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1.
Journal of Advances in Medical and Biomedical Research ; 30(140):215-222, 2022.
Article in English | EMBASE | ID: covidwho-1822724

ABSTRACT

Background & Objective: Measurement of inflammatory markers and lactate dehydrogenase (LDH) may contribute to the evaluation of lung involvement severity. This study aimed to evaluate relationship between severity of primary lung involvement with highest level of erythrocyte sedimentation rate (ESR) and LDH in patients with COVID-19. Materials & Methods: This descriptive-analytical study was conducted on 123 patients with COVID-19 in Shahid Sadoughi Hospital. Data including age, gender, ESR (mm/h), LDH (U/L), and high-resolution Computed Tomography scan (HRCT) findings and hospitalization ward were extracted from medical records. The regression model was used to determine the relation between HRCT findings with LDH and ESR. Results: Mean LDH, ESR, and HRCT findings were 508.41±224.65, 52.23±29.56, and 37.17± 22.18 respectively. A significant relation was seen between HRCT findings with highest level of LDH and ESR (P=0.001). A significant relation was observed between the highest levels of ESR and HRCT findings, regarding age, gender, and hospitalization wards (P<0.01). There was a significant relation between the highest level of LDH and HRCT findings regarding age group and hospitalization wards (P<0.01). Conclusion: A significant relation was seen between HRCT findings and highest levels of ESR and LDH in patients with COVID-19. Therefore, it seems that assessment of laboratory findings such as LDH and ESR can be helpful as cost-effective markers instead of chest CT scan for predicting the severity of lung injury when the CT scan report is controversial. The relation between HRCT findings with LDH and ESR were affected by age and hospitalization ward. However, more studies should be conducted in this regard.

2.
Vaccines ; 10(4), 2022.
Article in English | EMBASE | ID: covidwho-1822451

ABSTRACT

COVID-19 remains a deadly disease that poses a serious threat to humanity. COVID-19 vaccines protect the public and limit viral spread. However, public acceptance is significantly dependent on the efficacy and side effects (SEs) of the vaccinations being produced. Four important mechanisms have been examined for COVID-19 vaccines: DNA-based, mRNA-based, protein-based, and inactivated viruses. Vaccination safety research was formerly limited to manufacturer-sponsored studies, but numerous additional cross-sectional survey-based studies conducted globally have contributed to the generation of vaccine-related safety data reports. Twenty-seven studies and twenty-four case reports published-up till 2021 were overviewed for the presentation of SEs and their severity. Injection site pain remained the most dominant localized SE, while headache and fatigue were the most prevalent systemic SEs. Most studies reported that all vaccinations were safe, with very little or no adverse effects, but the nature of SEs was reported to be more persistent in DNA-and mRNA-based vaccines, while inactivated viral vaccines were associated with longer-duration SEs. Overall, SEs were found to be more dominant in women and youngsters. Case reports of adverse reactions have also been documented, but there is still a need to find out their pathological linkage with the COVID-19 vaccination.

3.
Informatics in Medicine Unlocked ; 28, 2022.
Article in English | EMBASE | ID: covidwho-1821299

ABSTRACT

The novel coronavirus 19 (COVID-19) continues to have a devastating effect around the globe, leading many scientists and clinicians to actively seek to develop new techniques to assist with the tackling of this disease. Modern machine learning methods have shown promise in their adoption to assist the healthcare industry through their data and analytics-driven decision making, inspiring researchers to develop new angles to fight the virus. In this paper, we aim to develop a CNN-based method for the detection of COVID-19 by utilizing patients' chest X-ray images. Developing upon the inclusion of convolutional units, the proposed method makes use of indirect supervision based on Grad-CAM. This technique is used in the training process where Grad-CAM's attention heatmaps support the network's predictions. Despite recent progress, scarcity of data has thus far limited the development of a robust solution. We extend upon existing work by combining publicly available data across 5 different sources and carefully annotate the comprising images across three categories: normal, pneumonia, and COVID-19. To achieve a high classification accuracy, we propose a training pipeline based on indirect supervision of traditional classification networks, where the guidance is directed by an external algorithm. With this method, we observed that the widely used, standard networks can achieve an accuracy comparable to tailor-made models, specifically for COVID-19, with one network in particular, VGG-16, outperforming the best of the tailor-made models.

4.
Annals of Thoracic Surgery ; 113(5):1401-1404, 2022.
Article in English | EMBASE | ID: covidwho-1821141
5.
European Journal of Molecular and Clinical Medicine ; 9(3):2809-2818, 2022.
Article in English | EMBASE | ID: covidwho-1820648

ABSTRACT

Aim: To evaluate neutrophilic lymphocyte ratio and lymphocyte monocyte ratio as prognostic markers in COVID 19. Material and method: The present retrospective observational studyconducted in the department of Medicine, Government Medical College, Jammu for a period of one year. The study comprised of 100 Covid 19 RT PCR positive cases admitted patient in ICU as well as Ward, in covid care centre of Government Medical College, Jammu. Patients characteristics were obtained from the hospital covid care centre satisfying inclusion criteria from electronic medical records and demographic, clinical, laboratory data were extracted included age, sex clinical features, signs and symptoms, comorbidities, exposure history, oxygen support during hospitalization, duration of oxygen support during hospitalization,imaging features of the chest (CT scoring), laboratory findings (Hemogram, Total leucocyte count, differential counts, NLR and LMR. Complete blood count including NLR and LMR collected at day of admission and day 3 of admission and documented on a standardized proforma. Two outcomes were evaluated: “discharge” or “died.” Results:In majority (53%) of patients, ventilation given was high flow followed by bipap (21%), ventimask (19%) and ventilator (5%). Ventilation given was room air in only 2 out of 100 patients (2%). In present study, only 10 out of 100 patients (10.00%) died.Discriminatory power of neutrophil lymphocyte ratio (AUC 0.865;95% CI: 0.781 to 0.925) was excellent and discriminatory power of lymphocyte monocyte ratio (AUC 0.791;95% CI: 0.698 to 0.867) was acceptable. Among both the parameters, neutrophil lymphocyte ratio was the best predictor of CTSI severity at cut off point of >3.57 with 86.50% chances of correctly predicting CTSI severity. Conclusion: It can be concluded from the results that NLR may be a rapid, widely available, useful prognostic factor in the early screening of critical illness in patients with confirmed COVID-19.

6.
International Journal of Physiology, Pathophysiology and Pharmacology ; 14(1):48-54, 2022.
Article in English | EMBASE | ID: covidwho-1820561

ABSTRACT

Background: Reverse transcription-polymerase chain reaction (RT-PCR) is a standard technique for diagnosing coronavirus disease 2019 (COVID-19). The parameters for the diagnosis of COVID-19 included the his-tory of exposure to positive COVID-19 patients, clinical signs and symptoms related to the disease, inflammation factors in the blood test or positive antigen-antibody test, and chest computed tomography (CT) findings. The current study evaluated the chest CT scan findings in patients with respiratory problems following positive RT-PCR of COVID 19. Materials and methods: This cross-sectional study was performed on 120 patients referred to Ali Ibn-Abi Talib Hospital in Rafsanjan, Kerman Province, Iran, with respiratory symptoms between Dec-2019 to Dec-2020. Two radiologists reviewed the chest CT scans of these patients using the checklist that included parameters such as the types of involvement (consolidation/grand-glass/crazy paving, etc.) and the patterns of involvement (central/periph-eral), and the pleural findings. Results: The CT scan was conducted in 107 patients with a typical condition and 11 patients with an atypical form of the disease. The frequency of the typical CT image of COVID-19 in the male group was significantly higher than that in the female group (P=0.004). The frequency of reverse halo sign, septal thicken-ing, cardiomegaly, and crazy paving was significantly higher in males than in females (P≤0.05). Also, there was a significant difference between age groups based on the number of involved lobes (P=0.04). Conclusion: Chest CT scan is an important diagnostic method for COVID 19 with high sensitivity. The parameters in the CT scan are beneficial for the diagnosis of COVID 19. In addition, some characters in CT scans in the male gender are more specific.

7.
Revue Medicale Suisse ; 17(758):1915-1921, 2021.
Article in French | EMBASE | ID: covidwho-1819198

ABSTRACT

The SARS-CoV-2 pandemic has caused an unprecedented global public health crisis. The term long Covid is used to describe diverse and heterogeneous symptoms that persist more than 4 weeks after infection with an estimated incidence of 10-40%, which varies between studies. The principal characteristics of long Covid are fluctuating symptoms of prolonged duration affecting multiple organs, such as fatigue, dyspnea, cough, anosmia, dysgeusia, chest pain, palpitations, headache, myalgia, cognitive and gastrointestinal disorders. Contributing factors, possible pathophysiological explanations and international recommendations can help in the management of the disease in the outpatient setting. Biopsychosocial and multidisciplinary management in primary care medicine is essential.

8.
Klimik Dergisi ; 35(1):14-20, 2022.
Article in Turkish | CAB Abstracts | ID: covidwho-1819127

ABSTRACT

Objective: The study aims to contribute to the literature by sharing the treatment process and results of patients who develop pneumothorax, pneumomediastinum, and subcutaneous emphysema, which are rarely seen in COVID-19 pneumonia, and to reveal the possible high mortality situation.

9.
Journal of Clinical and Diagnostic Research ; 16(4):OC24-OC27, 2022.
Article in English | EMBASE | ID: covidwho-1818677

ABSTRACT

Introduction: The portable Chest Radiograph (CXR) has an indispensable role in large scale screening and diagnosis of Coronavirus Disease 2019 (COVID-19), especially in developing countries with limited resources. It can help in predicting the severity of lung involvement in the patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, especially in areas where the Computed Tomography (CT) is unavailable. Aim: To determine the prognostic value of CXR at clinical presentation in assessing the disease severity and its correlation with inflammatory markers in COVID-19 hospitalised patients. Materials and Methods: This was a single-centre retrospective study, conducted at Sri Ramachandra Institute of Higher Education and Research, from October 2020 to December 2020, on hospitalised COVID-19 patients. Clinically, the patients were categorised as mild, moderate and severe, based on their peripheral oxygen saturation- more than 94%, between 90-93%, and less than or equal to 89%, respectively. Blood samples, drawn at presentation to the hospital tested for various inflammatory markers proven to be predictive of disease severity, were documented for the analysis purpose. The CXRs, done at the presentation, were scored based on the number of zones involved and type of abnormality present (ground glassing, consolidation and septal thickening). The CXRs were scored a minimum '0' to a maximum of '9'. Correlation between the radiograph score and inflammatory markers was further analysed. Results: Among the 456 study patients, 71% had mild, 15% had moderate and 14% had severe COVID-19 infection. The mean CXR score in each category was 1, 3 and 4, respectively (p-value <0.001). The study groups were grouped as mild and non mild (included the moderate and severe categories). A criterion CXR score of 2 was able to differentiate mild and non mild cases (sensitivity was 78.29%, specificity was 77.98%, positive predictive values was 58.38%, negative predictive values was 90.11%), with an accuracy of 78.1%. The inflammatory markers like Neutrophil Lymphocyte Ratio (NLR), Absolute Lymphocyte Counts (ALC), eosinophil%, D-dimer, Lactate Dehydrogenas (LDH), Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), and ferritin showed statistically significant difference between the two groups (p-value<0.001). Conclusion: The CXR can be used as a screening and predictive tool for disease severity in developing countries where access to Computed Tomography (CT) is limited. Given the possibility of subsequent waves of the COVID-19 pandemic and the risk of excessive radiation exposure from CT, CXR may be used as a reliable alternative.

10.
Environmental Health and Toxicology ; 37(1), 2022.
Article in English | EMBASE | ID: covidwho-1818600

ABSTRACT

Sodium hypochlorite is widely used as the main component of cleaners and has an excellent bleaching and sterilizing effect in living and medical environments. In addition to bleaching, it is used for wastewater treatment and for sterilization in food factories, and also for disinfectants during the COVID-19 pandemic. This study analyzed reports of the health effects of sodium hypochlorite and classified them by toxicity along the exposure pathway. Most case reports described the health effects of acute high-concentration exposure, with a common case being dental exposure, mainly during treatment.

11.
Research in Cardiovascular Medicine ; 11(1):6-12, 2022.
Article in English | EMBASE | ID: covidwho-1818466

ABSTRACT

Aim: Despite concerns about cardiovascular implications in coronavirus disease-2019 (COVID-19) patients, not all COVID-19 patients are visited by cardiologists and recommended to perform comprehensive cardiovascular assessments including measurement of biomarkers and echocardiography. We aimed to investigate the reasons for seeking cardiology care and to assess our cardiologists' diagnostic approaches to COVID-19 patients with potential cardiovascular involvement. Methods and Results: In this prospective, observational study, data of all consecutive COVID-19 patients admitted to six designated hospitals for COVID-19 in Iran in whom bedside cardiology consultation was requested were collected. A total of 148 patients including 105 (71%) males were included. The mean age was 57 ± 17 years. The most common reasons for cardiology consultation were dyspnea (56.7%), chest pain (12.8%), and suspected arrhythmias (10.8%). The most common comorbidities were hypertension (40.5%), diabetes mellitus (19.6%), and coronary heart disease (18.9%). A 12-lead electrocardiography (ECG) was obtained in all patients. Point-of-care ultrasonography or limited transthoracic echocardiography (TTE) was performed in 106 (71.6%) patients, and complete TTE was performed in 35 (23.4%) patients. Cardiac troponin was measured in 63 (42.6%) patients, and N-terminal pro B-type natriuretic peptide level was measured in 34 (23%) patients. Overall, 51 (34.5%) patients underwent invasive mechanical ventilation, inotropes were used in 29 (19.6%) patients, and 40 (27%) patients died. Conclusions: While preventing unnecessary investigations, the cardiologists should not overlook the lifesaving role of ubiquitous diagnostic modalities (such as ECG and TTE) in early detection and management of cardiac involvement in COVID-19.

12.
Lung India ; 39(2):191-194, 2022.
Article in English | EMBASE | ID: covidwho-1818451

ABSTRACT

Pulmonary veno-occlusive disease (PVOD) is an important cause of pulmonary arterial hypertension (PAH) and is classified under idiopathic cause of PAH. Over a period of time, PVOD has been studied in detail in the western countries and various diagnostic criteria are formulated. Being a rapidly progressive disease, early diagnosis is of utmost importance which helps to initiate appropriate treatment. Recent studies suggest that PVOD has a genetic predisposition and has an autosomal recessive pattern of inheritance. Here, we discuss the case of siblings diagnosed with PVOD to have such genetic predisposition for this disease.

13.
Tuberculosis and Respiratory Diseases ; 85(2):122-136, 2022.
Article in English | EMBASE | ID: covidwho-1818324

ABSTRACT

Although chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) have distinct clinical features, both diseases may coexist in a patient because they share similar risk factors such as smoking, male sex, and old age. Patients with both emphysema in upper lung fields and diffuse ILD are diagnosed with combined pulmonary fibrosis and emphysema (CPFE), which causes substantial clinical deterioration. Patients with CPFE have higher mortality compared with patients who have COPD alone, but results have been inconclusive compared with patients who have idiopathic pulmonary fibrosis (IPF). Poor prognostic factors for CPFE include exacerbation, lung cancer, and pulmonary hypertension. The presence of interstitial lung abnormalities, which may be an early or mild form of ILD, is notable among patients with COPD, and is associated with poor prognosis. Various theories have been proposed regarding the pathophysiology of CPFE. Biomarker analyses have implied that this pathophysiology may be more closely associated with IPF development, rather than COPD or emphysema. Patients with CPFE should be advised to quit smoking and undergo routine lung function tests, and pulmonary rehabilitation may be helpful. Various pharmacologic agents and surgical approaches may be beneficial in patients with CPFE, but further studies are needed.

14.
Experimental and Therapeutic Medicine ; 23(6), 2022.
Article in English | EMBASE | ID: covidwho-1818258

ABSTRACT

The purpose of the present study was to evaluate the feasibility of applying the advanced lung cancer inflammation index (ALI) in patients with coronavirus disease 2019 (COVID-19) and to establish a combined ALI and radiologic risk prediction model for disease exacerbation. The present study included patients diagnosed with COVID-19 infection in our single institution from March to October 2020. Patients without clinical information and/or chest computed tomography (CT) upon admission were excluded. A radiologist assessed the CT severity score and abnormality on chest radiograph. The combined ALI and radiologic risk prediction model was developed via random forest classification. Among 79 patients (age, 43±19 years;male/female, 45:34), 72 experienced improvement and seven patients experienced exacerbation after admission. Significant differences were observed between the improved and exacerbated groups in the ALI (median, 47.6 vs. 13.2;P=0.011), frequency of chest radiograph abnormality (24.7 vs. 83.3%;P<0.001), and chest CT score (CCTS;median, 1 vs. 9;P<0.001). For the accuracy of predicting exacerbation, the receiver-operating characteristic curve analysis demonstrated an area under the curve of 0.79 and 0.92 for the ALI and CCTS, respectively. The combined ALI and radiologic risk prediction model had a sensitivity of 1.00 and a specificity of 0.81. Overall, ALI alone and CCTS alone modestly predicted the exacerbation of COVID-19, and the combined ALI and radiologic risk prediction model exhibited decent sensitivity and specificity.

15.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816910

ABSTRACT

INTRODUCTION: COVID-19 has been declared as a pandemic by the World Health Organisation (WHO)in December 2019, as it spread globally and confirmed cases approach 5,000 000 patients and will exceed 365000 deaths on the 25 May 2020 across over 160 countries. Cancer patients are one of the most vulnerable groups in the current (COVID-19) pandemic. To date, the clinical characteristics of COVID-19-infected cancer patients remain widely not well understood. Patients and methods A retrospective study was conducted in Royal Wolverhampton NHS Trust for COVID-19 Cancer patients. Hospitalised cancer patients diagnosed with COVID-19 infection were identified between 30th March 2020 to 30th June 2020. Patients already have been diagnosed with cancer and had a laboratory-confirmed SARS-CoV-2 infection were enrolled. Clinical retrospective data were collected from hospital medical records, including demographic features, clinical features, laboratory findings, and chest radiograph and chest computed tomography (CT) images. Statistical analysis was done to assess the risk factors associated with severe events which required admission to an intensive care unit, the use of mechanical ventilation, or death Results Forty Cancer patients with Covid 19 infection during the period from 30th March 2020 to 30th June 2020 were enrolled. (52.6%) 22 of patients were females. Median age was 65 years .All patients were local residents of Wolverhampton. Among the cancer patients, Breast cancer was the most frequent type of cancer (n= 9;21.1%), followed by Gl cancers (n= 8;21%) and lymphoma (n = 6;15.8%).Twenty two patients (52.6%) were diagnosed with stage I-III cancer.18 patients (47.4%) were on active chemotherapy, 3 patients were on target therapy and 3 patients(7.9%) were on active immunotherapy. In addition to cancer, 31 (81.6%) patients had at least one or more coexisting chronic diseases. The most common clinical features on admission were fever (92.1%), dry cough (86.8%), and fatigue (92%);29 (76.3%) patients developed dyspnoea along with lymphopaenia (n = 32, 84.2%), high level C-reactive protein (n = 40, 100%), anaemia (n = 22, 57.9 %), and hypoproteinaemia (n = 21, 55.3%). The common chest computed tomography (CT) findings were ground-glass opacity (n = 13) and patchy consolidation (n= 4) .It is important to note that CT chest not done in 17 patients. A total of 19 patients had severe events and the mortality rate was (44.7%) .Median days of hospital admission was (12.5).It is noted that all patients with active immunotherapy had recovered despite disease progression. Conclusions: Cancer patients have deteriorating conditions and worse outcomes from the COVID-19 infection. It is recommended that cancer patients receiving antitumour therapies should have regular screening for COVID-19 infection and should avoid treatments causing immunosuppression or have dose reduction during COVID-19 Pandemic in second wave .Covid 19 has different response with patients on active immunotherapy need to be highlighted.

16.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816885

ABSTRACT

Introduction: A better understanding of the reality for cancer patients during COVID-19 will help us readapt current predication models. To further inform future clinical guidelines, we need a deep dive into rich data sources from apex Cancer Centres. We report on the outcomes of cancer patients receiving radical surgery between March-September 2020 (as well as 2019) in the European Institute of Oncology (EIO) in Milan and the South East London Cancer Alliance (SELCA). Methods: IEO is one of the largest cancer hospitals in Italy. SELCA includes 3 major hospital trust, treating about 8,000 new cancer patients per annum. Both institutions implemented a COVID-19 minimal pathway, whereby patients were required to shield for 14 days prior to admission and were swabbed for COVID-19 within 3 days of surgery. Positive patients had surgery deferred until a negative swab. Surgical outcomes assessed were: ASA grade, surgery time, theatre time, ICU stay>24h, pneumonia, length of stay (LOS), and admissions. For COVID-19, we focused on infection rate and mortality. Results: At IEO the number of radical surgeries (270 for gynaecological, 339 for head and neck, 377 for thoracic, and 491 for urological cancers) declined by 6% as compared to the same period in 2019 (n=1477 vs 1560). The main decline was observed for thoracic surgery (377 vs 460, i.e. -18%). Age, sex, SES, ethnicity, comorbidities, and performance status were all comparable between both periods (e.g. 58% male, 38% aged 70+, 48% high SES, 15% with existing cardiovascular diseases). Readmissions were required for 39%, and <1% (n=9) developed COVID-19, of which only 1 had severe disease and died. 11 died of other causes during follow-up (1%). At SELCA, the number of radical surgeries (321 for breast, 129 for colorectal, 114 for gynaecological, 152 for head and neck, 92 for liver, 56 for plastics/skin, 305 for thoracic, 72 for upper gastrointestinal, and 312 for urology) declined by 29% (n=1553 vs 2182). Even though a different geographical setting, characteristics were fairly comparable with the IEO: 58% males, 30% aged 70+, 34% high SES, 16% with existing cardiovascular diseases. Readmissions were required for 22%, <1% (n=7) developed COVID-19, and none died from it. 19 died of other causes within 30 days (1%). Conclusion: Milan and London were both at the epicentre of the first COVID-19 wave. Whilst a decline in number of surgeries was observed, the implemented COVID-19 minimal pathways have shown to be safe for cancer patients requiring radical treatment, with limited complications and almost no COVID-19 infections.

17.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816877

ABSTRACT

Introduction: The Coronavirus has spread across the globe and infected millions of people, having devastating effect on the global public health and economies. A fast diagnostic system should be implemented to mitigate the impact of the virus and save lives. In this study, we propose a decision tree-based ensemble model using two mixtures of discriminative experts (MoE) to classify COVID-19 and non-COVID-19 lung infections on chest X-ray images. The Epistocracy algorithm, a hyper-heuristic evolutionary method, is employed to optimize the neural networks used in this work. Using this approach can help detect COVID-19 cases and accelerate treatment of those who need it the most. Data: we collected 2,500 chest X-ray images from Henry Ford Health System consisting of 1,250 Covid images and 1,250 non-Covid images. The input images have been cropped and resized to 224 by 224 pixels. Out of 2,500 images, we left out 500 images containing 250 Covid and 250 non-Covid for testing. The rest, 2,000 images, were used 80% for training and 20% for validation. Methods and Results: To improve the accuracy of the proposed model, first we divided our 2,000 images into 5 different clusters using K-Means clustering algorithm with VGG16 feature extractor to help build strong discriminative expert models to be used in our proposed classifier. We trained VGG16, VGG19, InceptionV3, InceptionResNetV2, MobileNetV2, EfficientNetB7, Xception, and DenseNet201 to classify each cluster into Covid and non-Covid cases. The best result was obtained from VGG16 as a base model with a deep neural network as a head model optimized by Epistocracy algorithm. Then we built a mixture of transfer learning-based experts consisting of 5 different VGG16 models supervised by InceptionV3 as a gating network. Finally, we built a decision tree-based ensemble model to determine the classification of the data using two different MoEs with highest accuracies. As a result, for initial clusters c1, c2, c3, c4, and c5 we obtained validation accuracy of 92.50%, 86.30%, 86.51%, 85.34%, and 93.62% respectively. The first MoE had 93.75% accuracy on validation, and the second MoE had 94.25%. The final ensemble model on average obtained 94% accuracy on the testing dataset. More specifically, we got 96% accuracy on Covid images and 92% accuracy on non-Covid. Conclusion: we showed that an ensemble model consisting of two mixtures of cluster-based discriminative convolutional neural network experts can be used to detect Covid from non-Covid with high accuracy, and Epistocracy algorithm can be effectively used to optimize the hyper-parameters of the proposed models.

18.
Case Reports in Cardiology ; 2022, 2022.
Article in English | EMBASE | ID: covidwho-1816872

ABSTRACT

Background. Currently, the literature regarding the management of COVID-19 induced cardiomyopathy with reduced ejection fraction is limited. In this case report, we present the first documented case of COVID-19 induced myocardial stunning leading to severely reduced LV systolic function that was reversed by the administration of corticosteroids and tocilizumab. Case Summary. A 39-year-old female with well controlled systemic hypertension, tested positive for SARS-CoV-2 RNA and underwent self-isolation for 14 days. Patient presented to our facility a month later with one-week history of progressively worsening generalized body aches, chills, fever, watery diarrhea, nausea with associated mild dry nonproductive cough, shortness of breath and nonspecific chest pain. Initial labs demonstrated that she was COVID-19 positive, elevated troponin (4.295 ng/ml), and elevated BNP (2,291 pg/ml). Her initial Transthoracic echocardiography demonstrated an Left ventricular ejection fraction (LVEF) of 20-25% with apical akinesis. After administration of tocilizumab and corticosteroids, patient demonstrated interval improvement with LVEF improving to 50-55% within days. Her labs confirmed these findings with improved troponin (0.858 ng/ml) and BNP (209 pg/ml). Discussion. This case demonstrates that it can be safe and efficacious to use tocilizumab and corticosteroids in patients with COVID-19 induced cardiomyopathy. These finding suggest that cytokine storm is the predominant mechanism by which COVID-19 induced cardiomyopathy occurs. Additional studies are required to determine the role of corticosteroids and tocilizumab in management of this condition.

19.
Wound Repair and Regeneration ; 30(2):A56-A57, 2022.
Article in English | EMBASE | ID: covidwho-1816664

ABSTRACT

Background: Antiviral and anti-inflammatory activity of a unique solution of Ag released from Acticoat was tested in standard lab and animal models. Clinical effects of nebulized inhalation of the Ag solution in ventilated patients with MDR bacterial pneumonia, TENS, and COVID-19 were assessed. Methods: Ag release kinetics was determined using integration of absorption spectra at 350-650 nm. Inactivation of hHSV1 and SARSCoV- 2 by the Ag solution, colloidal silver, or stable silver nanoparticles was assessed using the ASTM E1052-20 protocol for antiviral testing of agents in solution. Rat lungs infected for 24 hours with Pseudomonas aeruginosa were treated with lavage of silver solution, tobramycin, or water, and rat survival and lung histology were assessed at 48 hours. Anti-inflammatory activity of the Ag solution was assessed using a pig contact dermatitis model. Eight patients, six with burn wounds who developed MDR pneumonia, one with burns who developed COVID-19, and one with TENS, all of whom were placed on ventilators, were treated with nebulized inhalation of the Ag solution and clinical parameters were measured. Results: Silver species (Ag0, Ag+, Ag3+) were rapidly released from the nanocrystalline silver dressing into distilled water at RT, reaching 50% saturation at 24 hours and 90% saturation at 48 hours with a concentration of γ400 mg/mL. The Ag solution inactivated hHSV1 by 4-logs and 5-logs at 4 and 24 hours, and inactivated 1-log and 6-logs of SARS-CoV-2 after 4 and 24 hours, respectively. Neither a colloidal silver product nor a stable Ag nanoparticle product inactivated hHSV1 or SARS-Cov-2 viruses. Lavage of infected rat lungs with the Ag solution prevented death and preserved normal lung tissue histology. Silver nitrate or tobramycin treatments did not prevent death, and massive inflammation and lung tissue destruction was observed histologically. The Ag solution was highly anti-inflammatory in the pig contact dermatitis model. Nebulized inhalation of the Ag solution via ventilator rapidly reversed clinical parameters in all six patients with MDR pneumonia, in the TENS patient, and the COVID-19-infected burn patient. Chest x-rays showed no evidence of silver deposits in lung tissues of any treated patients. Conclusions: Nebulized inhalation of a unique solution of Ag species released from the nanocrystalline silver wound dressing appears to be a highly effective new treatment for patients with MDR pneumonia, TENS, and COVID-19 due to its unique triple combination of antimicrobial, anti-inflammatory, and anti-viral actions.

20.
Respirology ; 27(SUPPL 1):154, 2022.
Article in English | EMBASE | ID: covidwho-1816642

ABSTRACT

Introduction/Aim: NBH is a new hospital with a public/private partnership without an established pleural disease management pathway for malignant effusion. A new outpatient model of management of IPC was established in January 2021 and we aim to assess the success of the new outpatient model indwelling pleural catheter(IPC) insertion pathway. Methods: The NBH outpatient pleural service started in Jan 2021. Initial IPC's insertions were carried on the ward with overnight hospital stay to educate the nursing staff and establish the outpatient pathways. Alternatively, for outpatients, insertions were performed in the procedure room and discharged following two-hour of clinical monitoring and a Chest X-Ray. Drainage bottles were funded either by the private health funds or arrangement with the hospital for public patients. The drainage in the community was carried out by Northern Sydney North Home Nursing Service with follow up the day after the procedure. All patients had threetimes a week drainage to start with followed by review at four weeks at the pleural clinic and decided on need for talc pleurodesis. If auto-pleurodesis was achieved the IPC was removed. Results: Between January - September 2021, 14 IPC inserted in our service ( Service was suspended for 3 months during COVID lock down period ). Nine patients had autopleurodeses by 4 weeks and IPC removed. Two died whilst the IPC is in-situ. Two had ongoing effusion past 4 weeks and it was changed to symptomatic drainage. Two patients had talc insertion via the IPC. Two had IPC after surgical (VATS) pleurodesis. None of the patients returned to the hospital following insertion of IPC for a pleural effusion related issue. No infections were reported. One accidental dislodgement of the IPC reported. Ward nursing staff had an education session 30mins after the first 3 insertions and refresher anytime an insertion is performed in the ward. Procedure room nurses were educated by the advance trainee. Over 80% patients were privately insured. Conclusion: The new outpatient model of IPC insertion in a new hospital with a public/private model was successful with auto-pleurodesis rate at high level and infection rates were low. The model was successful as majority of patients were privately insured and the hospital had to bear a minimal cost. The Northern Sydney North Home Nursing Service was vital to the success of the programme.

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