Management of Spontaneous Neck Hematoma in Patients on Anticoagulant Therapy: Our Experience from a Tertiary Care Center.

Spontaneous neck hematoma is a rare but life threatening condition which poses a challenge in clinical decision making. With the unsupervised outpatient use of oral anticoagulants, including newer generation ones and the thromboprophylaxis in  Covid-19 treatment protocol, the risk of developing spontaneous neck hematoma is high. In this context, our case series aimed at studying the clinicopathological profile, treatment options and outcome in patients presented with spontaneous neck hematoma in a tertiary care center. A retrospective chart review was done between the years 2010-2021, and three cases of spontaneous neck hematoma associated with anticoagulation therapy were identified. Based on our experience, we recommend a custom tailored approach to management of spontaneous neck hematoma.

Reclaiming the Airwaves: Exploring the Motivations for FM Radio Listening during COVID-19

Guided by the uses and gratifications theory, the current study examines the motivations behind FM radio listenership during the COVID-19 pandemic. A survey was conducted among 410 FM radio users from India. The result identified six motivations behind FM radio listenership, i.e., Information seeking, Relaxing-entertainment, Diversion, Companionship, Convenient multitasking, and Passing time. The study observed significant age and gender differences among the motivations behind FM radio listenership. All motivations, except passing time, were significant predictors of FM radio listenership. When convenient-multitasking, companionship, and diversion positively predicted listeners' affinity toward FM radio. The information-seeking motive negatively predicted the affinity. Information seeking, relaxing- entertainment and diversion positively predicted satisfaction with FM Radio. The theoretical and practical implications of the study were also discussed. © 2022 Broadcast Education Association.

Coronavirus disease 2019 subphenotypes and differential treatment response to convalescent plasma in critically ill adults: secondary analyses of a randomized clinical trial.

PURPOSE: Benefit from convalescent plasma therapy for coronavirus disease 2019 (COVID-19) has been inconsistent in randomized clinical trials (RCTs) involving critically ill patients. As COVID-19 patients are immunologically heterogeneous, we hypothesized that immunologically similar COVID-19 subphenotypes may differ in their treatment responses to convalescent plasma and explain inconsistent findings between RCTs . METHODS: We tested this hypothesis in a substudy involving 1239 patients, by measuring 26 biomarkers (cytokines, chemokines, endothelial biomarkers) within the randomized, embedded, multifactorial, adaptive platform trial for community-acquired pneumonia (REMAP-CAP) that assigned 2097 critically ill COVID-19 patients to either high-titer convalescent plasma or usual care. Primary outcome was organ support free days at 21 days (OSFD-21) . RESULTS: Unsupervised analyses identified three subphenotypes/endotypes. In contrast to the more homogeneous subphenotype-2 (N = 128 patients, 10.3%; with elevated type i and type ii effector immune responses) and subphenotype-3 (N = 241, 19.5%; with exaggerated inflammation), the subphenotype-1 had variable biomarker patterns (N = 870 patients, 70.2%). Subphenotypes-2, and -3 had worse outcomes, and subphenotype-1 had better outcomes with convalescent plasma therapy compared with usual care (median (IQR). OSFD-21 in convalescent plasma vs usual care was 0 (- 1, 21) vs 10 (- 1, to 21) in subphenotype-2; 1.5 (- 1, 21) vs 12 (- 1, to 21) in suphenotype-3, and 0 (- 1, 21) vs 0 (- 1, to 21) in subphenotype-1 (test for between-subphenotype differences in treatment effects p = 0.008). CONCLUSIONS: We reported three COVID-19 subphenotypes, among critically ill adults, with differential treatment effects to ABO-compatible convalescent plasma therapy. Differences in subphenotype prevalence between RCT populations probably explain inconsistent results with COVID-19 immunotherapies.

Study on airway assessment practices for elective procedures during pre-anesthetic evaluation in COVID-19 pandemic- A national online survey (SAFE PAC Survey).

Background and Aims: A pilot study among anesthesiologists, revealed a wide variation among individual practices including skipping pre-anesthetic airway assessment during COVID-19 pandemic because of the fear of getting infected. Risk of infection during pre-anesthetic airway assessment has not been studied. The primary objective of the survey was to evaluate the practices of airway examination by anesthesiologists during this pandemic period. Secondary objectives were to study the effects of institutional factors and other individual practices on risk modification and the incidence of COVID-19 infection among anesthesiologists. Material and Methods: A survey was conducted using a pre-validated questionnaire comprising of 35 questions. The questionnaire was circulated among 4676 members of the Indian Society of Anaesthesiologists (ISA) through Google Forms by email. Results: Of the 4676 members contacted via email, 470 were returned undelivered. From the remaining 4206 questionnaire recipients, 456 completed responses were obtained giving a response rate of 10.8%. Percentage, mean and standard deviation were calculated using EZR software. The conduct of pre-anesthetic airway assessment has decreased by 31.7% during the pandemic, leading to 5.2% of participants encountering unanticipated difficult airway. Among the respondents, eight percent were infected. Conclusion: Avoidance of preoperative airway assessment by anesthesiologists during the COVID-19 pandemic has led to rising unanticipated difficult airway undermining the patient safety. Adherence to recommended practices ensures safety from risk of COVID-19 infection.

Nanofibrous Facemasks with Curcumin for Improved Bacterial/Particulate Filtration and Biocidal Activity

The current COVID-19 pandemic situation has posed a significant threat to human health. This calls for versatile facemask filters with high filtration efficiency and biocidal activity. Herein, we have rationally designed a three-layered nanofilter mask consisting of electrospun polycaprolactone (PCL) and curcumin as a nanocoating on a polypropylene spunbond membrane. The nanomask thus developed had a particulate filtration efficiency of 96.8 +/- 0.1%, with good breathability (64 +/- 2 Pa) and a high quality factor (0.052 +/- 0.0005 Pa-1) for a coating thickness of similar to 20 mu m. An aerosol filtration efficiency of >99.99% was achieved for both bacteria and bacteriophages (a virus surrogate). Curcumin loading into the nanocoating induced significant contact-killing efficiency against bacteria and bacteriophages, implying the high biocidal activity presented by the nanomask. Furthermore, this mask could be reused up to 30 times after successive washing and drying, without alterations in its particle-filtration efficiency or fibrous morphology. Thus, by adopting a simple, scalable technique, a nanomask with manifold features was developed that satisfies the essential demands of air filtration in the current pandemic era.

Migration and reverse migration: Gulf-Malayalees’ perceptions during the Covid-19 pandemic

The United Arab Emirates has witnessed an exodus of long-term non-resident Indians, especially Malayalees, due to unforeseen impacts of the Covid-19 pandemic in 2020. The Emirates’ consequent economic setbacks, including a fear of the virus and falling job and financial security, threatened the survival of Indians–the largest expatriate demographic in the world and the Emirates. While apprehensive about their homeland’s ability to accommodate a mass reverse migrant population, the reverse migrants still retained attributes and values they associated with migration to the Emirates. Since the UAE hosts the largest number of Keralites in the world, the sample for this study comprises the first batch of Gulf-Malayalees, who had registered to return to Kerala. Through a means-end approach, this study reviews respondents’ attributes, consequences, and values at the time of migration and compares it with their perceptions during the sudden Covid-19 related reverse migration from the United Arab Emirates. © 2020 Informa UK Limited, trading as Taylor & Francis Group.

Neuropathological findings in two patients with fatal COVID-19.

AIMS: To describe the neuropathological findings in two cases of fatal Coronavirus Disease 2019 (COVID-19) with neurological decline. METHODS: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection was confirmed in both patients by reverse transcription polymerase chain reaction (RT-PCR) from nasopharyngeal swabs antemortem. Coronial autopsies were performed on both patients and histological sampling of the brain was undertaken with a variety of histochemical and immunohistochemical stains. RNAscope® in situ hybridization (ISH) using the V-nCoV2019-S probe and RT-PCR SARS-CoV-2 ribonucleic acid (RNA) was performed in paraffin-embedded brain tissue sampled from areas of pathology. RESULTS: Case 1 demonstrated severe multifocal cortical infarction with extensive perivascular calcification and numerous megakaryocytes, consistent with a severe multi-territorial cerebral vascular injury. There was associated cerebral thrombotic microangiopathy. Case 2 demonstrated a brainstem encephalitis centred on the dorsal medulla and a subacute regional infarct involving the cerebellar cortex. In both cases, ISH and RT-PCR for SARS-CoV-2 RNA were negative in tissue sampled from the area of pathology. CONCLUSIONS: Our case series adds calcifying cerebral cortical infarction with associated megakaryocytes and brainstem encephalitis to the spectrum of neuropathological findings that may contribute to the neurological decompensation seen in some COVID-19 patients. Viral RNA was not detected in post-mortem brain tissue, suggesting that these pathologies may not be a direct consequence of viral neuroinvasion and may represent para-infectious phenomena, relating to the systemic hyperinflammatory and hypercoagulable syndromes that both patients suffered.