Impact of COVID 19 on bacterial respiratory isolates (2018-2021) from a UK tertiary cardio-thoracic ICU

Aim: To study the impact of COVID-19 admissions during 1st and 2nd surges on bacteriology of ICU respiratory isolates. Method(s): Retrospective time trend analysis of bacterial respiratory isolates from a single centre, tertiary cardiothoracic ICU (CT-ICU) from patients admitted from Jan 2018- June 2021. We compared pre-COVID-19 (January 2018- March 2020) and COVID-19 periods (April 2020- June 2021) and surge periods (surge 1: March 2020- June 2020, surge 2: January- March 2021) to similar time frames in previous years. Chi-square test used to compare proportions. Result(s): 4974 respiratory isolates (Sputum-4230, BAL-563, ET secretions-181) included. During surge 2, culture positivity and gram-negative rates tripled from baseline (20% to 75%;p<0.05). Comparing the pre- pandemic to pandemic period, rates of Klebsiella sp, Acinetobacter sp and Stenotrophomonas sp increased from 12% to 21.3%, 2.4% to 6.2% and 10.5% to 14.3% respectively, while Pseudomonas sp dropped from 30.7% to 23.1% (all p<0.05). MDR Pseudomonas increased significantly from 38.9% to 47.9% (p<0.05), with a non-significant increase in MRSA (5.2% to 9.3%;p=0.34) and MDR enterobacterales (22.6% to 23%;p=0.48). Conclusion(s): This is the first report from a UK CTICU showing a marked epidemiological shift in the bacteriology of respiratory isolates in terms of organism profile, increase in culture positivity and MDR Pseudomonas rates during the pandemic. Analyzing trends on longevity of the findings will help guide changes to infection control and antibiotic policies. This emphasizes the importance of unit specific ecology in choosing appropriate timely antimicrobial therapy and therefore improving patient outcome.

Single-center experience in robotic-assisted Colorectal Surgery during COVID pandemic: First 72 cases

Aim: To present an analysis of The first 2-years' experience of robotic-assisted Colorectal procedures (RACp) using The DaVinci Xi platform. Method(s): This data were prospectively collected and include 72 RACp between February 2020 and December 2021.Indications were: malignancy in 74.3%, diverticular disease 10%, inflammatory bowel disease 8.6%, rectal prolapse 4.3%, intussusception 1.4% and recurrent volvulus 1.4%. Result(s): Over The 13-month study period, 72 RACp were performed including elective 57 cases and 15 semi-elective cases. These comprised: 25 right hemicolectomies, 25 high anterior resections, 6 extended right hemicolectomies,4 low anterior resections, 4 subtotal colectomies 2 restorative proctectomies, 3 abdominoperineal excisions of The rectum, 3 rectopexies that were performed. 51.2% were female and 48.6% were male with a median age of 45 years (22-85 years) and The median body mass index was 31 (18-46) kg/m2. Preoperative American Society of Anaesthesiology scores were reported as 1-2 in 72.9% (n=51) of patients and 27.1%(n=19) as 3. The median length of stay was 5 days (1-35), with readmission rate within 30 days of 8.6% (n=6) that were resolved conservatively. The mean operating time was 268 minutes and The mean console operative time was 158 minutes, with only 3 (4.3%) reported cases of conversion to open. The incidence of postoperative complications was 24.3% (Clavien-Dindo (CD) I/II-12.9%, CD III-10%, and CD V-1 case with superimposed COVID 19 within 30 days. Conclusion(s): RACp is a safe and viable modality in The treatment of Colorectal conditions and can be introduced safely with appropriate guidance and proctorship.

Robotic Surgery for Colorectal cancer: A single-center experience

Aim: To present our learning-curve data for patients that underwent robotic-assisted Colorectal Surgery (RCRS) at a large NE London DGH. Method(s):Wereport our data from50initial Colorectal Cancer resections, performed by two surgeons. We report The gender, age, histopathology, Surgery performed, surgical time, conversion, post-operative complications, and hospital stay. Result(s): The first 50 patients who underwent RCRS between February 2020 and December 2021 for malignancy were included. Twenty-one were right hemicolectomies, 16 high anterior resection, 6 extended right hemicolectomies, 4 low anterior resections (including a planned robotic boari flap in 1 case by a trained urologist), 3 abdominoperineal excisions of rectum. The male to female ratio was 1:1 and The mean age was 65 (range: 22-85) years. The ASA class distribution was 4% ASA I, 64% ASA II, 32% ASA III. The median surgical time was 263 minutes (120-620) with median console time 136 minutes (50-540), The median hospital stay 5 days (range: 2-35) and a conversion rate of 6% (3/50 patients). The most common post-operative complications were ileus 4% (4/50), wound infection 6% (3/50), anastomotic leak 6% (3/50), and abscess formation 2% (1/50). 1 mortality occurred in a patient with an operated leak who contracted COVID-19. All patients underwent confirmed RO resections with a negative CRM. Conclusion(s): We report our first 50 robotic cases for Colorectal malignancy, showing that robotic-assisted Surgery can be performed with low rates of conversion 3 cases (6%) and low rates of postoperative complications despite a challenging patient demographic and a sharp learning curve.

An Alternative Development Agenda for India

This book provides a revamped, transformative, and fiscally sustainable developmental agenda for India to radically improve the well-being and livelihoods of its citizens. Grounded in a 'people first' approach, this alternative agenda focuses on seven vital development and inter-connected areas, including health, education, food and nutrition, child development, gender, livelihood and jobs, and urbanization. The volume highlights the systemic issues plaguing these sectors and offers pragmatic and implementable solutions to address them. The author takes cognizance of the COVID-19 pandemic and draws attention to the limitations of the current public policies and suggests cost-effective interventions and strategies that focus on the poor. The volume discusses crucial themes of universalizing healthcare, battling malnutrition and food insecurity, ensuring quality schooling, unshackling gendered mindsets, enhancing livelihoods and improving the urban quality of life to spell out a pragmatic and workable development agenda for India. Accessible and reader-friendly, the book will be an essential read for scholars and researchers of development studies, economics, public policy, governance, development policy, public administration, political studies, South Asia studies. It will also be of interest to professionals in the development sector. © 2023 Sanjay Kaul. All rights reserved.

HIV SELF-TESTING UNCOVERS HIGH BURDEN of HIDDEN INFECTIONS in INDIA

Background: The number of undiagnosed persons globally remains a barrier to achieving UNAIDS 95-95-95 goals. While nearly 80% are aware of their status, there is much variability by age and geography. Many of those undiagnosed are not engaging in traditional HIV services and do not visit physical locations;novel strategies are needed to overcome structural barriers. We implemented an online, HIV self-testing (HIVST) service for vulnerable populations in India. Methods: An integrated web-based platform for HIVST www.safezindagi. net/selftesting was implemented across 24 Indian states in July 2021. Virtual outreach workers (vORWs) contacted clients on dating apps and social media platforms, provided counseling, and directed interested clients to HIVST via a platform that allowed for home delivery or pick up at a community site. HIVST could be assisted or unassisted with pre/post-test counseling from vORWS. Linkage to confirmatory testing/ART and PrEP was provided as needed. Descriptive statistics were used to characterize outcomes. Results: Between June 30-October 21, 2021, 2,234 clients registered and 1,356 (61%) clients ordered an HIVST kit. Median age of the 1,356 clients was 27 years;74% were male and 66% self-identified as MSM. Ten percent self-identified as transgender. In the prior 6 months, 67% reported condomless sex, 51% multiple partners, 13% transactional sex, 7% STIs, and 4% injection drug use. 1,190 clients (88%) received their kits within 3 days;44% used a courier service and 56% picked up from a community site. Of 1,070 (90%) results uploaded, 43 (4%) were positive with geographical variability (5 states had >4% positivity). The median age of the positive clients was 30 years and 74% were male. Of importance, 65% reported condomless sex with multiple partners in prior 6 months and none were previously tested for HIV. 19 (44%) were linked to confirmatory testing of whom 16 (84%) were confirmed positive and 14 (88%) initiated ART at public centers (see Figure). Conclusion: These data highlight the role of an HIVST platform to reach first time test-takers in a population with high risk behaviors and identified HIV burden >16 times the general population. With increasing online engagement and uptake of telemedicine globally, as well as continuing disruptions due to COVID-19, HIVST offers a critical approach to reach high-risk individuals, identify PLHIV, and link them to care and treatment.

Consenting surgical patients for the risk associated with contracting COVID-19 during their stay at the hospital

Aim: Literature is suggesting significant perioperative mortality and morbidity associated with COVID-19. Therefore, the Royal College of Surgeons (RCS) has produced guidance detailing additional considerations in consenting for surgery whilst COVID-19 is prevalent within society. Section 3A of this document emphasizes the need to discuss the risk of contracting COVID-19 while patients are in hospital. We conducted a multi-cycle closed-loop audit to examine the adherence to this guidance. Method: We completed four audit cycles, each comprising data collection and educational intervention to disseminate the guidance. Data was obtained from consent forms for patients who had consented to both emergency and elective surgery over a two-month period at a large NHS Trust in London. The intervention consisted of teaching sessions, regular emails to the general surgical department, and posters displayed in common areas. Results: Consent forms from 139 patients were reviewed over the four cycles (n=38, 41, 28, and 32). The proportion of patients consented for the risk of contracting COVID-19 during the perioperative period rose serially between the cycles (37%, 61%, 71%, and 85% respectively), and was significantly increased between the first and last cycle (p , 0.01, two-sided Z-test). The interventions proved most effective for senior house officers who improved from consenting 8% initially to 100% on completion of the audit. Conclusions: We demonstrate the marked effectiveness of simple interventions combined with serial auditing to disseminate this message. The same practice may help improve consenting practice at other centres whilst COVID-19 is prevalent in society.

COVID-Inflicted Coagulopathy: Expert Consensus on Management with Novel Oral Anticoagulants in India

Coronavirus disease 2019 (COVID-19) is a highly hypercoagulable viral infection complicated as COVID-inflicted coagulopathy (CIC), that is associated with increased risk of morbidity and mortality. International guidelines recommend low molecular weight heparin (LMWH) to treat CIC in both in-hospital and in-home settings. However, in India, using subcutaneous LMWH may not be a feasible option for a vast majority of patients under home management. Additionally, while some evidence advocates the use of novel oral anticoagulants (NOACs), in hospitalized settings, most guidelines find no role of NOACs in hospital settings. On the other hand, the resource crunch faced in recent COVID-19 pandemic in India forced physicians to treat many patients in home settings. These patients had been usually prescribed NOACs for ease of administration and adherence. Therefore, there is a need to form a consensus on the use of NOACs to manage CIC in India. © 2021 Journal of Association of Physicians of India. All rights reserved.

Facial Mask-related Acne and Acneiform Eruption During the Coronavirus Disease 2019 Pandemic: A Case Series

Use of a facial mask is a necessity during the current pandemic. The associated occlusion with extended daily use can lead to physiological changes in the skin with resultant irritation, itching, and infections. This can lead to exacerbation of pre-existing dermatoses or induction of irritant dermatitis or bacterial folliculitis. We observed several patients with previously controlled acne vulgaris who developed a flare. Also, in those without a history of pre-existing acne, an acneiform eruption was noted. The majority of patients were women who had pre-existing acne and needed to wear a N95 respirator or a surgical mask for several hours a day, every day. A few suggested simple preventative measures provided herein might help this vulnerable population.

FaceLock Homes: A Contactless Smart Home Security System to Prevent COVID Transmission

Smart home security and safety systems have gained more importance in recent years. This is attributable to their significant impact in reducing and preventing loss of assets and human life. The COVID-19 pandemic adds a new dimension to home security as potentially infected people or those not taking necessary precautions such as sanitization or wearing masks may enter homes and cause further transmission. The traditional security systems are effective in conventional scenarios but require human intervention and contact which can lead to the spread of the virus. This necessitates the development of smart security systems that are autonomous and contactless. This paper presents a novel IoT enabled home security system that restricts unauthorized access and at the same time ensures that permitted users are normothermic and are following proper COVID hygiene. The proposed system is a smart edge device that does not require a cloud platform for its computational needs. Facial recognition is used to authenticate and allow approved users to get access. If an unfamiliar person tries to enter the premises, the system takes a photo, computes mask detection on the image, measures temperature and sends these three data points as a WhatsApp notification to the administrative user. The door lock can then be controlled automatically or remotely using a WhatsApp bot. © 2021 IEEE.