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Background and aims: Onboarding of the FreeStyle Libre, an intermittently scanned continuous glucose monitoring (isCGM) device, was pre-dominantly conducted in-person prior to the Covid-19 pandemic. However, onboarding rapidly become virtual due to enforced social distancing restrictions. This audit aimed to determine if onboarding method impacted on glycaemic outcomes and engagement statistics in people living with diabetes (pwD). Method(s): PwD who started FreeStyle Libre between January 2019 and March 2022, had their mode of onboarding recorded and had >=70% data were identified and included within the audit. Glycaemic indices and engagement statistics (previous 90 day averages) were obtained from LibreView (Abbott, USA) three months after the last person was onboarded, and compared using linear models, adjusting for FreeStyle Libre duration, %active (where appropriate), age and sex. Result(s): From 1007 eligible participants (in-person 44% [n = 445];virtual 56% [n = 562]), FreeStyle Libre usage duration was greater for those onboarded in-person vs. virtually (974[891,1101) vs. 420[280,564] days [p < 0.001]). There were no significant differences in glycaemic or engagement indices between in-person and virtual onboarding methods: average glucose (10[9,11]) vs. 10[9,11])mmol/l), %time very-low (<3.0mmol/l, 0[0,1]) vs. 0[0,1]%), %time low (3.0-3.8mmol/ l, 2[1,4] vs. 2[1,4]), %time in range (3.9-10.0mmol/ l, 54[+/-17] vs. 53[+/-19]%), %time high (10.1-13.9mmol/ l, 27[21,31]) vs. 26[21,31]%), %time very-high (>13.9mmol/l, 14[6,24] vs. 15[7,26]%), %active (96[90,100] vs. 94[87,99]%) or scans/day (11[8,15] vs. 10[7,14]). Conclusion(s): There were no differences in glycaemic outcomes or engagement indices between pwD between onboarding methods. Virtual onboarding using online videos for isCGM is as equally effective as face to face.
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Introduction: The onset and rise of COVID-19 and its sudden progression to a worldwide pandemic lead medical and dental institutes to change their way of teaching and conducting assessments to distance learning as compared to the previously applied conventional approaches. Teaching and assessment during this era have changed vastly, earlier it was solely traditional/live Objective Structured Clinical Examination (OSCE) but due to the current circumstances electronic/online OSCE (E-OSCE) method was introduced. In Pakistan also, Pakistan Medical Council (PMC) and the College of Physicians and Surgeons of Pakistan (CPSP) conducted online exams so that the scheduled exams do not get delayed. Aim(s): The main objective of this paper is to measure the reliability of an E-OSCE and to compare it with the traditional OSCE. Methodology: This was a cross-sectional study which got conducted at the Rawal Institute of Health Sciences, Islamabad. Traditional OSCEs and E-OSCEs were conducted with 71 participants including final year students and house officers. Each OSCEs had 10 stations, including one interactive station in traditional OSCE. Students' scores in both the OSCEs were collected and paired t-test was used to compare the mean scores at p<0.05. Result(s): Total number of house officers were 27 and final year students were 44. The scores of 71 participants were collected. The difference between mean scores of house officers' traditional OSCE and E-OSCE was statistically significant (p=0.000). The difference between final year students traditional OSCE and E-OSCE was also statistically significant (p=0.020). Finally, the overall difference between traditional OSCE and E-OSCE was also statistically significant (p=0.000) Practical implication: The main objective of this study was to assess the reliability of an E-OSCE and to compare whether the electronic method of conducting OSCE is more reliable than the traditional method of conducting OSCE. Conclusion(s): Despite limitations and the biases, the results of E-OSCE proved to be better than traditional OSCE. Further research needs to be conducted on E-OSCE to control the factors causing biases and limitations.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.
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Background/Objectives: The COVID-19 pandemic continues to threaten public health and burden healthcare systems worldwide. Whole SARS-CoV-2 genome sequencing has become essential for epidemiological monitoring and identification of new variants, which could represent a risk of increased transmissibility, virulence, or resistance to vaccines or treatment. In this study, we assess the performance of various target enrichment methods for whole SARS-CoV-2 sequencing. Method(s): We applied three target enrichment methods - two multiplex amplification methods and one hybridization capture - to the same set of nasopharyngeal patient samples (N = 93) in high-throughput mode. SARS-CoV-2 genome was obtained using short-read next-generation sequencing. Result(s): All three methods provided excellent breadth of coverage of SARS-CoV-2 genome (above 99%), albeit with vastly different sequencing depth (5-fold difference) and uniformity of coverage (20% difference in coefficient of variation). Poor local coverage has negative impact on variant calling in the concerned region, leading to an occasional allele drop-out (1.2% SNPs affected for one method). Conclusion(s): We discuss the performance of each target enrichment method and their potential for scaling up, in order to promote prospective programs of large-scale genomic surveillance of SARS-CoV-2 worldwide. Genomic surveillance will be crucial to overcoming the ongoing pandemic of COVID-19, despite its successive waves and continually emerging variants.
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Introduction: Patients with chronic lymphocytic leukaemia (CLL) are at increased risk of infection. CLL is associated with a secondary immunodeficiency and impaired response to vaccination. Recent British Society of Haematology guidelines recommend that patients with CLL should receive vaccination against pneumococcal infection at diagnosis, an annual influenza vaccine and COVID-19 vaccination. Patients aged 70-79 years should also receive the Shingrix vaccine. Patients with CLL should not receive live vaccines. In response to this guideline, a letter detailing vaccination requirements was created for patients to give to their general practitioner (GP). The local process for vaccination referral has since changed. Previously, vaccination requirements were communicated to the GP via letter. There is now a dedicated Vaccination Hub to which clinicians can directly refer patients for appropriate vaccinations. Aim(s): The aim of this project was to assess vaccination referral and vaccination status in patients with newly diagnosed CLL. Method(s): All new diagnoses of CLL from 2021 to 2022 were identified by review of the Haematology Multi-Disciplinary Team meeting electronic registration forms. Electronic patient records were reviewed to determine vaccination referral completion and vaccination status. Result(s): A total of 29 patients were identified as new diagnoses of CLL. Seventeen patients were diagnosed in 2021 and 12 in 2022. Sixty-nine percent of the patients were male and the average age was 70.9 years. Vaccination was discussed with 11 patients (38%) and 10 patients (34%) were referred for vaccination. Eleven patients (38%) had never received a pneumococcal vaccine. Nine patients (31%) had previously received the vaccine but not within the past 5 years. Five patients (17%) patients had received one dose of Pneumovax 23 following referral. No patients had received the initial Prevenar 13 vaccine. Twelve patients (41%) had not received an influenza vaccine. Of those who had received the vaccine, the majority (70%) had received this routinely. Similarly, 71% of patients had received the COVID-19 vaccine routinely as opposed to three patients who received this postreferral. Of those who were eligible, 50% had received the Shingrix vaccine. Conclusion/Discussion: Local rates of vaccination in patients with CLL are low. Numbers were too small to allow for comparison between the methods of referral. Of those referred, not all received the appropriate vaccinations. Further work is therefore required to improve both the number and completion of the referrals. Future steps will include local teaching on vaccinations in CLL and the referral pathway.
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Introduction: The COVID-19 pandemic had a significant impact on healthcare. Acute pancreatitis (AP) is a clinically serious disease that almost always requires hospitalisation and treatment that cannot be delayed or planned. International studies have highlighted the potential negative impact of COVID-19 infection on the onset and severity of the disease. The aim of this study is to analyse the impact of the COVID-19 pandemic on the epidemiology, treatment and prognosis of acute pancreatitis at the population level. Method(s): Comparison of parameters of hospitalizations for acute pancreatitis, care provided and treatment outcomes during the pandemic (2020 + 2021) with previous years (2010-2019) using data from the National Registry of Covered Health Services. Presentation of pilot data. Result(s): Hospitalizations for AP increased slightly from 2010 to 2015 to about 7000/year with a relatively stationary number in 2016- 2021. Hospitalizations for AP in each month of 2020 and 2021 did not correlate with the number of COVID-19 positive patients and showed a similar trend (with peaks in summer and at the end of the year) as in the years prior to the pandemic. Concurrently with AP, 2.3% and 3.7% of patients had COVID-19 infection in 2020 and 2021, respectively. AP mortality in the pre-pandemic and pandemic years was virtually the same at 3.9%. There was no difference in length of hospital or ICU stay. There was a downward trend in the number of ERCPs and surgical interventions performed. Conclusion(s): According to pilot population data, the COVID-19 pandemic did not have an impact on the incidence or prognosis of acute pancreatitis in the Czech Republic. Changes in trends in interventions performed correlate with recent expert recommendations and are unlikely to be related to the reduction in care due to the pandemic.
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The proceedings contain 360 papers. The topics discussed include: comparison of three methods assessing spirometry bronchodilator responsiveness in children;the quality of spirometry testing: a systematic review;airflow severity in asthma minimally affects within-session oscillometry variability;corrected normative multiple breath washout data in pre-school aged children;prevalence and predictors of tidal expiratory-flow-limitation in healthy adolescents/young adults;impact of change of significant bronchodilator response definition;volume-dependence of reactance as a measure of ventilation inhomogeneity;mechanisms of impaired gas exchange following hospitalization for severe COVID-19;increased shunt and dead space in recovered COVID-19 pneumonitis patients;airway hyperresponsiveness detection in atopic asthma using exhaled nitric oxide;increased conductive ventilation heterogeneity following exposure to coal-mine fire smoke;accuracy of transcutaneous carbon dioxide monitoring during sleep studies;and effect of hematopoietic stem cell transplant on small airways function.
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Background: There have been numerous techniques used in laparoscopic appendectomy (LA) to divide the mesoappendix, including LigaSure, Harmonic scalpel, clips, endoloop ligatures, Endo GIA staplers, and bipolar coagulation. However, few studies have investigated monopolar diathermy for mesoappendix division. Therefore, this study aimed to assess both its safety and efficacy in LA. Method(s): In this prospective non-randomized study, patients (n = 87) who underwent LA for acute appendicitis were included. The bipolar electrocautery was used for mesoappendix division in the first 33 patients (BC group), while the monopolar electrocautery was used in the next 54 patients (MC group). Result(s): The median operative time was significantly shorter in the MC group (42 min. vs 47 min. in BE group, p = 0.01). One patient converted to open surgery in the MC group due to uncontrollable bleeding. There were no significant differences between both groups regarding postoperative complications and hospital stay (p = 0.91, p = 0.13, respectively). Conclusion(s): Monopolar electrocautery is safe and effective for mesoappendix division in LP in comparison to bipolar electrocautery. However, larger and multicentric studies are required to validate our results.Copyright © 2023 The Authors
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Funding: None. Synopsis: 61-year-old male who initially presented to an outside facility with streptococcal pneumoniae meningitis and bacteremia. Of note, he had history of COVID-19 pneumonia a month prior. On hospital day 15, he reported sudden onset lower back pain prompting imaging which demonstrated a contained rupture of an infrarenal aortic aneurysm that had significantly evolved in comparison to admission imaging where his infrarenal aorta had the largest dimension measuring 2.9cm. We present the successful application of neoaortoiliac system (NAIS). Method(s): Proceeding with midline laparotomy we encountered dense adhesive disease due to his history of surgery for colon cancer. After adhesiolysis, we exposed the aorta and aneurysm with severe surrounding inflammatory changes. 20cm of femoral vein was harvested, reversed, and joined for a span of 4cm using an Endo GIA 45mm vascular load to create our neoaorta. Proximal and distal clamp zones were developed. Upon entering the aneurysm, a foul smell was encountered, revealing that the noxious process had destroyed the posterior wall of the aorta and paraspinal tissues. Our neoaorta was anastomosed in end-to-end fashion to the infrarenal aorta and subsequently to the common iliac arteries. Flow was initially restored to the hypogastric arteries and then the external iliac arteries. The retroperitoneum was closed over our repair and covered with omentum. Result(s): On post-operative day 2, he had hematochezia;intraoperatively, the IMA was noted to be 1mm in size, though had brisk back-bleeding and was ultimately ligated. A flexible sigmoidoscopy revealed ischemic sloughing of the sigmoid colon near his previous anastomosis from his colon cancer resection though no transmural necrosis. He remains on high-dose ceftriaxone to complete a 6-week course and metronidazole for 10 days due to his sigmoid mucosal ischemia per infectious disease recommendations. He is now post-operative day 10 and remains in the ICU. Conclusion(s): Mycotic aortic aneurysms constitute 1-1.8% of aortic aneurysms. The standard of treatment is aggressive debridement of involved aortic wall and periaortic tissue, in-situ or extra-anatomic reconstruction, coverage with an omental flap and long-term antibiotic therapy. NAIS is resistant to infection and aneurysmal dilation, however, is a time-consuming procedure with a mean completion time of 8 hours. Dorweiler et al. demonstrated that vascular reconstruction with femoral vein in infected aortoiliofemoral fields has a mortality of 9-10% with negligible rate of late complications (graft stenosis, thrombosis, and dilation) and that venous morbidity after femoral vein harvest is well tolerated. Clagett et al. demonstrated that NAIS fashioned from greater saphenous vein had a failure rate requiring intervention of 64% compared to 0% for those constructed with deep femoral vein. Lastly, it is important to note that our patient was previously COVID-19 positive. This case demonstrates that the sequela of COVID-19 may have been a significant factor in our patient's pathophysiology. As we continue to learn about the effects of COVID-19 on vascular pathology, we must keep a large repertoire of operative techniques at hand in order to treat complex presentations of vascular emergencies. [Formula presented] [Formula presented] [Formula presented] Institution: Orlando Health, Orlando, FLCopyright © 2022
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Enhanced experience in performing percutaneous tracheostomies during the COVID-19 pandemic resulted in changes to airway management protocol for patients undergoing major head and neck reconstructive surgery within our department. Most patients now receive a percutaneous tracheostomy over the previously favoured surgical tracheostomy. The aim of this study was to review our experience in performing percutaneous tracheostomies, whilst comparing complication rates with surgical tracheostomies performed in similar settings. All consecutive patients undergoing free flap reconstructive surgery for head and neck cancer between June 2020 and November 2021 were included, with 56 patients receiving a percutaneous tracheostomy. Data across a range of variables including age, BMI, comorbidities and complications was compared with 56 surgical tracheostomies performed for the same group of patients before the COVID-19 pandemic and resultant protocol changes. In the percutaneous group, a marginally lower complication rate was observed over the surgical tracheostomy group;28.57% and 30.35% respectively. Analysis of the 16 patients who experienced complications in the percutaneous group led to development of selection criteria to identify appropriate patients to receive a percutaneous tracheostomy in future, based on factors such as BMI, bleeding risk and positioning deformities. The COVID-19 pandemic has offered a multitude of learning experiences for healthcare professionals to change our practice. In our unit, this has involved modifying the routine tracheostomy procedure used for airway management intra- and post-operatively in major head and neck reconstruction surgery.Copyright © 2023 The Authors
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Background: COVID-19 has made a series changes in all system of life especially in education. As a result, education has changed dramatically with the distinctive rise of e-learning. The present study was aim to examine the preference and perception of MBBS student on newly introduced online live video classes. Method(s):An online questionnaire survey consisting of closed and open-ended questions on nine different categories such as accessing online video content, previous experience with online learning, interaction with video lectures addressing the content, duration, visualize, timings and screen size, perceived learning experience, the online content learning assessment methods and the experience with the online learning management system.Two hundred and thirteen undergraduate medical students were participating in this study. And it was conducted by the large medical institution in Andhra Pradesh. Result(s): The e-learning methods were encouraged and its gaining popularity among the medical students and faculty. Our analysis shown 97.7% students were highly satisfied and 2.3% were not satisfied with online classes on comparison to the traditional methods of learning. Conclusion(s):The teaching method and teachers support are the pivotal elements which enable online learning experience with a mutual relationship. Furthermore, the usefulness and acceptability of e-learning among medical students as a part of their curriculum is still not fathomed in medical education.Copyright © 2022 Indian Medical Association. All rights reserved.
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This article discusses the treatment of panic disorder in terms of cognitive behavioral psychotherapy. Panic disorder is one of the most common anxiety disorders. The etiology of panic disorder assumes the coexistence of genetic and environmental factors. Panic attacks often accompany other mental and somatic diseases. The constant feeling of intense anxiety with a number of somatic symptoms affects the deterioration of everyday functioning, significantly reducing one's quality of life. The global situation caused by SARS-CoV-2 may correlate with the increase in the incidence of panic disorder. The introduction of appropriate therapeutic interventions at the earliest possible stage of the disease gives patients a chance for long-term remission. So far, it has been proven that the best results of pharmacological treatment are achieved thanks to the antidepressant and benzodiazepine drug groups. One of the non-pharmacological interventions with the highest clinical effectiveness is cognitive-behavioral psychotherapy. Compared to other trends, cognitive- behavioral therapy is characterized by the most reliable research proving its high effectiveness. Psychotherapy of panic disorders in the cognitive-behavioral approach includes a complete conceptualization of the patient's problem, taking into account individual theoretical models. Treatment of panic attacks is based on a protocol which takes into account both cognitive and behavioral interventions, e.g. psychoeducation, cognitive restructuring, breathing training, relaxation exercises and both interoceptive and in vivo exposures. Research results indicate that this therapy is an alternative form of treatment for panic disorders. Sources indicate that the effectiveness of interventions based on cognitive-behavioral therapy is comparable to that of pharmacotherapy.Copyright © 2022 Termedia Publishing House Ltd.. All rights reserved.
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Objective: Identify changes in breast cancer detection method, stage at diagnosis and treatment prior to, during and after stay-at-home orders and restricted health care access due to COVID-19. Method(s): Statistical comparison of detection method (patient (PtD), mammography (MamD) or other), Anatomic TNM Stage 8 (0-IV) and invasive BC treatment change over time by three time periods (time 1: 2019+Q1 2020;time 2: Q2-Q4 2020;time 3: 2021) using chi-square analysis in an institutional retrospective cohort of first primary breast cancer (BC) patients (n=1799), years 20192021. Result(s): In the years prior to the study, 2016-2019, there was no difference in detection method or stage at diagnosis by year with 682 to 733 newly diagnosed BC annually (p=.462). In 2020 (n=535) and 2021 (n=582) annual diagnosed cases dropped 22% and 15% from 2019 levels. Compared to time 1, time 2 MamD BC dropped significantly (64% to 58%) with a subsequent increase in MamD BC to 70% in time 3 (p < .001) creating a U-shaped curve for MamD over time. PtD BC increased in time 2 from 30% to 36% but declined in time 3 to 25% (p <.001). Concurrently, stage at diagnosis shifted from time 1 to time 2 with stage 0 and I declining [stage 0: 21% to 16%, stage I: 40% to 38%] and stage II and IV increasing [stage II: 28% to 33%, stage IV: 2% to 4% stage IV] (p<.001). Subsequently in 2021 stage shifted again with an increase in stage 0 to 22% and stage I to 45% and a decline in stage II (33% to 24%), III (9% to 7%) and IV (4% to 2%) (p<.001). Combining stage 0 and I, the percentage of lower stage BC declined from 61% to 54% and increased to 67% in time 3 (2021) when health services became more readily accessible. There was no change in type of surgery for invasive breast cancer (stage I-III, n=1386) with equivalent numbers of breast conserving surgery (58%), subcutaneous mastectomy (24%) and mastectomy (18%) over the time period. Chemotherapy treatment rates for invasive BC did not change (38%). Radiation therapy increased from 66% (time 1: 2019+Q1 2020) to 73% (time 2: Q2Q4 2020) then back to 64% in time 3: 2021 (p=.007) independent of surgery type but concordant with an increase in stage IA and stage IIB BC among invasive breast cancer cases in time 2: Q2-Q4 2020 (p<.001). Likewise, neoadjuvant therapy increased and then declined from 33% to 38% to 29% from time 1 to time 3 (p<.001). Conclusion(s): Number of diagnosed BC cases fell after the first quarter of 2020 during the time of COVID-19 related shut downs and decreased access to health services. During the Q2-Q4 2020 time period mammography detected BC declined with a relative increase in patient detected breast cancer. When mammography detection declined, BC stage at diagnosis shifted to higher stage concurrent with increased rates of radiation and neoadjuvant therapy. In 2021, the relative increase in mammography detected BC indicates a return to more normal screening patterns with a catch up for screening lost in the prior year due to access limitations. In the third time period: 2021, with the return to prior levels of mammography detected breast cancer, stage shifted back to pre-pandemic expected distribution and the excess treatment with radiation and neoadjuvant therapy declined to previously observed levels. Although the changes in detection method, stage and treatment did not persist they were statistically significant and could represent a need for re-establishing prepandemic screening behavior. (Table Presented).
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Background: During the pandemic, not only SARS-CoV-2 infections and their complications have an impact on public health. The management of non-communicable diseases such as diabetes mellitus can be affected too. Patients may not receive the same quality of care because of pandemic. Research question: To determine the impact of the pandemic on quality and outcome of diabetes care. Method(s): Retrospective comparison of two cohorts in a primary care setting in Switzerland. Adult patients (>=18 years) with a diagnosis of diabetes mellitus and with at least one consultation with a general practitioner, between 17 March 2018 and 16 March 2019 (cohort 1) and 17 March 2019 and 16 March 2020 (cohort 2), were included and observed for two years (until 16 March 2020 and 16 March 2021, respectively). Quality indicators and outcomes of diabetes care at patient and practitioner level, were compared before and during the COVID-19 pandemic. Result(s): A total of 27,043 patients and 191 practices were included, 23,903 in cohort 1 and 25,092 in cohort 2. The fraction of patients lost to follow-up attributable to the pandemic was 28% [95% Confidence Interval: 25%, 30%]. At patient level, regular measurements of weight, Hemoglobin A1c (HbA1c), blood pressure and serum creatinine were less frequent during the pandemic. At the practitioner level, fewer patients reached the target of an HbA1c value <=7% and a blood pressure value of <140/90mmHg during the pandemic. However, more patients had an LDL-cholesterol value of <2.6 mmol/l. Although higher HbA1c values were observed in the months after lockdown, values converged to the same level for both cohorts by the end of the follow-up period. Conclusion(s): A considerable quality drop in diabetes mellitus care could be observed during the pandemic (17 March 2020-16 March 2021). However, HbA1c values converged to the same level for both cohorts at the end of the observation period. Thus, the long-term effect on relevant outcomes has not yet been visible.
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Introduction: Pulmonary transit time (PTT), the time taken for contrast to travel from the left to right ventricle, can be used as a surrogate marker for cardiac output. There have been previous studies evaluating the prognostic significance of Magnetic Resonance (MR) and Computed Tomography (CT) PTT in heart failure patients. This study used dynamic CT images to determine the PTT and study its correlation with left and right ventricular ejection fraction and left and right cardiac output in COVID patients, with a known range of cardiac outputs. Method(s): 123 COVID-19 patients were retrospectively studied. A single contrast bolus timing scan was acquired with a 320-detector CT (Acquilion ONE, Canon). A single 2 mm slice was placed axially where left and right ventricle and descending aorta were visualised. Contrast administration and scan acquisition began at the same with 20 ml of Omnipaque with 40 ml saline flush at 5 ml/s. One image was acquired every second and the total scan time was 26 seconds. A circular ROI was placed in the centre left and right ventricle, the signal intensity was plotted over time for each of these regions. Matlab software was used to extract the peak contrast time between the right and left ventricles. MR cardiac images were acquired on a 3 T Prisma, which determined MR PTT, left and right ejection fraction (LVEF, RVEF) and left and right ventricle cardiac output (LVCO, RVCO). These values were already computed from a previous study where this data was taken from. Correlations were studied using the Pearson correlation method using Minitab software. Result(s): There was correlation between MR PTT and LVEF and RVEF, r = - 0.433 p<0.05 and r=-0.358 p<0.05 respectively. A correlation was also seen with CT PTT and LVEF (figure 1) and RVEF, r=-0.-345 p<0.05 and r=-0.2 p=0.029 respectively. A correlation was seen for MR PTT and LVCO and RVCO, r=-0.322 p<0.05 and r=-0.295 p<0.05 but not for CT PTT and LVCO and RVCO, r=-0.1 p=0.297 and r=-0.04 p=0.668 respectively. Conclusion(s): A correlation was seen between MR PTT and CT PTT for both LVEF and RVEF, but this was not seen for CT PTT and LVCO and RVCO. Further work is required to understand the limitations of the CT PTT and why it fails to correlate with these parameters. Limitations may include dynamic CT temporal resolution or due to poor image quality due to motion from breathing. Compared to previous studies there is agreement between the MR PTT and MR cardiac parameters. At this stage there is an indication that CT PTT could be a potential tool to estimate LVEF and RVEF. [Formula presented]Copyright © 2023
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Introduction: Lung Ultrasound (LUS) can track interstitial changes of COVID-19 pneumonia (CP) in the acute phase. CT has been used to evaluate the development of lung fibrosis post CP but its use is associated with increased ionising radiation. Aims and Objectives: We conducted a prospective single-centre pilot to assess the utility and feasibility of using serial LUS in adult patients recovering from CP. We hypothesize that LUS may provide a safe and acceptable alternative to CT imaging for the outpatient follow-up of these patients. Method(s): 21 subjects provided consent on the day of hospital discharge (D0) and were followed up for 83 days. High-resolution CT was performed on Day 83 and correlated with LUS on Days 0/41/83. Serum Ferritin, LDH, CRP, D-Dimer (Days 0/41/83), Spirometry (Day 41/83) and Quality of Life measures (EQ-5D Day 41/83) were obtained. 3 clinicians reviewed and scored the LUS images independently;CT scoring was performed by 2 thoracic radiologists blinded to the LUS findings. Result(s): 19 subjects completed the study (10 males [52%];mean age: 52 years [range:37-74]). LUS scores were significantly lower at Days 83 and 41 compared to Day 0 (Mean = 1.5 [D83] / 2.8 [D41] / 10.9 [D0] p<0.0001). Ground glass change was the most common finding on CT at Day 83. Correlation between LUS with HRCT at Day 83 was weak (Pearson r2=0.44). However a better correlation was observed in % change of LUS scores and KCO at Day 84 compared to Day 42 (r2=0.64). Conclusion(s): LUS may be a useful point of care tool for the assessment of patients recently recovered from CP. However its role in the evaluation of post CP lung fibrosis requires further study.
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Background: The coronavirus pandemic has accelerated the change to e-health services. Home spirometry has been rolled out to facilitate remote monitoring, but accurate measurements are essential. Aim(s): This study compares the technology for home spirometry (using Nuvoair) with that used for standard spirometry in hospital (using EasyOne). Method(s): Spirometry data of 81 children with CF (Cystic Fibrosis) were collected prospectively over a period of 9 months. All patients had paired spirometer measurements taken on the same day and time in clinic, prior to Nuvoair spirometers being given out for home use. A survey was sent to all participants included in the study. Result(s): Of 81 children, 54 provided interpretable measurements, 27 were excluded due to poor quality results. Mean age was 13.2 years (range 7.3 - 17.2). The mean difference between paired measurements in FEV1 (L) was 55 ml, 95% CI (29ml, 80 ml), FEV1% was 2.4%, 95% CI (1.5%, 3.4%) and FEV1 Z score was 0.22, 95% CI (0.14, 0.3). The Bland-Altman of FEV1 Z-score shows a degree of agreement between the methods with a bias of 0.22, limits of agreement (-0.3, 0.8). All the survey respondents (n=11) found home spirometer easy to use. 81% of the respondents preferred a combination of home and hospital testing. Conclusion(s): The study shows comparable results between the two methods of spirometry with no significant statistical or clinical difference. Feedback from families was positive. Home spirometers (Nuvoair) provide acceptable results when used with professional supervision and can be used as a resource in managing children with CF. Separate evaluation is needed for unsupervised home spirometry.
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Background: During COVID-19 pneumonia management, CT scan is highly contributive. It represents the gold standard examination for both positive and severity diagnosis. Objective(s): We aimed to compare 2 methods of evaluation of CT scan involvement. Method(s): We conducted a prospective cohort study in the ICU of Abderrahmen Mami hospital between January and December 2021. We included critically-ill patients COVID-19 who had a CT scan. We considered two ways to evaluate severity of lung damage: 1/Percentage of lung damage extent (< 50%, 50 to 75% and >= 75%), 2/ CT score (assimilated to Lung Ultrasound Score): Subdivision of each hemithorax into 6 regions: antero-superior and inferior, latero-superior and inferior, postero-superior and inferior. A score was attributed according to the patterns: 0 if normal parenchyma, 1 if few ground-glass lesions, 2 if extensive ground-glass lesions, and 3 if condensations. CT score was the sum of the scores of the 12 regions, thus varying between 0 and 36 Results: We included 158 patients with mean age of 56 +/- 13 years and gender ratio of 1.6. Mean values of SAPS II and APACHE II were respectively 25.4+/-7.7 and 8.7+/-5. Mean initial PaO2/FiO2 was 127.4 +/- 59.7mmHg and ARDS was diagnosed in 153 (98%) patients. The CT extent was distributed as <50 % (27.3 %), [50% - 75 %] (37.8 %) and > 75 % (34.9 %). Mean CT score was 19.4+/-5.8 [5 - 34]. The comparison of the 2 methods, showed a statistically significant result between the CT score and a damage < 50% (p = 0.002), and also between CT score and a damage >= 75% (p = 0.003). Conclusion(s): In COVID-19 pneumonia, lung damage extent seems to be appreciated with percentages as well as CT score. An external validity is mandatory for CT-scan score.
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Background: The covid-19 pandemic affected family planning management and the sexual and reproductive rights of couples. Objective(s): To determine the factors associated with the interruption of the use of contraceptive methods during the quarantine by COVID-19 in Peruvian women. Method(s): Analytical and cross-sectional study, which included 342 women who used a contraceptive method before the COVID-19 quarantine, to whom a virtual questionnaire disseminated on social networks was applied. Pearson's chi-square evaluated associations between method discontinuation and the factors studied. Result(s): Of the total number of women, 45% discontinued the use of contraceptive methods during the COVID-19 quarantine. The predominant age range was from 18 to 34 years (93.9%). The factors associated with this interruption were age (p = 0.044), marital status (p < 0.001), parity (p < 0.001), sexual relations (p < 0.001), and searching for information by digital means (p = 0.044). The main reason for stopping use was fear of contagion by COVID-19 (42.8%). Conclusion(s): About half of contraceptive method users interrupted their use during the COVID-19 quarantine, and the factors associated with said interruption were personal, reproductive, and informa-tional. Therefore, health personnel must provide comprehensive care for women, especially in health emergencies.Copyright © 2023 Bentham Science Publishers.
ABSTRACT
Purpose. To identify the occurrence and structure of changes in the pericardium ultrasonography among patients who have undergone COVID-19 and have cardiological symptoms, as well as to compare these changes with the pericarditis aspects and the infection time duration in a prospective cohort observational study. Methods. Inclusion/exclusion criteria: current or transferred COVID-19, new symptoms that occurred during or after infection and forced to consult a cardiologist, the absence of other prerequisites for pericarditis and vaccination against SARS-CoV-2. Echocardiography was performed with an emphasis on the pericardium and an assessment of the echogenicity amplification, the area of the hyperechoic zone, thickness and artifacts, as well as a questionnaire. Results. From 05.2020 to On 10.2020, 335 patients from the covid ward and 284 patients from the out-patient clinic were included. 86% of patients had transient chest discomfort. The peaks of treatment accrued to 4-5 and 10-11 weeks (Me 10[2-36] (1 to 64) weeks) from SARS-CoV-2 infection occurred. Typical ECG changes were registered in 3%, pericardial friction noise - in 7% of patients. In 20% of patients discomfort in the heart area was the first, in 27% - the dominant, in 14% - the only symptom of COVID-19. According to EchoCG data, 96% of the examined patients had ultrasound signs of different changes in the pericardium: slight effusion in 65%, signs of tamponade in 2%, thickening in 12%, local hyperechogenicity in 83%, local adhesion in 8% of patients. The group without pericardial changes was distinguished by the presence of epicardial fat >7 mm. A combination of the echo-cardiography criteria with the second symptom recorded at the visit or earlier was present in 76% of the applicants. Comparison of the recorded ultrasound patterns with the time elapsed since infection allowed us to distinguish ultrasound phases: 1) the phase of damage (pattern of initial edema) occurred at 1 week, 2) the phase of edema /exudation (pattern of visible effusion) - at 3 weeks, 3) fibrosis (pattern of pericardial compaction) - at 11 weeks, 4) regression of inflammatory changes (pattern of local fibrin deposition) - on week 22, 5) residual signs of transferred inflammation may be visualized in patients with symptoms 44 weeks after COVID-19. Conclusions. Consideration of the infectious process triggered by SARS-CoV-2, as a systemic inflammation, allows us to interpret the phenomenon of pericardial involvement as a reactive serositis having ultrasound phases. It was possible to trace some patterns of echocardiography at different stages of the infectious and post-infectious period. Clinical data of 76% of patients can be interpreted as pericarditis, changes in 20% - as an increase in echogenicity of the pericardium.Copyright © 2022 Russian Electronic Journal of Radiology. All rights reserved.
ABSTRACT
Since 2019, the coronavirus disease-19 (COVID-19) has been spreading rapidly worldwide, posing an unignorable threat to the global economy and human health. It is a disease caused by severe acute respiratory syndrome coronavirus 2, a single-stranded RNA virus of the genus Betacoronavirus. This virus is highly infectious and relies on its angiotensin-converting enzyme 2-receptor to enter cells. With the increase in the number of confirmed COVID-19 diagnoses, the difficulty of diagnosis due to the lack of global healthcare resources becomes increasingly apparent. Deep learning-based computer-aided diagnosis models with high generalisability can effectively alleviate this pressure. Hyperparameter tuning is essential in training such models and significantly impacts their final performance and training speed. However, traditional hyperparameter tuning methods are usually time-consuming and unstable. To solve this issue, we introduce Particle Swarm Optimisation to build a PSO-guided Self-Tuning Convolution Neural Network (PSTCNN), allowing the model to tune hyperparameters automatically. Therefore, the proposed approach can reduce human involvement. Also, the optimisation algorithm can select the combination of hyperparameters in a targeted manner, thus stably achieving a solution closer to the global optimum. Experimentally, the PSTCNN can obtain quite excellent results, with a sensitivity of 93.65% ± 1.86%, a specificity of 94.32% ± 2.07%, a precision of 94.30% ± 2.04%, an accuracy of 93.99% ± 1.78%, an F1-score of 93.97% ± 1.78%, Matthews Correlation Coefficient of 87.99% ± 3.56%, and Fowlkes-Mallows Index of 93.97% ± 1.78%. Our experiments demonstrate that compared to traditional methods, hyperparameter tuning of the model using an optimisation algorithm is faster and more effective. © 2023 Centro Regional de Invest. Cientif. y Tecn.. All rights reserved.