Fate and Transport of Coronavirus Surrogate through Compacted Clays for Pathogenic Waste Disposal.

An increased pathogenic waste post-COVID-19 pandemic forced policymakers to treat biomedical waste (BMW) similar to municipal solid waste (MSW) to dispose into dumpsites and MSW landfills across the globe. The granular bentonite of geosynthetic clay liners (GCLs) does not completely seal the macro-voids upon saturation due to the loss of osmotic potential in the salt environment from the leachate. Such behavior of GCLs can lead to advection-dominant virus migration through the liner system. A knowledge of the fate and transport of coronavirus and other viral pathogens in compacted clays is essential for safe disposal of the viral pathogens in MSW landfills. Although the attenuation and transport parameters for coronavirus have been recently evaluated theoretically, experimental backup is currently lacking. The present work uses Newcastle disease virus (NDV) as a surrogate to coronavirus due to structural similarities for studying the fate and transport in the compacted natural clays. This study also implicitly addresses the waste management facilities for waste generated from NDV outbreaks through poultry litter and carcasses. The interaction of bentonite and kaolin clays with the NDV was studied by varying the virus concentration, interaction time, and clay dose using batch sorption tests. The studied clays showed excellent attenuation efficiency for the NDV. Design parameters, viz., the diffusion coefficient and retardation factor, were evaluated, affirming the suitability of these clays for exclusive pathogenic waste disposal protocols that are discussed in this article.

Takotsubo Cardiomyopathy Triggered by Emotional Stress From the Russia-Ukraine War.

Stress-induced cardiomyopathy presents like acute coronary syndrome and is triggered by emotional stress or critical illness. Increased incidence has been reported during the COVID-19 pandemic and natural disasters. We describe a case of stress-induced cardiomyopathy as an indirect consequence of the Russia-Ukraine war. (Level of Difficulty: Beginner.).

The Impact of COVID-19 on the Clinical Practices, Working Environment, and Social Life of Intensivists in Non-COVID ICU

Purpose Enlightening the changes in the usual clinical practices, working environment, and social life of Intensivists working in noncoronavirus disease intensive care units (non-COVID ICU) during the COVID pandemic. Materials and methods Observational cross-sectional study for Indian intensivists working in non-COVID ICUs conducted between July and September 2021. A 16-question online survey consisting of the work and social profile of the participating intensivists, changes in the usual clinical practices, working environment, and impact on their social life was administered. For the last three sections, intensivists were asked to compare pandemic times to prepandemic times (pre-mid-March 2020). Results The number of invasive interventions performed by intensivists working in the private sector with lesser clinical experience (<12 years) were significantly less as compared to the government sector (p = 0.07) and clinically experienced (p = 0.07). Intensivists without comorbidities performed significantly lesser number of patient examinations (p = 0.03). The cooperation from healthcare workers (HCWs) decreased significantly with lesser experienced intensivists (p = 0.05). Leaves were significantly reduced in case of private sector intensivists (p = 0.06). Lesser experienced intensivists (p = 0.06) and intensivists working in the private sector (p = 0.06) spent significantly lesser time with family. Conclusion Coronavirus disease-2019 (COVID-19) affected the non-COVID ICUs as well. Young and private sector intensivists were affected due to less leaves and family time. HCWs need proper training for better cooperation during the pandemic time. How to cite this article Ghatak T, Singh RK, Kumar A, Patnaik R, Sanjeev OP, Verma A, et al. The Impact of COVID-19 on the Clinical Practices, Working Environment, and Social Life of Intensivists in Non-COVID ICU. Indian J Crit Care Med 2022;26(7):816–824.

An Investigation on Self-Medication Practice During the COVID-19 Pan-demic Among the Indian Population.

BACKGROUND: Self-medication has both negative and beneficial effects on people's health, as the COVID-19 epidemic has demonstrated. The goal of the study is to look into the epidemiology of self-medicated medications used for respiratory symptoms, as a COVID-19 preventive, for its symptoms, or after a positive COVID-19 test, and to see how symptom relief is viewed in India, as well as what demographic factors encourage self-medication. METHODS: Using a trial version of Qualtrics Core XM software to prototype 24 surveys, a web-based questionnaire was built, tested, and disseminated in several Indian states. RESULT: In the survey, 519 candidates participated. 43% of respondents reported that all symptoms were relieved. However, just 39% of all respondents took the government-recommended Ayushkwath, and 56% took a vitamin C tablet to improve immunity. Aspirin, ibuprofen, and azithromycin were shown to be the most commonly used medications for various symptoms, including fever, weariness, cough, sneezing, loose motion, and immune boost, and breathing problems. CONCLUSION: Self-medication was common, with many people taking drugs for which there was lit-tle scientific evidence. The frequency of self-medication was connected to age, region, and employment position.

Radiotherapy in COVID-19: a review

The World Health Organization (WHO) stated the novel coronavirus (COVID-19) a global pandemic on 11th March 2020. The virus-infected patients suffered from a respiratory disease called Severe Acute Respiratory Syndrome Coronavirus 2 (SAR-CoV-2). A proteinaceous exudate, alveolar edema, and hyperplasia associated with monocytes and lymphocytes alveolar inflammatory infiltration was observed in the affected patient's lungs. Virus broadens a systemic inflammatory reaction with a cytokine release syndrome which is characterized with the aid of using unexpected growth in many pro-inflammatory cytokines especially IL-6, IL-1, and TNF-a through activated M1 macrophage phenotype. Virus block IL-6 with tocilizumab and the usage of respirator device appears to be very vital. Radioactivity is the process by which unstable atomic nucleus losses energy by radiation, mainly using alpha, beta, and gamma rays. SARS-CoV-2 affected lungs can be treated by a low dose of radiotherapy. It was found that minute dose chest radiation therapy can be able to wean patients off a ventilator as it can reduce inflammation inside the lungs of severely infected COVID-19 patients. Numerous such clinical trials are underway and researchers may work to cure the COVID-19 lung infections by radiotherapy.

Hemodynamically-Guided Management of Heart Failure Across the Ejection Fraction Spectrum: The GUIDE-HF Trial.

BACKGROUND: Hemodynamically-guided management using an implanted pulmonary artery pressure sensor is indicated to reduce heart failure (HF) hospitalizations in patients with New York Heart Association (NYHA) functional class II-III with a prior HF hospitalization or those with elevated natriuretic peptides. OBJECTIVES: The authors sought to evaluate the effect of left ventricular ejection fraction (EF) on treatment outcomes in the GUIDE-HF (Hemodynamic-GUIDEd management of Heart Failure) randomized trial. METHODS: The GUIDE-HF randomized arm included 1,000 NYHA functional class II-IV patients (with HF hospitalization within the prior 12 months or elevated natriuretic peptides adjusted for EF and body mass index) implanted with a pulmonary artery pressure sensor, randomized 1:1 to a hemodynamically-guided management group (treatment) or a control group (control). The primary endpoint was the composite of HF hospitalizations, urgent HF visits, and all-cause mortality at 12 months. The authors assessed outcomes by EF in guideline-defined subgroups ≤40%, 41%-49%, and ≥50%, within the trial specified pre-COVID-19 period cohort. RESULTS: There were 177 primary events (0.553/patient-year) in the treatment group and 224 events (0.682/patient-year) in the control group (HR: 0.81 [95% CI: 0.66-1.00]; P = 0.049); HF hospitalization was lower in the treatment vs control group (HR: 0.72 [95% CI: 0.57-0.92]; P = 0.0072). Within each EF subgroup, primary endpoint and HF hospitalization rates were lower in the treatment group (HR <1.0 across the EF spectrum). Event rate reduction by EF in the treatment groups was correlated with reduction in pulmonary artery pressures and medication changes. CONCLUSIONS: Hemodynamically-guided HF management decreases HF-related endpoints across the EF spectrum in an expanded patient population of patients with HF. (Hemodynamic-GUIDEd Management of Heart Failure [GUIDE-HF]; NCT03387813).

Energy- efficient model "Inception V3 based on deep convolutional neural network” using cloud platform for detection of COVID-19 infected patients

COVID-19 is frightening the health of billions of persons and speedily scattering worldwide. Medical studies have revealed that the majority of COVID-19 patients. X-ray of COVID-19 is extensively used because of their noticeably lower price than CT. This research article aims to spot the COVID-19 virus in the X-ray of the chest in less time and with better accuracy.We have used the inception-v3 available on the cloud platform transfer learning model to classify COVID-19 infection. The online Inception v3 model can be reliable and efficient for COVID-19 disease recognition. In this experiment, we collected images of COVID-19-infected patients, then applied the online inception-v3 model to automatically extract features, and used a softmax classifier to classify the COVID-19 images. Finally, the experiment shows inception v3 is significant for COVID-19 image classification.Our results demonstrate that our proposed inception v3 model available on the cloud platform can detect 99.41% of COVID-19 cases between COVID-19 and Lung Mask diseases in 44 min only. We have also taken images of the normal chest for better outcomes. To estimate the computation power of the model, we collected 6018 COVID-19, Lung Masks, & Normal Chest images for experimentation. Our projected model offered a trustworthy COVID-19 classification by using chest X-rays.In this research paper, the inception v3 model available on the cloud platform is used to categorize COVID-19 infection by X-ray images. The Inception v3 model available on the cloud platform is helpful to clinical experts to examine the enormous quantity of human chest X-ray images. Scientific and clinical experiments will be the subsequent objective of this paper.

Prophylactic treatment of Glycyrrhiza glabra mitigates COVID-19 pathology through inhibition of pro-inflammatory cytokines in the hamster model and NETosis.

Severe coronavirus disease (COVID-19) is accompanied by acute respiratory distress syndrome and pulmonary pathology, and is presented mostly with an inflammatory cytokine release, a dysregulated immune response, a skewed neutrophil/lymphocyte ratio, and a hypercoagulable state. Though vaccinations have proved effective in reducing the COVID-19-related mortality, the limitation of the use of vaccine against immunocompromised individuals, those with comorbidity, and emerging variants remains a concern. In the current study, we investigate for the first time the efficacy of the Glycyrrhiza glabra (GG) extract, a potent immunomodulator, against SARS-CoV-2 infection in hamsters. Prophylactic treatment with GG showed protection against loss in body weight and a 35%-40% decrease in lung viral load along with reduced lung pathology in the hamster model. Remarkably, GG reduced the mRNA expression of pro-inflammatory cytokines and plasminogen activator inhibitor-1 (PAI-1). In vitro, GG acted as a potent immunomodulator by reducing Th2 and Th17 differentiation and IL-4 and IL-17A cytokine production. In addition, GG also showed robust potential to suppress ROS, mtROS, and NET generation in a concentration-dependent manner in both human polymorphonuclear neutrophils (PMNs) and murine bone marrow-derived neutrophils (BMDNs). Taken together, we provide evidence for the protective efficacy of GG against COVID-19 and its putative mechanistic insight through its immunomodulatory properties. Our study provides the proof of concept for GG efficacy against SARS-CoV-2 using a hamster model and opens the path for further studies aimed at identifying the active ingredients of GG and its efficacy in COVID-19 clinical cases.

An Update on Complications Associated with SARS-CoV-2 Infection and COVID-19 Vaccination.

Over the past two years, SARS-CoV-2 has dramatically spread worldwide and emerged as a major pandemic which has left an unprecedented mark on healthcare systems and economies worldwide. As our understanding of the virus and its epidemiology continues to grow, the acute phase clinical symptoms and long-term and vaccine-related complications are becoming more apparent. With heterogeneity in presentations, comparisons may be drawn between COVID-19-related sequelae and vaccination related adverse events. The present review article aims to address the currently available literature on the SARS-CoV-2 virus, immune responses, the pathophysiology of clinical presentations, and available vaccinations with its adverse events for the appraisal of its potential impact on the COVID-19 management system.

Prophylactic treatment of Glycyrrhiza glabra mitigates COVID-19 pathology through inhibition of pro-inflammatory cytokines in the hamster model and NETosis

Severe coronavirus disease (COVID-19) is accompanied by acute respiratory distress syndrome and pulmonary pathology, and is presented mostly with an inflammatory cytokine release, a dysregulated immune response, a skewed neutrophil/lymphocyte ratio, and a hypercoagulable state. Though vaccinations have proved effective in reducing the COVID-19-related mortality, the limitation of the use of vaccine against immunocompromised individuals, those with comorbidity, and emerging variants remains a concern. In the current study, we investigate for the first time the efficacy of the Glycyrrhiza glabra (GG) extract, a potent immunomodulator, against SARS-CoV-2 infection in hamsters. Prophylactic treatment with GG showed protection against loss in body weight and a 35%–40% decrease in lung viral load along with reduced lung pathology in the hamster model. Remarkably, GG reduced the mRNA expression of pro-inflammatory cytokines and plasminogen activator inhibitor-1 (PAI-1). In vitro, GG acted as a potent immunomodulator by reducing Th2 and Th17 differentiation and IL-4 and IL-17A cytokine production. In addition, GG also showed robust potential to suppress ROS, mtROS, and NET generation in a concentration-dependent manner in both human polymorphonuclear neutrophils (PMNs) and murine bone marrow-derived neutrophils (BMDNs). Taken together, we provide evidence for the protective efficacy of GG against COVID-19 and its putative mechanistic insight through its immunomodulatory properties. Our study provides the proof of concept for GG efficacy against SARS-CoV-2 using a hamster model and opens the path for further studies aimed at identifying the active ingredients of GG and its efficacy in COVID-19 clinical cases.

A review of the role of graphene-based nanomaterials in tackling challenges posed by the COVID-19 pandemic

In 2020, the World Health Organization (WHO) declared a pandemic due to the emergence of the coronavirus disease (COVID-19) which was resulted by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Significant efforts have been devoted by many countries to develop more advanced medicines and vaccines. However, along with these developments, it is also extremely essential to design effective systems by incorporating smart materials to battle the COVID-19. Therefore, several approaches have been implemented to combat against COVID-19. Recently, due to its superior physicochemical properties along with other fascinating properties, graphene-based materials have been explored for the current COVID-19 and future pandemics. Therefore, in this review article, we discuss the recent progress and the most promising strategies related to graphene and related materials and its applications for detection, decontamination, diagnosis, and protection against COVID-19. In addition, the key challenges and future directives are discussed in detail for fundamental design and development of technologies based on graphene and its related materials and lastly, our personal opinions on the appropriate approaches to improve these technologies respectively.

Insight towards the effect of the multi basic cleavage site of SARS-CoV-2 spike protein on cellular proteases.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presents an immense global health problem. Spike (S) protein of coronavirus is the primary determinant of its entry into the host as it consists of both receptor binding and fusion domain. Besides tissue tropism, and host range, coronavirus pathogenesis are primarily controlled by the interaction of S protein with the cell receptor. Moreover, the proteolytic activation of S protein by host cell proteases plays a decisive role. The host-cell proteases have shown to be involved in the proteolysis of S protein and cleaving it into two functional subunits, S1 and S2, during the maturation process. In the present study, the interaction of the S protein of SARS-CoV-2 with different host proteases like furin, cathepsin B, and plasmin has been analyzed using molecular docking and molecular dynamics (MD) simulation. Incorporation of the furin cleavage site (R-R-A-R) in the S protein of SARS-CoV-2 has been studied by mutating the individual amino acid. MD simulation results suggest the polytropic nature of the S protein. Our analysis indicated that a single amino acid substitution in the polybasic cleavage site of S protein perturb the binding of cellular proteases. This mutation study might help to generate an attenuated SARS-CoV-2. Besides, targeting host proteases by inhibitors may result in a practical approach to stop the cellular spread of SARS-CoV-2 and develop its antiviral.

The Impact of COVID-19 on the Clinical Practices, Working Environment, and Social Life of Intensivists in Non-COVID ICU.

Purpose: Enlightening the changes in the usual clinical practices, working environment, and social life of Intensivists working in noncoronavirus disease intensive care units (non-COVID ICU) during the COVID pandemic. Materials and methods: Observational cross-sectional study for Indian intensivists working in non-COVID ICUs conducted between July and September 2021. A 16-question online survey consisting of the work and social profile of the participating intensivists, changes in the usual clinical practices, working environment, and impact on their social life was administered. For the last three sections, intensivists were asked to compare pandemic times to prepandemic times (pre-mid-March 2020). Results: The number of invasive interventions performed by intensivists working in the private sector with lesser clinical experience (<12 years) were significantly less as compared to the government sector (p = 0.07) and clinically experienced (p = 0.07). Intensivists without comorbidities performed significantly lesser number of patient examinations (p = 0.03). The cooperation from healthcare workers (HCWs) decreased significantly with lesser experienced intensivists (p = 0.05). Leaves were significantly reduced in case of private sector intensivists (p = 0.06). Lesser experienced intensivists (p = 0.06) and intensivists working in the private sector (p = 0.06) spent significantly lesser time with family. Conclusion: Coronavirus disease-2019 (COVID-19) affected the non-COVID ICUs as well. Young and private sector intensivists were affected due to less leaves and family time. HCWs need proper training for better cooperation during the pandemic time. How to cite this article: Ghatak T, Singh RK, Kumar A, Patnaik R, Sanjeev OP, Verma A, et al. The Impact of COVID-19 on the Clinical Practices, Working Environment, and Social Life of Intensivists in Non-COVID ICU. Indian J Crit Care Med 2022;26(7):816-824.

Cardiac Thromboembolism in COVID-19: A Case Series.

Venous thromboembolism (VTE) is a very common complication of coronavirus disease-2019 (COVID-19) because of the acquired hypercoagulability in these patients. Cardiovascular thromboembolism (CTE) is another complication that is relatively rare yet catastrophic. We present two cases of COVID-19 which were complicated by CTE. Case one describes a 55-year-old male with COVID-19 who had an ST-segment elevation myocardial infarction (STEMI) secondary to coronary artery embolism and was also found to have biventricular thrombi (BVT). Case two describes a 65-year-old female presenting with STEMI secondary to coronary artery embolism. This document highlights how CTE can be present in COVID-19 patients and describes the available evidence for its management. Given the paucity of data on these complications, we illustrate the offered treatment which was based on the data extrapolated from the treatment of VTE in COVID-19 and the treatment of CTE in non-COVID-19 patients.

LiteCovidNet: A lightweight deep neural network model for detection of COVID-19 using X-ray images.

The syndrome called COVID-19 which was firstly spread in Wuhan, China has already been declared a globally "Pandemic." To stymie the further spread of the virus at an early stage, detection needs to be done. Artificial Intelligence-based deep learning models have gained much popularity in the detection of many diseases within the confines of biomedical sciences. In this paper, a deep neural network-based "LiteCovidNet" model is proposed that detects COVID-19 cases as the binary class (COVID-19, Normal) and the multi-class (COVID-19, Normal, Pneumonia) bifurcated based on chest X-ray images of the infected persons. An accuracy of 100% and 98.82% is achieved for binary and multi-class classification respectively which is competitive performance as compared to the other recent related studies. Hence, our methodology can be used by health professionals to validate the detection of COVID-19 infected patients at an early stage with convenient cost and better accuracy.

Biomechanical Dependence of SARS-CoV-2 Infections.

Older people have been disproportionately vulnerable to the current SARS-CoV-2 pandemic, with an increased risk of severe complications and death compared to other age groups. A mix of underlying factors has been speculated to give rise to this differential infection outcome including changes in lung physiology, weakened immunity, and severe immune response. Our study focuses on the impact of biomechanical changes in lungs that occur as individuals age, that is, the stiffening of the lung parenchyma and increased matrix fiber density. We used hydrogels with an elastic modulus of 0.2 and 50 kPa and conventional tissue culture surfaces to investigate how infection rate changes with parenchymal tissue stiffness in lung epithelial cells challenged with SARS-CoV-2 Spike (S) protein pseudotyped lentiviruses. Further, we employed electrospun fiber matrices to isolate the effect of matrix density. Given the recent data highlighting the importance of alternative virulent strains, we included both the native strain identified in early 2020 and an early S protein variant (D614G) that was shown to increase the viral infectivity markedly. Our results show that cells on softer and sparser scaffolds, closer resembling younger lungs, exhibit higher infection rates by the WT and D614G variant. This suggests that natural changes in lung biomechanics do not increase the propensity for SARS-CoV-2 infection and that other factors, such as a weaker immune system, may contribute to increased disease burden in the elderly.

Reviving the mutual impact of SARS-COV-2 and obesity on patients: From morbidity to mortality.

Obesity-related metabolic dysfunction, endothelium imbalance, chronic inflammation, immune dysregulation, and its comorbidities may all have a role in systemic inflammation, leading to the pulmonary fibrosis and cytokine storm, which leads to failure of lung function, which is a hallmark of severe SARS-CoV-2 infection. Obesity may also disrupt the function of mucociliary escalators and cooperation of epithelial cell's motile cilia in the airway, limiting the clearance of the coronavirus that causes severe acute respiratory syndrome (SARS-CoV-2). Adipose tissues in obese patients have a greater number of proteases and receptors for SARS-CoV-2 admittance, proposing that they could serve as an accelerator and reservoir for this virus, boosting immunological response and systemic inflammation. Lastly, anti-inflammatory cytokines such as anti-IL-6 and the infusion of mesenchymal stem cells could be used as a modulation therapy of immunity to help COVID-19 patients. Obesity, on the other hand, is linked to the progress of COVID-19 through a variety of molecular pathways, and obese people are part of the SARS-CoV-2 susceptible individuals, necessitating more protective measures.

A multicenter survey study of antifibrotic use for symptomatic patients with post-COVID-19 interstitial lung abnormalities.

Background: Little data exist on antifibrotic drugs for treating symptomatic patients with persistent interstitial lung abnormalities in the postacute phase of coronavirus disease 2019 (COVID-19). Herein, we describe the physician practices of prescribing pirfenidone and nintedanib for these patients and the physician-assessed response. Materials and Methods: This was a multicenter, retrospective survey study of subjects administered pirfenidone or nintedanib for post-COVID-19 interstitial lung abnormalities. Data on the demographic details, comorbidities, abnormalities on the computed tomography (CT) of the chest, treatment, antifibrotic drug use, and physician-assessed response were collected on a standard case record pro forma. We explored physician practices of prescribing antifibrotics (primary objective) and the physician-assessed response (secondary objective). Results: We included 142 subjects (mean age, 55.9 years; 16.2% women) at eight centers. The most common abnormalities on CT chest included ground glass opacities (75.7%), consolidation (49.5%), reticulation (43.9%), and parenchymal bands (16.8%). Of the 5701 patients discharged after hospitalization at six centers, 115 (2.0%) received antifibrotics. The drugs were prescribed an average of 26 days after symptom onset. One hundred and sixteen subjects were administered pirfenidone; 11 (9.5%) received the full dose (2400 mg/day). Thirty subjects were prescribed nintedanib; 23 (76.7%) received the full dose (300 mg/day). Of 76 subjects with available information, 27 (35.6%) and 26 (34.2%) had significant or partial radiologic improvement, respectively, according to the physician's assessment. Conclusions: Antifibrotic agents were administered to a minority of patients discharged after recovery from acute COVID-19 pneumonia. Larger, randomized studies on the efficacy and safety of these agents are required.