Preliminary assessment of COVID-19 Waste management scenario during lockdown in Chandigarh & nearby areas

Covid - 19 brought about a change in process of working in all the spheres. A change could be seen in the education sector, hospitality, transport, manufacturing, medical sector, etc. The economy and lifestyle were majorly hit at all levels. Even a single-unit family faced the brunt of the pandemic in several ways. The family size increased because members of the family who were away from homes working in different cities other than their native places shifted back. That resulted in variation in the quantity of waste generation at residences and a change in the composition of waste as well. While socialists, scientists, architects, and environmentalists are concerned about fancy topics like sustainability, climate change, environmental awareness, etc., one should not forget about the waste management system to add on points towards sustainability & healthy life. A proper waste management system plays a major role when the world faces such a pandemic situation. The study is aimed to find out the changes in the waste composition and change of mode and frequency of collection in the residential sector during the lockdown period. The need for such a study will help us frame better guidelines for future. It will also help us know the awareness level of public and how much more is required for better segregation of waste. This will further help us for better waste management. The methodology used in the paper is questionnaire based besides self-observation. The questionnaire was floated in tricity of Chandigarh, Mohali and Punchkula and Kharar. The findings of the paper reveal that there was considerable lowering in the frequency of collection of waste from the residential area which caused a lot of inconvenience to the owners. It has been found that the waste composition has changed over a period of time with more usage of plastics which were frequently used in the form sanitizer bottles, surface disinfectant bottles, and vegetable cleaning liquid bottle etc. besides packaging material used because of online shopping and extra usage of placebo medicines. © Published under licence by IOP Publishing Ltd.

Towards Providing Clinical Insights on Long Covid from Twitter Data

From the outset of the COVID-19 pandemic, social media has provided a platform for sharing and discussing experiences in real time. This rich source of information may also prove useful to researchers for uncovering evolving insights into post-acute sequelae of SARS-CoV-2 (PACS), commonly referred to as Long COVID. In order to leverage social media data, we propose using entity-extraction methods for providing clinical insights prior to defining subsequent downstream tasks. In this work, we address the gap between state-of-the-art entity recognition models and the extraction of clinically relevant entities which may be useful to provide explanations for gaining relevant insights from Twitter data. We then propose an approach to bridge the gap by utilizing existing configurable tools, and datasets to enhance the capabilities of these models. Code for this work is available at: https://github.com/VectorInstitute/ProjectLongCovid-NER. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Towards Providing Clinical Insights on Long Covid from Twitter Data

From the outset of the COVID-19 pandemic, social media has provided a platform for sharing and discussing experiences in real time. This rich source of information may also prove useful to researchers for uncovering evolving insights into post-acute sequelae of SARS-CoV-2 (PACS), commonly referred to as Long COVID. In order to leverage social media data, we propose using entity-extraction methods for providing clinical insights prior to defining subsequent downstream tasks. In this work, we address the gap between state-of-the-art entity recognition models and the extraction of clinically relevant entities which may be useful to provide explanations for gaining relevant insights from Twitter data. We then propose an approach to bridge the gap by utilizing existing configurable tools, and datasets to enhance the capabilities of these models. Code for this work is available at: https://github.com/VectorInstitute/ProjectLongCovid-NER. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Reinforced Sputnik-V Induced Spike Protein Antibody Levels in Pakistan: An Edge of Sputnik-V Over Sinopharm and SinoVac as Commercially Available COVID-19 Vaccines

Background: Despite several challenges, the SARS-CoV-2 pandemic is still not over. Rapid mass-scale immunization is critical to prevent further COVID-19-associated deaths. Objectives: Herein, we aimed to evaluate the rapid ramp-up effects of spike antibodies in response to Sputnik V, Sinopharm, and SinoVac first dose administration in the general public of Pakistan. Methods: A cross-sectional study was conducted on 2000 participants to examine Sputnik V, Sinopharm, and SinoVac first dose effects 21 days post-administration. From 1200 real-time PCR negative subjects, the samples were subjected to SARS-CoV-2 spike antibody levels using electro-chemiluminescence immunoassay (ECLIA) (Elecsys, # 09289267190 Roche, USA). Results: SARS-CoV-2 spike protein positivity was detected highest at 87% among participants receiving SputnikV with SARS-CoV-2 spike protein antibodies > 1.5 AU/mL compared to 47.6% and 25% in individuals receiving Sinopharm and SinoVac, respectively. Also, 36.04% of the Sputnik-administered individuals depicted antibody levels > 250 AU/mL. Of the participants, 55% had a previous history of COVID-19. Also, 14.86%, 4.76%, and 0% of the SputnikV, Sinopharm, and SinoVac administered subjects showed antibodies > 100 AU/mL, respectively, while > 25 AU/mL antibodies were found in 10.70% of SputnikV, 19.04% of Sinopharm and 10.71% of SinoVac administered individuals. Moreover, > 1.5-2.5 AU/mL antibodies levels were found in 25.10%, 23.80%, and 14.28% of participants with SputnikV, Sinopharm, and SinoVac administered vaccines, respectively. The antibody titers of < 1.5 AU/mL were detected among 13.30%, 52.38%, and 46.42% of subjects administered with SputnikV, Sinopharm, and SinoVac vaccines, respectively. Conclusions: Even before administrating the second booster dose of SputnikV, a significantly higher number of patients depicted rapid ramp-up of SARS-CoV-2 specific spike antibodies, which can significantly contribute to rapid mass-immunization. Despite all challenges, persistent antibody plateau monitoring is critical to attaining humoral immunity against SARS-CoV-2 infections. © 2022, Author(s).

Avoidable admissions in gynecology oncology patients undergoing minimally invasive hysterectomy (520)

Objectives: To determine the rate and identify factors associated with potentially avoidable admissions following a minimally invasive hysterectomy. Methods: Patients who underwent a minimally invasive hysterectomy for a suspected or known gynecologic malignancy between January 2019 to July 2021 were identified in our institution's prospectively curated quality improvement surgical database. Preoperatively, patients were assessed for planned same-day discharge versus a planned admission. Reasons for those who were admitted despite a planned same-day discharge were characterized as the following: anesthesia-related, comorbid conditions, intraoperative factors, social factors, system issues, and uncontrolled pain. For planned admissions, reasons for admission were categorized as necessary and potentially unavoidable. Descriptive statistics were used to summarize the cohort. Results: A total of 380 patients were identified, of which 267 (70%) patients had a planned same-day discharge, and 113 (30%) had an anticipated admission. Same-day surgery discharge rates increased over time (Figure 1). Two hundred and thirty-five patients (88%) were successfully discharged the same day. Of these patients, 17 (7%) presented to the emergency department (ED) within 30 days, and the re-admission rate in this group was 12% (n=2). Thirty-two patients did not successfully discharge on the same day, and five patients (15%) presented to the ED for evaluation within 30 days. Most unplanned admissions were anesthesia-related (n=15, 47%), followed by system issues (n=7, 22%), such as failure to recognize comorbid conditions in the preoperative period, intraoperative factors (n=5, 16%), postoperative pain (n=3, 9%), and social factors (n=2, 6%). Among the 113 anticipated admissions, 78 (69%) patients were deemed necessary due to multi-factorial comorbid conditions or surgical complexity. However, 35 (31%) patients could have been optimized for same-day discharge;reasons for which included patients with comorbid conditions that could have been optimized preopera- tively, such as poorly controlled diabetes (n=13, 12%), system issues, (n= 8, 7%), social factors (n= 7, 6%), anesthesia-related (n= 4, 4%), and surgical complexity (n=3, 3%). [Formula presented] Conclusions: Most patients were successfully discharged the same day, and of those who were deemed unsuitable for same-day discharge, nearly half could have been optimized for same-day discharge. Unplanned admissions in the anticipated same-day discharge cohort were primarily due to anesthesia-related concerns in the immediate postoperative period and where patient comorbid conditions could have been better optimized in the preoperative period. Recognizing potential areas for improvement and further optimizing same-day discharge will allow hospital systems to continue providing care for gynecologic oncology patients during COVID-19 surges.

Increasing volume and the role of gynecologic oncologists in peripartum hysterectomies – A single center study of 109 cases over 7 years (008)

Objectives: To evaluate the surgical volume, surgical outcomes, and the evolving role of gynecologic oncologists in peripartum hysterectomies (PPH). Methods: We conducted an IRB-approved retrospective chart review of PPH cases performed at our institution from June 1, 2014, to June 30, 2021. Clinical-pathologic information was ed into a REDCap database. All analyses were conducted using STATA 17. Results: A total of 109 cases were performed over the 7-year period. Gynecologic oncologists (GYO) involvement in the cases increased from 33% in 2014 to 80% in 2021. The mean age was 36 (range: 23-47) years. Most patients were White (81/109, 74.3%), and the median BMI was 30.7 (range: 21-57) kg/m2. Surgical indications included placenta accreta syndrome (PAS) in 84 (77%) cases, uterine atony in ten (9.2%), uterine rupture in three (2.8%), malignancy in five (4.6%), and hemorrhage other than atony in seven cases (6.4%). Intraoperative complications included bladder injury (or intentional dissection) in eight (7.3%), ureter injury in four (3.7%), vascular injury in three (2.8%), and femoral pseudoaneurysm in one (0.9%) of the cases. Postoperative complications included urinary tract infection in 11 (10.1%), nerve injury in one (0.9%), surgical site infection in 13 (11.2%), and venous thromboembolism in five (4.6%) cases. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) usage started in 2019 with one case followed by six cases in 2020 (31.6%) and 3/16 cases in the first half of 2020 (15.8%). A higher REBOA usage in 2020 corresponded with blood products shortages during the COVID crisis.[Formula presented] Conclusions: Overall volume and complexity of peripartum hysterectomy are increasing. This trend is likely driven by an increased incidence of placenta accreta syndrome cases. Gynecologic oncologists are increasingly delegated as primary surgeons in many institutions. Fellowship training programs should strongly consider training in peripartum hysterectomy for trainees.

Correlation of Radiological Findings (High Resolution Computed Tomography Chest) with Anti-SARS-COV-2 Antibodies in Patients Visiting Tertiary Care Hospitals

Background: Coronavirus (COVID 19) pandemic has taken so many lives and has contributed to an increase in morbidity due to its complications. The research is still in infancy and much has yet to be investigated. Objective: To correlate the HRCT findings on chest with antibody testing in patients visiting tertiary care hospitals in Lahore. Methodology: Three hundred and thirty-two patients with mild, moderate and severe symptoms of COVID 19 were recruited. Those with raised CRP levels were sent for HRCT chest and PCR testing as protocol of the hospitals. All patients were tested with Rapid antibody kits for reactivity. Results: Showed that males were affected more than females. Similarly, non-health care workers were more affected. All patients with bilateral involvement of lungs on HRCT chest and positive PCR findings also tested reactive on antibody testing. However, a few people with bilateral lung involvement and negative on PCR testing got reactive results on Rapid antibody testing. Linear regression model shows significant correlation of HRCT chest findings with Ant-SARC-COV 2 antibodies. Conclusion: HRCT findings (Unilateral and bilateral lung infiltrates) correlated significantly with Anti SARC-COV 2 Antibodies.

The utility of physical examination in ovarian cancer recurrence detection: a retrospective analysis informing virtual surveillance care

Objectives: To investigate the utility of symptom review, serum CA125, and physical exam in the detection of ovarian cancer recurrence to determine the role of virtual surveillance care in the post- COVID-19 era. Methods: Patients diagnosed with ovarian cancer between 2013 and 2020 were identified and included if they completed standard of care treatment with surgical resection and platinum doublet chemotherapy, had no evidence of disease after completion of treatment, and had recurrence of disease detected by symptoms, CA125, physical exam, or imaging. Patients were excluded if they did not have pretreatment elevated serum CA125 (>35 U/ml) or a complete medical record. All recurrences were confirmed with imaging or biopsy. Modalities of recurrence detection were defined as the following: symptoms, physical exam, elevated CA125, or other. “Other” was denoted if imaging studies were obtained for reasons other than suspected recurrence and recurrence was incidentally identified. Descriptive statistics were used to summarize the cohort. Kaplan Meier analyses were used to estimate overall survival. Results: 109 patients met criteria at our institution. At initial diagnosis, the median age was 61 years (range 33-84) and most patients had advanced-stage disease, with 73 (67%) patients with Stage III disease and 26 (23.9%) with Stage IV disease. The median time to recurrence was 12 months (range 3-65) and median overall survival was 56 months (95% CI 46-79). In 46 (42.2%) patients, recurrence was suspected based on multiple modalities. At time of recurrence, elevated CA125 was present in 97 (89.0%) patients, symptoms in 41 (37.6%) patients, and abnormal physical exam findings in 27 (24.8%) patients. Of patients with abnormal physical exam, 26 (96.3%) also had elevated CA125 or symptoms present. Recurrence was suspected based on abnormal physical exam findings alone in 1 (0.9%) patient. Detection modalities other than abnormal physical exam (e.g., CA125, symptoms) were present in 102 (93.6%) patients. Recurrence was incidentally found with imaging obtained for reasons other than suspicion of recurrence in 6 (5.5%) patients.(Table Presented) Conclusions: Most ovarian cancer recurrences can be detected by rising CA125 or symptoms. Physical exam may have limited value in the detection of recurrence. Review of CA125 and symptoms can be conducted virtually. The inclusion of virtual visits for ovarian cancer surveillance should be considered for patients with pretreatment elevated CA125.

Evaluation of epidemic prevention abilities for severe acute respiratory syndrome coronavirus-2 and middle east respiratory syndrome coronavirus in south korea

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) preferentially infects respiratory tract cells, but it has organotropism. Middle East respiratory syndrome coronavirus (MERS-CoV) is significantly distinct from common cold and SARS coronavirus. In past few years, the SARS-CoV-2 and MERS-CoV caused several deaths in South Korea. The aim of current study was to assess SARS-CoV-2 and MERS-CoV awareness and epidemic prevention ability in South Koreans.According to our results, out of 1500 participants, 98.8% and 64.3% were aware of SARS-CoV-2 and MERS-CoV, respectively. Moreover, 97% of the participants used masks for prevention of airborne diseases, while 65.3% of the participants reused the same mask for several days. In addition, 50% of the participants were not satisfied with the government support. Future viral epidemics can be prevented by disseminating advanced knowledge and awareness among general public.

SARCOIDOSIS WITH SUPERIMPOSED SARS-COV-2 LEADING TO HIGHER PREVALENCE OF CAPA?

TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: The recent SARS-CoV-2 pandemic has immensely affected individuals worldwide leading to a serious global emergency. It has the capability to end in post-infection complications and critical outcomes due to significant pro-inflammatory conditions. The role of SARS-CoV-2 in patients with immune disorders, such as sarcoidosis, and the specific interaction between these two diseases remains unclear. Here we present a case of a 65-year-old female with sarcoidosis who got infected with SARS-CoV-2 complicated by pulmonary embolism (PE) and COVID associated pulmonary aspergillosis (CAPA) CASE PRESENTATION: A 60-year-old African American female with a PMH of Sarcoidosis, Chronic thromboembolic pulmonary hypertension (CTEPH) on Riociguat, Macitentan, and Warfarin presented with cough, SOB, and fever for 1-week duration. Upon arrival to the ED, vital signs were significant for tachypnea and hypoxemia. COVID-19 PCR was positive. Initial chest CT revealed bilateral ground-glass opacities (GGOs) with multilobar chronic airspace disease. She was treated with Remdesivir and dexamethasone. During the hospital course, warfarin was held due to supratherapeutic INR. However, before discharge her respiratory parameters decompensated and she required HFNC to maintain her saturation. CT pulmonary angiogram revealed PE in the right distal segmental branch with significant bilateral patchy infiltrates more severe in the distribution of lower lobe suggestive of multilobar pneumonia with bilateral GGOs with crazy paving. Beta galactomannan came back positive and Voriconazole was started empirically with significant improvement in respiratory symptoms. Later fungal culture from sputum confirmed aspergillosis. DISCUSSION: SARS-CoV-2 activates the immune system which results in a release of inflammatory cytokines and leads to cytokine storms. But it remains unknown how the interaction differs in patients with an altered immune system, especially in cases of impairment of the T-cell immunity and granuloma formation, such as sarcoidosis. Some authors suggested that constitutional defects of the regulation of macroautophagy in sarcoidosis could lead to a more severe outcome from the novel SARS-CoV-2 infection. literature review showed that alveolar damage, dysfunctional mucociliary clearance, and altered immune system further facilitates fungal invasion. We, therefore, hypothesize that SARS-CoV-2 in a patient with underlying sarcoidosis may lead to increased risk for pulmonary aspergillosis. CONCLUSIONS: The role of infection from the novel coronavirus in patients having sarcoidosis is still largely unknown however clinicians should be aware that it has the risk of serious complications and clinical deterioration including further destruction of lung architecture, hypervascular response, hypercoagulability, and superinfection like CAPA. REFERENCE #1: https://www.lung.org/lung-health-diseases/lung-disease-lookup/sarcoidosis/learn-about-sarcoidosis REFERENCE #2: https://www.hopkinsmedicine.org/health/conditions-and-diseases/pulmonary-sarcoidosis REFERENCE #3: https://www.nature.com/articles/s41379-020-00661-1#citeas DISCLOSURES: No relevant relationships by Danilo Enriquez, source=Web Response No relevant relationships by SM Hossain, source=Web Response No relevant relationships by Tahmina Jahir, source=Web Response No relevant relationships by Ruby Risal, source=Web Response No relevant relationships by Marie Frances Schmidt, source=Web Response No relevant relationships by Binav Shrestha, source=Web Response No relevant relationships by Sabbena Uppal, source=Web Response

When to Operate, Hesitate and Reintegrate: Society of Gynecologic Oncology Surgical Considerations During the COVID-19 Pandemic

The COVID-19 pandemic has challenged our abilities to provide timely surgical care for patients, including women with gynecologic cancer. In March 2020, the American College of Surgeons, The US Surgeon General, and many medical and surgical academic societies recommended postponing elective surgical interventions. Recognizing that the pandemic may occur in waves, special considerations should be made for appropriate indications for surgical intervention in the setting of strained resources and personnel to meet surgical demand and prioritize excellent patient care. The purpose of this white paper is to highlight all phases of gynecologic cancer surgical care during the COVID-19 pandemic and to illustrate when it is best to operate, to hesitate, and reintegrate surgery. Regarding prioritization, patients should be counseled on risks of surgical delay versus in-hospital or community-acquired COVID-19 exposure in the perioperative setting. Patients should be informed that surgical prioritization is based on (1) local projected resources, (2) disease prevalence, (3) patient and tumor characteristics, and (4) expected outcomes from delays. Several prioritization algorithms have been developed that take into account disease characteristics, patient comorbidities, available personal protective equipment, length of hospital stay, local COVID-10 prevalence, and more. Most oncological procedures have been classified as semiurgent, with a high priority tier 3 designation (second to emergent cases and trauma). Published literature demonstrates that most women with newly diagnosed gynecologic cancer are unlikely to be impacted by a few weeks surgical delay. Those with malignancies with a propensity for metastasis or advanced stage ovarian and uterine malignancies that require interval cytoreduction should be prioritized when possible. For mitigation of complications before, during, and after surgery, patients should be educated on recommendations for social distancing, hand hygiene, and personal protective equipment such as face masks. Providers should abide by similar recommendations and use eye protection in the ambulatory and inpatient settings. N95 respirators or powered air-purifying respirators are recommended in the care of suspected or known COVID-19 patients. Clinical screening should be done at multiple points, COVID-19 testing should be done preoperatively, and a positive test result should delay surgery until asymptomatic formore than 14 days. Safety protocols are critical during procedural intubation and extubation, as this is themost hazardous aspect of surgery in a COVID-19-positive/unknown patient. Open surgery should not be considered safer than minimally invasive surgery. Practitioners for whom the risk of severe disease and death is highest should avoid participating in the surgical care of known COVID-19-positive patients, if possible. Telemedicine should be incorporated to limit provider and patient exposure in the postoperative setting. Virtual platforms have also demonstrated efficacy in virtual rounding as well as patient care settings to involve family members in treatment planning and discussions around diagnosis. Platforms emphasizing enhanced recovery time and same-day discharge should be prioritized, and measures should be taken to reduce delirium risk given lack of patient visitors. Reintegration efforts should focus on systematically prioritizing the nonurgent cases that were initially delayed. Surgical restrictions are likely to continue for some time, and institutional and departmental leadership will be paramount to optimize surgical manpower, support operative personnel, and use hospital resources equitably and responsibly.

Coronavirus disease 2019: scientific overview of the global pandemic.

Coronavirus disease 2019 (COVID-19) is the disease caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Genome sequencing of the virus revealed that it is a new zoonotic virus that might have evolved by jumping from bats to humans with one or more intermediate hosts. The immediate availability of the sequence information in the public domain has accelerated the development of quantitative RT-PCR-based diagnostics. Numerous clinical trials have been prioritized globally for testing new vaccines and treatments against this disease. This review provides a broad insight into different aspects of COVID-19, an introduction to SARS-CoV-2 mitigation strategies and the present status of diagnostics and therapeutics.