Educational Experience of Interventional Cardiology Fellows in the United States and Canada.

BACKGROUND: The COVID-19 pandemic and iodinated contrast shortage may have affected interventional cardiology (IC) fellowship training. OBJECTIVES: The aim of this study was to investigate the educational experience of first-year IC fellows in the United States and Canada. METHODS: A 59-question online survey was conducted among 2021-2022 first-year IC fellows in the United States and Canada. RESULTS: Of the 360 IC fellows invited to participate, 111 (31%) responded; 95% were from the United States, and 79% were men. Participants were mostly from university programs (70%), spent 61 to 70 hours/week in the hospital, and had an annual percutaneous coronary intervention case number of <200 (5%), 200 to 249 (8%), 250 to 349 (33%), 350 to 499 (39%), 500 to 699 (12%), or ≥700 (3%). For femoral access, a micropuncture needle was used regularly by 89% and ultrasound-guided puncture by 81%, and 43% used vascular closure devices in most cases (>80%). Intravascular ultrasound was performed and interpreted very comfortably by 62% and optical coherence tomography (OCT) by 32%, and 20% did not have access to OCT. Approximately one-third felt very comfortable performing various atherectomy techniques. Covered stents, fat embolization, and coil embolization were used very comfortably by 14%, 4%, and 3%, respectively. Embolic protection devices were used very comfortably by 11% to 24% of IC fellows. Almost one-quarter of fellows (24%) were warned about their high radiation exposure. Eighty-four percent considered IC fellowship somewhat or very stressful, and 16% reported inadequate psychological support. CONCLUSIONS: This survey highlights opportunities for improvement with regard to the use of intravascular imaging, atherectomy techniques, complication prevention and management strategies, radiation awareness and mitigation, and psychological support.

Mechanical Circulatory Support in Patients With COVID-19 Presenting With Myocardial Infarction.

ST-segment elevation myocardial infarction (STEMI) complicating COVID-19 is associated with an increased risk of cardiogenic shock and mortality. However, little is known about the frequency of use and clinical impact of mechanical circulatory support (MCS) in these patients. We sought to define patterns of MCS utilization, patient characteristics, and outcomes in patients with COVID-19 with STEMI. The NACMI (North American COVID-19 Myocardial Infarction) is an ongoing prospective, observational registry of patients with COVID-19 positive (COVID-19+) with STEMI with a contemporary control group of persons under investigation who subsequently tested negative for COVID-19 (COVID-19-). We compared the baseline characteristics and in-hospital outcomes of COVID-19+ and patients with COVID-19- according to the use of MCS. The primary outcome was a composite of in-hospital mortality, stroke, recurrent MI, and repeat unplanned revascularization. A total of 1,379 patients (586 COVID-19+ and 793 COVID-19-) enrolled in the NACMI registry between January 2020 and November 2021 were included in this analysis; overall, MCS use was 12.3% (12.1% [n = 71] COVID-19+/MCS positive [MCS+] vs 12.4% [n = 98] COVID-19-/MCS+). Baseline characteristics were similar between the 2 groups. The use of percutaneous coronary intervention was similar between the groups (84% vs 78%; p = 0.404). Intra-aortic balloon pump was the most frequently used MCS device in both groups (53% in COVID-19+/MCS+ and 75% in COVID-19-/MCS+). The primary outcome was significantly higher in COVID-19+/MCS+ patients (60% vs 30%; p = 0.001) because of very high in-hospital mortality (59% vs 28%; p = 0.001). In conclusion, patients with COVID-19+ with STEMI requiring MCS have very high in-hospital mortality, likely related to the significantly higher pulmonary involvement compared with patients with COVID-19- with STEMI requiring MCS.

Patient-reported access to telehealth: An important and unmeasured social determinant of health

Background: The recent COVID-19 pandemic expanded opportunities for remote oncology telehealth visits. However, reliable internet connectivity, digital literacy, and patient comfort with virtual medical visits may differ among patients, especially socially disadvantaged groups. The primary aim of this study was to identify patient demographics and social determinants of health (SDOH) which might limit access to remote telehealth services. Method(s): First, a retrospective analysis was performed of composite administrative data of all patient visits to a large regional cancer center over the COVID-19 pandemic (3/2020-4/2022). Second, a prospective, crosssectional study was conducted of patients with known or suspected malignancy presenting to the same center over six-months (11/2021-5/2022). Participants were asked a standard set of survey questions regarding telehealth accessibility during an in-person clinic visit. Demographics and SDOH were ed from the electronic health record (EHR). Result(s): Although Black patients comprised 43% (n=9,021) of all patient visits (n=20,953), the proportion of telehealth visits conducted among Black patients (29%;n=889) was significantly lower compared to White patients (71%, n=2,142, p<0.0001). Within the cross-sectional study cohort (n=149), 51% (n=76) were Black, 39% (n=58) resided in a rural county, and 8.7% (n=13) were uninsured or Medicaid-insured. Black participants were more likely to self-report lack of internet access (73.7% vs. 90.4%, p<0.01) and were less likely to report having access to or actively using a patient portal in the EHR compared to White patients (47.4% and 79.5%, respectively;p<0.001). Rates of self-reported access to videocapable devices (82.9% vs. 90.4%) and confidence in conducting video visits without assistance (59.2% vs. 68.5%) were similar among Black and White patients (p>0.05). The most common selfidentified challenge to telehealth usage among both races was limited digital literacy. Conclusion(s): Black patients disproportionally under-participated in telehealth visits, suggesting underlying structural disparities in access to digital care. A greater proportion of Black participants self-reported lack of internet access and access to a patient portal to the EHR compared to White patients. Ensuring equal internet access and digital literacy will be critical to reduce further disparities in cancer care among racial minorities.

Knowledge and Awareness Regarding Breast Feeding and Covid-19 Vaccination among Pregnant and Lactating Mothers Attending Opd in a Service Hospital during Covid-19 Pandemic

Aim: To assess the Knowledge and Awareness regarding Breastfeeding and COVID-19 vaccination among Pregnant and Lactating Mothers attending OPD in a Service Hospital during COVID-19 Pandemic. Material(s) and Method(s): Hospital based cross sectional study. Sample size of 380 Pregnant and Lactating Mothers attending OPD antenatally or postnatally were included in the study. Ethics committee approval was taken. A peer reviewed predesigned questionnaire was used to obtain information after taking consent. Demographic data and Knowledge of Mothers regarding Breastfeeding and COVID-19 Vaccination data was collected and analyzed. Result(s): Our Study revealed knowledge and awareness regarding Breastfeeding and COVID-19 Vaccination in Pregnant and Lactating Mothers during COVID-19 Pandemic in a Service Hospital to be 53% and 57% respectively. Our Study also found a significant correlation between Age and Education of Mothers and their Knowledge regarding Breastfeeding in Pregnant and Lactating Mothers during COVID-19 Pandemic. A significant Correlation was found between Education of Mothers and their Knowledge regarding COVID-19 Vaccine in Pregnant and Lactating Mothers during COVID-19 Pandemic. Conclusion(s): This study emphasizes the need to focus on promotion of breast feeding and COVID-19 Vaccination in Pregnant and Lactating during COVID-19 Pandemic. These simple steps may contribute in lowering Neonatal and Infant Mortality rates. Breastfeeding must continue after Maternal COVID-19 vaccination. Copyright © 2022 Ubiquity Press. All rights reserved.

INCREASED INTEREST IN WEIGHT LOSS AND BARIATRIC INTERVENTIONS DURING THE COVID-19 PANDEMIC: AN ANALYSIS OF INTERNET SEARCH QUERIES

Introduction: COVID-19 was declared a global pandemic in March 2020 and drastically changed daily life with ensuing stay-at-home orders. Studies have shown that adherence to healthy diet and exercise declined during this time. Internet search query data has been used to understand public interest in health-related behaviors such as smoking cessation. Therefore, the aim of this study was to examine whether internet searches for weight loss and bariatric interventions increased at the height of the pandemic. Methods: Google Ads Keyword Planner, a publicly available online tool, was used to obtain the search volumes for the keywords “weight loss,” “bariatric surgery,” “endoscopic weight loss procedure,” “gastric balloon,” and “endoscopic sleeve gastroplasty” per month from November 2017- October 2021. Search volumes were identified globally and by country (US, France, Spain, and Italy). Results: Globally, Google searches for “weight loss” peaked to 1,830,000 queries in April 2020, a 122% increase from April 2019 (Fig. 1a). By country, “weight loss” searches increased in April 2020 by 83% (1.8-fold) in the US, 311% (4-fold) in France, 679% (7.8- fold) in Spain, and 236% (3.4-fold) in Italy compared to the year prior (Fig. 1b,1c). Globally, average searches per month for “weight loss” from Mar 2020-Sep 2021 compared to prepandemic searches increased by 58% (Fig 1a). In the US, average monthly searches from Jul 2020-Sep 2021 increased by 43% for “bariatric surgery,” 16% for “gastric balloon,” 116% for “endoscopic sleeve gastroplasty,” and 309% for “endoscopic weight loss procedure” compared to Nov 2017-Jun 2020 averages (Fig. 2). Discussion: The COVID-19 pandemic heightened public interest in weight loss and endoscopic interventions. Several studies have shown that even one month into national lockdowns, people were reporting decreased physical activity, increased snack and alcohol consumption, and weight gain. This may have led to a rise in weight loss Google searches to combat these. Concurrently, research linking obesity with severe COVID-19 was publicized which may have contributed to an interest in weight loss. Elective procedures resumed in most hospitals in the US in summer 2020, possibly explaining the relative peaks in searches for bariatric procedures in July. Notably, interest in both weight loss and bariatric procedures not only increased during the height but have also remained elevated in 2021 as the planet slowly returns to a new normal. Furthermore, while total search volume is higher for ""bariatric surgery,"" there is clearly a rapidly rising interest in endoscopic procedures especially after July 2020. These data present an opportunity for gastroenterologists to provide continued patient education on optimal weight loss strategies varying from lifestyle modification, pharmacologic therapy, endobariatric therapy, and bariatric surgery. (Figure Presented) Figure 1. Google search volumes by month for the search query “weight loss” globally (1a), in the United States (1b), and in Europe (1c) from November 2017-September 2021 (Figure Presented) Figure 2. Google search volume by month for the search queries “bariatric surgery,” “endoscopic weight loss procedure,” “gastric balloon,” and “endscopic sleeve gastroplasty” in the United States from November 2017-September 2021

North American COVID-19 Myocardial Infarction (NACMI) Risk Score for Prediction of In-Hospital Mortality.

Background: In-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) is higher in those with COVID-19 than in those without COVID-19. The factors that predispose to this mortality rate and their relative contribution are poorly understood. This study developed a risk score inclusive of clinical variables to predict in-hospital mortality in patients with COVID-19 and STEMI. Methods: Baseline demographic, clinical, and procedural data from patients in the North American COVID-19 Myocardial Infarction registry were extracted. Univariable logistic regression was performed using candidate predictor variables, and multivariable logistic regression was performed using backward stepwise selection to identify independent predictors of in-hospital mortality. Independent predictors were assigned a weighted integer, with the sum of the integers yielding the total risk score for each patient. Results: In-hospital mortality occurred in 118 of 425 (28%) patients. Eight variables present at the time of STEMI diagnosis (respiratory rate of >35 breaths/min, cardiogenic shock, oxygen saturation of <93%, age of >55 â€‹years, infiltrates on chest x-ray, kidney disease, diabetes, and dyspnea) were assigned a weighted integer. In-hospital mortality increased exponentially with increasing integer risk score (Cochran-Armitage χ2, P â€‹< â€‹.001), and the model demonstrated good discriminative power (c-statistic â€‹= â€‹0.81) and calibration (Hosmer-Lemeshow, P â€‹= â€‹.40). The increasing risk score was strongly associated with in-hospital mortality (3.6%-60% mortality for low-risk and very high-risk score categories, respectively). Conclusions: The risk of in-hospital mortality in patients with COVID-19 and STEMI can be accurately predicted and discriminated using readily available clinical information.

Trends in Clinical Presentation, Management, and Outcomes of STEMI in Patients With COVID-19.

BACKGROUND: We previously reported high in-hospital mortality for ST-segment elevation myocardial infarction (STEMI) patients with COVID-19 treated in the early phase of the pandemic. OBJECTIVES: The purpose of this study was to describe trends of COVID-19 patients with STEMI during the course of the pandemic. METHODS: The NACMI (North American COVID-19 STEMI) registry is a prospective, investigator-initiated, multicenter, observational registry of hospitalized STEMI patients with confirmed or suspected COVID-19 infection in North America. We compared trends in clinical characteristics, management, and outcomes of patients treated in the first year of the pandemic (January 2020 to December 2020) vs those treated in the second year (January 2021 to December 2021). RESULTS: A total of 586 COVID-19-positive patients with STEMI were included in the present analysis; 227 treated in Y2020 and 359 treated in Y2021. Patients' characteristics changed over time. Relative to Y2020, the proportion of Caucasian patients was higher (58% vs 39%; P < 0.001), patients presented more frequently with typical ischemic symptoms (59% vs 51%; P = 0.04), and patients were less likely to have shock pre-PCI (13% vs 18%; P = 0.07) or pulmonary manifestations (33% vs. 47%; P = 0.001) in Y2021. In-hospital mortality decreased from 33% (Y2020) to 23% (Y2021) (P = 0.008). In Y2021, none of the 22 vaccinated patients expired in hospital, whereas in-hospital death was recorded in 37 (22%) unvaccinated patients (P = 0.009). CONCLUSIONS: Significant changes have occurred in the clinical characteristics and outcomes of STEMI patients with COVID-19 infection during the course of the pandemic.

Outbreak of Central-Line-Associated Bloodstream Infections (CLABSI) amid the COVID-19 Pandemic Associated with Changes in Central Line Dressing Care Accompanying Changes in Nursing Education, Nursing Documentation, and Dressing Supply Kits

Background. National Healthcare Safety Network (NHSN) data have revealed an increase in CLABSI associated with the COVID-19 pandemic, but data on factors mediating the increase are limited. Our hospital had been free of CLABSI for 18 months, but we encountered an outbreak of 7 CLABSI over a 5-month period beginning in November 2020. This led to an investigation that revealed that some underlying issues were related to COVID-19. Methods. Infection prevention staff at Omaha's Veterans Affairs Medical Center interviewed hospital staff and performed a retrospective chart review of patients with CLABSI (based on the NHSN definition) amid the COVID-19 pandemic. Results. The first case of CLABSI in the outbreak was detected in November 2020. Prior to that, there was no case of CLABSI since April 2019, as shown in the graph. Each case of CLABSI was associated with a different microorganism. Further investigation revealed deviations from our usual practices in central line dressing care. Our response to COVID-19 had included alterations in periodic competency training (including dressing care) for nursing staff as well as the rapid introduction of streamlined inpatient nursing documentation. Previously, dressing kits included chlorhexidine-impregnated dressings;in November, a kit without these dressings was introduced. A weekly audit of dressing care was begun in March 2021. No CLABSI was identified in April 2021. Conclusion. We encountered a CLABSI outbreak associated with deviations from usual central line dressing care. Using the concept of the Swiss cheese model of error prevention, we recognized alterations in three barriers: competency training;thorough documentation;and complete supply kits. The first two of these factors were directly related to our COVID-19 response. Our findings illustrate the relevance of the Swiss cheese model for maintaining a safe healthcare environment.

Disease and immunoprophylaxis model of human nose organoids to study SARS-CoV-2 and RSV infection

Background. There is a significant and unmet need for pre-clinical models to predict responsiveness of immunotherapies to both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and respiratory syncytial virus (RSV) infection. Airway organoid models have been recently developed to study respiratory viruses;however, the current methods rely on invasive or biopsy derived samples to generate lung or airway organoids. Objective. To establish human nose organoids (HNOs) as a model to study SARS-CoV-2 and RSV pathogenesis and test therapeutics. Methods. We developed a non-invasive method to establish HNOs using stem cells isolated from nasal-wash and mid-turbinate samples. We made air liquid interface (ALI) cultures from undifferentiated 3-dimensional HNOs and differentiated for 21 days to form differentiated nasal epithelium. We inoculated the apical epithelium and assessed SARS-CoV-2 and RSV infection on the apical compartment using real time-polymerase chain reaction, plaque assays and immunofluorescence techniques. We then evaluated the feasibility of HNO-ALI model system to test the efficacy of serum antibodies to prevent SARS-CoV-2 infection and palivizumab monoclonal antibodies to prevent infection using palivizumab sensitive and resistant RSV strains. We introduced the antibodies in the basolateral compartment and monitored its neutralizing capacity on the apical side mimicking the neutralizing effects of antibodies in circulation. Results. Our HNO-ALI cultures consist of well-differentiated, pseudostratified, ciliated, and mucosal respiratory epithelial cells and are susceptible to SARS-CoV-2, RSV A and B infection. SARS-CoV-2 and RSV replicates in the apical ciliated cells of the HNO-ALI cultures, peaks at 4 days, and plateaus at 8 days post infection. Infected HNO-ALI recapitulates aspects of SARS-CoV-2 and RSV disease, including viral shedding, asynchronous cilia beating/ciliary damage, and mucus hyper-secretion. Our model effectively showed protection to infection in a concentration dependent manner of the antibodies used. Conclusion. We established a non-invasive method to generate HNO-ALI epithelial model as an authentic and an alternative model to 1-D cell culture systems. Our ex-vivo HNO-ALI infection model provides a novel approach for testing therapeutic interventions.

Coronavirus Disease (COVID-19) Testing in Asymptomatic Patients Planned for Day Care Systemic Therapy: A Tertiary Cancer Center Experience

Introduction The Indian Council of Medical Research recommends coronavirus disease 2019 (COVID-19) testing for asymptomatic patients only in hospitalized condition or those seeking hospitalization for chemotherapy. Materials and Methods This was a retrospective study to assess the incidence of asymptomatic COVID-19 positivity among asymptomatic, adult patients who were planned for systemic therapy as day care at a tertiary care cancer center. COVID-19 testing was done by reverse transcriptase-polymerase chain reaction by throat/nasopharyngeal swab once before the first cycle of systemic therapy and once every 3 weeks until completion of systemic therapy. Results A total of 824 systemic therapies were delivered in day care from May 7 to June 20, 2020. Among the 761 COVID-19 testing done before systemic therapy, 11 patients were COVID-19 positive (1.45%, 95% confidence interval: 0.60-2.29). Among the 11 patients, 45% were negative before the first systemic therapy but tested positive before subsequent cycles. Among the asymptomatic COVID-19-positive patients, 54% were hospitalized for observation and 46% were on home quarantine for 14 days. None of them received investigational therapy or traditional treatment for COVID-19. None of the patients needed admission in the intensive care unit or oxygen/ventilatory support. There was no mortality among these patients. All patients turned COVID-19 negative at a median of 9 days. Currently, 45% (n = 5/11) of the patients have resumed systemic therapy. Conclusion The incidence of asymptomatic COVID-19 positivity among adult cancer patients planned for day care systemic therapy is low (1.45%). Hence, COVID-19 testing should be done after informed/shared decision with the patient/attendants. Repeat COVID-19 testing before each cycle of systemic therapy is preferable, as 45% of the patients were COVID-19 negative before the first cycle of systemic therapy and turned positive before subsequent cycles in the present study. There was no morbidity or mortality in this cohort of asymptomatic COVID-19-positive cancer patients.

Knowledge, confidence, and perception of respiratory therapists as frontliners in managing COVID-19 cases - A questionnaire survey

Background: The deadly outbreak of coronavirus disease 2019 (COVID-19) has imposed many challenges to health-care professionals (HCPs). The knowledge, confidence in performing clinical skills, and psychological impact have been studied among various HCP. Respiratory therapists (RTs) are the frontliners in handling critically ill COVID-19 victims. Although being an integral part, there are no studies on RTs in COVID-19. Hence, we aim to study the knowledge, confidence, and perception of RTs in managing COVID-19. Subjects and Methods: A cross-sectional, questionnaire-based survey conducted among RTs in India. The present study was conducted from July 15, 2020, to August 1, 2020. Descriptive analysis was used to describe demographics, mean knowledge, confidence levels, perception, and psychological impact on RTs. Results: A total of 68 RTs responded with a response rate of 70.8%. Of them, 60% (41) had good knowledge, 96% (65) had higher confidence in performing required clinical skills, 98.5% (67) had a perception that RTs plays an essential role in COVID-19 care, and 98.5% (67) had a negative psychological impact. Reliability of the questionnaire was found to be in acceptable range. Conclusions: This study found that RTs in general had good knowledge and higher level confidence in performing procedure related to COVID-19. RTs perceive that the role of RT in COVID-19 is important.

Detailed view on repurposed drugs, tracking of vaccines,and brief view on prophylactic nanomedicines as an alternative approach and patient care for covid-19

In December 2019, a rare case of pneumonia was reported in Wuhan, China. This was later analyzed and known to have similar characteristics as viral pneumonia caused by a novel coronavirus. Later, on 11 February 2020, the World Health Organization (WHO) officially named the disease as COVID19. The Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) ought to taint both the upper respiratory tract and the lower respiratory tract. This COVID-19 is spreading quickly with an immense rise in cases around the world. This infection’s mechanism stays obscure, and the medications explicit for the infection were not grown at this point. Infection is highly contagious. Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2) is one of seven kinds of crown infection, including the one which causes severe maladies like Middle East respiratory disorder (MERS) and abrupt, intense respiratory syndrome(SARS). Since its revelation, the infection has spread and has caused anxiety and fear among people. Recent vaccines are tracked, and clinical trials can bring an immediate protocol on a medication approach. By including different therapeutic approaches, it is easier to combat the disease quickly. With very low mortality and high transmission rate, new approaches to vaccines and nanomedicines bring down the spread. Controlled patient care is also crucial. On 11 March, the World Health Organization (WHO) declared the disease as ‘global pandemic’. COVID-19, therefore, poses a significant threat to global public health. This article reviews the epidemiology, pathogenesis, and diagnostic methods. The review also focuses on repurposed drugs, traced vaccines, and a quick view of prophylactic nanomedicines as an alternative for COVID 19. For this review, the complete database has been collected from various search engines such as PubMed, ScienceDirect, Scopus, Elsevier, etc., from the year 2001-2020 using the following keywords. © 2021 The Authors.

Phytomolecules having flavone and napthofuran nucleus exhibited better binding G-score against protease and SPIKE protein of novel corona virus COVID-19 (preprint)

The present study aims to screen the different phytoconstituents and drugs for potential treatment of the corona virus COVID-19 and for specificity through virtual screening. The plant molecules selected were based upon traditional knowledge and are prescribed in the Indian system of medicine for infectious/ respiratory conditions. The three target proteins selected for the study are 3CLpro, PLpro, and SPIKE. These proteins have defined pathological roles in disease transmission. The virtual screening was carried out in these proteins using the GLIDE Schrödinger Maestro software version 11.9.011. The efficacy was assessed by the calculated G-score of the ligand interaction with the amino acid side chains of the ligand binding domain. Molecules such as saponarin, mangiferin, and hesperidin exhibited better G-score with 3CLpro and PLpro. Similarly, diphyllin and tuberculatin exhibited better G-score for SPIKE protein. The reference anti malarial drug hydroxychloroquine showed better interactions with 3CLpro and PLpro. Similarly, protease inhibitors and antiviral drugs have shown interaction with 3CLpro specific protease protein. Interestingly, SPIKE protein ligands, diphyllin and tuberculatin from Justicia adhatoda (vasaka), were found to be unique and did not show affinity to protease inhibitor. It can be concluded, that the molecules having flavone scaffolds show better binding affinity with protease proteins 3CLpro and PLpro. SPIKE protein scaffold is different and showed better binding affinity with molecules having naptho-furan ring. The traditionally used plant phytoconstituents did not exhibit good binding affinity; however, we believe that a combination of these herbs might induce human immune system against microbial infection.