Hybrid deep neural network for automatic detection of COVID-19 using chest x-ray images

The 2019 coronavirus (COVID-19), started in China, spreads rapidly around the entire world. In automated medical imagery diagnostic technique, due to presence of noise in medical images and use of single pre-trained model on low quality images, the existing deep network models cannot provide the optimal results with better accuracy. Hence, hybrid deep learning model of Xception model & Resnet50V2 model is proposed in this paper. This study suggests classifying X-ray images into three categories namely, normal, bacterial/viral infections and Covid positive. It utilizes CLAHE & BM3D techniques to improve visual clarity and reduce noise. Transfer learning method with variety of pre-trained models such as ResNet-50, Inception V3, VGG-16, VGG-19, ResNet50V2, and Xception are used for better feature extraction and Chest X-ray image classification. The overfitting issue were resolved using K-fold cross validation. The proposed hybrid deep learning model results high accuracy of 97.8% which is better than existing techniques.

Early Enteral Feeding With Prebiotic-Containing Formula in Critically Ill Mechanically Ventilated Covid-19 Patients

Background: Optimal supportive care which includes adequate nutrient delivery remains the cornerstone in managing critically ill patients with COVID-19. Nutrition guiding principles for critically ill patients with COVID-19 strongly recommend providing early enteral nutrition (EEN) within 24-36 hours of admission to the intensive care unit (ICU) or within 12 hours of placement on mechanical ventilation (MV). Moreover, data show critically ill COVID-19 patients have negative alterations in their gut microbiome which is attributed to many factors including insufficient EN and fiber provision. The success and tolerance of EEN with a prebiotic formula in patients with COVID 19 is unknown. Here we aimed to assess, before and after implementation of an enteral feeding protocol, the achievement of EEN, estimated energy goals, and tolerance of a prebiotic formula in MV patients with COVID-19. Method(s): Data were collected and analyzed retrospectively from June 2020-May 2021 and prospectively from June 2021-January 2022. A protocol to promote EEN and improve nutrition delivery with a prebiotic-containing formula to patients within the seven days of ICU admission was created and implemented in June 2021 in the Medical ICU. Time to start EEN following invasive MV was assessed. Feeding adequacy over the first seven days of ICU admission was calculated by dividing the mean total calories of formula infused over the first seven ICU days by the estimated goal calories/day. The average number of bowel movements (BM) over the first seven ICU days was used to evaluate feeding tolerance. To determine the impact of inflammation and co-morbid conditions on feeding adequacy and tolerance, admission C-reactive protein (CRP) and Charlson Comorbidity Index (CCI) were trended with feeding adequacy. The Institutional Review Board approved the study. Result(s): A total of 343 patient records were analyzed with 203 patients in retrospective (R) and 140 patients in prospective groups (P). The post- MV feeding initiation time was shorter after implementing the feeding protocol (Mean 45.2 vs 33.8 hrs, and Interquartile Range (IQR) of Median (hrs) (18, 51) vs (16, 43) for the R and P groups, respectively (p = 0.04). Achievement of feeding goal rates were similar between groups (30.0 % vs 29.5%) (p >0.05). A prebiotic-containing formula was received in 36.2 % of patients in the R group versus 43.4 % in the P group. Providing a prebiotic formula had no impact on achieving goal nutrition in either period. In the R group, patients receiving the non-prebiotic formula had a higher total 7-days BM occurrence compared to the prebiotic formula group (8 vs 5.9 BMs/7 days, p = 0.03). In the P group there were no differences in the number of BMs between non-prebiotic and prebiotic formula groups (5.3 vs 5.0 BMs/7 days, p >0.05). Higher admission CRP and CCI values trended with higher incidence of inadequate feeding. Mean CCI was 4.42 and 4.17 for patients who received less than 25% goal feeding compared to those who received >80% of their goal feeds, respectively. Mean CRP was 12.3 and 11.4 for patients who received < 25% goal feeds compared to those who received >80% of goal feeds, respectively (p > 0.05). There were no differences in overall ICU length of stay between the R (11.7 days) and P (11.1 days) groups. (p = 0.34) Conclusion(s): EEN protocol implementation decreased time to EEN initiation in mechanically ventilated COVID-19 patients but did not affect patients in achieving goal nutrition in the first week of their ICU stay. Furthermore, COVID-19 patients tolerated EEN with prebiotic containing formulas. Further research is warranted to determine the impact of EEN with a prebiotic formula on the gut microbiome in critically ill MV patients with COVID-19.

Model of Visualization and Analytics for Open Data (Case: Election Voters & Kids Disability Category)

Several regional head elections had to be postponed due to the pandemic, including in Indonesia because of the COVID-19 pandemic. Several big cities in Indonesia are of concern because of their large population and GDP. This study conducts analysis and testing of datasets taken from Open Data in a city in Indonesia. In addition to conducting research on regional head elections, we also present information on voters from the category of kids with disabilities. The steps used in this research are using regional mapping data of the city of Surabaya in the Election of the Regional Head. Download the data or dataset for the Regional Head Election ampersand Categories of kids with disabilities. Based on the dataset voters from the category of children with disabilities are more than 5 percent.In this research, we use Python to process our datasets & Big Data technology. Data cleaning or cleansing, Exploratory Data Analysis, and Empirical Cumulative Distribution Functions (ECDF) in python are also needed. Result from ECDF chart with steady increase (increment of 0.1). The highest variance value is in Electoral District 5 = 6.090 and the lowest value is in Electoral District 4 = 0.90. The result of Open Data is graphical data visualization and candidate scores to help as an alternative for the 2024 Regional Head Election and the Category of kids with disabilities. © 2023 IEEE.

Topological study of hydroxychloroquine conjugated molecular structure used for novel coronavirus (COVID-19) treatment

The novel coronavirus disease 2019 (Covid-19) is a mutating and recombining pandemic that potentially spreading through an infected person in droplet-generated forms that have affected more than 200 countries and endanger the entire globe. There is no clear strategy for the care of COVID-19 cases. Moreover, experts across the globe are working actively to develop medicinal or anti-virus drugs. On the basis of recent clinical findings and recommendations, the study examined a variety of new medications that have shown antiviral activity against SARS-CoV-2, among other drugs, antimalarial medications Chloroquine (CQ) and Hydroxychloroquine (HCQ) have gained significant publicity to have promising effects against SARS-CoV-2. Linking a bioactive substance to a biocompatible polymer typically provides various concerns, such as improved drug solubilization, improved modification, precise restriction, and controlled discharge. An enormous number of medical analyses have confirmed that the characteristics of medical drugs have a nearby connection with their atomic structure. Medication properties can be acquired by considering the atomic structure of relating drugs. The calculation of the topological index of a medication structure empowers researchers to have a superior comprehension of the physical science and bio-organic attributes of drugs. Ev-degree and ve-degree based topological indices are two novel degrees based indices as of late defined in graph theory. Ev-degree and ve-degree based topological indices have been defined as corresponding to their relating partners. In this paper, we have computed topological indices based on ev-degree and ve-degree for the Hydroxyethyl Starch and Hydroxychloroquine (HCQ-HEC) bioconjugate molecular structure.

Door to acute stroke unit delays: a process-mapping highlighting factors delaying transfer in a tertiarycare hospital of Islamabad, Pakistan

Introduction: Stroke units have remarkably reduced morbidity and mortality in patients by bringing together a multidisciplinary team that aids in quick stroke diagnosis, emergency treatment, restoration of homeostasis, prevention of common complications, rehabilitation and secondary prevention. Our audit looks at factors that cause delay in early transfer of patients from emergency department to HASU (hyper-acute stroke unit) and aims to find solutions to reduce transfer time. Method(s): We obtained our data from stroke database maintained by hospital's medical records department. All patients presenting with acute stroke (ischemic and hemorrhagic) during the month of November and December2021 and fulfilling our inclusion criteria were evaluated. Result(s): A total of 138 patients presented to our stroke-care facility in the two months period with 79 eligible for stroke unit admission, out of which 52 (65.8%) were females and 27(34.2%) were males. The mean door to stroke unit time in our study was 278.6 minutes with major delays beyond 4hours caused by non-availability of beds(32.0%), covidrelated issues(25.5%),monetary issues(17.0%) initial referral delays(14.9%) and imaging delays(10.6%) respectively. Conclusion(s): Our audit showed that most of the delays were infrastructure- related like lesser stroke dedicated beds, separate facility for covidaffected stroke patients and no designated Ct scanner/ stroke nurse for acute stroke patients assessment in triage. Additional cause identified was low socioeconomic status hampering affordability of acute stroke care.

On entropy measures of polycyclic hydroxychloroquine used for novel coronavirus (COVID-19) treatment

The molecular structure of hydroxychloroquine (HCQ) used in the treatment of malaria is recently suggested for emergency used in COVID-19. The chemical compound of HCQ is produced by chemical alteration of ethylene oxide from human products, such as waxy maize starch. The molecular graph is a graph comprising of atoms called vertices and the chemical bond between molecules is called edges. A topological index is a numerical representation of a chemical structure which correlates certain physico-chemical characteristics of underlying chemical compounds besides its numerical representation. To distinguish the creation of entropy-based measures from the structure of chemical graphs, several graph properties have been utilized. For computing the structural information of chemical graphs, the graph entropies have become the information-theoretic quantities. The graph entropy measure has attracted the research community due to its potential application in discrete mathematics, biology, and chemistry. In this paper, our contribution is to explore graph entropies for molecular structure of HCQ based on novel information function, which is the number of different degree vertices along with the number of edges between various degree vertices. More precisely, we have explored the degree-based topological characteristics of hydroxyethyl starch conjugated with hydroxychloroquine (HCQ-HEC). Also, we computed entropies of this structure by making a relation of degree-based topological indices with the help of information function. Moreover, we presented the numerical and graphical comparison of the computed results.

Multi-System Inflammatory Syndrome in Children (MIS-C) in Local Settings of Developing Country

Multi-system inflammatory syndrome in children is a rare complication of corona virus-19 infection characterized by fever, inflammatory changes in body and multi-organ dysfunction or features consistent with incomplete/complete Kawasaki disease. We are presenting two cases of post-covid syndrome (MIS-C) in children. Copyright © 2022, Pakistan Pediatric Journal. All rights reserved.

Assessment of Predictors of Mortality in COVID-19 Patients Treated with Tocilizumab

Background: A hypersensitivity condition called cytokine storm is the main cause of death in COVID-19 patients. A monoclonal antibody called tocilizumab may be able to suppress the Interleukin-6 receptors (IL-6R) and lessen the likelihood that the body would have a hypersensitive immune response. Aim(s): To evaluate the mortality advantages of tocilizumab in individuals with COVID-19. Study design: Retrospective study. Place and duration of study: Bahria Town International Hospital Lahore from 16th June 2020 to 17th September 2021. Methodology: Patients with 96 confirmed instances of COVID-19 were enrolled. Two groups of patients were created. A single dosage of tocilizumab was administered to 52 participants in the first group, referred to as the survivors, and 44 patients in the second group, who passed away within 14 days. From the patients' medical records, the demographic information, co-morbid conditions, and laboratory values were obtained. The hospital's institutional review board and ethics committee (IRBEC) gave its approval for this study. The permission was ignored because this was a retroactive analysis. Result(s): 54.24 16.58 was the average age, and 54 (56.25%) of the population were men. 52 (54.16%) patients were survivors, compared to 44(45.83%) patients in the non-survivor group. In non-survivors compared to survivors, the older age group was shown to be statistically significant (62.78+/-12.86 vs. 51.65+/-11.68, p=0.003). Additionally, non-survivors had a greater BMI (p=0.006). In our study, hypertension and diabetes were the two co-morbid conditions that were most frequently detected (35.24% and 28.94%, respectively). The mortality rates among patients with diabetes, asthma, COPD, and cancer were all considerably higher (P=0.01, 0.006, and 0.004, respectively). Cancer and type-2 diabetes patients had death rates that were considerably higher (p=0.05 and p=0.01, respectively). C-reactive protein (CRP), D. Dimer, procalcitonin (PCT), and IL-6 were discovered to be the significant predictors of mortality (p 0.0001, 0.05, 0.001, and 0.004 respectively). Conclusion(s): Even though tocilizumab is authorised and has been shown to have positive results, people with diabetes, COPD, and asthma are more likely to experience negative results even after getting a single dosage of the medication. Similar to CRP, D. Dimer levels are reliable indicators of death. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

A descriptive analytical study to assess the efficacy of combination of various drugs in the treatment of COVID-19 infections

Purpose and Background: The purpose of this study is to examine the efficacy of several medications that are administered for the treatment of patients who have mild, moderate and severe case.

Leveraging Healthcare System with Nature-Inspired Computing Techniques: An Overview and Future Perspective

Nature-inspired computing (NIC) computer optimization algorithms are an emerging approach that relies on the principles and inspiration of the biological development of nature to build new and strong competitive tactics. Given the success of NIC approaches and techniques in big data analytic applications, it is expected that they may also be effectively applied in health care. The application of NIC in the management of the ongoing COVID-19 pandemic is a beneficial tool that may be widely employed in clinical and public health decision-making. Recent developments in artificial intelligence, machine learning, and bio-inspired optimization algorithms have boosted the relevance of biomedical signal and image processing research. Biomedical image processing is comparable in theory to biomedical signal processing in many aspects. It comprises the analysis, enhancement, and display of photographs collected via X-rays, ultrasound, magnetic resonance imaging (MRI), nuclear medicine, and visual imaging technologies. NIC is presently quickly emerging in many scientific and technological research domains, including biomedical sciences. In this perspective, nature optimization algorithms may play a key role in addressing the multiple elements of health care. Researchers, healthcare policymakers, physicians, and other interested parties might use the insights of our chapter to better prioritize research and development for the operationalization of AI in the event of future pandemics. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

A Retrospective, Cross-Sectional, Observational Study Comparing the Efficacy of Various Covid-19 Treatment Protocols

Purpose and Background: The goal of this study is to examine the efficacy of various medications that are recommended for the treatment of patients in India who are suffering from mild-to-severe cases of corona virus disease 2019 (COVID-19). Method(s): In study carried out a retrospective, cross-sectional, observational and descriptive study. Patients diagnosed with COVID-19 ranging from mild, moderate and severe were given as part of this treatment. The primary objectives are to compare the categorical treatment protocols for COVID-19 (as per NIH Treatment Guidelines) infected mild, moderate and severe patients. To evaluate the efficacy of the drugs on the basis of at the time of discharge improvement in SPO2, RR, D-Dimer, PCT, CRP and Ferritin Values. Result(s): A total of 266 patients included in this study mild to severe COVID 19 infection led to significant improvement in SPO2, Respiratory rate (RR), D-Dimer, Procalcitonin (PCT), C-Reactive Protein (CRP) and Ferritin level. Conclusion(s): Adult patients with mild, moderate and severe COVID-19 infection, when treated with different drug combination, were more likely to improve in terms of inflammatory markers and disease severity markers and were more likely to have a better clinical profile at the end of the treatment period. Copyright © 2022, Anka Publishers. All rights reserved.

A Study on the Health and Socioeconomic Impact of COVID-19 Pandemic and Barriers to Self-management of Diabetes during the Lockdown among Rural Residents of South India

Aim: To study the health and socioeconomic impact of the COVID-19 pandemic and to assess the barriers to self-management of diabetes during the lockdown, in rural South India. Materials and Methods: Details of demographic, social, economic, migration and health status were collected using a structured questionnaire from participants aged & GE;18 years belonging to the 21 villages of Chengalpattu and Kancheepuram districts of Tamil Nadu state in south India as part of the Telemedicine pRoject for screENing Diabetes and its complications in rural Tamil Nadu (TREND) study. From the 11,249 TREND participants, a random list of 25% (n = 2812) was system-generated using random numbers and 2812 participants were contacted for the study, of whom 2511 individuals participated. Telephonic interviews were conducted during the lockdown from June to August 2020. Further, qualitative interviews(Focus group discussions) were conducted among 27 individuals with diabetes between September and December 2020. Data were analyzed using thematic analysis. Results: The mean age of the study population was 43 & PLUSMN;14 years and 50.4% were women. Diabetes was present in 14.7%, hypertension in 31.9%, generalized and abdominal obesity in 33.3% and 46.5% respectively. When the lockdown was implemented in March 2020, 37% had migrated from urban to rural areas. Lack of daily wage jobs (68%), price of essential commodities (41.7%), social distancing/curfew (34.8%), mental fatigue/depression (14.7%), and loss of job (7.1%) were some reasons stated for their adverse social and financial circumstances. People with diabetes stated that they had to avoid or cut down their regular hospital visits due to travel restrictions. Many of the patients took the same medications for almost a year. Conclusion: Unemployment, poor mental health, and reduced household income were the most significant negative impacts faced by rural residents during the lockdown due to COVID-19. People with diabetes experienced disruptions in diabetes management due to the pandemic.

Impact of COVID-19 on Societal Behavior via Twitter Analytics

The outbreak of the COVID-19 pandemic has caused a notable challenge to the well-being of people all around the globe. In such times, it is of foremost importance to analyze the information posted by people on social media. In this study, a Twitter-based dataset related to COVID-19 has been analyzed, and the effect of the pandemic on societal behavior has been revealed. Tweets have been hydrated and pre-processed using the NLTK toolkit to find the most frequently posted COVID-related words. This research can help identify the social response of people to the Pandemic, realizing what people are majorly concerned about and extracting knowledge about the daily trend of sentiments around the world. It has been concluded from our analysis that rather than the expected negative trend in the use of COVID-19 terms on a daily basis, more positive figurative language has been used in the posted tweets.

COVID-19 PNEUMONIA IN THE SETTING OF IDIOPATHIC PULMONARY HEMOSIDEROSIS

SESSION TITLE: Diagnosis of Lung Disease through Pathology Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Idiopathic pulmonary hemosiderosis (IPH) is a rare pulmonary disease often resulting in diffuse pulmonary fibrosis. The majority of diagnoses present in infanthood with limited studies demonstrating late onset disease in patients older than 30 years. The mainstay of treatment is immunosuppressive therapy including systemic corticosteroids. Here we present a unique case of IPH in an unvaccinated individual with COVID-19 pneumonia. CASE PRESENTATION: Our patient was a 31 year-old male with a history of IPH diagnosed in early childhood with past hospitalizations for DAH and progressive pulmonary fibrosis for which he was treated with corticosteroids and cyclophosphamide years prior to this admission. He presented with six days of progressive shortness of breath and respiratory distress. He tested positive for COVID-19 four days prior to presentation. He was unvaccinated for COVID-19. Initial oxygen saturation was found to be 56% and non-invasive mechanical ventilation was started. CT angiography of the chest revealed diffuse ground glass opacities, bilateral consolidative changes, and redemonstration of pulmonary fibrosis with extensive honeycombing. Lab results were remarkable for elevated inflammatory enzymes including ferritin 1,335 ng/mL, lactate dehydrogenase 1,369 units/L, and C-reactive protein 6.5 ml/dL. Patient was started on intravenous glucocorticoids, IL-6 inhibitor, remdesivir. Work up for bacterial superinfection was unremarkable. His hospitalization was complicated by acute kidney injury, elevated liver enzymes, and anxiety. Despite the immunosuppressive therapy, the patient continued to have refractory hypoxemia. Due to his persistent hypoxemia, the family was contacted regarding the impending need for endotracheal intubation. They ultimately declined and the patient succumbed to his respiratory failure. DISCUSSION: Idiopathic pulmonary hemosiderosis remains to be a largely unstudied and rare disease with catastrophic respiratory sequela. There remains a scarcity of evidence surrounding the most effective treatment of these patients, although limited studies have shown mortality benefit with immunosuppressive therapy. In patients with IPH an insult such as COVID-19 infection could prove fatal. Preventative measures such as vaccination is vital in the protection of these patients. Further research regarding pathogenesis and treatment mechanisms for IPH is an aim of future study. CONCLUSIONS: Idiopathic Pulmonary Hemosiderosis is a rare but deadly disease often complicated by diffuse alveolar hemorrhage and pulmonary fibrosis. Considering the underlying pulmonary compromise in these patients, secondary insult from infection can have catastrophic outcomes. Reference #1: Saha B. K. (2021). Idiopathic pulmonary hemosiderosis: A state of the art review. Respiratory medicine, 176, 106234. https://doi.org/10.1016/j.rmed.2020.106234 Reference #2: Ioachimescu, O. C., Sieber, S., & Kotch, A. (2004). Idiopathic pulmonary haemosiderosis revisited. The European respiratory journal, 24(1), 162–170. https://doi.org/10.1183/09031936.04.00116302 Reference #3: Thornton, G. & Alotaibi, M. (2016). 979: IDIOPATHIC PULMONARY HEMOSIDEROSIS IN ADULT PATIENTS: AN EPIDEMIOLOGIC ANALYSIS. Critical Care Medicine, 44 (12), 321-321. doi: 10.1097/01.ccm.0000509655.03624.6e. DISCLOSURES: No relevant relationships by Allison Kunze No relevant relationships by Mohammed Siddiqui

HYDROXYCHLOROQUINE CAN BREAK YOUR HEART

SESSION TITLE: The Cardiac Intensivist 2 SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Hydroxychloroquine and chloroquine are medications derived from aminoquinoline. They are disease-modifying antirheumatic drugs used in the treatment of systemic lupus erythematosus (SLE). Although well tolerated, they do have side effects such as retinopathy, vacuolar myopathy, neuropathy, and as seen in our patient, cardiotoxicity. CASE PRESENTATION: Patient is a 48 year old female with a past medical history significant for chronic kidney disease secondary to autosomal dominant polycystic kidney disease, SLE on hydroxychloroquine who presented to the emergency department complaining of weakness. On arrival the patient was found to be in cardiogenic shock. Her transthoracic echocardiogram revealed a reduced ejection fraction of 37% and a large pericardial effusion concerning for tamponade physiology. Her COVID-19 PCR test was positive. She was taken for emergent pericardiocentesis which revealed 300cc of exudative fluid. Patient’s right heart catheterization revealed mean pulmonary capillary wedge pressure of 23 mmHg, pulmonary artery pressures of 44 mmHg/24 mmHg, mean 31mmHg, cardiac index 1.1L/min/m² by thermodilution, 1.7 L/min/m² by Fick. Following right heart catheterization and intra aortic balloon pump placement, the patient was admitted to the medical intensive care unit (MICU) and placed on intravenous inotropic and vasopressor support. Shortly after arrival to the MICU, patient had an increase in vasopressor requirements. Bedside ultrasound revealed cardiac tamponade. Patient had approximately 400cc of bloody pericardial fluid removed from her pericardial drain. The decision was made for emergent venoarterial extracorporeal membrane oxygenation (ECMO) to be initiated. Endomyocardial biopsy was performed which revealed vacuolization in the cytoplasm of several myocytes as well as lymphocytes in the interstitium of the endocardium. The vacuoles found in the cardiac myocytes were PAS positive. These biopsy results are consistent with hydroxychloroquine cardiotoxicity. The patient’s hydroxychloroquine was discontinued. In addition to hemodynamic support, she also received intravenous immunoglobuluin and systemic steroids. After a prolonged hospitalization she was successfully discharged. DISCUSSION: Cardiotoxicity is a rare adverse reaction seen with hydroxychloroquine. A 2018 systematic review revealed 127 cases of cardiac toxicity associated with the use of hydroxychloroquine or chloroquine. Most patients had been treated with the medication for a prolonged period of time and the toxicity is dose dependent. The mechanism behind hydroxychloroquine and chloroquine induced cardiomyopathy is believed to be secondary to lysosomal dysfunction as a result of toxic phospholipid accumulation in cardiomyocytes. CONCLUSIONS: In patients with new onset cardiomyopathy, a detailed medication reconciliation should be conducted to evaluate for toxins such as hydroxychloroquine and chloroquine. Reference #1: Della Porta, A., Bornstein, K., Coye, A., Montrief, T., Long, B., & Parris, M. A. (2020). Acute chloroquine and hydroxychloroquine toxicity: A review for emergency clinicians. The American Journal of Emergency Medicine. Reference #2: Abbi, B., Patel, S., Kumthekar, A., Schwartz, D., & Blanco, I. (2020). A Case of Cardiomyopathy With Long-term Hydroxychloroquine Use. JCR: Journal of Clinical Rheumatology, 26(8), e300. Reference #3: Chatre, C., Roubille, F., Vernhet, H., Jorgensen, C., & Pers, Y. M. (2018). Cardiac complications attributed to chloroquine and hydroxychloroquine: a systematic review of the literature. Drug safety, 41(10), 919-931. DISCLOSURES: no disclosure on file for Joseph Adams;no disclosure on file for Suliman Alradawi;No relevant relationships by George Kalapurakal No relevant relationships by Mohammed Siddiqui

Observation of Myocardial Involvement in Patients Recovered From COVID-19 by Using Cardiac Magnetic Resonance Imaging, In a Tertiary Care Hospital, Bangladesh.

It was previously reported that coronavirus caused myocardial injury in hospitalized patients. However, delayed cardiac involvement in symptomatic patient recovery from COVID-19 is not yet well known. The objective of this study was to evaluate cardiac involvement by using cardiac magnetic resonance (CMR) in symptomatic post-COVID-19 recovered patients. Thirty (30) patients who recovered from COVID-19 and had recently reported cardiac symptoms were studied in a prospective observational study performed at Popular Medical College Hospital, Dhaka, Bangladesh from March 2021 to September 2021. They underwent CMR examinations. CMR scanning protocol included the following: black blood, cine sequence, both short-axis and long-axis, T2-weight short tau inversion recovery (STIR) sequence, T2- weighted imaging (T2WI) and late gadolinium enhancement (LGE) and quantitative mapping sequences-native T1/T2 mapping and post-contrast T1 mapping. Myocardial edema and late gadolinium enhancement were assessed in all patients. Quantitative evaluation of native T1/T2 and ECV value and cardiac function were evaluated. There were 30 people in all in this study. The average age of the participants in the study was 36.6 years. Fourteen (46.6%) of the patients had abnormal cardiac MRI results, while the remaining 15(53.3%) had negative CMR findings. Among positive findings patients, 8(57.1%) of 14 had increased T2 signal. Increased myocardial edema was found in the same no of patients, involving 53.2% (128 of 224) of LV segments. Only 2 cases (2 of 14) showed mid myocardial and subepicardial LGE, involving 18 of 224, 8.03% of myocardial segments. Global native T1, T2 and ECV values are significantly elevated in all CMR positive findings patients. Native T1 1231ms (IQR: 1281.25-1257.5 versus 1155.5 (IQR: 1137.25-1172.75), T2 40 (IQR: 34.5-43.25) versus 35.5 (IQR: 34-37), ECV 31 (29.75-33.25) versus 23.5 (21.25-24.0), p<0.001; p<0.011 and p<0.001 respectively. Reduced RV functional were found in positive as compared with negative CMR findings patients, EF, 32.05 (IQR: 25.25-39.0) versus 54.5 (IQR: 52.0-57.75) and EDV, 117.5 (IQR: 102.0-134.25) versus 95.0 (IQR: 71.75-99.75), p<0.001 and p<0.001 respectively. In this study cardiac involvement was found in the post-COVID-19 recovered patient with cardiac symptoms. Cardiac MRI findings included myocardial edema, fibrosis and reduced right ventricular function. So attention should be paid to symptomatic post-COVID-19 recovered patients.

Carotid Endarterectomy Pathway at a Hub Site - the Impact of COVID-19

Aim: NICE Guidelines recommend that all patients who suffer from a TIA or non-disabling stroke are rapidly assessed and imaged. Patients suspected of having symptomatic carotid stenosis should be referred to a Vascular Centre for consideration of urgent carotid endarterectomy (CEA) within two weeks. Our aim was to assess the current referral-to-treatment timeline for carotid surgery in our Vascular Centre against these standards and explore the impact of the COVID-19 Pandemic on this. Method: We retrospectively interrogated the National Vascular Registry to identify patients undergoing CEA “pre-pandemic” (Jan - Dec 2019) and in a “contemporary period” (Jan - Sept 2021) Results: A total of 129 patients underwent CEA in the defined periods, including pre-Pandemic (80 patients) and contemporary (49 patients) periods. One patient had to be excluded due to inability to identify date of first symptoms. 2019 Data: The times (median) from symptoms to surgery were 10 days (interquartile range (IQR) 23 days), from imaging-to-referral, one day and from vascular review to surgery, two days. 2021 Data: The times (median) from symptoms to surgery were 10 days (IQR 12 days), from imaging-to-referral, two days and from vascular review to surgery, one day. Conclusions: The median time from symptoms to surgery has remained the same from pre-Pandemic data, though there is a decrease in IQR in current practice. We recommend creating a CEA Pathway to optimise the carotid service.

Impact assessment of COVID-19 on digital payment: an Indian perspective

The psychological and socioeconomic impact of the COVID-19 pandemic is significant and has changed the global order. Strict confinement has changed our everyday life and our buying behaviour. The purpose of this paper is to examine the impact of COVID-19 on the behaviour of digital payments in the Indian context. The cluster analysis technique is used to classify the types of customers according to their payment behaviour. The first group of clients may be described as ‘late majority’ and the second group of clients as ‘early majority’. The results suggest that fear of COVID-19 has contributed to digital initiatives by banks. The findings of this paper can be used by private and public sector banks or other small banks to understand the future implications of it in their payment operations and future policy to optimise the operational cost. © 2021 Inderscience Enterprises Ltd.