Rituximab in Myasthenia Gravis- Experience from a Low- and Middle-Income Country (LMIC) Setting.

Background: Myasthenia gravis (MG) is an immune-mediated disorder of the neuromuscular junction. About 10% are refractory to immunosuppressive therapy. Aims: To analyze the response of patients with generalized MG to rituximab. Methods and Materials: A retrospective review of patients with MG who received rituximab was carried out (n = 13, M:F = 6:7, mean age: 44.84 ± 15.73 years). Myasthenia Gravis Foundation of America (MGFA), MGFA post-intervention status (MGFA-PIS), and Myasthenia Gravis Status and Treatment Intensity (MGSTI) were assessed before and after rituximab. Results: The duration of MG was 104.07 ± 92.25 months. Before rituximab, the MGFA was IIA/IIB/IIIA/IIIB/IVB/V in 1/1/2/6/2/1 patients and MGSTI was four in eight patients and six in three patients. The mean duration of follow up was 20.92 ± 14.06 months (range, 4 to 42 months). Dose reduction or discontinuation of cholinesterase inhibitors could be achieved 12 patients. Complete stable remission (CSR) and pharmacologic remission (PR) were achieved in one and four patients respectively and five patients had minimal manifestations. Most patients attained level 0, 1 or 2 MGSTI at last follow up. No rituximab infusion-related adverse events were noted. Three patients had exacerbation of MG between one to five weeks after rituximab administration. Three patients died, one each due to a cardiac event unrelated to MG or treatment, complications related to myasthenic crisis, and coronavirus disease. Conclusions: Rituximab was effective in bringing about remission in MG and can be considered as a first-line agent. However, it has to be administered under close supervision as some patients develop exacerbation of MG akin to steroid-induced worsening.

A Study of Perception of Stress in Health-Care Workers Involved in the Management of COVID-19 Patients in Tertiary Care Center during COVID-19 Pandemic First Wave

Introduction: Health-care providers on the front line who are involved in managing patients with COVID-19 are at risk of developing emotional stress and other mental health symptoms. It is imperative to study mental stability in these health-care providers, which helps take the necessary steps to improve mental health during the pandemic period. Aims and Objectives: This study aimed to study the perception of stress in health-care workers (HCWs) involved in managing COVID-19 patients during the first wave. Materials and Methods: This was a prospective cross-sectional study conducted from March 2020 to July 2020. After obtaining informed consent over the phone, the Google Form link was sent to participants whose app number and response were accepted until July 15th, 2020. Google Form consisted of patient demographic characteristics and ten-item Perceived Stress Scale (PSS). Two hundred and seventy-two responses were analyzed. Results: We contacted 470 HCWs, of which 272 (57%) response was obtained, of which 145 (53.3%) were females, and 127 (46.7%) were males. The mean age of the participants was 30.44 years (standard deviation = 5.01). The mean PSS score was 17.73 & PLUSMN;5.33. Among participants, 136 (50%) were postgraduate students, 93 (34%) were nursing officers, and 43 (15.8%) were staff. Majority of HCWs, about 75.7% (206), had moderate stress, followed by low stress in 21.0% (57) and high stress in 3.3% (9). There was a statistically significant correlation between the perceived stress score and the total number of working days. Conclusion: The study conducted during the COVID-19 pandemic showed that three-fourths of HCWs had moderate stress, which has a significant impact on physical, mental, and psychological health. Females had more stress compared to male participants. Health-care providers in IP services had significant stress compared to HCWs in outpatient services.

A study on the surge in adoption of digital payments post COVID-19 with special reference to South Kerala

This study explores the influx of digital payment users in India as part of the aftermath of the covid pandemic. COVID-19 has dramatically fuelled the adoption of digital modes of payments with customers trailing away from the traditional cash and cheques by placing greater reliance on real-time and digital payments. In many markets, mobile money providers have become a vital part of the COVID-19 response, offering a much safer and socially distanced alternative to disburse payments to the public quickly, securely, and efficiently. This study takes into account whether residents of various districts in South Kerala are responding to the pandemic through the fast adoption of mobile payment apps and thus embracing digital transition. The paper also aims to provide significant insight into the various digital modes of payment and the challenges that lie ahead with digital transformation.

Low-intensity Aerobic Exercises during COVID-19 Pandemic in Children with Duchenne Muscular Dystrophy: A Home based Study

Duchenne muscular dystrophy (DMD) is a rare genetic disorder that affects about 0.8 million Indian children. The incidence rate of 1:3500 male births is the most common form of all muscular dystrophies. Covid-19 pandemic cause profound devastation to the lives of DMD children. The muscles are weaker in DMD, and the children are more prone to lung infections. Coronavirus (COVID-19) is a severe lung infection that disturbs the entire function of the World. DMD already has weakness in major muscles, including the respiratory. So, the study aims to identity the effect of low-intensity aerobic exercises in children with DMD. This is a home-based pilot study with 11 DMD children and wheelchair dependent since, for ten years, they have been on continuous rehabilitation and monitoring. When the pandemic was declared in India in March 2020, all children were given clear notes on the disease and its severity to the parents. Self-created quarantine exercise protocol, which includes Limb exercises, breathing exercises, trunk mobility exercises, and positioning, was taught along with a logbook given to all the children. Video calls, and WhatsApp videos, were used to monitor them regularly. The physiotherapist made a personal visit in June 2020 to review the exercises, and subsequently on Aug 20, Oct 20, Dec 20, Feb 21, and May 21. Observations are detailed here. The infection rate was 3 out of 9, and they got admitted to the hospital for other illnesses. All the children noted Flu infection but recovered within ten days without hospitalization. The parents monitored their SPo2 and temperature and updated them in the logbook. A lung function test was done using a handheld incentive spirometer during the personnel visit by the therapist and found satisfactory. The study concluded a significant improvement in the DMD children following low-intensity and quarantine exercises.

Detection of coronavirus disease 2019 in patients presenting with influenza-like illness

Coronavirus disease 2019 (COVID-19), a global public health emergency, has brought life to an unprecedented near-standstill. So many respiratory viruses including the new pandemic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can be attributed to influenza-like illnesses (ILIs). The differentiation of different respiratory viruses based on symptoms and clinical examination is very difficult without testing for a specific virus. All ILI patients should undergo COVID-19 testing as per WHO revised strategies and Indian Medical Council Research guidelines. Objectives To assess the prevalence of SARS-CoV-2 infection in patients with ILIs during the present pandemic. Patients and methods A prospective study was conducted in a dedicated COVID-19 hospital, Bengaluru. All ILI patients visiting the Victoria Hospital underwent nasopharyngeal and oropharyngeal swab collection and were tested for SARS-CoV-2 as per the Indian Medical Council Research-approved protocol. Results In all, 12 062 patients attended the fever clinic in Victoria Hospital attached to Bangalore Medical College and Research Institute. Out of them, 1167 (12.67%) patients presented with ILI. of the studied patients, 873 (78%) patients were under 50 years. Male patients constituted 67.09% of the study population. In the present study, 337 (30.55%) of the patients with ILI tested positive to SARS-CoV-2 antigen. Nearly 2/3rd of SARS-CoV-2-positive ILI patients were males and below 50 years. The positive rate of SARS-CoV-2 was higher in the noncontainment zone than the containment zones of ILI patients although statistically not significant (P=0.09). Conclusion Thirty percent of ILI patients were SARS-CoV-2 positive. Majority of SARS-CoV-2 positive tested ILI patients were men under the age of 50 years.

Unique features of a recombinant haemagglutinin influenza vaccine that influence vaccine performance.

The influenza vaccine field has been constantly evolving to improve the speed, scalability, and flexibility of manufacturing, and to improve the breadth and longevity of the protective immune response across age groups, giving rise to an array of next generation vaccines in development. Among these, the recombinant influenza vaccine tetravalent (RIV4), using a baculovirus expression vector system to express recombinant haemagglutinin (rHA) in insect cells, is the only one to have reached the market and has been studied extensively. We describe how the unique structural features of rHA in RIV4 improve protective immune responses compared to conventional influenza vaccines made from propagated influenza virus. In addition to the sequence integrity, characteristic of recombinant proteins, unique post-translational processing of the rHA in insect cells instills favourable tertiary and quaternary structural features. The absence of protease-driven cleavage and addition of simple N-linked glycans help to preserve and expose certain conserved epitopes on HA molecules, which are likely responsible for the high levels of broadly cross-reactive and protective antibodies with rare specificities observed with RIV4. Furthermore, the presence of uniform compact HA oligomers and absence of egg proteins, viral RNA or process impurities, typically found in conventional vaccines, are expected to eliminate potential adverse reactions to these components in susceptible individuals with the use of RIV4. These distinct structural features and purity of the recombinant HA vaccine thus provide a number of benefits in vaccine performance which can be extended to other viral targets, such as for COVID-19.

Patterns of cardiovascular diseases in COVID-19 patients admitted to tertiary cardiac care centre.

OBJECTIVES: To analyse the pattern of cardiovascular diseases (CVDs) in COVID-19 patients admitted to tertiary cardiac care centre. METHODS: We retrospectively analysed 511 adult patients admitted between July 1, 2020, and November 30, 2020, with COVID-19 infection and having either new onset or pre-existing CVDs. Clinical features, electrocardiogram (ECG), echocardiography, chest X-ray, biomarkers, haematological and biochemical parameters were analysed. RESULTS: The mean age of the patients was 56.62 ± 14.74 years. Male: Female ratio was 2.78:1. Pre-existing CVDs were present in 258 patients (50.5%). The most common cardiovascular manifestation was acute coronary syndrome (ACS), seen in 259 patients (50.7%). ST-segment elevation myocardial infarction (STEMI) was more common than non-ST-segment elevation ACS (NSTE-ACS). Possible myocarditis was seen in 52 patients (10.1%). Rhythm and conduction abnormalities were noted in 144 patients (28.2%), the most common being QT prolongation, seen in 51 patients (10%). In-hospital mortality occurred in 97 patients (18.9%). Age, serum Ferritin level, D-dimer, NT-pro-BNP and total leukocyte count were significantly higher among patients with in-hospital mortality compared to survival group. Blood lymphocyte count and Haemoglobin level were significantly lower in mortality-group, compared to survival-group. Incidence of pre-existing CVDs, cardiogenic shock, heart failure, atrial fibrillation (AF), and renal failure were significantly higher in mortality-group compared to survival-group. CONCLUSION: The most common CVD in COVID-19 patients in our study was ACS. STEMI was more common than NSTE-ACS. Advanced age, elevated serum ferritin, D-dimer, NT pro-BNP, leucocytosis, lymphopenia, lower haemoglobin, pre-existing CVDs heart failure, cardiogenic shock, AF and renal failure were associated with increased mortality in these patients.

Sudden lockdown and unseen challenges in India due to COVID 19-An outbreak analysis

The world is facing an unprecedented situation because of spread of coronavirus that causes the disease COVID-19 which is totally new, where no one can see light at the end of the tunnel. In last 3 months, this pandemic has spread to 204 countries, regardless of its being developed, developing or under developed. In comparison to developed countries and being a developing nation, India has to date curtailed the spread of virus to stage 2 of local transmissions by limiting its progression. The Government of India together with its States has taken stringent actions to prevent its spread, including a nationwide lockdown. The sudden lockdown in country of 1.3 billion has brought in many unseen challenges, which has created panic, confusion and inconvenience to the general public at large. Though the remedial steps are taken, but that may cause collateral damage in the long run, if not planned earlier. The main objective of the study is to apprise the world about certain hard realities, ignored situations and unseen challenges that are being faced by world’s 2nd most populous country due to sudden lock down. © 2021, World Research Association. All rights reserved.

Diagnostically fighting the coronavirus disease 2019 pandemic: A general perspective

The recent outbreak of severe acute respiratory syndrome-coronavirus 2 has brought human survival and existence to an all-time low. The infection seems to be uncontrollable, and the scientific community has no answer yet. The only means of keeping the infection under the check is the effective usage of both serological and molecular diagnostic testing. The article provides the readers with the basic understanding of the current pandemic situation and educates them regarding the same. It is essential that members of all the scientific background are aware of the current pandemic at its basic level. This would direct the scientific community to work toward warding off the pandemic which is the need of the hour.y

Response of ambient BC concentration across the Indian region to the nation-wide lockdown: results from the ARFINET measurements of ISRO-GBP

In this study, we assess the response of ambient aerosol black carbon (BC) mass concentrations and spectral absorption properties across Indian mainland during the nation-wide lockdown (LD) in connection with the Coronavirus Disease 19 (COVID-19) pandemic. The LD had brought near to total cut-off of emissions from industrial, traffic (road, railways, marine and air) and energy sectors, though the domestic emissions remained fairly unaltered. This provided a unique opportunity to delineate the impact of fossil fuel combustion sources on atmospheric BC characteristics. In this context, the primary data of BC measured at the national network of aerosol observatories (ARFINET) under ISRO-GBP are examined to assess the response to the seizure of emissions over distinct geographic parts of the country. Results indicate that average BC concentrations over the Indian mainland are curbed down significantly (10–40%) from prelockdown observations during the first and most intense phase of lockdown. This decline is significant with respect to the long-term (2015–2019) averaged (climatological mean) values. The drop in BC is most pronounced over the Indo-Gangetic Plain (>60%) and north-eastern India (>30%) during the second phase of lockdown, while significant reduction is seen during LD1 (16–60%) over central and peninsular Indian as well as Himalayan and sub-Himalayan regions. Despite such a large reduction, the absolute magnitude of BC remained higher over the IGP and north-eastern sites compared to other parts of India. Notably, the spectral absorption index of aerosols changed very little over most of the locations, indicating the still persisting contribution of fossil-fuel emissions over most of the locations. [ABSTRACT FROM AUTHOR] Copyright of Current Science (00113891) is the property of Indian Academy of Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A 25-Year-Old Sample Contributes the Complete Genome Sequence of Avian Coronavirus Vaccine Strain ArkDPI, Reisolated from Commercial Broilers in the United States.

Here, we report the complete genome sequence of Avian coronavirus strain ArkDPI of the GI-9 lineage, isolated from broiler chickens in North Georgia in 1994. This is the complete genome sequence of this vaccine strain, reisolated from broilers in the United States.

Epidemic Landscape and Forecasting of SARS-CoV-2 in India.

BACKGROUND: India was one of the countries to institute strict measures for Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) control in the early phase. Since, then, the epidemic growth trajectory was slow before registering an explosion of cases due to local cluster transmissions. METHODS: We estimated the growth rate and doubling time of SARS-CoV-2 for India and high burden states using crowdsourced time series data. Further, we also estimated the Basic Reproductive Number (R0) and Time-dependent Reproductive number (Rt) using serial intervals from the data. We compared the R0 estimated from five different methods and R0 from SB was further used in the analysis. We modified standard Susceptible-Infectious-Recovered (SIR) models to SIR/Death (SIRD) model to accommodate deaths using R0 with the sequential Bayesian method for simulation in SIRD models. RESULTS: On average, 2.8 individuals were infected by an index case. The mean serial interval was 3.9 days. The R0 estimated from different methods ranged from 1.43 to 1.85. The mean time to recovery was 14 ± 5.3 days. The daily epidemic growth rate of India was 0.16 [95% CI; 0.14, 0.17] with a doubling time of 4.30 days [95% CI; 3.96, 4.70]. From the SIRD model, it can be deduced that the peak of SARS-CoV-2 in India will be around mid-July to early August 2020 with around 12.5% of the population likely to be infected at the peak time. CONCLUSION: The pattern of spread of SARS-CoV-2 in India is suggestive of community transmission. There is a need to increase funds for infectious disease research and epidemiologic studies. All the current gains may be reversed if air travel and social mixing resume rapidly. For the time being, these must be resumed only in a phased manner and should be back to normal levels only after we are prepared to deal with the disease with efficient tools like vaccines or medicine. KEY POINTS: . QUESTION: What are the estimates of infectious disease parameters of early phase of novel SARS-CoV-2 epidemic in India? FINDINGS: Incidence pattern SARS-CoV-2 shows possible evidence of community transmission. However, the estimated Basic Reproductive Number (R0) is relatively lower than those observed in high burden regions (range 1.43-1.85). Our simulation using susceptible-infectious-recovered/death model shows that peak of SARS-CoV-2 in India is farther than currently projected and is likely to affect around 12.5% of population. MEANING: The lower estimated R0 is indicative of the effectiveness of early social distancing measures and lockdown. Premature relaxation of the current control measures may result in large numbers of cases in India.

Epidemic Landscape and Forecasting of SARS-CoV-2 in India (preprint)

BACKGROUND India was one of the countries to institute strict measures for SARS-CoV-2 control in early phase. Since, then, the epidemic growth trajectory was slow before registering an explosion of cases due to local cluster transmissions. METHODS We estimated growth rate and doubling time of SARS-CoV-2 for India and high burden states using crowd sourced time series data. Further, we also estimated Basic Reproductive Number (R0) and time dependent reproductive number (Rt) using serial intervals from the data. We compared the R0 estimated from five different methods and R0 from SB was further used in analysis. We modified standard SIR models to SIRD model to accommodate deaths using R0 with the Sequential Bayesian method (SBM) for simulation in SIRD models. RESULTS On an average, 2.8 individuals were infected by an index case. The mean serial interval was 3.9 days. The R0 estimated from different methods ranged from 1.43 to 1.85. The mean time to recovery was 14, SD 5.3 days. Daily epidemic growth rate of India was 0.16 [95%CI; 0.14, 0.17] with a doubling time of 4.30 days [95%CI; 3.96, 4.70]. From the SIRD model, it can be deduced that the peak of SARS-CoV-2 in India will be around mid-July to early August 2020 with around 12.5% likely to be infected at peak time of incidence. CONCLUSIONS The pattern of spread of SARS-CoV-2 in India is suggestive of community transmission. There is a need to increase fund for infectious disease research and epidemiologic studies. All the current gains may be reversed rapidly if air travel and social mixing resumes rapidly. For the time being, these must be resumed only in a phased manner, and should be back to normal levels only after we are prepared to deal with the disease with efficient tools like vaccine or a medicine.