Are doctors feeling burnout? - Multicenter cross-sectional study on burnout syndrome and its determinants during the ongoing pandemic.

Background: Though the concept of burnout has been around for long, its significance is increasing nowadays owing to the demanding nature of jobs. The latest ICD-11 also provides a detailed description of Burnout syndrome. Physicians are at high risk for experiencing burnout and this becomes especially relevant in the ongoing COVID-19 pandemic. Aim: To determine the risk of burnout among medical faculty and its predictors, if any. Materials and Methods: This was a multicentric cross-sectional study that included medical faculty from four tertiary care government teaching hospitals in north India. A survey was conducted during the current COVID-19 pandemic to assess burnout using a structured online questionnaire based on Burnout Assessment Tool. The questionnaire also included relevant socio-demographic, professional, health, and lifestyle-related details. Descriptive statistics, Mann-Whitney U Test/Kruskal Wallis Test, and Kendall's tau-b Test were used for statistical analysis. Results: A total of 244 medical faculty completed the survey. 27.87% were at risk of burnout, out of which 11.89% were at a very high risk of burnout. Dissatisfaction with the job and dissatisfaction with sleep (P < 0.01 for both) were associated with greater burnout scores and a greater risk of burnout. Conclusion: Faculty members are at high risk of burnout, regardless of sociodemographic and work-related factors.

Elsberg Syndrome with Mixed Presentation as Meningitis Retention Syndrome: A Pediatric Case Report and Comprehensive Review of the Literature.

Elsberg syndrome is a typically infectious syndrome that may cause acute or subacute bilateral lumbosacral radiculitis and sometimes lower spinal cord myelitis. Patients often present with various neurological symptoms involving the lower extremities, including numbness, weakness, and urinary disturbances such as retention. A 9-year-old girl with no significant past medical history presented with altered mental status, fever, urinary retention, and anuria and was found to have encephalomyelitis. An extensive diagnostic workup led to ruling out possible etiologies until identifying Elsberg syndrome. In this report, we describe a case of Elsberg syndrome caused by West Nile virus (WNV). To the best of our knowledge, this is the first reported case of its kind in the pediatric population. Utilizing PubMed and Web of Science databases, we reviewed the literature to describe the neurogenic control of the urinary system in correlation to a multitude of neurologic pathologies.

Evaluation of Safety Concerns for COVID-19 Immunization of Pregnant Women: a Systematic Review of Emerging Evidence.

Objectives: There is an urgent need to review the status of COVID-19 vaccine immunization in pregnant women globally, so that adverse outcomes may be prevented. In this study, we performed a systematic review to evaluate the probable outcomes of COVID-19 vaccination in pregnant women. Materials and methods:An electronic search over three months (June 15-August 15, 2021) was conducted. Original studies evaluating safety concerns in pregnant women for COVID-19 vaccination were included. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines were used for data collection and reporting of findings. Results:COVID-19 vaccination in pregnant women was not associated with increased adverse effects or complications to the mother as well as the developing fetus or new-born compared to non-vaccinated pregnant women. Vaccinated pregnant women showed a robust immune response against COVID-19 infection. Conclusion:COVID-19 vaccination during pregnancy causes no significant health risks for the mother or the developing fetus or new-born.

COVID-19 vaccination may enhance hippocampal neurogenesis in adults.

Emerging evidence suggests a detrimental impact of COVID-19 illness on the continued hippocampal neurogenesis in adults. In contrast, the existing literature supports an enhancing effect of COVID-19 vaccination on adult hippocampal neurogenesis. Vaccines against respiratory infections, including influenza, have been shown to enhance hippocampal neurogenesis in adult-age animals. We propose that a similar benefit may happen in COVID-19 vaccinated adults. The vaccine-induced enhancement of the hippocampal neurogenesis in adults thus may protect against age-related cognitive decline and mental disorders. It alsohints at an added mental health benefit of the COVID-19 vaccination programs in adults.

Pollution free UV-C radiation to mitigate COVID-19 transmission.

The high rate of transmission of the COVID-19 virus has brought various types of disinfection techniques, for instance, hydrogen peroxide vaporization, microwave generating steam, UV radiation, and dry heating, etc. to prevent the further transmission of the virus. The chemical-based techniques are predominantly used for sanitization of hands, buildings, hospitals, etc. However, these chemicals may affect the health of humans and the environment in unexplored aspects. Furthermore, the UV lamp-based radiation sanitization technique had been applied but has not gained larger acceptability owing to its limitation to penetrate different materials. Therefore, the optical properties of materials are especially important for the utilization of UV light on such disinfection applications. The germicidal or microorganism inactivation application of UV-C has only been in-use in a closed chamber, due to its harmful effect on human skin and the eye. However, it is essential to optimize UV for its use in an open environment for a larger benefit to mitigate the virus spread. In view of this, far UV-C (222nm) based technology has emerged as a potential option for the sanitization in open areas and degradation of microorganisms present in aerosol during the working conditions. Hence, in the present review article, efforts have been made to evaluate the technical aspects of UV (under the different spectrum and wavelength ranges) and the control of COVID 19 virus spread in the atmosphere including the possibilities of the human body sanitization in working condition.

SARS-CoV-2 Omicron Variant Genomic Sequences and Their Epidemiological Correlates Regarding the End of the Pandemic: In Silico Analysis.

Background: Emergence of the new SARS-CoV-2 variant B.1.1.529 worried health policy makers worldwide due to a large number of mutations in its genomic sequence, especially in the spike protein region. The World Health Organization (WHO) designated this variant as a global variant of concern (VOC), which was named "Omicron." Following Omicron's emergence, a surge of new COVID-19 cases was reported globally, primarily in South Africa. Objective: The aim of this study was to understand whether Omicron had an epidemiological advantage over existing variants. Methods: We performed an in silico analysis of the complete genomic sequences of Omicron available on the Global Initiative on Sharing Avian Influenza Data (GISAID) database to analyze the functional impact of the mutations present in this variant on virus-host interactions in terms of viral transmissibility, virulence/lethality, and immune escape. In addition, we performed a correlation analysis of the relative proportion of the genomic sequences of specific SARS-CoV-2 variants (in the period from October 1 to November 29, 2021) with matched epidemiological data (new COVID-19 cases and deaths) from South Africa. Results: Compared with the current list of global VOCs/variants of interest (VOIs), as per the WHO, Omicron bears more sequence variation, specifically in the spike protein and host receptor-binding motif (RBM). Omicron showed the closest nucleotide and protein sequence homology with the Alpha variant for the complete sequence and the RBM. The mutations were found to be primarily condensed in the spike region (n=28-48) of the virus. Further mutational analysis showed enrichment for the mutations decreasing binding affinity to angiotensin-converting enzyme 2 receptor and receptor-binding domain protein expression, and for increasing the propensity of immune escape. An inverse correlation of Omicron with the Delta variant was noted (r=-0.99, P<.001; 95% CI -0.99 to -0.97) in the sequences reported from South Africa postemergence of the new variant, subsequently showing a decrease. There was a steep rise in new COVID-19 cases in parallel with the increase in the proportion of Omicron isolates since the report of the first case (74%-100%). By contrast, the incidence of new deaths did not increase (r=-0.04, P>.05; 95% CI -0.52 to 0.58). Conclusions: In silico analysis of viral genomic sequences suggests that the Omicron variant has more remarkable immune-escape ability than existing VOCs/VOIs, including Delta, but reduced virulence/lethality than other reported variants. The higher power for immune escape for Omicron was a likely reason for the resurgence in COVID-19 cases and its rapid rise as the globally dominant strain. Being more infectious but less lethal than the existing variants, Omicron could have plausibly led to widespread unnoticed new, repeated, and vaccine breakthrough infections, raising the population-level immunity barrier against the emergence of new lethal variants. The Omicron variant could have thus paved the way for the end of the pandemic.

Patients' Satisfaction on Telemedicine Service in Relation to COVID-19 and Non-COVID-19 Problems: A Cross-Sectional Comparative Study.

BACKGROUND: Telemedicine service was historically started for ambulatory and hospice care patients. Since 2020, we have been in the midst of the COVID-19 pandemic. The availability of healthcare facilities became limited due to repeated locked down during the COVID-19 pandemic. Thus, telemedicine service has gained tremendous popularity among healthcare services. Telemedicine service was started at All India Institute of Medical Sciences (AIIMS), Deoghar, as a COVID Helpline facility to provide guidance and care to the home isolated COVID-19 patients during the second wave of COVID-19. But we observed that more than 40% of calls were due to non-COVID-19-related problems, but we managed the non-COVID-19-related calls by discussing with a specialist in conference calls or WhatsApp consultation. Therefore, we planned to compare individual satisfaction with telemedicine services in patients with COVID-19 and non-COVID-19-related problems. METHODS AND MATERIALS: This study was a cross-sectional retrospective analysis of the register of telemedicine maintained in AIIMS, Deoghar, callers were grouped into two- COVID-19 and non-COVID-19-related problems. We obtained feedback from the patients and recorded it in a google form, collected data were analyzed in both groups. Telephonic consent was taken for participating in the study. The sample size was calculated to be 252, the COVID-19 group: 126, and the non-COVID-19 group: 126, and simple random sampling was used to choose the participants from the 730 total callers of the first month of telemedicine service. Their response was graded on 4 points Likert scale (1=Poor, 2=fair, 3=Good, 4=Excellent) and outcomes were analyzed by IBM SPSS (version 20.0) software. A p-value of <0.05 was considered statistically significant. OBJECTIVE: The primary objective is to estimate the level of satisfaction in both groups and compare their level of satisfaction. The secondary objective is to determine the department-specific telemedicine services requirement for people in need. RESULTS: Out of a total of 252 patients, most (54%) callers were 18-45 years old, and 44% were above 45 years old. 64% of patients were male. 90% of callers were from urban or semi-urban districts. 90% of callers had a 10th-grade or more education. 89% of patients were willing to use telemedicine services in the future. An Independent sample t-test was used to compare the means of both the groups showed a significant difference (p < 0.05) in the level of satisfaction in the COVID-19 group to the non-COVID-19 group. It showed that satisfaction in the COVID-19 group was higher than the group with non-COVID-19-related problems. CONCLUSION: COVID-19 has changed the whole spectrum of healthcare needs of the community. Our study findings showed that there is a need for separate department-wise telemedicine services to provide satisfactory service for attending to problems related to that department. For example, problems with diabetes should be attended to by an endocrinologist or an internal medicine specialist. This study finding helped us to change the policy and start department-wise telemedicine service.

Structural analysis of spike proteins from SARS-CoV-2 variants of concern highlighting their functional alterations.

Aim: Mutations in the SARS-CoV-2 spike (S) protein have dramatically changed the transmissibility and pathogenicity of the virus. Therefore, we studied the binding affinity of Omicron spike-receptor binding domain (S-RBD) with human ACE2 receptor. Materials & methods: We used pyDockWEB and HADDOCK 2.4 docking for our study. Results: Computational docking indicated higher binding affinity of Omicron S-RBD as compared with wild-type SARS-CoV-2 and Delta S-RBD with ACE2. Interface analysis suggested four mutated residues of Omicron S-RBD for its enhanced binding. We also showed decreased binding affinity of Omicron and Delta S-RBDs with monoclonal antibodies. Conclusion: Compared with wild-type SARS-CoV-2, Omicron S-RBD exhibit higher binding with ACE2 and lower affinity against monoclonal antibodies.

COVID-19 vaccination may enhance hippocampal neurogenesis in adults

Graphical Emerging evidence suggests a detrimental impact of COVID-19 illness on the continued hippocampal neurogenesis in adults. In contrast, the existing literature supports an enhancing effect of COVID-19 vaccination on adult hippocampal neurogenesis. Vaccines against respiratory infections, including influenza, have been shown to enhance hippocampal neurogenesis in adult-age animals. We propose that a similar benefit may happen in COVID-19 vaccinated adults. The vaccine-induced enhancement of the hippocampal neurogenesis in adults thus may protect against age-related cognitive decline and mental disorders. It also hints at an added mental health benefit of the COVID-19 vaccination programs in adults.

A Bioinformatics Tool for Predicting Future COVID-19 Waves Based on a Retrospective Analysis of the Second Wave in India: Model Development Study

Background Since the start of the COVID-19 pandemic, health policymakers globally have been attempting to predict an impending wave of COVID-19. India experienced a devastating second wave of COVID-19 in the late first week of May 2021. We retrospectively analyzed the viral genomic sequences and epidemiological data reflecting the emergence and spread of the second wave of COVID-19 in India to construct a prediction model. Objective We aimed to develop a bioinformatics tool that can predict an impending COVID-19 wave. Methods We analyzed the time series distribution of genomic sequence data for SARS-CoV-2 and correlated it with epidemiological data for new cases and deaths for the corresponding period of the second wave. In addition, we analyzed the phylodynamics of circulating SARS-CoV-2 variants in the Indian population during the study period. Results Our prediction analysis showed that the first signs of the arrival of the second wave could be seen by the end of January 2021, about 2 months before its peak in May 2021. By the end of March 2021, it was distinct. B.1.617 lineage variants powered the wave, most notably B.1.617.2 (Delta variant). Conclusions Based on the observations of this study, we propose that genomic surveillance of SARS-CoV-2 variants, complemented with epidemiological data, can be a promising tool to predict impending COVID-19 waves.

COVID Crisis and Tourism Sustainability: An Insightful Bibliometric Analysis

The pernicious impact of COVID-19 on all the aspects of travel and tourism has posed a question of tourism sustainability before policymakers and researchers. This research aims to cast light on the bibliometric construct and knowledge structure of the contemporaneous research that evolved around tourism sustainability amid COVID-19. Bibliometric methods of performance analysis and science mapping were used to analyze a total of 440 bibliographic records retrieved from the Scopus database. The major findings showed sustainability as a trending area of tourism research amid COVID-19 and revealed the concentration of research in three prime domains: Management and sustainable development of tourism, environmental health, and mobility trends in the context of COVID-19 pandemic. These areas may be perceived as the recent domains, and they are imperative for future research.

Pathological involvement of placenta in COVID-19: a systematic review.

The mammalian placenta, which is responsible for bonding between the mother and the fetus, is one of the first organs to develop. Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection has caused a great threat to public health and affected almost all the organs including the placenta. Owing to limited available data on vertical transmission and pathological changes in the placenta of SARS-CoV-2 positive patients, we aim to review and summarize histopathological and ultrastructural changes in the placental tissue following SARS-CoV-2 infection. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines were used for review writing. Multiple studies have reported significant pathological changes in the placental tissue of SARS-CoV-2 positive mothers. On the other hand, some studies have demonstrated either no or very little involvement of the placental tissue. The most common pathological changes reported are fetal and maternal vascular malformation, villitis of unknown etiology, thrombus formation in the intervillous space and sub-chorionic space, and chorangiosis. Reports on vertical transmission are less in number. The observations of this review present a strong base for the pathological involvement of the placenta in SARS-CoV-2 infected mothers. However, a smaller number of original studies have been done until now, and most of them have small sample sizes and lack matched control groups, which are the big limitations for drawing an effective conclusion at this stage. Antenatal care can be improved by a better understanding of the correlation between maternal SARS-CoV-2 infection and placental pathology in COVID-19.

Structural analysis of spike proteins from SARS-CoV-2 variants of concern highlighting their functional alterations

Aim: Mutations in the SARS-CoV-2 spike (S) protein have dramatically changed the transmissibility and pathogenicity of the virus. Therefore, we studied the binding affinity of Omicron spike-receptor binding domain (S-RBD) with human ACE2 receptor. Materials & methods: We used pyDockWEB and HADDOCK 2.4 docking for our study. Results: Computational docking indicated higher binding affinity of Omicron S-RBD as compared with wild-type SARS-CoV-2 and Delta S-RBD with ACE2. Interface analysis suggested four mutated residues of Omicron S-RBD for its enhanced binding. We also showed decreased binding affinity of Omicron and Delta S-RBDs with monoclonal antibodies. Conclusion: Compared with wild-type SARS-CoV-2, Omicron S-RBD exhibit higher binding with ACE2 and lower affinity against monoclonal antibodies.

Cognitive framework and learning paradigms of plant leaf classification using artificial neural network and support vector machine

In this COVID-19 pandemic era, where people are losing their lives, there are several species and plants available on our Mother Earth that are beneficial to boosting the human immune system and sustaining their life. These plant leaves and trunks can also be used to effectively treat a variety of diseases in humans. The images of plants, as well as the identification of the leaf through artificial intelligence, are critical for obtaining such benefits. The proposed system automatically grades the various species and classify images of plant leaves into different families. The leaf image parameter is used to extract these properties such as colour, texture, shape, and so on. The proposed system makes use of colour and texture to form characteristics. The colour pattern for the texture uses GLCM and Shape extraction forms to extract colour information such as HSV (hue, saturation, value). The ANN (artificial neural network) algorithm is used to classify leaf images. Colour extraction, texture, and shape features, both alone and in combination, are used for classification. Using combined features yields better results than using single features. In the proposed system data set, 285 images are captured, 210 images with ANN are trained, and 75 images are used for the test set. With ANN, the system achieves an approximate 93.33% accuracy. The results were also validated with SVM (support vector machine), which provides an approximate 48% accuracy, indicating that ANN outperforms SVM. [ FROM AUTHOR] Copyright of Journal of Experimental & Theoretical Artificial Intelligence is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Anxiety among doctors during COVID-19 pandemic in a tertiary care center in India.

Background and Objectives: The ongoing pandemic of COVID-19 has a severe impact on the health-care system worldwide bringing doctors under immense pressure to work under stressful conditions. The main objective of this study was to assess anxiety among doctors and to understand the perceived causes of anxiety. Methodology: Questionnaires were made available to all willing doctors of SN Medical College, Agra; King George's Medical University, Lucknow, and GSVM Medical College, Kanpur, between May 12, 2020, and June 20, 2020 (during nationwide lockdown). The questionnaire consists of three main sections: details about respondents' working status, questions regarding respondents' reasons for concern, and Becks' Anxiety Inventory (BAI) scale. Results: Two hundred and fifty responses were received from about 599 doctors presented with the questionnaire. About 32% of the respondents have already done duties in COVID facilities and the rest are awaiting deployment at those facilities. Forty-two percent reported concern regarding transmitting the illness to close ones/loved ones/family members to be a cause of anxiety and 40% were worried about the quality of protective gear closely followed by examination-related worries. About 28.8% of the respondents scored >7 on BAI with 62.5% of these (18% of total respondents) reporting "moderate" levels of anxiety. Conclusions: Our findings underline the fact that pandemics such as COVID-19 cause significant levels of anxiety among doctors. The levels of anxiety differed for age, sex, and specialty. The perceived causes were the risk of transmitting to loved ones and concerns regarding protective gear. These outcomes highlight the need for early interventions to address anxiety and to provide support for doctors during such crises.

Pathological involvement of placenta in COVID-19: a systematic review

SUMMARY The mammalian placenta, which is responsible for bonding between the mother and the fetus, is one of the first organs to develop. Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection has caused a great threat to public health and affected almost all the organs including the placenta. Owing to limited available data on vertical transmission and pathological changes in the placenta of SARS-CoV-2 positive patients, we aim to review and summarize histopathological and ultrastructural changes in the placental tissue following SARS-CoV-2 infection. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines were used for review writing. Multiple studies have reported significant pathological changes in the placental tissue of SARS-CoV-2 positive mothers. On the other hand, some studies have demonstrated either no or very little involvement of the placental tissue. The most common pathological changes reported are fetal and maternal vascular malformation, villitis of unknown etiology, thrombus formation in the intervillous space and sub-chorionic space, and chorangiosis. Reports on vertical transmission are less in number. The observations of this review present a strong base for the pathological involvement of the placenta in SARS-CoV-2 infected mothers. However, a smaller number of original studies have been done until now, and most of them have small sample sizes and lack matched control groups, which are the big limitations for drawing an effective conclusion at this stage. Antenatal care can be improved by a better understanding of the correlation between maternal SARS-CoV-2 infection and placental pathology in COVID-19.

Emerging SARS-CoV-2 variants can potentially break set epidemiological barriers in COVID-19.

Young age, female sex, absence of comorbidities, and prior infection or vaccination are known epidemiological barriers for contracting the new infection and/or increased disease severity. Demographic trends from the recent coronavirus disease 2019 waves, which are believed to be driven by newer severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, indicate that the aforementioned epidemiological barriers are being breached and a larger number of younger and healthy individuals are developing severe disease. The new SARS-CoV-2 variants have key mutations that can induce significant changes in the virus-host interactions. Recent studies report that, some of these mutations, singly or in a group, enhance key mechanisms, such as binding of the receptor-binding domain (RBD) of the viral spike protein with the angiotensin-converting enzyme 2 (ACE2) receptor in the host-cells, increase the glycosylation of spike protein at the antigenic sites, and enhance the proteolytic cleavage of the spike protein, thus leading to improved host-cell entry and the replication of the virus. The putative changes in the virus-host interactions imparted by the mutations in the RBD sequence can potentially be the reason behind the breach of the observed epidemiological barriers. Susceptibility for contracting SARS-CoV-2 infection and the disease outcomes are known to be influenced by host-cell expressions of ACE2 and other proteases. The new variants can act more efficiently, and even with the lesser availability of the viral entry-receptor and the associated proteases, can have more efficient host-cell entry and greater replication resulting in high viral loads and prolonged viral shedding, widespread tissue-injury, and severe inflammation leading to increased transmissibility and lethality. Furthermore, the accumulating evidence shows that multiple new variants have reduced neutralization by both, natural and vaccine-acquired antibodies, indicating that repeated and vaccine breakthrough infections may arise as serious health concerns in the ongoing pandemic.

Government Policies Towards Businesses During Pandemic: Special Reference to MSMEs

Covid-19 pandemic has dealt with an exceptional shock to the global and Indian economy. The economy was already in a parlous state before Covid-19 struck. The prolonged country-wide lockdown disrupted demand & supply chains and led to a downward spiral in world economy. World trade is expected to have fallen between 13% to 32 % in 2020. Therefore, to rescue the economy, governments worldwide have announced impressive fiscal and monetary stimulus packages and brought about widespread changes in their trade and commerce policies. This paper discusses the Indian government's policies and measures during Covid-19 pandemic to overcome the national and international businesses' challenges. In response to the falling economy, the Reserve Bank of India lowered key interest rates, provided support to people regarding aid and subsidies, and implemented the SDGs. It has also revived MSMEs by introducing the 'Atmanirbhar Bharat' (self-reliant India) scheme and provided the Prime Minister's economic relief and stimulus package to combat the challenges imposed by Covid-19.

A Comprehensive Review of Neuromuscular Manifestations of COVID-19 and Management of Pre-Existing Neuromuscular Disorders in Children.

Since the emergence of SARS-CoV-2, several studies have been published describing neuromuscular manifestations of the disease, as well as management of pre-existing pediatric neuromuscular disorders during the COVID-19 pandemic. These disorders include muscular dystrophies, myasthenic syndromes, peripheral nerve disorders, and spinal muscular atrophy. Such patients are a vulnerable population due to frequent complications such as scoliosis, cardiomyopathy, and restrictive lung disease that put them at risk of severe complications of COVID-19. In this review, neuromuscular manifestations of COVID-19 in children and the management of pre-existing pediatric neuromuscular disorders during the COVID-19 pandemic are discussed. We also review strategies to alleviate pandemic-associated disruptions in clinical care and research, including the emerging role of telemedicine and telerehabilitation to address the continued special needs of these patients.