Scenario:

A young patient in his twenties was brought to the hospital’s emergency department due to on and off fever for 5 days associated with body pains only and then was tested for Covid19 which turned out to be positive then was immediately referred to other health care facility that can manage patients with CoviD19 disease adequately…then a few days after the young patient died due to a lung complication( ARDS-Acute Respiratory Distress Syndrome) from CoviD19 disease. In another health care facility setting, here came two women at the emergency department, one was in her late forties with hypertension and diabetes and the other was also hypertensive and diabetic at 58 years old, both of them had fever, cough and poor appetite for three days without difficulty of breathing and was also tested for CoviD19 disease which both results turned out to be positive and was subsequently admitted. Then 4 to 5 days after, both of them develop shortness of breath and was transferred to the intensive care unit for proper and guarded management. Then a few days after,the woman on her late forties died due to heart problem complication and then the other woman on her late fifties survived after 18 days in her hospital stay and was subsequently discharge well.

 

CoviD19 infects 8.46 million and kills more than 453,000 thousand victims:

Since December 2019 when the first case of Covid19 disease was reported from Wuhan China…and then spreads all over the world and kills hundreds of thousands and destroys global economy. Thus many scientists from influential countries around the globe partnered and collaborated with the wealthy multinational pharmaceutical industries to develop a drug/s and vaccine/s for the novel coronavirus or SARS CoV-2 that causes the dreaded CoviD19 disease. This collaboration studies or the Solidarity Clinical Trial is headed by no other than  the the World Health Organization ( WHO ). The purpose and aims of the Solidarity Clinical Trial is to rapidly discover a definite drug/s for the treatment of CoviD19 disease as a

current evolving situation globally. Many drugs that was repurposed under the WHO compassionate use for Covid19 disease was used while awaiting strict peer reviewed clinical study result protocol. And because there is no effective or definite drug treatment available for the new coronavirus infection, morbidity and mortality rates continue to piled up. 

 

 

Recently release Promising Repurposed Drugs for CoviD19 patients:Solidarity Clinical Trials by WHO

The world is very thankful enough that a cheap drug such as dexamethasone ( intravenous or oral form  ,intravenous remdesivir by Gilead and convalescent plasma was repurposed ( US-FDA EUA  ) and in combination with other medications (ACTT2 ) showed promising results by shortening hospital patients stay in the severely infected hospitalised patients and thus save lives. And the strict implementations of quarantines and lockdowns in each locality with the application of good personal hygiene and health practices contributed to ” Flatten the curve ” against CoviD19 disease worldwide.

 

Dr. Laertes B. Amihan talked with quarantine guards.

 

While waiting for the development of a new definite drug treatment for the dreaded Covid19 disease, infected patients still continue to rise in some areas and others are still in watchful waiting for the second novel coronavirus outbreak will occur, since most of the government loosens their grip with regards to the strict implementation of the enhanced community quarantines ( ECQ ) or lockdowns and changed it to a more relaxed modified generalized community quarantines or MGCQ. Thus some people unknowingly tend to forgot the protocols and as “social animals” mingles freely closely with each other with a big possibility of spreading the virus then a possible second wave CoviD19 outbreak will happen in the near future.

 

Absolute Advocacy to use mask…mask4all!!!

 

 If the possibility of second CoviD19 outbreak is highly entertained…then more sick patients will be going to our health care facilities presenting initially with mild symptoms ( 81% of patients ), severe ( 14% ) and critical ( 5% ). Based from foreign literature that there are subsets of the patients presenting with mild symptoms of Covid19 disease deteriorates or progress to critical illness regardless of having a comorbid factor or not having a one. Although we as clinicians already had the knowledge of who are the possible candidate that will deteriorate base from their history and comorbidity but still it will be really hard for us to pinpoint who are the patients will deteriorate and progress to critical illness. A new study will give a solution to that…and that is by using Artificial Intelligence or AI in health care.

 

Will Artificial Intelligence or AI Predicts Severe Disease in CoviD-19 Patients accurately?

 Thus, there was a case series study (involving 53 patients) from china that revealed using predictive analytics an AI or artificial intelligence technology that analyse historical data of the patient/s and then it can now more or less predicts 70 to  80% possibility of who are the patients that will progress to critical illness or ARDS presenting initially with a mild symptoms of CoviD19 disease. The study was collaborated by the NYU Grossman School of Medicine and NYU Courant Institute of  Mathematical Sciences USA and Wenzhou Central Hospital and Cangnan People’s Hospital in Wenzhou,China. 

 

Study Result:

In the result of the study, hallmarks of CoviD19 diagnosis such as ground glass opacities on chest computed tomography,fever, cough, lymphopenia, age, dyspnea on initial presentation, gender and well validated testing tools for pneumonia severity are not highly predictive of disease risk  progression for ARDS and critical illness. But neglected values such as mild elevation of the liver enzyme alanine aminotransferase ( ALT ), muscular pain or myalgias a marker for inflammation and an increase of hemoglobin are more predictive of disease severity and progression. The result of the study was published march 30, 2020 in the Journal Computers, Materials and Continua. The author of the study is Megan Coffee, MD, PhD, clinical assistant professor in the Department of medicine and member of the Division of Infectious Diseases and Immunology at NYU Langone.

 

 

 Although the dataset of the study was small but the result was still significant because this pilot study will lead to future validation studies which will use or include more number of patients to have a far more better peer reviewed acceptable results.

Likewise it will be able to give an advance hint, ideas or information to the physician of what, who and when will the patient go to disease progression and the health professional can immediately institute preventive treatment to the patient before it will deteriorate and progress to ARDS in the hospital setting.

 

Then another Great Intriguing…… ” NEW ” Discovery!!!


Just a few days ago, june 16, 2020…A Most Recent Predictive Analytics Model was develop by Cleveland Clinic researchers in the US to forecasts or to identify whether or not a patient is likely to test positive for CoviD19 and can identify disease severity outcomes and chances of hospitalization by 70 to 80% !!!. And t
he tool is the world’s first predictive analytics model of its kind…it is called a NOMOGRAM. The study was pre-proof published in the CHEST Journal in June 18, 2020.

The researchers used statistical algorithms from nearly 12,000 patients electronic medical records from Clevelands Clinic CoviD19 registry.

And this findings will surely surprise you!!! because the novel Predictive Analytics Model revealed…

That persons who received or have been vaccinated with pneumococcal polysaccharide vaccine (PPSV 23) are less likely to test positive for CoviD19.

That people who have been vaccinated or received flu vaccine shots are less likely to test positive for CoviD19.

That people who had been actively taking melatonin as pills for sleeping problems are less likely to test positive for Covid19.

That persons who are on carvedilol for hypertension and heart failure are less likely to test positive for Covid19.

That people who are taking paroxetine for anxiety,post traumatic stress disorders and as an anti-depressant pill are less likely to test for CoviD19.

That patients who belongs to the higher or greater economic level or status are less likely to test positive for Covid19 compared to patients that belongs to the lower income socioeconomic groups.

That being male status and of advancing age had an increase or higher risk or more likely to become positive for CoviD19.

Then patients of asian descent are less likely to test positive for Covid19 than their caucasian counterpart .


“The ability to accurately predict whether or not a patient is likely to test positive for Covid19,as well as potential outcomes including disease severity and hospitalization, will be paramount ineffectively managing our resources and triaging care.” said Lara Jehi, MD, Cleveland Clinic  Chief Research Information Officer and corresponding author on the study.

” Wheeeeew… I can’t remember all the laboratory results of my patients…” Where are my residents?”

“There are new laboratory tests and new clinical findings developing every day …its getting beyond the realm of human comprehension,” Donna Wolk,MHA,PhD , Division Director of molecular and Microbial Diagnostics and Development at Geisinger Health System.

Are the results extremely Intriguing?…It is your choice!


Conclusion:

 

 The application of Artificial Intelligence or AI in the future will prevent overwhelming intensive care unit admissions and less use of expensive ICU ventilators and ECMO machines in the near future for CoviD19 patients but the tool’s application is also extremely helpful for other types of diseases that affects humans.

The use of artificial intelligence or AI in medicine will not replace the clinicians decision making in treating their individual patients but will augment or aid and assist the physician with regards to clinical insights improvement and thus giving precision, tailor fit delivery of high value care and management to their respective patients…and first is… “Do no Harm”…

 

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