Objectives
COVID-19 pandemic has led to unprecedented increase in rates of stress and burn out among healthcare workers (HCWs). Heart rate variability (HRV) has been shown to be reflective of stress and burnout. The present study evaluated the prevalence of burnout and attempted to develop a HRV based predictive machine learning (ML) model to detect burnout among HCWs during COVID-19 pandemic.
Methods
Mini-Z 1.0 survey was collected from 1615 HCWs, of whom 664, 512 and 439 were frontline, second-line and non-COVID HCWs respectively. Burnout was defined as score ≥ 3 on Mini-Z-burnout-item. A 12-lead digitized ECG recording was performed and ECG features of HRV were obtained using feature extraction. A ML model comprising demographic and HRV features was developed to detect burnout.
Results
Burnout rates were higher among second-line workers 20.5% than frontline 14.9% and non-COVID 13.2% workers. In multivariable analyses, features associated with higher likelihood of burnout were feeling stressed (OR = 6.02), feeling dissatisfied with current job (OR = 5.15), working in a chaotic, hectic environment (OR = 2.09) and feeling that COVID has significantly impacted the mental wellbeing (OR = 6.02). HCWs with burnout had a significantly lower HRV parameters like root mean square of successive RR intervals differences (RMSSD) [P<0.0001] and standard deviation of the time interval between successive RR intervals (SDNN) [P<0.001]) as compared to normal subjects. Extra tree classifier was the best performing ML model (sensitivity: 84%)
Conclusion
In this study of HCWs from India, burnout prevalence was lower than reports from developed nations, and was higher among second-line versus frontline workers. Incorporation of HRV based ML model predicted burnout among HCWs with a good accuracy.
Serum protein electrophoresis (SPEP) is a method by which proteins present in serum are separated into different fractions based on their molecular weight and electric charge. Presence of M spike, composed of monoclonal protein, on electrophoretogram is a characteristic finding that can be seen in monoclonal gammopathies like multiple myeloma. M spike is most commonly seen in the gamma region however, the M-spike can be observed in fraction other than the Y fraction as well i.e. in the beta region and rarely alpha region. Here we have enumerated few cases where M protein has been seen in fractions other than the gamma region. Thus one needs to be cautious about the variable appearance of M-spike during interpretation of SPEP as some physiological proteins if elevated can also give rise to similar spike sometimes referred as pseudo monoclonal pattern.
Amyloid Light chain (AL) amyloidosis is characterised by deposition of intact free light chains or their fragments in extracellular space. Here, authors describe the journey of a diagnostically challenging patient who presented with features of nephrotic syndrome and was finally diagnosed with AL amyloidosis. A 45-year-old female presented to the Outpatient Department (OPD) with gradually progressive generalised body swelling. On examination, hepatomegaly, cardiomegaly and macroglossia were observed. Renal biopsy, capillary serum protein electrophoresis, immunotyping and serum free light chain assay were performed along with routine blood and urine investigations to detect the presence of monoclonal protein. Bone marrow biopsy was conducted for confirmation of diagnosis. Proteinuria with hypoalbuminaemia 1.8 g/dL was detected during routine investigations. Renal biopsy showed presence of amyloid deposits in glomerular mesangium and walls of medium sized blood vessels which tested positive for Immunoglobulin (Ig) G, IgA, kappa and lambda chains on immune florescence. Serum protein capillary electrophoresis findings demonstrated increase in beta 2 fraction and distortion in gamma region. Immuno typing showed presence of monoclonal IgA heavy chains and lambda light chains. Bone marrow biopsy confirmed presence of plasma cell dyscrasia. Based on these findings authors concluded that capillary gel electrophoresis is more sensitive method than agarose gel electrophoresis in detecting beta migrating monoclonal proteins.
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