Comparison of Obstetric Outcomes in First and Second COVID-19 Waves: Analysis from a COVID-19-dedicated Tertiary Care Hospital

Introduction: The physiological changes in the respiratory and cardiovascular systems in the immunosuppressed state of pregnancy may exacerbate clinical features and deteriorate outcomes due to COVID-19 infection. We aimed to compare the maternal and neonatal adverse effects in the first and second COVID-19 waves. Methodology: This study was a prospective cohort study conducted in a tertiary care COVID-19-dedicated hospital. In total, 104 (group A) and 96 (group B) COVID-19-positive pregnant women admitted during the first and second waves, respectively, were included in the study. Data on baseline variables, associated comorbidities, clinical presentations, management strategies, and neonatal and maternal outcomes were collected and compared using parametric and nonparametric tests and analyzed. Result(s): Around 2.08% in group A and 6.72% in group B of COVID-19-infected pregnant women, respectively, had moderate-to-severe disease and required intensive care unit stay. Almost 1.04% in group A and 3.84% in group B had maternal mortality, 13.4% and 19.8% babies of groups A and B required admission in neonatal intensive care units, and 8.6% and 7.3% of newborns in groups A and B had COVID-19-positive reports by reverse transcriptase polymerase chain reaction (RT-PCR) at birth, respectively. Of them, 2.1% newborns in group B had RT-PCR positive on day 7 of life and beyond, whereas none had positive RT-PCR reports on 7 days and beyond in group A. Conclusion(s): Dreadful maternal outcomes like requirement of ICU and mechanical ventilator and persistence of neonatal infections were higher during the second wave.Copyright © The Author(s). 2023.

Impacts of COVID-19 on Public Health in Urban Slums in India and Lessons for the Future

This paper examines the impact of the pandemic on India's public health system of the country, especially from the perspective of urban slumdwellers. Drawing on a qualitative study carried out by the Urban Health Resource Centre in selected slums in Indore and Agra, the paper reflects the impact of the pandemic on the provision of essential health services such as maternal and child healthcare, family planning, immunization for children and the detection and treatment of non-COVID ailments such as tuberculosis. The authors argue that the veritable collapse of healthcare to the most vulnerable sections of the population exposed the structural weaknesses of India's healthcare system. To build a more robust public health system in India to tackle future crises of this kind, the authors call for strengthening the health infrastructure in small to medium-sized cities and reinforcing other crucial determinants of well-being such as food security, livelihood opportunities and support and enhanced education opportunities. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023.

Role of Artificial Intelligence in Advancing Sustainable Development Goals in the Agriculture Sector

Artificial intelligence (AI) is the algorithms designed to make decisions, often using big real-time data to perform activities that at times go beyond human capabilities. Given the increasing gap in agricultural demand and supply worldwide, further widened by the COVID-19 pandemic (The pandemic has derailed the progress towards Sustainable Development Goals (SDGs) further off the track. The SDG financing gap per annum widened from USD 2.5 trillion to around USD 4.2 trillion), it necessitates innovative and cost-effective approaches to agriculture. AI has begun producing innovative technological solutions and data-driven insights to farming which gives confidence that it can be used to mitigate challenges around sustainable agricultural practices and facilitate getting SDGs back on track. In agriculture, AI has demonstrated immense potential in achieving enhanced productivity and improving the existing supply chains, delivery systems and market value/better pricing in both developed and developing countries for better utilisation of the produce. Several innovative uses of AI in agriculture have emerged worldwide, promising to advance farm productivity while improving sustainability and livelihoods at the same time. However, many of these experiments/pilots exist in silos. Due to this fragmented approach, a comprehensive understanding of how successful the use of AI has been in agriculture and what shortcomings or challenges were faced in some of these technological implementations has not been well evaluated. This chapter, therefore, assesses the pressing reasons to use innovative and cost-effective digital interventions like AI for SDGs in the agriculture sector. The paper then identifies the challenges in designing a successful AI programme and explores the potential of multi-stakeholder partnerships in this context. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

UNet Deep Learning Architecture for Segmentation of Vascular and Non-Vascular Images: A Microscopic Look at UNet Components Buffered With Pruning, Explainable Artificial Intelligence, and Bias

Biomedical image segmentation (BIS) task is challenging due to the variations in organ types, position, shape, size, scale, orientation, and image contrast. Conventional methods lack accurate and automated designs. Artificial intelligence (AI)-based UNet has recently dominated BIS. This is the first review of its kind that microscopically addressed UNet types by complexity, stratification of UNet by its components, addressing UNet in vascular vs. non-vascular framework, the key to segmentation challenge vs. UNet-based architecture, and finally interfacing the three facets of AI, the pruning, the explainable AI (XAI), and the AI-bias. PRISMA was used to select 267 UNet-based studies. Five classes were identified and labeled as conventional UNet, superior UNet, attention-channel UNet, hybrid UNet, and ensemble UNet. We discovered 81 variations of UNet by considering six kinds of components, namely encoder, decoder, skip connection, bridge network, loss function, and their combination. Vascular vs. non-vascular UNet architecture was compared. AP(ai)Bias 2.0-UNet was identified in these UNet classes based on (i) attributes of UNet architecture and its performance, (ii) explainable AI (XAI), and, (iii) pruning (compression). Five bias methods such as (i) ranking, (ii) radial, (iii) regional area, (iv) PROBAST, and (v) ROBINS-I were applied and compared using a Venn diagram. Vascular and non-vascular UNet systems dominated with sUNet classes with attention. Most of the studies suffered from a low interest in XAI and pruning strategies. None of the UNet models qualified to be bias-free. There is a need to move from paper-to-practice paradigms for clinical evaluation and settings.

Arrhythmia burden in COVID-19 patients from industrial workforce evaluated by remote patient monitoring technology

Introduction: Early reports from China estimated that overall cardiac arrhythmia prevalence in patients hospitalized for COVID-19 was 17%. A higher arrhythmia incidence (44%) was observed in patients admitted to intensive care unit. The industrial workforce was affected by COVID-19 to a great extent. A noteworthy proportion also suffered from cardiac abnormalities. Objective(s): To determine the incidence of arrhythmia in patients with COVID-19 among the industrial workforce using remote patient monitoring technology. Material(s) and Method(s): This was a retrospective, observational, descriptive study of the industrial workforce from Telangana State, India. Approval of the institutional ethics committee was obtained. The need for informed consent was waived off. Patients who tested positive for COVID-19 by RTPCR and aged above 18 years were eligible. The five-day recording of lead-2 ECG on Vigo Monitoring Solution (Connect Care India Pvt. Ltd) was collected and analysed. Brady-arrhythmia during day time, second degree AV block Type-2 (Mobitz II) during the day time, complete heart block, wide QRST, non-sustained ventricular tachycardia and sinus pause were considered "clinically significant". The other sub-types were defined as "clinically non-significant". The ECGs with regular sinus rhythm were interpreted as "normal". The prevalence of clinically significant, clinically non-significant and normal heart rhythm are described here. Result(s): Out of 240 COVID-19 patients who were on-board for remote monitoring, 216 (148 male and 68 female, mean age 51+/-15 years) met the eligibility criteria and only their ECG were analysed. Among them, 18 were known diabetics, 40 were hypertensive and 31 had both comorbidities. 112 were asymptomatic and 104 were symptomatic. The burden of arrhythmia was found clinically significant in 12 (5.6%) patients, clinically non-significant in 87 (40.4%) and normal among 117 (54%) out of 216 patients. Conclusion and Recommendation: The remote patient monitoring may be utilized as a tool for early screening of significant arrhythmia which are to be addressed immediately for better clinical outcome. These devices on being integrated into COVID-19 management strategies may contribute to patient satisfaction, emergency alerts, timely management, reducing mortality rate and enhancing the safety of healthcare providers.

Tocilizumab- a Treatment Option for Torsades De Pointes in Covid-19 Patients

Background The incidence of ventricular arrhythmias (VA) in Coronavirus disease 2019 (COVID-19) patients ranges from 1.6 to 5.9%. COVID-19 can trigger a systemic inflammatory response, which may unmask arrhythmias. Here we discuss a challenging case of COVID-19 that manifested as recurrent Torsades de Pointes (TdP). Case A 39-year-old female with no known past medical history presented with a complaint of multiple syncopal episodes in the last two days. Initial electrocardiograms (EKG) showed a heart rate of 62 with frequent premature ventricular contractions (PVCs) and a prolonged corrected QT(QTc) interval of 520ms. Frequent PVCs soon converted to TdP with loss of consciousness which was managed with successful direct current cardioversion (DCCV). However, the patient relapsed into TdP, warranting another successful DCCV. COVID-19 workup came back positive. Electrolytes were within normal limits;however, C-reactive protein (CRP) and troponin T levels were elevated. Decision-making The patient was started on intravenous (IV) magnesium for 24 hours. Following another episode of self-limiting TdP, IV isoproterenol was started, and tocilizumab was given. An echocardiogram showed no evidence of structural heart disease. During the hospital course, telemetry showed PVCs that decreased in frequency paralleled with a decrease in CRP and troponins. Repeat EKGs showed normalization of QTc interval. The patient declined implantable device placement or procedures and was eventually discharged with a heart monitor and a beta blocker. On follow-up, the patient denied any symptoms since the discharge, QTc remained normal, and the heart monitor did not show any VA. Conclusion Management of TdP generally involves magnesium, IV isoproterenol, and transvenous pacing. However, as described in this case, tocilizumab can cause QT interval shortening and a reduction in CRP and cytokine levels and may be beneficial for use in COVID-19 patients with QT prolongation and VA, including TdP. There are no strict guidelines for arrhythmias in COVID-19 patients. Accordingly, more studies need to be done to follow this patient population managed with tocilizumab for their eventual outcomes.Copyright © 2023 American College of Cardiology Foundation

Non-Detection of Post Covid Pulmonary Fibrosis (PCPF)through HRCT and PFT but possible throughTransbronchial Lung Biopsy

Background: 49 patients underwent Lung Biopsy due to different indications and Post-COVID Pulmonary Fibrosis(PCPF) was suspected in 25 patients. Objective(s): To document the evidence of PCPF in patients with history of suspected COVID 19 infection (in past oneyear) through Transbronchial Lung Biopsy(TBLB)with flexible bronchoscopy. PFT and HRCT gave variedpresentation. Method(s): we have evaluated patients who underwent Lung Biopsy on flexible Bronchoscopy between 08/07/2021 till31/01/2022 at Metro Hospitals and Heath Institute, Meerut, UP, India. The history of exposure to COVID 19 infectionwas taken. Most of these patients underwent Echocardiography (ECHO) for Left Ventricular Ejection Fraction (LVEF)and Pulmonary Artery Pressure (PAH), Pulmonary Function Test (PFT) and High Resolution CT Scan Chest (HRCTChest). Result(s): 49 patients underwent Lung Biopsy. 25 patients gave the history of exposure to COVID 19 infection with complaint of breathlessness and chest discomfort in the last 1 year. HRCT chest was suggestive of Atelectasis in 3 patients, Interstitial Lung Disease (ILD) in 6, Fibrosis in 8, Pulmonary Nodules in 4 and HRCT was not done in 4 patients. PFT showed Mixed Ventilator Defect in 8, Obstructive in 3, Restrictive in 7, small airway disease in 1 and 6 patients couldn't perform PFT. PAH was normal for 6,mild for 16, moderate for 2 and 1 severe. 4 patients had Coronary Artery Disease. 2 patients had major complications like pneumothorax who underwent TBLB. Conclusion(s): PCPF was detected with the help of TBLB in the patients with history of exposure to COVID 19 infection. However, TBLB may cause major complication like pneumothorax seen in 8% cases.

Futuristic Rehabilitation Technique Of Acquired Maxillectomy Defect In Post Covid19 Mucormycosis Using Polyether Ether Ketone Obturator Prosthesis- A Case Report

Background: Oroantral communication can occur due to maxillectomy defects, jeopardizing the integrity and function of oral cavity. It is an interdisciplinary challenge to restore these by surgery and prosthetics since many facets need to be addressed, such as speech, deglutition, mastication, aesthetics and psychological distress. Rationale: Surgical repair of maxillectomy defects is not always achievable due to various reasons such as poor systemic health, advanced age etc. Thus prosthetic rehabilitation becomes the most suitable treatment option. Relevance for Patients: Post COVID-19 mucormycosis has seen a surge in the past two years. It is an opportunistic fungal infection in humans infecting intracranial structures by direct invasion in the blood stream. Fundamental goal of prosthetic rehabilitation is the closure of oronasal communication and restoring it functionally thereby improving quality of life for the patient. CAD/CAM (computer aided design/computer aided milling) technology was employed to fabricate a milled framework for maxillary obturator in the most innovative way using PEEK (Polyether ether ketone). Result(s): PEEK material due to its excellent biocompatibility ensured a light weight prosthesis for the large maxillectomy defect and closure of the patency was achieved by the obturator framework.Copyright © 2022 Authors. All rights reserved.

Patient characteristics, anaesthetic workload and techniques in the UK: an analysis from the 7th National Audit Project (NAP7) activity survey.

Detailed contemporary knowledge of the characteristics of the surgical population, national anaesthetic workload, anaesthetic techniques and behaviours are essential to monitor productivity, inform policy and direct research themes. Every 3-4 years, the Royal College of Anaesthetists, as part of its National Audit Projects (NAP), performs a snapshot activity survey in all UK hospitals delivering anaesthesia, collecting patient-level encounter data from all cases under the care of an anaesthetist. During November 2021, as part of NAP7, anaesthetists recorded details of all cases undertaken over 4 days at their site through an online survey capturing anonymous patient characteristics and anaesthetic details. Of 416 hospital sites invited to participate, 352 (85%) completed the activity survey. From these, 24,177 reports were returned, of which 24,172 (99%) were included in the final dataset. The work patterns by day of the week, time of day and surgical specialty were similar to previous NAP activity surveys. However, in non-obstetric patients, between NAP5 (2013) and NAP7 (2021) activity surveys, the estimated median age of patients increased by 2.3 years from median (IQR) of 50.5 (28.4-69.1) to 52.8 (32.1-69.2) years. The median (IQR) BMI increased from 24.9 (21.5-29.5) to 26.7 (22.3-31.7) kg.m-2 . The proportion of patients who scored as ASA physical status 1 decreased from 37% in NAP5 to 24% in NAP7. The use of total intravenous anaesthesia increased from 8% of general anaesthesia cases to 26% between NAP5 and NAP7. Some changes may reflect the impact of the COVID-19 pandemic on the anaesthetic population, though patients with confirmed COVID-19 accounted for only 149 (1%) cases. These data show a rising burden of age, obesity and comorbidity in patients requiring anaesthesia care, likely to impact UK peri-operative services significantly.

Large Ovarian Dermoid, a Cause for Fetal Growth Restriction and Oligohydramnios: Rare Instance in Literature

Ovarian dermoids mostly remain asymptomatic during pregnancy. Large dermoids may present with torsion, hemorrhage, or rupture. However, a dermoid cyst causing fetal growth restriction (FGR) and oligohydramnios is a very rare entity. The authors report a case of a large ovarian dermoid (15 x 12 cm) hampering intrauterine fetal growth. Due to the coronavirus disease-2019 (COVID-19) lockdown, the patient was unable to get ultrasound examinations in early gestation, and thereby, surgical intervention was not possible during the second trimester. As a result, this growing teratoma finally led to FGR by either exerting a pressure effect upon the uterus or by dwindling its blood supply. Copyright © The Author(s). 2022.

Pattern of Lung Involvement in Predicting Severity and Sequelae in Patients With COVID-19.

Background During the COVID pandemic, high-resolution CT scan has played a pivotal role in detecting lung involvement and severity based on the segments of the lung involved. The pattern of involvement was not considered, and our aim is to observe the pattern of lung involvement in predicting severity and guiding management protocol in patients with COVID-19. Methodology It was a prospective observational study conducted with 151 patients admitted with COVID-19 with a positive reverse transcriptase polymerase chain reaction test (RT-PCR) in a single tertiary care hospital in south India. Patients with pre-existing lung pathologies were excluded from the study. Eligible patients were then divided into mild, moderate, and severe categories based on Indian Council of Medical Research (ICMR) guidelines, and high-resolution computed tomography (HRCT) chest was done, findings of which were then categorized based on lung involvement; into ground glass opacities (GGO), interstitial involvement and mixture of both. These were then analyzed to determine their importance with respect to the duration of stay and severity of the disease. Results The data collected was analyzed by IBM SPSS software version 23.0 (IBM Corp., Armonk, NY, USA). The study population included 114 males (75.5%) and 37 females (24.5%). HRCT chest was done which showed 62.3% of patients had GGO, 14.6% had interstitial lung involvement, 18.5% had a mixture of both and 4.6% had normal lung findings. These findings, when compared to clinical categories of severity, showed a significant co-relation between pattern of involvement of the lung and the severity of the disease. It also showed significant co-relation with the duration of stay. Conclusion HRCT chest has proven to be useful in the determination of patient's severity and can guide with management. We suggest earlier initiation of steroids and anticoagulants in patients with interstitial involvement even for the patients not on oxygen therapy yet. It can be used as a triage modality for screening due to the advantage of presenting with immediate results as opposed to RT-PCR which might take hours and can delay treatment which can prevent worsening.

Market Survey On Consumption Pattern Of Street Food Products In Prayagraj District

There is a dearth of knowledge regarding the consumption habits of street foods, despite the fact that individuals in low- and middle-income nations rely heavily on SF for their diet. An online survey employing a structured questionnaire was used to perform a cross-sectional study on 200 street food consumers in the Prayagraj/Allahabad District. Customers were approached and requested to participate who went to the randomly sampled Street Foods vendors and stores. The majority of consumers were male, between the ages of, and had at least a 10+2 and a Bachelor's degree. The primary findings showed that 91.5% of these consumers virtually always ate street food. In Prayagraj/Allahabad District, the most frequently consumed items were various types of street food products. chaat, bun, samosa, kachauri/khasta, fritters, south and north Indian chow mein, non-vegetarian, eggs, and dried goods. Consumers answered that they would prefer to buy healthier street foods (91.5%) if they were accessible. In the Prayagraj/Allahabad District, there is a sizable market for consumers of street food. Although street food is the majority of what is eaten, if healthier options are offered, people would be eager to buy them. Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.

Peripheral blood morphology and hemogram in COVID-19 patients correlates with disease severity: Insights from a Tertiary Care Center

Context: Coronavirus Disease 2019 (COVID-19) has profound hematopoietic manifestations reflected in complete blood count (CBC) parameters and peripheral blood morphology. Aims: We aimed to evaluate CBC and peripheral blood morphology in COVID-19 patients and correlated them with severity, progression, and mortality. Settings and Design: Prospective observational study. Methods and Materials: Baseline and sequential blood samples were collected in 197 hospitalized COVID-19 patients, and CBC and morphology were assessed and compared with severity, progression, and survival. Statistical Analysis Used: Independent samples t-test for parametric continuous and Chi-Square and Fisher Exact for categorical variables. Results: Of the 197 patients, 84 (42.6%) were non-severe and 113 (57.4%) severe. The severe group displayed higher mean Total leukocyte count (TLC) (mean 11,772/μL SD 5445 vs. mean 7872/μL SD 3789, P < 0.0001), neutrophils (mean 81.2% SD 17.01 vs. mean 59.8% SD 14.55, P < 0.0001), and Red Cell Distribution Width-Standard Deviation (RDW-SD) (mean 30.04 SD 17.1 vs. mean 16.95 SD 6.63, P < 0.0001) with lymphopenia (mean 12.86% SD 15.41 vs. mean 30.64% SD 13.23, P < 0.0001) and monocytopenia (mean 4.62% SD 3.56 vs. mean 7.23% SD 3.06, P < 0.0001). The severe group had significantly more pseudo Pelger-Huet (62.8% (71/113) vs. 22.9% (14/61), P < 0.0001), abnormal nuclear projections (27.4% (31/113) vs. 3.3% (2/61), P < 0.0001), elongated nucleoplasm (17.7% (20/113) vs. 3.3% (2/61), P = 0.0073), shift to left (100% (113/113) vs. 21.3% (13/61), P < 0.0001), prominent granules (100% (113/113) vs. 85.2% (52/61), P < 0.0001), cytoplasmic vacuolations (100% (113/113) vs. 50.8% (31/61), P < 0.0001), ring (8.3% (3/113) vs. 4.9% (3/61), P = 0.0117), fetoid (15.04% (17/113) vs. 1.6% (1/61), P = 0.039), and nucleolated forms (53.9% (61/113) vs. 21.3% (13/61), P < 0.0001) with red cell agglutination (8.8% (10/113) vs. 0% (0/61), P = 0.0154) than non-severe patients. The non-severe group showed lympho-plasmacytoid (98.4% (60/61) vs. 37.2% (42/113), P < 0.0001), monocytoid (96.7% (59/61) vs. 25.7% (29/113), P < 0.0001), apoptotic (100% (61/61) vs. 17.6% (20/113), P < 0.0001), and nucleolated lymphocytes (78.7% (48/61) vs. 5.3% (6/113), P < 0.0001) with prominent granules (80.3% (49/61) vs. 12.4% (14/113), P < 0.0001), cytoplasmic vacuolations (83.6% (51/61) vs. 30.1% (34/113), P < 0.0001), and plasma cells (45.9% (28/61) vs. 19.5% (22/113), P = 0.0004). The progressors (9/84) had baseline leukocytosis (TLC mean 15,889/cu mm SD 4163.96 vs. mean 6940.27/cu mm SD 2381.59, P < 0.0001) and lymphopenia (lymphocyte% mean 18.11% SD 10.75 vs. mean 32.1% SD 12.75, P = 0.0022) with elevated RDW-SD (P = 0.032) at 7 th to 10 th day of illness. The 14 non-survivors had significant thrombocytopenia (mean 63.35 × 10 3 /μL SD 30.72 vs. mean 230.77 × 10 3 /μL SD 98.77, P < 0.0001) with lymphocytes nadir at day 9 without recovery versus day 7 to 8 nadir before recovery in survivors. Conclusions: The peripheral blood morphological features are distinct in severe and non-severe COVID-19 patients and baseline leukocytosis, lymphopenia, and elevated RDW-SD at day 7 of illness are useful indicators of disease progression. © 2022 Medical Journal of Dr. D.Y. Patil Vidyapeeth ;Published by Wolters Kluwer - Medknow.

Occupational stress among Generation-Y employees in the era of COVID-19: cases from universities in India

Purpose: Several organizations decided to work remotely after the Indian Government proclaimed a state of emergency on March 24, 2020, to prevent the spread of COVID-19. Employees across all industries, particularly the Generation-Y, were stressed as a result of the COVID-19 outbreak. The purpose of this study is to fills that gap by looking at the effects of occupational stress factors (such as coworker support, work–life balance [WLB] and role expectation conflict) on Generation-Y employees in the educational sector during COVID-19. Design/methodology/approach: The causes and consequences of the three occupational stresses listed above were investigated. In total, 231 surveys from workers at private and public educational institutions in India were analyzed using partial least square-structural equation modeling analysis. Findings: The results revealed that support from coworkers greatly reduced job stress, the WLB had a positive impact on the work and personal lives, and the lack of role specification in Generation-Y employees had a negative impact on their job performance. Originality/value: This study has considered the occupational stress variables among Generation-Y in the era of COVID-19, which need attention to improve the performance of the academic sector. © 2022, Emerald Publishing Limited.

Use of Procalcitonin and Antimicrobial Stewardship Intervention to Limit Antibiotic Utilization in Patients Admitted to a Community Hospital with SARS-CoV-2 Infection

Background. Patients admitted to the hospital with SARS-CoV-2 infection are often treated with antibacterial agents in addition to antivirals, although bacterial coinfection in this population is uncommon. Overuse of unnecessary antibiotics can lead to suboptimal outcomes, including increased bacterial resistance, adverse events, and costs. Our Antimicrobial Stewardship (AS) Program routinely provides recommendations for appropriate therapy based on molecular/microbiologic tests, clinical findings, and procalcitonin (PCT). PCT can assist in differentiating bacterial from viral respiratory infections, and can be useful in the decision to discontinue antibiotic therapy if viral monomicrobial infection is suspected. The purpose of our quality improvement project was to review the appropriateness of antibiotics utilized for patients admitted with SARS-CoV-2 and to promote optimal patient care and AS at our institution. Methods. We performed a retrospective review of SARS-CoV-2 patients from our institution's COVID-19 registry for patients hospitalized from March 2020-April 2021. We compared patients with PCT < 0.25 ng/mL to those with PCT > 0.25 ng/mL and assessed differences in patient characteristics and disease presentation, including: age, gender, WBC, serum creatinine, culture results, disease severity, patient location, duration of antibiotics, length of stay, 30 day readmission and mortality. Characteristics were compared using descriptive statistics and appropriate inferential statistics. Results. Shown in Table 1. If prescribed antibiotics, median duration of antibiotic therapy was significantly reduced in the PCT < 0.25 group vs. the PCT > 0.25 group (2 days vs. 4.1 days). Median WBC, SOFA score, serum creatinine, and length of stay were significantly lower in the PCT < 0.25 group compared to the PCT > 0.25 group. Severity adjusted models showed significantly decreased duration and overall likelihood of antibiotic use for PCT < 0.25 vs. PCT > 0.25. 30 day readmission and 30 day mortality were significantly lower in the PCT < 0.25 group vs. the PCT > 0.25 group. Conclusion. Antibiotic utilization was reduced in patients admitted with SARS-CoV-2 infection and PCT < 0.25, and if prescribed antibiotics, duration was significantly shorter vs. those in the PCT > 0.25 group.

Awareness of Remdesivir Therapy among Dental Students

Introduction: While several authorized medicines and research drugs have displayed antiviral effectiveness against the SARS-CoV-2, there are currently no validated antiviral therapies for treating gravely ill patients with COVID-19. No particular antiviral drug has been shown to be successful in treating patients with extreme coronavirus disease 2019 . Remdesivir (GS-5734), a nuclear analog drug, has inhibitory activity on pathogenic animals and coronaviruses in humans. Aim(s): The survey intented to evaluate the dental students ' awareness of Remdesivir therapy. Materials And Method: This was a cross-sectional type of research based on a questionnaire which included 100 dental college students in Chennai. A self-designed questionnaire with ten questions generating knowledge and awareness amongst dental college students about Remdesivir therapy. Questionnaires were distributed via an online database survey world. Questions discussed understanding of Remdesivir treatment, signs, counter-inications, action mechanism and side effects. Data were collected and analyzed after the answers were obtained from 100 participants. Result(s): 27% were aware about Remdesivir therapy . 15% were aware of the mechanism of action of Remdesivir therapy . 15% were aware of the indications of Remdesivir therapy . 12% were aware of the contraindications of Remdesivir therapy.14%.were aware of the side effects of Remdesivir therapy . Conclusion(s): There was limited awareness among dental students regarding Remdesivir in managing viral infections. Intensified awareness and education programmes must be instituted to disseminate knowledge about Remdesivir therapy. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Challenges in Community Psychiatry - Farmer Suicides and Their Survivors

Community psychiatry has come a long way from when patients would be ‘shackled’ to developed countries now focusing on deinstitutionalisation of the mentally ill patients. Low- to middle-income countries, like India, need to focus on strengthening existing mental healthcare facilities and developing new mental health services as well as making these services easily accessible. This chapter provides an overview of the challenges faced and the attempts at finding possible solutions to these challenges. The global pandemic of COVID-19 has caused a significant increase in stress, anxiety and depression. Earlier, distance was a barrier, but due to the pandemic, accessing healthcare has become even more difficult. Telemedicine has been of invaluable help during this crisis. In the era of digital India, smart phone apps can be innovatively used for diagnosis or at least screening for mental illness and identifying persons who should seek professional help. GMHAT PC is one such tool that enables paramedical workers to screen patients using handheld devices. © 2023 Taylor and Francis.