Clinical profile of SARS-CoV-2 infection-associated pediatric Multisystem Inflammatory Syndrome (MIS-C): A case series from Western Maharashtra

Background and Objectives: Multisystem inflammatory syndrome (MIS-C) is a SARS-COV-2 infection-associated dreaded clinical sequelae in pediatric patients. Its epidemiology is complex and differs from severe acute COVID-19 infection in children. The present case-series report describes the various clinical features, laboratory markers, and interventions among 222 pediatric patients from one of the states in India with the highest prevalence of COVID-19 infection. Methods: An observational study was conducted at one of the tertiary healthcare institutes in the western region of Maharashtra state of India. Twenty-two children were hospitalized with diagnosed MIS-C, aged from 2 months to 18 years, from January to June 2021. Demographic and clinical characteristics and diagnostic and treatment parameters were collected from each subject. Statistical Package for Social Sciences version 21 software was used as a data analysis tool. Results: Clinical assessment revealed high-grade fever, non-purulent conjunctivitis, and abdominal complaints, which were the leading presentations of MIS-C. In inflammatory markers, serum IL-6 levels and D-dimer levels took a longer duration for normalization in the severe MIS-C group. Almost half of the mild-moderate MIS-C patients were managed with only systemic corticosteroids. All remaining patients recovered with the dual therapy of intravenous immunoglobulins (2 g/kg) and systemic corticosteroids with an improved clinical and biological response. Conclusions: The present clinical case-series report concluded that almost all MIS-C cases have a favorable prognosis with dual therapy of corticosteroids and immunoglobulins. With the principle of early diagnosis and prompt treatment, it is possible to manage patients without any critical support. However, long-term follow-up studies of these cases are warranted to validate the clinical approach. © 2022 Medical Journal of Dr. D.Y. Patil Vidyapeeth ;Published by Wolters Kluwer - Medknow.

Developing synchronous and asynchronous online learning models for engineering college students in India: A grounded theory approach

The Covid 19 pandemic lockdown in India led the education to move from classroom learning to online learning. This created the need for online learning pedagogies. The current study focuses on developing synchronous and asynchronous models of online learning for engineering students. The data for the current study was collected through interviews of engineering students of different specializations. Transcription of interviews were prepared and subjected to three levels of coding i.e. open coding, axial coding and selective coding in order to prepare concepts. The concepts were then integrated into a model using grounded theory approach. The finding indicate that synchronous mode leads to group learning, peer learning, learning through simulation and effective learning. The asynchronous mode leads to reinforcement based learning. © 2022, Rajarambapu Institute Of Technology. All rights reserved.

Outcomes of multisystem inflammatory syndrome in children temporally related to COVID-19: A longitudinal study

Introduction: The spectrum of clinical manifestations of COVID-19 in children is expanding since the global emergence of the COVID-19 pandemic from early reports in January 2020 depicting respiratory distress to a severe multisystem inflammatory syndrome (MIS-C) within various pediatric clusters. There is a paucity of data from resource-poor countries with respect to follow-up outcomes, particularly for coronary artery abnormalities. Considering this, we conducted a single centre prospective longitudinal study to describe the clinical, laboratory, echocardiographic findings and follow-up of children with MIS-C. Objectives: To study the clinical and laboratory characteristics and outcomes of multisystem inflammatory syndrome in children (MIS-C) temporally related to COVID-19. Methods: All children meeting the WHO case definition of MIS-C were prospectively enrolled. Baseline clinical and laboratory parameters were compared between survivors and non-survivors. Enrolled subjects were followed up for 4-6 weeks for evaluation of cardiac outcomes using echocardiography. The statistical data were analyzed using the SPSS version 12 software. Results: 31 children with MIS-C were enrolled in an eleven-month period. Twelve children had preexisting chronic systemic comorbidity. Fever was a universal finding;gastrointestinal and respiratory manifestations were noted in 70.9% and 64.3%, respectively, while 57.1% had a skin rash. Fifty-eight % of children presented with shock, and 22.5% required mechanical ventilation. The median (IQR) duration of hospital stay was 9 (6.5-18.5) days. Four children with preexisting comorbidities succumbed to the illness. The serum ferritin levels (ng/ml) [median (IQR)] were significantly higher in nonsurvivors as compared to survivors [1061 (581,2750) vs 309.5 (140,720.08), p value=0.045] (table 1). Six children had coronary artery involvement: 5 recovered during follow-up, while one was still admitted. Twenty-six children received immunomodulatory drugs, and five improved without immunomodulation. The choice of immunomodulation (steroids or intravenous immunoglobulin) did not affect the outcome (table 1). Conclusion: Most children with MIS-C present with acute hemodynamic and respiratory symptoms. The outcome is favourable in children without preexisting comorbidities. Raised ferritin level may be a poor prognostic marker. The coronary outcomes on followup were reassuring.

Morbidity and mortality trends of Covid 19 in top 10 countries.

The present article highlights morbidity and mortality trends of Covid 19 in the last 3 months in top 10 countries of the world. In spite of efforts being undertaken, all countries are showing an increasing trend in terms of morbidity and mortality. The order of countries in terms of mortality and morbidity has changed in the last 3 months. Various efforts are being undertaken by WHO and other agencies world over including the vaccine development initiative.

Lessons to be learnt from 100 year old 1918 influenza pandemic viz a viz 2019 corona pandemic with an eye on NTEP.

The article is about the 1918 H1N1 flu pandemic also called the "Spanish flu" which killed 50 million plus people worldwide, and the coronavirus pandemic (Covid-19) which has spread in the world at an alarming pace. As of now there are 11,327,790 cases and 532,340 deaths globally. Aim of this article is to draw conclusions and share knowledge from both the pandemics and apply these lessons in other health programmes.

Laboratory diagnosis of novel corona virus (2019-nCoV)-present and the future.

BACKGROUND: In December 2019 a novel coronavirus SARS-CoV-2 emerged in the Hunan seafood market in Wuhan, China, and soon became a global health problem. Since its outbreak, SARS-CoV-2 has had a major impact on clinical diagnostic laboratories. The scientific community has quickly risen to the occasion and reports of new developments have arrived at an unprecedented scale. At present, there is a growing list of over 400 SARC-CoV-2 diagnostic tests either in development or approved for clinical use. This presentation reviews the current laboratory methods available for testing COVID- 19 in microbiology laboratories and also provides an insight into the future diagnostics approaches. METHODS: Proper respiratory specimen collected at the appropriate time and from the right anatomical site is critical in the accurate and timely diagnosis of SARSCoV2. While oropharyngeal and nasopharyngeal swabs are recommended for the detection of early infection, other lower respiratory tract specimens like the sputum and bronchoalveolar lavage are used for late detection and monitoring of patients with severe COVID-19 pneumonia. RESULTS AND CONCLUSION: Real-time RT-PCR based molecular assay remains the test of choice for the etiological diagnosis of SARS-CoV-2 while serological tests are being introduced as supplementary tools. Finally, there is an urgent need for scaling up the diagnostic capacity by the introduction of reliable and accurate point-of-care tests which will assist in effective control of this outbreak. These assays can be used in the local hospitals and clinics bearing the burden of identifying and treating patients.

Benefits and limitations of serological assays in COVID-19 infection.

Accurate and rapid diagnostic tests are critical for achieving control of coronavirus disease 2019 (covid-19), a pandemic illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Diagnostic tests for covid-19 fall into two main categories: molecular tests that detect viral RNA, and serological tests that detect anti-SARS-CoV-2 immunoglobulins. Reverse transcriptase polymerase chain reaction (RT-PCR), a molecular test, has become the gold standard for diagnosis of covid-19; however, this test has many limitations that include potential false negative results, changes in diagnostic accuracy over the disease course, and precarious availability of test materials. Serological tests have generated substantial interest as an alternative or complement to RT-PCR and other Nucleic acid tests in the diagnosis of acute infection, as some might be cheaper and easier to implement at the point of care. A clear advantage of these tests over RT-PCR is that they can identify individuals previously infected by SARS-CoV-2, even if they never underwent testing while acutely ill. Many serological tests for covid-19 have become available in a short period, including some marketed for use as rapid, point-of-care tests. The pace of development has, however, exceeded that of rigorous evaluation, and important uncertainty about test accuracy remains.

Tuberculosis: Newer diagnostic tests: Applications and limitations.

A public health worry as is Tuberculosis (TB) has been making more than 10 million people globally suffer from its terror and causing more than 2 million people worldwide to lose their lives every year. Mankind is putting all its efforts, since the discovery of the causative bacilli, to come up with some dramatic improvements in providing high-quality TB diagnostic services. Nevertheless, it poses a challenge and many people with TB remain use only smear microscopy for diagnosis. In an environment where transmission is becoming easier by the day the challenge becomes burdensome once disease gets associated with drug resistance, HIV, other diseases, etc. It becomes of paramount importance to address this biggest public health challenge delivering timely diagnosis using advanced technologies. Initial microscopic examination forms the backbone of TB diagnosis since 100 years along with clinical confirmations. Newer advanced diagnostic tools coming into play are genotypic assays (LPA, CBNAAT, LAMP) that are rapid molecular tests, and culture methods (liquid culture media) with standard drug susceptibility testing assays. Program ideates to correlate these rapid molecular diagnostics with turn-around time (TAT) as low as around 2 hours, with conventional standard methods. These help in reinforcing the diagnostic capacities and also provide identification of drug resistance patterns for few most important first line and second line drugs. The present day developments have brought these tests to near-patient point of care. Culture tests (liquid culture media) are gold standard technique for the analysis of TB with its increased sensitivity and highest quality over all others. An on-going search under TB diagnostics is to find an efficient, reproducible, cost effective tool with minimal infrastructure requirements. This review conveys the advances made over the past decades in the diagnosis of the disease and drug resistance.

Covid-19 and social stigma: Role of scientific community.

COVID-19 has led to stigma and discrimination among various groups of people in different populations. Healthcare workers caring for those affected by COVID-19,3 people who have recovered from COVID-19,4 those belonging to lower socioeconomic groups, those having particular religious and racial identities have all been at the receiving end of the discrimination. COVID-19 has led to reinforcement of preexisting stereotypes against various groups. For instance, in Italy, in weeks before the national lockdown started, a state of emergency was declared but everyday life was going on as always, the sentiment toward the Chinese community changed: their restaurants were left empty, more and more parents did not want their children to go to school if they had a Chinese classmate, and a high-profile politician said on TV that 'we have all seen them eat live mice'.