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Case Presentation: A 19 year old male presented with sudden onset chest pain radiating to back. He was a smoker and denied using cocaine since his last hospitalization for cocaine-induced myocardial infarction 2 years ago. UDS was negative. EKG showed normal sinus rhythm with no ST-T wave changes. Initial troponin was 0.850. Potassium levels were low at 2.9 mmol/L but other labs were normal. Chest CT angiography ruled out aortic dissection. He was started on heparin drip. Stat Echocardiogram showed LVEF of 55-60% with no wall motion abnormalities. Repeat potassium levels normalized after replacement, however, his troponins were trending up from 3.9 and 11.5. He continued to complain of severe chest pain, so underwent cardiac catheterization which showed normal coronary arteries and LVEF 55-60%. Heparin drip was discontinued and NSAIDs and colchicine were started. Cardiac MRI (see Figure) was done that showed patchy mid-wall and epicardial delayed gadolinium enhancement involving the basal inferolateral wall, with mild hyperintense signal on the triple IR sequence, suggestive of myocarditis. On further probing, he reported receiving a second dose of Moderna COVID vaccine 3 days prior to presentation. Discussion(s): In December 2019, a novel RNA virus causing COVID-19 infection was reported, which quickly reached a pandemic level. COVID-19 vaccines were granted emergency use authorization by FDA. With millions of people receiving COVID-19 vaccinations worldwide, rare adverse effects are now being reported. The benefits of vaccination undoubtedly outweigh any minor side effects. However major adverse effects like this are potentially fatal. This case report warrants further investigation into the association of myocarditis with COVID-19 vaccinations and further recommendations regarding vaccination in younger adults.
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Background: The Government of India recommends pregnant and lactating women to get vaccinated against the Novel Coronavirus Disease 2019 (COVID-19). However, vaccine hesitancy in this population adversely affects the uptake of vaccination. There is an urgent need for assessing extent of vaccine hesitancy in this group and study its determinants, motivation stages and barriers. Objective(s): To determine psychosocial Factors affecting uptake of COVID-19 Vaccination in lactating women and their attitude towards infant vaccination in general and stage of motivation for vaccination. Method(s): A cross-sectional analysis survey was conducted amongst 80 women visiting postnatal OPD or immunization clinic of a tertiary care hospital of Delhi using Oxford COVID-19 vaccine hesitancy scale (OC19-VHS) and participants were classified as hesitant, non-hesitant, and unsure. Result(s): We enrolled 80 postnatal women with mean age of 25.3 ((SD, 9.6) years. The vaccine hesitancy rate was 44% acceptance rate in the participants. Regression analysis showed young age group (20-45 years), low socioeconomic status and no past history of COVID infection were factors independently associated with Vaccine hesitancy. Doubts on vaccine safety and concerns about its impact on lactation were primary barriers affecting vaccine uptake. Amongst participants in vaccine hesitancy group only 40% had got their children completely vaccinated for age. Conclusion(s): Nearly 40% lactating women visiting hospital had vaccine hesitancy and concern for its impact on lactation and vaccine safety were the primary determinants for reduced vaccine uptake in lactating women.
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A user often needs training and guidance while performing several daily life procedures, e.g., cooking, setting up a new appliance, or doing a COVID test. Watch-based human activity recognition (HAR) can track users' actions during these procedures. However, out of the box, state-of-the-art HAR struggles from noisy data and less-expressive actions that are often part of daily life tasks. This paper proposes PrISM-Tracker, a procedure-tracking framework that augments existing HAR models with (1) graph-based procedure representation and (2) a user-interaction module to handle model uncertainty. Specifically, PrISM-Tracker extends a Viterbi algorithm to update state probabilities based on time-series HAR outputs by leveraging the graph representation that embeds time information as prior. Moreover, the model identifies moments or classes of uncertainty and asks the user for guidance to improve tracking accuracy. We tested PrISM-Tracker in two procedures: latte-making in an engineering lab study and wound care for skin cancer patients at a clinic. The results showed the effectiveness of the proposed algorithm utilizing transition graphs in tracking steps and the efficacy of using simulated human input to enhance performance. This work is the first step toward human-in-the-loop intelligent systems for guiding users while performing new and complicated procedural tasks. © 2023 Owner/Author.
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BACKGROUND: The health and financial burdens faced by cancer survivors, compounded by the significant disruption in care and their increased risk for morbidity and mortality during the COVID-19 pandemic, emphasize the need to assess the mental health impact of the pandemic in this population. We examined the association between beliefs about COVID and posttraumatic stress disorder (PTSD) symptoms among breast and prostate cancer survivors. METHODS: Participants from two longitudinal cohort studies completed surveys assessing their beliefs about COVID- 19, as well as stress and PTSD symptoms. COVID beliefs were assessed using questions adapted from a previous coronavirus survey developed through an iterative process. PTSD symptoms were assessed using the PTSD Checklist (PCL-5). Participants with PCL-5 scores ≥ 33 were classified as having COVID-related PTSD symptoms. Surveys were completed between May 2020 and June 2021 and were categorized into four time points: season 1 from May 2020 to August 2020, season 2 from September 2020 to November 2020, season 3 from December 2020 to February 2021 and season 4 from March 2021 to June 2021. Chi-square, Fisher, Signed Rank Wilcoxon tests and general linear models were performed to assess the relationships between COVID beliefs and PTSD symptoms. RESULTS: Participants were 276 older cancer survivors (mean age 67 years), of whom 157 (57%) were female and had breast cancer and 118 (43%) were male with prostate cancer. Seventy (25%) self-identified as Black, 147 (53%) as White, and 36 (13%) identified as Latinx. Twenty-four participants (7%) had COVID-related PTSD symptoms. Participants with PTSD symptoms were more likely to be very worried about getting COVID (65% vs. 33%, p=0.007), more likely to think that ≥10% of people with COVID would die (75% vs. 40%, p=0.006), and that it was very likely that they or someone they know will get sick from COVID (64% vs. 23%, p=0.006). As the pandemic drew on, cancer survivors' beliefs about COVID changed such that fewer respondents reported that COVID changed their daily routine a lot in season 4 compared to season 1 (88% vs 65%, p <0.001), and fewer were very worried about getting COVID (38% vs. 19%, p=0.056). Temporality was also significantly associated with a decrease in PTSD symptoms with average PCL-5 scores decreasing from 14.2 to 8.9 in season 1 compared to season 4 (p <0.0001). CONCLUSIONS: As the pandemic progressed, cancer survivors tended to have decreased levels of PTSD symptoms, were less likely to have their routines disrupted and were less worried about getting COVID. However, among participants who had PTSD symptoms, concerns about COVID were significantly higher than among those without PTSD symptoms, emphasizing the need for mental health screening and counseling to better support survivors' coping with the impacts of the pandemic.
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Background: Antibiotic overuse leading to increasing antibiotic resistance has been a growing concern. Patients presenting with acute respiratory tract infections (RTI) are often started empirically on antibiotics and continued for days, unless confirmatory results are reported by microbiological testing. Procalcitonin is a serum inflammatory marker that increases in bacterial infections and is utilized as an adjunct to help differentiate viral versus bacterial pneumonia. Procalcitonin-guided management is associated with significantly lower antibiotic exposure and mortality. No studies exist in literature that assess the appropriate utilization of negative procalcitonin test for antibiotic discontinuation. This study assesses utilization of a negative PCT (<0.25 ng/ml) to guide antibiotic discontinuation in patients with pneumonia in a community hospital. Methods:Retrospective observational study including adult patients admitted to our community hospital in 1 year (July 2019-June 2020) with diagnosis of community acquired pneumonia and started on empiric antibiotic therapy and had procalcitonin levels checked. Our hypothesis was that PCT is not being appropriately used for discontinuation of antibiotics and that rate of discontinuation of antibiotics will be less despite a negative PCT. Statistical analysis was performed using XLSTAT. Categorical variables were represented by frequencies and proportions and compared using Chi-square and z test for two proportions. Results: 516 charts were reviewed. After excluding missing data, 176 patients were included. 100 patients had negative PCT. Antibiotics were discontinued in 16% of patients with negative PCT, compared to 58% (p<0.0001), in whom antibiotics were continued without any other indication (including UTI, severe COPD exacerbation, COVID pneumonia) despite a negative PCT. The difference between the percentage of antibiotic discontinuation in our PCT guided treatment sample (9%, n=16/176) was also found to be statistically significant (p< 0.001) compared to percentage of antibiotic discontinuation in population using data from a meta-analysis of 7 RCTs (42%, n=698/1658).1 Conclusion:Previous studies have shown that procalcitonin guided treatment aids in decreasing antibiotic exposure. In lower respiratory tract infections, clinicians order PCT test to aid in differentiating viral versus bacterial etiology and ultimately help guide antibiotic therapy. Our data analysis reveals that despite negative PCT, thus indicating a likely viral etiology, clinicians are not consistently making changes to empiric antibiotic use. This study addresses need for further recommendations from antibiotic stewardship programs regarding procalcitonin-guided antibiotic use and prevent unnecessary ordering of PCT test.
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Introduction: In December 2019, a novel RNA virus causing COVID-19, a respiratory illness that can lead to diffuse alveolar damage and respiratory failure, was reported. The virus facilitates host cell entry through angiotensin-converting enzyme-2 (ACE2) receptor which is present in many organs including kidneys. Kidney injury, including acute kidney injury (AKI), proteinuria and hematuria, has been a reported in COVID-19 patients. The extent of renal involvement has not been extensively correlated with prognosis and outcomes in COVID-19 patients. Methods: Retrospective chart review including patients aged 18 years and older, admitted to a community hospital from March 15, 2020 to April 15, 2020, testing positive for COVID-19. Patient characteristics on admission were collected which included presence of AKI, hematuria, proteinuria and underlying CKD stage, if any. Outcomes included intubation rate, ICU admission, length of stay and inpatient-mortality. Continuous variables were compared using independent t-test. Chi-square test was used to test relationships between categorical variables. Results: A total of 212 charts were studied. After removing missing data, 186 patients were included. 22.6% (n=42) had moderate-severe underlying CKD (stage 3 or more). 38.7% (n=72) of total patients had AKI on presentation. Urinalysis was not done in 51 patients, so of the rest 135 patients, 55.6% (n=75) had hematuria and 52.6% (n=71) had proteinuria on admission. Inpatient mortality was found to be significantly higher in patients with underlying moderate-severe CKD compared to those who did not (52.4% vs 31.3%, p=0.012). Patients with hematuria on admission had significantly higher rates of intubation (37.3% vs 20%, p=0.028) and ICU admissions (44% vs 26.7%, p=0.037) compared to those who did not have hematuria on admission. Length of stay was also significantly higher in patients who had hematuria on admission compared to those who did not (10±8 vs 7±6 days, p=0.042). AKI and proteinuria on admission resulted in no significant difference in intubation, ICU admission, length of stay, or inpatient mortality. No significant difference in length of stay, intubation, and ICU admission was found in patients with underlying mod-severe CKD compared to those who didn't. Conclusion: Early renal involvement and underlying CKD worsen the prognosis of COVID-19 pneumonia and result in higher mortality outcomes. Such patients, especially those with findings of hematuria on admission, need closer monitoring. Furthermore, many COVID-19 patients receive steroids and anticoagulants as part of treatment regimen which will need to be further evaluated as these therapies may contribute to further damage of the kidneys.