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1.
MMWR - Morbidity & Mortality Weekly Report ; 71(48):1531-1537, 2022.
Article in English | MEDLINE | ID: covidwho-2145606

ABSTRACT

Nirmatrelvir-ritonavir (Paxlovid), an oral antiviral treatment, is authorized for adults with mild-to-moderate COVID-19 who are at increased risk for progression to severe illness. However, real-world evidence on the benefit of Paxlovid, according to vaccination status, age group, and underlying health conditions, is limited. To examine the benefit of Paxlovid in adults aged >=18 years in the United States, a large electronic health record (EHR) data set (Cosmos ) was analyzed to assess the association between receiving a prescription for Paxlovid and hospitalization with a COVID-19 diagnosis in the ensuing 30 days. A Cox proportional hazards model was used to estimate this association, adjusted for demographic characteristics, geographic location, vaccination, previous infection, and number of underlying health conditions. Among 699,848 adults aged >=18 years eligible for Paxlovid during April-August 2022, 28.4% received a Paxlovid prescription within 5 days of COVID-19 diagnosis. Being prescribed Paxlovid was associated with a lower hospitalization rate among the overall study population (adjusted hazard ratio [aHR] = 0.49), among those who had received >=3 mRNA COVID-19 vaccines (aHR = 0.50), and across age groups (18-49 years: aHR = 0.59;50-64 years: aHR = 0.40;and >=65 years: aHR = 0.53). Paxlovid should be prescribed to eligible adults to reduce the risk of COVID-19-associated hospitalization.

2.
J Endocr Soc ; 6(Suppl 1):A441-2, 2022.
Article in English | PubMed Central | ID: covidwho-2119631

ABSTRACT

Introduction: Immune Checkpoint inhibitors (ICI) have been associated with multiple endocrinopathies including hypothyroidism, hyperthyroidism, primary and secondary adrenal insufficiency, hypophysitis and type 1 diabetes. Unlike other adverse effects from ICI, endocrinopathies tend to be irreversible. There are limited reports on the interaction of Covid-19 vaccine in patients receiving ICI for cancer treatment. Clinical Case: A 56 year old man with history of non-small cell lung cancer presents to the hospital with nausea, decreased appetite, fatigue and 30lb unintentional weight loss. He had been started on immunotherapy with pembrolizumab 4 months prior to symptom onset (total of 4 doses). His symptoms began the day after he received his first Covid-19 vaccine injection.At an outside hospital, his initial work up showed TSH of 0.02mcU/mL, free T3 of 8.3pg/mL and free T4 of 2.8ng/dL. Thyroid stimulating immunoglobulin (TSI) was negative and he did not undergo thyroid uptake scan due to recent contrast load for CT abdomen imaging. Patient was diagnosed with hyperthyroidism and started on methimazole 10mg daily. He presented to our hospital after two weeks at his oncologist's recommendation due to worsening symptoms and concern for failure to thrive. On admission, he was noted to have hypotension and tachycardia. Given the severity of his symptoms, we obtained an AM cortisol and ACTH. His baseline cortisol was 1.2mcg/dL, so he underwent a cosyntropin stimulation test. Patient was diagnosed with adrenal insufficiency given his subnormal response on cosyntropin stimulation test. He was treated with intravenous hydrocortisone 50mg every 8 hours and methimazole 20mg daily with dramatic clinical improvement within 24 hours. ACTH obtained prior to initiation of steroids subsequently resulted as undetectably low.Further hormonal work up including LH, FSH and IGF-1 were in the normal range with mildly elevated prolactin. MRI pituitary demonstrated a 4mm hypo-attenuation in the posterior pituitary. Discussion: Thyroid dysfunction is the most common adverse effect occurring in up to 30% of patients on ICI. Although less common, hypophysitis has been documented in 0.6-3.2% of patients on ICI depending on the drug. Many patients present only with adrenal insufficiency especially in those treated with pembrolizumab. Additionally, not all cases will present with radiographic findings of enhancement or inflammation of the pituitary gland. We describe a patient who developed acute symptoms of hyperthyroidism and adrenal insufficiency within 24 hours of receiving his Covid vaccine. We hypothesize that the vaccination may have triggered ICI-induced hypophysitis and hyperthyroidism in our patient. Resolution is yet to be determined. Conclusion: Hypopituitarism and hyperthyroidism can be life-threatening if undiagnosed and untreated. Patients on ICI should be closely monitored for adrenal insufficiency and other endocrinopathies after receiving Covid-19 vaccine.Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

3.
Journal of Clinical Oncology ; 40(16):E18644-E18644, 2022.
Article in English | Web of Science | ID: covidwho-2093001
4.
Movement Disorders ; 37:S499-S500, 2022.
Article in English | Web of Science | ID: covidwho-2084145
5.
Latin American Journal of Pharmacy ; 40(11):2617-2623, 2021.
Article in English | EMBASE | ID: covidwho-2073692

ABSTRACT

Coronavirus disease (COVID-19) is posing a huge burden on the entire world including developing countries like Pakistan. Our objective was to assess the knowledge, attitudes and perception of medical and non-medical college students towards COVID-19. A cross sectional survey was conducted among the college students of Punjab, Pakistan using a self-administered questionnaire during April-June 2021. Multivariate logistic regression modelling was used to evaluate adequate knowledge, good Attitude, and good Perception about COVID 19. P-value was determined using mood's median test and the value less than 0.05 was considered statistically significant. A total of 925 respondents completed the survey (37.8% males and 62.2% females). Mean knowledge score of the study respondents was 7.0 (maximum score 10.0). Mean attitude and perception scores were 37 and 33.5 respectively (maximum score 50.0). Statistically significant variations (p < 0.001) were observed in the knowledge of college students regarding number of people residing in the household and exercising regularly or not. Different age groups gave significant differences (p < 0.001) regarding the attitudes towards COVID-19). Significant variations were also found in the perception of the respondents depending upon the number of people residing in the household (p = 0.003), place of residence (p = 0.008). Pakistani students had satisfactory knowledge of COVID-19, but their attitudes and perceptions needed to be flourishing. These students could help reduce the spread of COVID-19 by guiding the general public on good COVID-19 practices. Copyright © 2021, Colegio de Farmaceuticos de la Provincia de Buenos Aires. All rights reserved.

6.
Technological Forecasting and Social Change ; 184, 2022.
Article in English | Web of Science | ID: covidwho-2069721

ABSTRACT

This paper investigates how oil price, COVID-19, and global energy innovation can affect carbon emissions under time-and frequency-varying perspectives. We contribute to the literature by being the first research to document the relationship between these variables in the short and long run (dynamically) at different frequencies in a multivariate context, thus providing a more detailed picture of the forces driving CO2 emissions. For this purpose, we use a novel methodology, i.e., the wavelet local multiple correlation (WLMC) recently developed by Polanco-Martinez et al. (2020). The results provide fresh evidence of long-run asymmetric dynamic correlations, highlighting how the oil price plays a key role in the dynamics of CO2 emissions. Moreover, we find that, during the long period, there is a strong negative co-movement between CO2 and the global energy innovation index, i. e., more investment in clean energy induces less emission. Supported by our findings, this research suggests crucial policy implications and insights for the governments worldwide in their efforts to revive their economies amidst the pandemic and environmental uncertainties.

7.
Indian Journal of Critical Care Medicine ; 26(10):1120-1125, 2022.
Article in English | EMBASE | ID: covidwho-2067000

ABSTRACT

Aims and objectives: In coronavirus disease-2019 (COVID-19) pneumonia, guidelines on timing and method of tracheostomy are evolving. The aim of the study was to analyze the outcomes of moderate-to-severe COVID-19 pneumonia patients who required tracheostomy and the safety with regard to the risk of transmission to the healthcare workers. Material(s) and Method(s): We retrospectively analyzed 30-day survival outcome of a total of 70 moderate-to-severe COVID-19 pneumonia patients on a ventilator, wherein tracheostomy was performed only in 28 (tracheostomy group), and the remaining were with endotracheal intubation beyond 7 days (non-tracheostomy group). Besides demographics, comorbidities, and clinical data including 30-day survival, and complications of tracheostomy were analyzed in both groups with respect to the timing of tracheostomy from the day of intubation. Healthcare workers were monitored for COVID-19 symptoms by carrying out periodical COVID tests. Result(s): The 30-day survival of the tracheostomy group was 75% as compared to 26.2% of the non-tracheostomy group. The majority of the patients (71.4%) had severe disease with PaO2/FiO2 (P/F ratio) <100. The first wave showed an 80% (4/5) whiles the second wave 100% (8/8) thirty days survival in the tracheostomy group performed before 13 days. All patients during the second wave underwent tracheostomy before 13 days with a median of 12th day from the day of intubation. These tracheostomies were performed percutaneous at the bedside, without any major complications and no transmission of disease to healthcare workers. Conclusion(s): Early percutaneous tracheostomy within 13 days of intubation demonstrated a good 30-day survival rate in severe COVID-19 pneumonia patients. Copyright © The Author(s). 2022.

8.
Chest ; 162(4):A1000, 2022.
Article in English | EMBASE | ID: covidwho-2060747

ABSTRACT

SESSION TITLE: Shock and Sepsis in the ICU Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Nocardiosis is a rare bacterial infection, which frequently affects immunocompromised patients. It can present as an acute, subacute, or chronic pulmonary infection with non-specific symptoms, such as fever, cough, dyspnea, weight loss, and hemoptysis. CASE PRESENTATION: A 34-year-old female with a history of chronic granulomatous disease and hidradenitis suppurativa on adalimumab presented to the ED with fever, shortness of breath, and productive cough of 2 days. Her vitals were T 101F, BP 66/48, HR 148, RR 42, and SPO2 94% on room air. On exam, she was cachectic, with bilateral crackles and rales in the right lung base. Extremities were cold, with trace pitting edema was present on bilateral lower extremities. COVID-19 PCR was negative. Despite fluid resuscitation, she remained hypotensive and was started on norepinephrine. Blood cultures were collected, and broad-spectrum antibiotics and an antifungal agent were initiated. Chest CT demonstrated bilateral multifocal consolidation with surrounding ground-glass opacities and complete consolidation of the right lower lobe. Due to worsening respiratory distress and tachypnea, and lack of improvement with non-invasive ventilation, she was intubated, placed on mechanical ventilation, and admitted to the Medical ICU. On hospital day 1, due to the patient's immunosuppression, unresolving shock, and radiographic findings, a bronchoscopy with bronchoalveolar lavage (BAL) was performed. On hospital day 2, a transthoracic echocardiogram showed LV ejection fraction of 20-25% with severe global hypokinesis of the LV. ACS workup had been unremarkable, with mildly elevated troponin and no ischemic changes on EKG. She was initiated on cardiac inotropes. On hospital day 3, BAL culture revealed Nocardia cyriacigeorgica. TMP-SMX and ceftriaxone were started for severe pulmonary nocardiosis. On hospital day 11, she was liberated from mechanical ventilation, and by hospital day 14, she was weaned off all pressors and inotropes. Approximately 4 weeks after admission, repeat TTE showed recovery of LV ejection fraction (55-60%) and she was discharged with a prolonged course of TMP-SMX and IV ceftriaxone, with duration to be determined at outpatient infectious disease follow-up. DISCUSSION: We discuss a unique case of severe pulmonary nocardiosis, presenting with ARDS and cardiogenic shock. To the best of our knowledge, this is the first case of a patient with pulmonary nocardiosis presenting with stress cardiomyopathy reported in the literature. While the pathophysiology is not well understood, theorized mechanisms include catecholamine excess, coronary artery spasm, microvascular dysfunction. CONCLUSIONS: This case highlights the need for a broad differential diagnosis in patients presenting with ARDS and cardiogenic shock and illustrates the value of clinical bronchoscopy in patients with unique presenting features. Reference #1: Lerner PI. Nocardiosis. Clin Infect Dis. 1996 Jun;22(6):891-903;quiz 904-5. doi: 10.1093/clinids/22.6.891. PMID: 8783685. Reference #2: Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, Wu KC, Rade JJ, Bivalacqua TJ, Champion HC. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005 Feb 10;352(6):539-48. doi: 10.1056/NEJMoa043046. PMID: 15703419. Reference #3: Park JH, Kang SJ, Song JK, Kim HK, Lim CM, Kang DH, Koh Y. Left ventricular apical ballooning due to severe physical stress in patients admitted to the medical ICU. Chest. 2005 Jul;128(1):296-302. doi: 10.1378/chest.128.1.296. PMID: 16002949. DISCLOSURES: no disclosure on file for D. Clark Files;No relevant relationships by Nisha Patel No relevant relationships by Meehir Shah

9.
Investigative Ophthalmology and Visual Science ; 63(7):1008-F0255, 2022.
Article in English | EMBASE | ID: covidwho-2058447

ABSTRACT

Purpose : In the COVID-19 era, tele-retinal technologies are rising to the forefront of contactless ophthalmic care. Point-of-care Optical Coherence Tomography (OCT) and fundus photography remotely analyzed by an off-site retina specialist (tele-R) must be validated for screening retinal disorders. This study assesses the feasibility of tele-R as a screening tool for diabetic retinopathy (DR) in an outpatient clinical setting. Methods : A retrospective study was conducted on 16 patients (32 eyes, 28 with DR, and 4 controls) presenting to the retina clinic (RC) of an urban academic medical center. Automated OCT-B and 45 fundus photographs of the posterior pole were taken using a Topcon Maestro 3D OCT-1 unit, and 3D topographical maps of the macula were generated. Images were transmitted to a remote retina specialist (blinded to patient history and demographics) who assessed severity of DR and diabetic macular edema (DME). Primary outcomes included grading of DR and DME with fundus and OCT-B images, respectively, using the International Clinical Diabetic Retinopathy classification scale. The secondary outcome was identifying the severity grade of DME using the 3D macular map. Concordance was tested between diagnoses obtained from tele-R assessment and in-person examination by the retina specialist (gold standard) using Cohen's Kappa statistic (κ). Eyes that could not be assessed were removed from analysis. Results : 30 of 32 eyes with sufficient data for analysis were included. The average age was 57.9 (±11.2) years. 37% of patients were male, 69% were Hispanic, and 94% had Type 2 diabetes. The κ±standard error (SE) for DR severity was 0.738±0.099 (p<0.001), for DME severity was 0.588±0.122 (p<0.001), and for presence of DME was 0.727±0.122 (p<0.001). The retina specialist was able to grade the DME severity in only 10/14 (71%) eyes using the 3D macular map alone, but in 93% (13/14) eyes with OCT-B images. Conclusions : Tele-R is a reliable modality for diagnosis of DR severity;there was substantial agreement on identifying DR severity using tele-R vs in-person examination. There was substantial agreement in discerning DME using tele-R vs in-person while only moderate agreement on determining the severity of DME, which suggests that tele-R may useful in identifying presence of DME but not determining the severity of edema.

10.
Investigative Ophthalmology and Visual Science ; 63(7):3792-F0213, 2022.
Article in English | EMBASE | ID: covidwho-2058417

ABSTRACT

Purpose : In recent years, innovations in tele-ophthalmology have shown promise in providing quality ophthalmic care to patients in low-access settings and high-risk environments such as the COVID-19 pandemic. Emergency departments and urgent centers may benefit from tele-ophthalmology applications;the tele-images can be sent to the covering ophthalmologist or, to another ED for evaluation of images prior to transferring the patient. In this study, we aimed to assess the ability of resident physicians to identify features of posterior-pole retinal pathology using teleophthalmology. Methods : Retrospective study on 16 patients (32 eyes;30 with retinal pathology and 2 controls) who presented to a retina clinic at an academic medical center. Automated OCT-B images with 3D topographic maps and fundus photographs of the posterior pole using a Topcon Maestro 3D OCT-1 unit were taken. Images were transmitted remotely to a resident physician who attempted to identify retina pathology using fundus photography and OCT. The same images were consequently evaluated by a retina specialist for grading. We then tested the concordance between diagnoses rendered via tele-OCT by the resident physician and the gold standard clinical examination (performed by the retina specialist) using Cohen's Kappa statistic (κ). Results : An overall average of 79.9% concordance for 69 potential findings was obtained between the retina attending's diagnosis with clinical examination and the resident physician's diagnosis using tele-OCT/fundus images based on Cohen's Kappa statistic (κ). The concordance was lower in eyes with vitreous hemorrhage most likely due to the inferior quality fundus and OCT-B images. The resident exam also identified the presence of any macular pathology in all 30 eyes with macular pathology and correctly identified the controls, indicating 100% sensitivity for identifying abnormal findings using tele OCT/fundus images. Conclusions : This study verifies the utility of resident screening of tele-OCT fundus and OCT-B images to identify retinal pathology. Tele-ophthalmology likely has a useful role in triaging retinal pathology whose outcomes could be affected by timely intervention. Many unnecessary emergency transfers may be avoided if the on-call ophthalmology residents are able to review the fundus and OCT images before hand.

11.
Investigative Ophthalmology and Visual Science ; 63(7):1383-A0079, 2022.
Article in English | EMBASE | ID: covidwho-2058064

ABSTRACT

Purpose : The COVID-19 pandemic exposed the need for increased mobilization of teleophthalmology resources. Artificial intelligence (AI) may serve as a tool to assist physicians in triaging highest need patients if the AI's assessment of disease is comparable to the physician's assessment. This study assesses the ability of AI software to diagnose diabetic retinopathy (DR) as compared to Tele-ophthalmology and in-person examination by a retina specialist. Methods : Records of forty patients (average age 55.1±10.9 years) presenting to an urban retina clinic were reviewed retrospectively for factors including demographics, retinal photos taken by Canon CR-2 Plus AF Retinal Imaging camera (Tokyo, Japan), and diagnosis of DR based on the International Clinical Diabetic Retinopathy (ICDR) classification scale during an in-person clinic visit in which a fundus exam was performed. Retinal photos were graded by AI software, EyeArt (EyeNuk, CA), as Normal, Mild DR, or More than Mild DR. Retinal images were also graded remotely by a retina specialist using the ICDR classification scale via TeamViewer software (Tele). Agreement between Tele, AI, and inperson DR diagnosis was assessed using Cohen's Kappa (κ) coefficient using IBM® SPSS® Statistics software. Results : Among 80 eyes, 33 were diagnosed in-person with no DR, 5 with mild nonproliferative DR (NPDR), 9 with moderate NPDR, 3 with severe NPDR, 7 with proliferative diabetic retinopathy (PDR), and 23 with regressed PDR. Eleven and 26 eyes could not be graded by Tele or AI, respectively. κ±SE for in-Person diagnosis vs Tele was 0.859±0.058 (p<.001), in-person vs AI was 0.751±0.082 (p<.001), and Tele vs AI was 0.883±0.063 (p<.001). Conclusions : AI is a reliable tool for screening patients for DR and referring them for physician evaluation since AI had a substantial rate of agreement with the in-person diagnosis and near perfect agreement with Tele. Tele grading was in near perfect agreement with the in-person diagnosis, showing that Tele is a reliable option for a physician to remotely screen patients that may be ungradable by AI. However, improvements are needed due to the high number of images that are ungradable via Tele and AI. Further studies should assess ways to reduce the number of ungradable images via Tele and AI and create a trend analysis for multiple visits for a given patient.

12.
Investigative Ophthalmology and Visual Science ; 63(7):1401-A0097, 2022.
Article in English | EMBASE | ID: covidwho-2057433

ABSTRACT

Purpose : During the Covid-19 era, understanding the benefits and limitations of tele-ophthalmology has become increasingly important. In this study, we aim to assess the accuracy of tele-ophthalmic diagnosis of diabetic retinopathy (DR) and diabetic macular edema (DME) when performed by resident physicians. Methods : Retrospective study on 16 patients (32 eyes;28 DR and 4 controls) who presented to a retina clinic at an academic medical center. Automated OCT-B images with 3D topographic maps and fundus photographs of the posterior pole using a Topcon Maestro 3D OCT-1 unit were taken. Images were transmitted remotely to a resident physician who assessed the severity of the DR and DME on the basis of the fundus photographs and OCT. The same images were transmitted to a retina specialist for grading. Primary outcomes included DR and DME grade as defined by the International Clinical Diabetic Retinopathy classification scale. We then tested the concordance between diagnoses rendered via tele-OCT by the resident compared to the retina attending's remote diagnosis and the gold standard retina specialist's clinical examination using Cohen's Kappa statistic (κ). Results : Agreement between ophthalmology residents and attendings on tele-OCT diagnosis of DR was substantial (78% concordance on presence and 75% on severity), while agreement on identifying and grading edema was moderate (60% concordance on DME presence and 52% concordance on overall DME severity). Detection of DR by residents via tele-retinal imaging is highly sensitive (100% sensitivity), while detection of DME is highly specific (79-95% specificity). Discordance between residents and attendings on DME grading may owe to differences in opinion regarding what constitutes mild edema versus no edema;however, both concordance and predictive accuracy increase when identifying patients with moderate to severe DME. Conclusions : This study provides proof of principle for the sensitivity and specificity for remote diagnosis of DR via tele-OCT fundus and OCT-B images. This technology may be useful in identifying patients at risk of severe vision loss and enable early detection of patients who need referral for prompt treatment. These findings may be particularly relevant to training programs looking to implement tele-retinal diabetic screening or using tele-OCT where prompt access to a retina specialist may not be possible.

13.
Cyber-Physical Systems: AI and COVID-19 ; : 189-206, 2022.
Article in English | Scopus | ID: covidwho-2048746

ABSTRACT

News articles have a strong effect on the readers’ sentiments, which in turn affects stock markets and the way economies of various countries perform. This chapter’s main idea is based on the efficient market hypothesis that highlights the conjunction of news and information with market performance. The work presented in this chapter analyzes the impact of news headlines on markets and how they affect the global economy during the unprecedented COVID-19 pandemic. This chapter proposes to use the lexicon method to calculate the sentiment values of the news headlines. Based on these values, stock index values are predicted using machine learning algorithms. The chapter predicts the effect of Indian news headlines on the Nifty index. This can then be extrapolated to global economies as well. © 2022 Elsevier Inc. All rights reserved.

15.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009600

ABSTRACT

Background: Assessments of health-related quality of life (HRQOL) are conducted by health systems to analyze and improve patient-centered care. Numerous studies have shown that the COVID-19 pandemic poses unique stressors for patients with cancer. However, the impact of the pandemic on HRQOL in patients with cancer is unknown. This study investigates change in self-reported global health scores in patients with cancer before and during the COVID-19 pandemic. Methods: In this single-institution retrospective cohort study, patients who completed the Patient-Reported Outcomes Measurement Information System (PROMIS) at a comprehensive cancer center before and during the COVID-19 pandemic were identified. Surveys were analyzed to assess change in the PROMIS global mental health (GMH) and global physical health (GPH) scores at different time periods (pre-COVID: 3/1/5/2019-3/ 15/2020, surge1: 6/17/2020-9/7/2020, valley1: 9/8/2020-11/16/2020, surge2: 11/17/2020-3/2/ 2021, and valley2: 3/3/2021-6/15/2021). Results: A total of 29,983 surveys among 7,209 patients were included in the study. Mean GMH scores for patients before the COVID-19 pandemic (50.57) were similar to that during various periods during the pandemic: surge1 (48.82), valley1 (48.93), surge2 (48.68), valley2 (49.19). Mean GPH score was significantly higher pre-COVID (42.46) than during surge1 (36.88), valley1 (36.90), surge2 (37.33) and valley2 (37.14) (Table). During the pandemic, mean GMH (49.00) and GPH (37.37) scores obtained through in-person were similar to mean GMH (48.53) and GPH (36.94) scores obtained through telehealth. Conclusions: In this single institution study, patients with cancer reported stable mental health and deteriorating physical health during the COVID-19 pandemic as indicated by the PROMIS survey. Modality of the survey (in-person versus telehealth) did not affect scores.

16.
Indian Journal of Critical Care Medicine ; 26:S57, 2022.
Article in English | EMBASE | ID: covidwho-2006350

ABSTRACT

Aim and background: A high interleukin-6 (IL-6) level in COVID- 19 plays a major role in the pathophysiology and is considered a relevant parameter in predicting the most severe course of the disease. In COVID-19 extracorporeal blood, purification is proposed as adjuvant therapy and aims at controlling the dysregulation in the autoimmune system. It essentially reduces high levels of several mediators and by this controls the cytokine storm, rather than actively targeting individual pathways of inflammation. Positive IL-6 balance post polymethyl methacrylate (PMMA) filter used for cytokine storm in COVID-19 patients with dialysis has shown to be an independent predictor of mortality. We present outcomes of severe COVID pneumonia patients with cytokine storm, acute kidney injury, chronic kidney disease, sepsis, and septic shock at our centre over a year. Objective: A retrospective analysis of data to understand the effect of hemofiltration for severe COVID-19 pneumonia. Materials and methods: All patients admitted to our unit, with severe COVID pneumonia with chronic kidney disease, sepsis, septic shock, and cytokine storm were included from August to December 2020. Demographic variable, clinical, and laboratory data were compared pre and post filtration with PMMA filters. Dialysis vintage, duration of mechanical ventilation, length of stay, and hospital were analysed. Results: We analysed 17 severe COVID patients (P/F ratio < 100) requiring ventilator support in whom hemofiltration was used for cytokine storm with dialysis, sepsis, and septic shock. The average age of these patients was 70.2 ± 18.2 years with no difference in the distribution of age and comorbidities. They all were divided as responders or non-responders groups based on the decrease or no change and increase, respectively, in their pre and post filtration levels of IL-6. Non-responders (N = 11) had 3.6-fold increase in IL-6 levels post hemofiltration with the majority of them on vasopressors;pre (8/11-72.7%) and post (9/11-81.8%) hemofiltration. None of the non-responders survived and we noted 54.5% of this group received hemofiltration post intubation. The non-responders also had a positive IL-6 balance post-hemofiltration which guided us to use this therapy early in the disease. Therefore, subsequent 6 patients were offered hemofiltration early, where we found a decrease in IL-6 levels by 21.4%. Out of the 6 responders, 4 survived and demonstrated a reduction in the IL-6 of 66.7%. None of these survivors required vasopressor support and we were able to avoid or reduce the need for ventilator support in them. Survivors had an average length of stay in ICU of 24 days and were discharged by the 30th day. One of the two non-survivors had succumbed secondary to a cardiac event, while the other was intubated before filtration in view of heart failure. Conclusion: The most prominent finding was the distinct increase in the IL-6 levels in non-survivors which was directed towards the early use of hemofiltration treatment. The present data though limited to a small subgroup of severe COVID patients suggest the need to prevent the positive IL-6 balance. Hemofiltration may be an alternative to be considered early in to prevent the cytokine storm and its ill effects.

17.
Polymer Chemistry ; 2022.
Article in English | Scopus | ID: covidwho-1972677

ABSTRACT

Designing a surface that can disinfect itself can reduce labor-intensive cleanings and harmful waste, and mitigate spread of surface borne diseases. Additionally, since COVID-19 is an airborne pathogen, surface modification of masks and filters could assist with infection control. Styrene-maleic acid (SMA) copolymers and their derivatives were shown to have lipid-bilayer disrupting properties, making them candidates as anti-viral materials. A series of network polymers with styrene-maleic acid-based polymers and control over polymer chain-length and composition were synthesized. All the polymers formed mechanically robust structures, with tunable Young's moduli on the order of MPa, and tunable swelling capability in water. The SMA-based bulk materials, containing a zwitterionic polar unit, showed excellent lipid disrupting properties, being up to 2 times more efficient than a 10% Triton solution. The highest performance was observed for materials with lower crosslink densities or shorter chain-lengths, with lipid disruption capability correlating with swelling ratio. Additionally, the material can capture the spike protein of SARS-CoV-2, with up to 90% efficiency. Both the lipid disrupting and spike protein capture ability could be repeated for multiple cycles. Finally, the materials are shown to modify various porous and non-porous substrates including surgical and KN95 masks. Functional network modified masks had up to 6 times higher bilayer disruption ability than the unmodified masks without inhibiting airflow. © 2022 The Royal Society of Chemistry.

18.
BMJ Global Health ; 7:A35, 2022.
Article in English | EMBASE | ID: covidwho-1968281

ABSTRACT

Objective The health systems costs of COVID-19 are high in many countries, including Pakistan. Without increases in fiscal space, COVID-19 interventions are likely to displace other activities within the health system. We reflect on the inclusion of COVID-19 interventions in Pakistan's Essential Package of Health Services (EPHS) and, from a financial optimisation perspective, propose which interventions should be displaced to ensure the highest possible overall health utility within budgetary constraints. Methods We estimated the costs of all 88 interventions currently included in the EPHS and collected published data on their cost-effectiveness. We also estimated total costs and costeffectiveness of COVID-19 vaccination in Pakistan. We ranked all EPHS interventions and COVID-19 vaccination by costeffectiveness, determining which interventions are comparatively least cost-effective and, in the absence of additional funding, no longer affordable. Results The EPHS assumes a spending per capita of US $12.96, averting 40.36 million disability-adjusted life years (DALYs). From a financial optimisation perspective, and assuming no additional funds, the introduction of a COVID-19 vaccine (US$3 per dose) should displace 8 interventions out of the EPHS, making the EPHS more cost-effective by averting 40.62 million DALYs. A US$6 dose should displace a further intervention and avert 40.56 million DALYs. A US$10 dose would partially fall out of the package, displacing four additional interventions. If health spending per capita decreased to US$8, a US$3 dose would still be affordable, but not US$6 or US$10 doses. Discussion Cost-effectiveness is only one criterion considered when deciding which interventions are included in (or removed from) a health benefits package. While displacing certain interventions to create fiscal space for the COVID-19 vaccine may lead to a financially optimal scenario, doing so may be politically unfeasible or socially undesirable. We highlight the difficult trade-offs that health systems face in the era of COVID-19.

19.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927762

ABSTRACT

Introduction: Mycoplasma pneumoniae is a respiratory tract pathogen that most commonly causes acute bronchitis. Pneumonia is a less common manifestation. Herein we describe a patient who presented with COVID19 like symptoms after exposure but was later found to have Mycoplasma with cryptogenic organizing pneumonia (COP). Case Description: A 63-year-old lady presented to the emergency department with a cough with minimal sputum production and dyspnea for one week and a generalized itchy rash for four days. She had a recent travel history, exposure to a COVID-19 patient, and was unvaccinated against COVID-19. On admission, vitals were normal except for a heart rate of 121/min. On examination, she had a maculopapular rash involving the face, neck, back, palms, and soles (Fig A and B). Labs were significant for total leukocyte count of 12.9 X 103/ mm3, D-dimer of 1125 ng/mL which increased to 1635ng/mL in 24 hours, erythrocyte sedimentation rate of 38mm/h, and C-reactive peptide of 101.5mg/L. Chest x-ray revealed bilateral opacities worse on the right (Fig C). A CT pulmonary angiogram was negative for PE but showed bilateral peripheral opacities greater on the right side, suggesting COVID19 as the etiology (Fig D). But COVID19 PCR was negative. Due to the presence of diffuse rash, mycoplasma IgG antibodies were checked which were positive. During the hospital course, she became hypoxic requiring nasal cannula oxygenation. The patient underwent bronchoalveolar lavage (BAL) with transbronchial lung biopsy (TBLB) which revealed 60% eosinophils with COP. She was treated with IV methylprednisolone, IV ceftriaxone, and doxycycline. Her respiratory symptoms got better, and the rash significantly improved with residual hyperpigmentation. The patient was discharged on tapering doses of steroids and levofloxacin to complete 14 days of antibiotics. Discussion: Mycoplasma pneumoniae is known to cause atypical pneumonia most commonly in young children than in adolescents and adults. COP is rarely seen with it. Common dermatological manifestations include erythematous maculopapular rash, erythema multiforme. Our patient was an elderly female who presented with classic maculopapular rash and respiratory symptoms. The presence of rash and hypoxia prompted us to get BAL with TBLB which led to the diagnosis of COP and early initiation of steroids. Although open lung biopsy is considered the best approach for diagnosis, BAL with TBLB has a positive predictive value of around 95%. Symptomatic improvement in such patients is quite impressive with steroids with complete recovery in most of the patients. (Table Presented).

20.
2021 IEEE India Geoscience and Remote Sensing Symposium, InGARSS 2021 ; : 258-260, 2021.
Article in English | Scopus | ID: covidwho-1922712

ABSTRACT

The present study focuses over Ahmedabad City of Gujarat State, India for the time period 1st March to 30th June comprising of the Pre-Lockdown Phase (PLP), the National Lockdown Phase - 1 (NLP1) and the Unlock Phase - 1 (ULP1). We have considered this time period over the years 2019, 2020 and 2021 to explore the effect of COVID induced lockdown on LST and understanding its variation. Satellite data acquired from AQUA - MODIS with a spatial and temporal resolution of 1 Km and 1-2 days respectively was used for the analysis of the LST. The average LST over Ahmedabad was 314.18 K, 311.79 K and 315.67 K for PLP over the years 2019, 2020 and 2021. For NLP1 the average LST over those years were 321.68 K, 318.73 K and 319.39 K respectively. And for the ULP1 the average LST over those years were 319.87 K, 314.07 K and 312.19 K respectively. We observe a 2.38 %, 2.22 % and 1.17 % increase in LST from the PLP to NLP1 during the years 2019, 2020 and 2021. The increase of LST during the NLP1 in 2020 showed that as the pollution decreased, the active elements that were present in the atmosphere which caused disturbance to the sensor on the satellite while calculating LST were reduced and we got a brighter top of surface. The decrease in LST from 2019 levels for the ULP1 is also observed indicating the effects of lockdown and onset of monsoon in 2020 and 2021. © 2021 IEEE.

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