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The devastating effect of Covid19 on the Indian economy is by now well-known. The growth rate of the economy slumped to a negative figure in the year 2020-21. What is less talked about, however, is the fact that growth slowdown in India had started several years before the pandemic struck. The two questions that naturally arise are: what explains the long economic slowdown and what can be done about it. This book is an in-depth analysis of the economic slowdown in India in recent years and the reasons behind the persistent slowdown in the growth rate of the Indian economy in the 2010s, especially in the latter half of the decade. While discussing both macro- and microeconomic policies, the volume examines how the perspective on economic policy has evolved over time in consonance with experience by investigating major instances of such slowdowns in the past. Three global slowdowns (viz. the Great Depression of 1929, the stagflation induced by the oil crisis of the 1970s and the Global Financial Crisis of 2007) and the industrial deceleration in India in the late 1960s and early 1970s are discussed. The author also probes into the problems of inequality, poverty, inflation in the Indian economy pre- and post- pandemic and policies targeted towards development, manufacturing, and distribution of vaccines. The book further discusses possible economic impacts of the Ukraine War and the long-term problem of global warming. Concise and thoroughly researched, this book will be of interest to beginners, scholars, research students and teachers interested in economics, policy making and development studies. © 2023 Asis Kumar Banerjee.
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Background: Chronic cardiovascular morbidities are major public health concern. The objective was to assess awareness and practice of selfcare activities among patients with chronic cardiovascular morbidity in Burdwan Medical College (BMC) and to explore constraints in selfcare practice. Materials & Methods: A facility-based, explanatory sequential, mixed-method study was conducted in Cardiology super-specialty outpatient department of BMC, West Bengal. A calculated sample of 185 patients with chronic cardiovascular morbidity were selected randomly;interviewed with predesigned, pretested schedule (adapted from H-SCALE) for quantitative component. For qualitative component, eight study participants, selected purposively, were interviewed with In-depth-interview guide. Multivariable logistic regression was done to find out predictors of selfcare practice. Thematic inductive analysis was done to explore constraints. Results: 73% study participants were aware about overall selfcare practices;43.8% performed satisfactory overall selfcare practice. Below secondary level educational status [AOR:0.412, 95% CI (0.178-0.956)] and lower & lower-middle socioeconomic status [AOR:0.063, 95% CI (0.017-0.230)] were found to create negative influence on favourable self-care practice. Thematic analysis revealed false belief, lack of motivation, lack of proper knowledge, emotional disturbances and Covid-19 pandemic impact as major constraints in selfcare practice. Conclusion: Selfcare awareness & practice both are low. Interventions are needed to ensure healthy lifestyle of patients. © 2023 National Journal of Community Medicine.
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This is the second part of a two-part series article. Recently, we have been in the middle of a difficult time due to the Covid-19 pandemic. Pandemics or global epidemics are not new to humankind;they have occurred many times in history. The discourse of epidemiology describes mainly the causal factors which need to be mitigated to prevent or combat the effects of epidemics. In epidemiology, we are not concerned for a person, but rather every individual globally, to make life healthier for all. In this article, we will discuss the basics of epidemiological practice that scientists have used for centuries to prevent epidemics with great results. Overall, we plan for better global health aided by epidemiology. © 2023, Indian Academy of Sciences.
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Background & Purpose: Pregnant women are at higher risk of developing severe COVID-19 compared with non-pregnant women, particularly in the third trimester1. Despite ongoing campaigns, the proportion of pregnant women vaccinated against SARS-CoV-2 is lower than in the general population2. The medium-term effects of COVID-19 during pregnancy are not well characterized. We report a cohort of pregnant women admitted to hospital with moderate-to-severe COVID-19. Method(s): Data from clinical records were retrospectively collected from all pregnant women admitted through the maternity assessment unit at St. Thomas' Hospital, between January 2021 and January 2022, due to COVID-19 requiring oxygen to maintain saturations >94%. Result(s): Fourteen women were identified (age=33.4+/-5.2 years;42.8% Caucasian;28.6% Black), requiring admission at 31+/-4.7 weeks gestation. Only two were double vaccinated (14.2%). Body mass index (BMI) was 27.2+/-6.4 kg/m2. Two women had concomitant co-morbidities (asthma and type 1 diabetes). They were managed in the obstetric high- dependency unit (level 1), barring one that required invasive ventilation for one day. The Delta variant was most commonly implicated (43%). All women requiring oxygen received steroids. Four women received Tocilizumab and three casirivimab/imdevimab;two received both. Four women were delivered by emergency Caesarean section due to maternal or fetal concerns, while the others continued their pregnancies. There was one late intrauterine death at 35 weeks. Women were followed-up for an average of six weeks. At follow-up in the obstetric medicine COVID-19 clinic, all women had complete resolution of COVID-19 on clinical examination, pulse oximetry and chest radiograph. Conclusion(s): In 14 pregnant women requiring admission to hospital for hypoxia secondary to moderate-to-severe COVID-19, concomitant co-morbidities and high BMI were not prevalent. Most were not vaccinated against SARS-CoV-2. Despite experiencing moderate-to-severe COVID-19, they had complete clinical and radiological resolution at six weeks follow-up.
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Background: Myasthenia gravis (MG) is an autoimmune disorder leading to variable degrees of skeletal muscle weakness. During pregnancy, infections can trigger exacerbations and should be treated promptly and aggressively.(1) Sotrovimab is a monoclonal antibody used as monotherapy in high-risk, symptomatic non-hospitalized patients at risk of developing COVID-19 disease. (2) It is thought to have retained activity against SARS-CoV-2 omicron variant. (3) Limited data are available on its use in pregnancy. Case: A 39-year-old woman with severe generalized MG, was referred to our joint neuro-obstetric multidisciplinary service. Her two previous pregnancies were complicated by severe exacerbations of MG necessitating intensive care admissions, and preterm labour. Her long-term therapy included high dose steroids, intravenous immune globulin (IVIG) and plasma exchanges. In this pregnancy, she additionally received rituximab in the first-trimester, allowing her prednisolone to be weaned to 20 mg daily, with ongoing 3-weekly IVIG. She received 3 doses of the Pfizer COVID-19 vaccine. At 19 weeks she developed mild coryzal symptoms, sore throat and myalgia. Lateral flow and polymerase chain reaction tests in the community confirmed infection with SARS-CoV-2. She was treated with sotrovimab with uneventful recovery at home. At 31 weeks, she again tested positive for SARS-CoV-2, after reporting mild COVID-19 symptoms. She received a second dose of sotrovimab and had a quick recovery. Subsequent SARS-CoV-2 genotyping indicated she had contracted the Omicron-BA.2 variant. Fetal surveillance for growth (SARS-CoV-2) and arthrogryposis (MG) did not raise concerns. At 35+3 weeks, she went into spontaneous labour and was delivered by caesarean section for evolving chorioamnionitis, with uneventful recovery for mother and baby. Discussion(s): We report a case of repeated treatment with sotrovimab (in second and third trimesters) of a high-risk, non-hospitalized pregnant woman, who was re-infected with SARS-CoV-2. We identified no immediate maternal, fetal or neonatal complications following two doses of sotrovimab for mild COVID-19.
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Ventilators have become the need of the hour in view of the pandemic COVID-19. Hospitals around the world have faced difficulty in managing the same. Non-Invasive Ventilation (NIV) involves offering breathing support in the form of a mask which can be a nasal or a face mask or a helmet. The proposed work analyses the design aspects of a helmet-based NIV and its effective management through the usage of a dedicated website capable of communicating with the ventilator directly. The entire analysis is carried out using the simulated ventilator model on Simulink. The communication aspects are tested by conveying necessary information to ThingSpeak, an IoT based analytics platform, which can be accessed by the user through a website. The website can be used to check availability of ventilators at places. © 2022 IEEE.
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Unemployment is a circumstance which arises when people above a specific age are not engaged in any kind of activities which contribute to the economic welfare of the individual and country. Unemployment is becoming a rising concern which is making the daily life of people difficult. Unemployment causes poverty and depression among the citizens. Nowadays there are different opportunities in different sectors. But people are not aware of those opportunities. Different states are there where there is a lack of skilled labour whereas many states are there that have skilled labour but less opportunities. Another reason for unemployment since 2020 is the COVID-19 pandemic. We have selected this topic to spread awareness among the citizens. This work attempts to detect the states of India which are in serious need of increasing employment opportunities. We have applied the concept of Supervised Machine Learning algorithms to detect the states with the lowest employment rate. The data visualization gives a better picture of the trends in unemployment rate over years. There has been a use of different popular algorithms like Logistic Regression, Support Vector Machine, K-nearest neighbors (kNN) Algorithm and Decision Tree. In the end we have tried to find the algorithm which is going to give us more accuracy so that necessary steps can be taken for the employment of the eligible and deserving people. © 2022 IEEE.
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Rationale: Current guidelines recommend peanut introduction to high-risk infants. However, compliance and rates of new peanut allergy (PA) require further study. Methods: Participants aged 4-11 months with no prior peanut exposure and (i) diagnosis of non-peanut food allergy, (ii) moderate-severe atopic dermatitis, or (iii) first degree relative with PA were enrolled. PA status was determined by skin testing and food challenge. Participants without PA were advised to consume 2 grams of peanut protein three times/week. Monthly questionnaires were administered, with follow-up visits at 18 and 30 months. Results: At baseline, 35/326 (11%) participants were peanut allergic. Of 291 without PA, 78 (27%) discontinued peanut at least temporarily 115 times during follow-up because of suspected participant reaction (40%), fear of reaction (3%), reaction or fear of reaction in a family member (21%), participant refusal (9%), peanut introduction was too much work (3%), or other reasons (23%), including the COVID-19 pandemic. Six of 291 participants (2.1%) who consumed peanut developed PA (2 consistent with FPIES). Among 291 participants without PA at baseline, none of the 17 participants with initial skin prick test of at least 4 mm and <10 mm developed PA. Conclusions: New PA after early introduction recommendations was rare, confirming the LEAP study findings. Transient discontinuation was common, mostly due to suspected participant reaction. High-risk children may require substantial support to keep peanut in their diet.
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Given the enormous global impact of the COVID-19 pandemic, outbreaks of highly pathogenic avian influenza in Canada, and manifold other zoonotic pathogen activity, there is a pressing need for a deeper understanding of the human-animal-environment interface and the intersecting biological, ecological, and societal factors contributing to the emergence, spread, and impact of zoonotic diseases. We aim to apply a One Health approach to pressing issues related to emerging zoonoses, and propose a functional framework of interconnected but distinct groups of recommendations around strategy and governance, technical leadership (operations), equity, education and research for a One Health approach and Action Plan for Canada. Change is desperately needed, beginning by reorienting our approach to health and recalibrating our perspectives to restore balance with the natural world in a rapid and sustainable fashion. In Canada, a major paradigm shift in how we think about health is required. All of society must recognize the intrinsic value of all living species and the importance of the health of humans, other animals, and ecosystems to health for all. © 2022 Authors: Mubareka, Amuasi, Banerjee, Carabin, Jack, Jardine, Jaroszewicz, Keefe, Kotwa, Kutz, McGregor, Mease, Nicholson, Nowak, Reed, Saint-Charles, Simonienko, Weese, Parmley, and The Crown.
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Background and Objectives: Pregnancy, an altered physiological state, is specifically vulnerable to psychological distress (PD), more so during the coronavirus disease 2019 (COVID-19) pandemic. This can impart detrimental consequences to both mother and child. This study assessed the magnitude of PD and associated factors among pregnant women in rural West Bengal. The proportion of pregnant women with COVID-19 symptomatology and its relationship with PD was also determined. Methods: This cross-sectional study was done among 130 pregnant women availing antenatal care in health centers during August-October 2020. Patient Health Questionnaire (PHQ-4) was used to assess PD and a 'Perception on COVID-19 Pandemic' (PCP) Scale was used to assess the perception of the COVID-19 pandemic (Cronbach's alpha = 0.75). Statistical analyses were done in SPSS Inc., SPSS for Windows, Chicago, USA. Results: The proportion of study participants with PD was 49.2%. Unsatisfactory antenatal care (AOR = 19.4, CI = 2.5-152.7), COVID-19 case within family/neighborhood (AOR = 6.3, CI = 1.2-34.9), strenuous spousal relationship (AOR = 7.3, CI = 1.1-50), increasing score in perceived susceptibility domain of PCP Scale (AOR = 1.3, CI = 1.1-1.6), and decreased daily sleep duration (AOR = 2.8, CI = 1.6-4.9) were found to be associated with PD. 38.5% of participants reported COVID-19 related symptoms. Conclusion: The magnitude of PD among pregnant women in the study area is high. Thus, proper counseling of pregnant mothers during antenatal visits by public health nursing personnel to alleviate fears about the pandemic would go a long way to reduce the negative impact of PD on mother and child. © 2022 Medical Journal of Dr. D.Y. Patil Vidyapeeth ;Published by Wolters Kluwer - Medknow.
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Portfolio optimization is one of the important problem classes in finance sector. As the world economy recovered and reaching the pre-COVID levels and is still continuing to grow, it is imperative to understand what kind of impact COVID-19 had on portfolio optimization and how quantum computers can be used in doing so. Hybrid quantum algorithms like variational quantum eigen solver (VQE), quantum approximate optimization algorithm (QAOA) have been tried for identifying optimal portfolios. In the present work, we employ these algorithms to carry out portfolio optimization for different time intervals (which includes pre and during COVID-19 periods) and unravel the impact of COVID19 on the same, across different industries. Our results show that the companies' stocks were growing steadily more on a sideways movement from 2016-2017. The stocks start to pick momentum from 2018-2019 and in 2020 early months as dip can be observed, however all the stocks recover to normal levels and even reaching lifetime highs from second half of 2020.
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Background: Electrical storm (ES) characterised by multiple episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) represents an increasingly difficult management problem in critical care. (1) Although, it occurs more frequently in adults, there are reports of its occurrence in children. Common causes of ES include genetic, structural heart disease and few reversible causes like endocarditis, myocarditis. In post corona virus (COVID) era, multisystem inflammatory syndrome in children (MISC) represents common cause of myocarditis in children. MISC can also be associated with superadded bacterial infection, of which endocarditis represent life threatening entity. Acinetobacter endocarditis is a rare causative agent of endocarditis in children. (2) We present an interesting case of ES in MISC state with endocarditis. Case report: A 2 month old child presented to the emergency department (ED) with hemodynamically significant ventricular tachycardia (VT) which was reverted with electrical cardioversion. Amiodarone and propranolol therapy was initiated, despite which the child suffered four episodes of hemodynamically significant VT in next 24 hours requiring electrical cardioversion and was put on elective invasive ventilation. Echocardiography revealed intracardiac hyperechoic oscillating mass attached to anterior mitral leaflet with normal left ventricular systolic function. (Fig 48) Blood investigations revealed raised anti COVID antibody with high inflammatory markers. Blood culture drawn at admission was positive for Acinetobacter and was treated with appropriate antibiotics. The child had VT free period of four days with pulse methylprednisolone and amiodarone. The child was gradually weaned from ventilator and put on non-invasive ventilation (NIV). While on NIV the child suffered another cardiac arrest, cause of which could not be ascertained. During this episode, the child suffered from irreversible neurological damage and eventually succumbed in the next 24 hours. Conclusion(s): MISC myocarditis and endocarditis both represent a state of high mortality, compounded more by electrical storm which can be difficult to manage, as in our case. [Formula presented] Copyright © 2022
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Background: Cardiac calcification is a broad entity encompassing calcific deposits in the valves, coronary arteries, aortic root, myocardium, endocardium, or pericardium. It is reported in approximately 19 percent of post myocardial infarction (MI) patients. (1) Coronary artery disease is by far the commonest cause of endo-myocardial calcification, other causes include endomyocardial fibrosis, myocarditis, metastatic calcification in chronic kidney disease patients. Post - acute coronavirus (COVID) syndrome is defined as the persistence of symptoms even beyond 4 weeks of onset of acute symptoms. (2) A recent study has shown that, beyond the first 30 days after infection, individuals with COVID are at increased risk of incident cardiovascular disease including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease. (3) This study cited the risk and additional burden of ischemic heart disease outcome as an hazard ratio of 1.66 (95% confidence interval of 1.52 - 1.80) and 7.28 (95% confidence interval 5.8 - 8.88) per 1000 population respectively. (3) We present an interesting case of a forty-three-year-old man with endo-myocardial calcification with ischemic cardiomyopathy (ICMP) and severely reduced left ventricular (LV) global longitudinal strain (GLS) in post COVID syndrome. Case report: A forty - three-year-old man presented to us with gradually worsening dyspnea on exertion - New York Heart Association (NYHA) grade II at present - and pedal edema since the past 6 months. He had a history of COVID infection prior to that for which he received institutional care and was discharged uneventfully - not requiring any intensive care stay during the hospitalization. On presentation now a 12-lead electrocardiogram was done which revealed left bundle branch pattern. He underwent - an echocardiogram which showed a reduced ejection fraction of 38 % along with regional wall motion abnormality in anterior, apical and lateral wall;a computed tomogram of thorax which did not reveal any lung disease but endo - myocardial calcification. (Fig 3) He further underwent myocardial strain imaging using echocardiography, which revealed a severely reduced LV GLS. (Fig 4) Routine blood investigations including inflammatory markers and Troponin levels were within normal limit, brain natriuretic peptide (BNP) levels were found to be very high. The patient underwent coronary angiogram which revealed significant disease in distal left main coronary artery and ostio-proximal left anterior descending and left circumflex artery. After detailed heart team discussion along with patient relatives the patient was advised coronary artery bypass grafting. The patient took discharge and went to a different hospital to undergo the same. Conclusion(s): Acute Coronavirus infection has already been wreaking havoc all around the globe since the past 3 years. We have now showcased a unique and devastating consequence of the post COVID state in a relatively young man. [Formula presented] [Formula presented] Copyright © 2022
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SARS-CoV-2 virus primarily affects the respiratory system, although other organ systems are also involved. Though pulmonary arterial hypertension (PAH) has been described in as a sequela of COVID pneumonia in adults, only a coincidental association between pre-existing PAH and SARS-CoV-2 infection in children has been reported. To our knowledge, severe COVID pneumonia-causing PAH in children, especially in infancy has not been reported yet. With the meteoric spread of the pandemic and rapid development of newer mutated variants, the timely discovery of new drugs is near impossible. The idea of repurposing existing drugs to treat COVID-19 is an attractive strategy, especially if they are already approved (for other indications) and have well-established safety profiles. Sildenafil specifically targets pulmonary vasodilation, endothelial function, and vascular remodelling. It hence has emerged as an effective first-line oral therapeutic agent for patients with symptomatic PAH in all age groups. We present a case series of four cases where Sildenafil has been repurposed for the treatment of PAH associated with severe COVID-19 pneumonia in infancy. Copyright © 2022 by author(s).
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Background and Aims: The aim of this project was to compare the performance of Addenbrooke's acute stroke team from September 2018 - September 2021 to the UK National Stroke Service Model time-targets for hyperacute stroke management. This period was chosen to cover performance before and during COVID, because the pandemic instigated radical changes in hyperacute stroke management processes and team structure in Addenbrooke's Hospital. From this audit, we hoped to determine the effects of these changes - the strengths and weaknesses of different team and process permutations to advise the development of an ideal stroke service model. Method(s): Data on door-to-1st responder time, door-to-CT time, door-to-thrombolysis time, door-to-thrombectomy time and door-toconsultant time for patients presenting during working hours (Mon-Fri, 0900-1700) from September 2018 to September 2021 was extracted from Addenbrooke's Hospital SSNAP database. Statistical analysis revealed a non-parametric distribution, thus median time and IQR were calculated for comparison between different covering teams. Kruskal- Wallis analysis was used to compare data of different teams, and subsequently, if significance was identified, pairwise Mann-Whitney U tests were conducted to determine statistically different groups. Result(s): Door-to-1st responder, door-to-CT, door-to-thrombolysis, door-to-thrombectomy, and door-to-consultant time varied over the 3 years depending on cover. Group 4 was identified as having significantly lower door-to-1st responder and door-to-consultant times. Conclusion(s): Better staffing and top-down prioritisation for consultant review were identified as factors supporting quicker management. Reduction of door-to-CT time, simplification of CT algorithm for rapid thrombolysis and expansion of thrombectomy services were identified as changes which could potentially improve hyperacute stroke management in Addenbrooke's Hospital. (Figure Presented).
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Introduction: Management of T1D with BD during lockdown was challenging. Objective(s): To explore parents' experience in managing CYP with T1D & BD during the lockdown and its influence in this cohort. To understand the effect of lockdown on emotional health for providing better care in the future. Method(s): The parents were randomly selected (n = 10) from the diabetes clinic. The data were collected using structured open and closed-ended questionnaires. Thematic analysis & deductive coding techniques were used to construct a theory. Result(s): Most parents believe that the risk of COVID-19 was higher than that of T1D complications, leading to delays in seeking medical attention. Fear, anxiety, and helplessness were the most common emotions linked to uncertainty, conflicting information and unending speculation based on daily media reports of fatalities. Most parents described isolation, restricted physical activity, and stress-induced eating behavior as responsible for weight gain and poor diabetes control. Parents universally stated reduced quality of life, worsening symptoms of autism and attention deficit hyperactivity disorder, explained partly by the suspension of traditional care during the lockdown. Parents reported CYP as having more frequent episodes of meltdowns, arguments, emotional outbursts, destructive behavior, deliberate self-harm, and sleep disturbances and anxiety around losing family members to COVID-19. Additionally, loss of extended family support/peer support in school during the lockdown and a 'toxic' home environment aggravated behavioral deterioration. Furthermore, the suspension of traditional consultant-led clinics and unfamiliarity with remote consultations were other influencers of anxiety. Conclusion(s): Parents reported a significant deterioration in the behavior of CYP with T1D & BD during the lockdown, which may affect their T1D control. Future studies are required to better understand the health need of this unique cohort so that resources can be aptly diverted to deliver patient-focused diabetes care.