ABSTRACT
The variants of coronavirus both delta and omicron are much more contagious and affecting greater percentage of human population. In this research, an attempt is made to predict classification of clinical emergency treatment of corona variant infected patients using their recorded cough sound file. Cough audio signal features such as zero crossing and mel-frequency cepstral coefficients (MFCC), chromo gram (chroma_stft), spectral centroid, spectral roll off, spectral-bandwidth are to be extracted and stored along with patient ID, date, and timings. Digital signal processing of recorded cough audio file obtained needs to be cleaned and pre-processed and normalized to get a training dataset in order to build intelligent ML model using multiclass classifier SVM for predicting the class labels with maximum accuracy. The model proposed in this research paper helps to systematically plan and handle emergency treatment of the patients by classifying their severity based on the cough audio signal using SVM. The built model predicts and classifies the emergency treatment level as low, medium, and high with 96% accuracy. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
ABSTRACT
Introduction: Treatment adherence is crucial for the success of Growth Hormone (GH) therapy. Non-adherence rates have varied over a wide range from 5% to 80% in the literature. Several factors may have an impact on treatment adherence. Besides, with the COVID-19 pandemic that affected the whole world, there were problems with the hospital admission and routine controls of the patients who used GH treatment. Objective(s): The survey's primary objective is to investigate adherence to treatment in patients with GH. The survey will also investigate potential problems in GH treatment during the pandemic. Material(s) and Method(s): The survey was sent to pediatric endocrinologists. Patient data, diagnosis, history of pituitary surgery, current GH doses, duration of GH therapy, who administers the therapy (mother and father, patient), duration of missed doses, reasons for missed doses as well as problems associated with GH therapy, and missed dose data in the recent year (after the onset of the pandemic) and causes were asked. The treatment adherence category was determined based on missed dose rates over the past month (0 to 5%, full adherence;5.1 to 10% moderate adherence;>10% non-adherence). Result(s): 427 cases from thirteen centers were evaluated. The median age of diagnosis of the cases (56.2% male) was 8.5 (0.13-16) years. GH treatment indications were isolated GH deficiency (61.4%), multiple pituitary hormone deficiency (14%), Turner syndrome (7.5%), idiopathic GH deficiency (7.5%), and SGA (2.8%), and other (6.8%). GH therapy was administered by 70% parents and 30% patients. Mean daily dose was 32.3 mcg/kg, the annual growth rate was 7.52+/-2.7 cm. GH adherence rate was good (70.3%), moderate (14.7%), and poor (15%), respectively. The reasons for non-adherence were mainly due to forgetting, being tired, inability to access medication, and pen problems. It was noteworthy that the COVID-19 pandemic had a negative effect on adherence in 22%. The problem with an appointment, taking the medication, and anxiety about going to the hospital were the main reasons. There was no difference between genders in the adherence rate. Non-adherence to GH treatment decreased statistically when the patient administered the treatment, increased age, the duration of the treatment, and COVID-19 pandemia. A non-statistical decrease was found in the annual growth rate as the skip rate increased. Conclusion(s): During the COVID-19 pandemic, poor adherence was found to be 15%, and the duration of hormone use and advanced age are important factors. The pandemic period negatively affected compliance.
ABSTRACT
Background. Severe COVID-19 infection is characterized by a dysregulated hyperinflammatory state that contributes to morbidity and mortality. Immunomodulatory therapy has been shown to improve outcomes. We investigated if the TNF-alpha inhibitor, infliximab (IFX), provides additional benefit over standard of care. Methods. We conducted a double-blind, randomized, placebo-controlled trial of IFX (single infusion of 5 mg/kg) compared to standard of care (including remdesivir and dexamethasone) in patients hospitalized with COVID-19 pneumonia. The primary outcome was time to recovery by day 29. Key secondary endpoints included 14-day clinical status and 28-day mortality. Results. A total of 1033 patients received study agent (517 assigned to IFX, 516 to common placebo), constituting the analyzed modified intention-to-treat cohort. Mean age 54.8 years, 60.3% were male, 48.6% Hispanic/Latino and 14% Black. Randomization was balanced for severity of illness and comorbidities. Participants randomized to IFX did not show a statistically significant difference in the primary endpoint with a recovery rate ratio of 1.13 (95% CI 0.99-1.27, p=0.0631) compared to placebo. The median (IQR) time to recovery was 8 days (7, 9) for IFX and 9 days (8, 10) for placebo. Patients assigned to IFX were more likely to have an improved clinical status at day 14 (OR 1.32;95% CI 1.05, 1.66). The 28-day mortality was 10.1% in the IFX arm and 14.5% in the placebo (OR 0.59 (95% CI 0.39, 0.90)), with a 40.7% lower odds of dying in patients receiving IFX. The improvement in mortality was demonstrated in patients requiring low- or high-flow O2 at baseline but not in those requiring mechanical ventilation or ECMO. Subgroup analysis identified the strongest effect in those with baseline CRP >75mg/ml. There was no imbalances in serious adverse events. Secondary infections were similar between groups (IFX 18.0%, placebo 16.5%). Conclusion. Although single-dose IV IFX did not demonstrate statistically significant improvement in time to recovery, it was associated with improvement in clinical status at day 14 and showed a substantial reduction in 28 day mortality compared to standard of care.
ABSTRACT
Background. Clostridioides difficile infection (CDI) is the leading cause of nosocomial diarrhea and a costly burden on the healthcare system. The COVID-19 pandemic brought enhanced infection control measures that could hypothetically decrease CDI transmission. Nonetheless, diarrhea secondary to COVID-19 and increased usage of broad-spectrum antibiotics could potentially increase testing for or frequency of CDI. We aimed to assess variations in CDI testing and frequency during the first surge of the COVID-19 pandemic in a tertiary community medical center in the Southern United States. Methods. Records from adult patients were retrospectively reviewed at Princeton Baptist Medical Center, Birmingham, AL. Three groups spanning equal time periods were created based on the CDC COVID-19 rate curves for Alabama: PPG (pre-pandemic, 03/01/2020 to 05/31/2020), PG (pandemic, 06/01/2020 to 08/ 31/2020), and SCG (seasonal control, 06/01/2019 to 08/31/2019). We included patients >= 18 years old and excluded readmissions and follow-up visits. We determined the frequency, testing rates, and positivity rates for CDI in each group to assess their differences. Also, we measured the rate of coinfection between C. difficile and SARS-CoV-2. CDI cases were defined as positive toxin enzyme-linked immunosorbent assay (EIA) and glutamate dehydrogenase (GDH), or positivity of either in addition to positive nucleic acid amplification test (NAAT). Differences in frequencies and rates across groups were compared with Fisher exact test. Results. Overall, 7,252 hospitalized patients and 29,671 outpatients were included (Figure 1). No outpatient CDI cases were detected. Outpatient testing rates were: PPG 3 (0.05%), PG 4 (0.05%), and SCG 9 (0.06%). Among inpatients, 3,912 (53.9%) were female with a mean +/- SD age of 61.2 +/- 17.5 years. Overall, CDI frequency, testing rates, and positivity rates did not vary significantly among all groups (Table 1). Among those tested, the only case of C.difficile/SARS-CoV-2 coinfection corresponded to PPG. Conclusion. There were no statistically significant differences in CDI frequency, or positivity rate between the pre-pandemic, pandemic, and seasonal control groups for inpatients. No CDI cases were detected in outpatients. This is likely due to a low testing rate in our population.
ABSTRACT
Purpose: Due to social isolation required during the COVID-19 pandemic, many practices made a sudden transition to telehealth with minimal preparation or telehealth training. Telehealth has been extensively studied in the adult population and shown to improve patient satisfaction in multiple settings with satisfactory clinical outcomes. However, the use of telehealth has been rarely studied in the adolescent and young adult population, where providers face unique challenges regarding consent and confidentiality. The Society of Adolescent Health and Medicine considers the confidential interview an essential component of health care for adolescents as it is consistent with their development of maturity and autonomy. Without it, some adolescents will forgo care leading to poor health outcomes. Though the field of Adolescent Medicine recognizes the importance of speaking with patients alone, it is difficult to establish confidentiality when conferencing with a patient over a telephone or video call. The purpose of this study is to compare patient satisfaction and visit confidentiality between telehealth and in person visits in adolescents and young adults. Methods: Patients were recruited from a subspecialty adolescent medicine clinic associated with a large children’s hospital, as well as from a system of free reproductive and primary care clinics with both school based and community sites. Data was gathered via anonymous survey, with questions modeled from the Child and Adolescent Health Measurement Initiative Young Adult Health Care Survey and the University of Rochester Telemedicine and Non-Telemedicine Visit Experience Interview. Online surveys were sent via email to patients seen both in person and via telehealth at all sites. Results: Survey results were obtained from both the telehealth (n=46, 28% of respondents) and in person (n=116, 71.6% of respondents) populations. Age of respondents varied between age 13-25. Respondents were majority female (95% telehealth vs 93% in person). 91.5% of telehealth respondents reported previous experience with teleconferencing technology for school or work compared to 83.5% of in person respondents. Of telehealth responses, 70.2% participated in a video visit, while 29.8% participated in a visit via telephone. 97.8% of telehealth respondents reported that they were able to meet with their provider one on one, compared to 97.4% of in person visits (p>0.05). When asked to rank their provider on a scale of 10, ratings were not significantly different, with a higher proportion of telehealth respondents ranking their provider as a 9 or 10 out of 10. 83% telehealth respondents agreed or strongly agreed that they would recommend telemedicine to a friend, and 100% of these respondents agreed or strongly agreed that it was easy to communicate with their provider during their visit. Conclusions: Adolescent and young adult patients perceive that confidentiality in telehealth visits is not significantly inferior to that of in-office visits and they generally have a positive evaluation of their telehealth experience. Future work should be done to evaluate best practices for how confidentiality is established and maintained in telehealth visits and to evaluate parental perception of telehealth visits in those adolescent patients who are under age 18. Sources of Support: None.