CLINICAL MEMORY OF COVID-19 PANDEMIC: A COMPARATIVE ANALYSIS OF CLINICAL AND ANGIOGRAPHIC CHARACTERISTICS OF PATIENTS WITH ACUTE CORONARY SYNDROME

Objectives: To describe the clinical characteristics and angiographic features of COVID-19 patients presenting with acute coronary syndrome (ACS) and to compare with non-COVID-19 ACS patients presenting simultaneously. Methodology: In a case control design, data were extracted from a prospectively collected COVID-19 and NCDR registry. All ACS patients who underwent cardiac catheterization from April 2020 to May 2021 were included. All of the patients were taken to the Cath lab for diagnostic coronary angiography and possible percutaneous intervention. Demographic and clinical characteristics, angiographic features, and in-hospital outcomes were compared between ACS patients with and without COVID-19. Results: A total of 4027 COVID-19 negative patients, and 80 COVID-19 positive were included. Total of 83% in COVID-19 and 88% in non-COVID-19 group had ST elevation myocardial infarction. Majority of the COVID-19 positive patients had sub-optimal TIMI flow grade (<III) post procedure and had a high thrombus burden (11.2% vs. 2.9%;p<0.001). Majority of the patients who had COVID-19 and ACS required mechanical circulatory support (48.8% vs. 0.3%;p<0.001). The mortality rates were also higher in COVID-19 positive group (38.8% vs. 1.3%;p<0.001). Among the COVID-19 positive patients 66.3% (53) had high thrombus burden (≥4 grade), intervention was performed in 73.7% (59). Post-intervention myocardial blush grade ≤2 was observed in 57.6% (34), slow flow in 85.3% (29), and phasic flow possibly due to elevated LVEDP in 41.2% (14) patients. Conclusion: COVID-19 patients with ACS had a higher severity of illness at presentation and worse outcomes as compared to simultaneously presenting non-COVID patients. © 2023 The authors.

The Impact of Illness Perception on Delay in Seeking Medical Help in Patients with Acute Chest Pain: A Cross-sectional Study in the United Arab Emirates

Background: The concern of contracting COVID-19 has prevented numerous individuals with ambiguous myocardial infarction symptoms from seeking medical attention, leading to delayed presentation and treatment of acute coronary syndrome (ACS). This delay could increase the risk of long-term consequences. Aim: The aim of this study is to evaluate the impact of illness perception on delay in seeking medical help in patients with acute chest pain in UAE during COVID-19 pandemic. Methods: A descriptive cross-sectional design was used. Results: A total of 222 in-patients participated in the study, with an average age of 54.3 years (SD=14, Range= 20-86). The average score of illness perception was 5.66 (SD=0.92), which indicates that CVD was perceived as moderately threatening to physical and emotional status. Univariate analysis showed that illness coherence having previous cardiac catheterization, diabetes and asthma were factors associated with delay in seeking medical services. The linear regression showed that college education was a strong predictor of delay, while a history of asthma and undergoing cardiac catheterization were independent predictors of shorter delay. Conclusion: Illness coherence perception and time of seeking medical help are correlated. In addition, illness perception of personal control is low, which indicates the need for educational intervention. Other clinical factors also impact patients' decisions, such as previous cardiac intervention and comorbidity, highlighting the target group for further attention from the healthcare team. © 2023 Mosleh et al.

A Comprehensive Review on Access Control Systems amid Global Pandemic

In the contemporary time of technology, security is the utmost concern for every building automation system. Access Control Systems are the backbone of any security system being employed in any intelligent building, and can be operated in a biometric or non-biometric manner. There are various types of recognition systems available, depending upon the required level of safety and security. The ongoing pandemic has challenged and tested Access Control System in many aspects.This paper aims to review the various forms of access control systems and their viability in the context of COVID-19. It is found that some access control solutions fail to provide the required security during this global epidemic due to their contact-based operations. So, in the midst of the worldwide pandemic, a realistic integrated electronic access control system can be designed to meet the requirements of users. © 2022 IEEE.

REDACS: Regional emergency-driven adaptive cluster sampling for effective COVID-19 management

As COVID-19 is spreading, national agencies need to monitor and track several metrics. Since we do not have perfect testing programs on the hand, one needs to develop an advanced sampling strategies for prevalence study, control and management. Here we introduce REDACS: Regional emergency-driven adaptive cluster sampling for effective COVID-19 management and control and justify its usage for COVID-19. We show its advantages over classical massive individual testing sampling plans. We also point out how regional and spatial heterogeneity underlines proper sampling. Fundamental importance of adaptive control parameters from emergency health stations and medical frontline is outlined. Since the Northern hemisphere entered Autumn and Winter season (this paper was originally submitted in November 2020), practical illustration from spatial heterogeneity of Chile (Southern hemisphere, which already experienced COVID-19 winter outbreak peak) is underlying the importance of proper regional heterogeneity of sampling plan. We explain the regional heterogeneity by microbiological backgrounds and link it to behavior of Lyapunov exponents. We also discuss screening by antigen tests from the perspective of "on the fly" biomarker validation, i.e., during the screening. [ FROM AUTHOR] Copyright of Stochastic Analysis & Applications is the property of Taylor & Francis Ltd 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.)

Statistical findings and outcomes of acute coronary syndrome patients during COVID-19 pandemic: A cross sectional study.

Introduction: Time to treatment of acute coronary syndrome (ACS) can be a matter of life or death considering its major contribution to cardiovascular mortality. The sudden outbreak of the Coronavirus Disease in 2019 (COVID-19) caused great uncertainty in achieving ACS time-frame goals. This study assesses ACS presentation time and outcomes before and during the COVID-19 pandemic. Methods: A total of 1287 ACS patients were included in this cross-sectional study. We compared mortality and other outcomes during hospital admission. Before-COVID was deemed as admission between March 2018 and February 2020, while admission between March 2020 and February 2022 was deemed as during-COVID. The association of admission on outcomes was measured using regression statistics. Results: There was a 51.2 % decline of total patients before-COVID (865 patients) to during-COVID (422 patients). While there is no difference in first medical contact (FMC) before [3 h (IQR 1-7)] compared to during the pandemic [3 h (IQR 2-9), p 0.058], we found a decrease in door to wire time < 12 h (43.41 % vs 18.98 %, p < 0.001). There was also a non-significant decrease in fibrinolysis (20.45 % vs 15.18 %, p 0.054) but an increase in those undergoing percutaneous coronary intervention (PCI) (58.36 % vs 77.04 %, p value < 0,001). We also found reduced mortality (12.52 % vs 9.69 %, p 0.151), heart failure (28.16 % vs 25.81 %, p 0.31), but more cardiogenic shock during the pandemic (9.19 % vs 13.33 %, p 0.028). Conclusions: While the mortality seems statistically unaffected, we found less admission and prolonged door to wire time during-COVID pandemic.

A 3-year analysis of the impact of COVID-19 pandemic on NSTEMI incidence, clinical characteristics, management, and outcomes.

OBJECTIVE: The COVID-19 pandemic has been associated with decreased incidence of acute coronary syndrome with worsened outcomes. Few studies have addressed the effects beyond the initial phases of the pandemic. This study elucidated the incidence, clinical characteristics, management, and outcomes of NSTEMI at a tertiary referral center from sample time periods of 2019-2022. METHODS: This study included consecutive NSTEMI patients from March 14-May 9, 2019-2022. Variables included baseline characteristics, clinical features on arrival, management strategy, time parameters, and adverse outcomes. The primary outcome was defined as death, heart failure requiring diuretics, and/or sustained ventricular arrhythmia. RESULTS: This study comprised 250 patients of whom 181 who were admitted during the COVID-19 outbreak. Baseline characteristics were similar among groups. There was a reduction in door-to-angiography time from 29 h in 2019 to 19 h in 2020 [p = 0.01] and 20 h in 2021 [p = 0.02]. PCI intervention increased from 31.8% in 2019% to 50.0% in 2020 [p = 0.05] and 54.7% in 2021 [p < 0.01]. Median length-of-stay (LOS) was reduced from 3 days in 2019 to 2 days in 2020 [p = 0.03]. There was no significant change in outcomes in COVID-19 cohorts compared to control year. CONCLUSIONS: NSTEMI patients during the first 2 years of the COVID-19 pandemic were associated with reduced door-to-angiography times and increased percutaneous coronary intervention (PCI), and patients in year one were associated with reduced LOS. This study suggests that NSTEMI may be managed more efficiently thus reducing hospital bed utilization and potential costs.

Neighborhood-level COVID vaccination and booster disparities: A population-level analysis across California.

Objectives: To describe vaccine and booster uptake by neighborhood-level factors in California. Methods: We examined trends in COVID-19 vaccination up to September 21, 2021, and boosters up to March 29, 2022 using data from the California Department of Public Health. Quasi-Poisson regression was used to model the association between neighborhood-level factors and fully vaccinated and boosted among ZIP codes. Sub-analyses on booster rates were compared among the 10 census regions. Results: In a minimally adjusted model, a higher proportion of Black residents was associated with lower vaccination (HR = 0.97; 95%CI: 0.96-0.98). However, in a fully adjusted model, proportion of Black, Hispanic/Latinx, and Asian residents were associated with higher vaccination rates (HR = 1.02; 95%CI: 1.01-1.03 for all). The strongest predictor of low vaccine coverage was disability (HR = 0.89; 95%CI: 0.86-0.91). Similar trends persisted for booster doses. Factors associated with booster coverage varied by region. Conclusions: Examining neighborhood-level factors associated with COVID-19 vaccination and booster rates uncovered significant variation within the large and geographically and demographically diverse state of California. Equity-based approaches to vaccination must ensure a robust consideration of multiple social determinants of health.

Relationship of political ideology of US federal and state elected officials and key COVID pandemic outcomes following vaccine rollout to adults: April 2021-March 2022.

Background: Scant research, including in the United States, has quantified relationships between the political ideologies of elected representatives and COVID-19 outcomes among their constituents. Methods: We analyzed observational cross-sectional data on COVID-19 mortality rates (age-standardized) and stress on hospital intensive care unit (ICU) capacity for all 435 US Congressional Districts (CDs) in a period of adult vaccine availability (April 2021-March 2022). Political metrics comprised: (1) ideological scores based on each US Representative's and Senator's concurrent overall voting record and their specific COVID-19 votes, and (2) state trifectas (Governor, State House, and State Senate under the same political party control). Analyses controlled for CD social metrics, population density, vaccination rates, the prevalence of diabetes and obesity, and voter political lean. Findings: During the study period, the higher the exposure to conservatism across several political metrics, the higher the COVID-19 age-standardized mortality rates, even after taking into account the CD's social characteristics; similar patterns occurred for stress on hospital ICU capacity for Republican trifectas and US Senator political ideology scores. For example, in models mutually adjusting for CD political and social metrics and vaccination rates, Republican trifecta and conservative voter political lean independently remained significantly associated with an 11%-26% higher COVID-19 mortality rate. Interpretation: Associations between the political ideologies of US federal elected officials and state concentrations of political party power with population health warrant greater consideration in public health analyses and monitoring dashboards. Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

The Effect of COVID-19 Lockdown on Cerebrovascular Accidents, Acute Coronary Syndrome, and Diabetic Ketoacidosis Visits the Emergency Department: A Retrospective Study.

Objective This study aims to assess the effect of the COVID-19 lockdown on acute coronary syndrome (ACS), cerebrovascular accident (CVA), and diabetic ketoacidosis (DKA) visits the emergency department (ED). Methods We compared two groups of patients attending King Abdulaziz University Hospital (KAUH) ED diagnosed with one of the following ACS, CVA, or DKA; patients presenting from 21 December 2019 to 23 March 2020 and patients presenting from 23 March 2020 to 21 June 2020, representing COVID-19 pre-lockdown and during-lockdown period, respectively. The variables we analyzed were age, nationality (Saudi/non-Saudi), and gender. Results Our total sample size was 285 patient visits, ACS (n=130), CVA (n=98), and DKA (n=57). Results showed a statistically significant relationship between the number of patients with ACS and the period of visitation to ED (45.24% reduction, p-value <0.001), while CVA (18.5% reduction, p-value 0.312) and DKA (16% reduction, p-value 0.508) showed no statistically significant relationship. Conclusion A lockdown may be necessary to control a pandemic. However, it may carry potential collateral damage, such as a decrease and delay in the presentation of life-threatening conditions, which may lead to worsening outcomes. A clinical presentation of these conditions should warrant comprehensive evaluation by healthcare workers regardless of an ongoing pandemic while implementing infection control guidelines.

Traumatic Proximal Femoral Fractures during COVID-19 Pandemic in the US: An ACS NSQIP® Analysis.

In order to determine the impact of COVID-19 on the treatment and outcomes in patients with proximal femoral fracture's (PFF), we analyzed a national US sample. This is a retrospective review of American College of Surgery's (ACS) National Surgical Quality Improvement Program (NSQIP) for patients with proximal femoral fractures. A total of 26,830 and 26,300 patients sustaining PFF and undergoing surgical treatment were sampled during 2019 and 2020, respectively. On multivariable logistic regression, patients were less likely to have 'presence of non-healing wound' (p < 0.001), functional status 'independent' (p = 0.012), undergo surgical procedures of 'hemiarthroplasty'(p = 0.002) and 'ORIF IT, Peritroch, Subtroch with plates and screws' (p < 0.001) and to be 'alive at 30-days post-op' (p = 0.001) in 2020 as compared to 2019. Patients were more likely to have a case status 'emergent', 'loss of ≥10% body weight', discharge destination of 'home' (p < 0.001 for each) or 'leaving against medical advice' (p = 0.026), postoperative 'acute renal failure (ARF)' (p = 0.011), 'myocardial infarction (MI)' (p = 0.006), 'pulmonary embolism (PE)' (p = 0.047), and 'deep venous thrombosis (DVT)' (p = 0.049) in 2020 as compared to 2019. Patients sustaining PFF and undergoing surgical treatment during pandemic year 2020 differed significantly in preoperative characteristics and 30-day postoperative complications when compared to patients from the previous year.

Spontaneous coronary artery dissection in a patient with recent COVID-19 infection: A case report.

We report a spontaneous coronary artery dissection (SCAD) case in a lady with a history of recent COVID-19 and without any known predisposing factors. We also highlight the value of CMR as a noninvasive tool for tissue characterization, which can also be more applicable during the COVID-19 pandemic.

Challenges for Electronic Access Control Systems amid pandemic: A Survey

To meet the demands for highest level security of today's world, a sophisticated security management system is essential. An access control system generally categorized into biometric and non-biometric types based upon contact or contactless in operation. This research work aims to survey the preferences of people, for understanding the role and need of access control systems during the difficult pandemic situation through an online survey. This survey finds that various access control solutions fail to provide the required security during this worldwide pandemic due to their contact-based operations. Henceforth, a feasible integrated electronic access control system requires to be adopted to fulfill the expectations of users amid global pandemic. © 2022 IEEE.

COVID-19 and the Heart: Could Transient Takotsubo Cardiomyopathy Be Related to the Pandemic by Incidence and Mechanisms?

Typical emergency hospital care during the COVID-19 pandemic has centered on pulmonary-focused services. Nonetheless, patients with COVID-19 frequently develop complications associated with the dysfunction of other organs, which may greatly affect prognosis. Preliminary evidence suggests that cardiovascular involvement is relatively frequent in COVID-19 and that it correlates with significant worsening of clinical status and mortality in infected patients. In this article, we summarize current knowledge on the cardiovascular effects of COVID-19. In particular, we focus on the association between COVID-19 and transient takotsubo cardiomyopathy (TTC)-two conditions that preliminarily seem epidemiologically associated-and we highlight cardiovascular changes that may help guide future investigations toward full discovery of this new, complex disease entity. We hypothesize that coronary endothelial dysfunction, along with septic state, inflammatory storm, hypercoagulability, endothelial necrosis, and small-vessel clotting, may represent a fundamental hidden link between COVID-19 and TTC. Furthermore, given the likelihood that new genetic mutations of coronaviruses or other organisms will cause similar pandemics and endemics in the future, we must be better prepared so that a substantial complication such as TTC can be more accurately recognized, its pathophysiology better understood, and its treatment made more justifiable, timely, and effective.

The Incidence and Impact of In-Hospital Bleeding in Patients with Acute Coronary Syndrome during the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic increased the complexity of the clinical management and pharmacological treatment of patients presenting with an Acute Coronary Syndrome (ACS). AIM: to explore the incidence and prognostic impact of in-hospital bleeding in patients presenting with ACS before and during the COVID-19 pandemic. METHODS: We evaluated in-hospital Thrombolysis In Myocardial Infarction (TIMI) major and minor bleeding among 2851 patients with ACS from 17 Italian centers during the first wave of the COVID-19 pandemic (i.e., March-April 2020) and in the same period in the previous two years. RESULTS: The incidence of in-hospital TIMI major and minor bleeding was similar before and during the COVID-19 pandemic. TIMI major or minor bleeding was associated with a significant threefold increase in all-cause mortality, with a similar prognostic impact before and during the COVID-19 pandemic. CONCLUSIONS: the incidence and clinical impact of in-hospital bleeding in ACS patients was similar before and during the COVID-19 pandemic. We confirmed a significant and sizable negative prognostic impact of in-hospital bleeding in ACS patients.

A qualitative study of COVID-19 related reasons for delayed presentation of patients with chest pain during the COVID-19 pandemic.

INTRODUCTION: In previous pandemics such as the Ebola virus outbreak in West Africa, it has been observed that patients with non-pandemic related complaints, delay their presentation to hospital. Similarly, delayed presentation of patients with chest pain during the COVID-19 pandemic has been documented. This qualitative study identified the COVID-19 related reasons which lead to this delay. METHODS: A qualitative study based on 10 individual patient interviews. Half of these were conducted at a public hospital emergency centre (EC) and the other half at a private EC. RESULTS: A variety of psychosocial factors were identified as themes for delayed presentation. Interestingly, the fear of contracting COVID-19 at the hospital was not found to be an important theme in our study. Rather, confusion around hospital protocols during the pandemic was identified as a recurrent theme. DISCUSSION: This study found that confusion about COVID-19 hospital protocols was the major pandemic related delaying factor. A number of themes unrelated to COVID-19 were also identified.

Patterns of cardiovascular diseases in COVID-19 patients admitted to tertiary cardiac care centre.

OBJECTIVES: To analyse the pattern of cardiovascular diseases (CVDs) in COVID-19 patients admitted to tertiary cardiac care centre. METHODS: We retrospectively analysed 511 adult patients admitted between July 1, 2020, and November 30, 2020, with COVID-19 infection and having either new onset or pre-existing CVDs. Clinical features, electrocardiogram (ECG), echocardiography, chest X-ray, biomarkers, haematological and biochemical parameters were analysed. RESULTS: The mean age of the patients was 56.62 ± 14.74 years. Male: Female ratio was 2.78:1. Pre-existing CVDs were present in 258 patients (50.5%). The most common cardiovascular manifestation was acute coronary syndrome (ACS), seen in 259 patients (50.7%). ST-segment elevation myocardial infarction (STEMI) was more common than non-ST-segment elevation ACS (NSTE-ACS). Possible myocarditis was seen in 52 patients (10.1%). Rhythm and conduction abnormalities were noted in 144 patients (28.2%), the most common being QT prolongation, seen in 51 patients (10%). In-hospital mortality occurred in 97 patients (18.9%). Age, serum Ferritin level, D-dimer, NT-pro-BNP and total leukocyte count were significantly higher among patients with in-hospital mortality compared to survival group. Blood lymphocyte count and Haemoglobin level were significantly lower in mortality-group, compared to survival-group. Incidence of pre-existing CVDs, cardiogenic shock, heart failure, atrial fibrillation (AF), and renal failure were significantly higher in mortality-group compared to survival-group. CONCLUSION: The most common CVD in COVID-19 patients in our study was ACS. STEMI was more common than NSTE-ACS. Advanced age, elevated serum ferritin, D-dimer, NT pro-BNP, leucocytosis, lymphopenia, lower haemoglobin, pre-existing CVDs heart failure, cardiogenic shock, AF and renal failure were associated with increased mortality in these patients.

Estimating the growth rate of infection during the early phase of a pandemic like COVID-19.

At the very outbreak of a pandemic, it is very important to be able to assess the spreading rate of the disease i.e., the rate of increase of infected people in a specific locality. Combating the pandemic situation critically depends on an early and correct prediction of, to what extent the disease may possibly grow within a short period of time. This paper attempts to estimate the spreading rate by counting the total number of infected persons at times. Adaptive clustering is especially suitable for forming clusters of infected persons distributed spatially in a locality and successive sampling is used to measure the growth in number of infected persons. We have formulated a 'chain ratio to regression type estimator of population total' in two occasions adaptive cluster successive sampling and studied the properties of the estimator. The efficacy of the proposed strategy is demonstrated through simulation technique as well as real life population which is followed by suitable recommendation.