Preclinical Characterization of the Omicron XBB.1.5-Adapted BNT162b2 COVID-19 Vaccine (preprint)

As SARS-CoV-2 continues to evolve, increasing in its potential for greater transmissibility and immune escape, updated vaccines are needed to boost adaptive immunity to protect against COVID-19 caused by circulating strains. Here, we report features of the monovalent Omicron XBB.1.5-adapted BNT162b2 vaccine, which contains the same mRNA backbone as the original BNT162b2 vaccine, modified by the incorporation of XBB.1.5-specific sequence changes in the encoded prefusion-stabilized SARS-CoV-2 spike protein (S(P2)). Biophysical characterization of Omicron XBB.1.5 S(P2) demonstrated that it maintains a prefusion conformation that adopts a flexible and predominantly open one-RBD-up state, with high affinity binding to the human ACE-2 receptor. When administered as a 4th dose in BNT162b2-experienced mice, the monovalent Omicron XBB.1.5 vaccine elicited substantially higher serum neutralizing titers against pseudotyped viruses of Omicron XBB.1.5, XBB.1.16, XBB.1.16.1, XBB.2.3, EG.5.1 and HV.1 sublineages and the phylogenetically distant BA.2.86 lineage than the bivalent Wild Type + Omicron BA.4/5 vaccine. Similar trends were observed against Omicron XBB sublineage pseudoviruses when the vaccine was administered as a 2-dose primary series in naive mice. Strong S-specific Th1 CD4+ and IFN{gamma}+ CD8+ T cell responses were also observed. These findings, together with prior experience with variant-adapted vaccine responses in preclinical and clinical studies, suggest that the monovalent Omicron XBB.1.5-adapted BNT162b2 vaccine is anticipated to confer protective immunity against dominant SARS-CoV-2 strains. ONE-SENTENCE SUMMARYThe monovalent Omicron XBB.1.5-adapted BNT162b2 mRNA vaccine encodes a prefusion-stabilized spike immunogen that elicits more potent neutralizing antibody responses against homologous XBB.1.5 and other circulating sublineage pseudoviruses compared to the bivalent Wild Type + Omicron BA.4/5 BNT162b2 vaccine, thus demonstrating the importance of annual strain changes to the COVID-19 vaccine.

A Novel Machine Learning Classification Model to Analyze the COVID-19 Pandemic's Impact on Academics: Sentiment Analysis Approach

The COVID-19 Pandemic is considered as the worst situation for human beings;it affected people's lives worldwide. Due to this pandemic, the respective government authority announced the lockdown to break the coronavirus chain. The lockdown impacted people's mental health, leading to many psychological issues as well as hampered students' academics. In this chapter we have studied the impacts on students' academics due to lockdown effect. The data has been collected via a google form questionnaire circulated to various educational institutes. Further, we have developed a novel machine learning classifier model called Naïve Bayes-Support Vector Machine for analyzing the data, which utilizes the properties of both classifiers by using a deep learning framework. We have used natural language processing (TextBlob, Stanza and Vader) libraries to label the dataset and applied in the proposed NBSVM method and other machine learning models and classified the sentiments into two categories (Positive vs Negative). We also applied the natural language processing libraries used a topic-modelling technique called Latent Dirichlet Allocation to know the essential topics words of both classes from students' feedback data. The study revealed 83% and 86% accuracy for unigram and bigram, respectively, whereas the precision was 79% and recall 81%. According to NLP libraries' result, approximately 71% of the feedback's sentiment is negative, and only 16% of feedbacks are positive. The proposed model shown that (Naïve Bayes-Support Vector Machine) outperforms the other variants of the Naïve Bayes and support vector machine. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The Outbreak of Novel Coronavirus-a New Type of Threat in 2020: Genesis, Detection, Treatment, and Management

Background: COVID-19 is a new, health-threatening infectious disease in the world in 2020 and is caused by a novel coronavirus SARS-CoV-2. As of July 13, 2020, 4,881,579 active cases of COVID-19 were diagnosed, and 571,080 deaths were reported globally. In India, 301,850 active cases and 23,187 deaths were reported. To date, no effective treatment is available against the deadly virus SARS-CoV-2. Drug manufacturers, institutional laboratories, and other organizations have started developing vaccines to combat COVID-19 infection. Method(s): Science Direct, Elsevier, PubMed, Scopus, and Nature databases were referred to know the current scenario of the disease. Moreover, recent data have been obtained from the World Health Orga-nization, Centre of Disease Control, case studies, newspapers, and Worldometer reports. Data of Vaccine Centre at the London School of Hygiene & Tropical Medicine, Clinicaltrials.gov, and US National Library of Medicine have also been accessed to obtain the latest information about ongoing clinical tri-als. Result(s): The primary source of the SARS-CoV-2 outbreak is connected to the Hunan seafood and live animal market in Wuhan city, Hubei Province, China. Like;SARS-CoV, and MERS-CoV, SARS-CoV-2 is also a zoonotic virus affecting the lower respiratory tract in humans. The pathogenesis of COVID-19 involves attachment of its Spike (S) protein to the angiotensin-converting enzyme 2 (ACE2) receptor in the lower respiratory tract in humans. The most common symptoms of COVID-19 are fever, cough, sore throat, fatigue, headache, myalgia, septic shock, and breathlessness. Few patients with COVID-19 infection experience diarrhea, vomiting, and abdominal pain. Currently, FDA approved drugs being used to treat COVID-19. Conclusion(s): This review article presents the importance of traditional Indian herbs recommended by AYUSH as precautionary and curative measures of COVID-19 until vaccines and drugs are made avail-able. Moreover, this article discussed the origin, symptoms, mode of transmission, management, and diagnostics techniques for the detection of the SARS-CoV-2 virus.Copyright © 2021 Bentham Science Publishers.

IoMT with Deep CNN: AI-Based Intelligent Support System for Pandemic Diseases

The Internet of Medical Things (IoMT) is an extended version of the Internet of Things (IoT). It mainly concentrates on the integration of medical things for servicing needy people who cannot get medical services easily, especially rural area people and aged peoples living alone. The main objective of this work is to design a real time interactive system for providing medical services to the needy who do not have a sufficient medical infrastructure. With the help of this system, people will get medical services at their end with minimal medical infrastructure and less treatment cost. However, the designed system could be upgraded to address the family of SARs viruses, and for experimentation, we have taken COVID-19 as a test case. The proposed system comprises of many modules, such as the user interface, analytics, cloud, etc. The proposed user interface is designed for interactive data collection. At the initial stage, it collects preliminary medical information, such as the pulse oxygen rate and RT-PCR results. With the help of a pulse oximeter, they could get the pulse oxygen level. With the help of swap test kit, they could find COVID-19 positivity. That information is uploaded as preliminary information to the designed proposed system via the designed UI. If the system identifies the COVID positivity, it requests that the person upload X-ray/CT images for ranking the severity of the disease. The system is designed for multi-model data. Hence, it can deal with X-ray, CT images, and textual data (RT-PCR results). Once X-ray/CT images are collected via the designed UI, those images are forwarded to the designed AI module for analytics. The proposed AI system is designed for multi-disease classification. It classifies the patients affected with COVID-19 or pneumonia or any other viral infection. It also measures the intensity level of lung infection for providing suitable treatment to the patients. Numerous deep convolution neural network (DCNN) architectures are available for medical image classification. We used ResNet-50, ResNet-100, ResNet-101, VGG 16, and VGG 19 for better classification. From the experimentation, it observed that ResNet101 and VGG 19 outperform, with an accuracy of 97% for CT images. ResNet101 outperforms with an accuracy of 98% for X-ray images. For obtaining enhanced accuracy, we used a major voting classifier. It combines all the classifiers result and presents the majority voted one. It results in reduced classifier bias. Finally, the proposed system presents an automatic test summary report textually. It can be accessed via user-friendly graphical user interface (GUI). It results in a reduced report generation time and individual bias.

Effective seed placement and weed management in dry direct seeded rice (DDSR) using zero till seed drill cum herbicide applicator

Rice is typically grown in Asia by transplanting seedlings into puddled soil (land preparation with wet tillage). With accelerated economic growth and COVID-19 outbreak with subsequent lockdown has led to the shortage of labour. There was concern among the farmers on timely completion of transplanting due to shortage of labour. Dry Direct seeded rice (DDSR) is one such technique, probably the oldest method of crop establishment, is gaining popularity because of its low-input requirement. To overcome the effect of rain on the seeds sown by DDSR technique there is a need for creating a provision for settling the seeds in place. The energy spent in the field for individual sowing and herbicide application practice can be reduced by combining both operations. In view of these, the following study was undertaken to perform simultaneous sowing and herbicide application in DDSR technique using a zero till drill and herbicide applicator. A tractor operated zero-till drill cum herbicide applicator serves as a multi-purpose implement that helps in carrying out two or more operations simultaneously. The sole purpose of the implement was to settle the seed in the furrow by using levellers followed by herbicide application which acts as a preemergence herbicide preventing the immediate emergence of weeds. By adopting this practice, about 300 MJ ha-1 energy and Rs. 3000 spentfor weed control can be saved. The emergence of the seed was not affected by the herbicide application as they are separated using a protective hood.

Post Covid Guillain-Barre Syndrome and pulmonary embolism: A rare combination

We hereby report a case with rare combination of Guillain-Barre Syndrome (GBS), Deep Vein Thrombosis (DVT) and Pulmonary embolism (PE) during post-covid period. A 67-year-old male presented with acute breathlessness and calf pain for seven days. He suffered from COVID-19 four weeks prior. He recovered fully then but was not on prophylactic anticoagulants. His lower limb venous doppler confirmed DVT. CT Pulmonary Angiography (CTPA) confirmed PE. His neurological examination revealed bilateral diminished ankle jerks and Babinski flexion reflex, though he had no neurological complaints. Nerve conduction studies revealed acute motor sensory axonal neuropathy (AMSAN) variant of GBS. He was treated with enoxaparin followed by rivaroxaban for thromboembolism and with intravenous immunoglobulins for GBS, to which he responded well. Early diagnosis of GBS saved him from further morbidity. Post Covid GBS has been rarely reported from India. Concurrence of GBS with DVT and PE is further rare. Copyright © 2023 Ubiquity Press. All rights reserved.

A Covid-19 Study and Forecasting

Covid-19 has proven to be a particularly challenging epidemic to contain. Covid-19 has been around for more than two years, despite the swift efforts of medical specialists. Our paper helps this cause by presenting ways to forecast the estimated number of cases in a certain state or country on a future date. This will contribute in the preparation and fight against the spread of the virus as people will know which states require lockdown and which do not. The research paper will also provide statistics on the many patterns that have been observed in India as a result of the Covid-19 problem, as well as how it has affected the people. © 2022 IEEE.

Surveillance of SARS-CoV-2 genome fragment in urban, peri-urban and rural water bodies: a temporal and comparative analysis

As a result of the SARS-CoV-2 pandemic, water bodies connected to anthropogenic activities may likely reveal the presence of viral genetic material. Urban, periurban and rural water bodies in and around Hyderabad, Telangana, India, were monitored for the presence of SARS-CoV-2 gene fragments during the first and second wave of COVID-19 infection. The SARS-CoV-2 genes were not detected in peri-urban and rural lakes, whereas urban lakes having direct functional attributes from domestic activity showed prevalence. Distinct variability in viral load observed among five water bodies was in concordance with human activity in the catchment area. High viral load was observed during the peaks of the first and second waves, specifically in urban lakes. [ FROM AUTHOR]

Discovery of Potential Inhibitors against Mainprotease of Sars Cov2 from Centella Asiatica by in Silico Study

Centella asiatica encompass be utilize towards healing a set of affliction of humans. Legendary mechanism exemplify to its existence of plenteous genetic activities. In this explore revise be projected to make out the phytoderived antiviral moieties from Centella asiatica against Covid-19 Mpro protein as well as comprehend the Insilico study foundation of molecular activity and during in current examine five isolate molecules in Centella asiatica retrieve as of the PubMed database and be subjected towards docking investigation. Dock analysis were done by using Auto dock vina and PyRx software and followed by admet SAR in addition to pkCSM servers, were used for analyse the drug-likeness prediction. Among 5 Phyto-Molecules, 4 moieties of Centella asiatica are very probable aligned with the Mpro protein of Sars Co V 2. Further, the selected Phyto-molecules on the natural source strength launch consistent prescription and bear frontage discovery. Acknowledged beat molecules could be further in use for in vitro, in vivo evaluation and to investigate their efficiency opposed to COVID-19. Copyright ©2009-2021, JGPT. All Rights Reserved.

Impact of Sars-CoV-2 Vaccination on Donor-Derived Cell Free DNA Levels in Renal Transplant Recipients

Purpose: COVID-19 poses a disproportionate threat to renal transplant recipients (RTR), who are chronically immunosuppressed. Studies have indicated a 16% mortality rate compared to <5% for the general population. Effective vaccines (Pfizer, Moderna and, Johnson & Johnson) provided hope for protection against severe COVID-19 in this at-risk population. However, based on experience with vaccines against other viral infections, two primary concerns arose: 1) would the SARS-CoV-2 vaccines be effective in this population;2) could these vaccines provoke rejection? Methods: To address these questions, we tested serum creatinine, anti-SARS-CoV-2 S antibody (Roche ElecsysR), Donor Specific anti HLA Antibodies, other antibodies against SARS-CoV-2, other coronaviruses (LABScreenTMCOVID Plus, One Lambda), and donor derived cell free DNA (dd-cfDNA;fraction, absolute and total quantity, using the ProsperaTM Test, Natera, Inc.) in RTR at the time of vaccine doses 1 and 2 and 1, 3, and 6 months after the second dose. dd-cfDNA >=1% and 78 cp/ mL indicated an increased risk of rejection. 53 patients were consented and enrolled in the study. This study received IRB approval. Statistical analysis was performed using paired two-tailed student's t-test. Result(s): This preliminary analysis analyzed the impact of vaccination on dd-cfDNA levels in 31 RTR patients. This cohort was primarily female (67%) and of hispanic descent (48.3%) with a median age 55 years (range: 19-81). All but 1 patient received the Pfizer vaccination series. Mean time from transplant to vaccination 1 was 114.6 months (range: 10-359 months). Between vaccination 1 and 2, no patients had clinical suspicion of rejection, were hospitalized or underwent for-cause biopsy. No significant differences in dd-cfDNA or total cf-DNA levels were found by Prospera testing between vaccination 1 and 2. (Table 1). Between vaccination 1 and 2, one patient had an increase dd-cfDNA% above the normal range (0.14%, 2.37%), but absolute dd-cfDNA quantity remained in normal range (13.70 cp/mL, 66.08 cp/ mL). At the time of the vaccination 1, dd-cfDNA% was elevated in 2 patients. At vaccination 2, dd-cfDNA% had returned to the normal range for one patient (ddcfDNA quantity was normal for both vaccinations), while both dd-cfDNA% and quantity remained elevated in the other. Conclusion(s): Based on measurement of dd-cfDNA fraction, absolute quantity and total quantity with the Prospera test at vaccination 1 and 2, there was no evidence of SARS-CoV-2 vaccination-induced rejection.

E-books Purchase Intention During the Covid-19 Pandemic in Southern Region of Malaysia

This study aims to explore the effects of price, accessibility, and brand image on e-books purchase intention in Southern Region of Malaysia. A total of 237 questionnaires were collected online from e-book users.Partial least square structure equation modeling was employed to evaluate the research model and hypotheses.The results showed that only price had a positive effect on e-books purchase intention, but accessibility and brand image do not have significant effect on e-books purchase intention.This research givesremarkable theoretical contributionsby exploringthese elements amidst the COVID-19 situation as components of theory of reasoned action,and their effects on e-books purchase intention. This study likewise gives imperative insights to business organizations especially book publisher to consider better price as the business initiative to gain a competitive advantage in the market.

OUTCOMES during and after LONG-TERM TOCILIZUMAB TREATMENT in PATIENTS with GIANT CELL ARTERITIS

Background: Data on the long-term efficacy and safety of tocilizumab (TCZ) for giant cell arteritis (GCA), including incidence and timing of disease relapse after TCZ discontinuation, is limited. Objectives: We aimed to evaluate the long-term outcomes of GCA patients treated with TCZ in a real-world setting. Methods: Retrospective analysis of GCA patients treated with TCZ for >9 months at a single center between 2010-2021. Time to relapse and annualized relapse rate during and after TCZ treatment, prednisone use and safety were assessed. Relapse was defned as the re-appearance of clinical manifestations of GCA that required treatment intensifcation regardless of the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels. The duration of TCZ treatment was determined as per the best clinical judgement of the treating rheumatologist. Results: A total of 57 GCA patients were followed for a mean (SD) period of 3.4 (1.7) years. Baseline characteristics and treatments received are shown in Table 1. Patients were maintained on their initial TCZ course for a mean (SD) period of 2.0 (1.3) years. The initial TCZ course lasted >12 months in 50 (88%) patients. During the initial TCZ course, 8 (14.0%) patients relapsed. Kaplan-Meier (KM) estimated relapse rates on TCZ were 10.5% and 14.9% at 12 and 18 months, respectively (Figure 1A). TCZ was discontinued due to long-term remission in 37 (64.9%) patients and after an adverse event in 6 (10.5%) patients. Of the 43 patients stopping TCZ due to remission or adverse event, 19 (44.2%) subsequently relapsed. KM estimated relapse rates after TCZ discontinuation were 30.4% and 44.0% at 12 and 18 months, respectively (Figure 1B). Overall, 12 patients received more than one TCZ course. The aggregation of all TCZ courses (mean 2.5 years) and all periods off TCZ following the initial TCZ treatment (mean 0.9 years) showed that 11 (19.3%) patients relapsed while on TCZ and 20 (35.1%) patients relapsed during time off TCZ. An analysis adjusting for age, sex, prednisone dose at initiation of frst TCZ course, and disease type (new onset vs. relapsing) at initiation of frst TCZ course showed an annualized relapse rate (95% CI) of 0.1 (0.0-0.2) during TCZ treatment and 0.4 (0.3-0.7) off TCZ (rate ratio 0.2, p<0.0001). By the end of follow up, 42 (73.7%) patients were able to wean off prednisone. During the study, 12 serious adverse events occurred in 11 (19.3%) patients. Among those 12 events, 3 (25%) were related or possibly related to TCZ exclusively (i.e., soft tissue infection, bacteremia, and COVID-19), 3 (25%) to prednisone exclusively (i.e., osteoporotic fracture, diabetic ketoacidosis and stroke), and 2 (16.7%) to either TCZ or prednisone (i.e., pneumonia and sepsis). Conclusion: Long-term TCZ treatment was efficacious in maintaining disease remission and sparing the use of prednisone in patients with GCA. Over 40% of patients stopping TCZ after long-term remission or adverse event relapsed following TCZ discontinuation.

Rising to the Occasion The Only Mantra for Success in the COVID-19 Pandemic

Introduction: The COVID-19 pandemic has been resulted in >2 million deaths globally. SARS COVID 2 is highly infectious and although most are either asymptomatic or mild to moderate, a substantial proportion face the severe life-threatening disease. The mortality risk with large population outbreaks has a major effect on lives, economies, and health care system across the world. The second wave of COVID-19 in India has had severe consequences in the form of increasing cases reduced supplies of the essential treatment and increased deaths, particularly in the young population. It was clearly misgovernance harming people more than lack of medical knowledge. Aim of the studies is to show how rising to the occasion by working together, prioritization, and the right level of resources utilization made things work smoothly with improved quality/outcomes. Background: COVID is a dynamic process. No ideal plan or model exists. We cannot wait for the nonmedical people or government to fix the problem, due to a lot of limitations. In our centre, we went on the extra mile for the benefits of patients including accommodating more ward/ICU patients, prioritization of experienced staff, and right level of resource utilization which helped to treat more patients with good outcome. Working together: 1. Infrastructure: Due to surge in the cases in need of beds with supporting equipment became the primary need. Due to the lockdown and demand, organizing these things was a challenge. Restrictions in place, workload pressures, limitations for regular meetings, things don't fall in place without hospital authority involvement. There are many smart ways of increasing beds in pandemic. From 20 ICU beds to 50 in short time was done without much civil work and cost. Most patients require a good basic care with supportive measures and time for healing, so we added extra beds. With single O2 port, attaching extensions, we were able to provide for more patients. With this expansion, the second challenge was O2 supply. We had 2 challenges one is better supplies and the other reduced the wastage. COVID-19 is a long game and best time to start implementing effective O2 systems. For better supplies, within short period oxygen generators were installed understanding a few limitations in O2 delivery with generator, we mixed with industrial O2 in lesser percentage. O2 misuse was significantly reduced with identifying O2 boys who works were to monitor O2 and saturation round the clock. This happened in short time with good training, and planning. 2. Second important thing was personale: Getting trained staff on time practically was not possible. Most trained staff have a notice period to serve. With few trained staff, making them leaders, were supported by junior staff in each shift. This system works well in pandemic, as there are minimal interventions by the staff, Charts were simplified. Responsibility of Ventilator/O2/Drugs was taken off from the staff. They had time for monitoring and troubleshooting. Interestingly, we also found less stress and anxiety among HCW with these models. We should have a few people who take complete charge of the situation. In pandemic only managing critical patients at a later stage doesn't improve outcomes, precious time will be lost if we delay early interventions. Third important thing is involving family;we involved families with precautions and consent. The results were very encouraging, and multiple benefits were seen. Fourth important thing is simple protocol and documentation. We made only two sheets for a couple of days with clear trends documented, it reduced the workload, time and improved the care. Fifth part is innovations. The learning experience was doing the basics right with supportive care and innovations if needed. Innovations play a big role in pandemics. Doing basics right and do not harm concept in mind, innovations can be done in clinical/non-clinical areas which can improve the outcomes. Conclusion: Working together, prioritising the staff and right level of recourses usage helps in better mana ement and outcomes. Innovations play a major role in a pandemic.

SARS-CoV-2 IgM and IgG serology and clinical outcomes in COVID-19 patients (preprint)

BackgroundThe SARS-CoV-2 virus has become pandemic for the last 2 years. Inflammatory response to the virus leads to organ dysfunction and death. Predicting the severity of inflammatory response helps in managing critical patients using serology tests IgG and IgM. We conducted a longitudinal study to correlate serum SARS-CoV-2 IgM and IgG serology with clinical outcomes in COVID-19 patients. MethodsWe analyzed patient data from March to December of 2020 for those who were admitted at AIIMS Rishikesh. Clinical and laboratory data of these patients were collected from the e-hospital portal and analysed. Correlation was seen with clinical outcomes and was assessed using MS Excel 2010 and SPSS software. ResultsOut of 494 patients, the mean age of patients was 48.95 {+/-} 16.40 years and there were more male patients in the study (66.0%). The patients were classified into 4 groups; mild-moderate 328 (67.1%), severe 131 (26.8%) and critical 30 (6.1%). The mean duration from symptom onset to serology testing was 19.87 {+/-} 30.53 days. In-hospital mortality was observed in 25.1% patients. The seropositivity rate (i.e., either IgG or IgM >10 AU) was 50%. There was a significant difference between the 2 groups in terms of IgM Levels (AU/mL) (W = 33428.000, p = <0.001) and IgG Levels (AU/mL) (W = 39256.500, p = <0.001), with the median IgM/ IgG Levels (AU/mL) being highest in the RT-PCR-Positive group. There was no significant difference between the groups in terms of IgM Levels and IgG levels with all other clinical outcomes (disease severity, septic shock, Intensive care admission, mechanical ventilation and mortality). ConclusionSerology (IgM and IgG) levels are high in RTPCR positive group compared to clinical COVID-19. However, serology cannot be useful for the prediction of disease outcomes except few situations. The study also highlights the importance of doing serology at a particular time as antibody titres vary with the duration of the disease.

Birthing Experience and Perinatal Outcomes with COVID-19: A Prospective Study

Aim: To study childbirth experience of women with coronavirus disease-2019 (COVID-19) at our institute and to assess clinical characteristics, maternal, and perinatal outcomes of SARS-CoV-2-positive pregnancies. Materials and methods: We conducted a prospective cohort study of all SARS-CoV-2-positive women who delivered at our institute from 1 September 2020 to 31 March 2021. The data was collected from labor room birth register, electronic medical record (EMR), and feedback questionnaire, Kerala Institute of Medical Sciences–Childbirth Experience Questionnaire (KIMS–CEQ), filled by women to express their childbirth experience. Results: Of the 50 women we studied, 84% were asymptomatic. In contrast to the majority of the studies published till now, preterm labor in our study was noted only in 12% cases. In our study, 62% delivered vaginally and cesarean section (CS) rate was 38%. All cesarean deliveries were done only for obstetric or fetal indications. A total of 6% women had minor peripartum complications. Majority of the neonates had normal appearance, pulse, grimace, activity, and respiration (APGAR) scores, and all were COVID-19 screen negative;12% required neonatal intensive care unit (NICU) admission;84% women opted to breastfeed their babies (direct breastfeeding or expressed breast milk) maintaining all precautions and hygiene they were taught;88% women experienced positive childbirth experience based on KIMS–CEQ score. Conclusion: In our study, the pregnancy complications including the pre-term labor and severity of COVID-19 are not found to be above those in screen negative pregnant women nor any case of vertical transmission of SARS-CoV-19 reported. Our study is unique as it also assesses the birthing experience in women with COVID-19 which shows that most of them had a positive birth experience at our institute. The COVID-19 status should not deprive any women of her childbirth rights, although more precautions are warranted. Clinical significance: A positive or negative childbirth experience can have far-reaching consequences in life of a woman and the newborn. It is the need of the hour to address the important issue of positive birth experience, especially during the era of ongoing COVID-19 pandemic. The KIMS–CEQ provides an efficient tool to assess birthing experience of women with COVID-19.

Telehealth: A new paradigm? Paediatric surgical subspecialty telemedicine survey in the COVID-19 Pandemic at a tertiary care centre

Background:Although the technology has been available and several pilot studies have shown success, use of telemedicine has previously been limited in the United States, especially among surgeons. This study aimed to investigate the benefits and obstacles for successful implementation of telemedicine visits in paediatric surgical subspecialties amid the COVID-19 pandemic.Methods:We analysed survey data from telemedicine visits with paediatric surgical subspecialists from May 1 through June 30, 2020 at our paediatric surgery subspecialty clinics. Univariate logistic regression was used to determine associations in survey responses and various demographic factors.Results:There were 164 respondents to the survey. The most frequently cited barrier to care was ability to get time off work (46.3%). Overall satisfaction with the telemedicine visit was 93.8%, and 55.6% responded that they would choose video telemedicine rather than an in-person or telephone visit. Those living at least 25 miles from the hospital had increased odds of indicating interest in using telemedicine for future visits (OR = 2.56, 95% CI = 1.12?5.86, p = 0.026). The average respondent saved between 30 minutes and 1 hour, and 45 minutes using telemedicine.Conclusions:The implementation of telemedicine at our institution in the paediatric surgical subspecialties has proven to be effective and well-received. Given the benefits of time and money saved for families, paired with high satisfaction rates and continued interest, paediatric surgical subspecialists should work to incorporate virtual visits into regular patient care, even well after the COVID-19 pandemic.Level of Evidence:Level IV

Bronchoscopic management of bronchopleural fistula due to COVID-19 a nonsurgical option

Background: COVID-19 has become a dreadful pandemic. One of the important complication is the development of pneumothorax/ pneumomediastinum which gets further complicated by bronchopleural fistula. Case Study: A 44year male patient with severe COVID pneumonia developed Left sided pneumothorax and treated conservatively with ICD and negative suctioning for 2 months and referred to us with persistent pneumothorax with BPF. As patient was unfit for surgery, bronchoscopic management was planned. With flexible bronchoscope, 6F Fogarty balloon was passed and inflated, leak site was identified in left upper lobe upper division. A Watanabe spigot size 5 was deposited at the opening of upper division and manipulated to apical segment. Other small openings were sealed with cyanoacrylate glue and autologous blood patch. After procedure negative suction was reapplied. Repeat Xray showed resolution of pneumothorax. Pleurodesis was done with talc slurry, post pleurodesis showed no pneumothorax and ICD was removed. Patient was discharged, follow up X ray after 4weeks showed no evidence of pneumothorax. Discussion: In most cases of BPF, leak seals after tube thoracostomy, only 3-5% will continue to have persistent leak. For medically inoperable cases, bronchoscopic balloon occlusion of site and subsequent injection with fibrin glue, liquid bioadhesive or blood patch can be done. For large leak;Amplatzer device, stents, spigots, coils are used. Conclusion: Bronchoscopic treatment can work well for a medically inoperable, complicated pneumothorax in COVID-19 disease.

Host transcriptome-guided drug repurposing for COVID-19 treatment: a meta-analysis based approach.

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been declared a pandemic by the World Health Organization, and the identification of effective therapeutic strategy is a need of the hour to combat SARS-CoV-2 infection. In this scenario, the drug repurposing approach is widely used for the rapid identification of potential drugs against SARS-CoV-2, considering viral and host factors. METHODS: We adopted a host transcriptome-based drug repurposing strategy utilizing the publicly available high throughput gene expression data on SARS-CoV-2 and other respiratory infection viruses. Based on the consistency in expression status of host factors in different cell types and previous evidence reported in the literature, pro-viral factors of SARS-CoV-2 identified and subject to drug repurposing analysis based on DrugBank and Connectivity Map (CMap) using the web tool, CLUE. RESULTS: The upregulated pro-viral factors such as TYMP, PTGS2, C1S, CFB, IFI44, XAF1, CXCL2, and CXCL3 were identified in early infection models of SARS-CoV-2. By further analysis of the drug-perturbed expression profiles in the connectivity map, 27 drugs that can reverse the expression of pro-viral factors were identified, and importantly, twelve of them reported to have anti-viral activity. The direct inhibition of the PTGS2 gene product can be considered as another therapeutic strategy for SARS-CoV-2 infection and could suggest six approved PTGS2 inhibitor drugs for the treatment of COVID-19. The computational study could propose candidate repurposable drugs against COVID-19, and further experimental studies are required for validation.