Spectrum of echocardiographic findings in patients with severe and critical COVID-19: a single center experience

Introduction: Information on the cardiac manifestations of coronavirus disease 2019 (COVID-19) is scarce. In this study we assessed the echocardiogram of consecutive patients with COVID-19 infection to assess the frequency of cardiac abnormalities. Materials and Methods: This retrospective descriptive study examined the echocardiographic study of 43 patients with severe and critical COVID-19 infection admitted at the ICU of Chitwan Medical College from May 16, 2021 to June 05, 2021. The study focused on left ventricle (LV) and right ventricle (RV) function. The results were then compared between severe and critical infections to examine if any differences exist between them. Results: The mean age of the study population was 54 years and predominately males. One-third were classified as critical COVID-19 while the remaining were severe COVID-19. Majority(83.7%) had a normal echocardiogram. Among the patients with abnormal reports, the distribution of echocardiographic pattern were biventricular dilation with biventricular dysfunction in two patients (4.6%), LV dialtion with LV dysfunction in two patients (4.6%) and isolated LV dysfunction (diastolic and systolic) in three patients (6.9%). None of the echocardiographic parameters were significantly different between the severe and the critical infection. Conclusion: COVID-19 in primarily a respiratory disease and the cardiac complications is largely attributed to the critical nature of the illness than the specific infection. Considering the risk of infection spread, routine echocardiography for all patients with COVID-19 infection is not advisable.

An Overview of Blockchain Technology and Its Adoption in Industry

The development of a cryptocurrency cannot occur without the use of a vital piece of technology known as blockchain. It is a distributed ledger that has progressed to the point where they are now even more applicable and beneficial. This is due to the passage of time and the development of many sectors. These days, blockchain technology is being employed in certain ways throughout all the industries. In this study, each and every significant attribute and weakness is discussed and analyzed. We have also conducted a literature analysis on blockchain-related topics and highlighted some of the most current sectors in which blockchain technology has found the greatest utility. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

A Comparative Study of Rapid SARS-Cov-2 Antigen Detection Assay against RT-PCR Assay for Diagnosis of COVID-19 in a Tertiary Hospital of Kathmandu.

Background The Coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has spread worldwide since its first recorded case in the city of Wuhan, China, in December 2019. SARS-CoV-2 infection causes asymptomatic to sever pneumonia. Severe cases may develop acute respiratory disease symdrome (ARDS), with an average mortality rate of 6.9%. Real Time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR) assay is the current reference standard laboratory method for the diagnosis of SARS-CoV-2 infection. However, it takes around 6-8 hours to get the result and is time consuming. Therefore, rapid and accurate tests for SARS-CoV-2 screening are essential to expedite disease prevention and control. Lateral flow immunoassay using monoclonal anti SARS-CoV-2 antibodies which target for SARS-CoV-2 antigen can be complimentary screening test if their accuracy were comparable to that of the real time reverse transcriptionpolymerase chain reaction (RT-PCR) assay. Objective To find the sensitivity and specificity of a rapid antigentest kit in comparison to reverse transcription-polymerase chain reaction (RT-PCR). Method A cross-sectional hospital based study was carried out at Shree Birendra Army Hospital, Kathmandu for a period of four months. Result Our finding shows sensitivity and specificity of rapid diagnostic tests (RDT) Ag kit as 60.6% and 96.4% respectively. Positive and negative predictive value was 83.7% and 89.0%. Likewise, positive and negative likelihood ratio was 17.0 and 0.4. The overall accuracy of the antigen kit was 88.1% in comparison to reverse transcriptionpolymerase chain reaction (RT-PCR) as the gold standard. Conclusion Our study concluded the use of rapid antigen kit is mainly useful for screening purposes.

Timely PCI Shows Beneficial Long-Term Outcomes in Late Presentation With STEMI: A Systematic Review and Meta-Analysis Between 2012 and 2022

Introduction: Approximately 8-40% of ST-elevation Myocardial Infarction (STEMI) present later than 12 hours after symptom onset. Current ACC/AHA guidelines recommend primary percutaneous coronary intervention (PCI) for STEMI after 12 hours of symptom onset only in the setting of cardiogenic shock or severe acute heart failure, (Class Ia, LOE B) or persistent ischemic symptoms (Class IIa, LOE B). There are limited data comparing long-term outcomes among patients with a late STEMI presentation managed with PCI versus medical therapy (MT). Objective(s): To compare long-term outcomes among patients treated with PCI versus MT who have late presentation of STEMI Methods: We followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to extract data from PubMed/Medline, Cochrane, Embase, and Clinicaltrials.gov databases by using the search terms "late" or "delayed" or ">12 hours" presentation with STEMI from 01/2012 through 12/2022. Included studies reported at least one of the following outcomes: all-cause mortality, reinfarction, heart failure, major adverse cardiac events (MACE), and stroke. Studies reporting delays in PCI due to COVID-19 positive status or COVID-19 enforced protocols were excluded to prevent the impact of pragmatic barriers on treatment. Relative risk (RR) was calculated using random effects model if heterogeneity was >50%, otherwise, fixed effects model was used Results: Seven studies (n=11,576, delayed PCI n=6,248, and medical therapy n=5,319) were included in our analysis. The median follow-up was 12 months (1-60 months). Overall, among patients with STEMI and PCI >12 hour after presentation had lower incidence of MACE (27% vs. 30%, RR 0.85, 95% CI 0.76-0.69, I2=30%, p=0.007) compared to MT alone, which was driven by a significantly reduced all-cause mortality with PCI (4.4% vs. 17%, RR 0.38, 95% CI 0.17-0.85, I2=95%, p=0.01). No significant differences were observed in the incidence of recurrent MI and heart failure hospitalizations. Conclusion(s): Our study suggests favorable outcomes of PCI in STEMI with presentation >12 hours compared with medical therapy. Further prospective studies are needed to validate our findings.

A Comparative Study of Rapid SARS-Cov-2 Antigen Detection Assay against RT-PCR Assay for Diagnosis of COVID-19 in a Tertiary Hospital of Kathmandu

Background The Coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has spread worldwide since its first recorded case in the city of Wuhan, China, in December 2019. SARS-CoV-2 infection causes asymptomatic to sever pneumonia. Severe cases may develop acute respiratory disease symdrome (ARDS), with an average mortality rate of 6.9%. Real Time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR) assay is the current reference standard laboratory method for the diagnosis of SARS-CoV-2 infection. However, it takes around 6-8 hours to get the result and is time consuming. Therefore, rapid and accurate tests for SARS-CoV-2 screening are essential to expedite disease prevention and control. Lateral flow immunoassay using monoclonal anti SARS-CoV-2 antibodies which target for SARS-CoV-2 antigen can be complimentary screening test if their accuracy were comparable to that of the real time reverse transcription-polymerase chain reaction (RT-PCR) assay. Objective To find the sensitivity and specificity of a rapid antigentest kit in comparison to reverse transcription-polymerase chain reaction (RT-PCR). Method A cross-sectional hospital based study was carried out at Shree Birendra Army Hospital, Kathmandu for a period of four months. Result Our finding shows sensitivity and specificity of rapid diagnostic tests (RDT) Ag kit as 60.6% and 96.4% respectively. Positive and negative predictive value was 83.7% and 89.0%. Likewise, positive and negative likelihood ratio was 17.0 and 0.4. The overall accuracy of the antigen kit was 88.1% in comparison to reverse transcription-polymerase chain reaction (RT-PCR) as the gold standard. Conclusion Our study concluded the use of rapid antigen kit is mainly useful for screening purposes. Copyright © 2022, Kathmandu University. All rights reserved.

Automatic corrugated box making line

This paper evaluates the need for corrugated boxes in the industry & the need for fast and efficient manufacturing of such boxes, even at a small scale. Nowadays, online shopping is increasing at a tremendous rate and with the advent of the corona pandemic, this rate has been increasing exponentially due to people's trust in packaged products. Corrugated boxes are lightweight, cost-effective, good shock absorbers, and help in keeping the product safe from contamination. With this project, we are manufacturing an automatic corrugated box- making line using PLC which will work at an efficient and fast pace, keeping the safety of people around at priority. The assembly line will consist of steps like pasting, punching and cutting using pneumatics, making all the steps work in a synchronized manner through the controlling feature of PLC. © 2022

Anaesthetic management of severe dextroscoliosis in a post-covid patient undergoing lumbar fixation and laminectomy

Aim: Patients who have severe case of kyphoscoliosis face functional and physical difficulties, making anaesthetic treatment challenging. In this example, a severe case of scoliosis was successfully treated under general anaesthesia. The case report aims to highlight the meticulous perioperative management of a patient with severe scoliosis, even after the surgery has been completed. Case: A 69-year-old woman with severe dextroscoliosis, single-vessel disease, and a recent history of covid (1 month ago) was scheduled for L1 to S1 fixation with L2-L4 laminectomy. On post-covid chest x-ray, the patient showed lung fibrosis, making anaesthetic management more challenging. Discussion: Scoliosis can cause a sort of respiratory restriction. The angle of the malformation is connected to the severity of the pulmonary issue. Cardiovascular, respiratory, and neurological dysfunction caused by the abnormality should be assessed prior to surgery. Fluid shift needs to be monitored carefully and corrected if necessary. There were no issues associated to ocular changes or the biracial plexus. Conclusion: Thorough preanaesthetic evaluation and optimization of the respiratory and cardiovascular systems is critical. In severe kyphoscoliosis, precise planning of anaesthesia induction and meticulous approach will result in a satisfactory outcome.

Impact of COVID-19 on the Stock Market Performance of Global IT Sector

Predicting return and volatility in the global Capital Market during a pandemic is challenging, and it is more difficult for a specific sector, particularly if that sector has a positive outlook. The goal of this research is to look at the impact of COVID-19 on the mean and volatility of the Information Technology Indexes of the best nine technology-driven countries based on return performance using an econometric GARCH model that is widely used. The daily returns of information technology indexes are evaluated for the same from November 2018 to February 2021. Data is taken from Yahoo Finance for CAC Tech (France), DAX Tech (Germany), FTSE All Tech (UK), KOPSI 200 IT (Korea), NIFTY IT (India), S&P 500 IT (US), S&P TSX (Canada), SSE_IT (China) and TOPIX17 (Japan). The results show daily positive mean returns for 8 countries' IT Indices and further, an uptrend in mean daily returns is observed in the crisis period for 6 countries' IT Indices. The exogenous variable COVID-19 which was taken as a regressor for the GARCH model was found to be positively significant for IT indices of all the countries. The overall results confirm the presence of the mean-reverting phenomenon for IT indices of all the countries.

Deep Vein Thrombosis after COVID-19 Vaccinations

[Formula presented] Background: COVID-19 vaccinations in the United States (Janssen, Moderna, and Pfizer) have been deemed generally safe and effective. Rare thrombotic events, now termed vaccine-induced thrombotic thrombocytopenia (VITT), have been reported after the Janssen and Moderna vaccinations. With millions of vaccinations being administered to adults, it is expected that some deep vein thrombosis (DVT) will occur coincidentally with vaccination. Whether COVID-19 vaccinations may contribute to DVT risk more generally (outside of VITT) has not been well studied outside of the initial clinical trials. Aims: Evaluate trends in DVT diagnosis before and after COVID-19 vaccination Methods: Vaccinated patients ≥ 18 years between 11/6/2020 through 6/1/2021 were analyzed using electronic medical records across the Mayo Clinic enterprise. Upper and lower DVT venous Duplex ultrasound (DUS) reports occurring 90 days before and after vaccination date (first dose for Pfizer and Moderna vaccines) were extracted and analyzed with a highly accurate, previously validated, Natural Language Processing (NLP) algorithm for acute DVT. Results: 382,527 patients with at least 1 COVID-19 vaccination were identified. The median age was 61 (IQR 44-72) and 55.3% were male. Pfizer was the most common vaccine administered (n=245,572, 64.2%), followed by Moderna (n=120,683, 31.6%) and Janssen (n=16,272, 4.3%). Most patients (91.5%) receiving vaccinations were from states with Mayo Clinic health services (Minnesota, n=197,834;Wisconsin, n=80,720;Florida, n=42,391;Arizona, n=28,882). The mean age at vaccination was 61.0 (SD 17.7), 56.5 (SD 19.1), and 54.7 (SD 16.3) for Moderna, Pfizer, and Janssen vaccines respectively. Women were most likely to receive the Pfizer (56.3%) compared to Moderna (54.1%) and Janssen (49.5%) vaccines. Non-white patients were most likely to receive Janssen (21%) compared to Moderna (7.7%) and Pfizer (8.2%) vaccines. Among all patients, 7,265 upper and lower venous DUS were performed in 5,960 patients. Figure 1 shows the utilization of DUS before and after COVID-19 vaccination and shows that more patients underwent DUS in the 90 days after vaccination compared to 90 days pre-vaccination. Acute DVT was identified by the NLP algorithm in 808 (714 patients) ultrasounds (11.1%);656 out of 6136 lower extremity DUS (10.7%) and 152 out of 1129 upper extremity DUS (13.5%). The overall rate of acute DVT (upper and lower) was 1.86 per 1000 patients, consistent with the expected background epidemiologic rate. Figure 2 shows the daily probability of acute DVT by ultrasound report in the 90 days before and after vaccination with a linear regression best fit line showing no overall correlation (R 2 = 0.0). Overall acute DVT post-vaccination occurred on 10.8% of DUS compared to 11.6% pre-vaccination (p=0.28). Among ultrasound reports in Janssen vaccinated patients, 7.0% of post-vaccination compared to 18.0% of pre-vaccination were positive for acute DVT (p=0.003). Among ultrasound reports in Moderna vaccinated patients, 11.0% of post-vaccination compared to 12.7% of pre-vaccination were positive for acute DVT (p=0.15). Among ultrasound reports in Pfizer vaccinated patients, 11.0% of post-vaccination compared to 10.4% of pre-vaccination were positive for acute DVT (p=0.56). Using a Cox proportional hazard model, pre vs post-vaccination time among the same patient cohort was compared for each vaccine. The hazard ratio for DVT post-vaccination was 0.68 (95% CI 0.34-1.38) for Janssen, 1.08 (95% CI 0.86-1.35) for Moderna, and 1.20 (95% CI 0.99-1.46) for Pfizer. After adjusting for age and sex, Pfizer and Janssen's vaccines did not have different risks for DVT compared to Moderna in the 90 days post-vaccination (HR 0.80, 95% CI 0.98-1.25 and HR 0.75, 95% CI 0.42-1.32 respectively). Conclusions: In this large cohort of COVID-19 vaccinated patients, no increased risk for acute DVT post-vaccination was identified for any of the approved vaccinations in the United States. Additionally, no significant difference was seen in the risk f r DVT post-vaccination when comparing each vaccine to each other. The probability of acute DVT on ultrasounds in the 90 days post-vaccination was lower than the pre-vaccination period with the Janssen vaccine possibly indicating over-testing in this group. These results provide additional reassurance of the safety of approved COVID-19 vaccines. [Formula presented] Disclosures: Padmanabhan: Veralox Therapeutics: Membership on an entity's Board of Directors or advisory committees. Pruthi: HEMA Biologics: Honoraria;CSL Behring: Honoraria;Genentech: Honoraria;Instrumentation Laboratory: Honoraria;Bayer Healthcare AG: Honoraria;Merck: Honoraria.

Prevalence of Cardiac Dysfunction in MIS-C in Children (MIS-C) related to COVID-19

Background: COVID-19 in children normally causes mild infectious illness, but serious repercussions can occur in combination with both acute infection and related phenomena in children, like the Multisystem Inflammatory Syndrome (MIS-C). In rural hospitals, there is less information available on Cardiac abnormality in MIS-C. Objectives: To know the prevalence of cardiac dysfunction of MIS-C children having COVID-19. Methodology: The MIS-C patients in this prospective research will be diagnosed using WHO criteria. On admission, MIS-C patients with cardiac marker positive will have an anomaly in one or more of the following: Electrocardiography, Brain Natriuretic Peptide (BNP), serum troponin, and/or echocardiogram. Results: We will determine the prevalence of cardiac dysfunction in MIS-C when the study is completed. We will compare outcome factors such as hospital stay days, ICU admission, and death based on the therapy received. We all also study the correlation between the inflammatory marker and LV dysfunction. Conclusion: The study will most likely provide information on the prevalence of heart abnormality in MIS-C children. Also, the outcome of the MIS-C with cardiac dysfunction will be revealed.

Trends in venous thromboembolism and death in COVID-19 positive patients in 2020

Background: COVID-19 infections in 2020 led to numerous healthcare challenges with rapidly evolving treatments. It is unclear whether evolving treatment regimens and an increased focus on venous thromboembolism (VTE) prevention have improved outcomes. Aims: Evaluate trends in VTE and death in COVID-19 infected patients. Methods: COVID-19 PCR positive patients ≥ 18 years of age tested between 1/1/2020 through 12/31/2020 were retrospectively analyzed using electronic medical records across the Mayo Clinic enterprise. VTE outcomes (upper and lower extremity DVT and pulmonary emboli) were assessed from radiology reports using validated Natural Language Processing (NLP) algorithms. Results: 54,345 patients with COVID-19 were evaluated with 3871 (7.1%) having associated hospital admission within 30 days of the first positive test. The median age was 43 (IQR 28-58) and 51% were male. A total of 312 VTE events (0.57%) and 429 deaths (0.79%) occurred in the first 30 days after the COVID-19 positive test. 303 (97.1%) of the VTE events occurred in patients with a hospitalization within 30 days (before or after testing). Monthly frequencies of VTE varied between 0.40-1.1% and death varied between 0.56-2.0% (Figure 1). The risk of hospitalization, death, and VTE increased with age (Figure 2). Although hospitalization for COVID-19 has continued to decrease, frequencies of VTE and death have remained largely similar since June and did not significantly worsen with the surge in cases in the last quarter of 2020. (Figure Presented) Conclusions: The risk of VTE and death among all patients with COVID-19 positive PCR testing is low but increases significantly with age. The frequency of VTE and death has remained largely unchanged since June with the data highlighting the need for more effective management strategies in those over 60 years old.

Selection of the right proxy market portfolio for CAPM

The purpose of the paper is to select the right market proxy for calculating the expected return, since critically evaluating proxies or selecting the correct proxy market portfolio is essential for portfolio management because the change in the market portfolio proxy affects returns. In this study, monthly data of equity indices are evaluated to find out the better market proxy. The indices taken are BSE 30 (Sensex), Nifty 50, BSE 100, BSE 200, and BSE 500. The macroeconomic variables used in the study are industrial production index (IIP), consumer price index (CPI), money supply (M1), and exchange rate in India. To avoid the influence of COVID-19, the research period was from January 2013 to December 2019 to critically evaluate these proxies in order to find the most appropriate market proxy. This paper reveals a noteworthy relationship between stock market returns and macroeconomic factors, while suggesting that the BSE 500 is a better choice for all equity indices, as the index also shows a significant relationship with all macroeconomic variables. BSE500 is a composite index comprising all sectors with low, mid and large cap securities, therefore it reflects the impact of macroeconomic factors most efficiently, taking it as a market proxy. This study was carried out in the context of India and can be replicated for other countries. © Rashmi Chaudhary

Design Optimization and Comprehensive Study of Three-Way Cylindrical-Shaped PPE Sterilizer

Personal protective equipment (PPE), including surgical masks and N95 respirators, is essential to the protection of all patients and healthcare staff, especially in the event of highly contagious pandemics. While the prevalence of coronavirus disease (COVID-19) is rising exponentially in the country, healthcare services are already outstripping demand for these needs. The first objective of this research paper is to derive the model of a three-way cylindrical-shaped PPE sterilizer with both dry and wet cleaning techniques for inactivating the SARS-CoV-2, and the single-stranded RNA virus that causes COVID-19, along with other harmful bacteria, fungi, pathogens, microbes, etc. This article incorporates general water cleaning, ultrasonic cleaning (with 25 kHz transducer), and ultraviolet (UV-C, 100–280 nm) germicidal irradiation techniques for sterilization. The second objective is to study the required time and estimated cost of PPE sterilization using the above-mentioned techniques to maximize the sterilization effect on PPE. The outcome of this research will provide assistance to healthcare organizations exploring viable methods to extend their reserves of PPEs. This paper provides more a theoretical but potent strategy for better and complete sterilization. © 2021, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

COVID-19 and Clinic Workflow Optimization Using Lean Six Sigma

Objectives: The COVID-19 pandemic has fundamentally changed the workflow of clinics. We applied Lean Six Sigma processes to optimize clinic workflow to reduce patient wait timesand improve the patient experience. Study Design: Prospective cohort study. Methods: We implemented (1) pushing most extended wait times to the end of the workfl owby rooming the patient directly and (2) using distractions during the waiting process by usingeducational videos and a timer for physician arrival in the patient exam room. We comparedthe patient wait times and subcomponents of Press Ganey scores as a surrogate forchanges in patient experience and satisfaction from the preimplementation period (n = 277)to the 3-month (September 1, 2020, to November 30, 2020) postimplementation period (n = 218). Results: There was a signifi cant reduction in overall throughput time (38 vs 35 minutes) andwait before rooming (11 vs 8 minutes), and increased physician time with patients (15 vs 17minutes) ( P < .0001 for all). These results corresponded with a signifi cant improvement inPress Ganey subcomponents of (1) waiting time in the exam room before being seen by thecare provider, (2) degree to which you were informed about any delays, (3) wait time at clinic(from arriving to leaving), and (4) length of wait before going to an exam room ( P < .001 forall). Conclusions: Simple, inexpensive measures can improve patient engagement and provide asafe setting for patients for clinic visits in the wake of COVID-19. In the future, clinics'common wait areas could be reappropriated to increase the number of clinic exam rooms.

A systematic review on the identification and diagnosis of clinical characteristics of covid-19 patients

World Health Organization (WHO) acknowledged the coronavirus disease 2019 (COVID-19) as one of the global diseases. The novel coronavirus disease is named Severe Acute Respiratory Syndrome Coronavirus (SARS-COV2) is a mild to severe respiratory disease having fever, cough, and shortness of breath as initial symptoms. This virus disseminates through contact with infectious persons, touching contaminated surfaces and infectious air droplets. The virus invades into healthy cells of the body especially the lungs causing the respiratory problems and sometimes causes organ failure by killing healthy cells which eventually leads to death. The origin of coronavirus disease was zoonotic, as the initial cases had been reported from animals in Wuhan. This paper presents the literature review on the identification and diagnosis of clinical characteristics of COVID-19 patients. Furthermore, the treatment and remedies of COVID-19 patients are discussed utilising machine learning and prediction models. The datasets related to the cases of COVID-19 patients are also discussed in this paper. Finally, the research gaps, open issues, and future directions are discussed. © 2021 CEUR-WS. All rights reserved.

CURE: An effective covid-19 remedies based on machine learning prediction models

Coronavirus disease (COVID-19) is a severe pandemic infectious virus that enters into healthy cells of a living body. COVID-19 virus makes copies in the organs of the host body by multiplying itself which ultimately leads to the death of some healthy cells and therefore weakens the immune system. In a mild stage, it mainly affects the respiratory tract and leads to pneumonia, organ failure, and death reaching the last stage. This paper focused on the early detection of the COVID-19 patient based on the positive symptoms of the disease. In this paper, the COVID-19 Remedies (CURE) scheme is proposed based on machine learning prediction models for the treatment of COVID patients. For experimental results, the performance analysis of the CURE scheme is evaluated on the Python platform which is tested using the Kaggle dataset from Johns Hopkins University. © 2021 CEUR-WS. All rights reserved.