Host immune responses in aged rhesus macaques against BBV152, an inactivated SARS-CoV-2 vaccine, and cross-neutralization with beta and delta variants.

The magnitude and duration of immune response to COVID-19 vaccination in older adults are known to be adversely affected due to immunosenescence and inflammaging. The threat of emerging variants warrants studies on immune response in older adults to primary vaccination and booster doses so as to understand the effectiveness of vaccines in countering the threat of emerging variants. Non-human primates (NHPs) are ideal translational models, as the immunological responses in NHPs are similar to those in humans, so it enables us to understand host immune responses to the vaccine. We initially studied humoral immune responses in aged rhesus macaques employing a three-dose regimen of BBV152, an inactivated SARS-CoV-2 vaccine. Initially, the study investigated whether the third dose enhances the neutralizing antibody (Nab) titer against the homologous virus strain (B.1) and variants of concern (Beta and Delta variants) in aged rhesus macaques immunized with BBV152, adjuvanted with Algel/Algel-IMDG (imidazoquinoline). Later, we also attempted to understand cellular immunity in terms of lymphoproliferation against γ-inactivated SARS-CoV-2 B.1 and delta in naïve and vaccinated rhesus macaques after a year of the third dose. Following the three-dose regimen with 6 µg of BBV152 with Algel-IMDG, animals had increased Nab responses across all SARS-CoV-2 variants studied, which suggested the importance of booster dose for the enhanced immune response against SARS-CoV-2-circulating variants. The study also revealed the pronounced cellular immunity against B.1 and delta variants of SARS-CoV-2 in the aged rhesus macaques even after a year of vaccination.

UVC-Based Air Disinfection Systems for Rapid Inactivation of SARS-CoV-2 Present in the Air.

The World Health Organization (WHO) declared in May 2021 that SARS-CoV-2 is transmitted not only by close contact with infectious respiratory fluids from infected people or contaminated materials but also indirectly through air. Airborne transmission has serious implications for the control measures we can deploy, given the emergence of more transmissible variants. This emphasizes the need to deploy a mechanism to reduce the viral load in the air, especially in closed and crowded places such as hospitals, public transport buses, etc. In this study, we explored ultraviolet C (UVC) radiation for its ability to inactivate the SARS-CoV-2 particles present in aerosols and designed an air disinfection system to eliminate infectious viruses. We studied the virus inactivation kinetics to identify the UVC dosage required to achieve maximum virus inactivation. Based on the experimental data, UVC-based devices were designed for the sanitization of air through HVAC systems in closed spaces. Further, a risk assessment model to estimate the risk reduction was applied which showed that the use of UVC radiation could result in the reduction of the risk of infection in occupied spaces by up to 90%.

SCOPE: Surveillance of COVID-19 in pregnancy- results of a multicentric ambispective case-control study on clinical presentation and maternal outcomes in India between April to November 2020.

OBJECTIVE: To determine the clinical manifestations, risk factors, treatment modalities and maternal outcomes in pregnant women with lab-confirmed COVID-19 and compare it with COVID-19 negative pregnant women in same age group. DESIGN: Multicentric case-control study. DATA SOURCES: Ambispective primary data collection through paper-based forms from 20 tertiary care centres across India between April and November 2020. STUDY POPULATION: All pregnant women reporting to the centres with a lab-confirmed COVID-19 positive result matched with controls. DATA QUALITY: Dedicated research officers extracted hospital records, using modified WHO Case Record Forms (CRF) and verified for completeness and accuracy. STATISTICAL ANALYSIS: Data converted to excel files and statistical analyses done using STATA 16 (StataCorp, TX, USA). Odds ratios (ORs) with 95% confidence intervals (CI) estimated using unconditional logistic regression. RESULTS: A total of 76,264 women delivered across 20 centres during the study period. Data of 3723 COVID positive pregnant women and 3744 age-matched controls was analyzed. Of the positive cases 56·9% were asymptomatic. Antenatal complications like preeclampsia and abruptio placentae were seen more among the cases. Induction and caesarean delivery rates were also higher among Covid positive women. Pre-existing maternal co-morbidities increased need for supportive care. There were 34 maternal deaths out of the 3723(0.9%) positive mothers, while covid negative deaths reported from all the centres were 449 of 72,541 (0·6%). CONCLUSION: Covid-19 infection predisposed to adverse maternal outcomes in a large cohort of Covid positive pregnant women as compared to the negative controls.

Contact Tracing of Healthcare Workers Exposed to COVID-19 Infection in a Tertiary-Care Hospital: Containing the Contagion.

Introduction: Healthcare workers (HCWs) are at higher risk of getting infected with COVID-19 infection due to their close proximity to COVID-19-positive patients. We studied the risk stratification and positivity rate in HCWs at risk of getting COVID-19 infection as well as the possible factors responsible for their being at risk of COVID-19 infection during the study period. Material and Methods: This prospective study was conducted after approval by the institutional ethics committee. The data regarding demographic variables, risk stratification, COVID-19 (reverse-transcription polymerase chain reaction) report, and possible sources of exposure for HCWs were recorded in a proforma by personal/telephonic interviews as well as from hospital records from March 2020 to June 2021. The data generated were entered into Microsoft Excel® software and analyzed using percentages, proportions, and Chi-square tests for qualitative variables. Results: COVID-19 infection's positivity rate was 19.5% among high-risk and 0.6% among low-risk HCW contacts. HCWs working in non-COVID-19 areas (67.9%) were more at risk than those working in COVID-19 areas (32.1%). In contrast, the COVID-19 positivity rate was significantly higher among high-risk contact HCWs from COVID-19 areas (34.2%) than in non-COVID-19 areas (12.6%). The maximum COVID-19 positivity rate was seen in high-risk contacts with body fluid exposure (21%), performing aerosol-generating procedures (20%), and close exposure in operation theaters (18%). Conclusions: Risk stratification is an important tool to contain infection among HCWs who had unprotected close contact with a COVID-19-positive case. With appropriate contact tracing, we were able to avoid over- and under-quarantine, save many man-hours as well as contain the spread of infection. HCWs should not only wear appropriate personal protective equipment (PPE) during work hours but should also practice mask-wearing and social distancing while they are in the community.

Using emerging technologies to improve the sustainability and resilience of supply chains in a fuzzy environment in the context of COVID-19.

In rapidly changing business conditions, it has become extremely important to ensure the sustainability of supply chains and further improve the resiliency to those events, such as COVID-19, that can cause unexpected disruptions in the value supply chain. Although globalized supply chains have already been criticized for lack of control over sustainability and resilience of supply chain operations, these issues have become more prevalent in the uncertain environment driven by COVID-19. The use of emerging technologies such as blockchain, Industry 4.0 analytics model and artificial intelligence driven methods are aimed at increasing the sustainability and resilience of supply chains, especially in an uncertain environment. In this context, this research aims to identify the problematic areas encountered in building a resilient and sustainable supply chain in the pre-COVID-19 era and during COVID-19, and to offer solutions to those problematic areas tackled by an appropriate emerging technology. This research has been contextualized in the automotive industry; this industry has a complex supply chain structure and is one of the sectors most affected by COVID-19. Based on the findings, the most important problematic areas encountered in SSCM pre-COVID-19 are determined as supply chain traceability, demand planning and production management as well as purchasing process planning based on cause and effect groups. The most important issues to be addressed during COVID-19 are top management support, purchasing process planning and supply chain traceability, respectively.

Empanelment of the Population to the Primary Medical Care Institution of Sri Lanka: A Mixed-Methods Study on Outcomes and Challenges.

The registration of individuals with designated primary medical care institutions (PMCIs) is a key step towards their empanelment with these PMCIs, supported by the Primary Health Care System Strengthening Project in Sri Lanka. We conducted an explanatory mixed-methods study to assess the extent of registration at nine selected PMCIs and understand the challenges therein. By June 2021, 36,999 (19.2%, 95% CI-19.0-19.4%) of the 192,358 catchment population allotted to these PMCIs were registered. At this rate, only 50% coverage would be achieved by the end of the project (December 2023). Proportions of those aged <35 years and males among those registered were lower compared to their general population distribution. Awareness activities regarding registration were conducted in most of the PMCIs, but awareness in the community was low. Poor registration coverage was due to a lack of dedicated staff for registration, misconceptions of health care workers about individuals needing to be registered, reliance on opportunistic or passive registration, and lack of monitoring mechanisms; these were further compounded by the COVID-19 pandemic. Moving forward, there is an urgent need to address these challenges to improve registration coverage and ensure that all individuals are empaneled before the close of the project for it to have a meaningful impact.

An investigation for the interaction of gamma oryzanol with the Mpro of SARS-CoV-2 to combat COVID-19: DFT, molecular docking, ADME and molecular dynamics simulations.

COVID-19 has affected more or less every nation across the world and affected the economy very badly. Infection of this virus in human took the life of millions. We have already faced the first and the second waves of COVID-19 and recently, the nations or humanity is afraid of new strain, that is, OMICRON. Considered to highly infectious than the previous strains. Therefore, the researchers are working to find a promising molecule with no or permissible toxicity. In the present work, authors have chosen 10 molecules including the molecules used in curing the infection from nCoV. All the molecules were docked against Mpro of nCoV using iGemdock, a reliable computational tool. Based on the binding energy obtained, it can be seen that only latermovir; remdesivir; zanamivir showed better binding affinity than the gamma oryzanol, the molecule of interest in this work. These three molecules are already in use to cure the patients siffering from the infection of nCoV. But, we need a cost effective and easily available molecule to fight against this viral infection. The binding energy obtained for the formation of complex of gamma oryzanol with Mpro of nCoV through molecular docking is -118.787 kcal/mol. It forms conventional hydrogen bonds with the CYS145 (2.51 Å), LEU141 (3.01 Å) and SER144 (3.09 Å); forms C-H bonds with PHE140 (3.37 Å) and HIS163 (2.91 Å), forms alkyl interactions with ALA191 (3.59 and 4.74 Å), CYS145 (4.90 Å). One interesting information is obtained that the value of log Kp of gamma oryzanol is least means more permeable to skin in comparison of other molecules used in the work. Gamma oryzanol in known for to its biological potency like it can modulate the oxidative stress as well as inflammation. DFT calculations of gamma oryzanol (GO) was made at different temperature and no change in the delocalization of electron density as well no change in free energy is observed. Molecular dynamics (MD) simulations of gamma oryzanol with the Mpro of nCoV at different temperatures was performed. The formation of the complex between GO and Mpro of CoV at 290 K, 300 K, 310 K and 320 K for 100 ns was investigated. It has been observed that the effective binding is observed at 290 K, therefore, it can be said that the inhibition of the Mpro of nCoV with GO is maximum at 290 K.Communicated by Ramaswamy H. Sarma.

Outcomes and Challenges in Noncommunicable Disease Care Provision in Health Facilities Supported by Primary Health Care System Strengthening Project in Sri Lanka: A Mixed-Methods Study.

The Primary Healthcare System Strengthening Project in Sri Lanka focuses on improving noncommunicable disease (NCD) care provision at primary medical care institutions (PMCIs). We conducted an explanatory mixed-methods study to assess completeness of screening for NCD risk, linkage to care, and outcomes of diabetes/hypertension care at nine selected PMCIs, as well as to understand reasons for gaps. Against a screening coverage target of 50% among individuals aged ≥ 35 years, PMCIs achieved 23.3% (95% CI: 23.0-23.6%) because of a lack of perceived need for screening among the public and COVID-19-related service disruptions. Results of investigations and details of further referral were not documented in almost half of those screened. Post screening, 45% of those eligible for follow-up NCD care were registered at medical clinics. Lack of robust recording/tracking mechanisms and preference for private providers contributed to post-screening attrition. Follow-up biochemical investigations for monitoring complications were not conducted in more than 50% of diabetes/hypertension patients due to nonprescription of investigations by healthcare providers and poor uptake among patients because of nonavailability of investigations at PMCI, requiring them to avail services from the private sector, incurring out-of-pocket expenditure. Primary care strengthening needs to address these challenges to ensure successful integration of NCD care within PMCIs.

Exploring the factors that affect user experience in mobile-health applications: A text-mining and machine-learning approach.

Recent years have witnessed an increased demand for mobile health (mHealth) platforms owing to the COVID-19 pandemic and preference for doorstep delivery. However, factors impacting user experiences and satisfaction levels across these platforms, using customer reviews, are still largely unexplored in academic research. The empirical framework we proposed in this paper addressed this research gap by analysing unmonitored user comments for some popular mHealth platforms. Using topic-modelling techniques, we identified the impacting factors (predictors) and categorised them into two major dimensions based on strategic adoption and motivational association. Findings from our study suggest that time and money, convenience, responsiveness, and availability emerge as significant predictors for delivering a positive user experience on m-health platforms. Next, we identified substantial moderating effects of review polarity on the predictors related to brand association and hedonic motivation, such as online booking and video consultation. Further, we also identified the top predictors for successful user experience across these platforms. Recommendations from our study will benefit business managers by offering an improved service design leading to higher user satisfaction across these m-health platforms.

Audit of Clinical Care Received by COVID-19 Patients Treated at a Tertiary Care Hospital of Nepal in 2021.

Like the world over, Nepal was also hard hit by the second wave of COVID-19. We audited the clinical care provided to COVID-19 patients admitted from April to June 2021 in a tertiary care hospital of Nepal. This was a cohort study using routinely collected hospital data. There were 620 patients, and most (458, 74%) had severe illness. The majority (600, 97%) of the patients were eligible for admission as per national guidelines. Laboratory tests helping to predict the outcome of COVID-19, such as D-dimer and C-reactive protein, were missing in about 25% of patients. Nearly all (>95%) patients with severe disease received corticosteroids, anticoagulants and oxygen. The use of remdesivir was low (22%). About 70% of the patients received antibiotics. Hospital exit outcomes of most (>95%) patients with mild and moderate illness were favorable (alive and discharged). Among patients with severe illness, about 25% died and 4% were critically ill, needing further referral. This is the first study from Nepal to audit and document COVID-19 clinical care provision in a tertiary care hospital, thus filling the evidence gap in this area from resource-limited settings. Adherence to admission guidelines was excellent. Laboratory testing, access to essential drugs and data management needs to be improved.

Historical perspectives of panic buying

Panic buying (PB) is being reported recently concerning the COVID-19 pandemic, but it has been there for a long time. PB creates a false impression of a shortage of food and other essential items and prompts others to rush to markets and stockpile essential items. Incidents of PB have probably not been reported before the twentieth century. Incidents of PB have been reported during the Cuban missile crisis, Spanish flu pandemic, oil crises, and toilet paper crisis. Besides essential items, PB has also been reported in association with a popular aerated beverage and arms/ammunition. Factors that are likely to initiate and/or propagate PB include survival instincts, social influence, and fear of the unknown. It appears there are possibly many other unexplored factors contributing to PB. Research on PB is limited. PB is likely to recur in the future. A clear understanding of the past events of PB shall provide useful insight into the same in the future. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Psychological Distress and Coping Among Dental Practitioners During the COVID-19 Pandemic: A Survey From India.

AIM: Most dental procedures are aerosol-generating and hence highly risky for spreading SARS-CoV-2 (COVID-19) infection. This can lead to sufficient psychological distress, avoidance of risky procedures, and impact on dental practice. We intend to examine the effect of the COVID-19 pandemic on dental practice and psychological distress among dental practitioners. METHODS: An online survey was conducted by an email-based survey link; 1257 registered dental practitioners were contacted across the country. RESULTS: Most dental practitioners continue to practice during the COVID-19 pandemic (81.08%). Postgraduate specialists significantly outnumber undergraduates in performing dental procedures (p=.001). Career-related anxiety was considerably high among postgraduates (61.96%; p=.036) during the initial phase of the SARS-CoV-2 pandemic in India. In contrast, self-efficacy was significantly better among postgraduates than undergraduates (p=.027). CONCLUSION: Dental practitioners suffered considerable impact due to the COVID-19 pandemic. It is important to enhance coping and self-efficacy strategies among dental practitioners.

Screening for Severe Illness at Diagnosis Has the Potential to Prevent Early TB Deaths: Programmatic Experience From Karnataka, India.

Due to the coronavirus disease (COVID-19) pandemic and its associated response, TB deaths increased for the first time in a decade. In any potentially fatal illness, an assessment of severity is essential. This is not systematically done for adults with TB, mostly due to a lack of policy and/or limited availability of diagnostic and clinical capacity. We developed a screening tool using simple and easily measurable indicators that can be used by paramedical TB program staff to quickly identify people with severe illness. During October-November 2020 in Karnataka, India, the paramedical program staff from 16 districts screened people with TB (aged ≥15 years) notified by public facilities for "high risk of severe illness," which was defined as the presence of any of the following indicators: (1) body mass index (BMI) ≤14.0 kg/m2; (2) BMI ≤16.0 kg/m2 with bilateral leg swelling; (3) respiratory rate >24/minute; (4) oxygen saturation <94%; (5) inability to stand without support. In this cohort study, we determined the incidence of program-recorded early deaths (within 2 months) and its association with high risk of severe illness. Of 3,010 people with TB, 1,529 (50.8%) were screened at diagnosis/notification, of whom 537 (35.1%) had a high risk of severe illness. There were 195 (6.5%, 95% CI=5.7, 7.4) early deaths: 59 (30.2%) within a week and 100 (51.3%) within 2 weeks of treatment initiation. The incidence of early deaths was significantly higher among those with high risk of severe illness (8.9%) at diagnosis compared to those without (3.8%) [adjusted relative risk: 2.36 (95% confidence interval=1.57, 3.55)]. To conclude, early deaths were especially high during the first 2 weeks and strongly associated with a high risk of severe illness at diagnosis/notification. Screening for severe illness should be explored as a potential strategy to end TB deaths.

Chronic Pain Management During a Pandemic: Evidence-Based Review.

Chronic pain is the leading cause of morbidity in the world and is strongly associated with physical and psychological disabilities. In this pandemic, most of the pain care centers are forced to shut their doors leaving patients in dismay and adding to their misery. A systematic review was performed following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All research articles from March 2020 to September 15, 2020, available on PubMed, Google scholar, and EmBase were included in this study. The keywords used for data search were "chronic pain," "coronavirus," "pain management," "COVID-19," "drugs usage in covid-19," "recommendation," and "guidelines". This review summarizes findings from the current literature available worldwide from different databases regarding guidelines to practice during chronic pain in coronavirus disease (COVID) crisis. This article acts as a specimen on how to handle future pandemics. We concluded that chronic pain management is a fundamental right and telemedicine is the silver lining that can be used for primary, follow-up consultation and to address mental health issues in chronic pain patients. Outpatient department visits should be scheduled using "forward triage." Pain Interventions should be carried out if urgent or semi-urgent with necessary precautions. Reopening of elective procedures with COVID testing can be planned, considering pain interventions to be usually percutaneous, of short duration, and involving office procedures with minimal aerosol generation. Drugs contrib- uting to immune suppression, for example, strong opioids and steroids, should be avoided. Regenerative therapy can be used instead during pain interventions. Physicians are expected to follow the recommended government guidelines before prescribing any drugs.