MR imaging spectrum in COVID associated Rhino-Orbito-Cerebral mucormycosis with special emphasis on intracranial disease and impact on patient prognosis.

In the wake of the ongoing Coronavirus Disease 2019 (COVID-19) pandemic, a new epidemic of COVID associated mucormycosis (CAM) emerged in India. Early diagnosis and prompt treatment of this deadly disease are of paramount importance in improving patient survival. MRI is the cornerstone of diagnosis of early extrasinus disease, particularly intracranial complications which have traditionally been associated with a high mortality rate. In this review, we depict the sinonasal, perisinus, orbital and intracranial involvement in CAM. Special emphasis is laid on intracranial disease which is categorized into vascular, parenchymal, meningeal, bony involvement and perineural spread. Vascular complications are the most common form of intracranial involvement. Some unusual yet interesting imaging findings such as nerve abscesses involving the optic, trigeminal and mandibular nerves and long segment vasculitis of the internal carotid artery extending till its cervical segment are also illustrated. In our experience, patient outcome in CAM (survival rate of 88.5%) was better compared to the pre-pandemic era. Presence of intracranial disease also did not affect prognosis as poorly as traditionally expected (survival rate of 82.8%). Involvement of brain parenchyma was the only subset of intracranial involvement that was associated with higher mortality (p value 0.016). The aim of this review is to familiarise the reader with the MR imaging spectrum of CAM with special focus on intracranial complications and a brief account of their impact on patient prognosis in our experience.

Robust anti-SARS-CoV2 single domain antibodies cross neutralize multiple viruses.

We report robust SARS-CoV2 neutralizing sdAbs targeting the viral peptides encompassing the polybasic cleavage site (CSP) and in the receptor binding domain (RBD) of the spike (S) protein. Both the sdAbs inhibited infectivity of the CoV2 S protein expressing pseudoviruses (LV-CoV2S). Both anti-CSP and RBD intrabodies (IB) inhibited the output of LV(CoV2 S). Anti-CSP IB altered the proteolytic processing and targeted the viral S protein for degradation. Because of cross-reactive CSPs in the entry mediators, the anti-CSP sdAb neutralized in vitro and in vivo the infectivity of SARS-CoV2 unrelated viruses such as herpes simplex virus 1 (HSV1) and pestes des petits ruminants virus (PPRV). Conversely, anti-HSV1 and anti-PPRV sera neutralized LV(CoV2 S) owing to the presence of CSP reactive antibodies indicating that a prior infection with such pathogens could impact on the pattern of COVID-19.

Is There a Rationale for Using Bacillus Calmette-Guerin Vaccine in Coronavirus Infection?

Coronavirus disease 2019 (COVID-19) has become a global pandemic in 2020. The pathogen responsible for the COVID-19 has been found to be coronavirus (2019-nCoV) with human transmission through droplets, airway secretions, and even direct contact with host. Currently multiple drugs and their combinations are being tried for the treatment of the COVID-19 disease, but none approved. In absence of definitive and approved treatment, it is imperative that prevention of COVID-19 infection is of utmost importance. For the same, face masks, hand hygiene, isolation, and quarantine are being practiced all over the world. However much successful these methods be, they cannot be used for a very long time. Thus, it becomes necessary that a vaccine be developed for the disease so that the further spread could be halted. Some reports suggest the use of Bacillus Calmette-Guerin (BCG) vaccine as the prophylaxis for coronavirus. BCG vaccine is a live attenuated vaccine, used for prophylaxis of Mycobacterium tuberculosis and is present in the essential list of the World Health Organization as well as immunization programs of many countries. Immunostimulatory antiviral effects of BCG vaccine are well known. At present, there are no published evidence available to support the use of BCG vaccine for the prevention of coronavirus infection. However, there have been speculations on enhanced immunity with BCG vaccine, which might be useful in prevention of coronavirus infection. Results from the clinical studies of BCG vaccine in vulnerable population are required to confirm this hypothesis.

Imaging of coronavirus disease (COVID-19): a pictorial review.

Coronavirus disease (COVID-19), caused by a highly contagious novel coronavirus, has seen a rapid surge of cases over the past 6 months spreading to more than 215 countries and posing a global threat to mankind. Reverse transcriptase-polymerase chain reaction (RT-PCR) from pharyngeal swabs is considered the gold standard for diagnosis of this disease. Portable chest radiography (CXR), point of care ultrasound, and computed tomography (CT) are crucial modalities in diagnosis and follow-up. Portable CXR can help in patients who are clinically unstable, and also to prevent the cumbersome process of steriliastion after every CT scan. However, chest CT is useful as a problem-solving tool, to look for progression and complications associated with the disease. In a few cases, in our experience (as has also been documented by others), RT-PCR was negative in early disease, and CT chest was able to detect the radiologi-cal findings raising suspicion of COVID-19. With this pictorial review, we aim to describe and illustrate the typical, and a few atypical, radiological findings of this disease.

COVID-19 pandemic: Psychological impact on anaesthesiologists.

BACKGROUND AND AIM: The anaesthesiologists are at the highest risk of contracting infection of coronavirus disease 2019 (COVID-19) in emergency room, operation theatres and intensive care units. This overwhelming situation can make them prone for psychological stress leading to anxiety and insomnia. MATERIALS AND METHODS: We did an online self-administered questionnaire-based observational cross-sectional study amongst anaesthesiologists across India. The objectives were to find out the main causes for anxiety and insomnia in COVID-19 pandemic. Generalised Anxiety Disorder-7 (GAD-7) scale and Insomnia Severity Index (ISI) were used for assessing anxiety and insomnia. RESULTS: Of 512 participants, 74.2% suffered from anxiety and 60.5% suffered from insomnia. The age <35 years, female sex, being married, resident doctors, fear of infection to self or family, fear of salary deductions, increase in working hours, loneliness due to isolation, food and accommodation issues and posting in COVID-19 duty were risk factors for anxiety. ISI scores ≥8 was observed in <35 years, unmarried, those with stress because of COVID-19, fear of loneliness, issues of food and accommodation, increased working hours and with GAD-7 score ≥5. Adjusted odd's ratio of insomnia in participants having GAD-7 score ≥5 was 10.499 (95% confidence interval 6.097-18.080; P < 0.001). CONCLUSION: The majority of anaesthesiologists on COVID-19 duty suffer from anxiety and insomnia. Addressing risk factors identified during this study with targeted interventions and psychosocial support will help them to cope better with the stress.