Understanding the Impact of Covid-19 on MSMEs in India: Lessons for Resilient and Sustained Growth of Small Firms

The pandemic has raised an issue of survival for most of the micro, small, and medium enterprises (MSMEs) because of their vulnerability in terms of size, limited financial resources, and inefficiency to deal with unpredicted situations. Therefore, the present study has adopted the contingency theory in times of change and uncertainties caused by COVID-19 on MSMEs and found out the ways to enhance its resilience and sustained the growth of this sector. This study has applied descriptive statistics and probit regression analysis to estimate the resilience and sustained growth of the firms through a change in the variables like turnover, labour employed, investment, and age of the firm. Based on the survey of 225 firms, the study observed that around 90 percent of surveyed firms realized a decline in their turnover with a 25 percent reduction in employment that mostly occur in the informal category. Interestingly, there was some increase in formal employment in around 50 percent of firms because of the business commitment of firms, shortage of informal workers, and availability of workers at lower wages. Smaller and younger firms in terms of employment and investment have a higher possibility to be affected by the external shocks indicating that the firm agility increases with firm age and size. Support measures by the government during the pandemic were found to be insufficient and have limited relevance to the MSME sector in its revival. For enhancing the resilience and sustainability of MSMEs, the study suggests small firms should be encouraged to financial planning against business uncertainties and proposes financial security measures viz. Uncertainty Corpus Fund for Small Businesses and Small Business Insurance.

Ethnopharmacological Potential of Phytochemicals and Phytogenic Products against Human RNA Viral Diseases as Preventive Therapeutics

RNA viruses have been the most destructive due to their transmissibility and lack of control measures. Developments of vaccines for RNA viruses are very tough or almost impossible as viruses are highly mutable. For the last few decades, most of the epidemic and pandemic viral diseases have wreaked huge devastation with innumerable fatalities. To combat this threat to mankind, plant-derived novel antiviral products may contribute as reliable alternatives. They are assumed to be nontoxic, less hazardous, and safe compounds that have been in uses in the beginning of human civilization. In this growing COVID-19 pandemic, the present review amalgamates and depicts the role of various plant products in curing viral diseases in humans.

Ethnopharmacological Potential of Phytochemicals and Phytogenic Products against Human RNA Viral Diseases as Preventive Therapeutics.

RNA viruses have been the most destructive due to their transmissibility and lack of control measures. Developments of vaccines for RNA viruses are very tough or almost impossible as viruses are highly mutable. For the last few decades, most of the epidemic and pandemic viral diseases have wreaked huge devastation with innumerable fatalities. To combat this threat to mankind, plant-derived novel antiviral products may contribute as reliable alternatives. They are assumed to be nontoxic, less hazardous, and safe compounds that have been in uses in the beginning of human civilization. In this growing COVID-19 pandemic, the present review amalgamates and depicts the role of various plant products in curing viral diseases in humans.

Coumarin-based combined computational study to design novel drugs against Candida albicans.

Candida species cause the most prevalent fungal illness, candidiasis. Candida albicans is known to cause bloodstream infections. This species is a commensal bacterium, but it can cause hospital-acquired diseases, particularly in COVID-19 patients with impaired immune systems. Candida infections have increased in patients with acute respiratory distress syndrome. Coumarins are both naturally occurring and synthetically produced. In this study, the biological activity of 40 coumarin derivatives was used to create a three-dimensional quantitative structure activity relationship (3D-QSAR) model. The training and test minimum inhibitory concentration values of C. albicans active compounds were split, and a regression model based on statistical data was established. This model served as a foundation for the creation of coumarin derivative QSARs. This is a unique way to create new therapeutic compounds for various ailments. We constructed novel structural coumarin derivatives using the derived QSAR model, and the models were confirmed using molecular docking and molecular dynamics simulation.

Optimal Covid-19 vaccine stations location and allocation strategies

Purpose This study proposes strategies for vaccine center allocation for coronavirus disease (COVID) vaccine by determining the number of vaccination stations required for the vaccination drive, location of vaccination station, assignment of demand group to vaccination station, allocation of the scarce medical professional teams to station and number of optimal days a vaccination station to be functional in a week. Design/methodology/approach The authors propose a mixed-integer nonlinear programming model. However, to handle nonlinearity, the authors devise a heuristic and then propose a two-stage mixed-integer linear programming (MILP) formulation to optimize the allocation of vaccination centers or stations to demand groups in the first stage and the allocation of vaccination centers to cold storage links in the second stage. The first stage optimizes the cost and average distance traveled by people to reach the vaccination center, whereas the second stage optimizes the vaccine's holding and storage and transportation cost by efficiently allocating cold storage links to the centers. Findings The model is studied for the real-world case of Chandigarh, India. The results obtained validate that the proposed approach can immensely help government agencies and policymaking body for a successful vaccination drive. The model tries to find a tradeoff between loss due to underutilized medical teams and the distance traveled by a demand group to get the vaccination. Originality/value To the best of our knowledge, there are hardly any studies on a vaccination program at such a scale due to sudden outbreaks such as Covid-19.

Exploring the Immunomodulatory Aspect of Mesenchymal Stem Cells for Treatment of Severe Coronavirus Disease 19.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is an enveloped, positive sense, single stranded RNA (+ssRNA) virus, belonging to the genus Betacoronavirus and family Coronaviridae. It is primarily transmitted from infected persons to healthy ones through inhalation of virus-laden respiratory droplets. After an average incubation period of 2-14 days, the majority of infected individuals remain asymptomatic and/or mildly symptomatic, whereas the remaining individuals manifest a myriad of clinical symptoms, including fever, sore throat, dry cough, fatigue, chest pain, and breathlessness. SARS-CoV-2 exploits the angiotensin converting enzyme 2 (ACE-2) receptor for cellular invasion, and lungs are amongst the most adversely affected organs in the body. Thereupon, immune responses are elicited, which may devolve into a cytokine storm characterized by enhanced secretion of multitude of inflammatory cytokines/chemokines and growth factors, such as interleukin (IL)-2, IL-6, IL-7, IL-8, IL-9, tumor necrosis factor alpha (TNF-α), granulocyte colony-stimulating factor (GCSF), basic fibroblast growth factor 2 (bFGF2), monocyte chemotactic protein-1 (MCP1), interferon-inducible protein 10 (IP10), macrophage inflammatory protein 1A (MIP1A), platelet-derived growth factor subunit B (PDGFB), and vascular endothelial factor (VEGF)-A. The systemic persistence of inflammatory molecules causes widespread histological injury, leading to functional deterioration of the infected organ(s). Although multiple treatment modalities with varying effectiveness are being employed, nevertheless, there is no curative COVID-19 therapy available to date. In this regard, one plausible supportive therapeutic modality may involve administration of mesenchymal stem cells (MSCs) and/or MSC-derived bioactive factors-based secretome to critically ill COVID-19 patients with the intention of accomplishing better clinical outcome owing to their empirically established beneficial effects. MSCs are well established adult stem cells (ASCs) with respect to their immunomodulatory, anti-inflammatory, anti-oxidative, anti-apoptotic, pro-angiogenic, and pro-regenerative properties. The immunomodulatory capabilities of MSCs are not constitutive but rather are highly dependent on a holistic niche. Following intravenous infusion, MSCs are known to undergo considerable histological trapping in the lungs and, therefore, become well positioned to directly engage with lung infiltrating immune cells, and thereby mitigate excessive inflammation and reverse/regenerate damaged alveolar epithelial cells and associated tissue post SARS-CoV-2 infection. Considering the myriad of abovementioned biologically beneficial properties and emerging translational insights, MSCs may be used as potential supportive therapy to counteract cytokine storms and reduce disease severity, thereby facilitating speedy recovery and health restoration.

Surgical Residents' Perspective on Online Education during COVID-19 Pandemic.

<b> Introduction: </b> The COVID-19 pandemic is an exceptional situation which has rigorously affected surgical education and training worldwide. This current situation has carved innovative ways like online teaching to counter the challenges of the pandemic faced by a surgical resident. However, online teaching is not complimentary to bedside teaching which is a traditional practice. Therefore, we designed this study to assess the residents' perceptive towards online learning as a mode of education which is extensively implemented during the COVID-19 pandemic at our centre. </br></br> <b> Methods:</b> This study was a cross-sectional survey. An online Google survey was circulated among junior residents in the department of General Surgery. This survey included residents' demographic profile, effect on working hours, their perception with online teaching, and effect on their surgical training during the COVID 19 pandemic. </br></br> <b>Results:</b> A total of 95 junior residents participated in this study. Surgical training and teaching was rigorously affected according to most of them and they also believe they have lost crucial training time in their tenure as a surgical resident. A majority found the communication with the faculty during online teaching adequate; however, the main drawback of online classes was the lack of clinical exposure and practical experience. Only 4.2% preferred 100% online teaching in future. </br></br> <b> Conclusion:</b> COVID-19 pandemic has affected surgical training much more as compared to other medical fields. However, we believe online education is still a potential instrument during the COVID-19 pandemic. Online learning platforms can be used in future as a supplement to time-honoured classroom teaching and didactic lectures.

Atypical presentations of fungal osteomyelitis during post COVID-19 outbreak - Case series.

Introduction: Mucormycosis and Aspergillosis are opportunistic fungal infections causing significant morbidity and mortality. Post the outbreak of COVID-19, these fungal osteomyelitis have seen a global rise with few atypical presentations noted. Case report: Current case series reports three such atypical presentations of fungal osteomyelitis including mandibular fungal osteomyelitis in two patients, fungal osteomyelitis mimicking space infection in a middle aged male, and suspected mixed fungal osteomyelitis involving maxillary sinus. Aggressive surgical debridement was indicated along with institution of antifungal therapy (Liposomal Amphotericin B, and Posaconazole). The fungal osteomyelitis was successfully treated with surgical and medical management with no recurrence. Discussion: The injudicious use of corticosteroids in COVID-19 patients along with their immunocompromised status increases their susceptibility to opportunistic fungal osteomyelitis. Prompt and aggressive surgical intervention along with antifungal therapy is important after diagnosing fungal osteomyelitis, as a delay could increase the mortality rate considerably.

Lessons Learnt From a Greenfield Hangar-Based 1,000-Bedded Temporary Hospital in India.

During the COVID-19 pandemic, the total number of hospital beds in the National Capital Region (NCR) of Delhi was 54,321 (roughly 300 beds per one lakh population), which was inadequate for the patients. Therefore, the Indian government initiated the construction of a 1,000-bedded greenfield hangar-based hospital to bridge the healthcare gap. As a result, Intensive Care Unit (ICU) beds in the facility augmented the COVID-19 care ICU beds in the city by 11%. The authors were involved in the planning, developing, and initiating the functioning of 1,000-bedded Dedicated COVID-19 Hospital (DCH). The hospital was conceptualized, built, and operationalized in 12 days only. Lessons learned from this experience would be of benefit should similar situations arise in future. Coordinating structural designing early with the entire project team-from facility administrators and medical practitioners to architects, consultants, and contractors-can result in a structure that better matches the facility's long-term needs and often saves construction time and costs. This article enumerates various challenges faced and the way they were addressed. This hangar-based hospital can be rapidly constructed and deployed on a massive scale. While structural integrity is essential, the planning team was particularly aware of the patient-centric modality of healthcare. Many modifications were carried out in the structure based on patient inputs. Informal discussions with discharged patients and relatives revealed that the human-centric approach was the mainstay of the therapy.

Patients’ perspective about speech, swallowing and hearing status post-SARS-CoV-2 (COVID-19) recovery: E-survey

Objective The present study investigates the COVID-19 survivors' perspective on speech, swallowing, and hearing-related issues post-COVID-19. We further investigate the recovery duration for speech, swallowing, and hearing-related symptoms post-COVID. Design Survey study;E-survey. Methodology A total of 78 subjects (35.78 years ± 11.93) participated in the survey. All the participants were diagnosed with the RTPCR method. To understand the recovery duration for the speech, swallowing and hearing issues post-COVID-19, we conducted a three-phase study. Results In the first phase of the survey, 68 subjects reported symptoms related to speech, swallowing, and hearing issues 15 days of post-COVID recovery. A total of 76.4% of subjects reported only swallowing-related issues, 4.41% only speech-related issues, whereas 1.47% reported the problem in speech and hearing functions. The 2nd phase of the study was conducted after the first phase of the study. Only 22 subjects reported the presence of swallowing, speech and hearing-related issues from the 68 subjects. During the last phase, only 12 subjects reported speech, swallowing, and hearing issues. All subjects recovered from the olfaction and gustation impairment, whereas 50% of subjects reported the presence of xerostomia. Conclusion From the present study, we conclude that the SARC-CoV-2 virus directly affects the respiratory system and affects the aero-digestive system and laryngeal system physiology. Individuals with comorbid conditions admitted in ICU during COVID-19 treatment and prolonged hospital stay were at higher risk of developing speech, swallowing, and hearing-related issues post-COVID-19. The present study indicated that all COVID-19 survivors should be screened for speech, swallowing, and hearing-related issues for early rehabilitation if needed.

Patients' perspective about speech, swallowing and hearing status post-SARS-CoV-2 (COVID-19) recovery: E-survey.

OBJECTIVE: The present study investigates the COVID-19 survivors' perspective on speech, swallowing, and hearing-related issues post-COVID-19. We further investigate the recovery duration for speech, swallowing, and hearing-related symptoms post-COVID. DESIGN: Survey study; E-survey. METHODOLOGY: A total of 78 subjects (35.78 years ± 11.93) participated in the survey. All the participants were diagnosed with the RTPCR method. To understand the recovery duration for the speech, swallowing and hearing issues post-COVID-19, we conducted a three-phase study. RESULTS: In the first phase of the survey, 68 subjects reported symptoms related to speech, swallowing, and hearing issues 15 days of post-COVID recovery. A total of 76.4% of subjects reported only swallowing-related issues, 4.41% only speech-related issues, whereas 1.47% reported the problem in speech and hearing functions. The 2nd phase of the study was conducted after the first phase of the study. Only 22 subjects reported the presence of swallowing, speech and hearing-related issues from the 68 subjects. During the last phase, only 12 subjects reported speech, swallowing, and hearing issues. All subjects recovered from the olfaction and gustation impairment, whereas 50% of subjects reported the presence of xerostomia. CONCLUSION: From the present study, we conclude that the SARC-CoV-2 virus directly affects the respiratory system and affects the aero-digestive system and laryngeal system physiology. Individuals with comorbid conditions admitted in ICU during COVID-19 treatment and prolonged hospital stay were at higher risk of developing speech, swallowing, and hearing-related issues post-COVID-19. The present study indicated that all COVID-19 survivors should be screened for speech, swallowing, and hearing-related issues for early rehabilitation if needed.

Ace2 and Tmprss2 Expressions Are Regulated by Dhx32 and Influence the Gastrointestinal Symptoms Caused by SARS-CoV-2.

Studies showed that the gastrointestinal (GI) tract is one of the most important pathways for SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19). As SARS-CoV-2 cellular entry depends on the ACE2 receptor and TMPRSS2 priming of the spike protein, it is important to understand the molecular mechanisms through which these two proteins and their cognate transcripts interact and influence the pathogenesis of COVID-19. In this study, we quantified the expression, associations, genetic modulators, and molecular pathways for Tmprss2 and Ace2 mRNA expressions in GI tissues using a systems genetics approach and the expanded family of highly diverse BXD mouse strains. The results showed that both Tmprss2 and Ace2 are highly expressed in GI tissues with significant covariation. We identified a significant expression quantitative trait locus on chromosome 7 that controls the expression of both Tmprss2 and Ace2. Dhx32 was found to be the strongest candidate in this interval. Co-expression network analysis demonstrated that both Tmprss2 and Ace2 were located at the same module that is significantly associated with other GI-related traits. Protein-protein interaction analysis indicated that hub genes in this module are linked to circadian rhythms. Collectively, our data suggested that genes with circadian rhythms of expression may have an impact on COVID-19 disease, with implications related to the timing and treatment of COVID-19.

A case study of Web Content Accessibility of 15 top-ranked Universities of India (preprint)

Accessibility of websites are very important for making it web-based information for persons with disabilities which further reinforced by COVID-19 pandemic. Web Content Accessibility Guidelines (WCAG) has been developed by World Wide Web Consortium (W3C) and accordingly Guidelines for Indian Government Websites (GIGW) has also been developed. In this case study we studied the home page of websites of 15 top ranked Higher Education Institutions of India ranked by National Institutional Ranking Framework (NIRF), started in 2016 for availability of basic accessibility features. The ranking used is of latest one i.e. of 2020. Qualitative observation has been made of the home page of each 15 universities and the NIRF website. Eleven fundamental accessibility features were taken in to account. Results revealed that most of these top15 ranked universities lack even basic accessibility feature making their websites inaccessible for persons with disabilities. Options like font size, screen reader, high contrast text also were not found on may website of top-15 universities. The website of NIRF had no basic features out of 11 considered in the study indicating a very poor condition of digital accessibility features of website of top ranked universities which needs urgent attention to achieve equity and inclusion as promised in NEP 2020.

Digital and Web Content Accessibility for Persons with Disabilities: A case study of Indian open universities (preprint)

The radical development of internet and other Information and Communication Technologies have changed the scenario of education system in general and open and distance learning in particular which was further accelerated by the recent COVID-19 pandemic. Information and Communication Technology (ICT) tools now a days are pivotal to any Open and Distance Learning (ODL) system. With the growth of ICT based education the issue of accessibility of digital information has also gained the attention of intelligentsia. With the interference of ICT tools, discussions have been taking place about the digital accessibility of web-based information available over websites. Websites of Open Universities are central source of educational and administrative information and learning for a learner enrolled in open and distance learning system. Further the basic promise of an open and distance learning system is providing education for marginalized group too and thus it must be as per the needs of persons with disabilities which has been recommended by United Nations Convention on Rights of Persons with Disabilities (UNCRPD). An enquiry has been made in present research to study primary accessibility features Screen Reader Access, High Contrast Text, Word Spacing, Text Resize feature and the feature of language change available over websites of Indian Open Universities. It was observed that about 45% of Indian Open University websites lacks any such accessibility features. Remaining 55% open universities of India, mostly were found providing two to four out of these five accessibility mechanisms required for persons with disabilities on any website. As Government of India has developed Guidelines for Indian Government Websites (GIGW) which has advised government institutions to confirm their websites in compliance with Web Content Accessibility Guidelines (WCAG 2.0) guidelines of World Wide Web Consortium (W3C) at ‘AA’ level. The preliminary study revealed that Indian Open Universities has long way to go to make their websites GIGW & WCAG 2.0 complaint in order to ensure digital accessibility in higher education through open and distance learning for persons with disabilities to ensure inclusion in higher education in India.

Development of a semi manual approach for extraction of inter-pedestrian interactions at an overpass facility

The present study developed a novel method of semi-manual data extraction technique for pedestrian position (subsequently speed and trajectory) data using front inclined camera angle as many times top-down angle is unavailable due to height restrictions. Vanishing point method was used to extract data for pedestrian body dimensions across vertical and pedestrian-specific trajectory planes. Using the trajectory and body dimension information, the spacings maintained between pedestrians were estimated. Subsequently, JUPedSim software was used for extracting the fundamental macroscopic properties (speed, flow density) from the pedestrian position data, and the results were compared using classical and voronoi approaches.The developed technique was able to extract the pedestrian trajectories with an error (standard deviation) of 0.039 m at the exit section and 0.11 m at the entry section. The average lateral, longitudinal and diagonal clearances maintained by a pedestrian to walk comfortably were observed as 0.25m, 0.90m and 1.07m respectively. The comparison study for voronoi vs classical approach showed that voronoi approach had lower fluctuations in estimation of macroscopic parameters.This semi-manual technique could be helpful in study of pedestrian gap maintaining behavior and establishment of different threshold levels for the crowd management. Such approach can directly be applied to CCTV footage (which mostly gives front inclined views of camera) to ensure the social distancing in the current ongoing pandemic COVID-19. Further, the proposed approach can be made automated using the image processing tools for different applications like determination of pedestrian stream characteristics, level of services, safety evaluation and ensuring social distancing.

Subcutaneous Emphysema and Pneumomediastinum Following Non-invasive Ventilation in a Patient With Severe COVID-19 Disease.

Subcutaneous emphysema (SE) and pneumomediastinum are rare complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While SE is often non-fatal and usually self-remitting, pneumomediastinum can be fatal with high mortality rates depending on the underlying etiology. Here, we present the case of a 39-year-old otherwise healthy male who tested positive for SARS-CoV-2. The patient was treated with non-invasive mechanical ventilation (NIMV) and developed severe SE and pneumomediastinum which resulted in a fatal outcome. Although the exact pathogenesis could not be determined, the extensive lung injury caused by SARS-CoV-2 pneumonia along with possible barotrauma secondary to NIMV could have been the culprits in this case. Early detection through careful observation of these potentially fatal complications in patients with severe coronavirus disease 2019 is crucial. Further studies determining the potential risk factors and incidence of SE and pneumomediastinum, especially in patients receiving invasive mechanical ventilation or NIMV, are needed.

Identification of Severe Acute Respiratory Syndrome Coronavirus-2 inhibitors through in silico structure-based virtual screening and molecular interaction studies.

The novel coronavirus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) or COVID-19 has caused a worldwide pandemic. The fatal virus has affected the health of human beings as well as the socio-economic situation all over the world. To date, no concrete medicinal solution has been proposed to combat the viral infection, calling for an urgent, strategic, and cost-effective drug development approach that may be achievable by applying targeted computational and virtual screening protocols. Immunity is the body's natural defense against disease-causing pathogens, which can be boosted by consuming plant-based or natural food products. Active constituents derived from natural sources also scavenge the free radicals and have anti-inflammatory activities. Herbs and spices have been used for various medicinal purposes. In this study, 2,96 365 natural and synthetic derivatives (ligands) belonging to 102 classes of compounds were obtained from PubChem and assessed on Lipinski's parameters for their potential bioavailability. Out of all the derivatives, 3254 obeyed Lipinski's rule and were virtually screened. The 115 top derivatives were docked against SARS-CoV-2, SARS-CoV, MERS-CoV, and HCoV-HKV1 main proteases (Mpro s) as receptors using AutoDock Vina, AutoDock, and iGEMDOCK 2.1. The lowest binding energy was exhibited by ligands 2 and 6 against all the four Mpro s. The molecular dynamic simulation was also performed with ligand 6 using the GROMACS package. Good bioactivity scores, absorption, distribution, metabolism, excretion, and toxicity profile and drug-like pharmacokinetic parameters were also obtained. Hydroxychloroquine was used as the control drug.

Impact of COVID-19: A radical modal shift from public to private transport mode.

The unprecedented shock triggered by the COVID-19 pandemic has caused significant impact on public transportation services, travel behavior and mode choice preferences. Increasing risk of virus contagion in shared travel modes might result in a systemic shift from public transport to car commute. Such a shift causes increased congestions, emissions with a burden on the existing infrastructure. Given the urgent need of reconsideration of transport in a post-COVID world, this study presents insights into the possible shift from public transport to car commute due to the coronavirus crisis, potential factors influencing the mode shift, with emphasis being also laid on suitable strategies for promoting public transport use in the future world. Based on an online questionnaire survey conducted in India, results of logistic regression model indicate that commuters' socio-economic characteristics such as age, gender and monthly income tend to significantly influence mode switch preferences. In addition, trip characteristics including travel time, overcrowding and hygiene are strongly associated with mode shift preferences from public transport to car use. Commuters' perceptions on several strategies for promoting public transport have also been assessed, which will indeed pave the way for the formulation of post-COVID transport policies. In essence, efforts need to be directed towards restoring users' confidence and trust by providing a safe, secure and healthy environment to the public transport users.