Admission Protocol Research Articles

Triage admission protocol with a centralized quarantine unit for patients after acute care surgery during the COVID-19 pandemic: A tertiary center experience in Taiwan.

During the COVID-19 surge in Taiwan, the Far East Memorial Hospital established a system including a centralized quarantine unit and triage admission protocol to facilitate acute care surgical inpatient services, prevent nosocomial COVID-19 infection and maintain the efficiency and quality of health care service during the pandemics. This retrospective cohort study included patients undergoing acute care surgery. The triage admission protocol was based on rapid antigen tests, Liat® PCR and RT-PCT tests. Type of surgical procedure, patient characteristics, and efficacy indices of the centralized quarantine unit and emergency department (ED) were collected and analyzed before (Phase I: May 11 to July 2, 2021) and after (Phase II: July 3 to July 31, 2021) the system started. A total of 287 patients (105 in Phase I and 182 in Phase II) were enrolled. Nosocomial COVID-19 infection occur in 27 patients in phase I but zero in phase II. More patients received traumatological, orthopedic, and neurologic surgeries in phase II than in phase I. The patients' surgical risk classification, median total hospital stay, intensive care unit (ICU) stay, intraoperative blood loss, operation time, and the number of patients requiring postoperative ICU care were similar in both groups. The duration of ED stay and waiting time for acute care surgery were longer in Phase II (397 vs. 532 minutes, p < 0.0001). The duration of ED stay was positively correlated with the number of surgical patients visiting the ED (median = 66 patients, Spearman's ρ = 0.207) and the occupancy ratio in the centralized quarantine unit on that day (median = 90.63%, Spearman's ρ = 0.191). The triage admission protocol provided resilient quarantine needs and sustainable acute care surgical services during the COVID-19 pandemic. The efficiency was related to the number of medical staff dedicated to the centralized quarantine unit and number of surgical patients visited in ED.

COVID-19 EXPERIENCE AT A NON-COVID REMOTE MULTI-SPECIALITY HEALTH CENTRE

Background- Coronavirus disease 2019 (COVID-19) pandemic has affected all emergency branches, and likewise, its incidental diagnosis, as well as a varied neurological presentation, presented as a new war for health centers situated at resource constraint remote peripheries. Objectiveon the basis of a set admission protocols we tried to identify circulating and radiological indicators in the suspected COVID-19 patient population, to triage them, till the conrmation of their COVID-19 status. Methods and Material- We did a retrospective analysis of hemogram, other blood th th investigations and chest X ray of all patients who were admitted in Lifeline hospital Azamgarh from 5 May 2020 to 11 September 2020 and diagnosed later on as COVID-19 positive. Results- The most signicant ndings were Lymphopenia (absolute lymphocyte count [ALC] &lt;2 9 9/ 9 ×10 /L) in 52.9% patients with 4 having mild (ALC 1-2 ×10 L), and ve with moderate lymphopenia (ALC0.5-1 ×10 /L). Another nding 9 was Monocytopenia (&lt;0.2 ×10 /L) present in 9 (52.9%) patients and eosinopenia in one patient. Platelet count were almost normal, with only 3 9 (17.6%) patients having mild to moderate (50-150 × 10 /L) thrombocytopenia. Raised levels of C- reactive protein (CRP) was present in 5 (29.4%) patients. Chest X Ray was abnormal in 2 (11.8%) patients with bilateral ground glass opacities (GGO). Conclusions- We found almost same ndings on chest X-ray and in blood investigation like raised haemoglobin level, leukopenia, lymphopenia, eosinopenia and raised CRPlevel in this highly specialized small patient population like other studies, hence their presence have the potential to indicate SARS-CoV-2 infection, during the covid pandemic irrespect

Analysis of the Efficacy of Universal Screening of Coronavirus Disease with Antigen-Detecting Rapid Diagnostic Tests at Point-or-Care Settings and Sharing the Experience of Admission Protocol-A Pilot Study.

Aims: To introduce the admission protocol of a COVID-19 specialized hospital outlined by the government, including the assessment of reverse transcription polymerase chain reaction (RT-PCR), low dose chest computed tomography (CT) and antigen-detecting rapid diagnostic test (Ag-RDT) for patient screening. Materials and Methods: This was a retrospective cohort study of 646 patients who were admitted between December 2020, and February 2021, during the third wave of COVID-19 in Korea. Ag-RDT and RT-PCR were routinely performed on all patients who required admission, and low-dose chest CT was performed on high-risk patients with associated symptoms. Any patients with high-risk COVID-19 infection according to the Ag-RDT test were quarantined alone in a negative pressured room, and those with low-risk COVID-19 infection remained in the preemptive quarantine room with or without negative pressure. The diagnostic values of the Ag-RDT test and associated cycle threshold (Ct) values of the RT-PCR test were subsequently evaluated. Results: In terms of the diagnostic value, the Ag-RDT for COVID-19 had a sensitivity of 68.3%, specificity of 99.5%, positive predictive value (PPV) of 90.3%, and negative predictive value (NPV) of 97.9%. For the 355 symptomatic patients with low-dose chest CT, the diagnostic values of combined evaluations had a sensitivity of 90.2%, specificity of 99.0%, PPV of 86.1%, and NPV of 99.3%. The cut-off Ct value for positive Ag-RDT was ≤25.67 for the N gene (sensitivity: 89.3%, specificity: 100%), which was regarded as a high viable virus in cell culture. There were no patients or medical staff who had COVID-19 in the hospital. Conclusion: Appropriate patient care was possible by definitive triage of the area, according to the symptoms and using diagnostic tests. Screening protocols, including the Ag-RDT test and low-dose chest CT, could be helpful in emergency point-of-care settings.

To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient Protocol.

Inadequate nutritional rehabilitation of severely malnourished adolescents with Anorexia Nervosa (AN) increases the risk of medical complications. There is no consensus on best practices for inpatient nutritional rehabilitation and medical stabilization for severe AN. This study aimed to elaborate an admission protocol for adolescents with severe AN based on a comprehensive narrative review of current evidence. A Pubmed search was conducted in July 2017 and updated in August 2020, using the keywords severe AN or eating disorders (ED), management guidelines and adolescent. Relevant references cited in these guidelines were retrieved. A secondary search was conducted using AN or ED and refeeding protocol, refeeding syndrome (RS), hypophosphatemia, hypoglycemia, cardiac monitoring or cardiac complications. Evidence obtained was used to develop the admission protocol. Selective blood tests were proposed during the first three days of nutritional rehabilitation. Higher initial caloric intake is supported by evidence. Continuous nasogastric tube feeding was proposed for patients with a BMI < 12 kg/m2. We monitor hypoglycemia for 72 h. Continuous cardiac monitoring for bradycardia <30 BPM and systematic phosphate supplementation should be considered. Developing protocols is necessary to improve standardization of care. We provide an example of an inpatient admission protocol for adolescents with severe AN.

Antibody Cocktail in Moderate to Severe COVID-19 Infection: A Series of 10 Cases

In the wake of the Coronavirus Disease 2019 (COVID-19) pandemic, scientists all over the world are in a relentless search for a cure. None of the therapies advised till date have shown significant benefit in treating COVID-19 infection. An antibody cocktail consisting of a combination of casirivimab and imdevimab is the newest weapon in the armamentarium against the disease. Currently, it has shown great promise in treating mild non hospitalized cases. The authors present the results of a series of 10 cases aged 18-70 years that demonstrate the efficacy of this cocktail in treating moderate to severe cases as well. All the patients received Roche’s Antibody cocktail© on admission and standard treatment protocol comprising of remdesivir, methylprednisolone and low molecular weight heparin was given. Oxygen supplementation was titrated to achieve a target SpO2 of 88-92%. Majority (70%) of the patients demonstrated an improvement in SpO2 /FiO2 ratio and a decline in the inflammatory marker levels 3-5 days after receiving the cocktail. Eight out of the 10 patients could be discharged home after 10-14 days of admission. The remaining two had severe disease with Computed Tomography Severity Index (CTSI) &gt;17/25 and died despite receiving all the available therapies. Antibody cocktail is an effective adjuvant therapy against moderate to severe COVID-19 pneumonitis, demonstrating rapid improvement in SpO2 /FiO2 ratio, inflammatory markers and a shortened duration of hospital stay.

Changing Clinical Profile of Dengue Fever Epidemic in North KeralaA Retrospective Study

Introduction: Dengue fever is one of the most common vectorborne infections worldwide and is now endemic in Kerala. Knowledge about changing clinical presentation of dengue fever is important for timely diagnosis and appropriate management. Aim: To document changing trends in clinical presentation and course of illness among patients admitted with dengue fever in Kerala, India. Materials and Methods: This hospital-based, retrospective, observational study was conducted at Government Medical College and Hospital, Kannur, Kerala, India, from September 2021 to June 2022. The patients with dengue fever, presented in seasonal epidemic of the year 2019 was compared to similar patients presented during the year 2014. Data regarding clinical presentation, duration of hospital stay, complications and haematological parameters of the study population was collected using prevalidated questionnaire. Descriptive data were expressed in frequency, percentage, mean and standard deviation. Continuous and discrete variables were compared by Welch’s t-test, whereas categorical variables were compared using Pearson’s Chi-square test. Results: Out of the total 184 patients studied, 91 were from 2014 and 93 from 2019. The major presenting complaints were fever, body aches, headache, nausea and vomiting, arthralgia, and retroorbital pain incidence of which were similar in both the study years. Patients admitted in 2019 have shorter duration of fever (5.78 vs 6.79 days), earlier onset of severe thrombocytopaenia (6.62 vs 7.27 days) and delayed onset of complications (5.56 vs 3.6 days) compared to those admitted in 2014. They also had higher incidence of thrombocytopaenia (70.97% vs 54.94%) and complications (49.46% vs 14.29%) during the course of their illness. Conclusion: The study indicates towards a significant shift in clinical presentation of dengue fever in Kerala which may influence the admission and monitoring protocol of dengue fever patients in the years to come.

Refusal of beds and triage of patients admitted to intensive care units in Brazil: a cross-sectional national survey.

To obtain data on bed refusal in intensive care units in Brazil and to evaluate the use of triage systems by professionals. A cross-sectional survey. Using the Delphi methodology, a questionnaire was created contemplating the objectives of the study. Physicians and nurses enrolled in the research network of the Associação de Medicina Intensiva Brasileira (AMIBnet) were invited to participate. A web platform (SurveyMonkey®) was used to distribute the questionnaire. The variables in this study were measured in categories and expressed as proportions. The chi-square test or Fisher's exact test was used to verify associations. The significance level was set at 5%. In total, 231 professionals answered the questionnaire, representing all regions of the country. The national intensive care units had an occupancy rate of more than 90% always or frequently for 90.8% of the participants. Among the participants, 84.4% had already refused admitting patients to the intensive care unit due to the capacity of the unit. Half of the Brazilian institutions (49.7%) did not have triage protocols for admission to intensive beds. Bed refusal due to high occupancy rates is common in Brazilian intensive care units. Even so, half of the services in Brazil do not adopt protocols for triage of beds.

Compliance on Patient’s Admission Protocol of Birth Center Personnel in the 5th District of Camarines Sur, Philippines

This study utilized the descriptive method of research. The researchers used the questionnaire checklist as the main data gathering tool. It was supplemented by an informal interview and records review to support the data gathered. To quantify and interpret the data, appropriate statistical tools was used such as percentage technique and weighted mean. The main goal of this research is to assess the level of compliance on patients’s admission protocol of birth center personnel in the 5th District of camarines Sur, Philippines.. Results of the study showed majority of the Respondents are Single, from 21-30 years old, on a job order/contractual employment status, Roman Catholic and College graduate. Further, data shows that birth center personnel are moderately complied on the indicators under Admission but complied on the indicators under Active Labor, Fully Dilated and Effaced Stage, Postpartum and Newborn Care, And on Referral. In addition, there are some factors that greatly affect the compliance of birthing facility personnel on Admission Protocol. Three top most factors that affects the compliance of birthing facility personnel on admission protocol are financial stability of the patient, transportation resources, and the distance of the hospital from the birthing facility. And lastly, the proposed plan would help strengthen the compliance of the birthing facility personnel on admission protocol. The proposed plan was formulated taking into account the results on the compliance and factors affecting the compliance of birthing facility personnel on admission protocol.

Impact of COVID-19 pandemic on pediatric dentistry treatment procedures

Aim: The SARS-CoV-2 (COVID-19) pandemic has forced pediatric dentistry to limit clinical procedures due to children’s role in spread of the virus and transmission routes in pediatric patients. In order to minimize contamination and cross-infection risk, dental examinations and treatments had been postponed and patient admission protocols rearranged. This study aimed to evaluate the effects of pandemic on the number of patients admitted and treated in the pediatric dentistry clinic of a university hospital in the one-year period following the March 2020 global pandemic declaration.&#x0D; Methodology: The study included pediatric patients aged 0-14 years admitted to a pediatric dentistry clinic of a faculty of dentistry between March 2019 and March 2021 in order to compare and make a retrospective evaluation of the one-year time intervals before and after the pandemic announcement in March 2020. Children were divided into the age groups 2-6 and 7-14. Evaluation parameters were chosen as examination, radiograph (panoramic and periapical), fissure sealing or local fluoride application, compomer, composite filling, amputation, root canal treatment, prefabricated crown, tooth extraction, and space maintainer.&#x0D; Results: The results of the study showed a statistically significant decrease in monthly average number of examinations after the declaration of the pandemic regardless of age and gender (p&lt;0.001). In both age groups, there is a proportional decrease in amputation, posterior tooth beam composite filling, fissure sealant or topical fluoride application, root canal treatment, compomer filling, prefabricated crown procedures during the pandemic compared to the pre-pandemic, while the number of filming procedures increased proportionally (p&lt;0.001).&#x0D; Conclusion: Dental clinicians were advised to take on more radical treatment options during the pandemic. Further studies are needed to examine the effects of the statistical decrease in the number of procedures in the field of pediatric dentistry and treatment services on long-term community oral health.&#x0D; &#x0D; How to cite this article: Yüksel BN, Bezgin T. Impact of COVID-19 pandemic on pediatric dentistry treatment procedures. Int Dent Res 2021;11(3):140-8. https://doi.org/10.5577/intdentres.2021.vol11.no3.2&#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.&#x0D;

PCCAMN—Path Constancy Based Channel Assignment in Mobile ADHOC Network for Healthcare Data Transmission

A MANET is a self-governing network for mobile devices in many crucial domains, including health care, for transmitting health data of the patients. The key challenge in MANETS is maintaining the links between devices under mobility; it creates limitless network disconnections and path loss frequently. Such issues, raises network delay and minimize packet delivery ratio (PDR) and entire set-up throughput brings reduced quality of services (QOS). To get better QoS, stable path selection and link disconnection count based nearby device selection carried out in this work. It’s on this basis that the thesis is exploring the design and the analysis of the FPC. The FPC is designed in network simulator with the support of optimized fuzzy logic (FL). It has obtained three inputs which is fallout to 27 set of laws. This law sets (LS) direct in the fortitude of the precedence to select best path set to transmit a packets from sender to destination. The analyses are with previous protocols of Distributed Admission Control Protocol (DACP) and Call Admission Protocol of MANET. The outcome results monitored with delay, Packet Delivery Ratio (PDR), throughput and overheads as the QOS metrics of network.

Essay content and style are strongly related to household income and SAT scores: Evidence from 60,000 undergraduate applications.

There is substantial evidence of the relationship between household income and achievement on the standardized tests often required for college admissions, yet little comparable inquiry considers the essays typically required of applicants to selective U.S. colleges and universities. We used a corpus of 240,000 admission essays submitted by 60,000 applicants to the University of California in November 2016 to measure relationships between the content of admission essays, self-reported household income, and SAT scores. We quantified essay content using correlated topic modeling and essay style using Linguistic Inquiry and Word Count. We found that essay content and style had stronger correlations to self-reported household income than did SAT scores and that essays explained much of the variance in SAT scores. This analysis shows that essays encode similar information as the SAT and suggests that college admission protocols should attend to how social class is encoded in non-numerical components of applications.

COVID-19 outbreak in North Macedonia: an overview of its impact on dentistry

Since the pandemic of the novel coronavirus - SARS-CoV-2 - has been declared and strict social measures have been introduced in the middle of March, including curfew, the dentistry had to adjust and find ways to better adapt itself to the new situation. This article provides a brief overview of the situation with COVID-19 in our country since the beginning of the pandemic, gives a reminder of what COVID-19 is, and which its modes of transmission are, and considers the ways of protection in dental offices considering that dentistry is one of the riskiest activities given the patient-dentist proximity and the use of specific high-speed handpieces. This review also provides an overview of the dental preventive measures taken worldwide, including in the field of Pediatric Dentistry, as well as an overview of dental patients' management, and gives possible best ways to care for healthy, sick or patients suspected for COVID-19. Finally, an extensive presentation of the way of work at the University Dental Clinical Center and the Faculty of Dental Medicine in Skopje, North Macedonia, over the last year is given, including protocols for admission of patients.

The safety and efficacy of modifying the admission protocol to the epilepsy monitoring unit in response to the COVID-19 pandemic

PurposeThe coronavirus disease 2019 (COVID-19) pandemic has impacted admission to epilepsy monitoring units (EMUs) for classification and presurgical evaluation of patients with refractory epilepsy. We modified the EMU admission protocol via anti-seizure medications (ASM) withdrawal implemented one day before admission; thus, we aimed to evaluate the efficacy and safety of this modified protocol. MethodsIn January 2021, we initiated ASM tapering 24 h before—rather than on the first day after—EMU admission, contrasting with the previous protocol. We retrospectively reviewed EMU admissions between January and April of 2018, 2019, and 2021, and identified the time required to record the first seizure, and EMU yield to confirm or change the epilepsy classification. We also evaluated the safety of the modified protocol, by monitoring the seizure frequency for up to 5 months after the discharge from the hospital. ResultsOne hundred four patients were included (mean age: 30 years, men: 43%); excluding a longer disease duration and abundance of normal routine electro-encephalogram (EEG) in patients admitted before the pandemic, no differences were observed in patients' characteristics. On average, it took 41 h and 21 h to record the first seizure using the standard and modified protocols, respectively (p < 0.001, 95% CI: 10–30). Other characteristics were investigated both before and after the COVID-19 pandemic, and epilepsy classifications were confirmed twice using the modified protocol (OR = 2.4, p = 0.04, 95% CI: 1.1–5.5). Multivariate regression analysis confirmed the shorter time to record the first seizure using the modified admission protocol (23 h less, p < 0.001; 95% CI: 12–34). Finally, 36 (86%) patients admitted during the pandemic exhibited no increase in seizure frequency after the discharge from the hospital. ConclusionsInitiating ASM withdrawal one day before EMU admission was deemed to be an efficient and safe way to confirm epilepsy classification and significantly decrease the length of hospital stay. Ultimately, this will shorten the long waiting list for EMU admission created by the COVID-19 pandemic.

Clipping of unruptured cerebral aneurysms : Are older patients at higher risk?

BackgroundThe incidence of aneurysms is steadily increasing in older patients due to the aging population. This study compared radiological parameters as well as clinical outcomes between patients younger than 65 years and those over 65 years of age, with special respect to individual treatment options.MethodsRetrospective data were obtained for patients with cerebral aneurysms at a single academic institution within a 7-year period. Data reviewed included admission protocols, patient charts, operating reports as well as outpatient clinic charts. Aneurysmal characteristics as well as surgical outcome were compared between older patients, defined as patients older than 65 years of age, and a control group of patients younger than 65 years of age. To evaluate and compare individual clinical characteristics various scores including the Hunt and Hess score, the Fisher score, and the Glasgow outcome scale were used.ResultsA total of 347 patients were included in the final analysis. The control group included 290 patients, while 57 patients were in the older patient group. Neither the Hunt and Hess scores nor Fisher scores were significantly correlated to patient age. The Glasgow outcome scale was significantly lower in the older group after clipping of ruptured aneurysms (p < 0.000) but not significantly different after clipping of unruptured aneurysms (p = 0.793).ConclusionPostoperative Glasgow outcome scale scores were not significantly different after clipping of unruptured cerebral aneurysms approximately 1 cm in diameter in older patients compared to the younger age group. Therefore, clipping of unruptured cerebral aneurysms may also be a valuable treatment option for older patients.

Laparoscopic bariatric surgery is safe during phase 2–3 of COVID-19 pandemic in Italy: A multicenter, prospective, observational study

BackgroundSars-Cov-2 epidemic in Italy caused one of the greatest 2020 European outbreaks, with suspension of elective bariatric/metabolic surgery (BMS). From May 2020 a significant decline of the epidemic has been observed (phase 2); National Health Service protocols permitted elective BMS’ resumption. A new, more severe COVID-19 surge, the “second wave”, started on October 2020 (phase 3). AimThe primary end point was to analyze the outcomes of any Sars-Cov-2 infection and related morbidity/mortality within 30 POD after laparoscopic BMS during phase 2–3; secondary end points were readmission and reoperation rates. MethodsStudy design prospective, multicenter, observational. SettingEight Italian high-volume bariatric centers. All patients undergoing BMS from July 2020 through January 2021 were enrolled according to the following criteria: no Sars-Cov-2 infection; primary procedures; no concomitant procedure; age > 18 < 60 years; compensated comorbidities; informed consent including COVID-19 addendum; adherence to specific admission, in-hospital and follow-up protocols. Data were collected in a prospective database. Patients undergone BMS during July-December 2019 were considered a control group. Results1258 patients were enrolled and compared with 1451 operated on in 2019, with no differences for demographics, complications, readmission, and reintervention rates. Eight patients (0·6%) tested positive for Sars-Cov-2 infection after discharge, as well as and 15 healthcare professionals, with no related complications or mortality. ConclusionsIntroduction of strict COVID-19 protocols concerning the protection of patients and health-care professionals guaranteed a safe resumption of elective BMS in Italy. The safety profile was, also, maintained during the second wave of outbreak, thus allowing access to a cure for the obese population.

High rate of critical coronary stenosis in comatose patients with Non-ST-elevation out-of-hospital cardiac arrest (NSTE-OHCA) undergoing therapeutic hypothermia-Experience from the HAnnover COoling REgistry (HACORE).

Myocardial infarction is the most frequent cause for out-of-hospital cardiac arrest (OHCA) in adults. Patients with ST-segment elevations (STE) following return of spontaneous circulation (ROSC) are regularly admitted to the catheterisation laboratory for urgent coronary angiography. Whether patients without obvious STE (NSTE) should receive coronary angiography as part of a standardised diagnostic work-up following OHCA is still debated. We analysed a cohort of 517 subsequent OHCA patients admitted at our institution who received a standardised diagnostic work-up including coronary angiography and therapeutic hypothermia. Patients were 63±14 years old, 76% were male. Overall, 180 (35%) had ST-elevation in the post-ROSC ECG, 317 (61%) had shockable rhythm (ventricular fibrillation or tachycardia) at first ECG. ROSC was achieved after 26±21 minutes. Critical coronary stenosis requiring PCI was present in 83% of shockable and 87% of non-shockable STE-OHCA and in 48% of shockable and 22% of non-shockable NSTE-OHCA patients. In-hospital survival was 61% in shockable and 55% in non-shockable STE-OHCA and 60% in shockable and 28% in non-shockable NSTE-OHCA. Standardised admission diagnostics in OHCA patients undergoing therapeutic hypothermia with a strict admission protocol incorporating ECG and coronary catheterisation shows a high rate of relevant coronary stenosis in STE-OHCA irrespective of the initial rhythm and in NSTE-OHCA with initial shockable rhythm. Based on the unfavourable outcome and low PCI rate observed in NSTE-OHCA patients with a primary non-shockable ECG rhythm it might be reasonable to restrict routine early coronary angiography to patients with primary shockable rhythms and/or ST-segment elevations after ROSC.

Seroprevalence of antibodies against varicella among medical students - a need for immunization record for medical school admission

Introduction and Aim:This study was conducted at a medical University in UAE to assess the risk of acquiring Varicella – a vaccine-preventable disease, by estimating antibody titers among the clinically exposed students to provide a scientific implementation of immunization guideline during admission to medical school.&#x0D; Materials and Methods: This cross-sectional study involved 88 students in clinical years attending a medical college in the UAE. The students' demographics, vaccination data, and history of natural infection with vaccine-preventable communicable infectious diseases were collected, with more significance on Varicella. Blood samples were collected to determine varicella IgG via ELISA.&#x0D; &#x0D; Results:Out of 88 medical students, 20.45% of students had vaccination during childhood and 60.22%of students had a natural infection in the last five years. Three students (3.4%), who had childhood vaccination acquired the infection which is statistically significant during their clinical study years. 70.4% of students who had childhood vaccination and natural infection are at risk of acquiring varicella infections due to the waning of antibodies. 13.64% were found to be negative for varicella antibody titers are at the highest risk.&#x0D; &#x0D; Conclusion:Medical students are most susceptible to acquiring the infection. Medical Universities should take up a policy, that each student needs to take booster vaccinations as a mandatory requirement before admission into the first year, which is practiced as an admission protocol in Western countries like the United States of America but not in Asian countries. Special emphasis should be placed on catch-up vaccination of students because the likelihood of severe infection increases with age.

Non-Respiratory Symptoms of Patients Infected with SARS-CoV-2 (Coronavirus Disease 2019): Lessons from Their Initial Presentation at the Hospital

Background and objectives: As the COVID-19 pandemic spreads, it is becoming increasingly evident that this coronavirus is not limited to the respiratory system and that the musculoskeletal system can also be affected. The purpose of the present study was to describe non-respiratory symptoms of laboratory-confirmed COVID-19 cases. Materials and Methods: All patients with SARS-CoV-2 admitted to our hospital, between 1 August and 30 September 2020, were included in this retrospective study. Data were extracted from medical records. Epidemiological, clinical, laboratory and radiological characteristics at the initial presentation at the hospital were collected and analyzed. Results: A total of 79 COVID-19 patients were enrolled. The mean age of the patients was 44.08 years (age range, 18–87 years) and 59.5% were male. The most common symptoms were fatigue in 60 (75.9%) patients, followed by fever (73.4%), myalgia (51.9%), cough (41.8%), anosmia (38%) and arthralgia (36.7%). The muscles of the upper back and the knee joint were the most painful anatomic region and joint, respectively. The laboratory findings on admission showed that D-dimer, CRP and procalcitonin levels were increased, without significant gender differences (p > 0.05). Chest imaging demonstrated pneumonia in 20 (25.3%) patients. Conclusions: Our results indicate that from the onset of the symptoms of COVID-19 patients, musculoskeletal symptoms, such as fatigue, myalgia and arthralgia, were present in three-quarters of all patients. These findings could help elaborate updated triage and admission protocols for suspect COVID-19 patients at the hospital and Emergency Department presentation.

Resource Utilization and Outcomes in Isolated Low-Grade Renal Trauma at a Level 1 Trauma Center

ObjectiveTo examine admission and transfer patterns of isolated low-grade renal trauma given lack of evidenced based guidelines. MethodsWe employed a retrospective cohort design to analyze patients with low grade renal trauma from 2005 to 2018. We used an Abbreviated Injury Score (AIS) <3 for non-abdominal categories to ensure that intensive care unit admission/hospital transfer was due to renal trauma (n = 87). Treatment and discharge survival were compared. ResultsMean age for floor (n = 31) and intensive care unit (ICU) (n = 46) patients were 33 (IQR = 20) and 42 (IQR = 46) years old, respectively. Mean injury severity score (ISS) was 7.7 (IQR 4) for floor and 8 (IQR=3.75) for ICU admissions (P = .61) Mean ISS was 7.53 (IQR = 4) for transfers and 8.27 (IQR = 3.25) for non-transfers (P = .26). Blood products were administered only to 3 (6.5%) ICU patients all over 60 years old. Fourteen (45.1%) and 26 (56.5%) of floor and ICU admissions were transferred from a lower-level trauma center. ICU mean length of stay (LOS) was 37 hours (IQR = 23 h.). Mean hospital LOS was 43.4 hours and 71.9 hours for the floor and ICU patients (P = .08), and 69.02 hours and 52.58 hours for transfer vs non-transferred (P = .31). All patients were discharged alive and the majority (94%) was discharged home. ConclusionGiven expedient ICU discharge, low transfusion rate, and low complication rate, inter-hospital transfer and ICU admission are unnecessary for patients under 65 years. Transfer and admission protocols for isolated renal trauma are needed to avoid resource overutilization.

Formula omitted]-learning algorithm in solving consensusability problem of discrete-time multi-agent systems

This paper solves the consensusability problem for the single-input discrete-time multi-agent system (MAS) over directed graphs by the linear quadratic regulator (LQR) design method. It is proved that the maximum consensus region is exactly the largest gain margin (GM) of LQR. Based on this, the necessary and sufficient condition on consensusability is derived by solving a standard algebraic Riccati equation (ARE). The developed framework permits that the consensusability problem can be solved when the agents’ models are completely unavailable. Q-learning algorithm is employed to compute the maximum consensus region and implement the consensus protocol design. The algorithm runs only on a single agent rather than the intercommunicating MAS hence the unattainable initial admissible protocols are not required. A numerical example is given to illustrate the effectiveness of the developed methods.