Stereoselective and regioselective Heck arylation at C-17 exocyclic double bond of andrographolide to generate labdane-based lead molecule against acute lung injury

Andrographolide (AG-1) is identified as an attractive scaffold based on in silico/in vitro/in vivo (preclinical and clinical) studies against COVID-19 infection, for which hardly any effective drug is available to date. Due to complexity of its chemical structure, stereoselective and regioselective Heck arylation reactions at C-17 exocyclic double bond of AG-1 is a major challenge and we stepped forward to generate a small focused library of compounds. Among all the molecules, AG-12 and AG-13 were predicted to have better pharmacokinetic profiles than AG-1. Upon evaluation of in vivo efficacy of AG-12 and AG-13 in comparison to AG-1 using an LPS-induced acute lung injury model, AG-13 showed promising action towards reduction of the neutrophil count, minimization of oxidative stress, and inhibition of inflammatory cytokines. Further, lead optimization should be carried out towards developing potential natural product-driven therapeutics to combat acute respiratory distress syndrome (ARDS) situations during COVID-19. © 2023 Elsevier B.V.

Self-assessment of Psychological Issues of Bangladeshi and Russian Students on the Online Learning During the Pandemic

Currently the educational systems of many countries have a growing influence of the changing educational paradigm due to global changes in global politics, economics' transition to the information society and the challenges of pandemics. COVID-19 has significantly affected tertiary learning systems in Bangladesh, Russia and all around the world, and has forced curricula to be transformed into an online format. The research was conducted at the University of Dhaka and the University of Rajshahi in Bangladesh, as well as at the Peter the Great St. Petersburg Polytechnic University in Russia. The analysis of the participants' answers helped to identify the following psychological issues on learning continuity by the university students, such as: attention, motivation, emotion and anxiety of students. According to the research, students from Bangladesh got tired faster, felt loneliness more acutely, and experienced health problems than their Russian colleagues during online learning. Russian students took notes of their lectures more often, claimed to use various memorization techniques, spent more time online while studying, and were more demanding of handout materials and presentations. Bangladeshi students faced more difficulties with concentration and focusing their attention during online training. The motivation and interest of Bangladeshi students in online learning were significantly lower than Russian students' learning motivation. Also, the level of stress and anxiety among Bangladeshi students was higher. Thus, psychological issues on learning continuity based on learner satisfaction are vital to minimize the negative impact of rapid changes in the educational process and ensure effective online education during digital transformation. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Boerhaave syndrome: Provision of emergency services during the COVID era

Background: The provision of emergency surgery was significantly impacted during the COVID-19 pandemic. This was due to limited intensive care beds and the risk of catching COVID-19 in the post-operative period. The aim of this study was to determine whether outcomes for patients with Boerhaave syndrome were negatively affected by service constraints during the COVID-19 pandemic. Method(s): Single centre case control study of patients with Boerhaave syndrome before and during the COVID pandemic. Univariate and multivariate analyses was employed to determine whether patient outcomes following Boerhaave syndrome were influenced by the COVID pandemic (defined here as 2020-2022) compared to a pre-pandemic period (2013-2019). Result(s): During the COVID pandemic, 7 patients presented with Boerhaave syndrome, although none of these patients tested positively for COVID-19. Patient characteristics and outcome data of these patients were compared to a group of 14 patients with Boerhaave syndrome during a pre-pandemic period. The median age of patients presenting with Boerhaave syndrome was statistically significantly lower during the pandemic compared to those presenting before the pandemic (28 years versus 60 years, p=0.04). There was no significant difference in the treatment approach between the two groups, with non-operative and operative measures being employed in both groups equally (p=0.66), suggesting that the pandemic did not influence treatment decision. There was no difference in the use of endoscopic stenting between the groups (p=0.25). 30-day mortality was equal between patients admitted during the pandemic and those admitted before the pandemic (p=0.13). Conclusion(s): This study demonstrated that the median age of patients presenting with Boerhaave syndrome during the pandemic was significantly lower than it was historically. This may have reflected shifts in behaviour and lifestyle during the pandemic. Never-the-less, the impact on services during the pandemic did not appear to influence treatment choice, and 30-day mortality remained the same for both patient groups. This may have reflected provision of COVID-secure pathways and locations.

Ten year experience of treating Boerhaave syndrome: A single centre analysis

Background: Boerhaave syndrome is a rare condition characterised by spontaneous barogenic, transmural rupture of the oesophagus. We aimed to examine a ten-year experience of Boerhaave syndrome at our centre. Method(s): Cohort analysis of Boerhaave syndrome over a ten year period (2012-2022). Univariate analysis was employed to determine risk factors associated with inferior patient survival. Result(s): During the study period, 40 patients presented with oesophageal perforation, of which 21 (52.5%) were spontaneous transmural rupture. Median age of patients with Boerhaave syndrome was 51 years, in predominantly male (15, 71.4%), non-smokers (13, 61.9%). The most common site of rupture was the lower oesophagus (12, 57.1%), although the exact site of rupture was unknown in 5 (23.8%) patients. 14 (66.7%) patients were treated conservatively with antibiotics. Three (14.3%) patients underwent endoscopic oesophageal stent insertion (either alone or in combination with surgical treatment). Five (23.0%) underwent thoracoscopic washout and drain insertion and 1 (4.8%) underwent open thoracotomy washout and drain insertion. Overall 10-year survival was 80.8%. There was no association between mortality and patient age, sex, smoking status, length of stay, location of perforation, coronavirus status or mode of nutrition on univariate analysis (p>0.05 throughout). Patient age was the greatest predictor of prolonged length of stay beyond 10 days (c-statistic 0.74). Modality of surgery also had no bearing on 1- and 10-year mortality (p=0.95). Conclusion(s): Boerhaave syndrome is an uncommon condition which may be treated with an array of approaches, including non-operative measures, endoscopic and surgical intervention, depending on individual patient characteristics. The availability of multimodal treatment at a specialist oesophagogastric centre may have contributed to favourable patient outcomes. Given the rarity of Boerhaave syndrome, identification of risk factors for poor patient outcomes is difficult to determine, due to statistical underpowering.

The Effect of COVID-19 on the Management of Upper Gastro-intestinal Cancers at a London NHS Trust

Background: The advent of the COVID-19 pandemic in 2020 led to staff redeployment and prioritization of urgent care services. Cancer services were impacted by staff and resource diversion. Cancer diagnoses fell by 33% due to reduction in surveillance, diagnosis, and screening. Upper gastro-intestinal cancers (UGI) include cancers of the esophagus, stomach, small intestine, pancreas, liver, and gall bladder. These cancers progress insidiously, present at late stages and are challenging to treat. Delayed diagnosis significantly reduces the scope of treatment options available and therefore impacts the prognosis of the patient. A Public Health England Report in 2021 showed a reduction in tumor resection surgeries in UGI cancers between March to May 2020 and December to February 2021. The backlog of surgical cancer management is ongoing as the pandemic evolves and NHS service provisions adapt. It is important to understand the effects of COVID-19 on diagnosis, staging and treatment of UGI cancers in order to improve service provision in the ensuing years. Method(s): This was a cross-sectional study conducted at Barking, Havering and Redbridge NHS Trust from January to June 2019, 2020 and 2021. Data for 316 study participants was sourced from the Somerset Cancer Database and supplemented with data from electronic patient care records. Six months of data was compared in 2019 (pre-pandemic), 2020 (mid-pandemic including the first lockdown) and 2021. The data was analysed as raw proportions and percentages. Result(s): The number of UGI cancers diagnosed was lowest in 2020 during the height of the pandemic compared to 2019 and 2021. The most common cancer in all three years was pancreatic. Pancreatic cancer was also the most common emergency cancer presentation. The highest proportion of stage IV cancers presented in 2021 (67%). The proportion of cases that resulted in palliative care management increased from 2019 to 2021 (67% and 70% respectively). 53% of all patients came from neighbourhoods that fell within 50% of the most deprived areas nationally. Conclusion(s): The COVID-19 pandemic has had variable impacts on the presentation and management of UGI cancers at the BHRUT NHS Trust. This study exhibits local trends and percentages following suit from Public Health England's National Cancer Registration and Analysis Service data for trend-based discussion. Further research within London NHS Trusts is encouraged to understand the full impact of COVID-19 on surgical cancer services in the NHS.

COVID-19 and HIV-associated Nephropathies: Double Whammy

The number of COVID-19-associated nephropathies (COVAN) rapidly increased before the fourth wave of the COVID-19 pandemic. Similarities and common lesions with the HIV-associated nephropathy (HIVAN) remarkably affect mostly African Americans positive for the APOL1 risk variants;therefore, these cases must be prioritized in new targeted clinical trials. Copyright © 2022, Bentham Science Publishers. All rights reserved.

Responsible Governance in Containing the Spread of Covid-19 in a Developing State

Aim. The study aims to scan through the public institutional policy implementation in tackling the global pandemic and framing universal policies for responsible governance. It also measures the impact of training interventions and non-training implications in containing the spread of COVID-19 at the grassroots level. Methods. The samples were drawn empirically from pathological tests conducted over 23 weeks to precisely examine the success of the State Government's approach in lowering COVID-19 mortality and spread. Through trend analysis, the outcome has been predicted. The study establishes a link between acknowledged ideas and government practices, providing insight into how relevant the implementation of planned state-craft programs is. Results. The findings indicated that government-imposed policies account for timely pandemic containment, and even a tiny developing state lacking advanced medical facilities and technology can set an example in combating the epidemic. Conclusions. The temporal analysis is based on the inputs acquired from government publications and other sources, allowing us to assess policy initiatives that encompass training interventions and non-training implications as prioritised by the State Government. The paper shows that a good emergency preparedness and response system is needed to prevent huge losses in any sector. This includes the already-struggling health sector, which India needs to put first to avoid more tragedies.

Bacterial and fungal infection in COVID-19 diagnosed cases in a tertiary care ICU setting in the wake of second wave in Kolkata, India

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM: Fungal and bacterial infections increase the mortality rate of COVID-19-positive patients. In addition to the risk factors that we cannot change, invasive procedures should be avoided, constant blood sugar regulation should be applied, and unnecessary antibiotics use should be avoided.  : To investigate the incidence of bacterial and fungal infection of hospitalized patients intensive care units with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in this retrospective observational study in a tertiary care hospital in Kolkata in the wake of second-wave in India.  : A retrospective study of hospitalized patients with confirmed SARS-CoV-2 by PCR was analyzed study in a tertiary care hospital in Kolkata in the wake of second-wave from February 2021 to October 2021.  : The records of 327 patients hospitalized in ICU with the diagnosis of COVID-19 were investigated from electronic health records and hospitalization files.  : The demographic characteristics (age, gender), the number of ICU hospitalization days and mortality rates, APACHE II scores, accompanying diseases, antibiotic-steroid treatments taken during hospitalization, and microbiological results (blood, urine, tracheal aspirate samples) of the patients were recorded. Blood cultures, respiratory samples, pneumococcal or Legionella urinary antigens, and respiratory viral PCR panels were obtained from COVID-19 patients, respectively. The average APACHE II score of the patients was 28 ± 6.  : A positive blood culture was identified in 60 patients (7.1%), of which 39 were classified as contaminants. Bacteremia resulting from respiratory infection was confirmed in two cases (one each community-acquired Klebsiella pneumoniae and ventilator-associated Enterobacter cloacae). Line-related bacteremia was identified in six patients (three Candida, two Enterococcus spp., and one Pseudomonas aeruginosa). All other community-acquired bacteremias (n = 16) were attributed to non-respiratory infections. Zero concomitant pneumococcal, Legionella or influenza infection was detected. A low yield of positive respiratory cultures was identified;Staphylococcus aureus was the most common respiratory pathogen isolated in community-acquired coinfection (4/24;16.7%), with pseudomonas and yeast identified in late-onset infection. Invasive fungal infections (n = 3) were attributed to line-related infections. Opportunistic fungal infection was detected in 58 patients (17.37%) of 327 patients monitored in ICU with a COVID-19-positive diagnosis. Candida albicans was the opportunistic fungal agent isolated from most blood samples taken from COVID-19-positive patients. The mortality rate of COVID-19-positive patients with candidemia was 80%. While 2/3 patients (66.6%) for whom fungi were grown from their tracheal aspirate died, one patient (33.3%) was transferred to the ward.  : Prolonged mechanical ventilation support was associated with the development of nosocomial candidemia and bacteremia. Parallel to the developments in the field of diagnosis and treatment, an increase in the incidence of fungal infections and the number of patients who are in the risk group for the development of opportunistic fungal infections have been observed in recent years. Among the hospitalized patients, those most at risk in terms of fungal infections are intensive care unit (ICU) patients. The rate of Candida infections amongst critical care patients is very and may pose severe mortality if not diagnosed, treated, and handled effectively, and promptly.

Symptomatology, prognosis and clinical findings of myocarditis as an adverse event of COVID-19 mRNA vaccine: a systematic review

Funding Acknowledgements Type of funding sources: None. Background Myocarditis, an inflammation of the myocardium in the absence of ischemic injury, may be caused by viruses, drugs, and vaccines. The Myocarditis following COVID-19 vaccinations is most commonly seen in young adult males and commonly after the second dose of the mRNA vaccine. It usually presents with chest pain, dyspnoea, palpitations but has a diverse clinical presentation and varied therapeutic response. We aim to systematically collate the symptomatology, prognosis, and clinical findings of COVID-19 vaccine adverse events causing Myocarditis. Method Following the PRISMA statement 2020, a systematic search was conducted to isolate confirmed cases of COVID-19 vaccine-induced Myocarditis. By applying the BOOLEAN logic, the following keywords were used: COVID-19, SARS-CoV-2, Myocarditis, Mortality. Four databases were searched from January 2021 through August 2021: PubMed, Science Direct, Google Scholar, and Cochrane Library;the reference lists of screened studies were searched as well (umbrella methodology). Results In total, 12 case reports, 10 case series and 1 cohort study with a total of 107 patients were included in the final analysis. A total of 101 male patients were recorded, and 6 were female showing male dominance. The mean age of all participants was 24.73 years(SD = 13.18), ranging from 14 to 70. The most common presenting symptoms were chest pain (47.66%), fever (35.51%), and myalgia (25.23%). Lab findings showed elevated Troponin I, CRP, and ESR levels in the majority of patients. ECG was abnormal in most of the patients, which include sinus rhythm (24%), ST-elevation (42.05%) and T wave inversion (13.08%). Echo findings include decreased Ejection fraction in 19.62% of patients while 13.08% of patients having a hypokinetic left ventricular wall. Further, CMR finding suggestive of confirmed myocarditis cases in 36% patients while rest are suspected one. Overall mortality(1.86%) was low among patients. Conclusion There is increasing evidence for Myocarditis as a rare adverse event of COVID-19 mRNA vaccination in young adults. This evidence is strongest amongst young male patients. The majority of the patients complain of chest pain and fever. In lab findings Troponin I, CRP and ESR are usually increased and ST elevation is common in the ECG. This entity is mainly treated with nonsteroidal anti-inflammatory drugs, Colchicine, Beta-blockers, ACE inhibitors, Steroids. However, prognosis and outcomes are favourable with a very low mortality rate.

Learning Continuity During the Novel Coronavirus (COVID-19): A Case Study of Arts Faculty Students at University of Dhaka

The COVID-19 pandemic has been affecting the educational and social systemsworld over, and Bangladesh is no exception. Insufficiency of trained human resources in dealing with the pandemic has been prompting the populous at large to clamor for more. Therefore, this paper analyzes the experiences and perceptions of the students of the Faculty of Arts about learning continuity practices during the ongoing COVID-19. Quantitative approaches were used for this study. From the various departments of the Faculty of Arts, 205 students replied to the online survey questionnaire. The data were analyzed using SPSS version 20. The study shows the learners agree with the learning continuity practices. However, high costs of internet bandwidth are causing major impediments for sustaining online education in the long run. Results of the chi-square test showed there was no major difference in the use of personal computers between male and female students. This study was limited to only the Faculty of Arts at the University of Dhaka. The findings of this study would be helpful for universities in Bangladesh to improve the quality of e-learning and implement clear policies and guidelines. Present paper also provides some policy level implications based on the findings. The current study offers several areas for future research. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Influence of the Changing Organizational Culture on the Work Outcomes of Agile Teams in the Pandemic Era

In a VUCA world, contemporary organizations are impacted by many triggers invoked due to government rules, external business environment, and at times by the interaction of people within the organization. This paper focuses on how the changing organizational culture impacts and influences the work outcomes of agile teams operating as complex adaptive systems (CAS) in pandemic situations. During the COVID19 pandemic, the organizational culture of organizations has undergone a remarkable change and more staff are working from home and this impacts the work outcome of the agile teams. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Blended Learning during Pandemic Through Knowledge Management: An Analytical Study

Blended Learning (BL) essentially fuses high-tech digital learning with traditional ones to involve students in "network learning", which helps in transcending physical boundaries. Especially during the ongoing COVID-19 pandemic, BL has been embraced as a realistic possibility to ensure seamless knowledge distribution regardless of time and space. Knowledge Management (KM)-based approaches are typically used to collect, coordinate, and control processes that may be utilised efficiently to both recognise and address customer needs. This study aims to explain how to apply KM techniques within the BL environment to increase educational excellence and quality. We used a quantitative approach, specifically by adopting an online questionnaire circulated to about 272 undergraduate students, primarily from the Department of Information Science and Library Management (ISLM) of the University of Dhaka, Bangladesh. We received completed answers from 74 students;the data gathered were analysed using Statistical Package for the Social Sciences (SPSS) version 20. The findings reveal that KM can be used with BL, especially during crisis times like the one we have today, as it includes integrated tasks and online and e-learning. Finally, the study also proposed an intuitive model for applying BL through KM. Importantly, this study seems to be among the first to examine the students' perceptions about BL and KM integration during a pandemic. Therefore, this research would possibly prompt further research on different aspects of the combined learning process at different universities, especially within Bangladesh. © 2022 World Scientific Publishing Co.

COVID-19 propagation and the usefulness of awareness-based control measures: A mathematical model with delay

The current emergence of coronavirus (SARS-CoV-2 or COVID-19) has put the world in threat. Social distancing, quarantine and governmental measures such as lockdowns, social isolation, and public hygiene are helpful in fighting the pandemic, while awareness campaigns through social media (radio, TV, etc.) are essential for their implementation. On this basis, we propose and analyse a mathematical model for the dynamics of COVID-19 transmission influenced by awareness campaigns through social media. A time delay factor due to the reporting of the infected cases has been included in the model for making it more realistic. Existence of equilibria and their stability, and occurrence of Hopf bifurcation have been studied using qualitative theory. We have derived the basic reproduction number (R-0) which is dependent on the rate of awareness. We have successfully shown that public awareness has a significant role in controlling the pandemic. We have also seen that the time delay destabilizes the system when it crosses a critical value. In sum, this study shows that public awareness in the form of social distancing, lockdowns, testing, etc. can reduce the pandemic with a tolerable time delay.

DYNAMICAL ANALYSIS OF A FRACTIONAL-ORDER MODEL INCORPORATING FEAR IN THE DISEASE TRANSMISSION RATE OF SEVERE INFECTIOUS DISEASES LIKE COVID-19

This paper deals with a fractional-order three-dimensional compartmental model with fear effect. We have investigated whether fear can play an important role or not to spread and control the infectious diseases like COVID-19, SARS etc. in a bounded region. The basic results on uniqueness, non-negativity and boundedness of the solution of the system are investigated. Stability analysis ensures that the disease-free equilibrium point is locally asymptotically stable if carrying capacity exceeds a certain threshold value. We have also derived the conditions for which endemic equilibrium is globally asymptotically stable that means the disease persists in the system. Numerical simulation suggests that the fear factor has an important role which is observed through Hopf-bifurcation. © 2022 Mathematics in Applied Sciences and Engineering. All rights reserved.

Learning Continuity in the Realm of Education 4.0: Higher Education Sector in the Post-pandemic of COVID-19

Learning continuity in the realm of Education 4.0 is posing a stiff challenge to educators due to the physical restrictions imposed by the coronavirus pandemic on institutional learning. Around 320 million learners were prevented from going to schools/colleges across India causing a sudden joltin all educational activities. Despite the challenges, higher education institutions responded affirmatively and evolved to harness the advantages of assistive technologies to ensure the continuity of teaching–learning activities, research, and thus service to the society. The paper discusses the evolution of the blended learning paradigm and its efficacy to ensure higher learning specifically at the tertiary level. In the quest to identify a suitable instructional mechanism, academic institutions have pursued a variety of techniques including synchronous, asynchronous, or mixed-mode heutagogic learning approaches. The researchers seek to use a thematic literature review of the various relevant learning models to explain the nuances of blended learning attributed to the factors of commitment, flexibility, collaboration, and self-paced managed learning environments. The paper proposes a narrative of andragogic styles that are universal and acceptable for higher education institutions to practice and avoid disruption to education. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Symptomatology, prognosis and clinical findings of myocarditis as an adverse event of COVID-19 mRNA vaccine: A systematic review

Background: Myocarditis, an inflammation of the myocardium in the absence of ischemic injury, may be caused by viruses, drugs, and vaccines. The Myocarditis following COVID-19 vaccinations is most commonly seen in young adult males and commonly after the second dose of the mRNA vaccine. It usually presents with chest pain, dyspnoea, palpitations but has a diverse clinical presentation and varied therapeutic response. We aim to systematically collate the symptomatology, prognosis, and clinical findings of COVID-19 vaccine adverse events causing Myocarditis. Method: Following the PRISMA statement 2020, a systematic search was conducted to isolate confirmed cases of COVID-19 vaccine-induced Myocarditis. By applying the BOOLEAN logic, the following keywords were used: COVID-19, SARS-CoV-2, Myocarditis, Mortality. Four databases were searched from January 2021 through August 2021: PubMed, Science Direct, Google Scholar, and Cochrane Library;the reference lists of screened studies were searched as well (umbrella methodology). Results: In total, 12 case reports, 10 case series and 1 cohort study with a total of 107 patients were included in the final analysis. A total of 101 male patients were recorded, and 6 were female showing male dominance. The mean age of all participants was 24.73 years(SD = 13.18), ranging from 14 to 70. The most common presenting symptoms were chest pain (47.66%), fever (35.51%), and myalgia (25.23%). Lab findings showed elevated Troponin I, CRP, and ESR levels in the majority of patients. ECG was abnormal in most of the patients, which include sinus rhythm (24%), ST-elevation (42.05%) and T wave inversion (13.08%). Echo findings include decreased Ejection fraction in 19.62% of patients while 13.08% of patients having a hypokinetic left ventricular wall. Further, CMR finding suggestive of confirmed myocarditis cases in 36% patients while rest are suspected one. Overall mortality(1.86%) was low among patients. Conclusion: There is increasing evidence for Myocarditis as a rare adverse event of COVID-19 mRNA vaccination in young adults. This evidence is strongest amongst young male patients. The majority of the patients complain of chest pain and fever. In lab findings Troponin I, CRP and ESR are usually increased and ST elevation is common in the ECG. This entity is mainly treated with nonsteroidal anti-inflammatory drugs, Colchicine, Beta-blockers, ACE inhibitors, Steroids. However, prognosis and outcomes are favourable with a very low mortality rate.

Relationship between social vulnerability and case fatality rate at the level of counties and countyequivalents in the contiguous united states during the covid-19 pandemic

Introduction: Pandemics prior to the COVID-19 pandemic have been known to disproportionately affect counties and county-equivalents with high social vulnerability. Social vulnerability refers to the potential negative effects on communities caused by external stresses on human health. Such stresses include natural or human-caused disasters, or disease outbreaks. On the other hand, case fatality rate estimates the proportion of deaths among identified confirmed cases. Hypothesis: A higher social vulnerability is associated with a higher case fatality rate at the levels of counties and county-equivalents in the contiguous United States during the COVID-19 pandemic. Methods: Data from 2990 counties and county-equivalents such as independent cities, districts, and parishes that are considered county-equivalents for census purposes was analyzed. Counties and county-equivalents from the non-contiguous states of Alaska and Hawaii were excluded as well as 59 counties and county-equivalents without available SVI data and/or available CFR data. Available SVI public source data was collected from the Centers for Disease Control andPrevention, while available CFR public source data was collected from the Emory Clinical Cardiovascular Research Institute. Results: Median SVI was 0.5185 [Range: 0.0006-1] and median CFR was 1.56% [Range: 0%-8.77%]. A vaccination rate ratio (RR) and 95% CI for SVI was calculated using Wald's unconditional maximum likelihood estimation to compare CFRs of counties and county-equivalents with low social vulnerability (SVI: 0%-33%), moderate social vulnerability (33%-66%), and high social vulnerability (66%-100%). A higher SVI was associated with a higher CFR such that the RR for relative differences in CFR between counties and county-equivalents with a low social vulnerability and counties and county-equivalents with a high social vulnerability was 0.83, while the RR for relative differences in CFR between counties and county-equivalents with a moderate social vulnerability and counties and county-equivalents with a high social vulnerability was 0.89. Conclusions: Public policy interventions need to target counties and county-equivalents with a higher social vulnerability to help the most vulnerable of people.

Symptomatology, prognosis, and clinical findings of COVID 19 induced myocarditis: A systematic review

Background: With the advent of the novel coronavirus (COVID-19) in December 2019, numerous case studies have been reported on its impact on cardiac cells, and we purpose to perform a systematic review that explains the symptomatology, prognosis, and clinical findings of COVID-19-related myocarditis patients. Methods: PRISMA guidelines were employed and peer-reviewed journals in English related to COVID - 19 were included. Exclusion criteria included <50 y, known heart problems. Age criteria was guided by prior systematic report by Kariyanna et al (2020). Search engines included Pubmed, Google scholar, Cochrane Central and Web of Science database using SARS-CoV-2 or COVID 19 and myocarditis. The data were analyzed and synthesized qualitatively using MS Excel PIVOT and quality was rated using the Research and Quality Scoring Method by Sackett and Haynes, the Jadad scale, and the items published by Cho and Bero (Han et al., 2011). Results: A total of 22 studies on 37 patients were included;6 were confirmed myocarditis while the rest have possible myocarditis. Among all these 62% were male and showing dominance. The most common presenting symptoms appear to be fever, chest pain, shortness of breath, and cough. Most of the patients have shown elevation in cardiac biomarkers (troponin levels, CRP, CK level, CK-MB, NT-pro BNP). Electrocardiogram changes include sinus rhythm, tachycardia, and non specific ST - segment elevation and T wave changes. Echocardiography results commonly found were left ventricular dysfunction and increased wall thickness. CMR was performed in 8 patients, with features of reduced ejection fraction, myocardial edema, and hypokinesia, whereas biopsy has been performed among 3 patients due to the invasive nature of the procedure and common findings include inflammatory biomarkers were raised. Overall Prognosis appears to be bad in which 25% of patients were not able to survive and 75% of them were recovered. Conclusions: Myocarditis-related COVID-19 mortality continues to be high and under-estimated. The patient manifestations are identical and difficult to distinguish from COVID-19-related symptoms. Just a limited number of patients undergo confirmatory tests, such as an MRI or an endomyocardial biopsy, which may not be available. Further studies are needed to confirm and quantify the actual prognosis and outcomes of patients with COVID-19 myocarditis. Moreover, available data on the usage of glucocorticoids in the coronavirus infection is controversial to our knowledge. Corticosteroid therapy is unsuccessful in the treatment of viral myocarditis, according to a Cochrane systematic review conducted in 2013. It also allows viral clearance to be overdue. Corticosteroids, on the other hand, reduce the chance of mortality for ICU patients in Wuhan. To concede, more studies, clinical trials, and duration is needed for a thorough understanding of COVID - 19, and its impact on cardiac health.

A rare manifestation of COVID-19 in the abdomen: Acute pancreatitis

Introduction: Coronavirus, a novel menace, is exacting terrible human toll and mass death till date. It was thought that COVID-19 primarily affects the respiratory system, but recent studies have reported gastrointestinal manifestations as well. However, the incidence of acute pancreatitis in the setting of COVID-19 is a rising debate due to unknown mechanisms, especially in the absence of any precipitating factors for pancreatitis Case Description/Methods: An otherwise healthy 30-year-old female presented to the emergency department with pain in the lower abdomen radiating to the back, fever, cough, vomiting, diarrhea, and sore throat for the past seven to ten days. Her initial examination revealed a temperature of 100°F, a pulse rate of 85 beats /minute, blood pressure of 110/70 mmHg, respiratory rate of 20 breaths/minute, and oxygen saturation of 94% on room air. Her swab result for SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) came positive. Laboratory testing revealed a rise in serum lipase and serum lipase level. Her ultrasonography (USG) of the abdomen was suggestive of fatty liver changes (hyperechoic parenchymal echogenicity) and no gallstones. She was managed conservatively with intravenous fluid, analgesics and antibiotics for bacterial infection. Absence of any predisposing factor for pancreatitis in the setting of COVID led to the diagnosis of acute pancreatitis induced by COVID-19. Her contrast-enhanced computed tomography (CECT) of the abdomen also confirmed our suspicion. Discussion: The rationale behind the development of acute pancreatitis in the presence of COVID- 19 infection, with no past medical history and precipitating risk factor for pancreatitis, is suggestive of COVID-19 as a triggering factor. This case highlights the importance of pancreatic enzyme monitoring if patients have abdominal complications and without further delay, proper management can be set up if diagnosed early. Future complications such as chronic pancreatitis and pseudocyst formation can also be prevented if timely diagnosed. (Figure Presented) .