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Background: The specialty of dentistry was being reassembled in its response to Covid-19 pandemic. Teledentistry proved to be a promising way to reach the marginalized population, therefore providing effective substitute of physical dentist-patient interaction with minimal risk of cross infection. Aim(s): To assess the level of knowledge regarding teledentistry among urban population of Lahore. Moreover it was also focused to analyze the experience and satisfaction of patients regarding the use of virtual dental platforms. Methodology: A cross-sectional study was conducted from April 2022 to June 2022 among 125 general dental patients visiting University Dental Hospital, University of Lahore who have used the virtual dental platforms. The sampling was done with non-probability convenience sampling technique. A self-structured questionnaire with 21 close ended questions was used. Questionnaire was divided into two sections. The first section consisted of 5 questions regarding patient's demographic data, how did they get to know about teledentistry and for who didthey used teledentistry platform. Result(s): A total of 125 patients participated in the study, out of which 38(30.4%) were male and 87(69.6%) were female. A large majority 120(96%) of patients were in the age category of 20-40 years. In reference to education, majority of the participants were graduates 107(85.6%). According to our study 14(11.2%) participants wereextremely familiar with the term teledentistry compared to 42(33.6%) who were slightly familiar and only 12(9.6%) were extremely unfamiliar. Regarding familiarity about different platforms of teledentistry (e.g., Marham, Oladoc etc. 30(24%) were moderately familiar 13(10.4%) were extremely familiar and 30(24%) were extremely unfamiliar. About satisfaction, majority 62(49.6%) of people were satisfied with the increasing trend of teledentistry. Conclusion(s): The majority of the survey participants expressed positive responses towards teledentistry in all domains. This study found high levels of patient satisfaction with virtual consultation.There is a further need to improve the knowledge and promote teledentistry. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.
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Background: The COVID-19 pandemic has prompted the world to make various efforts to control its spread by finding ways to diagnose COVID-19 quickly and accurately. Early identification of COVID-19 infection is essential, especially in hospitals with limited resources. We aimed to generate two scores based upon clinical and laboratory findings in patients screen for COVID-19 infection. Methodology: This study used a retrospective cohort design that involved 705 adults (>= 18 y old) admitted in Dr. Sardjito Hospital and Dr. S. Hardjolukito Hospital. The patients' data collected included demographic characteristics, anamnesis on signs and symptoms, history of contact with COVID-19 patients, history of staying or visiting an endemic area, comorbidities, and laboratory and radiologic indicators. All variables with a P < 0.25 on the bivariate test were included in a univariable logistic regression. If the P < 0.05, the variable was included in the multivariable logistic regression with a P < 0.05 considered significant. Receiver Operating Characteristic (ROC) producing an area under the curve (AUC) with 95% confidence intervals (CIs) was used to assess discrimination power. Result(s): Two scores were generated;score in Model 1 consisted of clinical signs, basic laboratory indicators, and chest X-ray, and in Model 2 consisted of clinical signs, chest X-ray, basic and advanced laboratory indicators, including C-reactive protein (CRP), lactate dehydrogenase (LDH), albumin, and D-dimer. The ROC score of Model 1 was 0.801 (0.764-0. 838), which is considered good discrimination, and of Model 2 had excellent discrimination with a ROC of 0.858 (0.826-0. 891);the differences in the ROC of the two models was statistically significant (P = 0.03). The score of Model 1 more than 5 had 85% sensitivity and 61% specificity of positive COVID-19. A score of Model 2 more than 4 had 83% sensitivity and 72% specificity for diagnosing positive COVID-19. Conclusion(s): A simple score consisting of clinical symptoms and signs, and simple laboratory indicators can be used to screen for COVID-19 infection. Copyright © 2022 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
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Background and Aims: The COVID 19 pandemic have affected the patients with ST segment elevation myocardial infarction as the number of patients presenting with STEMI declined substantially and those who underwent primary PCI had poor outcome. Our aim was to analyze the in-hospital and 30-days mortality in STEMI undergoing Primary PCI during second wave of COVID 19. Method(s): A prospective cohort study was conducted at Shahid Gangalal National Heart Centre, Bansbari, Kathmandu. Convenience sampling of patients who underwent primary PCI were enrolled in this study and were followed up for 30 days. Numerical variables were described as Mean +/- Standard Deviation (SD) and categorical variables were described as frequency and percentage. p values were calculated and considered significant if < 0.05. Result(s): During this study period of 2 months from 1st May 2021 to 30th June 2021, 97 patients with STEMI underwent primary PCI, including 12 (12.47%) COVID 19 positive cases. 30 days mortality was 15.4% including in-hospital mortality of 11.34%. Among COVID 19 positive cases, in-hospital mortality was 33.33% and 30-days mortality was 55.55% which was significantly higher than non COVID 19 patient who underwent primary PCI (P=0.003). Conclusion(s): Overall, mortality rate of primary PCI during COVID 19 second wave has been increased and mortality of COVID 19 positive patients who underwent primary PCI was significantly higher than non-COVID 19 patients who underwent primary PCI. Copyright © 2022 Cardiac Society of Nepal. All rights reserved.
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INTRODUCTION: The criteria for the COVID-19 patients' selection that benefit most from ECMO therapy are yet to be defined. In this study, we evaluate the predictive performance of the ECMO mortality predictive models in patients with COVID-19. METHOD(S): A retrospective study was performed in two high-complexity hospitals between March 18, 2020, and December 31, 2021. We included patients over 18 years old with COVID-19 infection confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) who received V-V ECMO due to COVID-19-related ARDS. We evaluated the predictive performance (discrimination, calibration, and accuracy) of death prediction of the following predictive models: i) Prediction of Death due to Severe ARDS in V-V ECMO score (PRESERVE);ii) The Respiratory Extracorporeal Membrane Oxygenation Survival Score (RESP) score;iii) Prediction of Survival on ECMO Therapy- Score (PRESET) score, to predict death. Also, we perform a cost-benefit analysis using the health-related quality of life reported by the CESAR TRIAL and the US life expectancy. Besides, we add the mortality predicted probability calculated with the best predictive model to the cost-benefit analysis. Therefore, the cost/QALY formula was: cost/QALY = cost / age-specific life expectancy*health utilitiesz.ast;survival probability. RESULT(S): We included 38 adult patients who received ECMO due to COVID-19. The PRESET score had the highest discrimination (AUROCs 0.81 [CI95% 0.67-0.94]) and the best calibration (Hosmer-Lemeshow test, p=0.6). The optimal threshold for this score was 7 (sensitivity 67%, specificity 89%, accuracy 78%). The cost per QALY in the USA, adjusted to life expectancy, was higher than UDS 100,000 in patients older than 45 years with a PRESET>10. CONCLUSION(S): The PRESET score had the highest predictive performance and could help in the patient's selection that benefits most from this resource-demanding and highly invasive therapy. Also, the addition of the costbenefit analysis output can help decide which patient to place on ECMO therapy, especially in low-resource settings.
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INTRODUCTION: More than 5 million patients are admitted to ICUs in the United States annually (1). Prior to the 1990s, little attention was given to the post ICU course, however, studies have shown high rates of functional impairment, cognitive impairment and depression in ICU survivors, a phenomenon known as Post ICU Syndrome (PICS) (2). Chronic pain is thought to be an important mediator for Post ICU Syndrome. Incidence of chronic pain after ICU hospitalization has been reported between 28-77% (3). Prior studies performed primarily in Europe and Australia in surgical and trauma ICUs largely looked at incidence of pain within one year of discharge. The purpose of this study is to identify the incidence of chronic pain in medical ICU survivors diagnosed with respiratory failure due to COVID-19 infection. The novelty of this study is that all patients investigated were admitted with the same diagnosis to a medical ICU. METHOD(S): This is an observational study looking to determine the incidence of chronic pain 1 year after discharge from hospital in patients who were admitted to an intensive care unit due to acute respiratory failure from COVID-19 infection. The brief pain inventory, a validated survey to assess the severity of pain and its impact on daily functions, was used to establish the presence of chronic pain. RESULT(S): 116 patients were called 1 year after discharge from the hospital. Out of 116 patients, 65 patients responded to our survey. 51 patients declined to participate in the study. Out of 65 patients who completed the survey, 29 (44%) patients reported having pain in the past week different from usual day to day pain that was not present prior to ICU hospitalization. 11 patients were omitted due to having surgery in the past month. 21 (32%) patients reported a moderate to severe amount of pain experienced in the week prior to follow up. 18 (28%) patients reported moderate to severe interference with general activity due to pain. CONCLUSION(S): Of patients discharged from the hospital after ICU hospitalization due to acute respiratory failure secondary to COVID-19 infection, 44% experienced chronic pain 1 year after hospital discharge. A significant number of patients had pain affecting their quality of life.
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Background. The COVID-19 pandemic has caused an unprecedented global public health emergency. Vaccine uptake in low and middle income countries (LMICs) lags developing nations and immunity from vector-based vaccines commonly used in LMICs may be inferior to mRNA vaccines. Thus, defining clinical characteristics that can help identify and triage cases and allocate resources in LMICs of priority. Hyperglycemia has been associated with higher morbidity and mortality in numerous diseases and in critical illness. We seek to understand the relationship between COVID-19 and hyperglycemia. Methods. This is a single center retrospective review of cases with COVID-19 between January 2021 and June 2021. Adult patients >18 years of age were reviewed and those with a molecular-based laboratory confirmed SARS-CoV-2 infection were included in our study. Patients with known diabetes, elevated A1C or prior steroid use within 2 weeks of admission were excluded. Clinical characteristics, demographics, glucose levels, C-reactive protein (CRP) and ferritin were reviewed. Results. A total of 120 patients were reviewed, of which 60.8% were male. Hyperglycemia ( >140mg/dL) was present in 57.5%. Hyperglycemia was associated with elevation of inflammatory markers including CRP and Ferritin (p=0.12) (Table 1). Hyperglycemia was more common in patients requiring supplemental low flow oxygen (table 2) and was more common in patients who did not survive (Figure 1). The mortality rate was higher in the hyperglycemia group with 61.5%, a statistically significant finding. Association between hyperglycemia and inflammatory markers. Conclusion. Hyperglycemia on admission was an independent risk factor for disease progression and death. Inflammatory markers were also higher in patients with hyperglycemia. These patients had no prior steroid use or diabetes. Thus, it is possible that it reflects inflammation, stress, or endocrine end-organ damage due to SARS-CoV-2. If validated in larger studies, this simple test can help clinicians identify patients at risk of decompensation and allocate resources and therapeutics accordingly.
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Background. In 2021, there were approximately 1300 people on a given day who have experienced homelessness within the city of Detroit, Michigan. Sheltered beds within the 24 homeless shelters in the city were drastically cut in half during the COVID-19 pandemic due to concerns of overcrowding perpetuating SARS-CoV-2 outbreaks. We aimed to describe the outreach efforts made by Street Medicine Organizations (SMO) of Detroit during the SARS-CoV-2 pandemic, highlighting infection prevention and control strategies, and promotion of COVID-19 vaccinations amongst the unsheltered homeless. Methods. Health promotion interventions were directed at individuals who were unsheltered (defined as those living on the streets of Detroit, encampment sites and abandoned buildings). Education, which was provided through in-person sessions, as well as targeted COVID-19 informational pamphlets were distributed with every street-based run. Hygiene kits, which included masks, hand sanitizer and gloves were distributed thrice weekly at shelters and encampment sites. Since access to hand hygiene was drastically limited, the SMO constructed 10 hand washing stations throughout the city. COVID-19 vaccination in people experiencing homelessness started in April 2021. Results. SMO prioritized a 60 square mile range within the city of Detroit, providing care to approximately 500 persons over the months of April 2020 to April 2021. Demographics for this population varied;age ranged from 23 to 76 years old, sex was 70% males, race were 67% Black, 29% White and 4% Hispanic. More than 2000 hygiene kits were distributed throughout this period. Ninety-one individuals experiencing unsheltered homelessness were provided the COVID-19 vaccine in April 2021. Conclusion. Individuals experiencing unsheltered homelessness face unique challenges to accessing timely medical care, which has been further exacerbated during the pandemic. These individuals have limited or no access to necessary measures needed to prevent the spread and severity of diseases of SARS-CoV-2. We describe a focused and effective approach to preventing infection among these individuals as a model for organizations nationally.
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Background: Recent evidence has suggested the presence of unique coagulation abnormalities in patients with COVID-19. Clot waveform analysis (CWA) has not been adequately described as a tool for the evaluation of coagulation. Aim(s): To comparatively assess the changes in clot waveform analysis (CWA) parameters between COVID-19 patients upon hospital admission and healthy individuals. Method(s): In this retrospective observational study, we evaluated 227 CoVID-19 patients upon their hospital admission, prior to the initiation of anticoagulation therapy relative to 84 healthy individuals. Coagulation tests and CWA were performed on BCS XP System (SIEMENS). The CWA parameters of PT, aPTT and Fifrinogen (FIB) were the change in Absorbance (dmA) and the time difference between the starting time of the reaction (mixing of reagent and sample) until a specific absorbance change (absorbance threshold). All statistical analyses were performed using SPSS27. Variables were tested with Student's t tests or Mann-Whitney U tests for differences in distributions of dmA and dsec of PT, aPTT and FIB between two groups. P values < 0.05 were considered statistically significant. Result(s): A statistically significant increase in the dmA values of PT, aPTT and FIB was detected in CoVID-19 patients compared with the healthy individuals (p < 0.001) (fig.1). A statistically significant decrease in CoVID-19 patients was found only for the dsec values of FIB (p < 0.001) (fig.2). Conclusion(s): CWA variables upon admission in COVID-19 patients may be used for the evaluation of their inflammatory response or/ and hypercoagulopathy. Our results may help to identify patients at a high risk of thromboembolism. (Figure Presented).
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Background: We recently reported that in United States, 388 organs from SARSCoV- 2 nucleic acid test (NAT) positive 150 donors were procured between Aug 2020 to Sep 2021. Nearly 1 million deaths have been attributed to SARS-CoV-2 pandemic however only selected group of donor organs were assessed for transplantation. Even after procurement, 28% (of 388) organs were discarded. For kidney transplants (KT), commonest reason for relatively high-quality organ discards (35%) was 'exhaustion of wait list', indicating reluctance to accept these organs. Method(s): We investigated potential risk of donor transmission of SARS-CoV-2 by a prospective study including 23 KT recipients with prior SARS-CoV-2 vaccination. Donor serum and pre-implantation kidney biopsy tissue were assessed for detection of SARSCoV- 2 via a validated commercially available real-time reverse transcription polymerase chain reaction (RT-PCR) (threshold 73 copies/mL). All recipients had SARS-CoV-2 RTPCR on plasma and nasopharyngeal swab at Day-7 post-KT. Result(s): A total of 23 KT were performed from 22 SARS-CoV-2 NAT positive donors between Nov 2021 and Feb 2022. All 22-donor serum samples and 23 procurement biopsies were negative for SARS-CoV-2, including those from 8 donors with symptomatic disease. Six (of 22 donors;27%) had death attributable to SARS-CoV-2 complications. Three recipients with asymptomatic donors were diagnosed with clinical SARS-CoV-2 disease at 10, 14, and 23 days post-KT during 4th pandemic surge. Both graft and patient survival rate was 100% at a median 3 month followup. Collation with national 'Organ Procurement and Transplant Network' registry showed that majority of other organs from these donors were not procured [zero pancreata, zero lungs, 11 (50%) livers, 19 (86%) hearts]. Among 42 KT [55% (23/42) performed at our center], 10 transplanted livers, and 3 hearts;no graft loss or death was reported. Conclusion(s): In this single-center study we report an absence of detectable SARSCoV- 2 virus in donor kidney tissue and plasma from SARS-CoV-2 positive donors.and absence of recipient viremia and nasopharyngeal detectable virus immediately after KT indicating a lack of donor transmission. Our results of excellent graft and patient survival favor utilization of SARS-CoV-2 infected donors.
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Background: Antiviral antibody responses to SARS-CoV-2 vaccines are reduced in kidney transplant recipients (KTRs) on belatacept compared to those not on belatacept. However, factors associated with lower odds of developing antibody responses in KTRs on belatacept are not known. Method(s): We conducted a retrospective multicenter cohort study of all KTRs on belatacept who received three mRNA vaccine doses at our institutions, where all KTRs on belatacept had anti-SARS-CoV-2 receptor-binding domain (RBD) antibodies measured by the Roche Elecsys immunoassay. The primary outcome was development of anti-RBD antibodies after the third vaccination. Result(s): 58 KTRs on belatacept were included. Median age was 62 and 69% were female. 78% were on prednisone, 60% on mycophenolate, 11% on mTOR inhibitors and 9% on azathioprine. After the third vaccine, 32/58 KTRs (55%) developed anti-RBD antibodies (Fig. 1A) with a median level of 3.3U/mL (Fig. 1B). Using univariate logistic regression, we found that age>=60, eGFR<45ml/min/1.73m2, prednisone use, and no prior SARS-CoV-2 infection were associated with significantly lower odds of developing anti-RBD responses after vaccination (Fig. 1C). These associations remained significant in the adjusted multivariable model (Fig. 1D). We also evaluated correlation between anti-RBD antibody levels and the number of days between vaccination and the most recent belatacept infusion for each vaccination but did not find an association between the two (Fig. 1E-G). Conclusion(s): Prednisone use, age>=60, eGFR<45ml/min/1.73m2, and no history of SARS-CoV-2 infection are associated with lower odds of anti-RBD antibody responses after vaccination in KTRs on belatacept.
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Introduction &Objective: Patients with long term ureteric stents for urinary diversion need regular changes, done at intervals appropriate for their condition, type of stent and adjusted to stent encrustation risks. This is usually done under General Anaesthesia in the operating room. We present our series of patients on ureteric stents with change of stents done under local anaesthesia in the endoscopy suite as an outpatient day procedure. Method(s): Since July 2021, we started a stent change service for our patients on long term ureteric stents done solely by Urologists in the outpatient day procedure setting under Local anaesthesia. This is done in the outpatient endoscopy suite away from the operating theatre, with flexible cystoscopy aided by fluoroscopy. We review our series of ureteric stent changes including indications and technical success rate of stent change. Result(s): 56 patients underwent stent change under local anaesthetic from 7th July 2021 to 16th Feb 2022, with mean age of 75 years old (range 55 to 97). 24(42%) were male and 32(57%) female. 9 patients had bilateral stents changed (16%), with the rest unilateral. Etiology wise, 34 (61%) had strictures, 13 (23%) had stones, and 9 (16%) had extraluminal compression. Mean duration from the last stent change was 4.6 months (SD = 1.38) based on clinical condition and stent type. 54 (96%) of patients had successful stent changes. The two patients with unsuccessful stent changes had failed retrograde wire access, one with tight extraluminal compression and the other with severe stent encrustation. Advantages of the new service for the patients include avoiding risks of sedation or general anaesthesia, and procedure performed as day surgery with decreased duration of hospital stay, particularly in this time of COVID-19 pandemic. From a resource point of view, this has freed up operating theatre space and anaesthetist manpower to focus on Urological procedures needing general anaesthesia, decreasing waiting time for higher acuity cases. Conclusion(s): Moving flexible cystoscopy guided ureteric stent change from major operation theatre under general anaesthesia to an ambulatory endoscopy center setting under local anaesthesia is a feasible and safe option for patients with long-term ureteric stents. It avoids risk of general anaesthesia, is potentially cost saving and conserves hospital resources.