KAP Study Regarding COVID-19 Amongst Pregnant Women, in Central India

Objectives: To assess the knowledge, attitude and practices of preventive measures against COVID-19 infection among pregnant women. It is our understanding that assessing healthcare needs and healthcare education form the pillars for better healthcare thereby this study was conducted. Methodology: An observational cross-sectional study was conducted in which 150 antenatal women were included. Face-to-face interview was conducted by using a self-developed internally validated semi-structured questionnaire based on 3 major domains, Knowledge (10), Attitude (10) and Practice (4), with close ended questions. Each response-correct was allotted score 1 & incorrect allotted score of 0. The responses were described as frequencies and percentages. Scoring system-Poor score<60%, Fair score 60-75%, Good score > 75% of total score in each domain. Result(s): 103(68.7%) had good knowledge and 121(80.7%) had poor attitude, regarding COVID affecting their pregnancy, antenatal visits and unborn baby. 113(75.3%) were practicing preventive habits. Conclusion(s): Our study showed the anxiety and fear related to Covid-19 affected mental health of women and their adherence to antenatal care which needs to be addressed in providing antenatal care services.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Multi-operator Variant of Differential Evolution and its Application in Classification of COVID-19 CT-scan Images

Novel coronavirus disease (COVID-19), caused by the virus (SARS-CoV-2), has drastically impacted human beings' lives since early 2020. The virus is constantly changing, and with mutations, it becomes diverse and spreads more easily. Several automatic COVID-19 diag-nostic tools are proposed that emphasize feature extraction mechanism from radiographical images using modern deep learning technology. The general idea is to leverage smart solutions of pre-trained networks for deep-feature processing. However, all the extracted features may not essentially contribute to the performance of the COVID-19 diag-nostic model, and hence an optimal subset of features must be discov-ered. Motivated by this, we propose a novel feature selection method based on multi-operator differential evolution (MODE), which helps to acquire optimal feature-subset. To show the efficacy of the proposed algorithm, we focus on applying the COVID-19 classification model through medical imaging. Eight advanced pre-trained architectures have been selected for COVID-19 feature extraction from CT-scan medi-cal imaging. After that, the proposed feature selection technique based on MODE is applied. A customized SVM kernel is implemented that supports feature classification. The result analysis shows the perfor-mance of the existing COVID-19 designs with the proposed feature selection technique, MODE, integrated with a customized SVM kernel. It even beats the existing state-of-the-art frameworks carried forward for COVID-19 diagnosis. We have observed that MODE feature selec-tion is suitable for fast COVID-19 detection, having overall accuracy of 85.27%.

Psychological Impact Among Newly Diagnosed Covid-19 Positive Cases

Background: India was one of the worst affected countries during the second wave of COVID-19 infection. The pandemic brought in a multitude of psychological problems leading to a negative impact on the mental health of affected individuals. Several studies across the globe have assessed the psychological impact of this pandemic in general and vulnerable populations with a scanty data in the assessment of those found positive for this condition. Material(s) and Method(s): This was a cross-sectional, descriptive and observational study conducted at a tertiary health care centre involved in the management of COVID-19 cases. Cases were assessed using a semi structured proforma for socio demographic and clinical details, Impact of Events Scale Revised (IES-R) and Patient Health Questionnaire- 9 S6(PHQ-9) to assess psychological impact. Descriptive and inferential statistics were used for data analysis. Result(s): A total of 60 individuals participated in the study. The mean age of the participants was 50.8 +/- 14.10 years, with a majority of males (65%). More than half (53%) of the individuals had minimal severity on IES-R while about 9% showed moderate to severe levels. About 32% had minimal depression while 25% had moderately severe or severe depression on PHQ-9 score. A significant positive correlation was observed between number of deaths due to COVID-19 infection in the family and IES-R scores. Conclusion(s): Higher levels of stress and depression were found among those found positive for COVID-19. This highlights the need for early assessment of psychological problems and timely intervention to avoid long term psychiatric sequelae to those affected by COVID-19 infection.

Implementation of Digital Technologies and Automation: Key Strategy of Improving Project Efficiency During Challenging Phase

The current outbreak and the financial crisis occurred due to Coronavirus (COVID‐19);the global economy is melting like an ice-cream. This current pandemic and the market condition have affected not only the human but also greatly impacted the commodities prices, demand & supply especially into the industry those which believes on the traditional way of working such as oil & gas and other energy sectors. If I will talk about only the oil and Gas or Petroleum industry, then based on the current market information and statistics then the short team impact is nearly 25% to 30% decrease in the petroleum consumptions, but the long-term impact can be even more than 35% to 40%. The CAPEX and OPEX investment for research and development have been slashed like anything. When the world started investing into the other source of energy then it has started forcing oil and gas industry to think out of the box and industry must change rapidly prior to losing a substantial market share because of orthodox thinking in terms of utilizing the available technology or investing in the future technologies. This paper will discuss about the way how to shift the whole industry from man oriented to machine oriented, uses of traditional technologies to the modern technologies and implementation of digitization and automation of running plant as well as upcoming projects starting in the earliest phase e.g., Feasibility study, Pre-Feed, FEED and EPC stage (including Pre-Commissioning/Commissioning) and the operation phase of the projects. Copyright © 2022, International Petroleum Technology Conference.

Hyperviscosity Syndrome Complicating Igg Myeloma - Cognizance of Early Plasmapheresis Is Crucial

BACKGROUND: Hyperviscosity syndrome (HVS) is an infrequent but life-threatening complication of multiple myeloma (MM) and classically presents with the triad of mucosal bleed neurological and visual disturbances. HVS is typically associated with Immunoglobulin M (IgM) MM and very rarely may complicate IgG MM. Even suspicion of HVS necessitates therapy based on clinical severity rather than the calculated degree of viscosity. While plasmapheresis promptly decreases serum viscosity by 30-50% early initiation of antimyeloma therapy is crucial to prevent rebound phenomena. AIM OF THE STUDY: In this context, we report a case of IgG MM which despite being complicated by HVS had gratifying outcome attributable to early clinical suspicion and consequent prompt therapeutic intervention. METHOD(S): Case report - A 60-year-old lady presented with headache altered sensorium blurring of vision and bleeding from both nostrils of two days duration. She also had breathlessness on exertion and generalized fatigue for one month. Clinical evaluation was remarkable for pallor hypertension (blood pressure - 160/96 mm Hg) tachypnea (respiratory rate - 26/minute) with blood clots in nostrils bleeding from gums dry tongue and skin bruising on the arms. Besides altered mentation neurological evaluation revealed bilateral venous congestion and perivenular flame-shaped hemorrhages on direct ophthalmoscopy. There were no features of heart failure peripheral lymphadenopathy or organomegaly. Her initial blood sampling was difficult as blood was rapidly clogging during sampling itself. After rapid saline infusion, samples could be drawn and processed. Hemogram showed normocytic normochromic anemia (hemoglobin-6.3%g/ dL) thrombocytopenia (platelets -71 000/mm3) and rouleaux formation without hemolysis or blast cells on peripheral blood smear. SARS-CoV-2 PCR was negative. She had reversal of albumin-globulin ratio (total protein -10.6 g/dL;albumin -2.1 g/dL) hypercalcemia (corrected calcium - 14 mg/dL) and raised creatinine of 2.5 mg/dL. Her coagulation profile was essentially normal. Computed tomography images of head chest and abdomen were essentially normal. Further evaluation revealed M-spike (5.3%gm/dL) on serum protein electrophoresis raised IgG (4.69 g/dL) increased kappa light chain (kappa 171 mg/L lambda 24.3 mg/L;ratio -7) on serum-free light chain assay monoclonal band of IgG Kappa on serum immune-fixation electrophoresis. Bone marrow aspiration revealed 60% plasma cells (Figure-1) with sheets of plasma cell on bone marrow biopsy having kappa-restriction on immunohistochemistry thereby confirming multiple myeloma and ruled out remote possibility of lymphoplasmacytic lymphoma-related HVS. In view of presumptive HVS complicating multiple myeloma patient was managed with urgent plasmapheresis and consequently initiated on bortezomib-based anti-myeloma triplet therapy including lenalidomide and dexamethasone (VRd) besides supportive therapy for hypercalcemia and acute kidney injury. After three sessions of plasmapheresis patient showed complete resolution of symptoms of HVS with remarkable change in plasma color (Figure-2). Her acute kidney injury also recovered by day-7, and she went home walking on day-10 of her hospitalization. Two months later she was tolerating her chemotherapy well with complete resolution of hypergammaglobulinemia. Six months later she is in complete remission and is being planned for autologous hematopoietic stem cell transplant. RESULT(S): Discussion - Classical triad of HVS include mucosal bleed, neurological disorders, and visual disturbances.5 Presence of oro-nasal bleed mandates thorough retinal evaluation since hemorrhages may occur without visual symptomatology. Furthermore, clinical signs include hypertension, congestive heart failure5, priapism6, and decreased hearing merit consideration. Structure of protein is an important determinant of viscosity, whereby spherical proteins rotate through plasma and contribute very little and large linear proteins spin end over end and raise viscosity disproportionatel . Likewise, IgM (molecular weight of 950 Kd) has a high axial length-to-width ratio and, therefore, raises plasma viscosity at levels above 5 g/ dL. IgA circulates as a dimer, and results in HVS at levels above 7 g/dL7. HVS complicating IgG MM with IgG circulating as a monomer (molecular weight of 180 Kd) is rare and accounts for less than 5% of cases and requires IgG level usually above 10 g/dL7. Even presumptive suspicion of HVS necessitates therapy based on clinical severity rather than the calculated degree of viscosity as correlation between serum viscosity and clinical manifestation is not precise;nevertheless, symptoms attributable to HVS are rare if serum viscosity is less than 4 centipoise (CP) [normal value -1.5 CP]. With rapid symptomatic relief following plasmapheresis, absence of further therapeutic and prognostic implications and logistic constraints, serum viscosity and Ig G subtyping8 couldn't be estimated in the index case. As IgM is predominantly limited to intravascular space (over 80%), only a single session of plasma exchange (removal of 1-1.5 plasma volume) typically, decrease plasma viscosity by 30% to 50%, and reduce IgM level by 60%9 and is generally sufficient to abate acute symptoms in patients with IgM-related HVS. In contrast, maximum of three sessions of plasmapheresis10 may be needed in IgG-related HVS (due to late and less efficient removal of IgG as it is near equally distributed between the intravascular space and extravascular space) or if the viscosity remains over six CP11. Although International Myeloma Working Group does not specifically identify HVS as myeloma-defining event, clearly its presence warrants Bortezomib-based chemotherapy for rapid decline of Ig levels.5 However, pharmacological treatment should never be considered as an alternative to plasma exchange for immediate hyperviscosity reduction.5 Moreover, patients with HVS tend to have plasma volume expansion;hence, actual anemia may be partially dilutional. Consequential red blood cell transfusion can have negative rheological impact of adding red cells to the circulation and further increase in blood viscosity and worsen HVS.5 Therefore, red blood cell transfusion is recommended only after blood viscosity reduction. Symptomatic HVS consequent to IgG MM with IgG levels below 5 g/dL7 is infrequent and hence reported for its novelty. Moreover, early clinical suspicion of HVS and consequent pre-emptive plasmapheresis (even before completion of work-up of MM) may improve clinical outcome as evident in the index case. CONCLUSION(S): To conclude, neurological dysfunction at presentation of MM with / without mucosal bleed and visual disturbance should caution us toward an albeit infrequent, yet devastating complication of HVS, which is otherwise potentially reversible subject to early clinical suspicion and prompt initiation of appropriate therapy.

Indian Multicenter Phase Ii Randomised Controlled Study Comparing Post Stem Cell Maintenance Regimen for Newly Diagnosed Multiple Myeloma (Impose Bortecon Study)

Introduction: Autologous stem cell transplant (ASCT) remains the backbone therapeutic modality with the highest progression-free survival (PFS) and overall survival (OS) benefit even in the era of the novel agents in newly diagnosed multiple myeloma (NDMM). The survival post-transplant can be prolonged using maintenance therapies. The regimen with maximum benefit is still debated, with bortezomib showing PFS benefit even in the high-risk myeloma. Aims & Objectives: This randomized phase II trial is aimed at studying the efficacy (as measured by overall survival (OS), progression- free survival (PFS)), and safety of post-ASCT different maintenance regimens in patients with NDMM. Material(s) and Method(s): Multicentric open-label interventional study with randomized allocation, parallel assignment, with intention-totreat analysis. Recruitment was prospective starting 01 Jan 2017, including all NDMM patients eligible for the study. Remission status was evaluated at D100 and every 6 months for 2y post-ASCT, including MRD analysis by multicolor flow cytometry (MFC) and PET/CT. The four arms included (Arm-A) bortezomib alone (V), (Arm-B) bortezomib in combination with cyclophosphamide and dexamethasone (VCD), (Arm-C) bortezomib in combination with lenalidomide (VR), and (Arm-D) Lenalidomide starting D100 till 2y post-ASCT. Adverse events with CTACE grade<2 were defined as non-serious and the rest as serious. JMP ver. 13 was used for statistical analysis and p<0.05 was considered significant. Kaplan Meier statistics was used for survival analysis. Result(s): A total of 123 patients have enrolled of which 92 patients completed the study protocol and the rest 31 patients were excluded because of protocol deviation due to the COVID pandemic. The median age of the study population was 54.5y (35-76y) with a male preponderance (67%). There was no statistically significant difference between the four arms on the log-rank test in the OS (p-0.99), clinical PFS (p-0.65), biochemical PFS (p-0.6), or MFC-based PFS (p-0.83). There was a statistically significant difference between the four arms on the log-rank test (p-0.0185) on PET/CT-based PFS (PFS being in a descending order VCD>V>VR>R regimen). The all-cause mortality of the study participants was 19.57% (n-18) and the difference in deaths among the various groups was not statistically significant (p-0.85). The tolerability, serious and non-serious adverse were significantly higher amongst Arm D patients. Conclusion(s): We conclude that there was no difference in OS between the different regimens. Patients on Lenalidomide-only therapy had significantly inferior Imaging-PFS.

Role of copper levels in patients with myelodysplastic syndromes

Background: Patients with inadequate amounts of copper often present with cytopenias and exhibit dysplasia on bone marrow, mimicking myelodysplastic syndrome (MDS) and pose diagnostic difficulties. Method(s): This cross-sectional observational study was performed from January 2020 to June 2021. Patients diagnosed with MDS were included in the study and serum copper levels were measured by the Inductively Coupled Plasma Mass Spectrometry (ICPMS) method. Copper supplementation with intravenous copper chloride 2.5mg daily for the first two weeks, followed by oral 3mg copper sulfate thrice daily for the next three months, was given for copper-deficient patients. Response assessment was performed with repeat hemogram and serum copper levels. Result(s): A total of 57 patients were diagnosed with MDS, of these, 33 (57.89%) were males and 24 (42.10%) were females. The mean age was 54.3+/-14.6 years (13-81). The distribution of patients in different types of MDS was MDS-SLD in 15, MDS-MLD in 18, MDS-EB1 in 7, MDS-EB2 in 8, and MDS-U in 9 patients. Anemia was seen in (87.71%) of patients, with mean hemoglobin 7.6+/-2.1g/dL (4.6-14.5g/dL). Neutropenia was seen in 31 (54.38%) with a mean absolute neutrophil count(ANC) of 2073+/-2139/muL (211-10,952/muL). Thirty seven (64.91%) patients had thrombocytopenia with a mean platelet count of 1,05,298+/-1,21,769/muL (9,000-6,74,000/muL). The mean serum copper levels were 146.69+/-42.36mug/dL (54.2-254.0mug/dL). Only three (5.26%) patients out of 57 were found to have copper deficiency. All three patients with low copper levels were found to have anemia, thrombocytopenia, and mildly raised serum erythropoietin levels. All three patients had dyserythropoiesis on bone marrow examination, and only one patient each had cytoplasmic vacuolations in erythroid precursors and dysmegakaryopoiesis. Among the three patients with copper deficiency, two patients had significant improvement in cytopenias after copper supplementation, and one had lost follow-up due to COVID-19. Conclusion(s): This study is the first from India to evaluate the role of copper in patients presenting with predominantly hematological manifestations. For patients presenting with cytopenias or marrow dysplasia resembling MDS, copper deficiency should be considered in the differential diagnosis. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest. Copyright © 2022

The Impact and Challenges of Covid-19 Pandemic on E-Learning

COVID-19 has caused havoc on educational systems around the globe, impacting over 2 billion learners in over 200 countries. University, college, and other institutional facility cutbacks have impacted more than 94% of the world’s largest population of students. As a result, enormous changes have occurred in every aspect of human life. Social distance and mobility restrictions have significantly altered conventional educational procedures. Because numerous new standards and procedures have been adopted, restarting classrooms once the restrictions have been withdrawn seems to be another issue. Many scientists have published their findings on teaching and learning in various ways in the aftermath of the COVID-19 epidemic. Face-to-face instruction has been phased out in a number of schools, colleges, and universities. There is concern that the 2021 academic year, or perhaps more in the future, will be lost. Innovation and implementation of alternative educational systems and evaluation techniques are urgently needed. The COVID-19 epidemic has given us the chance to lay the groundwork for digital learning. The goal of this article is to provide a complete assessment of the COVID-19 pandemic’s impact on e-learning and learning multiple papers, as well as to suggest a course of action. This study also emphasises the importance of digital transformation in e-learning as well as the significant challenges it confronts, such as technological accessibility, poor internet connectivity, and challenging study environments. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

An Update of Pharmacological and Non-pharmacological Therapies for COVID-19 Pandemic Trivia

Background: The whole planet is facing one of the scariest pandemic situations in this era. On 11th February, 2020 the World Health Organization announced the name of an unknown disease as COVID-19, which is caused by the ssRNA virus SARS-CoV-2 (formally recognized as a sister of SARS-CoV and MERS-CoV). The epicenter of this disease is Wuhan, Hubei Province, China. COVID-19 can affect all age groups, but particularly affects immune compromised and aged persons with co-morbid conditions. It is highly contagious disease that involves mild to severe respiratory symptoms along with breathing difficulties. Objectives: As SARS-CoV-2 is a new strain of β-coronavirus that spreads from animals to humans via an unknown intermediate host, no vaccines have been developed yet and only supportive treatment is given to the infected patients. The review paper highlights the pharmacological therapy as a supportive treatment given to the COVID-19 patients and nonpharmacological therapeutic approaches for the prevention. Methods: Methods: Authors were surveyed and reviewed numerous articles, magazines, news papers, conference proceedings from different search engines and made the review successful. Results: Some drugs of different categories are approved and prescribed to the patients and some others are still under investigation and have gone through clinical trials. Conclusion: As no specific treatment or drugs for this disease have been developed till the date;therefore, social distancing, home quarantine, and proper healthy lifestyle management are the best current short-term options to avoid further spread of this pervasive virus.

Mental health problems in health-care workers of tertiary level COVID-19 care centers in Central India

Background: The health-care workers (HCWs) who are overburdened during the COVID-19 pandemic are at increased risk of developing psychological disorders. Aim: The aim of this study was to assess the magnitude of psychological problems such as depression, anxiety, and fear of COVID-19 among the HCWs and to study their correlates. Material and Methods: The study is an online multicentric cross-sectional survey of mental health problems in the HCWs of three tertiary level COVID care centers in Central India. HCWs were assessed using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and Fear of COVID-19 Scale. Results: Out of 467 HCWs assessed, 25.5% of the participants had depression (defined by PHQ-9 score of more than 5), whereas anxiety was present in 24.4% of the study subjects (defined by GAD-7 score of more than 5). Forty-six percent of the participants had medium-to-high levels of fear of COVID-19. Female gender, working in the nonclinical department, direct involvement in care of COVID-19 patients, perceived worsening of physical health status following the pandemic outbreak, and past history of psychiatric problem were the factors significantly associated with presence of depression as well as anxiety. Age of the participant had a positive correlation with fear of COVID-19 and a negative correlation with depression and anxiety levels. Conclusion: HCWs serving in COVID hospitals are vulnerable to develop mental health problems and appropriate screening measures and interventions should be designed so as to preserve mental health of this vital task force.

Lichen planus drugs re-purposing as potential anti COVID-19 therapeutics through molecular docking and molecular dynamics simulation approach

Background and Aim: The present study intends to investigate COVID-19 by targeting their main proteins with 17 selected drugs used for treating Oral Lichen Planus (OLP) which is a chronic muco-cutaneous disorder. Here, an attempt is made to gain better insight into the structure of various drugs targeting specific proteins which will be helpful in developing drugs useful for therapeutic and preventive measures. Method: In silico studies, molecular docking and molecular dynamic simulations were performed to repurpose the therapeutic drugs (n = 17) which were used to treat OLP against COVID-19. In addition, the maximum binding affinities of the key protein spike glycoprotein, main-protease (Mpro) of coronavirus, and Angiotensin-Converting Enzyme-2 (ACE-2) in the human body were evaluated with the selected drugs. Results: Epigallocatechin-3-gallate (EGCG) showed the highest docking values among the drugs selected for repurposing. Among the target proteins, EGCG has shown maximum binding affinity with ACE-2 receptor. Further, according to the molecular dynamic simulation studies, EGCG has shown the least conformational fluctuations with Mpro. Conclusion: EGCG can be a potential inhibitor drug which can bind with ACE-2 receptor thus inhibiting the interaction of mainly Mpro protein and spike glycoprotein of SARS-CoV-2. Relevance for Patients: EGCG, a natural compound shows antiviral potential having considerably high affinity and stability with SARS-CoV-2. It might be further employed as a lead drug against selective inhibitors of SARS-CoV-2 for the therapeutic management of COVID-19 patients after necessary clinical trials.

When Hammer Misses the Nail: Health Aspirations and Internal Migration in India

As the COVID-19 pandemic rages through the world, public health systems in India continue to fail the poor, most notably migrant labourers and their families. The historical levels of death and economic damage have strengthened support for investment in health infrastructure. However, calls for investment in health infrastructure overlook the role of the agency of migrants in effective health systems. This chapter elaborates on the links between health aspirations and migration decisions of rural households. Through a case study of seasonal migrants in Nuapada, Odisha, this chapter argues that precarity of seasonal migrants deprioritizes health aspirations for a life that “they have a reason to value”. Using a framework based on the capacity to aspire and the capabilities approach, I find that rural households in the sample have generally low health aspirations for their children. These aspirations—including levels of health and debt for health expenses—are further lower for girls than for boys. While debt related to health expenses is a key factor in creating debt traps that sustain high-risk low-return seasonal migration, lower health aspirations impair any investment in health or access to health systems. This chapter cautions against a singular focus on building infrastructures, and argues for thoughtful integration of the agency of migrants to develop effective health systems in the future. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Dysfunctional State of T Cells or Exhaustion During Chronic Viral Infections and COVID-19: A Review.

Coronavirus disease 2019 (COVID-19) continuously affecting the lives of millions of people. The virus is spread through the respiratory route to an uninfected person, causing mild-to-moderate respiratory disease-like symptoms that sometimes progress to severe form and can be fatal. When the host is infected with the virus, both innate and adaptive immunity comes into play. The effector T cells act as the master player of adaptive immune response in eradicating the virus from the system. But during cancer and chronic viral infections, the fate of an effector T cell is altered, and the T cell may enters a state of exhaustion, which is marked by loss of effector function, depleted proliferative capacity and cytotoxic effect accomplished by an increased expression of numerous inhibitory receptors such as programmed cell death protein 1 (PD-1), lymphocyte-activation protein 3 (LAG-3), and cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) on their surface. Various other transcriptional and epigenetic changes take place inside the T cell when it enters into an exhausted state. Latest studies point toward the induction of an abnormal immune response such as lymphopenia, cytokine storm, and T cell exhaustion during SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection. This review sheds light on the dysfunctional state of T cells during chronic viral infection and COVID-19. Understanding the cause and the effect of T cell exhaustion observed during COVID-19 may help resolve new therapeutic potentials for treating chronic infections and other diseases.

Nanocurcumin formulation: a possible therapeutic agent for post COVID inflammatory syndrome.

Over the last twenty months, the attention of the world has been focusing on managing the unprecedented and devastating wave of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) and mitigating its impacts. Recent findings indicated that high levels of pro-inflammatory cytokines are leading cause of poor prognosis in severely ill COVID-19 patients. Presently, the multiple variants and highly contagious nature of virus makes challenge humongous. The shortage and vaccine hesitancy also prompted to develop antiviral therapeutic agents to manage this pandemic. Nanocurcumin has potential antiviral activities and also beneficial in post COVID inflammatory complications. We have developed nanocurcumin based formulation using pyrroloquinoline quinone (PQQ) which protects cardio-pulmonary function and mitochondrial homeostasis in hypobaric hypoxia induced right ventricular hypertrophy in animal model and human ventricular cardiomyocytes. Nanocurcumin based formulation (NCF) with improved bioavailability, has proven several holistic therapeutic effects including myocardial protection, and prevents edema formation, anti-inflammatory and antioxidant properties, maintaining metabolic and mitochondrial homeostasis under hypoxic condition. The post COVID-inflammatory syndrome also reported to cause impaired heart function, lung injuries and increased C-reactive protein level in severely ill patients. Thus, we speculate that NCF could be a new treatment option to manage post COVID-19 inflammatory syndrome.

A fatal association of COVID-19 and acute complicated Type-B aortic dissection: Interventional management in a difficult situation

We present a rare case with simultaneous COVID-19 pneumonia and acute complicated type -B aortic dissection (ACTBAD). With strained health services a major procedure endovascular aortic repair (EVAR) was performed. Despite successful EVAR, patient had sudden unexplained cardiac arrest. Procedural mortality is high among COVID-19 infected patients.

Academic urology tweet performance dashboard

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has limited in-person opportunities such as away rotations and residency interviews within academic urology. Twitter may serve as a vital tool mitigating these barriers and expanding the field. Our study aims to re-evaluate Twitter usage among academic urology programs in 2020 compared to 2009-2019. METHODS: We evaluated 83,000 tweets from 113/133 U.S. academic urology program twitter accounts during 2009-2020 through the Application Programming Interface on April 2, 2021. Text patterns were interpreted as positive, neutral, or negative via sentiment analysis. Tweets, number of followers, @mentions, hashtags, and account creations were analyzed. We captured word cloud (visualization of most frequent words) and trigram (most frequent three-word combinations) analysis. RESULTS: Our data revealed that 2020 depicted a record number of tweets (22,544) and account creations (23). For all programs, the median (IQR) number of tweets and followers was 1,748 (872- 3,051) and 2,201 (1,509-3,956). The University of North Carolina (8,707) tweeted the most. However, Johns Hopkins (5,365) had the most followers. The most frequently mentioned account in both 2009- 2019 and 2020 was the American Urological Association (@americanurological). @uro-res and @uroresidency ranked higher in 2020 than previously. Compared to 2009-2019, positive sentiment increased by 3%, while negative decreased by 2%. Word cloud analysis identified urology and resident as the most prominent words in 2020, shifting from urology and cancer (2009-2019). Trigram analysis revealed 2009-2019 tweets pertained around (risk, prostate, cancer) whereas 2020 tweets revolved around (virtual, open, house), suggesting a context shift to program recruitment. CONCLUSIONS: Our novel findings reveal that urology programs are capitalizing Twitter to promote residency recruitment and education via increased tweets and account creations, which will have far-reaching implications on urology's future.

Deep learning techniques for the real time detection of Covid19 and pneumonia using chest radiographs

The newly detected virus also called coronavirus spreads the disease Covid19. World Health Organization (WHO) confirmed this virus as a worldwide pandemic as it has infected millions of people and has taken away many lives across the globe. An infection caused by Covid19 disease majorly destroys the respiratory tract of human beings that ends with multiple organ failures or death in the worst case. In the present work, chest radiographs were provided as input to various deep learning CNN architectures for the purpose of feature extraction. After extracting the features, the images were provided as the input to various machine learning classifiers that classify the chest radiographs as Covid-19 positive, pneumonia infection, or healthy scans. © 2021 IEEE.

The impact of the COVID-19 pandemic on intravitreal bevacizumab use

Purpose : The COVID-19 pandemic has led to stay-at-home orders which may lead to fewer medical and ophthalmology visits. Efficacy of treatments for retinal vascular diseases such as wet age-related macular degeneration (wet AMD) depend on strict adherence to regimens of anti-vascular endothelial growth factor (VEGF) injections. The purpose of this study is to describe and compare the number of bevacizumab injections administered in 2019 and 2020 to determine if the COVID-19 pandemic may have affected usage. Methods : We conducted a single-center, retrospective observational study which compared the number of bevacizumab injections in January through November 2020 with the number of bevacizumab injections in 2019. The total number of injections for each month and year were compared.Results : The total number of bevacizumab injections in 2020 (Jan-Nov) was 683 compared to 801 in 2019 (Jan-Nov), a 14.7% reduction (p = 0.02). Significantly fewer injections were administered in March, April, and May 2020 (p < 0.01), and from August to November (p < 0.01). The fewest number of injections for 2020 were administered in April (n = 45) and May (n = 45). Conclusions : In this patient population, a significant reduction in bevacizumab injections occurred during the COVID pandemic, and the drop in injections was first seen in March 2020 which coincided with stay-at-home orders within the catchment area. These data suggest that the Covid-19 pandemic likely affected the number of patients coming to the retina clinic. Additional data is needed to determine if other factors may have contributed to this decline, and if these missed visits has adversely affected visual acuity outcomes.

The Impact of the COVID-19 pandemic on aflibercept and ranibizumab anti-VEGF Injections

Purpose : The COVID-19 Pandemic resulted in a substantial decrease in outpatient ophthalmology clinic visits due to stay-at-home orders. Retinal vascular diseases and wet age-related macular degeneration require adherence to treatment regimens with antivascular endothelial growth factor (anti-VEGF) injections. The purpose of this study was to assess how the COVID-19 pandemic affected the number of injections compared to prepandemic values. Methods : This retrospective, observational clinical study assessed all anti-VEGF injections of aflibercept and ranibizumab for both 2019 (Jan-Dec) and 2020 (Jan-Nov) at an academic center. The total number of injections for each year was compared, as well as the number of injections for each month in 2020 compared to the average number of monthly injections in 2019. Both 1-sample and 2-sample t-tests were conducted, and a p-value less than 0.05 was considered significant. Results : The total number of aflibercept and ranibizumab injections in 2019 (Jan-Nov) were 4989 and 522 respectively, compared to 4855 and 515 in 2020 (Jan-Nov). No significant difference in injections was noted between 2019 and 2020 for either aflibercept (p=0.31) or ranibizumab (p=0.80). When analyzing each month in 2020 compared to the average number of aflibercept injections per month in 2019, there were significantly fewer aflibercept injections administered in February (p<0.01), August (p=0.03), and November (p<0.01), but significantly higher injections administered in July (p<0.01) and October (p<0.01). For ranibizumab, significantly fewer injections were administered in March (p=0.02), April (p=0.02), and May (p<0.01), but a higher number of injections were administered in September (p<0.01) and November (p<0.01). Conclusions : Despite stay-at-home orders, there was no significant decrease in the overall number of aflibercept or ranibizumab injections during the COVID pandemic compared to the prior year. Although further information is needed to determine if these injections represent both new and return patients, these data suggest that in this specific population, patients still returned to their retina specialist for care despite the ongoing pandemic.

The Placebo Effect on COVID Patients: When the Mind Cures the Body

In this time of novel coronavirus (COVID-19) when everyone is looking for the right treatment and the vaccine a psychological effect can really help make the situation better at homes. There is no doubt in an ideology that the human mind is a compelling tool and so powerful that it is well aware about the concept of placebo effect. It somehow convinces the human body that the placebo medication given in the procedure is equivalent to the proper Medication. This paper aims to analyses the placebo effect in curing the pain and its role in curing the symptoms of the novel coronavirus (COVID-19) because it is possible that this method may have healed the body of COVID patients. This has been done by considering the related experiments and researches of placebo effect. In this paper conducting the online survey which is help to find the placebo effects on the COVID-19 Patients and taking their opinion towards it and 280 patients for using as a sampling which help to find the approximation of placebo effect on COVID-19 patient. The influences of the placebo effect on the medical business and COVID treatment both have been highlighted. A discussion in futuristic sense about the placebo effect in treatment of COVID-19.