Patient Experience of Remote Healthcare during the Pandemic in Rheumatoid Arthritis and Adult Juvenile Idiopathic Arthritis

Background/Aims COVID-19 challenged traditional care models and necessitated introduction of remote consultations. We wanted to understand the experiences of people with rheumatoid arthritis (RA)/adult juvenile idiopathic arthritis (AJIA) on accessing healthcare remotely, and how well people understood their condition and treatment. Methods This collaborative work between the National Rheumatoid Arthritis Society (NRAS) and clinicians in Oxford led to the development of an electronic questionnaire that was disseminated in July 2021 for four weeks through e-newsletters and all NRAS social media platforms. Those living in the UK with RA and AJIA aged 18 and over were eligible. Analyses of data were performed in Microsoft Excel and IBM SPSSv28. Results We analysed 316 responses. There was a middle-aged (ages 46 to 54, 54.1%, n=171), Caucasian (97.5%, n=306), female (92.4%, n=292) preponderance. Most had RA (93%, n=294) followed by another inflammatory arthritis (4.1%, n=13) and AJIA (2.8%, n=9). The majority had their condition for >10 years (43.4%, n=137) but some were diagnosed <12 months ago (3.2%, n=10). Two thirds of participants (66.5%, n=210) did not know their DAS28 score. Of the remaining third, the most commonly reported measure was moderate disease activity (12%, n=38). Those with higher self-reported DAS28 scores were using analgesia more regularly (p<0.01) but we found no difference in NSAID, DMARD or steroid use. Age did not influence steroid usage (p=0.35), but those who had their condition for longer used more steroids and regular analgesia. Only 33.9% (n=107) of responders felt their condition had been managed adequately in the pandemic, with more reporting poor status (40.8%, n=129) rather than good (16.8%, n=53). Those living in the South of England reported statistically better disease control than those from the North, despite having more virtual assessments (p=0.02). Travelling and fear of Covid appeared more important than consultation skills. Just over a fifth (20.3%, n=64) felt greater focus should be given to patient concerns. Of the 9.1% of patients (n=29) with a new diagnosis made during the pandemic, 24.1% (n=7) unable to book a GP appointment easily. Patients experienced a median symptom time of 4-10 weeks before consulting GPs. Once assessed, 31% (n=9) were referred immediately while the median time was 4-8 weeks. We found 58.6% (n=17) of patients received their diagnosis within their initial rheumatology consultation and 76.5% (n=13) of these started a DMARD immediately. Conclusion Despite a greater emphasis on patient education and PROMs influencing clinical decision-making, it is staggering that two-thirds did not know their DAS28 score. Analgesia and steroid use were common in patients with well-established disease which remains a concern. Accessing appointments was a significant barrier to patients and delays in care were experienced at every step in the NHS management pathways. Remote consultations need greater emphasis on patient concerns.

Covid-19 vaccine (covishield) heralding Moyamoya angiopathy

Indroduction: Thrombotic complications leading to cerebrovascular events occuring in conjunction with Covid-19 vaccination though rare, is well-documented. Moyamoya Angiopathy is a progressive intracranial vasculopathy leading to recurrent strokes. Case presentation: We present two index cases of young patient presenting with stroke and TIA following Covid-19 vaccination (COVISHIELD) leading to unmasking of Moyamoya Angiopathy. Conclusion(s): Arterial stroke following Covid-19 vaccination is documented, but uncommon. However, in the background of a vasculopathy, it may not be so rare. Moyamoya Angiopathy has been closely studied in the model of inflammatory pathophysiology in genetically predisposed patients leading to progressive vaso-occlusive disease. Few reports of Covid-19 infection potentiating Moyamoya Angiopathy symptoms are also documented. Thus, as an extrapolation of the inflammatory etiopathogenesis of Moyamoya Angiopathy, Covid-19 vaccination can similarly affect the Moyamoya symptomatology. These two index cases open new lines of enquiry regarding the interplay of Covid-19 vaccination and neurological destabilization in patients with underlying vasculopathy of inflammatory pathophysiology.Copyright © 2022

Mucormycosis in COVID-19 patients: A tertiary care experience

Introduction: Zygomycetes consisting of Mucorales order is a group of fungal infections. These species cause life threatening opportunistic fungal infections mucormycosis. This infection is highly prevalent in immunocompromised. During the 2 nd wave of Covid 19 pandemic corticosteroid treatment was used which has been linked to development of Mucormycosis. In our tertiary care teaching hospital we saw that patients suffering from Covid-19 infections developed mucormycosis. We present these cases in our study. To study the clinical, demographical,and Laboratory parameters in Covid-19 patients with Mucormycosis. Material(s) and Method(s): Retrospective Study. All biopsy proven cases of Mucormycosis (which developed after Covid-19 infection) were included. Relevant Clinical Demographics and Laboratory data was retrieved from the available case sheets. The data was tabulated in Excel sheet and further reviewed. Result(s): A total of 22 patients were diagnosed as suffering from mucormycosis majority were unvaccinated. 11 patients out of 22 (50%) started manifesting mucormycosis within one week of COVID infection. All the patients who had only single comorbidity (22.72%) suffered from mild disease and patient who had more than one comorbidity suffered from moderate (27.27%) to severe (50%) COVID infection. Conclusion(s): It is suggested that patients with Covid-19 infection are at risk for development of opportunistic fungal infections like Mucormycosis. Hence the physicians who are involved in treating such patients must be mindful of the fact that mucormycosis can develop in them. Histopathology helps in establishing a concrete diagnosis of Mucormycosis.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Information retrieval and extraction on COVID-19 clinical articles using graph community detection and Bio-BERT embeddings

In this paper, we present an information retrieval system on a corpus of scientific articles related to COVID-19. We build a similarity network on the articles where similarity is determined via shared citations and biological domain-specific sentence embeddings. Ego-splitting community detection on the article network is employed to cluster the articles and then the queries are matched with the clusters. Extractive summarization using BERT and PageRank methods is used to provide responses to the query. We also provide a Question-Answer bot on a small set of intents to demonstrate the efficacy of our model for an information extraction module. © ACL 2020.All right reserved.

Assessment of e-learning in prosthodontics during COVID-19 pandemic: Perspective of students and faculty

Background: The goal of this study was to analyze the dental students' and faculty's perceptions of the usefulness of e-learning in prosthodontics during the difficult time of the COVID-19 pandemic. Materials and Methods: A cross-sectional study with a sample size of 213 students and 10 faculty members was conducted at the institutional level. The participants' perspectives on e-learning were formed using prevalidated anonymous questionnaires, one for students and the other for faculty, each including a total of 20 questions, both closed and open ended. The data were examined using SPSS version 24.0 for statistical analysis. Mean and standard deviation were used for descriptive statistics, whereas frequencies and percentages were used for categorical data. Results: The survey participants, students, and instructors all agreed that online classes had certain advantages since they fit better into their schedules. Both students and professors were dissatisfied with the learning quality because the prosthodontics subject is mostly a practical domain that necessitates active demonstrations and debates to master the practical aspects of the subject. Discussion: The results of this study revealed the substantial challenges that teachers and dental students encounter when it comes to e-learning in prosthodontics. These findings can be used to improve students' and faculty's learning experiences, as well as to develop an effective and productive online learning platform. Conclusion: The current study's findings revealed the substantial challenges that dental students and instructors confront when it comes to e learning in prosthodontics. This can then be used to advise the university's dentistry education section in developing an effective and productive online teaching platform aimed at improving students' learning experiences. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Catastrophic Antiphospholipid Crisis Triggered by Anticoagulant Switch

Case report - Introduction: The COVID-19 pandemic led to drastic changes for some patients on warfarin for venous thromboembolic (VTE) disease and atrial fibrillation. Warfarin monitoring necessitates frequent interaction with healthcare workers, which is sufficiently risky for COVID-19 transmission. As a result, selected patients were swapped over to novel oral anticoagulants (NOACs). Our patient was changed without investigating for antiphospholipid syndrome (APLS);it later transpired he was triple antibody positive. He presented in a crisis and we describe his narrative. Patients on warfarin due to presumed unprovoked venous thromboembolic disease should not be swapped to NOACs without completing, or checking, previous antiphospholipid antibody testing. Case report - Case description: A 73-year-old gentleman presented locally in August 2020 with erythema over the anterolateral surface of his left leg. He was initially treated with antibiotics for presumed cellulitis. Within a few days this lesion became necrotic and rapidly spread. At this point, he was transferred to a tertiary rheumatology centre. Within days to weeks, he developed several necrotic lesions affecting his trunk and limbs, with facial sparing noted. Approximately 30-35% of his whole-body surface became involved. He soon developed an oxygen requirement, with CTPA demonstrating lymphocytic interstitial pneumonitis without evidence of pulmonary emboli (PE). Throughout his admission, he had several other pathologies such as hyponatraemia that required level 2 care and severe noninfectious diarrhoea. Skin biopsy identified thrombotic vasculopathy. Serology confirmed triple positive antiphospholipid antibody status and a dsDNA titre of>400 iU/mL. This was the first-time serology had been undertaken despite a history of three deep vein thrombosis (DVT) episodes and two PE incidents. He had no history of SLE symptoms. His initial management for vasculitis secondary to APLS at the point of limited necrosis consisted of IV methylprednisolone followed by rituximab and PO prednisolone. While there was some delay in the progression of his disease, new areas of necrosis arose, leading to the patient receiving cyclophosphamide. Low molecular weight heparin was used for anticoagulation. This gentleman later developed proteinuria and neurological symptoms, fulfilling the criteria for catastrophic antiphospholipid syndrome. He received plasma exchange, without an improvement. He developed complications from his disease and treatment, including poor wound healing. It became apparent his condition would not improve and active treatments were stopped. He passed away 6 weeks after initial presentation. Prior to his admission to hospital, his warfarin was swapped to a NOAC. This is thought to have been the trigger behind catastrophic thrombosis. Case report - Discussion: After excluding other conditions such as necrotising fasciitis, this gentleman was rapidly started on IV methylprednisolone to halt any further progression. This is because glucocorticoids have the greatest evidence base for managing this poorly understood acute disease manifestation. After this failed to manage his condition, he was given a further immunosuppressive agent in the form of rituximab. This was used after his serology confirmed triple antibody status. It was hoped this would stop any further immunological mediated disease progression. Oral prednisolone was started at 40mg at this stage and kept under review with a tapering schedule. Cyclophosphamide was given within a few days of rituximab, with hope of a quicker onset of action. A careful MDT decision was made on these drug choices, particularly regarding their combined use and appreciating their side effect profiles. Cyclophosphamide has evidence behind its use, especially for those with APLS associated with lupus. While he did not develop any infections related to treatment, his condition progressed. Case reports suggest that plasma exchange can be useful in the management of catastrophic antiphospholipid syndrome, so the team recommen ed this. Consent at this stage became tricky due to his altered mental status, but it was felt he did demonstrate capacity for this specific decision. As his condition did not improve after this level of immunosuppression, the team reached the decision that no other treatments would likely change the outcome. He remained on oral steroids for the remainder of his admission. The other management facet of APLS crises pertains to anticoagulation. Low molecular weight heparin was recommended by the haematologists. His NOAC was stopped after the diagnosis was confirmed. Warfarin was restarted later in his admission given he had been well on this for years. Case report - Key learning points: This fascinating case exemplifies the importance of completing an antiphospholipid antibody screen for patients who present with unprovoked venous thromboembolic disease. NOACs are commonly used anticoagulant medications. Several case reports have demonstrated that patients with antiphospholipid syndrome experience breakthrough thromboembolic events when treated with NOACs. The highest risk is associated with history of arterial thrombosis and those with triple positive antibody status. Three clinical trials have either been completed or are in the process of investigating whether NOACs sufficiently prevent thromboembolic disease in these patients. The TRAPS study compared rivaroxaban to warfarin in those with triple antibody positive antiphospholipid syndrome. The study was terminated early given that higher adverse events were observed in the rivaroxaban arm (19%, n11/59) versus warfarinised patients (3%, n2/61). The RAPS study found no difference in thromboembolic risk and results from the ASTRO-APS study looking into apixaban are awaited. There is insufficient evidence to suggest that NOACs prevent VTE in a similar fashion to warfarin, so many still advocate the use of warfarin. The optimal immune management of this acute complication is not well elucidated, with a shortfall in mechanistic pathological understanding. The conference will generate discussion on this subject matter in detail. During the COVID-19 pandemic, it has been observed for patients to change anticoagulation from warfarin to NOACs. Given NOACs do not require monitoring, this medication change reduces the number of interactions patients have with healthcare services. We postulate this change triggered the crisis in our patient, where we suggest continuation of warfarin would have been ideal. This is due to the history of several unprovoked thromboembolic events without a prior antiphospholipid screen being completed. Dissemination of learning points from this case are imperative to ensure decision-making encompasses patients who may have undiagnosed antiphospholipid syndrome.

Catastrophic Antiphospholipid Crisis Triggered by Anticoagulant Switch

Case report - Introduction: The COVID-19 pandemic led to drastic changes for some patients on warfarin for venous thromboembolic (VTE) disease and atrial fibrillation. Warfarin monitoring necessitates frequent interaction with healthcare workers, which is sufficiently risky for COVID-19 transmission. As a result, selected patients were swapped over to novel oral anticoagulants (NOACs). Our patient was changed without investigating for antiphospholipid syndrome (APLS);it later transpired he was triple antibody positive. He presented in a crisis and we describe his narrative. Patients on warfarin due to presumed unprovoked venous thromboembolic disease should not be swapped to NOACs without completing, or checking, previous antiphospholipid antibody testing. Case report - Case description: A 73-year-old gentleman presented locally in August 2020 with erythema over the anterolateral surface of his left leg. He was initially treated with antibiotics for presumed cellulitis. Within a few days this lesion became necrotic and rapidly spread. At this point, he was transferred to a tertiary rheumatology centre. Within days to weeks, he developed several necrotic lesions affecting his trunk and limbs, with facial sparing noted. Approximately 30-35% of his whole-body surface became involved. He soon developed an oxygen requirement, with CTPA demonstrating lymphocytic interstitial pneumonitis without evidence of pulmonary emboli (PE). Throughout his admission, he had several other pathologies such as hyponatraemia that required level 2 care and severe noninfectious diarrhoea. Skin biopsy identified thrombotic vasculopathy. Serology confirmed triple positive antiphospholipid antibody status and a dsDNA titre of>400 iU/mL. This was the first-time serology had been undertaken despite a history of three deep vein thrombosis (DVT) episodes and two PE incidents. He had no history of SLE symptoms. His initial management for vasculitis secondary to APLS at the point of limited necrosis consisted of IV methylprednisolone followed by rituximab and PO prednisolone. While there was some delay in the progression of his disease, new areas of necrosis arose, leading to the patient receiving cyclophosphamide. Low molecular weight heparin was used for anticoagulation. This gentleman later developed proteinuria and neurological symptoms, fulfilling the criteria for catastrophic antiphospholipid syndrome. He received plasma exchange, without an improvement. He developed complications from his disease and treatment, including poor wound healing. It became apparent his condition would not improve and active treatments were stopped. He passed away 6 weeks after initial presentation. Prior to his admission to hospital, his warfarin was swapped to a NOAC. This is thought to have been the trigger behind catastrophic thrombosis. Case report - Discussion: After excluding other conditions such as necrotising fasciitis, this gentleman was rapidly started on IV methylprednisolone to halt any further progression. This is because glucocorticoids have the greatest evidence base for managing this poorly understood acute disease manifestation. After this failed to manage his condition, he was given a further immunosuppressive agent in the form of rituximab. This was used after his serology confirmed triple antibody status. It was hoped this would stop any further immunological mediated disease progression. Oral prednisolone was started at 40mg at this stage and kept under review with a tapering schedule. Cyclophosphamide was given within a few days of rituximab, with hope of a quicker onset of action. A careful MDT decision was made on these drug choices, particularly regarding their combined use and appreciating their side effect profiles. Cyclophosphamide has evidence behind its use, especially for those with APLS associated with lupus. While he did not develop any infections related to treatment, his condition progressed. Case reports suggest that plasma exchange can be useful in the management of catastrophic antiphospholipid syndrome, so the team recommen ed this. Consent at this stage became tricky due to his altered mental status, but it was felt he did demonstrate capacity for this specific decision. As his condition did not improve after this level of immunosuppression, the team reached the decision that no other treatments would likely change the outcome. He remained on oral steroids for the remainder of his admission. The other management facet of APLS crises pertains to anticoagulation. Low molecular weight heparin was recommended by the haematologists. His NOAC was stopped after the diagnosis was confirmed. Warfarin was restarted later in his admission given he had been well on this for years. Case report - Key learning points: This fascinating case exemplifies the importance of completing an antiphospholipid antibody screen for patients who present with unprovoked venous thromboembolic disease. NOACs are commonly used anticoagulant medications. Several case reports have demonstrated that patients with antiphospholipid syndrome experience breakthrough thromboembolic events when treated with NOACs. The highest risk is associated with history of arterial thrombosis and those with triple positive antibody status. Three clinical trials have either been completed or are in the process of investigating whether NOACs sufficiently prevent thromboembolic disease in these patients. The TRAPS study compared rivaroxaban to warfarin in those with triple antibody positive antiphospholipid syndrome. The study was terminated early given that higher adverse events were observed in the rivaroxaban arm (19%, n11/59) versus warfarinised patients (3%, n2/61). The RAPS study found no difference in thromboembolic risk and results from the ASTRO-APS study looking into apixaban are awaited. There is insufficient evidence to suggest that NOACs prevent VTE in a similar fashion to warfarin, so many still advocate the use of warfarin. The optimal immune management of this acute complication is not well elucidated, with a shortfall in mechanistic pathological understanding. The conference will generate discussion on this subject matter in detail. During the COVID-19 pandemic, it has been observed for patients to change anticoagulation from warfarin to NOACs. Given NOACs do not require monitoring, this medication change reduces the number of interactions patients have with healthcare services. We postulate this change triggered the crisis in our patient, where we suggest continuation of warfarin would have been ideal. This is due to the history of several unprovoked thromboembolic events without a prior antiphospholipid screen being completed. Dissemination of learning points from this case are imperative to ensure decision-making encompasses patients who may have undiagnosed antiphospholipid syndrome.

Demographic Risk Factors for Mortality of Covid 19 Patients Admitted in A Tertiary Care Hospital: A Cross-Sectional Study

Context/Background: During the COVID-19 pandemic, government worldwide imposed severe re-strictions on public life to limit its spread. For informed decision making it is important to quantitatively assess how the age, gender, and length of stay affects mortality of COVID 19 patients. It is important to find out more useful prognostic factor for mortality. This study revealed prevalence of mortality across age, gender, and length of stay and assessed determinants of mortality using independent variable age, gender, and length of stay. Methodology: A Cross-sectional observational study was conducted on 3084 Covid 19 positive patients admitted during April 2020 to June 2021 at Bundelkhand Medical College Sagar. Results: In this study mortality occurred in 510 patients. Age group analysis presented that majority of patients died in 60–74-year age group whereas maximum patients who died are having length of stay for 0-7 days, whereas gender has no significant role. There was significant influence of age group and length of stay on the mortality of Covid-19 positive patients (χ2(9) =495.30, P<.001). Conclusions: Mortality of covid positive patients being impacted by demographic risk factors like age group, length of stay. © 2022, MedSci Publications. All rights reserved.

Pharmacological Facet of Curcuma longa: A Review

The plant Curcuma longa, a perennial herbaceous member of the Zingiberaceae (ginger family), produces turmeric. Protein, fat, minerals, carbs, and moisture are all included in turmeric. Curcumin (diferuloylmethane), a phenolic diketone that makes up 34 percent of curcumin and is made up of curcumin I, curcumin II, and curcumin III, is what gives turmeric its characteristic yellow colour. Curcumin have versatile pharmacotherapeutic potential and their biological functions have been thoroughly investigated in recent years. As the main bioactive component, curcumin has numerous pharmacological properties including antioxidant, anti-inflammatory, anti-hypertensive, anti-diabetic, hepatoprotective, anti-rheumatoid arthritis and anti-cancer properties. In persons who are active, it improves recuperation and performance. It helps with viral infections and dental issues such as dental pain, gingivitis. Covid also benefits from curcumin. ar-turmerone also possesses antiinflammatory properties. Ar-turmerone is a potentially effective treatment for a number of neurologic conditions like schizophrenia. Multiple health advantages are provided by curcumin when mixed with boosting agents. Copyright © 2022, Global Research Online. All rights reserved.

Analytical Approach Toward Face Mask Detection Using Artificial Intelligence Techniques

By continuous hike of the deadly COVID-19 pandemic, the lifestyle of an individual has switched and changed all over the globe. Every individual has found it necessary to use a face mask in these situations. Identifying individual is wearing a face mask is very challenging due to wave of the deadly COVID-19 pandemic. The author proposed an approach in this study review work that would limit the evolution of the COVID-19 virus by personal identification who is not covering up any face mask. Many pieces of research have showed that wearing a mask reduces the possible chance of viral transmission of this life-threatening coronavirus and provides a sense of protection. The research during this zone has hiked over the past years. A typical review of the literature is studied to evaluate whether or not human beings are wearing masks, and based on these reviews, a modified analysis is done to detect which approach is feasible. This review included various search methodologies, too many research papers were recognized out of which seventeen are relevant papers. This paper will assess the research progresses related to the facial masks of an individual. It also helps the author to review out the ongoing and the forthcoming scenario of this research which have been working on facial mask detection using artificial intelligence. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

AC-CovidNet: Attention Guided Contrastive CNN for Recognition of Covid-19 in Chest X-Ray Images

Covid-19 global pandemic continues to devastate health care systems across the world. At present, the Covid-19 testing is costly and time-consuming. Chest X-Ray (CXR) testing can be a fast, scalable, and non-invasive method. The existing methods suffer due to the limited CXR samples available from Covid-19. Thus, inspired by the limitations of the open-source work in this field, we propose attention guided contrastive CNN architecture (AC-CovidNet) for Covid-19 detection in CXR images. The proposed method learns the robust and discriminative features with the help of contrastive loss. Moreover, the proposed method gives more importance to the infected regions as guided by the attention mechanism. We compute the sensitivity of the proposed method over the publicly available Covid-19 dataset. It is observed that the proposed AC-CovidNet exhibits very promising performance as compared to the existing methods even with limited training data. It can tackle the bottleneck of CXR Covid-19 datasets being faced by the researchers. The code used in this paper is released publicly at https://github.com/shivram1987/AC-CovidNet/. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Machine Learning Approaches in Deal with the COVID-19, Comprehensive Study

The novel Covid illness (COVID-19) has spread more than 219 nations on the globe as a pandemic, making disturbing impacts on medical care, financial conditions, and global connections. The primary goal of the review is to give the Artificial Intelligence's technological aspect and other applicable innovations and their suggestions for standing up to COVID-19 and prevention of the pandemic's frightful impacts. This article presents various approaches with AI moves toward that have huge contribution in the medical service fields, then, at that point, features and sorts their applications in facing Corona virus, like identification and finding, information examination and treatment methods, exploration and medication improvement, social control and benefits, and the expectation of outbreaks. The review tends to the connection between the innovations and the pandemics just as the expected effects of innovation in medical care with the presentation of AI and normal language processing devices. It is usual that this exhaustive review will uphold specialists in demonstrating medical services frameworks and drive further investigations in cutting edge innovations. At last, we conclude that enticing simulated artificial intelligence techniques, probabilistic models, as well as supervised learning are needed to handle future pandemic difficulties. © The Electrochemical Society

Study of patterns of presentation in post COVID19 mucormycosis

Objective: To study the clinico-radiological presentation patterns in patients of post COVID-19 mucormycosis. Background: COVID-19 infection has been responsible for various neurological disorders like stroke, encephalitis, Guillain Barre syndrome etc. almost all over the world. The second wave of this deadly virus was followed by sudden upsurge of cases of mucormycosis in India. While the exact reason for this is still unknown, it is hypothesized to be attributed to steroid use in immunocompromised states like Diabetes Mellitus and possible contamination of intranasal oxygen with industrial oxygen. There have been various patterns of presentations of these patients to mucor units. Neurological involvement was seen in majority of these cases. This study was aimed to study clinical and radiological aspects of such patients. Design/Methods: Total 81 patients, diagnosed as mucormycosis after recovery from COVID-19 illness and who got admitted in mucor units of two tertiary care hospitals of India were included in the study. The presenting clinical features and radiological patterns of involvements were assessed. Results: Out of 81, 46(56.79%) were males and 35(43.21%) were females. Maximum 21(25.92%) patients were between 51-60 years. Most common presenting complaints were heaviness over cheek followed by headache, blurring of vision, nasal discharge, nasal crusting, chemosis of eye, decreased facial sensations and hemiparesis. MRI findings included sinusitis, cavernous sinus thrombosis, orbital cellulitis, anterior circulation infarcts and intracranial fungal abscesses. Rhino-orbital-cerebral mucormycosis was the most common pattern seen in 49(60.49%) patients followed by rhino-orbital form in 19(23.45%) patients and rhino-cerebral mucormycosis in the remaining 13(16.04%) patients. Conclusions: Mucormycosis has emerged as an important complication of COVID-19 infection after the second wave of pandemic in India. Major neurological manifestations have been seen to be associated with it. Lessons need to be learned from this mucormycosis epidemic for prevention of spread and management of this dreaded entity in other regions of the world.

Prognostic Factors Associated with Mortality in Covid 19 Disease: A Retrospective Single Centre Institutional Study

Background:To evaluate the association of the demographic, clinical sign and symptoms and laboratory biomarkers in predicting the mortality in COVID-19 infected patients. Materials and Methods: This was a single centre retrospective observational study carried out in atertiary care centre of a tribal region of central India, which was a referral centre for COVID-19.Parameters taken into account were physiological parameters,symptoms at admission,radiographic findings and laboratory findings. Results: Out of 103 deaths included in this study 76 were male and 37 females (2:1). Mean age of the deceased were 54.90 years (18-90 years). The most common symptom on admission was breathlessness in 92 patients (89.32%). Abdominal symptoms like diarrhoea and vomiting were associated in 7.7 % of the deceased patients only.Most of the patients who died were older patients having age 60 years and above (65.04 %). Most of the patients who died had Spo2 less than 90 % on admission (85.43 %).Lymphopenia (92.23 %) was the most commonly observed finding on blood investigations done in deceased patients followed by increased CRP level (78.64 %). Comorbidities were present in 77 patients out of 103 patients (74.75%) included in this study. Diabetes and hypertension were being the most common comorbidities associated in these patients.Death was not commonly observed in patients with COVID 19 associated with respiratory diseases. Conclusion: Identified prognostic factors can help clinicians and policy makers in tailoring management strategies for patients with COVID-19 infectious disease while researchers can utilize our findings to develop multivariable prognostic models that could eventually facilitate decision-making and improve patient important outcomes.

Touchless Doorbell with Sanitizer Dispenser: A Precautionary Measure of COVID-19

We all aware of COVID-19 impact around the world which made us to be more cautious in our social life. In this situation, we need to adopt few precautionary measures such as washing hands regularly, sanitization and social distancing. In this regard, we need to upgrade our gadget which comes under physical contacts regularly with people as it can be high risk of transmission of virus. Here doorbell is one such an example which comes under gadget with multiple person contacts, so there should be an upgradation to avoid physical contact while using doorbell. This made us to develop a product called as touchless doorbell with sanitizer dispenser, which avoids physical contacts as well as provides sanitizing the hand. It consists of two IR transceivers, and microcontroller along with surrounding circuitry helps to control sanitizer and doorbell. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Cross-Species Translation of Correlates of Protection for COVID-19 Vaccine Candidates Using Quantitative Tools

Background. Several COVID-19 vaccines have been authorized, and the need for rapid, further modification is anticipated. This work uses a Model-Based Meta-Analysis (MBMA) to relate, across species, immunogenicity to peak viral load (VL) after challenge and to clinical efficacy. Together with non-clinical and/or early clinical immunogenicity data (ECID), this enables prediction of a candidate vaccine's clinical efficacy. The goal of this work was to enable the accelerated development of vaccine candidates by supporting Go/No-Go and study design decisions, and the resulting MBMA can be instrumental in decisions not to progress candidates to late stage development. Methods. A literature review with pre-specified inclusion/exclusion criteria enabled creation of a database including nonclinical serum neutralizing titers (SN), peak VL after challenge with SARS-CoV-2 (VL), along with data from several clinical vaccine candidates. Rhesus Macaque (RM) and golden hamster (GH) were selected (due to availability and consistency of data) for MBMA modeling. For both RM and GH, peak post-challenge VL in lung and nasal tissues were used as surrogates for clinical disease and were related to pre-challenge SN via the MBMA. The VL predictions from the RM MBMA were scaled to incidence rates in humans, with a scaling factor between RM and human SN estimated using early Phase 3 efficacy data. This enabled clinical efficacy predictions based on ECID. To qualify the model's predictive power, efficacies of COVID-19 vaccine candidates were compared to those predicted from the MBMA and their respective Ph1/2 SN data. More recently available clinical data enable building a clinical MBMA;comparing this to the RM MBMA further supports SN as predictive. Results. The MBMA analyses identified a sigmoidal decrease in VL (increasing protection) with increase in SN in all three species, with more SN needed (in both RM and GH) for protection in nasal swabs than in BAL (see figure). The comparison between predicted and reported clinical efficacies demonstrated the model's predictive power across vaccine platforms. RM and GH MBMA Protection Models and Translational Prediction with Observed Efficacies Sizes of circles indicate relative weight of the data in the respective quantitative model. Model and data visualizations have been harmonized (across tissue-types) separately for each of RM and GH using VACHER (Lommerse, et al., CPT:PSP, in press). Conclusion. By quantifying adjustments needed between species and assays, translational MBMA can inform development decisions by using nonclinical SN and VL, and ECID to predict protection from COVID-19.

Knowledge and awareness about different face masks during COVID-19 among Indian healthcare professionals

Introduction: Lockdown was imposed in many countries in the world owing to very high infection spread in the COVID-19 pandemic resulting in high mortality. Preventive measures were instilled at the community as well as individual-level including the use of face masks, sanitization, and frequent hand washing. Previous literature data suggest using various types of masks to prevent the spread of infection. Aim: The present cross-sectional study was conducted to assess the knowledge and awareness about different types of masks during COVID-19 in Indian healthcare professionals. Materials and Methods: The study was based on the survey questionnaire distributed to the subjects using google forms in online link form. The subjects were recruited for the study based on voluntary participation in Indian healthcare professionals. The survey was conducted on 998 professionals on different types of facemasks.