Antiviral activity of the human endogenous retrovirus-R envelope protein against SARS-CoV-2

Coronavirus-induced disease-19 (COVID-19), caused by SARS-CoV-2, is still a major global health challenge. Human endogenous retroviruses (HERVs) represent retroviral elements that were integrated into the ancestral human genome. HERVs are important in embryonic development as well as in the manifestation of diseases, including cancer, inflammation, and viral infections. Here, we analyze the expression of several HERVs in SARS-CoV-2-infected cells and observe increased activity of HERV-E, HERV-V, HERV-FRD, HERV-MER34, HERV-W, and HERV-K-HML2. In contrast, the HERV-R envelope is downregulated in cell-based models and PBMCs of COVID-19 patients. Overexpression of HERV-R inhibits SARS-CoV-2 replication, suggesting its antiviral activity. Further analyses demonstrate the role of the extracellular signal-regulated kinase (ERK) in regulating HERV-R antiviral activity. Lastly, our data indicate that the crosstalk between ERK and p38 MAPK controls the synthesis of the HERV-R envelope protein, which in turn modulates SARS-CoV-2 replication. These findings suggest the role of the HERV-R envelope as a prosurvival host factor against SARS-CoV-2 and illustrate a possible advantage of integration and evolutionary maintenance of retroviral elements in the human genome.Copyright © 2023 The Authors.

Adoption of food delivery apps during a crisis: exploring an extended technology adoption model

Purpose: This study aims to provide insight into consumer behavior regarding the use of food delivery apps when making purchases. To investigate the primary elements affecting users' intentions to use meal delivery applications, this study suggests an extension to the technology acceptance model through some contextual variable such as "various food choices (VFC),” "trust (TRR),” "perception of COVID-19-related risks (PCR)” and "convenience (CONV)” during the pandemic. Design/methodology/approach: A cross-sectional data of 407 was collected in the Indian context. This research adopts the covariance-based structural modeling approach to test the hypotheses along with hierarchical regression to predict the efficiency of constructs. Findings: Considering the outcomes, "perceived usefulness (PU)” was positively influenced by "perceived ease of use (PEOU),” "VFC” and "CONV.” In addition, the attitude (ATT) was positively impacted by "PU,” "TRR” and "PEOU.” Nevertheless, "PCR” negatively influenced ATT. In additional, this research illustrates the positive impact of ATT and PU on behavioral intention to use. Originality/value: By confirming the technology acceptance model's capacity for explanation in relation to food delivery apps, this study adds to the body of knowledge. The primary focus of this study is on determining the direct impact of the identified determinants on the adoption of food delivery applications within the context of a pandemic situation in developing countries. © 2023, Emerald Publishing Limited.

Dense Feature Memory Augmented Transformers for COVID-19 Vaccination Search Classification

With the devastating outbreak of COVID-19, vaccines are one of the crucial lines of defense against mass infection in this global pandemic. Given the protection they provide, vaccines are becoming mandatory in certain social and professional settings. This paper presents a classification model for detecting COVID-19 vaccination related search queries, a machine learning model that is used to generate search insights for COVID-19 vaccinations. The proposed method combines and leverages advancements from modern state-of-the-art (SOTA) natural language understanding (NLU) techniques such as pretrained Transformers with traditional dense features. We propose a novel approach of considering dense features as memory tokens that the model can attend to. We show that this new modeling approach enables a significant improvement to the Vaccine Search Insights (VSI) task, improving a strong well-established gradient-boosting baseline by relative +15% improvement in F1 score and +14% in precision. © 2022 Association for Computational Linguistics.

Unravelling Lifelong Learning in Multi-Generational Workforce Using Text Mining

Accelerated structural transformations characterize the workplace post-pandemic. A lifelong learning ecosystem must be built to ensure a smooth and inclusive transition since generational diversity is ubiquitous in contemporary organizations. The present phenomenological qualitative study attempts to explore generational diversity from the lens of lifelong learning construct across the three prominent generations, X, Y, and Z, present in the workforce. The data collected from 24 semi-structured telephonic interviews were analyzed using text mining and topic modeling. The results suggest differences and similarities among the members of different generations. The topics derived waxed and waned across generations. While the drive to engage in continuous learning varied across generational cohorts, the preferred mode for engaging in it was similar. The study provides insights that could help enhance the effectiveness of human resource management practices and firms' competitiveness during tough times. Further, the findings contribute to the existing literature by adopting machine learning as a tool to extract and decode the latent topics across the three generational cohorts. © 2023 K.J. Somaiya Institute of Management Studies and Research.

A study on disruption to recovery in business school of India during COVID-19 using appreciative inquiry approach from a multi-stakeholder perspective

Business schools need to revisit, reflect and re-align to the new normal. The paper makes an attempt to identify the measures for institutional continuity taken by a leading private business school of India. A multi-stakeholder analysis was used to understand the intricacies of 'trilemma' (Admission-Teaching & Learning-Placement) of business education. An Appreciative Inquiry (AI) approach was implemented in the study. A series of 'Brainstorming' sessions were held in the virtual mode involving participants from various stakeholder groups, woven around the 5D approach of Appreciative Inquiry. The study gives an insight to the apprehensions and concerns of the different stakeholders related to the 'trilemma'. The overarching schema for successful mitigation strategies implementation has been proposed. Research on micro-level measures to reposition management education in the new normal is scarce. The study uncovers the challenges and redundancies due to the abrupt shift and details synergetic and dynamic interventions for their mitigation. Copyright © 2023 Inderscience Enterprises Ltd.

Differential impact of COVID-19 on mental health and burnout.

BACKGROUND: There may be differential impact of the COVID-19 pandemic on mental health and burnout rates of healthcare professionals (HCPs) performing different roles. AIMS: To examine mental health and burnout rates, and possible drivers for any disparities between professional roles. METHODS: In this cohort study, online surveys were distributed to HCPs in July-September 2020 (baseline) and re-sent 4 months later (follow-up; December 2020) assessing for probable major depressive disorder (MDD), generalized anxiety disorder (GAD), insomnia, mental well-being and burnout (emotional exhaustion and depersonalization). Separate logistic regression models (at both phases) compared the risk of outcomes between roles: healthcare assistants (HCAs), nurses and midwives (nurses), allied health professionals (AHPs) and doctors (reference group). Separate linear regression models were also developed relating the change in scores to professional role. RESULTS: At baseline (n = 1537), nurses had a 1.9-fold and 2.5-fold increased risk of MDD and insomnia, respectively. AHPs had a 1.7-fold and 1.4-fold increased risk of MDD and emotional exhaustion, respectively. At follow-up (n = 736), the disproportionate risk between doctors and others worsened: nurses and HCAs were at 3.7-fold and 3.6-fold increased risk of insomnia, respectively. Nurses also had a significantly increased risk of MDD, GAD, poor mental well-being and burnout. Nurses also had significantly worsened anxiety, mental well-being and burnout scores over time, relative to doctors. CONCLUSIONS: Nurses and AHPs had excess risk of adverse mental health and burnout during the pandemic, and this difference worsened over time (in nurses especially). Our findings support adoption of targeted strategies accounting for different HCP roles.

Optimization of COVID-19 risk factors using fuzzy logic inference system

According to the WHO, the topmost priority during the COVID-19 pandemic is to recognize the risk factors for the severity of this disease. Because of this, we conducted a series of calculations based on several symptoms of CORONA infections. The study aimed to estimate the rigorousness and identify the risk factors of COVID-19 infection and calculated the risk % by taking a wide range of symptoms like Body Temperature, Cough, Cold, Breathing problems, and Loss of senses of Smell & Taste. We have used MATLAB to simulate a model based on Mamdani fuzzy inference system to help those who can identify their symptoms. In the proposed model Mean of Maxima kind of De-Fuzzifier is applied. Additionally, we also conducted a comparability analysis of risk factors across 5 - 6 studies. The study concludes that if a patient's body temperature is 38.4 °C, suffering from cough (6), cold (8) and breathing rate in pulse oxy-meter is 95, loss of sense of smell is 17% then the risk of his being infected by coronavirus is 50%. Based on the results obtained, we have also proposed a set of rules for further prevention and mitigation of pandemics. Our findings will help in developing targeted prevention and control strategies to combat this worldwide pandemic. In the future also the outcomes are very beneficial when Artificial Neural networks, Machine Learning will be used to train the model and provide more accurate results. The results have also motivated the authors that the inter-disciplinary approach toward such collaborative research works would lead to finding more effective solutions to such serious problems. In this era when there is the threat of biological warfare across the globe, such studies have also opened new avenues for strategic & timely mitigation of biological agents over large sample sizes. © 2022 River Publishers. All rights reserved.

Practicing Telemedicines in India

The great use of telecommunication technology propels new healthcare system of telemedicine through which diagnosis as well as treatment can be done in the remote areas. The ancient Greek language explain the terminology of telemedicine in the phrase of distance healing. As per WHO, Telemedicine is the delivery of health-care services, where distance is a critical factor, by all health-care professionals using information and communications technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and the continuing education of health-care workers, with the aim of advancing the health of individuals and communities. Historically the concept of teleconsultation was evolved in the first half of twentieth century when the data of ECG was communicated through telephone lines, this can be traced as first evidence of this unique healthcare system. Further the introduction of electrical system of telegraph as well as evolution of telephone revolutionized this system of healthcare. when the Technology of telemedicine help both patients as well as service providers in multiple ways involving physicians, surgeons, pharmacists, paramedical staff, IT and electronics engineers, government, hospitals and end user public Location is now a days no problem and therefore there is no limitation of the availability of healthcare facilities to such location or remote location. The biggest role in such development is played by the communication technology which may provide healthcare services to every nook and corner of the location. It can decrease the health staff pressure because in India WHO guidelines ask to maintain the ratio 1:1000 of doctor and Indian public compared to present 0.62:1000 ratio of doctor and public. The great advantage of this system is that in case of epidemic or pandemic like COVID 19 Telemedicine can keep the health staff are well general public free from contagious infection (COVID-19). There are a number of networking communication modes that can be applied, which may improve the patient compliance,dosage regimen can be managed in better fashion thus increase the longevity of person life. Disasters management during pandemics present unique challenges which can be addressed effectively as happened during the lockdown. This technology-based practice can break the infectivity chain of the transmission of communicable diseases This chapter incorporates basic concept of telemedicine, its origin and types, communication technologies, services by telemedicine, types of telemedicine, tools of telemedicine, telemedicine software's and guidelines related to practicingtelemedicine in reference to Indian context. Copyright © RJPT All right reserved.

Practicing Telemedicines in India

The great use of telecommunication technology propels new healthcare system of telemedicine through which diagnosis as well as treatment can be done in the remote areas. The ancient Greek language explain the terminology of telemedicine in the phrase of distance healing. As per WHO, Telemedicine is the delivery of health-care services, where distance is a critical factor, by all health-care professionals using information and communications technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and the continuing education of health-care workers, with the aim of advancing the health of individuals and communities. Historically the concept of teleconsultation was evolved in the first half of twentieth century when the data of ECG was communicated through telephone lines, this can be traced as first evidence of this unique healthcare system. Further the introduction of electrical system of telegraph as well as evolution of telephone revolutionized this system of healthcare. when the Technology of telemedicine help both patients as well as service providers in multiple ways involving physicians, surgeons, pharmacists, paramedical staff, IT and electronics engineers, government, hospitals and end user public Location is now a days no problem and therefore there is no limitation of the availability of healthcare facilities to such location or remote location. The biggest role in such development is played by the communication technology which may provide healthcare services to every nook and corner of the location. It can decrease the health staff pressure because in India WHO guidelines ask to maintain the ratio 1:1000 of doctor and Indian public compared to present 0.62:1000 ratio of doctor and public. The great advantage of this system is that in case of epidemic or pandemic like COVID 19 Telemedicine can keep the health staff are well general public free from contagious infection (COVID-19). There are a number of networking communication modes that can be applied, which may improve the patient compliance,dosage regimen can be managed in better fashion thus increase the longevity of person life. Disasters management during pandemics present unique challenges which can be addressed effectively as happened during the lockdown. This technology-based practice can break the infectivity chain of the transmission of communicable diseases This chapter incorporates basic concept of telemedicine, its origin and types, communication technologies, services by telemedicine, types of telemedicine, tools of telemedicine, telemedicine software's and guidelines related to practicingtelemedicine in reference to Indian context. Copyright © RJPT All right reserved.

EXAMINING THE RELATIONSHIP BETWEEN HEALTH LITERACY AND TECHNOLOGY ACCESS AND USAGE IN ADULT INPATIENTS DIAGNOSED WITH TYPE 2 DIABETES MELLITUS

BACKGROUND: Considering the increased reliance on health technology during the COVID-19 Pandemic, Electronic Health (eHealth) interventions have become important for DM self-management (e.g., glucose monitoring). We have previously shown low HL to be a barrier to technology usage in the general inpatient adult population. However, the role of lowHL specifically for DM self-management requires further evaluation. METHODS: This is a sub-analysis of the Hospitalist Study, an observational, ongoing, quality improvement study of adults (age ≥18 years) enrolled from June 2019-March 2021. Patients were eligible for our sub-study if they were English speaking, had a DM diagnosis, and completed the brief health literacy screen. Participants completed questionnaires assessing technology access/use and online capabilities. Descriptive statistics, bivariate chi-squared, and multivariate logistic regression analyses (adjusted for age, race, education, and gender) were performed using STATA version 15.1 (StataCorp). RESULTS: Among 110 participants, the mean age was 61±15 years, most identified as Black (76%) and/or female (51%) and had at least some college education (58%). There were no significant differences in device ownership between low (n=15) and adequate (n=95) HL groups (93% vs. 94%, p=0.96). Those with low vs. adequate HL were less-likely to have previously used the internet (47% vs. 83%, p=0.006) and less-likely to independently use several internet features: use search engine (33% vs. 76% p<0.001), open online attachment (33% vs. 68%, p =0.005), upload images/files to a website (20% vs 54%, p=0.005), print webpages/online information (27% vs. 49%, p=0.04), use a video (47% vs. 72%, p=0.02), and/or use an interactive video (27% vs. 52%, p=0.01). In the multivariate analysis, participants with low HL remained significantly associated with decreased ability to independently perform online tasks (all measures p<0.05). CONCLUSIONS: Our data suggest that low HL may be a barrier to internet access and usage among patients with DM, but not for technology ownership. Future studies are necessary to ensure that at-risk populations can effectively utilize novel eHealth technologies particularly in the rapidly changing landscape of technology use in the clinical setting.

Randomised trial of synthetic osmotic cervical dilator versus dinoprostone for labour induction

Background: Induction of labor is a commonly performed obstetric intervention. Vaginal prostaglandin E2 (dinoprostone) is the recommended first choice agent in the UK. Mechanical methods of induction are slower to achieve cervical ripening but have a lower risk of adverse effects. Objective: To compare the efficacy, maternal and neonatal safety, and maternal satisfaction of a synthetic osmotic cervical dilator (Dilapan-S) with vaginal prostaglandin E2 (dinoprostone) in cervical ripening for induction of labour. Design: Open-label, multicentre, superiority, randomised controlled trial in four UK National Health Service maternity units. Participants: Eligible participants were women ≥ 16 years of age undergoing induction of labour for a singleton pregnancy, ≥ 37 weeks' gestation with vertex presentation and intact membranes. The trial did not reach its planned sample size of 860 due to restrictions on research during the Covid-19 pandemic. Interventions: Women were randomly assigned to receive Dilapan-S or dinoprostone using a telephone randomisation system minimised by hospital, parity, BMI and maternal age. The induction agent was replaced as required until the cervix was assessed as favourable for labour. Main outcome measures: The primary outcome was failure to achieve vaginal delivery (i.e. caesarean delivery). Secondary outcome measures included maternal and neonatal adverse events. Analysis was by intention-to- treat, adjusting for design variables where possible. Results: Between 19 December 2017 and 26 January 2021, 674 women were enrolled: 337 were randomly assigned to Dilapan-S and 337 to dinoprostone (n = 337). The primary outcome was missing for two women in the dinoprostone group. Failure to achieve vaginal delivery (caesarean section) occurred in 126 women (37.4%) allocated to Dilapan-S, and 115 (34.3%) women allocated to dinoprostone (adjusted risk difference 0.02, 95% confidence interval -0.05 to 0.10). There were similar maternal and neonatal adverse events between the groups. Conclusions: Women undergoing induction of labour with Dilapan-S have similar rates of caesarean section and maternal and neonatal adverse events compared to dinoprostone.

Common respiratory viruses and collapsing health: Prodigious focus on ambient air pollution

Ambient air pollution is one of the treacherous and malign problems facing humanity and other living beings on the earth today. Although the air pollutants such as particulate matters (PM) and microscopic contaminants have been associated with widespread morbidity and mortality, studies have also indicated those pollutants as a potential synergist to respiratory infirmities in both adults and children. Many viral contaminants have also been reported as potential detriments of respiratory distresses. Exposure to poor grades of ambient air can lead to numerous health consequences, such as adverse effects on the lung, heart, and other vital organs. In recent years, many studies infer that pollution along with viral contaminants impart substantial worldwide burden of diseases on human beings. Excessive air suspended pollutants such as micro or nanoparticulate matters bring down the life expectancy of human beings in many ways. Regardless of the passage of entry, fine and ultrafine PM that enter into systemic circulation affect vascular endothelial cells by producing local oxidative stress and have the capacity to cross biological barriers, thereby creating numerous deleterious effects on vital organs. Pollution-induced systemic inflammation is mediated by proinflammatory cytokines such as interleukin-6, interleukin-1 β, and tumor necrotic factor-α. These systemic inflammatory mediators are implicated in causing or exacerbating many complications in the human body. This article is an attempt to accentuate the pollution-linked health impediments, as well as the fountainheads of ambient air pollution so that some effective strategies can be developed to manage this global peril. © 2022 Biomedical and Biotechnology Research Journal (BBRJ).

Safety and sagacious use of remdesivir: Paramount focus on contemporary perspectives

The outbreak of COVID-19 has severely impacted the viability on the earth. Its pathogen severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has manifested catastrophic effect on the world's demographics and emerged as the most epizootic agent for human beings. Even though considerable progress in research has led to a better understanding of the virus, there is no specific and potent treatment or cure has been proven effective for this disease. Based on the available scientific evidences, U. S. Food and Drug Administration has issued an emergency use authorization for the emergency use of remdesivir against SARS-CoV-2 virus in critical and hospitalized patients. Remdesivir is a prodrug form of a nucleoside analog GS-441524. It is given intravenously because of its poor absorption through oral route. Remdesivir acts against viral RNA-dependent RNA polymerase targeting viral genome replication. It has been used in many countries as an emergency drug for the treatment of COVID-19 in hospitalized patients. However, in order to substantiate the result through suitable statistics, large-scale clinical trials are required. As per existing studies, the most common adverse effects reported after intravenous administration of remdesivir are elevation in the level of aminotransferase enzymes and bilirubin. Renal impairment, hypotension, and diarrhea have also been revealed in few patients. As of now, there is limited trial data available on remdesivir, so irrevocable epilogues cannot be drawn. However, it is believed by many therapists that irrational use of remdesivir should be prohibited. The erroneous use of remdesivir can lead to the SARS-CoV-2 virus mutating, and its consequence may be ill-starred in future. © 2022 Biomedical and Biotechnology Research Journal (BBRJ).

Reduced Mortality Rate in Critically Ill Patients with COVID-19 with the Implementation of a Treatment Protocol-Experience of a Tertiary Care Center in the Midwest during the Initial Surge of COVID-19

Background. COVID-19 has been an unprecedented pandemic resulting in high mortality. We report our experience of using a treatment protocol in the intensive care unit (ICU) during the first peak of the pandemic. Methods. All patients diagnosed with SARS-CoV-2 infection admitted to the ICU between April 14-June 14, 2020 were included. Remdesivir was made available for use in our institution on May 14th 2020, and thereafter, a treatment protocol combining remdesivir, corticosteroids and tocilizumab was implemented in the ICU, with doses as follows: Remdesivir 200mg intravenously (I.V.) on day 1, then 100 mg for 4 days;tocilizumab 400 mg I.V. once a day for 2 days;dexamethasone 6 mg I.V. daily for 10 days followed by taper. During pre-protocol period, patients were receiving hydroxychloroquine (400 mg once on day 1 followed by 200 mg twice daily orally for 4 days). We compared the pre-protocol period (labeled as P1: April 14, 2020- May 13, 2020) with protocol period (P2: May 14, 2020 -June 14, 2020) for clinical outcomes. Results. A total of 32 and 48 patients were included during P1 and P2 respectively. Both groups were similar in terms of demographic characteristics, mean (±SD) age [55(±10) and 54 (±12) years] and mean Charlson-Deyo risk score at admission [2.4(±0.8) and 2.5 (±0.9) respectively]. During both periods, a comparable number of patients needed mechanical ventilation (65% and 66% respectively), anticoagulation (74% and 76% respectively) and inotropes (41% and 40%). The mean duration of ICU stay during P1 was significantly longer than P2 [15.4 (±2.8) days versus 9.3 ± (3.8) days, p< 0.0001)]. During P1, mean duration of mechanical ventilation [10 (±1.6) days] was also significantly longer than P2 [7.1 (±2.7) days] (p= 0.0004). There was a significant reduction in mortality rate from 68% (22/32) during P1 to 10.4% (5/48) in P2 (p< 0.0001). Patients were 4.3 times more likely to die during P1 than P2 (95% CI= 2.47-7.86). Conclusion. Our results showed a decrease in ICU mortality rate by 57.6% with the implementation of a treatment protocol combining remdesivir, tocilizumab and corticosteroids during the first months of the initial surge of the pandemic, with a significant decline in length of ICU stay and duration of mechanical ventilation;and support the therapeutic data endorsed by IDSA/NIH guidelines.

Coronavirus Disease, Diabetes and Glucocorticoid a Terrible Trio for Invasive Mucormycosis: An Observational Study from Northwest Rajasthan

Objective: This study aims to describe the epidemiology, predisposing factors, clinical manifestations, management, and outcome of post-COVID rhino-cerebralorbital mucormycosis. Methods: This is a prospective observational study of patients with post-COVID RCOM conducted tertiary care hospital during May-June 2021. Results: The mean age of patients was 49.58±15.12 years and majority (64.80%) were male. The majority of patients were rural, Hindu and illiterate. Diabetes was present 78.10% patients, glucocorticoids were required in 66.30%, and supplemental oxygen was used in 27.60% of patients. Most of the patients developed symptoms of RCOM within 15 days of COVID-19. Majority of patients (46.67%) had stage 3 disease and orbit was involved in 60% of patients. All patients received intravenous antifungal drugs and combined antifungal drugs and surgical debridement was performed in 77.10% patients. Predictor associated with poor outcome were RCOM stage 3c or above and qSOFA score ≥2 at presentation. Conclusion: Diabetes and glucocorticoids are the most important risk factors for post-COVID RCOM. COVID-19 patients must be followed closely for 2-4 weeks to detect mucormycosis as earlier as possible. Antifungal drugs should be started immediately if clinico-radiological feature suggest RCOM before microbiological confirmation. Combined medical and surgical treatment significantly reduces mortality. © 2021 Journal of Association of Physicians of India. All rights reserved.

Factors affecting the outcome of the usage of high-flow nasal cannula on severe or critically ill COVID-19 patients: a multicentric study from a developing nation

In resource-constrained settings, High-Flow Nasal Cannula (HFNC) can reduce the burden on mechanical ventilation in COVID-19 induced Acute Hypoxemic Respiratory Failure (AHRF). The aim was to observe the factors those might affect the outcome of the usage of HFNC on severe/critically ill COVID-19 patients. This is a multicentric prospective observational study. We observed rRT-PCR positive severe/critically ill ICU patients requiring HFNC for more than six hours. Statistical analysis was done to correlate between factors and outcome. Weaning from HFNC was successful in 47.5% of patients. The death rate was higher in 50 years older (56.50%), and patients with asthma (60.57%), COPD (60.00%), and CKD (68.42%). Fever (91.67%), cough (72.5%), and dyspnea (67.5%) were the most common symptoms. Mortality rates were higher for patients with raised blood sugar, creatinine levels. Severely systemic inflammatory response was seen very high for the expired patients. On HFNC, percent saturation of oxygen (SpO2) and partial pressure of oxygen (PaO2) progression was significantly high for the surviving patients requiring less inspired fraction of oxygen (FiO2%). The survival rate was higher for the patients using both HFNC and non-rebreather mask (NRM) concomitantly. While after HFNC- SpO2% and FiO2% were significantly related with outcome of the HFNC only treated patients, duration of hospital stay and on HFNC- FiO2% affected the HFNC + NRM treated patients' outcome. HFNC could save more lives of critically ill AHRF patients who otherwise might need invasive or noninvasive ventilation. Some biochemical tests were observed to have association with the prognosis of the disease though HFNC was given to all. Survival benefit of dual HFNC and NRM therapy needs future study.

SIGNIFICANT REDUCTION IN MORTALITY RATE IN CRITICALLY ILL PATIENTS WITH COVID-19 WITH THE IMPLEMENTATION OF A TREATMENT PROTOCOL-EXPERIENCE OF A TERTIARY CARE CENTER IN MIDWESTERN UNITED STATES DURING THE FIRST PEAK OF THE COVID-19 PANDEMIC

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: COVID-19 has been an unprecedented pandemic resulting in serious morbidity and mortality. Knowledge of optimal treatment regimens for COVID-19 is evolving. The purpose of the study was to evaluate the impact of a treatment protocol on clinical outcomes of patients with COVID-19 in the intensive care unit (ICU) at a tertiary-care center during the first peak of the pandemic in Midwestern United States. METHODS: Methods: All ICU patients diagnosed with SARS-CoV-2 infection hospitalized between April 14-June 14, 2020 were included. Remdesivir was made available for use in our institution on May 14th 2020, and a treatment protocol combining remdesivir, corticosteroids and tocilizumab was implemented in the ICU, with doses as follows: Remdesivir 200mg intravenously (I.V.) on day 1, then 100 mg for 4 days;tocilizumab 400 mg I.V. once a day for 2 days;dexamethasone 6 mg I.V. daily for 10 days followed by taper. During pre-protocol period, patients were receiving hydroxychloroquine (400 mg once on day 1 followed by 200 mg twice daily orally for 4 days). We compared the pre-protocol period (labeled as P1: April 14, 2020- May 13, 2020) with protocol period (P2: May 14, 2020 -June 14, 2020) for clinical outcomes. Famotidine and multivitamins were administered to all patients during P1 and P2. RESULTS: A total of 32 and 48 patients were admitted to the ICU during P1 and P2 respectively. Both groups were similar in terms of demographic characteristics, mean (±SD) age [55(±10) and 54 (±12) years] and mean Charlson-Deyo risk score at admission [2.4(±0.8) and 2.5 (±0.9) respectively]. During both periods, a comparable number of patients needed mechanical ventilation (65% and 66% respectively), anticoagulation (74% and 76% respectively) and inotropes (41% and 40%). The mean duration of ICU stay during P1 was significantly longer than P2 [15.4 (±2.8) days versus 9.3 ± (3.8) days, p<0.0001)]. During P1, mean duration of mechanical ventilation [10 (±1.6) days] was also significantly longer than P2 [7.1 (±2.7) days] (p=0.0004). There was a significant reduction in mortality rate from 68% (22/32) during P1 to 10.4% (5/48) in P2 (p<0.0001). Patients were 4.3 times more likely to die during P1 than P2 (95% CI= 2.47-7.86). CONCLUSIONS: We observed a decrease in ICU mortality rate by 57.6% with the implementation of a treatment protocol combining remdesivir, tocilizumab and corticosteroids;we also noted a significant decline in length of ICU stay and duration of mechanical ventilation. CLINICAL IMPLICATIONS: A treatment-protocol combining remdesivir, tocilizumab and corticosteroids was effective in deceasing mortality rate by more than 50% in our ICU during the first peak of the pandemic. Our results support data recently endorsed by the NIH showing beneficial effects of these pharmacologic therapeutic interventions. DISCLOSURES: No relevant relationships by Sandeep Gupta, source=Web Response No relevant relationships by Jitendrakumar Gupta, source=Web Response No relevant relationships by Ashlesha Kaushik, source=Web Response

Mixed method research on lifelong learning: Capturing its dynamics in a multi-generational workforce in the wake of COVID 19

The coronavirus outbreak has ignited significant disruptions across industries. An agile mindset to assimilate learning into life is mandatory to be able to perform in the redesigned workplace. The pandemic is disrupting the workforce of all the generations. The present mixed-method study seeks to examine the differences in lifelong learning attribute of the prominent generations in the Indian workforce through qualitative, in-depth interviews followed by a more generalisable, quantitative survey. The qualitative interview data of the Phase 1 was analysed using text mining and topic modelling. Based on the topics identified, the quantitative data related to lifelong learning and self-efficacy was gathered in the Phase 2 from the respondents of different generations by questionnaire. The lifelong learning trait differences and drivers of self-efficacy across generational cohorts were analysed by MANOVA followed by a regression analysis. The results suggest that there are major differences across generations. © 2021 Inderscience Publishers. All rights reserved.

Tetravalent SARS-CoV-2 Neutralizing Antibodies Show Enhanced Potency and Resistance to Escape Mutations.

Neutralizing antibodies (nAbs) hold promise as therapeutics against COVID-19. Here, we describe protein engineering and modular design principles that have led to the development of synthetic bivalent and tetravalent nAbs against SARS-CoV-2. The best nAb targets the host receptor binding site of the viral S-protein and tetravalent versions block entry with a potency exceeding bivalent nAbs by an order of magnitude. Structural studies show that both the bivalent and tetravalent nAbs can make multivalent interactions with a single S-protein trimer, consistent with the avidity and potency of these molecules. Significantly, we show that the tetravalent nAbs show increased tolerance to potential virus escape mutants and an emerging variant of concern. Bivalent and tetravalent nAbs can be produced at large-scale and are as stable and specific as approved antibody drugs. Our results provide a general framework for enhancing antiviral therapies against COVID-19 and related viral threats, and our strategy can be applied to virtually any antibody drug.

Impact of COVID-19 on the outcomes of gastrointestinal surgery

COVID-19 pandemic has brought a paradigm shift in the treatment of various surgical gastrointestinal disorders. Given the increasing number of patients requiring hospitalization and intensive care for SARS-CoV-2 infections, various surgical departments worldwide were forced to stop or postpone elective surgeries to save the health resources for COVID-19 patients. Since the declaration of the COVID-19 pandemic by the World Health Organization on 12th March 2020, the recommendations from the surgical societies kept evolving to help the surgeons in making informed decisions regarding patient care. Moreover, various socio-economic and epidemiological factors have come into play while deciding the optimal approach towards patients requiring gastrointestinal surgery. Surgeries for many abdominal diseases such as acute appendicitis and acute calculous cholecystitis were postponed. Elective surgeries were triaged based on the urgency of performing the surgical procedure, the hospital burden of COVID-19 patients, and the availability of healthcare resources. Various measures were adopted such as preoperative screening for SARS-CoV-2 infection, use of personal protective equipment, and the COVID-19-free surgical pathway to prevent perioperative SARS-CoV-2 transmission. In this article, we have reviewed the recent studies reporting the outcomes of various gastrointestinal surgeries in the COVID-19 pandemic era and the recommendations from various surgical societies on the safety precautions to be followed during gastrointestinal surgery.