Underlining the Role of Legal Systems, Legal Education and Legal Awareness in Managing Substance Abuse During Covid-19 Pandemic with Special Reference to Alcohol Consumption in India

A recently released report titled ‘Magnitude of Substance Use in India 2019' found that a significant part of India's population suffers from substance use disorders and are in need of treatment. Dedicated facilities for treatment of these people are inadequate in terms of available resources and necessary infrastructure. Even amongst different types of substances that are widely used and subsequently abused, the prevalence of alcohol is highest. In many Indian states, imposition of liquor prohibition and subsequent illegitimisation of alcohol's production, sale, consumption, etc. resulted in public health management problems. These problems received great public attention when the lockdown imposed to control the spread of COVID-19 pandemic in India resulted in closure of non-essential industries, shops and workplaces. It also led to the imposition of a nationwide prohibition on sale of liquor. Research suggests that during lockdown, people suffering from alcohol abuse disorders had a hard time coping with withdrawal symptoms. The problem was further aggravated by lockdown restrictions and non-availability of treatment facilities. Delving into the experiences recorded during the lockdown, this research looks at the role that legal systems, legal education and legal awareness can play in risk mitigation and management of substance abuse. © 2023 DMICS.

Firm-Specific Determinants of Firm Performance in the Hospitality Sector in India

The hospitality sector has been one of the worst-hit industries due to the onset of the COVID-19 pandemic, followed by nationwide lockdowns and curfews. Further, other factors, including the Russia–Ukraine war, commodity price rise, and recession, have acted as hurdles in the slow recovery process. Policy experts at different forums have advocated for proactive and robust measures by the government to reduce adverse impacts during these unprecedented times. To design such measures, determining the firm-specific factors that significantly impact their profitability is essential. In this context, this study tries to understand firm-specific factors that affect the hospitality sector's performance in India. It also explores whether the firm-specific characteristics have changed over time due to changes in political regimes and differ between private and publicly listed companies. Using a sample of 440 public and private hospitality firms for 11 years (2010–2020) and after controlling for unobserved heterogeneity using firm fixed effects, we tested the relationship between firm characteristics and performance. The estimation results demonstrate that the net asset turnover, liquidity, foreign earnings intensity, and age have significant, positive impacts on profitability. In contrast, solvency and size have negatively impacted firm performance. Further, we found differences in the magnitudes of coefficients for private and publicly listed companies. The findings provide important implications for managers and regulators to stimulate new solutions to overcome the ongoing difficult period. © 2022 by the authors.

Design of Steel Intensive Quarantine Centre

In pandemic conditions, where the COVID-19 infection is increasing exponentially, quarantine centres have become very necessary to separate and restrict the movement of people. These structures are also helpful in similar situations like disaster management, defence purposes and housing for poor people. Planning and Designing of Steel Intensive Quarantine Centre' takes on the task of designing and analysing an economical, ecological and rapid construction solution of a modular quarantine centre building. It facilitates a faster construction facility due to steel construction instead of RCC, which takes almost 70–80% more time and is not recyclable like steel. The schematic and elevation plans have been tweaked with additional architectural features to ensure ventilation, sunlight and accessible transit of patients. For economical structural design, the iterative method is incorporated to find columns with the minimum size and shape to achieve ample carpet area, i.e., star-shaped. While designing the structures, i.e., portal frame and truss roof frame are subjected to the same loading conditions. For resisting the lateral forces, different types of bracings have been incorporated in plan and elevation. The construction of a portal frame requires specialized labour to handle compound sections and connections, whereas construction of truss sections is possible by skilled labour or directly use prefabricated truss sections with the help of unskilled labour. Compound sections pose a significant challenge due to their unavailability and transportation difficulties. In contrast, the sections for trusses are readily available even in the remote market. Moreover, the construction of both structures provides rapid construction. The portal frame costs about 16% cheaper than the steel frame due to smaller sections and absence of compound sections. For validation of our work, we have used manual and automated calculation to minimize the error. The structure is expandable for future expansion by techniques such as expansion joint and satellite arrangement. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

The Impact of COVID-19 on Online Fashion Apparel Purchase Intention

The purpose of this study is to determine the influence of Covid-19 on the intention to purchase online fashion clothing. A structured questionnaire was used to collect data from 231 customers in an online survey. The researchers utilised exploratory factor analysis to uncover the most important elements that influence customer behaviour while purchasing online fashion items. Multiple regression study revealed that situational variables, practical motive, and safety and precaution had a positive and substantial influence on customers' online buy intention for fashion items. Hedonic incentive, on the other hand, had a minor impact, despite being beneficial on purpose. A structured questionnaire was shared with the respondents for data collection. The Questionnaire was floated between individuals who purchase fashion apparel online. The questions assessing the four predictors were first subjected to an exploratory factor analysis. Second, multiple regression was used to determine the influence of these variables on online purchase intentions among customers.

Design, Fabrication, and Testing of a Solar Powered Air Purifier with UV Sterilization Capability

Rising air pollution is a cause of concern throughout the world. With rapid industrialization, growth of transportation industry, increasing construction activities, all has taken a toll on the air quality. The air quality in most parts of our country remains poor to moderately pollute for maximum part of the year. P.M. 2.5, P.M. 10, NOx, and SOx are the primary pollutants. Along with the poor quality of air, COVID-19 has added to the misery by affecting the respiratory tract and further worsening the condition of a patient. Through this project, we aim to build a economical solar powered air purifier that can be installed in each and every household as well as outdoors, catering to the air quality indoors, and contributing in purification of the air in the surrounding environment. The air purifier would be capable of providing air filtration as well as sterilization be powered by solar energy and be available at an affordable price. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Low Serum Albumin at Admission Is Associated with Mortality among Inpatients with Cirrhosis: A Multi-National Experience

Background: MELD and Child-Pugh scores have traditionally been used as prognostic indicators in patients with cirrhosis. Albumin infusions in outpatients have been associated with improved outcomes, but not in transplant waitlisted patients or inpatients. This aim of this study was to assess whether low serum albumin (sAlb) on admission alone is a poor prognostic indicator among cirrhotic inpatients from a new multi-national cohort. Method(s): The CLEARED study is a global study that enrolled consecutive non-electively admitted inpatients without organ transplant or COVID-19 from 6 continents. Admission demographics, medical history, laboratory data, inpatient course, death/hospice transfer and mortality at 30 days post-discharge were recorded. Patients were divided into 3 groups: sAlb <28gm/L(A), sAlb >=28 but <35gm/L (B), and sAlb>=35gm/L (C) were compared. Multi-variable logistic regression was performed using inpatient mortality and overall 30-day mortality as outcomes. Result(s): 2429 patients were enrolled from 21 countries worldwide. The distribution was A:49%, B:39%, C:12%. Gp A patients were significantly younger (54yrs vs. 57yrs vs 58yrs p<0.0001) but with similar gender distribution, and higher MELD-Na score of 25 vs. 20 vs. 17 (p<0.0001). Gp A patients were more likely to have alcohol as etiology of cirrhosis (49% vs. 45% vs 38%, p=0.004), and were more likely to have either infection (27% vs. 18% vs. 13%, p<0.0001), HE (39% vs. 33% vs. 23%, p=0.005) or fluid related issues as a reason for admission (p<0.0001). More patients in Gp A received albumin infusion during their hospital stay (120gm vs. 100gm vs. 100gm p=0.0004), mostly for the indications of AKI (47% vs. 49% vs. 47%, p=0.79) and performance of large volume paracentesis (44% vs. 42% vs. 41%, p=0.80), followed by bacterial peritonitis indication (22% vs. 17% vs. 11%, p=0.01). Group A patients had longer hospital stays (9 days vs. 8 days vs. 7 days (p<0.001), but similar ICU transfer (23% vs. 22% vs. 20%, p=0.55). group A patients were more likely to die while inpatients (19% vs. 11% vs. 5%, p<0.0001), or by 30 days post-discharge (29% vs. 20% vs. 9%, p<0.0001). Table shows the admission variables associated with a poor outcome. Conclusion(s): Hypoalbuminemia is extremely common among admitted cirrhotic patients, with sAlb of <28gm/L occurring in almost half. Together with MELD-Na score and infection at admission, a low sAlb is associated with a poor outcome in these patients. Future studies will need to validate these findings and to assess whether albumin infusions will improve the outcome of these patients. (Figure Presented).

Differences in Mortality Rates in Inpatients with Cirrhosis Depends on the Low, Middle or High Income Country Location: Multi-National Cleared Consortium Experience

Background: Although cirrhosis is a major cause of mortality worldwide, there could be disparities in outcomes. This needs a global consortium to study disparities in inpatient cirrhosis care Aim: Define the impact of location in prediction of outcomes in inpts with cirrhosis. Method(s): CLEARED prospectively enrolled non-electively admitted cirrhosis pts without COVID from all continents. To ensure equity, we allowed only 50 pts/site. Admission details, cirrhosis history, inpatient & 30-day course were recorded. World bank classification of low/low middle income (LMI), upper middle (UMI) & High income (HI) were used. Cirrhosis details, inpatient & 30-day outcomes were compared between groups. Multi-variable regression was performed using inpatient & 30-day mortality as outcomes. Result(s): 2758 pts from 21 countries from all continents, including Africa & Australia, were included.727 were L/LMI, 1050 UMI & 981 pts were from HICs. More men & younger pts were in LMI. Cirrhosis details: More pts in HI gp had 6M hospitalizations & infections, HE & ascites while prior variceal bleeding was higher in LMI . Prior HCC & transplant listings were lower in LMI but similar in UMI/HI. Alcohol & NASH was highest in HI. Viral hepatitis & cryptogenic were highest in UMI.Admissions: Admission MELD was highest in LMI. LMI pts were admitted more for GI Bleed, HE, & DILI, while anasarca & HBV flares were higher in UMI. Higher SBP (36% vs 24% vs 21% p<0.0001) & lowest skin/soft-tissue infections were in LMI (5% vs 5% vs 10% p=0.008);rest were similar. Nosocomial infections, driven by UTI were highest in LMI & HI pts (15% vs 14% vs 11% UMI, p=0.03). Admission diuretics, PPIs, Lactulose & statins were highest & antivirals lower in HI. SBP prophylaxis & rifaximin were highest in LMI pts. Outcome(s): More LMI pts needed ICU & had more organ failures (Fig B). Discharge MELD was highest in LMI. In-hospital mortality was highest & transplant lowest in LMI. This extended to 30-day mortality & transplant in LMI patients vs HI pts.Regression: In-hospital mortality was linked with age, infections, MELD & being in a LMI/UMI vs HIC while being on a transplant list, diabetes, & SBP prophylaxis were protective (Fig C). 30-day mortality predicted by age, ascites, HCC, discharge MELD, organ failures, LMI/UMI vs HIC but rifaximin was protective(Fig D). In-hospital transplant was higher with high MELD, admission rifaximin & listed pts &lower in LMI (OR 0.26) & UMI (OR 0.22) & age. 30-day transplant was higher in those with hyponatremia, ascites & HRS, on the list & on rifaximin and lower in LMI (OR 0.24) & UMI (OR 0.59) vs HI. Conclusion(s): In a global study of inpatients with cirrhosis, there were major differences in outcomes. Not being in a high-income country significantly increased the risk of inpatient and 30-day mortality independent of demographics, medications, in-hospital course, and cirrhosis severity likely due to disparities in access to transplant, which should be accounted for in global models. (Figure Presented).

Scope and limitations of digital learning's in developing countries: A real time survey

Since its inception in 2019, coronavirus wreaked havoc on health and economical systems of the world. The impact of COVID-19 on Education system is most important area of concern as economy and health structures can be reformed, but compromised education system can damage even future hope of the globe. Resourceful educational systems were able to opt certain technological system to provide the best possible care of their scholars through IT and other means of AI. But, developing countries, like India where the reach of internet connectivity and teaching methodologies are major barrier while adopting the online mode of delivering the syllabi content. In our previously published survey report on outcome of online teaching-learning during COVID-19, we concluded that digital learning cannot replace the conventional methodology of education though it can help in building education system more effective. The announcement of third wave of COVID-19 by WHO sparked panic among students as well as educational, systems. This paper is a small initiative to understand the students' perception and adaptation towards digital education reforms along with their sentiments ranging from complete acceptance of online classes over traditional teaching techniques. In this survey, we shared online questionnaire in different educational institutions of India through different stake holders. We received the response of 284 students from 12 states of the country. Our survey reports around 70% students are feeling fit to face the third wave of COVID as a student. Zoom app has established as more convenient and popular platform to get connected for digital learning. About 60% of students are comfortable while adopting the digital learning and study from home. Certain issues related to training of faculty while adopting digital learning style and methodology, practical exposure and compromised one-to-one interaction is still a big challenge for the students.

Assessment of Modified BAT Algorithm for MOOC Learner Influence Maximization

Identification of a small group of individuals based on their maximal influence cascade is influence maximization. During the COVID-19 pandemic, discussion forums on the Massive Open Online Course (MOOC) platform have become a paramount interaction medium among learners, and the identification of influential learners evolved as a substantial research issue. In this research paper, an optimization function based on an independent cascade is established for the discussion forum influence maximization problem. A modified version of the BAT algorithm is proposed which memorizes the bad experience of the BAT. The proposed Modified algorithm helps the BAT to remember the worst location that has already been traversed for a reliable estimation in an optimized manner while exploring the best solution. Further, the performance of BAT and Modified BAT for influence maximization on the discussion forum network of a MOOC platform is evaluated which shows the excellent performance of modified BAT. Convergence graph for different populations on deviating probability depicts the effective performance of modified BAT over generic BAT algorithm. © 2022 ACM.

Design of Steel Intensive Quarantine Centre

In pandemic conditions, where the COVID-19 infection is increasing exponentially, quarantine centres have become very necessary to separate and restrict the movement of people. These structures are also helpful in similar situations like disaster management, defence purposes and housing for poor people. Planning and Designing of Steel Intensive Quarantine Centre’ takes on the task of designing and analysing an economical, ecological and rapid construction solution of a modular quarantine centre building. It facilitates a faster construction facility due to steel construction instead of RCC, which takes almost 70–80% more time and is not recyclable like steel. The schematic and elevation plans have been tweaked with additional architectural features to ensure ventilation, sunlight and accessible transit of patients. For economical structural design, the iterative method is incorporated to find columns with the minimum size and shape to achieve ample carpet area, i.e., star-shaped. While designing the structures, i.e., portal frame and truss roof frame are subjected to the same loading conditions. For resisting the lateral forces, different types of bracings have been incorporated in plan and elevation. The construction of a portal frame requires specialized labour to handle compound sections and connections, whereas construction of truss sections is possible by skilled labour or directly use prefabricated truss sections with the help of unskilled labour. Compound sections pose a significant challenge due to their unavailability and transportation difficulties. In contrast, the sections for trusses are readily available even in the remote market. Moreover, the construction of both structures provides rapid construction. The portal frame costs about 16% cheaper than the steel frame due to smaller sections and absence of compound sections. For validation of our work, we have used manual and automated calculation to minimize the error. The structure is expandable for future expansion by techniques such as expansion joint and satellite arrangement. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Comparative Analysis of Transfer Learning and Attention-driven Memory-based Learning for COVID-19 Fake News Detection

In the pandemic COVID-19 situation, the world is facing a pandemic of fake information which often stirs the public attention by attacking their emotional quotient. Scenario reached a situation where people in search of worthy information for public health and precaution, getting fake news. This unprecedented expansion of fake information has become a challenging research issue. Deliberate efforts have been attempted in this manuscript for finding a solution to this COVID-19 fake news detection problem with the help of deep learning models. Two deep learning models-BERT, a transfer learning model, and attention-based bi-directional long short-term memory (LSTM), a memory-based model, have been applied in order to get accurate fake news classification outcomes. A comparative outcome of both models is presented which shows BERT outperforms and gives excellent results in comparison to the attention-based bi-directional LSTM model. The achieved training accuracy by BERT is 86% which is much higher than the accuracy achieved by attention-based Bi-LSTM. BERT precision, recall, and F-score are 0.82, 0.79, and 0.80, respectively, which shows that BERT can detect COVID-19 fake news better than the attention-based Bi-LSTM model.

CORONA’S SPILLOVER EFFECTS ON THE TOURISM INDUSTRY: SCALE DEVELOPMENT AND VALIDATION

The current article takes a tourism-focused perspective to evaluate the impact of COVID-19 on the attitude of the tourist to travel. For this, the present article conceptualizes, develops, and validates the multidimensional scale on preventive measures of COVID-19. Further, we have developed a new model named Financial Crisis from Contagious Disease (FCCD) stimulator to assess the impact of the virus on the short-term performance of the global tourism industry. The study was exploratory, where initial items were generated through the qualitative method. The purification of the scale items and extraction of the distinct factors were performed through a quantitative approach (exploratory factor analysis). Further, confirmatory factor analysis was used to validate the scale. The findings of the study manifested a multidimensional scale measuring the preventive measures of COVID-19 in the tourism context. The research renders a 25-item scale with four distinct factors named Isolation (7 items), Quarantine (7 items), Social Distancing (6 items), and Community Containment (5 items). The present scale will add to the literature of COVID-19 in the context of the tourism industry. The authors assume that this will be the first comprehensive scale, prepared on the guidelines of the World Health Organization (WHO), that will measure the effect of preventive measures of COVID-19 on the attitude of the tourist to travel during a pandemic situation © 2022 Cognizant, LLC.

THE EFFECT OF CONVERTING AN INTEGRATED BEHAVIORAL HEALTH PRACTICE TO TELEHEALTH DURING THE COVID-19 PANDEMIC

STATEMENT OF PROBLEM/QUESTION: When COVID-19 emerged in March 2020, we transitioned to 100% telemedicine visits. We asked: 1. Is our practice providing equitable depression screening and care for patients after transitioning to telemedicine? 2. How might we improve access to care and increase equity for depression in our practice and systemwide? DESCRIPTION OF PROGRAM/INTERVENTION: In March 2019, we integrated mental health services at our academic faculty internal medicine practice consisting of over 5000 patients. We implemented the Collaborative Care model (University Washington, AIMS): 1) to consistently identify patients in primary care with distressing depressive symptoms, and 2) to quickly treat patients with distressing symptoms of depression. We began systematically screening patients for depressive symptom severity and treated using a team-based approach. The team-based approach included psychotherapy, psychiatric consultation, support for psychosocial needs, and online resources. MEASURES OF SUCCESS: We will describe our workflow and program evaluation measures. We explored whether differences in screening and treatment rates occurred based on age, sex and payor status comparing patients screened and treated one year before versus one year after the start of the COVID pandemic as we transitioned to using telemedicine. Patients were defined as “screened” if the Patient Health Questionnaire, 9-item version (PHQ-9) was administered at their physical examination, Annual Wellness Visit, or new patient visit. Patients were defined as“treated” if they enrolled in our mental health program and had more than one visit with the program psychologist. Chi-square tests of independence were conducted to determine associations between time period (Pre COVID vs Pandemic) and equity variables: age (<65 and 65+ years), payor (Medicaid vs. all others), and sex. FINDINGS TO DATE: The number of Annual Wellness, physicals and new patient visits dropped from 2,333 during the pre-COVID period to 1,464 during the pandemic period. The percentage of patients screened for depression using the PHQ-9 at physical examinations initially dropped, then increased dramatically in the Fall of 2020 and has trended back up to pre-COVID rates. Overall, our results may indicate we are offering equitable care. There were no significant differences in screening rates comparing the pre-COVID and pandemic periods stratified by age (p=.24), payor (p=.16) or sex (p=.32);patients who screened positive for depression, stratified by age (p=1.0), payer (p=.15) or sex (p=.22);or for patients who were treated on age (p=.14), payer (p=.51) or sex (p=.39). KEY LESSONS FOR DISSEMINATION: Screening and treatment of depression markedly improved in our primary care ambulatory setting since integrating mental health services. Depression screening after the start of the pandemic nearly ceased but has nearly returned to pre-COVID levels. Screening for depression in the clinic served to improve screening rates, but additional solutions are needed to modernizing telehealth tools for screening for depression.

CLEARED Global consortium results highlight regional variation and need for equity in inpatient outcomes in hospitalized patients with Chronic Liver Disease

Background and aims: A global study with equitable participation for cirrhosis and chronic liver disease (CLD) outcomes is needed. We initiated the Chronic Liver disease Evolution And Registry for Events and Decompensation (CLEARED) study to provide this global perspective. Aim to evaluate determinants of inpatient mortality and organ dysfunction in a multi-center worldwide study. Method: We prospectively enrolled pts with CLD/Cirrhosis >18 years without organ transplant or COVID-19 who were admitted non-electively. To maintain equity in outcome analysis, a maximum of 50 pts/site were allowed. Data for admission variables, hospital course, and inpatient outcomes (ICU, death, organ dysfunction [ODF]) were recorded. This was analyzed for death and ODs using significant variables on admission and including World Bank classification of low/middle-income countries (LMIC). A model for in-hospital mortality for all variables during the hospital course, including ODs) was analyzed. Results: 1383 pts (55 ± 13 yrs, 64% men, 39% White, 30% Asian, 10% Hispanic, 9% Black, 12% other) were enrolled from 49 centers (Fig A). 39% were from high-income while the rest were from LMICs. Admission MELDNa 23 (6–40) with history in past 6 months of hospitalizations 51%, infections 25%, HE 32%, AKI 23%, prior LVP 15%, hydrothorax 8% and HCC 4%. Leading etiologies were Alcohol 46% then NASH 23%, HCV 11% and HBV 13%. Most were on lactulose 52%, diuretics 53%, PPI 49% and statins 11%, SBP prophylaxis 16%, beta-blockers 35% and rifaximin 31%. 90% were admitted for liver-related reasons;GI bleed 30%, HE 34%, AKI 33%, electrolyte issues 30%, anasarca 24% and 25% admission infections. In-hospital course: Median LOS was 7 (1–140) days with 25% needing ICU. 15% died in hospital, 3% were transplanted, 46% developed AKI,15% grade 3–4 HE, 14% shock, 13% nosocomial infections and 13% needed ventilation. Logistic Regression: Fig B shows that liver-related/unrelated factors on admission which predicted in-hospital mortality and development of organ dysfunction with MELDNa and Infections being common among all models. Nosocomial infections and organ dysfunctions predicted mortality when all variables were considered. High-income countries had better mortality outcomes likely due to transplant and ICU availability. AUCs were >0.75 (Figure Presented) Conclusion: In this worldwide equitable experience, admission cirrhosis severity and infections are associated with inpatient outcomes, which are greater in low-income settings. Liver-related and unrelated factors and regional variations are important in defining critical care goals and outcome models in inpatients with cirrhosis.

COMPARING SINGLE-CENTRE STROKE ADMISSIONS IN SCOTLAND BEFORE AND DURING TWO LOCKDOWN PERIODS DUE TO THE SARS-COV-2 PANDEMIC

Background and aims: Quality care for medical emergencies has been affected by SARS-CoV-2 pandemic globally. Factors include increasing emergency admissions, public reluctance to seek medical help, and government-imposed public health measures. We aim to investigate the impact of the pandemic on our local acute stroke service. Methods: We conducted a retrospective analysis in a Scottish tertiary neurology referral centre, comparing acute stroke service over three-month periods: pre-pandemic (04/2019-06/2019), first lockdown (04/2020-06/2020), and second lockdown (01/2021-03/2021). We compared rates of acute stroke admissions, delayed presentations (beyond 24 hours after symptoms onset), tPA rates, door-to-needle times (DTN), SARS-CoV-2-related strokes, and non-SARS-CoV-2-related strokes. Results: Acute stroke admissions reduced significantly over the two lockdown periods compared with pre-pandemic (364 vs 398 vs 454, p<0.0001). 53/316 (16.8%) ischaemic strokes received tPA pre-pandemic, dropping to 21/245 (8.6%) during the first lockdown, and 33/231(14.3%) in the second [p=0.0111], without significant difference in DTNs. 160/527 (30.4%) strokes had delayed presentation in lockdowns, compared with 66/352 (18.8%) pre-pandemic [p<0.0001]. In the 6-month pandemic periods, 13/531 strokes (2.4%;11 ischaemic, 2 TIAs) were related to SARS-CoV-2-infection. Age and sex were similar compared with non-SARS-CoV-2-related strokes;however, the former had a much higher baseline NIHSS (12 vs 4, p<0.05), with 2 receiving tPA. Conclusions: As in previous studies, significant reductions in acute stroke admissions during the pandemic were noted in our centre. More patients presented delayed, thus missing the thrombolysis window. Only a small proportion of strokes were thought to be related to SARS-CoV- 2-infection in our centre, but with severer symptoms.

Semiquantitative Chest computed tomography score in novel coronavirus-infected patients: its correlation with oxygen saturation and role in predicting oxygen therapy requirement

Context Quantitative and semiquantitative indicators of lung involvement in coronavirus disease 2019 (COVID-19) could help to stratify patients and thus help in triaging and speeding up the entire workflow in hospitals as patients with higher severity scores require early therapeutic intervention and critical care. Objective To calculate computed tomography (CT) severity score for COVID-19 infection based on lobar involvement by the disease and correlate this score with oxygen saturation levels (SpO 2) of the patients and to further predict oxygen therapy requirement in patients with various scores. Settings and design This was a prospective study. Patients and methods This was a prospective study on 154 RT-PCR-proven novel coronavirus (SARS-CoV-2)-infected (COVID-19) patients. SpO 2 values of all the patients were obtained within 6 h of scan. All of the scans were reviewed, and the degree of lobar involvement was used to produce a semiquantitative CT score. Statistical analysis used Scatter plot correlation and receiver operator characteristic curve analysis were performed. Results CT score and SpO 2 values of patients were plotted in the scatter plot chart, and Pearson correlation coefficient (r) was calculated, which was -0.836, suggesting a strong negative correlation. A total of 46 patients were given oxygen therapy, and they had SpO 2 value less than or equal to 94%, with CT score ranging from 10 to 22. Receiver operator characteristic curve analysis was done to determine and reach an optimum cutoff value of 11 for oxygen therapy requirement, with a sensitivity and specificity of 95.83 and 95.58%, respectively. Conclusions CT score in COVID-19-infected patients has a strong negative correlation with SpO 2, and it definitely helped to predict the requirement of oxygen therapy in our study.

Antibody Response Profile in COVID-19 Infection in Healthcare Workers: Insights from a Study at a Reference Laboratory

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has imposed an unprecedented burden on our healthcare system. Serological testing for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) antibodies serves as an useful marker for determining an infection by the virus in the recent past and the immune response. The immune response, including the humoral response to the infection is one of them and the knowledge in this area is still evolving. Virus specific antibodies are expected to help in eliminating the virus and to provide protective immunity against reinfection. Aim: To serially monitor the total antibody response to SARSCoV-2 in order to gain better insight into the duration of antibody persistence. Materials and Methods: This prospective observational study was conducted in 66 Healthcare Workers (HCW) with a history of Reverse Transcription- Polymerase Chain Reaction (RT-PCR) proven COVID-19 infection. The study was conducted between May 2020 to April 2021 at the Suburban diagnostics Central Processing Laboratory, Mumbai, Maharashtra, India. Serum samples were serially examined for the presence of total antibodies against the Nucleocapsid (N) protein of SARS-CoV-2 upto 180 days postinfection. A further follow-up examination was done at 360 days. A qualitative Electrochemiluminescence Immunoassay (ECLIA) assay was used for assessment of the antibody response. The chi-square or Fisher-exact test was used to compare categorical variables and the Mann-Whitney U test, Kruskal Wallis test and student t-test were used to compare continuous variables across groups. For assessing relationship between variables, the Pearson test or linear regression were used as appropriate. Results: Out of 66 healthcare workers, 32 were male (48.5%) and 34 were females (51.5%) with the median age of 29.5 years. Out of 66 cases, 62 (94%) cases developed antibodies against SARS-CoV-2 at different time intervals, 48 cases during the 14-30 day interval, 10 cases during the 31-60 day interval, three cases during the 61-90 day interval and one case during the 90-120 days interval. Thirty one out of 35 (88%) cases that could be followed-up at 360 days showed persistence of antibodies. No patient reported symptoms which would warrant a repeat RT-PCR test. Conclusion: This study showed that the antibody response to SARS-CoV-2 virus was sustained for 12 months postinfection in most cases. The absence of fresh infection in these cases during the study period suggests that the antibodies might protect against reinfection with the virus. So, it may be safe to defer vaccination in postinfection cases by 6-9 months thereby saving precious resources.

Guidelines assessment and practices during COVID-19 autopsies

'PANDEMIC': A word which shook the whole world due to the fear of severe acute respiratory syndrome (SARS) - coronavirus-2 (CoV-2) outbreak in Wuhan, China which affected myriad lives worldwide till date. These numbers are increasing rapidly causing an inevitable rise in autopsy cases. Many reputed organizations stepped forward and released guidelines regarding the post-mortem examination in suspected COVID-19 cases. At present we are equipped with various such guidelines. Centre of Disease Control (CDC), Royal College of Pathologists (RCP) and WHO guidance are considered worldwide which elaborate the risks, precautions and safety measures for the Health care worker. In India, Ministry of Health & Family Welfare (MOHFW) has framed the guidelines on dead body management. The following article is a review of the guidelines given by various apex bodies with a pragmatic approach regarding applicability and feasibility in the Indian scenario with certain recommendations. © 2021. Journal of Indian Academy of Forensic Medicine. All rights reserved.