The Use of Geographic Information Systems to Shape COVID-19 Policies Regarding Masking and Distancing with a Partially Vaccinated Population

Geographic information systems (GIS) and choropleth maps for COVID-19 cases as well as COVID-19 test and vaccination rates proved very valuable to informing decision-making on the local and regional levels of government in Shelby County, Tennessee, USA. The authors have all served on the City of Memphis and Shelby County COVID Joint Task Force and share here their observations about the challenges and promises related to these techniques in the context of a fast-changing environment. As the pandemic unfolded, new virus variants emerged and the population became increasingly vaccinated. Consequently, the use of GIS changed, and maps needed to be continually adapted to the shifting needs of decision makers. The authors describe their approaches to leveraging GIS techniques to monitor the spread of the disease, draw conclusions about the effect of policy measures, and address health disparities. They outline the strengths and weaknesses of choropleth maps, reflect on how best to facilitate interorganizational communication of the derived information, and suggest desirable aspects of educational courses for GIS as well as skill sets in personnel that they came to appreciate as essential. © 2023 Taylor and Francis Group, LLC.

Towards Intermediated Workflows for Hybrid Telemedicine

The growing platformization of health has spurred new avenues for healthcare access and reinvigorated telemedicine as a viable pathway to care. Telemedicine adoption during the COVID-19 pandemic has surfaced barriers to patient-centered care that call for attention. Our work extends current Human-Computer Interaction (HCI) research on telemedicine and the challenges to remote care, and investigates the scope for enhancing remote care seeking and provision through telemedicine workflows involving intermediation. Our study, focused on the urban Indian context, involved providing doctors with videos of remote clinical examinations to aid in telemedicine. We present a qualitative evaluation of this modified telemedicine experience, highlighting how workflows involving intermediation could bridge existing gaps in telemedicine, and how their acceptance among doctors could shift interaction dynamics between doctors and patients. We conclude by discussing the implications of such telemedicine workflows on patient-centered care and the future of care work. © 2023 Owner/Author.

Developing Contemporary Survivorship Clinic for Recipients of Hematopoietic Cell Transplantation: A Single Center Experience

Introduction: Survival after hematopoietic cell transplantation (HCT) has improved tremendously over the last few decades. HCT survivors are at increased risk of long-term complications and secondary cancers. This poses unique challenges to the HCT-related healthcare system given the growing need for survivorship care. Developing a HCT survivorship program with a dedicated clinic to survivors ensures equitable access to care and ongoing patient education. Herein, we describe our program survivorship model and our initial experience. Method(s): The Moffitt Cancer Center (MCC) survivorship clinic (SC) planning committee was initiated in September 2019. The SC was launched in January 2021 with the mission to provide high-quality, comprehensive, and personalized survivorship care and to empower patients and community health care providers with education and a roadmap for screening for late effects. The SC initially focused on allogeneic (allo) HCT patients and later opened to autologous (auto) HCT recipients in February 2022. HCT patients are referred by primary HCT team after HCT with an emphasis on preferred timeframe of initial SC visit no earlier than 3 months but less than 12 months from HCT. SC is located at 2 physical locations: main campus and satellite, with virtual visit options to account for the distance from MCC and COVID considerations. SC applies a consultative model. SC is staffed by dedicated advanced practice professional (APP), supervised by SC faculty. The scope of SC care includes but is not limited to prevention of infections (education, vaccinations), surveillance of late effects (endocrine, pulmonary function, cardiac, bone health), and general cancer screenings (breast, colon, skin cancer). Patients' clinical data from SC inception to August 2022 were reviewed. Result(s): From January 2021 to August 2022, a total of 138 patients were seen in SC. The majority were seen in person (62% in clinic, 38% by virtual visit). Median age was 58 years (range, 19-82). Median time to first SC visit was 21 months (range, 3-1464) after HCT. Allo HCT was the most common type of HCT seen in clinic (87%, n=120). Most common diagnoses were acute myeloid leukemia (43%, n=59), myelodysplastic syndrome (17%, n=23), and acute lymphoblastic leukemia (10%, n=14). Only 17 patients (12%) were seen in 2021 but the volume increased significantly in 2022. Currently there are more than 10 patients seen in SC per month. Conclusion(s): We report successful experience in launching a contemporary HCT SC despite the challenges of an ongoing COVID pandemic. As a stand-alone cancer center, we serve a wide geographical location with subspecialty and primary care providers dispersed throughout the community. Our consultative model and experience could provide a useful guide for other programs. In 2023, we plan to expand our SC to a broader population of patients receiving other cellular immunotherapies.Copyright © 2023 American Society for Transplantation and Cellular Therapy

SIGNIFICANCE OF ELEVATED SARS-CoV-2 ANTIGEN LEVELS DURING EARLY HOSPITALIZATION

Background: Patients hospitalized with COVID-19 randomized to standard of care (SoC) plus placebo or SoC plus monoclonal antibody (mAb)[bamlanivimab, sotrovimab, amburvimab-romlusevimab, or tixagevimab-cilgagavimab] as separate arms of TICO/ACTIV-3 did not show differences in the time to sustained recovery through day 90. Combining these cohorts, we assessed if early changes in plasma nucleocapsid antigen(pNA) were associated with clinical outcomes. Method(s): TICO/ACTIV-3 enrolled 2,254 patients between 8/5/2020 to 9/30/2021. We used the Quanterix assay to measure pNA of stored samples. We selected those with pNA in the top quartile at baseline through day 5 and examined the association with baseline factors and clinical outcomes through day 90 using regression methods (proportional odds logistic, Cox proportional hazard, and Fine-Gray competing risk models as appropriate). Result(s): Of the 2,149 patients with a baseline value and at least one measurement of pNA on Days 1-5, we found a median age 57 (IQR 46-68), 58% male, 64.9% with one or more co-morbidities, 82.1% unvaccinated, 37.6% with delta variant, median symptom duration 8 days (IQR 6-10), and 9.2% on high flow nasal oxygen (HFNO) or non-invasive ventilation (NIV). Participants with pNA in the top quartile (>4693.5 ng/L at baseline and >29.9 ng/L at day 5) occurred more commonly among those with baseline renal impairment [OR 4.1 (95% CI 2.8 to 5.9)], and pulmonary severity of illness requiring oxygen of < 4 L/min [OR 2.2 (95 %CI: 1.5 to 3.4)], >4 L/min [OR 4.9(95% CI: 3.3, to 7.4)], and HFNO/NIV [OR 5.3 (95% CI: 3.1 to 9.0)] compared to those not using supplemental oxygen at study entry. Patients with positive anti-spike antibody at baseline had lower odds of persistently high pNA [OR 0.15 (95%CI: 0.10 to 0.20)]. Participants with pNA levels in the top quartile through day 5 were associated with increased risk of all-cause day 90 mortality [HR 4.4 (95% CI: 3.2, 5.9)], and reduced incidence of sustained recovery through day 90 [RRR 0.40 (95% CI: 0.35 to 0.45)]. Conclusion(s): PNA levels in the top quartile over the first 5 days were associated with elevated risk for death and reduced recovery. This group includes those with renal impairment, use of oxygen for COVID-19, and negative for anti-spike antibody. Top quartile pNA in early infection identified subjects on lower level of oxygen that were high risk for poor outcomes potentially identifying those that would benefit from additional treatment. (Figure Presented).

Safety and efficacy of apremilast in adults hospitalized with COVID-19

Introduction: Apremilast, a nonbiologic oral phosphodiesterase 4 (PDE4) inhibitor, was evaluated as a treatment for the hyperinflammatory response in patients (pts) hospitalized with severe COVID-19. Aims and Objectives: To assess the safety and effectiveness of apremilast plus standard of care (SoC) in pts hospitalized with severe COVID-19. Method(s): COMMUNITY (EudraCT 2020-002594-10) was a phase 3, double-blind, randomized, multinational, platform trial in adult pts hospitalized with COVID-19. Pts received apremilast 30 mg BID (APR) or placebo (PBO) for 14 days or until hospital discharge, whichever occurred first. Supportive care (per study center practices) was allowed except for CYP3A inducers and concurrent PDE4 antagonists. Result(s): From November 24, 2020 to June 4, 2021, 384 pts were enrolled (APR+SoC: n=194;PBO+SoC: n=190);enrollment halted early due to futility. Mean age was 56.5 years;59% were men. Most pts had a COVID-19 clinical severity score of 4 (48%) or 3 (29%) (range: 1-8, 1=death). Median (95% CI) time to confirmed clinical recovery through Day 29 (primary endpoint) was 14 (11-15) days for both groups (P=0.8779). All-cause mortality incidence rates through Day 29 (key secondary endpoint) were 18% (APR+SoC) and 17% (PBO+SoC) (P=0.9665). Treatmentemergent adverse event (TEAE) rates were similar between APR+SoC (54%;n=189) and PBO+SoC (55%;n=187) groups. TEAEs Common Terminology Criteria AE grade >=3 occurred in 25% of APR+SoC pts and 30% of PBO+SoC pts. Serious TEAE rates were 27% (APR+SoC) and 30% (PBO+SoC). Conclusion(s): Although APR+SoC did not improve survival in pts hospitalized with severe COVID-19, APR was well tolerated with a safety profile consistent with the established safety profile.

Functional Foods: A Promising Strategy for Restoring Gut Microbiota Diversity Impacted by SARS-CoV-2 Variants (preprint)

Natural herbs and functional foods contain bioactive molecules capable of augmenting the immune system and mediating anti-viral functions. Functional foods, such as prebiotics, probiotics, and dietary fibers, have been shown to have positive effects on gut microbiota diversity and immune function. The use of functional foods has been linked with en-hanced immunity, regeneration, improved cognitive function, maintenance of gut mi-crobiota, and significant improvement in overall health. The gut microbiota plays a critical role in maintaining overall health and immune function, and disruptions to its balance have been linked to various health problems. SARS-CoV-2 infection has been shown to affect gut microbiota diversity, and the emergence of variants poses new challenges to combat the virus. SARS-CoV-2 recognizes and infects human cells through ACE2 receptors prevalent in lung and gut epithelial cells. Humans are prone to SARS-CoV-2 infection because the respiratory and gastrointestinal tracts are rich in microbial diversity and contain high ACE2 and TMPRSS2. This review article explores the potential use of functional foods in mitigating the impact of SARS-CoV-2 variants on gut microbiota diversity and the potential use of functional foods as a strategy to combat these effects.

KNN-WT BASED COVID-19 DETECTION USING CHEST X-RAY BINARY CLASSIFICATION

A novel virus commences in Wuhan China in December 2019. It was named as novel coronavirus (nCovid-19) or severe acute respiratory syndrome corona virus-2 (SARS-CoV-2). Due to its zoonotic nature, it had affected animals as well as human beings. The stated virus is spreading at such a rapid rate that it has razed human lives and the global economy. To aid in such pandemic situation, we have proposed a novel neural network-based model for diagnosing coronavirus from a raw chest X-Ray image. The proposed model uses K-Nearest Neighbor (KNN) for classifying the input image. It will support binary classification i.e., COVID effected X-Ray and normal X-Ray. Several collected input images are initially pre-processed using dual-tree complex wavelet transform (DTCWT). Then, feature extraction is executed using mobilenet architecture. Further, image classification is performed using the KNN based model. Lastly, the output is predicted whether it belongs to the Covid-19 class or normal class. For visualizing the effectiveness of the proposed KNN based classifier, parameters such as accuracy, recall, precision, and F1 score are calculated. A comparison is made by calculating the average of all the parameters with existing techniques. Experimental results showed that the proposed KNN-WT model achieves an accuracy of 99%. It outperformed all the existing algorithms. © 2023 Little Lion Scientific.

Dynamics of Gold in the Contemporary Era

Since the beginning of gold standards, gold is always preferred over paper currency. Over the years, gold has been found to have a peculiar linkage with different asset classes. The current study is an attempt to analyse the probable relationship of gold prices with crises. The current study highlights as to how gold could act as a saviour during the time of global crisis like the current pandemic (COVID 19). Additionally, it conducts a comparative assessment of gold returns vis-à-vis equity market returns and inflation over the last decade. Finally, the study concludes with alternative gold investment options and policy remarks. © 2021 MDI.

Dynamics of Gold in the Contemporary Era

Since the beginning of gold standards, gold is always preferred over paper currency. Over the years, gold has been found to have a peculiar linkage with different asset classes. The current study is an attempt to analyse the probable relationship of gold prices with crises. The current study highlights as to how gold could act as a saviour during the time of global crisis like the current pandemic (COVID 19). Additionally, it conducts a comparative assessment of gold returns vis-a-vis equity market returns and inflation over the last decade. Finally, the study concludes with alternative gold investment options and policy remarks.

Knowledge, Attitude and Practice in Medical Management of Glaucoma: A Cross-sectional Study from a Tertiary Care Hospital at Uttarakhand, India

introduction: Glaucoma is most common cause of irreversible blindness in the world. Hence, awareness about the disease, importance of drugs effect and its side-effects and accurate method of eye drop instillation is very crucial. Aim(s): To assess Knowledge, Attitude and Practice (KAP) at the medication, doctor and patient level in clinical practice. Material(s) and Method(s): It was a cross-sectional, descriptive, questionnaire based study conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India, for duration of two years from July 2020 to June 2022. It included 290 patients diagnosed with glaucoma. They were asked to demonstrate method of instillation of eye drop to assess correct method and to cover a few aspects of questionnaire regarding medication instillation. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 21.0. The p-value was determined for questions in the questionnaire using Chi-square test. The p-value <0.05 was considered significant. Result(s): About 88 (30.34%) patients were educated about the nature and progression of glaucoma. Punctal occlusion was explained to 40 (13.79%) patients and assisted instillation to 25 (8.62%) patients. Approximately 62 (70.45%) patients were educated about their disease. About 244 (84.14%) patients noticed that their ophthalmologist clinic had a television in Outpatient Department (OPD). Family screening was advised in only 67 (23.1%) of the patients. Only 53 (18.28%) patients were emphasised on strict control of associated systemic illness. conclusion: Proper patient education about glaucoma and treatment by healthcare provider plays a crucial role. Most of the patients were not educated about method of instillation of drops. Correct instillation of drops was crucial to achieve target Intra Ocular Pressure (IOP), minimising side-effects and reducing the cost of treatment. Family screening and control of associated systemic conditions were often missed by majority of ophthalmologists however, it is important to keep in mind. Copyright © 2022 Journal of Clinical and Diagnostic Research. All rights reserved.

COVID-19 Hospitalizations in North Texas: Impact of Insurance Status

Background. Texas has one of the highest rates of uninsured populations in the US (Fig1). We hypothesized that those without insurance were more likely to be hospitalized for COVID-19 but were at higher risk for severe disease and mortality due to uncontrolled medical illness prior to hospitalization. Methods. We conducted a retrospective analysis of patients hospitalized in 81 hospitals in Dallas- Ft. Worth (DFW) area. All inpatients and outpatients with COVID-19 from 3/1/2020 to 4/1/2021 were included to examine risk for hospitalization. Subset analysis included those hospitalized with COVID-19. Data presented is comparison between Medicaid and uninsured population as they were similar in age distribution (Fig 2). Results. 198, 174 COVID-19 unique individuals were identified;7.5% had Medicaid and 25.1% were uninsured. Among Medicaid, 29.6% were hospitalized vs. 25.8% of Medicaid vs. uninsured (adjusted odds ratio (aOR) 1.26 (1.20, 1.33). Among the 71,778 (~36%) hospitalized for COVID-19, comparing Medicaid vs. uninsured: 44.9 vs. 56.3% had ICU care;51.4% vs. 80.2% had pneumonia, 41.1% vs. 67.5% had respiratory failure with higher odds of developing these outcomes in uninsured (see Table 1). Median duration of hospital stay was longer in uninsured than Medicaid ( see Table 2a) and mortality in the hospital was 7.4% vs. 7.9% among Medicaid vs. uninsured (p< 0.0001). Thirty-day readmission rates were lower for Medicaid vs. uninsured (Table 3). In the year prior to the COVID-19 hospitalizations, use of health care among the uninsured was lower compared to Medicaid patients for outpatient, inpatient, and ER visits (p< 0.0001 for all comparisons;see Table 2b). Conclusion. Uninsured in North Texas had lower odds of hospitalization vs. Medicaid patients, likely due to younger age, but once hospitalized had higher risk for COVID pneumonia, ICU care, and respiratory failure. Median number of days was higher among uninsured but in-hospital mortality was higher among Medicaid population. Prior contact with healthcare system was lower among uninsured and 30-day readmissions were also lower, suggesting barriers accessing health care. Poorer outcomes among uninsured once hospitalized may be due to untreated comorbidities (Fig 3). Expansion of Medicaid has the potential of ameliorating these disparities.

COVID-19 Hospitalization Impact of Age, Race and Ethnicity Among Medicaid and Uninsured

Background. Texas has one of the highest rates of uninsured patients in the US and is one of the few states that has not expanded Medicaid (Fig 1). We sought to examine if there were differences by age, race, and ethnicity in the risk COVID-19 outcomes among those with Medicaid coverage vs. the uninsured population. (Table Presented) Methods. We conducted a retrospective analysis of all patients hospitalized in 81 hospitals in Dallas-Fort Worth area. All inpatients with COVID-19 from 3/1/2020 to 9/30/2021 were included in the analysis. We examined the following COVID-19 outcomes: ICU care, pneumonia, and respiratory failure stratified (separate logistic models for each outcome) by race, ethnicity, and age adjusted for a multitude of sociodemographic, clinical, and co-morbid characteristics (Fig 2). Results. 71,778 individuals diagnosed with COVID-19 were hospitalized: 12.9% had Medicaid and 23% were uninsured. For all COVID-19 study outcomes (ICU care, pneumonia, and respiratory failure), White Medicaid patients had lower odds ratios vs. their White uninsured counterparts indicating worse outcomes compared to Black Medicaid patients vs. Black uninsured counterparts (Table 1). Similarly, for all outcomes, Hispanic Medicaid patients had lower (worse) odds ratios vs. Hispanic uninsured counterparts compared to the same model with non-Hispanic patients. Finally, for all three outcomes, the youngest Medicaid age cohort (18-44 years) were less likely to require ICU care, have pneumonia or respiratory failure vs. the youngest uninsured patients;while conversely there was trend (not always statistically significant) that middle aged or older Medicaid cohorts were more likely compared to their same age uninsured counterparts to experience these outcomes. Adjusted odds ratio of COVID-19 outcomes by insurance status stratified by race, ethnicity, and age group. Conclusion. We found that age modified the risk for ICU care with younger Medicaid recipients at lower odds vs. uninsured than older cohorts. For race and Hispanic ethnicity, all Medicaid groups had lower likelihood of poor COVID-19 outcomes compared to their uninsured counterparts. However, the effect was more pronounced among Whites vs. Blacks and Hispanics vs. non-Hispanics (Fig 3). Providing health insurance such as Medicaid to uninsured younger patients could significantly improve health outcomes, especially among Whites, Hispanics, and younger patients.

Analyzing The Factors Affecting Media Consumer Trends During The COVID-19 Period - The Rise Of Web Series By Different Otts V/S Traditional TV Serials In India

In the recent decade OTT platforms, also known as "Over the top," have seen a tremendous rise in the number of consumers and also gained a huge market share in the entertainment industry. The OTT service most users probably interact with regularly is video OTT. Services like Netflix and Disney+ Hotstar are video OTT services that provide users with a number of programming options, both in terms of a licensed library of TV shows and films and original programming. The study's objective is to carry out a detailed study of OTT (over-the-top) platforms, and how and why OTT platforms are rising in India. This study also investigates OTT platforms at the time of the COVID-19 pandemic. We found that recent years have witnessed several films emerging as pan-India hits, and the rise of alternative platforms has only widened the opportunities for actors and filmmakers. This study concludes that there is no competition between theatres and digital platforms filmmakers must up their game. OTT has resulted in more opportunities and redefined viewership patterns. Films and other mediums will thrive together because the same actors and makers are exploring different platforms. Copyright © 2023 Ubiquity Press. All rights reserved.

Adherence to safety precautions in the operation theatre among anaesthesiologists in the COVID era.

Background and Aims: The COVID-19 pandemic led to significant infections among healthcare workers and deaths warranting the need for personal protective equipment. This study aimed to estimate the proportion of anaesthesiologists adhering to safety precautions and to evaluate their adherence patterns, difficulties faced and coping mechanisms in the operation theatre during the pandemic. Methods: This was a multicentric mixed methods study conducted among anaesthesiologists from two tertiary care hospitals. A paper-based questionnaire was given to all participants. The first part consisted of 21 questions regarding safety measures and extent of adherence. The second part was a response sheet regarding the various difficulties faced and coping mechanisms adopted. Following this, an in-depth interview was conducted to understand the same. The proportion of anaesthesiologists in different categories of adherence, patterns of adherence, difficulties faced, and coping mechanisms were computed and compared. Thematic framework analysis was done for in-depth interview. Results: Sixty participants were included. The adherence levels for N95 masks and face shields were higher. Most participants practised frequent handwashing and took showers after work. Fogging, difficulty in communication, marks on the face were the commonly faced difficulties. Self reassurance, adjusting the fit of masks/face shields, or taking breaks were the coping mechanisms mostly followed. Themes generated from in-depth interview include waning of caution, adaptation through innovative methods and stress due to uncertainty. Conclusion: The N95 mask was the most preferred safety precaution. Ease of use and safety were important considerations for adherence. Physical and mental acclimatisation and improved knowledge of disease played a vital role.

Pulmonary rehabilitation in the management of rhino-orbito-cerebral mucormycosis infection: A post-covid-19 complication

Mucormycosis, often known as 'black fungus' in India, is a fungal illness that has been identified in COVID-19 patients on an irregular basis. This case report describes a patient who was diagnosed with rhino-orbital-cerebral mucormycosis infection following COVID-19 infection. The COVID-19 infection weakens the patient's immune system, making the patient more susceptible to other fungal infections. He had surgery for this as well as ocular exenteration surgery. A physiotherapy treatment was intended to battle the post-surgery problems, including COVID-19 infection. The goal of the physiotherapy was to improve the patient's facial muscles after surgery. Following recovery from the COVID-19 infection, it also aimed to strengthen the patient's respiratory capacity and increase his exercise tolerance. As a result, the patient's quality of life improves. It included the facial proprioceptive neuromuscular facilitation (PNF) exercise as well as a well -planned cardiovascular exercise programme. The 6-minute walk test, peak expiratory flow rate, and quality of life questionnaire were used to assess the efficacy of the physiotherapy treatment.

Examining the Impact of Telemedicine Services on Covid-19 Related Parental Anxiety Using a Novel Pasc System

Aims Imposition of restrictions during COVID-19 pandemic adversely affected access and quality of pediatric consultations leading to increased parental anxiety. During pandemic AIIMS Patna initiated telemedicine-based COVID-19 Children's Helpline 'COViTel' in eastern part of India. The aim of the study was to assess the impact of telehealth services on parents' level of anxiety regarding COVID-19 illness in their children using a newly developed Parental Anxiety Score related to Child health (PASC). Methods A prospective cohort study was conducted on 75 parents seeking teleconsultation on 'COViTel' for children either diagnosed with COVID-19 or having direct contact with a COVID-19 positive case. As there was no existing scoring system to assess parental anxiety related with COVID-19 illness, a 6-item PASC (figure 1) was developed to assess parents anxiety level before and 3 days after pediatric teleconsultation. Ethical clearance was granted by institute ethics committee. Results Demographic details are provided in table 1. Parents had moderate level of anxiety (PASC 8) with highest score on item 6 at the time of registration (table 2). Parental anxiety had significantly reduced (PASC 4.2) after teleconsultation (mean difference= 3.787, 95% CI 2.899-4.674, P<0.01) with maximum reduction on item 2 (mean difference= 1.147 95% CI 0.93-1.36, P<0.01) on paired t-test. Conclusion This is first kind of study proving effectiveness of teleconsultation in mitigating parental anxiety related to COVID-19using a novel PASC score.

ARE ABO INCOMPATIBLE KIDNEY TRANSPLANT RECIPIENTS AT HIGHER RISK OF INFECTIONS?-A SINGLE CENTER EXPERIENCE

Introduction: Because of the limited donor pool, transplants are being done across the blood group and even HLA incompatibility barriers. But this comes at the cost of increased immunosuppression and the side effects. Effect of this intensified immunosuppression on the incidence of post transplant infections and the type of infection has not been studied extensively. Methods: We retrospectively analysed the incidence of infection in ABO incompatible transplants (ABOi) and compared it with propensity matched cohort of ABO compatible transplants(ABOc) over the same timeframe i.e. 2011 to April 2019. using hospital eHIS record system. Patients were matched with 1:2 ratio (ABOi: ABOc) for age (<60yr, >60yrs),sex, number of previous transplants, pretransplant infections, history of prior immunosuppression, diabetic status, NODAT, and induction agent used. Desensitization protocol for ABO incompatible transplant includes rituximab with double filtration plasmapheresis, plasmapharesis or immunoadsorption to target anti blood group titre of 8. Patient with high immunological risk (e.g.second transplant, HLA incompatible) receive ATG induction while others receive basiliximab induction. Valganciclovir prophylaxis was given only in patients with ATG induction. Results: [Formula presented] [Formula presented] During the study period 89 patients underwent ABOi transplants which were compared with 178 ABOc transplants. (Table1)Mean follow up duration was 50.45months (SD 26.8) in ABOi group and 49.47months (SD28.7) in ABOc group. 17% patients lost to follow up with their last follow up being more than 2 years before. Incidence of overall infections was similar in both the groups (59% (43/89) Vs 44.3% (79/178);p=0.6). (Table2) Incidence of urinary tract infections(UTI)was significantly more in ABOi group vs ABOc group.(23.5% (21/89) vs 11.79% (21/178);p=0.019). Cytomegalovirus infections (CMV) were significantly more in ABOi group 12.3% (11/89) as compared to ABOc group 5% (9/187) (p=0.04). All the patients with CMV infection were CMV IgG positive pretransplant except 2, one from ABOc group who was CMV IgG negative and another from ABOi group who’s pretransplant CMV serology was unavailable. There was no significant difference in incidence of fungal infection, pneumocystis infection, diarrheal infections (other than CMV),pneumonia (other than CMV, PCP, fungal), Herpes, BKV infection. Incidence of post-transplant tuberculosis (3.3% (3/89) Vs 2.8% (5/178);p=1.0) and SARS COV2 infections (12.3% (11/89) vs 9% (16/178);p=0.39 was similar in both the groups. Patient survival was similar in both the groups i.e.95.5% but death censored graft loss was significantly more in ABOi group 0.9% (8/89) as compared ABOc group 0.3% (5/178) p=0.03. Reason of graft loss in all the patients was immunological and not infection. Infection was cause for death in three ABOi patients and four ABOc patients. Conclusions: Overall incidence of infections in ABOi transplants was similar to Abo compatible transplant. Incidence of UTIs and CMV infections were significantly higher in ABOi group. No conflict of interest

Analysis of Ponseti Method in Congenital Talipes Equinovarus (CTEV)

Introduction: Congenital talipes equinovarus (CTEV) is the most common congenital foot disorder, commonly known as congenital clubfoot. Ponseti method of manipulation and serial plaster casting is the gold standard treatment for idiopathic congenital clubfoot. The purpose of this study is to analyse the efficacy of correction of Congenital Talipes Equinovarus deformity (CTEV) using ponseti method. Materials and Methods: This analysis was carried out at the Jhalawar Medical College Hospital's Orthopaedics Department, including 30 children with idiopathic CTEV of age less than 2 years, among which 13 unilateral and 17 bilateral CTEV, total 47 feet, willing for treatment. Patients were followed up weekly for corrective casting till tenotomy and corrective cast was applied for three weeks after final correction or percutaneous tendo-achilles tenotomy. Results: Assessment of results using Pirani severity scoring6,7 at the end of treatment and on regular follow-ups. The most common age group was 0-1 months with 24(80%) cases.Among 30 cases,there were 22 males(73.30%) & 8 females(26.70%). 17 cases were bilateral(56.67%) and 13 cases(43.33%) were unilateral. Post casting treatment, percutaneous tenotomy was done in 14 cases (46.67%) in which 12 cases(54%) were male and 2 cases(16%) were female. No patient has undergone extensive surgery like postero-medial soft tissue release or bony procedures to correct the deformity. Only two recurrence were recorded which was due to non compliance due to occurrence of pandemic COVID-19 Lockdown. They were treated with manipulation and pop cast followed D-B splint. Conclusion: Ponseti method is an excellent conservative method of treatment of Congenital Talipes Equino varus. Treatment must start at the earliest possible for better outcome. Long term follow up till 4 years age would be better to assess the relapse rate.

A blockchain approach on security of health records for children suffering from dyslexia during pandemic COVID-19

The Electronic Health Record (EHR) systems provide health information about patients. Data security, integrity, and management of EHR are crucial problems. Records can be modified and altered by different stockholders as the different users may be using them in more than one form. We provide a new approach, methodology, and system for calculating dyslexia symptoms in this research with a machine learning algorithm and secure dyslexia data storage using blockchain technology. The major role of our paper is to test a primary-age group student against dyslexia, a student detected in such early years of his life for such a disability then he or she can be easily cured for the disabilities and can spend the rest of his life normally. For this, we will be using various machine learning algorithms. Dyslexic patterns and a large amount of data can be shared for future clinical research, statistical analysis, and quality assurance because the framework is language-independent and built on Blockchain and a decentralized big data repository. This paper presents the design, execution, and test results, demonstrating the dyslexia health management system's high potential for worldwide deployment using blockchain technology. © 2022 Elsevier Inc. All rights reserved.