Isopp 2023

The proceedings contain 109 papers. The topics discussed include: dose intensity of palbociclib and initial body weight dosage: implications on progression free survival in 220 patients with ER+/HER2-negative metastatic breast cancer;characteristics of Nirmatrelvir/Ritonavir (Paxlovid) recipients and clinical interventions by oncology pharmacists at a tertiary outpatient cancer center;safe handling of non-carcinogenic drugs in the Ghent University Hospital: development, implementation and communication of hospital-specific guidelines;case series: use of olaparib in uncommon locations in patients with impaired homologous recombination;real-world data evaluation of medicines used in special situations in oncohematology: a retrospective study from a comprehensive cancer institution;Dostarlimab in the treatment of recurrent endometrial cancer: real life experience;medication-related osteonecrosis of the jaws and CDK4/6 inhibitors in breast cancer;and efficacy and safety outcomes of generic imatinib in adults with chronic myeloid leukemia (CML) following the switch from branded imatinib.

Lichen planus after COVID-19 infection and vaccination

Background: Lichen planus (LP) is an inflammatory disorder believed to result from CD8+ cytotoxic T-cell (CTL) mediated autoimmune reactions against basal keratinocytes. We present a review of LP following COVID-19 infection and vaccination. Method(s): Literature searches were conducted on PubMed and Google Scholar from 2019 to 7/2022. 35 articles were selected based on subject relevance, and references within articles were also screened. Result(s): 39 cases of post-vaccination LP and 6 cases of post-infection LP were found among case reports and case series. 150 cases of postvaccination LP and 12 cases of post-infection LP were found in retrospective and prospective studies. Conclusion(s): LP is a rare complication of COVID-19 infection and vaccination that may be mediated by overstimulation of T-cell responses and proinflammatory cytokine production. However, it does not represent a limitation against COVID-19 vaccination, and the benefits of vaccination considerably outweigh the risks.

Refractory circulatory failure in COVID-19 patients treated with veno-arterial ECMO: A retrospective single-center experience

Objectives: Data about COVID-19 patients treated with veno-arterial-ECMO (VA-ECMO) is limited. Reported survival rates range from 27.9% to 77.8%, depending on VA-ECMO indication. A subgroup of patients suffers from circulatory failure due to a COVID-19 associated hyperinflammatory state (CovHI). In these patients, differentiation between inflammation and sepsis is difficult but important. In this retrospective case series, differential diagnoses of COVID-19 associated refractory circulatory failure and survival rates in different indications for VA-ECMO are investigated. Method(s): Retrospective analysis of 28 consecutive COVID-19 patients requiring VA-ECMO at the University Hospital Regensburg between March 2020 and May 2022. Specific treatment for COVID-19 was in accordance with respective guidelines. Mycotic infections were either invasive or met current definitions of COVID19-associated-pulmonary aspergillosis. Result(s): At VA-ECMO initiation, median age was 57.3 years (IQR: 51.4 - 61.8), SOFA score 16 (IQR: 13 - 17) and norepinephrine dosing 0.53mug/kg/min (IQR: 0.32 - 0.78). Virus-variants were: 61% wild-type, 14% Alpha, 18% Delta and 7% Omicron. Survival to hospital discharge was 39%. 17 patients were primarily supported with VA-ECMO only (survival 42%), 3 patients were switched from VV to VA-ECMO (survival 0%), and 8 patients were converted from VA to VAV or VV-ECMO (survival 50%). Indications for VA-ECMO support were pulmonary embolism (PE) (n=5, survival 80%), right heart failure due to secondary pulmonary hypertension (n=5, survival 20%), cardiac arrest (n=4, survival 25%), acute left heart failure (ALHF) (n=11, survival 36%) and refractory vasoplegia (n=3, survival 0%). Inflammatory markers at VA-ECMO initiation were higher in patients with ALHF or vasoplegia;in these patients a higher rate of invasive fungal infections (10/14, 71% vs. 4/14, 29%;p=0.023) compared to the other patients was found. Conclusion(s): Survival on VA-ECMO in COVID-19 depends on VA-ECMO indication, which should be considered in further studies and clinical decisions making. Circulatory failure due to vasoplegia should be considered very carefully as indication for VA-ECMO. A high rate of mycotic infections mandates an intense microbiological workup of these patients and must be considered as an important differential diagnosis to CovHI.

How the COVID-19 Pandemic Changed the Work of Managers: Case Study of Economic Managers

The COVID-19 pandemic has fundamentally changed the business environment in many sectors. This study analyzes how the pandemic and the resulting global economic crisis have influenced changes in management. The aim was to explore changes in the dominance of management functions through the lens of economic managers in various companies. A case study approach was adopted to achieve the research objective. The sample file consisted of 238 managers from various operational fields in the Slovak Republic. A new methodology was created to measure the overall changes. An indicator of the rate of change in the dominance of the management functions was calculated. The index consists of two factors: changes in the time devoted to each management function during the pandemic, and changes in the importance of basic activities performed within the individual management function. This study provides an overview of all industries and describes the changes in the context of a company's revenue development during the pandemic. It was discovered that the centralization of strategic decision making was significantly underestimated. Up to 78.69% of managers working in companies whose revenues decreased during the pandemic increased the time devoted to planning, and 90.98% of them decreased the time devoted to leading people. © 2023 by the authors.

A regional clinical audit of the provision of adjuvant systemic anti-cancer treatment following lung cancer resection in eligible patients across Greater Manchester to support national benchmarking

Introduction: Adjuvant anti-cancer systemic therapy (SACT) following lung resection improves overall survival in stage II/II non-small cell lung cancer (NSCLC). The Getting It Right First Time (GIRFT) National Specialty Report for Lung Cancer recommends centres publish adjuvant SACT rates for National benchmarking and proposes a target of >40% of eligible patients undergo SACT. We report a regional audit into the uptake of adjuvant SACT in Greater Manchester (GM). Method(s): A retrospective case review of all patients undergoing curative-intent NSCLC surgery with a pathological stage of II/III from 01/01/21 to 30/04/21. Data collected included patient demographics, uptake of adjuvant SACT, reasons for no adjuvant SACT and tolerance and complications of SACT. Result(s): 58 patients underwent surgical resection within the audit period and were eligible for adjuvant SACT. Median age was 70 years (range 45 - 81) and 60% were female. 47% (27/58) commenced adjuvant SACT;41% (24/58) were treated with chemotherapy and 7% (4/58) were treated with tyrosine kinase inhibitors. 58% (14/24) of patients that commenced adjuvant chemotherapy completed 4 cycles. Carboplatin/Vinorelbine was the commonest regimen (82%, 18/22). There were no grade III-V complications and no chemotherapy-related deaths. Dose reduction due to toxicity was required in 14% (3/22). The reasons adjuvant systemic therapy was not given were patient choice in 32% (10/31), poor physical health such that risks outweighed benefits in 42% (13/31), and other reasons (e.g. need to treat synchronous primary tumours) in 26% (8/31). COVID-19 was not recorded as a cause for adjuvant omission/ dose reduction. Conclusion(s): This data provides national benchmarking information for adjuvant SACT in NSCLC and suggests the target of >40% is achievable and appropriate. Interventions that improve patient fitness pre- and post-operatively might increase adjuvant SACT uptake. This regional audit will be extended to review all eligible patients in 2021 and further data will be presented. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

Alpha, Delta, Omicron—Oh My! A SARS-CoV-2 Genome Alignment Activity to Understand Mutations and COVID Variants

COVID took over the world starting in 2020. Everyone quickly "knew" about the novel coronavirus, but how much do they actually know about the virus behind COVID-19? This classroom activity gives students real-world practice in evaluating actual genetic sequences from SARS-CoV-2 and working with genome alignments to identify mutations and cluster different emergence patterns. This activity works through alignments, mutations/variants, protein folding, structure and function, and medical/ immunology implications of the different variants. There are seven parts to this activity, and each one can be incorporated alone into a lesson or collectively used for a lab, case study, or other supplemental activity to strengthen learning objectives in genetics, biology, immunology, and public health. This learning activity is scalable to different levels and has successfully been incorporated into K–12 education as well as college and graduate education. [ FROM AUTHOR] Copyright of American Biology Teacher (University of California Press) is the property of University of California Press 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.)

Mild COVID-19 clinical course among paediatric patients with primary immunodeficiency

Background: The clinical course of coronavirus disease-2019 (COVID-19) varies from those who are asymptomatic, experience mild symptoms such as fever, cough, and dyspnea, to more severe outcomes including acute respiratory distress, pneumonia, renal failure, and death. Early reports suggested severe outcomes in patients with primary immunodeficiency (PID), particularly those with type 1 interferon signalling defects. This prompted a rigid approach to social distancing to protect this patient population, particularly children. To date, real-world data describing the course and outcome of COVID-19 in paediatric PID patients remains scarce. Method(s): In this retrospective case series, we describe the clinical course of 36 paediatric patients with underlying primary immunodeficiency (PID) followed by SickKids Hospital (Toronto, Canada) who were symptomatic and tested positive for SARS-CoV-2 infection between October 2020 to November 2022. Result(s): Our cohort consisted of patients with combined immunodeficiency (66.7%), antibody deficiency (22.2%), neutrophil dysfunction (8.3%), and immune dysregulation (2.8%). The median age was 7.5 years (range: 8 months - 17 years), with 21 male and 15 female patients. Three (8.3%) patients were post-hematopoietic stem cell transplant (HSCT) and 12 (33%) patients were on immunoglobulin replacement. Nine (25%) patients had underlying lung problems including bronchiectasis (1), interstitial lung disease on home oxygen therapy (1), and underlying asthma (7). Most patients had mild clinical course and were managed at home. The most common symptoms were fever (80%), cough (75%) and other upper respiratory tract symptoms (72%). Nineteen (52.7%) patients experienced other symptoms which included headache, lethargy, or gastrointestinal upset. At the time of the infection, 13 patients (36.1%) had received 2 doses of a SARS-CoV-2 vaccine, 5 patients (13.9%) had received 1 dose, and 18 (50%) were not vaccinated. None of the patients received antiviral or monoclonal antibody as prophylaxis or treatment. Only 1 patient required hospital admission out of precaution given the close proximity to HSCT. All patients recovered without complications. Conclusion(s): The paediatric patients with PID followed by our centre experienced mild to moderate COVID-19 symptoms and recovered fully without complications. These findings support the return of much needed social interactions among children, which were impacted severely during the COVID-19 pandemic.Copyright © 2023 Elsevier Inc.

Hemoperfusion with CytoSorb as Adjuvant Therapy in Critically Ill Patients with SARS-CoV2 Pneumonia

Background: Several pro- and anti-inflammatory cytokines involved in COVID-19 and it is reasonable to speculate that their removal from blood might limit organ damage. Hemoperfusion with CytoSorb is a technique developed to adsorb molecules in the middle molecular weight range (up to 55 kDa). Studies in vitro and in vivo have shown that HP is highly effective in clearing blood from a number of cytokines. Method(s): We report a case series of 9 consecutive COVID-patients admitted to our COVID Intensive Care Unit (ICU). Five of them were treated with HP using CytoSorb (T), due to the heavy emergency overload it was impossible to deliver blood purification in the other 4 patients (C), who were also considered as potential candidates by the attending medical team. All patients had pneumonia and respiratory failure requiring continuous positive airway pressure. Different antibacterial prophylaxes, antiviral, and anti-inflammatory therapies including steroids were delivered. Result(s): Our results show a better clinical course of T compared to control patients (C), in fact all T except 1 survived, and only 2 of them were intubated, while all C required intubation and died. CRP decreased in both groups, but to a greater extent after HP. Lymphocytopenia worsened in control patient but not in treated patient after HP. Procalcitonin increased in 2 of the not treated patients. In all survived patients (n = 4) HP reduced pro-inflammatory cytokines, as IL-6, TNF-alpha, and IL-8. Notably, a striking effect was observed on IL-6 levels that at the end of the second session were decreased by a 40% than before the first treatment. Serum levels of IL-8 and TNF-alpha were lowered within normal range. In all patients the treatment was safe and there were no complications. Conclusion(s): Our study suggests a potential efficacy of HP in an early phase of viral infection not only for improving survival in the treated patients but also by the remodeling treatment-associated cytokine levels.

Potential role of Pancreatic Stone Protein (PSP) as early marker of bacterial infection in COVID-19 patients

Background: Sepsis is a life-threatening condition that needs immediate diagnosis and treatment to maximize the chances of survival. Bacterial superinfection is a severe and frequent complication among COVID-19 patients and its diagnosis is challenging. Previous reports suggested that Pancreatic Stone Protein (PSP) may be a predictive biomarker for sepsis in critically ill patients. We report a case series of three COVID- 19 patients admitted to our intensive care unit (ICU) with risk of sepsis. Method(s): We daily monitored PSP, procalcitonin (PCT), and C-reactive protein (CRP) levels in three COVID- 19 patients admitted to our ICU. Microbiological sampling and antibiotic treatment were performed according to the ward organization and in case of clinical suspects for infection. Positive cultures and antibiotic treatment were retrieved from clinical charts and patients were followed from ICU admission up to a maximum of 20 days. Result(s): Patient 1 (male, 55 years-old, overweight, no other comorbidity) was admitted to the ICU in treatment with Ceftriaxone then interrupted on day 7. On day 2 he was intubated and piperacillin/tazobactam was started on day 12 for suspected hospital acquired pneumonia. PSP levels markedly increased on day 10 with no significant changes in CRP and PCT levels. On day 13 a positive bronchospirate for Klebsiella pneumoniae was found. Similarly, patient 2 (male, 70 years-old, mild emphysema and diabetes) was admitted to ICU without antibiotic and with a PSP level of 287 ng/ml. His conditions rapidly worsened in severe septic shock requiring intubation. CRP markedly raised 48-72 hours after PSP with only mild increase of PCT. Patient 3 (male, 78 years-old, no comorbidities) was admitted to ICU with high levels of PSP and piperacillin/tazobactam therapy was started. After 48-72 hours CRP levels increased with no significant changes of PCT. A positive bronchospirate for Ps. aeruginosa was collected on day 3. Conclusion(s): Our findings suggest a potential role of PSP as early biomarker of sepsis in critically ill COVID-19 patients. Daily PSP monitoring may anticipate an appropriate treatment of COVID-19 patients with a septic complication in comparison with the actual laboratory markers. Further studies are needed to confirm our hypothesis.

A survival genome-wide association study to identify variants associated with COVID-19 risk of death

Background/Objectives: SARS-CoV-2 infection clinical manifestations hugely vary among patients, ranging from no symptoms, to life-threatening conditions. This variability is also due to host genetics: COVID-19 Host Genetics Initiative identified six loci associated with COVID-19 severity in a previous case-control genome-wide association study. A different approach to investigate the genetics of COVID-19 severity is looking for variants associated with mortality, e.g. by analyzing the association between genotypes and time-to-event data. Method(s): Here we perform a case-only genome-wide survival analysis, of 1,777 COVID-19 patients from the GEN-COVID cohort, 60 days after infection/hospitalization. Case-only studies has the advantage of eliminating selection biases and confounding related to control subjects. Patients were genotyped using Illumina Infinium Global Screening Arrays. PLINK software was used for data quality check and principal component analysis. GeneAbel R package was used for survival analysis and age, sex and the first four principal components were used as covariates in the Cox proportional hazard model. Result(s): We found four variants associated with COVID-19 patient survival at a nominal P < 1.0 x 10-6. Their minor alleles were associated with a higher mortality risk (i.e. hazard ratios (HR)>1). In detail, we observed: HR=1.03 for rs28416079 on chromosome 19 (P=1.34 x 10-7), HR=1.15 for rs72815354 on chromosome 10 (P=1.66 x 10-7), HR=2.12 for rs2785631 on chromosome 1 (P=5.14 x 10-7), and HR=2.27 for rs2785631 on chromosome 5 (P=6.65 x 10-7). Conclusion(s): The present results suggest that germline variants are COVID-19 prognostic factors. Replication in the remaining HGI COVID-19 patient cohort (EGAS00001005304) is ongoing at the time of submission.

COVID-19 associated severe mucocutaneous blistering eruptions: A case series

Introduction: Mucocutaneous eruptions are associated with many viral processes and present as erythema multiforme (EM), reactive infectious mucocutaneous eruption (RIME), Stevens Johnson syndrome (SJS) or toxic epidermal necrosis (TEN). Limited reports have described the association of COVID-19 and mucocutaneous eruptions in children and adults to date. Method(s): This was a multicenter descriptive case series performed at six tertiary medical centers. Inclusion required a clinical diagnosis of EM, RIME, SJS or TEN and a positive COVID-19 test (rapid antigen or PCR) less than 4 weeks prior to onset of dermatologic manifestation. Data was collected at time of each patient encounter. Result(s): A total of 7 patients met criteria and had a median age of 15 years for pediatric patients (<18 years of age) and 36 years for adult patients (>18 years of age). Patients were found to have a diagnosis of RIME in 85.7% of cases. Oral mucosal involvement was the most common clinical finding (100%), followed by ocular (57.1%), urogenital (57.1%) and skin (42.9%) involvement. 71.4% of cases required hospitalization for their cutaneous eruption. No patients died from their inflammatory condition. Discussion(s): This case series highlights the development of mucocutaneous eruptions in association with COVID-19 infection. Within our cohort, RIME was the most commonly identified COVID-associated eruption. These findings provide additional evidence that abnormalities in host immune response to viral pathogens play a role in severe mucocutaneous blistering conditions. Further investigation will aid our understanding of this disease to improve diagnostics and advance targeted treatments for patients in the future.

Virtual educational therapy: A case study of clinical supports and advocacy

A case study is a research approach that is used to generate an in-depth, multifaceted understanding of a complex issue in its real-life context. It is both time- and space-bound and is useful to explore, describe, and explain phenomena. It is an established research design that is used extensively in a wide variety of disciplines, particularly in the social sciences, including education. Many master's programs employ the case study methodology as the basis for the culminating project. The case study methodology is especially relevant to advancing "younger disciplines" such as educational therapy. Many do not understand the training and difference in approaches between an Educational Therapist and a tutor, so publishing case studies is crucial. This book presents a board-certified educational therapist's year-long case study of clinical supports and advocacy for a student with learning disabilities who is attending school remotely during the COVID-19 pandemic. With online and blended learning, now the norm in K-12 education, educational therapists need new models of intervention, treatment, and relationship-building for their child-age clients. The book offers detailed single-case research focused on a middle-school student who is learning virtually while challenged with attention-deficit/hyperactivity disorder as well as visual and verbal memory issues, but who is nonetheless found ineligible for special education services. Across eight chapters, the book describes the neuropsychological principles, research-based techniques, personal interactions, clinical approaches, and advocacy efforts that led to a vulnerable student's significant gains in academic skills and outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Managing risk in commercial property development projects during the COVID-19 pandemic: Evidence from China

The COVID-19 pandemic is the biggest global health crisis in years. China is the first market primarily affected by the COVID-19 pandemic, with unprecedented lockdown measures bringing real estate and other economic activities to a standstill. This study has two objectives: (1) to identify the risks critical to the risk management of commercial real estate (CRE) development projects based on the project life cycle stages and (2) to identify the stages most affected by the COVID-19 pandemic and the risk factors at different stages. Three rounds of the Delphi study were conducted with nine experts involved in the construction project. The findings indicate that the construction, lease and sale phases are prone to significant risks. Additionally, the analytic hierarchy process (AHP) identified ‘health and safety risk' as the most critical risk factor during the construction phase and ‘marketing and payback risk' as the most critical risk factor during the lease and sale phase. This study enhanced the effectiveness of risk management practices for implementing CRE development projects in China.

Strategies for Developing a Culturally Inclusive Online Learning Environment During the COVID-19 Pandemic in Australian Universities: A Case Study

This chapter presents a qualitative case study in Australian universities on the effective strategies for creating a culturally inclusive online learning environment with the use of IT governance. While examining the online learning experiences of the university students, the researchers identified features in synchronous and asynchronous online learning platforms, such as language support and meaningful and structured online activities, are the effective strategies to cater for the learning needs of the linguistically and culturally diverse students and let their voices be heard. The findings of this study are useful for university management, teaching and learning unit, and IT resources auditing and steering committees to utilise IT resources to attain the learning goals of university students and the organisational goals of the universities in maintaining academic excellence and embracing cultural diversity. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Making the Business IT Alignment Evaluation Models Accessible: A Revisit of Luftman's Strategic Alignment Maturity Model and a Guide Towards Its Operationalization and Applicability Within Organizations

The outbreak of the COVID-19 pandemic has been forcing organizations to search for the provision of uninterrupted modes of operation for both their internal workers and external stakeholders. Basically, enterprises had to enter in an overextended state of organizational agility by swiftly revisiting their business strategies, offerings, and services;simultaneously, the time to assess the procurement of new IT solutions that could support their new state of doing business had to be reduced significantly. This continuous process to ascertain the long-term sustenance of the organization by means of matching the business with proper IT strategies and configurations is known as the Business IT Alignment (BITA). Despite the plethora of academic studies addressing the topic of BITA, to this day, the theoretical concocting of such studies makes it difficult for organizations to find a way to operationalize them. Additionally, the existence of many alignment evaluation frameworks seems to be countered by their offering of a series of complicated assessment procedures that are difficult to be implemented. Thereby, organizations are forced to create and use ad-hoc assessment methods for their BITA analysis. For this reason, we perform an exploratory case study negotiating the conduct of in-depth semi-structured interviews within three companies operating in Belgium, to investigate the need for an operationalized version of the alignment-measuring model, created by Luftman. The development of a methodology for an operationalized version of such a model could facilitate the swift determinization of the overall strategic alignment maturity level for every organization, regardless of their size, location, context or business domain. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Clinical characteristics, complications, and outcomes of severe COVID-19 ARDS patients supported by ECMO and triaged for lung transplantations

Objectives: More than 200 patients have benefited from lung transplantation who failed to recover from COVID-19-induced acute respiratory distress (ARDS) with conventional ventilatory support and/ or extracorporeal membrane oxygenation support (ECMO) in USA. We aim to share our experience and lessons learned at our institute through this case series. Method(s): After IRB approval, we performed a retrospective chart review and identified 37 patients who received ECMO for COVID-19 induced ARDS between May 2020 through January 2022. Out of these, 12 received a formal consultation from the transplant team. We studied patient characteristics, interventions during ECMO support, and evaluation outcomes. Result(s): Most of our patients had single organ failure i.e., lung, except for two who required dialysis after ECMO initiation. Six out of the 12 patients received bilateral lung transplant. One patient received the transplant before ECMO initiation. However, the patient required two runs of ECMO after the transplant due to postop complications from suspected COVID19 reinfection and deceased on postoperative day 101. All the patients after transplant had an expedited recovery except one who required prolonged hospitalization before starting physical therapy. The median length of hospital stay for the transplant group was 148 (89- 194) days and for the non-transplant group was 114 (58-178) days. The 30-day survival rate was 100% for the transplant group. At a median follow-up of 207 (0- 456) days after discharge, 5(83.3%) patients in the transplant group and 3(50%) patients in the nontransplant group were alive. In the non-transplant group, 4 patients received ECMO support for more than 75 days and at last follow-up 2 were alive and functioning well without needing new lungs. This asks for an objective prospective study to define the timeline of irreversibility of the lung injury. Conclusion(s): Lung transplantation is a viable salvage option in patients with COVI-19 induced irreversible lung injury. However, the irreversibility of the lung injury and the timing of lung transplant remains to be determined case-by-case. (Figure Presented).

Peripartum Covid 19 admissions in an intensive care unit - Case series

Introduction: Peripartum women are at increased risk for severe illness with coronavirus disease (Covid-19) infection. Recent medical literature has drawn attention to the possible influence of COVID-19 on the course of pregnancies and its long-term effects.1-5 Objective: This case series aimed to observe the clinical course of peripartum women with confirmed Covid-19 admitted to a critical care unit in the North-west of England. Method(s): Since the start of the pandemic, all pregnant women with Covid-19 infection admitted to the critical care unit were monitored and followed up. Demographic profile, medical co-morbidities, treatment received, respiratory support and vaccination status were noted. Result(s): From March 2020 until February 2022, 8 women in our practice were shifted to the critical care unit post-partum in view of worsening work of breathing & increasing oxygen requirement after initial management in the delivery suite. All admissions were during the 3rd wave of the pandemic in the UK, between June to October 2021. 5 patients underwent Caesarean section under spinal anesthesia & 3 were shifted post normal vaginal delivery. Mean age in the study population was 33.25 years (SD +/- 3.99) and mean length of stay in the ICU was 6.62 days (SD +/- 3.99). Only one woman required intubation & mechanical ventilation for 10 days and the rest were managed on High Flow Nasal Cannula (HFNC) or Continuous Positive Airway Pressure (CPAP) hood and self-proning manoeuvres. 50% of the patients received Tocilizumab. All women were discharged home and there were no maternal deaths. Pre- admission none of the women were vaccinated, but on follow up 5 out of the 8 had completed their vaccination. All women were emotionally distraught due to being isolated from their family and new born. When reviewed at 12 weeks, one patient experienced post traumatic stress disorder (PTSD) and one had features of long Covid syndrome. On follow up, all new born babies were doing well. Conclusion(s): From the limited amount of data available, psychological stress was common to all patients. Being isolated from their new-born and family was the most difficult emotional aspect for the mothers in addition to finding it difficult to breathe and uncertainty about the future. Most mothers and new-born babies were discharged from the hospital without any serious complications. However, further observation and long term follow up is imperative. Use of guidelines in peripartum patients will aid in appropriate escalation of care. Key words: COVID-19, Pregnancy, Peri-partum, Long Covid syndrome.

The role of ECMO in pediatric COVID-19: An updated systematic review and meta-analysis

Objectives: The aim of this systematic review and metaanalysis was to evaluate the effectiveness of ECMO in pediatric COVID-19 patients in terms of mortality rate, rate of successful weaning, and frequency of complications. Method(s): A comprehensive search of electronic databases including PubMed, Cochrane Library, and EMBASE was conducted to identify relevant studies published up to December 2022. Inclusion criteria for the studies included observational studies and case series with a minimum of five patients that reported on the use of ECMO in children with COVID-19. Statistical analysis was performed using R version 4.0.3 and the metafor and meta packages. Result(s): Seven studies involving a total of 73 pediatric COVID-19 patients who received ECMO were identified. The pooled estimate of mortality in children receiving ECMO was 21.5% (15 out of 73 patients;95% CI: 9.9% to 40.5%;I2 = 14%). The success rate for weaning off/decannulation of ECMO was estimated to be 85.1% (52 out of 61 patients;95% CI, 67.8-93.9;I2 = 1%). The overall complication rate was 32.6% (14 out of 43;95% CI, 20.3-47.7;I2 = 0%). Conclusion(s): The results of this systematic review and meta-analysis indicate that ECMO may be an effective treatment option for children with severe COVID-19, particularly those requiring mechanical ventilation. The success rate for weaning off/decannulation of ECMO was estimated to be 85.1%, while the overall complication rate was 32.6%. However, the small sample size and high risk of bias in the included studies should be taken into consideration when interpreting these results. Further research is necessary to confirm the efficacy of ECMO in pediatric COVID-19 patients and determine the optimal use of this treatment.

Stochastic Dynamics of the COVID-19 Epidemic Via a New Mathematical Model

This work considers a new stochastic mathematical model for the transmission dynamics of the coronavirusCOVID-19 by providing the healthy compartment together with the quarantine/isolation compartment. In the deterministic model, global stability conditions of the disease-free equilibrium E0 and the endemic equilibrium E*are derived in terms of the threshold quantity Rd0. Based on the chaotic behavior, we develop and analyze a fourdimensional stochastic COVID-19 epidemic model. Uniqueness, boundedness, and positiveness of the proposed stochastic model are investigated in a biologically feasible region. In terms of the stochastic basic reproduction number Rs0 of the stochastic model, extinction and persistence of the COVID-19 disease are derived. Our theoretical findings are supported by some numerical simulations. The sensitivity of the model with respect to the parameters involved in the system is studied to investigate the most sensitive parameter towards the highest number of infected individuals. We confirm the stability analysis by showing the elasticity of Rs 0 with respect to the variation of each parameter. We present real data of a case study with the first wave of the COVID-19 epidemic in the United Kingdom. We compare our numerical results with the real data. © 2023 L&H Scientific Publishing, LLC. All rights reserved.

A Case Series Analysis of Intestinal Ischemia in Covid- 19 Pandemic

Introduction: Coronavirus disease-2019 (COVID-19) caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has caused a global health crisis. Initially considered a respiratory tract pathogen, it can cause multiple organ dysfunction. It has also been described to predispose to venous and arterial thromboembolism;however, limited published data is available regarding mesenteric thrombosis COVID-19. Clinicians should be aware of the life-threatening situation in COVID-19 patients. Method(s): A case series analysis of 9 patients admitted and managed under department of operation over a duration of 13 months from September 2020 to September 2021 Results: Out of the total of 9 cases of intestinal ischemia, 3 were COVID-19 positive (rapid antigen, RT PCR or CORADS 4 or higher), overall mortality being 55.5% and patients with COVID- 19 were found to have 100% mortality in the study. Mortality in conservatively managed patients was 100%, Mortality in surgically managed patients was 42.8%. Pre operative acidosis, hypoxia and hypotension were found to be important determinants of outcome of the disease. Conclusion(s): Treatment of COVID - 19 and intestinal Ischemia should go simultaneously and in line with the latest evidence based guidelines of COVID 19, Patients who survive an acute event are likely to die of other complications related to the COVID-19 like ARDS, Disseminated Intravascular Coagulation etc that could have predisposed them to intestinal ischemia. Perioperative acidosis, hypoxia and hypotension are important determinants of the outcome of the course of the disease.