Post-obturation Analgesia requirements in patients vaccinated against Covid-19: a short observational study. (preprint)

Aim: To evaluate the need for Post obturation analgesia (acetaminophens) requirements in patients vaccinated against Covid-19, as the role of the NASID’s is still controversial, and the most recommended drug is acetaminophens after Covid-19 Vaccination. Material and Methods: 50 patients vaccinated against Covid-19 undergoing root canal treatments for symptomatic pulpits in molar teeth, were divided into two groups of 25 each on the basis of gender (Group M for males and Group F for females.) Each patient was given a prescription for 650 mg of acetaminophen tablets to be taken 8 hourly with instructions to avail the same only if needed for pain. They were instructed to keep a record of the number of tablets consumed as per record sheet 1, and if the pain did not subside then a stronger analgesic Ketorolac DT 10mg twice a day had to be taken and recorded. In case the pain was accompanied by swelling, the patient was given a prescription of amoxicillin 500mg TDS along with analgesics. Results: In Group M and Group F the mean number of analgesic tablets required was 0.44±0.65, 0.80±1.08 respectively, and the difference was statistically insignificant (p=0.360). The statistical analysis was done by student’s t-test using SPSS (Statistical Package for Social Sciences) Version 20.0 statistical Analysis Software. Conclusion: Within the limitations of this study, this is concluded that acetaminophen is effective in relieving post-obturation pain in patients vaccinated against COVID-19. Keywords: NSAID’s, Acetaminophen, Root Canal Treatment, COVID-19 vaccination, Covisheild

COVID-19 and the Sikh Community in the UK: A Qualitative Study.

The COVID-19 pandemic has had, and continues to have, a significant effect on individuals worldwide, and it is clear that minority communities including the Sikh community have been particularly affected by the virus. The current study assessed the impact of the pandemic in a sample of 44 British Sikhs across 11 virtual focus groups. Three main themes emerged including making meaningful connections, struggling to adjust and the organisation of gurdware (Sikh places of worship) in coping with the COVID-19 pandemic. Findings highlight that faith may promote collective action for collective healing especially during mass trauma, with specific insight into what this may entail for the Sikh community.

Secondary infections modify the overall course of hospitalized COVID-19 patients: A retrospective study from a network of hospitals across North India (preprint)

IntroductionSARS-CoV-2 infection increases the risk of secondary bacterial and fungal infections and contributes to adverse outcomes. The present study was undertaken to get better insights into the extent of secondary bacterial and fungal infections in Indian hospitalized patients and to assess how these alter the course of COVID-19 so that the control measures can be suggested. MethodsThis is a retrospective, multicentre study where data of all RT-PCR positive COVID-19 patients was accessed from Electronic Health Records (EHR) of a network of 10 hospitals across 5 North Indian states, admitted during the period from March 2020 to July 2021.The data included demographic profile of patients, clinical characteristics, laboratory parameters, treatment modalities, and outcome in those with secondary infections (SIs) and those without SIs. Spectrum of SIS was also studied in detail. ResultsOf 19852 RT-PCR positive SARS-CO2 patients admitted during the study period, 1940 (9.8%) patients developed SIs. Patients with SIs were 8 years older on average (median age 62.6 years versus 54.3 years; P<0.001) than those without SIs. The risk of SIs was significantly (p < 0.001) associated with age, severity of disease at admission, diabetes, ICU admission, and ventilator use. The most common site of infection was urinary tract infection (UTI) (41.7%), followed by blood stream infection (BSI) (30.8%), sputum/BAL/ET fluid (24.8%), and the least was pus/wound discharge (2.6%). As many as 13.4% had infections with more than organism and 34.1% patients had positive cultures from more than one site. Gram negative bacilli (GNB) were the commonest organisms (63.2%), followed by Gram positive cocci (GPC) (19.6%) and fungus (17.3%). Most of the patients with SIs were on multiple antimicrobials - the most commonly used were the BL-BLI for GNBs (76.9%) followed by carbapenems (57.7%), cephalosporins (53.9%) and antibiotics carbapenem resistant entreobacteriace (47.1%). The usage of emperical antibiotics for GPCs was in 58.9% and of antifungals in 56.9% of cases, and substantially more than the results obtained by culture. The average stay in hospital for patients with SIs was twice than those without SIs (median 13 days versus 7 days). The overall mortality in the group with SIs (40.3%) was more than 8 times of that in those without SIs (4.6%). Only 1.2% of SI patients with mild COVID-19 at presentation died, while 17.5% of those with moderate disease and 58.5% of those with severe COVID-19 died (P< 0.001). The mortality was highest in those with BSI (49.8%), closely followed by those with HAP (47.9%), and then UTI and SSTI (29.4% each). The mortality rate where only one microorganism was identified was 37.8% and rose to 56.3% in those with more than one microorganism. The mortality in cases with only one site of infection was 28.8%, which steeply rose to 62.5% in cases with multiple sites of infection. The mortality in diabetic patients with SIs was 45.2% while in non-diabetics it was 34.3% (p < 0.001). ConclusionsSecondary bacterial and fungal infections can complicate the course of almost 10% of COVID-19 hospitalised patients. These patients tend to not only have a much longer stay in hospital, but also a higher requirement for oxygen and ICU care. The mortality in this group rises steeply by as much as 8 times. The group most vulnerable to this complication are those with more severe COVID-19 illness, elderly, and diabetic patients. Varying results in different studies suggest that a region or country specific guideline be developed for appropriate use of antibiotics and antifungals to prevent their overuse in such cases. Judicious empiric use of combination antimicrobials in this set of vulnerable COVID-19 patients can save lives.

Genomic analysis of SARS-CoV-2 breakthrough infections from Varanasi, India (preprint)

Studies worldwide have shown that the available vaccines are highly effective against SARS-CoV-2. However, there are growing laboratory reports that the newer variants of concerns (VOCs e.g. Alpha, Beta, Delta etc) may evade vaccine induced defense. In addition to that, there are few ground reports on health workers having breakthrough infections. In order to understand VOC driven breakthrough infection we investigated 14 individuals who tested positive for SARS-CoV-2 after being administered a single or double dose of Covishield (ChAdOx1, Serum Institute of India) from the city of Varanasi, which is located in the Indian state of Uttar Pradesh. Genomic analysis revealed that 78.6% (11/14) of the patients were infected with the B.1.617.2 (Delta) variant. Notably, the frequency (37%) of this variant in the region was significantly lower (p<0.01), suggesting that the vaccinated people were asymmetrically infected with the Delta variant. Most of the patients tested displayed mild symptoms, indicating that even a single dose of the vaccine can help in reducing the severity of the disease. However, more comprehensive epidemiological studies are required to understand the effectiveness of vaccines against the newer VOCs.

Successful Application of Wastewater-Based Epidemiology in Prediction and Monitoring of the Second Wave of COVID-19 in India with Fragmented Sewerage Systems- A Case Study of Jaipur (India) (preprint)

The present study tracked the city-wide dynamics of severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2) RNA in the wastewater from nine different wastewater treatment plants (WWTPs) in Jaipur during second wave of COVID-19 out-break in India. A total of 164 samples were collected weekly between February 19th and June 8th, 2021. SARS-CoV-2 was detected in 47.2% (52/110) influent samples and 37% (20/54) effluent samples. The increasing percentage of positive influent samples correlated with the citys increasing active clinical cases during the second wave of COVID-19 in Jaipur. Furthermore, WBE based evidence clearly showed early detection of about 20 days (9/9 samples reported positive on April 20th, 2021) prior to the maximum cases & maximum deaths reported in the city on May 8th, 2021. The present study further observed the presence of SARS-CoV-2 RNA in treated effluents at the time window of maximum active cases in the city even after tertiary disinfection treatments of UV & Chlorine. The average genome concentration in the effluents and removal efficacy of six commonly used treatments; Activated Sludge Treatment + Chlorine disinfection (ASP + Cl2), Moving Bed Biofilm Reactor (MBBR) with Ultraviolet radiations disinfection (MBBR + UV), MBBR + Chlorine (Cl2), Sequencing Batch Reactor (SBR) and SBR + Cl2 were compared with removal efficacy of SBR + Cl2 (81.2%)> MBBR + UV (68.8%) > SBR (57.1%) > ASP (50%) > MBBR + Cl2(36.4%). The study observed the trends & prevalence of four genes (E, RdRp, N, and ORF1ab gene) based on two different kits and found that prevalence of N> ORF1ab >RdRp> E gene, suggested that the effective genome concentration should be calculated based on the presence/absence of multiple genes. Hence, it is imperative to say that using a combination of different detection genes (E, N, RdRp & ORF1ab genes) reduce false positives in WBE. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=131 SRC="FIGDIR/small/21263417v1_ufig1.gif" ALT="Figure 1"> View larger version (40K): org.highwire.dtl.DTLVardef@156126corg.highwire.dtl.DTLVardef@1d39404org.highwire.dtl.DTLVardef@19a9dcdorg.highwire.dtl.DTLVardef@1ee3a0c_HPS_FORMAT_FIGEXP M_FIG C_FIG HighlightsO_LISuccessful application of WBE with prediction of 14-20 days for COVID-19 in Jaipur C_LIO_LIA comparison of SARS-CoV-2 RNA removal efficacy of 9 WWTPs was investigated C_LIO_LISBR showed better performance than MBBR with SARS-CoV-2 RNA removal from wastewater C_LIO_LIPresence of SARS-CoV-2 in effluents even after UV and Chlorine disinfection C_LIO_LIUsing a combination of different detection genes reduce false positives in WBE C_LI

Ruptured cerebral aneurysms in COVID-19 patients: A review of literature with case examples.

BACKGROUND: The novel severe acute respiratory syndrome coronavirus 2 is responsible for over 83 million cases of infection and over 1.8 million deaths since the emergence of the COVID-19 pandemic. Because COVID-19 infection is associated with a devastating mortality rate and myriad complications, it is critical that clinicians better understand its pathophysiology to develop effective treatment. Cumulative evidence is suggestive of cerebral aneurysms being intertwined with the hyperinflammatory state and hypercytokinemia observed in severe COVID-19 infections. CASE DESCRIPTION: In case example 1, the patient presents with chills, a mild cough, and sore throat. The patient develops high-grade fever of 39.8° C, decreased oxygen saturation of 93% on room air, and an extensive spontaneous subarachnoid hemorrhage (SAH) in the basal cisterns from a ruptured left posterior communicating artery aneurysm. In case example 2, the patient presents with a positive PCR test for COVID-19 2 weeks prior with spontaneous SAH and found to have a large multilobulated bulbous ruptured aneurysm of the anterior communicating artery. Both patients' symptoms and high-grade fever are consistent with hypercytokinemia and a hyperinflammatory state, with elevated granulocyte colony-stimulating factor, inducible protein-10, monocyte chemoattractant protein-1, M1P1A, and tumor necrosis factor-α inflammatory mediators found to be elevated in COVID-19 intensive care unit admissions. CONCLUSION: COVID-19 effect on cerebral aneurysms requires future studies to clearly delineate correlation, however, hypercytokinemia and a hyperinflammatory state are strongly implicated to cause degenerative vascular changes that may predispose patients to cerebral aneurysm formation, change in size or morphology, and resultant aneurysm rupture.

Estimation of real-infection and immunity against SARS-CoV-2 in Indian populations (preprint)

Infection born by Coronavirus SARS-CoV-2 has swept the world within a time of a few months. It has created a devastating effect on humanity with social and economic depressions. Europe and America were the hardest hit continents. India has also lost several lives, making the country fourth most deadly worldwide. However, the infection and death rate per million and the case fatality ratio in India were substantially lower than many of the developed nations. Several factors have been proposed including the genetics. One of the important facts is that a large chunk of Indian population is asymptomatic to the SARS-CoV-2 infection. Thus, the real infection in India is much higher than the reported number of cases. Therefore, the majority of people are already immune in the country. To understand the dynamics of real infection as well as level of immunity against SARS-CoV-2, we have performed antibody testing (serosurveillance) in the urban region of fourteen Indian districts encompassing six states. In our survey, the seroprevalence frequency varied between 0.01-0.48, suggesting high variability of viral transmission among states. We also found out that the cases reported by the Government were several fold lower than the real infection. This discrepancy is majorly driven by a higher number of asymptomatic cases. Overall, we suggest that with the high level of immunity developed against SARS-CoV-2 in the majority of the districts, it is less likely to have a second wave in India.

Implications of COVID-19-induced nationwide lockdown on children's behaviour in Punjab, India.

BACKGROUND: Lockdown is one of the prevalent tools that are used to control the spread of COVID-19 virus in India. Under the circumstances created during lockdown period, children are deprived from the social interaction and companionship; because of which, they are susceptible to psychiatric disorders. Therefore, in this study, efforts were to understand the impacts of lockdown on the mental status of the children of India and their specific causes. STUDY DESIGN: It is a questionnaire-based study. METHODS: A web-based questionnaire was prepared, and 400 parents from four districts of Punjab, India, namely, Ludhiana, Sahibzada Ajit Singh (SAS) Nagar, Sangrur and Ferozepur, were telephonically interviewed. Further, the information collected from the interviews was statistically analysed using Statistical Package for the Social Sciences (SPSS) software. RESULTS: Findings from this study revealed that 73.15% and 51.25% of the children were having signs of increased irritation and anger, respectively; 18.7% and 17.6% of the parents also mentioned the symptoms of depression and anxiety, respectively, among their children, which were also augmented by the changes in their diet, sleep, weight and more usage of the electronic equipment. Children (~76.3%) persistently urge to go outdoors and play with their friends; therefore, they could lag in social development. Further, observations from Pearson's correlation revealed that during lockdown, children's mental health is significantly related to the area of their house, number of children in the family, qualification of their mother and socio-economic status of their family. CONCLUSIONS: This study made it evident that the mental health of the children residing in Punjab, India, was compromised during the lockdown period induced by the COVID-19 pandemic. Findings of this study may also trigger the international authorities to frame the guidelines of lockdown in the interest of mental health of their native children.

On the airborne aspect of COVID-19 coronovirus (preprint)

It is a widely accepted view that COVID 19 is either transmitted via surface contamination or via close contact of an un-infected person with an infected person. Surface contamination usually happens when infected water droplets from exhalation/sneeze/cough of COVID sick person settle on nearby surfaces. To curb this, social distancing and good hand hygiene advise is advocated by World health Organization (WHO). We argue that COVID 19 coronovirus can also be airborne in a puff cloud loaded with infected droplets generated by COVID sick person. An elementary calculation shows that a $5~\mu m$ respiratory infected droplet can remain suspended for about 9.0 minutes and a $2~\mu m$ droplet can remain suspended for about an hour! And social distancing advise of 3 feet by WHO and 6 feet by CDC (Centers for Disease Control and Prevention) may not be sufficient in some circumstances as discussed in the text.