Assessment of palliative approach in the pain management in endodontic emergencies during Covid-19 outbreak: Retrospective cohort study

Aim: During the coronavirus disease, a palliative approach was recommended for the management of endodontic emergencies. This retrospective cohort study was conducted to investigate the effectiveness of dexamethasone or ibuprofen-acetaminophen combination for pain management in endodontic emergencies. Material(s) and Method(s): One hundred and eight records of patients who presented to the emergency department with dental pain were evaluated retrospectively. Since interventional procedures were not performed during the pandemic period, Specific analgesics/antibiotics for the management of pain were preferred. A follow-up protocol with a questionnaire was developed to observe the effectiveness of palliative treatment and make changes if necessary. All participants received a questionnaire to rate the pain levels 6, 12, 18, 24, 48, and 72 hours after taking the drug. All data were collected from the patient file and assessed. After inclusion and exclusion criteria, 32 patients were included (n = 19, ibuprofen + acetaminophen;n = 13, dexamethasone). Data were analyzed using the chi-square test (P = 0.05). Result(s): In both groups, a significant decrease in pain was experienced immediately after medication and at 6, 12, and 18 hours, with no significant difference (P >.05). However, dexamethasone (Group II) resulted in lower pain levels than ibuprofen\acetaminophen (Group I) at 24 and 48 hours (P <.05) Discussion: Both dexamethasone and ibuprofen-acetaminophen can be good palliative choices in endodontic emergencies in pandemic conditions. However, at 24 and 48 hours, dexamethasone resulted in lower pain levels.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Dysphagia rehabilitation in post-COVID patients: Review of the literature

COVID-19 causes acute respiratory failure syndrome (SIRA), leading patients to require intubation in the intensive care unit (ICU). A common complication of this ventilatory support is dysphagia, which has a prevalence of up to 30%.This work aims to describe rehabilitation methods in patients with coronavirus infection based on levels of evidence according to the GRADE System, so a systematic review of the literature was carried out. The selected articles were divided into the following subtopics: diagnosis of dysphagia and rehabilitation in COVID patients. The gold standard for the diagnosis of dysphagia is the videofluoroscopic swallowing study (VFS). Fiberoptic Evaluation of Swallowing Assessment (FEES) has high sensitivity and specificity, although they have the disjunction of an aerosol-generating procedure (AGP);however, in a pandemic situation, the study of choice in the literature is VF. Once the diagnosis is made, it is necessary to initiate rehabilitation as soon as possible, even from hospitalization in patients who have hemodynamic stability to prevent long-term effects and promote normal swallowing even before discharge. In patients with COVID-19 infection dysphagia, the risk-benefit of assessment tools and therapy used for diagnosis should be decided to help to maintain social distancing. It becomes imperative to carry out clinical studies with high levels of evidence that allow us to generate Clinical Practice Guides for the benefit of our patients.Copyright © 2021 Sociedad Medica del Hospital General de Mexico. Published by Permanyer.

A cross-sectional study to evaluate the validity of a novel patient-reported outcome measure of medication adherence in Chronic Obstructive Pulmonary Disease

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a respiratory condition characterised by a progressive and irreversible decline in lung function. COPD prevalence increased by 44.2% between 1990 and 2015, resulting in 3.2 million deaths globally in 2015.(1) Inhalers are an essential treatment for people living with COPD. However, poor adherence to inhaled medicines is associated with worsening symptom severity, increased hospitalisation, comorbidity, and mortality.(2) Patient Reported Outcome Measures (PROMs) have been designed to examine the factors that contribute to poor medication adherence (MA). To date, none provide a holistic assessment that could be used to design tailored MA interventions. This study sought to address this by evaluating a novel PROM that holistically assesses four key factors of MA referred to as Social, Psychological, Usage, and Rationale, in short, SPUR. Aim(s): To explore the validity of the SPUR model as a holistic PROM of MA in patients living with COPD Methods: This cross-sectional study surveyed adults living with COPD from a large London NHS Trust between January and December 2021. Participants were eligible if they had >=1 inhaler prescribed for a minimum of 6 months prior to the study and were able to read and write in English. Participants who were too clinically unwell to independently complete the survey were excluded, which often included those with a Covid-19 diagnoses. Convenience sampling was used to recruit participants from in-patient wards and the acute admissions unit prior to administration of face-to-face surveys. Survey questions related to socio-clinical data, the SPUR tool, and a previously validated PROM known as the Inhaler Adherence Scale (IAS) that was included as a comparator. The Medication Possession Ratio (MPR), a measure of a patient's pill count in a given time period, was used as an objective comparator of MA. MPR, IAS, and SPUR scores were compared using Spearman's rank correlation coefficient (p). Symptom severity was examined using the COPD Assessment Test (CAT), with a Chi-square analysis (chi2) conducted to explore the relationship between the CAT and SPUR. Result(s): From 123 patients approached for this study, 100 participated providing a response rate of 81.3%. The modal age range was 70-79 years. Participants were predominantly white (90%), educated to GCSE level (51%), and identified as female (52%). Over two thirds (67%) were ex-smokers. SPUR was significantly (p<0.01) and positively correlated with IAS (p=0.65) and MPR (p=0.30), demonstrating that SPUR is a valid measure of MA. Chi-Square analysis identified a significant (p<0.01) relationship between CAT and SPUR scores (chi2=8.570);hence SPUR could reliably identify patients with poorer adherence, which was associated with worsening symptom severity. Conclusion(s): A study strength includes the implementation of an objective measure (MPR) and PROM (IAS) as part of validating SPUR. However, the results should be treated cautiously given the small sample size, which was limited due to Covid-19. This study provides early evidence of SPUR as a reliable holistic measure of MA with significant associations to COPD symptom severity, which could be applied in clinical practice to prospectively address patient outcomes linked to poor MA.

Relationship of college students' risk perception of COVID-19 and their anxiety and depression: A moderated mediation model.

Objective To explore the effects of perceived risk of COVID-19 of college students on their anxiety and depression, as well as the roles of attention to negative information and perceived social support, so as to provide theoretical basis for colleges and universities to formulate corresponding intervention measures. Methods By the convenience sampling method, totally 1 404 college students from Shaanxi and Henan provinces were investigated online by using General Information Questionnaire, Perceived Risk of COVID-19 Pandemic Scale, Attention to Negative Information Scale, Patient Health Questionnaire, Generalized Anxiety Disorder and Perceived Social Support Scale. SPSS 20. 0 was used for data analysis, Pearson correlation method was used to explore the correlation between variables. The mediating effect of attention to negative information and the moderating effect of perceived social support were analyzed by PROCESS. Results The scores of anxiety and depression of the 1 404 college students included in the study were 4.03 +/- 4.48 and 6.21 +/- 5.41, respectively. The detection rate of anxiety symptom was 29.9%, and that of depression symptom was 44.4%. The risk perception of COVID-19 epidemic of the college students was positively correlated with attention to negative information (r = 0.373, P<0.001), anxiety (r = 0.227, P<0.001), and depression (r = 0.226, P<0.001). Anxiety (r = 0.553, P<0.001) and depression 0 = 0.497, P<0.001) were positively correlated with attention to negative information, while perceived social support was negatively correlated with the risk perception of the COVID-19 (r = - 0.154, P<0.001), attention to negative information (r= - 0.259, P<0.001), anxiety (r = - 0.321, P<0.001) and depression (r=- 0.278, P<0.001). The risk perception of COVID-19 affected the anxiety and depression of the students mainly through the mediating effect of attention to negative information. The total effect of risk perception of COVID-19 and anxiety was 0. 227, and the mediating effect accounted for 80. 18% of the total effect. The total effect of risk perception of COVID-19 and depression was 0. 228, and the mediating effect accounted for 90. 35% of the total effect. Perceived social support played a moderating role in the last half of this mediating model. Conclusion Risk perception of COVID-19 indirectly affects the occurrence of anxiety and depression in college students through attention to negative information, and perceived social support plays a moderating role in this mediating model. The findings suggest that when a risk event occurs, colleges and universities should pay attention to guiding students to adjust their attentional bias to external information, and give students enough care and support to improve their mental health.Copyright © 2023 Xi'an Medical University. All rights reserved.

Acute hemorrhagic leukoencephalitis after administration of the first dose of ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELDTM) vaccine

Background: Many central and peripheral nervous system complications, following COVID-19 vaccination, have been described. We report an unusual case of central demyelinating disorder, following the administration of the ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELDTM) vaccine. Case-report: The 28-year female developed sudden onset headache followed by weakness of the left upper and lower limbs, and gait ataxia. Neurological symptoms developed two weeks after administration of the first dose of the ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELDTM) vaccine. Magnetic resonance imaging brain revealed T2/FLAIR hyperintense lesions involving bilateral subcortical white matter, splenium of the corpus callosum, and both cerebellar hemispheres. Few lesions showed blooming on gradient echo sequence suggestive of a hemorrhagic component. Post-contrast T1 images showed mild enhancement of demyelinating lesions. The patient was treated intravenously with methylprednisolone. After 12 weeks of follow-up, there was a substantial improvement in her symptoms. She became independent in all her activities of daily living. Conclusion(s): In conclusion, this is an unusual case of acute hemorrhagic leukoencephalitis following ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELDTM) vaccination.Copyright © 2022 The Author(s)

The effect of COVID-19 on vascular elasticity and liver function in overweight patients.

Objective. To study the changes in the vascular wall, vascular age and metabolic parameters in polymorbid COVID-19 conva-lescents. Material and methods. The study included 62 patients with hypertension who reached the target blood pressure (BP) with dual an-tihypertensive therapy after severe and extremely severe COVID-19. The following examinations were performed: laboratory tests of metabolic parameters, assessment of changes in the vessel elasticity indices (pulse-wave velocity (PWV), augmentation index (AI), central systolic BP (cSBP), 24-hour BP monitoring, and non-invasive markers of liver fibrosis. Results. According to office BP measurements, after the coronavirus infection, an increase in systolic BP (SBP) by 29.6% and di-astolic BP (DBP) by 23.6%, as well as heart rate (HR) by 11.8% (p<0.05) was reported during regular antihypertensive therapy. In addition, 24-hour BP monitoring data indicated an increase in the average daily SBP, DBP, and heart rate. After the coronavirus infection, an increase in PWV by 35.4% (p<0.05), AI by 24.4% (p<0.05), cSBP by 22.1% were reported. Carbohydrate and lipid metabolism parameters deteriorated. A pronounced adverse effect of coronavirus infection on liver function was observed. The vascular age (according to the modified SCORE scale) increased by 6 years (p<0.05). Conclusion. Our study showed that patients after severe and extremely severe COVID-19 have a high risk of liver fibrosis, hypertension and lipid metabolism control worsening and accelerating vascular aging.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

Use of disease assessment tools to increase the value of case reports on Susac syndrome: two case reports.

BACKGROUND: Susac syndrome is an immune-mediated, ischemia-producing, occlusive microvascular endotheliopathy that threatens the brain, retina, and inner ear. There is a need for disease assessment tools that can help clinicians and patients to more easily, accurately, and uniformly track the clinical course and outcome of Susac syndrome. Ideally, such tools should simultaneously facilitate the clinical care and study of Susac syndrome and improve the value of future case reports. To meet this need, two novel clinical assessment tools were developed: the Susac Symptoms Form and the Susac Disease Damage Score. The former is a comprehensive self-report form that is completed by patients/families to serially document the clinical status of a patient. The latter documents the extent of damage perceived by individual patients/families and their physicians. Both forms were initially trialed with two particularly representative and instructive patients. The results of this trial are shared in this report. CASE PRESENTATION: Patient 1 is a 21-year-old Caucasian female who presented with an acute onset of headache, paresthesias, cognitive dysfunction, and emotional lability. Patient 2 is a 14-year-old Caucasian female who presented with an acute onset of headache, cognitive dysfunction, urinary incontinence, ataxia, and personality change. Both patients fulfilled criteria for a definite diagnosis of Susac syndrome: both eventually developed brain, retinal, and inner ear involvement, and both had typical "snowball lesions" on magnetic resonance imaging. The Susac Symptoms Form documented initial improvement in both patients, was sufficiently sensitive in detecting a subsequent relapse in the second patient, and succinctly documented the long-term clinical course in both patients. The Disease Damage Score documented minimal disease damage in the first patient and more significant damage in the second. CONCLUSIONS: The Susac Symptoms Form and the Disease Damage Score are useful disease assessment tools, both for clinical care and research purposes. Their use could enhance the value of future case reports on Susac syndrome and could improve opportunities to learn from a series of such reports.

Optimal approach to T-cell ALL

T-lineage acute lymphoblastic leukemia (T-ALL) is curable for most children and adolescent and young adult patients with contemporary frontline chemotherapy regimens. During the past decade, improved survival rates have resulted from the optimization of frontline chemotherapy regimens, the use of minimal residual disease (MRD) assessment for evaluating a patient's risk for relapse, and the intensification of treatment based on the persistence of MRD. Optimization of initial therapy is critical because relapsed T-ALL after initial intensive chemotherapy is incurable for most adult patients. Current T-ALL salvage chemotherapy regimens are minimally effective, and unlike in B-cell ALL, there are no approved antibody therapies or chimeric antigen receptor T-cell therapies for relapsed disease. Immunotherapy and small-molecule inhibitors are beginning to be tested in relapsed T-ALL and have the potential to advance the treatment. Until effective salvage strategies are discovered, however, intensive frontline therapy is required for cure. In this article I review the current frontline chemotherapy regimens for adult patients with T-ALL, summarize the novel targeted and immune therapeutics currently in early-phase clinical trials, and outline how these therapies are helping to define an optimal approach for T-ALL.Copyright © 2022 by The American Society of Hematology.

Guillain-Barre syndrome following SARS-CoV-2 vaccination: Is there a real association?

Background: Guillain-Barre Syndrome (GBS) is the most common cause of acute flaccid paralysis, with an incidence of 0.81-1.89 cases per 100,000. With the SARS-CoV-2 virus pandemic, major international vaccination campaigns continue to be carried out to minimize the total burden of the disease. This study aims to report a case series of consecutive GBS patients after SARS-CoV-2 vaccination during the massive campaign in Mexico in 2021. Method(s): A single-center, observational study of consecutive GBS subjects diagnosed by Asbury criteria from January 1 to August 31, 2021. Including GBS-related symptoms on or after six weeks of vaccination record, both first and second doses. Result(s): From a total of 53 GBS patients, eight had a history of SARS-CoV-2 vaccination, 87.5% male, the median vaccination-symptom onset and symptom-to-admission time were 15 (IQR 12.75-23.25), and 3.5 (IQR 1.5-8.25), all of them had GBS Disability Scale >=3 at admission. Acute inflammatory demyelinating polyneuropathy (AIDP) was the most common electrophysiological variant encountered in this population. All patients received treatment Intravenous Immunoglobulin (IVIG) or Plasma Exchange (PE), 62.5% recovered independent walk at three months follow up. Conclusion(s): The annual incidence of GBS cases associated with vaccination remains lower (0.81 - 1.89 cases / 100,000 persons) than non-vaccinated patients;this should encourage health authorities to continue promoting massive vaccination as benefits outweigh the risks.Copyright © 2021

Physiotherapy results of a patient with critical illness polyneuropathy due to COVID-19: A case report

The aim of this study is to examine the results of physiotherapy in a patient with critical illness polyneuropathy (CIP) due to coronavirus disease 2019 (CO-VID-19). The 48-year-old male patient with CIP due to COVID-19 was enrolled in a physiotherapy program for 3 months with 5 sessions/week. Pain intensity, motor skills, daily living activities, fatigue level, cognitive status, and decubitus ulcer were evaluated with a visual analogue scale, the Medical Research Coun-cil-Sum Score, the Functional Independence Scale, the Fatigue Severity Scale, the Standardized Mini-Mental Test, and pressure wound staging, respectively. Positive improvements were achieved in functional level, fatigue, pain, and pressure sores with the physiotherapy program for this patient with CIP due to COVID-19. This report provides an idea about the effects of physiotherapy programs for COVID-19-related CIP to academics and clinicians working in this field.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Assessment and management of the SARS-CoV-2 infection: A secondary center experience: Approach to COVID-19 infection

Aim: The aim of the study was to evaluate the management and outcomes of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a secondary hospital. Material(s) and Method(s): This study included 699 hospitalized patients who had positive rRT-PCR for SARS-CoV-2 and/or typical findings of COVID-19 on chest computed tomography (CT). Demographics, comorbidities, initial laboratory tests on admission, treatment modalities, complications and outcomes were evaluated retrospectively. Result(s): The mean age was 57.0+/-15.6 (range:16-94 years), and male to female ratio was 1.24;58.7% of the patients had at least one underlying comorbidity, the most common was hypertension;18.1% of the patients had lymphopenia, 35.7% hyperferritinemia, 58.3% had increased lactate dehydrogenase, and 58.5% had increased D-dimer. Chest CT revealed moderate and severe stages in 57.9% of the patients. Hydroxychloroquine was given to 37.2% and favipiravir to 67.1% of the patients. No significant difference was observed between treatment groups in terms of mortality (P=0.487);5.8% of the patients were transferred to the ICU, 75.6% of whom needed non-invasive and 36.5% invasive mechanical ventilation. The overall case-fatality rate was 0.9. Discussion(s): Older age, male gender, low lymphocyte count, CT findings, including bilateral involvement and severe stage were significantly associated with poor prognosis and mortality.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Spatial assessment of disease surveillance during the first wave of the COVID-19 pandemic

Background: Early surveillance of COVID-19 in Scotland included routine monitoring of positive test rates and COVID-19-related NHS 24 calls. The COVID Symptom Study (CSS) provides another surveillance source, collating self-reported symptoms in the general population and predictions of likely infection. Aim(s): To capture spatial patterns of COVID-19 infection using Spatio-temporal (ST) analyses on three data streams: positive test rates, NHS24 calls, and CSS predicted cases. These were compared to assess which was best for early disease surveillance. Method(s): Data streams recorded weekly counts of activity by postcode district (PCD) during the first wave of the pandemic. ST analyses assessed the relationship between COVID-19 testing, NHS 24 COVID-19 calls, and CSS predicted COVID-19 cases, applying a Leroux conditional auto-regression (CAR) spatial GLM, adjusting for spatial covariates. Result(s): Positive test rates were associated with the proportion of NHS 24 calls related to COVID-19 per PCD (OR=1.038, 95% credible interval, 1.024-1.052) and the proportion of CSS app users predicted as cases, (OR=1.014, 0.974-1.056). A temporal effect was seen between all streams, after adjusting for spatial covariates. Using both NHS24 and the CSS to model COVID-19 positive test rates accounted for more ST variability than with the separate models, implying that combining sources may improve surveillance accuracy. Conclusion(s): NHS 24 and the CSS can identify similar trends/clusters of COVID-19 and gold-standard testing data, particularly when used in parallel. In the early stages of a pandemic, when widespread testing might not be available, alternative sources of data may be used to inform outbreak management.

Trastuzumab deruxtecan (T-DXd) + durvalumab (D) as first-line (1L) treatment for unresectable locally advanced/metastatic hormone receptor-negative (HR-), HER2-low breast cancer: updated results from BEGONIA, a phase 1b/2 study

Background: Patients with HR- advanced/metastatic breast cancer (a/mBC) with a low level of HER2 (immunohistochemistry [IHC] score 1+ or IHC 2+ and negative in situ hybridization [ISH]) have poor prognosis. Combining 1L chemotherapy with immune checkpoint inhibitors can modestly improve outcomes vs chemotherapy alone, but treatment benefit is largely seen in patients with PD-L1+ disease. BEGONIA (NCT03742102) is an ongoing 2-part, open-label platform study, evaluating safety and efficacy of D, an anti-PD-L1 antibody, combined with other novel therapies in 1L triple-negative a/mBC, including HR-, HER2-low disease. T-DXd is a trastuzumab-topoisomerase I inhibitor antibody-drug conjugate that improves survival in patients with previously treated HR-, HER2-low mBC (NCT03734029;Modi NEJM 2022). Here, we report updated results of the T-DXd + D combination from BEGONIA. Method(s): Patients with unresectable HR-, HER2-low (per local testing, IHC 2+/ISH-, IHC 1+/ISH-, or IHC 1+/ISH untested) a/mBC were enrolled in the T-DXd + D arm. Patients eligible for 1L treatment, regardless of PD-L1 status, received intravenous T-DXd 5.4 mg/kg + D 1120 mg every 3 weeks until progression or unacceptable toxicity. PD-L1, assessed using the VENTANA PD-L1 (SP263) Assay, was defined as high if >= 5% of the tumor area was populated by PDL1-expressing tumor or immune cells. Primary endpoints were safety and tolerability. Secondary endpoints included investigator-assessed objective response rate (ORR;RECIST v1.1);progressionfree survival [PFS];and response duration. Patients included in the efficacy analysis had >= 2 ontreatment disease assessments, progressed, died, or withdrew from the study. Result(s): As of April 8, 2022, 56 patients received T-DXd + D (34 ongoing) and 46 were included in the efficacy analysis. Median (range) follow-up was 10.1 (0-22) months. Median age was 53.5 years, 71% had received prior treatment for early stage BC, and 64% had visceral metastases at baseline. Confirmed ORR was 26/46 (57% 95% CI, 41-71) and unconfirmed ORR was 33/54 (61% 95% CI, 47-74);1/46 patients (2%) had complete and 25/46 (54%) had partial responses. Confirmed response occurred irrespective of PD-L1 expression (PD-L1 high ORR, 5/7 [71%];PD-L1 low, 13/21 [62%];PD-L1 missing, 8/18 [44%]). Median duration of response was not reached;however, 64% of patients remained in response at 12 month follow-up and 73% had an ongoing response at data cutoff. Median PFS was 12.6 months (95% CI, 8-not reached). Adverse events (AEs) were consistent with the agents' known safety, with treatment-related AEs occurring in 49 patients (88%), any Grade 3/4 AEs in 18 patients (32%), and any serious AEs in 10 patients (18%). The most common all-Grade AEs were nausea (41 [73%]), fatigue (26 [46%]), and vomiting (17 [30%]). Adjudicated treatment-related interstitial lung disease/pneumonitis occurred for 5 patients (9%), which were mostly Grade 1 or 2 and 1 case of Grade 5 associated with COVID pneumonia. Seven patients (13%) and 21 patients (38%) had T-DXd dose reduction and dose delay, respectively;22 (39%) had D dose delay. Seven patients (13%) discontinued treatment due to AEs. Conclusion(s): For patients with HR-, HER2-low a/mBC, T-DXd in combination with D in the 1L setting shows manageable safety and promising efficacy including durable responses and an encouraging PFS. Although subgroups were small, responses were observed irrespective of PD-L1 expression. Analysis of additional translational data is ongoing. Funding(s): AstraZeneca/Daiichi Sankyo.

Neuro-Behcet's disease in the setting of active COVID-19 infection

Background: Cases of SARS-COV-2 triggering or exacerbating autoimmune responses has been described in the literature, and it has shown that use of steroids in non-severe COVID-19 may potentially increase mortality. Case presentation: A 22 year-old African-American man presented with headache, weight, loss, and oral/scrotal ulcerations. Case report: Neurological exam revealed somnolence and right hemiplegia. MRI was remarkable multiple enhancing lesions involving the brainstem and left hemisphere. He was found to have a positive SARS-CoV-2 test. Work-up was unrevealing, and he was diagnosed with Neuro-Behcet's disease (NBD) based on the International Criteria for Behcet's Disease (ICBD)ackspaceD)BackspaceBackspacep. The patient was treated with systemic steroids, which resulted in both clinical and radiological improvement of his disease without exacerbation of his SAR-CoV-2 infection. Conclusion(s): This case presentation suggests that IV steroids may be safe in the treatment of NBD in adult patients presenting with SARS-CoV-2 infection.Copyright © 2021

Behavioral, Emotional Problems and Fatigue in Adolescents After COVID-19 Infection: A Cross-Sectional Study

Objective: This study aimed to investigate behavioral, emotional problems and fatigue in adolescents after COVID-19 infection. Also, we examined relationships between baseline inflammation levels, fatigue, and the current behavioral and emotional problems of adolescents. Material(s) and Method(s): A total of 110 adolescents (56 boys, 50.9%, mean age 14.72 years) and their parents were included in the study. Psychiatric assessments of the adolescents were performed 7.31+/-2.35 months after discharge from hospital. Behavioral and emotional problems was assessed using the Child Behavior Checklist (CBCL) 6-18 parent-rated questionnaire. Result(s): We collected baseline inflammatory markers including C-reactive protein (CRP), the neutrophil/lymphocyte ratio (NLR), the monocyte/lymphocyte ratio (MLR), and the systemic immune-inflammation index (SII). The proportions of adolescents that were in the clinical range in at least one behavioral and emotional domain were as follows: 44.5% in the entire sample, 35.7% in boys, and 53.7% in girls. Thought problems were the most common problems in the entire sample (25.5%). The rates of internalizing and externalizing symptoms were 33.6% and 16.4%, respectively. Somatic and attention symptoms were more frequent in females than in males. Inflammatory marker levels did not correlate with behavioral and emotional scores. Fatigue symptoms were determined in 36.4% of all adolescents. We found that somatic and attention problems are more common in fatigued adolescents. Conclusion(s): Our findings demonstrated that screening for behavioral, emotional problems, and fatigue in adolescents with COVID-19 infection is necessary. Future studies with a follow-up design are needed to determine whether a relationship exists between behavioral, emotional problems and baseline inflammation levels after COVID-19 infection. Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.

Clinical Dilemma of Diabetic Ketoacidosis and COVID-19 Infection

The COVID-19 Pneumonia with diabetic ketoacidosis is a dreadful health condition. Diabetic ketoacidosis is one of the severe metabolic complications and it can be precipitated by infection. We presented a case of 48 years female with no known comorbidities who presented with COVID-19 symptoms and with Diabetic Ketoacidosis. The case presented with elevated inflammatory markers, high anion gap metabolic acidosis with type I respiratory failure. During admission, the oxygen saturation had marked drop, later her improvement was steady followed by gradual tapering of the oxygenation. Marked improvement was noticed in the subsequent follow-up. COVID-19 infection can be precipitated by preexisting diabetes or newly diagnosed diabetes and the severity of COVID-19 infection is more pronounced in patients with diabetes mellitus, thus should be managed timely and accordingly. The scarce studies among the COVID-19 cases with diabetic ketoacidosis reflect the need for further studies for the availability of a wider range of information. Copyright © 2021, Kathmandu University. All rights reserved.

Does The Suffering End After Cure From Covid?

Background Multisystem involvement of Covid-19 has been known since beginning of the pandemic. Multisystem after-effects or sequelae of covid-19 have been noted and the term 'long Covid' encompasses these signs and symptoms. This leads to prolonged morbidity which have not been adequately addressed by Covid guidelines.The primary aim of our study was to know the spectrum of different sequelae patients have endured after recovery from acute Covid-19 and study their impact on their quality of life. Methods It was a longitudinal observational study of a cohort of 146 patients who recovered from Covid-19 illness. Patients were enrolled within a week of their onset of Covid symptoms and were followed up monthly for a duration of 6 months with a detailed clinical and investigational pulmonary, cardiac, neurological and psychiatric assessment anda final follow-up after a year. Impact on quality of life was assessed using EQ-5D-3L questionnaire. Those lost to follow up were excluded from the analysis. Results 120/146 patients qualified for final analysis. Pulmonary sequelae (40%) were the majority among the patients, followed by psychiatric (25%), neurological (21.7%) and opportunistic infections (5.8%). 4/120 died within a year. 62/120 patients documented worsening in quality of life. Sequelae like pulmonary fibrosis, PTSD had the worst impact on the quality of life.95% severe, 54.5% moderate and 25% mild Covid patients reported deterioration in QoL score respectively. Conclusion Study indicates health related consequences from Covid-19 extend far beyond acute infection andmake significant impact on their quality of life, regardless of the severity of the disease. Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.

The Utility of Passive and Portable Sensor Data for Monitoring the Symptomatology of Depression and Anxiety: E-Poster Viewing

Introduction: Mobile devices and smartphones have made technology in healthcare more accessible to patients, with COVID-19 further expediting the integration of technology into healthcare. Depression and anxiety are measured via self-report, personality assessments, or during a psychological evaluation with a mental health clinician. These methods of assessing symptomatology lack the benefits of today's technology. This study aims to explore the utility of passive and portable data collection in individuals with anxiety and depression. Materials / Methods: A systematic literature search was conducted through ScienceDirect, PubMed, NCBI, and JMIR electronic databases for studies that were published between 2015-2021 using the following keywords: depression, mobile health, digital phenotyping, mobile applications, mobiles phones, passive EMA, psychiatric assessment, and mhealth. Inclusion criteria;(1) peer-reviewed articles published between 2015 and 2021;(2) studies published in English;(3) studies that use data sensors to monitor and measure the symptomatology of anxiety, depression, and cardiovascular health. A total of 15 studies met criteria. Result(s): Of the 13 studies reviewed, all found at least some correlation between mobile phone usage and depressive symptomatology. 5 studies found a large correlation between GPS data and severity of depressive symptomatology. Contrastingly, one study found that, although people with depressive symptoms spend less time calling and texting others, they spend more time on their phones. Another study states that individuals with depression let their phones ring for longer and have more missed calls. Additionally, 6 studies found a correlation between usage and anxious symptomatology. Mobile phone utilization was found to be far less correlated with anxiety and is a weaker predictor of such symptomatology. The studies found that increased calls, speech presence, and social media usage were directly correlated with increased anxiety. Discussion(s): All research analyzed shows the significance of passive sensor data when screening individuals for emotional symptomatology. This is stated with the implication that EMA are used alongside the sensor data to give a comprehensive picture of the patient. GPS data plays a central role in the ability to screen for symptomatology related to depression and anxiety due to location variability or lack thereof. Conclusion(s): Future research should focus on longer-term studies, that collect more passive data, and have larger sample sizes to ensure that the full extent of interaction between these pathologies can be understood. It should also be noted that other sensors such as ambient light and audio sensors displayed significant results, however, data on their ability to correlate to symptomatology is limited. Learning Objectives: 1. Learn the new and emerging methods of screening for depression and anxiety. 2. Learn new ways to interpret passive sensor data. 3. Learn how a combined approach of passive data collection and active EMA can improve the identification of symptomatology. Keywords: mobile health, digital phenotyping, passive EMA, psychiatric assessment, mobile sensors, depression Copyright © 2022

Agreeability of Tele-ophthalmology and Artificial Intelligence-Based Diagnosis of Diabetic Retinopathy

Purpose : The COVID-19 pandemic exposed the need for increased mobilization of teleophthalmology resources. Artificial intelligence (AI) may serve as a tool to assist physicians in triaging highest need patients if the AI's assessment of disease is comparable to the physician's assessment. This study assesses the ability of AI software to diagnose diabetic retinopathy (DR) as compared to Tele-ophthalmology and in-person examination by a retina specialist. Methods : Records of forty patients (average age 55.1±10.9 years) presenting to an urban retina clinic were reviewed retrospectively for factors including demographics, retinal photos taken by Canon CR-2 Plus AF Retinal Imaging camera (Tokyo, Japan), and diagnosis of DR based on the International Clinical Diabetic Retinopathy (ICDR) classification scale during an in-person clinic visit in which a fundus exam was performed. Retinal photos were graded by AI software, EyeArt (EyeNuk, CA), as Normal, Mild DR, or More than Mild DR. Retinal images were also graded remotely by a retina specialist using the ICDR classification scale via TeamViewer software (Tele). Agreement between Tele, AI, and inperson DR diagnosis was assessed using Cohen's Kappa (κ) coefficient using IBM® SPSS® Statistics software. Results : Among 80 eyes, 33 were diagnosed in-person with no DR, 5 with mild nonproliferative DR (NPDR), 9 with moderate NPDR, 3 with severe NPDR, 7 with proliferative diabetic retinopathy (PDR), and 23 with regressed PDR. Eleven and 26 eyes could not be graded by Tele or AI, respectively. κ±SE for in-Person diagnosis vs Tele was 0.859±0.058 (p<.001), in-person vs AI was 0.751±0.082 (p<.001), and Tele vs AI was 0.883±0.063 (p<.001). Conclusions : AI is a reliable tool for screening patients for DR and referring them for physician evaluation since AI had a substantial rate of agreement with the in-person diagnosis and near perfect agreement with Tele. Tele grading was in near perfect agreement with the in-person diagnosis, showing that Tele is a reliable option for a physician to remotely screen patients that may be ungradable by AI. However, improvements are needed due to the high number of images that are ungradable via Tele and AI. Further studies should assess ways to reduce the number of ungradable images via Tele and AI and create a trend analysis for multiple visits for a given patient.