A Combination of Inflammatory and Hematological Markers is Strongly Associated with the Risk of Death in Both Mild and Severe Initial Disease in Unvaccinated Individuals with COVID-19 Infection

Background Inflammatory and hematological markers are used extensively for early prognostication and monitoring in COVID-19. We aimed to determine whether routinely prescribed laboratory markers can predict adverse outcome at presentation in COVID-19. Methods This retrospective observational study was performed on 401 samples collected between July to December 2020 from COVID-19 positive subjects, admitted at All India Institute of Medical Sciences, Delhi, India. Clinical details and laboratory investigations within 3 days of COVID-19 positivity were obtained. Clinical outcomes were noted from patient medical records, till discharge or death. Laboratory parameters, with individually defined cut-offs, were used, either singly or in combination to distinguish survival and death for those having severe and non-severe disease at initial presentation. Findings Total Leukocyte count, Absolute neutrophil count, Neutrophil to Lymphocyte ratio, C-Reactive Protein (CRP), Interleukin-6 (IL-6), Lactate Dehydrogenase, Ferritin and Lymphocyte to CRP ratio (LCR) were significantly altered at presentation in severe COVID-19 as compared to non-severe cases;and, also in those who died due to COVID-19 compared to those who survived. A combination of four markers, CRP (≥3.9mg/dL);IL-6 (≥45.37pg/ml);Ferritin (≥373ng/mL);1/LCR ≥0.405 was found to strongly predict mortality in cases with non-severe presentation as also in severe cases. Conclusion and Interpretation The combination of routinely used markers, CRP, IL-6, Ferritin and 1/LCR can be used to predict adverse outcomes, even in those presenting with mild to moderate disease. This would identify subset of patients who would benefit from closer monitoring than usual for non-severe disease.

Mycobiome profiling of nasopharyngeal region of SARS-CoV-2 infected individuals.

The present cross-sectional study aims to explore the fungal community composition of the nasopharyngeal region of SARS-CoV-2 infected individuals and how the infection influences the mycobiome therein. The infection significantly (p<0.05) influenced the alpha diversity. Interestingly, a higher abundance of Cladosporium and Alternaria was noted in the infected individuals and inter-individual variation in mycobiome composition was well supported by beta dispersion analysis (p < 0.05). Moreover, decrease in Aspergillus abundance was observed in infected patients across the four age groups. This study provides insight into the alteration in mycobiome during the viral disease progression and demands continuous investigation to monitor fungal infections.

A cross-sectional study to describe the spectrum of ocular manifestations and risk factors of mucormycosis presenting to a tertiary hospital of East India.

Purpose: To report the clinico-demographic profile of rhino-orbito-cerebral mucormycosis (ROCM) in patients during the "second wave" of the COVID-19 pandemic in eastern India, and their ophthalmic manifestations at presentation to our tertiary institute. Methods: Cross-sectional study amongst patients presenting to our center based on their hospital records. Demographic information, history related to COVID-19, records of detailed ocular examination, and microbiological, radiological, and histopathological investigation were entered into an online worksheet and analyzed using SPSS 26.0. Results: A total of 219 patients with ROCM were treated from May to September 2021, and 110 of these had ocular manifestations at presentation (50.2%). The age of patients ranged from 22 to 83 years and the mean ± standard deviation (SD) age was 49.9 ± 12.9 years. Ninety (81.8%) patients had been diagnosed with diabetes mellitus, 31 (34%) had hypertension, and 10 had other comorbidities. The duration between the onset of COVID-19 and mucormycosis symptoms was 0 to 60 days with a mean ± SD interval of 20.9 ± 12.6 days. Fifty-six (50.9%) patients had a history of steroid use. Unrelenting ocular or facial pain was the most common presenting symptom, ptosis was the most common anterior segment manifestation, and ophthalmic artery occlusion was the most common posterior segment manifestation. Conclusion: Our data from eastern India reinforces the relationship between COVID-19, diabetes, corticosteroid use, and ROCM. Knowledge of various presenting anterior and posterior segment manifestations of the disease as described in the present study will guide clinicians to recognize the disease early and make every effort to prevent complications.

Mycobiome profiling of nasopharyngeal region of SARS-CoV-2 infected individuals

The present cross-sectional study aims to explore the fungal community composition of the nasopharyngeal region of SARS-CoV-2 infected individuals and how the infection influences the mycobiome therein. The infection significantly (p<0.05) influenced the alpha diversity. Interestingly, a higher abundance of Cladosporium and Alternaria was noted in the infected individuals and inter-individual variation in mycobiome composition was well supported by beta dispersion analysis (p < 0.05). Moreover, decrease in Aspergillus abundance was observed in infected patients across the four age groups. This study provides insight into the alteration in mycobiome during the viral disease progression and demands continuous investigation to monitor fungal infections.

Online Classrooms: A Research Study to understand factors affecting Students' motivation towards E-Learning

With advent of technology, disruptive ideas are witnessed blowing minds daily. Who could have thought students learning on internet will be witnessed? Distance Learning in India for education in India initiated within Correspondence Courses in 1962, responding to an ever-increasing demand for education could not be met by traditional system (Suresh, n.d.). Since then, online learning has seen a revolution, and now there is Khan Academy, Coursera, LinkedIn Learning, Udemy, Udacity, Codec demy, eDX, etc., among various online learning platforms available at one's perusal. (MOOCs) are also examples of online learning options organizations are using to up skill their employees. In recent times, because of current COVID-19 situation, schools and colleges are facing a challenging time to provide quality education as they are unable to open their gates for students due to Government restrictions to contain spread of virus. This paper will discover influence of online education on students and what motivates them to pursue E-Learning. [ FROM AUTHOR] Copyright of Cardiometry is the property of Cardiometry and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

A novel service robot assignment approach for COVID-19 infected patients: a case of medical data driven decision making.

Coronavirus Disease-19 (COVID-19) is a major concern for the entire world in the current era. Coronavirus is a very dangerous infectious virus that spreads rapidly from person to person. It spreads in exponential manner on a global scale. It affects the doctors, nurse and other COVID-19 warriors those who are actively involved for the treatment of COVID-19 infected (CI) patients. So, it is very much essential to focus on automation and artificial intelligence (AI) in different hospitals for the treatment of such infected patients and all should be very much careful to break the chain of spreading this novel virus. In this paper, a novel patient service robots (PSRs) assignment framework and a priority based (PB) method using fuzzy rule based (FRB) approach is proposed for the assignment of PSRs for CI patients in hospitals in order to provide safety to the COVID-19 warriors as well as to the CI infected patients. This novel approach is mainly focused on lowering the active involvement of COVID-19 warriors for the treatment of high asymptotic COVID-19 infected (HACI) patients for handling this tough situation. In this work, we have focused on HACI and low asymptotic COVID-19 infected (LACI) patients. Higher priority is given to HACI patients as compared to LACI patients to handle this critical situation in order to increase the survival probability of these patients. The proposed method deals with situations that practically arise during the assignment of PSRs for the treatment of such patients. The simulation of the work is carried out using MATLAB R2015b.

Targeting intra-viral conserved nucleocapsid (N) proteins as novel vaccines against SARS-CoVs.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the global pandemic of the Coronavirus disease in late 2019 (COVID-19). Vaccine development efforts have predominantly been aimed at 'Extra-viral' Spike (S) protein as vaccine vehicles, but there are concerns regarding 'viral immune escape' since multiple mutations may enable the mutated virus strains to escape from immunity against S protein. The 'Intra-viral' Nucleocapsid (N-protein) is relatively conserved among mutant strains of coronaviruses during spread and evolution. Herein, we demonstrate novel vaccine candidates against SARS-CoV-2 by using the whole conserved N-protein or its fragment/peptides. Using ELISA assay, we showed that high titers of specific anti-N antibodies (IgG, IgG1, IgG2a, IgM) were maintained for a reasonably long duration (> 5 months), suggesting that N-protein is an excellent immunogen to stimulate host immune system and robust B-cell activation. We synthesized three peptides located at the conserved regions of N-protein among CoVs. One peptide showed as a good immunogen for vaccination as well. Cytokine arrays on post-vaccination mouse sera showed progressive up-regulation of various cytokines such as IFN-γ and CCL5, suggesting that TH1 associated responses are also stimulated. Furthermore, vaccinated mice exhibited an elevated memory T cells population. Here, we propose an unconventional vaccine strategy targeting the conserved N-protein as an alternative vaccine target for coronaviruses. Moreover, we generated a mouse monoclonal antibody specifically against an epitope shared between SARS-CoV and SARS-CoV-2, and we are currently developing the First-in-Class humanized anti-N-protein antibody to potentially treat patients infected by various CoVs in the future.

A comprehensive easy-to-use techno-human solution for the resource-constrained nations in the fight against communicable disease like the Coronavirus Pandemic

Following the advent of the novel Coronavirus, the governments and authorities introduced various mobile applications in the fight against COVID-19. However, these are either restricted by the developer country or not comprised of certain key features, due to which, a vast population from the low- or middle-income country, remains underprivileged from associated benefits. The purpose of this study is to explore and demonstrate how to build a comprehensive and easy-to-use application for mobile health service delivery especially fabricated to fight communicable diseases like COVID-19. Mostly open-source technologies are used to build a distributed scalable client-server application. Then the application is evaluated with the stress-test and usability-test. Besides COVID-19 advisories and guidelines, the study demonstrates complete conceptualization and development of an IoT-based mobile application. It comprises three key features that bring comprehensiveness. One is the ‘contact logger & tracer’ that enables users to maintain a list of contacts who get notified if any of them reported COVID-19 positive in the last 14 days. Two is the ‘self-assessment' which helps users to predict the chances of COVID-19 infection using a scientific rationale. Three is the ‘infection tracker’ that guides users to identify infected hotspots to plan the route accordingly. The usability-test affirmed that the application is easy-to-use. Further, this study demonstrates how to construct such an easy-to-use application mostly with open-source resources. It can help the needy authorities or groups from resource-constrained countries to adopt and develop such applications quickly. Further research on the post-implementation effect will add value to this study.

Oral dysbiosis and its linkage with SARS-CoV-2 infection.

The human oral cavity harbours complex microbial communities with various commensal microorganisms that play pivotal roles in maintaining host health and immunity but can elicit local and systemic diseases. The role of commensal microorganisms in SARS-CoV-2 infection and disease susceptibility and enrichment of opportunistic pathobionts in the oral cavity is poorly understood. The present study aims to understand the altered landscape of the oral microbiome and mycobiome in SARS-CoV-2 infected patients (n = 30) and its correlation with risk factors compared to non-infected individuals (n = 24) using targeted amplicon sequencing. Diminution of species richness, an elevated abundance of opportunistic pathogens (Veillonella, Acinetobacter, Klebsiella, Prevotella, Gemella, and Streptococcus) and impaired metabolic pathways were observed in the COVID-19 patients. Similarly, altered oral mycobiome with enrichment of known respiratory disease causing pathogenic fungi were observed in the infected individuals. The data further suggested that reduction in immunomodulatory microorganisms lowers the protection of individuals from SARS-CoV-2. Linear discriminant analysis identified several differentially abundant taxa associated with risk factors (ageing and co-morbidities). We also observed distinct bacterial and fungal community structures of elderly infected patients compared to the younger age group members making them highly vulnerable to SARS-CoV-2 infection and disease severity. Furthermore, we also assessed the dynamics of the oral microbiome and mycobiome in symptomatic and asymptomatic patients, host types, co-morbidities, and viral load in the augmentation of specific pathobionts. Overall, the present study demonstrates the microbiome and mycobiome profiling of the COVID-19 infected individuals, the data further suggests that the SARS-CoV-2 infection triggers the prevalence of specific pathobiont.

Spectrums of oral health diseases during covid-19 pandemic

Aim: Purpose of the present study was to evaluate the spectrum of oral health diseases in Covid-19 pandemic. Methodology: The descriptive cross-sectional study was conducted via available retrospective data in various Department of Dentistry of lockdown period in KIST Medical College and Teaching Hospital, Imadole, Nepal. The study period was August 2021 to December 2021 and was approved by Institutional Review Committee Approval with registration number 2078/79/59. Convenient sampling technique was followed. Participants with the cases of infection, trauma and with symptoms of pain were more than the patients who had come for routine check-ups. Results: Before the pandemic, patients were far more likely to opt for conservative treatment, whereas in the pandemic more common surgical procedures eliminated this superiority-according to the Wilcoxon test, for comparison of filled and extracted teeth,

Transcutaneous retrobulbar amphotericin-B (TRAMB) injection in orbital mucormycosis.

We aim to highlight the role of transcutaneous retrobulbar amphotericin-B (TRAMB) in cases of rhino-orbital mucormycosis. With the COVID-19 pandemic a rapid surge in the number of cases of rhino-orbital mucormycosis has been noted. The gold standard treatment for the progressive orbital disease is exenteration; however, organ salvage should be attempted, when possible. Here comes the role of TRAMB injection. We present a case of a man in his 70s, a known diabetic, who recovered from COVID-19 pneumonia but developed left-sided axial proptosis with orbital apex syndrome and ophthalmic artery occlusion secondary to rhino-orbital mucormycosis. The patient underwent debridement of paranasal sinuses and received intravenous liposomal amphotericin-B and three TRAMB injections. After three TRAMB injections significant improvement in extraocular movements, proptosis and ptosis was noted. An early intervention in orbital disease can avert a more radical procedure.

Assessment of interrelationship between meteorology, air quality and COVID 19 cases in Gujarat state.

In the present study, pollutants levels from March 1, 2020, to August 30, 2020, were compared with similar periods of 2019 to assess the impact of lockdown due to COVID 19 on the quality of air in 3 different cities of Gujarat, India named Ahmedabad, Gandhinagar, and Valsad. Data was collected from AccuWeather and Central Pollution Control Board website for study period. Data was analyzed by comparing air quality taking 2019 as reference and correlation matrix were developed for study sites. Lockdown resulted from COVID-19 has shown decline trends in pollutant concentration resulting in improved air quality in the study area. In the first city Ahmedabad, Gujarat an air pollutant parameter such as CO, PM2.5, PM10, NO2, and SO2 were reduced by 54%, 181%, 70%, 33%, and 103% respectively. Almost similar trends were observed in the rest of the two cities also i.e., Gandhinagar and Valsad. NO2 level got reduced by a factor of 100% which can be associated with ban on vehicular movement. Correlation between the air pollutant and metrological variables with COVID-19 variables were also studied be developing correlation matrix. In Gandhinagar, a strong correlation was observed between carbon monoxide, and PM10 with COVID-19, a moderate correlation between NO2, and SO2 with the COVID-19 variables, a week correlation was found between temperature and COVID-19, and no correlation is found between wind speed and COVID-19 variables.

Nasopharyngeal microbiome reveals the prevalence of opportunistic pathogens in SARS-CoV-2 infected individuals and their association with host types.

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is causing a severe global health emergency owing to its highly infectious nature. Although the symptoms of SARS-CoV-2 are well known but its impact on nasopharyngeal microbiome is poorly studied. The present cross-sectional study was intended to understand the perturbation in the nasopharyngeal microbiome composition within the infected (n = 63) and non-infected (n = 26) individuals using 16S rRNA gene based targeted amplicon sequencing and their association with host types and the prevalence of opportunistic pathogens at the stage of infection. The results confirmed that number of OTUs were significantly (p < 0.05) decreased in the SARS-CoV-2 infected individuals in comparison to non-infected individuals. Pairwise Wilcoxon test showed a significant (p < 0.05) increase in the abundance of Proteobacteria in infected individuals compared to non-infected ones and vice-versa for Fusobacteria and Bacteroidetes. Similarity percentage (SIMPER) analysis showed the increment in the abundance of opportunistic pathogens (Haemophilus, Stenotrophomonas, Acinetobacter, Moraxella, Corynebacterium 1, Gemella, Ralstonia, and Pseudomonas) involved in secondary infection. Furthermore, this study highlighted the microbial community structure of individuals within and across the families. In this study, we also performed the assesment of microbiome associated with host types (age and genders) and COVID-19 conditions (symptomatic and asymptomatic). The data suggested that the host types/conditions during the COVID-19 infection are potential factors in enrichment of specific bacterial communities in upper respiratory tract.