Association of Alpha 1 Antitrypsin Deficiency with COVID-19 Mortality: Basis for Clinical Trials

Coronavirus disease 2019 (COVID-19) has emerged as a pandemic leading to unprecedented disruption of global health and economy. Countries with a large population of European/Hispanic ancestry have been found to have the highest COVID-19 related case fatality rates. This prompted us with an interesting question that whether host immune programming and host genetic modifiers might be responsible for the higher mortality rate in these ethnicities. Transmembrane protease serine 2 (TMPRSS2) is critical in priming the viral spike protein and the host ACE2 receptor before the virus enters into the host cell. Recent results from the COVID-19 Host Genetics Initiative identified ELF5 rs766826 as a protective factor to severe COVID-19 which decreases the expression of TMPRSS2. Moreover, multiple studies have experimentally demonstrated that alpha 1 antitrypsin (A1AT) (encoded by SERPINA1 gene) is an inhibitor of TMPRSS2 and provided support to the already approved therapy as a candidate for COVID-19. Interestingly A1AT deficiency is common among Europeans and Latinos. We have also analyzed the gnomAD dataset to show that Europeans and Latinos have a substantially higher carrier frequency of AlAT deficiency (~12%) compared to other large ethnicities. A1AT has the dual role of an antiviral and anti-inflammatory molecule for treating COVID-19. To date, eight clinical trials have been started to find out the effectiveness of A1AT in COVID-19. Low A1AT level in severe COVID-19 has also been found to be a poor prognostic marker. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Detection of Sars-Cov-2 from human chest CT images in Multi-Convolutional Neural Network's environment

This article focuses on the detection of the Sars-Cov2 virus from a large-scale public human chest Computed Tomography (CT) scan image dataset using a customized convolutional neural network model and other convolutional neural network models such as VGG-16, VGG-19, ResNet 50, Inception v3, DenseNet, XceptionNet, and MobileNet v2. The proposed customized convolutional neural network architecture contains two convolutional layers, one max pooling layer, two convolutional layers, one max pooling layer, one flatten layer, two dense layers, and an activation layer. All the models are applied on a large-scale public human chest Computed Tomography (CT) scan image dataset. To measure the performance of the various convolutional neural network models, different parameters are used such as Accuracy, Error Rate, Precision, Recall, and F1 score. The proposed customized convolutional neural network architecture's Accuracy, Error Rate, Precision Rate, Recall, and F1 Score are 0.924, 0.076, 0.937, 0.921, and 0.926 respectively. In comparison with other existing convolutional neural network strategies, the performance of the proposed model is superior as far as comparative tables and graphs are concerned. The proposed customized convolutional neural network model may help researchers and medical professionals to create a full-fledged computer-based Sars-Cov-2 virus detection system in the near future. © 2023 IEEE.

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

Impact of Azithromycin and 8-Hydroxychloroquine in 2019 Novel Coronavirus (COVID-19) Pandemic: A Systematic Review

As we know novel coronavirus is an emergent nuisance in this stipulated period. Corona virus is a group of enveloped viruses, with non-segmented, single stranded & positive sense RNA genomes. Human Corona virus is mainly subdivided into four categories such as 229E, NL63, OC43, HKU1. Epidemiologically it has a greater prevalence in the modern era. The features encountered in the clinical course of the disease are multifarious spanning from cough, sneezing, fever, breathlessness. It may take 2-14 days for a person to notice symptoms after infection. Azithromycin and 8 Hydroxychloroquine both plays an instrumental role for management of COVID-19. Azithromycin is a macrolide antibiotic and it binds with a 50s ribosome then inhibits bacterial protein synthesis. On the other hand 8-Hydroxychloroquine was approved by United State in the year of 1955 .Basically it is used as a antimalarial drugs . Briefly, in inflammatory conditions it binds with toll like receptor & blocks them. 8- hydroxychloroquine increases lysosomal pH in antigen presenting cells . In inflammatory conditions it blocks toll like receptors on plasmacytoid dendritic cells. In our review we focused on the role of Azithromycin, and 8-hydroxychloroquine in Covid-19 .Copyright © 2021 International Journal of Pharma and Bio Sciences. All rights reserved.

Acute STEMI : Before and During the COVID-19 Pandemic Single Center Study

Background: During COVID-19 pandemic, the pattern of hospital admissions for acute ST-elevation myocardial infarction (STEMI) has been changing, and increased mortality and morbidity is being noted in these patients. Patient may present with acute myocardial infarction, myocarditis simulating a presentation like STEMI, coronary spasm, myocardial injury not fulfilling the criteria of type 1 & type 2 acute MI and cardiomyopathy. In this study we have tried to determine some important differences among the patients presented with STEMI during The COVID-19 pandemic versus non-COVID-19 era. Method(s): This prospective observational study was carried out in National Heart Foundation Hospital & Research Institute from 8thMarch,2019 to 7th March, 2021. Total 2531 patients were included. The study populations were divided into two groups. Group I: Acute STEMI patients presenting during pre COVID period (n=1385). Group II: Acute STEMI patients presenting during COVID period (n=1146). COVID period was calculated from 8th march, 2020 onward as first case of COVID -19 was detected on that day in Bangladesh. All patients presented with Acute STEMI was included in the study however NSTEMI-ACS, Unstable angina were excluded from the study. Result(s): Male was predominant in both groups. Regarding risk factors Hypertension, Obesity and family H/O of CAD was statistically significant (p<0.05). Acute STEMI patients presented lately during COVID-19 period probably due to lock down& lack of transport facility. Regarding coronary artery disease severity, vessel score was more during COVID period. SV-CAD were more during pre COVID period while DV-CAD & TV-CAD were more during COVID period. Gensini score was also calculated among the study populations, it was 57.21+/-28.42 and 63.16+/- 40.43respectively in group I and group I, which was statistically significant. Regarding treatment options of the patients, primary PCI was less during COVID period, however medical management, elective PCI and Thrombolysis were more during COVID era. Regarding in hospital outcome, acute LVF, cardiogenic shock were more during COVID period which were also statistically significant. [Formula presented] [Formula presented] Conclusion(s): During COVID -19, STEMI patients presented lately in comparison to pre COVID period. Coronary artery Disease were more severe during COVID period as evaluated by Vessel Score & Gensini Score. During COVID -19 period majority of patients got medical management& routine PCI were done more in comparison to primary PCI. In Hospital outcome of STEMI was worse during COVID-19 period in terms of acute LVF & cardiogenic shock. [Formula presented] [Formula presented] [Formula presented]Copyright © 2023

Isolation and Intensive Care (ICU) Service, Surge Capacity and Pandemic Training in Government Designated COVID-19 Clinics and Hospitals of Nepal

Background The coronavirus pandemic preparedness and response activities began in Nepal after the detection of the first case on 24 January 2020. Highest daily case record in June 2020 was 671, but it reached above 5,000 in October 2020. Objective This study assessed preparedness and response status of government designated COVID-19 clinics and various level hospitals. Method A web-based survey was conducted among government designated COVID-19 clinics and Level hospitals in June 2020. The Medical Operations Division of the COVID-19 Crisis Management Center (CCMC) retained contact list of focal person in each facility for regular updates. Forty-nine out of 125 clinics and all level hospitals (five Level-1, 12 Level-2, three Level-3) provided responses. Result There were 25 or less isolation beds in the majority of COVID-19 clinics (83.7%) and Level-1 hospitals (60%), whereas the majority of Level-2 (92%) and Level-3 hospitals (67%) had arranged >25 beds. Only five clinics, one Level-1 hospital, six Level-2 and two Level-3 hospitals had a surge capacity of additional 20 or more isolation beds. Only one-fourth of the designated health facilities had arranged separate isolation facility for vulnerable population. Majority of the designated clinics and Level-1 hospitals had five or less functional ICU beds and functional ventilators. Very few Level-2 hospitals had > 10 ICU beds and > 10 ventilators. Healthcare workers in the majority of facilities were trained on donning/doffing, hand washing, swab collection, and healthcare waste management, but, a very few received formal training on patient transport, dead body management, epidemic drill, and critical care. Conclusion This study revealed insufficient preparation in COVID-19 facilities during the initial phase of pandemic. The findings were utilized by the government stakeholders at central, provincial and local levels for scaling up surge capacity and improving health services at the time of case surge. As the pandemic itself is a dynamic process, periodic assessments are needed to gauze preparedness and response during different phases of disease outbreak. Copyright © 2022, Kathmandu University. All rights reserved.

POLICY FAILURE BEFORE COVID-19 PANDEMIC AND OPTIONS FOR THE GOVERNMENT IN NEAR FUTURE

In the context of Covid-19 pandemic, majority of the Indian states failed miserably in disease surveillance, primarily because of almost a complete policy void in health system and coordination failure in the preceding years. This chapter attempts to analyse the historical traits of health policy matrix of pandemic preparedness and post-epidemic policy interventions in different countries and then look into the sheer neglect of public health in general and epidemic preparedness in particular in India. While recognizing the fact that restrictive policies of quarantine, lockdown and isolation can at best postpone the disease spread, these policies actually could have reduced the burden of epidemic only if the health infrastructure and public health policy matrix were robust enough for inserting correct dose of disease surveillance and treatment. The surveillance mechanism had hit a floor as the public-funded test coverage was low and inadequate in most of the states. The private demand for prevention (in the form of behavioural change and going for detection) could not supplement the overall preventive services. State-wise data analysis identifies that the death rates were very high in some states primarily owing to demographic pattern and prevalence of non-communicable diseases. This indicates that what we need at this hour is not compartmentalized and segregated vertical programmes for specific diseases, but a holistic approach towards health system strengthening, with a renewed focus on public health comprising strict disease surveillances and preventive mechanism. © 2022 selection and editorial matter, Rajib Bhattacharyya, Ananya Ghosh Dastidar and Soumyen Sikdar;individual chapters, the contributors.

Observation of Myocardial Involvement in Patients Recovered From COVID-19 by Using Cardiac Magnetic Resonance Imaging, In a Tertiary Care Hospital, Bangladesh.

It was previously reported that coronavirus caused myocardial injury in hospitalized patients. However, delayed cardiac involvement in symptomatic patient recovery from COVID-19 is not yet well known. The objective of this study was to evaluate cardiac involvement by using cardiac magnetic resonance (CMR) in symptomatic post-COVID-19 recovered patients. Thirty (30) patients who recovered from COVID-19 and had recently reported cardiac symptoms were studied in a prospective observational study performed at Popular Medical College Hospital, Dhaka, Bangladesh from March 2021 to September 2021. They underwent CMR examinations. CMR scanning protocol included the following: black blood, cine sequence, both short-axis and long-axis, T2-weight short tau inversion recovery (STIR) sequence, T2- weighted imaging (T2WI) and late gadolinium enhancement (LGE) and quantitative mapping sequences-native T1/T2 mapping and post-contrast T1 mapping. Myocardial edema and late gadolinium enhancement were assessed in all patients. Quantitative evaluation of native T1/T2 and ECV value and cardiac function were evaluated. There were 30 people in all in this study. The average age of the participants in the study was 36.6 years. Fourteen (46.6%) of the patients had abnormal cardiac MRI results, while the remaining 15(53.3%) had negative CMR findings. Among positive findings patients, 8(57.1%) of 14 had increased T2 signal. Increased myocardial edema was found in the same no of patients, involving 53.2% (128 of 224) of LV segments. Only 2 cases (2 of 14) showed mid myocardial and subepicardial LGE, involving 18 of 224, 8.03% of myocardial segments. Global native T1, T2 and ECV values are significantly elevated in all CMR positive findings patients. Native T1 1231ms (IQR: 1281.25-1257.5 versus 1155.5 (IQR: 1137.25-1172.75), T2 40 (IQR: 34.5-43.25) versus 35.5 (IQR: 34-37), ECV 31 (29.75-33.25) versus 23.5 (21.25-24.0), p<0.001; p<0.011 and p<0.001 respectively. Reduced RV functional were found in positive as compared with negative CMR findings patients, EF, 32.05 (IQR: 25.25-39.0) versus 54.5 (IQR: 52.0-57.75) and EDV, 117.5 (IQR: 102.0-134.25) versus 95.0 (IQR: 71.75-99.75), p<0.001 and p<0.001 respectively. In this study cardiac involvement was found in the post-COVID-19 recovered patient with cardiac symptoms. Cardiac MRI findings included myocardial edema, fibrosis and reduced right ventricular function. So attention should be paid to symptomatic post-COVID-19 recovered patients.

Formulation, process optimization, and quality evaluation of barnyard millet (Echinochloa frumentacea)-based ready-to-eat (RTE) extruded snack

COVID-19 pandemic has increased the demand for antioxidant and micronutrient-rich foods that are easy to prepare, consume, and require less handling. In this research, we worked on the development of nutritious extruded snack made from barnyard millet, defatted soy flour, Indian gooseberry powder, and rice flour. Box–Behnken Design of Response Surface Methodology was utilized to determine the influence of process variables viz;blend ratio of barnyard millet and defatted soy flour, extruder barrel temperature, and Indian gooseberry powder on nutritional and organoleptic properties of snack. Optimized extruded snack were attained at blend ratio (6:1), barrel temperature (115°C), and Indian gooseberry (12.25 g/100 g of total flour). Extruded snack presented good overall acceptability along with high fiber (16.84 g/100 g), protein (18.91 g/100 g), total phenol (67.51 mg GAE/100 g), and total flavonoid (153.61 mg RE/100 g) content. Microbial analysis indicates that extruded snack can be stored for up to 60 days without microbial contamination. Novelty impact statement: The pandemic has made people refocus on the foods that are nutritious, yet take less time to prepare and handle. In the present research, we explored the use of locally available and low-cost barnyard millet and defatted soy flour coupled with Indian gooseberry powder—a rich source of antioxidants and rice flour for the preparation of nutritious snack. Extrudates developed with a higher blend ratio at higher barrel temperature and enriched with Indian gooseberry content displayed excellent nutritional, bioactive, and dimensional characteristics. The study will help formulate extruded snack with high protein, antioxidants, as well as fiber content. © 2022 Wiley Periodicals LLC.

Concerned, yet committed: A tertiary hospital healthcare workers’ concerns and readiness in the face of the COVID-19 pandemic

Background: Healthcare workers (HCWs) are a vital resource in every society. The concerns of HCWs during pandemics are unique as they have to consider multiple issues including their health as well as the risks to their loved ones. The coronavirus disease 2019 (COVID-19) pandemic provides no exception in testing HCWs’ readiness. Purpose: We aim to study the concerns and preparedness of HCWs at Singapore General Hospital (SGH), a tertiary healthcare institution, during the COVID-19 pandemic. Of interest were the differences between HCWs from the emergency department (ED) compared to other non-ED locations. Methods: A cross-sectional study was carried out in the form of a voluntary survey containing 34 questions. All data were anonymous. Chi-square analysis and Bonferroni correction were carried out to ascertain the significance of the associations between the two groups. Results: A total of 1,249 responses were received. Of all respondents, 57 percent felt that their jobs put them at great risk of exposure to COVID-19 while 67 percent accepted the risk as part of their job and 60 percent were still afraid of falling ill. Among the respondents, 78 percent responded that they would not look for another job while almost half considered it acceptable if their colleagues resigned. There were significant differences between ED and non-ED staff in terms of feeling that not only they but also those close to them were at high risk of exposure to the disease, people avoiding them and their families due to their job and ED staff feeling that there would be increased workload but inadequate manpower to handle the demands. Conclusion: Despite previous experience with pandemics, this study highlights that there still are issues faced by HCWs that need to be addressed in order for them to function effectively. Although there are differences between ED and non-ED HCWs’ concerns, all HCWs need to be recognized as crucial stakeholders and due attention should be given to them. © 2022 Weston Medical Publishing. All rights reserved.

SARS-CoV-2 Infection in Hospitalized Children: An Elevated Body Mass Index is a Marker of Increased Risk of Acute Respiratory Failure

Background. Several risk factors are known to increase the severity of coronavirus disease 2019 (COVID-19) illness in adults, including age and obesity. Specific comorbidities affecting COVID-19 outcomes in children are less well defined. Methods. We performed a retrospective cohort study of overweight and obese (OW) children compared to underweight and normal weight (NW) children with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Children between 2 and 18 years of age who were admitted to Texas Children's Hospital from April through December of 2020 with a positive SARS-CoV-2 polymerase chain reaction test were included. Asymptomatic patients undergoing surveillance testing for SARS-CoV-2 were excluded. Body mass index (BMI) was calculated using the Centers for Disease Control definition. Demographic and clinical information was obtained from the electronic medical record. Statistical analyses were performed using SAS 9.0. Results. We identified 145 total children who met inclusion criteria. Fifty-five (38%) children were NW and 90 (62%) children were OW. Demographics and characteristics are shown (Figure 1). Underlying asthma or chronic lung disease was present in 13 (24%) vs 31 (34%) in the NW and OW groups respectively (P=0.17). OW children were more likely to have pneumonia than NW children [relative risk1.6 (CI 1.40-2.45)]. An elevated BMI was also associated with an increased risk of requiring oxygen [relative risk 1.4 (CI 1.03-1.96)]. The median length of hospitalization was 4 days for NW versus 5 days for OW children (P=0.6). Admission to the Intensive Care Unit (ICU) was similar between the groups (P=0.7). There was no significant difference in treatments administered to children in the two groups, although there was a trend towards increased steroid (29 (53%) vs 59 (67%), P=0.13) and remdesivir (12 (22%) vs 30 (33%), P=0.14) use in the OW children. Four children in each group died. Conclusion. For children admitted with symptomatic COVID-19, being overweight or obese was significantly associated with having pneumonia and with requiring oxygen. A difference in ICU admission, length of hospitalization, and mortality was not observed. Obesity prevention along with vaccination efforts may prevent COVID-19 related morbidity in this group.

Post-COVID-19 HSV encephalitis: a review.

BACKGROUND: Herpes simplex virus encephalitis (HSVE) is one of the most common infectious causes of sporadic encephalitis. Coronavirus disease (COVID-19) has been associated with immune dysregulation of the host that might increase the risk of infections like HSVE following SARS-CoV-2 infection. There is paucity of literature on post COVID-19 HSVE. This study was conducted with the aim of analyzing the clinical presentation, brain imaging, and outcome of patients presenting with HSVE within 6 weeks of COVID-19 and providing a comprehensive review on the possible mechanisms of post-COVID-19 HSVE. METHODS: This observational study included patients who had laboratory-confirmed HSVE (type 1 or type 2) and a history of COVID-19 within the previous 6 weeks. Patients were followed up for 3 months. RESULTS: Eight patients were included and all of them had type 1 HSVE. The mean latency of onset of neurological symptoms from being diagnosed with COVID-19 is 23.87 days and a majority of the patients have received injectable steroids with a mean duration of 6.5 days. Behavioral abnormality was the commonest neurological presentation and typical brain imaging involved T2 FLAIR hyperintensities of the medial temporal lobes. All patients received intravenous acyclovir 10 mg/kg every eight hourly for atleast 14 days. One patient with concomitant rhinocerebral mucormycosis succumbed while the majority had a complete recovery. CONCLUSION: Possible immune dysregulation in COVID-19 may increase the susceptibility of HSVE in patients with a history of recent SARS-CoV-2 infection. The clinical manifestations and laboratory findings of HSVE in such patients are similar to typical HSVE.

Robotic Arm Utilization in Global Covid-19 Management

Humanity has always aspired to provide life-like traits and characteristics to its products to discover a replacement for himself to carry out his commands and also to adapt easily in an unfriendly environment. Since the late 2019, covid-19 pandemic has spread all over the world cause immense damage in the healthcare unit worldwide.To make a comeback into normal lifestyle towards medical unit robots are used for better treatment of patients. By considering these features, the authors have designed and developed a Low-Cost 3D printed humanoid robotic arm which can also be controlled and operated wirelessly. The proposed model in this paper uses a wireless RF module which acts as a common interface between the master and slave part of the prototype. The software platform Arduino IDE is used to give instructions to the hardware via high level code. The controller executes the program and performs the necessary movements and functions of the robotic arm in desired manner. The proposed model works on wireless technology which not only makes it more sophisticated at low cost but also provides six degrees of freedom. This model can be a key ingredient to free police workers in hazardous conditions, towards intelligent local traffic management systems and smart cities. © 2021 IEEE.

Development and Performance Assessment of Oxygen Generator and Pulse Oximetry for Covid-19 Patients in Case of Emergency: Lessons from the Field

With the emergence of Covid-19, as more people got affected by the fatal disease, the demand for a device to measure the oxygen content in our body has grown up. Due to unavailability of effective treatments, the outcome for critically ill Covid-19 patients depends on the availability of supportive medical care. In the current scenario of limited resources, it is important to identify patients who require close monitoring and serious care, including supplementary oxygen. The rapid spread of this virus as a global pandemic has brought in prodigious challenges to the healthcare system. Several oximeters are currently available on the market that can be utilized for this purpose. However, because they are powered by batteries, their performance degrades over time as the battery drains. In comparison to the widely utilized IR sensor in pulse oximeters, the MAX sensor employed in the suggested device is better. During the second wave of Covid-19, as more people got affected by this life-threatening illness, India witnessed a surge in the demand for oxygen supply. In light of this, apart from the oximeter, we have also suggested a methodology to construct a DIY oxygen generator that can be made using easily available materials in case of an emergency. Water has a chemical formula H2O which can be broken into its constitutional elements H2 and O2. Water is already rich in hydroxide ions but adding sodium bicarbonate as a catalyst raises the OH-concentration even more, allowing it to be utilized as an electrolyte. This paper aims to design a technique to develop both these devices cost-effectively and reliably. © 2021 IEEE.

IoT based Sanitization Tunnel

The Covid-19 Pandemic has caused huge losses worldwide and is still affecting people all around the world. Even after rigorous, incessant and dedicated efforts from people all around the world, it keeps mutating and spreading at an alarming rate. In times such as these, it is extremely important to take proper precautionary measures to stay safe and help to contain the spread of the virus. In this paper, we propose an innovative design of one such commonly used public disinfection method, an Automatic Walkthrough Sanitization Tunnel. It is a walkthrough sanitization tunnel which uses sensors to detect the target and automatically disinfects it followed by irradiation using UV-C rays for extra protection. There is a proposition to add an IoT based Temperature sensor and data relay module used to detect the temperature of any person entering the tunnel and in case of any anomaly, contact nearby covid wards to facilitate rapid treatment. © 2021 IEEE.

Reversible cerebral vasoconstriction syndrome in a patient with COVID-19

COVID-19 infection is well-known to produce different neurological complications, including cerebrovascular diseases. Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by transient segmental vasoconstriction of the cerebral vasculature, has been rarely reported in association with COVID-19 infection. The causative agent, the novel coronavirus (SARS-CoV-2), binds to the angiotensin-converting enzyme 2 (ACE-2) receptors for its entry into the host cell. This leads to downregulation of the ACE-2 and increased activity of the renin-angiotensin-aldosterone (RAAS) axis resulting in sympathetic overactivity and vasoconstriction. This might be the possible mechanism of RCVS in COVID-19. We hereby report a case of RCVS occurring in a SARS-CoV-2infected patient. This was a 38-year-old male without any comorbidities or risk factors, who presented with headache and confusion. His SARS-CoV-2 RT-PCR was positive. MRI of the brain was normal but cerebral angiography revealed segmental vasoconstriction in bilateral middle cerebral arteries and the terminal part of the internal carotid arteries, which resolved almost completely after 2 weeks. He was treated with oral nimodipine 60 mg every 6 hourly. A database search revealed 2 previous cases of RCVS associated with COVID-19. In conclusion, RCVS is a rare complication of COVID-19. It is possibly under-recognized as only a few COVID-19 patients with headaches undergo cerebral angiography especially when parenchymal brain imaging is normal.

Stabilizing COVID-19 Infections in US by Feedback Control based Test and Quarantine

COVID-19 has caused an unprecedented amount of mental and economic turmoil with ever increasing fatality and no vaccination in sight. Here, feedback control theory based regulation of daily tests and quarantine is proposed to guarantee prescribed degree of exponential decay in number of infections. A dynamic model of COVID-19 is constructed and the parameters are further optimized using trust region method to match the reported cases trend in the US. Next, Lyapunov stability based controllers are designed that prescribe the amount of daily positive tests to be done in order to eradicate the infections in a much shorter time span without any further social restrictions. The results show a dramatic reduction in the number of cases and span of COVID-19 can be obtained doubling the number of daily quarantines.

Clinical Presentation, Management and In-Hospital Outcome of COVID-19 among Non-Healthcare Personnel and Healthcare Personnel in a Tertiary Cardiac Care Hospital

The huge numbers of non-healthcare personnel (non-HCP) who get infected by corona virus disease 2019 (COVID-19) not only paralyze health care systems but also put health care personnel (HCP) at potential risk globally. Objective of the study was to compare the Healthcare personnel (HCP) and non-HCP COVID-19 cases. This prospective observational study was carried out in National Heart Foundation Hospital and Research Institute of Bangladesh from March 08, 2020 to July 20, 2020. During this study period all admitted non-HCP who subsequently was diagnosed as COVID-19 positive by rRT-PCR and HCP of this hospital, who experienced fever or respiratory symptoms or came in close contact with COVID-19 patients at home or their workplace and become COVID-19 positive, were included. Out of 320 infected patients, 181(56.6%) patients were non-HCP and 139(43.4%) were HCP. Non-HCP were older than HCP (Mean age: 52.95+/-13.82 years vs. 34.08+/-11.11 years;p=0.001). Non-HCP were predominantly male and HCP were predominantly female (73.5% vs. 41% & 26.5% vs. 59%;p=0.001). Non-HCP had more risk factors and co-morbidities than HCP (p=0.001). Typical symptoms of COVID-19 such as fever and cough were prevalent in HCP. More aggressive treatment was required for non-HCP. Non-HCP had more severe disease and higher case fatality rate (9.4% vs. 0.7%;p=0.001) than HCP. Disease severity (OR 0.03, 95% CI 0.01-0.15) and DM (OR 0.09, 95% CI 0.01-0.94) were the independent predictor of mortality. Non-HCP was older in age, predominantly male and had more co-morbidities than HCP. Typical symptoms of COVID-19 were prevalent in HCP. Non-HCP had more severe disease and higher case fatality rate than HCP.