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The pathophysiology behind Coronavirus Disease-2019 (COVID-19) has remained blur even after more than two years of onset of the pandemic. Apart from pulmonary parenchymal involvement, widespread vascular thrombosis affecting both pulmonary and extra-pulmonary systems has also been seen to contribute to COVID-19 associated morbidity. This vascular manifestation often remains undiagnosed due to non specific and varied symptoms that range from asymptomatic detection to life threatening presentations. A series of six COVID-19 positive (three male and three female) cases who presented with thrombosis of pulmonary, coronary and cerebral vessels despite being on thromboprophylaxis are reported herein. The age of patients ranged from 32 to 80 years. Out of six patients, three had comorbidities. The most common complication was Pulmonary Thromboembolism (PTE, n=3) followed by Brain infarct (n=2) and Myocardial Infarction (MI, n=1). Out of three patients with PTE, one patient had concurrent Deep Vein Thrombosis (DVT). All patients were managed as per guidelines issued by the Ministry of Health and Family Welfare for severe COVID-19 disease. Out of six patients, three patients died and three were discharged. The series highlights the need for high index of suspicion on the part of the treating physician that could aid in early detection and successful management of this potentially fatal condition.Copyright © 2023 Journal of Clinical and Diagnostic Research. All rights reserved.
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Introduction &Objective: In the ongoing Covid-19 era where physical distancing is utmost important, we assessed the feasibility of ambulatory tubeless supine mini-PCNL under spinal anaesthesia for stone size between 1.5 - 3 cm to minimise hospitalisation. Method(s): Between June 2020 to August 2021, total 284 patients underwent PCNL out of which 122 underwent ambulatory tubeless mini-PCNL. The inclusion criteria were those consented for study, size of the stone 1.5 - 3 cm, pre-operative Covid-19 negative test (CT-chest and RT-PCR). Those excluded were with solitary kidney, morbidly obese, active UTI, congenital abnormalities. Patient's demographics, peri-operative parameters, stone free rate, blood loss, pleural complications and requirements of auxiliary procedures were prospectively evaluated Results: All the patients underwent supine mini-PCNL in FOSML (Flank-Oblique Supine Modified Lithotomy) position through a single tract of size 14/16 Fr. In, 18 (15%) patients' additional tracts were made for inaccessible secondary stones. Holmium laser and pneumatic source of energy were used for fragmentation of stones. Supra 12th rib tracts were made in 23 (19%) patients while in remaining 99 (81%) had infra-costal tracts. Complete SFR (stone-free rate) was achieved in 112 (92%) under fluoroscopy and the remaining 10 (8%) needed auxiliary procedure to render stone free. Average total operative time was 44 +/- 15 minutes and no nephrostomies were placed. All patients were discharged within 24 hours of operation with only 7 (6%) patients required readmission within 48 hours of discharge with hematuria and were managed conservatively. No other major complications occurred except for mild fever in few. Conclusion(s): Ambulatory supine tubeless mini-PCNL under spinal anaesthesia is safe and effective in this uncertain rapidly spreading COVID-19 era to minimise hospitalisation. It should be recommended whenever feasible, and it is easy to adapt to this newer approach especially for urologist already performing supine PCNL.
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Introduction: With the evolution of centralised ‘hub and spoke’ microbiology services, the expansion of infectious diseases as a medical specialty and the advent of joint infection training pathways, the infection services within the United Kingdom (UK) are experiencing a period of rapid change. Despite this, to date there has been no comprehensive description of the distribution of specialty staffing and service provision across the country. To this end, the British Infection Association (BIA), in conjunction with the Royal College of Pathologists (RCPath), has undertaken a national survey of National Health Service (NHS) infection services. Methods: Questions were compiled following consultation with an expert panel including BIA Council members. An online survey was distributed to clinical leads at all UK NHS acute trusts or health boards with inpatient beds and data were collected between April and August 2021. Results: The overall response rate was 72% (108 respondents). The median number of infection consultant full time equivalents (FTE) per service was 6.1 overall (5.6 per 1000 acute beds) although this varied between the devolved nations and was lowest in centres with microbiology specialists only. Forty-three services had three or fewer FTE medically qualified infection specialists. Overall, 17.5% of all funded FTE consultant-level posts were vacant, although this was markedly higher for microbiology-accredited posts (20.3%) than for infectious diseases (ID) (9.3%) or medical virology (14.6%). There were fewer vacancies in centres with ID-accredited consultants;median 1.0 (IQR 0–2.2) versus those with microbiology only;1.8 (IQR 0–2.9). Distribution of non-consultant staff was extremely heterogenous with 44 services having none and 25 having one or less FTE (most of which employed microbiology-only accredited consultants). 30% of organisations reported at least one vacant training post. Half of the responding organisations reported at least one consultant accredited in ID but only 28 provided inpatient care with a total of 520 ‘dedicated’ ID beds, of which 235 were negative pressure side-rooms. Geographically, several large areas of the country lacked inpatient ID capacity and/or ID-accredited consultant expertise. The burden of laboratory-related and reporting work in relation to staffing levels is disproportionately greater at smaller centres;there are a median 7.7 (IQR 5.9–9.5) hours/person/week at centres with three or fewer consultants and 4.0 (IQR 2.1–6.3) at larger centres. Conclusion: Microbiology specialists continue to provide the bulk of infection services across the UK and there is marked geographical variation in staffing with regards to other specialities. With Core Infection Training now producing dual-accredited consultants, there is an untapped potential to expand inpatient ID service provision although the requirement for placements on an existing inpatient ID unit may be limiting this currently. There are extremely high vacancies rates across the country but smaller, microbiology-only centres are hardest-hit with many barely attaining the consultant numbers required to staff a safe on-call rota. Workforce planning with utilisation of the valuable expertise of non-medically-trained staff, such as Clinical Scientists, is urgently needed. The results of this survey, in conjunction with Best Practice Standards recently published by the BIA, RCPath and Royal College of Physicians can inform commissioning and delivery of infection expertise in the context of the aftermath of the COVID-19 pandemic.
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Introduction: Medical education has been adversely affected during COVID-19 pandemic. Imparting medical education through e-platforms exclusively was a novel experience both for students and teachers. Even though online classes have been ongoing since almost a year and half, not much data on perception and experience about e-learning among medical students is available from India. Aim: To evaluate perceptions, experiences and challenges faced by medical students regarding e-learning during lockdown period owing to COVID-19 along with their future preferences. Materials and Methods: The present study was a questionnaire based cross-sectional survey regarding use of e-learning during COVID-19 pandemic among 340 MBBS (Bachelor of Medicine and Bachelor of Surgery) and Bachelor of Science Nursing (BSc-NUR) students. It was conducted in the Department of Pulmonary Medicine at Shri Lal Bahadur Shastri Medical College and Hospital Mandi, Himachal Pradesh, India from May-July 2021. Students perceptions’ of e-learning were assessed using the validated Technology Acceptance Model (TAM) model and responses were measured on 5-point Likert scale. Quantitative data was expressed by mean and standard deviation and significant level of differences between means were tested by Student’s t-test (unpaired). Proportions were compared by Chi-square test or Fisher’s-exact test. Results: Out of 400 students, 340 responded of which 225 were females. Of the total 340 students, 97.9% (n=333) respondents, had an idea of e-learning and more than half (n=188;55.3%) had used any type of e-learning platform prior to onset of COVID-19. More number of MBBS students had used e-learning than BSc-NUR students (55% v/s 41%;p=0.033). Cell phone was the most common device (n=324;95.3%) used. The quick sharing of material (n=258;76%) and flexibility (n=233;68.5%) were top rated benefits of e-learning. The key disadvantages were suboptimal practical training (n=222;65.3%) and lack of face-to-face interactions (n=146;43%). Majority of students voted for traditional learning (n=156;45.9%) closely followed by blended learning (n=140;41.2%). Conclusion: The students had an overall positive attitude towards e-learning and wanted to continue e-learning alongside traditional teaching i.e., blended learning. Exploration of merits and barriers to e-learning during pandemic can act as a guide to implement blended learning in medical curriculum for enhanced teaching/learning experience.
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Digitalization is growing like never and e-learning is a major part of it. Over the last decade, a significant growth has been seen in e-learning. The advancements and innovations in technology have created the option of distance learning for people which incorporates different mediums of learning, e.g., video tutorials, slideshows, etc. Moreover, ever since the COVID-19 pandemic has started, the concept of online classes has become an integral part of many people. This coronavirus has compelled to cease the normal functioning of schools, colleges, and universities, and thus, the use of online learning has enhanced. The objective of this work is to develop a robust virtual platform for the students which would work as an alternative for the offline college classes. Many analysis techniques have been incorporated for teachers to evaluate the students’ performance and also to classify them according to the special skills and abilities they possess. We have used J2EE technologies and Bootstrap framework while developing the system. MySQL is used for the database requirement. This system would help the students and teachers to manage their daily study pattern. Most importantly, it gives the benefit of studying at your own pace, anytime, and anywhere. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Introduction: Necessity is the mother of invention, is not only an English language proverb but it has been proved several times in several ways, and recently it has been proved during this COVID-19 outbreak that online medical education has erupted as one of the inventions during these stressful situations as a necessity. In these difficult situations, universities seek to deliver medical education through various new methods or modalities, to ensure the continuous learning of medical students. Novel ways of online teaching should be considered in new medical curriculum development, as well as methods of delivering lectures and practical skills for medical students. In this pandemic situations, medical faculty administrators also had to improvise to make an adjustment, from the formerly class-based lecture to online lecture. This study aimed to measure the perception of medical students regarding the quality and effectiveness of online medical education during COVID-19 Pandemic. Materials and Methods: This study was held in Santosh Medical College, Ghaziabad, from April 2020 to August 2020. This is a cross-sectional survey done by using an electronic questionnaire which was based on the result of previously conducted lectures, practical, and small group discussions. It is carefully checked for validation and reliability before considering it for a study. Questionnaires were made on Google Forms and then this e-questionnaire was sent via WhatsApp to all of students. All the data were collected, tabulated, and analyzed. Results: Three hundred and ninety-nine number of students responded to the electronic survey conducted via WhatsApp. Students' perception about the effectiveness and quality of medical online education revealed few supportive and few inhibitory factors. Conclusions: Data obtained in this study can be used as a valuable input to judge the effectiveness and utility of the online methodology in the future. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.
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Background: Increasing evidence suggests that endothelial activation and dysfunction contribute to COVID-19 pathogenesis by altering vessel integrity, promoting pro-coagulative and inflammatory state. Aims: 1. Investigate changes in coagulation, inflammation and endothelium associated with the progression and severity of COVID-19, as well as their correlation to survival and/or occurrence of venous thromboembolic events (VTE). 2. Explore potential new biomarkers to predict COVID-19 severity. Methods: Samples were collected from COVID-19 patients after appropriate consent. Disease severity was assessed with WHO ordinal scale on day of sampling. In addition to routine haematology, biochemistry and coagulation analysis, additional analysis spanning coagulation, endothelium, platelet, inflammatory biomarkers by conventional assays and multiplex immuno-assays were undertaken. Results: Participants included 151 COVID-19 patients aged 18 years and greater, 16 healthy volunteers and 9 non-COVID-19 ICUcontrols. COVID-19 patients were categorised in 7 groups based on severity and time from symptom onset and the data also provides mortality and VTE rates (Table 1). The biomarker profile of hospitalised COVID-19 patients demonstrated an increase in plasma levels of cytokines, inflammatory, soluble endothelial cell markers and markers of coagulation activation when compared to the ambulatory group (Figure 1). Significantly higher levels of inflammatory markers (CRP, WBC, fibrinogen, serum amyloid P, alpha 1 acid glycoprotein) were observed in patients with VTE and in the non-survivors group. Interestingly, the same trend was seen for coagulation (FVIII, VWF) and fibrinolysis markers (D-dimer, TFPI, t-PA) with higher levels in the VTE and non-survivors group. In addition, higher plasma levels of endothelial markers (ICAM-1, angiopoietin, TIE-2, LYVE-1, syndecan) were observed in severe COVID-19 when compared to non-COVID-19 ICU-controls. (Figure Presented) Conclusions: Our study provides evidence of a strong, global inflammatory response in COVID-19 patients. The elevation of circulating markers suggests significant endothelial cell activation/dysfunction and a possible cause for the pro-coagulant phenotype observed in these patients.
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Coronovirus Disease 2019 (COVID-19) manifests with a varied spectrum of symptoms ranging from asymptomatic disease to Acute Respiratory Distress Syndrome (ARDS) and death. Contrary to the expectation of the herd immunity in controlling the pandemic, reinfection with COVID-19 poses a new threat in the control of the pandemic. Authors hereby have described three cases who developed COVID-19 infection for the second time after complete recovery from the first infection. All three patients were less than 50 years of age with no co-morbidities. First case developed the second infection three weeks after having recovered from the first infection whereas second and third case developed repeat infection after two and four months of recovery respectively. The severity of the repeat infection along with the duration between the two infections has been discussed in this article.
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To limit the spread of covid-19, it is recommended that all the gathering intensive activities have closed and all the citizens are recommended to self-isolate. In the lieu of above mentioned recommendation, all the working units of education sector like schools, institutes, coaching centers etc. have been closed around the globe for indefinite period. To avoid educational impact of this pandemic government has decided to continue online studies through various available online modes like zoom, Google Classroom, Apple Clips, Quizlet and Microsoft Teams etc. This model has certain new aspects which were not there in traditional education scheme. The main objective of this paper is to discover various aspects of this educational model. What is perception of various stakeholders about these new teaching modes? What is the impact on the health of stakeholders' when they are following this educational pedagogy? How stakeholders are responding to new activities that are part of this new teaching medium? This research piece is analyzing these aspects. To attain the objective in mind, a questionnaire was prepared and sends to various users of this model. Their responses were collected, filtered, analyzed [using SPSS version-20] and presented for discussion. The analysis will help us find the problematic areas that can be work upon to make it perfect and reliable education model. As a result, it can be used not only as substitution model but can be widely accepted as a powerful tool for teaching online.
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COVID-19 related restrictions made it necessary for mental health outpatient care to abruptly transition to virtual care. For some youth and families, multiple stresses related to isolation, loss of friend and family supports, school cancellation are exacerbated by financial stress, limited parenting skills and challenges with emotion regulation. Such situations put young people at risk for deteriorating mental health and conflictual family situations, which could lead to Emergency (ED) presentations, admission, and child protective service or police involvement. At-risk young people include current outpatients, those who have been referred but not seen, and patients presenting to ED. Methods: A system was developed for categorizing all patients as high, medium or low risk and an algorithm de-veloped as to level of intervention required for each. All patients on the waitlist were triaged for risk level. A pathway was developed to have high risk patients referred from ED seen virtually within 3 days and other high risk patients monitored closely. Patient flow was adjusted to allow flexible matching of capacity to demand. Return visits to ED and evaluation of patient satisfaction with virtual care were used as outcome measures. Results: Patients referred to the rapid response pathway were seen in a shorter time than had previously been the case. Fewer patients returned to the ED on multiple occasions. Conclusions: Development of systems for categorizing patient risk levels, development of a virtual rapid response pathway, and flexing capacity to meet demand has enabled flexible rapid response to high needs patients.
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Introduction: Covid-19 pandemic has an impact on worldwide education system. To avert the danger of human life, all school, colleges and university around the world have to be shut down. To circumvent the educational loss due to this pandemic, the educational bodies have decided to continue the teaching through online modes where instructor and students will be connected virtually. Objective: This new model is considered as Contingency Educational Model (CEM). There are three major stakeholders in this Model: Students, Teachers and Parents. This paper is an effort to analyse the perspective of these stakeholders about this CEM. The scope of the paper is limited to the school and colleges of India Region. Methods: To evaluate the above-mentioned aspect, the questionnaire method of survey was adopted by the authors. A questionnaire was designed keeping in mind IES (Indian Education system) and CEM (Contingency Education Model). Some of the key factors that authors considered are the usefulness of this model, skill enhancement of users, ease of use, privacy & security, and intention to use this model. Results: Based on responses given by the respondents, these aspects are evaluated, using MS Excel & SPSS tools. The current paper has summarized the experiences of various stakeholders in the Contingency Education Model that has implemented on the recommendations of UNESCO. Conclusion: The CEM is very much required to save the education loss that Covid-19 might generate due to all over world lockdown. © 2021, Radiance Research Academy. All rights reserved.