenarios and quizzes that facilitated group discussion. This intervention was repeated weekly between weeks 8–10, to ensure that all PEM staff were exposed to the intervention. The 2nd intervention, implemented on week 14, involved feedback of personalised antibiotic prescribing data, along with average antibiotic prescribing rates for the department, to each member of PED staff.Results502 children with RTIs presented during the study period. Antibiotic prescribing rates significantly decreased from 28.6% during the pre-intervention period to 20.5% at the end of the study (p<0.05). Antibiotic prescribing for a discharge diagnosis of URTI decreased from 9.3% to 4.8% (p=0.11), for otitis media from 78.9% to 53.8% (p=0.13), for tonsillitis from 71.8% to 48.8% (p=0.03) and for LRTI and pneumonia from 66.7% to 51.7% (p=0.31).ConclusionsThe combination of an educational intervention and individualised feedback of prescribing data was associated with a significant reduction in overall antibiotic prescribing for children with RTIs managed in an ED setting. However, although reductions were seen for individual pathologies, statistical significance was not always reached. This may be due to the relatively small sample size;far fewer children were recruited during the 16 week study period than predicted due to the impact of the COVID pandemic on rates of PED presentations. In general the interventions were easy to implement;however manual interrogation of patient notes was required to collect individual clinician prescribing data, this was labour intensive and would ideally be automated through the use of electronic prescribing systems. Further work is required to show if the findings from this study can be replicated in other settings and if this impact is sustained or requires repeated AMS interventions.

7.
Heart Lung Circ ; 30(10): 1430-1432, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1340666
8.
Arch Dis Child ; 2020 Dec 17.
Article in English | MEDLINE | ID: covidwho-1318013

ABSTRACT

OBJECTIVE: To undertake a systematic review of reviews of the prevalence of symptoms and signs of COVID-19 in those aged under 20 years. DESIGN: Narrative systematic review of reviews. PubMed, medRxiv, Europe PMC and COVID-19 Living Evidence Database were searched on 9 October 2020. SETTING: All settings, including hospitalised and community settings. PATIENTS: Children and young people (CYP) under age 20 years with laboratory-proven COVID-19. STUDY REVIEW, DATA EXTRACTION AND QUALITY: Potentially eligible articles were reviewed on title and abstract by one reviewer. Quality was assessed using the modified AMSTARS criteria and data were extracted from included studies by two reviewers. MAIN OUTCOME MEASURES: Prevalence of symptoms and signs of COVID-19. RESULTS: 1325 studies were identified and 18 reviews were included. Eight were high quality, 7 medium and 3 low quality. All reviews were dominated by studies of hospitalised children. The proportion of asymptomatic CYP ranged from 14.6% to 42%. Fever and cough were the the most common symptoms; proportions with fever ranged from 46% to 64.2% and with cough from 32% to 55.9%. All other symptoms or signs including rhinorrhoea, sore throat, headache, fatigue/myalgia and gastrointestinal symptoms including diarrhoea and vomiting were infrequent, occurring in less than 10%-20%. CONCLUSIONS: Fever and cough are the most common symptoms in CYP with COVID-19, with other symptoms infrequent. Further research on symptoms in community samples are needed to inform pragmatic identification and testing programmes for CYP.

10.
Am J Surg Pathol ; 46(1): 89-96, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1254925

ABSTRACT

Approximately 20% of patients with symptomatic syndrome-associated coronavirus-2 (SARS-CoV-2) infection have gastrointestinal bleeding and/or diarrhea. Most are managed without endoscopic evaluation because the risk of practitioner infection outweighs the value of biopsy analysis unless symptoms are life-threatening. As a result, much of what is known about the gastrointestinal manifestations of coronavirus disease-2019 (COVID-19) has been gleaned from surgical and autopsy cases that suffer from extensive ischemic injury and/or poor preservation. There are no detailed reports describing any other gastrointestinal effects of SARS-CoV-2 even though >3,000,000 people have died from COVID-19 worldwide. The purpose of this study is to report the intestinal findings related to SARS-CoV-2 infection by way of a small case series including one with evidence of direct viral cytopathic effect and 2 with secondary injury attributed to viral infection. Infection can be confirmed by immunohistochemical stains directed against SARS-CoV-2 spike protein, in situ hybridization for spike protein-encoding RNA, and ultrastructural visualization of viruses within the epithelium. It induces cytoplasmic blebs and tufted epithelial cells without inflammation and may not cause symptoms. In contrast, SARS-CoV-2 infection can cause gastrointestinal symptoms after the virus is no longer detected, reflecting systemic activation of cytokine and complement cascades rather than direct viral injury. Reversible mucosal ischemia features microvascular injury with hemorrhage, small vessel thrombosis, and platelet-rich thrombi. Systemic cytokine elaboration and dysbiosis likely explain epithelial cell injury that accompanies diarrheal symptoms. These observations are consistent with clinical and in vitro data and contribute to our understanding of the protean manifestations of COVID-19.


Subject(s)
COVID-19/pathology , Intestinal Diseases/pathology , Intestinal Diseases/virology , Intestines/pathology , Intestines/virology , Adult , Aged , Aged, 80 and over , Biomarkers/metabolism , Biopsy , COVID-19/diagnosis , COVID-19/immunology , Cytokines/metabolism , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/immunology , Gastrointestinal Hemorrhage/pathology , Gastrointestinal Hemorrhage/virology , Humans , Intestinal Diseases/diagnosis , Intestinal Diseases/immunology , Intestines/immunology , Ischemia/diagnosis , Ischemia/immunology , Ischemia/pathology , Ischemia/virology , Male , Thrombosis/diagnosis , Thrombosis/immunology , Thrombosis/pathology , Thrombosis/virology
11.
Ann Surg ; 2020 Dec 22.
Article in English | MEDLINE | ID: covidwho-1101933

ABSTRACT

OBJECTIVE: Examine the impact of Coronavirus-2019(COVID-19) pandemic on the outcomes in patients with critical limb threatening ischemia(CLTI) or diabetic foot infection(DFI). BACKGROUND: Patients with CLTI and/or DFI are at risk of amputations if not treated in a timely manner. METHODS: We compared the outcomes in patients with CLTI or DFI during two periods; Period 1[P1] (15/03/2019-31/05/2019) and period 2[P2] (15/03/2020-31/05/2020- corresponding to COVID-19 pandemic). RESULTS: 139 patients were treated in P1 [mean age 70 years (±11), Male:Female=102:37] while 95 patients were treated in P2 [mean age 67(±12), Male:Female=64:31]. The two cohorts were matched regarding Rutherford category (P=0.25) and GLASS classification (P=0.38). Notably, the time from onset of symptom to clinical presentation was significantly longer [31(1-105) days vs 27(0-78) days, (P=0.017)], whereas the time from presentation to first intervention was significantly shorter [3 (0-61) days vs 5 (0-65) days, (P=0.013)] in P2 compared to P1. There was a significantly higher WCC(P=0.014) and CRP(P=0.004) on admission in P2. Having treatment for CLTI or DFI in P2 was an independent predictor of worse primary patency rate and Freedom from major adverse limb events (F-MALE). At 90 days, amputation-free survival (AFS) and Limb salvage (LS) were noticeably worse in P2 compared to P1 (AFS was 80% and 87% while LS was 64% and 72% in P2 and P1 respectively). CONCLUSIONS: Patients with CLTI and DFI experienced a significantly delayed presentation with features of sepsis on admission in P2. Treatment in P2 was a predictor of worse primary patency and F-MALE and therefore close and long follow-up is advisable.

14.
J Cataract Refract Surg ; 47(11): 1483-1484, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-966212
16.
Indian J Microbiol ; 60(4): 420-429, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-812511

ABSTRACT

Worldwide, millions of individuals have been affected by the prevailing SARS-CoV-2. Therefore, a robust immune system remains indispensable, as an immunocompromised host status has proven to be fatal. In the absence of any specific antiviral drug/vaccine, COVID-19 related drug repurposing along with various other non-pharmacological measures coupled with lockdown have been employed to combat this infection. In this context, a plant based rich fiber diet, which happens to be consumed by a majority of the Indian population, appears to be advantageous, as it replenishes the host gut microbiota with beneficial microbes thereby leading to a symbiotic association conferring various health benefits to the host including enhanced immunity. Further, implementation of the lockdown which has proven to be a good non-pharmacological measure, seems to have resulted in consumption of home cooked healthy diet, thereby enriching the beneficial microflora in the gut, which might have resulted in better prognosis of COVID-19 patients in India in comparison to that observed in the western countries.

17.
Mod Pathol ; 33(11): 2156-2168, 2020 11.
Article in English | MEDLINE | ID: covidwho-744362

ABSTRACT

SARS-CoV-2, the etiologic agent of COVID-19, is a global pandemic with substantial mortality dominated by acute respiratory distress syndrome. We systematically evaluated lungs of 68 autopsies from 3 institutions in heavily hit areas (2 USA, 1 Italy). Detailed evaluation of several compartments (airways, alveolar walls, airspaces, and vasculature) was performed to determine the range of histologic features. The cohort consisted of 47 males and 21 females with a median age of 73 years (range 30-96). Co-morbidities were present in most patients with 60% reporting at least three conditions. Tracheobronchitis was frequently present, independent from intubation or superimposed pneumonia. Diffuse alveolar damage (DAD) was seen in 87% of cases. Later phases of DAD were less frequent and correlated with longer duration of disease. Large vessel thrombi were seen in 42% of cases but platelet (CD61 positive) and/or fibrin microthrombi were present at least focally in 84%. Ultrastructurally, small vessels showed basal membrane reduplication and significant endothelial swelling with cytoplasmic vacuolization. In a subset of cases, virus was detected using different tools (immunohistochemistry for SARS-CoV-2 viral spike protein, RNA in situ hybridization, lung viral culture, and electron microscopy). Virus was seen in airway epithelium and type 2 pneumocytes. IHC or in situ detection, as well as viable form (lung culture positive) was associated with the presence of hyaline membranes, usually within 2 weeks but up to 4 weeks after initial diagnosis. COVID-19 pneumonia is a heterogeneous disease (tracheobronchitis, DAD, and vascular injury), but with consistent features in three centers. The pulmonary vasculature, with capillary microthrombi and inflammation, as well as macrothrombi, is commonly involved. Viral infection in areas of ongoing active injury contributes to persistent and temporally heterogeneous lung damage.


Subject(s)
Coronavirus Infections/pathology , Coronavirus Infections/virology , Lung/pathology , Lung/virology , Pneumonia, Viral/pathology , Adult , Aged , Aged, 80 and over , Autopsy , Betacoronavirus , COVID-19 , Cohort Studies , Female , Humans , Italy , Male , Middle Aged , New York City , Pandemics , Pneumonia, Viral/virology , Retrospective Studies , SARS-CoV-2
19.
Indian J Microbiol ; 60(3): 263-268, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-591838

ABSTRACT

Severe acute respiratory syndrome coronavirus (SARS-CoV-2) known as COVID-19 has emerged as a major threat to human existence. COVID-19 seems to have undergone adaptive evolution through an intermediate host, most likely bats. The flu leads to severe pneumonia that causes respiratory and multi-organ failure. The absence of any known treatment procedures, drugs, or vaccines has created panic around the World. The need is to develop rapid testing kits, drugs and vaccines. However, these proposals are time-consuming processes. At present social distancing along with previously known traditional medicines can act as quick and short-term alternatives for treating this viral flu.

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