Prevalence of Glaucoma in Cataract Patients - a Comparison between Pre-Covid and Post-Covid Periods

Objectives: Globally, cataract and glaucoma are the predominant causes of blindness. Screening glaucoma in patients referred for cataract surgery is a convenient tool for detecting glaucoma cases in rural population. The COVID period has adversely affected eye care as the routine screening and follow-ups at hospital were substantially reduced owing to pandemic restrictions. We aim to study the impact of COVID on detection of glaucoma in patients with cataract. Method(s): It was a retrospective study conducted to compare the prevalence of glaucoma in rural patients presenting with cataract pre- and post-COVID. Details of 975 consecutive patients each were taken prior to March 2020 (pre-COVID) and after October 2021 (post-COVID) from hospital database and patient case files. Result(s): The prevalence of glaucoma was higher during the pre-COVID time (3.8%) as compared to pre-COVID (3.8%), but the result was not statistically significant. In both the groups, primary open-angle glaucoma was the pre-dominant form of glaucoma, with prevalence being 1.5% and 2.2% in the pre-COVID and post-COVID groups, respectively. The mean intraocular pressure and mean VCDR values were higher in the post-COVID group as compared to the pre-COVID group, and the result was statistically significant. Conclusion(s): This was the first study to compare the prevalence of glaucoma in patients with cataract in rural population in the pre-COVID and post-COVID periods. In the aftermath of the pandemic, the present study emphasizes the role of screening and follow-ups in glaucoma management to prevent irreversible loss of vision.Copyright © 2023 The Authors.

Perspective of dental health-care professionals during the second wave of COVID-19 pandemic: a national online survey

Objectives: COVID-19 pandemic has shown a substantial impact on the entire world both physiologically and psychologically. By the hit of the second wave, which opened dangerous gates for secondary infections, apprehension was carried among health-care sectors. These secondary infections were due to decreased immunity. On the other hand, risk modifiers, such as diabetes and hypertension played a leading role in the mortality rate. A substantial number of studies have not been conducted so far regarding the impact of this second wave on dental healthcare professionals. The present study aimed to evaluate the dental healthcare professionals' perspective levels during the second wave of the COVID-19 pandemic through a web-based survey. Material and Methods: A total of 853 responses were gathered by sending 15 questions in Google forms. Data collected were gathered and subjected to statistical analysis, expressed in frequency distribution and Pearson's Chi-square test was performed. Results: Data obtained and projected that the study population expressed higher anxiety and stress levels, despite which was many of them showed an inclination to work during these tough times. The knowledge about secondary fungal infections like Mucormycosis, which was caused due to immune suppression, was abundant among the participants. A significant proportion conveyed the ill effect of COVID-19 on clinical practice and academics as well. Conclusion: Dental professionals have shown a positive perspective despite of higher stress levels and being a part of frontline workers, they are much primed to assure, educate, and treat the patients amidst the COVID-19 pandemic.

New horizons for e-Learning in nephrology: The ISN Video Abstracts Series initiative

Introduction: Triggered by the recent revolution posed by the digital era, medical education has evolved enormously over the last decade. Much of this transformation was further accelerated by the COVID-19 pandemic. Video Abstracts are an innovative tool in science communication allowing a quick overview of a scientific paper. It can be used to build capacity by connecting patients and healthcare professionals to education and research, fostering critical thinking, and filling gaps in education. The Video Abstracts Series is an initiative that was envisioned by the ISN Education Working Group in association with the DOPPS collaboration and put into action by the ISN Education Social Media Team. Starting in Dec 2021, the International Society of Nephrology (ISN) Video Abstracts Series has integrated the ISN global education strategy. The videos are allowed a maximum length of 2:20 min to fit the Twitter limits. It constitutes a video narrative of a study's principal characteristics and findings. The project was fully developed based on voluntary work, from conception to video production. Method(s): This study aimed to assess quantitatively the impact of the ISN Video Abstracts Series initiative. From Dec 2021 to Sept 2022, video impressions, engagements, and video views from Twitter, Facebook, LinkedIn, Instagram, and the Academy were analyzed. Result(s): The ISN Video Abstracts Series highlighted studies published in the Kidney International Reports (KIR, n=12);Kidney International (KI, n=12);and the ISN-DOPPS initiative (n=1). In combination, the 25 Video Abstracts, resulted in 139,402 impressions;3,434 engagements;and 25,041 video views. Most of the interactions occurred on Twitter (79.8%). In this digital platform, on average videos had 5,300 impressions and 790 views. The videos redirected the user to the journal publication in 435 instances. The ISN Video Abstracts Series addressing the KIR publication "Nicotinamide Adenine Dinucleotide Biosynthetic Impairment and Urinary Metabolomic Alterations Observed in Hospitalized Adults With COVID19-Related AKI", had the most views (n=2,125). Conclusion(s): The future of continuing medical education relies on new strategies and media to build capacity and bridge the gaps. The ISN offers a wide variety of educational and interactive resources through Social Media and the ISN Academy, its official e-Learning portal. The Video Abstracts Series is an innovative, inclusive, and resourceful tool. It combines sharp and concise information with an entertaining format that captures and retains the user's attention, opening new perspectives in the ISN strategy to boost continuing medical education in nephrology globally. No conflict of interestCopyright © 2023

Known *Anti Sars-Cov Protease Inhibitors* On Sars-Cov-2 Related Intracellular Reception Sites: *Docking Interaction* And Computer Aided Optimization Of Molecular Structure For *Chemioselective Interactions*

Molecular docking and molecular dynamics aided virtual search of OliveNet™ directory identified potential secoiridoids that combat SARS-CoV-2 entry, replication, and associated hyperinflammatory responses. OliveNet™ is an active directory of phytochemicals obtained from different parts of the olive tree, Olea europaea (Oleaceae). Olive oil, olive fruits containing phenolics, known for their health benefits, are indispensable in the Mediterranean and Arabian diets. Secoiridoids is the largest group of olive phenols and is exclusive to the olive fruits. Functional food like olive fruits could help prevent and alleviate viral disease at an affordable cost. A systematized virtual search of 932 conformers of 78 secoiridoids utilizing Autodock Vina, followed by precision docking using Idock and Smina indicated that Nüzhenide oleoside (NZO), Oleuropein dimer (OED), and Dihydro oleuropein (DHO) blocked the SARSCoV-2 spike (S) protein-ACE-2 interface;Demethyloleuropein (DMO), Neo-nüzhenide (NNZ), and Nüzhenide (NZE) blocked the SARS-CoV-2 main protease (Mpro). Molecular dynamics (MD) simulation of the NZO-S-protein-ACE-2 complex by Desmond revealed stability during 50 ns. RMSD of the NZO-S-protein-ACE-2 complex converged at 2.1 Å after 20 ns. During MD, the interaction fractions confirmed multiple interactions of NZO with Lys417, a crucial residue for inhibition of S protein. MD of DMO-Mpro complex proved its stability as the RMSD converged at 1.6 Å. Analysis of interactions during MD confirmed the interaction of Cys145 of Mpro with DMO and, thus, its inhibition. The docking predicted IC50 of NZO and DMO was 11.58 and 6.44 μM, respectively. Molecular docking and dynamics of inhibition of the S protein and Mpro by NZO and DMO correlated well. Docking of the six-hit secoiridoids to IL1R, IL6R, and TNFR1, the receptors of inflammatory cytokines IL1β, IL6, and TNFα, revealed the anti-inflammatory potential except for DHO. Due to intricate structures, the secoiridoids violated Lipinski's rule of five. However, the drug scores of secoiridoids supported their use as drugs. The ADMET predictions implied that the secoiridoids are non-toxic and pose low oral absorption. Secoiridoids need further optimization and are a suitable lead for the discovery of anti-SARS-CoV-2 therapeutics. For the moment, olive secoiridoids presents an accessible mode of prevention and therapy of SARS-CoV-2 infection.

Medical Image Classifications: Deep Learning Prospective

Machine learning and deep learning technologies are reshaping the global medical industry at a breakneck pace. Image classification is one of its rapidly expanding fields. It is incorporated into nearly all technologies aimed at achieving intelligent smart health systems. The current paper implements and applies two image classification models based on convolutional neural network (CNN) versions to various image classification datasets. The current work makes use of the significant lungs X-ray images from COVID-19 medical datasets. It analyses the models' accuracy by adjusting their parameters such as layer count and activation function in order to identify the ideal parameters for CNN that provide the highest accuracy while classifying images. It evaluated the models' performance on the desired dataset and calculated the F-score, specificity and sensitivity matrices to validate the suggested models, as well as analysing their behaviour as a function of the image type. It achieves an accuracy of 90% for lungs X-rays in the COVID-19 dataset. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Genomic sequencing profile of SARS-CoV-2 in different parts of western Odisha, India

Genetic lineages of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) have continued to emerge and circulate around the world since the onset of the COVID-19 pandemic. There are numerous variants of SARS-CoV-2, the virus that causes corona virus disease 2019 (COVID-19). Like other viruses, SARS-CoV-2 evolves over time. Most mutations in the SARS-CoV-2 genome have no impact on viral function, but certain variants have gained worldwide attention because of their rapid emergence within populations, evidence of transmission, and clinical implications. During the pandemic, most parts of India were affected, including Odisha, leading to high rates of morbidity and mortality. For the present study, 368,303 samples were received by the COVID-19 lab i.e., medical college level (Virus Research Diagnostic Laboratory) VRDL from six districts of western Odisha, including approximately 25,000 COVID-19-positive samples. The diagnostic method of the quantitative RT-PCR cannot be used to distinguish among the variants created by mutation of the genes initially, therefore selected positive clinical samples were sent in cold chain for whole genome sequencing (WGS), using the Illumina Seq. at ILS, BBSR for variant detection. The reported observation from the next generation sequencing (NGS) based sequenced samples of western Odisha updated in the INSACOG-WGS portal confirms the presence of Delta (B.1.617.2) and Delta sublineages, Omicron (BA.2), and Omicron (B.1.1.529). Maximum infection was caused by Delta sublineages (83.5%) irrespective of age, sex, and geographic area followed by Delta and Omicron. Molecular diagnosis and WGS based study reveal the widespread transmission of the fatal virus, significantly affecting every corner of the globe. Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.

Molecular Medical Diagnosis of COVID-19 and Omicron Variant

Genetic lineages of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) have continued to emerge and circulate around the world since the onset of the COVID-19 pandemic. There are numerous variants of SARS-CoV-2, the virus that causes corona virus disease 2019 (COVID-19). Like other viruses, SARS-CoV-2 evolves over time. Most mutations in the SARS-CoV-2 genome have no impact on viral function, but certain variants have gained worldwide attention because of their rapid emergence within populations, evidence of transmission, and clinical implications. During the pandemic, most parts of India were affected, including Odisha, leading to high rates of morbidity and mortality. For the present study, 368,303 samples were received by the COVID-19 lab i.e., medical (Virus Research Diagnostic Laboratory) VRDL from six districts of western Odisha, including approximately 25,000 COVID-19-positive samples. The diagnostic method of the quantitative RT-PCR cannot be used to distinguish among the variants created by mutation of the genes initially. Therefore, selected positive clinical samples were sent in cold chain for whole genome sequencing (WGS), and disease severity was sequenced using the Illumina Seq at ILS, BBSR for variant detection. The reported observation from the next generation sequencing (NGS) based sequenced samples of western Odisha updated in the INSACOG-WGS portal confirms the presence of Delta (B.1.617.2) and Delta sub lineages, Omicron (BA.2), and Omicron (B.1.1.529). Maximum infection was caused by Delta sub lineages 83.5%) irrespective of age, sex, and geographic area followed by Delta and Omicron. Molecular diagnosis and WGS based study reveal the widespread transmission of the fatal virus, significantly affecting every corner of the globe. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Effect of Migrant Labourer Inflow on the Early Spread of Covid-19 in Odisha: A Case Study

Odisha is a state in the eastern part of India with a population of 46 million. Annually, a large number of people migrate to financial and industrial centers in other states for their livelihood earning. Bulk of them returned to Odisha during the early stage of national lockdown (March June2020) due to the Covid-19 outbreak as their places of work became Covid hotspots while Odisha was much less affected. This triggered the Odisha government to take precautionary measures such as mandatory quarantine of returning migrants, setting up of containment zones, and establishing temporary medical centres (TMC). Moreover, it was necessary for the government to devise a policy that could slow down the spread of Covid-19 in Odisha due to inflow of migrants. Being part of a task-force constituted by government to understand Covid-19 spread dynamics in Odisha, we predicted the number of people who would get infected primarily due to reverse-migration. This helped the government to make timely resource mobilisation. After analyzing reasons behind the rise in infections at various districts with large migrant population, we mapped the prediction problem to Sequential Probability Ratio Test (SPRT) of Abraham Wald. Our predictions were highly accurate when compared with real data that were obtained at a later stage. Two levels of SPRT were carried out over the data provided by the government. Use of SPRT for Covid-19 spread analysis is novel, particularly to predict the number of possible infections much ahead in time due to the sudden inflow of migrants.

Medical Image Classifications: Deep Learning Prospective

Machine learning and deep learning technologies are reshaping the global medical industry at a breakneck pace. Image classification is one of its rapidly expanding fields. It is incorporated into nearly all technologies aimed at achieving intelligent smart health systems. The current paper implements and applies two image classification models based on convolutional neural network (CNN) versions to various image classification datasets. The current work makes use of the significant lungs X-ray images from COVID-19 medical datasets. It analyses the models’ accuracy by adjusting their parameters such as layer count and activation function in order to identify the ideal parameters for CNN that provide the highest accuracy while classifying images. It evaluated the models’ performance on the desired dataset and calculated the F-score, specificity and sensitivity matrices to validate the suggested models, as well as analysing their behaviour as a function of the image type. It achieves an accuracy of 90% for lungs X-rays in the COVID-19 dataset. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Stacked BiLSTM with ResNet50 for Medical Image Classification

The healthcare sector plays a significant role in the industry, where a client looks for the highest amount of care and services, no matter the cost. However, this sector has not satisfied society's presumption, even if this industry consumes a considerable percentage of the national budget. In the past, medical experts have been looking for smart medical solutions. This work focuses on accurate and early detection of illness from various medical images. Early detection not only aids in the development of better medications but can also save a life in the long run. Deep learning provides an excellent solution for early medical imaging in healthcare. This paper proposed a Stacked-based BiLSTM with Resnet50 Model using an AdaSwarm optimizer to classify and analyze the medical illnesses from the different medical image datasets. For this study, four medical datasets were used as benchmarks: Covid19, Pneumonia, Ma, and Lung Cancer. Accuracy, AUC, ROC, and F1 Score performance metrics are used to evaluate the prosed model from other models. The proposed model gives a mean ACCURACY, AUC, ROC, and F1 Score on these four datasets are 98%, 99%, 97%, and 98%, respectively. © 2022 IEEE.

Face Mask Detection in Public Places Using Small CNN Models

The spread of coronavirus can be prevented among the people in a crowded place by making face mask mandatory so that the droplets from the mouth and nose would not reach the masses nearby. The negligence of some people, i.e., by not wearing the mask, causes the spread of this pandemic. Therefore, persons who do not wear masks should be tracked at the entrance to public venues such as malls, institutions, and banks. The mechanism proposed warns if the individual is wearing or not wearing the mask. The proposed system is built in a small CNN model to integrate any low-end devices with minimal cost. The small CNN model like ShuffleNet and Mobilenetv2 are evaluated in Transfer Learning and Deep Learning but the Deep Learning model has better performance than the Transfer Learning. Again, the Deep Learning approach, i.e., mobilenetv2 plus Support Vector Machine achieved 99.5% accuracy, 99.01% sensitivity, 100% precision, 100% FPR, 99.51% F1 score, 99.01% MCC, and 99.01% kappa coefficient. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

A Retrospective Analysis of Effect of COVID-19 on Revision Total Knee and Hip Arthroplasty

Background: The SARS-CoV-2 (Covid-19) has significantly impacted the health of the people around the globe. Primary Total Hip arthroplasty (THA) and Total Knee arthroplasty (TKA) were significantly affected in the pandemic time. The canceled surgeries of THA and TKA were rescheduled as majority of the beds in the hospitals were occupied by COVID patients. Due to this, patients for such surgery accumulated and many patients faced serious health issues. In addition to THA and TKA, Covid-19 pandemic also significantly impacted Total Joint arthroplasty (TJA) volume. According to analysis, the annual volume of the TKA and THA for 2020 was around 128,000 and 66,000 respectively. Aim: To analyze the effect of COVID-19 on revision total knee and hip arthroplasty. Methods: For the study, the data was collected from the institutional registry for TJA and pending revisions for the TKA and THA patients. Approximately 465 inpatient beds between April 2019 and March 2020 considered for the study. Procedures were conducted for 12 months prior to the initial shutdown of elective surgery (April 19 – March 20). The percentage changes for urgent revisions for TJA were compared focusing on pre and post-Covid TKA and THA. Results: Two groups were defined as pre-Covid patients (n = 190) and post-Covid patients (n= 160). The mean age of the patient in pre-Covid group was 75.3 years (SD = 1.01) and post-Covid group was 68.9 years (SD = 11.52). For TKA revision, in pre-covid group, 33.3% of the patients had Aseptic loosening and 22.2% had Periprosthetic joint infection, and 16.6% required Urgent revision. On the other hand, in post-Covid group, 33.3% of the patients had Aseptic loosening and 21.2% had Periprosthetic joint infection, and 18.1% required Urgent revision. Post-Covid cases of THA were also increased as out of 94 patients, 15.9% required Urgent revision. There was no significant difference between the groups for TKA revision (p>0.05). Similarly, apart from Aseptic loosening (p<0.05), there was no significant difference between the groups for THA revision (p>0.05). Conclusion: It has been carried out that revision of TKA and THA decreased in health care system during Covid-19 pandemic compared to pre-Covid. The numbers of urgent cases were increased in both groups such as the numbers of urgent cases for THA were 15.9% and TKA was 18.1% post-Covid and these are creating the backlog for the care professionals to provide the better treatment and recovery of the patients.

Criminal Activities During COVID-19: Evidence from India

The CVOID-19 Pandemic increased the hardships of millions of people all over the world and also increased the disparity between the rich and the poor with rising unemployment, loss of educational days, institutional failure, infrastructural collapse, malnourishment and malnutrition due to the stringent lockdown measures which forced numerous sections of society into the brink of poverty and destitute. The pandemic has led to multifarious problems require multi-stakeholder approach. The problem of rising criminal behaviour and the increasing crime rates coupled with the failure of the law enforcement institutions to tackle the challenges due to overload, shortage of manpower and the uniqueness of the problem has posed a serious problem to the law-and-order situation of the country. The problem becomes chronic due to the rising technical nature of crimes requiring adequately trained manpower to deal with such issues as well as the necessary dedicated infrastructural support to complement such efforts. The aspect of policy development as a base to cater and legally recognize such nature of crimes also becomes a challenge due to the pandemic induced lockdown and protocols which is crippling the law-making power of the legislatures severely. Based on qualitative approach, this paper tries to study the rising nature of crime and criminal activities in India during the COVID-19 pandemic, reasons and various probable actions and measures to be taken to solve these criminal activities. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Case Report on Cerebral Palsy-with Ayurvedic Treatment Protocol

Cerebral palsy is a non-progressive disorder, which arising in early stages of development of child. There are many etiology factors like antenatal, natal and postnatal factors responsible for causing cerebral palsy but exact cause is still unknown. Spasticity is the main feature of cerebral palsy(). Classification of CP is too broad on the basis of physiological and topographic etc. Symptoms of spastic cerebral palsy can be corelated with Jadhata in Ayurveda. In Jadata, there is tightness of muscles occurs. Improvement can be got in children with ayurvedic treatment. Aim- To improve the quality of life of child suffered from spastic CP. Place and duration of study- Study was done in Parul Ayurved Hospital, Vadodara, Gujarat. Method- In this case study, Samavardhan ghrita() orally, snehana() with bala taila() and svedan () with dashmmola kwath () was given to child for 31 days. Results- mild improvement in spasticity and achievement of milestones have observed. Patient got discharged from IPD of hospital due to COVID 19 pandemic. Conclusion- Hence, through Ayurveda treatment, improvement in symptoms of spastic cerebral palsy can achieve and quality of life of child can increase spontaneously.

Molecular epidemiology of a familial cluster of SARS-CoV-2 infection during lockdown period in Sant Kabir Nagar, Uttar Pradesh, India

We report a familial cluster of 24 individuals infected with SARS-CoV-2. The index case had a travel history &spent twenty four days in the house before being tested and was asymptomatic. Physical overcrowding in the house provided a favourable environment for intra-cluster infection transmission. Restriction of movement of family members due to countrywide lockdown limited the spread in community. Among the infected, only 4 individuals developed symptoms. The complete genome sequences of SARS-CoV-2 was retrieved using next-generation sequencing from eight clinical samples which demonstrated a 99.99% similarity with reference to Wuhan strain and the phylogenetic analysis demonstrated a distinct cluster, lying in the B.6.6 pangolin lineage.

Epidemiology and clinical characteristics of suspected COVID-19 patients with severe acute respiratory infection (SARI) admitted to a tertiary care teaching hospital

Introduction: The COVID-19 pandemic has affected human beings globally. At present, medical science is flooded with literature related to various aspects of COVID-19. But, there is hardly any data found on literature comparing the epidemiology, clinical features, and outcome data of hospitalized COVID-19 SARI patients with non-COVID SARI patients. In this study, we tried to find out the epidemiology, clinical characteristics, and outcome of patients with a severe acute respiratory infection (SARI) admitted as suspected COVID-19 patients in a tertiary care teaching hospital. Objectives: 1. To know the demographic parameter (age, sex, BMI, comorbidities) and clinical characteristics (presenting symptoms, duration of symptoms, disease severity, etc.) of the SARI patients with suspicion of COVID-19. 2. To know the clinical outcome (duration of hospital stay and survival to hospital discharge) in these patients. Materials and methods: It was a prospective observational study, conducted at AIIMS, New Delhi. After obtaining permission from the institute ethics committee and written informed consent from their legally acceptable representatives, adult patients (18-75 years) of either sex, fulfilling WHO case definition of severe acute respiratory infection (SARI) with clinical suspicion of COVID-19 infection were included in the study. No formal sample size estimation was performed as no previous study is available in the Indian population when the study was planned and 450 adult patients (n = 450) were included in the study. The only exclusion criterion was the patients or relatives who refused to provide consent for the study. Demographic parameters, systemic comorbidities, and baseline clinical data were collected at the time of admission. Standard intensive care protocol as per current Surviving Sepsis Guidelines and standard management of respiratory failure and acute respiratory distress syndrome were followed in all patients. Protocolized weaning and extubation were followed. Fluid and vasopressor management was guided by hemodynamic variables and point of care ultrasound. Antibiotics therapy was initiated at presentation as per institute protocol and tailored according to the appropriate cultures (blood, urine, abdominal fluid, and tracheal aspirate whenever suitable) and sensitivity report when available. All data were collected in standard case record proforma. Results: A total of 450 patients with a severe acute respiratory infection (SARI) as per WHO case definition were included in the study. All collected data were entered in a spreadsheet (Microsoft Excel). Normality was tested by Shapiro- Wilk test. Normally distributed data were presented as mean and standard deviation (SD), skewed data as median (Interquartile range) and categorical data were presented as absolute number and percentages. For comparison of related samples, the paired and unpaired t test were used for normally distributed data and the Wilcoxon signed rank test and Mann-Whitney U test were used for skewed data. P value of less than 0.05 was considered as statistically significant. A total of 450 patients with a severe acute respiratory infection (SARI) as per WHO case definition were included in the study. Out of total 450 SARI patients, 291 (64.6%) were positive for SARS-Cov-2 in RT-PCR. The median age of this cohort of SARI patients was 47(34-59) years. All the SARI patients were divided into two subgroups as COVID -19 SARI and non COVID -19 SARI patients. The COVID-19 SARI patients were slightly older in age (48 vs45 years, p = 0.02). The male gender was more common in the whole cohort of SARI patients as well as in both the sub groups. The common presenting symptoms were shortness of breath, malaise, fever, cough, abdominal pain, nausea, nausea / vomiting, chest pain, myalgia, diarrhea, etc. in the cohort of all SARI patients. The incidence fever, cough, and sore throat were higher among COVID-19 SARI patients. There was no significant difference in incidence of shortness of breath, chest pain, nausea and diarrhea runny nose and wheeze b tween both the groups. But the incidence of myalgia and abdominal pain was significantly higher in non-COVID SARI patients. There was there is no significant difference in duration of fever [4 (2-6) vs 3 (2-3) days, p = 0.17] between the two groups of SARI patients. The common comorbid conditions associated in SARI patients were hypertension, DM, CKD, CAD, malignancy, asthma, CLD, COPD, and obesity. The prevalence of these comorbid conditions was similar in both the SARI groups except for CKD and obesity. CKD was more prevalent non COVID-19 SARI patients and obesity was more prevalent COVID- 19 SARI patients. The on admission vital parameters were similar (RR, p = 0.84;HR, P = 0.23;temperature, p = 0.07;SBP, p = 0.05;DBP, p = 0.06) in both group of SARI patients. On comparing the on admission parameters between the two groups of SARI patients, non-COVID SARI patients had significantly low Hb level, low total protein and low albumin level whereas other laboratory parameters (TLC, Platelet, PT/INR, APTT, creatinine, bilirubin) were similar in the both groups. The oxygen saturation/FiO2 ratio was significantly lower in COVID-19 SARI patients. The requirement of ICU admission in this cohort of 450 SARI patients was 33.5%. But, there was no significant difference in requirement of ICU admission between these two groups of SARI patients (32.3% vs. 35.8%, p = 0.44). But, more number of COVID-19 SARI patients required mechanical ventilation (31.6% vs. 22.6%, p = 0.04). The median duration of hospital stay was 9 (5-15) days. The COVID-19 SARI patients had more number of days of hospital stay [11(7-16) vs. 7 (4-12) days, p = 0<000.1]. Among these cohort SARI patients, 34.4% patients died, and there was no significant difference in mortality in these two groups of SARI patients (37.1% vs. 29.5%, P = 0.1) Discussions: To the best of our knowledge, it is the first study on SARI patients that compared epidemiological, clinical features, and outcome data of hospitalized COVID-19 vs non-COVID SARI patients. Conclusion: Clinical features like fever, cough, and sore throat were higher in COVID-19 SARI patients. Though, the need for ICU admission was similar in both the groups, patients with COVID-19 SARI required more mechanical ventilation and more days of hospital stay. But, the death rate was similar in both groups.

Physiological effect of prone positioning in mechanically ventilated SARS-CoV-2 infected patients with severe ARDS: An observational study

Introduction: Prone positioning during mechanical ventilation (MV) has been shown to improve oxygenation and decrease mortality in ARDS patients. Prone position reduces lung strain and stress, leads to a more homogenized distribution of lung aeration and recruitment of dorsal alveoli, thus, leading to improvement in oxygenation.1 In mechanically ventilated patients of severe ARDS with PaO2/FiO2 (P/F) ratio < 150, prone position for at least 16 hours a day for consecutive 4 days decreased 28-day mortality by almost 50%.2 To the best of our knowledge, no study has so far assessed the physiological effect of prone position in SARS-CoV-2 infected ARDS patients undergoing invasive MV. Hence, in this observational study, the physiological effect of prone position in SARS-CoV-2 infected severe ARDS patients is being reported. Objectives: To find out the physiological effect of prone positioning in mechanically ventilated SARS-CoV-2 patients with severe ARDS. Materials and methods: Permission from the Institute Ethics Committee was obtained before recruitment of patients and consent was obtained from legally acceptable representatives. In this prospective observational study, 20 consecutive laboratories confirmed SARS-CoV-2 patients with severe ARDS (PaO2/FiO2 < 150) on invasive mechanical ventilation were included in the study. As per ICU protocol, in the absence of contraindication, all mechanically ventilated ARDS patients with PaO2/FiO2 < 150 were placed in at least 16 hours/day prone position for consecutive days till the criteria for proning is met. Demographic characteristics, baseline respiratory mechanics, and blood gas data were collected before initiation of the prone position, after 4 and 16 hours of the prone position, and after 4 hours of return of supine position. Prone responders were defined by a 20% increase in PaO2/FiO2 ratio during the prone session and sustained responders were defined by a 20% increase in PaO2/FiO2 ratio 4 hours after return of supine position. Statistical analysis: All collected data were entered in a Microsoft Excel datasheet. Categorical data were presented as absolute numbers or percentages and non-parametric data were presented as the median and interquartile range (IQR). Unrelated data (between prone responders and non-responders) were compared by Mann-Whitney U test or chi-square test as applicable. Longitudinal variables were compared by Friedman's test and multiple comparisons were performed by Dunn's test. A two-sided p value < 0.05 was considered significant. All statistical analyzes were performed using Graph Pad Prism version 8.0.0 for Mac OS (Graph Pad Software, San Diego, California, USA). Results: The median age in this cohort of 20 severe SARS-CoV-2 infected ARDS was 56 (45.5-67) years. The median P/F ratio was 56 (54- 66) with a median (IQR) PEEP of 12 (12-14) before initiation of prone position. The median (IQR) SOFA score was 7.5 (5.5-9) at the time of inclusion. Seventy-five percentage (95% CI 53.1-88.8) patients were prone responders at 16h prone session and 50 (95% CI 29.9-70.1) % patients were sustained responders after return to supine position. Prone responders had significantly higher baseline respiratory compliance (p = 0.03, Mann Whitney U test) but all other respiratory and blood gas variables were similar between responders and non- responders. There was significant decrease in plateau pressure (p < 0.0001), peak airway pressure (p < 0.0001), and driving pressure (p < 0.0001);and increase in static compliance (p = 0.001), P/F ratio (p < 0.0001), PaO2 (p = 0.0002) and SpO2 (p = 0.0004) at 4h and 16h since initiation of prone session and also after return of supine position. Noradrenalin requirement didn't change during the prone session (p = 0.20). Percentages of changes in static compliance significantly correlated with P/F ratio after return of supine position (r2=0.62, p = 0.0034) but not at 4h (p = 0.14) and 16h (p = 0.20). Percentages of changes in P/F ratio and driving pressure at 16h (r2=-0.47, p = 0.04) and after return of supine position (r2=-0. 9, p = 0.0089) were significantly correlated;but no correlation was found at 4h (p = 0.09). Baseline static compliance was a predictor of prone response with reasonable accuracy [AUROC (95% CI) 0.82 (0.59-1.00)]. Static compliance < 14 predicted no response from prone position with sensitivity (95% CI) and specificity (95% CI) of 80 (37.6-99) % and 73.3 (48.1-89.1) % respectively. Discussions: We have found that around 75% of the SARS-CoV-2 infected patients with severe ARDS responded with a 16-hour prone position in terms of oxygenation. Overall, there is an improvement in lung mechanics in terms of static compliance, driving pressure, and plateau pressure without any changes in the hemodynamic support. In our series, all the included patients had 'stiff lung' as evident by low static compliance. Previous studies reported a variable change in respiratory system compliance in the prone position in ARDS patients,3 whereas we have found a significant decrease in driving pressure and static compliance. Recruitment of the dorsal lung region was the biologically plausible mechanism of improvement in static compliance as both driving pressure and compliance were correlated with change in P/F ratio.4 We have found that these correlations were present even after the return of supine position which indicated sustained lung recruitment in SARS-CoV-2 infected patients. Determination of baseline static compliance is important as it was a predictor of the absence of a response from the prone position and these patients may be subjected to extracorporeal membrane oxygenation early in the course of the disease. Limitations: In our study, the major limitation was the small sample size, and we could not assess the effect of prone position on the chest wall and lung compliance separately as esophageal manometry was not used. Conclusion: Prone position in SARS-CoV-2 infected severe ARDS patients is associated with improvement in lung compliance and oxygenation in 75% of the patients and persisted in about 50% of the patients.

Response to the COVID-19 pandemic in India: Case studies on leadership in crisis situations

On January 30, 2020, India reported its first case of (COVID-19). In this article, we explore insights into leadership in crisis situations as the country combats the pandemic. We examine dimensions of leadership from two perspectives - positional, and systemic, and the success and challenges that lie therein. We consider the leadership-in-crisis vignettes using the address by the Prime Minister wherein the declaration of nation-wide lockdown was made (positional), and that of the Indian state of Madhya Pradesh, which suffered from a leadership vacuum as it combated the pandemic (systemic). We report that strategic communication could help bring stakeholders on-board with ease and enthusiasm, complementing a preemptive and graded national response, while systemic failures or stand-stills could compromise the pandemic response despite wide societal engagement and broad political will. Crises situations increase the demand on leaders exceptionally and make their role much more complex, expansive, and time-sensitive. However, at the same time, the system must build the inherent resilience to absorb and overcome shocks, and circumvent dependencies. In summary, leadership-in-crisis requires self-adequacy.

Docking of FDA Approved Drugs Targeting NSP-16, N-Protein and Main Protease of SARS-CoV-2 as Dual Inhibitors

At present world is lurching under the spread of new SARS-CoV-2 infection. The treatment is still elusive despite the relentless effort by the scientists against various viral structures. Whereas the 3-Chymotrypsin-like proteases cleave polyproteins and structural proteins help in viral replication. At the same time, non-structural proteins stimulate mRNA cap methylation to evade the immune response. The present study aims to identify novel dual inhibitor compounds with potential hits simultaneously against any of these three targets, including 3C-like proteases, N-protein, and NSP16 through virtual screening, molecular docking approach, and molecular dynamics. Such dual inhibitors may provide the necessary treatment to alleviate the current pandemic. We screened 265 FDA approved infectious disease drugs against three types of Covid-19 targets, i.e., 3C-like proteinase (6w63), N-protein (6vyo), and Non-structural protein 16 (6w4h) using a computer-assisted drug repurposing approach in this study. The Schrodinger suite 2019 is employed for high throughput screening, molecular docking, and binding free energy through the Glide module. We sorted 27 drugs, out of which the best common three drugs were suggested based on their virtual statistics parameters. We found three drugs that belonged to two main categories as dual inhibitors. The Plazomicin (Aminoglycoside) and Cefiderocol (Cephalosporins) are an antibiotic group of drugs, and the Vanganciclovir is antiviral. The molecular dynamics simulation studies over 30000ps for Plazomicin against NSP16 was conducted based on their promising docking scores profile. The RMSD parameter remained stable at 2.5A for ligands for 30000ps. Thus these three compounds can be validated as a SARS-CoV-2 therapy through clinical trials.

Dietary supplementation and medication of vitamin c and vitamin d in covid-19 – a hypothesis

On 31 December 2019, the World Health Organization was informed about a cluster of cases of pneumonia with unknown origin detected in Wuhan City, Hubei Province, China. The infection spread first in China and then in the rest of the world, and on the 11th of March, the World Health Organization declared COVID-19 as a pandemic. The world is in the grip of the COVID-19 pandemic. As there isn't any vaccine or medication developed in the treatment of COVID 19, hence peoples are forced to quarantine. The article is based on a hypothesis, it reviews information regarding the disease, its viral structure, pathophysiology, clinical symptoms, mode of transmission, prevention, and management. In addition to that, we aimed to highlight the source, pharmacological properties, and dietary role of Vitamin C and Vitamin D in reducing the risk of respiratory tract infections, and pneumonia, such clinical symptoms are directly related to COVID-19. Based on some clinical evidence in different hospitals suggesting IL-6 and TNF-α inhibitor drugs as a possible therapy for COVID-19. Through several mechanisms, vitamin C and vitamin D can reduce the risk of infections. Evidence supporting the role of vitamin C and vitamin D in reducing the risk of COVID-19. So we can think about it and by using it, we can defeat COVID-19. This is the thought of this article. © 2020, Advanced Scientific Research. All rights reserved.