Awake Prone Positioning for Patients with Covid-19 and Acute Respiratory Failure: A Meta-Analysis

INTRODUCTION: Awake prone positioning has been broadly utilised for non-intubated patients with COVID-19- related acute hypoxemic respiratory failure but the results from randomised controlled trials (RCTs) are inconsistent. Hence, we aimed to perform an updated meta-analysis to assess the efficacy and safety of awake prone positioning and identify the subpopulations which are likely to benefit the most. METHOD(S): We followed the PRISMA guidelines and an a priori protocol (PROSPERO CRD42022342426) to conduct our study. An electronic search was carried out on several databases including PubMed, Embase and ClinicalTrials.gov from inception to June 2022. We included only RCTs comparing awake prone position (intervention) with the supine positioning or standard of care with no prone positioning (control). Our primary outcomes were risk of intubation and all-cause mortality. Secondary outcomes included the need for escalating respiratory support, length of ICU and hospital stay, ventilation-free days and adverse events. RevMan 5.4 was used to conduct meta-analyses using a random-effects model. Risk ratios (RRs) and mean differences (MDs) were used as effect measures. RESULT(S): Eleven RCTs were included in our study with a cumulative sample size of 2385 patients. Our meta-analysis showed that awake prone positioning reduced the risk of intubation in the overall population (RR 0.84, 95% CI: 0.74- 0.95). In subgroup analyses, a greater benefit was observed among patients who received advanced respiratory support (i.e., high-flow nasal cannula or nasal intermittent positive pressure ventilation at enrolment) compared with patients receiving conventional oxygen therapy and in intensive care unit (ICU) settings compared with non-ICU settings. Awake prone positioning did not decrease the risk of mortality (RR 0.94, 95% CI: 0.78-1.12) and had no effect on any of the secondary outcomes. CONCLUSION(S): This meta-analysis demonstrated that in patients with COVID-19-related acute hypoxemic respiratory failure, awake prone positioning reduced the risk of intubation, particularly in those patients requiring advanced respiratory support and in those enrolled in the ICU setting but did not decrease the risk of death.

Detection of Omicron Caused Pneumonia from Radiology Images Using Convolution Neural Network (CNN)

COVID-19 disease caused by the SARS-CoV-2 virus has created social and economic disruption across the world. The ability of the COVID-19 virus to quickly mutate and transfer has created serious concerns across the world. It is essential to detect COVID-19 infection caused by different variants to take preventive measures accordingly. The existing method of detection of infections caused by COVID-19 and its variants is costly and time-consuming. The impacts of the COVID-19 pandemic in developing countries are very drastic due to the unavailability of medical facilities and infrastructure to handle the pandemic. Pneumonia is the major symptom of COVID-19 infection. The radiology of the lungs in varies in the case of bacterial pneumonia as compared to COVID-19-caused pneumonia. The pattern of pneumonia in lungs in radiology images can also be used to identify the cause associated with pneumonia. In this paper, we propose the methodology of identifying the cause (either due to COVID-19 or other types of infections) of pneumonia from radiology images. Furthermore, because different variants of COVID-19 lead to different patterns of pneumonia, the proposed methodology identifies pneumonia, the COVID-19 caused pneumonia, and Omicron caused pneumonia from the radiology images. To fulfill the above-mentioned tasks, we have used three Convolution Neural Networks (CNNs) at each stage of the proposed methodology. The results unveil that the proposed step-by-step solution enhances the accuracy of pneumonia detection along with finding its cause, despite having a limited dataset. © 2023 Tech Science Press. All rights reserved.

Effect of Preadmission Proton Pump Inhibitor (Ppi) on the Clinical Outcome of Covid -19 Hospitalised Patients during the Pandemic at the James Cook University Hospital, Middlesbrough, Cleveland, United Kingdom

Introduction: The primary objective of this study was to assess whether proton pump inhibitor (PPI) use at pre-admission affected clinical outcomes among covid 19 hospitalised patients. Aims & Methods: Prospectively captured data was analysed to include patients (>18 year) at the hospital with covid 19 infection . PPI data was derived from hospital and primary care records and the study period is over between February 2020 and February 2021.Clinical outcomes of covid 19 patients who were on proton pump inhibitors preadmission were compared with that of covid 19 patients who were not on proton pump inhibitors at the same time. The primary endpoint of the study was 60-day mortality, intensive care unit admission, high dependency unit admission as well as the development of covid-19 complications. Additional endpoints included length of critical care admission. Result(s): A total of 305 patients were included in the study,158 were on proton pump inhibitors and 147 not on proton pump inhibitor at index admission. There were 101 males and 57 females with a mean age of 61.65 in the PPI group, and in the no-PPI group there were 92 males and 55 females with a mean age of 57.28. The mean length of stay was9.98 in the PPI group and 11.83 in the non-PPI group. There was a slightly increased mortality rate of 29.93% in the non-PPI group compared with 28.48 % in the PPI group. Intensive Care Unit (ITU) and High Dependency Unit (HDU) admissions were higher in the non-PPI group (64.62%,30.6% respectively) than in the PPI group (58.22%,27.21%). Complications were more common in the non-PPI group;84.3% had pulmonary complications,7.3% had thromboembolic complications. In the PPI group 72.15% had pulmonary complications which was over 10 % less than in the non-PPI group, 4.4% had thromboembolic complications which was 1.66 times less than the non-PPI group. Conclusion(s): In Our study PPI usage at index admission failed to show any worsening of outcomes in Covid 19 hospitalised patients, as opposed to recent published papers. This proposed causation needs further evaluation via well conducted prospective studies.

Does a National Lockdown Affect the Characteristics of Deep Vein Thromboses in Patients in the Community?

Aim: Has lockdown and COVID-19 led to a change into the characteristics of DVT's and patients who have them alongside a review of the DVT service. Method: Data was collected retrospectively from electronic patient records system for the following periods: 1st April until 30th June 2019 and 1st April until 30th June 2020. These were the key months during the first United Kingdom national lockdown. Data was analysed for patient demographics, risk factors, characteristics of the DVT, management and DVT reoccurrence. Statistical analyses were preformed using GraphPad Prism 8. Results: 227 patients sustained community DVT's in 2019 and 211 patients in 2020 during the study period. 13 of these patients in 2020 were COVID-19 positive. There was a difference in gender distribution (p= 0.0128) with 128 males and 99 females in 2019, 93 males and 118 females in 2020. No significant difference was noted for the incidence of thrombophilia with 9 in 2019 and 3 in 2020 (p=0.1437). Fewer long-haul journeys were made (p=0.012) with 16 in 2019 and only 2 in 2020. Fewer patients had immobility as a risk factor with 79 in 2019 and 55 in 2020 (p=0.0494). However, there were more patients using the contraceptive pill (p=0.0086) with 1 in 2019 and 9 in 2020. Conclusion: There is no significant difference in the characteristics, extent, and management of DVT's prior to and during Lockdown during COVID-19. National Lockdowns do not affect community DVT's however it is important to highlight the surrounding inpatient numbers.

Challenges and Coping Strategies of Radiology Doctors During COVID-19 Era, Lahore, Pakistan

Objective: To evaluate the challenges and coping strategies by Radiology Doctors during the COVID-19 Era. Materials and Methods: It is a mixed-method cross-sectional study done over one month in Radiology Department, Shaikh Zayed Hospital, Lahore, Pakistan with a convenient sampling technique. Results: 80% of the radiologists faced challenges during the pandemic. Age, gender, marital status, monthly income, residents, and years of residency showed significant associations with challenges faced by doctors in the radiology department during the COVID-19 pandemic. Many challenges in terms of management, psychological aspects, training education, and research work were faced by the radiologists but they coped with them heroically. Conclusion: COVID-19 posed a spectrum of unforeseen challenges to the radiologists of Shaikh Zayed Hospital, Lahore. Challenges related to management, psychological aspects for doctors, research work and training education were all tackled by the senior and junior doctors by using various coping strategies.

Leveraging Data Mining Strategies for Predictive Modeling of COVID-19 Outbreak and its Socio-economic Impacts: A Simulation for Public Health in Iran (Regular Paper)

We present a thorough analysis of socio-economic impacts of COVID-19 on public health through data mining strategies including correlation index matrix, auto-regressive integrated moving average, decision trees, heatmaps and statistical performance evaluation. We acquired and filtered data for mortality and outbreak prediction through key features such as total cases, daily new cases, active cases, total deaths, daily new deaths, newly recovered, death rate and recovery rate for 54 days. The socio-economic impacts of the pandemic through quantitative analysis of stock market index, currency inflation,gasoline prices, interest rate, consumer price index and crude oil prices were also investigated. With correlation index matrix and heatmaps, we discovered the nature and intensity of interdependency of these features and developed the regressive estimation model to forecast the values of inter-related features for 10 days. We observed a highest correlation of +0.95 between recovery rate and total infected cases. We also observed aninverse correlation of -0.81 between daily new cases and recovery rate due to unexpected rise in outbreak. Also, the mild but positive index for economic impacts, such as currency inflation,depict the virus' adverse impact on the fiscal situation. The statistical representation of the developed prediction models through bar charts show outstanding performance when evaluated on the benchmarking merits of mean absolute error, root mean square error, relative error and percentage accuracy.

"Race for SARS-CoV2 Vaccine:" The Propitious Oral Route

In today's pandemic era, the public is eyeing eminent scientists to develop a successful vaccine against the highly contagious SARS-CoV2 infection, commonly known as COVID-19. It will be a relief to the overwhelmed medical fraternity. The oral cavity can be a great medium to deliver needle-free vaccination, which is psychologically beneficial to the general public. It is the most exigent vaccination method and still lacks protocols to investigate the efficacy of these systems. However, oral vaccination seems promising, offers several benefits at the societal level, is economically beneficial and hints at the possibility of rendering both cellular and antibody-mediated immunity. Here, this review article gives an overall view of oral vaccination, its challenges, and possibilities, with a focus on vaccine development against SARS-CoV2, administered via the oral route.

Does a national lockdown affect The Characterises of deep vein thromboses and patients in the community?

Background : There is growing evidence identifying COVID-19 as a significant risk factor for thrombosis in in-patients. However it remains uncertain if patients in the community have been influenced during the COVID-19 pandemic and national lockdown. This study, across four centres in the UK, reviewed out-patients with a Deep Vein Thrombosis (DVT). Aims : Has lockdown and COVID-19 led to a change in to the characteristics of DVT's and patients who have them alongside a review of the DVT service. Methods : Data was collected retrospectively from electronic patient records system for the following periods: 1 st April until 30 th June 2019 and 1 st April until 30 th June 2020. These were the key months during the first United Kingdom national lockdown. Data was analysed for patient demographics, risk factors, characteristics of the DVT, management and DVT reoccurrence. Statistical analyses were preformed using GraphPad Prism 8. Results : 227 patients sustained community DVT's in 2019 and 211 patients in 2020 during the study period. 13 of these patients in 2020 were COVID-19 positive. There was a difference in gender distribution ( P = 0.0128) with 128 males and 99 females in 2019, 93 males and 118 females in 2020. No significant difference was noted for the incidence of thrombophilia with 9 in 2019 and 3 in 2020 ( P = 0.1437). Fewer long-haul journeys were made ( P = 0.012) with 16 in 2019 and only 2 in 2020. Fewer patients had immobility as a risk factor with 79 in 2019 and 55 in 2020 ( P = 0.0494). However, there were more patients using the contraceptive pill ( P = 0.0086) with 1 in 2019 and 9 in 2020. Conclusions : There is no significant difference in the characteristics, extent and management of DVT's prior to and during Lockdown during COVID-19. National Lockdowns do not affect community DVT's however it is important to highlight the surrounding inpatient numbers.

DIAPHRAGM DYSFUNCTION: A SEQUELA OF SARS-COV-2 INFECTION

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: The clinical spectrum of SARS-CoV-2 infection varies from asymptomatic infection to critical illness and death. Many patients report persistent dyspnea and fatigue for months following their acute illness. SARS-CoV-2 has an affinity for neural and muscular tissue which may lead to persistent dyspnea and fatigue among the survivors. Here, we discuss a case of diaphragmatic dysfunction due to COVID-19 infection contributing to persistent dyspnea. CASE PRESENTATION: A 49-year-old male smoker with medical history notable only for COVID-19 infection 5 months prior, was admitted for worsening shortness of breath associated with right sided chest discomfort and cough for several months. On evaluation, he was found to be tachypneic and tachycardic with mild hypoxia.Four weeks prior, he was hospitalized with similar complaints and was noted to have a newly found right middle and lower lobe atelectasis with elevation of right hemidiaphragm on chest x-ray (CXR) and CT. Bronchoscopy done during that admission revealed mucus plugs in the right middle and lower lobes which were evacuated. At that time, he was discharged with prednisone and ICS/LABA inhaler which did not improve his symptoms. At current presentation, CTA of the chest revealed persistent but improved atelectasis compared to CT imaging from previous admission, but the right hemidiaphragm elevation persisted. Subsequent sniff test was positive for paradoxical motion of the right hemidiaphragm with normal movement of the left hemidiaphragm suggestive of right diaphragmatic paralysiCardiologic evaluation, including echocardiogram and stress test were unremarkable. The patient failed conservative management and pulmonary rehabilitation. He then underwent surgical plication of the right hemidiaphragm. Post-operative CXR showed improved right lung atelectasis and improved position of the right hemi diaphragm, with subsequent amelioration of his symptoms. DISCUSSION: The mechanism of neuromuscular involvement in COVID-19 infection is not fully understood. The viral spike protein unique to SARS-CoV-2 has high affinity to ACE2 receptors on skeletal muscle fibers1. Direct neuromuscular involvement by SARS-CoV-2 virus has been postulated to cause diaphragmatic paralysis1. Viral replication activates an inflammatory response leading to myotoxic injury via a cytokine storm2. CONCLUSIONS: Diaphragm dysfunction can be one of the consequences of COVID-19 infection. Neuromuscular injury impairs contraction of the diaphragm, which inhibits lung movement and contributes to impaired clearance of secretion leading to persistent dyspnea. REFERENCE #1: Paliwal VK, Garg RK, Gupta A, Tejan N. Neuromuscular presentations in patients with COVID-19. Neurol Sci. 2020;41(11):3039-3056. doi:10.1007/s10072-020-04708-8 REFERENCE #2: Ramani SL, Samet J, Franz CK, et al. Musculoskeletal involvement of COVID-19: review of imaging. Skeletal Radiol. Published online 2021. doi:10.1007/s00256-021-03734-7 DISCLOSURES: No relevant relationships by Ammar Ahmed, source=Web Response No relevant relationships by Madeeha Banu, source=Web Response No relevant relationships by Clifford Hecht, source=Web Response No relevant relationships by Kenneth Joseph, source=Web Response No relevant relationships by Swetha Paduri, source=Web Response No relevant relationships by Azib Shahid, source=Web Response

COVID-19 pneumonia: Guiding the decision to intubate based on independent assessment of oxygenation and work of breathing

With the emergence of COVID-19, healthcare worldwide is afflicted. While there is a spectrum of disease severity and presenting symptoms in infected patients, hypoxemic respiratory failure is the leading cause of mortality. Decision to intubate in rapidly deteriorating patients plays a significant role in determining patient outcome. In most patients, COVID-19 pneumonia initially causes worsening hypoxemia but minimal impairment of lung compliance which determines the work of breathing (WOB). Once adequate arterial oxygenation is established, a tool to determine WOB independent of oxygen needs can guide the decision to intubate for invasive mechanical ventilation (IMV). We monitored oxygen requirements and WOB in 14 patients admitted to our ICU with severe COVID-19 pneumonia. All patients had radiographic evidence of extensive lung disease, significant hypoxemia and multiple comorbidities. Hypoxemia was managed through non-invasive means, predominantly using highflow nasal cannula. To assess WOB, we used a scale developed by us assigning points to the respiratory rate and use of respiratory accessory muscles (range, 1 to 7) (Figure 1a). This was used at the time of initial evaluation and throughout the ICU stay. Out of 14 patients, 10 did not require intubation and recovered while 4 were intubated. We compared the maximum and average WOB of the non-intubated patients throughout their ICU stay with the WOB of intubated patients measured within 24 hours before intubation (Figure 1b). The maximal and the average WOB were higher in patients requiring intubation (mean ± SD, maximal 4.3 ± 0.9 vs 5.5 ± 1.0 pts, p = 0.028 and average 2.7 ± 0.6 vs 3.9 ± 0.5 pts, p = 0.002). Breakdown of the various WOB components demonstrated a statistically significantly higher maximal and average use of respiratory accessory muscles (assessed as their aggregate sum) and higher average respiratory rate in intubated patients. However, the maximal respiratory rate was not significantly higher. Our data illustrates the initial response to COVID-19 lung injury is tachypnea which can be sustained with adequate oxygenation. As lung injury progresses with more recruitment of respiratory accessory muscles, intubation for IMV becomes necessary. Our WOB scale becomes a useful tool to assist in the decision of when to intubate. It is simple to teach, apply and incorporate into routine patient assessment. We recommend routine and systematic WOB assessment to plan for orderly nonemergent intubations for IMV. Further refinement on the interventions recommended based on specific WOB level and other modifying factors is awaited.

Novel Coronavirus: A Review from Origin to Current Status of Therapeutic Strategies

Coronaviruses (CoVs) are continuously emerging, highly transmissible, and pathogenic agents that primarily target the human respiratory system. Previous outbreaks of severe acute respiratory syndrome-CoV and Middle East respiratory syndrome-CoV remain life-threatening and global public health concerns. A novel CoV outbreak that occurred in December 2019 in Wuhan, China was declared a pandemic outbreak that has since killed millions of individuals worldwide. Rapid transmission, genetic variations, and unavailability of specific therapeutic drugs are major factors that led to this alarming and deadly situation. Currently, > 200 clinical vaccine trials are underway to combat infection. This review summarizes reports related to CoV origin, genetic variations, drug options, status of nine vaccines that were in phase III trials, and novel therapies including convalescent plasma and stem cell treatment.

Big Data Collection in Vulnerable Populations: Application to Real World Clinical and Public Health Settings

Introduction: Obesity is a major public health problem worldwide and the prevalence of childhood obesity is of particular concern. Effective interventions for preventing and treating childhood obesity aim to change behaviour and exposures at the individual, community, and societal levels. However, monitoring and evaluating such changes is challenging. Development in the fields of behaviour change science, public health, clinical paediatrics, technology, citizen science and Big Data analytics can be harnessed to implement multidisciplinary research addressing the prevention and treatment of child and adolescent obesity at a population level. The H2020 project “BigO: Big Data Against Childhood Obesity” (http://bigoprogram.eu) is one example of such research efforts. Following the emergence of the COVID-19 pandemic, the BigO research team in Ireland adapted study procedures to ensure collection of Big Data could continue with modified procedures. Aim: To present the approach used for BigO data collection in Ireland during the COVID-19 pandemic and to explore changes in data collection over time. Methods: Step 1 reviewed and sought approval for ethical and regulatory procedures relevant to the collection, monitoring, and storage of personal data collected during the COVID-19 pandemic in children from the general population and those attending a multidisciplinary clinical service for severe obesity. Step 2 explored recruitment strategies and the informed consent and assent process. Step 3 explored the collection of anonymized data including: photographs of meals, beverages and advertisements, physical activity metrics, and masked GPS data using geo-hash representing geographical area rather than detailed coordinates. Following aggregation, analysis, and visualization of collected data descriptive statistics were used to explore patterns of behaviour in the population over time in order to better understand whether the system could be used to monitor behaviours through a period of significant societal change. Results: New ethical approval was granted for the updated methods. From 88 secondary schools approached to participate in the study, five agreed to commence an online consent process with parents and students. In the school setting, 700 children were eligible for study inclusion and 178 consented to participate, respectively. For the clinical study, images of outdoor advertisements collected from participants in Ireland changed during lock-down periods as children had less access to outdoor space and use of study smartwatches was discontinued to adhere to local infection control policies. Please see Table 1 for further details on results of the clinical study. Conclusions: Real-time collection of Big Data was possible through a period of societal upheaval though the expected volume of data was reduced. Such data may prove an important tool for monitoring interventions at the level of the individual child or at the population level for this vulnerable group.

Frequency of use of facemasks and sanitizers during COVID 19 pandemic among the residents of lahore

Background: Coronavirus disease 2019 (COVID-19) is an infectious disease leads to severe acute respiratory syndrome coronavirus. In December 2019;the disease was first identified in Wuhan, one of the cities of province of China. The disease has spread globally and resulting in the coronavirus pandemic 2019-20. The majority of cases lead to mild symptoms. Some cases cause pneumonia and multi-organ failure. Aim: To determine frequency of use of facemasks and sanitizers during COVID 19 pandemic among the residents of Lahore. Research methodology: This descriptive study was conducted at Lahore from 16th March 2020 to 15th September 2020 among residents of Lahore. After taking informed consent from 1200 subjects of 10 years age or more from both sexes were selected through convenient sampling method. The data were entered and interpreted as frequency and percentage distribution. Results: In this study 1200 subjects were included, 820(68.33%) males and 380(31.67%) females. 668(81.56%) males and 300(78.94%) females were in the age group of 19-44 years while 421(51.34%) males and 187(49.21%) females were educated. In this study 408(49.75%) males and 193(50.79%) females used face masks whereas 412(50.24%) males and 187(49.21%) females used no facemasks. 448(54.63%) males and 201(52.89%) females used sanitizers whereas 372(45.37%) males and 179(47.11%) females used no sanitizers. Conclusion: Around half of males and females used facemasks and sanitizers of any category. Majority of highly educated and educated males and females used facemasks and sanitizers thus showing education as profound factor. Use of facemasks among illiterate females was better than males. © 2020 Lahore Medical And Dental College. All rights reserved.

COVID-19: Mapping the Peer-Reviewed Research

Novel coronavirus is a new addition in the family of coronaviruses and was first reported in December 2019 in China. SARS and MERS were the earlier forms of viruses in this family of viruses. The outbreak was considered a pandemic in March 2020 by WHO. The pandemic moved the health sciences researchers around the world to study various aspects of widespread disease. To know the volume and hotspots of COVID-19 research this study is prepared using the bibliometric method of research evaluation. Scopus and Web of Science;two most widely used indexing databases are used to retrieve the already published research on the COVID-19 pandemic. Two data sources are selected for comprehensive coverage. Health scientists have carried out 1060 research studies on the pandemic until now. These publications have been cited with an average of 1.4 citations per publication. China is leading in producing COVID-19 research followed by the United States of America and the United Kingdom with 32%, 13%, and 6% share respectively. Top-ranked journals categorized in first and second quartiles are publishing most of the research on COVID-19. BMJ, the Lancet, and Journal of Medical Virology are the most preferred journals by the researchers to publish their research on COVID-19

Information Dissemination during Covid-19 and Lockdown: The Role of University libraries of Sindh, Pakistan

Universities librarians play vital and varied roles in the life of the university, guiding students and faculty at the reference desk, instructing library research sessions, and developing library collections. It is a truism to say that librarians in all sectors of an academic library wear many different hats and provide numerous services to patrons. This research paper seeks to investigate the role of university libraries in this outbreak situation. The novel virus COVID-19 discovered as a global pandemic. This contagious virus changed working Style tradition to online because of the shutdown of all activities of life. The main objective of this study to find out those services, skills, instructional, and training programs being carried out during this period of the pandemic. Secondly, another aim of this study is to highlight how university libraries are contributing to their members for disseminating and mobilizing information during this emergency. In this study online survey research design used and covers 29 libraries from private sector universities of Sindh Province, Pakistan. The collected data were analyzed by the Statistical Package for Social Sciences (SPSS) software version23.0. Findings also revealed that highest percentage (79.3%) of the university library providing the services during the lockdown in contrast to few libraries relying on traditional services not offered online services in this outbreak, lockdown period. The study concluded that in this new information era library staff, should always be ready to face a challenging situation. Mostly university libraries suggested in the future to adopt webinars services and focused on motivating, encouraging the librarians to enhance their digital skills to be in pace with the present digital age. © 2020. All Rights Reserved.