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Background: Chronic cardiovascular morbidities are major public health concern. The objective was to assess awareness and practice of selfcare activities among patients with chronic cardiovascular morbidity in Burdwan Medical College (BMC) and to explore constraints in selfcare practice. Materials & Methods: A facility-based, explanatory sequential, mixed-method study was conducted in Cardiology super-specialty outpatient department of BMC, West Bengal. A calculated sample of 185 patients with chronic cardiovascular morbidity were selected randomly;interviewed with predesigned, pretested schedule (adapted from H-SCALE) for quantitative component. For qualitative component, eight study participants, selected purposively, were interviewed with In-depth-interview guide. Multivariable logistic regression was done to find out predictors of selfcare practice. Thematic inductive analysis was done to explore constraints. Results: 73% study participants were aware about overall selfcare practices;43.8% performed satisfactory overall selfcare practice. Below secondary level educational status [AOR:0.412, 95% CI (0.178-0.956)] and lower & lower-middle socioeconomic status [AOR:0.063, 95% CI (0.017-0.230)] were found to create negative influence on favourable self-care practice. Thematic analysis revealed false belief, lack of motivation, lack of proper knowledge, emotional disturbances and Covid-19 pandemic impact as major constraints in selfcare practice. Conclusion: Selfcare awareness & practice both are low. Interventions are needed to ensure healthy lifestyle of patients. © 2023 National Journal of Community Medicine.
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With COVID-19 paralyzing street food businesses, street food vendors are trying to sustain their operations. The current study helps them by identifying the importance of five prominent stimuli viz. authenticity, quality, staff-service, ambience, and value for money in developing desire for street food in individuals in India. Furthermore, the study contributes by identifying the role of street food nostalgia (as a mediator) and perceived risk of COVID-19, age, and gender (as moderators) on the direct impact of each stimulus on the desire for street food. The study uses partial least squares path modelling to validate the hypotheses using SmartPLS. The findings are comparable to other developing Asian countries, as the proposed associations are validated with perceptual responses from three prominent cities and well-known street food destinations in India. The study showed the relative importance of the five-stimuli based on the stimulus-organism-response framework in developing a desire for street food. The findings suggest partial to complete mediation of street food nostalgia across the three samples. Lastly, the perceived risk of COVID-19 along with age and gender emerged as prominent moderators for many of the direct effects of stimuli on desires for street food. © 2023 Informa UK Limited, trading as Taylor & Francis Group.
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Macrofungi are diverse in their uses as good source of protein in our diet, nutraceuticals, cosmeceuticals medicine, and for making beautiful art pieces. Several species serve as decomposers and many form mycorrhizal associations with plants. The commercial cultivation of several macrofungi has been steadily increasing globally. Cultivation of Cordyceps militaris can be done in a variety of media including silkworm pupae, rice, or liquid nutrition. Macrofungi are diverse with complex and highly varied growth conditions and bioactive constituents, most macro-fungal resources have not yet been fully explored and implicated, leading to an urgent need for appropriate strategies to address the problem. Increasing attention has been paid to the cultivation and application, of these fungi as potential probiotics. The accumulated secondary metabolites in medicinal mushrooms have been widely accepted as sources of safe and effective nutraceuticals, cosmeceuticals, and pharmaceuticals. Various mushrooms are utilized as foods appreciated for their exquisite flavour and are used extensively for their medicinal properties. Recently, we saw how an invisibly small entity an ultramicroscopic virus created a turmoil in dynamic ecosystem of the planet Earth and caused the human societies to grind to a halt. Of course, human lives have pivoted around the metabolic ingenuity of fungi for a long time and these organisms can still be the tools to learn the intricacies of life, their mutualistic behaviour with other organisms and potential to produce a large number of secondary metabolites useful to fight diseases and providing good memory and better health are our present day concerns. Entangled body of tubes can teach the lessons of human survival in this crucial time of Corona pandemic. These macrofungi could modulate immune cell's response and possess antimicrobial, antioxidants, and anticancer properties. In Western Ghats as well as Himalayan mountain ranges of India, the lush green vegetation supports a variety of naturally occurring macrofungi. Brief details of some of the well-known fungi found in India, Macedonia, and other parts of the world are highlighted in this chapter. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.
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Recently the Coronavirus disease-2019 (COVID-19) has affected the public throughout the world and has become a severe risk to human being. COVID-19 is a growing communicable disease and has caused major mortality and morbidity beside socioeconomic damage. No successful treatment has been accepted for this type of pandemic disease. In this situation nanotechnology has been very much helpful in preclinical studies for different types of pathogens of diseases like respiratory viruses, herpes virus, human papillomavirus, and HIV. Therefore nanoparticles have been of interest for the management of COVID-19 disease due to their small and distinctive properties, like simple preparation, low cost, easy modification, and appropriate size. For COVID-19 disease, nanotechnology-based management comprises the development of tools for exact, speedy, and responsive diagnosis, the manufacture of efficient disinfectants, and the delivery of vaccines and antiviral drugs into the human body. In this review the main object is to recommend some approaches to design and produce successful diagnostic and beneficial drugs against COVID-19 with the help of nanotechnology. This review mainly focuses on COVID-19 prevention, diagnosis, and therapy. Molecular nanotechnology is a provisional field of nanotechnology investigating the opportunity of industrial molecular assembly machinery that can rearrange substances at a molecular or atomic level. Nanomedicine is the application of these nanorobots, introduced into the body, to identify viruses. Molecular nanotechnology is extremely hypothetical, anticipating what innovations nanotechnology may yield and the programs offered for the investigation of COVID-19. © 2023 Elsevier Inc. All rights reserved.
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In this paper, we propose a seven compartmental model based on ordinary differential equations (ODEs) to understand the importance of non-pharmaceutical interventions and pharmaceutical protocols. The boundedness and non-negativity of solutions of the model are discussed to ensure the feasibility of solutions of the model. To classify epidemic and endemic cases of the model, we determine the basic reproduction number. Local stability analysis of the non-negative equilibria is performed to gather a dependency of all compartmental populations on time. It is inspected that social awareness parameter controls the symptomatic and asymptomatic populations. It is also found that restrictions on public gathering reduce the transmission of novel coronavirus effectively. Furthermore, the recovery of the COVID-19 infected people is significantly increased when proper medication and adequate clinical support are arranged immediately. Finally, numerical results demonstrate that transmission of novel coronavirus can be prevented and regulated in a densely populated country like Bangladesh when COVID-19 health rules are strictly followed and movement of infected people is minimized as non-pharmaceutical strategies. Apart from non-pharmaceutical interference, medication during quarantine and sufficient clinical support play a pivotal role to minimize the demise of COVID-19 infected people once they are infected © 2023 L&H Scientific Publishing, LLC. All rights reserved
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The worldwide health crisis is caused by the widespread of the Covid-19 virus. The virus is transmitted through droplet infection and it causes the common cold, coughing, sneezing, and also respiratory distress in the infected person and sometimes becomes fatal causing death. As the world battles against covid-19, the proposed approach can help to contain the clustering of covid hotspot areas for the treatment of over a million affected patients. Drones/ Unmanned Aerial Vehicles (UAVs) offer a great deal of support in this pandemic. As suggested in this research, they can also be used to get to remote places more quickly and efficiently than with conventional means. In the hospital's control room, there would be a person in command of the ambulance drone. For hotspot area detection, the drone would be equipped with FLIR camera and for detection and recognition of face the video transmission is used by raspberry pi camera. The detection of face is done by Haar cascade Classifier and recognition of the face with LBPH algorithm. This is used for identify the each individual's medical history or can be verified by Aadhar Card. Face recognition between still and video photos was compared, and the average accuracy of still and video images was 99.8 percent and 99.57 percent, respectively. To find the hotspot area is to use the CNN Crowd counting algorithm. If the threshold value is less than equal to 0.5 than it is hotspot area , if it is greater than 0.5 and less than equal to 0.75 than it is semi-normal area , if it is greater than 0.75 and less than equal to 1 than it is normal area. © 2022 IEEE.
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Many regions of the world are now facing the second wave of boomed cases of COVID-19. This time, the second wave of this highly infectious disease (COVID-19) is becoming more devastating. To control the existing situation, more mass testing, and tracing of COVID-19 positive individuals are required. Furthermore, practicing to wear a face mask and maintenance of physical distancing are strongly recommended for everyone. Taking all these into consideration, an optimal control problem has been reformulated in terms of nonlinear ordinary differential equations in this paper. The aim of this study is to explore the control strategy of coronavirus-2 disease (COVID-19) and thus, minimize the number of symptomatic, asymptomatic and infected individuals as well as cost of the controls measures. The optimal control model has been analyzed analytically with the help of the necessary conditions of very well-known Pontryagin's maximum principle. Numerical simulations of the optimal control problem are also performed to illustrate the results.
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Objectives: To review transformation in the Govt. Policy and regulation accelerating product licensing for supporting timely Covid-19 vaccines in India. Method(s): Govt. policy for approval of vaccines and amendments of Drug regulations were studied during 1st January 2019 to 31st December 2021 were studied referring websites of Dept. of Health & Family Welfare, Govt. of India and website of CDSCO and analyzed. Result(s): Change in Government policies and amendment of Drug Rules in India have given opportunities for improving access to medicines and vaccines. The newly introduced New Drugs and Clinical Trial Rules have provisions to market drugs and vaccines without local clinical trials if, the new drug is approved and marketed in countries specified by the Central Licencing Authority (CLA) subject to some conditions. Thereafter CDSCO has published a guideline in this matter and the process of approving new vaccines becomes easier. This guidelines stated that no local clinical trials are required if a vaccine for Covid-19 already approved by USFDA, MHRA, PDMA Japan and listed by WHO for emergency use for Covid-19. These two steps helps quick approval for emergency use of vaccines already approved by CDSCO approved countries. Using these provisions Covid -19 vaccines developed by Moderna in US already got approval for import by an Indian company and hope that some more vaccines will be available in India in future using these provisions. Indian legislation allowed to conduct different phases of Clinical trials simultaneously resulting development of cost effective Covid-19 vaccines in shorter time. Conclusion(s): These proactive regulatory steps helped Indian manufacturers to develop Covid-19 vaccines in a record time and made it available in global market. These provisions also facilitated Covid -19 vaccines developed and marketed in developed market available in India. Copyright © 2022
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The vulnerability of human health is amplified in recent times with global increase in non-communicable diseases (due to lifestyle changes and environmental insults) and infectious diseases (caused by newer pathogens and drug-resistance strains). Clinical management of diseases is further complicated by disease severity caused by other comorbid factors. Drug-based therapy may not be the sole approach, particularly in scenarios like the COVID-19 pandemic, where there is no specific drug against SARS-CoV-2. Nutritional interventions are significant in armouring human populations in disease prevention, and as adjunctive therapy for disease alleviation. Amidst ongoing clinical trials to determine the efficacy of Vit. D against infections and associated complications, this review examines the pleiotropic benefits of nutritional adequacy of vitamin D (Vit. D) in combating viral infections (COVID-19), its severity and complications due to co-morbidities (obesity, diabetes, stroke and Kawasaki disease), based on research findings and clinical studies. Supplements of Vit. D in combination with other nutrients, and drugs, are suggested as promising preventive-health and adjunct-treatment strategies in the clinical management of viral infections with metabolic comorbidities. © 2022 The Authors
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Background: Resistance to antibiotics is rising markedly. Factor which contributes to resistance is the rampant irrational use of antibiotics. The trend of prescribing antibiotics in intensive care units (ICUs) of eastern India is less explored. Aims and Objectives: The aim of the study was to describe and analyze the utilization of antibiotics as per the WHO/INRUD prescribing core indicators in an intensive and critical care unit (CCU) of a tertiary center in eastern India. Material(s) and Method(s): A prospective observational study was carried out on prescription pattern of antibiotics. Case records of patients with restricted antibiotic therapy were reviewed and evaluated using descriptive statistics. A total of 353 prescriptions were evaluated and analyzed. Result(s): Among the total 353 patients most common age group admitted was 41-60 years. Males were more in numbers. Myocardial infarction and post-operative complications were the most common cause of admission in ICU and CCU, respectively. Ceftriaxone (44%) and meropenem (37%) were the drugs used rampantly in ICU and CCU. More than 90% of prescriptions had injections and drugs were written in generic names. Almost 90% of patients in CCU had antibiotics in their prescription. Adverse events occurred in 14.7% of patients and thrombophlebitis was the most common adverse event occurred. Conclusion(s): The study has given us an overall impression of the antibiotics usage pattern in ICU and CCU of this teaching institution. The study has shown that antibiotics should be used judiciously in ICU and CCU. Policy can be made on the basis of the result of this study. Copyright © 2022 Pratap Chatterjee, et al.
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Covid-19 has had a significant impact on the real estate sector the world over. The significance of real estate to the Indian economy is substantial - both, in terms of GDP contribution and employment generation. As a supplier of both commercial and residential infrastructure, real estate acts as a fulcrum for growth and enables holistic socio-economic development. This paper studies the extent of the impact of Covid-19 on the Indian real estate sector, and evaluates the response to the challenges on the part of Real Estate Regulatory Authorities (RERAs) and other agencies in the real estate regulatory framework. Using primary data from a survey covering 257 respondents from 16 states, and secondary data from surveys conducted in two separate waves of Covid-19 - one by Anarock and another by the Confederation of Real Estate Developers' Associations of India - better insights are obtained. Notifications issued by RERAs and Ministries, RBI directives, representations made by various stakeholder associations, and a focus group discussion of experts and professionals are other in-puts used in the analysis of the regulatory response. The data indicate that the effect of Covid-19 on real estate has been severe, with the severity getting compounded after the second wave. The stress extends to all stakeholders in the real estate ecosystem. The measures announced by various regulatory agencies are considered inadequate by developers, who have argued for a more robust response, including GST and other fiscal changes. Experts recommend amendments to the RERA Act, as well as the use of technology and innovation for long-term adjustment.
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Mask wearing has become critical for preventing the aerosolization and inhalation of virus-laden particles during the ongoing COVID-19 global pandemic. However, facial masks with effective filtration are either not readily accessible (e.g., N95) or have reduced filtration efficiency due to air gaps between the mask and wearer (e.g., cloth masks). We have developed a novel combination of a mask and shield named Mask And Shield Integrated (MASI) that provides nearly the same levels of protection as an N95 mask by addressing these issues. Magnetic latches reduce gaps between the mask and wearer, while a novel fin structure on the shield provides protection against floating particles. A series of experiments was performed to study MASI’s efficacy in both eliminating mask gaps and also providing N95-like filtration efficiency. MASI was found to solve both problems, thus providing a low-cost mask solution that can be applied to a broad range of environments to prevent inhalation of small air-borne particles. IEEE
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SESSION TITLE: Lung Cancer Assessment and Risk Calculations SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Detection of pulmonary nodules is central to early diagnosis of lung cancer. Many types of observer error have been reported in literature. During the pandemic the radiology departments were stretched, and it is possible that the radiologists were primarily looking to either confirm or rule out COVID and missed nodules due to satisfaction of search and fatigue. This study was undertaken to estimate the magnitude of such errors. METHOD: 1312 consecutive chest CT scans interpreted in two specialist radiology units during the months of May-Jun 2021 (peak of India's 2nd covid wave) were used in this study. All scans were processed by qCT-Lung, a deep learning algorithm capable of flagging nodules. The radiology reports of the cases flagged by qCT were searched for findings suggestive of lung cancer. Cases for which nodules or mass were not mentioned in the report were re-read by an independent radiologist with qCT's assistance. The radiologist was aware of the context and was asked to mark flagged lesions as Yes/no for nodules. They also rated the nodule for malignancy potential in a positive directed five-point Likert scale if the flag was correct and gave an alternative finding if incorrect. RESULTS: 381 (29.0%) scans were flagged for nodules by qCT. 52 of these were also reported in radiology reports. Of the 329 scans re-read by radiologist, 65 (19.8 %) scans were reported as having nodules. These 65 scans had a total of 134 nodules. The median size (longest diameter) of these nodules was 14 mm (range: 7 - 33) and most (95) were solid nodules. The most common reason (94.5%) of false flag by qCT was ground-glass opacity with consolidation. 53 of 65 of the correctly identified scans were given malignancy rating of 1 or 2 (non-malignant or probably non-malignant). 10 were given a rating of 3 (could be malignant or non-malignant) and 2 were rated as probably malignant. Two cases of lung cancers were flagged by both qCT and reports. CONCLUSIONS: Nodules were not reported in 65 scans. All of them can't be considered as missed by radiologists. From the ratings provided by the radiologist doing re-reads - it is possible that previous radiologists could have not reported the nodule due to perceived malignancy risk. 12 scans had ratings that would have warranted follow-up action. False flags were mainly due to ground glass with consolidation. The occurrence of ground glass opacities in COVID could in part explain the high number of false flags in this study. CLINICAL IMPLICATIONS: All scans had nodules with size > 6 mm and 26 had multiple nodules making the patients eligible for follow-up as per Fleischner guideline. Radiologist report only clinically significant findings focussing mostly on indication(s) of the scan. Taking a conservative approach and reporting all nodules irrespective of perceived risk will help clinicians plan follow-up. Algorithms like qCT-Lung can help readers in identifying all nodules. DISCLOSURES: Employee relationship with Qure.ai Please note: 15/12/2020 Added 04/04/2022 by Vikash Challa, value=Salary Removed 04/04/2022 by Vikash Challa Employee relationship with Qure.ai Please note: Current employee Added 04/04/2022 by Vikash Challa, value=Salary Owner/Founder relationship with bodyScans Please note: Current co-founder Added 04/05/2022 by Era Dwivedi, value=Salary Employee relationship with Aarthi Scans and Labs Please note: Current Employee Added 04/04/2022 by Arunkumar Govindarajan, value=Salary Owner/Founder relationship with bodyScans Please note: Current Director Added 04/05/2022 by Arpit Kothari, value=Salary Employee relationship with Qure.ai Please note: Current employee Added 04/04/2022 by Souvik Mandal, value=Salary Employee relationship with Qure.ai Please note: Current employee Added 04/04/2022 by Ankit Modi, value=Salary Self relationship with Qure.ai Please note: Current employee Added 04/04/2022 by SAI NAREN V S, value=Salary Employee elationship with Qure AI Please note: Current Employee Added 04/04/2022 by Vanapalli Prakash, value=Salary Employee relationship with Qure.ai Please note: Current employee Added 04/07/2022 by Preetham Putha, value=Salary Employee relationship with Qure.ai Please note: 4 years Added 04/04/2022 by Bhargava Reddy, value=Salary Employee relationship with Qure.ai Please note: Current Employee Added 03/27/2022 by Saigopal Sathyamurthy, value=Salary Owner/Founder relationship with Qure.ai Please note: Current co-founder Added 04/04/2022 by Prashant Warier, value=Salary
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SESSION TITLE: Respiratory Care: Oxygen, Rehabilitation, and Inhalers SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Background More than 1.5 million Americans live with supplemental oxygen that improves quality of life in adults living with chronic lung disease. After hospitalization for serious illness such as pneumonia (especially COVID), heart failure, COPD exacerbation or other lung disease, patients are discharged on supplemental oxygen. Hypoxemia often resolves after recovery from the illness and supplemental oxygen is no longer needed. As a part of “Choosing Wisely” campaign from ABIM, ATS/ACCP recommends “For patients recently discharged on supplemental home oxygen following hospitalization for an acute illness, don’t renew the prescription without assessing the patient for ongoing hypoxemia within 90 days after discharge. Objectives The primary objective of the study is to improve home oxygen reassessment after discharge from the hospital. METHODS: Study Design Subjects will be identified by electronic medical records (EMR) report and will include data from the 1st of January 2021 to 30th June 2021 (period of 6 months) Inclusion Criteria Subjects 18 years and older who were discharged from the RPH on supplemental oxygen Exclusion: Subjects 18 years and older on oxygen for palliation and hospice Study Outcomes The primary outcome measure will be assessed as percent of patients in whom oxygen requirement reassessed and percent in whom oxygen requirement was not reassessed. The secondary outcome measure will be assessed as percent of patients who had PCP follow up and percent of patients on continuous oxygen without reassessment Quality improvement PDSA: Phase I: pre-intervention data Phase II: Intervention-> education session to the providers and new epic order inclusion (BPA for reassessment and discontinuation) Phase III: post-intervention survey RESULTS: Based on chart review, 155 patients qualified for the study criteria. Among 155 patients, regarding the primary outcome-> 63 patients (40.6%) 90 days oxygen reassessment was done, 64 patients (41.2%) oxygen reassessment was not done, 10 patients (6%) died within the 90 days reassessment period and 19 patients were 90 days reassessment was not applicable (12%- 19 patients-on long term oxygen). Regarding the secondary outcomes, 113 patients (72.9%) were followed up with PCP, 16 patients (10.3%) did not have follow up, 19 patients (12.2%- no information available) had outside PCP follow up, 7 patients (4.5%- 2 died on same admission, 5 opted for hospice). Regarding patient who continued to use oxygen, 74 patients (47.7%) were continued on oxygen, 47 patients (30.3%) were discontinued of oxygen and 34 patients (22%) did not have any information available regarding oxygen use. CONCLUSIONS: From the above data, There is room for improvement regarding oxygen reassessment by educating primary care providers. Post intervention survey will be done in 6 months. CLINICAL IMPLICATIONS: Improve oxygen reassessment in patients after discharge with oxygen DISCLOSURES: No relevant relationships by Anam Aqeel No relevant relationships by Mansur Assaad No relevant relationships by Apurwa Karki No relevant relationships by Shobha Mandal No relevant relationships by Rajamurugan Meenakshisundaram
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SESSION TITLE: Pathology Identifying Chest Infections Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Coronavirus disease 2019 (COVID-19) patients presented in a wide variety and had multiple complications. The well-known associations found are myocardial infraction, pulmonary embolism, meningitis, encephalitis. We are presenting a new diagnosis of Hairy cell leukemia in COVID 19 patients. CASE PRESENTATION: We present a 55-year-old pleasant female with no significant past medical history;non immunocompromised who presented with 7 days history of shortness of breath on exertion, fever, fatigue, and cough. Her physical exam was unremarkable, but she was desaturating on presentation hence was placed on oxygen via nasal canula. On work up she tested positive for COVID-19. Initial chest Xray revealed bilateral diffuse pulmonary infiltrates. Complete blood count (CBC) showed pancytopenia with white blood cell count (WBC) 0.8 × 103/μL (4–10 × 103/μL), absolute neutrophil count (ANC) 0.5 × 103/μL (2–7 × 103/μL), hemoglobin (Hgb) 10.4 g/dL (13.0–17.0 g/dL), and platelet count 156× 103/μL (150–400 × 103/μL). She received treatment for COVID 19 pneumonia as per the protocol. On repeat CBC check there was minimal improvement in her counts. The rest of her WBC differential showed a lymphopenia with ALC ranging from 350–500 with no other obvious immature cells or blasts to suggest a myeloid neoplasm such as acute leukemia. Work-up including vitamin B12, folate, TSH, EBV, ANA, and hepatitis were unremarkable. She also received treatment with supportive granulocyte colony-stimulating factor (G-CSF) but there was minimal improvement. As her pancytopenia persisted for 1 week the peripheral blood smear was done which showed pancytopenia (with prominent red cell agglutination, with rare, atypical lymphoid cells with multiple hairy projections. A bone marrow (BM) aspirate was hypocellular showing markedly decreased trilineage hematopoiesis with atypical lymphoid cells with oval or indented nuclear borders, unclumped chromatin, absent or inconspicuous nucleoli, and moderate to abundant pale blue cytoplasm with multiple circumferential cytoplasmic projections (hairy cells) [Figure:1]. The hairy cells showed strong positivity for CD20[Figure:2]. She was followed up by hematology and was started on treatment. DISCUSSION: Hairy cell leukemia (HCL) is a rare B cell lymphoproliferative disease with marked cytopenia and circulating leukemia cells. Multiple viruses (EBV, HTLV1) were found to be associated with multiple different malignancies. It is found that COVID19 is not associated with any malignancy so far, but our patient got diagnosed with HCL during COVID19 illness. CONCLUSIONS: The association of HCL could be an incidental finding but we need to do further studies to clarify the associations Reference #1: Kohla, Samah et al. "A Rare Case of Hairy Cell Leukemia with Unusual Loss of CD123 Associated with COVID-19 at the Time of Presentation.” Case reports in oncology vol. 13,3 1430-1440. 4 Dec. 2020, doi:10.1159/000512830 DISCLOSURES: No relevant relationships by Apurwa Karki No relevant relationships by Shobha Mandal No relevant relationships by Rajamurugan Meenakshisundaram
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SESSION TITLE: Issues After COVID-19 Vaccination Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Since the onset of the COVID-19 pandemic, vaccines were introduced to mitigate the spread of the virus. Depending on the COVID-19 vaccine, regimens consist of one dose (ie, J&J) or two doses (ie, Pfizer and Moderna) and is followed by a third dose/booster (for immunocompromised/immunocompetent individuals). Here, we present a case of COVID-19 infection in a triple vaccinated patient with concurrent rheumatoid arthritis (RA) receiving disease modifying antirheumatic drugs (DMARDs) who was unable to mount an adequate immune response to the vaccine. CASE PRESENTATION: Patient is a 67 year old male with PMH of RA (on DMARDs) presented to the ED with complaints of shortness of breath. He was on treatment for RA with leflunomide, rituximab and prednisone. He was COVID-19 triple vaccinated. In ED, the patient was found to be hypoxic, saturating at 87% on room air with a respiratory rate of 18. Physical examination was significant for coarse breath sounds bilaterally and remaining vitals were unremarkable. Patient was initially placed on 3 L oxygen via NC but due to persistent hypoxia, was transitioned to high-flow nasal cannula. Further investigations revealed that the patient was COVID-19 positive. He was treated with remdesivir and dexamethasone. His oxygen requirements continued to escalate and he was ultimately intubated. While in the ICU, the patient's hypoxia continued to worsen despite optimal medical and ventilatory management and he subsequently died. DISCUSSION: DMARDs are a group of medications used to slow the progression of rheumatoid arthritis. They work by reducing the immune response of B cells, T cells and cytokines. Our patient was on two commonly prescribed medications for rheumatoid arthritis, leflunomide and rituximab. The former acts by inhibiting the pyrimidine synthesis pathway, thereby decreasing T lymphocyte production and the latter depletes CD-20 positive B cells. While there is limited data on COVID-19 vaccine, it has been established that patients on DMARDs have reduced antibody titres after immunization against influenza and pneumonia vaccinations [1, 2]. A study assessing the effectiveness of a third vaccine dose in patients taking rituximab vs placebo found a significant difference in seroconversion (78.8% vs 18.2%, p=<0.0001) and neutralizing activity (80.0% vs 21.9%, p=<0.0001) [3]. In our case, the patient was on two immunosuppressive drugs which suppressed both the humoral and cell mediated immunity, resulting in an inadequate immune response and subsequently developing COVID. CONCLUSIONS: This case highlights patients on immunosuppressant therapy failing to mount an adequate immune response to the COVID-19 vaccine, warranting more booster doses in patients on DMARDs. Reference #1: Adler S, Krivine A, Weix J et al. Protective effect of A/ H1N1 vaccination in immune-mediated disease–a prospectively controlled vaccination study. Rheumatology 2012;51:695–700. Reference #2: Franca ILA, Ribeiro ACM, Aikawa NE et al. TNF blockers show distinct patterns of immune response to the pandemic influenza A H1N1 vaccine in inflammatory arthritis patients. Rheumatology 2012;51:2091–8. Reference #3: David S, Koray T, Filippo F et al. Efficacy and safety of SARS-CoV-2 revaccination in non-responders with immune-mediated inflammatory disease. http://dx.doi.org/10.1136/annrheumdis-2021-221554 DISCLOSURES: No relevant relationships by Gursharan Kaur No relevant relationships by Aishwarya Krishnaiah No relevant relationships by sandeep mandal
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The Indian stock market witnessed a sharp recovery in the post-COVID-19 period owing to the sweeping investor enthusiasm. The event studies show that the 2020 lockdown and announcement of the first fiscal package had a significant impact on the stock returns. The impact of other events like the first COVID-19 case, second fiscal package, beginning of the vaccination drive, and the second wave was insignificant. Our estimates also show a significant impact of investor sentiment on stock returns, except during periods of extreme volatility. Further, the stock returns are positively related to oil price and negatively related to the exchange rate. © 2022 Economic and Political Weekly. All rights reserved.
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For the past two years, doxycycline has been employed hugely for the treatment of COVID 19 over the globe. Excessive use of doxycycline can result in bacteria and gene resistance, which affects the future treatment of infectious diseases. Furthermore, unused doxycycline left from the hospital and pharmaceutical industries may have an adverse effect on the environment, posing a significant menace to modern society. As a result, doxycycline detection is required. Herein, we developed blue luminous nitrogen-doped carbon quantum dots (N-CQDs) using ascorbic acid and diethylenetriamine (DETA) as carbon and nitrogen sources via a microwave-assisted technique for the differential detection of doxycycline (DC) via a fluorescence quenching mechanism, even when other tetracycline derivatives interfere. The quenching mechanism has been elaborately explained by using a Stern-Volmer plot, UV-vis and fluorescence spectroscopy, and TCSPC to attribute the static quenching and inner filter effect. In addition, the limit of detection of our suggested sensor is 0.25 μM. To confirm the structural properties and the size of the N-CQDs, FT-IR, Raman spectroscopy, HRTEM, DLS, and EDX have been performed. Moreover, this approach was used to identify doxycycline in pharmaceutical waste and bacterial cells. Because of its great sensitivity and selectivity, N-CQDs are ideal for measuring DC in environmental applications. © 2022 American Chemical Society. All rights reserved.