pre-COVID Era Research Articles

Spectrum, Outcomes, and Mortality Predictors of Acute Kidney Injury among Non-COVID-19 Patients during COVID-19 Pandemic: Data from Four Intensive Care Units.

The data of acute kidney injury (AKI), that is, community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI) among non-COVID patients from intensive care units (ICU) during the coronavirus disease-2019 (COVID-19) pandemic are scarce. We planned to study the change in the profile of such patients compared to the pre-pandemic era. This prospective observational study was conducted at four ICUs dealing with non-COVID patients at a government hospital in North India, and was aimed at assessing outcomes, and mortality predictors of AKI among non-COVID patients during the COVID-19 pandemic. Renal and patient survival at ICU transfer-out and hospital discharge, ICU and hospital stay duration, mortality predictors, and dialysis requirement at discharge were evaluated. The current or previous COVID-19 infection, previous AKI or chronic kidney disease (CKD), organ donors, and organ transplant patients were excluded. Among the 200 non-COVID-19 AKI patients, diabetes mellitus (DM), primary hypertension, and cardiovascular diseases were the predominant comorbidities in descending order. The commonest cause of AKI was severe sepsis, followed by systemic infections and post-surgery patients. Dialysis requirements at ICU admission during ICU stay and above 30 days were seen in 20.5, 47.5, and 6.5% of patients, respectively. Incidence of CA-AKI and HA-AKI was 1.24:1, whereas dialysis requirement above 30 days was 0.85:1, respectively. The 30-day mortality was 42%. Hepatic dysfunction [hazard ratio (HR): 3.471], septicemia (HR: 3.342), age above 60 years (HR: 4.000), higher sequential organ failure assessment (SOFA) score (HR: 1.107; p = 0.001), anemia (p = 0.003), and low serum iron (p = 0.001) were important mortality predictors in AKI. Compared to the pre-COVID era, CA-AKI was more common than HA-AKI due to restricted elective surgeries during the COVID-19 pandemic. Acute kidney injury with multiorgan involvement and hepatic dysfunction, elderly age with higher SOFA score and sepsis were predictors of adverse renal and patient outcomes. Singh B, Dogra PM, Sood V, Singh V, Katyal A, Dhawan M, et al. Spectrum, Outcomes, and Mortality Predictors of Acute Kidney Injury among Non-COVID-19 Patients during COVID-19 Pandemic: Data from Four Intensive Care Units. Indian J Crit Care Med 2023;27(2):119-126.

Realising rural economic transformation: Pathways to inclusive and sustainable prosperity in post-COVID-19 Asia

The world is adjusting to regain control over direct economic impacts of the COVID-19 pandemic. This adjustment is occurring whilst global collective action is also gearing up to tackle climate change, avert biodiversity collapse and redress unsustainable growth practices that featured in pre-Covid era global economic activity for decades. COVID-19 pandemic experience since December 2019 has been a period of pronounced anxiety and inspiration. Despite the angst of widespread calamity, and the loss of over six million lives, a coordinated global effort helped contain the impacts well short of initial predictions. Progress toward eliminating poverty, the central goal in rural economic transformation, has been set back by decades. The strength in organising — through social and business processes — marked the resilience endured. The recovery is patchy and uneven across individual nations, and the medium-term prospects remain contingent on the efficacy of funding essential human services and clear market bottlenecks. Bridging capacity constraints across the rural–urban continuum also remain a need to ease the regulatory burden as the world tackles widespread externalities of the past to create new growth opportunities.In this special issue, emerging and established academics from the Asian region and beyond,11These papers were drawn from presentations made at a conference organised by the Asian Development Bank Institute on ‘Rural economic transformation: embracing opportunities in better living in Asia’ held during 15–17 November 2021. All contributors are from Asian Development Bank member nations. draw insights from research and analysis on the challenges facing policy makers, businesses, and households in raising living standards and inspiring the pursuit of individual and social affluence during these uncertain but opportune times.

Clinical outcomes of obstructive colorectal cancer patients during the coronavirus disease 2019 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has affected all aspects of clinical care including diagnosis and treatment of colorectal cancers (CRCs) globally, including in Türkiye. During the initial peak of the pandemic, elective surgeries and outpatient clinics were restricted in addition to the government-imposed lockdown, resulting in a decrease in the number of colonoscopies being performed and patients admitted to inpatient wards for treatment of CRCs. In this study, we aimed to investigate whether the pandemic has affected presentation characteristics and outcomes of obstructive colorectal cancer in this period. This is a single-center, retrospective cohort study based on all CRC adenocarcinoma patients that underwent surgical resection in a high-volume tertiary referral center in Istanbul, Türkiye. Patients were divided into two groups before and after 15 months of identification of 'patient-zero' in Türkiye (March 18, 2020). Patient demographics, initial presentation characteristics, clin-ical outcomes, and pathological cancer stages were compared. Overall, 215 patients underwent resection for CRC adenocarcinoma during 30 months (COVID era: 107, pre-COVID era: 108). Patient characteristics, tumor location, and clinical staging were comparable between two groups. During the COVID period, the number of obstructive CRCs (P<0.01) and emergency presentations (P<0.01) increased significantly compared to the respective pre-COVID period. However, there were no differences between 30-day morbidity, mortality, and pathological outcomes (P>0.05). Although the results of our study indicate a significant increase in emergency presentation and a decrease in elective admissions of CRCs during the pandemic, patients treated during the COVID period were not at a significant disadvantage in terms of post-operative outcomes. Further efforts should be made to decrease risks related to an emergency presentation of CRCs for future adverse events.

Spectrum of infections in renal transplant recipients, factors affecting long term patient and graft outcomes over 10 years including COVID pandemic periods

Introduction: Multiple factors including infections affect graft and patient outcomes in Renal Allograft Recipients. Survival data from tropical countries is scarce, especially during the COVID 19 pandemic. Subjects and Methods: In this ambispective study, records of KTRs between 2011 to 2019 and prospective follow up of subsequent transplants up till 2021 was done. Infection rate, etiology, and patient and graft outcomes were studied with appropriate investigations. Univariate and multivariate analysis was done to assess the predictors of patient and graft outcomes. Results: A total of 249 patients were studied, of which 218 episodes of infection occurred in 129 patients (49.79%). Bacterial infections were the most common (40.50%), followed by viral (35.20%), mycobacterial (11%), and fungal (8.10%). Of all infections, 52.3% of cases occurred within the 1st 6 months. Infections led to patient mortality in 14.7% of cases. Infections were significantly associated with graft rejection and chronic graft dysfunction. Donor age, cytomegalovirus (CMV) infection, and graft rejection were independent predictors of chronic graft dysfunction. Recipient age and graft rejection were independent predictors of graft loss. Graft survival was 88.53%, 73.75%, and 44.90% at the end of 1, 3, and 5 years, respectively, with average 18% of total graft losses occurring during the pre-COVID era as compared to 39% in COVID period. Conclusion: Invasive fungal infections and tuberculosis are more common in late transplant period. Recipient and donor age, graft rejection, CMV infection, and COVID pandemic period affected graft and patient outcomes. COVID pandemic period led to a disproportionately higher occurrence of graft loss.

Increased risk of diabetic ketoacidosis in an Urban, United States, safety-net emergency department in the COVID-19 era

&lt;abstract&gt;&lt;sec&gt; &lt;title&gt;Aims&lt;/title&gt; &lt;p&gt;The incidence of diabetic ketoacidosis (DKA) increased during the COVID-19 pandemic but estimates from low-resource settings are limited. We examined the odds of DKA among emergency department (ED) visits in the Los Angeles County Department of Health Services (DHS) (1) during the COVID-19 pandemic compared to the pre-COVID era, (2) without active COVID infections, and (3) stratified by effect modifiers to identify impacted sub-groups.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Methods&lt;/title&gt; &lt;p&gt;We estimated the odds of DKA from 400,187 ED visits pre-COVID era (March 2019–Feb 2020) and 320,920 ED visits during the COVID era (March 2020–Feb 2021). Our base model estimated the odds of DKA based on the COVID era. Additional specifications stratified by effect modifiers, controlled for confounders, and limited to visits without confirmed COVID-19 disease.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Results&lt;/title&gt; &lt;p&gt;After adjusting for triage acuity and interaction terms for upper respiratory infections and payor, the odds of DKA during the COVID era were 27% higher compared to the pre-COVID era (95%CI 14–41%, p &amp;lt; 0.001). In stratified analyses, visits with private payors had a 112% increased odds and visits with Medicaid had a 20% increased odds of DKA during the COVID era (95%CI 7–36%, p = 0.003).&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Conclusions&lt;/title&gt; &lt;p&gt;We identified increased odds of DKA during the COVID pandemic, robust to a variety of specifications. We found differential effects by the payor; with increased odds during COVID for privately-insured patients.&lt;/p&gt; &lt;/sec&gt;&lt;/abstract&gt;

Pulmonary mucormycosis in the pre-COVID era: A retrospective study from South India

Pulmonary mucormycosis in the pre-COVID era: A retrospective study from South India

Cross-Border Shopping of Czech Citizens Before, During, And After Covid Pandemic: A Quantitative Research

This paper delves into an examination of the determinants influencing cross-border shopping behavior among citizens of the Czech Republic. Specifically, the study scrutinizes the dynamic shifts in these determinants across three distinct temporal phases: pre-COVID, during the pandemic, and post-COVID. Employing a consistent methodology, we administered three identical questionnaires to gather comprehensive data during these periods. Throughout the investigation, it became apparent that the Czech Republic experienced a surge in inflation compared to its neighboring nations during the final period under consideration. The proportion of families engaging in cross-border shopping reached its nadir during the COVID period and attained its zenith in the aftermath of the pandemic. This nuanced trend is attributed to the economic repercussions of inflation, compelling many families to transition to international shopping practices. To elucidate these patterns, we employed ordinal logistic regression to assess two pivotal determinants influencing the frequency of cross-border shopping. The geographical distance between residents’ abodes and international shopping venues emerged as a salient factor during the COVID period, reflecting heightened apprehensions about long-distance travel. However, this influence substantially waned post-COVID, as domestic inflation rendered cross-border shopping exceptionally advantageous. Furthermore, the significance of family size was pronounced in the pre-COVID era, with larger families exhibiting a proclivity for cross-border shopping. Notably, this correlation diminished during and post-COVID, indicating a leveling effect across family sizes. In summary, families of varying sizes exhibited comparable cross-border shopping frequencies during each period, with a discernible decline during the COVID era and a subsequent resurgence post-pandemic.

The Impact of Bank Regulation on Bank Performance: A Novel Analysis of the Pre-Covid Era with Cross-Country Evidence

Banks play a pivotal role in all economies by bringing balance to the economic flows of surplus and deficit. As a result of this, they are heavily regulated by national and globally accepted regulations such as the Basel III Accord. This research aims to ascertain the impact of the prudential Basel III regulations on the financial performance of selected listed African banks before the advent of Covid-19. The study used the fixed effects and random effect estimator to fit the static panel data established for the study. A panel of 45 listed banks from six African nations were used, covering the period from 2010 to 2019. The study concludes that the adoption of tighter and higher Basel III regulatory requirements has a double-edged-two-face implication on African banks’ financial performance. This conclusion is based on the findings that the capital adequacy ratio has a positive effect on the financial performance of African banks while the liquidity and minimum capital requirement have a negative effect.

Impact of COVID-19 Pandemic on Acute Appendicitis Presentation

Objectives: This research aimed to compare the incidence and severity of acute appendicitis (AA) before and during the COVID-19 pandemic. Materials and Methods: Two southern Saudi Arabian high-volume hospitals hosted this retrospective investigation. The COVID pandemic period (March–June 2020) and the pre-COVID period were identified (March–June 2019). The frequency, clinical manifestation, and severity of AA were compared for patients who underwent appendectomies during these periods. Results: In the study hospitals, total admissions decreased by 52.3% (95% confidence interval [CI]: 51.1%–53.3%) from 6231 patients during the pre-COVID period to 3261 patients during the COVID period. In the 2019 study period, 107 cases of AA were surgically treated, compared to 61 cases in 2020. The observed reduction rate was 57.1% (95% CI: 47.5%–66.8%). During the COVID period, the duration from the onset of symptoms to hospital admission and hospital admission to surgery was significantly shorter for patients. There were no significant differences between the COVID and pre-COVID periods in terms of the clinical picture or severity of AA. Conclusions: During the COVID era, there was a significant decrease in the number of AA patients hospitalized, which may indicate the efficacy of home treatment for mild cases. The successful measures taken by the Saudi Arabian government during the curfew, along with the optimal utilization of resources and logistics, resulted in the early presentation and management of AA, yielding results comparable to the pre-COVID era.

The COVID-19 Era Is Associated With Delays in Esophageal Cancer Diagnosis and Treatment

IntroductionThe coronavirus disease-2019 (COVID-19) pandemic has substantially affected the delivery of healthcare globally. The purpose of this study was to evaluate the association of this era with the timeline of care in esophageal cancer patients. MethodsWe performed a retrospective chart-review of patients presenting to a single high-volume tertiary care center with the diagnosis of esophageal cancer. COVID era was defined as March 2020-December 2020 and compared with the year before (3/2019-12/2019). ResultsIn total, 117 patients presented in the COVID-era versus 190 in pre-COVID. Stage 3 + 4 disease was found in 77.8% of the patients in the COVID-era compared to 68.9% in the pre-COVID era (P = 0.34). Diagnoses through emergency department admission were 35.5% in the COVID versus 26.7% in the pre-COVID group (P = 0.15). In the COVID era it took a median of 78 d to visit primary care provider (versus 52 d, P = 0.12 in pre-COVID), 45 d to endoscopy (versus 18 d, P = 0.004) and 38 d to treatment initiation (versus 36 d, P = 0.48). Thirty-five percent of the patients underwent esophagectomy compared to 26% in the pre-COVID-era. Median days of intensive-care-unit (ICU) (2 versus 3, P = 0.16) and hospital stay (14 versus 15, P = 0.28) were similar in both groups as well as postoperative 30-day morbidities (63 versus 63%, P = 0.48). One-year follow-up showed 83.7% (95% confidence interval [CI]: 73.8%-90.1%) survival in the COVID-group compared to 76.4% (95% CI: 66.9%-83.5%) in the pre-COVID-group (P = 0.58). Only three patients had a positive COVID result. ConclusionsOur institution treated fewer esophageal cancer patients during COVID-19 accompanied by a delay in endoscopic diagnosis. Postoperative outcomes and 1-year survival remained similar.

AN ANALYSIS OF FINANCIAL PERFORMANCE OF SELECT INDIAN INDUSTRY SECTORS BEFORE AND AFTER COVID 19

Covid-19 impacted the Indian industries as there were lock down restrictions, supply chain disruptions and other issues. The stock market which is an indicator of industry’s performance crashed when lockdown was announced. Financial performance of the companies got impacted and many of them are the process of recovery. A study was conducted to find the impact of Covid on the financial performance of three key industry sectors in India, namely, Healthcare, Automotive and Information Technology. The above analysis shows that 4 out of 5 Top companies in the Healthcare, Automotive and Information Technology sectors have recovered after Covid and have done well in their growth and profits. The IT industry stocks compared to other industries under study, have performed well post pandemic. The Automotive industry has also recovered but is not growing as compared to pre Covid era, the shortage of silicon chip can be a reason behind its slow growth. The healthcare industry improved drastically due to the need of medical attention needed in the country. The analysis shows that 4 out of 5 Top companies in the Healthcare, Automotive and Information Technology sectors have recovered after Covid and have done well in their growth and profits. KEY WORDS: Covid-19, Healthcare, Automotive, Information Technology, Profitability and growth.

Mucormycosis in Post Novel Corona Virus Patients: An Institutional Experience.

Mucormycosis is an emerging angioinvasive fungal infection caused by ubiquitous saprophytic filamentous fungus that belongs to the class Zygomycosis. Mucormycosis or black fungus infections in patients with recent COVID-19 infections has given rise to a new epidemic during the second wave of this current COVID-19 pandemic in India. Steroid misuse, poor glycemic control, use of industrial grade oxygen, improper humidification and specific variants strains have resulted in profound immunosuppression and are attributed for the high incidence of COVID associated Mucormycosis (CAM) in India. The aims of the present study were to assess the age and gender specific incidence of CAM, the utility of special stains (PAS and GMS) for diagnosing mucormycosis (false negatives and sensitivity). In the present study emphasis was laid on identifying if there exists a correlation between host response, angioinvasion and bone invasion with mortality. The Present study is a retrospective, cross sectional analytical study taken up in the Department of Pathology, Guntur Medical College for a period of 2months between 1st of May 2021 to 30th of June 2021. Results were tabulated in Microsoft excel 2016 and SPSS software version 14 was used for calculation of odds ratio and for performing multivariate analysis. All samples were routinely fixed using 10% buffered formalin, processed and sectioned. All the sections were stained with Haematoxylin and Eosin and also special stains for fungus like periodic acid Schiff (PAS) and Gomori Methenamine silver (GMS) were used wherever required. CAM is a serious complication after recovery from COVID-19 infection due to its high morbidity and mortality (13.7% in this series). CAM epidemiology and presentation is mostly similar to non-COVID mucormycosis seen in pre-COVID era.

382 IMPACT OF AGE ON MORTALITY IN STEMI PATIENTS DURING THE SARS-COV2 PANDEMIC:DATA FROM THE ISACS-STEMI COVID-19 REGISTRY

Abstract Background Several reports have described the negative prognostic impact of ageing in patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary angioplasty. During the COVID-19 pandemic, increased mortality was observed in patients admitted for STEMI. However, there are no data on the impact of ageing on the outcome of this high-risk patients during the pandemic. Objectives The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving primary PCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 11920 of March until June 30, 2019 and 2020). Primary study endpoint of this analysis was in-hospital mortality. Secondary endpoints was 30-day mortality. Results Our population is represented by 16083 STEMI patients undergoing mechanical reperfusion, who were divided according to age (&amp;lt; 55 years, n = 4179 (25,98%); 55-65 years, n = 4814 (29,93%); 65-75 years, n = 4016 (24,97%); 75-65 years, n = 2226 (13,84%); &amp;gt;85 years, n = 821 (5,10%). Ageing was linearly and independently associated with in-hospital (figure 1) and 30-day mortality (adjusted p &amp;lt; 0.0001). The COVID pandemic had a significant impact on in-hospital and 30-day mortality (adjusted p &amp;lt; 0.001), that was linearly related to age, particularly for in-hospital mortality (Figure 1). Conclusions Our study showed that among STEMI patients undergoing primary angioplasty, age was linearly associated to mortality in both precovid and covid era. The COVID-19 pandemic had a significant impact on mortality, especially in more advanced age.

CMR findings in patients referred for suspected myocarditis following mRNA-based COVID vaccination compared with pre-COVID myocarditis referrals: A single-centre observational study.

Vaccination is considered the key to overcome the COVID pandemic. For the first time mRNA-based vaccinations are used in humans. Case series suggested an increased risk of myocarditis after vaccination. This study sought to describe CMR findings in patients with suspected mRNA-vaccine associated myocarditis. A total of 33 consecutive patients referred for CMR work-up of suspected myocarditis associated with mRNA-based vaccination were included. A historical cohort of 135 consecutive patients referred for suspected myocarditis in the pre-COVID era served as control group. All patients underwent multi-parametric CMR including CINE and late gadolinium enhancement (LGE) imaging as well as parametric T1/T2 mapping of the left ventricular myocardium. Patients referred for suspected vaccination-related myocarditis were more often female (55% vs 32%, p=0.015) and demonstrated smaller LV dimensions as well as a better LV function compared to patients of the control group. CMR revealed a lower prevalence of non-ischemic LGE in patients with suspected vaccination-myocarditis (6% vs 22%, p=0.04). However, among patients without LGE we observed a higher prevalence of an abnormal T1/T2 mapping result in patients with suspected vaccination-myocarditis compared to the control group (45% vs 18%, p=0.010). In this small single-centre study, compared to myocarditis referrals in the pre-COVID era, patients currently referred for CMR work-up of suspected mRNA-vaccination-associated myocarditis demonstrated lower prevalence of LGE but higher prevalence of abnormal T1/T2 mapping. These hypothesis-generating observations may point towards a rather subtle myocardial damage and support the routine use of T1/T2 mapping in this indication.

Making better IS security investment decisions: discovering the cost of data breach announcements during the COVID-19 pandemic

PurposeStock price reactions have often been used to evaluate the cost of data breaches in the current information systems (IS) security literature. To further this line of research, this study examines the impact of data breaches on stock returns, information asymmetry and unsystematic firm risk in the context of COVID-19.Design/methodology/approachThis paper employs an event study methodology and examines data breach events released in public databases, spanning pre- and post-COVID settings. This study investigated 283 data breaches of the US publicly traded firms, and the economic cost was measured by cumulative abnormal returns (CARs), trading volume, bid-ask spread and unsystematic risk.FindingsThe authors observe that data breaches during the COVID pandemic make investors react more negatively to data breach announcements, as reflected in the significantly negative difference in CARs between breached firms before COVID and those after COVID. The findings also indicate that, after the disclosure of data breach incidents, information asymmetry is reduced to a lesser extent compared with that in the pre-COVID setting. The authors also find that data breach events lead to an increase in the unsystematic risk of breached companies in the pre-COVID era but no change in the post-COVID era.Originality/valueThis study is the first effort to examine the economic consequences of data breaches by investigating the effects in the form of trading activities and risk measurement in the COVID setting.

Evaluation of lymph node status in cancer patients during pandemic period

Background. This is a clinicopathological study comparing lymph node involvement in breast carcinomas before and during the COVID-19 period. During the pandemic, access to healthcare was limited, which led to a delay in the diagnosis and treatment of malignant tumors, which often presented in advanced stages, with lymph node metastases. Methods. A retrospective study was performed on 40 patients with carcinomas treated by surgical excision of the tumor combined with lymph node resection. Histopathological examination of lymph nodes was performed to detect malignant metastases, and the mean lymph node positivity rate was calculated. Odds ratio was used to measure the association between pre covid era and covid era (p value &lt; 0.05 being considered statistically significant). Results. Lymph node metastasis was observed in 10 patients in 2019 (50%) and in 16 patients in 2021 (80%). The average node positivity rate was significantly higher in 2021 (39.4%) than in 2019 (21.1%). Conclusion. During the Covid-19 pandemic, there was a considerable delay in presenting patients for symptoms of malignancy. This led to a delay in the diagnosis of malignancies, which were treated in advanced stages, frequently with metastases in the regional lymph nodes. Patient awareness should be improved to ensure early presentation and reporting of symptoms. Surgeons must be more vigilant and fully explore the dissection field to ensure that all involved lymph nodes are resected, thus avoiding recurrence and improving the patient's overall prognosis.

Did Physicians Have a Role to Play in National Blood Crisis?

Background: The pandemic of COVID-19 (Coronavirus disease 2019) impacted the practices of blood product procurement and transfusion in multiple ways, including failed blood donation drives, staffing limitations and low donor turnout. On January 1, 2022, the American Red Cross declared the worst national blood crisis in over a decade. The effect was most notable on the community medical centers with limited resources in securing products for blood transfusion. However, evidence is lacking for the usage of blood products in a community teaching hospital during this pandemic. Study Design and Methods: We aimed to contrast the adherence to restrictive transfusion practice in the COVID era with the pre-COVID era irrespective of COVID-19 diagnosis. We performed a retrospective observational study involving packed red blood cell (PRBC) transfusions in patients from June 2020 to August 2020 (COVID era) and September 2019 to November 2019 (pre-COVID era). Patients with hemoglobinopathies were excluded. A detailed chart review to include the number of PRBC transfusions, documented indication for transfusion and it was also determined if transfusions met restrictive blood transfusion criteria (as per guidelines from the Association for the Advancement of Blood & Biotherapies (AABB)) (Table 1). Demographic data included age, gender, history of coronary artery disease (CAD) or prior gastrointestinal bleed, use of antiplatelet and anticoagulation, use of deep vein thrombosis prophylaxis inpatient, and diagnosis on admission. Chi-square was applied to test the statistical association between qualitative variables and Unpaired t-test/Mann Whitney U test was applied to test the mean difference of quantitative. The level of significance was set at 5%. Results: A total of 215 patients were screened and 208 met our inclusion criteria. There were 108 PRBC transfusions in the COVID era group and 100 PRBC transfusions in the pre-COVID era group, with equal distribution in both groups for age, sex, ethnicity and prior gastrointestinal bleed. The leading diagnosis on admission in both COVID era and pre-COVID era groups was acute hypoxia (53.7% and 36% p<0.001), followed by gastrointestinal bleeding. Lower proportion of patients receiving transfusion were on anticoagulant or antiplatelet therapy in COVID era group as compared to pre-COVID era (antiplatelet: 6.2% vs 19%, p<0.001 and anticoagulant: 12.1% vs 27%, p<0.001), though COVID era group had lower fraction of patients receiving pharmacological prophylaxis for deep vein thrombosis (DVT) (13.9% vs 29%, p<0.001). There was a higher percentage of transfusions in critical care units in the COVID era group than pre-COVID era group (38.9% vs 22%, p<0.008). Documented indications for transfusions in both groups were hemoglobin < 7 (47.2% vs 43%), acute coronary syndrome (ACS) or history of CAD (12% vs 11%), active bleed (35.2% vs 35%) and down trending hemoglobin (5.6% vs 11%). Restrictive transfusion criteria were met in only 67% vs 79% in COVID era and pre-COVID era transfusion cases respectively (p=0.008). Subgroup analysis of documented indications for transfusion among both groups is displayed in Graph 1. Conclusions: As evident from our results, the COVID era group despite having comparable, if not fewer risk factors associated with blood loss, received blood transfusion with less stringent adherence to restrictive blood transfusion guidelines. COVID pandemic had a significant impact on the landscape of blood transfusion and our study brought to light the physician's role in more liberal use of blood products. Due to a higher number of critical care admissions and the morbidity/mortality during this pandemic, compel physicians to have a more liberal mindset towards blood transfusions. However, given the acute shortage of blood products it is vital that we adhere to restrictive blood transfusion guidelines. In view of the ongoing National Blood Crisis, please visit RedCrossBlood.org or call 1-800-RED CROSS (1-800-733-2767) to donate blood. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Mediating Role of Perceived Health Risk on Customer Experience and Customer Satisfaction: Evidence from the Airline Industry in India During COVID-19

With a steep decrease in the rate of COVID-19 infection, and a corresponding increase in the number of vaccinated people, countries have begun to re- open borders to foreign travellers, triggering the resumption of aviation services. However, people are still apprehensive, and are avoiding travel, hindering air travel to get back to the pre-COVID era. This paper determines the experience of air travellers’ during the pandemic applying EXQ model. Additionally, it investigates the role of perceived health risk as a mediating variable in an extended EXQ model. We collected data from a sample of 122 air travelers during the pandemic and analyzed it using IBM SPSS. The outcome of this study sheds light on the experiences of pandemic-affected airline passengers, revealing in the process, factors that passengers value much more now than ever before. The findings confirm that perceived health risk significantly mediates the relationship between customer experience and satisfaction.

Abstract 13924: Impact of a Pandemic on Women Diagnosed With Peripartum Cardiomyopathy

Background: Peripartum cardiomyopathy (PPCM) is a dilated form of cardiomyopathy that occurs during the last month of pregnancy or up to five months postpartum. Approximately 1,100 women develop PPCM in the United States each year. The aim of our study is to compare the incidence of PPCM prior to the start of the Coronavirus Disease 2019 (COVID) pandemic to afterwards and to determine the impact of COVID on hospitalized patients with PPCM. Methods: This was a retrospective study of 2,286 patients with a diagnosis of PPCM who were admitted to a private hospital system across the United States between the year 2017 and year 2021. There was 1,790 patients in the pre-COVID cohort, and 496 patients in the COVID era cohort. Demographics of patients were collected, with t-test and chi square p-values utilization for statistical description. Results: The mean age of women was 32.13 years. In the COVID era cohort, the percentage of Hispanic patients was significantly higher than the pre-COVID era (16.84% vs. 12.34%, p=0.012). In the COVID era, patients were more likely to have preeclampsia (20.16% vs. 13.52%, p&lt;0.001), HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome (2.62% vs. 0.61%, p&lt;0.001), respiratory failure (19.56% vs. 10.57%, p&lt;0.001), and myocardial infarction (3.63% vs. 1.90%, p=0.022). There was no significant difference in troponin and d-dimer values between the two era cohorts. The average length of stay, percentage of patients admitted to the intensive care unit (ICU), and death did not significantly differ between the pre-COVID and COVID era cohorts. Conclusion: In our study, although there was no significant difference in length of stay, ICU admission, or death in the COVID era cohort, myocardial infarction, preeclampsia, HELLP syndrome, and respiratory failure were each more prevalent in women with PPCM during the COVID era. These findings might indicate suboptimal access to outpatient and inpatient medical care during the COVID pandemic, which could have led to these more serious diagnoses.

Adaptation and Change in Practices in Neuro-Intervention during COVID-19 Pandemic: Experience from Department of Interventional Neurology at Referral Tertiary Care Hospital in Bangladesh

Background: Different adaptation and changes have been practiced during COVID-19 pandemic. Objective: In this paper we investigated the impact of the COVID-19 pandemic on service delivery in the department of interventional neurology and adaptation of the department to the changed environment. Methodology: This was a retrospective analysis of diagnostic digital subtraction angiography (DSA) procedures done from January 2018 to December 2020 and were analyzed to detect significant breaks in time trend. Results: A total of 358, 426 and 251 patients got admitted for DSA in consecutive three years from 2018 to 2020 respectively. There was a sudden drop in the number of DSA procedures from 30 to 50 patients per month in the pre-COVID era before March 2020 to less than 10 patients per month during the COVID period of March to June 2020. However, the situation gradually improved following the introduction of RT-PCR test for SARS CoV-2 in June 2020. A poison regression showed a significant increase in monthly DSA procedures in the year 2019 compared to the year 2018, but a significant decrease in the pandemic year of 2020. Conclusion: By incorporating COVID-19 testing as a pre-requisite test before DSA procedures, the department of interventional neurology recovered from experiencing a significant drop in the number of performed DSA procedures in the initial periods of the pandemic to reaching a level observed in the pre-COVID era. Bangladesh Journal of Infectious Diseases, April 2022;9(Suppl_1): S3-S8