A telepathology based screening tool for COVID-19 by leveraging morphological changes related to leukocytes in peripheral blood smears.

As we approach the aftermath of a global pandemic caused by Severe Acute Respiratory Syndrome-Corona Virus (SARS-CoV-2), the importance of quickly developing rapid screening tests has become very clear from the point of view of containment and also saving lives. Here, we present an explorative study to develop a telepathology-based screening tool using peripheral blood smears (PBS) to identify Coronavirus Disease (COVID-19)-positive cases from a group of 138 patients with flu-like symptoms, consisting of 82 positive and 56 negative samples. Stained blood smear slides were imaged using an automated slide scanner (AI 100) and the images uploaded to the cloud were analyzed by a pathologist to generate semi-quantitative leukocyte morphology-related data. These telepathology data were compared with the data generated from manual microscopy of the same set of smear slides and also the same pathologist. Besides good correlation between the data from telepathology and manual microscopy, we were able to achieve a sensitivity and specificity of 0.83 and 0.71, respectively, for identifying positive and negative COVID-19 cases using a six-parameter combination associated with leukocyte morphology. The morphological features included plasmacytoid cells, neutrophil dysplastic promyelocyte, neutrophil blast-like cells, apoptotic cells, smudged neutrophil, and neutrophil-to-immature granulocyte ratio. Although Polymerase Chain Reaction (PCR) and antibody tests have a superior performance, the PBS-based telepathology tool presented here has the potential to be an interim screening tool in resource-limited settings in underdeveloped and developing countries.

Assessment of Out of Pocket Expenditure and associated factors for availing COVID-19 vaccination by the beneficiaries in Bengaluru: South India (preprint)

Background: Government of India has introduced COVID 19 vaccination in Jan 2021. There are no studies on out of pocket expenditure in COVID- 19 vaccination in India, hence this study was undertaken to estimate the out of pocket expenditure for availing COVID 19 vaccine, to assess the factors associated with out of pocket expenditure for COVID vaccination and adverse events following immunisation. Methods: This is a cross- sectional study conducted during Sep 2021- Dec 2021 of a medical college. A total of 438 study subjects above 18 years fulfilling inclusion and exclusion criteria were studied using probability proportional to population size. Data was collected using interview method by pre-tested semi structured proforma and analysed using descriptive & inferential statistics. Results: The mean direct cost in Government vaccination centre was 3.24- 6.74 INR, indirect cost 809.10 -1076.35 INR, total cost was 812.34 - 1079.49 INR.The mean direct cost in private vaccination centre was 1446.9 -1845.65 INR, indirect cost 1140- 1398 INR and total cost was 2586.90 -2241.54 INR. The mean total cost was OOPE for COVID 19 vaccination was 852.80 -1128.512 INR, out of which direct cost was only 36.17(-359.20). The higher mean OOPE was found in loss of wages 670.02 INR. The factors associated with higher out of pocket expenditure was type of vaccine (P=0.031, OR=2.141, 95% CI=1.07-4.24) occupation of the study subject (P=0.000, OR=2.043, 95% CI= 1.37-3.03), reported stress following vaccination (P= 0.018, OR=1.72, 95%CI=1.098-2.703), adverse event within 48hrs (P=0.006, OR=2.125, 95% CI= 1.248-3.62), received any medication for adverse event (P=0.041, OR= 1.721, 95% CI= 1.022-2.84) Conclusion: Majority of the study subjects utilized public facility. The higher mean out of pocket expenditure was for indirect cost loss of wages. This study shows that type of vaccine, occupation of the study subject and adverse event within 48 hrs, had 2 times higher out of pocket expenditure compared to other factors. Among the AEFI, fever was the most common, followed by pain at the injection site and myalgia.

Prevention of SARS-CoV-2 Spread in Dental Clinic: The Future Challenge in Resuming Clinical Practice

In the present scenario, the pandemic of coronavirus disease 2019 (COVID-19), which is responsible for simple upper respiratory infection to fatal pneumonia and multi-organ failure has become a major public health challenge and a public health emergency of international concern. Apart from secondary and tertiary care, it is very much essential to provide primary care, prevention, and early detection. To prevent the virus from the human-human transmission and to control the situation, the protocols vary at various setups. Due to the uniqueness of dental settings and practice, the risk of cross-infection can be high between patients and dental practitioners. Establishment of strict and effective infection control protocol is necessary owing to the varying sustainability of the virus on different surfaces. The area of concern for a dental professional is the oral cavity and upper respiratory region where the host recipient cell receptor, angiotensin-converting enzyme receptor 2, is present abundantly acts as the host cell entry route for the coronavirus. Dental professionals play an important role in preventing the transmission of SARS-CoV-2;we aim to review the infection control measures in dental practice. © 2020 Wolters Kluwer Medknow Publications. All rights reserved.