On Water Pictet-Spengler Reaction of Tryptophan followed by Buchwald Coupling for the Synthesis of Natural Products Stellarines A, B and β-Carboline Derivatives: Their Molecular Docking against SARS-CoV-2 MPro

Natural products are versatile moiety in the drug discovery and development, however, their synthesis being one of the major challenges in this field. In this regard, an environment friendly synthesis of 1-benzoyl-9H-pyrido[3,4-b] indole-3-carboxamide β-carboline derivatives has been reported via Pictet-Spengler reaction of tryptophan methyl ester with 2-oxoaldehydes in water as solvent. Natural products Stellarines A and Stellarines B having anti-inflammatory activity against iNOS inhibition (IC50 value of 19.3 and 18.6 μM) isolated from the root of Stellaria dichotoma L. var. lanceolata Bunge were also synthesized from β-carboline derivatives using amidation followed by Buchwald coupling. The synthetic strategy has advantage of using non toxic and inexpensive materials for producing excellent yields. These functionalized β-carboline carboxamide derivatives have been evaluated against SARS-CoV-2 Mpro(7BQY) using molecular docking studies. © 2023 Wiley-VCH GmbH.

Retrospection of NDMP and Forecasting its Prophecy with Special Reference to Covid-19

National Disaster Management Authority of India strongly believes the NDMP has to be dynamic and actionable;hence it always keeps an eye over finding the probable grey areas getting into action as the disasters show-up;backed by a continuous improvement and developmental approach. This has been fruitful and well effective in the form of revised NDMP 2019 and the guidelines of it are practiced well in synchronization from Union government, states, and UTs. Although, The COVID-19 pandemic has greatly challenged the existing guidelines and practices as it has been an unprecedented situation the modern world has been into since the evolution of the concept and process of disaster management. This paper is an attempt to investigate which of the already existing guidelines proved to be lethal in tackling the current disaster and to what extent they were flexible and how it can be optimised in future to meet the requirements of disaster management. A brief study of various aspects is carried out such as the earlier time frames referring to the final implementation of NDMP, mainstreaming framework, social inclusion and community involvement, Investigation of Risk characteristics, structural measures, non-structural measures, and capacity building provisions. It also discusses the probable changes and optimisation needed to be done in policies of disaster governance, preparation and response, infrastructure development, technological aid, and most importantly decentralisation and percolation of disaster management practices, at large. © 2023 DMICS.

Complications and Outcomes of Peritoneal Dialysis in Indian Subcontinent: Two Decades of Experience from a Single Centre

Introduction: Continuous Ambulatory Peritoneal Dialysis (CAPD) was first introduced in 1990. It is now being considered at per or even better than MHD in many centers in India. Regional Institute of Medical Sciences (RIMS),Imphal is a tertiary care hospital in Northeastern part of India which is surrounded by neighboring states and border states of Myanmar where communication, transport, renal health care system is least developed. Many patient used to die due to lack of availability of hemodialysis facility. Since September 2001, CAPD programme was started at RIMS hospital, Imphal to treat the patient of CKD in Manipur, other neighboring states and Myanmar. It has been already more than 21 years and 736 number of PD catheter insertion is done at RIMS till September 2022. Method(s): Tenckhoff catheters were implanted either trans-peritoneally by surgeon or percutaneously by the nephrologist under local anaesthesia. All the details data about the patients were collected and accumulated. Accumulation and collection of data is constantly done by designated analyzers in RIMS centers in order to be continually updated on the demographics of renal patients using PD. These data were constantly documented and analyzed to assess the outcome and complications of PD. A total of 736 CKD patients were implanted with CAPD catheter between September 2001 to September 2022 and their detail data were analysed. Result(s): Out of total 736 PD cases there were 276 episodes of peritonitis. 58.6% cases had single episode of peritonitis as in Table -1. Out of 276 episodes of peritonitis 27 cases were culture positive.The leading causative agent of peritonitis was Staphylococcus aureus (37% of culture positive cases). Staphylococcus epidermidis was responsible for 18.5% of culture positive episodes as shown in Table-2. The incidence of ESI was 0.03 per person-years.The most common infective organism was S. aureus which was responsible for 12 (52%) of cases Table-3. Out of total 736 PD cases 72 patients were shifted to HD over the twenty one -year period, refractory peritonitis was the most common cause of technique failure ( 41.6 %) (Table- 4). A total of 125(16.9%) patients among 736 had PD catheter tip migration of which 46% were surgically removed and re-inserted. Omentectomy was require in 14.4 % of patient due to omental wrap around PD catheter (Table 5). There were 443 admissions to the hospital by these PD patients during the study period, of which 173(39%)were due to peritonitis. Non-peritoneal infections were the second most common cause responsible for 98(22.1%) hospital admissions. The non-peritoneal infections included covid 19 pneumonia in 5 patients (Table 6). Out of 736 patients, 145 patients(14.7%) were continuing on PD and12 patients (1.6%)underwent renal transplantation(Table-8). Conclusion(s): Our study suggests that there has been considerable improvement in overall outcome and mortality in patients on PD over the 20 years period. Peritonitis is the most common complication associated with PD. Having a well-trained staff will decrease the complications. This modality of renal replacement therapy in terms of long-term survival and quality of life and should be encouraged at the national level. No conflict of interestCopyright © 2023

Media consumption during COVID-19 and its impact on psychological well-being

Introduction: Media have never been as essential as it has become during the time of pandemic. Every information related to disease, prevention, and precaution was on media. Since most of the people confined to their homes, they used media not only to get the information about pandemic but also used media as companion, which enhanced the overall consumption of media significantly. This study aims to assess the changed consumption pattern of media in Indian population before and during the pandemic and its relation to the psychological well-being. Materials and Methods: It was a cross-sectional web-based survey. Four hundred and five respondents participated in it. Data analysis was done using descriptive and inferential statistics. Results: It was found that media consumption pattern and duration both have changed during the pandemic. There was a significant difference between before and after usage of all types of media. There was also significant difference for viewing media category in demographic subgroups, age (P = 0.000), marital status (P = 0.000), occupation (P = 0.000), and place of living (P = 0.036). Females (odds ratio [OR] =2.045, 95% confidence interval [CI]: 1.305, 3.203) and retired (OR = 0.039, 95% CI: 0.003, 0.470) were significantly associated with poor mental well-being. Respondents consumed media for sometimes (OR = 2.045, 95% CI: 1.557, 4.012) and frequently (OR = 4.946, 95% CI: 1.995, 12.264) were also associated with poor mental well-being. Conclusion: The study demonstrates the existence of poor mental well-being among women and retires more. It also demonstrates that people who preferred watching news more during the pandemic had the chance of suffering from poor mental well-being. © 2022 by the Author(s).

Prevalence of low back pain and osteoporosis in health care workers after the COVID 19 pandemic

Aim: Prevalence of low back pain and osteoporosis in health care workers after the COVID 19 pandemic. Material(s) and Method(s): The present prospective study was conducted among 300 apparently healthy adults who are working as a health care individual in the institute. A questionnaire addressing known risk factors for osteoporosis was made. The severity of the LBP was graded using a visual analogue scale for pain (VAS). The VAS is a reliable scale used to register the intensity of chronic pain where 0 signifies no pain and 10 signifies the worst pain imaginable. Those who had chronic LBP were also questioned on whether the onset of LBP preceded the Covid-19 pandemic, and whether the severity of the LBP had increased during the pandemic. Result(s): Light, moderate, sedentary and vigorous physical activity was revealed in 50.1%, 33.6%, 11.1% and 5.2% of the subjects respectively. >1 hour sun exposure in a day was reported among 15.4% of the subjects.In this study, low back was found among 42.7% of the subjects. Mean BMD level was -0.49+/-2.40. Mean BMD level was lower in subjects having back pain, sedentary/vigorous physical activity and no sun exposure as compared to counterparts. Conclusion(s): The confinement decreed due to the COVID-19 pandemic led to a significant increase in LBPintensity among health care workers. Copyright © 2022 Ubiquity Press. All rights reserved.

COVID-19 Pandemic: Perspective on Quality of life

Introduction: The COVID-19 pandemic has a profound impact on all aspects of the lives of societies in the world. Quality of life is a measure that can express a person's well-being in a pandemic situation. There is very less information about the impact of COVID-19 pandemic on the quality of life. Thus, the objective is to assess the impact of COVID-19 pandemic on quality of life among the employed population and to study the change in lifestyle related factors contributing to quality of life. Methodology: Cross sectional web-based study was conducted from December 2020 - May 2021 among ≥18 years of study participants. Convenient sampling method was used. Data analysis was done using Epi info software 7.2.2 version. Results: A total 252 study participants completed the study. The impact of COVID-19 pandemic was severe on physical domain 114(43.51%) and on psychological domain 20(7.63%). Overall impact of COVID-19 pandemic on quality of life was moderate 136(51.91%). 234(89.31%) participants responded that there was excellent change in lifestyle related practices. Conclusion: COVID-19 pandemic had overall moderate impact on quality of life in our study subjects, along with excellent change in lifestyle related practices. These findings would need to be verified in larger population. © 2022 University of Stockholm. All rights reserved.

Risk factors for novel corona virus (COVID-19) re-infections among health care workers at tertiary care center: A case control study

Introduction: Healthcare Workers (HCWs) are repeatedly exposed to SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona Virus 2) or the COVID-19 virus. This study aimed to identify factors associated with SARS-CoV-2 re-infection among HCWs in a tertiary care centre. Methods: We conducted a case–control study. Cases were defined as those with a second positive reverse transcription-polymerase chain reaction (RT-PCR) report after a symptom free period of atleast 30 days after previous positive RT-PCR report and controls were those with a single covid-19 episode (RTPCR positive) during Aug-2020 to Jul-2021. All HCWs (second positive report) were included as cases and matched controls (age, gender) recruited in 1:2 ratio. They were interviewed using a google form and clarifications (if any) were obtained on phone. Analyses were performed using logistic regression models. Results: A total of 53 cases and 110 controls were included. Age>50 (AOR-1.63 95%CI-1.06-5.59), Men (AOR-4.13 95% CI-1.70–10.05), Nurses (AOR-11.24 95% CI-1.05–119.63), not using N95(AOR-2.89 95% CI-1.02–5.05), Diabetic (AOR-3.51 95%CI-2.01-8.73) and inadequate use of personal protective equipment or PPE (AOR 4.82 95% CI 1.18–19.65) were identified as risk factors. Conversely, graduate (AOR 0.06 95% CI 0.01–0.53) and postgraduate (AOR-0.05 95% CI-0.005–0.7) education, feeling scared or nervous (AOR-0.45 95% CI-0.22–0.91), not always wearing any gloves, caps and goggles/face shields (AOR 0.10 95% CI-0.02–0.41), hand hygiene (AOR-0.42 95% CI-0.1-0.94) and consistent use of N95 masks or double masking (AOR-0.27 95% CI-0.09–0.80) even outside the workplace were protective factors. Conclusion: Study highlights protection provided by high-performance filtering masks or double masking among HCWs. These modifiable risk factors should be considered while designing, implementing, and monitoring COVID-19 biosafety protocols.

COVID19 Pandemic: Perspective on Quality of life

Introduction: Globally COVID-19 pandemic impacted on all dimensions of the lives in the world. Quality of lifemeasures person’s well-being. Very less information was available about the influence of COVID-19 pandemic onqualityoflife.Thus,objectivewastoassessimpactandchangeinlifestylerelatedfactorscontributingtoqualityoflife among employedpopulationduetoCOVID-19pandemic. Methodology:Webbasedcrosssectionalstudywasconductedamong>18yearsofstudyparticipants.Convenientsa mplingmethodwasused. DataanalysiswasdoneusingEpi infosoftware7.2.2version. Results: A total 252 study participants completed the study. COVID-19 pandemic impact was severe on physicaldomain 114(43.51%) and on psychological domain 20(7.63%). Over all the effect of pandemic on quality of lifewas moderate 136(51.91%). 234(89.31%) participants responded that there was excellent change in lifestylerelatedpractices. Conclusion:COVID-19pandemichadmoderatelyaffectedqualityoflifeinourstudysubjects,alongwithexcellentchangeinlifestylerelate dpractices. Studies in huge population will be requiredtoverify these findings.

Mystery Of Shedding Corona Virus In Tears Of Patients Affected With Covid-19

The severe acute respiratory syndrome corona virus 2 (SARSCoV-2)caused 2019 new corona virus illness (COVID-19) has spread globally, causing a pandemic. The WHO declared the outbreak a pandemic on January 31, 2020.2020 has been marged as covid pandaminc year. SARSCoV2 caused a global outbreak of this infectious disease. number of cases has continued to rise since then. Corona virus is a highly infectious disease spread mostly by respiratory droplets and direct contact with affected individuals. Viral isolation and quantitative reverse-transcription polymerase chain reaction (RT-PCR) analysis confirm the diagnosi While the pathways of virus transmission are still debated, several investigations have been conducted to identify tear film and conjunctiva as the mode of virus transmission. Multiple case reports have surfaced in which ophthalmic doctors were found to be infected during routine managment. From January 26 to February 9,2020, 30 confirmed novel coronavirus pneumonia (NCP) patients were recruited for a prospective interventional case series investigation at zhejiang university's first affiliated hospital. Tear and conjunctival secretions were collected twice with disposable sample swabs at a 2-to-3 day interval for the reverse transcription polymerase chain reaction assay. Twenty-one individuals with NCP of the common type and nine patients with NCP of the severe kind were included in the study. The lone patient with conjunctivitis had two samples of tear and conjunctival secretions, both of which generated positive RTPCR results. A total of 58 samples from different patients were found to be negative. © The Electrochemical Society

POST COVID-19 VACCINATION INFLAMMATORY ARTHRITIS: A CASE SERIES OF PATIENTS AT A DISTRICT GENERAL HOSPITAL

Background/Aims Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has undoubtedly changed the course of the pandemic and lessened hospital admissions and death as a result of the aforementioned virus. Reactive arthritis has been reported with other vaccinations, for example influenza, and now it seems patients are presenting with similar symptoms post SARS-CoV-2 vaccination, the first human mRNA vaccine to be used against a virus. There are occasional case reports in the literature of patients developing various rheumatological conditions post COVID-19 vaccination including reactive arthritis and polymyalgia rheumatica. Currently the Summary of Product Characteristics (SmPC) for Pfizer BioNTech, Moderna and AstraZenica vaccinations only list myalgia and arthralgia as side effects in the musculoskeletal and connective tissue disorders section. Our aim was to collect data in a prospective manner on patients who presented to clinic with a new rheumatological condition which was believed to have been triggered by receiving a COVID-19 vaccination and their progress was followed over time. Methods Data have been collected prospectively from patients who have presented to the West Suffolk NHS Foundation Trust rheumatology department with symptoms which are thought to be attributable to COVID-19 vaccination over the last five months. Results Nineteen patients had a new inflammatory condition that appeared to have been triggered by the COVID-19 vaccination. The mean age of onset of symptoms is 65.2 years (range 22-85 years) with the mean number of days between vaccine and symptom onset of 9.6 days. 89% presented within 14 days of vaccination. Eleven patients received the Pfizer BioNTech vaccine and 6 the AstraZeneca vaccine. Seven patients presented after their first vaccine and seven after their second. Three had symptoms after both. The most common presentation was a small joint polyarthritis (8 patients) and polymyalgia rheumatica type symptoms (5). All but one were seronegative. So far, outcomes have varied between self-resolution or conservative management (6 patients), short- and long-term prednisolone requirement (6) and initiation of disease modifying anti-rheumatic drugs (5). Conclusion The emergence of post-COVID-19 vaccine inflammatory arthritis appears to be a new condition which rheumatologists will be required to treat. With the introduction of booster vaccinations and third doses this phenomenon is likely to be seen in clinic for the foreseeable future. Further data are required in order to guide best treatment options and enable better prognostic indicators.

Real-world Experience with Favipiravir for Treatment of COVID-19 among Indian Healthcare Professionals

Introduction: Favipiravir has shown promising results for COVID-19 globally. Though many Indian patients have received favipiravir, there is a lack of realworld data for its clinical use by the practicing physicians. Hence, a qualitative survey was conducted to understand real-world use of favipiravir in management of COVID-19. Methods: A cross-sectional, web-based, qualitative survey was conducted between September 2020 to October 2020, among Indian physicians from various specialties involved in COVID-19 care and using favipiravir in their practice. Physicians were provided survey link having a structured questionnaire with 32 questions. They were enquired on- 1) demographics,practice information, 2) place of favipiravir in clinical practice, 3) treatment protocol for mild to moderate COVID-19, 4) dosage and duration of favipiravir, 5) effectiveness of favipiravir, 6) tolerability of favipiravir 7) global efficacy and safety assessment of favipiravir. Results: A total of 500 physicians were contacted, of which 50 physicians completed the questionnaire. 25(50.0%) were from south zone followed by 12(24.0%) from west. . Majority physicians (47, 97.9%) stated that favipiravir was used for COVID-19 in outpatient setting. Favipiravir was considered as the current drug of choice for ' mild COVID-19 with fever(86.6%). All physicians agreed that favipiravir was being used as per the recommended dose.. A total of 75% & 62.5% physicians agreed to observed clinical improvement by around 3-5 days & 5-7 days in symptomatic mild & moderate COVID-19 respectively. Conclusion: Majority of the physicians considered favipiravir to be safe and effective in treatment of mild to moderate COVID-19. © 2021 Journal of Association of Physicians of India. All rights reserved.

Clinical usefulness of favipiravir in moderate COVID-19 patients: Indian real-world experience

Introduction: Favipiravir, a broad-spectrum antiviral agent, acts by inhibiting RNA-dependent RNA polymerase. It is approved in India in the management of mild-moderate COVID-19. It has shown potent in vitro activity against SARS-CoV-2. It has a wide therapeutic safety margin indicated by a wide CC50/EC50 ratio for a high dose. It has shown promising results in clinical studies conducted in China, Russia, Japan, and India. Treatment guidelines from many countries and some states from India have included favipiravir in the treatment protocol. A recently published phase III trial on favipiravir in India has shown early clinical resolution and acceptable safety in mild-moderate COVID-19 infection. Objectives: The primary objective of the study was to evaluate the effectiveness of favipiravir in moderate COVID-19 patients, while the secondary objective was to determine the safety of favipiravir. Materials and methods: We retrospectively analyzed medical records of favipiravir-treated COVID-19 cases from 3 centers to capture key details of moderate COVID-19 patients including medical history, symptoms, supportive treatment, and clinical outcome. The protocol of the study was approved by Independent Ethics Committee. Results: Data from medical records of 193 patients was available for analysis, including 54 patients of moderate severity. The mean age was 59.94 ± 13.18 years. 58.92% of the patients were male. Hypertension (78.57%) and diabetes (55.35%) were the two most prevalent comorbidities. Majority (85.71%) of patients had at least one comorbidity, while 66.07% had ≥2 comorbidities. Mean SpO2 was 92.83 ± 1.88% with a median of 93% (90-98). The most common clinical features were fever (87.5%), cough (80.35%), dyspnoea (57.14%) and myalgia (48.12%). The mean CRP was 65.58 ± 34.74 with a median of 57.85 (1.20 to 151) and the mean d-Dimer was 1082.95 ± 1129.7 with a median of 815 (156-7435). Favipiravir has been used for an average duration of 12.30 ± 3.99 days, with median duration of 14 days (1-14 days). The rate of clinical improvement on days 3, 5, 7 and 10 was 30.35%, 75%, 89.29% and 96.42%. Fever and dyspnoea were fully resolved by day 7 in all enrolled patients, while myalgia was resolved by day 10 in all patients and cough was resolved by day 10 in 97.77% of patients. Corticosteroid was used in 37.5% patients. Oxygen requirements on days 3, 5, 7 and 10 were 28.57%, 14.28%, 8.92% and 7.14% patients respectively. Progression of the disease was seen in 10.71% of cases. Overall favipiravir was well tolerated with few commonly reported adverse events like diarrhoea and nausea, which does not require drug discontinuation. 91.07% patients and physician rated favipiravir as good or very good on global assessment scale. Discussions: An open-labeled nonrandomized study1 from China compared the effect of favipiravir (day 1: 1,600 mg twice daily;days 2-14: 600 mg twice daily) vs lopinavir/ritonavir (day 1-14: 400/100 twice daily) in the treatment of COVID-19. Compared with the lopinavir/ritonavir arm, however, patients in the favipiravir arm showed a statistically significant shorter median length of time to viral clearance (4 vs 11 days, p < 0.001), improvement in chest CT findings at day 14 after randomization (91.4 vs 62.2%, p = 0.004), and lower incidence of adverse effects (11.43 vs 55.56%, p < 0.001). Chen et al.2 had conducted a prospective, open-label multicentric trial in China to compare two treatment arms in the management of clinically confirmed COVID-19 (maximum duration of symptom onset before randomization: 12 days). Post hoc analysis demonstrated that favipiravir-treated patients showed a trend toward clinical improvement at day 7 among those with moderate COVID-19 (71.43 vs 55.86%, 95% CI: 0.0271 to 0.2843, p = 0.0199) and earlier resolution of fever and cough (p < 0.0001). A Japanese observational study group recorded the details of hospitalized COVID-19 patients in Japan to assess the safety and efficacy of favipiravir. In >90% of cases, favipiravir was administered at a dose of 1,800 mg orally on ay 1 followed by 800 mg twice daily on subsequent days. The median duration of therapy was 11 days. Rates of clinical improvement at 7 and 14 days were 73.8 and 87.8%, 66.6 and 84.5%, and 40.1 and 60.3% for mild, moderate, and severe disease, respectively. Thus, the vast majority of patients with mild and moderate disease recovered from the illness. Conclusion: Approximately 90% clinical resolution rate in moderate COVID-19 patients in real-world settings supports its role in the management of hospitalized patients. Reduction in the oxygen requirement highlights its protective role against disease progression. Overall favipiravir was found to be effective and safe in the management of moderate COVID-19.