Development of a practical guide to infectious diseases with elements of digital technologies

A doctor of any specialty in his practice is faced with an infectious pathology, in connection with which the early diagnosis of infectious diseases is important both from a clinical and epidemiological standpoint. The aim - design and development of a unified practical guide to infectious diseases with elements of digitalization of content on pharmacotherapy. Material and methods. When developing the structure of the practical guide "Tactics of an infectious disease doctor", prototypes of educational and methodological materials were worked out. The structure of the practical guide included socially significant infectious diseases of viral, bacterial etiology, the most important helminthiases and protozoses, which practitioners of various specialties may encounter, both in inpatient and outpatient settings. Results and discussion. In the practical guide "Tactics of an infectious disease doctor" all nosologies are presented in a unified form: a brief definition of nosologies, characteristics of the etiological agent, epidemic process, clinical classification, examples of the formulation of a diagnosis, diagnosis, organization of medical care, treatment, pharmacotherapy, approximate terms of temporary disability, criteria recovery, rehabilitation, dispensary observation, recommendations for treatment and prevention. The practical guide contains a short guide to medicines. An innovation is the presentation of medicines via a QR code. Also, by means of a QR code, it is possible to switch to the electronic version of the practical guide. Recommendations for the prevention of infectious diseases are given in the form of pictographic diagrams. Conclusion. The practical guide "Tactics of an infectious disease doctor" allows primary care physicians and general practitioners in a short time period to make the optimal decision on the tactics of managing patients with infectious diseases, within the framework of modern clinical guidelines and approaches set out in national guidelines.Copyright © 2021 Infectious Diseases: News, Opinions, Training. All rights reserved.

Treatment cost assessment for COVID-19 inpatients in Shenzhen, China 2020-2021: facts and suggestions.

Background: Knowledge regarding the treatment cost of coronavirus disease 2019 (COVID-19) in the real world is vital for disease burden forecasts and health resources planning. However, it is greatly hindered by obtaining reliable cost data from actual patients. To address this knowledge gap, this study aims to estimate the treatment cost and specific cost components for COVID-19 inpatients in Shenzhen city, China in 2020-2021. Methods: It is a 2 years' cross-sectional study. The de-identified discharge claims were collected from the hospital information system (HIS) of COVID-19 designated hospital in Shenzhen, China. One thousand three hundred ninety-eight inpatients with a discharge diagnosis for COVID-19 from January 10, 2020 (the first COVID-19 case admitted in the hospital in Shenzhen) to December 31, 2021. A comparison was made of treatment cost and cost components of COVID-19 inpatients among seven COVID-19 clinical classifications (asymptomatic, mild, moderate, severe, critical, convalescent and re-positive cases) and three admission stages (divided by the implementation of different treatment guidelines). The multi-variable linear regression models were used to conduct the analysis. Results: The treatment cost for included COVID-19 inpatients was USD 3,328.8. The number of convalescent cases accounted for the largest proportion of all COVID-19 inpatients (42.7%). The severe and critical cases incurred more than 40% of treatment cost on western medicine, while the other five COVID-19 clinical classifications spent the largest proportion (32%-51%) on lab testing. Compared with asymptomatic cases, significant increases of treatment cost were observed in mild cases (by 30.0%), moderate cases (by 49.2%), severe cases (by 228.7%) and critical cases (by 680.7%), while reductions were shown in re-positive cases (by 43.1%) and convalescent cases (by 38.6%). The decreasing trend of treatment cost was observed during the latter two stages by 7.6 and 17.9%, respectively. Conclusions: Our findings identified the difference of inpatient treatment cost across seven COVID-19 clinical classifications and the changes at three admission stages. It is highly suggestive to inform the financial burden experienced by the health insurance fund and the Government, to emphasize the rational use of lab tests and western medicine in the COVID-19 treatment guideline, and to design suitable treatment and control policy for convalescent cases.

Analysis on occurrence and risk factors of drug-induced liver injury in patients with novel coronavirus pneumonia.

Objective: To analyze the occurrence and risk factors of drug-induced liver injury (DILI) in patients with novel coronavirus pneumonia (COVID-19). Method(s): The medical records of patients with COVID-19 who were discharged from the First Hospital of Changsha from January 15 to March 7, 2020 were collected and the patients were divided into the DILI group and the non-DILI group based on DILI diagnostic criteria. Basic information of patients in the 2 groups including gender, age, underlying diseases, classification of COVID-19, liver function test results on admission and after medication, drug use, time to DILI onset after medication, and treatments and outcomes of DILI were recorded and compared. The incidence of DILI in patients with COVID-19 was calculated, and the factors whose P<0.05 in inter-group comparison were included in the multivariate logistic regression analysis to calculate the odds ratio (OR) and95% confidence interval (CI). Result(s): A total of 203 discharged patients with COVID-19 met the inclusion criteria. Of them, 36 patients developed DILI, the incidence was 17.73%. Between the DILI group and the non-DILI group (167 patients), the differences were statistically significant in gender distribution, proportion of patients with underlying diseases such as hypertension, fatty liver, and cholelithiasis, clinical classification of COVID-19, and the kinds of drug use (P<0.05 for all), but not statistically significant in levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBil) on admission (P>0.05 for all). The levels of ALT and AST in patients in the DILI group after medication were higher than those before medication, and the differences were statistically significant (P<0.001 for all). The median time for time to DILI onset after medication was 8 (6, 11) days and none of the patients had obvious clinical signs and symptoms. After the occurrence of DILI, 16 patients stopped the suspicious drugs and received liver-protective treatments, 6 patients only stopped the suspicious drug without additional treatments, and 14 patients received liver-protective treatments without drug withdrawal. Among the 36 patients in the DILI group, liver function were improved in 34 patients but did not returned to normal in 2 patients when they were discharged from the hospital. Multivariate logistic regression analysis showed that male (OR=3.939, 95%CI: 1.426-10.883, P=0.008), being severe and critical in clinical classification (OR=6.433, 95%CI: 2.411-17.162, P<0.001), fatty liver (OR=3.815, 95%CI: 1.298-11.215, P=0.015), cholelithiasis (OR=16.347, 95%CI: 1.267-210.990, P=0.032), and the kinds of drug use >8 (OR=10.181, 95%CI: 3.606-28.744, P<0.001) were the independent risk factors of DILI in patients with COVID-19. Conclusion(s): The incidence of DILI in COVID-19 patients discharged from the First Hospital of Changsha is 17.73%. Male, being severe and critical in clinical classification of COVID-19, fatty liver, cholelithiasis, and the kinds of drug use >8 are the independent risk factors for DILI patients with COVID-19.Copyright © 2020 by the Chinese Medical Association.

An Early Detection Of NIPAH Infectious Disease Based On Integrated Medical Features For Human Using Ensemble RBM Techniques

Background: The importance of early diagnosis of a hazardous illness cannot be overstated. The transmission rate is extremely high, especially in the current pandemic condition. The ability to predict epidemics will aid public health in reducing mortality and morbidity. Machine Learning (ML) approaches are used in the construction of an effective disease prognosis model. Furthermore, only if the model learns good associated features from the data is it possible to generate a speedy outcome. As a result, selecting features is also necessary before beginning the forecasting process. Objective(s): However, because of the virus's dynamic structure, it's difficult to predict Nipah disease and/or zoonotic infection. Furthermore, there is no clinical treatment for Nipah. The major goal of this research is to develop a prognostic model for early diagnosis of Nipah disease using a combination of several clinical factors such as symptoms, disease incubation information, and routine blood test results confirmed by a lab technician.Proposed System: The healthcare application and data are more complex to handle than other ML applications since various clinical features are assessed throughout disease manifestation. As a result, selecting the most relevant variables is critical when designing a prognosis model for any viral disease. To deal with clinical features from a vast number of features, we proposed a Restricted Boltzmann Machine (RBM) method in this research. Additionally, we employed a hybrid ensemble learning method to predict if the patient was infected with NiV after choosing features using the RBM. Data Collection: The proposed system is being implemented using the NiV infection dataset that erupted in Kozhikode, Kerala in 2018 and 2019. Result(s): The developed stacking-based ensemble Meta classifier was successfully implemented using the python programming language, and its performance was evaluated using a variety of metrics includingaccuracy, precision, recall, f1-score, log loss, AUROC and MCC. Our proposed Stacking Ensemble Meta Classifier (SEMC) model achieved an accuracy rate of 88.3% with a log loss of 0.36. Model precision, recall, f1-score, AUROC, and MCC value were 92.5%, 89.2%, 90.9%, 92.1%, and 0.74 respectively. In addition, we calculated the gravitational pull of each feature using the SHAP approach and discovered that altered sensorium, fever, headache, and cough were the most critical clinical indicators that distinguished NiVD infection from our dataset. Therefore, this classification may assist the pathologist in diagnosing NiVD with symptoms before performing the RT-PCR medical test. Conclusion(s): Using our proposed SEMC technique, we developed a prognostic model for the diagnosis of Nipah in humans. The proposed technique's discriminatory efficiency exhibited good NiVD diagnosis efficacy. We anticipate that this model will aid medics in determining a prognosis more quickly during future epidemics. However, to achieve maximum accuracy, the model requires more unique samples.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Risk factors for fatal outcome in patients with severe COVID-19: an analysis of 107 cases in Wuhan.

Objective: To analyze the risk factors of fatal outcome in patients with severe COVID-19. Method(s): The clinical characteristics of 107 patients with severe COVID-19 admitted in Renmin Hospital of Wuhan University from February 12 to March 12, 2020 were retrospectively analyzed. During the hospitalization 49 patients died (fatal group) and 58 patients survived (survival group). The clinical characteristics, baseline laboratory findings were analyzed using R and Python statistical software. The risk factors of fatal outcome in patients with severe COVID-19 were analyzed with multivariate logistic regression. Result(s): Univariate analysis showed that the two groups had statistically significant differences in age, clinical classification, dry cough, dyspnea and laboratory test indicators (P<0.05 or <0.01). The random forest model was used to rank the significance of the statistically significant variables in the univariate analysis, and the selected variables were included in the binary logistic regression model. After stepwise regression analysis, the patient's clinical type, age, neutrophil count, and the proportion of CD3 cells are independent risk factors for death in severe COVID-19 patients. Dry cough is an independent protective factor for the death of severe COVID-19 patients. Conclusion(s): COVID-19 patients with fatal outcome are more likely to have suppressed immune function, secondary infection and inflammatory factor storm. These factors may work together in severe patients, leading to intractable hypoxemia and multiple organ dysfunction and resulting in fatal outcome of patients. The study indicates that timely intervention and treatment measures against above factors may be effective to save the lives of patients with severe COVID-19.Copyright © 2020 by the Chinese Medical Association.

Risk factors for fatal outcome in patients with severe COVID-19: an analysis of 107 cases in Wuhan.

Objective: To analyze the risk factors of fatal outcome in patients with severe COVID-19. Method(s): The clinical characteristics of 107 patients with severe COVID-19 admitted in Renmin Hospital of Wuhan University from February 12 to March 12, 2020 were retrospectively analyzed. During the hospitalization 49 patients died (fatal group) and 58 patients survived (survival group). The clinical characteristics, baseline laboratory findings were analyzed using R and Python statistical software. The risk factors of fatal outcome in patients with severe COVID-19 were analyzed with multivariate logistic regression. Result(s): Univariate analysis showed that the two groups had statistically significant differences in age, clinical classification, dry cough, dyspnea and laboratory test indicators (P<0.05 or <0.01). The random forest model was used to rank the significance of the statistically significant variables in the univariate analysis, and the selected variables were included in the binary logistic regression model. After stepwise regression analysis, the patient's clinical type, age, neutrophil count, and the proportion of CD3 cells are independent risk factors for death in severe COVID-19 patients. Dry cough is an independent protective factor for the death of severe COVID-19 patients. Conclusion(s): COVID-19 patients with fatal outcome are more likely to have suppressed immune function, secondary infection and inflammatory factor storm. These factors may work together in severe patients, leading to intractable hypoxemia and multiple organ dysfunction and resulting in fatal outcome of patients. The study indicates that timely intervention and treatment measures against above factors may be effective to save the lives of patients with severe COVID-19.Copyright © 2020 by the Chinese Medical Association.

Influencing factors and clinical significance of liver function damage in patients diagnosed with COVID-19.

Objective: To invetigate the influencing factors and clinical significance of liver function damage (LFD) in patients diagnosed with Corona Virus Disease 2019 (COVID-19). Method(s): The retrospective case-control study was conducted. The clinicopathological data of 51 patients with COVID-19 who were admitted to the Sino-French New City Branch of Tongji Hospital Affiliated to Huazhong University of Science and Technology by the 5th group assisting team from the First Hospital of Jilin University from February 9th to 27th in 2020 were collected. There were 27 males and 24 females, aged from 36 to 86 years, with an average age of 68 years. The treatment modality was according to the diagnostic and therapeutic guideline for COVID-19 (Trial 6th edition) issued by National Health Commission. Observation indicators: (1) clinical data of patients;(2) analysis of liver function index and treatment of LFD;(3) analysis of influencing factors for LFD. Measurement data with normal distribution were represented as Mean+/-SD, and measurement data with skewed distribution were described as M (range). Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. The Logistic regression method was used for univariate analysis. Result(s): (1) Clinical data of patients: of the 51 patients, 21 were classified as ordinary type of COVID-19, 19 as severe type and 11 as critical type. In terms of medical history, 31 patients suffered from more than or equal to one kind of chronic disease, 20 had no history of chronic disease. Thirteen patients had the drinking history and 38 had no drinking history. Seven patients were hepatitis positive and 44 were hepatitis negative. Five patients had septic shock at admission, 5 had systemic inflammatory response syndrome (SIRS), and 41 had neither shock nor SIRS. The body mass index (BMI), time from onset to admission, temperature, heart rate, respiratory rate of the 51 patients were (24+/-3)kg/m2, (13+/-5)days, 36.5 (range, 36.0-38.1 ), 82 times/minutes (range, 50-133 times/minutes), 20 times/minutes (range, 12-40 times/minutes). The white blood cell count, level of creatinine, and level of b-type natriuretic peptide within 24 hours after admission were 6.3x109/L [range, (2.2-21.7)x109/L], 75 mumol/L (range, 44-342 mumol/L), 214 ng/L (range, 5-32 407 ng/L). (2) Analysis of liver function index and treatment of LFD: the level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), direct bilirubin (DBil), indirect bilirubin (IBil), activated partial thromboplastin time (APTT) and prothrombin time (PT) were 31 U/L (range, 7-421 U/L), 29 U/L (range, 15-783 U/L), 36 U/L (range, 13-936 U/L), 76 U/L (range, 41-321 U/L), 4.9 mumol/L (range, 2.6-14.3 mumol/L), 5.8 mumol/L (range, 2.6-23.9 mumol/L), 37.2 s (range, 30.9-77.1 s), 13.9 s (range, 12.5-26.7 s), respectively. The percentages of cases with abnormal ALT, AST, GGT, ALP, DBil, IBil, APTT and PT were 47.1%(24/51), 47.1%(24/51), 35.3%(18/51), 13.7%(7/51), 7.8%(4/51), 2.0%(1/51), 21.6%(11/51), and 19.6%(10/51), respectively. Of the 51 patients, LFD was detected in 10 patients classified as ordinary type, in 9 patients as severe type, and in 10 as critical type, respectively. In the 51 patients, 1 of 22 patients with normal liver function developed respiratory failure and received mechanical ventilation within 24 hours after admission, while 9 of 29 patients with abnormal liver function developed respiratory failure and received mechanical ventilation, showing a significant difference between the two groups (chi2=5.57, P<0.05). (3) Analysis of influencing factors for LFD. Results of univariate analysis showed that clinical classification of COVID-19 as critical type was a related factor for LFD of patients (odds ratio=10.000, 95% confidence interval: 1.050-95.231, P<0.05). Conclusion(s): COVID-19 patients with LFD are more susceptible to develop respiratory failure. The clinical classification of COVID-19 as critic l type is a related factor for LFD of patients.Copyright © 2020 by the Chinese Medical Association.

Impact of the Covid-19 pandemic on the care of patients with chronic arterial disease. A nuclear medicine physician's perspective

Aim/Introduction: The health reorganisation measures, imposed after the serious health emergency resulting from the SARS-CoV-2 pandemic, may have had a negative impact on the follow-up of patients with chronic pathologies. Our intention was to assess their repercussion in our environment, observing what happened in patients with a history of coronary artery disease (CAD) in terms of accesibility and diagnostic performance. Material(s) and Method(s): Retrospective observational study of 756 patients consecutively referred to our Department for myocardial perfusion (MP) studies. Two time groups were established (G1 and G2), both lasting one year, taking as a cut-off point the establishment of the state of health alarm in our country. From the total number of records reviewed 131 patients were selected (mean age 65.74 > 11.03 SD), all with a history of CAD prior to the performance of the MP (G1 56.49%;G2 43.52%). Delay times between test request and test performance were obtained: G1 (17.89 days > 9.85 SD), G2 (16.32 > 20.81 SD) and study results based on two variables, stability or inducible ischaemia. Result(s): In the pre-alarm period (G1) there were more requests for PM studies than in G2 (419 vs 337), with a similar percentage of CAD to total patients (17.66% vs 16.91%). Typical clinical presentation, following the traditional clinical classification, predominated and was statistically significant (p=0.001) for this first group (78.38% vs 52.63%). However, G1 showed a lower number of positive PM results than G2 (37.83% vs 43.85%), and the percentage of total catheterisations performed was also lower (57.14% vs 68%). In relation to the mean delay time between positive PM and catheterisation, a shorter duration was observed for G1 (65.64 days > 46.19 SD) than for G2 (95.41 days > 71.73 SD). No statistically significant differences (p=0.768) were found between the mean ages of patients in the two groups. Conclusion(s): In our health care system, the follow-up of patients with CAD after the establishment of the alarm status was affected by a lower percentage of patients referred to our Department and a longer delay between positive PM and catheterisation. In this period, it is remarkable the higher number of positive PM in patients without typical clinical features. We are unaware of the possible involvement of covid-19 in this situation, currently being investigated by our working group.

Thrombocytopenia and thrombosis associated with AstraZeneca ChAdOx1 nCoV-19 Vaccination-Results of Australian centralized clinical triage system and functional assay testing system

Background: As a severe, though rare complication of COVID-19 vaccination, vaccine induced immune thrombotic thrombocytopenia (VITT) emerged in 2021 as a public health issue affecting vaccine confidence. Australia pre-emptively instituted a nationally coordinated system for diagnosis and management incorporating state based immunoassays (ELISA) for PF4 antibodies and national centralised functional testing using three functional assays. Aim(s): To evaluate the triage strategy based upon clinical presentation, thrombocytopenia and D-Dimer used to direct VITT testing. Method(s): Consecutive cases presenting between April 1 and June 11, 2021 referred for VITT testing in Australia were assessed regarding clinical classification, immune-assay and functional assay results, thromboses and mortality according to triage category (Table 1). Functional testing proceeded for all triaged as Probable VITT , ELISA positive and unusual site thromboses positive patients if triaged Less likely , and only for quality assurance purposes if Much less likely VITT . Anti-PF4 antibodies were measured by IgG-specific ELISA (Asserachrom, Stago Diagnostics). Platelet-activating antibodies were assayed using whole blood procoagulant platelet flow cytometry assay (Lee et al), PF4-serotonin release assay or multiplate multiple electrode aggregation. Result(s): 92% of 52 patients with a final diagnosis of VITT supported by a positive antibody assay (immunological or functional) were triaged prior to VITT specific testing into the high probability category. 100% ELISA positive individuals within the high and intermediate clinical probability groups were supported by detection of a platelet activating antibody using a functional assay and 0% in the low probability group. 16% of clinical VITT patients without confirmation of anti-PF4 antibodies by ELISA had VITT diagnosis supported by functional assay in a final clinico-pathological adjudication. Conclusion(s): Triage of testing according to clinical probability of VITT based on clinical criteria and standard laboratory tests was helpful in directing testing in resource constrained period. Demonstration of platelet activating antibodies in functional assays significantly contributes to definition of the VITT syndrome. (Table Presented).

DOES ANGIOTENSIN II RECEPTOR BLOCKERS/ANGIOTENSIN CONVERTING ENZYME INHIBITORS INCREASE THE RISK OF COVID-19 INFECTED PATIENTS?

Objective: The study aims to determine whether ACEI/ARB use associated with an increased probability of viral infection and investigate whether there are differences in disease severity and mortality between ACEI/ARB users and non-ACEI/ARB users. Material and methods: In this retrospective study, 330 patients with severe acute respiratory syndrome coronavirus 2 disease were divided into two groups: patients using ACEI/ARB Blocker and patients not using it. Baseline features and prognoses were compared for the two groups. Results: The rate of intensive care hospitalization in the group using ACE/ARB was significantly (p<0.05) higher than the group not using ACEI/ARB on the day of hospitalization in the intensive care unit. The degree of clinical classification in the group using ACEI/ARB was significantly (p<0.05) higher than the group not using ACE/ARB. The mortality rate in the group using ACE/ARB was significantly (p<0.05) higher than the group not using ACEI/ARB. Conclusion: Although it has been determined that the use of antihypertensive ACEI/ARB in COVID 19 patients is associated with mortality and survival, it has been concluded that the continuation of ACEI/ARB use would be more appropriate for the continuation of antihypertensive treatment.

CLINICAL CONDITIONS ASSOCIATED with PASC in KAISER PERMANENTE MID-ATLANTIC STATES

Background: The natural history of the longer-term effects of SARS-CoV-2 (COVID-19), known as Post-Acute Sequelae of SARS-CoV-2 (PASC), is limited. Disease characterization and definition changed over time and identification via standard diagnosis codes was only recently enacted. We aim to identify a cohort of individuals with, or at-risk for, PASC among Kaiser Permanente Mid-Atlantic States (KPMAS) members, and to identify the clinical conditions of greater burden for those with PASC. Methods: Within our electronic health record system (including internal/external records), we identified adult patients (≥18 years) who had a detectable SARS-CoV-2 RT-PCR result between 1/1/2020-12/31/2020. Non-COVID disease diagnoses/conditions were categorized into specific time intervals based on the first positive SARS-CoV-2 test as the index date (T0), defined as: 1) "prevalent": diagnoses in 4 years prior to T0 and excluded from later consideration;2) "persistent/acute": new disease diagnoses 0-30 days post-T0 and persisted 30-120 days further, and not included as prevalent;3) "incident/late": new disease diagnoses 30-120 days post-T0, not previously identified as prevalent or persistent/acute. Diagnoses were grouped using Clinical Classification Software (CCS) to isolate conditions for PASC. Final CCS distributions were computed relative to the condition counts for each time interval, validated by infectious disease physicians to identify conditions of focus (COF). Results: From the resulting 31,390 patients, we identified the 14 most common COF (Table 1). The most common persistent/acute COF were other lower respiratory disease (4.5%) and respiratory failure (2.7%). Most common incident/late COF (i.e., >2.0% of those testing COVID+) were abdominal pain, gastrointestinal disorders, other nervous system disorders, nonspecific chest pain, dizziness or vertigo, malaise and fatigue, anxiety disorders, mental health disorders, other lower respiratory disease (not previously diagnosed), and cardiac dysrhythmias. No other COF were >2.0% in the persistent or incident time periods. Conclusion: We have identified conditions clinically associated with COVID-19 that persist from infection or present as incident beyond the acute COVID-19 period. This condition list should be utilized in clinical practice when following up with COVID-19 patients. Further research is needed to understand how these conditions compare to people who did not have COVID-19 and to describe their severity, persistence, and resolution.

POST-ACUTE SEQUELAE of SARS-CoV-2: CLINICAL CONDITION COMPARISON in A MATCHED COHORT

Background: Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) is a novel condition generally defined as new onset or persistence of symptoms related to SARS-CoV-2 beyond convalescence or first 30 days post-diagnosis. PASC has not been well defined by conditions or timeline manifestation. We measured PASC incidence in an integrated health system population (Kaiser Permanente Mid-Atlantic States;KPMAS) and provided supporting evidence for PASC-related conditions of focus (COF) identified from our previous research. Importantly, KPMAS is a closed healthcare system with high ascertainment of COVID-19 among our members, as well as PASC conditions and symptoms. Methods: Using KPMAS electronic health records, we identified adult patients (≥18 years) who had a SARS-CoV-2 RT-PCR test result (detected or undetected) from 1/1/2020 to 12/31/2020. We defined 3 diagnostic time intervals, predicated on the first test date of identified PASC phenotypes. These time intervals were defined as: T1) "Prevalent": 4 years prior to PCR test identifying prevalent conditions;T2) "Acute/Persistent": 0-30 days post-PCR and persisted in 30-120 day follow-up;T3) "Incident/Late": 30-120 days post-PCR identifying incident conditions/symptoms. We enforced mutual exclusivity per patient by removing conditions and symptoms from T2 previously identified in T1 and those from T3 previously identified in T1 or T2. Diagnoses were grouped using Clinical Classification Software (CCS). The PCR-positive patients (cases) were matched to PCR-negative patients (controls) by month of test, age group, race, sex, and medical center. We prioritized 1:3 (case:control) matching, followed by 1:2, then 1:1. Risk ratios with 95% confidence intervals comparing case to control COF were calculated to determine significant COF. Results: Matching successfully resulted in 28,118 cases and 70,293 controls. Demographic differences were negligible and showed no association (Highest Cramer's V: Age-.0511). Overall, risk of COF was 12% greater among cases than controls (Table 1). During T3, risk was significantly higher among cases for the following COF: anosmia, cardiac dysrhythmia, diabetes, genitourinary disorders, malaise, and nonspecific chest pain. Conclusion: We delineated significant COF among those experiencing incident PASC in our KPMAS population. Our findings contribute to the overall evaluation of PASC and provide supporting evidence for an accepted definition. Further understanding the severity and duration of these conditions will be crucial.

The utility of using genomic testing on needle core biopsies during the COVID-19 pandemic: Molecular characterization, risk stratification, neoadjuvant outcome, and future implications

Introduction: The COVID-19 pandemic has caused an extraordinary challenge for global health. New guidelines were implemented, including postponing non-essential surgical procedures to conserve resources. In response, the COVID19 Pandemic Breast Cancer Consortium expert opinion suggested the use of core biopsies for genomic testing to help triage patients for surgical vs. systemic treatment. To better understand how expedited genomic results could impact peri-operative care, we performed a pre-operative quality project to assess testing Mammaprint (MP), a 70-gene risk of recurrence assay, and Blueprint (BP), an 80-gene molecular subtyping assay, on core biopsies. Here we report our experience with MP and BP testing on core biopsies, and the correlation between test results and response to neoadjuvant therapy.Design: From April to December 2020, all core biopsies with a breast carcinoma diagnosis from our clinic (300 patients) were routinely sent for MP and BP testing as part of a rapid result program that was initiated to see whether test results could be obtained in time and whether they would lead to more informed pre-operative treatment decisions. Unstained slides were sent for genomic and receptor testing concurrently. When genomic results differed from IHC/FISH results or suggested a different S treatment plan vs. clinical factors alone, we referred to this as "reclassification." For those patients who completed their neoadjuvant chemotherapy, we grouped them by their genomic results and by their conventional IHC/FISH/Clinical classification, and compared the outcome. Results: MP and BP results from core biopsy were available for 96.6% of patients (n=290/300). The average time from biopsy to test results was 10 days, and the average lab turnaround time was 5 days. Results were available for tumor conference discussions 100% of the time. MP and BP re-classified 84 of 300 patients (28%) from conventional IHC/FISH subtyping, and reclassified 42 of 195 patients (22%) of patients from their risk category based on traditional clinical factors (Table-1). Of the 38 patients with available post-neoadjuvant therapy outcome, 13 patients (34%) achieved pathologic complete response (pCR). 16 patients were classified as Her-2 enriched by IHC/FISH of which 9 (56%) achieved pCR. MP/BP aligned with the IHC/FISH Her-2 enriched classification in 11/16 patients, while 5 patients were reclassified to Luminal B by MP/BP. Of the 11 patients with concordant IHC/FISH and MP/BP results, 8 achieved pCR (73%), while one of the 5 cases reclassified to Luminal B achieved pCR (20%). Of the patients who were classified Luminal by IHC (9 patients), one patient achieved pCR (11%), and of the patients classified luminal (A or B) by MP/BP (12 patients) two achieved pCR (16%). Of the IHC-triple negative patients and genomic basal patients, three patients achieved pCR in each group (23% and 20%, respectively). Conclusion: Performing MP/BP tests on core needle biopsies hold a high success rate. Incorporating test results into peri-operative discussions may result in better-informed decisions about treatment planning and timing of surgery versus systemic therapy. A higher rate of pCR was seen in the MP/BP Her-2 enriched group compared to the IHC/FISH Her-2 enriched group. Although this workflow was designed to triage patients during the COVID pandemic, this approach has great potential beyond the pandemic.

Severity Assessment in COVID-19 Pneumonia: Comparison of Semi-Quantitative and Quantitative CT Analyses

Objective: To investigate the performance of semi-quantitative CT (SCT) and automated quantitative CT (QCT) analyses for differentiating mild disease from the severe disease in COVID-19 pneumonia. Materials and Methods: Sixty-seven laboratory confirmed COVID-19 patients were enrolled. The patients were grouped into mild and severe disease regarding clinical features. CT images were evaluated by three observers independently. Three different SCT scoring methods and QCT analysis were performed. The two disease groups were compared in terms of SCT and QCT parameters. Intraclass correlation coefficient was used to investigate inter-rater reliability. The performance of SCT and QCT in the differentiation of mild disease and severe disease was evaluated using receiver operating characteristics (ROC) analysis. Results: Inter-rater reliability was excellent for all SCT scores. SCT and QCT scores were significantly different between two disease groups (p<0.05). Five-point score showed the best performance regarding to area under curve (AUC) values. The cut-off value of >7 for 5-point score had 88.89% sensitivity and 82.76% specificity and cut-off value of >10.29% for QCT score (%) had 75.00% sensitivity and 98.04% specificity for differentiating the mild disease from severe disease. Conclusion: QCT may play an important role in the management of COVID-19 pneumonia with its high specificity values. (English) [ FROM AUTHOR] Amaç: COVID-19 pnömonisinde hafif hastalığı şiddetli hastalıktan ayırt etmede semi-kantitatif BT (SBT) ve kantitatif-BT (KBT) analizlerinin performansını karşılaştırmak. Yöntem: Çalışmaya 67 laboratuvar tarafından doğrulanmış COVID-19 hastası dahil edildi. Hastalar klinik özelliklerine göre hafif ve ağır hasta olarak gruplandırıldı. BT görüntüleri bağımsız olarak üç gözlemci tarafından değerlendirildi. Üç farklı SBT skorlama yöntemi ve KBT analizi uyulandı. Íki hastalık grubu SBT ve KBT parametreleri açısından karşılaştırıldı. Gözlemciler arası güvenilirliği araştırmak için sınıf içi korelasyon katsayısı kullanıldı. Hafif hastalık ve ağır hastalık ayrımında SBT ve KBT'nin performansı, ROC analizi kullanılarak değerlendirildi. Bulgular:Gözlemciler arası güvenilirlik, tüm SBT skorları için mükemmeldi. SBT ve KBT değerleri hafif ve ağır hastalık grupları arasında anlamlı olarak farklıydı (p<0.05). Eğri altındaki alan (EAA) göz önüne alındığında SBT skorlama yöntemleri arasında beşli skorlama en iyi performansı gösterdi. ROC analizinde beşli skorlama için en uyun kesim noktası 7 olarak belirlenmiş olup bu değere ait duyarlılık %88.89, özgüllük %82.76 olarak hesaplanmıştır. KBT değeri (%) için kesim noktası %10.29 olarak belirlendiğinde duyarlılık değeri %75.00, özgüllük değeri ise %98.04 olarak hesaplanmıştır. Sonuç:KBT, yüksek özgüllük değerleri ile COVID-19 pnömonisinin yönetiminde önemli bir rol oynayabilir. (Turkish) [ FROM AUTHOR] Copyright of Gazi Medical Journal is the property of Gazi Medical Journal 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.)

[Blood Group Distribution Characteristics of COVID-19 Patients in Xinjiang].

OBJECTIVE: To analyze and summarize ABO and Rh(D) blood group distribution and related indicators of COVID-19 patients, and understand the relationship between blood group and disease course of COVID-19 patients in Xinjiang. METHODS: A total of 831 patients with confirmed or asymptomatic COVID-19 infection treated in People's Hospital of Xinjiang Uygur Autonomous Region from July 2020 to August 2020 were enrolled as study group, and 2 778 healthy people in a third Grade A hospital in the region during the same period were selected as control group. ABO and Rh(D) blood group antigens were identified, and relevant medical data were collected for statistical analysis. RESULTS: The proportion of O-type population and Rh(D) positive population in the study group was 24.79% and 96.27%, which were lower than those in the normal control group (29.73% and 97.73%) (P<0.05). The proportion of AB type and Rh(D) negative population was 14.20% and 3.73%, which was higher than that in control group (10.62% and 2.27%) (P<0.05). The proportion of female patients in Type O group was lower than that in control group. The proportion of female patients in AB group was higher than that in control group (P<0.01), while the proportion of type O patients in the age group less than or equal to 45 years old and greater than 60 years old was lower. Different blood groups of Uygur population showed their own characteristics in different sex, but there was no statistical significance due to the limited sample (P>0.05). Moreover, the course of disease and clinical diagnosis of COVID-19 patients were different among different blood groups (P<0.05). CONCLUSION: This study found that the blood type distribution of COVID-19 patients in Xinjiang has its own characteristics, and the blood type is related to the course and clinical diagnosis of COVID-19. In the future, the data can be widely included in people from different ethnic groups and different regions to improve relevant studies.

The Effect of Measles, Rubella, Mumps, Hepatitis A and Hepatitis B IgG Seropositivity on The Clinical Course of COVID-19 Disease in Children

Objective: Many hypotheses have been proposed and researched regarding why coronavirus disease 2019 (COVID-19) disease is clinically milder and has better outcomes in pediatric patients. These include immune differences, inflammatory response level, T-lymphocyte profile, ACE 2 expression level, melatonin secretion level, less exposure to environmental contaminants, less chronic diseases, and cross-immunity to other viruses. Material and Methods: In this study, it was aimed to examine the relationship between measles, rubella, mumps, hepatitis A and B vaccine serological responses and the asymptomatic or symptomatic course of COVID-19 infection in children diagnosed with COVID-19. Between March and June 2020, we compared the symptomatic status of children with COVID-19 who were vaccinated for these factors and who did not have a history of measles, rubella, mumps, hepatitis A and hepatitis B infection among the SARS-CoV-2 PCR positive cases. Results: Seventy-two patients were included in the study. Half of the patients were males. The median age of the cases was 167 months (min: 18 months, max: 213 months). Thirty-seven (51.3%) of all cases were asymptomatic and 35 (48.6%) were symptomatic. There was no statistically significant difference between measles, rubella, mumps, hepatitis A and hepatitis B serological vaccine responses and clinical classification. Conclusion: As a result, in our study, no significant association was found between measles, rubella, mumps, hepatitis A and hepatitis B serological vaccine responses and symptom development status in COVID-19. Further studies are needed to investigate the reasons for the better clinical course of the disease in pediatric cases compared to adults.

Clinical Classification and Severity Scoring Systems in Chronic Pancreatitis: A Systematic Review.

INTRODUCTION: Chronic pancreatitis (CP) is characterised by pain, functional deficits, nutritional and mechanical complications. Frequently managed in out-patient settings, the clinical course is unpredictable and requires multi-disciplinary care. There remains substantial variation in management. In contrast to acute pancreatitis, there are no globally accepted classification or severity scores to predict the disease course or compare interventions. We conducted a systematic review to determine the scope and clinical use of existing scoring systems. METHODS: A systematic search was developed with a medical librarian using the Embase, Medline and Cochrane databases. Original articles and conference abstracts describing an original or modified classification or scoring system in CP that stratified patients into clinical and/or severity categories were included. To assess clinical application/validation, studies using all or part of a score as a stratification tool to measure another parameter or outcome were selected. Studies reporting on diagnosis or aetiology only were excluded. Four authors performed the search in independent pairs and conflicts were resolved by a fifth author using CovidenceTM systematic review software. RESULTS: Following screening 6,652 titles and 235 full-text reviews, 48 papers were analysed. Eleven described original scores and 6 described modifications of published scores. Many were comprehensive but limited in capturing the full spectrum of disease. In 31 studies, a score was used to categorise patients to compare or correlate various outcome measures. Exocrine and endocrine dysfunction and pain were included in 6, 5, and 4 scoring systems, respectively. No score included other nutrition parameters, such as bone health, malnutrition, or nutrient deficiency. Only one score has been objectively validated prospectively and independently for monitoring clinical progression and prognosis, but this had been applied to an in-patient population. CONCLUSION: Available systems and scores do not reflect recent advances and guidelines in CP and are not commonly used. A practical clinical classification and scoring system, validated prospectively for prognostication would be useful for the meaningful analysis in observational and interventional studies in CP.