Impact of prolonged wearing of face masks - medical and forensic implications.

Since December 2019, the global outbreak of coronavirus disease had a significant impact on humanity. Because of the large number of casualties worldwide, the WHO (World Health Organization) declared the coronavirus disease caused by SARS-CoV-2 a pandemic. Since the start of the pandemic, facial masks have become essential as well as mandatory to protect ourselves from COVID-19. As a result of the pandemic, healthcare professionals (HCPs) have been required to wear personal protective equipment (PPE) for extended periods. Wearing face masks for an extended period has been shown to have several negative effects on HCPs. Additionally, face masks have hampered the use of digital techniques for facial identification. This paper examines the effects of wearing face masks for an extended period, as well as the effect of wearing face masks on facial identification technology. The Web of Science, PubMed, and Scopus databases were searched and screened for relevant studies. According to the current review, prolonged use of masks was found to be associated with adverse effects on the face and skin, including acne, redness, rashes, and itching. The use of masks also resulted in headaches, hypoxic conditions, and changes in voice and speech parameters. This communication in no way intends to advocate the discontinuation of wearing masks, on the contrary, the primary goal of this article is to spread awareness about the adverse effects associated with prolonged use of facial masks (N95, KF94, or surgical). This will help in increasing compliance with mask mandates by helping to develop preventive solutions to the problems that tend to deter the general public. This also demonstrates how the use of masks has become a challenge for facial recognition technologies.

An SBQ-R assessment of the impact of COVID-19 pandemic on the mental health of young adults in North India.

BACKGROUND AND AIM: During the COVID-19 pandemic in India, an increase in the number of suicides was observed in India. Therefore, the present study aims to explore various factors affecting the mental health of an individual and their consequences. Moreover, it has been attempted to assess the suicidal risk in the population of North India by using the Suicidal Behaviors Questionnaire-Revised (SBQ-R). METHODOLOGY: The young adults from the North Indian population belonging to the age group of 18 to 35 years (24.93±4.42 years) have been incorporated into the study. A total of 190 responses (102 males and 88 females) were recorded through online mode. The present questionnaire has incorporated the Suicidal Behaviors Questionnaire-Revised (SBQ-R) and some of the parameters taken from the psychology today online survey. RESULTS: The demographic characteristics of the respondents were described by using frequencies and percentages, means, and standard deviations. Cronbach's alpha, Kaiser-Meyer-Olkin (KMO), and the Bartlett sphericity were calculated. The mean SBQ-R score was recorded to be 4.62±1.5. Further, during the factor analysis with the principal component method, seven factors have explained the 70.797% of the cumulative variance with an eigenvalue of 1. CONCLUSIONS: The SBQ-R assessment revealed a minimal risk of suicidal behavior but the frequency distribution of the parameters taken for the psychological assessment has highlighted that anxiousness or worriedness has a significant impact on the mental health of the population at risk. Therefore, it is recommended that some precautionary measures, such as online mental health services, should be taken by the health ministry to keep the population healthy.

Evaluation of Liver Histopathological Findings of Coronavirus Disease 2019 by Minimally Invasive Autopsies.

AIM: The severe acute respiratory syndrome coronavirus 2 outbreak resulted in severe health impact with the loss of many lives across the world. Pulmonary parenchyma suffers the most from the brunt of the infection. However, evidence suggested a systemic involvement during the course of illness. Information on morphological changes of the liver is sparse in the literature. We aimed to evaluate the pathological findings in the liver by minimally invasive autopsies. METHODS: Postmortem core biopsies of the liver obtained from patients who succumbed to coronavirus disease 2019 disease were studied. Demographic findings, comorbidities, and relevant laboratory tests were collected. Detailed histopathological changes were assessed. RESULTS: Liver function tests were available in 40 cases, and it was deranged in 80% cases. A spectrum of histological changes was observed. Macrovesicular steatosis and nonspecific portal inflammation of mild degree were the common morphological changes. Features suggestive of vascular alteration were noted in more than half of the cases. These included increased portal vein branches, irregular luminal dilation, and herniation of portal veins into the periportal hepatocytes. In addition, we observed morphological changes attributed to terminal shock-related changes. CONCLUSION: The present study results highlight that liver parenchyma changes may be related to multiple pathogenic mechanisms. The presence of vascular alteration in portal tracts suggests derangement of hepatic vasculature related to systemic hypercoagulable state induced by the viral infection. It remains to be established if the histological changes are related to direct viral insult or to the systemic response caused by the viral attack.

COVID-19 pandemic: a reminder to develop forensic radiology facility.

COVID-19 outbreak has resulted in a substantial morbidity and mortality, and has put the health system under tremendous stress. A need for devising and adopting newer methods and techniques is being emphasized in the healthcare facilities to combat the effects of the SARS-CoV-2. Besides patient care, focus needs to be laid on the effective and dignified management of the deceased and medico-legal services provided by the hospitals and medical institutions during the COVID-19 pandemic. Considering the likelihood of forensic experts and autopsy personnel being exposed to SARS-CoV-2 inadvertently during the autopsy, it is recommended to resort to safer and minimally invasive techniques of postmortem examination of the dead. In this regard, employing radiological techniques for postmortem examination appears to be a promising option during the COVID-19 pandemic. An inherent advantage of postmortem radiography over conventional autopsies is the minimization of the risk of transmission of infection to the health care workers. Our correspondence highlights on the possibility of using radiological facilities as an effective replacement of high-risk conventional autopsy procedures during the COVID-19 pandemic.

COVID-19 pandemic and "survival of the fittest".

Occurrence and recurrence of COVID-19 cases have been observed globally. The complex relationship of host-pathogen and the environment plays a vital role in understanding the widespread recurrence of the SARS-CoV-2 among humans. Though the pathobiology of the disease is not completely understood, it is well established that COVID-19 poses a greater threat to individuals with co-morbidities and a weakened immune system. The article deals with the notion of innate immunity, natural selection, and the survival of the fittest during the COVID-19 outbreak. The article also attempts to introduce the concept of "lifestyle and cultural immunity" that needs to be addressed and incorporated at an early stage of childhood to boost up the human immune system. The communication further discusses the role of vaccination and micro-organisms pre-existing in the environment which are required to enhance the immunity of an individual.

Evaluation of Bone Marrow Findings of COVID-19 by Minimally Invasive Autopsies: A Single Tertiary Care Centre Experience from India.

The 2019 novel coronavirus (2019-nCoV) originated in Wuhan City of China. In India, first confirmed case of coronavirus disease (COVID-19) was reported on January 30, 2020 and India is presently hit by second wave of COVID-19. The aim of the present study was to evaluate bone marrow findings of COVID-19 by minimally invasive autopsies to aid in understanding pathophysiology of the disease. This prospective study was conducted at tertiary care centre of Western Rajasthan. After obtaining approval from Institute's ethics committee and consent from next of kins, minimally invasive autopsies were conducted in 37 COVID-19 deceased patients within an hour after the death. The tissue specimens were processed with standard biosafety measures. Electronic medical records were reviewed retrospectively and patients' clinical details and results of laboratory investigations were noted. In this prospective study, bone marrow biopsies were collected from 37 COVID-19 minimally invasive autopsies. Mean age of these cases was 61.8 years and male: female ratio was 2.36. Comorbidities were observed in 25 (67.5%) of all cases. Histopathological analysis revealed hypercellular, normocellular and hypocellular marrow in 5, 25 and 5 cases respectively (two biopsies were inadequate). There was marked interstitial prominence of histiocytes in 24 (68.5%) cases. Out of these, evidence of haemophagocytosis was observed in 14 (40%) cases, marked increase of haemosiderin laden macrophages in 20 (57.1%) cases. There was prominence of plasma cells in 28 (80%) cases. The present study attempted to fill the gap of dearth of literature from our country in COVID-19 autopsy studies by highlighting bone marrow findings. The data support the evidence of development of secondary haemophagocytic lymphocytosis in COVID-19 cases.

Evaluation of Pathological Findings of COVID-19 by Minimally Invasive Autopsies: A Single Tertiary Care Center Experience from India.

Objectives The 2019 novel coronavirus (2019-nCoV) has spread across the globe with more than 6 lakh deaths. Clinical autopsies are important to understand the pathobiology of the disease. Materials and Methods Autopsy techniques have been modified to be minimally invasive autopsies in all COVID-19 positive cases, and tissue biopsies were sampled from lungs, liver, and bone marrow within an hour after death. Detailed histological analysis was performed in the sampled tissues, along with immunohistochemistry. Patients' clinical records were collected. Statistical Analysis Descriptive statistics were used to summarize data. Results Of the 21 cases studied, 76.2% patients were ≥ 60 years of age, 80.9% were males, and 85.7% had co-morbidities. Histopathological analysis revealed diffuse alveolar damage (including exudative and organizing phase) in 88.9% cases. Microthrombi were seen in 44.4% cases. Additional findings include viral cytopathic changes, metaplastic change in the epithelium, intra-alveolar hemorrhage, and pulmonary edema. Liver showed centrizonal congestion with hepatocytic loss, lobular inflammation, steatosis, Kupffer cell hypertrophy, and sinusoidal neutrophilic infiltration, while significant portal infiltrate and cholestasis were absent to minimal. Bone marrow revealed hemophagocytosis in 60% cases. Conclusion Incorporation of minimally invasive autopsies provides an effective method to study the pathological findings in COVID-19 deaths in resource-constrained settings. Presence of pulmonary microthrombi in a significant number of cases supports the vascular events, apart from the characteristic diffuse alveolar damage, as an important pathogenic mechanism for lung injury in COVID-19 infections. Histopathological findings in the liver and bone marrow suggest indirect insult to these organs, related to circulatory and/or hyperinflammatory response to viral infections.

Persistence and distribution of SARS-CoV-2 in the aerosol and on the surfaces.

ABSTRACT: The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has created havoc worldwide ever since its emergen-ce in December 2019. The current evidence indicates that the virus remains viable in aerosols for hours and on fomites for few days. A little information is available on the topic, the present communication reviews the perseverance and distribution of the novel coronavirus in the aerosol and on various inanimate surfaces so that the appropriate safety measures can be undertaken and the virus protection guidelines may be framed accordingly.

Management of the dead during coronavirus disease 2019 outbreak: Practices and perceptions of forensic practitioners from India.

The coronavirus disease 2019 pandemic has mandated a response from administrative agencies and the health sector globally, however, the number of cases and deaths continue to rise. While management of the living is paramount, the management of the dead is also important. Guidelines for managing the dead have been issued and implemented by various local administrations, in accordance with national and international guidelines. This questionnaire-based research aims to develop an understanding of the knowledge, perceptions and practices of forensic practitioners from India as regards the management of the dead during the coronavirus disease 2019 pandemic. This Pan-India study included 278 forensic medicine experts (249 males and 29 females) working in various hospitals and medical institutions across the country. The questionnaire included various issues involving the management of dead bodies in cases involving coronavirus disease 2019, such as infection control practices, body screening, handling and autopsy, disposal practices, local administrative policies, and available infrastructure and resources. We found that guidelines are mostly being followed across India, barring disparity in issues relating to testing in the dead bodies, the role of local administration in the body disposal, and the use of personal protective equipment while handling bodies and during autopsies. Mortuaries now need to be upgraded, and general infrastructure requires improvement. Periodic training of all stakeholders and assessment of facilities are recommended.

Household Transmission of COVID-19: A Cross-Sectional Study.

INTRODUCTION: The COVID-19 pandemic has brought the entire world to a standstill. The disease is rapidly transmitting in the community. Imposed lockdowns due to the COVID-19 pandemic have effectively delayed the transmission in the community but the transmissibility in households needs to be explored. The aim of this study was to estimate the household transmission of COVID-19 and assess the factors affecting transmission. PATIENTS AND METHODS: A cross-sectional study where the data were collected from a single isolation center, was conducted. Patients were contacted by phone. Information regarding number of COVID-19-positive cases in the family, their demographic details, along with number of rooms in their household was collected. RESULTS: A total of 369 families of COVID-19-positive patients were contacted. Nineteen families with a single member were excluded. Out of 350 families with a total 2126 members, 480 (22.5%) were COVID-19 positive. Mean age was 30.12 years (±14.39) and majority of them were males (68.9%). Majority of the cases (67.3%) were in the age group (19-49 years). Mean rooms per person were 0.51± 0.20 (0.14 to 1.50). Mild negative correlation was seen between number of positive COVID-19 cases and rooms per person (r= -0.138, p=0.008) while moderate negative correlation with number of family members and proportion of family members being COVID-19 positive (r= -0.542, p≤0.0001). CONCLUSION: One in four family members got infected with COVID-19, they were majority males and in the working age group. Negative correlation of positive cases with number of family members and mild negative correlation between rooms per person and proportion of family member affected indicates some other factors may be responsible for household transmission than these factors.

Workplace safety concerns in medico-legal death investigations related to COVID-19.

The personnel involved in the management of COVID-19 affected dead bodies, including law enforcement personnel at the scene of crime, personnel involved in transportation of the dead bodies, forensic practitioners, autopsy pathologists, mortuary personnel, as well as the family members of the dead, etc. are at risk of exposure to SARS-CoV-2 infection. Post-mortem examination is a high-risk procedure, considering that it involves aerosol generating procedures, and exposure to body fluids. The safety of the forensic practitioners and support staff in the management of suspected or confirmed COVID-19 deaths hence, is of extreme importance, especially in the absence of pre-autopsy testing for COVID-19 and due to non-availability of adequate first-hand medical history of the deceased. This communication aims to highlight the current practices and advises certain guidelines in ensuring occupational health and safety in view of these risks in medico-legal death investigations.

COVID-19 and the need for stringent rules on data sharing.

This communication refers to the retractions of the two high profile COVID-19 papers of the top medical journals when the data analytics company declined to share the raw data of the papers. In this commentary, we emphasize that it is very pertinent for the journals to mandatorily ask the authors for sharing of the primary data. This will ensure data integrity and transparency of the research findings, and help in negating the publication frauds.

Inexplicable COVID-19! Would pathological autopsy be the panacea?

SARS-CoV-2 has swamped the entire world, unfolding into a COVID-19 pandemic. Efforts are on to develop an understanding of the various aspects related to SARS-CoV-2 and COVID-19. A pathological autopsy can play a vital role in understanding the pathophysiology of the disease, which may be vital in evolving effective management strategies. Despite its significance in the present circumstances, only a limited number of pathological autopsies are being conducted worldwide. The paper stresses on the need for taking up pathological autopsies globally and discusses its present status and the way forward, along with international perspectives and recommendations for consideration of pathological autopsy.

Preparing for a COVID-19 pandemic: Redefining roles of multidisciplinary team in a large tertiary hospital in Rajasthan.

Through this manuscript, we would like to share our experience with building a COVID hospital, allocating duties, planning and managing supplies during COVID-19 pandemic. This manuscript is prepared by the Doctors of various specialties with vast experience involved in actual planning of the infrastructure and resources. This comprehensive manuscript will help teams to prepare and train, stockpile necessary equipment and prepare their staff to deal with current crisis if there is a surge in infected cases.

Agony of the laborers and daily wagers during the COVID-19 induced lockdown in India.

The COVID-19 pandemic has not only brought the global health crisis but it also triggered the distressing effects on the social and economic life of the people. This pandemic has affected all segments of the population but the most vulnerable sections and occupations are suffering a lot. The communication traces the stipulation and misery of the labourers and daily wagers in India during lockdown, which was implemented as a necessary preventive measure to contain the COVID-19 outbreak.

Exploring the emergence of vertical transmission of SARS-CoV-2: A Rapid Review.

Novel Coronavirus, SARS-CoV-2 is responsible for the global pandemic of COVID-19. It has been shown to spread through respiratory droplets, direct contact and environmental fomites. The possibility of its spread by other modes viz. airborne, fecal-oral, vertical, etc. is being explored and can have implications in planning preventive strategies and disease management. A systematic analysis was carried out using the keywords; "COVID 19 vertical transmission", "SARS-CoV-2 pregnancy", and "SARS-CoV-2 vertical transmission", and the cases suggestive of possible vertical transmission of SARS-CoV-2 were studied in detail. The available evidences point at a possibility of vertical transmission of SARS-CoV-2.

COVID-19 Sets off Mass Migration in India.

The communication discusses COVID-19 triggered reverse migration in India. India has witnessed the second largest mass migration in its history after the Partition of India in 1947, where more than 14 million people were displaced and migrated to India and Pakistan respectively, depending on their religious faiths. The opinion describes the trend of migration and related effects on the migrants as well as the nation at large.

Perils of human remains examination in COVID-19 times.

The novel coronavirus, SARS-CoV-2 has surged globally bringing the whole world virtually to a standstill. Due to its highly contagious nature, various guidelines, protocols and preventive strategies have been devised for the safety of healthcare workers during management of the living as well as the dead. However, guidelines and precautions to be followed during the examination of the human skeletal remains are largely lacking. The present communication intends to address the issue of safe handling of human remains during medicolegal investigations in the COVID-19 pandemic times.

Use of Complementary and Alternative Medicine (CAM) and Home Remedies by COVID-19 Patients: A Telephonic Survey.

COVID-19 is caused by a novel coronavirus which was first reported in Wuhan city, China. The pandemic has led to considerable mortality globally. India, at present has the second largest burden of COVID-19 cases globally. Clinical trials with new interventions, including new vaccine candidates are being explored in the scientific world. Countries like China and India, with a rich history of traditional medicine, are exploring the effectiveness of traditional medicines to treat COVID-19. This study included 725 patients from an Isolation center, of which 230 (31.7%) were excluded due to reasons like incorrect phone numbers, no response on phone, or denying consent to participate. Finally, 495 participants had responded, of which 367 (74.1%) had not used any Complementary and Alternative Medicine (CAM) product or home remedies while 128 (25.8%) people used 161 CAM products and home remedies during the treatment and even afterward. More than half of the participants (59.6%) among them had consumed Ayurvedic Kadha. Many respondents consumed more than one CAM products or home remedies but there were no reported acute or severe adverse effects with these products. However, it is essential to ensure the safety of these interventions on long-term use because patients with other comorbidities can have a detrimental effect due to these products or due to drug herb interaction with their ongoing medications. Hence, long-term follow-up studies of recovered patients are crucial in determining the effects of medications or CAM products on organ functions due to disease or interventions.