Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 13 de 13
Filter
1.
Critical Care Medicine ; 50:13-13, 2022.
Article in English | Academic Search Complete | ID: covidwho-1595766

ABSTRACT

B Introduction: b SARS-CoV-2 can cause severe pediatric disease via acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C). Outcomes included case incidence and severity over time, risk factors for higher severity disease, vital sign and lab trajectories, clinical outcomes, and acute COVID-19 vs. We sought to determine the characteristics, changes over time, outcomes, and severity risk factors of SARS-CoV-2 infected children within the National COVID Cohort Collaborative (N3C). [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

2.
BMC Med Educ ; 21(1): 557, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1496164

ABSTRACT

BACKGROUND: Pakistan has not been a major contributor to medical research, mainly because of the lack of learning opportunities to medical students. With the increase in online learning systems during COVID-19, research related skills can be taught to medical students via low-cost peer taught virtual research workshops. AIM OF THE STUDY: To assess the effectiveness of a comprehensive low-cost peer-taught virtual research workshops amongst medical students in Pakistan. METHODS: This quasi-experimental study assessed the effectiveness of five virtual research workshops (RWs) in improving core research skills. RWs for medical students from across Pakistan were conducted over Zoom by medical students (peer-teachers) at the Aga Khan University, Pakistan, with minimal associated costs. The content of the workshops included types of research, ethical approval and research protocols, data collection and analysis, manuscript writing, and improving networking skills for research. Improvement was assessed via pre-and post-quizzes for each RW, self-efficacy scores across 16 domains, and feedback forms. Minimum criteria for completion of the RW series was attending at least 4/5 RWs and filling the post-RW series feedback form. A 6-month post-RW series follow-up survey was also emailed to the participants. RESULTS: Four hundred medical students from 36 (/117; 30.8%) different medical colleges in Pakistan were enrolled in the RWs. However, only 307/400 (76.75%) medical students met the minimum requirement for completion of the RW series. 56.4% of the participants belonged to the pre-clinical years while the rest were currently to clinical years. The cohort demonstrated significant improvement in pre-and post-quiz scores for all 5 RWs (p <  0.001) with the greatest improvement in Data Collection and Analysis (+ 34.65%), and in self-efficacy scores across all domains (p <  0.001). 166/307 (54.1%) participants responded to the 6 months post-RWs follow-up survey. Compared to pre-RWs, Research involvement increased from 40.4 to 62.8% (p <  0.001) while proportion of participants with peer-reviewed publications increased from 8.4 to 15.8% (p = 0.043). CONCLUSION: Virtual RWs allow for a wide outreach while effectively improving research-related knowledge and skills, with minimal associated costs. In lower-middle-income countries, virtual RWs are a creative and cost-effective use of web-based technologies to facilitate medical students to contribute to the local and global healthcare research community.


Subject(s)
Education, Distance , Education, Medical/methods , Peer Group , Students, Medical , Humans , Pakistan
4.
Cell Rep ; 36(7): 109527, 2021 08 17.
Article in English | MEDLINE | ID: covidwho-1330685

ABSTRACT

COVID-19 pathology involves dysregulation of diverse molecular, cellular, and physiological processes. To expedite integrated and collaborative COVID-19 research, we completed multi-omics analysis of hospitalized COVID-19 patients, including matched analysis of the whole-blood transcriptome, plasma proteomics with two complementary platforms, cytokine profiling, plasma and red blood cell metabolomics, deep immune cell phenotyping by mass cytometry, and clinical data annotation. We refer to this multidimensional dataset as the COVIDome. We then created the COVIDome Explorer, an online researcher portal where the data can be analyzed and visualized in real time. We illustrate herein the use of the COVIDome dataset through a multi-omics analysis of biosignatures associated with C-reactive protein (CRP), an established marker of poor prognosis in COVID-19, revealing associations between CRP levels and damage-associated molecular patterns, depletion of protective serpins, and mitochondrial metabolism dysregulation. We expect that the COVIDome Explorer will rapidly accelerate data sharing, hypothesis testing, and discoveries worldwide.


Subject(s)
COVID-19/genetics , COVID-19/metabolism , Databases, Genetic , Metabolome , Proteome , Transcriptome , Access to Information , Adult , COVID-19/immunology , Case-Control Studies , Data Mining , Datasets as Topic , Female , Gene Expression Profiling , Humans , Male , Metabolomics , Middle Aged , Proteomics , Young Adult
5.
JAMA Netw Open ; 4(7): e2116901, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1306627

ABSTRACT

Importance: The National COVID Cohort Collaborative (N3C) is a centralized, harmonized, high-granularity electronic health record repository that is the largest, most representative COVID-19 cohort to date. This multicenter data set can support robust evidence-based development of predictive and diagnostic tools and inform clinical care and policy. Objectives: To evaluate COVID-19 severity and risk factors over time and assess the use of machine learning to predict clinical severity. Design, Setting, and Participants: In a retrospective cohort study of 1 926 526 US adults with SARS-CoV-2 infection (polymerase chain reaction >99% or antigen <1%) and adult patients without SARS-CoV-2 infection who served as controls from 34 medical centers nationwide between January 1, 2020, and December 7, 2020, patients were stratified using a World Health Organization COVID-19 severity scale and demographic characteristics. Differences between groups over time were evaluated using multivariable logistic regression. Random forest and XGBoost models were used to predict severe clinical course (death, discharge to hospice, invasive ventilatory support, or extracorporeal membrane oxygenation). Main Outcomes and Measures: Patient demographic characteristics and COVID-19 severity using the World Health Organization COVID-19 severity scale and differences between groups over time using multivariable logistic regression. Results: The cohort included 174 568 adults who tested positive for SARS-CoV-2 (mean [SD] age, 44.4 [18.6] years; 53.2% female) and 1 133 848 adult controls who tested negative for SARS-CoV-2 (mean [SD] age, 49.5 [19.2] years; 57.1% female). Of the 174 568 adults with SARS-CoV-2, 32 472 (18.6%) were hospitalized, and 6565 (20.2%) of those had a severe clinical course (invasive ventilatory support, extracorporeal membrane oxygenation, death, or discharge to hospice). Of the hospitalized patients, mortality was 11.6% overall and decreased from 16.4% in March to April 2020 to 8.6% in September to October 2020 (P = .002 for monthly trend). Using 64 inputs available on the first hospital day, this study predicted a severe clinical course using random forest and XGBoost models (area under the receiver operating curve = 0.87 for both) that were stable over time. The factor most strongly associated with clinical severity was pH; this result was consistent across machine learning methods. In a separate multivariable logistic regression model built for inference, age (odds ratio [OR], 1.03 per year; 95% CI, 1.03-1.04), male sex (OR, 1.60; 95% CI, 1.51-1.69), liver disease (OR, 1.20; 95% CI, 1.08-1.34), dementia (OR, 1.26; 95% CI, 1.13-1.41), African American (OR, 1.12; 95% CI, 1.05-1.20) and Asian (OR, 1.33; 95% CI, 1.12-1.57) race, and obesity (OR, 1.36; 95% CI, 1.27-1.46) were independently associated with higher clinical severity. Conclusions and Relevance: This cohort study found that COVID-19 mortality decreased over time during 2020 and that patient demographic characteristics and comorbidities were associated with higher clinical severity. The machine learning models accurately predicted ultimate clinical severity using commonly collected clinical data from the first 24 hours of a hospital admission.


Subject(s)
COVID-19 , Databases, Factual , Forecasting , Hospitalization , Models, Biological , Severity of Illness Index , Adult , Aged , Aged, 80 and over , COVID-19/ethnology , COVID-19/mortality , Comorbidity , Extracorporeal Membrane Oxygenation , Female , Humans , Hydrogen-Ion Concentration , Male , Middle Aged , Pandemics , Respiration, Artificial , Retrospective Studies , Risk Factors , SARS-CoV-2 , United States , Young Adult
6.
Ann Glob Health ; 87(1): 41, 2021 04 23.
Article in English | MEDLINE | ID: covidwho-1225915

ABSTRACT

Background: Healthcare workers (HCWs) across the globe have met tremendous challenges during the COVID-19 (coronavirus disease 2019) pandemic, such as shortages of personal protective equipment, extensive work hours, and constant fear of catching the virus or transmitting it to loved ones. Adding on to the already existing burnout, an increase in incidents of violence and aggression against HCWs was seen in Pakistan and globally. Objectives: Primarily to review cases of violence against HCWs in Pakistan, highlighting and comparing the instigating factors seen within the country and globally. Secondly, to enlist possible interventions to counter workplace violence in healthcare during a pandemic and in general. Methods: Incidents of violence towards HCWs in Pakistan during the COVID-19 pandemic occurring between April 7, 2020, and August 7, 2020, were included. The incidents reported from local newspapers were reviewed. Findings and Conclusion: A total of 29 incidents were identified, with perpetrators of violence most commonly being relatives of COVID-19 patients. Most frequent reasons included mistrust in HCWs, belief in conspiracy theories, hospitals' refusal to admit COVID-19 patients due to limited space, COVID-19 hospital policies, and the death of the COVID-19 patients. Protests by doctors and other HCWs for provision of adequate PPE, better quarantine conditions for doctors with suspected COVID-19, and better compensation for doctors on COVID-19 patient duty resulted in police violence towards HCWs. To avoid such incidents in the future, institutions, healthcare policymakers, media organisations, and law enforcement agencies must work together for widespread public awareness to counter misconceptions and to exhibit responsible journalism. In hospitals, measures such as de-escalation training and increased security must be implemented. Furthermore, law enforcement agencies must be trained in non-violent methods of crowd dispersal and control to manage peaceful protests by HCWs over legitimate issues.


Subject(s)
COVID-19/epidemiology , Health Personnel , Workplace Violence/statistics & numerical data , Female , Humans , Male , Pakistan/epidemiology , Pandemics , SARS-CoV-2
7.
J Am Med Inform Assoc ; 28(11): 2354-2365, 2021 10 12.
Article in English | MEDLINE | ID: covidwho-1223363

ABSTRACT

OBJECTIVE: To rapidly develop, validate, and implement a novel real-time mortality score for the COVID-19 pandemic that improves upon sequential organ failure assessment (SOFA) for decision support for a Crisis Standards of Care team. MATERIALS AND METHODS: We developed, verified, and deployed a stacked generalization model to predict mortality using data available in the electronic health record (EHR) by combining 5 previously validated scores and additional novel variables reported to be associated with COVID-19-specific mortality. We verified the model with prospectively collected data from 12 hospitals in Colorado between March 2020 and July 2020. We compared the area under the receiver operator curve (AUROC) for the new model to the SOFA score and the Charlson Comorbidity Index. RESULTS: The prospective cohort included 27 296 encounters, of which 1358 (5.0%) were positive for SARS-CoV-2, 4494 (16.5%) required intensive care unit care, 1480 (5.4%) required mechanical ventilation, and 717 (2.6%) ended in death. The Charlson Comorbidity Index and SOFA scores predicted mortality with an AUROC of 0.72 and 0.90, respectively. Our novel score predicted mortality with AUROC 0.94. In the subset of patients with COVID-19, the stacked model predicted mortality with AUROC 0.90, whereas SOFA had AUROC of 0.85. DISCUSSION: Stacked regression allows a flexible, updatable, live-implementable, ethically defensible predictive analytics tool for decision support that begins with validated models and includes only novel information that improves prediction. CONCLUSION: We developed and validated an accurate in-hospital mortality prediction score in a live EHR for automatic and continuous calculation using a novel model that improved upon SOFA.


Subject(s)
COVID-19 , Pandemics , Cohort Studies , Electronic Health Records , Hospital Mortality , Humans , Prospective Studies , Retrospective Studies , SARS-CoV-2
8.
Elife ; 102021 03 16.
Article in English | MEDLINE | ID: covidwho-1136623

ABSTRACT

COVID19 is a heterogeneous medical condition involving diverse underlying pathophysiological processes including hyperinflammation, endothelial damage, thrombotic microangiopathy, and end-organ damage. Limited knowledge about the molecular mechanisms driving these processes and lack of staging biomarkers hamper the ability to stratify patients for targeted therapeutics. We report here the results of a cross-sectional multi-omics analysis of hospitalized COVID19 patients revealing that seroconversion status associates with distinct underlying pathophysiological states. Low antibody titers associate with hyperactive T cells and NK cells, high levels of IFN alpha, gamma and lambda ligands, markers of systemic complement activation, and depletion of lymphocytes, neutrophils, and platelets. Upon seroconversion, all of these processes are attenuated, observing instead increases in B cell subsets, emergency hematopoiesis, increased D-dimer, and hypoalbuminemia. We propose that seroconversion status could potentially be used as a biosignature to stratify patients for therapeutic intervention and to inform analysis of clinical trial results in heterogenous patient populations.


Subject(s)
COVID-19/epidemiology , COVID-19/virology , SARS-CoV-2 , Seroconversion , Biomarkers , COVID-19/immunology , COVID-19/metabolism , Comorbidity , Complement Activation/immunology , Complement System Proteins/immunology , Hematopoiesis , Homeostasis , Hospitalization , Humans , Hypoalbuminemia , Interferons/metabolism , Models, Biological , Seroepidemiologic Studies , Signal Transduction
9.
J Pak Med Assoc ; 71(Suppl 1)(1): S83-S88, 2021 01.
Article in English | MEDLINE | ID: covidwho-1080012

ABSTRACT

The coronovirus disease-2019 pandemic has severely impacted surgical education and training in Pakistan and worldwide, causing problems, such as risk of infection, limited hands-on training, examination delays, and trainee redeployment to non-surgical specialties. The current review was planned to describe innovative strategies adopted by surgical training programmes worldwide in order to suggest comprehensive recommendations at the level of the College of Physicians and Surgeons Pakistan and individual institutions to counter the challenges presented by the pandemic in Pakistan. The innovative use of technology, including open-access online educational portals, virtual educational activities and simulation-based learning, can help reform education delivery during the pandemic. Hospitals' implementation of "shift schedules" for rotations helps continue training while minimising risks. Moreover, examination boards and residency programmes must appropriately tailor their eligibility criteria and assessment processes to the current situation. Lastly, it is vital to safeguard trainees' mental wellness during the pandemic and after by ensuring readily available professional psychological support when needed.


Subject(s)
COVID-19 , Education, Medical, Graduate/methods , General Surgery/education , Surgeons/education , Developing Countries , Education, Distance , Humans , Internship and Residency , Pakistan , Pandemics
10.
PLoS One ; 16(1): e0244886, 2021.
Article in English | MEDLINE | ID: covidwho-1059976

ABSTRACT

INTRODUCTION: While chest x-rays (CXRs) represent a cost-effective imaging modality for developing countries like Pakistan, their utility for the prognostication of COVID-19 has been minimally explored. Thus, we describe the frequency and distribution of CXR findings, and their association with clinical outcomes of patients with COVID-19. METHODS: All adult (≥ 18 years) patients presenting between 28th February-31st May to the emergency department of a tertiary care hospital in Pakistan, who were COVID-19 positive on RT-PCR with CXR done on presentation, were included. A CXR Severity Score (CXR-SS) of 0-8 was used to quantify the extent of pulmonary infection on CXR, with a score of 0 being negative and 1-8 being positive. The patients' initial CXR-SS and their highest CXR-SS over the hospital course were used for analysis, with cut-offs of 0-4 and 5-8 being used to assess association with clinical outcomes. RESULTS: A total of 150 patients, with 76.7% males and mean age 56.1 years, were included in this study. Initial CXR was positive in 80% of patients, and 30.7% of patients had an initial CXR-SS between 5-8. The mortality rate was 16.7% and 30.6% patients underwent ICU admission with intubation (ICU-Int). On multivariable analysis, initial CXR-SS (1.355 [1.136-1.616]) and highest CXR-SS (1.390 [1.143-1.690]) were predictors of ICU-Int, and ICU-Int was independently associated with both initial CXR-SS 5-8 (2.532 [1.109-5.782]) and highest CXR-SS 5-8 (3.386 [1.405-8.159]). Lastly, age (1.060 [1.009-1.113]), initial CXR-SS (1.278 [1.010-1.617]) and ICU-Int (5.047 [1.731-14.710]), were found to be independent predictors of mortality in our patients. CONCLUSION: In a resource-constrained country like Pakistan, CXRs may have valuable prognostic utility in predicting ICU admission and mortality. Additional research with larger patient samples is needed to further explore the association of CXR findings with clinical outcomes.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Radiography, Thoracic/methods , Adult , Aged , COVID-19/epidemiology , COVID-19/mortality , Emergency Service, Hospital , Female , Hospitalization , Humans , Length of Stay , Lung/pathology , Male , Middle Aged , Pakistan/epidemiology , Retrospective Studies , SARS-CoV-2/isolation & purification , Severity of Illness Index , Tertiary Care Centers
11.
Preprint in English | bioRxiv | ID: ppbiorxiv-426787

ABSTRACT

IntroductionVarious CT severity scores have already been described in literature since the start of this pandemic. One pertinent issue with all of the previously described severity scores is their relative challenging calculation and variance in inter-observer agreement. The severity score proposed in our study is relatively simpler, easier to calculate and apart from a trained radiologist, can easily be calculated even by physicians with good inter-observer agreement. Therefore, a rapid CT severity score calculation can give a clue to physician about possible clinical outcome without being dependent on radiologist who may not be readily available especially in third world countries. ObjectiveThe objective of this study is to develop a simple CT severity score (CT-SS) with good inter-observer agreement and access its correlation with clinical outcome. MethodsThis retrospective study was conducted by the Department of Radiology and Internal Medicine, at the Aga Khan University Hospital Karachi, from April 2020 to August 2020. Non-probability consecutive sampling was used to include all patients who were positive for COVID-19 on PCR, and underwent CT chest examination at AKUH. Severity of disease was calculated in each lobe on the basis of following proposed CT severity scoring system (CT-SS). For each lobe the percentage of involvement by disease was scored - 0% involvement was scored 0, <50% involvement was scored 1 and >50% involvement was scored 2. Maximum score for one lobe was 2 and hence total maximum overall score for all lobes was 10. Continuous data was represented using mean and standard deviation, and compared using independent sample t-tests. Categorical data was represented using frequencies and percentages, and compared using Chi-squared tests. Inter-observer reliability between radiologist and COVID intensivist for the 10 point CT-SS rated on 0-10 was assessed using the Kappa statistic. A p-value < 0.05 was considered significant for all analyses. ResultsA total of 73 patients were included, the majority male (58.9%) with mean age 55.8 {+/-} 13.93 years. The CT-SS rated on 0-10 showed substantial inter-observer reliability between radiologist and intensivist with a Kappa statistic of 0.78. Patients with CT-SS 8-10 had a significantly higher ICU admission & intubation rate (53.8% vs. 23.5%) and mortality rate (35.9% vs. 11.8%; p = 0.017), as compared to those with CT-SS 0-7. ConclusionWe conclude that the described CT severity score (CT-SS) is a quick, effective and easily reproducible tool for prediction of adverse clinical outcome in patients with COVID 19 pneumonia. The tool shows good inter-observer agreement when calculated by radiologist and physician independently.

12.
PLoS One ; 16(1): e0244886, 2021.
Article in English | MEDLINE | ID: covidwho-1007114

ABSTRACT

INTRODUCTION: While chest x-rays (CXRs) represent a cost-effective imaging modality for developing countries like Pakistan, their utility for the prognostication of COVID-19 has been minimally explored. Thus, we describe the frequency and distribution of CXR findings, and their association with clinical outcomes of patients with COVID-19. METHODS: All adult (≥ 18 years) patients presenting between 28th February-31st May to the emergency department of a tertiary care hospital in Pakistan, who were COVID-19 positive on RT-PCR with CXR done on presentation, were included. A CXR Severity Score (CXR-SS) of 0-8 was used to quantify the extent of pulmonary infection on CXR, with a score of 0 being negative and 1-8 being positive. The patients' initial CXR-SS and their highest CXR-SS over the hospital course were used for analysis, with cut-offs of 0-4 and 5-8 being used to assess association with clinical outcomes. RESULTS: A total of 150 patients, with 76.7% males and mean age 56.1 years, were included in this study. Initial CXR was positive in 80% of patients, and 30.7% of patients had an initial CXR-SS between 5-8. The mortality rate was 16.7% and 30.6% patients underwent ICU admission with intubation (ICU-Int). On multivariable analysis, initial CXR-SS (1.355 [1.136-1.616]) and highest CXR-SS (1.390 [1.143-1.690]) were predictors of ICU-Int, and ICU-Int was independently associated with both initial CXR-SS 5-8 (2.532 [1.109-5.782]) and highest CXR-SS 5-8 (3.386 [1.405-8.159]). Lastly, age (1.060 [1.009-1.113]), initial CXR-SS (1.278 [1.010-1.617]) and ICU-Int (5.047 [1.731-14.710]), were found to be independent predictors of mortality in our patients. CONCLUSION: In a resource-constrained country like Pakistan, CXRs may have valuable prognostic utility in predicting ICU admission and mortality. Additional research with larger patient samples is needed to further explore the association of CXR findings with clinical outcomes.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Radiography, Thoracic/methods , Adult , Aged , COVID-19/epidemiology , COVID-19/mortality , Emergency Service, Hospital , Female , Hospitalization , Humans , Length of Stay , Lung/pathology , Male , Middle Aged , Pakistan/epidemiology , Retrospective Studies , SARS-CoV-2/isolation & purification , Severity of Illness Index , Tertiary Care Centers
13.
Br J Psychiatry ; 218(2): 75-76, 2021 02.
Article in English | MEDLINE | ID: covidwho-890130

ABSTRACT

Besides a global health crisis, the COVID-19 pandemic has potential to have a severe and long-lasting psychological impact on frontline healthcare workers such as paramedics. It is imperative to shed light on these mental health issues and employ interventions to protect the mental wellness of this vulnerable group of healthcare workers.


Subject(s)
COVID-19 , Emergency Medical Technicians/psychology , Mental Disorders/therapy , Occupational Diseases/therapy , Adult , Depressive Disorder/therapy , Humans , Mental Disorders/etiology , Mental Disorders/prevention & control , Occupational Diseases/prevention & control , Occupational Stress/therapy , Psychological Trauma/therapy , Psychosocial Intervention , Stress Disorders, Post-Traumatic/therapy , Suicide/prevention & control
SELECTION OF CITATIONS
SEARCH DETAIL
...