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Background: COVID-19 has a significant biopsychosocial impact on the lives of people who are infected, with the stigma associated with the illness being one of the major issues. However, the level of stigma based on demographics, gender differences, hospital-based or home-based care is yet to be explored. Hence, this study aimed to infer the level of stigma between these groups in the urban district of south India. Materials and Methods: This cross-sectional study recruited 50 participants who were recently infected with COVID-19 and were receiving either hospital or home-based care. The stigma was assessed using a standardized questionnaire which has four domains. MannWhitney U test was conducted to analyze the data. Results: Median age is 54 years and the majority of the participants are male (74%). The mean score of enacted stigma subscale was 4.48, disclosure fear was 2.34, internalized stigma was 2.82, perceived externalized stigma was 7.32 and the total stigma mean score was 17. The perceived externalized stigma subscale was higher in males (7.57 ± 5.96) when compared to females 6.62 ± 5.53. Total stigma scores were higher for males 17.2 ± 10.1 when compared to females 16.2 ± 10.5. The total stigma score was more (17 ± 10.3) among home isolated COVID patients as compared to hospitalized patients (16.9 ± 10.2). Conclusion: Increased levels of stigma among COVID-19 patients have various important psychosocial implications. This study highlights the need for larger prospective cohort studies to further understand stigma in the context of COVID-19. © 2022 by the Author(s).
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Introduction: Bipolar affective disorder (BPAD) is a severe mental illness causing significant problems in the lives of individuals with the disorder and those who care for them as well are. Most of the time people with mental illness are taken care of by mental health professionals, while little priority is given to their caregivers. There are numerous studies in India attempting to understand the impact of illness on caregivers and the problems faced by the caregivers of persons with BPAD. Methods: The study aimed to assess the family caregivers' stress and burden among caregivers of persons with BPAD at a tertiary care center in Dharwad, India. Descriptive research design and simple random sampling was used for recruiting 50 samples. Apart from sociodemographic schedule, burden assessment scale and perceived stress scale (PSS) were used for data collection. Results: The mean age of caregivers was 44.76 years. The average duration of illness of the patients was 9.80 years and their mean annual income was 35,500 rupees reported in the study. The mean score of impact of wellbeing subscale was higher (11.34) when compared with other sub scales of the burden assessment scale, and the overall score of burden assessment scale (31.82) indicated high levels of burden. PSS mean was 21.44, indicating high stress levels. Conclusion: The study concludes that burden and perceived stress were elevated among the caregivers of people with BPAD during the COVID-19 pandemic.
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Introduction: The COVID-19 pandemic has affected the health services globally. The impact on the provision of vascular access services for patients with chronic kidney disease is not known. One can speculate that reduced hospital bed capacity, limited elective theatre lists, and the shielding requirement for vulnerable patients in this particular group will have an adverse effect. This study was conducted to evaluate the effect of the COVID-19 pandemic on dialysis access procedures performed at a tertiary care centre. Methods: This was a single centre, retrospective, observational study of all dialysis access procedures performed between January 2019 and December 2020. Patient data were collected from electronic patient records, operation theatre databases, and clinical case records. Vascular access procedures were categorised according to the site and type of dialysis access (autogenous/non-autogenous fistulas) and secondary access procedures. Secondary access procedures were those that dealt with complications of vascular access. Peritoneal access procedures were also included in the data. Placement of acute and long term dialysis catheter lines were excluded. Pre-COVID data from 2019 were compared with the 2020 data. Statistical methods for data analysis were performed using SPSS version 23.0 by applying Pearson’s chi square test for variables to measure the significance of outcome. Results: A total of 271 dialysis access related procedures were performed in 2019 versus 212 in 2020. There was a significant drop of 21.7% in the total number of dialysis access procedures during the COVID-19 pandemic in the year 2020 (p <.05). In the pre-COVID era, 162 (59.8%) procedures were the formation of autogenous arteriovenous fistulas. The case mix consisted of 69 (25.5%) radiocephalic fistulas, 70 (25.8%) brachiocephalic fistulas, 13 (4.8%) first stage basilic vein transpositions, and 10 (3.7%) second stage basilic vein transpositions. In comparison, during the year 2020, 118 (55.7%) procedures were autogenous arteriovenous fistulas. The case mix included 54 (25.5%) radiocephalic fistulas and a similar proportion of brachiocephalic fistulas (n = 54 [25.5%]), six (2.8%) first stage basilic vein transpositions, and four (1.9%) second stage basilic vein transpositions. There were 14 (5.2%) non-autogenous arteriovenous graft formations in 2019 versus 21 (9.9%) in 2020 (p <.05). There were 53 (19.5%) secondary vascular access procedures in 2019 versus 30 (14.1%) in 2020 (p <.05). The proportion of peritoneal dialysis catheter placements, repositioning, and catheter exchanges increased slightly. Forty-two (15.5%) procedures were done in 2019 versus 43 (20.3%) in 2020. The proportion of new peritoneal catheters was significantly higher in the year 2020 (p <.05). There were 35 (12.9%) new peritoneal dialysis catheter placements (nine laparoscopic/26 open insertions) in 2019, whereas in 2020 there were 38 (17.9%) n (one laparoscopic, 31 open and five percutaneous). There were no laparoscopic peritoneal dialysis catheter placements after the start of the pandemic. Conclusion: During the COVID-19 pandemic, there was a significant reduction in the total number of vascular access procedures performed and also secondary surgical interventions, but an increase in the use of arteriovenous grafts. The number of new peritoneal dialysis access increased despite overall reduction in the total number of procedures. Percutaneous peritoneal tube insertion technique was introduced during the pandemic to reduce hospital admissions while laparoscopic techniques were abandoned.
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Background: The COVID-19 is a viral communicable disease and the World Health Organization declared it as a public health emergency of international concern. This pandemic has challenged the entire world including India's health-care system and resources. It is a devastating recurrence in people with underlying health issues or comorbidities, eventually resulting in mortality. Comorbidities including both medical and psychological disorders among COVID patients have a large amount of impact on the individual's mental health as well as functioning. Materials and Methods: The study comprised 800 hospitalized COVID-19 patients during the first wave from North Karnataka region in India. The data were collected using a structured interview schedule through hospital telephones. The ethical approval was obtained from the Institute Research Ethics Committee. Results: The mean age of the hospitalized COVID patients was 41.02 ± 15.21, and the mean age of comorbidity was 47.69 ± 14.84. Following medical comorbidities such as diabetes (9.3%), hypertension (9.3%), cancer (1.8%), diabetes + hypertension (2.1%), and asthma (0.9%) and psychological comorbidities such as anxiety (3.8%) and depression (3.3%) were found among the hospitalized COVID patients during the first wave. Conclusions: It can be observed that comorbidity may increase the risk of death among COVID patients who were hospitalized and appropriate medical and psychological interventions can be provided for various co comorbidities at the earliest to prevent further defuncting and distress caused by the pandemic. © 2021 Archives of Mental Health.
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Multi-agent reinforcement learning (MARL) consists of large number of artificial intelligence-based agents interacting with each other in the same environment, often collaborating towards a common end goal. In single-agent reinforcement learning system the change in the environment is only due to the actions of a particular agent. In contrast, a multi-agent environment is subject to the actions of all the agents involved. Multiagent systems can be deployed in various applications like stock trading to maximize profits in stock market, control and coordination of a swarm of robots, modeling of epidemics, autonomous vehicle and traffic control, smart grids and self-healing networks. It is not possible to solve these complex tasks with a pre-programmed single agent. Instead, the many agents should be trained to automatically search for a solution through reinforcement learning (RL) based algorithms. In general, arriving at a decision in a multi-agent system is almost close to impossible due to exponential increase of problem size with an increase in the number of agents. In this paper, multi-agent systems using Deep Reinforcement Learning (DRL) is explored with a possible application in modeling of epidemics. Different stochastic environments are considered, and various multi-agent policies are implemented using DRL. The performance of various MARL algorithms was evaluated against single agent RL algorithms under different environments. MARL agents were able to learn much faster compared to single RL agents with a more stable training phase. Mean Field Q-Learning was able to scale and perform much better even in the situation of hundreds of agents in the environment and is a sure candidate to model and predict the epidemics, in the existing frightening dangerous situation of corona pandemic. © 2021 IEEE.
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Purpose: We characterized the outcomes of COVID-19 in our population of solid organ transplant recipients (SOTRs). Since these individuals are immunocompromised, with multiple comorbidities, we hypothesized that they would be at increased risk of COVID-19 related complications and manifest delayed viral clearance. Methods: A single-center retrospective chart review was conducted of all COVID-19 positive SOTRs in our hospital system from March to November 2020. Variables of interest included demographic data, clinical course, virologic assays, clinical suspicion for graft dysfunction, and biopsy results. Re-admissions within 60 days of discharge were recorded, as were persisting positive SARS-CoV2 PCR tests >4 weeks from initial diagnosis. Results: We identified 60 SOTRs who tested positive for COVID-19 by nasopharyngeal swab PCR. This included 40 renal, 17 liver, and 9 heart, lung, pancreas, or small bowel transplant recipients (“other”). 7 patients had received dual organs. 66.6% were men and 63% African American. The most common comorbidities were hypertension (88%), chronic kidney disease as defined by an abnormal Cr (68%), diabetes (50%), and obesity defined by BMI >30 (33%). Forty patients required hospitalization, with a median 6.5-day length of stay. 15 were admitted to an ICU, including 8 who required mechanical ventilation and 3 who required oxygen via high flow nasal cannula. Other outcomes are summarized in the Table. The readmission rate was high, and a 9.3% mortality rate was found in non-liver transplant recipients. In general, immunosuppression management consisted of antimetabolite and calcineurin inhibitor dose reduction. However, graft rejection was not proven on biopsy, despite being suspected in 3 cases (2 kidney, 1 liver). Conclusions: COVID-19 in SOTRs results in higher rates of hospitalization, ICU admission, and death, as compared to reported outcomes in the general population. Our series showed clinical variability depending on type of organ transplant, with worse outcomes in non-liver transplant recipients. As we move toward the approval and distribution of effective vaccines, it is important to recognize that SOTRs represent a group that is particularly vulnerable to this virus, and would benefit from early access to preventive strategies.
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Introduction: The novel coronavirus SARS-CoV-2 has ravaged the United States and transformed the way medical care is delivered. As specialists in upper airway anatomy, otolaryngology (ENT) services may be called upon to manage various head-and-neck complaints for patients with COVID-19. While ear, nose, and throat (ENT) consults may benefit critically ill patients, they also expose physicians to the transmission of COVID-19. We sought to identify the reasons for ENT intervention and examine trends in testing through the pandemic. Method: Records for all ENT consults from May 1 to September 29, 2020, were retrospectively reviewed. Demographic information, admission diagnoses, length of stay, COVID status, and ENT interventions were recorded. Univariate analysis was performed. Results: Of 1343 distinct consults, 965 (72%) were tested for COVID-19, with 62 (4.6%) positive. In May 200 (70%) of 287 consults were tested with 2 (0.7%) positive, while in September, 251 (78.5%) of 320 consults were tested with 22 (6.9%) positive. The most common ENT consultation for COVID-positive patients was nasal and oropharyngeal bleeding (n = 19, 30.6%), followed by facial trauma (n = 15, 24.2%). Other reasons included respiratory distress, tracheostomy, and foreign body (retained COVID swab). Of 96 interventions for patients with COVID-19, 49 (51%) were for management of bleeding, 24 (25%) were for upper airway evaluation (UAE), and 8 (8.3%) were for tracheostomy or trach management. Conclusion: Although patients with COVID-19 necessitated various otolaryngologic interventions, management of bleeding was the most common complaint, which may be associated with therapeutic anticoagulation as well as coagulopathy from the disease process. Bleeding control was followed by UAE and trach management, 2 aerosol-generating procedures that may increase the risk of COVID transmission. The proportion of consults tested and confirmed positive for COVID- 19 at our institution increased from May to September, possibly assisting otolaryngologists to take appropriate preventive precautions.
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COVID-19 is associated with a significant distress and stigma. Due to the nature of the disease, it is difficult to conduct counseling and therapy without taking significant precautions such as wearing a complete personal protective equipment kit which impedes with rapport and dampens the speech which is quite essential for therapy. Herewith, we present a case where we used technology-based interventions, course, and outcome. Although the results of this case study cannot be generalized, few factors clearly stand out in the treatment of psychological distress among COVID-19-positive clients - psychoeducation, supportive therapy components of Cognitive Behavioral Therapy (CBT), and management of expressed emotion may play a key role in dealing with rural population. Family interventions were used to facilitate healthy family communication pattern (using technology) toward healthier involvement, connectedness aid client's recovery in the aftermath and acceptance of COVID-19 diagnosis. Intervention should also equip and empower client and family to deal with stigma and helplessness through clarifying misconceptions, providing knowledge, and enhancing agency or mastery over circumstances. These can serve as guidelines during treatment of psychological distress among COVID-19-positive clients and their families.
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Introduction: COVID-19 is a highly infectious disease caused by an RNA virus belonging to a large family of coronaviruses. WHO declared COVID-19 as a public health emergency and classified it as a pandemic. The COVID-19 pandemic affected the medical education globally. Aim of the Study: The aim of the study is to evaluate the impact of COVID-19 on the internship program. Materials and Methods: A cross sectional study was conducted among the medical and dental students of various universities in Makkah region of Saudi Arabia. A questionnaire consisting of 15 close ended, pre-tested questions was developed to determine the experiences and perceptions of medical and dental interns due to COVID-19. The data were tabulated and analyzed using SPSS version 21. Chi-square test was used to assess the experiences and perceptions among the Medical and Dental interns. P-value of less than 0.05 was considered statistically significant. Results: The study included 453 participants, out of which 253 were dental interns and 200 were medical interns. 231 (51%) of male interns participated in this study and 222 (49%) female interns participated. 140 (55.6%) and 138 (69.3%) of the participants of the dental and medical interns respectively felt COVID-19 affected options to select specialties of their interest for post-graduation, whereas, 112 (44.4%) and 61 (30.7%) of the dental and medical interns felt other way. Conclusion: Majority of the participants reported that COVID-19 did not affect them psychologically. In addition, most of the medical and dental interns felt covid-19 affected opinions to select specialties of their interest for post-graduation.