Hyponatremia in Empty Sella Syndrome: Is it a Covid Sequelae?

The symptoms associated with empty sella syndrome (ESS) include headache, giddiness, vomiting, visual field deficits, and endocrine problems, as well as the radiological appearance of an enlarged sella turcica. This case report highlights a 45-year-old female who had a COVID-19 infection 2 months back and presented with chronic headache, giddiness, and lethargy having persistent hyponatremia later diagnosed as empty sella syndrome on brain magnetic resonance imaging. In this case, we tried to correlate all of these clinical and radiological features as COVID-19 sequelae due to post-Covid hypothalamic-pituitary axis dysfunction.Copyright © 2023 Authors. All rights reserved.

Multisystem Imaging Recommendations/Guidelines: In the Pursuit of Precision Oncology

With an increasing rate of cancers in almost all age groups and advanced screening techniques leading to an early diagnosis and longer longevity of patients with cancers, it is of utmost importance that radiologists assigned with cancer imaging should be prepared to deal with specific expected and unexpected circumstances that may arise during the lifetime of these patients. Tailored integration of preventive and curative interventions with current health plans and global escalation of efforts for timely diagnosis of cancers will pave the path for a cancer-free world. The commonly encountered circumstances in the current era, complicating cancer imaging, include coronavirus disease 2019 infection, pregnancy and lactation, immunocompromised states, bone marrow transplant, and screening of cancers in the relevant population. In this article, we discuss the imaging recommendations pertaining to cancer screening and diagnosis in the aforementioned clinical circumstances.Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.

Detection of ADR on Covid Vaccine Safety Data

Due to pandemic vaccines are developed at a rapid pace. There is a requirement to ensure proper post-market pharmacovigilance. The proposed model will help speed up this process by classifying the Adverse Drug Reactions (ADRs) of the vaccines based on the severity. This will help vaccine manufacturers take necessary and timely action. The model will input the patient data (such as symptoms, vaccination details, and patient health details), which will be preprocessed and cleaned. The ADR will then be classified as a minor, major, or deadly reaction. The system made use of Count Vectors (CV), Word TF-IDF, N-gram TFIDF, and Character TF-IDF feature with Naive Bayes, Random Forest, Logistic Regression, Gradient Boost, and Adaboost machine learning classifiers. Using Random Forest with word-level TF-IDF comparatively a higher accuracy of 93.83% and an F1 score of 0.92 was achieved. © 2022 IEEE.

Online education status at government and private dental college during COVID-19 pandemic in India: A comparative study

Introduction: Pandemic COVID-19 has spread all over the world very profligately in a short interval. This has had disturbed the main determinant of the future economics that is the education sector. India is a country with a vast number of colleges and dental colleges are a part of nurturing budding dentists. Aim: The aim of the study was to assess the status of online education at government and private dental colleges of India during a COVID-19 pandemic. Materials and Methods: This is a cross-sectional questionnaire-based study;conducted among the faculties of all Indian government and private dental colleges taking online classes for bachelor of dental surgery students. A pretested and validated questionnaire was sent to faculty members through a Google form. To assess the differences in perception among faculties of different colleges, the use of Chi-square test was done whereas descriptive statistics surveyed the frequency distribution. Results: More than 70% of faculty members both from private and government colleges agreed that tracking of students is difficult during online classes. A laptop was used by the maximum number of respondents, that is, government (77.8%) and private (81.5%) as the mode for taking online classes. About 50% of government faculties and 59.5% of private faculty members used zoom as an online platform tool for taking classes whereas others used the Google meet app for taking classes. Conclusion: The COVID-19 pandemic has paved the way for E-Learning in dental education in India. Faculties agree to complete the theory syllabus and conduct sessional examinations as an alternative during the lockdown period. However, they show strong reservations in carrying out practical/clinical simulations and university exams online.

Indian Multicenter Phase Ii Randomised Controlled Study Comparing Post Stem Cell Maintenance Regimen for Newly Diagnosed Multiple Myeloma (Impose Bortecon Study)

Introduction: Autologous stem cell transplant (ASCT) remains the backbone therapeutic modality with the highest progression-free survival (PFS) and overall survival (OS) benefit even in the era of the novel agents in newly diagnosed multiple myeloma (NDMM). The survival post-transplant can be prolonged using maintenance therapies. The regimen with maximum benefit is still debated, with bortezomib showing PFS benefit even in the high-risk myeloma. Aims & Objectives: This randomized phase II trial is aimed at studying the efficacy (as measured by overall survival (OS), progression- free survival (PFS)), and safety of post-ASCT different maintenance regimens in patients with NDMM. Material(s) and Method(s): Multicentric open-label interventional study with randomized allocation, parallel assignment, with intention-totreat analysis. Recruitment was prospective starting 01 Jan 2017, including all NDMM patients eligible for the study. Remission status was evaluated at D100 and every 6 months for 2y post-ASCT, including MRD analysis by multicolor flow cytometry (MFC) and PET/CT. The four arms included (Arm-A) bortezomib alone (V), (Arm-B) bortezomib in combination with cyclophosphamide and dexamethasone (VCD), (Arm-C) bortezomib in combination with lenalidomide (VR), and (Arm-D) Lenalidomide starting D100 till 2y post-ASCT. Adverse events with CTACE grade<2 were defined as non-serious and the rest as serious. JMP ver. 13 was used for statistical analysis and p<0.05 was considered significant. Kaplan Meier statistics was used for survival analysis. Result(s): A total of 123 patients have enrolled of which 92 patients completed the study protocol and the rest 31 patients were excluded because of protocol deviation due to the COVID pandemic. The median age of the study population was 54.5y (35-76y) with a male preponderance (67%). There was no statistically significant difference between the four arms on the log-rank test in the OS (p-0.99), clinical PFS (p-0.65), biochemical PFS (p-0.6), or MFC-based PFS (p-0.83). There was a statistically significant difference between the four arms on the log-rank test (p-0.0185) on PET/CT-based PFS (PFS being in a descending order VCD>V>VR>R regimen). The all-cause mortality of the study participants was 19.57% (n-18) and the difference in deaths among the various groups was not statistically significant (p-0.85). The tolerability, serious and non-serious adverse were significantly higher amongst Arm D patients. Conclusion(s): We conclude that there was no difference in OS between the different regimens. Patients on Lenalidomide-only therapy had significantly inferior Imaging-PFS.

Impact of COVID-19 on various sectors

COVID-19 is a disease that belongs to the SARS COV-2 family and is highly infectious. Complete lockdown is the most common strategy employed by affected countries. Increased COVID-19 instances have affected people's health and daily lives and various sectors of the country. This chapter aims to explain the impact of COVID-19 on the various sectors. We examined ten various sectors in this study: financial institutions, agricultural and supply chains, tourism and hospitality, FMCG, Pharmaceuticals, Education, Railways, Delhi rail services, Power, and Telecom. © 2022 Nova Science Publishers, Inc..

Additional Dose of SARS-CoV-2 Vaccine Increases Neutralization Capacity in Solid Organ Transplant Recipients

Purpose: Solid organ transplant recipients (SOTR) develop weak antibody responses after SARS-CoV-2 vaccination. Published data on neutralizing activity of plasma, a better measure of protection, in SOTR following an additional dose of SARSCoV- 2 vaccine is limited. Method(s): Plasma was longitudinally collected from SOTR following initial COVID- 19 vaccination. Neutralizing activity against SARS-CoV-2 was assessed using the cPass Neutralization Antibody Detection Kit (GenScript, Biotech). ELISAs were performed against SARS-CoV-2 proteins (S1, N, RBD), CMV (glycoprotein B), Influenza A H1N1 (nucleoprotein), HSV-1, EBV glycoprotein (gp350), and tetanus toxoid for comparison. Result(s): Demographic and clinical characteristics are summarized in table 1. No participants had evidence of COVID-19 infection as IgG titers to SARS-CoV-2 N protein were low. Neutralizing activity against SARS-CoV-2 RBD was observed in 39.6% of individuals (N=21/53) ~93 days after initial vaccination. Participants with neutralizing activity were more likely to have received a liver transplant (47.6% vs 6.25%, p=0.001), and less likely to be on an anti-metabolite (52.4% vs. 87.5%, p=0.009) or triple immunosuppression (14.3% vs. 53.1%, p=0.008). After an additional vaccine dose, 78.1% (N=25/32) of participants developed neutralizing activity with significant increases in viral neutralization (figure 1, median 36.8% [95%CI 18.9-64.6] to 97.2% [95%CI 74.0-98.9], p<0.0001). Participants with low neutralizing activity demonstrated adequate antibody titers to other microbial antigens (figure 2). Conclusion(s): An additional dose of SARS-CoV-2 vaccine increased the number of SOTR with neutralizing activity and the magnitude of the seroresponse. SOTR with low neutralizing activity maintain humoral responses to other microbial antigens suggesting the diminished seroresponse might be related to inhibition of new B cell responses.

Smart and sustainable economy: How COVID-19 has acted as a catalyst for China's digital transformation

Digital economy using internet, cloud computing, big data, as well as fintech in order to drive economic activities using digital information as a key factor for production has permeated all aspects of society as a result of unexpected onset of the COVID-19 pandemic. Recently, a white paper titled "The Development and Employment of China's Digital Economy in 2021" was released by The China Academy of Information and Communications Technology (CAICT), analyzing the development pattern of China's digital economy since the onset of COVID-19. This chapter summarizes the development of digital economy, the employment situation in various regions and industries in China, thereby making an in-depth analysis of the digital transformation of traditional industries along with putting forward policy suggestions for promoting further development of China's digital economy. Since the onset of COVID-19, China's digital and smart economy has ushered in creating new opportunities for growth and development as well as simultaneously combatting challenges in the macro environment. © 2022, IGI Global. All rights reserved.

A Modern Replica for COVID-19 Pestilential Disease Identification

Detection of COVID-19 disease and its unmasking, demands a certain level of proficiency. The Work exhibited in the paper proposes a novel Deep Learning based approach to recognize COVID-19 contagious infection using CT scans and X- Rays of lungs in Humans. So that labour and risk intensive task for radiotherapists of taking samples from the patients can be minimized and risk of community spread can be avoided. Our model takes into the CT scan chest images of the patient having a certainty of infection and returns the most significant disease category related to that patient. In our study, we demonstrated a Deep Learning framework model that follows the methodology of up-skilled feature extraction techniques along with Logistic Regression [LR] and other usable classifiers. This is used on images to detect and report the presence of infection that is being prevailed in an organ with a considerably pinpoint accuracy of 97.8%. Also after trying the model on spatial information real- time dataset of our Family members, who were infected by the disease, this model was able to detect 8 out of 10 images correctly. © 2022 IEEE.

EVALUATION OF COUNTRY WIDE IMPLEMENTATION OF VIDEO CONSULTATION SOFTWARE DURING THE COVID19 PANDEMIC

Introduction During the COVID19 pandemic, TEC Cymru purchased Attend Anywhere video consulting software and made implementation and training available for all Welsh clinical services. Many services used video consulting software to reduce face-to-face contact and maintain services whilst staff were otherwise redeployed. Methods Data were collated from questionnaires from clinician and patients after their video consultation and collated by the research team at TEC Cymru. Results 654 questionnaires were collected between March 2020 and January 2022 with 42% from Cardiff & Vale. Video consultations were reported as excellent by 302 (47%). 439 (75%) of respondents reported a face-to-face visit was prevented. Most patients were white British (90.8%) and most were in the 25-44 age range (71.1%). More patients reported excellent ratings than clinicians suggesting a discrepancy between expectation. 69.7% of patients reported benefits of not taking time off work for consultations and 83.0% reported that video consultations would reduce rates of sexually transmitted infections. Further data can be presented comparing patient and clinician ratings. The responses to each patient enablement statement are presented in the attached table. Discussion Those that used video consulting during the pandemic had high satisfaction ratings and felt empowered by this mode of delivery of care. Clinician data focused on technical challenges and concern remains of those without technological capability. (Table Presented).

Decision-making using Placental Growth Factor(PLGF) in Preeclampsia-Pilot study in Wales

Objective: PLGF point of care blood test is a NICE validated tool recommended between 20 and 34+6 weeks gestation to diagnose and predict early onset of preeclampsia. During the Covid pandemic, we pioneered and assessed the clinical utility of this point of care blood test in NHS Wales by doing a pilot study of 6 months at our district hospital with 2700 deliveries/annum. Design: Prospective study Method: Patients presenting at maternity day assessment unit with new onset hypertension, proteinuria or worsening chronic hypertension were selected. This simple point of care blood test with a turnaround time of 15 minutes was conducted by the triage midwife at the bedside. Patients were classified into red (<12 pg./ml), amber (≥12-< 100 pg./ml) and green (≥100 pg/ml) alert groups. We interpreted our results using the PARROT trial flowchart and clinical decisions were made based on the risk stratification and overall clinical picture. Results: Cases in the Red alert group and high blood pressure were admitted and to our surprise all 6 cases developed severe preeclampsia (3 of which developed HELLP) within the same week. They were delivered after stabilization of blood pressure and prophylactic steroids for the preterm fetus. The amber group was managed with increased outpatient surveillance until a maximum of 37 -38 weeks. Using the reported high negative predictive value of 97.5% in the green group (PARROT trial), we could reassure 64% of the green group patients to prolong the pregnancy without inpatient admission and continue antenatal care till term. Our cohort experience of 34 patients found that overall 68% of the cases were managed with outpatient surveillance. Conclusions: PLGF is now incorporated into our routine practice. The amber to green risk stratification helped in reducing unnecessary inpatient admissions and improved patient experience by alleviating maternal anxiety. There were no stillbirths and it prevented iatrogenic preterm deliveries by giving clinicians reassurance in their decisions. The Red alert group with PLGF <12 pg./ml, was highly suggestive of placental dysfunction needing early delivery. The Amber alert group (with the PLGF ≥12 and <100 pg/ml) may be cared with increased outpatient surveillance. Those patients in the Green alert group (with the PLGF ≥100 pg./ml) were reassured and cared for till term, if possible. The underlying caveats always being PLGF was always supplemented by a complete clinical evaluation to determine early prediction and management of pre-eclampsia.

Could vaccine dose stretching reduce COVID-19 deaths?

We argue that alternative COVID-19 vaccine dosing regimens could potentially dramatically accelerate global COVID-19 vaccination and reduce mortality, and that the costs of testing these regimens are dwarfed by their potential benefits. We first use the high correlation between neutralizing antibody response and efficacy against disease (Khoury et. al. 2021) to show that half or even quarter doses of some vaccines generate immune responses associated with high vaccine efficacy. We then use an SEIR model to estimate that under these efficacy levels, doubling or quadrupling the rate of vaccination by using fractional doses would dramatically reduce infections and mortality. Since the correlation between immune response and efficacy may not be fully predictive of efficacy with fractional doses, we then use the SEIR model to show that fractional dosing would substantially reduce infections and mortality over a wide range of plausible efficacy levels. Further immunogenicity studies for a range of vaccine and dose combinations could deliver outcomes in weeks and could be conducted with a few hundred healthy volunteers. National regulatory authorities could also decide to test efficacy of fractional dosing in the context of vaccination campaigns based on existing immune response data, as some did for delayed second doses. If efficacy turned out to be high, the approach could be implemented broadly, while if it turned out to be low, downside risk could be limited by administering full doses to those who had received fractional doses. The SEIR model also suggests that delaying second vaccine doses will likely have substantial mortality benefits for multiple, but not all, vaccine-variant combinations, underscoring the importance of ongoing surveillance. Finally, we find that for countries choosing between approved but lower efficacy vaccines available immediately and waiting for mRNA vaccines, using immediately available vaccines typically reduces mortality.

Covid-19 vaccination hesitancy: Causes, legislation and ethics

Covid-19 vaccines have now been around for quite some time and inoculation is in progress all around the world. However, some apprehensions with regards to efficacy do seem to be existing for some founded/unfounded reasons, and at the same time, a substantial reluctance (“Vaccine Hesitancy”) and/or non-acceptance (“Vaccine Refusal”) of the vaccine basedlargely on personal choice seems to be emerging as a major cause of concern. This matter of individual choice apparently has the potential of compromising success of the entire vaccination drive both qualitatively as well as quantitatively, that is;not only the desired results of near total success evade us but the expected outcome may get inordinately delayed as well. This article, while looking into historical as well as recent impediments to Vaccination (Hesitancy and Refusal), is an effort to analyze the reasons for the same and bring out some remedial measures. © 2021, Punjab Academy of Forensic Medicine and Toxicology. All rights reserved.

Antibody response against sars-cov-2 following chadox1(astezeneca azd 1222) vaccine in health care workers in a tertiary care hospital in india

BACKGROUND: The ChAdOx1 nCoV-19 vaccine against COVID-19 is a two-dose vaccine spread 3 to 4 weeks apart. This study aims to ascertain the antibody response to each dose with respect to age, previous infection status etc. METHODS: Baseline total COVID-19 antibody level was ascertained using Siemens SARS-CoV-2 Total Antibody assay in consenting health care workers before the first dose of vaccination. Adverse effects were noted in each individual and were monitored weekly for the total antibody titre following both doses. Descriptive statistical tests were used to analyse the changes in antibodies levels weekly after both doses. Association of previous COVID infection and age with antibody levels was assessed. RESULTS: Median (range) of age of the 30 study participants was 31.5 years.23% of the participants had a history of previous COVID-19 infection. Mild adverse events following immunisation were reported by 87% participants after first dose whereas only in 7% after second dose. Median baseline antibody titres were significantly higher among those with previous COVID infection as compared to previously uninfected individuals. Antibody titres increased consistently after first dose and showed a declining trend following the second dose in all participants and showed no significant association with previous COVID-19 infection or age. CONCLUSIONS: Antibody titre response was similar amongst the various age groups. Higher response in the previously infected individuals following first dose may make them ideal candidates for a single dose vaccine regimen. Individuals showing lower levels of neutralising antibodies can be ideal candidates for a booster dose. © Medicina Moderna 2021.