SCOPE: Surveillance of COVID-19 in pregnancy- results of a multicentric ambispective case-control study on clinical presentation and maternal outcomes in India between April to November 2020.

OBJECTIVE: To determine the clinical manifestations, risk factors, treatment modalities and maternal outcomes in pregnant women with lab-confirmed COVID-19 and compare it with COVID-19 negative pregnant women in same age group. DESIGN: Multicentric case-control study. DATA SOURCES: Ambispective primary data collection through paper-based forms from 20 tertiary care centres across India between April and November 2020. STUDY POPULATION: All pregnant women reporting to the centres with a lab-confirmed COVID-19 positive result matched with controls. DATA QUALITY: Dedicated research officers extracted hospital records, using modified WHO Case Record Forms (CRF) and verified for completeness and accuracy. STATISTICAL ANALYSIS: Data converted to excel files and statistical analyses done using STATA 16 (StataCorp, TX, USA). Odds ratios (ORs) with 95% confidence intervals (CI) estimated using unconditional logistic regression. RESULTS: A total of 76,264 women delivered across 20 centres during the study period. Data of 3723 COVID positive pregnant women and 3744 age-matched controls was analyzed. Of the positive cases 56·9% were asymptomatic. Antenatal complications like preeclampsia and abruptio placentae were seen more among the cases. Induction and caesarean delivery rates were also higher among Covid positive women. Pre-existing maternal co-morbidities increased need for supportive care. There were 34 maternal deaths out of the 3723(0.9%) positive mothers, while covid negative deaths reported from all the centres were 449 of 72,541 (0·6%). CONCLUSION: Covid-19 infection predisposed to adverse maternal outcomes in a large cohort of Covid positive pregnant women as compared to the negative controls.

Safety and feasibility of distraction procedure in growing rods for Early Onset Scoliosis as day care procedure - A retrospective observational study of 653 procedures

Purpose: To investigate the safety and feasibility of growth rod distraction procedure as 'daycare surgery' in early-onset scoliosis (EOS). EOS is an 'enigma' in spine surgery as early fusion and deformity correction will negatively affect truncal growth and pulmonary development. Likewise, delaying the treatment would lead to grotesque deformity with severe systemic implications. Therefore, worldwide we use 'Growth rods' for EOS and periodically distract it to allow for spinal growth in a 'controlled' manner. However, regular distraction every 6 months until definitive fusion would incur huge financial challenges and resource utilization . Our hypothesis is that the growth rod distraction procedure can be routinely used as a daycare procedure, thereby, cutting down the cost and resource utilization, especially in these pandemic times. Method(s): Hospital records and operation notes were retrospectively reviewed of 119 patients with a focus on details of neurological events/ complications during their index surgeries/lengthening procedures. Multimodality IONM was used as a mandatory protocol in all our index cases . However, for growth rod lengthening procedures we had well-defined indications-i) patients in whom intraoperative drop in signals were present during index case ii)patients who had intraspinal abnormality and had synchronous neurosurgical procedure iii) patients who underwent rod exchange/revision surgery concurrent with lengthening procedure. Except for these indications, none of our patients had IONM during the routine lengthening procedure.An amplitude drop of greater than 50% in trans cranial MEP or somatosensory evoked potentials (SSEP) was considered a neuromonitoring 'alert'. Result(s): 653 procedures involving primary growing rod surgeries (119 / 653) and lengthening procedures (534/653) were performed in 119 patients with EOS with a mean age of 7.3+/-2.3 years. Traditional growing rods (TGR-454/534) or magnetically controlled growing rods (MCGR-80/534) were implanted and subsequent lengthening procedures (Average -4.7 (range 2-9)) were done at stipulated intervals (TGR- 6.5 months, MCGR -3.8 mo). The mean anesthesia to surgical time for TGR (96.6+/-23 min vs 41.3 +/- 12 min) and MCGR was done as an outpatient procedure with mean average time of 26.2+/-9 minutes, respectively. The mean average blood loss in TGR vs MCGR was reported as 108+/-38 mL vs 0 mL.None of the patients with rod lengthening procedures required blood transfusion or experienced a neuromonitoring alert. On the morning of surgery these patients were admitted on short admission to Operating theatres and were not administered any pre-medication drugs. Induction was done using propofol (calm patients) or sevoflurane (restless patients) and BIS monitoring was done throughout the procedure. Intraoperative pain management was done using a fentanyl bolus. Furthermore, In the immediate post-operative period these patients were managed on fentanyl single bolus dose (0.5 microgram/kg) and later administered paracetamol injection (15 mg/kg - <30 kg) or ketorolac injection (0.1 mg/kg). At discharge, patients were managed on non-steroidal anti-inflammatory oral medications. Average reporting pain control (VAS-1.3+/-0.78) was satisfactory and mobilization was initiated within 4 hours, postoperatively. All our patients were discharged on the same evening with oral analgesics. Our 30-day readmission was noted in 2/119 secondary to superficial wound infection, which was managed on oral antibiotics. Conclusion(s): Growth rods (TGR, MCGR ) lengthening procedures can be safely undertaken as 'daycare surgery' under standardized anaesthesia and pain protocol. Secondly, intraoperative neuromonitoring can also be avoided in distraction procedures, thereby, helping in cost-cutting. This is especially relevant in changing paradigms of resource limitation in the COVID pandemic situation worldwide.

Modeling of cyber threat analysis and vulnerability in IoT-based healthcare systems during COVID

The fast advancement of IoT technology has transformed human existence by introducing the facilitation of home automation, traffic systems, e-healthcare, oil and gas stations, and smart vehicles. The cyber threat and vulnerabilities injection have increased to a great extent during the COVID-19 period, when the world went into virtual mode for technology usage. The security of IoT devices has been a major apprehension in recent years, particularly in the healthcare industry, where recent threats by cyber criminals and terrorists have shown severe IoT security flaws. The IoT-Attributes and Threat Analyzer for Tracing Malicious Traffic in Smart Sensor Environment, abbreviated as IoT-ATATMT, is presented in the proposed work to address the aforementioned challenge and is based on the IoT-Flock, an open-source sensor data generating tool. The IoT-Flock tool creates a use-case for both regular and suspicious smart devices to analyze traffic. In addition, the work also includes an open-source application for transforming IoT-recorded Flock’s traffic into an IoT dataset. We first created an IoT healthcare dataset using the suggested architecture in this study, which includes both regular and IoT attack traffic. After that, we used several machine learning algorithms for detecting cyber threats to safeguard the e-healthcare system toward using them via a created dataset. © 2022 Elsevier Inc. All rights reserved.

Prospective Evaluation of Hematological Indices in Prognostication of COVID-19 Infection in Pregnant Population

Background: Neutrophil-to-lymphocyte ratio (NLR) is a well-established inflammatory marker that has been studied in COVID-19 inflicted patients. Pregnancy per se is associated with its own physiological changes in hematological parameters. No study has specifically been done on the pregnant population to evaluate the role of various hematological markers for prognosticating the severity of COVID-19 infection. Aim: The aim of this study was to prospectively evaluate changes in NLR and other indices in a cohort of pregnant women with severe and non-severe COVID-19. Materials and methods: Prospective cohort study at a COVID dedicated tertiary care center of a low-middle income country for a period of 6 months involving hospitalized COVID-19 positive pregnant women. Results: In total, 8/8 (100%) and 6/8 (75%) of the pregnant women with severe COVID-19, had a raised NLR and platelet-to-lymphocyte ratio (PLR), respectively, compared to only 3/47 (6.4%) and 1/47 (2.13%) with non-severe COVID-19 (p <0.0001, p <0.0001). These ratios were noted to normalize at 2 and 4 weeks follow-up in the survivors of severe COVID-19. Conclusion: This is the first prospective study demonstrating an association between COVID-19 disease severity in pregnant women and NLR and PLR on admission. These indices may be utilized for prognostication and better preparations for the care of pregnant women hospitalized with COVID-19 infections.

Role of Online English Language Learning in Enhancing Linguistic Skills

With the emergence of new era of online learning, it becomes important to find out how effectively the online learning programs are implemented and also to comprehend learners' learning of linguistic skills during the unforeseen and unpredictable situations during Covid -19.An attempt has been made to delineate how each of the various language skills are enhanced through online learning to explore role of online English language learning in enhancing linguistic skills among school students. Mixed method approach including both qualitative and quantitative data was used. The sample consisted of 30 students of grade 9 and 7 English Language teachers of high schools of Distt. Mandi H.P. The paper concluded that online learning has proved as an effective platform through which both the students and teachers had active interaction. Students were able to gain a different experience of language learning outside the classroom with the focus on language skills. © The Electrochemical Society

IoT based System Design for Human Health Monitoring for Covid -19 Outbreak

A prescription for AI can assist physicians in developing more precise diagnoses and enhancing patient outcomes. Physicians now have a formidable new ally in the war on disease. This article discusses the importance of IoT-based health monitoring systems and the major characteristics that differentiate them from traditional health monitoring systems and also how the system is helpful in times of pandemic. The proposed system will help the physicians in tracking fundamental patient data, as well as those who live in remote places. The proposed model has been successfully emulated on software through the use of ThinkSpeak and Proteus. The hardware implementation is discussed utilizing a microcontroller, sensors, and an ESP8266 Wi-Fi module to create an IOT-based health monitoring system capable of successfully displaying basic patient parameters. © 2022 IEEE.

A review on COVID-19 vaccinations

The year 2019 witnessed a pandemic named COVID-19 caused by infection severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It emerged in Wuhan, China, in December 2019 and has affected millions since then. It led to a global cry for vaccine development. Scientists arrayed the SARS-CoV-2 genome within a month of the outbreak. They used the parallels between SARS-CoV-1 and SARS-CoV-2 to speed up the vaccine preparation. As of now, different types of COVID-19 vaccines are prevailing. © 2022 Biomedical and Biotechnology Research Journal (BBRJ).

A phase 2/3, participant-blind, observer-blind, randomised, controlled study to assess the safety and immunogenicity of SII-ChAdOx1 nCoV-19 (COVID-19 vaccine) in adults in India.

BACKGROUND: This phase 2/3 immunobridging study evaluated the safety and immunogenicity of the ChAdOx1 nCoV-19 Coronavirus Vaccine (Recombinant) (SII-ChAdOx1 nCoV-19), manufactured in India at the Serum Institute of India Pvt Ltd (SIIPL), following technology transfer from the AstraZeneca. METHODS: This participant-blind, observer-blind study randomised participants 3:1 to SII-ChAdOx1 nCoV-19 or AZD1222 (ChAdOx1 nCoV-19) (immunogenicity/reactogenicity cohort) and 3:1 to SII-ChAdOx1 nCoV-19 or placebo (safety cohort). The study participants were enrolled from 14 hospitals across India between August 25 and October 31, 2020. Two doses of study products were given 4 weeks apart. The primary objectives were to demonstrate non-inferiority of SII-ChAdOx1 nCoV-19 to AZD1222 in terms of geometric mean titre (GMT) ratio of anti-SARS-CoV-2 spike IgG antibodies 28 days after the second dose (defined as lower limit of 95% CI >0·67) and to determine the incidence of serious adverse events (SAEs) causally related to SII-ChAdOx1 nCoV-19. The anti-spike IgG response was assessed using a multiplexed electrochemiluminescence-based immunoassay. Safety follow-up continued until 6 months after first dose. Trial registration: CTRI/2020/08/027170. FINDINGS: 1601 participants were enrolled: 401 to the immunogenicity/reactogenicity cohort and 1200 to the safety cohort. After two doses, seroconversion rates for anti-spike IgG antibodies were more than 98·0% in both the groups. SII-ChAdOx1 nCoV-19 was non-inferior to AZD1222 (GMT ratio 0·98; 95% CI 0·78-1·23). SAEs were reported in ≤ 2·0% participants across the three groups; none were causally related. A total of 34 SARS-CoV-2 infections were reported; of which 6 occurred more than 2 weeks after the second dose; none were severe. INTERPRETATION: SII-ChAdOx1 nCoV-19 has a non-inferior immune response compared to AZD1222 and an acceptable safety/reactogenicity profile. Pharmacovigilance should be maintained to detect any safety signals. FUNDING: SIIPL funded the contract research organisation and laboratory costs, while the site costs were funded by the Indian Council of Medical Research. The study vaccines were supplied by SIIPL and AstraZeneca.

The nexus between the exchange rates and interest rates: evidence from BRIICS economies during the COVID-19 pandemic

Purpose: This paper aims to investigate whether the interest rate differentials Granger cause expected change in the exchange rate during the COVID-19 period. The study examines if the investors in the international assets and exchange rate markets take advantages of the relevant information obtained during the COVID-19 pandemic. Design/methodology/approach: This paper used daily data ranging from January 31, 2020 to June 30, 2020 and considered BRIICS economies. The study implemented the Toda–Yamamoto’s Granger causality approach to identify the causality between interest rate differentials and exchange rates. For robustness checks, the study used ARLD short-run dynamics to infer causal relations. Findings: Overall, the results indicate that the interest rate differentials improve the predictability of subsequent exchange rate changes in all six BRIICS economies during the COVID-19 period wherein investors are forward-looking. The empirical results pass the robustness checks. Originality/value: There is a lack of studies exploring the relationship between interest rate differentials and exchange rates in the presence of an unanticipated event such as the current pandemic. To the best of the authors’ knowledge, this is the first study to explore the causal linkages between interest rate differentials and expected change in exchange rates, focusing on the COVID-19 outbreak period. © 2020, Emerald Publishing Limited.