Graded Challenges to Penicillin in Icu Patients

Introduction: There is emerging data for safety and efficacy of graded challenges to penicillin (GCP), without penicillin skin testing, in patients with low risk reaction histories. We describe outcomes of GCP in ICU patients. Method(s): From 8/2021 to 6/2022, allergy/immunology physicians completed e-consults for ICU patients with a penicillin allergy label. Low risk history was defined as unknown reaction or a history of a cutaneous-only reaction >5 years ago and was verified by chart review or patient/family contact. GCP consisted of a 2-3 step challenge to amoxicillin or ampicillin. Patient demographics, GCP results, pre/post GCP antibiotics regimens, and a 2-4 week follow up were collected. Result(s): There were 40 ICU patients with low-risk reaction histories. Historical reactions included: rash (17, 43%), hives (10, 25%), angioedema (5, 13%), and unknown (8, 20%). The median age was 63.5 years (interquartile range: 58.8- 72.3). Patient characteristics included: 24/40 patients (60%) intubated, 12/40 (30%) receiving steroids, 10/40 (25%) COVID-19+, 8/40 (20%) receiving vasopressors, 7/40 (18%) on antihistamines, and 1/40 (3%) on ECMO. A total of 32/40 (80%) patients underwent GCP. There was a negative GCP in 31/32 (97%) patients;one patient developed self-limited abdominal pain. Twelve of 32 (38%) patients transitioned to penicillins: from cephalosporins (10/12), vancomycin (3/12), metronidazole (1/12), meropenem (1/12), macrolide (1/12). There were 15/40 (37.5%) deaths at 2-4 weeks follow up. Conclusion(s): : GCP was safe and efficacious in critically ill ICU patients with low risk reaction histories. Given the high ICU mortality, patients should be carefully identified for GCP. Copyright © 2022

Application of Three-Dimensional Printers for Production of Personal Orbital Implants during Pandemics

Objective: The production of personalized prosthesis depends on human resources and involves a manufacturing process in which patients are involved individually in. As the world is experiencing the COVID-19 pandemic, less contact with the manufacturer is needed to stay safe. 3D printed prosthesis has reduced the need for human resource in the process, while allowing the patient to be completely removed from the design and manufacturing process. In this study an approach in which the patient is kept out of the manufacturing process was investigated. Material(s) and Method(s): The prosthesis model was created by using the image data obtained from the medical imaging devices. The outer part of the prosthesis was shaped with a developed image sampling system. The model was produced using three-dimensional printer. A cytotoxic analysis of the raw material used in the manufacturing process was performed. Result(s): The total production cost of the orbital implants was approximately about 8$. The cytotoxic analysis showed that layered manufacturing strategies could be used to develop implants and prostheses applicable to patients. Conclusion(s): COVID-19 underlined the importance of social distancing which is hard to apply during manufacturing of an eye prosthesis. The manual method results in an eye prosthesis which suits well after numerous trials. On the contrary, Digital Imaging and Communications in Medicine (DICOM) based eye prosthesis designation and manufacturing is not only rapid but also flawlessly fitting due to precise measurement during the manufacturing. Copyright © 2022, Nobelmedicus. All rights reserved.

Outcome Comparison Between Tocilizumab and Pulse Solumedrol in Severe Covid Disease Among Resource Depleted Areas

Introduction: Pandemic coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 coronavirus has recently emerged. Objective(s): The main objective of the study is to find the outcome comparison between tocilizumab and pulse solumedrol in severe COVID disease among resource depleted areas. Material(s) and Method(s): This cross sectional study was conducted in Central Park Medical College and Teaching Hospital, Lahore and the duration of this study was from August 2021 to March 2022. The data was collected through non-probability consecutive sampling technique. The data was collected into two groups. Men and non-pregnant women over 18 years old COVID diagnosis confirmed by real time polymerase chain reaction (RT-PCR) Pao2 / FIO2 <200 Laboratory: high sensitivity C reactive protein> 5 mg / L;lactic dehydrogenase (LDH) > 245 U / l;Ferritin> 300;D-dimer> 1500;Interleukin-6> 7.0 pg / ml were included. Result(s): The data was collected from 300 patients, 150 in each group. There were 72.9% male aged 41-60 years 45.8% were female with a mean age of 55.4 +/- 10.6 years. Diabetes and hypertension was the most common comorbidity in selected patients. Tocilizumab group had more number of males (P = 0.017), with higher incidence of coronary artery disease (CAD, P = 0.008). Conclusion(s): It is concluded that Tocilizumab decreased the propensity of severe COVID-19 patients to require invasive mechanical ventilation when compared to high-dose solumedrol pulse, especially in those with severe ARDS, but this did not translate to improved 30-day survival in them. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

Comparison of prevalence, clinical evolution and vaccination rate against COVID 19 in a population of patients diagnosed with Dual Bipolar disorder and Non-dual bipolar disorder

Introduction: Since the beginning of the pandemic, 4,745,519 cases, 396,878 hospitalizations and 82,884 deaths with COVID-19 have been reported in Spain. As of August 24, 2021, 76.4% of And alusians over 12 years of age have the complete vaccination regimen. Objective(s): Main: to calculate the prevalence of COVID 19 infection, clinical evolution, and vaccination rate in a population of patients diagnosed with dual bipolar disorder. Secondary: compare these data with those obtained inpatients diagnosed with non-dual bipolar disorder. Method(s): Retrospective descriptive study. The study population is made up of patients diagnosed with dual bipolar disorder and nondual bipolar disorder (according to DSM 5 criteria). Infection, admission, death, and vaccination data were obtained from the patient's medical history. Result(s): Of the 7 patients diagnosed with dual bipolar disorder, the prevalence of COVID 19 infection, since the beginning of the pandemic is 0% and of the 21 patients diagnosed with non-dual bipolar disorder the prevalence is 9.51% (2/21). Of the patients with COVID 19 infection, none required hospital admission and no deaths occurred. The vaccination rate in the group of patients with dual bipolar disorder is 85,71% (6/7) and in the group of non-dual bipolar disorder is 61.91% (13/21), no finding statistically significant differences between both groups. Conclusion(s): In our study the prevalence of COVID 19 infection inpatients diagnosed with dual bipolar disorder is 0% and the vaccination rate is 85.71%. While in patients with non-dual bipolar disorder the prevalence is 9.51%, there were no admissions, no deaths and the vaccination rate is 61.91%.

The Association of Sars CoV-2 Cycle threshold (CT VALUE) with Severity and Outcomes in SARS CoV-2

Background & Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19 is a novel betacoronavirus that first appeared in Wuhan, Hubei Province, China in late December 2019. Real-time reverse-transcription polymerase chain reaction (RT-PCR) test has been routinely used as the diagnostic test to detect SARS-CoV-2 nucleic acids in respiratory specimen swabs from throat, nasopharynx, and nose of individuals suspected of COVID-19 during the acute phase of infection. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cycle threshold (Ct) has been suggested as an approximate measure of initial viral burden. So this study was undertaken retrospectively to evaluate association of CT values of patients tested positive for SARS CoV 2 by RT-PCR with clinical features and the outcomes of patients. Material(s) and Method(s): A retrospective study was performed among patients tested positive for SARS CoV 2 by RT-PCR & admitted in at Dr.Chandramma Dayananda Sagar institute of Medical education and research, Harohalli, Ramanagara. during the period of 08 months from January 2021 to August 2021. The details of the patients on duration of hospital stay, age, presence of comorbidities, intubation, mortality were recorded. The obtained CT values were classified into 3 Groups: Group 1 > 30.0, Group 2-25.0-29.9, Group 3 < 25. The data was analysed using descriptive statistics. Result(s): The study comprised of 668 (men 451,women 217) patients tested positive for SARS CoV 2 by RT-PCR. The mean age in men was 51 years and women was 38 years. 209 patients of Group 3, (31.2%) patients were significantly higher age, co-morbidities like Hypertension, Diabetes mellitus and obstructive lung disease, more than 418 patients of Group 2 (62.5%) and 41 patients of Group 1 (6.13%) patients. Duration of hospital stay was 14 days in Group 3 compared to Group 2 and Group 1 patients. Noninvasive ventilation (12.8%), Invasive ventilation (11.4%) and mortality (11.6%) is more in Group 3 compared to Group 2 and Group 1 patients. Conclusion(s): This study provide evidence that Low CT values suggestive of greater SARS CoV 2 viral load are associated with the severity of illness and duration of hospitalization. CT values may allow for early risk stratification in patients with SARS CoV 2. Copyright © 2022 Ubiquity Press. All rights reserved.

Providing Post Emergency Care (ProPEr Care) Virtually

Study Objectives: Providing access to primary care after an emergency department (ED) visit can reduce hospital admissions, improve chronic disease management and reduce repeat (ED) visits. A significant number of patients presenting to our institution either do not have a Primary Care Provider (PCP) or are unable to obtain a timely follow-up with their PCP after ED discharge. The COVID pandemic provided an opportunity to fill this gap by integrating tele-health. We implemented a pilot program called ProPEr Care to provide rapid ED based follow-up in a virtual clinic. This clinic was staffed by either emergency medicine (EM) or dual trained emergency medicine (EM) and internal medicine (IM) physicians with the goal of improving patient outcomes. In addition to addressing medical needs, the clinic physician utilized existing hospital resources such as care coordination and outreach workers to help patients obtain medical insurance and establish long-term primary care. To our knowledge, this program is novel in emergency medicine. Methods: At the time of discharge, the ED physician, at their discretion, can schedule a patient for a ProPEr care clinic visit within the next 7-14 days. An EM or EM-IM trained physician provides the virtual follow-up visit using the Doximity™ platform with video or phone call only options. The goal is to provide a bridge while the patient is in the process of establishing a PCP. We contacted patients via a phone call at least 30 days after their ProPEr care clinic visit and asked a series of 10 follow-up questions. Survey questions were developed based on similar studies from other medical specialties. Data was collected and stored in Microsoft Excel™. Basic demographic data was reported from Tableau™, and survey results were calculated in Microsoft Excel™. Results: The majority of our patients felt they were seen quickly (88%) and that the virtual visit was more convenient than a traditional in-person visit (94%). 72% felt that ProPEr care prevented them from coming back to the ED for the same reason. The ProPEr care clinic was able to arrange referrals for all the patients who needed specialty care (100%) and provided electronic prescriptions for all of the patients who needed refills for their long-term medications (100%). Conclusion: A post ED discharge virtual clinic visit provided by an EM or dual trained EM-IM physicians ensures rapid follow-up care, facilitates specialty referrals and potentially reduces return ED visits. It can also help establish long-term primary care. Future studies should evaluate the cost and benefits of a ProPEr care clinic and its impact on hospital readmissions, and health system utilization. [Formula presented]

Prevention of Covid-19 affected patient using multi robot cooperation and Q-learning approach: a solution.

Combat with the novel corona virus (COVID-19) has become challenging for all the frontline warriors like, medic people, police and other service provider. Many technology and intelligent algorithms have been developed to set the boundary in its incremental growth. This paper proposed a concept to set the boundary on spreading of this disease among the medic people, who are directly exposed to the COVID-19 patient. To reduce their risk to be infected, we have designed the theoretical model of the medic robot to provide medical services to the confirmed case patient. This paper explains the deployment and execution of assigned work of medic robot for patient carrying, delivering food, medications and handling the emergency health services. The medic robots are divided into various group based on their works. The COVID-19 area is considered as a multi-robot environment, where multiple medic robots will work simultaneously. To achieve the multi-robot cooperation and collision avoidance we have implemented the simplest reinforcement learning approach i.e. the Q-learning approach. We have compared the result with respect to the improved-Q-learning approach. A comparative analysis based on parameters like simplicity, objective, deployed robot category and cooperation has been done with some other approaches mentioned in the literature. For simplicity as well as the time and space complexity purpose the results reveal that Q-learning approach is a better consideration. The proposed approach reduces the mortality rate by 2%.