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With COVID-19 paralyzing street food businesses, street food vendors are trying to sustain their operations. The current study helps them by identifying the importance of five prominent stimuli viz. authenticity, quality, staff-service, ambience, and value for money in developing desire for street food in individuals in India. Furthermore, the study contributes by identifying the role of street food nostalgia (as a mediator) and perceived risk of COVID-19, age, and gender (as moderators) on the direct impact of each stimulus on the desire for street food. The study uses partial least squares path modelling to validate the hypotheses using SmartPLS. The findings are comparable to other developing Asian countries, as the proposed associations are validated with perceptual responses from three prominent cities and well-known street food destinations in India. The study showed the relative importance of the five-stimuli based on the stimulus-organism-response framework in developing a desire for street food. The findings suggest partial to complete mediation of street food nostalgia across the three samples. Lastly, the perceived risk of COVID-19 along with age and gender emerged as prominent moderators for many of the direct effects of stimuli on desires for street food. © 2023 Informa UK Limited, trading as Taylor & Francis Group.
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The world has been pushed to the edge of a precipice commonly been addressed to as Coronavirus S (SARS-CoV2), one of the world's most widespread viral pandemic in recent times. Many studies are underway and investigating the new role of existing drugs, exploring the safety and efficacy of recently developed vaccines, after getting detailed insights into the behavioural characteristics of SARS-CoV2. Presently supportive and symptomatic treatment, along with practices like disease surveil-lance, contact tracing, and early diagnosis may help control the future of COVID-19 outbreaks. An ef-fort has been made to compile the information about coronavirus;its clinical manifestations, differential diagnosis, preventive aspects, and therapeutic options as a review.Copyright © 2021 Bentham Science Publishers.
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SESSION TITLE: Critical Care Management of COVID-19 SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: Acute respiratory distress syndrome (ARDS), due to Coronavirus disease 2019 (COVID-19) Is associated with a significant rate of mortality. The ideal sedative(s) of choice in mechanically ventilated COVID-19 patients is still unclear. Here we report the clinical outcomes of using propofol for more than 48 hours vs any other sedative in such patients. METHODS: This was a retrospective study of patients admitted to an intensive care unit (ICU) at Trumbull Regional Medical Centre and Sharon Regional Medical Centre between February 2020 and January 2022 with COVID-19 viral pneumonia. Our study consisted of 176 patients with moderate to severe ARDS as per Berlin’s criteria who were mechanically ventilated for atleast 48 hours. The primary outcome was mortality at 28 days from the date of intubation. Secondary outcomes included ventilator free days during the first 28 days after intubation (defined as being alive and free from mechanical ventilation), mortality at the end of hospitalization, length of stay, and readmission rate. RESULTS: Out of 176 patients, 100 patients received sedation with propofol for more than 48 hours (test group) and 76 patients received other sedative agents or received propofol for less than 48 hours (control group). We compared the outcomes of the two different groups using paired t-test. The average age of the study population (63 vs 67 p=0.061), gender((0.44 vs 0.49 females p=0.54), BMI (34.93 vs 34.08 p=0.54), and oxygen requirement on admission (0.73 vs 0.64 p= 0.227) were not statistically different between the test and control groups respectively. Prevalence of comorbidities including diabetes, hypertension, chronic kidney disease, active cancer, and COPD were not significantly different between the two groups. There was a significant difference in the primary outcome of mortality at day 28 from intubation between the test and control group (0.62 vs 0.84 p=0.001). A significant difference in the secondary outcome of mortality at the end of hospitalization between the test group and control group (0.67 vs 0.84 p =0.009) was also observed. There were no statistically significant differences in the rest of secondary outcomes. CONCLUSIONS: In this retrospective study, using propofol for more than 48 hours was associated with decreased mortality at day 28 (22%) as well as at end of hospitalization (17%) in mechanically ventilated COVID-19 patients. Propofol is known to have antiviral effects as well as immunosuppressive effects on biosynthesis of inflammatory cytokines by macrophages which is likely responsible for the mortality benefits that we encountered in this study. CLINICAL IMPLICATIONS: Even though we found mortality benefits with using propofol in our study population, further investigations using prospective studies with a larger study population are required and clinicians need to be cautious with the complications associated with long term use of propofol. DISCLOSURES: No relevant relationships by Arooj Ahmed no disclosure submitted for Manuel Bautista;No relevant relationships by Apeksha Gupta No relevant relationships by Anirudh Jaglan no disclosure on file for Saman Karki;no disclosure submitted for Ritha Kartan;No relevant relationships by Tamandeep Kaur No relevant relationships by Sanjay Mahat No relevant relationships by Krutarth Pandya No relevant relationships by Stuti Patel No relevant relationships by Janki Patel no disclosure on file for Kim Porter;No relevant relationships by Aayush Pradhan No relevant relationships by Arun Pyakuryal No relevant relationships by Pratik Saha No relevant relationships by Parth Shah
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Synthetic dyes have high fastness property and are stable under diverse conditions but over time it is seen that they are toxic to the environment and some are carcinogenic. Dyes derived from natural sources like tartrazine, cochineal red and sunset yellow may cause allergies when used alone or in a combination. Some of the colourants that had been approved by the Food and Drug Administration for use in various industries like food, pharmaceuticals, cosmetics are found to promote cancer. The purpose of the present study is to extract natural dyes from peel of fruits and vegetables, flowers and study the effect of different mordanting techniques (pre-mordanting, simultaneous mordanting, post-mordanting) on dyeing, The extracts were applied as direct dyes in the presence of mordants. Dyeing of cotton cloth was performed using extracts of Pomegranate peel (Punica granatum), Orange peel (Citrus sinensis), Marigold flowers (Tagetes erecta), Kidney bean seed coat (Phaseolus vulgaris). Colour strength, shade and fastness properties of the dyes have been tested. In pre and post mordanting, colour change was observed in Marigold and Pomegranate. In simultaneous mordanting, colour change was seen in Marigold, Pomegranate, Orange peel and Kidney bean. The obtained results have shown the dyeing potential of organic wastes as a source for cotton dyeing. Using waste as a source of natural dyes will help in reducing the environmental pollution. Our studies on market research for demand led us to the conclusion that there is demand for comfortable environmental friendly mask having increased functional properties.
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Healthcare has become a prime global concern with a prompt need for delivering, managing and facilitating fast, reliable and efficient healthcare systems. Recently, the healthcare sector has witnessed a drastic converge towards digitized healthcare owing to the development, involvement, integration and dependency on the Information and Communication Technology (ICT) sector. Consequently, the medical sector is gearing up to become more upgraded, energetic, professional and agile for delivering, supporting and purveying ICT-enabled healthcare services. However, with the changing healthcare scenario particularly after COVID pandemic, there has been a prompt dependency on technology-enhanced healthcare irrespective of the geographical boundaries and time. This paper highlights the current trends in the healthcare sector with an in-depth analysis of global as well as Indian healthcare sector. It focuses on the importance of digital healthcare and its underlying technologies and platforms, entities involved;and applications. It also discusses the key challenges in offering digital healthcare as well as future perspectives. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Background: The suitability of teleconsultation is crucial for the effective delivery of health care services. Therefore, we evaluated the factors determining the suitability of teleconsultations for hepato-biliary diseases during the COVID-19 pandemic. Methods: In a prospective study conducted between March 2020 and January 2021, we asked the hepatologists delivering the tele-consultations in a tertiarycare center to fill a pre-validated questionnaire to assess the suitability of the given consult in real-time. The patient's sociodemographic and clinical details were noted. Patients were interviewed telephonically seven days after the consultation, and the level of understanding and hospitalization rate was assessed. A consult was deemed suitable when the physician reported its suitability in the absence of hospitalization. Factors determining the suitability of tele-consultations were evaluated on univariable analysis and machine learning models such as decision tree and extreme gradient boosting (XGB). Results: Of 1419 registrations, 1118 (87.2%) patients with male-gender (71%), age of 46 years (IQR: 18-68), and a rural background (72.7%) were analyzed. On univariable analysis, patients with skilled occupation, higher education, paying status, hepatitis B, C, and non-alcoholic fatty liver disease (NAFLD) were likely to be suitable (p<0.05). Patients with cirrhosis (compensated or decompensated), acute-on-chronic liver failure (ACLF), and biliary obstruction were likely unsuitable (p<0.05). A decision tree was developed from the significant variables on univariable analysis and important variables derived from the XGB-model. Patients with compensated cirrhosis who were educated or involved in a skilled occupation with an age of <55 years had a probability of 78% towards suitability. Hepatocellular carcinoma, decompensated cirrhosis, and ACLF patients were unsuitable with a probability of 60-95%. In non-cirrhotic liver diseases, hepatitis B, C, NAFLD were suitable with the probability of 89.7%. Extrahepatic biliary obstruction and previous failure of teleconsultation were unsuitable with a probability of 70%. Other tropical illnesses, extrahepatic portal venous obstruction, noncirrhotic portal fibrosis, dyspepsia, dysphagia not requiring any intervention were suitable with a probability of 88%. Conclusion: A simple decision tree can reliably guide physicians for conducting tele-consults for hepatobiliary diseases during the COVID-19 pandemic and beyond.
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Purpose: Property management in commercial real estate (CRE) is an important operational function that needs to be managed because it brings large cost implications to the organization. As India aspires to become a developed real estate market, analysis of the growing importance of automating property services and technology acceptance by stakeholders are two key concerns that need to be explicitly addressed. This study aims to examine the extent of property technology (PropTech) adoption in India and propose a technology-enabled stakeholder management model in Indian CRE. Design/methodology/approach: The research is qualitative in nature and follows the grounded theory approach. Research data were collected by conducting a series of semi-structured interviews with 18 property management professionals from different prominent Indian companies using PropTech. Findings: The findings suggested the nine most typical automated property management functions in Indian CRE. The result of this research is the automated property services model for stakeholder management in CRE. The model demonstrates the value of implementing technology in property services in India. Practical implications: The study provides useful insights into how artificial intelligence (AI) in property management can be applied to address property-related challenges, various stakeholder needs and improve property performance in accordance with energy efficiency policies. Originality/value: This paper attempts to add to the limited body of literature on technology in the property management domain. The model demonstrates how automated property services meet the needs of different stakeholders in CRE and provides remote working procedures within the COVID-19 pandemic context. © 2021, Emerald Publishing Limited.
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TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: The novel coronavirus disease (COVID-19) has been associated with diffuse lung injury. Corticosteroids have been shown to suppress inflammation-mediated lung injury and as a result, decrease progression to respiratory failure. Based on the RECOVERY trial, the use of dexamethasone in patients hospitalized with COVID-19 resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or supplemental oxygen at randomization [1]. Per IDSA treatment guidelines dexamethasone use in hospitalized patients is strongly recommended, thereby prompting most intuitions in the United States and worldwide to initiate its use. We present a unique case of Nocardia farcinica brain abscess in the setting of prolonged dexamethasone use in a patient with COVID-19 infection. CASE PRESENTATION: 80-year-old female from Pakistan with a past medical history of hypertension, who while in Pakistan was diagnosed with COVID-19 and treated with Xarelto and dexamethasone (dose and duration unknown). Her course was complicated by the development of left elbow and hand Zoster and over the 10 days prior to presentation, she was noted to develop increasing left-sided weakness and aphasia. Patient was transferred to the United States where a CT scan revealed a left frontal mass, prompting transfer to a tertiary care facility. MRI brain revealed a left frontal cystic rim-enhancing lesion that was concerning for a brain abscess. The patient subsequently underwent left frontal stereotactic brain biopsy with recovery of 3 mL of purulent fluid. Gram staining revealed beaded branching gram-positive rods. She was initially placed on vancomycin/cefepime/metronidazole/dexamethasone and was changed to IV Bactrim/ceftriaxone/doxycycline to cover for Nocardia and Actinomyces. Modified acid-fast stain returned positive with beaded, branching, filamentous rods, consistent with Nocardia. Cultures returned with Nocardia farcinica. DISCUSSION: Nocardia infection primarily occurs via inhalation or direct skin inoculation and subsequently disseminates hematogenously to end organs, which include the brain [2]. Nocardia typically presents as a respiratory or skin infection;brain abscesses are rare and primarily found in immunocompromised patients. As outlined in this case, an immunocompromised state was induced by high dose steroid use. Corticosteroids modulate inflammatory mediators and thereby cause immunosuppression. New symptoms should be monitored closely in patients undergoing steroid therapy, as seen in our patient who presented with new onset aphasia and left sided weakness. This is especially true during the COVID-19 pandemic that has prompted widespread use of dexamethasone in order to prevent respiratory failure and death. CONCLUSIONS: Physicians should be vigilant of superimposed infections in patients with COVID-19 receiving high dose steroids. REFERENCE #1: RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384(8):693-704. doi:10.1056/NEJMoa2021436. REFERENCE #2: Lin YJ, Yang KY, Ho JT, Lee TC, Wang HC, Su FW. Nocardial brain abscess. J Clin Neurosci. 2010;17(2):250-253. doi:10.1016/j.jocn.2009.01.032 DISCLOSURES: No relevant relationships by Waqas Bhatti, source=Web Response No relevant relationships by Tanisha Kaur, source=Web Response
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Timely and precise identification of COVID19 is an arduous task due to the shortage and the inefficiency of the medical test kits. As a result of which medical professionals have turned their attention towards radiological images like Computed Tomography (CT) scans. There have been continued attempts on creating deep learning models to detect COVID-19 using CT scans. This has certainly reduced the manual intervention in disease detection but the reported detection accuracy is limited. Motivated by this, in the present work, an automatic system for COVID-19 diagnosis is proposed using a concatenation of the Mobilenetv2 and ResNet50 features. Typically, the features from the last convolution layer of the transfer learned Mobilenetv2, and the last average pooling layer of the learned ResNet50 are fused to improve the classification accuracy. The fused feature vector along with the corresponding labels is used to train an SVM classifier to give the output. The proposed technique is validated on the benchmark COVID CT dataset comprising of a total of 2482 images with 1252 positive and 1230 negative cases. The experimental results reveal that the proposed feature fusion strategy achieves a validation accuracy of 98.35%, F1-score of 98.39%, the precision of 99.19%, and a recall of 97.60% for detecting COVID-19 cases with 80% training and 20% validation scheme. The obtained results are better than the comparison models and the existing state of artworks reported in the literature. © 2021, Springer Nature Singapore Pte Ltd.
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Background: Medication related adverse effects often contribute to morbidity in older adults with complex care needs, which may contribute to increase healthcare utilization. We present a unique case with medication induced catatonia, resulting from an adverse drug reaction. Case Presentation: A 58 year old male with history of depression since 2015 on sertraline, s/p renal transplant in 2004, on tacrolimus (7mg/6mg) and mycophenolate, presented with gradual decline in mental status over 3 months. With no prior history of catatonia, family reported minimal responsiveness, limited expressivity and not acting himself. On physical exam, patient was mute. withdrawn, but alert to self, not following commands. He was noted to be stiff along with bilateral upper extremity rigidity. Given the suspicion for serotonin syndrome, sertraline was held. Tacrolimus level was 7.8. Neurology, rheumatology and psychiatry services were consulted to evaluate the decline in mental status. Multiple findings were suggestive of catatonia. Extensive evaluation included CT/MRI Brain, EEG, CSF analysis, paraneoplastic panel, HIV, syphilis, COVID-19, urine toxicology, heavy metal screen, thyroid panel, autoimmune panel, complement studies, SPEP and infectious workup. All were inconclusive. Given no obvious infectious, neurologic, rheumatologic, metabolic or malignant etiology, psychiatry favored the diagnosis of medication induced catatonia due to tacrolimus. Naranjo Scale score was 1-2. Tacrolimus was switched to cyclosporine a month after his presentation. He was treated with lorazepam and had clinical improvement with mutism, increased interactivity and spontaneous behavior though rigidity and hyperreflexia persisted. Despite up titrating lorazepam, clinical improvement was unimpressive. He subsequently required electro-convulsive therapy with significant improvement in resolution of hypertonicity, frontal release signs and primitive reflexes. He was discharged to subacute rehabilitation. Conclusion: Rational prescribing is common in older adults with complex care needs and may result in a drug-induced disease. Often times adverse drug reactions may be unpredictable. Clinicians should maintain a heightened level of vigilance, knowledge and awareness for ongoing adverse drug event monitoring for less common idiosyncratic reactions, which may lead to potential morbidity and mortality and increased health care utilization.
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Background: Telemedicine has emerged as an essential tool for health-care delivery amidst the COVID-19 pandemic We evaluated the feasibility and impact of tele-hepatology services in a resource-constrained set-up Methods: Consecutive patients with liver diseases availing tele-hepatology services via smartphone 4G network at a tertiary-care centre were recruited The evaluation was done using an adapted MAST-model (content-validity: 99 3%, reliability: 0 778) in a telephonic-survey design between March and July 2020 The feasibility, impact, and safety of tele-hepatology services were evaluated from a random sample of patients, 7-21 days after the consultation Results: Of 1419 registrations, 1281 consultations (90 3%) were completed with 42 manhours (interquartile range;IQR: 40-44) per tele-OPD Twohundred- ten out of 245 random patients (85 7%) responded during survey [age-in years: 46 (IQR: 35-56) and females: 32 3%] Audio (54 3%) or video-calls (45 7%) were common modes of consultation One-hundred-eighty-six patients (88 6%) were suitable for tele-consultations Diagnosis was achieved in 197 patients (94%) (Table 1) and 173 patients (82 4%) complied with the treatment Patient's satisfactionrate, improvement-rate, and success-rate were 85 2%, 49.5% and 46.2%;respectively. Convenience and confidence in tele-consultation during the prevailing situation were expressed in 208 patients (99 0%) and 176 patients (83 8%);respectively Physical-quality of life (QOL) and mental-QOL was improved in 141 patients (67 1%) and 174 patients (82 8%);respectively Median cost (Indian rupees) and manhour saved per tele-consult were 699 (IQR: 399-2999) and 10.6 (IQR: 6.4-15.1). Dissatisfied patients were likely to have low diagnosis-rate, unsuitability for tele-consultation, noncompliance to treatment, unsuccessful consultation, poor understanding, and uncomfortable conversation during teleconsultation Twenty-two patients were hospitalised and 3 patients died during follow up and none were related to teleconsultation Patient-reported barriers for tele-consultation were connectivity-issues (22 8%), language-barrier (1 4%), unavailability of smart-phone (1 4%) and reimbursement issues (0 4%) Conclusion: Telemedicine is a feasible, acceptable, and reasonably effective tool for rendering healthcare services utilising limited resources during turbulent times of COVID-19 pandemic Systematic implementation and formal cost-effectiveness of telemedicine should further be explored in hepatology services(Table Presented).
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Background: Directly acting antiviral (DAA) agents are currently the cornerstone of hepatitis C virus (HCV) management Preliminary studies have pointed towards a potential role of certain DAAs in the management of COVID-19 Both daclatasvir and sofosbuvir have been reported to have antiviral activity against the novel coronavirus (nCoV-19) In this background, we conducted a preliminary survey among patients with HCV on DAA therapy to ascertain the incidence of COVID-19 in these patients Methods: A total of 600 HCV infected patients belonging to the Punjab region in India, enrolled in our institutional registry were contacted in the last week of March, 2020 Data was telephonically collected by audio-visual contact with the patients as a part of tele-hepatology services Those patients who were receiving or were due to receive DAA therapy were enquired about COVID-19 related symptoms These patients were again followed up telephonically after 12-weeks for re-assessment of symptoms Results: Thirty-six patients [83 3% males;median age 43 (27-63) years] were on DAA regimens Five (13 9%) patients were on sofosbuvir-daclatasvir, while rest of the patients (86 1%) were on the sofosbuvir-velpatasvir regimen None of the patients reported any COVID-19 related symptoms during this period Two (5 5%) patients died due to liver-related complications During the same time-period, the state of Punjab reported 294 69 cases per million population with a positivity rate of 1 92% Conclusion: A preliminary survey of patients with HCV undergoing DAA therapy showed no incidence of COVID-19 symptoms in these patients A preventive or curative role of DAA as postulated needs to be ascertained Further, longitudinal randomized control trials are required to establish the role of anti-HCV DAAs in the management of COVID-19.
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Background: Psychological immunity comprises an individual’s ability to safeguard and promote mental health. Oláh’s psychological immune system is a multi-dimensional model which incorporates factors affecting mental health like optimism, self-esteem, and control over emotional faculties;it consists of personal protective and promotive resources that offer immunity to environmental stress. This model can be useful for exploring relevant psychological phenomena like resilience and the cognitive and behavioural concepts associated with it. Objective: To describe psychological immunity and the key concepts driving it. Method: Narrative review of literature relevant to psychological immunity. Conclusion: It has been pointed out that the factors influencing resilience have useful equivalents within the psychological immune system model, implying that resilience is a key factor promoting psychological immunity. The psychological immune system model will be important for investigating interactions with the biological immune system, especially concerning interven-tions that can enhance health, like resilience training. Furthermore, the model can act as a unifying framework for psychological phenomena like well-being and coping. © IJCRR.