Using the "omnicell" automatic drug dispensing cabinet to monitor sedative drugs in a critical care unit

Introduction: Automatic drug dispensers are now widely used in critical care.1-2 They can provide information about dispensed drugs. Good practice in sedation restricts the use of sedatives and titrates doses to defined responses.3-4 Objectives: To extract drug dispenser issuing records for sedatives and link these to patient records to evaluate sedative use. Method(s): in October 2019, we introduced two Omnicell XT automated dispensing cabinets (Omnicell inc. CA, USA) into a 42 bedded general/neurological unit. ICNARC (Intensive care national audit and research centre) and CCMDS (Critical care minimum data set) data was collected using the Ward Watcher program. Dispenser issuing records for alfentanil, propofol and midazolam were obtained as Excel files for 13 months from January 2020. Output time stamps were converted to dates and times. Outputs were linked to outputs of the ICNARC and CCMDS records for the patients that the drugs were issued to. All the outputs had patients identified by their unique hospital numbers. These were used in Excel "power queries" to produce a spread sheet with a single row per patient. Multiple admissions used the first diagnosis, the final outcome and the total length of stay. The total dose of sedatives was calculated from ampoule dose and number. The duration of treatment was calculated from the first and last issues of the drug. ICNARC codes were used to identify the primary system in the admission diagnostic code and those patients admitted for COVID-19. Variables were compared using Chi Squared, Mann-Whitney U and Kruskal Wallis Tests. The significance of associations was established using Spearman's Rho. Linear regression was used to define relationships more clearly. Result(s): Table one summarises the patient characteristics with respect to all admissions during the study period and for patients who had had the studied drugs issued to them. Midazolam was used in fewer patients, they were more likely to be male, heavier (p>0001) and to die than patients receiving Propofol or Alfentanil (p>0.001). With respect to diagnostic groups, all the sedatives, particularly Midazolam (p<0.001), were more likely to be used in patients with COVID-19. The relationship between the dose of sedative drugs and patient age and weight was explored using the dose per advanced respiratory day. All three drugs had a significant but weak negative relationship with age, lower doses being given to older people (Propofol r2 = 0.02, p=0.01. Alfentanil r2 = 0.04, p=0.00. Midazolam r2 = 0.07, p=0.00.). There was also a weak but significant relationship between increasing dose of Propofol with patient weight (r2 = 0.02, p=0.01), but there was no relation between weight and doses of the other drugs. Conclusion(s): Information from automatic drug dispensers can be interpreted and combined with other datasets to produce clinically relevant information. The limited weak relationships between drug dose and age and weight suggests that sedative drugs could have been better titrated to response.

Association Between Severe SARS-CoV-2 Infection and De Novo HLA Donor Specific Antibody Production in Lung Transplant Recipients: Single-center study

Objectives: The COVID-19 pandemic has led to significant morbidity and mortality in lung transplant recipients (LTR). Respiratory viral infections may be associated with de-novo HLA donor-specific antibody (DSA) production and impact lung transplant outcome. Since one of the immunomodulation strategies post-SARS-CoV-2 infection in LTR include decreasing or holding anti-metabolites, concerns have been raised for higher incidence of de-novo DSA production in LTR. Method(s): We performed a retrospective chart review of 80 consecutive LTR diagnosed with COVID-19 to investigate this concern. COVID-19 disease severity was divided into 3 groups: mild, moderate, and severe. Mild disease was defined as patients with COVID-19 diagnosis who were stable enough to be treated as out-patients. Moderate disease was defined as patients who required admission to the hospital and were on less than 10 liters of oxygen at rest. Severe disease was identified as patients who required hospitalization and were on more than 10 liters of oxygen with or without mechanical ventilation or extra corporal membrane oxygenation (ECMO). Groups were compared using the Kruskal-Wallis test. Result(s): A total of 23, 47, and 10 LTR were diagnosed with mild, moderate, and severe COVID-19 respectively. De-novo HLA DSAwere detected in 0/23 (0%), 3/47 (6.3%), and 4/10 (40%) LTR with mild, moderate, and severe COVID-19 respectively (p = 0.0007) within 6 months post-COVID-19 diagnosis. Conclusion(s): Severe COVID-19 may be associated with increased risk of de novo HLA DSA production resulting in allograft dysfunction.Copyright © 2023 Elsevier Inc.

When Aways Went Away: How the Elimination of Away Rotations During Covid-19 was Perceived by Applicants Across Specialties

Introduction: COVID-19's emergence and subsequent social distancing guidelines resulted in severe restrictions on away rotations (ARs). This multi-institutional cross-sectional study investigated how these restrictions were perceived by residency applicants across specialties. Method(s): In fall, 2020, an online survey regarding COVID-19's impact on graduating medical students' education was distributed to ACGME Medical Schools. Demographics, specialty choice, and pre- COVID plans to participate in ARs verses one's participation post- COVID were collected. Respondents who provided e-mails received a post-Match follow-up survey in which retrospective thoughts on ARs were explored. Participants were grouped by specialty choice (medical, procedural, surgical) and answers were compared between groups using Kruskal-Wallis test. Result(s): 58 Institutions distributed the initial survey to 8200 graduating students. 1473 responded (18%). 81% were 25-29;65% were female. 49% were medical, 24% procedural and 26% surgical. Surgical and procedural applicants were more likely to have planned to participate in ARs (p<0.001) and be concerned that limitations on ARs would negatively impact their match (p<0.001). Of 1221 initial survey respondents who provided e-mails, 458 participated in the follow-up survey (37.5%). Demographics were similar to the index survey. Post-Match, surgical and procedural applicants were more likely to wish they could have participated in ARs and to propose that future ARs only be offered in-person (p<0.001). Conclusion(s): This multi-institutional survey across specialties highlights the perceived value of ARs for surgical and procedural candidates. Should opportunities for ARs continue to be limited, alternative opportunities for applicants to connect with programs and optimize successful matches should be investigated.

Covid-19 vaccine responses in individuals with type 1 diabetes are comparable to control subjects without diabetes

Aims/Hypothesis: Covid-19 has been associated with poorer outcomes in individuals with type 1 diabetes. Most existing data relate to hospitalised patients with few data available on seroprevalence and the effects of Covid-19 on people with diabetes in the general population. We examined antibody responses to SARS Cov-2 infection and vaccination in people with and without diabetes. Method(s): From June 2020, capillary blood samples collected remotely from 1828 individuals (type 1 diabetes n = 267) were analysed for SARS-CoV- 2 antibodies to RBD (infection pre-Jan 2021/vaccination post -Jan 21) and N (infection post Jan 21) antigens using low serum volume luciferase-based assays developed "in house". Questionnaire data recording experiences of Covid-19 and vaccinations dates were collected simultaneously with the samples. Median antibody levels were compared using Kruskal-Wallis tests. Result(s): There was evidence of SARS CoV-2 infection in 317/1828 (17%) of individuals screened with no evidence of more severe self-reported Covid-19 symptoms in those with diabetes (no participants were hospitalised) and almost a quarter of those with type 1 diabetes were asymptomatic. Although samples were collected at variable time points from vaccination, robust antibody responses to vaccination were observed (Pfizer, AstraZeneca, and Moderna) after the second vaccination with no differences in antibody levels between those with and without diabetes (p = 0.3). Conclusion(s): Hospitalised individuals with Covid-19 and type 1 diabetes were at greater risk of complications but this study shows that among the non-hospitalised population, clinical symptoms, antibody responses to infection, and vaccination in those with type 1 diabetes was similar to control subjects.

Identification of Facebook posts on nephrology-related terms that benefit patient outreach

Objective: The impact of social media on public health has been examined in various studies. However, none have explored user engagement based on the type of Facebook posts related to renal disease. Therefore, the present study sought to determine which type of nephrology-related posts have greater user engagement. Setting(s): Facebook pages. Method(s): The posts on a specific Facebook page curated by a team of nephrologists in Malaysia were examined in this cross-sectional study. The type of post, likes, comments, shares of a post and reach of a post were used for data analysis. Analysis of variance was used to quantify the relative contribution of each independent variable to the odds of the post being highly liked or shared. The Kruskal-Wallis test was used to compare links, photos, shared videos, status and videos for parameters such as reach, the number of times a specific piece of content has been displayed on a screen (impressions), and user engagement. Result(s): Shared videos and photos received the highest median reach of 5,862 and 5,880, respectively. People who 'liked' the page in 2019, 2020 and 2021 numbered 193, 4,196 and 2,835, respectively. Among the types of content on the Facebook page, photos and shared videos received the highest median lifetime reach of the post compared to links, status and videos in terms of 'people who liked the page'. Conclusion(s): The study findings suggest that posting a video or photo maximises the chance of engagement and meaningfully impacts public health outcomes.Copyright © The Author(s) 2023.

Covid-19 Vaccination Impact on Atrial Arrhythmias - Real-World Evidence from the Certitude Registry

Background: The COVID-19 vaccines were developed unprecedentedly and have proven safe and efficacious in reducing transmissibility and severe infection. The impact of mRNA-based COVID-19 vaccines on atrial arrhythmias (AA) incidence is unknown. Objective(s): To analyze the incidence of AA after COVID-19 vaccination in patients with a cardiac implantable electronic device (CIED). Method(s): BIOTRONIK Home Monitoring data and Medicare claims data from CERTITUDE patients implanted with a CIED between 2010-20 were utilized to identify recipients of one or more doses of the COVID-19 vaccine in 2021. Those who had influenza vaccination in 2020 were also identified in the same cohort as a control. From remote monitoring data, the number of atrial high rate events (AHR) and % burden of AA in the three months post-vaccination was compared to the preceding three months using Wilcoxon signed rank test. Kruskal-Wallis test was used for group difference comparisons. New AF diagnosis was determined from ICD-10 diagnosis codes in Medicare claims. Result(s): First and 2nd doses of COVID vaccine (50% Pfizer, 47% Moderna, and 3% J&J) were administered to 7757 and 6579 individuals with a CIED (age 76.2 (+/-9.0) y, 49% males), respectively. In the same cohort, 4723 (61%) individuals received the influenza vaccine. A statistically significant increase in the number of AHR episodes and % burden of AA was noted in the three months post-vaccination compared to the preceding three months after the 1st and 2nd doses of the COVID-19 vaccine (Figure). No such association was noted following influenza vaccination. In subgroup analysis, AHR episodes increased significantly in age groups >70 and men. Post-vaccination increase in AHR episodes was more significant in those without a pre-vaccination history of AHR episodes (mean increase of AHR 6.9+/-88.4, p<0.001) and was non-significant in those with a preceding history of AHR (p=0.8). Among the 764 patients with no AF diagnosis in claims preceding the first COVID-19 vaccine, 87 (11.4%) developed a new AF diagnosis or AHR event in the first three months post-vaccination. Conclusion(s): We report a small but significant increase in the number of CIED-detected atrial arrhythmias following vaccination for COVID-19 but not influenza, specifically in men and age >70 years. Acknowledging the immense public health benefit of COVID-19 vaccines, our results should prompt increased awareness of evaluating for AF in this high-risk group following vaccination. [Formula presented]Copyright © 2023

Vaccination in Patients with Inflammatory Rheumatic Diseases: Preliminary Results of an International, Real-World Life Panlar's Register

Objectives: To evaluate vaccination among patients with inflammatory rheumatic diseases initiating disease-modifying antirheumatic drugs (DMARD) Methods: Data from the real-world life PANLAR's register of consecutive patients diagnosed with RA, PsA, and axSpa (2010 ACR-EULAR /2006 CASPAR-2009 ASAS) from Dec 2021 to Dec 2022 were analyzed. Prevalence of recommended vaccinations were compared between different inflammatory rheumatic diseases. Categorical variables were expressed as %. Tables were analyzed with chi2 or Fisher tests, continuous variables (median, IQR)with the Kruskal-Wallis test, according with the variables type. A p value <=0.05 was considered significant. Result(s): 608 patients were included. Among patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial Spondyloarthritis (axSpA) are presented in the table. RA and axSpA seemed to have lower vaccination rate of pneumococcal vaccines than PsA. (p = 0.045 for conjugate anti pneumococcal vaccine in RA vs PsA). A large percentage of the population was vaccinated against COVID-19. There was a high rate of influenza vaccination in all three diseases. Conclusion(s): In Latin America, anti-pneumococcal vaccination is low, especially in patients with RA and axSpA. For other vaccines there was an acceptable level of vaccination without differences between diseases.

Trajectory of Post-Covid Neurocognitive Recovery in People Living with and without Hiv

Background: Neurocognitive dysfunction is common in long COVID and in people living with HIV (PWH). It is unknown whether PWH experience different disturbances in neurocognitive function following COVID-19 compared to HIVseronegative people. Method(s): The amfAR-Johns Hopkins University COVID Recovery Study is a prospective observational cohort study consisting of four groups: participants who had SARS-CoV-2 infection for the first time within 30 days prior to enrollment with HIV (PWH, arm 1) and without HIV (arm 2);participants with no history of SARS-CoV-2 infection with HIV (arm 3) and without HIV (arm 4). 93.5% of the cohort had received a COVID-19 vaccine prior to enrollment. Cognitive tests were administered at 1-and 4-months post symptom onset (arms 1-2) or post-enrollment (arms 3-4) in seven domains. Age standardized scores (all tests) and age-sex-and education-standardized scores (verbal fluency) were obtained. Standardized scores were compared using the Mann-Whitney U Test and the Kruskal-Wallis test. Result(s): PWH scored lower than HIV-seronegative participants at 1 and 4 months post-COVID on three tests: the Hopkins Verbal Learning Test-Revised (HVLT-R) learning (M1, p=0.011, M4, p=0.015), HVLT-R memory (M1, p=0.029, M4, p=0.007), and category-cued verbal fluency (VF;M1&4, p< 0.001). For the majority of timepoints, PWH who were post-COVID produced equivalent scores as PWH who never had COVID (p-levels > 0.05). Comparing post-COVID HIV-seronegative people to those who never had COVID, post-COVID participants scored lower than never-COVID participants on the Oral Trail Making Test part A (OTMT) test of processing speed at month 1 (p=0.033). Between month 1 and 4, HIV-seronegative people who were post-COVID showed improvements in HVLT-R Recognition (p=0.039), OTMT A (p=0.003), and OTMT B test of executive function (p=0.032). Conclusion(s): Neurocognitive scores in PWH were independent of COVID status, suggesting that higher frequencies of post-COVID neurocognitive dysfunction in PWH compared to HIV-seronegative people are due to HIV-associated factors more so than COVID. HIV-seronegative, post-COVID people demonstrate diminished recognition memory, processing speed, and executive function at 1 month post-COVID that improves by 4 months. Post-COVID neurocognitive dysfunction is present, if temporary, even in a highly vaccinated cohort of people.

Relationship between Covid 19 Vaccination and Psa Level

INTRODUCTION AND OBJECTIVE: Some reports have indicated that the COVID vaccine could affect parameters used for some cancer screenings. The effect of COVID vaccination on breast cancer screening mammograms has been hotly debated and anecdotal reports of a rise in prostate-specific antigen (PSA) after COVID vaccination have appeared in the media. We explored the relationship between PSA levels and COVID vaccination. METHOD(S): With IRB approval, we queried the electronic medical record for men who received at least two mRNA COVID vaccine injections (Pfizer or Moderna), at least one PSA test within two years prior to the first vaccine injection and at least one PSA within one year of their second injection and before any third injection. PSA results were grouped according to the timing of the post vaccination PSA. The pre-vaccine PSA closest to the first injection was used. Both within and between subject analyses were conducted. Wilcoxon signed rank tests were performed to compare PSAs pre- and post- vaccine for each time defined group. McNemar tests were used to assess the percentage of patients crossing a 4.0 ng/dl threshold when compared with their prevaccine PSA. Difference in relative PSA change across the groups was compared using a Kruskal Wallis test. RESULT(S): 5713 men met inclusion criteria. Median prevaccine PSA was 1.2 ng/dl (IQR 0.6-2.7 ng/dl). The median time difference between vaccine injection 1 and 2 was 22 days (IQR 21- 28 days). Within each time group, a significant increase in PSA was observed pre to post and a higher proportion of men went above 4.0 relative to those going below. However, no significant differences were observed across groups (Table 1). CONCLUSION(S): Due to the lack of intergroup differences, PSA increases most likely reflect natural progression rather than any temporal effect of vaccination.

Search method for two cutoff values in clinical trial using Kruskal-Wallis test by minimum P-value approach

In clinical trials, age is often converted to binary data by the cutoff value. However, when looking at a scatter plot for a group of patients whose age is larger than or equal to the cutoff value, age and outcome may not be related. If the group whose age is greater than or equal to the cutoff value is further divided into two groups, the older of the two groups may appear to be at lower risk. In this case, it may be necessary to further divide the group of patients whose age is greater than or equal to the cutoff value into two groups. This study provides a method for determining which of the two or three groups is the best split. The following two methods are used to divide the data. The existing method, the Wilcoxon-Mann-Whitney test by minimum P-value approach, divides data into two groups by one cutoff value. A new method, the Kruskal-Wallis test by minimum P-value approach, divides data into three groups by two cutoff values. Of the two tests, the one with the smaller P-value is used. Because this was a new decision procedure, it was tested using Monte Carlo simulations (MCSs) before application to the available COVID-19 data. The MCS results showed that this method performs well. In the COVID-19 data, it was optimal to divide into three groups by two cutoff values of 60 and 70 years old. By looking at COVID-19 data separated into three groups according to the two cutoff values, it was confirmed that each group had different features. We provided the R code that can be used to replicate the results of this manuscript. Another practical example can be performed by replacing x and y with appropriate ones.

Presentation Traits Of Vaccinated Versus Unvaccinated Heart Failure Patients At Acute Covid-19 Hospitalization

Introduction: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) exhibits 25-30% mortality in hospitalized patients with heart failure (HF). Cardiovascular disease is the most significant comorbidity associated with increased mortality in COVID-19 patients with data suggesting local and systemic inflammation play a critical role in cardiac functional abnormalities. SARS-CoV-2 vaccination reportedly reduces severity of infection. We sought to characterize if vaccination had any protective effect on patients with HF hospitalized for acute COVID-19. Hypothesis: Baseline cardiac biomarkers including CRP, ferritin, high sensitivity cardiac troponin I (hs-cTnI), and pro-brain natriuretic peptide (pBNP) may be lower in vaccinated COVID-19 HF patients revealing the impact of vaccination on reducing inflammation by SARS-CoV-2 infection. Method(s): Electronic health records underwent IRB exempted extraction of demographics, anthropometrics, vital signs, laboratory tests, and ICD-10-CM-based Elixhauser comorbidity categories. Continuous data summarized with median [IQR] were compared using Kruskal-Wallis test and discrete data with chi-squared test. Result(s): Among HF patients with a recorded vaccine status admitted between July 3, 2021 and March 17, 2022, 206 underwent acute COVID-19 hospitalization. Vaccinated (n=91, 44%) and unvaccinated (115, 56%) patients exhibited statistically similar distribution of males (56%), aged 78[69-86] years with comorbidities 5[4-7] distributed across Whites (88%), Blacks (8%), and other races (4%). There were no intergroup differences with most prevalent comorbidities at admission including hypertension (99%), diabetes (41%), chronic pulmonary disease (37%), obesity (36%), deficiency anemia (31%), and renal failure (25%). There were no intergroup differences in initiation of COVID-19 directed treatments. Baseline biomarkers in vaccinated versus unvaccinated were CRP 6.0[1.3-9.5] vs. 6.9[2.7-11.3] mg/dL (p=.25), ferritin 171[76-552] vs. 432[79-876] ng/mL (p=.13), LDH 245[192-317] vs. 338[260-439] U/L (p=.003), D-dimer 0.89[0.53-1.73] vs. 1.36[0.95-2.80] mg/L FEU (p=.06), hs-cTnI 27[14-67] vs. 28[16-81] ng/L (p=.39), and pro-BNP 3487[1516-7162] vs. 3278[1549 vs. 9001] pg/mL (p=.90). Clinical visit criteria respectively were hospital LOS 4.9[2.9-10.3] vs. 5.4[3.4-10.3] days (p=.27), ICU admission 10% vs. 17% (p=.15), and discharge disposition expired or Hospice 15% vs. 16% (p=.48). Rehospitalization occurred similarly between groups and was not significant. Conclusion(s): Acute and chronic inflammation are pathogenic drivers of HF. Inflammatory biomarkers lower among vaccinated patients with HF included CRP, ferritin, D-dimer, and hs-cTnI, although not significant. LDH, however, was significantly lower suggesting improved host widespread tissue perfusion as one mechanism of reduced severity in patients with HF undergoing SARS-CoV-2 vaccine breakthrough infection. One study caveat is that despite inclusion of all patients, these preliminary findings are likely not sufficiently powered to validate our hypothesis.Copyright © 2022

Clinical Outcomes of Stage III Non-small Cell Lung Cancer Patients Treated With Radical Radiotherapy in a Institution in Brazil

Introduction: Lung cancer is the leading cause of cancer death. Most cases are diagnosed at advanced stages. Stage III cancers are treated in a curative manner, despite the low success rate. Our objective was to define the clinical and epidemiological profile of stage III non-small cell lung cancer (NSCLC) patients (pts) treated with radiotherapy (RT) and their response to therapy. Method(s): It is a retrospective and observational study of all non-surgical stage III NSCLC pts treated with RT with curative intent at a public cancer center in the south of Brazil between January/2016 and June/2022. Data collected: dates of biopsy, treatment initiation, image progression or relapse, death and last registration;ECOG-PS;sex;smoking status;histology;stage (TNM 7th Ed) and chemotherapy (CT) use. Survival analysis were performed using the Kaplan-Meier method and factors associated with the events were analyzed using Cox regression. Groups were compared with chi-square and Kruskal-Wallis tests. Result(s): Eighty-seven pts were identified;median age 63 years-old;46 (52%) male, 78 (90%) former or present smokers;51 (62%) ECOG-PS 0/1;49 (58%) squamous (sq) histology;48 (60%) stage IIIb;60 (68%) had abdomen, bone and brain scans;64 (73%) had concurrent CT, 11(13%) sequential and 12 (14%) exclusive RT;64 (74%) concluded RT;53 (60%) had disease progression or relapse and 47 (54%) died. It took a median of 77 days (d) from biopsy to treatment initiation, without difference between pre or during COVID-19 pandemic. The follow-up was of 305d, progression free survival 192d and overall survival 253d (median for all), using the treatment initiation as baseline date. Younger pts and ECOG-PS 0/1 pts were more commonly treated with concurrent CT (X2:8,87;p 0,0054 and X2:10,82;p 0,004 respectively). No factor influenced progression free survival on uni or multivariable analyses. Factors correlated with overall survival on univariable analysis were: ECOG-PS (hazard ratio (HR) 2,02;p 0,010);bone scan (HR 0,5;p 0,028);treatment conclusion (HR 3,53;p<0,0001). Multivariable analysis: ECOG-PS (HR 2,95;p 0,017), non-sq histology (HR 2,26;p 0,044);RT conclusion (HR 4,69;p<0,0001). Conclusion(s): Our study shows shorter overall and progression free survival than literature, with a large portion of patients being treated with ECOG-PS of 2 or greater and without adequate systemic staging. About one-quarter of patients did not conclude the treatment, and this was the most negative factor impacting survival next to ECOG-PS.Copyright © 2023

A Questionnaire Survey of the Mental Health of Japanese Expatriates in China During the COVID-19 Epidemic in 2021

This study examined the impact of coronavirus disease 2019 (COVID-19) on Japanese expatriates living in China. The survey period was from March 30 to July 31, 2021;responses were received via an online survey. An online survey gathered responses from 236 participants about the impact of COVID-19 on their work and life. While 80% of the participants re-sponded that COVID-19 had impacted their work and life, 60% said that it had a physical or mental impact. Kruskal–Wallis test and Mann–Whitney U test were conducted to compare the effects of COVID-19 on job performance, including personal attributes. The impact of COVID-19 was associated with gender (p =.007), age (p =.010), occupation (p =.005), job title (p =.009), and living arrangements with or without a partner (p =.005). The impact was also correlated with age (p =.030), job position (p =.014), number of times the respondent had lived in Japan (p =.003), and number of years in Japan (p =.015). The most significant effect on mental and physical health was correlated with job position (p =.016). Thus, Japanese expatriates living in China were substantially affected by the COVID-19 epidemic;although, 60% of them said their region was easy to live in. Further, despite the Chinese government's strict isolation orders, they found the thorough testing and use of the coronavirus tracking app reassuring. This suggests the importance of providing not only mental care for expatriates during the COVID-19 epidemic but also prompt decision-making based on an accurate understanding of the local situation. © Fuji Technology Press Ltd.

High Fatigue Scores in Patients with Idiopathic Inflammatory Myopathies: A Multigroup Comparative Study from the Covad E-Survey

Background. Idiopathic inflammatory myopathies (IIM) are a rare, multisystem, heterogeneous disease, and contribute to a high psychological burden. The patients' perception of physical health, deteriorating independence and social and environmental relationships may not always be a direct function of disease activity. To face with these aspects, several worldwide specialized organization have recommended the use of patient reported outcome measures (PROMs) both in clinical trials and observational studies to highlight patient's perception of the disease. Unfortunately, data on fatigue scores in IIM is limited. We compared fatigue VAS scores in patients with IIM, autoimmune diseases (AIDs) and healthy controls (HCs) and triangulated them with PROMIS physical function in a large international cohort made up of answers from the e-survey regarding the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. Methods. Data of 16327 respondents was extracted from the COVAD database on August 31th 2021. VAS fatigue scores were compared between AID, HC and IIM using univariate followed by multivariate analysis after adjusting for baseline differences. We further performed a propensity score matched analysis on 1827 subjects after adjusting for age, gender and ethnicity. The Kruskal-Wallis test was used for continuous variables and chi-square test for categorical variables, and Bonferroni's correction was applied for the post hoc analyses considering IIMs as a reference group. Results. We analyzed answers from 6988 patients, with a mean age of 43.8 years (SD 16.2). The overall percentage of female was 72% and the population ethnicity was mainly composed of White (55.1%), followed by Asian (24.6%), and Hispanic (13.8%). The overall fatigue VAS was 3.6 mm (SD 2.7). IIMs VAS was 4.8 mm (SD 2.6), AIDs 4.5 mm (SD 2.6), and HC 2.8 mm (SD 2.6) (p<0,001). VAS fatigue scores of IIMs were comparable with AIDs (p 0.084), albeit significantly higher than the HCs (p<0,001). Notably, fatigue VAS was lower in IIMs than AIDs in two distinct subsets: inactive disease as defined by the patient's perception and the excellent general health condition group, where IIMs had worse scores (p<0,05). Interestingly, fatigue VAS was comparable in active disease defined by physician assessment, patient perception, based on general functional status, or when defined by steroid dose being prescribed. Notably, after propensity matched analysis of patients adjusting for gender, age and ethnicity (1.827 answers, i.e. 609 subjects per group, p=1) the differences disappeared and IIMs and AIDs had comparable fatigue levels across all levels of disease activity, although the fatigue discrepancies with HCs were substantially confirmed. After application of a multivariate linear regression analysis we found that lower fatigue VAS scores were related to HC (p<0,001), male gender (p<0,001), Asian and Hispanic ethnicities (p<0,001 and 0,003). Conclusions. Our study confirms that there is a higher prevalence of fatigue in all the AIDs patients, with comparable VAS scores between IIMs and other AIDs. We can also read our data commenting that females and/or Caucasians patients suffer a higher impact of this manifestation of chronic autoimmune diseases upon their lives. This is why these subjects, to our judgement, should be carefully evaluated during outpatients visits and to whom we should spend some extra time to discuss health related issues and how to improve them.

The Prevalence and Short-Term Outcomes of Acute Kidney Injury in Patients Hospitalized with Covid-19 Infection

Introduction: Acute Kidney Injury is common among COVID-19 patients and is associated with adverse outcomes. This study aims to determine AKI's prevalence and short-term outcomes among admitted COVID-19 patients, as this is not well understood in East Africa. Method(s): We reviewed medical records of all laboratory confirmed COVID-19 patients hospitalized in a private facility in Nairobi between 1st January and 31st December 2021. Data on patient baseline characteristics, clinical course during admission and short-term outcomes were extracted. Patients with confirmed renal failure at admission, chronic dialysis before admission or patients with less than 2 serum creatinine levels measurements available were excluded. AKI was defined according to the KDIGO criteria using serum creatinine levels. Descriptive statistics of means, medians, inter-quartile range and standard deviation as well as the use of frequency/proportion/percentages for categorical variables were used for profiling participants' socio-demographics and clinical parameters. Means for patients with AKI and those without AKI were compared using the Mann-Whitney U test and the Kruskal-Wallis test for continuous variables, Chi-square test was used for categorical variables. Univariate and logistical regression analysis was used to determine the association between AKI severity and various risk factors. Result(s): The majority of the 365 included patients were male (61.4%) aged >= 50 years. AKI developed in 74 (20.3%) patients with 52.7%, 18.9% and 28.4% in stages 1, 2 and 3 respectively. Of these 13.5% needed renal replacement therapy. AKI was common in critically ill patients (43.2%) with the majority being in stages 2 and 3. It was further associated with respiratory failure as 36.0% of mechanically ventilated patients developed AKI compared to 17.8% of non-ventilated patients. Among the AKI patients, 24.3% died and 75.7% were discharged. Of the survivors, the majority (56.8%) achieved full renal recovery at discharge. The AKI risk factors were older age (OR 1.046 p<0.001), male sex (OR 2.490 p 0.002), multiple comorbidities (OR 3.694 p 0.001), hypertension (OR 2.598 p 0.001), diabetes mellitus (OR 2.586 p<0.001) and pre-existing CKD (OR 10.550 p<0.001). Conclusion(s): AKI in COVID-19 is common and results in full renal recovery in most patients. Its severity increases in critically ill patients and is significantly associated with respiratory failure and mortality. No conflict of interestCopyright © 2023

Effect of low-to-moderate dose glucocorticoids on viral clearance in COVID-19: a retrospective study.

Objective: To study the effect of low-to-moderate dose glucocorticoid therapy on viral clearance in patients with COVID-19. Methods: A total of 72 patients diagnosed with COVID-19 from January 19 to February 17, 2020 at the First Affiliated Hospital, Zhejiang University School of Medicine were recruited. All patients received oral arbidol and combination of lopinavir/ritonavir or darunavir/cobistitat for antiviral therapy, and symptomatic supportive care. Among them, 51 patients received methylprednisolone (0.75-1.50 mg.kg-1.d-1) (glucocorticoid treatment group), and 21 patients did not use glucocorticoid (control group). The time of virologic negative conversion in sputum and the time of radiologic recovery in lung since onset were compared between the two groups. The Kruskal-Wallis test or Fisher exact test was used to compare the difference between groups. Results: The median ages of the glucocorticoid group and the control group were 52 (45, 62) and 46 (32, 56) years (chi2=4.365, P<0.05). The clinical conditions at hospital admission were different between the two groups (P<0.01). The severe cases accounted for 52.0%, while moderate cases in the control group accounted for 71.4%. The median times from the onset to virologic negative conversion in the two groups were 15 (13, 20) and 14 (12, 20) days (P>0.05). The median times from onset to radiologic recovery were 13 (11, 15) and 13 (12, 17) days in the two groups (P>0.05). In moderate cases, the median times from the onset to virologic conversion in sputum were 13 (11, 18) days in the glucocorticoid group and 13 (12, 15) days in the control group (P>0.05). The median times from onset to radiologic recovery in lung were 12 (10, 15) and 13 (12, 17) days, respectively (P>0.05). Conclusion(s): Low-to-moderate glucocorticoid treatment has no effect on the time of virus clearance in patients with different clinical types of COVID-19, and also no effect on accelerating radiologic recovery in lung, so it is not recommended.Copyright © 2020 by the Chinese Medical Association.

Effect of COVID 19 pandemic on oral maxillofacial trauma casualties: A cross-sectional analytical study at a regional trauma centre, Chidambaram

COVID -19 pandemic has unprecedented effect globally. The world health organization has declared it to be a Public Health Emergency of International Concern (PHEIC). The pandemic has a widespread effect on all sectors particularly on health care and management. This has an indirect effect on the lifestyle of people. Various studies have shown that there is a drastic reduction in cases with heart ailments and other major systemic diseases during this era of pandemic. This is a study conducted on trauma cases that has been reported during this pandemic before and after lockdown to analyze the effect of lifestyle on road traffic accidents, to differentiate the mode of maxillofacial injuries, to assess the severity of injury. Aim(s): To study and compare prevalence, mode, severity and the effect of lifestyle on maxillofacial injury reported at casualty during lockdown. Objective(s): 1) To estimate the total prevalence of OMF trauma casualties for the past 7 months (Jan 2020-July 2020) at a Regional Trauma Centre, Chidambaram. 2) Assess the prevalence of OMF trauma casualties during the pre & post lockdown period at a Regional Trauma Centre, Chidambaram. 3) Assess the mode of injury in relation to OMF trauma casualties during the pre & post lockdown period at a Regional Trauma Centre, Chidambaram. 4) Assess the severity of injury (soft tissue and bony) in relation to OMF trauma casualties during the pre & post lockdown period at a Regional Trauma Centre, Chidambaram. 5) To compare the effect of alcohol in relation to OMF trauma casualties during the pre & post lockdown period at a Regional Trauma Centre, Chidambaram.Copyright © 2021 The Authors

Nonparametric Homogeneity Test for Small Samples and Its Applications to COVID-19 Epidemic Curves Forecasting

The COVID-19 pandemic is accompanied by intensive attempts to build mathematical models to predict it. For this, various models are used, both traditional differential equations and machine learning models. Classical epidemiological compartment models contain parameters that are difficult to measure. Their results are used to model various scenarios, but it is difficult to obtain a reliable forecast with their help. Machine learning models, on the other hand, do not use prior assumptions, and their inferences are based only on training samples. This usually results in more reliable forecasts. In both the first and second cases, it is necessary not only to estimate the forecast error, but to compare the prediction accuracy of different models by checking the error homogeneity also. An additional factor complicating the problem is the small size of available samples in some cases. This forces one to resort to resampling methods. The article describes the Klyushin-Petunin test for testing the homogeneity of samples with ties in a multi-sample design and compares it with the traditional Anderson-Darling, Kruskal-Wallis and Friedman tests using the example of three methods for predicting the COVID-19 epidemic in the basis of epidemic data in Germany, Japan, South Korea and Ukraine. © 2022 IEEE.

Health Disparities in the Door to Electrocardiogram Time in Patients Presenting with Chest Pain to the Emergency Department: Insight from One of the Largest Public City Hospitals in the United States

Background In recent years, research has demonstrated the disparities in cardiovascular disease diagnosis and outcomes for various populations. We aim to study the demographic and COVID-19-related disparities in the door to electrocardiogram (DtE) time for patients presenting with chest pain in a diverse public city hospital. Methods We conducted a retrospective chart review of patients presenting with chest pain to the emergency department between June 1, 2019 and July 31, 2022. Data regarding age, sex, race, COVID-19 status, and DtE time were collected. Wilcoxon rank sum and Kruskal Wallis tests were used to compare medians. Linear regression was performed to further understand the relationship between age and DtE time. Results Of 10,918 patients, 51% were female (age: 49 +/- 17) and 49% were male (age: 48 +/- 16). A significantly lower median DtE time was noted in males (z=2, p=0.045), patients without COVID-19 (z= -2.84, p=0.004) and in age less than 45 years (z=2.38, p=0.017). In a linear regression adjusting for age, sex, race, and COVID-19 status, advancing age was directly correlated with greater DtE time. For every 10-year increase in age, the DtE time increased by 6.2 minutes (p<0.001). Conclusion DtE time was longer in females and in patients with COVID-19. No race-based disparities were found in this analysis. Paradoxically, younger patients presenting with chest pain had a significantly shorter DtE time, despite a higher prevalence of acute coronary syndrome in older age groups. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Comparing the effectiveness of online and face-to-face teaching and learning approaches on student performance using nonparametric methods

The Covid-19 epidemic has impacted teaching and learning practices not just in elementary and secondary schools, but also in higher institutions. As a result, the new modes of learning and teaching activities that have changed from face-to-face to online may have an impact on students' performance. The goal of this study is to use nonparametric approaches to compare the performance of students at a tertiary institution who were studying face-to-face with those who were learning online. The quantitative students' evaluation scores in a statistics course from different schools in the institution were used in this study. The Shapiro-Wilk test reveals that the data violated the normality assumption of parametric techniques. As a result, nonparametric statistical analysis using the Mann-Whitney U Test and the Kruskal Wallis Test, which are alternative methods for the independent t-test and one-way analysis of variance were used to investigate whether differences in performance scores are significantly different between groups of students who have experienced different learning methods and have been in different schools. In terms of performance scores in a statistics course, our results demonstrate that online learning approaches outperform physical face-to-face learning. © 2023 Author(s).