COVID-19 Associated Brain Fog and Neurocognitive Assessment

BACKGROUND/AIMS: In this study, we aimed to make detailed neurocognitive assessments of patients who presented with brain fog after coronavirus disease-2019 (COVID-19) infection and to investigate their complaints after one-year of follow-up. MATERIALS AND METHODS: Patients who had COVID-19, which was not severe enough to require intensive care, and who subsequently applied to neurology due to cognitive complaints were included in this study. A neurocognitive test battery was applied to those patients who agreed to detailed examination (n=16). This battery consisted of the following tests: mini-mental test, enhanced cued recall test, phonemic fluency, categorical fluency, digit span, counting the months backwards, clock-drawing, arithmetic operations, trail-making, cube copying, intersecting pentagons, and the interpretation of proverbs and similes. At one year, the patients were called by phone and questioned as to whether their cognitive complaints had persisted. Those patients with ongoing complaints were invited to the hospital and re-evaluated via cognitive tests. The results are presented in comparison with age-matched healthy controls (n=15). RESULTS: Almost all of the patients' scores were within the "normal" range. The Spontaneous recall of the patients was statistically significantly lower than the controls (p=0.03). Although there were decreases in executive functions and central processing speed (trail making-A, trail making-B and reciting the months backwards tests) in the patient group, these differences were not statistically significant (p=0.07;p=0.14 and p=0.22, respectively) compared to the controls. We observed that the cognitive complaints of the patients had disappeared by the one-year follow-up. CONCLUSION: In our patients with brain fog, most of whom had mild COVID-19, we observed that among all cognitive functions, memory domain was most affected compared to the controls. At the one-year follow-up, COVID-related brain fog had disappeared.

Primary care network (PCN) based 'type 2 diabetes optimisation clinics' run by primary care clinicians are a cost effective and efficient way of improving treatment targets for patients with poorly controlled diabetes, despite the constraints of the Covid-19 pandemic

Background: Approximately 10% of people living with type 2 diabetes in Waltham Forest (WF) who are treated with oral hypoglycaemic agents (OHA) alone and not under specialist care have an HbA1c > 75mmol/mol. No optimisation clinic exists at PCN level in WF, despite maximum capacity reached in specialist community and secondary care clinics. Aim(s): To establish a remote PCN based optimisation clinic during the Covid-19 pandemic, using motivational and patient empowerment interviewing techniques. Improvement in HbA1c, blood pressure and lipid profile underpinned the study. The 'behaviour change model' was also used to assess patient engagement. Method(s): We identified and consulted with 43 patients using an extended consultation of 25 min. Engagement and recall after 3 months were facilitated by a dedicated administrator and optimal care was ensured via monthly remote consultant input. Result(s): 38 patients were optimised with oral hypoglycaemic agents (OHA) alone and completed the pilot. 31/38 patients had an HbA1c reduction of more than 11mmol/ mol, with a significant overall median reduction across the whole cohort (pre 88mmol/mol vs 70mmol/mol, p < 0.0001). There was also a significant median reduction in triglyceride level (pre 1.56mmol/l vs 1.20mmol/l, p = 0.0247). In terms of behaviour change, all but one patient improved their behaviour towards their diabetes significantly. The approximate cost of the pilot per patient was 263 (excluding medication). Conclusion(s): A PCN based optimisation clinic using active recall is a cost effective and efficient method for significantly improving glycaemic control in people living with type 2 diabetes.

Outcomes of a Pilot Contribution Database for the ICU Pharmacy Team at the University Hospitals of Leicester NHS Trust

Introduction It has long been felt that many contributions made by the ICU Pharmacy team, are not well showcased by the yearly regional network multi-speciality contributions audit. Themes specific to ICU are diluted amongst Trust and region wide data, and valuable learning for the multi-disciplinary team (MDT) is subsequently overlooked. Objective(s): The aims of this project were to: * Develop and pilot a MicrosoftTM Access © database for the ICU pharmacy team to record significant contributions. * Enable the production of reports to the ICU Quality & Safety board, to raise awareness, disseminate concerns, and influence future quality improvement projects. * Provide examples to contribute to the training of the whole MDT. * Generate evidence of team effectiveness and encourage further investment. * Provide team members with a means to recall contributions, for revalidation, appraisal, prescribing re-affirmation and framework mapping. Method(s): * A database was built with a user-friendly data-entry form to prevent overwriting. Fields were agreed with peers who would be using the database. * The team were invited to voluntarily enter their contributions which they thought added value and provided useful learning. * The pilot phase ceased with the emergence of the Omicron SARS-CoV-2 variant, due to staffing pressures and surge planning. Result(s): * Between 12/07/2021 and 25/11/2021, a total of 211 contributions were recorded. * Pharmacists entered 88.6% and a single technician entered 11.4% of these. * Independent Prescribing was utilised in 52.13% of contributions, and deprescribing in 25.12%. * Figure 1 demonstrates the contributions by drug group * The top 5 drugs associated with contributions were: ? Dalteparin ? Vancomycin ? Voriconazole ? Meropenem ? Co-trimoxazole * Treatment optimisation was an outcome for 76.3% of all contributions. Figure 2 stratifies these by type. Contributions. * Drug suitability was a cause for intervention in 12.8% of all contributions, encompassing allergies, contraindications, cautions and interactions and routes. * Medicines reconciliation accounted for 17.54% of all contributions, which almost half were Technician led. Admission was the most common stage to intervene (81.08%), followed by transcription. * Of all contributions, 37.91% were classified as patient safety incidents. Reassuringly 76.25% of these were prevented by the Pharmacy team. Themes have been extracted from these incidents and are presented in Table 1. Conclusion(s): PROTECTED-UK1 demonstrated the value pharmacists contribute to the quality and safety of patient care on ICU. Studies of similar quality and scale including Pharmacy Technicians are lacking, but even in this pilot study, it is evident how important their input is. Independent prescribing is a fundamental and well utilised part of our ICU Pharmacist skillset, supporting the GPICS2 recommendation that ICU pharmacists should be encouraged to become prescribers. Compiling a team interventions database is a useful tool to highlight local priority areas for guideline development;training;and ensuring that appropriate decision support is built into electronic prescribing systems. To improve the usefulness of the data, further stratification of contributions according to the Eadon Criteria3 may be worthwhile, to expand its use as a medication safety thermometer for ICU.

Could Telenutrition Be Applied Interchangeably with the Face-to-Face Interview for Dietary Intake Assessment in Patients with Type 2 Diabetes During the COVID-19 Pandemic?

Background: COVID-19 pandemic has caused limitations, in patients' accessibility in clinical and research settings. We sought whether telenutrition could be applied interchangeably with face-to-face interview for dietary intake assessment by 24-hour recall in patients with type 2 diabetes mellitus (T2DM) during the COVID-19 pandemic. Method(s): Sixty-eight females with T2DM aged 50-55 years were enrolled randomly in a descriptive-analytic cross-sectional study. The patients completed three consecutive 24-hour dietary recalls. The first one was a face-to-face interview, and the subsequent two recalls were conducted by telephone call. The total energy and 18 selected nutrients intake were calculated for the three interviews. Result(s): The mean (+/- SD) age of participants was 53.97 +/- 2.14 years. The face-to-face interview resulted in significantly higher total energy and 18 selected nutrients intake than the two telenutrition interviews (P value range: 0.031-0.001). No significant differences were found between the data provided from the two telenutrition interviews. Conclusion(s): Telenutrition underreports and underestimates the total energy and nutrient intakes compared with the face-to-face interview in the 24-hour dietary recall. Therefore, it cannot be recommended to be applied interchangeably with a face-to-face interview for dietary intake assessment during the COVID-19 pandemic, especially in patients whose nutrition assessment is of clinical importance. A combination of the two methods using new communication applications (e.g. WhatsApp) may cover the defects of telenutrition method.Copyright © 2023, Kerman University of Medical Sciences. All rights reserved.

A Novel Interprofessional Approach to Inpatient Ready to Feed Infant Formula Management Throughout a National Supply Chain Crisis

Background: Institutions across the country are experiencing delays in receipt of essential infant formula and feeding supplies due to a supply chain crisis. The supply chain crisis commenced during the COVID-19 pandemic and has continued into present day, late 2022. The supply chain crisis led to an unstable supply of ready to feed (RTF) infant formulas for a children's hospital within a medical center containing a neonatal ICU, pediatric ICU, pediatric floor and newborn nursery. RTF formulas are the recommended inpatient infant feeding due to their sterility. Method(s): To address these RTF formula supply challenges, interprofessional leadership from Clinical Nutrition, Nursing and Supply Chain developed a local infant formula committee. The committee convened based on the needs of the institution, ranging from daily to weekly beginning October 2021 to present day. A shared, live spreadsheet allowed for real time inventory of RTF formula on the Nursing units and amount of product pending receipt in supply chain. Upon identification of low RTF supply, increased usage or RTF outage, the committee implemented a three-tiered action plan for each unit. For the first tier, the formula roomdiluted a higher calorie RTF liquid with water to the desired calorie density (example RTF 24 to RTF 20 calorie/oz). The medical team had an infant formula substitution list to guide feeding alternatives for specialty preparations. In the second tier, the formula room prepared stock formula for each unit daily, with a 24-hour expiration time, to accommodate potential for rapid census changes outside of the formula room operation. As a third layer of safety, powder emergency stock was pre-measured and sent with instructions for Nursing to reconstitute with sterile water, in a dedicated space, if all stock RTF formula was used. The powder emergency stock expired in 30 days, which allowed for a longer shelf life than the stock RTF formula. Result(s): It is practical for institutions without a formula room to implement similar processes using dedicated infant formula preparation space and storage. It also worth mentioning during this time there was a national shortage of powdered infant formulas due to a recall issued in May of 2022 by a major formula manufacturer. The national shortage included elemental powdered formulas for which there is no RTF alternative. Management of elemental formula outages were managed on a case-by-case basis by the Clinical Nutrition department. The Committee also convened to discuss allocations and identify substitutions for other neonatal and pediatric specialty items including sterile water, feeding preparation bottles, ENFit syringes and syringe caps, breastmilk collection containers and infant feeding nipples. Conclusion(s): Using this three-tiered process, the medical center provided sterile RTF formula to infants when available, remained consistent with best practices, predicted inventory needs consistent with usage and prevented waste of powdered infant formula in a time of scarcity. Technology and the anticipatory interprofessional leadership using a three-tiered action plan equipped the medical center for this most extraordinary infant formula crisis nationally.

An audit of uptake of flu, COVID-19 and pneumococcal vaccines in a cohort of people living with HIV

Background: People living with HIV are at greater risk of complications associated with influenza, SARS-CoV-2 and pneumococcus than the general population and BHIVA guidelines recommend vaccinating all patients against these infections. The purpose of this audit was to determine the uptake of these vaccines, and factors associated with uptake, to inform vaccine delivery models. Method(s): All patients who received HIV care in our service at the end of November 2022 were included. Demographic data were collected from the service database, clinical data and pneumococcal vaccine (Prevenar-13) status were obtained from clinical records and COVID-19 and flu vaccine (2021) uptake was obtained from the Vaccine Management Tool (VMT). At the time of audit all patients were recommended to have received at least 3 doses of a SARS-CoV-2 vaccine. Caldicott approval was received for this work. Result(s): There were 364 patients known to the service of which one was excluded as clinical information was not available. Sixty-seven percent had received flu vaccine, 88% >= one dose of COVID-19 vaccination, 76% at least 3 doses of COVID-19 vaccination and 88% had received Prevenar-13. Three percent had received no vaccines and 60% had completed all vaccines. Uptake of both flu and COVID-19 vaccines were lower in the following groups: <50 years old (51% and 62% respectively), urban residence (65%, 71%), higher deprivation scores (51-65%, 64-75%) less time in HIV care (57%, 70%), those not on ART (13%, 25%), CD4 <200 cells/mm3 (40%, 50%), detectable viral load (33%, 42%), those out of care (23%, 23%) and those known to the harm reduction service (33%, 33%). There was higher uptake of Prevenar-13 in all groups. Uptake of all vaccines was high in those with comorbidities. Conclusion(s): The high uptake of Prevenar-13 in higher risk groups suggests that the model of vaccine delivery, opportunistic and pro-active recall for inhouse vaccination, is more effective for protecting those at highest risk for poor outcomes and for those for whom access is challenging compared to the centralised national recall system at designated Vaccine hubs. Vaccination resourcing, planning and delivery should consider the needs of specific risk groups to ensure best outcomes.

VSV-BASED COVID VACCINE FOR THE PREVENTION OF BREAKTHROUGH SARS-CoV-2 INFECTIONS

Background: More than 12 billion doses of COVID-19 vaccine administrations and over 630 million natural infections should have developed adequate levels of herd immunity over the last three years. However, there have been many new waves of coronavirus infections. The development of safe and effective vaccines to control breakthrough SARS-CoV-2 infections remain an urgent priority. We have developed a recombinant VSV vector-based vaccine to fulfill this worldwide need. Method(s): We have used a recombinant vesicular stomatitis virus (rVSV)-based prime-boost immunization strategy to develop an effective COVID-19 recall vaccine candidate. We have constructed an attenuated recombinant VSV genome carrying the full-length Spike protein gene of SARS-CoV-2. Adding the honeybee melittin signal peptide (msp) at the N-terminus enhanced the protein expression and adding the VSV G protein transmembrane domain and the cytoplasmic tail (Gtc) at the C-terminus of the Spike protein allowed efficient incorporation of the Spike protein into pseudotype VSV. Result(s): In immunized mice, rVSV with chimeric rVSV-msp-S-Gtc induced high levels of potent neutralizing antibodies (nAbs) and CD8+ T cell responses, while the full-length Spike with Gtc proved to be the superior immunogen. More importantly, rVSV-msp-S-Gtc-vaccinated animals were completely protected from subsequent SARS-CoV-2 challenges. Furthermore, rVSV-Wuhan and rVSV-Delta vaccines, and an rVSV-Trivalent (mixed rVSV-Wuhan, -Beta and -Delta) vaccine elicited potent nAbs against live SARS-CoV-2 Wuhan (USAWA1), Beta (B.1.351), Delta (B.1.617.2) and Omicron (B.1.1.529) viruses. Heterologous boosting of rVSV-Wuhan with rVSV-Delta induced strong nAb responses against Delta and Omicron viruses, with the rVSV-Trivalent vaccine consistently inducing effective nAbs against all the SARS-CoV-2 variants tested. All rVSV-msp-S-Gtc vaccines also elicited an immunodominant Spike-specific CD8+ T cell response. Conclusion(s): rVSV vaccines targeting SARS-CoV-2 variants of concern can be considered as an effective booster vaccine in the global fight against COVID-19.

Thyroiditis Post COVID-19 mRNA Booster Dose Vaccination

Introduction: SARS-CoV-2 vaccines have been associated with thyroid dysfunction including thyroiditis and Graves' disease. We report a patient who developed thyrotoxicosis secondary to thyroiditis after COVID-19 mRNA booster dose vaccination. Case Description: A 74-year-old man with no known personal or family history of thyroid disorders went to his primary care physician with symptoms of palpitations. Of note, he had the first booster (third dose) of the Pfizer/BioNTech vaccine about 1 week before. He did not recall any similar symptoms after the first two doses of the same vaccine. There were no other symptoms of thyrotoxicosis such as hand tremors, weight loss or mood change. There was no family history of thyroid disorders. He was not on any medications such as amiodarone and was not taking any herbal supplements. He did not have any symptoms of upper respiratory tract infection. There was no neck pain. Physical examination was unremarkable with no goiter or thyroid eye manifestations. Thyroid function: free T4 elevated at 46.7 pmol/L (11.5-22.7) and TSH suppressed at 0.01 mIU/L (0.5-4.5). Thyroid stimulating immunoglobulin was positive at 200% (50-179). He was initially started on carbimazole 15mg daily. However, the patient became rapidly hypothyroid despite dose reduction and subsequent discontinuation of carbimazole with free T4 of 8 pmol/L and TSH of 36.4 mIU/L. An ultrasound of the thyroid gland showed vascularity with no discrete nodules. No thyroid uptake scan was done. The diagnosis was revised to thyroiditis post vaccination. Hypothyroidism persisted despite discontinuation of carbimazole before recovery 8 months later. Patient was well and did not require any thyroxine supplementation. Discussion(s): It is postulated that COVID-19 vaccines triggered thyroiditis via an autoimmune inflammatory syndrome caused by the vaccine adjuvants. A high index of suspicion is necessary and a thyroid uptake scan may be useful in making the diagnosis. Thyroiditis is a self-limiting condition and recognising it is important as no specific thyroid treatment is necessary in most patients. Patients should not be deterred from subsequent vaccination as COVID-19 infection has higher mortality risk than thyroiditis.Copyright © 2023

Essential fatty acid and lipoprotein status in pediatric cystic fibrosis: Impact of cystic fibrosis transmembrane conductance regulator modulators

Background: Dyslipidemias and essential fatty acid deficiencies (EFADs) are well established complications of cystic fibrosis (CF). In the general population, a diet high in saturated fat is associated with hyperlipidemia and greater risk of cardiovascular disease and type 2 diabetes. Increasing life expectancy in CF brings concern about the risks of the "legacy" high-fat CF diet. The impact of CFTR modulators on CF-related dyslipidemia and EFAD is not known. Previous studies reported dyslipidemia in people with CF (PwCF) using traditional lipid measures. This study aimed to evaluate the lipoprotein and fatty acid profiles in children and adolescents with CF and to correlate biochemical results with clinical and molecular findings. Plasma and red blood cell (RBC) samples were studied to compare the ability of each method to identify EFAD markers. Method(s): Blood samples (n = 171) were obtained from 142 (78 female) children with CF aged 9.8 +/- 4.7 (range 4 months to 18 years) during routine laboratory draws at pediatric CF center clinic visits. Pancreatic insufficiency was present in 92% and glucose intolerance or diabetes in 14%. Body mass index percentile (BMI%ile) for age z-scorewas 0.23 +/- 0.89 (range -2.4-2.6). F508del mutation was homozygous for 56% and heterozygous for 41%. CFTR modulator therapy had been initiated 3 or more months before for 62% of samples. Sample collection began in September 2019, paused during the COVID-19 pandemic, and resumed in July 2021. An accredited, regional laboratory with expertise in fatty acid analysis processed all samples. Serum was separated and refrigerated for lipoprotein analysis, plasmawas separated and frozen, and RBCs were washed and frozen for fatty acid analysis. Nuclear magnetic resonance lipoprotein assayswere conducted to determine particle number and size of lipoprotein classes. Triglyceride, total cholesterol, and high-density lipoprotein cholesterol (HDL-C) were measured directly (Roche). Low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) were calculated. To correlate laboratory results with clinical findings, medical records were reviewed, and a CF clinic dietitian conducted 24-hour dietary recalls concurrent with study labs. Result(s): Of PwCF homozygous F508del/F508del, 43% tested positive for EFAD biomarkers (RBC linoleic acid, RBC mead acid, RBC triene/tetraene ratio), compared with 13% of PwCF heterozygous F508del ( p <=0.01) (Figure 1). There was no significant difference in concentrations of fatty acid and EFAD biomarkers between those who had or had not initiated CFTR modulator therapy. Lipoprotein abnormalities were identified in 69% of samples with low HDL-C and 39% with large HDL-C, 87% with large VLDL-C particle size and 52% with large VLDL-C particle number, and 5% with high LDL-C or small LDL-C particle numbers. High total cholesterol was found in 15% and high triglycerides in 17%. HDL-C was low in 24%, and 3% had high LDL-C. (Figure Presented) Figure 1. Differences in concentrations of red blood cell (RBC) linoleic and mead acids and triene/tetraene (T/T) ratio between F508del homozygous and F508del heterozygous individuals Conclusion(s): Despite clinical advances and use of CFTR modulator therapy, EFAD remains prevalent and underrecognized in the pediatric CF population. Of PwCF, those homozygous for f508del may have a higher risk of EFAD. Limitations of this study (four different CFTR modulator therapies and small sample sizes in each group) may have precluded significant findings for EFAD and lipid profiles, but PwCF receiving modulator therapy appear to have healthier lipid profiles than those not receiving therapy. Lipids and fatty acid are not routinely evaluated in PwCF, but evaluation should be included in the standard of care for timely dietary interventionsCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

Replication of recall-based memory phenomena via an online experiment

Conducting psychological experiments online has become popular in Japan and is useful for psychological research during the COVID-19 pandemic. Previous studies found that well-known psychological phenomena were successfully observed through online experiments. However, using recall tests, including a free recall test or a cued recall test, might be difficult in an online experiment. This is because the suggestion function, which is included in the Input Method Editor (IME), can aid recall when participants type their response. Recently, a plugin for online experiments, which might overcome this problem, was developed. However, it remains unclear if this technique is effective for psychological studies that use recall tests. Therefore, I examined whether false memory and retrieval-induced forgetting were replicated by recall tests in online experiments when the IME was bypassed by using the plugin. The results indicated that false recall and retrieval-induced forgetting were successfully observed. Given my results, online experiments using some types of recall tests can be conducted without the suggestion function. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Development of a Lymphoid Organ-Chip to Evaluate Covid Vaccine Boosting Strategies

Background: Secondary lymphoid organs provide the adequate microenvironment for the development of antigen (Ag)-specific immune responses. The tight collaboration between CD4+ T cells and B cells in germinal centers is crucial to shape B cell fate and optimize antibody maturation. Dissecting these immune interactions remains challenging in humans, and animal models do not always recapitulate human physiology. To address this issue, we developed an in vitro 3D model of a human lymphoid organ. The model relies on a microfluidic device, enabling primary human cells to self-organize in an extracellular matrix (ECM) under continuous fluid perfusion. We applied this Lymphoid Organ-Chip (LO chip) system to the analysis of B cell recall responses to SARS-CoV-2 antigens. Method(s): We used a two-channel microfluidic Chip S1 from Emulate, where the top channel is perfused with antigen (spike protein or SARS-CoV-2 mRNA vaccine), while the bottom channel contains PBMC (n = 14 independent donors) seeded at high-density in a collagen-based ECM. Immune cell division and cluster formation were monitored by confocal imaging, plasmablast differentiation and spike-specific B cell amplification by flow cytometry, antibody secretion by a cell-based binding assay (S-flow). Result(s): Chip perfusion with the SARS-CoV-2 spike protein for 6 days resulted in the induction CD38hiCD27hi plasmablast maturation compared to an irrelevant BSA protein (P< 0.0001). Using fluorescent spike as a probe, we observed a strong amplification of spike-specific B cell (from 3.7 to 140-fold increase). In line with this rapid memory B cell response, spike-specific antibodies production could be detected as early as day 6 of culture. Spike perfusion also induced CD4+ T cell activation (CD38+ ICOS+), which correlated with the level of B cell maturation. The magnitude of specific B cell amplification in the LO chip was higher than in 2D and 3D static cultures at day 6, showing the added value of 3D perfused culture for the induction of recall responses. Interestingly, the perfusion of mRNA-based SARS-CoV-2 vaccines also led to strong B cell maturation and specific B cell amplification, indicating that mRNA-derived spike could be expressed and efficiently presented in the LO chip. Conclusion(s): We developed a versatile Lymphoid Organ-Chip model suitable for the rapid evaluation of B cell recall responses. The model is responsive to protein and mRNA-encoded antigens, highlighting its potential in the evaluation of SARS-CoV-2 vaccine boosting strategies.

User Consumption Behavior Recognition Based on SMOTE and Improved AdaBoost

The sudden outbreak of COVID-19 has dealt a huge blow to traditional education and training companies. Institutions use the WeChat platform to attract users, but how to identify high-quality users has always been a difficult point for enterprises. In this paper, researchers proposed a classification algorithm based on SMOTE and the improved AdaBoost, which fuses feature information weights and sample weights to effectively solve the problems of overfitting and sample imbalance. To justify the study, it was compared with other traditional machine-learning algorithms. The accuracy and recall of the model increased by 19% and 36%, respectively, and the AUC value reached 0.98, indicating that the model could effectively identify the user's purchase intention. The proposed algorithm also ensures that it works well in spam identification and fraud detection. This research is of great significance for educational institutions to identify high-quality users of the WeChat platform and increase purchase conversion rate.

Kidney stone detection using an optimized Deep Believe network by fractional coronavirus herd immunity optimizer

In this study, a computer-assisted kidney stone diagnosis system based on CT images has been proposed. The method is based on a combination of deep training and metaheuristics. The method aims to provide a customized Deep Believe Network (DBN) based on a fractional version of the coronavirus herd immunity enhancer to provide an efficient and reliable kidney stone diagnosis system. The designed method is then authenticated by running a standard benchmark called a "CT kidney dataset". Subsequently, a comparison is made between the results and some other state-of-the-art methods. Simulations show that the recommended DBN/FO-CHIO outperforms the other studied approaches in terms of efficiency with an accuracy of 97.98%. Moreover, the proposed DBN/FO-CHIO recall outperforms others with 92.99%, demonstrating its excellent accuracy compared to other comparison algorithms. Moreover, the higher specificity of the proposed method compared to the other evaluated approaches indicates its advanced event-independent value.Copyright © 2023 Elsevier Ltd

Survey of Home Cleaning Practices With Noninvasive Ventilation Equipment

Purpose:Home noninvasive ventilation (NIV) equipment is often observed to be dirty, potentially increasing patients' risk of respiratory infection. This study aimed to describe the cleaning practices of home NIV patients. Method(s):This single-site, cross-sectional, observational study surveyed 100 patients from the respiratory failure clinic regarding cleaning instructions, cleaning habits, barriers, and motivators to cleaning. Open-ended responses were analyzed with basic content analysis and closed categorical responses with frequencies and percentages. Result(s):Of 100 participants, 77% responded. Cleaning instructions most commonly recalled included cleaning with soapy water for masks (26/47, 55%), head straps (19/47, 40%), and tubing (21/47, 45%);vinegar solution for humidifiers (9/39, 23%);and replacing filters (14/39, 36%). Fourteen respondents reported barriers to cleaning, including forgetfulness (7/14, 50%) and physical difficulties (6/14, 43%). Commonly reported cleaning practices included soapy water to soak masks (28/77, 36%) and tubing (35/77, 46%), weekly masks (34/77, 44%) and tubing cleaning (29/77, 38%), vinegar solution to clean humidifiers for the 36 humidifier users (15/36, 44%), monthly humidifier cleaning (13/36, 36%), and monthly filter cleaning/replacement (36/77, 47%). Conclusion(s):Few respondents could recall specific instructions about when and how to clean their equipment. Many reported routine cleaning, with varied methods and frequencies. Our results will inform future NIV equipment cleaning educational package design.Copyright © Cardiovascular and Pulmonary Section, APTA.

Analysis of Malfunctions & Injuries Attributed to CT Scanners Before and After the Pandemic

Given the stresses placed on healthcare during the COVID-19 pandemic, and the critical role of computed tomography (CT) scanners in diagnosing cancers and other disorders, this project is designed to investigate the impact of the COVID-19 pandemic on reported malfunctions, injuries (and deaths) attributed to CT scans. Data were extracted from the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database. Yearly numbers of adverse event (AE) reports attributed to CT scanners including malfunctions, injuries, and deaths were recorded for the last 10 years (2012 to 2021). Monthly numbers of reports were also recorded for the 12 months immediately preceding the pandemic (2019/03 to 2020/03), as well as all the months after WHO declared COVID-19 a global pandemic (since 2020/03). It was found that the reported rates of injuries and malfunctions for CT scanners increased during the COVID-19 pandemic. The analysis also revealed unusual trends such as spikes in the malfunction rates from 2015 to 2018 compared to the preceding years, as well as in injuries and deaths. Manufacturers most responsible for these AE spikes included Philips, Superdimension, GE, Siemens, etc. The FDA Recall Database was further mined, and similar trends were identified in the yearly recalls over 2015- 2018, which correlated well with the malfunction rates (less apparent for injuries and deaths). While this project was originally centered around adverse pandemic-related effects on CT scanners, the important pre-pandemic findings warrant further research. These results might help prevent future AEs caused not only by CT scans but also by other medical devices. © 2022, Avestia Publishing. All rights reserved.

Impact of the COVID-19 pandemic on blood services operations: Korean experience

The coronavirus disease 19 (COVID-19) pandemic had a profound impact on blood services operations in Korea. Blood collection was affected due to decrease in donor availability caused by avoidance of public places, social distancing policies, and cancellation of blood drives. The negative impact on blood collection was more pronounced with the COVID-19 pandemic than with other outbreaks experienced previously such as the influenza (H1N1) outbreak or the Middle East respiratory virus (MERS) pandemic. To cope with the blood shortage, campaigns to appeal for blood donation, raise public awareness on the importance of blood donation and gain donor's confidence in safe blood donation were implemented using mass communication media such as TV and radio broadcasting as well as postings on various social media platforms. Upon Korean Red Cross Blood Services's (KRCBS) request, the Ministry of Health and Welfare (MoHW) approved the relaxation of the geographical restrictions regarding indigenous malaria thus enabling collection of more than 23,000 units of whole blood. To mitigate even a theoretical risk of transfusion-transmission of SARS-CoV-2 via blood donation from pre-symptomatic COVID-19 donors, the KRCBS received the data on COVID-19 identified cases from the Korean Disease Control and Prevention Agency (KDCA) from the early get-go of the pandemic for cross referencing to donors for further recipient investigation and recall of blood products not transfused. Communication with donors, staff members, national health authorities, hospital customers and other stakeholders was and remains of utmost importance to respond to this unprecedented situation which is still ongoing.Copyright © Annals of Blood. All rights reserved.

The most common self reported reasons for delay and avoidance of Covid-19 vaccines in patients with hereditary angioedema and recurrent angioedema

Background: In the context of the COVID-19 pandemic, it is especially important to understand why patients avoid or continuously postpone immunization. The authors aim to understand the impact of the increasingly active spread of anti-vaccine arguments of the vaccination opponents, as well as the general distrust in the pharmaceutical industry, science and healthcare professionals in patients with Hereditary Angioedema (HAE) and recurrent Angioedema (AE) in North Macedonia. Method(s): A total of 92 patients diagnosed with AE and 35 patients diagnosed with HAE underwent structured interview conducted during routine check-ups. Result(s): 52 of the AE patients and 10 of the HAE patients stated that they are indecisive or opposed to vaccination, mostly because of a generalized negative attitude towards vaccines. The patients often stated that their attitude is based on a personal or a family member's negative experience with vaccines (76.9% of AE and 60% of HAE patients opposed to vaccination). When asked about the basis of such opinion, the patients' answers were vague and unspecific. The majority stated that they do not recall the source of information, some speculated about possible role of vaccines in autism diagnosis of a close family member, allergies or other pediatric diseases caused by vaccines, despite the lack of proof of connection. Such examples can be explained with the human tendency to remember negative information, although they have read such information somewhere on the internet or social media with no reliable source or validation. Confirmation bias is the tendency of individuals to seek information that confirm their existing hypothesis, while avoiding explanations that do not fit in with their opinion. Because of this, the previously formed negative attitude towards vaccines, can cause any negative symptoms to be misinterpreted as vaccine side-effects, additionally reaffirming the negative attitude. 61.5% of AE and 70% of HAE patients opposing vaccination stated that they believe that vaccines lead to serious adverse events, do not protect the individuals and society from infective diseases and are not sufficiently tested prior to their use. Conclusion(s): In conclusion, the author considers that continuous education of patients is a key condition for an improved rate of COVID-19 immunization of HAE and AE patients.

Cyclin-dependent kinase 4/6 inhibitor in advanced breast cancer during the COVID pandemic period: efficacy in relation to vaccination for SARS-COV 19

Introduction: More than 2 years after the WHO declaration of a pandemic, SARS-Cov-2 still represents a public health problem The pandemic has increased the complexity of cancer treatments including breast cancer. These difficulties were highlighted in adjuvant treatments but above all in metastatic disease. Vaccination has been one of the most important public health factors that has reduced deaths, hospitalizations and the severity of symptoms related to infection. In metastatic breast cancer hormone receptor positive and HER2/neu negative currently the first line of treatment is given by the association between cyclin 4/6 inhibitors and hormone therapy (aromatase inhibitors or fulvestrant) A well-known and frequent side effect of this therapy is the reduction of white blood cell values and neutrophils. The hypothesis that this study is to evaluate whether treatment with cyclin inhibitors initiated before the period of vaccinations may have influenced, due to the reduction in white blood cell values, an increased risk of infection in these patients. Material(s) and Method(s): In our study, we selected patients who had started treatment with cyclin inhibitors before starting the vaccination cycle (in Italy up to the fourth dose in cancer patients) and continue it without evidence of disease progression. All patients were offered a vaccination cycle with mRNA COVID vaccines and were followed during their cancer treatments. All patients, at least 90 days after the last dose of vaccine, have been tested for antibodies against SARS CoV-2 (trimeric spike protein) with a value expressed in binding antibodies unit (BAU) according to international standard WHO During the observation period (starting from the first dose of vaccine administered) the patients were clinically checked and in case of suspicion of infectious pathology with symptoms suggestive of SARS-COV-19 infection, they were tested with molecular swab Results: We evaluated 52 patients who started cyclin treatment before the vaccination course and who are currently without signs of disease recurrence During the study period we found 14 SARSCOV19 infections (28% of patients) and one patient with two infectious episodes. No patients needed treatment in a hospital or resuscitation setting. All patients have fully recovered from the infection and at most after 21 days have resumed the treatment still in place Statistically, a linear regression calculation was applied to evaluate a functional relationship between variables measured on the basis of sample data. We did not find a relationship between spikes or infections compared to the start date of the vaccination cycle;instead we observed a relationship between the value of the spike and the date of last immunization (considered as an active infection or fourth dose of vaccine) with a reduction in the values the further you go away Conclusion(s): The data of the study show that there is a correlation between the time elapsed between the last vaccination and the risk of getting sick. For this reason, the fourth recall represents a strong help to reduce this risk. We did not find any ranges we could refer to regarding the dosage of trimeric spike protein. Considering the positivity rate of infections that does not exceed the general vaccinated population and the absence of serious infectious symptoms with hospitalization, treatment with cyclin inhibitors appears to be a safe treatment even in a pandemic period. (Table Presented).

Relationship between Pain, Physical Activity, and Quality of Life in Patients with Haemophilia a and Haemophilia B

Introduction: The extended half-life (EHL) registry was established in 2016 to ascertain the long-term outcomes in patients with HaemophiliaA(HA) and B(HB) receiving replacement therapy. The aim was to quantify disease burden and quality of life at baseline and after switching to EHLs. Method(s): The study is a prospective, observational cohort study that enrolled patients switching EHLs or on standard replacement therapy after informed consent following local ethics approval and was registered at www.clinicaltrials.gov (NCT02938156). The study was paused during the COVID pandemic. Here the baseline results are presented for pain, activity and quality of life and their correlations. Pain evaluation was assessed through the brief pain inventory (BPI) 7-day recall, quality of life by EuroQol-5 Dimension (EQ5D5L) and physical activity through the international physical activity questionnaire (IPAQ). The BPI assess severity of pain and the interference with activities. IPAQ assess physical activity undertaken across a comprehensive set of domains. Three levels of physical activity are used to classify the populations: 'low', 'moderate', and ' high'. Result(s): A total of 231 HA and 97 HB were included in the analysis, of whom 231 had switched to EHL products and 96 were on standard replacement therapy. The levels of Physical Activity were similar between Haemophilia types, with approximately 46%, 32% and 22% of patients reporting high, moderate, and low physical activity, respectively. BPI mean (+/-SD) severity score in HA was 2.86 (+/-2.1), HB 3.24 (+/-2.0);interference score HA 3.22 (+/-2.8), HB 3.09 (+/-2.5), mean EQ5D5L visual analogue scale (VAS) for HA 72.92 (+/-15.5) and HB 71.10 (+/-18.2). Within instruments, IPAQ sub-scores and BPI average scores were highly correlated. Between instruments, the strongest linear correlations were seen between theVAS and the BPI scores (R=-0.59, p< 0.0001, n=206 for the average interference score, R=-0.57, p< 0.0001, n=208 for the average pain severity, v.s. the VAS). Correlations between the IPAQ total score and either VAS or BPI scores were weaker, even when limiting to patients with moderate or high activity and using a log scale given the skewed distribution of the IPAQ summary measure. Discussion/Conclusion: The study demonstrates for the first time a strong correlation between pain and quality of life, and weaker correlation between physical activity and quality of life.

The successful use of Pezzer Catheter in Covid-19 patients

Introduction: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was often during the pandemic era. Over 3500 patients were treated in our hospital and approximately 400 required mechanical ventilation and presented pneumothorax due to barotrauma. We present our experience in cases of recurrent or loculated pneumothoraces in Covid-19 patients treated successfully with the use of Pezzer catheter. Material(s) and Method(s): Cases were collected retrospectively based on author recall. Ninety-one intubated patients ranging in age from 65 to 78 years presented with pneumothoraces. A 28 French Argyle intercostal catheter was inserted initially, resulting in re-expansion. Despite the above treatment 41 patients (45%) were unstable with recurrent or loculated pneumothoraces and one found hard to ventilate them. So, a Pezzer catheter made of Latex was placed at the site of the loculated pneumothorax. Result(s): All pneumothoraces were resolved within 3 days after the insertion of a Pezzer catheter and the subcutaneous emphysema decreased significantly. There were no major complications recorded. Conclusion(s): 1. It is well known that the most basic issue that may have an impact on airleaks is chest tube management. That is the reason we concentrated on the type and position of chest drain. 2. Our experience supports the use of Pezzer catheter connected to water seal in cases of persistent pneumothorax with prolonged air leak and increasing subcutaneous emphysema, since it promotes pleurodesis, reduces significantly the duration of the intrapleural drainages and the length of the in-hospital stay. 3. The procedure is cost-effective, safe, and easy to perform.