Evaluating the Performance of Low-cost PM Sensors over Multiple COALESCE Network Sites

Air quality is a global concern, with particulate matter receiving considerable attention due to its impact on human health and climate change. Recent advances in low-cost sensors allow their deployment in large number to measure spatio-temporal and real-time air quality data. Low-cost sensors need careful evaluation with both regulatory approved methods and other data sets to understand their efficacy. In this work, PM concentrations measured by deploying low-cost sensors at four regional sites are evaluated through comparison with satellite-based model MERRA-2 and the SASS reference instrument. Daily PM2.5 mass concentration variation was analyzed at four regional sites of India from January 2020 to July 2020, including pre-lockdown and six different lockdown periods. Higher PM2.5 concentration was observed at Rohtak (119 mu g m-3) compared to Mahabaleshwar (33 mu g m-3), Bhopal (45 mu g m-3) and Kashmir sites during the pre-lock down period. During the lockdown period, the PM2.5 mass concentration was reduced significantly compared to the pre-lockdown period at every location, although the PM2.5 concentration was different at each location. The air quality trend was quite similar in both the measurements, however, MERRA-2 reconstructed PM2.5 was significantly lower in the pre-lockdown period compared to the lockdown periods. Significant differences were observed between low-cost sensor measurements and MERRA-2 reanalysis data. These are attributed to the MERRA-2 modelling analysis that measures less PM2.5 concentration as compared to ground-based measurements, whereas low-cost sensor are and biases.

A comprehensive review on COVID-19 with main focus on management and treatment options

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus of the same family as SARS-CoV and Middle East respiratory syndrome coronavirus, has spread globally, leading the World Health Organization to announce it as a pandemic. The disease caused by SARS-CoV-2, 2019 coronavirus disease (COVID-19), causes flu-like symptoms that may become severe in people at high risk. Infection is known to spread from human to human and through contact with contaminated surfaces. COVID-19's main symptoms include nausea, cough, fatigue, mild dyspnea, sore throat, headache and gastrointestinal problems. Real time polymerase chain reaction is used as a diagnostic device using nasal swab, oropharyngeal swab, tracheal aspiration or bronchoalveolar lavage samples. Antiviral medications, steroids, IL-6 antagonist and respiratory support devices are the primary treatments being used to treat the condition. In addition, while several interventions have been suggested, quarantine is the only method that seems to be successful in lowering the risk of infection. The COVID-19 pandemic reflects the present generation's major global public health issue, following the 1918 pandemic influenza epidemic. The pace and frequency of clinical trials conducted to evaluate possible COVID-19 therapies underscore both the need and capacity to deliver high-quality evidence even in the midst of a pandemic. Various vaccines have been developed which are in different phases and we hope to have a vaccine for the general population soon, as it could prevent the spread of the disease. Copyright © 2022, Kuwait Medical Association. All rights reserved.

A study on significance and correlation of red cell distribution width with severity of clinical illness in COVID-19 patients

BACKGROUND: Global pandemic COVID-19 is an acute respiratory illness with a high rate of hospitalization and death rate. Red cell distribution width coefficient of variation (RDW-CV), a routine component of complete blood count (CBC) automatically generated by most hematology analyzers is a useful predictor of clinical outcomes in critically ill patients and in those with infection and sepsis. RDW will provide information for early risk stratification of COVID-19 patients, thereby enabling timely intervention for reducing morbidity and mortality. In such a massive pandemic, early stratification of cases based on routinely available biomarkers can be of great help inefficient utilization of critical care and laboratory assets. MATERIALS AND METHODS: We retrospectively studied the significance and correlation of RDW (CV) (admission) with the severity of clinical illness in 800 confirmed cases of COVID-19 between August 2020 and October 2020 at our hospital. Demographic and clinical details were obtained from medical records;data pertaining to CBC were retrieved through electronic records of our fully automated hematology analyzer (NihonKoden 5 part auto analyzer Model-MEK- 7300K). Statistical workup was done and results were analyzed. RESULTS: Of 800 patients, 60% were male. RDW (CV) > 14.5 (elevated) seen in 52% males and 47% females. Elevated RDW was noted in 43.6% (300/688) nonsevere illnesses (mild and moderate), 82% (92/112) in the severe illness group. The mean RDW (CV) for mild, moderate, and severe cases was found to be 14.21 +/- 0.61, 15.32 +/- 0.67, and 16.34 +/- 1.64, respectively. The number of survivors was 704 (88%). The number of people who died was 96 (12%). Elevated RDW was seen in 74% (71/96) who died and 45% (321/704) of people who survived. To determine the efficacy of RDW (CV) in identifying the severity of disease, a ROC curve was used in which a cutoff value of 13.65 is obtained with a sensitivity of 97.3% and specificity of 85%. CONCLUSION: Higher RDW (CV) was found to have a significant association with clinical severity and mortality prediction. Hence, it can be considered as one of the important hematological parameters in the workup to efficiently stratify the patients at the earliest in COVID-19.

COVID-19 pandemic: A lockdown experience with veterinary tele-health services in Kashmir

Telehealth facility was launched to extend veterinary services throughout Kashmir valley. It was also desired for continuation of veterinary internship during the COVID-19 lock-down period. A total of 714 response forms were received from the participating veterinary faculty of clinical disciplines in six months. The majority (n=504, 70.6%) of the cases pertained to the dairy cattle. Thirty per cent (n=9/30) of the designated specialists participated. The tele-health facility was availed by interns (44.25%), farmers/animal owners (36.51%), field veterinarians (15.28%) and the para-veterinarians (3.97%) in significantly decreasing order. Telephone mobile calls, WhatsApp messages (text, photos and videos), and the SMS text messages were the platforms used. The animals with medical problems (67.66%) were significantly more than those showing gynaecological (18.25%) and surgical (14.09%) ailments. More than half (52.58%) of the cases were reported from the nearby three districts. The remaining (47.42%) animal owners resided in rest of the seven districts. Most of the complaints pertained to skin and appendages (27.18%), alimentary (25.79%) and reproductive tract (18.25%) in the affected cattle respectively. Udder and teat affections, metabolic diseases, and repeat breeding were tentatively diagnosed in majority of the cows. From this preliminary study, it is concluded that the veterinary telehealth service can reach far-off places and education can be continued amidst lockdown period. Short duration and lack of the follow up details are the weakness of this study. Additionally, more veterinary specialists need be persuaded to participate in telehealth modality.

Restoring the values of traditional foods

Poverty affects ~ 26% of the world’s population and is a challenge that humanity must overcome by the end of 2030, as per the agenda set by the United Nations. Witnessing the current world scenario, it is crucial to find an alternative to overcome this challenge, especially in the context of the situation of the COVID-19 pandemic, which is expected to affect consumers directly or indirectly. With this in mind, this chapter is designed to analyze the value of traditional foods and their importance in planning and adopting strategies to strengthen local, regional, and global food systems. The revaluation of traditional food systems is certainly a good option, which can overcome emergencies of food insecurity such as famines and droughts or unprecedented occurrences such as the COVID-19 pandemic, which the world has recently experienced. Based on this logic, institutional resilience can be defined as the capacity to adapt or transform institutional norms or arrangements in a territory. In this context, the concept of traditional foods allows the witnessing and practice of historically inherited cultural expressions. Finally, to ensure the sustainability of traditional foods, it is imperative that local governments design appropriate policies to befit future generations. © 2022 Elsevier Inc. All rights reserved.

Online KidClot education for patients and families initiating warfarin therapy: The eKITE study.

Anticoagulation with Vitamin K antagonists (VKA) has always posed challenges in terms of monitoring requirements. These challenges were further exacerbated in the setting of the COVID-19 pandemic, with limited access to and/or avoidance of laboratory testing. The importance of utilizing point of care (POC) health technology for individualized patient management is salient. The foundation of effective home INR monitoring is establishing patient knowledge about their therapy and INR testing proficiency. The eKITE series was developed to support patients in establishing foundational knowledge required for VKA (warfarin) management and INR monitoring. The primary objectives were to evaluate eKITE, a patient-oriented innovative online education program for warfarin therapy, participant learning stress, and patient preference for online learning. This multi-center prospective study provided patients access to warfarin online education. Participants were required to complete written quizzes assessing warfarin knowledge of key concepts proficiency and identifying knowledge deficits. Patient preference, evaluating calm (lack of anxiety) while learning, and an INR on a home meter was completed. Participants performed INR tests at home and reported INRs by telephone. The analysis included 144 children and caregivers enrolled at five US and CDN sites. Most indications for anticoagulation were cardiac (congenital or acquired heart disease) with varied INR target ranges. Mean knowledge scores for warfarin and INR self-testing modules were 97%, with low anxiety with TTR of 84%. Patient preferred online learning. eKITE is an effective teaching modality for warfarin/home INR monitoring with safe INR testing and warfarin management that is appropriate for pediatrics and adults alike. PROLOGUE: The whir in the hallways is deafening. Lights bright, alarms are ringing in a chorus of unsynchronized beeps and screeches. It has been more than a week since I have slept. Snuggled beside me is my precious child, whining and equally irritated with the asynchronous symphony, further compounded by anxiety, procedures, and pain. The sun has broken. The staff smiles are welcoming and incessant, as one after one, they approach hurried, urgent, assiduous, their need to coach me for our upcoming departure to the warmth of home. Each provides essential information that I will require to keep my child, my treasure, safe and healthy. Yet, my eyes are heavy, blurred, and my brain foggy, trapped in a dark heavy cloud. How am I to follow? Comprehend? and retain anything? As they instruct, my precious child yearns for loving arms, compassion and love, whining, crying in disquiet. Overwhelmed does not adequately describe my ineffable exhaustion. Amidst this, how am I to learn about warfarin? Such a challenging medication, with so much to know. Concentrate, I tell myself, focus; now is my only opportunity to learn. I must be alert. It seems to be nonsensical.

The impact of COVID-19 on parental experience in a tertiary neonatal unit

Background All neonatal units, have implemented policies designed to prevent the spread of COVID-19 infection. Parents of babies admitted to neonatal units have had to make adjustments to comply with such guidance and visiting restrictions. Only one parent could visit their baby at a time and they were required to wear a surgical mask while on the neonatal unit. On site parent accommodation was not available. Objectives 1. To assess parental experience on a tertiary neonatal unit during the COVID-19 pandemic. 2. To determine if the support received was deemed adequate. 3. To identify ways to improve family experiences. Methods Parents of babies who had been admitted to the neonatal unit for at least one week, were asked to complete a questionnaire regarding their experience during the Covid-19 pandemic. Parents of babies receiving palliative care were excluded from the study. One questionnaire was completed by each household. The questionnaire took into account guidance from RCPCH, BAPM and the charity Bliss. Data were collected prospectively over approximately six weeks between 25/ 6/20 to 5/8/20. The data was analysed using Microsoft excel software. Differences were assessed for statistical significance using the chi square test. Results A total of 38 questionnaires were completed. Thirty four (89.5%) parents felt either quite involved or fully involved in caring for their babies (e.g. feeding, bathing, skin care, taking the temperature and changing their nappy), while four parents (10.5%) felt a little involved (p<0.05). There were 21 parents (62%) out of 34, who stated that there was no impact on the amount of time they spent giving kangaroo care and 13 parents (38%) felt it had decreased as a result of the pandemic. Most parents (70%) did not experience any effect on the time spent breast feeding. Twenty four (63%) parents expressed concern with the quality of time they were able to spend with their babies. Thirty one parents (97%) were moderately to very satisfied with the updates from the neonatal team (p< 0.05). Fifty percent of parents had no problems visiting their babies in hospital, while 50% found it difficult. Parents, generally felt they received excellent care. Concerns were expressed over the visiting restrictions and the impact of this on bonding with their babies. Some parents believed that wearing a face mask may affect their babies development. They also expressed an impact on their emotional wellbeing from the lack of shared experience with their partners and family support. They made suggestions about alternative ways of updating parents such as telephone conferencing. Conclusions Most parents felt they received excellent care but some expressed concerns about bonding with face masks identified as a particular stressor. Given the challenges of the pandemic, there is need to embrace different modalities to update parents and enhance family centered care. These methods include telephone conferencing and secure video messaging services.

Steroids use in non-oxygen requiring COVID-19 patients: a systematic review and meta-analysis.

BACKGROUND: Corticosteroids have become the mainstay treatment in severe COVID-19. However, its role is mild disease is controversial due to lack of robust scientific evidence. This systematic review and meta-analysis were conducted to assess effect of steroids in mild COVID-19 patients. METHODS: PubMed, EMBASE, Web of Science and medRxiv were searched from 31 December 2019 to 14 May 2021 for studies that reported effectiveness of steroids in non-oxygen requiring COVID-19 patients in terms of progressing to severe disease, mortality, duration of fever, duration of viral clearance and length of hospital stay (LOHS). Studies on inhalational steroids, case reports and reviews were excluded. Risk of bias (ROB) was assessed by the Cochrane's ROB tool and ROBANS tool. Quantitative data synthesis was done using the generic inverse variance method. RESULTS: A total of 6411 studies were identified, 2990 articles were screened after exclusion. Seven studies which fit the criteria (involving 2214 non-oxygen requiring COVID-19 patients) were included and analysed. Overall odds of progression to severe disease among the non-oxygen requiring COVID-19 patients receiving steroids was 5.97 [95% confidence interval (CI): 1.27-27.99, I2 = 0%] and odds of death (OR: 1.35, 95% CI: 1.01-1.79; I2 = 0%) as compared to the patients not receiving steroids. Mean duration of fever (7.4 days), duration to viral clearance (18.9 days) and LOHS (20.8 days) were significantly higher in the steroid arm, as compared to that in no-steroid arm (6.7, 16.5 and 15.2 days, respectively). CONCLUSION: Steroids in non-oxygen requiring COVID-19 patients can be more detrimental than beneficial. PROTOCOL REGISTRATION: The study was prospectively registered in PROSPERO (CRD 42021254951).

COVID-19-associated mucormycosis presenting to the Emergency Department-an observational study of 70 patients.

BACKGROUND: Mucormycosis (MM) is a deadly opportunistic fungal infection and a large surge in COVID-19-associated mucormycosis (CAM) is occurring in India. AIM: Our aim was to delineate the clinico-epidemiological profile and identify risk factors of CAM patients presenting to the Emergency Department (ED). DESIGN: This was a retrospective, single-centre, observational study. METHODS: We included patients who presented with clinical features or diagnosed MM and who were previously treated for COVID-19 in last 3 months of presentation (recent COVID-19) or currently being treated for COVID-19 (active COVID-19). Information regarding clinical features of CAM, possible risk factors, examination findings, diagnostic workup including imaging and treatment details were collected. RESULTS: Seventy CAM patients (median age: 44.5 years, 60% males) with active (75.7%) or recent COVID-19 (24.3%) who presented to the ED in between 6 May 2021 and 1 June 2021, were included. A median duration of 20 days (interquartile range: 13.5-25) was present between the onset of COVID-19 symptoms and the onset of CAM symptoms. Ninety-three percent patients had at least one risk factor. Most common risk factors were diabetes mellitus (70%) and steroid use for COVID-19 disease (70%). After clinical, microbiological and radiological workup, final diagnosis of rhino-orbital CAM was made in most patients (68.6%). Systemic antifungals were started in the ED and urgent surgical debridement was planned. CONCLUSION: COVID-19 infection along with its medical management have increased patient susceptibility to MM.

The psychological impact of the COVID-19 pandemic on dental healthcare professionals

Aims and Objectives: The advent of the novel coronavirus disease-2019 (COVID-19) pandemic has sparked a global crisis. Cumulatively, the modifications in patient care and financial restraints are leading to heightened levels of anxiety amongst dentists, making it imperative to comprehend the psychological health implications of the dental professionals. This study aimed to evaluate the psychological impact of the COVID-19 pandemic among Indian Dentists through an online web-based survey.Materials and Methods: The present randomized survey was designed to evaluate the anxiety levels. A total sample size of 405 was calculated. The questionnaire included demographic information and all the variables linked to probable cause of stress during clinical practices and the future prospects of the profession. The questions had to be responded on a scale of 1-10. The responses were statistically analyzed by subjecting the responses to descriptive analysis, Student's t test, and Pearson's chi-square tests.Results: A total of 405 responses were received. The levels of anxiety reported were high. Majority of the dentists were troubled by the thought of being in a high-risk profession and of transmitting the disease to others. Almost all questions were responded with a score of >5 on a scale of 1-10 depicting heightened anxiety levels. The fear levels were noted to be elevated in patients aged more than 35 years.Conclusion: Long-term unrecognized anxiety can predispose to significant psychiatric morbidity and fatigue. Identifying and acknowledging adverse factors in a crisis situation will facilitate early intervention to reduce and mitigate the impact of stress. © 2020 Journal of International Oral Health. Published by Wolters Kluwer . Medknow.

EACH: A phase II study evaluating the safety and anti-tumour activity of avelumab and cetuximab in recurrent/metastatic squamous cell carcinomas

Background: Patients with R/M SCC have low response rates to second line therapies, including PD-1 inhibitors nivolumab and pembrolizumab, representing an area of unmet clinical need. Cetuximab has modest activity as a single agent but potentiates the activity of radiotherapy in locally advanced head & neck SCC (HNSCC) and chemotherapy in R/M HNSCC. Cetuximab initiates Natural Killer cell antibody-dependent cell-mediated cytotoxicity, resulting in an anti-tumour immune response and the potential to augment the activity of PD-1/PD-L1 inhibition. Methods: Trial entry required histologically confirmed R/M SCC of any site, unselected by PD-L1 expression, considered incurable by local therapies and no previous treatment with cetuximab for recurrent/metastatic disease. Prior therapy with anti-PD-1, anti-PD-L1 or anti-PD-L2 was excluded. Patients had avelumab 10 mg/kg + cetuximab 500 mg/m2 intravenously every 2 weeks, for up to 1 year. Primary endpoint was occurrence of dose-limiting toxicity within 42 days of treatment starting, graded using CTCAE v5. Secondary endpoints were objective response (ORR) and disease control rate (DCR) at 6 and 12 months using iRECIST. Results: 16 patients, median age 58 years (range 34 – 88), were enrolled from 2 UK hospitals between July 2018 and October 2019. The trial stopped after completing the safety run-in. 5 patients remain on treatment, 9 stopped treatment early (7 disease progression, 1 patient choice, 1 due to risk of COVID-19). 2 patients died whilst on treatment (both unrelated to trial treatment). Grade 3 AEs were seen in 4 patients and grade 5 in 1 patient. None were related to trial treatment. No patients experienced dose-limiting toxicity. Of 10 patients evaluable for response by iRECIST 2 (20%) had complete response, 3 (30%) had partial response and 4 (40%) had stable disease as their best response, representing an ORR of 50%. One patient had confirmed disease progression. In 6 patients who remained on trial for >6 months, all 6 had disease control at 6 months (2 CR, 1 PR, 3 SD). Conclusions: Avelumab + cetuximab is safe and tolerable, and demonstrates promising efficacy in R/M SCC patients. Clinical trial identification: NCT03494322;20/03/2018;Sponsor reference: UCL/17/0560. Legal entity responsible for the study: University College London. Funding: Merck KGaA. Disclosure: M. Forster: Advisory/Consultancy, Travel/Accommodation/Expenses: BMS;Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Merck;Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: MSD;Advisory/Consultancy: Novartis;Advisory/Consultancy: PharmaMar;Advisory/Consultancy, Travel/Accommodation/Expenses: Roche;Advisory/Consultancy: Nanobiotix;Advisory/Consultancy, Travel/Accommodation/Expenses: Guardant Health;Advisory/Consultancy: Oxford VacMedix;Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: AstraZeneca;Advisory/Consultancy: Takeda;Research grant/Funding (institution): Boehringer Ingelheim;Travel/Accommodation/Expenses: Celgene. J. Sacco: Honoraria (self), Research grant/Funding (institution), Travel/Accommodation/Expenses: BMS;Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: MSD;Honoraria (self), Advisory/Consultancy: Amgen;Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): Immunocore;Honoraria (self), Advisory/Consultancy: Delcath;Honoraria (self): Pierre Fabre;Research grant/Funding (institution): AstraZeneca. A. Kong: Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Merck;Honoraria (self), Speaker Bureau/Expert testimony: BMS;Advisory/Consultancy: Centauri Therapeutics;Advisory/Consultancy: Amgen;Advisory/Consultancy, Research grant/Funding (institution): Puma Biotechnology;Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: MSD;Research grant/Funding (institution): AstraZeneca. G. Wheeler: Honoraria (self): AstraZeneca. J. Hartley: Full/Part-t me employment: AstraZeneca;Advisory/Consultancy, Shareholder/Stockholder/Stock options: ADC Therapeutics. All other authors have declared no conflicts of interest.