ABSTRACT
In severe Covid-19 pneumonia, acute respiratory distress syndrome (ARDS) associated with cytokine storm is the leading cause of death. Tocilizumab was approved for chimeric antigen receptor T-cell therapy induced cytokine release syndrome and it may provide clinical benefit in these severe covid-19 pneumonia. In this retrospective cohort study, we evaluated patients with severe COVID-19 pneumonia admitted between May 2021 and June, 2021. Patients who were received tocilizumab during treatment, were enrolled for the study. Systemic steroids, hydroxychloroquine, and azithromycin were concomitantly used for the patients. The outcome was measured as an improvement in peripheral oxygen saturation by change in mode of oxygen therapy and improvement in laboratory parameters after tocilizumab administration. Out of 23 treated patients (18 Male, 5 Females), 19 patients received a single dose of tocilizumab and another four patients received two doses of it. Of these 23 patients, 3/3 with NRBM (non-rebreather mask) showed improvement and shifted to nasal cannula for oxygenation. 11/12 patients with NIV(non-invasive) showed improvement. 5/8 patients with invasive ventilation showed gradual improvement and shifted to NIV. A total of 4/23 (17%) patients didn’t show any improvement and died. Inflammatory markers like CRP, percentage of lymphocytes, and ferritin also showed significant improvement after administration of tocilizumab. Our study showed that in patients with severe COVID-19, tocilizumab was associated with significant improvement in clinical and laboratory parameters. These findings require further validation from ongoing clinical trials of Tocilizumab in COVID-19 patients.
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Education is a valuable aspect of society, but COVID-19 made a drastic impact on the education system. It necessitated a flexible approach among institutions, Teachers, and students. For managing education effectively, institutions have initiated to apply electronic mode in the education system and comparable features are available on many platforms. It is argued that students are not aware of such platforms and they also pass from Fear, Anxiety, and control addiction. Further, Focus upon Training of Teachers with the articulation of particular Curriculum is necessitated and also course has not designed in a different language to increase their reach and more opportunities for the youth of rural India. Low Internet interpretation demands much investment for making sufficient digital infrastructure and there are certain societal barriers to online education. Still, faith in private players’ investment in education is not supported due to their profit-oriented nature. Present chapters attract the adoption of online education to respond to the recent pandemics, particularly in Higher Education in India. For this purpose, some factors of digitalization that are in use in Indian Universities try to evaluate based on static analysis of Factors Awareness, Anxiety, Network Issues, Problems of students are facing not having required technology along with language barriers. On the other hand Training of Teachers, and the process of online education at Indian University. The present chapter attracts, how managing Education in pandemic based on an empirical study regarding paramount factors of higher education in the Indian Universities. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Objective: The study's aim was to determine the neutrophil-to-lymphocyte ratio (NLR) is most helpful predictor factor for COVID-19-related serious illness. Methods: A total of 51 patients with COVID-19 infection with laboratory-confirmed reports were enrolled in this study: Age, neutrophil-to-lymphocyte (LYMLYM) ratio (NLR), an examination, and comparison. Data analysis, compilation, and report writing were completed based on the acquired data. Using SPSS.ver-23, standard statistical procedures were used to analyze the mean and standard deviation, as well as the Pearson correlation. If p<0.05, it is deemed significant. Results: The mean hemoglobin level was 12.44±3.55%, the mean platelet count was 1.95±0.65 cumm, the mean white blood cell count was 17400 ±6455.22 cumm, and the mean NLR was 5.72±1.24. When we looked at people who had hypertension, diabetes mellitus, and high cholesterol, we found that the NLR value was significantly higher in people with these diseases (p=0.05). Conclusion: We found that NLR is an excellent way to predict COVID-19-infected patients who are likely to get a lot of other illnesses and have a lot of problems early on.
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Most of the hospitals store their patient's data locally and some even do not have any backup storage. This poses a real threat of data loss or data corruption. Although many hospitals are migrating to cloud storage, the clouds have their own threat vectors. Recently, various health care providers were hit by ransomware and Distributed Denial of Service attacks during the COVID-19 outbreak. Due to these attacks, many emergency services were halted, affecting hundreds of thousands without any healthcare. Another problem with these traditional database practices is that they often misplace or mix the patient's data, which, needless to say, have severe complications. Many researchers are working on IPFS and Blockchain technology to improve the storage of medical records. This article presents a detailed study of the IPFS and Blockchain based healthcare secure storage solutions. It analyzes the existing solutions and their architecture, which will further facilitate the future research and development of emerging IPFS and Blockchain technologies.
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The obfuscation and the kind of cover-up or delay in COVID-19 crisis response put the veracity of global healthcare settings at stake and appended a biological dimension to geopolitical tensions. The ineffectual surveillance systems of public health and social measures cause the swift viral transmission pace amid mounting death toll and necessitate for an effective, cohesive, and strategic response. The digital ecosystem can serve the purposes intended in a transparent and immutable manner. This article highlights the problems encountered by the global healthcare settings in responding to pandemic and throws light on how the global digital ecosystem can handle crisis by managing the landscape radically through transparent information sharing via Internet of things (IoT) with the data being utilized by artificial intelligence (AI) and blockchain technologies on a cross-disciplinary collaborative basis. It will help to develop and provide borderless solutions of public health via monitoring, surveillance, detection, and prevention as well as digi-tool-assisted repurposed treatment by the use of authentic and decentralized distributed database that makes all contributors (participating countries, United Nations Organizations, the world medical associations, and global media and publications) accountable, inviolable, and efficient to tackle healthcare processes. It will extricate a blanket ban on information sharing thereby bringing democracy and freedom.
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To control the spread of the coronavirus (COVID-19) pandemic, the Government of India imposed various phases of lockdown starting from the third week of March 2020. Improvement in city air quality has emerged as a benefit of this lockdown in India. The objective of this paper is to quantify the health benefits due to this lockdown. PM2.5 concentrations in nonattainment cities (NACs) in Uttar Pradesh and the Delhi-National Capital Region (NCR) in North India were studied. Data from prelockdown and the various lockdown phases were compared, with 2019 as a benchmark. Compared with those in 2019, the PM2.5 concentrations during lockdown Phase 1 were approximately 44.6% lower for cities in Uttar Pradesh and approximately 58.5% lower for the Delhi-NCR. The health impacts of particle inhalation were quantified using the multiple-path particle dosimetry and AirQ+ models, which revealed that the most considerable improvement was during lockdown Phase 1. Among the prelockdown and lockdown phases, Phase 1 exhibited the minimum PM2.5 concentration and thus the greatest health benefits. For the selected cities, the concentration of particle deposition in the tracheobronchial region of human lungs showed its maximum reduction during lockdown Phase 1(30.14%). Furthermore, the results highlighted a decrease of 29.85 deaths per 100,000 persons during lockdown Phase 1, primarily due to the reduction in PM2.5 concentrations. This quantification of the health benefits due to a decrease in PM2.5 may help policymakers implement suitable control measures, especially for NACs, where the respirable particulate matter concentrations remain very high. © 2021, AAGR Aerosol and Air Quality Research. All rights reserved.
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In December 2019, a novel coronavirus, called COVID-19 was discovered in the city of Wuhan China, which spread to various cities as well as other countries. At present novel coronavirus has become the most important health hazard, causing severe issues about a concern to the human being and has become a pandemic. Due to the prone of this deadly virus, uncertainty is significantly the facility for a health condition. There are solutions to handle insecurity about health from coronavirus for assessing the condition through FIS (Fuzzy Inference System). Therefore, for this particular reason we study and develop the fuzzy system to help assess the safety of health-related issues of the patient's condition according to the changes of environment. The FIS is permitted to assess the patient's history like temperature of the body, travel history, disinfection frequency, breathing problem, suffering cough and cold and ventilation rate. A fuzzy system consists of several steps like fuzzification, fuzzy database rule and also defuzzification. Furthermore, a study of FIS identifies the risk of health status according to the patient's condition. In this paper, we proposed a fuzzy rule system which is implemented with MATLAB fuzzy tools for simulation to assess the health conditions of the patient and prevention from COVID-19 disease. © 2021 IEEE.
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Introduction: Many times critically ill patients who are either suspected cases of COVID-19 or COVID-19 positive coming to intensive care units require central venous access. Wearing personal protective equipment (PPE) for placing a central venous catheter can make the procedure challenging because of poor visibility. Insertion of the central venous catheter becomes even more difficult when the patient is in respiratory distress and is unable to lie flat on the bed. In COVID-19 positive or suspected patients where it is difficult to cannulate internal jugular vein (IJV) or subclavian vein due to anatomical or medical reasons, we suggest ultrasound-guided “low approach” femoral central venous access as an alternative.2 We report a case of acute pulmonary edema secondary to rheumatic heart disease which was managed successfully with ultrasoundguided low approach femoral central venous access. Materials and methods: A 37-year-old woman with a history of rheumatic heart disease presented in intensive care with acute pulmonary edema. The nasopharyngeal swab was taken for reverse-transcriptionpolymerase- chain-reaction (RT-PCR) assay to rule out COVID-19. The patient was managed in a line of acute pulmonary edema with an upright position, oxygen support, noninvasive ventilation (NIV), furosemide, and morphine. This patient required urgent central venous access for starting vasopressor and further management. As the patient was unable to lie flat on the bed and multiple attempts for vascular access were already tried in the emergency department, we planned for low approach femoral access. We used ultrasound with a linear probe to scan the femoral vessel at the level of the groin. By keeping the femoral vein in the center of the screen, a needle was inserted from the middle of the linear probe at an angle of 30 to 45°. The position of the guidewire inside the femoral vein was confirmed with ultrasound by using a long axis view before threading the catheter over it. The cannulation was successful in the first attempt. Discussions: In this case, we successfully inserted an ultrasound-guided femoral central line 5 cm below the inguinal ligament in a view to further reduce catheter induced infection rate. It has been suggested that the risk of infection will be very much reduced if we use full barrier precaution, ultrasound guidance, low approach, tunneling, and medicated catheter. Another advantage of low approach femoral access is that a person doing this procedure is away from the respiratory passage of the patient it may reduce chances of airborne infection during the COVID-19 pandemic. Placing the catheter in the femoral vessel will not interfere with the respiratory care (helmet-based NIV). Proning patients during mechanical ventilation and dressing of the line is also not a problem with low approach femoral venous access. Femoral access should be avoided in patients with peripheral venous and arterial disease and renal transplant. Conclusion: In this case, we have highlighted that modification of femoral venous access helps to achieve the central access quite fast and also increases the safety of both patient and operator. We suggest that in present times of COVID-19 pandemic, ultrasound-guided low approach femoral central venous access may be used in emergencies and also where other options of central venous cannulation are not suitable.
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Background: In response to the COVID-19 pandemic in San Diego, California, the Infectious Disease Division at the University of California San Diego established a COVID-19 Clinic dedicated solely to managing patients safely in their homes. This strategy was developed in response to: i) concerns regarding transmission of infection in the healthcare setting, ii) avoiding overwhelming the healthcare system with COVID-19 patients, iii) providing patients with expedited access to specialists, and iv) reducing the burden on the emergency department and urgent care. Methods: The COVID-19 clinic staff is comprised of a dedicated nurse, administrative assistant, and four infectious diseases (ID) physicians who aim to see patients within 24 hours of referral via virtual clinics 5 days a week. An ID physician initially assesses each patient in a direct telemedicine visit and answers their questions, assesses disease severity, provides both symptom management and emotional support, and education about self-isolation and transmission-based precautions. The patients are then triaged to daily nursing phone calls and follow up visits as needed. Results: Over a period of 12 weeks (March 27 to June 16, 2020), the clinic has seen 179 patients. To assess the impact of the clinic, patients are asked to complete a 6-point verbal patients satisfaction survey after their visit. Of the 133 patients who have completed the survey to date, the vast majority reported high satisfaction with their encounters with the COVID-19 physician, with a mean score of 4.8 or higher on all six questions (on a scale of 1 to 5). When asked “Did you feel comfortable talking to your COVID-19 ID physician?” on a scale of 1 to 5, the average score was 4.9. When asked “Did the physician do a good job answering your questions?” the average was 4.9. Patients reported feeling safer after talking with their physician (mean score 4.8), and felt better educated on how to self-quarantine at home (mean score 4.85) and when to seek care from an emergency room, urgent care or hospital (mean score 4.83). Conclusion: The UCSD COVID-19 Clinic demonstrates how telemedicine can be utilized in response to a public health crisis by creating a virtual clinic to provide ID care for patients in their homes.
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Introduction: Corona Virus Disease (COVID-19) outbreak is one of the biggest medical challenges to humankind in recent times, started from China in December 2019, and had spread to almost all the countries of the world. The social, psychological and economic fissures exposed by the pandemic resulted in mass disruption in human behaviour population. This is pushing them towards more stress. Aim: To analyse the anxiety and depressive symptoms in COVID-19 positive patients. Materials and Methods: A cross-sectional study was conducted on 325 COVID positive patients who were admitted in isolation ward in tertiary care centre and were enrolled in this study, out of which 18 refused to give the consent and 5 were already taking psychiatric medications and were excluded. Telephonic contact was not established with rest of the 5 patients. After ethical clearance, the anxiety and depressive symptoms were assessed by using Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D), respectively by using paired t-test. Results: Maximum patients belonged to age group of 21-40 years (54.9%). Maximum patients were males (70%). Almost 3/4th of the population (64%) had depressive symptoms of different severity and 61% had anxiety symptoms. Significant association of anxiety symptoms was seen with gender (p=0.001) and marital status (p=0.002). No association with depressive symptoms was seen with gender (p=0.087) and marital status (p=0.399). Conclusion: COVID-19 had significant impact on the patients. More than half of the population had showed the psychological issues in the form of anxiety and depression. Males and married patients were affected more with both anxiety and depressive symptoms.
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The newly emerged public health crisis threatening the world with emergence or spread of a novel coronavirus named SARS-CoV-2 associated with higher infection rates and deaths especially elderly people and people with Hypertension, Diabetes Mellitus, Cerebrovascular and Cardiovascular diseases throughout the world. As of 17thJune 2020, 216 countries were affected with 83,26,825 confirmed cases including 4,48,081 total deaths. India has reported around 3.6 lakh confirmed cases with more than 12 thousand total deaths. To respond this pandemic, India needs to set-up an adequate, well equipped and dedicated health care facility to contain the spread of infection and manage the infected patients as well as providing protection to the healthcare workers (HCW). Quality management and preventive strategies of a hospital plays very important role for this purpose. Quality management is the fundamental feature of a hospital to establish customer satisfactions and desired outcomes. High quality care health services involve doing the right things, for the right patient, at the right time, in the right way to minimise the harm and resource waste. Preventive strategies especially infrastructure development & Infection prevention and control policies (IPC) are very crucial. The effective, safe, people centred, timely, equitable, integrated and efficient heath care delivery improvement with appropriate quality management system and preventive strategies will be helpful to combat with “COVID-19”. This study highlights the “Quality management and Preventive Strategies of a Hospital responding to COVID-19” for providing better healthcare services in Indian healthcare management system.