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BackgroundLupus is a heterogenous diseases which results in significant premature mortality. Most studies have evaluated risk factors for lupus mortality using regression models which considers the phenotype in isolation. Identifying clusters of patients on the other hand may help overcome the limitations of such analyses.ObjectivesThe objectives of this study were to describe the causes of mortality and to analyze survival across clusters based on clinical phenotype and autoantibodies in patients of the Indian SLE Inception cohort for Research (INSPIRE)MethodsOut of all patients, enrolled in the INSPIRE database till March 3st 2022, those who had <10% missing variables in the clustering variables were included in the study. The cause of mortality and duration between the recruitment into the cohort and mortality was calculated. Agglomerative unsupervised hierarchical cluster analysis was performed using 25 variables that define SLE phenotype in clinical practice. The number of clusters were fixed using the elbow and silhouette methods. Survival rates were examined using Cox proportional hazards models: unadjusted, adjusted for age at disease onset, socio-economic status, steroid pulse, CYC, MMF usage and cluster of the patients.ResultsIndian patients with lupus have significant early mortality and the majority of deaths occurs outside the hospital setting.Out of 2211 patients in the cohort, 2072 were included into the analysis. The median (IQR) age of the patients was 26 (20-33) years and 91.7% were females. There were 288 (13.1%) patients with juvenile onset lupus. The median (range) duration of follow up of the patients was 37 (6-42) months. There were 170 deaths, with only 77 deaths occurring in a health care setting. Death within 6 months of enrollment occured in in 80 (47.1%) patients. Majority (n=87) succumbed to disease activity, 23 to infections, 24 to coexisting disease activity and infection and 21 to other causes. Pneumonia was the leading cause of death (n=24). Pneumococcal infection led to death in 11 patients and SARS-COV2 infection in 7 patients. The hierarchical clustering resulted in 4 clusters and the characteristics of these clusters are represented in a heatmap (Figure-1A,B). The mean (95% confidence interval [95% CI] survival was 39.17 (38.45-39.90), 39.52 (38.71-40.34), 37.73 (36.77-38.70) and 35.80 (34.10-37.49) months (p<0.001) in clusters 1, 2, 3 and 4, respectively with an HR (95% CI) of 2.34 (1.56, 3.49) for cluster 4 with cluster 1 as reference(Figure 1C). The adjusted model showed an HR (95%CI) for cluster 4 of 2.22 (1.48, 3.22) with an HR(95%CI) of 1.78 (1.29, 2.45) for low socioeconomic status as opposed to a high socioeconomic status (Table 1).ConclusionIndian patients with lupus have significant early mortality and the majority of deaths occurs outside the hospital setting. Disease activity as determined by the traditional activity measures may not be sufficient to understand the true magnitude of organ involvement resulting in mortality. Clinically relevant clusters can help clinicians identify those at high risk for mortality with greater accuracy.Table 1.Univariate and multivariate Cox regression models predicting mortalityUnivariateMultivariateVariablesHazard ratio (95% Confidence interval)P valueHazard ratio (95% Confidence interval)P valueCluster1Reference-Reference-20.87 (0.57, 1.34)0.5320.89 (0.57, 1.38)0.59831.22 (0.81, 1.84)0.3371.15 (0.76, 1.73)0.51342.34 (1.56, 3.49)<0.0012.22(1.48, 3.22)<0.001Socioeconomic statusLower1.78 (1.29, 2.45)<0.001Pulse steroidYes1.6 (0.99, 2.58)0.051MMFYes0.71 (0.48, 1.05)0.083CYCYes1.42 (0.99, 2.02)0.052Proliferative LNYes0.99 (0.62, 1.56)0.952Date of birth age0.99 (0.98, 1.01)0.657CYC- cyclophosphamide, MMF- Mycophenolate mofetilFigure 1.A. Agglomerative clustering dendrogram depicting the formation of four clusters. B.Heatmap depicting distribution of variables used in clustering C. Kaplan-Meier curve showing the survival function across the 4 clusters[Figure omitted. See PDF]REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone eclared.
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Intro: Delta and Omicron variants of SARS-CoV-2 are highly contagious, currently dominating the globe and recognized as variant of concern (VOC). The transmissibility efficiency of viruses, disease symptoms, and severity of COVID- 19 is highly heterogeneous. Therefore, testing at the community level is essential to identify the infected people at an early stage-carrying VOC to reduce the spread of virus and combat the pandemic. Method(s): In this study, we analysed thousands of genome sequences representing 30 different SARS-CoV-2 variants and identified Delta and Omicron variants specific nucleic acid signatures in the spike gene. Based on the variant specific nucleic acid sequences we synthesized different oligos and optimized a mPCR assay that can specifically differentiate the Delta and Omicron variants. We further translated our work into a dipstick assay (Tohoku Bio-array, Japan) by adding tag linker sequence to 5' end of the forward primer and adding biotin in 3' end of the oligos. Finding(s): A total of 250 samples were subjected to WGS using MiSeq platform and these confirmed samples were processed for validation of our specific designed probes using PCR assay and the readout was found to be 100% specific to Delta, BA.1 & BA.2 of SARS-CoV-2 variants which were further confirmed by Sanger sequencing. The dipstick was used to screen these samples, and specific signals were observed. WGS and Sanger sequencing were used to validate our PCR and dipstick assay results, and the readout was found to be 100% specific. The results can be visualised by the naked eye and interpreted easily. Conclusion(s): This study developed a rapid point-of-care test of SARS-CoV-2 patients, which can differentiate Delta, BA.1 and BA.2 variants at the same time of confirmation of the infection in patient. The current nucleic-acid chromatography-based dipstick assay is highly specific and can work even in the case of low viral load as well.Copyright © 2023
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Introduction: Hypertension is the most common co-morbidity associated with COVID-19 patients. Many patients take angiotensin-converting enzyme (ACE) inhibitors for the management of hypertension. The study aimed to compare the clinical and hematologic features in hypertensive and non-hypertensive patients suffering from COVID-19. Material(s) and Method(s): This observational study compared clinical and hematologic features in hypertensive and non-hypertensive patients suffering from COVID-19. The study enrolled patients from SMS Medical College, Jaipur (Rajasthan, India) after approval from the institutional Ethics Committee. The comparison of quantitative variables was performed using the Mann-Whitney test, and qualitative attributes were compared using the chi-squared test. The level of confidence is considered at 5%. Result(s): There were no significant differences found in clinical and hematologic features between hypertensives and non-hypertensives suffering from COVID-19. Conclusion(s): The present study concludes that there is no evidence that either use of ACE inhibitors is useful or harmful in patients with hypertension. Therefore, it is endorsed to use these agents in the management of hypertensives in patients suffering from COVID-19, till further evidence is found.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
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Following the publication of the original article [1], the authors identified that Supreet Singh Nayyar, Rahul Kurkure, Arun Yadav, Jyoti Mishra, Biswajit Das and Shubankar Tiwari were incorrectly assigned to affiliation 3. The authors are assigned to affiliation 2. The original article [1] has been corrected. © 2023 The Author(s).
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Originally thought to be a respiratory pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), has been shown to cause a dizzying array of symptoms, including all major organ systems of the human body. As time elapsed, new strains of the virus have emerged, validating concerns about genetic mutation. No single treatment has proven beneficial in treating the consequences, and the world has been left at the mercy of this deadly pathogen. It has been proven that COVID-19 can cause strokes, myocardial infarcts, mesenteric infarcts, acute limb ischemia, and a wide array of other symptomatology. This review aimed to evaluate whether there exists an association between COVID-19 and pancreatitis. Forty publications (34 case reports and 4 case series) were included in the review. In total, 44 cases of acute pancreatitis (38 cases of acute edematous pancreatitis and 6 cases of necrotizing pancreatitis) in COVID-19 patients without any predisposing factors have been published since January 2020. Fortunately, only 4 (9.1%) of these patients were reported to have died. Although the exact mechanism by which COVID-19 causes pancreatitis is still unclear, studies so far have reported it as a multifactorial phenomenon. COVID-19 associated pancreatic injury is thought to involve direct cellular damage via local replication of SARS-CoV-2 within pancreatic cells, as they express angiotensin-converting enzyme 2 receptors even more strongly than lung cells. Our review concludes that acute pancreatitis should be kept in the differential list of all COVID-19 patients with gastrointestinal manifestations, especially in patients with acute abdomen.Copyright © 2023, Society of Gastrointestinal Intervention.
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The new coronavirus SARS-CoV-2 is an infectious virus with a long incubation period, which was first detected in Wuhan, China, spread all over the world, seriously threatening human life. Therefore, accurate and rapid detection of SARS-CoV-2 is very important for controlling the epidemic and preventing its further spread. Currently, nucleic acid detection makes an important contribution to the prevention and control of SARS-CoV-2. In this study, a new and highly sensitive nucleic acid detection method for SARS-CoV-2 has been proposed. The nucleic acid sequences were digitized by Entropy-based mapping technique. Then, the digitized these sequences were divided into 100-unit sections using the sliding window method and given as input to Capsule Networks.10988 segments (5494 SARS-CoV-2, 5494 normal) are classified with capsule nets. With the proposed method, an accuracy performance of 100% was achieved by using capsule networks to identify SARS-CoV-2 from nucleic acid sequences. The results show that the proposed method successfully identifies SARS-CoV-2 from nucleic acid sequences © 2023, Brazilian Archives of Biology and Technology. All rights reserved
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Background: COVID-19 pandemic has exacerbated symptoms in existing diagnosed cases of anxiety. Its impact on people with mental illness is expected to be significant, leading to an increase in relapse rates and expectedly inducing or exacerbating death anxiety. Aims & Objectives: This study aimed to assess the impact of Covid 19 fear on general anxiety and wellbeing and death anxiety and compare people with anxiety spectrum disorders on perceived fear, autonomic anxiety symptoms, and death anxiety with those without these disorders. Materials & Methods: We recruited 36 participants with anxiety spectrum disorder (generalized anxiety disorder (n=6), obsessive-compulsive disorder (n=17), panic disorder (n=5) and mixed anxiety and depression (n=8) and 36 individuals free from any psychiatric illness. Tools used include General Health Questionnaire, Fear of COVID-19 Scale, Perceived Stress Scale, Beck Anxiety Inventory and Multidimensional Fear of Death Scale. Results: A statistically significant correlation was noted between many variables in both the study groups. The regression analysis showed a significant difference in general well-being and anxiety & death anxiety in the clinical group. Study outcomes indicated that the current pandemic has triggered significant fear and anxiety in anxiety patients and among healthy controls and has triggered significant death anxiety in the clinical and healthy control group. Conclusion: The study showed that fear of covid-19 is a predictive factor for stress, death anxiety, and general well-being. These findings may be helpful to plan preventive measures, tailored intervention focusing on death anxiety and relapse plans effectively. © 2022 by the Author(s).
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Purpose: Our study aims to compile data on the clinical presentation, pathological and radiological findings in cases of post-COVID mucormycosis, and present the management strategy used in our center. Methods: This is a retrospective cohort observational study based at a tertiary healthcare institution in Northern India. All COVID-positive patients presenting with clinical features of mucormycosis were included in the study. They underwent complete otorhinolaryngeal, medical, and ophthalmological examination after thorough history taking. Biochemical tests, biopsy and imaging studies were done for all the patients. The treatment strategy included a multidisciplinary team approach, that is, intravenous antifungals as well as surgical debridement of necrotic tissue via Modified Denker's approach or open maxillectomy, and orbital exenteration, if required. Patients were followed up for six months to look for recurrence. Results: Twenty-three patients were studied, out of which 14 were males and 9 were females. Pathological findings of 13 out of 15 patients, who underwent surgical debridement revealed mucormycosis as a causative agent, received Amphotericin. Aspergillus was found in two cases which received Voriconazole. Eleven out of 20 patients who were treated in our hospital survived. Three patients were lost to follow up. The average hospital stay of discharged patients was 14 days. Conclusion: Post-COVID mucormycosis was reported at an alarming rate after the second COVID wave in India especially after steroid therapies in diabetic patients. Thus a timely, aggressive, team approach using Modified Denkers or open maxillectomy along with proper intravenous antifungals is the key to survival in such patients. © 2023, The Author(s).
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Critically endangered Aquilaria malaccensis Lam. is known for highly expensive agarwood with unique aroma. Agarwood has been used as a phytomedicine in chronic degenerative neurological disorders, paralysis, rheumatism, asthma, and others. Its production is dependent naturally or artificially on interaction of endophytic fungi, and by nailing, drilling, and microbial inoculation respectively. The majorly produced biomarkers of terpenes, fatty acids, alkanes, chromones, and flavonoids exhibited several biological activities in congruence to their ethnomedicinal claims. During the pandemic, several in-silico, studies showed the potential of a few sesquiterpene hydrocarbons against covid-19. The review aimed to deliver a comprehensive outline of the immunomodulatory potential of agarwood oil with allied traditional medicinal use, biomarkers, pharmacological evaluation, toxicity, and mechanistic action. The review eventually showed the agarwood oil, extracts, and major biomarkers viz., aromadendrene II, valencene, phytol, octacosane, caryophyllene oxide, b-caryophyllene, hinesol, agarospirol, with immunomodulatory, anti-inflammatory, and allied neural, antidiabetic, antimicrobial activity, toxicity, along with molecular target binding potential against 3CLpro, RDRP, Mpro, PLpro, Spike protein S1 of SARS-CoV2 through in-vitro, in-vivo, in silico studies and limited human clinical trials. The expression of HMGR, ASS, ADXPS, ADXPR, FPS, and WRKY genes of sesquiterpenoid biosynthetic pathways were upregulated for signature aroma and immunomodulatory markers viz., d-guaiene, dodecane, tetracosane, agarospirol, farnesol, and geranylgeraniol acetate as a defensive response. The review would ignite future research on potential immunomodulatory markers viz., caryophyllene oxide, octacosane, heneicosane, agarospirol, n-hexadecanoic acid, a-eudesmol, a-santalol and inoculum guided invitro agarwood production restoring the prized aroma, therapeutic efficacy, and wild population. (c) 2022 SAAB. Published by Elsevier B.V. All rights reserved.
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Introduction: The COVID-19 pandemic has been raging across the globe since early January 2020. Various geographical regions have been passing multiple swells of upsurge of cases which aren't matched temporally as well as in severity. The diapason of the complaint ranges from asymptomatic to severe life-hanging complaint. Advanced age and the presence of comorbidities similar as cardiovascular complaint, diabetes mellitus, hypertension, chronic lung complaint, chronic kidney complaint, cancer, and obesity are among the major threat factors for severe disease. Aims and objectives: Significance of lab parameter among Corona Patients. Materials and methods: The covid- 19 opinion was verified by reverse transcription- polymerase chain reaction (RT- PCR) assay of nasopharyngeal swab sample. Hematology blood samples were used to analyze by flow cytometry. Biochemical samples were used to analyze by completely auto analyzer diagnostic outfit. Serology tests were carried out the styles based on indirect ELISA technique, immune plates are coated with a admixture of purified viral antigen and probe using the patient serum. Results: It is found that there is statistically significant (p-value<0.05) mean difference within the lab parameters (IL-6, LDH and Ferritin) in Covid patients using the Post Hoc Analysis. It is also found that there statistically significant (p-value<0.05) mean difference between RBC, Hb level, Hematocrit, MCV, MCH, MCHC, Platelet, RDW, PCT and NL ratio while Age, WBC, MPV, M(Monocyte), E(Eosinophil), B(Basophil), D-dimer and PDW were found to be statistically insignificant (p-value>0.05) with respect to gender. Discussion: CBC, D- dimer, IL-6, LDH and Ferritin were analysed and found associated with adverse outcomes. There is significant association of age, gender, comorbidity. Conclusion: High NLR at admission associated with a higher mortality. Laboratory features (e.g., IL-6, LDH, Ferritin D-dimer etc.) were associated with poor outcomes.
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The sudden outbreak of the virus COVID-19 has created a pandemic situation worldwide. Humankind has not experienced such a danger caused by this disease in the past hundred years. Apart from all the health issues, the pandemic has created an immense impact on social life, economics, mental peace, and all aspects of human life. Prolonged quarantine is creating uncertainties;death tolls are creating fear. According to the World Health Organization, this public health emergency is likely to create anxiety, loneliness, depression, fear of losing jobs, being economically unstable, and committing suicide. In our present discussion, we prepare a statistical record using data collected from all over the world to find the intensity of mental disorder caused by this pandemic. Now we aim at finding the polarity of the specified term used by social media users. We aim to formulate a highly efficient mechanism that will detect depressive sentences more accurately. In our work, we try to formulate an optimal mechanism implementing the Latent Dirichlet Allocation approach to modify our findings and prove through a comparative study that depression affects the highest among people age 40−50. We experience that this age group is highly devastated in fear of losing jobs because of to this pandemic. The standard psychiatric symptom of lack of self-dignity and self-confidence that can happen to a human at the middle age is proliferated due to extended lockdown and its after effects. There is much research in sentiment analysis, which shows us the impact of COVID-19 in recent days. Surprisingly, recognizing symptoms of the midlife crisis in the pandemic situation of COVID-19 is yet to achieve. © 2022 Elsevier Inc. All rights reserved.
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From December 2019, COVID-19 pandemic has hit the human civilization in an unprecedented way. It has taken more than five million lives in just a span of two years. Two major mechanisms via which COVID-19 affects us are either via direct respiratory disorder and lung failure or otherwise via delayed flare of immune systems more prevalently known as the cytokine storm. Mesenchymal stem cells (MSCs) can be a potential therapeutic agent against mortality and morbidity of COVID-19 via direct differentiation into pulmonary epithelial cells as well as via antiinflammatory paracrine activities. MSCs are also can be useful to replicate COVID-19 infection in an in vitro organ model. In current study, we are systematically reviewing and finding out the potential applications of MSCs which could help mankind to combat COVID-19. © 2022 Elsevier Inc. All rights reserved.
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PURPOSE: The purpose of this study is to present a better understanding of the specialized telehealth service in Bangladesh from the service provider and service recipients by aged people METHOD: Both quantitative and qualitative methods were used to collect data from Diabetes Mellitus (DM) patients. Data were collected by online telephone interviewing with an interview schedule. A total of 100 aged people with diabetes were selected purposively for a quantitative interview and 10 In-depth Interviews (IDIs) & Key Informant Interviews (KIIs) were conducted. RESULT: The majority of patients aged was between 61 to 68 years with a mean age of 63.6 +/- 7.01years. The difference of age of DM patients by sex was found statistically significant (x2 = 39.49, df = 31;Cramer's V = .032;P=<.003). The main source of information about digital health was: relatives (55%), neighbors (31%), television (12%), newspaper (10%), social media (9%), and healthcare providers (6%). Strong relationship was found between age of respondents and sources of information (x2= 77.08;Cramer's V= .032, df = 13;Sig;P= < .009). About 59% of DM patients were benefited from telehealth services during COVID-19, however;they encountered some difficulties like effective access to digital technology, cost, and diagnosis facilities. About 83% of respondents suggest formalizing community engagement programs to extend the digital health services during a health emergency. The common barriers to the engagement of community people in digital health care are lack of social awareness, lack of peer group support, and gender disparities. Poor counseling, language barrier, bad internet signal, and lack of family members' support were the key barriers during teleconsultation services. CONCLUSION: Telehealth has the potential to address critical health issues of aged people and effective community engagement may be the best option to reach older people with diabetes in Bangladesh during any health emergency.
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Aim and background: Delirium is the disturbance of consciousness characterised by acute onset, rapid fluctuations in mental status, and impaired cognitive functioning. The patient's ability to receive, process, store, and recall information is impaired in delirium. Objective: To study the incidence of delirium in patients in COVID and non-COVID ICU. To also study various risk factors associated with delirium. Materials and methods: After ethical committee approval and written informed consent, this study was carried out over a period of 1 year (August 2020 to July 2021). Each patient meeting the inclusion criteria was evaluated on the RAAS score within 24 hours of admission, then screened for delirium according to CAM-ICU worksheet every 6th hourly after admission in MICU. 50 patients were studied each in COVID and non-COVID ICU. Patients found to have delirium after the first assessment were classified as new cases. Various risk factors were evaluated prospectively. Results: Incidence of delirium in non-COVID ICU was 29%, while in COVID ICU was 37%. Delirium is present in a patient who has risk factors including smoking, higher severity of illness, oversedation, and mechanical ventilation. Antipsychotics can be used for patients who develop delirium. Conclusion: Delirium is a preventable issue in ICU patients that can be managed by preventing the risk factors that will decrease overall length of stay in ICU.
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Aim: To compare chest computed tomography (CT) diagnosis of ground glass opacities in the COVID-19 patients. Study design: Retrospective study. Place and duration of study: Department of Radiology, Ghulam Muhammad Mahar Medical College Sukkur from 1st July 2020 to 31 August 2021. Methodology: Fifty patients on differential CT diagnosis of ground glass opacities seen in COVID 19 patients were enrolled. Thoracic CT images by applying auto exposure-control settings and ranges of scan were done. The noise-index was kept as 12.3. Using helical 16 slice Alexion CT-Toshiba. Keeping a comparison with viral infection CT images a list of 7 signs which were positive for Covid CT scan were recorded. Peripheral lesions meant any lesions which effects peripheral area up to 3 to 4 cm lung periphery with/without having central dispersal. A hazy-opacity was termed as ground glass. Results: Mean age of the patients was 49.1±10.2 years with 27 (54%) males and 23(46%) females. Mix ground glass opacitites and consolidation were also the features of the CT imaging in coronavirus posisitve cases. Man-Whitney test results showed that combined-CT scoring had a SE value as 0.044 with a confidence interval between 0.756-0.927. Comparing the differential CT values within COVID and non COVID patients based on RT PCR results it was observed that posterior region lower lobe involvement was a feature of COVID-19 patients while crazy paving pattern and peripheral distribution was also seen in corona patients. Conclusion: Present study highlights that chest CT helps in differentitaing corona virus from other causes of pneumonias and grond glass opacities.
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Purpose: The racial composition of Mississippi is Caucasian (C) 58%, African American (AA) 38%, and others 4%, whereas the SARS-CoV-2 PCR positive rates are 16% in AA, 25% in Hispanics, and 6% in C children. We aimed to study the disparities of MIS-C in Mississippi and whether MIS-C follow the same racial distribution as SARS-CoV-2 infection? Methods: Retrospective study of consecutive MIS-C patients <18 years of age hospitalized at our center over 1 year. We compared demographics, clinical presentation, laboratory findings, and treatment of MIS-C by race/ethnicity. We compared the distribution of MIS-C cases with that of SARS-CoV-2 infection rates. Results: During the study period, 51 MIS-C patients hospitalized. Median age was 9 year, 58% male, 36(71%) were AA, 13(25%) were C, 1 was Asian, and 1 was Hispanic. We found a significant delay between onset of symptoms and hospitalization in AA than C children, 2.3±2.1 vs. 0.6±1.5 days (P=0.002). Cardiac symptoms were present in 24%, and 39% had Kawasaki's disease-like symptoms. Only absolute neutrophil count was associated with cardiac dysfunction (p= 0.01) on multivariate analysis. Creatinine and ferritin levels were associated with ICU admission;p= 0.01 and 0.03, respectively. Differences in inflammatory and cardiac biomarkers between AA and C races are summarized in Figure 1. AA children with MIS-C had increased length of hospitalization (8.1 vs 5.2 days;p=0.04), a higher trend of more admissions to ICU (38.9% vs 23.1%;p=0.3) and cardiac involvement (36.1% vs 23.1%;p=0.5) than C Children (Figure 2). Conclusion: In Mississippi, racial disparity in MIS-C exceeds the differences of SARS-CoV-2 infection rates in children. AA children had delayed hospitalization from the onset of symptoms, severe inflammation, longer length of stay, a higher trend for more cardiac dysfunction and ICU admissions than C children. Our findings could assist health professionals in devising appropriate strategies to target minority children.
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However, it is this very set of tests that have come Hin question. First, what is the normal and acceptable range (upper & lower limits) of different Clinical Chemistry and Immunoassay biomarkers in a particular population has been debated in different scientific fora. This is because the level of markers can change in relation to other biochemicals, biomolecules and hormones, which themselves vary considerably with race, gender, age, different physiological conditions (like pregnancy, new-born) and other illnesses & interfering substances. The variation can be to an extent that each individual can seem to have their own set-point of these parameters. A second problem which the diagnosticians have to grapple with is the variability of test-results in itself;even a broadly similar set of instruments and methods can provide variable results. It is then a real challenge to physicians, to decide whether the patient is suffering from a disease or not, since other factors can also cause changes in test levels. Standardization and harmonization of clinical chemistry and immunoassay testingis therefore still a formidable challenge, due to the lack of proper reference intervals and sometimes due to standardized measurement procedures. Laboratory medicine community the world over has realized that, variability in test results in different platforms can create a lot of confusion to clinicians and the general population;harmonization of procedures is therefore the need of the hour. In this talk, I will provide few examples and technical solutions to address laboratory challenges and to take it forward from both Clinical Chemistry as well as Immunoassay platforms. To begin with, harmonization and standardization of TSH and other thyroid function tests are still a formidable challenge, due to the lack of proper reference intervals and standardized measurement procedures. It has been documented that even a broadly similar set of instruments and methods can give up to 40% more or less values in TSH levels. Based on a particular population's demographic variations, reference interval can be different for immunoassay like TSH. Therefore, we have verified the reference interval for the Indian population for TSH in our laboratory. We have screened 800 subjects, of which 630 healthy subjects were chosen in the study group for reference interval verification. The reference interval (90% Confidence interval) for TSH by non-parametric procedure (bootstrap) was 0.48- 4.52, and by parametric one (after transformation of the data) was 0.45-4.27 for the adult population, which is little different from the manufacturer's guidelines. Similarly, we have conducted a study of 2797 female patients and 2805 male patients in a six month period and have observed that, women have a greater risk of being 14% under-diagnosed of acute coronary syndrome, if we donot use gender specific cut off (Male: 32.3 pg/ml and Female: 14.6pg/ml for the Indian population), with high th sensitive troponin I assay near the 99 percentile of a reference control population. Therefore, implementation of sex-specific hs-cTnI assay was able to identify 14% of under-diagnosed women with ACS in 6 months period. This in turn also decreased the number of men being diagnosed by 3%. On a similar note, there has been a continuous challenge in the health care system in U.S, Europe and other countries to standardize and harmonize the HbA1c reporting: the decision on what to report in NGSP (%) and/or IFCC (mmol/mol) units along with eAG (in either mmol/L or mg/dL). This globalization places a responsibility on laboratory medicine specialists to work together to reduce the current variability in patient results, which arises from differences between units, methods and laboratory practices in different countries. Due to the standardization efforts of IFCC, NGSP, and also due to ongoing efforts of manufacturers and laboratories, the quality of HbA1c reporting has increased dramatically. Consequently, there has been a paradigm shift: HbA1c is now considered the gold standard, not only for monitoring, but also for diagnosis of diabetes. We have performed verification studies of HbA1c by different methods: HPLC, Capillary Electrophoresis, Enzymatic, Immunoassays in 200 samples and compared 60 samples with hemoglobinopathies. Finally, we have also explored harmonizing the clinical protocol based on the use of inflammatory and routine laboratory biomarkers in 2,654 COVID-19 patients. To explain the role of harmonizing routine laboratory parameters in disease monitoring, two adult males, two adult females and one adolescent girl were selected. These are representative examples of different manifestations of COVID 19, with Adult Respiratory Distress Syndrome (ARDS), Cardiac Injury, Neurological manifestations and Pediatric Multi system inflammatory syndrome (PIMS), admitted in the Intensive care unit (ICU) of the hospital, which will be discussed. Therefore, the road map for laboratory medicine will involve strategies for harmonizing, communicating and integrating with all stakeholders, like, clinicians, diagnosticians and IVD industry, in order to formulate guidelines for assisting in correct measurement, diagnosis and management of diseases.
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Globally, millions of documented SARS-CoV-2 infections with hundreds of thousands of deaths already reported. The majority of the fatal events have been reported in adults older than 70 years and those who have multiple co-morbidities. Despite the misery fatality of the virus, a significant number of peoples recovered from critical conditions also. Mild cases improved significantly with symptomatic management with strict maintenance of isolation. Therefore, many people believed that COVID-19 is a short-term illness, mild cases recovered completely within 2 weeks and severe or critical illness may require 3-6 weeks for complete recovery. However, the latest issue coming forward is delayed recovery in the surviving patients from severe or moderate COVID presenting with multisystem complications. We reported two cases of post COVID complications, newly named as "long COVID syndrome". We described the common symptoms two patients experienced following recovery from acute phase of COVID-19 and how they were managed. We also discussed on the pathogenesis and management plan of common symptoms persisting after recovery of COVID-19.