Disease Severity and Pathophysiology of COVID-19 in Type 2 Diabetes Mellitus Patients

The world is facing COVID 19 pandemic which has created a chaos among the mankind. It has created a huge burden in the health care facilities. COVID 19 disease is caused by emerging mutants of Severe acute respiratory syndrome corona virus 2(SARS CoV-2). The virus is highly contagious and infects through the respiratory route. It invades the respiratory tract mainly the lungs causing pneumonia. Patient usually presents with fever, nonproductive cough, breathlessness, myalgia and fatigue. Severe cases can rapidly progress to acute respiratory distress syndrome and multi organ failure, death may occur due to complication. Furthermore early identification and diagnosis of high risk cases like hypertension and diabetes and prevention of the serious complication in them help in decreasing the burden on the intensive healthcare facilities. As we know the doctor to patient ratio in a developing country like India is very low, thus it becomes very important for the doctor to know the impending risk in his/her patients. So we have made an effort to understand the pathophysiology involved, the treatment protocols followed in patient of type 2 diabetes mellitus with COVID 19 infection. Regular monitoring of the blood sugar levels during the hospital stay becomes important to detect the red flags of complication. Assessment of the severity of the disease and prognosis in type 2 diabetes mellitus patient and non-diabetics has been contrasted. This might help provide better intensive care management for all the patients at early stage and decrease the morbidity and mortality in the COVID 19 patients. We have tried to unfold the relationship between two hyper inflammatory diseases that is type 2 diabetes mellitus which is chronic inflammatory condition and SARS CoV 2 which causes acute inflammation. It should be noted that both the diseases have tendency to cause multi organ dysfunction and failure.

Need of Two Doses of COVID Vaccine

The epidemic has affect the lifestyle in one or other way, made the world economies to stop, forced to change our work style and connect with our close peoples, and forcing medical systems to their highest possible state. As a result, significant production efforts are needed to ensure that needs is full filled. While the vaccine is effective, its efficacy will be harmed if sufficient doses are not manufactured in time. When the vaccinations were originally tested, participants had a relatively mild immune reaction after receiving the first dose of COVID vaccine, followed by a robust reaction after receiving we learned a lot from the second wave of coronavirus. It not only highlighted the disease's unpredictability, but it also provided look into the various ways we can prevent a potential third wave of COVID. Despite of this, some people are still hesitant to get the vaccination or feel that missing their second dose of COVID is a viable choice. But you should be aware that vaccinations are our only means of protection against the virus, with the second COVID dose being the more crucial of the two dosages. You are not completely protected from the virus until and unless you receive the two doses. Getting both doses of these vaccines increases your chances of receiving full immunity. Only receiving one dose of the vaccine will not provide you with full protection or the vaccine's full efficacy. Receiving one dose of the two-dose vaccinations provides some protection, albeit we don't know the entire level of the protection or how long it will persist.

Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio as a Severity Marker in Moderate to Severe COVID-19 Patients

The world is facing COVID-19 pandemic which has created havoc amongst the mankind. It has created huge burden on health care facilities. The COVID-19 disease is caused by a newly emerged mutant of corona virus that is SARS-CoV-2. The virus is highly contagious and infects through respiratory route. It invades the respiratory tract mainly lungs causing coronavirus pneumonia. Patients usually present with fever, non-productive cough, breathlessness, myalgia, fatigue. In severe cases, disease can rapidly progress to ARDS (Acute Respiratory Distress Syndrome), septic shock, MODS (Multi-Organ Dysfunction Syndrome). Death may occur due to the complications. Furthermore, early diagnosis of severe cases and early interventions help in decreasing the burden on intensive healthcare facilities. HRCT scans are being used to assess the disease severity and CT score were calculated which was graded as mild, moderate and severe with score 0-8, 9-15 and 16-25 respectively. But this is highly expensive for general population of a developing country like India. Interleukins, D-dimer, ferritin, pro-calcitonin tests have also been used to assess the severity but again they pose a financial constraint for the population. So we needed a basic investigation which could let us assess the severity of disease and prognosis of the patient early for effective and early management of the patient. This might help provide better intensive care management for the patients at early stage and decrease the morbidity and mortality in COVID-19 patients. We have tried to unfold the CBC as prognostic marker for COVID-19 patients.

Role of Herd Immunity in COVID-19

Background: With the rise in cases of COVID-19, the concept of herd immunity came into play which is expected to play a very important role in the control of this pandemic. For herd immunity to work we require only a part of the entire population to be immune which can be either by vaccination or natural infection. Although we are exactly not sure about the lasting impact that these antibodies will have on us or about the re activation of virus, as of now this remains the best option with us to combat the disease process. The effectively of vaccine, virus transmission, and the level of pre-existing immunity along with other factors play a very important role in determining the time required to reach herd immunity. With this we can prevent the immune compromised or individuals with other co-morbid conditions predisposed to this disease as in them the disease process would be fast and response to treatment slow or undetermined. The main element of vaccine production depends on the population behaviours along with the pathogen. It is on the basis of these criteria that we analyse the study between herd immunity and COVID-19. As we know now that this disease spreads as the healthy individuals come in contact with infected individuals therefore the most effective way to prevent it is by maintaining social distancing. So with the herd immunity coming into play the transmission of the disease is stopped and we can achieve our aim of preventing the spread of the disease by making just a part of the population immune. Objective: The purpose is to review the article related to attainment of herd immunity in COVID-19. Methodology: For the review article we gathered the data from various data bases like PubMed, Google scholar, and science direct and other websites involving searches such as herd immunity, vaccines, natural immunity, COVID-19. Result: After reviewing the article we can say that herd immunity plays a very important role in controlling the transmission of COVID-19 Conclusion: After looking at all the perspectives although we conclude that herd immunity will play the leading role in the control of transmission but it is a very challenging task that would take a lot of time to become effective, till then measures such as social distancing, hygiene practices and sanitation should be considered to stop disease transmission.

Mucormycosis in COVID-19

COVID-19 a global pandemic started in December 2019 and in these last year it has been linked to a range of bacterial, fungal, and viral infections. Mucormycosis sometimes known as black fungus is one of the rare but deadly angioinvaise fungal infection caused by group of fungi mucormycocetes which leads to upsurge of Mucormycosis in COVID-19 patients. Many states in India have declared mucormycosis as an epidemic due to its upsurge in numbers and higher fatality rate. Though mucorales can affect the any part of body but it has tissue tropism towards nasal sinuses, orbit, CNS, pulmonary, skin. Most common clinical presentation of fungi is infection of sinus with nasal blockage and discharge. Mucormycosis is a non-contagious fungal infection, more common in immune compromised patient. Acute inflammatory reactions in COVID-19, corticosteroids treatment and diabetes enfeeble the immunity and it makes the perfect storm for Mucormycosis. Diabetes that isn't well managed results in the acidosis a satisfactory environment for fungi to grow. An early diagnosis and management can decrease the fatality rate. Aim: The goal of this study is to provide a comprehensive overview of the literature concerning Mucormycosis aetiology, features, and management and how it can be prevented in COVID-19 (SARSCoV-2) patients. Conclusion: COVID-19, overuse of corticosteroid along with uncontrolled diabetes leads to an upsurge of mucormycosis. So an effort should be made to stringently monitor and keep the blood glucose level under control and judicious use of corticosteroid and antibiotics should be practiced in COVID-19 patients.

PPE and Infection among Healthcare Workers Dealing with Covid19 Pandemic

One more difficulty displayed in December 2019, beginning the improvement of truly great overall succeeding disillusionments at whatever point saw. The torture, known as 'SARS-CoV-2,' produces Coronavirus inconvenience, which the World Thriving Game plan has dissipated as ' Covid. Coronavirus Confusion 2019 seen as respiratory degradation with a quick of trans-mission generally through droplet course and physical contact. Attested usage of individual careful stuff (PPE) is a shown and astonishing technique for blocking Covid spread in clinical idea settings, need to plan the data, demeanor, and fundamental need PR actioners, and see the concerned factors concerning wearing and disposal of Personal PE among state of the art clinical benefits workers. The present for the most part circumstance of a pandemic has affected humanity considering everything and still continues to create an upheaval among all bits of the overall people, be it those from financially weaker establishment or the rich piece of the overall people. I truly need to merge the effects of such a surprising mass event and particularly illuminate its ramifications for mental winning of individuals. It likewise means to intertwine the gravity of the issues related to overwhelming flourishing and how the degree of people affected is essentially extending.

Thromboembolic Disorders in Covid-19 Patient

Background: Thrombotic events can be seen among patients having cardiovascular illness. Along with COVID-19 the disease severity has found to be increasing. Thromboembolism has been widely seen among severely ill patients. The autopsies of the ceased patients due to complications created by COVID-19 indicated the role of deep vein thrombosis, endothelium dysfunction and so on. But over activation can leads to severe inflammation among vital organs such as lungs and can damage the tissues resulting into multiple organ failure from where living chances of the patients plunges. Several enzymes and vital proteins inside the patient's body was found to be out of their tolerance level and showing huge fluctuations in their readings. These are termed as biomarkers as they can be used as indicators for the worsening condition of the patient. COVID-19 must be dealt with utmost precaution as it is still considered as understudied pathogenic disease. Various biomarkers can he used in order to detect the deterioration of the patient's condition into critical condition. Empirical study highlighting facts about bidirectional relationship between COVID-19 severity and impact of cardiovascular function of non-Comorbid patient must be done in order to understand the viral behavior.

Impact of Covid-19 in India

India is the second largest populous country suffering from the pandemic due to Corona Virus. Social separation and lockdown rules were implemented, but they had a negative influence on economic situation of our country. While there was a negative toll on the economy and the human interaction of our country, environment was the only sector which was positively impacted. During early December in 2019, the first Corona Virus epidemic was announced in Wuhan, Hubei Province, the WHO (World Health Organisation) declared an outbreak a Public Health Emergency of International Concern (PHEIC) on 30th January, 2020, and on 20th February, 2020, WHO formally recognised this epidemic of coronavirus disease as COVID-19, where CO stands for Corona, VI-Virus D-Disease, and 19 for 2019 as that was the year this infection first caused an epidemic. The Severe Acute Respiratory Syndrome Coronavirus 2 causes COVID-19 disease (SARS-CoV-2). The Corona Virus Disease outbreak introduced not only illness and death, but also hitherto new difficulties including as public health, food availability, deadly interactions, and the global economy. It paved the way for the entire globe to face new challenges that no one could have predicted.

Dysosmia and Dysgeusia in COVID-19 Patients

Background: Coronavirus disease 2019 or COVID-19 is the evolving disease that has grappled the whole world. Clinical manifestation of COVID-19 is still under lens as novel coronavirus is constantly evolving. Mutations are one of the key features of the viruses which happen at times. Changing clinical;manifestation of COVID-19 creates a new challenge as no one solution can be applied among infected individuals. The viral behavior is constantly changing and one must be vigilant about it. Dysosmia and dysgeusia are impairment in taste and smelling sensation. These can occur due to chemotherapy, drug abuse and so on. But it has been now associated with onset of COVID-19. Lot of patients of COVID-19 is complaining about these conditions. These conditions can coexist with the disease and can persist, post recovery too. Objective: Generally, both of these conditions are not life threatening and fade away after the recovery from the disease. Psychological impact of these conditions has been registered among certain patients as these are the sensory impairments which are part and parcel of daily life. This review pinpoints the motive of further exploring them. Methods: Original papers, reviews, preprints, and letters to editors relating to our topic were reviewed using MeSH terms in PubMed, Google Scholar electronic databases. Conclusion: Dysosmia and dysgeusia can be used as indicator for the onset of the COVID-19. The hypothesis of extreme exposure to disinfecting chemicals must be examined further to bring and solid correlation. Professional help is needed post recovery from COVID-19 to regain the balance in life.

Covid in Pediatric Population

Background: Coronavirus disease 2019 or COVID-19 is still wreaking havoc all across the world even after more than one and half year has been passed since its inception. More than three million causalities have been reported from across the world which is unprecedented in the past hundred years of human civilizational history. Pediatric age group have been so far escaped from the wrath of the COVID-19 as they are going through their peak of immune system response. Some neonates have suffered severe disease conditions due to COVID-19 and post COVID-19 related complications. COVID-19 infected mothers have not found to be transmitting the infection through womb or placenta also known as vertical transmission, but several antibodies taste for COVID-19 in neonates born to infected mothers tested positives. Teenagers are so far not produces adverse clinical outcome post COVID-19 infection like their older counterparts but it is anticipated that third phase or the wave is going to hit the teenagers harder. Preventive measures are the effective way to deal with the infection. Complacency has no place in this raging pandemic and one must remain vigilant. More study needs to be done to ensure empirical backing for all the related studies.

Effectiveness of training program on awareness among nursing staff, lab technicians and sanitary workers regarding bio-medical waste management in a Tertiary Care Hospital in central India

Background : A serious threat to both general and medical community is the proper collection and proper dumping of the Bio-medical Waste. In India, 1.87 lakh healthcare facilities with 17.01 lakh beds generates 519 tonnes of biomedical waste every day, Central Pollution Control Board (CPCB). There are Healthcare Facilities (HCF) that still handle and accumulate such wastes inappropriately without understanding its hazardous repercussions on environment and human society. Study is attributed to awareness and negligence related issues. It covers a wide spectrum of information required for Healthcare Facilities (HCF) in regards to modifications in Bio-Medical Waste Management Rules, 2016' (BMWM2016) from year 2016 till November 2019 and rules amended in view of the COVID-19 pandemic. Aim : Effectiveness of Training Program on awareness among Nursing Staff, Lab Technicians and Sanitary Workers regarding Bio-medical Waste management at a Tertiary Care Hospital in Central India. Methodology : Interventional Study will be implicated from September 2020 to December 2022 in Acharya Vinoba Bhave Rural Hospital (AVBRH) Tertiary Care Hospital, Sawangi, Wardha, Central India by the Post Graduate Student. Assessment of awareness will be done by distributing a set of questionnaires and then training the Healthcare Personnel (HCP), regarding Bio-Medical Waste Management based upon direct observation in the workplace. A total of 422 Nurses, Lab Technicians and Sanitary Workers will be enrolled as study participants. The Study participants will be demonstrated regarding proper standards of Bio-Medical Waste management. Expected Outcomes/Results and Conclusion : Data will be analyzed and appropriate statistical tests will contemplate the results of study.