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Background: COVID-19 pneumonia is newly recognized illness has spread rapidly around the world. It causes much morbidity and mortality. Diabetes in COVID-19 patients is individual risk factor and documented in worldwide studies to contribute to severity of the disease, increased length of stay and higher mortality. Aggressive management of blood sugars and acute diabetic complications reduce the length of stay and mortality. Method(s): The improvement project carried over for four months in King Fahd Armed Forces hospital. Randomly selected 200 patients admitted to the hospital with diabetes and COVID-19 studied. The unified treatment protocol applied for all patients and blood sugars monitored closely and optimized. Data collected on bimonthly basis and analyzed. The patient characteristics taken from data extraction tool (Oasis) of hospital. Median values for length of stay and post discharge FBS and RBS were calculated Microsoft Excel tool. Mortality rates calculated by percentages. Result(s): 200 patients studied in the 4 months study period. The median length of stay was 3 days. The mortality rate was 2.5%. The median FBS and RBS in the patient group monitored in the post discharge clinic was 130 mg/dl and 170 mg/dl respectively. The results compared with the standard international studies and improvements in primary and secondary outcomes documented. Discussion(s): The length of stay in the study population in the project was 3 days as compared to 13 days in a major international study helping rapid turnover of beds and financial savings. The mortality was 2.5% compared to 7.3% in a major published study, reflecting the implications of aggressive management of diabetes by teamwork. The median values of FBS 130 mg/dl and RBS of 170mg/dl achieved by regular follow-up and support to the patient by running postdischarged clinic definitely help reducing readmissions and acute complications of uncontrolled diabetes. Conclusion(s): COVID-19 patients with diabetes are more prone to have more severe disease, and tend to stay longer in hospital and have higher mortality compared to non-diabetics. An aggressive preemptive strategy with unified treatment protocols and readily available service of endocrinologist and effective control of diabetes and acute complications of diabetes significantly reduces the length of and mortality in COVID-19 patients with diabetes.
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The unrelenting protraction of Coronavirus Disease 2019 (COVID-19), inflicted by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is tending to craft havoc all over the world for the past few months. Considering the looming repercussions due to this deadly virus worldwide, there is an impending necessity to comprehend this newfangled contagion. To develop an effective eradication measure and preventive strategy, knowledge about the virus structure, life cycle, and metabolism is imperative. Better insight into the virus life cycle helps us to identify and design drugs that can hit crucial targets of this dreadful virus. The close genetic similarity between SARS-CoV-2 and SARS-CoV, which triggered an outbreak in the year 2003, could be of great strategic importance in designing effective drug formulations. This will also help in the development of leveraging immunological measures to develop an effective vaccine against SARS-CoV-2. This eventually will help us to progress our strategies related to the virus. Not on the positive side, there is some misinformation going all around the world despite the strict regulations from the WHO and other government agencies to inform the citizens to abstain from the rumour-mongering regarding COVID-19. Further, evidence needs to be gathered on vaccine strategies to cure the patients suffering from COVID-19. This information will also help us in designing both drug inhibi-tors as well as prophylactic measures against SARS-CoV-2.Copyright © 2021 Bentham Science Publishers.
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Background. A 2016 needs assessment survey of infectious diseases (ID) training program directors revealed gaps in ID fellows' education including the application of antimicrobial stewardship into clinical practice. Direct involvement of ID trainees in inpatient antimicrobial stewardship (AS) activities has previously been described with favorable outcomes and achievement of program goals. Engagement of ID fellows in outpatient (OP) AS activities including targeted provider feedback has not been well described and may provide opportunity for more hands-on OP AS experience for trainees. Methods. Our OP AS program developed a 4-week virtual rotation experience for ID fellows to meet organizational needs for AS education during the COVID-19 pandemic. Acute respiratory tract infection (ARI) was chosen as a disease state priority. The expected progression of the ID fellow was as follows: Week 1: Review Core Elements of outpatient AS, regulatory requirements, and disease state priorities;review available stewardship tracking data sources;Week 2: Review facility-level antibiotic use data for a single outpatient clinic, and identify top 3 antibiotic prescribers in the clinic;Week 3: Deliver a virtual outpatient AS presentation to all providers at a single clinic, and create antibiotic report cards (See Figure 1) for top antibiotic prescribers;Week 4: Conduct 15-min targeted provider feedback sessions using antibiotic report cards for top 3 providers. Example Antibiotic Report Card Results. Between September 2021-April 2022, three ID fellows completed the OP AS rotation experience. All fellows completed each week of the rotation successfully. Solicitation of feedback from providers receiving targeted feedback sessions (See Figure 2) is ongoing, and a standardized feedback form will be sent to all ID fellows completing the rotation at the end of the academic year to evaluate the program's success in meeting pre-specified learning objectives. The rate of antibiotic prescribing for uncomplicated acute respiratory tract infection will be re-evaluated post-intervention for providers receiving targeted education. Targeted Provider Feedback Survey Conclusion. Direct involvement of ID fellows in OP AS activities may be mutually beneficial for trainees and OP AS programs. A virtual format for AS education and intervention was practical and feasible.
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Background. At the Michael E. DeBakey Veterans Affairs Medical Center, an interdisciplinary outpatient parenteral antimicrobial therapy (OPAT) clinic was developed in August 2020 during the COVID-19 pandemic (Figure 1). Standardized weekly safety monitoring and clinical follow-up was implemented via tele-OPAT visits by an infectious diseases (ID) pharmacist or ID PA with ID physician oversight. This study aimed to describe the practices implemented through initiation of our OPAT clinic, and its impact on clinical outcomes. Figure 1: Description of intervention and clinic model Methods. This retrospective cohort study compared clinical outcomes of veterans receiving home OPAT one year pre- and post-implementation of a dedicated OPAT clinic. OPAT episodes initiated during the intervention period, prescribed for less than 7 days, not completed at time of analysis, administered with hospice services, or at a hemodialysis center, infusion suite, skilled nursing facility or long-term care facility were excluded. The primary endpoint was treatment failure during or within 30 days of OPAT completion defined as requiring repeat OPAT course for the same infection, unplanned admission, unplanned surgical intervention or procedure for additional source control, or death from any cause. Results. A total of 191 OPAT episodes were included in the analysis (preintervention group, n= 76 vs. post-intervention, n=115). The most common indications for OPAT included bone/joint infections (34%), bacteremia (24%), and endocarditis (13%). Treatment failure was lower in the post-intervention vs. preintervention group (29% vs 46%, p = 0.01) with a median time to treatment failure of 24 days. Treatment failures in both groups were primarily driven by unplanned hospital admissions (Table 3). The median time to ID follow-up from OPAT initiation was shorter in the post-intervention vs. pre-intervention arms (6 days vs. 9 days, p< 0.001). The adverse event rate was higher (13% vs. 4%, p= 0.06), and modifications were made more frequently in the post-intervention (49% vs. 29%, p=0.007). Table 1: Demographics and baseline characteristics Table 2: OPAT indications, antimicrobials, and microbiology Table 3: OPAT follow-up, complications, and treatment failure Conclusion. Implementation of an interdisciplinary OPAT clinic led to shorter time to ID follow-up, more frequent OPAT modifications, and reduced treatment failure. The median time to treatment failure suggests the need for ongoing surveillance beyond the initial 2 weeks of OPAT.
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Introduction: & Background: Diabetes in COVID-19 patients is individual risk factor and documented in worldwide studies to contribute to disease severity, increased length of stay and higher mortality (fig-1). Aggressive management of blood sugars and acute diabetic complications reduce the length of stay and mortality. Methods: Randomly selected 200 patients admitted with diabetes and COVID-19 studied. The unified treatment protocol (fig-2) applied for all patients and blood sugars monitored closely and optimized. Data collected on bimonthly basis and analyzed. Patients’ characteristics taken from data extraction tool (Oasis) of hospital. Median values for length of stay and post discharge FBS and RBS were calculated Microsoft Excel tool. Mortality rates calculated by percentages. Results: 200 patients studied in the 4 months study period. The median length of stay was 3 days. The mortality rate was 2.5% (fig-3,4). The median FBS and RBS in the patient group monitored in the post discharge clinic was 130 mg/dl and 170 mg/dl respectively. The results compared with the standard international studies. Discussion: Diabetes in COVID-19 patients posed great challenge as increased severity and mortalities reported compared to non-diabetic. Taking a pre-emptive strategy to combat this problem by aggressively manage diabetes help in reducing length of stay and morbidity. The length of stay in studded population was 3 days as compared to 13 days in a major international study(Ref: 1) . Financial saving come from rapid turnover of beds. The mortality was 2.5% compared to reported 7.3% in a major study (Ref: 2), reflecting the implications of aggressive management of diabetes. Regular follow-up and support by running post-discharge clinic definitely help reducing readmissions and acute complications of uncontrolled diabetes. Conclusion: Aggressive management of diabetes in COVID-19 patients by tailored treatment protocols and dedicated teams will help to decrease the morbidity and mortality.Presentation: No date and time listed
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The novel coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The immune response to SARS-CoV-2 can play an important role in disease pathogenesis and clinical manifestations. Considering the antiviral, immuno-modulatory, anxiolytic, antiinflammatory and antioxidant properties, this open labelled, controlled, interventional, prophylactic study was conducted on individuals at risk in containment zones of different cities of India, viz., Lucknow, Aligarh, New Delhi, Srinagar, Mumbai and Bengaluru. The study focuses on number of patients turning COVID-19 positive, change in ISQ and WHOQOL-BREF scales in both the groups. Apparently, healthy individuals at risk in containment zones were divided into intervention and control groups. The intervention group was further divided into two subgroups. The first subgroup received Unani regimen- I including Unani Joshanda with Khamira Marwareed (KM), the second subgroup received Unani regimen- II including Unani Joshanda with Tiryaq Arba (TA). The control group did not receive any intervention. The duration of intervention was 20 days;follow ups were planned on day 10, day 20 and day 35. A total number of 33021 participants were enrolled in the study, of which 30,931 participants completed the study. It was observed that individuals receiving Unani regimen-I demonstrated lower risk of developing COVID-19 by 74% and those receiving Unani regimen-II by 62% in comparison to the control group. Interventional groups showed highly significant (p<0.001) effect on the quality of life.
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Background: Coronavirus disease 2019 (COVID-19) associated inflammatory cytokine storm that worsens COVID-19, relies heavily on the inflammatory response. IL-6, a TH1 cytokine, PCT and CRP have been linked to serious illness and a higher mortality rate. We further tried to evaluate the role of these indicators and their association with clinical severity in COVID-19 patients. Material and Methods: Eighty-three consecutive patients with age 18 years with RT-PCR test positive for SARS-CoV-2 were included in the study. Demographic characteristics (age and sex), underlying co-morbidities, symptoms, physical findings, and laboratory tests of the patients were recorded. All patients were categorized as having mild, moderate, and severe COVID-19 disease, according to the Indian Council of Medical Research (ICMR). The levels of IL-6 and PCT were estimated by electrochemiluminescence immunoassay (ECLIA) using Cobas-e411 Immunoassay System, and Quantitative CRP was done by Unicorn-230 automated biochemistry analyzer to find out their correlation with disease severity and outcome. Multiple Regression was performed to find out factors associated with the adverse outcome of the disease. Result: Mean age of patients was 51 years. IL-6, CRP, and PCT levels increased in 73%, 68.0%, and 8.2% patients on admission, respectively. The most common co-morbidity associated with the disease was hypertension (25%), followed by diabetes (24%) and respiratory disease (15%). Increased IL-6, CRP, and PCT levels were found in 77 percent, 79 percent, and 20 percent of patients, respectively. We found that IL-6 (P0.05), CRP (P0.05), and PCT (P0.05) were significantly raised in COVID-19 patients with increasing severity of the disease. The Area under the receiver operating characteristic (AUROC) of these parameters ranged between 0.65 and 0.8 (IL-6, 0.828;CRP, 0.809;and PCT, 0.658), indicating a reliable biomarker to assess clinical severity.
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Corona Virus or COVID-19 Disease is an infectious disease caused by newly discovered coronavirus. It caused a lot of damage to the Mankind around the world. It is also parallelly called as SARS-CoV-2 and was first reported in Wuhan City, China by the officials in December 2019. On 30 January 2020, the Director-General Tedros Adhanom of World Health Organization declared the outbreak of the coronavirus. Currently, many Pharma Companies aiming to develop vaccine to the COVID-19. To avoid being exposed to coronavirus, we must cover our nose and mouth with a mask, wash our hands frequently and avoid direct contact with the people who are already affected. This Paper aims to detect whether a person who is facing the camera is wearing a face mask or not in real time. Deep Learning is the best Technology present in the current Industry for its effectiveness in reorganization and classification using image processing. It proposes a retina face mask which a one stage detector and with further developments and modifications, this model can be used in Airports, Railway Stations and other highly crowed public areas.
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Purpose: COVID-19, a pandemic declared on March 11th, 2020, makes it crucial for the whole world to control and ensure safety measures to control such infections in the future. Fear, worry, and panic remain widespread, especially among healthcare workers. We aimed to compare the knowledge, attitude, anxiety, and behaviours of medical and non-medical students towards vaccination against COVID-19. Material and Methods: We conducted a cross-sectional study for one month on the MBBS/BDS and undergraduate nonmedical students through an online questionnaire which consisted of a multiple choice KAP questionnaire consisting of four sections (i.e., socio-demographic details, knowledge, attitudes, and behavior). Multiple linear regression was performed to determine the variables predicting knowledge and attitudes towards COVID-19 vaccination. Results: Vaccine hesitancy was detected in 17% of Undergraduate Medical Students, while the same was noted in 45% of non-medical students. 48.7% of medical students knew about different vaccines available in India for COVID-19 viz a viz the same in non-medical students was 49.5%. The majority of the students (35.8% medical and 48.6% non-medical) considered Covishield the best currently available vaccine in India. The majority of the students (Medical 86.5% and non-medical 75.2%) thought that the COVID-19 vaccine could reduce the spread of the disease in the community. In the multiple regression model, better socioeconomic status, holding nuclear families, and having a history of essential vaccinations uptake were linked with knowledge, while attitudes were substantially associated with being female and having previous history of vital vaccines uptake.Conclusion: The results showed that medical students had sufficient knowledge, an optimistic attitude, and moderate levels of concern towards COVID-19. Vaccine hesitancy was much less among medical when compared to non¬medical students. Expanding knowledge and regulatory oversight of vaccine research and the public release of safety data may lessen vaccine reluctance among students. © 2021, Arabian Gulf University. All rights reserved.
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Background:This ongoing coronavirus disease 2019 (Covid-19) pandemic is a great challenge for our health-care systems and their infrastructure. Diagnostic confirmation of infected individuals based on RT-PCR is important for the contain- ment of viral spread because despite high viral loads, infection can be asymptomatic. To come up with the limited sup- plies in low socio economic countries like ours, pooling of specimens was proposed as a method to screen large number of patients. To analyse the effect of pooling of samples on the sensitivity of RT-PCR, we compared Cycle threshold (Ct) values of pools with those of the deconvulated (individual) samples. Methods:From March 2020 to October 2020, we performed Covid-19 testing by RT-PCR from areas with varying preva- lence of population referred to VRDL, JNMCH, Aligarh. To circumvent the limited availability of RNA extraction and PCR reagents, pool testing was started. 5 samples were pooled together and these pools were tested by RT-PCR. Negative pools were reported as negative whereas positive pools were deconvoluted and each sample was tested individually. In this study, 408 pools i.e 2040 samples were analysed. Results:In our study, a ΔCt value of 0.96 (i.e. an increase in Ct value in the pooled sample as compared to individual sample) was found that shows a slight loss of PCR sensitivity in pooled samples which is relatively small compared to the inherent clinical sensitivity of the standard assay. But the gains in cost effectivity and savings of resources are considera- bly high. Conclusions: As pooling of samples is a cost effective way for Covid-19 testing, the slight loss in the sensitivity of PCR can be overcomed by considering the Ct cut-off value for positive pools slightly above the kit cut off value to circumvent the dilution effect.
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Patients with significant cerebrovascular comorbidities (e.g. brain ischemia, vascular dementia) are more affected and are more likely to have worsened post-acute neurologic sequelae after SARSCoV-2 infection. This may be due to viral invasion and propagation in brain endothelial cells (BECs) and disruption of the blood-brain barrier (BBB). Viral spike protein used to bind and infect host cells encodes an arginine-glycine-aspartic acid (RGD) motif that it may use to bind integrins cell receptors that play an important role in cerebrovascular integrity. Therefore, integrins may represent an acute and post-acute SARS-CoV-2 therapeutic target. However, the interplay between vascular dysregulation, integrin function, and COVID-19 is unclear. As we have previously demonstrated that activation of the integrin α5 plays a key role in BBB breakdown, stroke injury, OGD/R, SARS-CoV-2 infection, and its inhibition with the clinically validated peptide ATN-161 is therapeutic in these conditions, we hypothesize that SARS-CoV-2 alters BEC α5 integrin (and associated tight junction protein) expression as a means of infecting and altering cerebrovascular integrity, and this can be prevented by ATN-161. Methods: Mouse BECs (bEnd3) were inoculated with heat-inactivated SARS-CoV-2 (Isolate USAWA1/2020) or delta variant of SARS-CoV-2 spike protein for 24 h then later exposed to hypoxia for 6h to model the effects of in vivo pulmonary infection. Cells were pretreated with ATN-161 (1, 5, and 10μM) 1h before SARS-CoV-2 challenge and during hypoxia. α5 and claudin-5 proteins were analyzed by immunoblotting. Results: Both SARS-CoV-2 inoculations induced integrin α5 and decreased claudin-5 expression (delta > SARS-CoV-2) in a dose-dependent fashion, although higher doses of SARS-CoV-2 (2.5 and 5 μg) had no effect on these proteins. SARS-CoV-2 spike protein challenge at 0.5 μg followed by hypoxia resulted in increased α5 and decreased claudin-5 expression in either hypoxia or SARSCoV-2+hypoxia combination. ATN-161 (10μM) pretreatment inhibited SARS-CoV-2+hypoxia-induced α5 upregulation and restored claudin-5 loss. In addition to its demonstrated anti-viral effects, ATN161 may be an important therapy for SARS-CoV-2-mediated cerebrovascular injury.
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COVID-19, a viral infection spread across the world affecting many people around the world. In ABO blood type, certain types are more prone to infections and causes severe symptoms. Relationship between ABO blood type and COVID-19 still needs to be found out. A prospective cohort study was conducted to evaluate a relationship between ABO blood type and COVID-19. Data was collected from 148 patients who presented for COVID testing through PCR or nasal swab tests. COVID positive patient’s blood test was performed to find out ABO blood group/type and their symptoms with which they presented. The blood group distributions, age and gender of these patients were recorded. It was seen that there is a statistically significant association between COVID and blood group A+, A-, B+ with p-value of 0.01, 0.03 and 0.01 respectively and no statistical significance was found between B-, O+, O-, AB+ and AB-with P-value of 0.06, 0.1, 0.9, 0.7 and 0.8 respectively. Multi variate analysis performed showed age, blood group and ICU stay to be significantly associated with COVID with p-value of <0.01, 0.05, <0.01 and gender to be non-significantly associated with COVID with p-value of 0.7. Blood group A+, A-and B+ are more prone to contract COVID virus with more severe symptoms. Fever and cough have been to be positively associated with COVID cases and found to be affecting patient’s health. Age is also found be affecting patient’s life, with a higher chance of contracting COVID-19 as the increases.
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The cloud computing is amongst the most trending fields with several lines of research possibilities, driven by cost-benefits offered by cloud adoption to businesses around the globe. Cloud adoption is more pressing than ever before, especially in the current context of global health emergency caused by pandemic outbreaks of Covid-19, where in 'WFH - Work from Home' is the new normal and businesses require 'Any-Time, Any-Where' access to IT. However, one of the major barriers to cloud adoption viz 'Security of Data' continues to be a cause of concern. In this study, authors have attempted to address this concern by studying encryption techniques available in the literature and generally adopted by the Cloud Service Providers, identifying attributes and aspects that may be enhanced further, for strengthening of solution in used for security of Data in Motion. Through this study, authors have proposed a methodology for addressing key allocation and key management issues by way of optimization and opened a new dimension of research possibilities in future. © 2021 IEEE.
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BACKGROUND: Early coronavirus disease 2019 (COVID-19) diagnosis prior to laboratory testing results is crucial for infection control in hospitals. Models exist predicting COVID-19 diagnosis, but significant concerns exist regarding methodology and generalizability. AIM: To generate the first COVID-19 diagnosis risk score for use at the time of hospital admission using the TRIPOD (transparent reporting of a multivariable prediction model for individual prognosis or diagnosis) checklist. DESIGN: A multivariable diagnostic prediction model for COVID-19 using the TRIPOD checklist applied to a large single-centre retrospective observational study of patients with suspected COVID-19. METHODS: 581 individuals were admitted with suspected COVID-19; the majority had laboratory-confirmed COVID-19 (420/581, 72.2%). Retrospective collection was performed of electronic clinical records and pathology data. RESULTS: The final multivariable model demonstrated AUC 0.8535 (95% confidence interval 0.8121-0.8950). The final model used six clinical variables that are routinely available in most low and high-resource settings. Using a cut-off of 2, the derived risk score has a sensitivity of 78.1% and specificity of 86.8%. At COVID-19 prevalence of 10% the model has a negative predictive value (NPV) of 96.5%. CONCLUSIONS: Our risk score is intended for diagnosis of COVID-19 in individuals admitted to hospital with suspected COVID-19. The score is the first developed for COVID-19 diagnosis using the TRIPOD checklist. It may be effective as a tool to rule out COVID-19 and function at different pandemic phases of variable COVID-19 prevalence. The simple score could be used by any healthcare worker to support hospital infection control prior to laboratory testing results.