ICU outcomes and survival in patients with severe COVID-19 in the largest health care system in central Florida.

BACKGROUND: Observational studies have consistently described poor clinical outcomes and increased ICU mortality in patients with severe coronavirus disease 2019 (COVID-19) who require mechanical ventilation (MV). Our study describes the clinical characteristics and outcomes of patients with severe COVID-19 admitted to ICU in the largest health care system in the state of Florida, United States. METHODS: Retrospective cohort study of patients admitted to ICU due to severe COVID-19 in AdventHealth health system in Orlando, Florida from March 11th until May 18th, 2020. Patients were characterized based on demographics, baseline comorbidities, severity of illness, medical management including experimental therapies, laboratory markers and ventilator parameters. Major clinical outcomes analyzed at the end of the study period were: hospital and ICU length of stay, MV-related mortality and overall hospital mortality of ICU patients. RESULTS: Out of total of 1283 patients with COVID-19, 131 (10.2%) met criteria for ICU admission (median age: 61 years [interquartile range (IQR), 49.5-71.5]; 35.1% female). Common comorbidities were hypertension (84; 64.1%), and diabetes (54; 41.2%). Of the 131 ICU patients, 109 (83.2%) required MV and 9 (6.9%) received ECMO. Lower positive end expiratory pressure (PEEP) were observed in survivors [9.2 (7.7-10.4)] vs non-survivors [10 (9.1-12.9] p = 0.004]. Compared to non-survivors, survivors had a longer MV length of stay (LOS) [14 (IQR 8-22) vs 8.5 (IQR 5-10.8) p< 0.001], Hospital LOS [21 (IQR 13-31) vs 10 (7-1) p< 0.001] and ICU LOS [14 (IQR 7-24) vs 9.5 (IQR 6-11), p < 0.001]. The overall hospital mortality and MV-related mortality were 19.8% and 23.8% respectively. After exclusion of hospitalized patients, the hospital and MV-related mortality rates were 21.6% and 26.5% respectively. CONCLUSIONS: Our study demonstrates an important improvement in mortality of patients with severe COVID-19 who required ICU admission and MV in comparison to previous observational reports and emphasizes the importance of standard of care measures in the management of COVID-19.

Validation of Wired and Wireless Interconnected Body Sensor Networks.

Current medical facilities usually lead to a very high cost especially for developing countries, rural areas and mass casualty incidents. Therefore, advanced electronic health systems are gaining momentum. In this paper, we first compared our novel off the shelf experimental wired Body Sensor Networks (BSN), that is, Digital First Aid (DigiAID) with the existing commercial product called as Hexoskin. We showed the viability of DigiAID through extensive real measurements during daily activities by both male and females. It was found that the major hurdle was wires to be worn by the subjects. Accordingly, we proposed and characterized the wireless DigiAID platform for wireless BSN (WBSN). Understanding the effect of body movements on wireless data transmission in WBSN is also of major importance. Therefore, this paper comprehensively evaluates and analyzes the impact of body movements, (a) to ensure transmission of data at different radio power levels and (b) its impact on the topology of the WBSN. Based on this we have proposed a dynamic power control algorithm that adapts the transmitting power according to the packet reception in an energy efficient manner. The results show that we have achieved substantial power savings at various nodes attached to the human body.

A Preliminary Investigation of the Intersection of Race and Disabilities among Inmates in the U.S. State Prison System.

The American prison system is overcrowded with minorities in general, and African Americans, in particular. The Department of Justice notes that more than 50% of the prison population have some type of mental disability. In this study, we examine the intersection between race and disabilities in the U.S. State prison system. Using the Rehabilitation Services Administration data set, the study highlights the prevalence and type of disabilities in the prison inmate population. Results demonstrate that African American inmates are overrepresented among inmates with disabilities, are more likely to have mental disabilities relative to physical disabilities, and these results hold for various types of mental disabilities including cognitive, psychosocial, and other mental disabilities. Study limitations and directions for future research are also discussed.

Hyaluronidases: A Therapeutic Enzyme.

BACKGROUND: Hyaluronidase is the most important enzyme found in the interstitial matrix, effectively degrading the hyaluronic acid. Hyaluronidases are extensively found in the venom of various animals such as snake, scorpion, spider and others. Up till now five venom hyaluronidases are identified with a defined three-dimensional structure. These enzymes are involved in different biochemical, physiological and pathological conditions like degradation of hyaluronic acid, embryogenesis, transmembrane diffusion of drugs and toxins, inflammatory and allergic response to antigens, healing of wounds, bacterial meningitis, bacteremia and pneumonia. These enzymes are used as an adjuvant therapy in cancer and to expedite the dispersion and absorption of drugs as well as to reduce the tissue edema. and to reduce the progression of metastatic breast cancer as well as used in ophthalmological procedures in combination with local anesthetics, reduction of dermatological aging, regulation of hyaluronan, as a spreading factor and with numerous clinical applications. CONCLUSION: In this review an attempt was made to summarize the physiological, adjuvaent and therapeutic significance of hyaluronidase enzymes from different animal sources.

Evaluation of antibiotic resistant bacteria in underground drinking water and transfer of their resistant character to normal flora of the body.

The untreated surface water for drinking and domestic use is an alarming situation to public health especially in prevalence of antibiotics resistant bacteria. This investigation aimed to isolate and identify the antibiotic resistance bacteria in underground water samples in district Dera Ismail Khan, Pakistan. The underground water samples were collected from four different places using hand pumps (Khyber town, riverside, Gomal University and united town). Cultured on nutrient agar media, identified by Gam staining and biochemical tests. There after antibiotic resistance assay were performed by measuring zone of inhibition of different antibiotics by disc diffusion method. Six different bacterial colonies were isolated and identified as Enterobacteriaceae, Serriata specie, Proteues, Pseudomonas, all these bacterial colonies were 33% resistant to chloramphenicol with and 100% resistant to amoxicillin. Some colonies were also considered as resistant, according to the criteria of National Committee for Clinical Records (NCCL) that less than 10mm zone of inhibition are considered as resistant. Subsequently, the chloramphenicol resistance bacteria were analyzed for their ability to transfer resistant gene to sensitive bacteria. In in-vitro method, an isolate M1b (resistant) was found capable to transfer resistance gene to M1a isolate (sensitive) in nutrient rich environment. It was concluded that antibiotics resistance bacteria found in underground water, moreover capable of transferring the antibiotic resistant character to suitable recipient i.e. normal flora of the body or to other pathogens by conjugation.