Digital Imaging System for the Detection of Diabetic Retinopathy

COVID-19 since its appearance caused serious problems to the health sector due to the increase in infected and deceased people by directly affecting their respiratory system, making it a primordial disease that led all countries to fight this virus, generating that other diseases go to the background such as diabetes mellitus, which is a disease caused by the neglect of people's lifestyles, that has been increasing over time and that has no cure but can be prevented by controlling your blood glucose level, this disease causes diabetic retinopathy in people that with the advance of it can cause loss of sight. In addition, to detect its stage the ophthalmologist relies on his experience, occupying a lot of time and being prone to make mistakes about the patient. In view of this problem, in this article a digital image processing system was performed for the detection of diabetic retinopathy and classified according to the characteristics obtained from the features by analyzing the fundus of the eye automatically and determining the stage in which the patient is. Through the development of this system, it was determined that it works in the best way, visualizing an efficiency of 95.78% in the detection of exudates, and an efficiency of 97.14% in the detection of hemorrhages and blood vessels, resulting in a reliable and safe system to detect diabetic retinopathy early in diabetic patients. © 2023 IEEE.

Association between Type 2 Diabetes Mellitus and Covid-19 Severity: A Literature Review

We conducted a review and evaluated the already documents reports for the relationship among diabetes and COVID-19. The review outcome shows that the COVID-19 severity seems to be greater among patients with diabetes as comorbidity. So, strict glycemic control is imperative in patients infected with COVID-19. Thus, world-wide diabetes burden and COVID-19 pandemic must be deliberated as diabetes increases the COVID-19 severity. Established on this, it is precise significant to follow specific treatment protocols and clinical management in COVID-19 patients affected with diabetes to prevent morbidity and mortality.Copyright © 2023 The Authors.

Impact of IL-35 and Presepsin on Immunological, Hematological, and Biochemical Parameters in COVID-19 Patients

Backgrounds: Immune-inflammatory responses appear to play a key role in severe SARS-CoV-2 infections. Interleukin-35 (IL-35) and presepsin (PSN) are inhibitory cytokine and pro-inflammatory interleukin, which play a crucial role in the immune system modulation, respectively. Therefore, the study of IL-35 and PSN interaction with other parameters may be critical for managing patients with COVID-19. Material(s) and Method(s): A total of 125 severe/critical COVID-19 patients and 60 healthy persons as a control group were enrolled in this work. These patients were admitted to Marjan medical city and Al-Sadeq hospital in Iraq during February to August 2022 and diagnosed as severe cases depending on the SpO2 percentage according to the guidelines released by the National Health World. Anti-and pro-inflammatory cytokines (IL-35 and PSN) were detected by ELISA technique. Finding(s): Presepsin showed a positive correlation with admission to the respiratory care unit (RCU) (r=.022, p=.011). A negative correlation was found between presepsin and C-reactive protein (CRP) (r=.21, p=.018). Both PSN and IL-35 in biochemical tests showed a positive strong effect on glucose levels in COVID-19 patients (r=.234, p=.008 and r=.241, p=.007, respectively). IL-35 had a positive impact on alkaline phosphatase (ALP) (r=.28, p=.002). Hemoglobin (Hb) level showed a positive correlation with presepsin (r=.2, p=.02). Conclusion(s): This study confirms the growing evidence showing the direct role of regulatory pro-inflammatory cytokines in the development and control of COVID-19 through the interaction with other parameters.Copyright © 2023, TMU Press.

The Optimal Method to Predict Hemoglobin A1c from Flash Glucose Monitor Data

In situations where it is difficult for patients to visit hospitals, such as the coronavirus disease pandemic, it is important to more detailly predict hemoglobin A1C (HbA1c) from flash glucose monitor (FGM) data. CGM data over 14 days can be obtained from a FGM sensor;therefore, there are many options for extracting the duration from which glucose levels are derived. Thus, the extracted durations were closely studied to determine which mean glucose levels can predict HbA1c more accurately. Seventy-three outpatients with type 2 diabetes mellitus underwent HbA1c testing, wore a FGM (FreeStyle Libre Pro), and did not change diabetic treatments, on a hospital visit. FGM data over 24 h 13 days (from 00:00 on day 2 to 24:00 on day 14 [FGM attachment: day 1]) were analyzed. The mean glucose levels were calculated corresponding to the following durations: 1 day: day 2 ~ day 14 (n=13), 2 days: days 2-3 ~ days 13-14 (n=12) 12 days: days 2-13 ~ days 3-14 (n=2), 13 days: days 2-14 (n=1) [total 91 durations] (extracted mean glucose levels). Data were analyzed in all patients (n=73), in patients with hypoglycemia in the 13 days (Hypo) group (n=40), and in patients without hypoglycemia in the 13 days (Nonhypo) group (n=33). In all patients, HbA1c was correlated to all 91 extracted mean glucose levels (r=0.76-0.86, p<0.001). HbA1c was the most significantly correlated to the mean glucose levels over 13 days (days 2-14). "Correlation coefficients between HbA1c and extracted mean glucose levels" ("r, HbA1c, EMGL") were also correlated to number of extracted days for the extracted mean glucose levels (r=0.80, p<0.001 [n=91]). In the Hypo group, HbA1c was correlated to all 91 extracted mean glucose levels (r=0.55-0.73, p<0.001). The mean glucose levels over 13 days (days 2-14) were the most significantly correlated to HbA1c. "r, HbA1c, EMGL" correlated to the number of extracted days for the extracted mean glucose levels (r=0.68, p<0.001;Fig. 2). In the Nonhypo group, HbA1c was correlated to all 91 extracted mean glucose levels (r=0.73-0.87, p<0.001). The mean glucose levels over 12 days (days 2-13) were the most significantly correlated to HbA1c. "r, HbA1c, EMGL" correlated to the number of extracted days for the extracted mean glucose levels (r=0.61, p<0.001). The results of the present study are consistent with that of a previous study reporting that the minimum duration needed to estimate time in range over 90 days is 14 days. In the prediction of HbA1c using data from one FGM sensor, prolonged measurement can make the glucose management indicator more accurate. Especially for patients with hypoglycemia, the importance of prolonged measurement may be applicable.

Hyperglycemia and Hypoglycemia Contributions to Acute Respiratory Distress Syndrome

Purpose of Study Non-diabetic COVID-19 patients with elevated admission fasting blood glucose levels ('hyperglycemia') inexplicably have an increased 28 day mortality and higher inhospital complications including the Acute Respiratory Distress Syndrome (ARDS) but potentially contributing blood glucose changes during ARDS development were not reported (Wang S et al: Diabetologia 2020). Our goal was to determine blood glucose alterations before and during acute lung injury development in a rat model used to study ARDS. Methods Used We sequentially evaluated blood glucose levels for 24 hours and lung lavage protein levels (lung permeability) and lung lavage neutrophil numbers (lung inflammation) at 24 hours to assess acute lung injury ('ARDS') in young (~3 month) and old (~12 month) control and a novel strain of hyperoxia surviving 'resistant' rats before and after administering high and low insulin doses and before and after interleukin- 1/lipopolysaccharide (IL-1/LPS) insufflation. Summary of Results Glucose levels increase rapidly and sequentially in young control, but not young resistant, rats peaking ~2 hours after insufflation. Glucose levels also increase in old control and old resistant rats after insufflation compared to young control and young resistant rats after insufflation. The pattern of glucose levels at 2 hours after insufflation resembles lung lavage proteins and neutrophils at 24 h after insufflation (table 1). Administering high insulin (High In) doses decreases glucose levels ('hypoglycemia') and worsens ARDS while administering low insulin (Low In) doses correct glucose levels and improve ARDS. Conclusions Hyperglycemia develops in both young and old rats developing ARDS and high or low glucose levels parallel worse acute lung inflammation and acute lung injury ('ARDS'). Controlling glucose judiciously with insulin may be beneficial in combatting ARDS caused by SARS-CoV-2 infection and other insults.

Remote telemedicine strategy based on multi-risks intervention by intelligent wearable health devices in elderly comorbidities patients with coronary heart disease

Background: Telemedicine based on wearable intelligent health devices becomes increasingly promissing for the elderly due to the accelerated aging population. Especially during COVID-19 pandemic, more elderly coronary heart disease patients with chronic comorbidities are in less secondary prevention management at home. Objective(s): To explore the prevention effect on main cardiovascular risk factors and repeated hospitalization in elderly comorbidities patients by telemedicine intervention based on multi-parameter wearable monitoring devices. Method(s): Total of 337 patients with comorbidities of coronary heart disease, hypertension and diabetes, with age more than 65 years old were recruited in the study from October 2019 to January 2021. They were randomly divided into control group and telemedcine intervention group. The latter used remote multi-parameter wearable devices to measure blood pressure, glycemic and electrocardiograph at home every day. A real-time monitoring platform would alarm any abnormal data to the doctors. Both doctors and patients can read the measurement results on a real-time mobile phone APP and interact with each other remotely twice a week routinely. A medical team remotely indicated the medications, while offering guidance on lifestyle. In contrast, the control group adopted traditional outpatient medical strategy to manage diseases. Result(s): A total of 306 patients were enrolled in the follow-up experiment finally: 153 in the intervention group and 153 in the control group. Patient characteristics at baseline were balanced between two groups. After 12 months, compared with the control group, the intervention group saw the following metrics significantly reduced: Systolic blood pressure (SBP) (131.66+/-9.43 vs 137.20+/-12.02 mmHg, P=0.000), total cholesterol (TC) (3.65+/-0.79 vs 4.08+/-0.82 mmol/L, P=0.001), low density lipoprotein cholesterol (LDL-C) (2.06+/-0.53 vs 2.38+/-0.61 mmol/L, P=0.002), and fasting blood glucose (FBG) (6.26+/-0.75 vs 6.81+/-0.97 mmol/L, P=0.000), while the following metrics went up significantly: Blood pressure control rate (77.3% vs 59.1%, P=0.039), blood lipid control rate(39.4% vs 21.2%, P=0.037), glycemic control rate (71.2% vs 51.5%, P=0.031), and medication adherence score (7.10+/-0.77 vs 6.80+/-0.73, P=0.020). Linear regression model analysis indicates that when interaction frequency >=1.53, 2.47 and 1.15 times/week, the SBP, LDL-C and FBG levels would be controlled, respectively. Cox survival analysis finds that the hospitalization rate of intervention group is significantly lower than that of the control group (24.18% vs 35.29%, P=0.031). Conclusion(s): The telemedicine interactive intervention based on multiparameter wearable devices provides effectively improvement of cardiovascular risk controlling, medication adherence, while reducing the hospitalization rate of patients. A frequency of doctor-patient interactions more than 2 times/week is beneficial for disease management the elderly at home. (Figure Presented) .

Myocardial infarction with non-obstructive coronary arteries (MINOCA) complicating myocarditis

Myocarditis can lead to myocardial infarction in the absence of coronary artery obstruction. We report a case of probable myocarditis, complicated by myocardial infarction with non-obstructive coronary arteries. A 19-year-old man presented with chest pain typical of myocarditis. He was a smoker but was otherwise well. Electrocardiogram revealed diffuse ST-elevation and echocardiography revealed a thin, akinetic apex. Troponin-T levels on admission were raised leading to an initial diagnosis of myocarditis being made. However, late gadolinium enhancement study on cardiac magnetic resonance imaging demonstrated transmural enhancement typical of ischaemia. Coronary angiogram was normal, leading to a likely diagnosis of myocardial infarction with non-obstructive coronary arteries. It is important to highlight that coronary assessment remains important when working up for myocarditis, as myocardial infarction with non-obstructive coronary arteries can often complicate myocarditis in cases of normal angiography. Another important lesson was on how cardiac magnetic resonance imaging provided vital evidence to support underlying ischaemia despite normal coronary angiogram, leading to a diagnosis of myocardial infarction with non-obstructive coronary arteries. Myocardial infarction with non-obstructive coronary arteries remains a broad 'umbrella' term and cardiac magnetic resonance imaging, as well as more invasive coronary imaging techniques during angiography, can further assist in its diagnosis. Our case provides a reminder that myocardial infarction with non-obstructive coronary arteries, although increasingly recognised, remains under-diagnosed and can often overlap with peri-myocarditis, highlighting the need to employ multi-modality imaging in guiding management.Copyright © The Author(s) 2021.

Remote Patient Monitoring and Glycemic Control Trends during the Covid-19 Pandemic

Background and Aims: COVID-19 created challenges to diabetes care and accelerated the need to optimize healthcare delivery outside of traditional settings. Due to subsequent stayat- home orders, many clinicians sought remote patient monitoring (RPM) solutions to remain engaged with their patients with diabetes (PWD) and to provide care. This study examined RPM uptake and diabetes-related outcomes during the COVID- 19 pandemic for PWD using a RPM solution. Method(s): The Glooko platform is used globally by millions of PWD and populates a real world data repository of 100+ billion data points. The analysis included diabetes device syncs from 100,000+ Glooko patient users during Year 2020. Descriptive statistics were used to evaluate trends in RPM usage and diabetes outcomes (glucose, self-monitoring, etc.). Result(s): RPM uploads increased by 36% during the "lockdown" and remained high even as clinics reopened. Five months into the pandemic, peak glucose levels on Sundays and Saturdays increased, but remained lower than pre-pandemic levels (-1.2% and -0.7%, respectively). Average glucose levels dropped early on and gradually increased over the year but with lower weekend and holiday spikes. Self-monitoring of blood glucose (SMBG) readings were within recommended range over 50% of the time and the average number of daily SMBG checks exceeded established clinical guidelines. Additional data will be presented. Conclusion(s): The Glooko RPM platform offered an important clinical tool to providers and patients during the pandemic which resulted in increased engagement, improved glucose trends, and increased self-monitoring. Remote care provided clinics and patients with necessary insights to collaborate and manage diabetes despite the lack of in-clinic visits.

IDF2022-1278 Pilot trial to optimize gestational weight gain and step counts in women with gestational diabetes: ACTIVE PATIENT GDM

Background Physical activity and dietary habit optimization in women with gestational diabetes mellitus (GDM) or such a history can improve both short-term [1,2] and long-term outcomes [3]. This requires strategies that are accessible, usable, and perceived as beneficial. Aim To examine uptake and engagement for the following interventions: (1) step and weight tracking through an online platform using a pedometer and weight scale, with delivery of weekly goals;(2) weekly telephone-based health coaching;and (3) a combination of these. We are assessing recruitment, completion of health coaching sessions and/or step count and weight data upload, and participant perspectives. Method Five-city pilot randomized controlled trial (Montreal, Halifax, Calgary, Winnipeg, Toronto;Canada). Women with GDM are recruited at 20-32 weeks' gestation. Data collection is through web-based questionnaire, electronic tracking of data upload, coaching session logs, chart review (gestational weight gain;blood pressure;A1C;glucose levels;offspring sex, weight, and gestational age), in-depth telephone interview (perspectives, breastfeeding status), and mailed in pedometers with concealed windows worn for 7 days (baseline and 37 weeks). Participants are randomized to one of the 3 interventions described or a control arm (resource website only). Results The trial started in August 2019 with COVID-related interruptions. By June 30, 2022, 192/225 mothers were recruited (recruitment ongoing): 27/192 (14%) withdrew, 13 are currently undergoing interventions, and 152 completed final questionnaires. An interim process analysis of the first 52 indicates that those randomized to step and weight tracking employ the pedometer and scale a mean 81.6% (SD 29.6%) and 69.0% (SD 32.0%) of the time, respectively. High proportions report step tracking (92.3%, n = 24/26) and health coach conversations (87.5% n = 21/24) as useful, with weight tracking endorsed by over half (61.5%, n = 16/26). Conclusion The findings will inform a larger scale clinical trial in terms of impacts on gestational weight gain and appropriate for size offspring status.Copyright © 2023 Elsevier B.V.

Increased Availability of Iscgm Shows Stable Glycemic Control Despite Covid-19 Pandemic - a Glyculator 3.0-Based Benchmark Analysis

Background and Aims: Despite advances in CGM technology, most studies rely on industry support, making multi-manufacturer analyses difficult. Here, using a new open-access CGM benchmarking platform - GlyCulator 3.0, we analyzed the impact of reimbursement of isCGM (November 2019) and rtCGM (March 2018) in Poland on management of diabetes throughout COVID-19 pandemic. Method(s): The study was performed in a single diabetes center that manages patients aged 0-26 years. Percentage of CGM users who satisfied Time in Range (TIR) criterion (>70% of time glucose levels within 70-180 mg/dl) was calculated for 2019- 2021. To create a uniform benchmark, we selected two weeks from March each year- a period not confounded by countryspecific holidays. CGM files were manually downloaded and included into analysis if provided at least 70% CGM active time in the predefined periods. Glycemic variability metrics were computed using GlyCulator 3.0 (https://glyculator.btm .umed.pl/). Result(s): After download and filtering, 971 periods from 604 patients were included for analysis. The number of isCGM users increased over years 2019-2021 (Chi2 for users over total clinic population, p < 0.0001), for rtCGM users this trend was not significant (p = 0.6066). Percentages of users who met TIR >70% target remained at ~60% for rtCGM and ~40% for isCGM. There was no significant difference in the fraction of patients meeting TIR criteria during the analyzed years (Chi2 for rtCGM p = 0.5279, isCGM p = 0.6038). Conclusion(s): Widespread CGM use allowed us to confirm that the patients' diabetes management was not significantly affected by the COVID-19 pandemic. The GlyCulator 3.0 software allows for fast and reliable CGM benchmarking in similar epidemiological scenarios.

Is The Co-administration of Metformin and Clomiphene Superior to Induce Ovulation in Infertile Patients with Poly Cystic Ovary Syndrome and Confirmed Insulin-resistance: A Double Blind Randomized Clinical Trial

Objective: This study aimed to compare the effects of clomiphene citrate (CC) combined with metformin or placebo on infertile patients with poly cystic ovary syndrome (PCOS) and insulin resistance (IR). Material(s) and Method(s): We included 151 infertile women with PCOS and IR in a university hospital from November 2015 to April 2022 in this prospective, double-blind, randomized, placebo-controlled trial. Patients were randomized into two groups;group A: received CC plus metformin (n = 76) and group B: received CC plus placebo (n = 75). The ovulation rate was the main outcome measure. Clinical pregnancy, ongoing pregnancy, live birth and abortion rates were secondary outcome measures. Result(s): There was no remarkable difference in ovulation rate in two groups. Moreover, no significant changes were observed in clinical pregnancy, ongoing pregnancy, live birth and abortion rates between two groups. A larger proportion of women in group A suffered from side effects of metformin (9.3% versus 1.4%;p=0.064), although this was not significant. Conclusion(s): In IR infertile women with PCOS, metformin pre-treatment did not increase the ovulation, clinical pregnancy and live birth rates in patients on clomiphene citrate.Copyright © 2023 Tehran University of Medical Sciences.

SARBOHYDRATE METABOLISM DISORDERS AND THEIR OUTCOMES IN THE LONG-TERM PERIOD IN HOSPITALIZED PATIENTS WITH COVID-19.

BACKGROUND: Diabetes mellitus (DM) is a predisposing factor for the development of many infectious complications. Numerous studies have demonstrated the association of hyperglycemia in patients having DM with a high risk of a more unfavorable course of COVID-19. However, hyperglycemia is often detected in patients with a COVID-19 not having anamnesis of DM. The following remains unclear: the etiological factors causing such disorders of carbohydrate metabolism, the persistence of these disorders and the characteristics of the course, as well as their comparative effect on the outcomes of COVID-19 and the further prognosis of patients. AIM: To study the prevalence and nature of carbohydrate metabolism disorders in patients with moderate to severe course of COVID-19, as well as 6 months after it. MATERIALS AND METHODS: Hospitalized patients with a confirmed diagnosis of COVID-19 of moderate and severe course of the disease were examined. There were no medical interventions outside recommendations of patient management. The observation was carried out during two time periods: inpatient treatment of a COVID-19 and 6 months after discharge. The following were evaluated: anamnesis data, the level of fasting plasma glucose;HbA1c, the results of computed tomography of the lungs, the drug therapy taken in all patients. Descriptive statistics methods were used to evaluate the parameters. RESULT(S): The study included 280 patients with a median age of 61.5+/-14,2 years. During the disease, a violation of carbohydrate metabolism was detected in 188 people (67%), the remaining patients (33%) made up the normoglycemia group. Patients with hyperglycemia were stratified in a following way: a group with an established diagnosis of DM before COVID -19 included - 56 people (20%), a group with steroid-induced hyperglycemia (SIH) - 95 people (34%), a group of stress- induced hyperglycaemia - 20 people (7%), with undiagnosed diabetes - 17 people (6%). In the postcovid period (after 6 months), the normal level of glycemia in the same sample group was observed in 199 people (71.4%);8 people (3%) were diagnosed with new cases of DM. The mortality rate was 10 people (3.6%) in the group of SIH (8 people) and undiagnosed DM (2 people). CONCLUSION(S): The use of glucocorticoids in hospitalized patients with COVID-19 leads to high incidence of SIH, which has reversible character. About 6% among hospitalized patients with a COVID-19 had undiagnosed DM and were not receiving antihyperglycemic therapy. The highest mortality was noted in the group of SIH, which allows us to conclude that SIH worsens the prognosis of patients to the greatest extent. Patients with newly diagnosed hyperglycemia, regardless of the level of hyperglycemia, are characterized by a more unfavorable course.Copyright © Endocrinology Research Centre, 2022.

Comparison of serum telomerase, CBC and insulin resistance and their relationship with physical fitness factors in active and sedentary elderly people under quarantine of coronavirus

The aim of this study was to compare serum telomerase, CBC and insulin resistance and their relationship with physical fitness factors in active and sedentary elderly people under quarantine of coronavirus. In this study, healthy men and women with a mean age of 61.43+/-6/07 in coronavirus pandemic conditions participated in this study voluntarily. Subjects were divided into three groups of physical activity: high, medium and low. The international Physical Activity Level Questionnaire (IPAQ) was used to assess the level of physical activity. Serum telomerase, CBC and insulin resistance were measured in different groups after measuring physical fitness factors. Results showed that BMI is higher in the sedentary group than the groups with moderate and high levels of physical activity;In addition, blood Hb and Hct levels were higher in the moderate physical activity group than in the sedentary group, but blood Plt levels were lower in the moderate physical activity group than in the sedentary group. Another result of the present study was the negative correlation of telomerase with BMI and the positive correlation of telomerase with Hb, Hct and RBC, although there was no correlation between telomerase and physical fitness factors. In addition, BMI was negatively correlated with fitness factors, glucose levels, insulin resistance and CBC. Physical fitness in the elderly people under quarantine of coronavirus has a positive relationship with some blood parameters but no correlation was observed between telomerase and insulin resistance with physical fitness.Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.

Symptoms and Glycemic Control in Young People with Type 1 Diabetes following SARS-CoV-2 Infection: an Observational Study

Objective: To describe clinical manifestations of SARS-CoV-2 infection in children, adolescents, and young adults with established type 1 diabetes and explore the effects of COVID-19 on glycemic control and disease course. Method(s): Observational study conducted at three pediatric diabetes clinics in Israel between mid-March-2020 and mid- March-2021. Included were young people with established type 1 diabetes, <30years, who tested positive for SARS-CoV-2 (qRTPCR). Data was collected from medical files, diabetes devices, and COVID-19 questionnaire. Outcome measures were analyzed by presence/absence of clinical symptoms (symptomatic/asymptomatic) and by age group (pediatric, <19years/young adults, 19-30years). Result(s): Of 132 patients, mean age 16.9+/-5.3years, with COVID- 19 confirmed infection, 103 (78%) had related symptoms;the most common were headaches, fatigue, fever and loss of sense of smell. All had mild disease course, but four required hospitalization and two cases were directly related to COVID-19 infection (pleuropneumonia in a patient with immunodeficiency syndrome, one case of diabetic-ketoacidosis). Logistic regression analysis showed that age (OR=1.11, 95%CI, 1.01, 1.23;P=0.033), elevated glucose levels (OR=5.23, 95%CI, 1.12, 24.41;P=0.035) and comorbidities (OR=8.21, 95%CI, 1.00, 67.51;P=0.050) were positively associated with symptomatic infection. Persistent symptoms occurred in 16.5% of the cohort over a median of 6.7 months;age (OR=1.14, 95%CI, 1.01, 1.29;P=0.030) and elevated glucose levels (OR=3.42, 95%CI, 1.12, 10.40;P=0.031) were positively associated with persistent symptoms. Usually, no change was reported in glucose levels (64%) except for a temporary deterioration in glycemic control during the short infection period. Conclusion(s): Young people with established type 1 diabetes experience mild COVID-19 infection. Elevated glucose levels during COVID-19 infection and older age were associated with prolonged disease course.

A Matched-Group Comparison of Interventions for COVID-19 During the First and Second Waves of the COVID-19 Pandemic in a County Hospital in Chicago

Background. The COVID-19 pandemic continually challenges the scientific community to develop and evaluate viable treatments. In May 2020, remdesivir became the first medication to receive emergency use authorization for the treatment of COVID-19, while dexamethasone became standard of care for patients requiring supplementary oxygen in late 2020. Methods. This was a retrospective observational study of hospitalized adult patients with confirmed coronavirus disease 2019 (COVID-19) admitted in the first wave (3/2020-7/2020) and second wave (10/2020-1/2021) at Cook County Hospital. Variables on demographic, clinical data and outcomes were extracted from the EMR. The measured intervention was use of dexamethasone with remdesivir during the second wave;patients were matched by age and diabetic status to patients in the first wave who had received only remdesivir. The primary outcome was mortality;secondary outcomes were ICU admission and intubation. Conditional logistic regression was used to examine associations between use of dexamethasone and each outcome, controlling for glucose levels, use of remdesivir and severity of disease. Results. 621 patients were admitted in the first wave (3/2020-7/2020) versus 355 in the second wave (12/2020-1/2021). Median age was 55 years and 56 years, respectively. Most patients were Hispanic and Black. In the first wave, 296 patients (48%) were admitted with severe COVID-19 (defined as oxygen saturation on room air at or below 94%) versus 163 patients (46%) in the second wave. Logistic regression showed no association between use of dexamethasone and ICU admission, mortality or intubation. Use of remdesivir showed no association with any of the outcomes. Glucose and severe/critical disease were strongly associated with ICU admission (p=0.01 and p=0.003) and mortality (p=0.06 for both). Conclusion. Despite promising medications, in this study the mortality and disease severity of COVID-19 was very similar to that seen in the first wave. This could be due to patients presenting with more advanced disease and undiagnosed or poorlycontrolled comorbidities that may offset the potential benefit of these treatments. Enhancing access to care and decreasing health inequalities may be more worthwhile than finding a 'miracle drug'.

A Smart Prevention Management in Gestational Diabetes Mellitus

Gestational Diabetes Mellitus (GDM) is a high blood glucose level during pregnancy. Patients have frequent follow-ups throughout pregnancy. The concept of health technology enables the accessibility and efficiency of therapy in terms of time-saving and promotes adherence, especially during Covid-19. The study conducts the predictive of GDM risk using a data classification model, which has high accuracy (more than 90%). The model is used for improving the patient's self-awareness through the color notification feature. In addition, we design the GDM's system, including the electronic health information exchange, to ensure interoperability, improve service accessibility and increase patient participation. Finally, this prototype is evaluated by medical staff using the Technology Acceptance Model. The results are satisfactory and accepted because the data technology and standard are incorporated to deliver high performance. Besides, this system is expected to reduce workload and provide convenience. © 2022 IEEE.

CARDIAC TAMPONADE SECONDARY TO COVID-19 INFECTION

SESSION TITLE: Infections In and Around the Heart Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Due to the novelty of COVID-19 virus, complications of this severe respiratory infection are continually emerging. The inflammatory response to the virus carries a high mortality rate and can lead to a variety of cardiothoracic complications such as acute coronary syndrome, thromboembolism, and heart failure [1]. Here, we present a case of a young female who suffered cardiac tamponade (CT) from a pericardial effusion (PEEF) attributed to COVID-19 infection, which has only been described a handful of times in the literature. CASE PRESENTATION: A 33-year-old female with a history of Down syndrome and morbid obesity presented with worsening dyspnea and fever for one week. Her initial oxygen saturation was 50% on room air, and bilevel noninvasive ventilatory support was initiated. Her viral PCR was positive for COVID-19. A computed tomography angiogram of the chest revealed small bilateral pulmonary emboli, diffuse ground-glass consolidations, and small bilateral pleural effusions. Her respiratory status continued to decompensate and she was placed on mechanical ventilation. She became hypotensive requiring vasopressor support. The following morning, an echocardiogram (TTE) revealed an ejection fraction of 40-45% and a new PEEF with early right ventricular diastolic collapse consistent with CT physiology. She underwent emergent pericardiocentesis, and 220 mL of bloody fluid was drained. PEEF studies revealed a glucose level of 186 mg/dL, LDH of 1380 U/L, and protein of 3.0 g/dL. Total nucleated count was 16,545/uL with 68% neutrophils. Gram stain showed a few white blood cells without organisms, and final bacterial, fungal, and acid-fast cultures were negative. A pericardial drain was left in place, but the procedure was complicated by a pneumothorax and a chest tube was placed. A follow-up TTE the next day revealed improvement of the PEEF without signs of CT. A repeat chest x-ray showed resolution of the pneumothorax. Unfortunately, the patient’s oxygenation and hemodynamic status continued to worsen. She eventually suffered cardiac arrest with pulseless electrical activity and succumbed to her illness. DISCUSSION: New knowledge regarding complications of COVID-19 infection is continually emerging. According to a February 2022 systematic review, only 30 cases of severe PEEFs with CT secondary to COVID-19 have been recorded. The mechanism by which PEEFs form is unclear. It is proposed that the entry of the virus into inflammatory cells causes a release of cytokines such as TNF-alpha, IL-1, IL-6, and IL-8. This resulting cytokine storm allows rapid inflammation and infiltration of fluid into the pericardial sac [1]. CONCLUSIONS: In a decompensated patient with COVID-19, a stat TTE should be obtained to rule out PEEF. Physicians must be cognizant of this uncommon yet highly fatal complication in unstable COVID-19 patients, as cardiac tamponade is a potentially reversible cause of cardiac arrest. Reference #1: Kermani-Alghoraishi, M., Pouramini, A., Kafi, F., & Khosravi, A. (2022). Coronavirus Disease 2019 (COVID-19) and Severe Pericardial Effusion: From Pathogenesis to Management: A Case Report Based Systematic Review. Current problems in cardiology, 47(2), 100933. https://doi.org/10.1016/j.cpcardiol.2021.100933 DISCLOSURES: No relevant relationships by Amanda Cecchini No relevant relationships by Arthur Cecchini No relevant relationships by Kevin Cornwell No relevant relationships by Krupa Solanki

The Effects of Increased Glucose Level and Glycolysis on SARS CoV-2 Infection.

COVID-19 has entered our lives as an infection with high mortality rates. Although the vaccination process has provided benefits, the death toll remains frightening worldwide. Therefore, drugs and combined therapies that can be used against COVID-19 infection are still being investigated. Most of these antiviral medications are investigational drug candidates that are still in clinical trials. In this context, holistic and different approaches for the treatment of COVID-19, including prophylactic use of natural medicines, are under investigation and may offer potential treatment options due to the fact that this is still an unmet medical need of the world. Thus, inhibiting the increased glycolysis in COVID-19 infection with glycolysis inhibitors may be beneficial for patient survival. This short review highlights the potential benefits of glycolysis inhibition as well as controlling the elevated glucose levels in patients with COVID-19.

MACROPHAGES IN EPICARDIAL ADIPOSE TISSUE AND SERUM NT-proBNP IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE

Coronary artery disease (CAD) is widely considered a chronic inflammatory disorder, and dysfunction of epicardial adipose tissue could be an important source of the inflammation. Amino-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) is a known marker of cardiovascular disorders of cardiac origin. Recent studies show that inflammatory stimuli may influence its secretion. Our purpose was to evaluate NT-proBNP serum concentration in relation to immune cell ratios in epicardial adipose tissue (EAT), and cytokine levels in the patients with stable CAD. Patients with stable CAD and heart failure classified into classes II-III, according to the New York Heart Association (NYHA) scale, scheduled for the coronary artery bypass graft (CABG) surgery, were recruited into the study (n = 10;59.5 (53.0-65.0) y. o.;50% males). The EAT and subcutaneous adipose tissue (SAT) specimens were harvested in the course of CABG surgery. Immunostaining with anti-CD68, anti-CD45, anti-IL-1β and anti-TNFα monoclonal antibodies was performed to evaluate cell composition by differential counts per ten fields (400 magnification). Fasting venous blood was obtained from patients before CABG. Blood was centrifuged at 1500g, aliquots were collected and stored frozen at -40 °С until final analysis. Concentrations of NT-proBNP, IL-1β, IL-6, IL-10, TNFα were determined in serum samples by enzyme-linked immunosorbent assay (ELISA). We have found increased production of IL-1β and TNFα cytokines in EAT compared to SAT. Concentrations of NT-proBNP exceeded 125 pg/ml in 4 patients, and correlations between the CD68+ macrophage counts in both EAT and SAT samples (rs = 0.762;p = 0.010 and rs = 0.835;p = 0.003, respectively). NT-proBNP levels showed positive relations with CD45+ leukocyte counts (rs = 0.799;p = 0.006), and with IL-1β+ cell numbers (rs = 0.705;p = 0.023) in EAT samples only. As for the serum biomarkers, NT-proBNP levels showed negative correlation with fasting glucose levels (rs = -0.684;p = 0.029), and positive correlation with serum IL-6 concentrations (rs = 0.891;p = 0.001). Increased serum concentrations of NT-proBNP in CAD patients correlate with accumulation of macrophages in EAT, which is associated with increased production of IL-1β in EAT and correlates with some metabolic parameters.

Acute disseminated encephalomyelitis after COVID-19 vaccination: A case report

Objective: To report a case of a patient who developed acute disseminated encephalomyelitis in the setting of recent COVID-19 vaccination. Background: NA Design/Methods: Data was obtained through the medical records system of Westchester Medical Center in Valhalla, New York. Results: We report on a 53-year-old female patient with a past medical history of obstructive sleep apnea who presented in the emergency room (ER) with left-sided numbness and weakness, ataxia, vertigo, and slurred speech in the context of a three month long history of headaches that started one day after she received her first dose of COVID-19 vaccine. Brain imaging studies showed findings most suggestive of acute disseminated encephalomyelitis (ADEM). Initial pretreatment cerebrospinal fluid (CSF) analysis showed markedly elevated protein with normal glucose level. Extensive workup was negative for infectious, oncologic, autoimmune, and psychiatric etiologies. Over the course of hospitalization, the patient was found to have isolated elevated liver function tests (LFTs) with transaminitis and hepatomegaly on ultrasound. The initial treatment of a five-day methylprednisolone course did not result in significant clinical improvement. The patient was then started on plasma exchange therapy (PLEX) and successfully recovered by the end of the last session. Conclusions: Our case report exemplifies a rare but severe neurologic condition observed in the setting of recent COVID-19 vaccination in a previously healthy woman.