Hospital Setup Research Articles

Correlation of magnetic resonance angiography and transcranial doppler ultrasound in acute stroke patients

The incidence of cerebrovascular diseases increases with age, and the number of strokes is projected to increase as the elderly population grows. Most cerebrovascular diseases are manifest by the abrupt onset of a focal neurologic deficit. Computed Tomography images identify or exclude hemorrhage as the cause of stroke, and they identify extra-parenchymal hemorrhages, neoplasms, abscesses, and other conditions masquerading as stroke. Non-contrast CT brain is the 1st imaging investigation usually performed in acute stroke patients. Magnetic Resonance Imaging (MRI) reliably documents the extent and location of infarction in all areas of the brain, including the posterior fossa and cortical surface. It also identifies intracranial hemorrhage and other abnormalities but is less sensitive than CT for detecting acute blood. Diffusion-weighted imaging is more sensitive for early brain infarction than standard MR sequences or CT, as is fluid-attenuated inversion recovery (FLAIR) imaging. Using IV administration of gadolinium contrast, MR perfusion studies can be performed. Thus it is evident that both TCD and MRA are promising modalities in the evaluation of acute stroke. This dissertation aims to compare and correlate the findings of MRA and TCD and their advantages and disadvantages in the practical hospital set-up. Total 50 patients – 30 Male and 20 Females – with a clinical diagnosis of stroke (Acute or Chronic) were evaluated with MRI and MR Angiography and Transcranial Doppler(TCD) with TCD being performed prior to MRI/MRA in all patients. Time interval between these two examinations was 2 to 8 hours. Out of 50 patients studied, 10 patients were excluded due to inadequate insonation windows. Of the 40 patients, 24 patients showed abnormality on MRA. Of the MRA abnormal 24 patients, 20 were abnormal on TCD (True positive on TCD), while 4 were normal on TCD (False negative on TCD). Also of the 16 MRA normal patients, 9 were normal on TCD (True negative) while 7 were abnormal on TCD (False positive). Analysis of above findings revealed, Sensitivity 83.33 %, Specificity 56.25%, Positive predictive value 74.07 %, Negative predictive value 69.23 % for TCD compared to MRA in Assessment of the Anterior circulation.

Atypical Mycobacterial Infection in Post Abdomino-Thoracic Trauma: A Case Report

Objective/Background: SSIs remain a significant cause of morbidity and mortality after surgery. One in eight patients develop SSI after exploratory laparotomies making it one of the major factors responsible for post-operative mortality and morbidity. Atypical mycobacteria are responsible for a spectrum of diseases ranging from superficial skin infections to widely disseminated systemic infections. Health care associated infections due to non-tuberculous mycobacteria is on the rise due to contaminated hospital water supplies, solutions, improperly sterilized instruments and devices. Our case is of an atypical mycobacterial infection in a patient with abdomino-thoracic trauma who underwent multiple surgeries. Case presentation: A 24 year old gentleman presented with a penetrating stab injury to the abdomen and left hemi-thorax following an assault. Patient underwent an emergency exploratory laparotomy which revealed a 4 x 4 cm defect in the left hemi-diaphragm, through which the stomach was herniating into the left thoracic cavity. During the 2nd post-operative week, patient developed empyema thorax, for which pigtail drain was placed initially and later thoracotomy with decortication and intercostal drainage were performed. Following discharge after 2 weeks, he presented with fever, body pain and pus discharge from the previously inserted intercostal drain site. Pus obtained was positive for acid fast bacilli and gene expert was negative. Atypical mycobacterial infection was diagnosed based on high index of suspicion and he received treatment for 6 months. Conclusion: This case highlights that identification of atypical mycobacterial infections in post-operative patients require a high index of suspicion. Management requires multi-drug approach and surgical intervention wherever necessary. Even with the existing sterilization techniques and preventive measure, atypical mycobacterial infection cannot be completely eliminated from a hospital set-up and hence must be considered in all nosocomial infections.

A study of plasma levels of zinc in children with pica in a public hospital setup

Background: Pica is the craving and purposeful consumption of non-food substances. In children with pica, there is a greater possibility of zinc deficiency. Objectives: To study the plasma levels of zinc in children having pica and to study the efficacy of pica as a clinical marker of zinc deficiency. Method: This is a case control study of children attending the outpatient department of a tertiary health centre. A total of 92 children were enrolled in the study, of which 46 children who had the habit of pica were taken as cases and the remaining 46 children without the habit of pica were enrolled as controls. Serum zinc levels of the 92 children were estimated. Results: Of the 92 children included in the study, 56% of cases and 47% of controls belonged to the age group of 2 to 2.5 years. It was observed that 96% of cases had zinc deficiency whereas 100% of controls had normal zinc levels. The mean zinc level of the cases was 46.73±21.32mcg/dL compared to 148.5±15.4mcg/dL in the controls. Accuracy of pica as a clinical marker of zinc deficiency was 97%. Conclusions: The mean zinc level of the cases who had pica was significantly lower than the mean zinc level of the controls indicating that pica is a useful clinical marker for zinc deficiency. Sri Lanka Journal of Child Health, 2023: 52(2): 182-187

Development of a Technology-Based Intervention to Improve Help-Seeking in Distressed Non-Treatment-Seeking Young Adults With Common Mental Health Concerns.

Background There is a dearth of interventions aimed at improving help-seeking for common mental health concerns among distressed young adults, particularly in the urban Indian context. Availability of cost-effective, targeted intervention for improving appropriate help-seeking can pave the way for reducing the treatment gap. This could prove especially beneficial in low-resource settings. This study describes the guiding principles, underlying theory, and development process of a simple technology-based help-seeking intervention for distressed non-treatment-seeking young adults. Methods Several models of professional help-seeking behavior were examined to ascertain a suitable theoretical framework for the development of the intervention to enable help-seeking among distressed non-treatment-seeking young adults. Pilot work was carried out before the development, along with content validation of the intervention by field experts. Results Help-seeking intervention was developed based on the preferences of young adults and literature review. Eight core intervention components and one optional component were developed, which were built on selected theoretical frameworks. These components have been postulated to enhance awareness of common mental health problems, the utility of self-help, and support of significant others, and to increase the skills to understand when it may be appropriate to step up to professional help-seeking. Conclusion Help-seeking interventions delivered beyond the traditional clinic and hospital setups prove useful as low-intensity interventions acting as gateways to seek mainstream mental health services. Further research will evaluate the feasibility, acceptability, and effectiveness of the intervention in reducing perceived barriers and enhancing inclination to seek professional help and help-seeking behavior among distressed non-treatment-seeking young adults.

Correlation of Depression, Anxiety with Perceived Social Support among Nursing Staff Working in COVID- 19 Pandemic

Objective: To determine the correlation between perceived social support, anxiety and depression among nursing staff working in a COVID-19 dedicated hospital setup.Study Design: Cross-sectional study.Place and Duration of Study: The study was carried out at the Armed Forces Institute of Mental Health (AFIMH), Rawalpindi, Pakistan, from August 2020 to July 2021.Materials and Methods: We consecutively sampled 128 subjects. Basic demographic data, including age, gender, ethnicity, and socioeconomic status, were recorded. All participants were requested to complete a brief demographic sheet, the Urdu version of the Depression, Anxiety and Stress Scale 21 (DASS-21) and the Urdu version of the Multidimensional Scale of Perceived Social Support (MSPSS).Results: The mean age of patients was 30.81 ± 6.56 years with range of 21-45 years. There were 80(62.50%) male and 48(37.50%) female nurses. ean total depression score was 7.90 ± 5.71. The mean total anxiety score was 8.49 ± 6.23. The mean multidimensional scale of perceived social support (MSPSS) score was 47.29 ± 22.53. There was a significant negative correlation between the MSPSS score and the depression score (r= -0.407, p-value < 0.001). There was a significant negative correlation between the MSPSS score and anxiety score (r= -0.365, p-value < 0.001).Conclusion: Results of this study highlight that there is a statistically significant negative correlation between perceived social support and depression, anxiety and stress levels found among nursing staff working in a COVID-19 dedicated hospital setup.

PREVALENCE AND PHENOTYPIC CHARACTERIZATION OF MULTI-DRUG-RESISTANT ISOLATES CAUSING WOUND INFECTIONS IN A TERTIARY CARE CENTRE

Objective: Wound infections lead to 70-80% mortality among post-surgeries and one-third of nosocomial infections. The prolonged hospitalization due to diagnostic tests, complete antibiotic course, and clearing of wound infection all together increase the healthcare cost.Methods: The present study was a cross-sectional study carried out in the Department of Microbiology, Central laboratory, and teaching hospital from May 2022 to October 2022. All consecutive, non-duplicate gram-positive and gram-negative bacteria isolates were collected from pus and wound swabs from outpatients and hospitalized patients during the study period.Results: A total of 260 isolates from various wound swabs and pus samples were collected from March 2022 to August 2022. Species-wise distribution of organisms along with antibiotic susceptibility testing shows that 15 out of 63 (24%) Escherichia coli, 12 out of 38 (31.5%) Klebsiella pneumoniae, 06 out of 29 (20.6%) P. aeruginosa, 06 out of 09 (40%) Acinetobacter baumannii, 05 out of 08 (62%) Klebsiella oxytoca, 04 out of 12 (33%) Citrobacter freundii, 01 out of 07 (14.3%) Enterobacter aerogenes were multi-drug-resistant (MDR). Previously few studies mentioned S. aureus was predominant, followed by P. aeruginosa in polymicrobial wound infections. Our study found that around 2-3% of cultures showed two organisms. The antibiotics like amikacin and imipenem worked well against all gram-negative organisms up to 72%, and 85%, respectively. Similar findings of organisms in other studies showed sensitivity to amikacin and imipenem up to 77% and 100%; 70% and 83%, respectively.Conclusion: The organisms causing wound infections and the empirical therapy and switch to correct antibiotics as soon as possible to avoid misuse of antimicrobials and prevent the spread of drug-resistant strains among the community and hospital setup.

Are Incident Reporting Systems in Healthcare Systems a Requirement for Improving Patient Safety? A Review

Adverse events such as medical errors, injuries, or equipment failures which could harm patients, caregivers, or other individuals or has the potential to harm them are known as medical incidents. Avoidance of unintended or unexpected harm to people during the provision of healthcare is mandatory. In healthcare settings incident reporting refers to collecting healthcare incident data with the aim of enhancing patient safety and quality of care. This review aims to discuss the practice, usefulness and drawbacks of Incident Reporting System (IRS) in healthcare systems. The history of adverse events assessment in hospital setup runs back till 1980s. Since then, many developed countries have put emphasis on the establishment of IRSs in their health systems. In 2005, the World Health Organization issued a guideline to be followed on the establishment of incident reporting systems in healthcare organizations. Benefits of incident reporting in healthcare systems include prevention of reoccurrences of adverse events, provision an updated knowledge and understanding about risk events, create lessons and promote safety-minded culture. It saves a considerable sum of money of the healthcare budget in the long run. Under-reporting is the main challenge in incident reporting. It is recommended to implement comprehensive IRSs in health services in all developing countries in order to drive good medical practice and to ensure the safety and quality of patient care.

Magnetic resonance imaging investigations in patients with metallic dental prosthesis: "The associated dilemma for medical fraternity and the dentist's role".

Interdisciplinary referrals for dental examination in hospital setups are common before radiotherapy, kidney transplants, or magnetic resonance imaging (MRI). The patients who walk in could be random patients with metallic or porcelain-fused-to-metal prostheses done elsewhere but might require an opinion before the MRI. This leaves quite a responsibility on the consulting dentist to green signal the procedure. There is a lack of evidence in the literature, to confirm the absence of any untoward consequence during such MRI, which might leave the dentist in dilemma. Dental materials' magnetic behavior raises concern regarding whether they are 100% nonferromagnetic; furthermore, the examining dentist might be unaware of the metal used (Co-Cr, Ni-Cr, or trace elements). Clinicians may also come across full-mouth rehabilitated patients with multiple crown-bridge prostheses or metallic superstructure for implant prostheses. Research in the area leaves many unanswered questions because most studies have evaluated artifacts during MRI and are in vitro. Titanium is considered to be safe due to its paramagnetic behavior, whereas the literature does not rule out the probability of dislodgment of other porcelain fused to metal (PFM) prostheses. Due to less reported literature there exists dilemma to ascertain MRI in these patients. An online Google Search, PubMed, and gray literature portray the ambiguity associated with metal and PFM crowns and their magnetic behavior during MRI. Most studies were associated with the artifacts caused during MRI and methods of reducing them under in vitro situations. The concern for dislodgment has also been expressed in a few reports. Certain steps of a pre-MRI checkup and an innovative technique have been discussed to assure patient safety during the MRI. The technique explained is inexpensive and a quick aid that can be executed before the investigation. There is a need to study and understand the magnetic behavior of Co-Cr and Ni-Cr crowns in the presence of various MRI strengths.

A retrospective study of lipid profile in SARS-CoV-2 infection

Background: Coronavirus disease 2019 (COVID-19), a pandemic, infected millions of individuals globally. Several studies have been done on the demographic, clinical, laboratory, and radiological parameters of SARCoV-2 disease. However, information on the association of lipid profiles with disease severity is very sparse. SAR-CoV-2 patients with dysglycemia and hypertension are shown to have a worse prognosis. Dyslipidemia is considered one of the most important cardiovascular risk factors. The association of lipid profile with disease severity is less commonly studied. Although it is a cost-effective, easily performed, and routinely done test at clinical and hospital setups, it can be an independent risk factor for assessing disease severity. Aims and Objectives: The present study was undertaken to investigate lipid profile variation in SARS-CoV-2 infections and its association with disease severity. Materials and Methods: The Institutional Ethics Committee of Malla Reddy Institute of Medical Sciences and Hospital, Hyderabad, approved this retrospective study before it was conducted there. A total of 400 SARS-CoV-2 patients were enrolled in this study. From March 2, 2021 to December 4, 2021. All the data regarding serum lipid profiles were extracted electronically. Results: We found that mean values of total cholesterol (TC) (98.15), high-density lipoprotein cholesterol (HDL-C) (25.11), and low-density lipoprotein cholesterol (LDL-C) (38.30) compared to mild cases were significantly lower in severe cases: were significantly lower T-C (132.74), HDL-C (33.50), and LDL-C (59.25). A statistically significant difference was found between both groups in terms of TC (P < 0.001), HDL-C (P < 0.001), and LDL-C (P < 0.001). In addition, in the severe cases, triglycerides (TGs) levels showed an upward trend (256.95) and were significantly higher than in the mild cases (153.07) (P < 0.001). Conclusions: Decreased levels of TC, LDL-C, and HDL-C and increased levels of TGs were observed in severely ill Covid-19 cases. Higher TG levels immediately correlate with disease severity, and lower concentrations of TC, LDL-C, and HDL-C are reciprocally associated with it. Our study about lipid profiles helps provide a new perspective on SAR-CoV-2 infection.

Microbiological Profile of Blood Stream Infections in a Tertiary Care Hospital, J&K. India

Background: Worldwide, bacteremia is one of the serious infections that cause significant morbidity and mortality in hospitalized patients. A wide range of microorganisms have been implicated in the etiology of BSIs. Early detection of these pathogens along with the determination of antimicrobial susceptibility patterns have been shown to improve treatment outcomes. The present study aimed to determine the microbiological profile of BSIs in a major tertiary care hospital in North India.
 Materials and Methods: This is a cross-sectional study conducted in the Department of Microbiology Government Medical College Srinagar. Blood samples submitted in brain heart infusion (BHI) broth for culture and sensitivity over a period of one year from September 2021 to 30th August 2022 were included in the study and processed per standard laboratory protocol techniques for isolating and identifying pathogens causing BSI. The antimicrobial susceptibility of bacterial isolates was determined by the disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines.
 Results: Out of 4260 blood samples, 1204(28.26%) isolates were obtained. Of these isolates, 575(47.75%) were Gram‑positive bacteria and 468 (38.87%) were Gram‑negative bacteria. Candida species were isolated from 161(13.7%) positive samples and 32 showed contamination. The most commonly identified organism was Coagulase‑negative Staphylococcus (CoNS) (22.59%) followed by Staphylococcus aureus(17.69%), Acinetobacter spp. (13.70%), Klebsiella spp (10.13%) and Escherichia coli (6.47%). Among the gram-positive bacteria, maximum resistance was seen with methicillin and azithromycin. No resistance was seen with vancomycin and linezolid. Most of the gram-negative bacilli were multidrug-resistant. Maximum resistance was seen with ampicillin(91.7%), amoxiclav (86.5%), ceftriaxone (88.5%), and gentamicin (60.9%). Higher prevalence of resistance was observed in Gram‑negative bacteria when compared with Gram‑positive bacteria.
 Conclusion: Hence, empirical treatment of BSIs should be based on the current knowledge of bacterial resistance profiles as provided by microbiology laboratory reports. The results of this study warrant continuous monitoring of antimicrobial patterns for the clinicians along with judicious antibiotic policy to mandate antimicrobial sensitivity testing against the BSIs in the hospital setup so that appropriate therapeutic measures should be taken at the earliest.

Development and validation of a questionnaire to find usage patterns and beliefs about therapeutic ultrasound among physiotherapists in Delhi NCR

Background: Musculoskeletal injuries are commonly faced problems. With technological advancement and sedentary lifestyle, its prevalence is increasing every day. Till a few years ago pharmacotherapy was the mainstay of treatment, but as awareness is increasing; Physiotherapy is emerging as one of the effective non-pharmacological treatment approaches. Physiotherapy is an application of manual therapy and electrotherapy for the correction of pain and bodily dysfunctions. Therapeutic ultrasound is a commonly used electrical modality in physiotherapy setups. Evidence suggests a strong beneficial effect of it on musculoskeletal pains and injuries. The Indian Physiotherapy practice has its own modification as per cultural and social influence. There are various setup models like private clinics, hospital setups, institution-based OPD, etc. As they work in different clinical setups, the beliefs about the usage of ultrasound also vary among them. So, the current study aims to develop a questionnaire to find usage patterns and beliefs about therapeutic ultrasound and to establish the content validity of the same. Results: The questionnaire was developed through an extensive literature search done by different search engines with therapeutic ultrasound, parameters, and Physiotherapists as the keywords used. The final draft of the questionnaire once formed was assessed for content validity. Lawshe’s method of content validity was used in which the questionnaire was sent to 5 panelists included in the study based on inclusion criteria and their opinion on each item was taken. A content validity ratio was calculated as 0.72. Indicating a moderate content validity of the questionnaire formulated. Conclusion: Using Lawshe’s method, a questionnaire with two sections on usage patterns and beliefs about therapeutic ultrasound in physiotherapists of Delhi/NCR was formulated with moderate content validity. Future work will determine the scoring method for using this tool, interrater reliability, and predictive validity to facilitate optimal utilization of such questionnaire in clinical and academic practice.

Level of Stress Among Health Care Workers in COVID-19 Dedicated Setup

Objective: To determine the co-relation between perceived social support and stress among nursing staff working in a COVID-19 dedicated hospital setup. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Mental Health (AFIMH), Rawalpindi from 30 Aug 2020 to 02 March 2021. Materials and Methods: We consecutively sampled 128 subjects. All participants were requested to complete a brief demographic sheet, Urdu version of the Depression, Anxiety and Stress Scale 21 (DASS-21) to assess the level of severity of stress among nursing staff and the Urdu version of the Multidimensional Scale of Perceived Social Support (MSPSS). Data analysis was done using SPSS version 23.0. Results: The mean duration of stay of nursing staff in ward was 4.86 ± 2.28 weeks. Sixty-two (48.44%) nurses had duration of 2 to 4 weeks while 66 (51.56%) nurses had duration of more than 4 weeks of stay in the ward. The mean total stress score was 6.86 ± 5.80. The mean multidimensional scale of perceived social support (MSPSS) score was 47.29 ± 22.53. There was significant negative correlation between MSPSS score and stress score (r= -0.396, p-value < 0.05). Conclusion: Results of this study highlighted that a significant negative co-relation is present between perceived social support and stress among nursing staff working in a COVID-19 dedicated hospital setup.

A study of reporting pattern of adverse drug reactions in a tertiary care teaching hospital

Background: Adverse drug reactions (ADRs) are one of the prime causes of morbidity and mortality, increase in hospital stay and socioeconomic burden on the patients. Periodic monitoring aids in formulating methods for safe usage of medicines in hospitals. Identification of ADRs and their reporting pattern can provide useful information for their prevention. Hence this study was done to see the pattern of reported ADRs in Patna Medical College and Hospital, Patna in a 3 months of study.Methods: It was an observational and retrospective study carried out between July 2022 to September 2022. Both outpatients and inpatients were included in the study. The ADRs in the form of Individual Case Safety Reports (ICSRs) were sent to the nearby adverse drug reaction monitoring centre (AMC).Results: The occurrence of ADRs was more common in females (56.25%) as compared to males (43.75%). Patients of age-group 21-40 years (40.625%) were most commonly involved. Medicine department (34.375%) reported the maximum percentage of ADRs. Antimicrobials (37.50%) was the most common drug-group causing ADRs. Maximum reported ADRs (81.25%) were probable, 9.375% were possible, 6.25% were certain, while 3.125% were unlikely with the suspected drug as per Naranjo scale.Conclusions: The pattern of ADRs reported in our hospital is comparable with the results of studies conducted in hospital setup elsewhere, along with a few differences. The study results revealed opportunities for interventions in ADR management especially for the preventable ADRs to ensure safer drug use.

A Novel Denture Labelling Technique for Human Identification.

The importance of denture labelling has been acknowledged worldwide by different forensic organizations. Denture labelling is important to identify victims of crimes, mass disasters, accidents, patients with memory loss as well as misplaced dentures in old-agehomes. This article describes a simple technique of incorporating a metallic marker in the denture. The metallic marker is inscribed with the patient'sphotographand Aadhaar number (a unique identification number issued to Indian residents by the Unique Identification Authority of India). The photograph would help in day-to-day identification, e.g., in old-age homes and large hospitalsetups. The Aadhaar number would provide additional details of the individuals, thus ensuring quick identification. The proposed method is simple and cheap, with the marker easily readable and resistant to high temperature, thus satisfying the ideal requirements of a denture marker.

FACTORS INFLUENCING CONTINUING PROFESSIONAL DEVELOPMENT CHOICES IN DENTAL PROFESSIONALS OF PAKISTAN

Aim of this study was to assess the frequency of attending the continuing professional development CPD courses by dental practitioners working in hospitals and private setup of Punjab. A cross-sectional survey of 330 dental practitioners was done using a self-administered questionnaire. The collected data were processed using SPSS 23.0., percentage contribution of each of the significant variable was obtained. practitioners with 3-8 years of years of dental practice experience are keener in attending CDE courses and 31.5% of them are attending the CDE courses at least once in 6 months while the dentist with least clinical experience are 46.5% who are attending the courses rarely. 38.5% of the dentists who are practicing in Private groups are attending CDE courses at least once in 6 months while 60.8% of dental practitioners working in hospital setups are least bothered in attending CDE courses.

Antibiogram And Prevalence Of ESBL Genes In Escherichia Coli From Clinical Specimen

The members of the Enterobacteriaceae family are among the most common causative agents of various clinical infections. Some pathogens produce enzymes to escape the effect of antibiotics and the ESBL enzyme is the new strategy of the bacterial pathogen which is responsible for emerging antimicrobial resistance. The prevalence of Gram Negative bacteria that are usually associated with the production of ESBLs enzymes is on the rise around the globe, both in residing area and hospital setups, as a result, multiple therapeutic problems including antibiotic resistance are being faced. The current study was aimed to look at the characteristics, the pattern of antibiotic resistance, and to estimate the prevalence of ESBL-producing Escherichia coli in clinical isolates. The samples after collection were streaked and cultured on MacConkey, and chocolate, and blood agar. The identification of the isolates was done based on various biochemical characteristics, and the API 20-E test. The modified Disc Diffusion method was used to confirm ESBL enzyme synthesis, and the Kirby Bauer disc diffusion method was used to assess antibiotic susceptibility. Out of 121 isolates of E. coli, 51.2% (n=62) were recovered from female patients and 48.8% (n=59) were obtained from male patients. The genotypic detection of ESBL genes was done by PCR followed by gel electrophoresis. Of total 47 E. coli confirmed for the production of ESBLs, 91.4% (n=43) were found harbouring blaCTX-M followed by blaTEM and blaSHV with 21.2% (n=10) and 8.5% (n=4) prevalence. The table gives an overview of ESBL gene distribution in clinically isolated E. coli. The current study indicates the magnitude of antimicrobial resistance and the underlying genes especially the blaCTX-M gene among the E. coli isolates.

Personalized patient ventilation at large scale: Mass Ventilation System (MVS)

This paper describes a Mass Ventilation System (MVS) which serves as a medical ventilator system. It can be used to ventilate large number of COVID-19 patients in parallel (5 – 50+) with personalized respiratory parameters. The system has been designed to be medically suitable for both non-invasive and invasive patient ventilation. It protects healthcare workers with its centralized air filtering solution, it increases the effectiveness of the healthcare workers with its networked communication and it can be operated in a temporary emergency hospital setup. In this paper, we describe the basic concept and building blocks of the system.

Abstract 12574: Highest Post-PCI Ischemic Event Occurrences in African American Men During COVID-19 Outbreak Compared to Before COVID-19: A Community Hospital Experience

Introduction: African Americans (AAs) have a higher risk for post-PCI ischemic events and worse COVID-19-related events than non-AAs. Race and gender-related post-PCI events before and during the COVID-19 pandemic in a community hospital setup are unknown. Methods: Demographics and one-year post-PCI ischemic event occurrences were compared between AAs and non-AAs undergoing PCI immediately before (2017-2019) and during COVID-19 (2020-2022) in an urban community hospital. Results: In total, 291 and 292 non-AAs and 221 and 219 AAs who underwent PCI before and during the COVID-19 pandemic respectively, were included in the analysis. AAs were younger and had a higher prevalence of diabetes and ACS (p<0.01 for all). Among non-AAs, there were no differences in major demographics except a higher % of pts with prior PCI (p=0.02) before vs. during COVID-19. Platelet counts were higher in both groups during COVID-19 (p≤0.008) (Table). Among AAs, % of pts with ACS was higher during COVID-19 (p=0.003) which was mainly driven by a higher % of NSTE-ACS (p<0.001). In total, one-year recurrent ischemic events were higher during the COVID-19 pandemic compared to before (112 vs. 198, p<0.001). Among non-AAs, although the total number of events was higher during COVID-19 (p<0.001), % of pts with events were similar and all-cause death and MI were higher during the COVID-19 (p≤0.008). Among AAs, both total events and % of pts with events were higher during COVID-19 (p≥0.02). Except for all-cause death, other ischemic events were higher in AAs during COVID-19 (p≤0.02) which occurred in men (p=0.0001) but not in women (p=ns). TIMI bleeding events were numerically lower during COVID-19 Conclusions: In our community hospital, AAs have a higher risk for post-PCI ischemic events which mainly occurred in men during COVID-19, whereas non-AAs have a similar risk before and during COVID-19. This data suggest that AA men with COVID-19 undergoing PCI should be treated with aggressive antiplatelet therapy.

Abstract 15093: Elevated Risk of Recurrent Ablation in Black Compared to White Patients With Atrial Fibrillation: Another Paradox of Atrial Fibrillation in Blacks

Introduction: Lower prevalence of atrial fibrillation (AF) despite a higher prevalence of risk factors in blacks compared to whites (AF paradox) has been reported. However, less information is available about recurrent ablation events in blacks compared to whites. Methods: Demographic characteristics and one-year recurrent ablation events were analyzed in AF patients admitted to a community hospital from 2018 to 2021. Results: Recurrent AF ablation occurred in 3.7% (16/435) of the study population and was significantly higher in black compared to white patients [9/86 (10.5%) vs. 7/349 (2.0%), respectively, p=0.0001]. Black race and history of atrial flutter were predictors of recurrent AF ablation (p<0.05) within one year of initial ablation. Black patients were younger (p=0.03) with a significantly higher prevalence of hypertension, diabetes, cardiomyopathy/heart failure, thyroid disease, renal disease, sleep apnea, COVID-19, pacemaker/AICD placement, and history of Ventricular tachycardia (Table). Concomitant medications were similar between races besides higher use of antihypertensive medications in black patients (Table). Conclusions: In our community hospital setup, black patients with AF had a higher prevalence of comorbidities and significantly higher incidence of one-year recurrent ablation events despite similar therapy compared to white patients. These observations should be explored in a larger prospective study to understand the differential association of comorbidities in black AF patients and associated higher risk for recurrent events.

Severity of mandibular arch crowding in different sagittal malocclusions.

Mandibular anterior crowding is caused by a variety of factors. Mandibular incisor crowding can be caused by a number of causes including incisor and molar inclination, early loss of deciduous molars, mandibular growth, and oral musculature. The study was aimed to perform an association of the lower anterior crowding severity with gender and type of malocclusion. The current study was performed in a hospital setup and data about mandibular arch crowding patients were collected from the Records management system of a Private Dental Hospital in Chennai city. All the patient data on Mandibular arch crowding were sourced and tabulated after which statistical analysis with SPSS-IBM was done. Data collection was done over a period from June 2019 to February 2021. The entire study sample size was 634 case records. The result obtained from the statistical analysis was found that nearly 46% of the patients were found to have Mandibular arch crowding with female predilection (50%). The most commonly associated age groups were children than adults (63.2%) associated with mild type of crowding (65.1%). The most commonly involved malocclusion was found to be Class 1 (88.4%) Mild imbrications of the lower arch were common and were seen mainly in subjects with Class I malocclusion. Female subjects presented with more prevalence of mandibular arch crowding when compared to male subjects. Children were more affected by crowding than adults.