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A 36-year-old lady presented with fever, cough, maculopapular rash, painless sialadenitis, episcleritis, and arthralgia of more than 10 months, occurring in episodes since she tested positive for COVID-19 in 2020. Her symptoms were well controlled with corticosteroid and immunosuppressant therapy. Her clinical presentation and findings on bronchoscopy resembled that of sarcoidosis. However, the bronchial biopsy histopathology ruled out sarcoidosis. An increased serum immunoglobulin G4 level and its possible association with COVID-19 raises the question of whether the possibility of immunoglobulin G4-related disease (IgG4-RD) could be entertained.
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Introduction and Objectives: Limited healthcare access and resource inequities pose significant barriers to care, all of which have been amplified during the COVID-19 pandemic. DFUs represent an especially challenging medical problem to prevent and treat due to the resource intensive care required. We sought to evaluate the feasibility of multidisciplinary, mobile, DFU outreach clinics to improve access to care. Method(s): Our clinic model focused on creating mobile diabetic foot clinics staffed by volunteer clinical providers who specialize in Vascular Surgery, Diabetes, and Podiatry. We recruited volunteer healthcare providers from an academic medical center. We partnered with local community centers with established programs providing services to unhoused individuals. Result(s): Between June 2020 and August 2022, a total of 130 unhoused individuals were seen at four mobile clinics set up at different locations. Diabetic foot care was provided by volunteers from seven departments: Endocrinology/Diabetes, Vascular Surgery and Vascular Lab, Podiatry, Addiction Medicine, Smoking Cessation, and Financial. On average, 32 healthcare provider volunteers participated at each clinic. Services provided include: vitals, blood glucose, HgA1c, lipid panel testing, ankle-brachial index, podiatric exam, wound care, medical education, COVID vaccination/booster, insurance enrollment, and new socks and shoes. Of 130 unhoused patients, 29% had hypertension (38), 34% had abnormal ABI (44), and 14% had diabetes (18). Fifteen patients were further identified as high risk for developing DFU-associated amputation (12%) and were provided with ambulatory follow-ups. Conclusion(s): In our pilot experience, it is feasible to provide consistent comprehensive DFU care through mobile outreach clinics. By using the infrastructure of partner organizations and healthcare expertise of an academic center, our clinics could integrate into existing community services. [Formula presented]Copyright © 2022
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Developing modifiable natural products those having antiviral activities against SARS-CoV-2 is a key research area which is popular in current scenario of COVID pandemic. A diaryl heptanoid curcumin and its derivatives are already presenting promising candidates for anti-viral drug development. We have synthesized single crystals of a dimethylamino derivative of natural curcumin and structural characterization was done by single crystal XRD analysis. Using steady-state absorption and emission spectra and guided by complimentary ab initio calculations, we unraveled the solvent effects on the photophysical properties of the dimethyl amino curcumin derivative. Chemical reactivity of the compound has investigated using frontier molecular orbitals and molecular electrostatic potential surface. High stability of the curcumin derivative in water environment has evaluated by Radial Distributions Functions (RDF) calculated via Molecular Dynamics (MD) simulations. The inhibitory activity of the title compound was evaluated by in silico methods and the stability of the protein-ligand complexes were studied using Molecular Dynamics simulations and MM-PBSA analysis. With this detailed study, we hope to motivate scientific community to develop new curcumin derivatives against SARS-CoV-2 virus.
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Introduction: Patients on maintenance hemodialysis are at higher risk for severe COVID-19. Various inflammatory markers have been used to assess the severity of COVID 19 in general population. However, whether the same markers are useful among hemodialysis patients is yet to be ascertained. Hence this study was conducted. Methods: This is an observational, retrospective and prospective study. All patients who were on maintenance hemodialysis, affected with COVID-19 infection and requiring hospitalization, between March 2020 to June 2021 were included. Clinical profile, biochemical parameters and inflammatory markers at admission, during the hospital stay and at the time of final outcome were noted. Patient’s clinical condition was scored as per WHO clinical progression scale (WHOCPS), and were classified as “non-severe” (0-5), and “severe” (6-10). The medications received by them in the hospital was noted. Patient’s discharge status was categorized into stable discharge, discharged with home oxygen therapy or death. Results: 140 patients were included in the study. Diabetic nephropathy was the major cause for ESRD (fig1). Most patients had co-morbidities as shown in fig2. 17% of the patients had a previous kidney transplant. 25.7 % required supplemental oxygen at presentation. 15% required ICU care and 12.9% required mechanical ventilation eventually. The % of lymphocytes, IL6, Albumin and LDH correlated with severity of the disease. These values were observed during the hospital stay, and were higher in patients who required ICU care and mechanical ventilation (table 1). % of lymphocytes, CRP, IL6, albumin and LDH were found to be higher at the time of admission in patients who required ICU care and Mechanical ventilation. Between Days 2-5, total WBC counts, %lymphocytes correlated with complications and mortality (Table 2). Rising CRP, LDH, Ferritin and total WBC counts were associated with longer ICU stay. CRP, LDH and Ferritin levels were higher in those who had higher WHOCP score, thus correlating poor outcomes (table 3). Ferritin and albumin showed a significant difference between severe and non-severe cases at discharge. ROC curve at admission (fig 5) showed that LDH had better AUC than IL 6. During days 2-5, the % of lymphocytes had better AUC than Total counts (Fig 6). At discharge, serum albumin was found to be the best predictor of the outcome (fig 7) 90% of the patients who required oxygen support/ ICU care/ mechanical ventilation received corticosteroids and remdesvir. Prophylactic anticoagulants were used in 101 patients. Tocilizumab(n=3) and Tofacitinib (n=1)were used in those patients who had severe COVID-19 illness, with very high inflammatory markers. 80% recovered, 17.1% expired and 2.9% required home oxygen therapy at discharge. 27 % of patients developed complications (secondary bacterial infections, mucormycosis, deep vein thrombosis, stroke, and myocardial infarction). Conclusions: LDH on day of admission, % of lymphocytes on days 2-5, and serum albumin on day of discharge were the best predictors of outcomes among CKD patients on hemodialysis having COVID-19. Use of these biomarkers will definitely be more helpful for optimum usage of drugs, and will help us risk stratification of hemodialysis patients. No conflict of interest
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Background: The use of complementary and alternative medicine (CAM) therapies has surged since the spread of COVID-19 pandemic. However, the efficacy and safety of these CAM therapies remains majorly unexplored. Objective: To understand the efficacy and safety of Nochi Kudineer Chooranam (5 gm), Mahasudarsan Chooranam (3 gm) , Adathodai Manapagu (10 ml), Omatheeneer (10 ml), Maldevi chenduram (100 mg) with honey in management of COVID 19 patients. Methods: We conducted a randomised, controlled, open label trial in patients hospitalized with SARS-CoV-2 infection who had an oxygen saturation of 90% or more while breathing ambient air. Patients were randomized into two groups in a 1:1 ratio to either intervention group, receiving seven days of siddha medicine (Intervention group; n = 50) or standard care (control group; n = 50). The primary end point was clinical markers and patient recovery status on day 8. Results: A total of 100 patients with confirmed COVID-19 with average age of 37 yrs (interquartile range, 28-49) participated in the study. There was no statistically difference between groups at baseline (P > 0.05). After intervention, patients in the intervention group had statistically (P < 0.05) significant reduction in the symptoms when compared to standard care. By end of the intervention period, 6 patients (12%) were hospitalized in the control group and none of them were reported for intervention group. Conclusion: Among patients with mild to moderate COVID-19, 7 days of siddha medicine showed a significant reduction in the clinical symptoms and requirement of hospitalisation, with no adverse events. Therefore, the particular siddha medicine preparation could be used safely and effectively for the management of COVID-19 patients.
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Kerala, a South Indian state has tribal population in all her districts. About 1.5% of the total population of the state constitute tribal population. They depend upon natural environment and resources for their survival. Children from the same community usually depend on government funded schools for their education. Education for this deprived section during COVID 19 Pandemic was a massive exclusion and an uphill task. Digital divide and medium of communication (Standard Malayalam) were some of the critical concerns to knowledge acquisition among tribal children. This paper primarily focuses on the challenges of online education among tribal students with a clear emphasis on the English language acquisition. This study was conducted in four most tribal populated districts of the State, namely, Wayanad, Malappuram, Palakkad, and Idukki. This is a qualitative explorative study that explores the experiences of the tribal students' English language learning challenges from the teachers' perspective in these districts. © The Electrochemical Society
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Given the novel corona virus discovered in Wuhan, China, in December 2019, due to the high false-negative rate of RT-PCR and the time-consuming to obtain the results, research has proved that computed tomography (CT) has become an auxiliary One of the essential means of diagnosis and treatment of new corona virus pneumonia. Since few COVID-19 CT datasets are currently available, it is proposed to use conditional generative adversarial networks to enhance data to obtain CT datasets with more samples to reduce the risk of over fitting. In addition, a BIN residual block-based method is proposed. The improved U-Net network is used for image segmentation and then combined with multi-layer perception for classification prediction. By comparing with network models such as AlexNet and GoogleNet, it is concluded that the proposed BUF-Net network model has the best performance, reaching an accuracy rate of 93%. Using Grad-CAM technology to visualize the system's output can more intuitively illustrate the critical role of CT images in diagnosing COVID-19. Applying deep learning using the proposed techniques suggested by the above study in medical imaging can help radiologists achieve more effective diagnoses that is the main objective of the research. On the basis of the foregoing, this study proposes to employ CGAN technology to augment the restricted data set, integrate the residual block into the U-Net network, and combine multi-layer perception in order to construct new network architecture for COVID-19 detection using CT images. -19. Given the scarcity of COVID-19 CT datasets, it is proposed that conditional generative adversarial networks be used to augment data in order to obtain CT datasets with more samples and therefore lower the danger of overfitting.
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Background The use of complementary and alternative medicine (CAM) therapies has surged since the spread of COVID-19 pandemic. However, the efficacy and safety of these CAM therapies remains majorly unexplored. Objective of the current study is to understand the efficacy and safety of one such traditional CAM therapy of South India, known as ‘Siddha’ system of medicine, in the management for the COVID-19 patients. Methods We conducted a randomised, controlled, open label trial in patients hospitalized with SARS-CoV-2 infection who had an oxygen saturation of 90% or more while breathing ambient air. Patients were randomized into two groups in a 1:1 ratio to either intervention group, receiving seven days of siddha medicine (Intervention group;n=50) or standard care (control group;n=50). The primary end point was clinical markers and patient recovery status on day 8. Results A total of 100 patients with confirmed COVID-19 with average age of 37 yrs (interquartile range, 28-49) participated in the study. There was no statsistically difference between groups at baseline (P>0.05). After intervention, patients in the intervention group had statistically (P<0.05) significant reduction in the symptoms when compared to standard care. By end of the intervention period, 6 patients (12%) were hospitalized in the control group and none of them were reported for intervention group. Conclusion Among patients with mild to moderate COVID-19, 7 days of siddha medicine showed a significant reduction in the clinical sysmptoms and requirement of hospitalisation, with no adverse events. Therefore, the particular siddha medicine preparation could be used safely and effectively for the management of COVID-19 patients. Clinical Trial Registration CTRI/2020/08/026999.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), accountable for causing the coronavirus diseases 2019 (COVID-19), is already declared as a pandemic disease globally. Like previously reported SARS-CoV strain, the novel SARS-CoV-2 also initiates the viral pathogenesis via docking viral spike-protein with the membranal angiotensin-converting enzyme 2 (ACE2) - a receptor on variety of cells in the human body. Therefore, COVID-19 is broadly characterized as a disease that targets multiple organs, particularly causing acute complications via organ-specific pathogenesis accompanied by destruction of ACE2+ cells, including alveolus, cardiac microvasculature, endothelium, and glomerulus. Under such circumstances, the high expression of ACE2 in predisposing individuals associated with anomalous production of the renin-angiotensin system (RAS) may promote enhanced viral load in COVID-19, which comparatively triggers excessive apoptosis. Furthermore, multi-organ injuries were found linked to altered ACE2 expression and inequality between the ACE2/angiotensin-(1-7)/mitochondrial Ang system (MAS) and renin-angiotensin-system (RAS) in COVID-19 patients. However, the exact pathogenesis of multi-organ damage in COVID-19 is still obscure, but several perspectives have been postulated, involving altered ACE2 expression linked with direct/indirect damages by the virus-induced immune responses, such as cytokinin storm. Thus, insights into the invasion of a virus with respect to ACE2 expression site can be helpful to simulate or understand the possible complications in the targeted organ during viral infection. Hence, this review summarizes the multiple organs invasion by SARS CoV-2 linked with ACE2 expression and their consequences, which can be helpful in the management of the COVID-19 pathogenesis under life-threatening conditions.
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COVID-19 , SARS-CoV-2 , Angiotensin-Converting Enzyme 2 , Humans , Pandemics , Peptidyl-Dipeptidase A/metabolism , SARS-CoV-2/pathogenicityABSTRACT
Introduction: Blood transfusion services (BTS) being an essential medical service should cater to the patient needs especially to those who are transfusion dependent. BTS faced numerous challenges to maintain the sustainability in service provision during the SARS-CoV-2 pandemic. Our aim was to study the impact of SARS-CoV-2 pandemic on blood transfusion services. Material and methods: This retrospective cross-sectional study was carried out in the department of transfusion medicine in a tertiary care teaching hospital blood centre in south India. Data on blood collection, blood issues, wastage and number of blood donation camps was evaluated before and after COVID-19 i.e. from January 2019 to December 2020. The data obtained was tabulated and results were noted. Data were analysed using SPSS software version 21 for Windows statistical software package (SPSS Inc., Chicago IL, USA). Results: There was a 52.4 % drop in blood donation, 54.5 % in blood component preparation, and 54.6% in blood issue during COVID-19. There was an increase in blood discard rate by 0.13% with double the rate of discards due to expiry of blood and blood components alone during COVID-19. Conclusion: COVID-19 pandemic had a major impact on Blood transfusion services. Blood centres must make an emergency preparedness action plan to prepare and manage the blood supply during similar future threats based on the experience in this pandemic.
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OBJECTIVE: Large data on the clinical characteristics and outcome of COVID-19 in the Indian population are scarce. We analysed the factors associated with mortality in a cohort of moderately and severely ill patients with COVID-19 enrolled in a randomised trial on convalescent plasma. DESIGN: Secondary analysis of data from a Phase II, Open Label, Randomized Controlled Trial to Assess the Safety and Efficacy of Convalescent Plasma to Limit COVID-19 Associated Complications in Moderate Disease. SETTING: 39 public and private hospitals across India during the study period from 22 April to 14 July 2020. PARTICIPANTS: Of the 464 patients recruited, two were lost to follow-up, nine withdrew consent and two patients did not receive the intervention after randomisation. The cohort of 451 participants with known outcome at 28 days was analysed. PRIMARY OUTCOME MEASURE: Factors associated with all-cause mortality at 28 days after enrolment. RESULTS: The mean (SD) age was 51±12.4 years; 76.7% were males. Admission Sequential Organ Failure Assessment score was 2.4±1.1. Non-invasive ventilation, invasive ventilation and vasopressor therapy were required in 98.9%, 8.4% and 4.0%, respectively. The 28-day mortality was 14.4%. Median time from symptom onset to hospital admission was similar in survivors (4 days; IQR 3-7) and non-survivors (4 days; IQR 3-6). Patients with two or more comorbidities had 2.25 (95% CI 1.18 to 4.29, p=0.014) times risk of death. When compared with survivors, admission interleukin-6 levels were higher (p<0.001) in non-survivors and increased further on day 3. On multivariable Fine and Gray model, severity of illness (subdistribution HR 1.22, 95% CI 1.11 to 1.35, p<0.001), PaO2/FiO2 ratio <100 (3.47, 1.64-7.37, p=0.001), neutrophil lymphocyte ratio >10 (9.97, 3.65-27.13, p<0.001), D-dimer >1.0 mg/L (2.50, 1.14-5.48, p=0.022), ferritin ≥500 ng/mL (2.67, 1.44-4.96, p=0.002) and lactate dehydrogenase ≥450 IU/L (2.96, 1.60-5.45, p=0.001) were significantly associated with death. CONCLUSION: In this cohort of moderately and severely ill patients with COVID-19, severity of illness, underlying comorbidities and elevated levels of inflammatory markers were significantly associated with death. TRIAL REGISTRATION NUMBER: CTRI/2020/04/024775.
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COVID-19 , Adult , COVID-19/therapy , Humans , Immunization, Passive , India/epidemiology , Middle Aged , SARS-CoV-2 , COVID-19 SerotherapyABSTRACT
COVID-19 virus started to outbreak in China in the year January 2020. Contact tracing is an open-minded measure of control that applies to an extensive range of transmissible diseases. It is being used to fight infections like SARS, tuberculosis, smallpox, and many sexually transmitted diseases (STDs). From the moment of the lockdown, there have been a great many talks of applications helping to combat the coronavirus. Technical developers bring a solution to this problem by providing tools that help to contain the coronavirus. This kind of application is helpful, but it lacks in accuracy and privacy concerns. COVID-19 virus, irrespective of causes, solution, treatments, clinical signs, and symptoms is discussed in this paper. The main aim of this paper proposes a contact tracing using k-nearest neighbour, which shows the correct prediction of an affected person of COVID-19 based on the distance and also reduces the transmission of disease. It was tested on the WHO dataset obtained the prediction accuracy of which was carried out on clinical and quarantine data. The evaluation result shows that the contact tracing technique's accuracy has been improved using the proposed algorithm. © 2021 River Publishers
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We provide the South Asian Declaration, containing the consensus guidelines for coronavirus disease 2019 (COVID-19) vaccination in cancer patients.
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A gap in knowledge exists regarding drug use among drivers and other road users (pedestrians, bicyclists) who are seriously or fatally injured in crashes in the United States. This study examines the prevalence of alcohol as well as selected over-the-counter, prescription, and illegal drugs in the blood of seriously or fatally injured drivers and other crash victims near the time of their crashes before and during the COVID-19 public health emergency. Data was collected at Level 1 trauma centers and medical examiner offices. The 3,003 participants represent a convenience sample of roadway users who were seriously or fatally injured during the study period. Trauma centers and medical examiners made available small volumes of blood for toxicological analyses from the total collected during their normal clinical procedures. The results indicate drug prevalence was high among seriously and fatally injured roadway users before the public health emergency began and was even higher during, especially for alcohol, cannabinoids (active THC), and opioids. Drivers in particular showed significantly higher overall drug prevalence during the public health emergency, with 64.7% testing positive for at least one active drug, compared to 50.8% before. Drivers also showed an increase in testing positive for two or more categories of drugs going from 17.6% before to 25.3% during the public health emergency. Of particular note, active THC was more prevalent among drivers during the public health emergency than alcohol (32.7% versus 28.3%), and opioid use among drivers almost doubled from 7.5% to 13.9%. Overall, the results of this study suggest the highway safety community should be concerned about the impact of other drugs as well as alcohol. In particular, the observed cannabis and opioid prevalence rates before and during the public health emergency could be indicative of a growing problem. These findings are prevalence rates only and cannot be used to determine whether the people were impaired at the time of their crash.
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COVID-19 is a viral pandemic disease affecting more than 215 countries worldwide. Understanding the nature of the disease is a challenge not only for the scientists but also for general public. In this study, the authors have evaluated the perception of general public about the disease COVID-19 using a questionnaire survey. Questionnaire was designed using Google Forms and circulated through the social media like WhatsApp and Facebook. The questions related to the personal details on age, sex and education were received from the respondents. Further, the general understanding about COVID-19, causal organism and symptoms, airborne nature of COVID-19, their spread and containment were also received. The opinion of the respondents towards controlling the disease by State and Central Government, implementation of policy for containment of COVID-19 for Buildings with Air conditioning system were also received using the questionnaire. A total of 463 people responded to the questions. Among the respondents 70.9% are female and the remaining 29 % male. The age of the respondents ranges from 18 to 57. Maximum number of respondents provided correct answer related to the nature, size, shape and the spread of the causal organism. However, confusion prevailed among the respondents related to the medicinal system to practice and the distance of the viral spread. Maximum respondents are satisfied with the steps taken by the Government in controlling the disease and supports bringing a bill for clearance and certification for COVID-19 in A/c Buildings and other public Buildings. The study can be used as an insight by both Central and State Government and the policy makers of India in creating further awareness towards the disease among general public.
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COVID 19 being the biggest pandemic affecting everyone around the globe either directly or indirectly. The rate of infection fastens everyday, where India stands 6th among all the countries in the world. Daily wage workers are the most affected personalities due to to covid-19 lockdown. Although many organisations help them and take them into attention, still a lot of them continue to struggle. The aim of the study is to create and test the extent of awareness on various effects of COVID-19 on daily wage workers. A self-assessed questionnaire comprising about 12 questions were passed on to 109 individuals through an online platform “google forms”. The responses were collected and analysed using SPSS software. Most of the respondents are aware about the various issues faced by the workers in their day to day life. They can also coexist in this society with us, after the massacre that is caused to them due to the lockdown, if we show some gratitude towards them.
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The world is in lockdown in part due to the COVID-19 pandemic, this has meant that except facilities that are considered to be essential have all been shutdown. This includes all schools and other educational institutes. With schools being shut down, students spend their newly found free time to engage in leisurely activities, such as cooking, reading and spending time on online game apps. While there was once a time when parents would condemn their children engaging in some activities, this pandemic has resulted in parents allowing their children the freedom like they never had before. The aim of the study is to assess the time spent on online gaming and gaming motives of school children during lockdown. Questionnaire of 14 questions was made using Google Forms and articles related to the topic and the questionnaire was sent to 101 subjects, all of whom were school children and were below the age of 18 as of when they were taking the survey.The results were obtained and statistically analysed through SPSS software, chi square test was done to check the association and a p value of 0.05 was said to be statistically significant. The survey was conducted in the month of May 2020. From the survey, it was evident that the amount of time spent on online games by adolescents has increased during the lockdown, where 29.70% of the respondents played for 3-6 hours, 17.82% played for 6-10 hours and 4.95% played for more than 10 hours a day .The primary motive for the majority of the participants(52%) to choose online games (massively multiplayer online games) was to interact with their friends.From the survey it was also evident that both male and female adolescents had the same primary motive and spent more time on online games(p-value>0.05).It was found that the children preferred to play games of their choice when given the opportunity. From the survey it was evident that both male and female adolescents had the same primary motive of interacting with their friends by playing massive multiplayer online games and spent more time on online games. Getting engaged with multiplayer online games was the important reason for not giving proper attention towards the online classes conducted by their schools. Awareness has to be given to both adolescents and their parents to hit a balance.
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Coronavirus disease [Covid 19] is an infectious communicable disease caus-ing severe causality among the world’s population. A communicable disease with high intense spread rates originated from China. As a result the world has locked all its gates, lockdown prevails in the entire world. Economy-the most affected sector in any country, daily life living is now restricted. The main aim of this study is to test the knowledge and create awareness on various attributes that are related to the Indian economy among the Trichy popula-tion. A self assessed questionnaire containing 14 questions about Indian economy during COVID 19 were framed and was shared through an online survey platform. The questionnaire was passed to 109 individuals. Responses from them were collected and were analysed through SPSS. Many residents from Trichy are aware about various aspects that affect our economy. Most of the responses from them were relevant and correct, emphasizing that they are already aware in these Fields. Pandemic plays an important role in deciding a country’s economy. It shows its effects on all sectors of the government. Mea-sures should be adopted by the citizens in order to escape from this economic fever. © 2020, J. K. Welfare and Pharmascope Foundation. All rights reserved.