Establishment of medical service protocols in large public hospitals for the prevention and control of coronavirus disease 2019.

Coronavirus disease 2019(COVID-19) poses a challenge to hospitals for the prevention and control of public health emergencies. As the main battlefield of preventing and controlling COVID-19, large public hospitals should develop service protocols of diagnosis and treatment for outpatient, emergency, hospitalization, surgery, and discharge. The construction of medical protocols should be based on the risk factors of key points and focused on pre-inspection triage and screening, to establish a rapid response mechanism to deal with exogenous and endogenous risk factors. Implementation of all-staff training and assessment, strengthening the information system, and use of medical internet service are important. This study explores the construction of medical protocols in large public hospitals during the pandemic, and provides a reference for the orderly diagnosis and treatment in hospitals during the pandemic.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.

Trauma-focused therapy in early intervention for psychosis settings: Results of a feasibility RCT of 'EMDR for psychosis'

Aims: Trauma is particularly prevalent amongst Early Intervention (EI) patients and is associated with adverse clinical and prognostic outcomes. To determine the feasibility of a large-scale randomized controlled trial (RCT) of an 'EMDR for psychosis' intervention for trauma survivors with active psychotic symptoms supported by EI services, we conducted a single-blind RCT comparing 16 sessions of EMDRp + TAU versus TAU only. Method(s): EMDRp therapy and trial assessments were completed both in-person and remotely during the COVID-19 pandemic, and key feasibility outcomes (recruitment & retention, therapy attendance/ engagement, adherence to EMPRp treatment protocol, and the 'promise of efficacy' of EMDRp on relevant clinical outcomes) were examined at 6- and 12-month post-randomization assessments. Results and Conclusion(s): 60 participants (100% of the recruitment target) received TAU or EMDR + TAU. The feasibility criteria examined in this trial were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable post-treatment outcomes, including improved psychotic symptoms (PANSS), subjective recovery (QPR), post-traumatic symptoms (PCL-5;ITQ), depression (PHQ-9), anxiety (GAD-7) and general health status (EQ-5D-VAS) at the 6-month assessment. Signals of efficacy at 12-month were less pronounced, but remained robust for trauma symptoms and general health status. The findings will be discussed with relevance to future clinical trials of trauma-focused therapy in clients with early psychosis, and the provision of more tailored trauma therapies for EI service users.

Factors Influencing Work Satisfaction and Compliance of Using Ppe among Shop Assistants during Covid-19

Objectives: The objectives of the study was to assess the level of work satisfaction, assess compliance of using PPE among shop assistants during COVID-19 and to find the factors influencing work satisfaction. Method(s): A quantitative approach with descriptive design was used for the study. Eighty samples were selected by using convenient sampling technique. The study was conducted in 4 districts of Kerala through online platform as well as through offline mediums. Result(s): From the study, it is evident that majority of the subjects (55%) were satisfied with their work at the time of COVID-19 and more than half (55%) of the samples have enough compliance with the use of PPE and only 7.5% have less compliance with the use of PPE. Demographic variables such age, relationship status, and work experience were found to be statically significant (p<0.05) with work satisfaction, and other variables did not have a significant association. Conclusion(s): This study provides a baseline for assessing the level of work satisfaction and compliance of PPE among shop assistants in selected areas. Periodic reinforcements, proper education, availability and trainings on the use of PPE can reduce the spread of Corona Virus and improve PPE compliance to an extend. Good working environment support from family and good rapport with colleagues can help to improve work satisfaction .Copyright © 2023 The Authors.

Efforts to Optimize Clinical Trial Management by Revising Deviation Reports and Classifying Deviation Cases for Efficient Clinical Trial Quality Improvement at Asahikawa Medical University Hospital.

Face-to-face communication during on-site monitoring is important for clinical trial quality assurance. However, with the coronavirus disease early 2020 pandemic, medical institutions placed restrictions on hospital visits to secure their medical systems. Asahikawa Medical University Hospital similarly established restrictions on outpatient and inpatient visits and legal restrictions on outside vendors. Therefore, the frequency of on-site monitoring of clinical trials conducted at our hospital was reduced. Since there was no sign of convergence at the infection units even after 2 years, we investigated the frequency of on-site monitoring and the frequency of clinical trial deviations in the review of the system. In addition, although a clinical trial deviation report form (previous form)was prepared in the fiscal year 2019, there were many free descriptions, and many deviation reports were difficult to understand. Similarly, there were cases where deviations were not recorded on the deviation report form but only on article records (source documents), such as electronic medical records after consultation with the sponsor, and deviations were not recorded in a uniform format. Thus, the hospital experienced difficulty tabulating and classifying the number of deviation occurrences. Based on this experience, this report describes the progress of revising the clinical trial deviation report, clarifying the items to be included in the report, and establishing a system to clarify the process related to clinical trial deviation occurrences.Copyright: © 2023 the Japanese Society of Clinical Pharmacology and Therapeutics (JSCPT).

Relationship of Vaccination History and Pregnancy Health Protocol Compliance with Positive Antigen Test Result at Community Health Center in Medan, Indonesia

BACKGROUND: A comprehensive screening at delivery revealed that roughly 14% of pregnant women who tested positive for COVID-19 did not exhibit any symptoms. The SARS-CoV-2 antigen swab test is frequently utilized as a diagnostic technique. Inadequate implementation of health protocol compliance can enhance the vulnerability of a community to the COVID-19 virus, according to previous findings. This suggests that these health protocol compliance and the vaccination program are important for preventing and controlling the spread of the virus. AIM: This study aims to determine the relationship of vaccination history and health protocol compliance with positive antigen swab results among pregnant women at the Community Health Center in Medan. METHOD(S): This is a cross-sectional and observational study that was conducted in February 2022 at the Community Health Center in Medan, North Sumatra, Indonesia. Two hundred pregnant women who met the inclusion and exclusion criteria make up the sample population. Antigen sampling for SARS-CoV-2 was performed in the Pramita laboratory. Following the collection and processing of sample and antigen swab data, IBM SPSS version was utilized to conduct statistical analysis. RESULT(S): The result showed that four of the pregnant women were infected with COVID-19, and they accounted for 2% of the sample population. The health protocol carried out by pregnant women was not significantly related to the swab results. Therefore, vaccination history had no significant association with COVID-19 symptoms, but people who received vaccines had more negative swab test results compared to those who did not, where three out of four positive samples were unvaccinated. CONCLUSION(S): Based on the results, only 2% of pregnant women were infected with COVID-19 at the Community Health Centre in Medan, because this study was carried out when COVID-19 cases had decreased. The statistical analysis results showed that the history of vaccination was not significantly related to SARS-CoV-2 antigen swab results. However, there was a clinical tendency that vaccines can reduce the number of positive cases, where three out of four positive samples were not vaccinated.Copyright © 2023 Sarma Nursani Lumbanraja, Reni Hayati, Khairani Sukatendel, Johny Marpaung, Muhammad Rusda, Edy Ardiansyah.

Rapid protocols to support COVID-19 clinical diagnosis based on hematological parameters

Purpose: In December 2019, the Covid-19 pandemic began in the world. To reduce mortality, in addiction to mass vaccination, it is necessary to massify and accelerate clinical diagnosis, as well as creating new ways of monitoring patients that can help in the construction of specific treatments for the disease. Objective: In this work, we propose rapid protocols for clinical diagnosis of COVID-19 through the automatic analysis of hematological parameters using evolutionary computing and machine learning. These hematological parameters are obtained from blood tests common in clinical practice. Method: We investigated the best classifier architectures. Then, we applied the particle swarm optimization algorithm (PSO) to select the most relevant attributes: serum glucose, troponin, partial thromboplastin time, ferritin, D-dimer, lactic dehydrogenase, and indirect bilirubin. Then, we assessed again the best classifier architectures, but now using the reduced set of features. Finally, we used decision trees to build four rapid protocols for Covid-19 clinical diagnosis by assessing the impact of each selected feature. The proposed system was used to support clinical diagnosis and assessment of disease severity in patients admitted to intensive and semi-intensive care units as a case study in the city of Paudalho, Brazil. Results: We developed a web system for Covid-19 diagnosis support. Using a 100-tree random forest, we obtained results for accuracy, sensitivity, and specificity superior to 99%. After feature selection, results were similar. The four empirical clinical protocols returned accuracies, sensitivities and specificities superior to 98%. Conclusion: By using a reduced set of hematological parameters common in clinical practice, it was possible to achieve results of accuracy, sensitivity, and specificity comparable to those obtained with RT-PCR. It was also possible to automatically generate clinical decision protocols, allowing relatively accurate clinical diagnosis even without the aid of the web decision support system. © 2023, The Author(s), under exclusive licence to The Brazilian Society of Biomedical Engineering.

Comparative effectiveness and safety of a pharmacist-managed protocol for the transition from intravenous to subcutaneous insulin

Purpose: To evaluate the effectiveness and safety of a pharmacist-managed protocol for transitioning critically ill patients from intravenous (iv) to subcutaneous insulin compared with a provider-managed process. Method(s): This single-center, retrospective, observational study included patients admitted to the medical or surgical/trauma intensive care unit who received a continuous infusion of iv insulin from January 2019 to April 2021. Patients were excluded if they were less than 18 years of age, pregnant, incarcerated, or received iv insulin for the diagnosis of diabetic ketoacidosis, hyperglycemic hyperosmolar state, calcium channel blocker or beta blocker overdose, or hypertriglyceridemia. The primary outcome was the percentage of blood glucose (BG) concentrations within the target range of 70-150 mg/dL from 0 to 48 h following transition to subcutaneous insulin. Secondary outcomes included percentage of BG concentrations within goal range following transition at 0-12 h and 12-24 h, incidence of hypo- and hyperglycemia, and percentage of patients requiring dose adjustments after initial transition. Result(s): A total of 110 unique patients were included with 70 patients in the provider-managed group and 40 patients in the pharmacist-managed group. On average, pharmacists transitioned patients to 63% basal insulin based on their 24-h total day dose of insulin. The pharmacist-managed group achieved glycemic control in 53% of transitions at 12 h, 40% at 24 h, and 47% from 0 to 48 h, while the provider group achieved glycemic control in 25% of transitions at 12 h, 12% at 24 h, and 18% from 0 to 48 h (p < 0.001 for all time points). As for safety end points, the pharmacist-managed group demonstrated lower rates of hypoglycemia (p = 0.001), severe hypoglycemia (p = 0.332), hyperglycemia (p < 0.001), and severe hyperglycemia (p < 0.001) compared with the provider-managed group. Conclusion(s): Pharmacists can effectively and safely transition critically ill patients from iv to subcutaneous insulin utilizing a standardized protocol.Copyright © 2023 Pharmacotherapy Publications, Inc.

NR3C1 rs41423247: genetic predictor of complications in pneumonia caused by SARS-CoV-2

Background/Objectives: Runaway inflammation is a key feature of COVID-19. NR3C1 gene encodes for glucocorticoid receptor which plays an important role in inflammation reaction. The variant rs41423247 cause increased glucocorticoid receptors sensitivity. This study aimed to investigate the impact of variants of NR3C1 gene on the course of COVID-19 pneumonia in patients with necessarily artificial lung ventilation. Method(s): The study group included 20 patients (9 women and 11 men) with diagnosis viral COVID-19 pneumonia on artificial lung ventilation at the intensive care unit. All patients underwent daily standard examinations according clinical protocols. Determination of NR3C1 gene variants was carried out by using PCRRFLP. Result(s): There were found the significant negative correlations between NR3C1 gene variants and level of SpO2 (rS = -0.601, p = 0.008), Glasgow Coma Scale score (rS = -0.523, p = 0.026). Also, it was defined a protective effect of genotype CC at risk of development acute respiratory distress syndrome in this patients (chi2 = 4.38, p = 0.037, OR = 0.05 (CI:0.01-0.66)). Conclusion(s): The investigated variant rs41423247 of the NR3C1 gene may be the genetic predictor of complicated course of COVID-19 pneumonia. .

Longitudinal robustness of a thoracic radiographic AI model for COVID-19 severity prediction

The 'ging' of artificial intelligence/machine learning (AI/ML) models after initial development and evaluation is known to frequently occur and can pose substantial problems. When there are changes in population, disease characteristics, imaging equipment, or protocols, model performance may start to deteriorate, and the performance predicted in a research setting may no longer hold after deployment (either in a clinical setting or in further research). This data shift phenomenon is a common problem in AI/ML. We trained and evaluated a previously in-house developed AI/ML model for COVID severity prediction using two COVID-19-positive consecutive adult patient cohorts from a single institution. The first cohort was from the time that the Delta strain was dominant accounting for <95% of cases (June 24-December 11, 2021, 820 patients, 1331 chest radiographs (CXRs)) and the second cohort was from the time that the Omicron variant was dominant (Jan 1-21, 2022, 656 patients, 970 CXRs). Inclusion criteria were COVID-positivity and the availability of CXR imaging exams, in general for patients not admitted to ICU and prior to ICU admission for those patients admitted to ICU as part of their treatment. Exclusion criteria were image acquisition in ICU or the presence of mechanical ventilation. Our image-based AI/ML model was trained to predict, based on each frontal CXR from a COVID-positive patient, whether this patient would be admitted to ICU within a 24, 48, 72, or 96-hour window. The model was evaluated 1) in a cross-sectional test when trained on a subset/tested on an independent subset of the Delta cohort, 2) similarly for the Omicron cohort, and 3) in a longitudinal test when trained on the Delta cohort/tested on the Omicron cohort. Cohorts were similar in ICU admission rate and fraction of portable CXRs, while immunization rate was higher for the Omicron cohort. The model did not demonstrate signs of aging with performances in the longitudinal test being very similar to those within the Delta cohort, e.g., an area under the ROC curve in the task of predicting ICU admission within 24 hours of 0.76 [0.68;0.84] when trained/tested within the Delta cohort and 0.77 [0.73;0.80] for the longitudinal test (p>0.05). The performance within the Omicron cohort was similar as well, at 0.76 [0.66;0.84]. Our AI/ML model for COVID-severity prediction did not demonstrate signs of aging in a longitudinal test when trained on the Delta cohort and applied as-is to the Omicron cohort. © COPYRIGHT SPIE. Downloading of the is permitted for personal use only.

Assessment of COVID-19 Control and Prevention Measures in Student Dormitories at Mazandaran University of Medical Sciences, 2021.

Background and purpose: Adherence to the principles of personal protection and commitment to health guidelines and principles of prevention perform important roles in controlling COVID-19 in a community. In this re3search we studied necessary measures to prevent COVID-19 in university dormitories at Mazandaran University of Medical Sciences, 2021. Material(s) and Method(s): In this descriptive-analytical study, 114 students in active dormitories during the COVID-19 pandemic participated in an online survey and their views and knowledge about COVID-19 preventive measures in the dormitories were examined. The samples were recruited using census method and data were analyzed in SPSS. Result(s): The results of the Chi-square test showed a significant relationship between adherence to preventive measures and educational level (P=0.015). Following personal hygiene was found to be significantly different according to being a local student, having underlying diseases, and the number of students at rooms (P<0.05). Findings showed that physical distancing and screening had no significant relationship with any of the variables studied (P>0.05). Conclusion(s): The study showed that among the four areas investigated, personal hygiene practices and following the principles of prevention of COVID-19 were in a good condition, while physical distancing and screening were not satisfying. Therefore, university authorities should make serious changes to improve these issues at dormitories.Copyright © 2023, Mazandaran University of Medical Sciences. All rights reserved.

Impact of the COVID-19 pandemic on the treatment of head and neck cancer in Brazil

Introduction: To restrict the spread of COVID-19 infection, billions of people around the world have been quarantined or in social isolation. As a result of these health public measures, only essential services were maintained. Outpatient consultations and non-urgent surgeries were suspended to reduce hospitalizations and the risk of contagion. This context resulted in a delay in the diagnosis of several diseases, including head and neck cancer (HNC). Objective(s): To assess the impact of the COVID-19 pandemic on the treatment of HNC, comparing the number of surgery and radiotherapy, and chemotherapy procedures carried out during the pre-pandemic and pandemic periods in Brazil. Material(s) and Method(s): We compared the mean number of HNC surgeries and the number of radiotherapy and chemotherapy procedures carried out during the pre-pandemic (from March to July 2015-2019) and pandemic period (from March to July 2020) in the five geographic regions of Brazil. Result(s): Between 2015 and 2019, the mean number of surgeries for HNC was 5410. In 2020, during the same period, there were 3522 surgeries, representing a 35% decrease during the pandemic period. The greatest decrease was observed in the Northern region (60.7%). The number of radiotherapy and chemotherapy procedures increased by 50,8% in the pandemic period, with a higher prevalence in the Northeast (75.1%). Conclusion(s): During the peak of the COVID-19 pandemic, the data demonstrate a likely change in the HNC treatment protocol in Brazil.

Artificial Intelligence driven security model for Internet of Medical Things (IoMT)

The Internet of Medical Things (IoMT) has been applied to provide health care facilities for elders and parents. Remote health care is essential for providing scarce resources and facilities to coronavirus patients. Ongoing IoMT communication is susceptible to potential security attacks. In this research, an artificial intelligence-driven security model of the IoMT is also proposed to simulate and analyses the results. Under the proposed plan, only authorized users will be able to access private and sensitive patient information, and unauthorized users will be unable to access a secure healthcare network. The various phases for implementing artificial intelligence (AI) techniques in the IoMT system have been discussed. AI-driven IoMT is implemented using decision trees, logistic regression, support vector machines (SVM), and k-nearest neighbours (KNN) techniques. The KNN learning models are recommended for IoMT applications due to their low consumption time with high accuracy and effective prediction. © 2023 IEEE.

Enhanced BB84 quantum cryptography protocol for secure communication in wireless body sensor networks for medical applications.

Wireless body sensor network (WBSN) is an interdisciplinary field that could permit continuous health monitoring with constant clinical records updates through the Internet. WBAN is a special category of wireless networks. Coronavirus disease 2019 (COVID-19) pandemic creates the situation to monitor the patient remotely following the social distance. WBSN provides the way to effectively monitor the patient remotely with social distance. The data transmitted in WBSN are vulnerable to attacks and this is necessary to take security procedure like cryptographic protocol to protect the user data from attackers. Several physiological sensors are implanted in the human body that will collect various physiological updates to monitor the patient's healthcare data remotely. The sensed information will be transmitted wirelessly to doctors all over the world. But it has too many security threats like data loss, masquerade attacks, secret key distribution problems, unauthorized access, and data confidentiality loss. When any attackers are attacking the physiological sensor data, there is a possibility of losing the patient's information. The creation, cancellation, and clinical data adjustment will produce a mass effect on the healthcare monitoring system. Present-day cryptographic calculations are highly resistant to attacks, but the only weak point is the insecure movement of keys. In this paper, we look into critical security threats: secure key distribution. While sharing the secret key between communicating parties in the wireless body sensor networks in the conventional method like via phone or email, the attackers will catch the private key. They can decrypt and modify more sensitive medical data. It can cause a significant effect like death also. So need an effective, secure key distribution scheme for transmission of human body health related data to medical professional through wireless links. Moreover, a new enhanced BB84 Quantum cryptography protocol is proposed in this paper for sharing the secret key among communicating parties in a secure manner using quantum theory. Besides, a bitwise operator is combined with quantum concepts to secure the patient's sensed information in the wireless environment. Instead of mail and phone via sharing secret key, quantum theory with the bitwise operator is used here. Therefore, it is not possible to hack the secret key of communication. The body sensor's constrained assets as far as battery life, memory, and computational limit are considered for showing the efficiency of the proposed security framework. Based on experimental results, it is proven that the proposed algorithm EBB84QCP provides high secure key distribution method without direct sharing the secret key and it used the quantum mechanism and bitwise operator for generating and distributing secret key value to communicating parties for sensitive information sharing in the wireless body sensor networks.

Infection Control among Healthcare Workers and Management of a Scabies Outbreak in a Large Italian University Hospital.

This retrospective observational study describes the results of an ad-hoc designated prevention protocol aimed at containing the spread of the scabies infestation among healthcare workers (HCWs) of a large University Hospital in Italy. The outbreak started on October 2022 and a preventive protocol was set up thanks to a multidisciplinary approach. HCWs at high scabies risk were defined as subjects working in Operative Units with a scabies prevalence higher than 2%, close contacts of a confirmed case of scabies, or HCWs with signs and symptoms of the disease. All cases at high scabies risk underwent a dermatological examination, and the infested HCWs were suspended from work until definitive healing. Mass drug administration was established for all HCWs working in Operative Units with a scabies prevalence higher than 2%. Until March 2023, out of 183 screening dermatological examinations, 21 (11.5%) were diagnostic for scabies. Between 11 October 2022 (date of the first diagnosed scabies case) and 6 March 2023 (the end of incubation period related to the last case detected), the frequency of scabies was 0.35% (21 scabies cases/6000 HCWs). The duration of the outbreak in our hospital was 14.7 weeks. Statistical analysis shows a significant association between scabies and being a nurse and having an allergy to dust mites. We obtained a low frequency of scabies infection, limiting the duration of the outbreak and the related economic burden.

When Characteristics of Clinical Trials Require Per-Protocol as Well as Intention-to-Treat Outcomes to Draw Reliable Conclusions: Three Examples.

Under exceptional circumstances, including high rates of protocol non-compliance, per-protocol (PP) analysis can better indicate the real-world benefits of a medical intervention than intention-to-treat (ITT) analysis. Exemplifying this, the first randomized clinical trial (RCT) considered found that colonoscopy screenings were marginally beneficial, based upon ITT analysis, with only 42% of the intervention group actually undergoing the procedure. However, the study authors themselves concluded that the medical efficacy of that screening was a 50% reduction in colorectal cancer deaths among that 42% PP group. The second RCT found a ten-fold reduction in mortality for a COVID-19 treatment drug vs. placebo by PP analysis, but only a minor benefit by ITT analysis. The third RCT, conducted as an arm of the same platform trial as the second RCT, tested another COVID-19 treatment drug and reported no significant benefit by ITT analysis. Inconsistencies and irregularities in the reporting of protocol compliance for this study required consideration of PP outcomes for deaths and hospitalizations, yet the study coauthors refused to disclose them, instead directing inquiring scientists to a data repository which never held the study's data. These three RCTs illustrate conditions under which PP outcomes may differ significantly from ITT outcomes and the need for data transparency when these reported or indicated discrepancies arise.

A randomised controlled trial to improve the resilience of oesophageal cancer survivors in rural China: A study protocol.

AIM: To design a protocol based on the experiences of long-term survivors to facilitate resilience for oesophageal cancer patients in rural China. BACKGROUND: According to the latest Global Cancer Statistics Report, 604,000 new cases of oesophageal cancer were reported, of which over 60% of the disease burden is distributed in China. The incidence of oesophageal cancer in rural China (15.95/100,000) is twice as high as those in urban areas (7.59/100,000). To be sure, resilience can help patients better adapt to post-cancer life. But universal interventions involving improving the resilience of oesophageal cancer patients have much less been explored, especially for rural patients. METHODS: The two-arm, parallel design, non-blinded, randomised controlled trial will be implemented in 86 adults diagnosed with oesophageal cancer and will be randomly assigned to the control group or the intervention group via the blocked randomisation. The intervention group will undergo an intervention with one-on-one guidance from a nurse while viewing a CD of the experiences of long-term survivors with oesophageal cancer in rural areas. Every 2 weeks, a theme session will be introduced, and the entire intervention will continue for 12 weeks. Psychosocial variables (resilience, self-efficacy, coping mode and family support) will be surveyed at baseline, post-intervention and 3 months after the intervention. The paper complies with the Standard Protocol Items: Recommendations for Intervention Trials 2013 and Consolidated Standards of Reporting Trials guidelines for study protocols adapted for designing and reporting parallel group randomised trials. CONCLUSION: The intervention programme transitions from hospitalisation to discharge, which includes one-on-one interventions by medical personnel and a portable CD describing the experiences of long-term survivors with rural oesophageal cancer. Once the intervention's effectiveness is proven, this protocol will provide psychological support for massive oesophageal cancer patients. RELEVANCE TO CLINICAL PRACTICE: The intervention programme may be used as an auxiliary therapy to promote patients' postoperative psychological rehabilitation. This programme has the advantages of being cost-effective, flexible, accessible, and convenient and can be implemented without the limitation of time, place and clinical medical staff. TRIAL REGISTRATION: The Chinese Clinical Trial Registration number is ChiCTR2100050047. Registered on 16 August 2021.

[Determining factors of survival in patients with severe coronavirus infection admitted to intensive care unit in the third and fourth waves of COVID-19 pandemic]. / A kórházi túlélést meghatározó tényezok a COVID­19-járvány 3. és 4. hulláma idején súlyos koronavírus-fertozéssel intenzív osztályra felvett betegekben.

INTRODUCTION: During COVID-19 pandemic, a high mortality rate (20-60%) of patients admitted to intensive care unit has been observed. Identification of risk factors can support the understanding of disease pathophysiology and the recognition of vulnerable patients, prognostication and selection of appropriate treatment. OBJECTIVE: Beyond characterisation of a local, critically ill COVID-19 population, analysis of the associations between demographic/clinical data and patient survival were investigated. METHOD: Retrospective, observational study has been performed by recording demographic, clinical data and outcome parameters on patients with severe respiratory insufficiency caused by COVID-19. RESULTS: 88 patients were enrolled. Median age was 65 years and 53% of patients were male, median BMI was 29 kg/m2. Noninvasive ventilation was used in 81%, endotracheal intubation in 45%, prone positioning in 59% of all cases. Vasopressor treatment was introduced in 44%, secondary bacterial infection was detected in 36% of all cases. Hospital survival rate was 41%. Risk factors for survival and the effect of evolving treatment protocols were analyzed with multivariable regression model. A better survival chance was associated to younger age, lower APACE II score and non-diabetic status. Effect of the treatment protocol was found to be significant (OR = 0.18 [95% CI: 0.04-0.76], p = 0.01976) after controlling for APACHE II, BMI, sex, two comorbidities and two pharmaceutical agents (tocilizumab, remdesivir). CONCLUSION: Survival rate was favourable if patients were younger, with lower APACHE II score and if non-diabetic. Low initial survival rate (15%) significantly improved (49%) in association with the protocol changes. We would like to facilitate Hungarian centres to publish their data and initiate a nationwide database to improve the management of severe COVID disease. Orv Hetil. 2023; 164(17): 651-658.

INTERIM RESULTS OF THE PML-16, PML-19 PROTOCOLS FOR PRIMARY MEDIASTINAL LARGE B-CELL LYMPHOMA THERAPY

Introduction. Primary mediastinal lymphoma (PML) is an aggressive lymphoid tumor treatment success of which is determined by induction therapy. To date, none of the standard chemotherapy regimens (CT) have demonstrated an advantage in efficacy. Intensive therapy programs are associated with high toxicity. Aim - to evaluate the efficacy and toxicity of two pilot prospective treatment protocols PML-16 and PML-19 as well as the possibility of using the analysis of freely circulating tumor DNA (ctDNA) to assess MRD in patients with PML. Materials and methods. From January 2016 to January 2022, 34 previously untreated PML patients were included in the study;average age - 32;stage > I - in 60 %;extramediastinal lesions - in 14.7 %;bulky disease - in 73.5 % of patients. Positron emission tomography combined with computed tomography (PET-CT) was performed;ctDNA was determined to assess the completeness of remission. Results. Eighteen patients received treatment according to the PML-16 protocol (6 courses of chemotherapy;2 blocks of RmNHL-BFM-90 + 4 courses of R-EPOCH). After the end of therapy, all 18 patients achieved PET-negative remission. The next 16 patients received treatment according to the PML-19 protocol (4 courses of chemotherapy;2 blocks of R-mNHL-BFM-90 + 2 courses of R-EPOCH) in combination with lenalidomide. After the end of therapy, 9 (56 %) patients achieved PET-negative remission;7 (44 %) retained pathological activity (D4-5 points). After 3 and 6 months 15 (94 %) patients achieved normalization of metabolic activity. Considering the high frequency of false-positive results in patients with PML, a ctDNA study was performed to determine the depth of remission in 15 patients. After the end of therapy, all 15 patients had complete elimination of ctDNA. Of these, 5 (33 %) remained PET-positive at the end of treatment. During further observation, after 3-6 months, in 4 patients the level of metabolic activity decreased to physiological without the use of consolidating therapy. After the end of therapy, one patient suffered the new coronavirus infection, COVID-19. A month later, residual formation of SUVmax 14.2 remained in the mediastinum. The patient is currently under observation. With a median follow-up of 36 months (9 to 76 months) all 34 patients are in remission. Conclusion. The effectiveness of PML-16 made it possible to abandon the consolidation therapy and refuted the idea of the need for 6 courses of CT. The combination of programs based on the application of the principle of high-dose short-pulse induction of remission (R-mNHL-BFM-90) in combination with the prolonged administration of medium doses (R-EPOCH) was crucial in achieving a successful result. The inclusion of lenalidomide in the "PML-19" program made it possible to achieve complete remission in 100 % of cases after 4 courses. The possibility of using DNA analysis to assess MRD in patients with PML was shown.Copyright © 2022 Izdatel'stvo Meditsina. All rights reserved.

A Secure and Efficient Scheme for Mutual Authentication for Integrity of Exchanged Data in IoMT

The emergence of pandemic diseases like Covid-19 in recent years has made it more important for Internet of Medical Things (IoMT) environments to build contact between patients and doctors in order to control their health state. Patients will be able to send their healthcare data to the cloud server of the medical service provider in remote medical environments through sensors connected to their smart devices, such as watches or smartphones. However, patients' worries surrounding their data privacy protection are still present. In order to ensure the security and privacy of patients' healthcare data in remote medical environments, a number of different schemes have been proposed by researchers. However, these schemes have not been able to take all security requirements into account. Consequently, in this study, we have proposed a secure and effective protocol to safeguard the privacy of patients' medical data when it is sent to the server. This protocol entails two components: mutual authentication of the patient and the server of the medical service provider, as well as the integrity of the exchanged data. Also, our scheme satisfies security requirements and is resistant to well-known attacks. Following this, we used the Scyther tool to formally analyze our proposed scheme. The results showed that the scheme is secure, and in the section on performance analysis, we demonstrated that the proposed scheme performs better than comparable schemes. © 2023 IEEE.