Face Mask Compliance and Complacency amongst Pakistan's Youth During the Third Wave of COVID-19

Objective: To assess the reasons for compliance with face mask usage amongst Pakistani youth. Study Design: Internet-based cross-sectional survey. Place and Duration of Study: Different cities of Pakistan, in April 2021. Methodology: Persons currently residing in Pakistan aged 18-29 were included in the study. The questionnaire included questions to identify self-perceptions of vulnerability to COVID-19, followed by questions about social situations where respondents wore facemasks. Results: A large number of (1,034,90%) respondents reported compliance with facemasks. Specifically, 1048(92%), 962(85%), and 850(75%) of respondents wore facemasks in healthcare facilities, marketplaces, or at work or school respectively. Nevertheless, when self-regulating, such as with family or around friends, compliance fell to 200(18%). Compliance turns to complacency when people are expected to self-regulate face mask usage. Females were more compliant than males (p<0.001). A large 779(68%) of compliant youth relied on information from Internet-based resources. Conclusion: The study correlates the reasons for compliance and complacency. In Pakistan, the most compliant youth get information from the Internet, particularly official websites and social media. © 2023, Army Medical College. All rights reserved.

Constructing custom-made radiotranscriptomic signatures from CT angiograms: An application in COVID-19 vascular inflammation

Background: Advances in computational methodologies have enabled processing of large datasets originating from imaging studies. However, most imaging biomarkers suffer from a lack of direct links with underlying biology, as they are only observationally correlated with pathophysiology. Purpose(s): To develop and validate a novel AI-assisted image analysis platform, by applying quantitative radiotranscriptomics that quantifies cytokinedriven vascular inflammation from routine CT angiograms (CTA) performed as part of clinical care in COVID-19. Method(s): We used this platform to train the radiotranscriptomic signature C19-RS, derived from the perivascular space around the aorta and the internal mammary artery in routine chest CTAs, to best describe cytokinedriven vascular inflammation, defined using transcriptomic profiles from RNA sequencing data from human arterial biopsies (A). This signature was validated externally in 358 clinically indicated CT pulmonary angiograms from patients with or without COVID-19 from 3 different geographical regions. Result(s): First, 22 patients who had a CTA before the pandemic underwent repeat CTA <6 months post COVID-19 infection (B). Compared with 22 controls (matched for age, gender, and BMI) C19-RS was increased only in the COVID-19 group (C). Next, C19-RS was calculated in a cohort of 331 patients hospitalised during the pandemic, and was higher in COVID-19 positives (adjusted OR=2.97 [95% CI: 1.43-6.27], p=0.004, D). C19-RS had prognostic value for in-hospital mortality in COVID-19, with HR=3.31 ([95% CI: 1.49-7.33], p=0.003) and 2.58 ([95% CI: 1.10-6.05], p=0.028) in two testing cohorts respectively (E, F), adjusted for clinical factors and biochemical biomarkers of inflammation and myocardial injury. The corrected HR for in-hospital mortality was 8.24 [95% CI: 2.16-31.36], p=0.002 for those who received no treatment with dexamethasone, but only 2.27 [95% CI: 0.69-7.55], p=0.18 in those who received dexamethasone subsequently to the C19-RS based image analysis, suggesting that vascular inflammation may have been a therapeutic target of dexamethasone in COVID-19. Finally, C19-RS was strongly associated (r=0.61, p=0.0003) with a whole blood transcriptional module representing dysregulation of coagulation and platelet aggregation pathways. Conclusion(s): We present the first proof of concept study that combines transcriptomics with radiomics to provide a platform for the development of machine learning derived radiotranscriptomics analysis of routine clinical CT scans for the development of non-invasive imaging biomarkers. Application in COVID-19 produced C19-RS, a marker of cytokine-driven inflammation driving systemic activation of coagulation, that predicts inhospital mortality and identifies people who will have better response to anti-inflammatory treatments, allowing targeted therapy. This AI-assisted image analysis platform may have applications across a wide range of vascular diseases, from infections to autoimmune diseases.

The Capabilities, Challenges, and Resilience of Digital Learning as a Tool for Education During the COVID-19

The current study’s objective examines contemporary advancements in learning utilizing digital technology for educational purposes during the recent pandemic outbreak. The study analysed the challenges, capabilities, and resilience of these digital learning environments and the future of digital learning. The PRISM statement is used to select records and assess the final 37 studies for the current investigation. According to the findings, the COVID-19 pandemic posed a significant challenge to educational institutions, and online learning was a challenging work for students and teachers. The availability of a large number of digital learning platforms, on the other hand, considerably mitigates the problem. Students’ and teachers’ skills and capacities have grown as a result of the learning process utilising digital platforms. The current study’s findings show that education in the post-COVID-19 era is heavily reliant on digital sources, and that new technologies greatly enhance the learning process. © 2022. International Journal of Interactive Mobile Technologies. All Rights Reserved.

FREQUENCY OF MYOCARDITIS IN COVID-19 PATIENTS

Objective: To determine frequency of myocarditis in COVID-19 patients. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology-National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi and Pak Emirates Military Hospital (PEMH), Rawalpindi, from Dec 2020 to May 2021. Methodology: A total of 143 hospitalized patients who had tested positive for COVID-19 infection via RT-PCR were included in the study. Patients with pre-existing cardiac conditions were excluded. All patients underwent transthoracic echocardiography and their ejection fractions were recorded. Meticulous testing for the inflammatory markers including CRP, serum ferritin, procalcitonin and interleukin-6 (IL-6) and cardiac biomarker (NT-pro-BNP) was carried out. The data was recorded on a specially designed questionnaire and later transferred to SPSS-23 for analysis. Myocarditis was diagnosed on the basis of reduced Ejection Fraction or raised NT pro BNP or both in a person without any known cardiac pathologies before getting COVID-19. Results: Out of total 143 COVID-19 patients included in the study, 24 patients (16.8%) developed myocarditis. The frequency of myocarditis in COVID-19 positive male population was 14.6% (10.5% of all myocarditis cases) and that of female population was 22.5% (6.3% of all myocarditis cases). The raised pro-inflammatory markers IL-6 and CRP were significantly associated with development of myocarditis while ferritin was not significantly associated. Only 28% of the study population recovered and got discharged from the hospital, however, there were no survivors among those who developed myocarditis. Conclusion: Myocarditis is a serious complication of COVID-19 and directly linked to increased mortality risk. There is an increasing need to perform serial assays for the inflammatory as well as cardiac biomarkers including IL-6, Trop-I and NT-pro-BNP for early detection and prompt treatment of this not so uncommon complication. © 2021, Army Medical College. All rights reserved.

COVID-19 Pandemic and Immune Boost up: The Synergistic Role of Nutrients

World Health Organization (WHO) declared a global public health emergency due to the recent spread of COVID-19 throughout the world. Millions of people are affected daily and thousands died. Almost all countries are now paying attention to control this pandemic outbreak. Therefore, researchers are trying to identify the pathophysiology of the disease, appropriate prognosis, effective management and prevention of COVID-19. Based on current published evidence, this review article specifies the role of different nutrients in the possible prevention and management of COVID-19 and viral infections. Balanced nutrition including adequate vitamin C, vitamin A, vitamin D, magnesium, selenium, zinc and phytonutrients have shown promising immune-boosting roles in COVID-19 and other respiratory infections due to their potential anti-inflammatory and antioxidants properties. These micronutrients act against COVID-19 infections both individually and synergistically.

Intensive Care Unit Management of the COVID-19

Coronavirus disease of 2019 is the public health emergency of international concern (PHEIC). COVID-19 leads to the development of acute respiratory distress syndrome (ARDS) in some patients. The management of acute respiratory distress syndrome in such patients involves non-invasive and invasive ventilation techniques. The non-invasive ventilation techniques must be employed first before initiating invasive mechanical ventilation techniques. High Flow Nasal cannula, Bi-level Positive Air Pressure (BiPAP) and Helmet ventilation are the non-invasive techniques that are employed in the management of COVID-19 related acute respiratory syndrome. The hazard of aerosol transmission of the virus to the Healthcare and paramedical staff must be taken into consideration before using any of these non-invasive techniques. The burden on hospital ventilatory equipment can also be appeased when non-invasive techniques are utilized. Early intubation of the patient must be avoided if possible. The clinical presentation of the patient and the vital signs like oxygen saturation and respiratory rate must be monitored regularly in order to assess the need of the patient to be ventilated. The careful use of non-invasive and invasive ventilation techniques can reduce the mortality from acute respiratory distress syndrome in COVID-19 patients.

Impacts of reduced deposition of atmospheric nitrogen on coastal marine eco-system during substantial shift in human activities in the twenty-first century

The novel infectious disease (COVID-19) took only a few weeks from its official inception in December 2019 to become a global pandemic in early 2020. Countries across the world went to lockdown, and various strict measures were implemented to reduce the further spread of the infection. Although, the strict lockdown measures were aimed at stopping the spread of COVID-19, however, Its positive implications were also observed for the environmental conditions across the global regions. The present study attempted to explore the eco-restoration of coastal marine system in response to reduced deposition of atmospheric nitrogen (NO2) emission during the substantial shift in human activities across the global metropolitan cities. Remotely data of NO2 emission were taken from Ozone Monitoring Instrument and the coastal water quality along the marine system was estimated from MODIS-Aqua Level-3 using Semi-Analytic Sediment Model (SASM). The changes in tropospheric NO2 in 2020s were also compared with the long-term average changes over the baseline period 2015 - 2019. A significant reduction in anthropogenic mobility (85 - 90%) has been observed in almost all countries over different places, especially grocery, parks, workplaces, and transit stations. A massive reduction in tropospheric NO2 was detected in Wuhan (53%), Berlin (42%), London (41%), Karachi (40%), Paris (38%), Santiago (35%), and Chennai (34%) during the strict lockdown period of the early 2020 as compared to the last five years. However, after the partial lockdown was lifted, tropospheric NO2 values bounced back and slightly increased over Karachi (6%) and Bremen (12%). For water turbidity, the rate of reduction was found to be the highest along the different coastal regions of the Mediterranean Sea and Black Sea (51%), West Atlantic Ocean (32%), East Atlantic Ocean (29%), and Indian Ocean (21%) from Apr to Jun 2020. The monthly comparison of overland-runoff in 2020 compared to 2019 across the different costal watersheds indicates that the observed decline in turbidity might have been due to the reduced deposition of atmospheric nitrogen. The findings of this study suggest that the recent decline in tropospheric NO2 and water turbidity might be associated with reduced emissions from fossil fuels and road transports followed by COVID-19 forced restrictions in the twenty-first century. The inferences made here highlight the hope of improving the global environmental quality by reducing greenhouse gas emissions using innovative periodic confinement measures on heavy transport and industries while securing public health and socioeconomics.

Radiotranscriptomic analysis of perivascular adipose tissue quantifies vascular inflammation in COVID-19 from routine ct angiograms: stratification of “new uk variant” infection and prediction of inhospital outcomes

Background Evidence suggests that adverse outcomes in COVID-19 may be driven by a cytokine-induced vascular inflammatory response, caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). Aim We aimed to develop a non-invasive method for quantifying cytokine-driven vascular inflammation in patients with acute COVID-19 infection that could allow risk stratification. Methods We developed a platform for rapid development of novel imaging biomarkers of vascular inflammation, by applying quantitative radiotranscriptomics to images from standard Computed Tomography Angiography (CTA). We used this platform to train a radiotranscriptomic signature (C19-RS) from the perivascular space around the aorta and the internal mammary artery, visualized in routine chest CTAs, to best describe cytokine-driven vascular inflammation, defined using transcriptomic profiles from RNA sequencing data from human arterial biopsies. This signature was tested externally in 435 clinically indicated CT pulmonary angiograms (CTPAs) from patients with or without COVID-19 from 3 different geographical regions. Results COVID-19 patients were characterised by significantly higher C19-RS values (adjusted odds ratio of 2.97 [95%CI: 1.43-6.27], p=0.004), while patients infected with the new B.1.1.7 variant (“UK variant”) were also found to have higher C19-RS values compared to those with the original variant, evidence suggestive of higher degrees of vascular inflammation. C19-RS had prognostic value for in-hospital mortality in COVID-19, with hazard ratios of 3.31 ([95%CI: 1.49-7.33], p=0.003) and 2.58 ([95%CI: 1.10-6.05], p=0.028) in two external testing cohorts respectively, after correction for clinical factors and biochemical biomarkers of inflammation (WBC, CRP) and myocardial injury (troponin). Importantly, the corrected HR for in-hospital mortality was 8.24[95%CI: 2.16- 31.36], P=0.002 for those who received no treatment with dexamethasone, but only 2.27[95%CI: 0.69-7.55], p=0.18 in those who received dexamethasone after the test, suggesting that anti-inflammatory treatment may be modifying the natural history of COVID-19 infection by improving outcomes specifically in those patients with high vascular inflammation. Conclusions Our study introduces a new radiotranscriptomic signature, C19-RS, extracted from routine CTPAs, trained to detect cytokine-driven arterial inflammation, and demonstrates that vascular inflammation determined in this way has prognostic value in patients with COVID-19. The “UK variant” leads to higher vascular inflammation measured in this way, and the risk associated with COVID-19 arteritis is modifiable by dexamethasone.

Automatic Detection of COVID-19 Disease in Chest X-Ray Images using Deep Neural Networks

The worldwide spread of COVID-19 has marked a devastating impact on the global economy and public health. One of the significant steps of COVID-19 affected patient's treatment is the faster and accurate detection of the symptoms which is the motivational center of this study. In this paper, we have analyzed the performances of six artificial deep neural networks (2-D CNN, ResNet-50, InceptionResNetV2, InceptionV3, DenseNet201, and MobileNetV2) for COVID-19 detection from the chest X-rays. Our dataset consists of 2905 chest X-rays of three categories: COVID-19 affected (219 cases), Viral Pneumonia affected (1345 cases), and Normal Chest X-rays (1341 cases). Among the implemented neural networks, ResNet-50 demonstrated reasonable performance in classifying different cases with an overall accuracy of 96.91%. Most importantly, the model has shown a significantly good performance in detecting the COVID-19 cases in the test dataset (Precision = 1.00, Sensitivity = 1.00, Specificity = 1.00, and F1-score = 1.00). Therefore, among the deep neural networks presented in this paper, ResNet-50 can be adapted as a reliable method for faster and accurate COVID-19 affected case detection. © 2020 IEEE.

TRACHEOESOPHAGEAL FISTULA: A RARE COMPLICATION OF PROLONGED INTUBATION IN COVID-19

SESSION TITLE: Medical Student/Resident Disorders of the Mediastinum Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Tracheoesophageal fistula (TEF) is a rare condition that can be congenital or acquired. Patients of the novel Corona Virus Disease 2019 (COVID-19) remain intubated for prolonged periods that can give rise to a multitude of complications. Here we present a case of a 53-year-old female who got intubated after developing COVID pneumonitis, complicated by acute respiratory distress syndrome (ARDS). She developed TEF at the end of the third week of intubation. CASE PRESENTATION: A 53-year-old female presented to the hospital with hypoxemic respiratory failure caused by COVID pneumonitis. She got intubated and her hospital course was complicated by ARDS. She got extubated by the end of the third week but reintubated for persistent hypoxemia two days later. She was on the pressure control mode of ventilation with positive end-expiratory pressure (PEEP) of 16, Inspiratory Pressure ( Pi) of 19 and peak pressure of 35. Suddenly, she developed hypoxemia and gastric distension on the same ventilator settings and her peak pressure dropped to 22. The X-ray of the abdomen was normal. Sudden dropping of peak pressure prompted the clinician to get computerized tomography (CT) scan of the neck which revealed trachea-esophageal fistula. (Figure 1,2,3). She was treated with tocilizumab, Flolan, and broad-spectrum antibiotics. The fistula was bypassed temporarily with a tracheostomy tube and a plan was made to follow up with the surgery team for possible surgical intervention. DISCUSSION: COVID-19 patients who develop severe respiratory disease remain on mechanical ventilation for a prolonged time period. In addition to the lack of specific guidelines to treat this disease, the severity of illness, heavy sedation, and significantly long time period of intubation add to poor outcomes in these patients. Complications of prolonged intubation include ventilator-dependent respiratory failure, ulceration, granulation tissue formation, tracheal or laryngeal stenosis, and rarely tracheoesophageal fistula to name a few. [1] The sudden deterioration of respiratory status, dropping peak pressures, and gastric distension are a few signs of fistulous opening in the trachea. The commonest site of TEF is at the bifurcation of the trachea. [2] These patients should be extubated as early as their respiratory status allows but should not be delayed for more than two weeks to avoid these complications. CONCLUSIONS: Patients with severe COVID-19 disease remained intubated for a prolonged period. Tracheostomy tube placement should not be delayed or they can develop multiple complications. If a patient develops sudden desaturation, gastric distension, or drops peak pressures without changing the baseline ventilator settings, TEF should always be in the differentials, and management should proceed with either immediate surgical intervention or supportive care temporarily and surgical intervention later in course Reference #1: Surgery and perioperative management for post-intubation tracheoesophageal fistula: case series analysis.Puma F, Vannucci J, Santoprete S, Urbani M, Cagini L, Andolfi M, Potenza R, Daddi NJ Thorac Dis. 2017 Feb;9(2):278-286. Reference #2: Moersch HJ, Tinney WS. A fistula between the esophagus and the tracheobronchial tree. Medical Clinics of North America. 1944 Jan 1;28(4):1001-7. DISCLOSURES: no disclosure on file for Asad Chohan;No relevant relationships by Soban Farooq, source=Web Response no disclosure on file for Rajesh Kumar;No relevant relationships by S Roomi, source=Web Response No relevant relationships by Rehan Saeed, source=Web Response no disclosure on file for Maryam Siddique;No relevant relationships by Usama Talib, source=Web Response