COVID-19 patient accounts of illness severity, treatments and lasting symptoms

First-person accounts of COVID-19 illness and treatment can complement and enrich data derived from electronic medical or public health records. With patient-reported data, it is uniquely possible to ascertain in-depth contextual information as well as behavioral and emotional responses to illness. The Novel Coronavirus Illness Patient Report (NCIPR) dataset includes complete survey responses from 1,584 confirmed COVID-19 patients ages 18 to 98. NCIPR survey questions address symptoms, medical complications, home and hospital treatments, lasting effects, anxiety about illness, employment impacts, quarantine behaviors, vaccine-related behaviors and effects, and illness of other family/household members. Additional questions address financial security, perceived discrimination, pandemic impacts (relationship, social, stress, sleep), health history, and coping strategies. Detailed patient reports of illness, environment, and psychosocial impact, proximal to timing of infection and considerate of demographic variation, is meaningful for understanding pandemic-related public health from the perspective of those that contracted the disease.

Systematic review and meta-analysis of the placebo effect in panic disorder: Implications for research and clinical practice

Objective: This review aimed to measure the degree of placebo response in panic disorder. Data Sources: We searched major databases up to 31 January 2021, for randomized pharmacotherapy trials published in English. Study Selection: A total of 43 studies met inclusion criteria to be in the analysis (with 174 separate outcome measurements). Data Extraction: Changes in outcome measures from baseline in the placebo group were used to estimate modified Cohen’s d effect size. Results: A total of 43 trials (2392 subjects, 174 outcomes using 27 rating scales) were included in the meta-analysis. Overall placebo effect size was 0.57 (95% confidence interval = [0.50, 0.64]), heterogeneity ( I2: 96.3%). Higher placebo effect size was observed among clinician-rated scales compared to patient reports (0.75 vs 0.35) and among general symptom and anxiety scales compared to panic symptoms and depression scales (0.92 and 0.64 vs 0.56 and 0.54, respectively). There was an upward trend in effect size over the publication period ( r = 0.02, p = 0.002) that was only significant among clinician-rated scales ( r = 0.02, p = 0.011). There was no significant publication bias, Egger’s test ( p = 0.08). Conclusion: We observed a substantial placebo effect size in panic disorder. This effect was more prominent for some aspects of panic disorder psychopathology than for others and was correlated with the source of the assessment and publication year. This finding has implications both for research design, to address the heterogeneity and diversity in placebo responses, and for clinical practice to ensure optimal quality of care. Systematic review registration number: PROSPERO, CRD42019125979.

Ophthalmic artery angioplasty for age-related macular degeneration

BackgroundThere is considerable overlap of contributors to cardiovascular disease and the development of age-related macular degeneration (AMD). Compromised ocular microcirculation due to aging and vascular disease contribute to retinal dysfunction and vision loss. Decreased choroidal perfusion is evident in eyes with dry AMD and is thought to play a role in retinal pigment epithelial dysfunction, the rate of development of geographic atrophy, and the development of neovascularization. The aim of the study was to demonstrate that AMD is correlated with a compromised blood flow in the ocular pathway and show OA angioplasty as a potential treatment of late-stage AMD.MethodsBased on the potential for the ophthalmic artery (OA) to be an anatomical target for the treatment of AMD as outlined above, five patients were found to be eligible for compassionate use treatment, presenting clinically significant late-stage AMD with profound vision loss in one or both eyes, and are included in this retrospective study.ResultsOA narrowing, or significant calcium burden at the ophthalmic segment of the internal carotid artery compromising the origin of the OA was confirmed in all cases. Subsequent OA cannulation was achieved in all patients with some difficulty. Subjective patient reports indicated that all patients perceived a benefit following the procedure; however, improved postoperative visual acuity did not confirm that perceived benefit for one of the patients.ConclusionsFeasibility and safety of the OA angioplasty were demonstrated, and a benefit perceived in five patients with profound vision loss and a desire to achieve improved quality of life. A clinical trial with controlled schedule, imaging, and methodologies is needed to confirm these results.

PORT-A-CATH catheter rupture: case report

Introduction: The modern management of cancer treatment requires access to the venous system repeatedly for the passage of drugs, fluids and blood components. Peripheral veins are rapidly damaged by repeated punctures and by fluids that pass through them. To solve this problem, long-term vascular accesses avoid repeated punctures. One type of long-term venous access is the Port-A-Cath, which is an implantable device usually in the chest with a central venous catheter. Case report: Next, the case of a 34-year-old female with a diagnosis of breast cancer in the right breast is presented. It is treated with a radical mastectomy, and after the procedure a port-a-cath is placed in the left subclavian route for future treatments. The first cycle of chemotherapy is performed, later the patient reports pain at the catheter placement site with increased volume and progressive increase in pain. The patient goes to her health center for an evaluation, they decide to take a chest X-ray showing the migration of the catheter. The management used was through the seldinger technique at the femoral puncture site with a 6 Fr Amplatz GooseNeck Snare Guide, with which it was possible to extract the foreign body at the level of the left brachiocephalic vein. Conclusion: The implantation of a Port-A-Cath catheter is associated with some risks in the process. Catheter and patient care should be maintained to decrease the incidence of complications.

COVID-19 Data Forecasting and Spread Visualization Using ML

The COVID-19 global pandemic has affected everyone's day-to-day life. The COVID spread data is increasing rapidly which needs to be visualized in some format. The statistical data includes infected, recovered, and the death count which is visualized by various tools. This project presents an interactive dynamic dashboard to display the details about the COVID-19 patient reports, scheduled reports, timely reports, geographical reports including state-wise, district wise. It should have options to display the metrics using charts, graphs, etc. Application features include registration, download report in multiple formats, email the report, schedule a report, share a report. Users can check for Epass availability; the decision will be taken by checking the covid-affected counts on the source and destination. Patient details will be stored in the cloud. The model includes a prediction of upcoming covid-affected count using ML.

Hiệu quả của phương pháp oxy hóa qua màng ngoài cơ thể (ECMO) trong hỗ trợ điều trị hội chứng suy hô hấp cấp nguy kịch trên bệnh nhân Covid

TÓM TẮT Sự bùng phát của hội chứng viêm đường hô hấp cấp do coronavirus 2 (SARS-CoV-2) nhanh chóng trở thành đại dịch trên toàn thế giới với hơn 40 triệu người mắc và hơn 1 triệu người chết tính đến ngày 17 tháng 10 năm 2020. Nhiều bệnh nhân COVID-19 được báo cáo cho thấy rằng có thể dẫn đến suy hô hấp cấp cần chăm sóc đặc biệt (ICU) và thiết bị hỗ trợ thở và bệnh cảnh có thể nhanh chóng tiến triển thành chứng suy hô hấp cấp (ARDS) với thiếu oxy ở mức độ nặng và gây ra tử vong dù đã có sự hỗ trợ của thiết bị hỗ trợ thở, cả 2 khả năng này thậm chí có thể cùng xảy ra. Các tổ chức quốc tế và các chuyên gia trong lĩnh vực này khuyến nghị sử dụng ECMO cho những bệnh nhân ARDS bị bệnh nặng có COVID-19. Tuy nhiên, tỷ lệ sống sót là rất thấp trong những trường hợp được sử dụng ECMO với COVID-19 trong đợt đầu tiên. Nghiên cứu của chúng tôi nhằm đánh giá kết quả bước đầu ứng dụng kỹ thuật ECMO trong hỗ trợ điều trị hội chứng suy hô hấp cấp nguy kịch trên bệnh nhân COVID-19 tại trung tâm hồi sức bệnh viện Trung ương Huế. ABSTRACT EFFECTIVENESS OF EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) IN THE TREATMENT OF ACUTE RESPIRATORY DISTRESS SYNDROME IN PATIENTS WITH COVID-19 The outbreak of acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2) quickly developed into a worldwide pandemic with more than 40 million people infected and more than 1 million dead as of October 17, 2020. Numerous patient reports COVID-19 can lead to acute respiratory failure requiring intensive care (ICU) and ventilators, and it can rapidly evolve into a certificate of acute respiratory failure (ARDS) with red oxygen in the heavy and death, despite the protective ventilator, even both. International organizations and experts in the field recommend ECMO for critically ill ARDS patients with COVID-19. However, survival is very low in the ECMO - corrected case series with COVID-19 during the first COVID-19 wave. Our study aimed to evaluate the results of the initial application of transmembrane oxygenation (ECMO) technique in the support of critical acute respiratory distress syndrome on COVID-19 patients at the hospital resuscitation center of Hue central hospital. Keywords: ECMO, ARDS, COVID-19.

Evaluasi Hasil Labioplasti Menggunakan Skor CLEFT-Q

Application of CLEFT-Q score instrument in the assessment of surgical outcomes for cleft lip and/or cleft palate based on patient reports is still relatively new. This study was aimed to establish the normative value of the Indonesian version of CLEFT-Q score in post-cleft lip surgery patients and to differentiate the results of cleft lip surgery according to the score based on the type of cleft, age, and sex. This was a preliminary study using the Indonesian CLEFT-Q instrument. Patients were interviewed for filling out the Indonesian version of CLEFT-Q after surgery. There were 75 samples in this study. Significant results were found in the association between age and CLEFT-Q score (p<0.05 and R>0.35). Variable selection for multi-variable analysis included cleft type and age in the model, where age alone indicated a significant relationship. The linear regression model involved the relationship between CLEFT-Q scores and gender, age, and cleft type as covariates. The correlation shown was classified as having moderate strength (R=0.46) for all covariates. In conclusion, the normative value of the Indonesian version of CLEFT-Q score with an approach to post-cleft lip surgery patients got a value that was in accordance with the highest standard in the literature, namely 91. The results of cleft lip surgery according to the Indonesian version of CLEFT-Q score based on the type of cleft, age and gender can be applied according to the literature.Keywords: cleft lip; cleft palate; cleft lip and palate; Indonesian version of CLEFT-Q Abstrak: Penerapan skor CLEFT-Q dalam penilaian luaran operasi bibir sumbing dan/atau langit-langit terbelah berdasarkan laporan pasien masih relatif baru. Penelitian ini bertujuan untuk mene-gakkan nilai normatif skor CLEFT-Q berbahasa Indonesia pada pasien pasca operasi bibir sum-bing serta membedakan hasil operasi bibir sumbing menurut skor tersebut berdasarkan tipe cleft, usia, dan jenis kelamin. Jenis penelitian ialah studi pendahuluan penggunaan CLEFT-Q berbahasa Indonesia. Pasien diwawancarai untuk melakukan pengisian CLEFT-Q berbahasa Indonesia setelah operasi. Hasil penelitian mendapatkan total 75 sampel. Hasil bermakna ditemukan pada hubungan antara usia dan skor CLEFT-Q (p <0,05 dan R > 0,35). Seleksi variabel untuk analisis multivariabel mengikutsertakan tipe cleft dan usia di dalam model, dan variabel usia saja yang mengindikasikan adanya hubungan bermakna (95% CI 1,15-2,33; p=0,006). Model regresi linear melibatkan hubungan antara skor CLEFT-Q dengan jenis kelamin, usia, dan tipe cleft sebagai kovariat dan mendapatkan korelasi kekuatan sedang (R=0,46) untuk semua kovariat. Simpulan penelitian ini ialah nilai normatif skor CLEFT-Q berbahasa Indonesia dengan pendekatan terhadap pasien pasca operasi bibir sumbing mendapatkan nilai yang sesuai dengan standar tertinggi pada kepustakaan yaitu 91. Hasil operasi bibir sumbing menurut skor CLEFT-Q berbahasa Indonesia berdasarkan tipe cleft, umur dan jenis kelamin dapat diterapkan sesuai kepustakaan.Kata kunci: cleft lip; cleft palate; cleft lip and palate; skor CLEFT-Q berbahasa Indonesia

Temporal Trend in SARS-CoV-2 Symptoms in Pregnant Women

Objective The objective of this study was to examine temporal trends in the clinical presentation of patients diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pregnancy. Study Design This is a retrospective cohort study of pregnant women who were universally screened for SARS-CoV-2 and tested positive. This multi-center study of admissions to labor and delivery units in New York City and Long Island included all SARS-CoV-2-infected pregnant women admitted to labor and delivery units between April 10th and June 4th 2020. Six Northwell Health hospitals and Maimonides Medical Center were included in the study. The main measures of the study included patient reports of COVID-19 symptoms: fever, cough, chest pain, shortness of breath, nausea, vomiting, and intensive care unit (ICU) admissions. The main outcome measure was the percentage of all infected women who reported any of the above symptoms. Results In total, 427 infected pregnant women were included in the study. There was a statistically significant decline in the percentage of patients presenting with any symptoms over the course of the study. In addition, disease severity, symptoms of fever, cough, and chest pain/shortness of breath also significantly declined over time, and no ICU admissions were noted after the third week of April. Conclusions There was a temporal shift away from symptomatic presentation in pregnant women diagnosed with SARS-CoV-2 over the course of the first months of the epidemic in New York. Further studies are necessary to elucidate the cause of this change in presentation among pregnant women, to determine whether this trend is also observed in other patient populations. Key Points

Interpretable surface-based detection of focal cortical dysplasias: a MELD study

Introduction: One outstanding challenge for machine learning in diagnostic biomedical imaging is algorithm interpretability. A key application is the identification of subtle epileptogenic focal cortical dysplasias (FCDs) from structural MRI. FCDs are difficult to visualise on structural MRI but are often amenable to surgical resection. We aimed to develop an open-source, interpretable, surface-based machine-learning algorithm to automatically identify FCDs on heterogeneous structural MRI data from epilepsy surgery centres worldwide. Methods: The Multi-centre Epilepsy Lesion Detection (MELD) Project collated and harmonised a retrospective MRI cohort of 1015 participants, 618 patients with focal FCD-related epilepsy and 397 controls, from 22 epilepsy centres worldwide. We created a neural network for FCD detection based on 33 surface-based features. The network was trained and cross-validated on 50% of the total cohort and tested on the remaining 50% as well as on 2 independent test sites. Multidimensional feature analysis and integrated gradient saliencies were used to interrogate network performance. Results: Our pipeline outputs individual patient reports, which identify the location of predicted lesions, alongside their imaging features and relative saliency to the classifier. Overall, after including a border-zone around lesions, the developed MELD FCD surface-based algorithm had a sensitivity of 67% and a specificity of 54% on the withheld test cohort, and a sensitivity of 85% on a restricted subcohort of seizure free patients with FCD type IIB who had T1 and FLAIR MRI data. Conclusions: This multicentre, multinational study with open access protocols and code has developed a robust and interpretable machine-learning algorithm for automated detection of focal cortical dysplasias, giving physicians greater confidence in the identification of subtle MRI lesions.