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Coronavirus disease 2019 (COVID-19) is an acute infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The first case of COVID-19 was identi-fied in Wuhan, China, and quickly spread to the world, resulting in the COVID-19 pandemic more than three years ago. The incubation pe-riod varies from 2-14 days. People who are either immunocompromised due to a medical condition or by medications or treatments are more likely to be sick with COVID-19 for longer periods when compared to immunocompetent people. We report a case of an 83-year-old gentleman who has reported a positive reverse transcription polymerase chain reaction (RT-PCR) test for COVID-19 for 360 days. He had been hospitalized six times since the onset of symptoms in Feb-ruary 2022. He had a history of melanoma and non-Hodgkin's lymphoma.Copyright © 2023, The Indonesian Foundation of Critical Care Medicine. All rights reserved.
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Penicilliosis is a fungal infection caused by the fungus Penicillium marneffei or Talaromyces marneffei . Penicillosis is commonly seen in immunocompromised patients such as in HIV(AIDS). Herein, we present a case of penicilliosis in an oral cavity cancer patient who was admitted for the management of SARS-CoV-2 infection at our hospital. A 50-year-old male patient operated on for squamous cell carcinoma of the oral cavity who completed his adjuvant chemoradiation 2 months ago, presented to our hospital with dry cough for more than 3 weeks. His nasopharyngeal swab was positive for the severe acute respiratory distress syndrome (SARS-CoV-2). During his hospital stay for SARS-CoV-2 infection, he was diagnosed with disseminated penicilliosis. The patient was treated with intravenous antifungals caspofungin and voriconazole. However, he succumbed to disseminated fungal sepsis. This case highlights the need to consider penicilliosis as a possible opportunistic pathogen, especially in immunocompromised patients such as cancer.
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Coronaviruses constitute a family of viruses that gives rise to respiratory diseases. COVID-19 is an infectious disease caused by a newly discovered coronavirus also termed Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As COVID-19 is highly contagious, early diagnosis of COVID-19 is crucial for an effective treatment strategy. However, the reverse transcription-polymerase chain reaction (RT-PCR) test which is considered to be a gold standard in the diagnosis of COVID-19 suffers from a high false-negative rate. Therefore, the research community is exploring alternative diagnostic mechanisms. Chest X-ray (CXR) image analysis has emerged as a feasible and effective diagnostic technique towards this objective. In this work, we propose the COVID-19 classification problem as a three-class classification problem to distinguish between COVID-19, normal, and pneumonia classes. We propose a three-stage framework, named COV-ELM based on extreme learning machine (ELM). Our dataset comprises CXR images in a frontal view, namely Posteroanterior (PA) and Erect anteroposterior (AP). Stage one deals with preprocessing and transformation while stage two deals with feature extraction. These extracted features are passed as an input to the ELM at the third stage, resulting in the identification of COVID-19. The choice of ELM in this work has been motivated by its faster convergence, better generalization capability, and shorter training time in comparison to the conventional gradient-based learning algorithms. As bigger and diverse datasets become available, ELM can be quickly retrained as compared to its gradient-based competitor models. We use 10-fold cross-validation to evaluate the results of COV-ELM. The proposed model achieved a macro average F1-score of 0.95 and the overall sensitivity of 0.94 +/- 0.02 at a 95% confidence interval. When compared to state-of-the-art machine learning algorithms, the COV-ELM is found to outperform its competitors in this three-class classification scenario. Further, LIME has been integrated with the proposed COV-ELM model to generate annotated CXR images. The annotations are based on the superpixels that have contributed to distinguish between the different classes. It was observed that the superpixels correspond to the regions of the human lungs that are clinically observed in COVID-19 and Pneumonia cases.
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Introduction: There is increased scrutiny on cardiac screening of competitive athletes after COVID19 illness, and cardiac magnetic resonance (CMR) is frequently undertaken. Limited reports with echocardiography-based strain techniques suggest occult abnormalities in collegiate athletes after COVID-19. Cardiac involvement in the adolescent athlete has not been well characterized. The purpose of this study is to describe CMR findings, including strain encoded (SENC) imaging, in adolescent athletes after COVID-19 (C19+AA). Methods: Retrospective review was performed of ambulatory C19+AA patients who underwent CMR (Group A). Healthy athletes (Group B) and nonathlete healthy controls (Group C) underwent CMR with SENC for comparison. Myocardial strain was evaluated by MyoStrain (Myocardial Solutions, Morrisville, NC). LV global (GLS) and regional strain (from modified AHA-16 segment model) were compared between the three groups with abnormal defined as magnitude <17 and statistical significance set at p < 0.05. Results: Group A patients were younger (n = 87, 52% male, age 15.4±1.8 yrs) than Group B (n = 19, 63% male, age 21.3±1.6 yrs) and Group C (n = 9, 52.6% male, age 19.3±1.1 yrs) with no difference in LVEF between the three groups (Group A = 59.1±3.9%, Group B = 60.3±6.2%, Group C = 61.0±4.1%). Despite preserved global function, Group A had significantly lower GLS (-17.6±2.3% vs Group B =-20.8±1.4%, p <0.04 and Group C =-19.1±2.4%, p = 0.02) with no difference between the latter groups (p = 0.07). Higher numbers of abnormal segments were observed in Group A (6.9±3.7, 43.1%) vs Group B (2.4±1.9, p < 0.0001) and Group C (3.7±3.5, p < 0.0001) with no difference between the latter groups (p = 0.1). Conclusions: Global and regional strain abnormalities were common in C19+AA in the setting of normal LVEF. This may represent occult myocardial abnormalities in adolescents after COVID-19. Future longitudinal studies with age matched controls are needed to monitor for progression.
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Introduction: Myocarditis is an important cause of sudden cardiac death in competitive athletes. There have been reports of myocardial inflammation on cardiovascular magnetic resonance (CMR) in athlete and nonathlete populations after SARS-CoV-2 infection;however, their clinical and functional significance is not known. We sought to investigate the relationship between left ventricular (LV) strain and other CMR markers suggestive of myocardial inflammation or fibrosis. Hypothesis: Reduced myocardial strain is associated with the presence of CMR abnormalities suggestive of inflammation, fibrosis, or necrosis in athletes recovering from SARS-CoV-2 infection. Methods: Collegiate athletes (N = 123) underwent a comprehensive CMR exam including strain encoded (SENC) imaging. We analyzed LV global longitudinal strain (GLS) across five groups defined by the presence or absence of late gadolinium enhancement (LGE), and T1 or T2 abnormalities. Myocarditis diagnosis on CMR required both abnormal T1 or LGE, and abnormal T2, in the same LV segment. Results: We enrolled 11 COVID negative control athletes (Group 1). Among COVID positive athletes, 42 had no abnormalities on CMR (Group 2), 31 had isolated right ventricular insertion point (RVIP) LGE (Group 3), 28 had LGE beyond RVIP (Group 4), and 11 athletes had myocarditis (Group 5). GLS was significantly lower in Groups 3, 4, and 5 compared with negative controls (p<0.05, Figure 1). There was a deterioration in GLS as CMR abnormalities progressed from control athletes to those with LGE and myocarditis. There was no significant difference in LV ejection fraction between the 5 groups. Conclusions: In conclusion, SARS-CoV-2 infection in collegiate athletes leads to subtle abnormalities in cardiac function detected by GLS that correlate with abnormal mapping and LGE suggestive of myocardial inflammation and fibrosis. The clinical significance of these abnormalities remains to be determined.
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Introduction: Preexisting endothelial dysfunction and effects of selective pulmonary vasodilator therapy are postulated to prevent vascular remodeling and decrease morbidity and mortality in pulmonary arterial hypertension (PAH) patients with COVID-19. However, research on outcomes in PAH patients with COVID-19 is limited. We studied morbidity and mortality from COVID-19 in a tertiary PAH referral center. Methods: Of 596 clinic patients on at least one PAH specific medication, 27 patients were diagnosed with COVID-19 between March 2020 and January 2021. Retrospectively evaluated outcomes included mortality, hospitalization, intensive care unit admission (ICU), mechanical ventilation (MV), extracorporeal membrane oxygenation (ECMO), lung transplant, and hospital readmission within 30 days. Results: Of 27 PAH patients with COVID-19 (mean age=60 years;74% female;96% non-Hispanic;74% White), 15 (56%) were hospitalized, 7 (26%) died, and 1 (4%) underwent ECMO followed by lung transplant. Hospitalized patients, compared to non-hospitalized patients, had higher mean age (64 vs 56 years), number of patients on IV prostacyclin (20% vs 0%), mean REVEAL 2.0 score (8.4 vs 6.5), and moderate-severe RV dysfunction (6, 40% vs 3, 25%). There was no difference in NYHA FC and mean pulmonary arterial pressure (45 mm Hg vs 43.7 mm Hg) between hospitalized and non-hospitalized patients. Complications during hospitalization included worsened hypoxemia (13, 87%), cardiac ischemia (4, 15%), new or worsening arrhythmias (3, 11%), and acute kidney injury (AKI) (6, 22%). Four patients (27%) required ICU admission and MV. Of these, 2 (50%) had new or worsening arrhythmias and all 4 (100%) had AKI. Of 15 patients hospitalized, 5 (19%) were readmitted to the hospital within 30 days. The 7 patients who died during hospitalization, compared to 8 who survived, had increased rates of ICU admission and MV (43% vs 12.5%) and higher REVEAL 2.0 scores (10.1 vs 6.9). Conclusion: COVID-19 in hospitalized PAH patients was associated with high rates of multi-organ complications, mortality, ICU admission, and hospital re-admission. Advanced age, IV prostacyclin therapy, higher REVEAL score, moderate to severe RV dysfunction, and AKI were associated with adverse outcomes.
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Introduction & Objective: The COVID-19 pandemic brought significant challenges to all healthcare systems around the world. We studied its impact on our supra-regional ESWL service. Methods: Patients who received ESWL using our onsite lithotripter (Storz Modulith SLX-F2) during the initial National Lockdown (NL) period were compared with those treated over a similar time period in 2019. Patients with renal calculi were excluded for direct comparison as only a small number of patients with renal calculi were treated during NL. As the supraregional centre, we continued to provide acute treatment during NL albeit with restricted access due to staff redeployment, and within safety restrictions, and continued to receive patients from other network centres. Results: 25 patients with ureteric calculi treated in 2019 were compared with 23 patients treated during NL. The mean ages were 56.6 VS 50.0 (2019 VS NL). The mean time to treat were 20.9 VS 19.4 days (2019 VS NL). Two patients' 2nd treatment got delayed during NL. Treatment outcomes are outlined in table 1. The mean residual stone sizes were 4.9mm VS 5.7mm (2019 VS NL). In 2019, complication rate was 16.0% with the commonest being pain (75.0%) when compared to 21.7% during NL (80% pain). Steinstrasse were not seen in either group. One patient treated during NL sustained a moderate peri-renal haematoma managed conservatively. Treatment parameters such as number of shocks delivered and screening time were equivalent between groups. Conclusions: COVID-19 led to pressures on health services and also patients changed their patterns of presentation. Restricted access to the operating theatre made use of non-invasive treatments an essential part of patient management during the lockdown period. We show equivalent outcomes to normal practicedespite treating larger and potentially more challenging stones, with few complications and while minimising COVID- 19-related risks to the patient. (Table Presented).
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Background: Coronavirus Disease 2019 (COVID-19) poses many workflow challenges for healthcare systems. Elective cardiovascular magnetic resonance (CMR) exams were postponed until safety protocols were instituted. Since reopening, imaging labs are managing COVID-19 safety triaging, exam backlog, and increased referrals, thus innovative solutions for process improvement are needed. Purpose: An accelerated compressed sensing (CS) real-time (RT) technique offers dynamic cardiac imaging with high spatial and temporal resolution without image degradation. We sought to evaluate the efficiency of a rapid RT CMR protocol with a goal to decrease scan time without compromising study quality and comprehensiveness. Methods: We retrospectively evaluated 219 CMRs (Siemens Magnetom Sola 1.5T) performed 09/01/2020-10/15/2020. After excluding 81 exams due to heterogeneous protocols (Figure 1), we analyzed 138 CMR exams using standard cardiomyopathy or myocarditis protocols. CMR studies utilized either a rapid RT short axis (SAX) cine (spatial resolution of 2.5 mm2 or better and temporal resolution of 55 ms or better) or standard breath-held (BH) SAX cine protocol (Figure 2). Protocols were chosen by the interpreting physician. Previous internal quality control demonstrated similar volumetric quantification between RT and BH SAX cines. RT cines were reconstructed inline using a CS-based method. We analyzed the length of time needed to complete each protocol and the number of series performed. Statistical analysis included student t-test with p value <0.05 considered significant. Results: of 138 analyzed CMR exams, there were 23 rapid protocols and 115 standard protocols performed. The mean image acquisition time for the rapid protocol was significantly shorter at 26 ± 6 minutes (range 18-44 min) vs 33 ± 6 minutes (range 22-49 min) for the standard protocol, p < 0.001. This represents a mean relative reduction in scan time of 21%. More time was saved in rapid myocarditis (scan time 25 ± 6 min vs 34 ± 6 min, p = 0.01;relative time reduction 26%) vs rapid cardiomyopathy protocols (scan time 27 ± 6 min vs 31 ± 6 min, p = 0.04;relative time reduction 13%). There was no significant difference in the number of series performed (62 ± 14 series in rapid vs 67 ± 11 series in standard protocols, p = 0.09). T1 and T2 maps constituted the same percentage of acquired images regardless of protocol used (T1 maps 1.8% vs 1.7% for cardiomyopathy, 1.4% vs 1.4% for myocarditis in standard vs rapid protocols respectively;T2 maps 1.8% vs 1.7% for cardiomyopathy, 5.6% vs 5.8% for myocarditis in standard vs rapid protocols respectively). Conclusions: A rapid CMR protocol utilizing a CS-based RT imaging is significantly shorter as compared to the standard protocol with adequate diagnostic quality. Rapid CMR protocols are an effective tool for process improvement during the COVID-19 pandemic.
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AIMS: It is imperative to understand the risks of operating on urgent cases during the COVID-19 (SARS-Cov-2 virus) pandemic for clinical decision-making and medical resource planning. The primary aim was to determine the mortality risk and associated variables when operating on urgent cases during the COVID-19 pandemic. The secondary objective was to assess differences in the outcome of patients treated between sites treating COVID-19 and a separate surgical site. METHODS: The primary outcome measure was 30-day mortality. Secondary measures included complications of surgery, COVID-19 infection, and length of stay. Multiple variables were assessed for their contribution to the 30-day mortality. In total, 433 patients were included with a mean age of 65 years; 45% were male, and 90% were Caucasian. RESULTS: Overall mortality was 7.6% for all patients and 15.9% for femoral neck fractures. The mortality rate increased from 7.5% to 44.2% in patients with fracture neck of femur and a COVID-19 infection. The COVID-19 rate in the 30-day postoperative period was 11%. COVID-19 infection, age, and Charlson Comorbidity Index were independent risk factor for mortality. CONCLUSION: There was a significant risk of contracting COVID-19 due to being admitted to hospital. Using a site which was not treating COVID-19 respiratory patients for surgery did not identify a difference with respect to mortality, nosocomial COVID-19 infection, or length of stay. The COVID-19 pandemic significantly increases perioperative mortality risk in patients with fractured neck of femora but patients with other injuries were not at increased risk. Cite this article: Bone Jt Open 2021;2(5):330-336.
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The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) virus has emerged as public health emergency affecting 206 countries worldwide. India is second highest currently worst effected by Covid 19 pandemic with close to 12.6 million cases and 1.6K deaths reported till date. Maharahstra is the highest Covid-19 burden state in India reporting quarter of overall cases. The city of Nagpur, in Maharashtra state, ranks 4th in terms of reported COVID-19 cases, with 2.5 lakh incidences and more than 4,000 deaths As the transmission rate of COVID-19 is high, it is imperative to study its disease epidemiology in regions of high endemicity to bolster our understanding of its spread, transmission dynamics and contact tracing to undertake appropriate public health control measures.. The present study was undertaken to study the incidence and trend of COVID-19 infection from various zonal regions of Nagpur city, using real time PCR (RT PCR). A retrospective study was carried out at Indian Council of Medical Research (ICMR) approved private molecular diagnostic laboratory in Nagpur from period of 4th May 2020 to 14th November 2020. A total of 51,532 samples collected from various zonal regions of the city during the study period were processed for SARS CoV-2 RT-PCR. Patient information was collected using a pre-defined study proforma which included demographic details such as name, age, gender, address, along with other information, like details of sample collected, kits used and date of sample collected and processed. The study reports an overall Covid-19 positivity of 34% in Nagpur region. The zone wise distribution of positive cases indicated high rate of COVID-19 in endemic regions of Nagpur such as Satranjipura (49%), Ashi nagar (44%), Gandhibagh (43%) & Lakadganj (43%). Rates of infection were high in economically productive age group (21-40) with males being more vulnerable than females. The result of present epidemiology study highlights important data with respect to regions of endemicity within Nagpur city zones. The present data has high public health importance and will be useful for local civic bodies and other community stake holders to undertake appropriate control measures in future epidemic waves of Covid 19. Interestingly, the Government's reduction in testing rates has been helpful in increasing testing per day. The authorization of private laboratories has also increased testing.