Clinico-epidemiological and vaccination profile of patients attending flu clinic of a tertiary health care institution in Eastern India during the third wave of COVID-19 pandemic

Introduction and aim. With the third wave of COVID-19 hitting the country, there is an urgent need to systematically document the clinical-epidemiological and vaccination details of the patients to formulate evidence-based decisions. So, this study was planned to describe the profile of patients attending the flu clinic of a tertiary care hospital in eastern India. Material and methods. This hospital-based cross-sectional study was done for 6 weeks (Jan-Feb 2022) among 623 patients using a pre-tested, structured questionnaire related to COVID-19. An unadjusted odds ratio was calculated and statistical significance was attributed to a p-value <0.05. Results. Out of 623 patients, almost 90% of the patients were vaccinated against COVID-19 with at least one dose of any vaccine. Cough (57.8%) was the most common complaint. Patients aged > 60 years and those having one or more than one comorbidity suffered from moderate-severe COVID-19 infection when compared to their counterparts (p<0.001). Also, 2.1% of fully vaccinated, 3.8% of one dose vaccinated and 10.9% of unvaccinated patients suffered from moderate-severe COVID-19. Conclusion. During the third wave of the COVID-19 pandemic, a smaller number of elderlies compared to the previous two waves were affected indicating age shifting. The severity of COVID-19 was less among vaccinated individuals compared to unvaccinated highlighting the importance of COVID-19 vaccination. © 2022 Universidad Nacional de Colombia, , Department of Linguistics. All rights reserved.

Real-time remote audio-visual system versus standard buddy system to monitor the doffing of personal protective equipment during COVID-19 pandemic: an observational study

Introduction: Literature states a higher self-contamination rate among healthcare workers (HCWs) while doffing personal protective equipment (PPE). During the COVID-19 pandemic, onsite trained observers were not always available to monitor PPE compliance. The remote audio-visual doffing surveillance (RADS) system has the potential to overcome this limitation [1, 2]. We aimed to compare the efficacy of this real-time RADS system against the onsite buddy system for monitoring the doffing of PPE. Method(s): This prospective, observational study was conducted at our tertiary care centre in northern India. Study was registered in the clinical trial registry India (CTRI/2020/11/038172). 200 HCWs who cared for COVID-19 patients in the intensive care units were included. Group A included HCWs who performed doffing with the help of an onsite trained observer and group B included HCWs who performed doffing with the RADS system. An independent observer noted the error at any step using the CDC doffing checklist, in both groups. An online questionnaire to analyse the level of satisfaction post-doffing was also surveyed. Result(s): The proportion of errors committed during doffing was significantly lower in group B compared to group A with a low relative risk of 0.34 (95% CI 0.22-0.51) (p < 0.001) (Fig. 1). In both groups, there was no difference in HCWs feedback regarding the ease of the system and fear of committing an error. Though the perceived quality of monitoring was felt better with onsite buddy, the overall confidence rating of being safe after doffing was better with the RADS system. Conclusion(s): Real-time RADS system may be more effective than the onsite buddy system for ensuring the safety of HCWs during doffing PPE. HCWs level of satisfaction related to the ease and anxiety with the monitoring systems were comparable. RADS system can reduce reliance on HCW resources and can integrate well into existing healthcare systems.

Utility of urinary biomarkers for diagnosis of acute kidney injury (AKI) in COVID-19

Introduction: Incidence of AKI reported varies from 0.5% to 37%.These incidence cannot be extrapolated in our patients as the severity of COVID-19 infection, the ethnicity of the patients l, the clinical profile and the healthcare delivery system is different.The aim of this study was to explore whether urinary cell cycle arrest markers and other renal biomarkers have a role in predicting AKI in critically ill patients with COVID-19 and acute respiratory disease Methods: This prospective, longitudinal cohort study included critically ill COVID-19 patients without AKI at study entry. Patients aged more than 18 years with moderate or severe respiratory disease as defined by Berlin criteria were subsequently recruited from November 2020 to May 2021. Urine samples were collected on admission to critical care areas for determination of KIM1, NGAL, IL-18,IGF-BP-7, TIMP -2 at the time point of study inclusion, 12h, 24h, 48h, after inclusion. The demographic information, comorbidities, clinical, and laboratory data were recorded. The study outcomes were the development of AKI and mortality during hospitalization. Result(s): [Formula presented] ROC analysis was done to determine the diagnostic performance of the various urinary biomarkers;AUC was 0.655 for normalised IL-18, 0.685 for normalised NGAL, 0.658 for normalised TIM-1, and so on Conclusion(s): AKI was common in critically ill COVID-19 patients. Raised values of urinary biomarkers with clinical information, are useful for the identification of AKI in critically ill COVID-19 patients. No conflict of interestCopyright © 2023

Characteristics and outcomes of parturients with COVID-19, admitted to a critical care unit: A single-center retrospective observational study.

Background: Data on outcomes of coronavirus disease 2019 (COVID-19) in pregnancy are scarce, although they represent a unique physiological state affecting both the mother and child. We present collated data from a tertiary care center in North India, encompassing the outcome, clinical characteristics, and management of these patients. Materials and Methods: Parturients ≥ 18 years old, with COVID-19 reverse transcriptase polymerase chain reaction positive for severe acute respiratory syndrome coronavirus 2, requiring intensive care unit (ICU) admission at a tertiary care hospital were included. Data were retrospectively collected from April 2020 to November 2021. Results: In all, 26 parturients were admitted to ICU with COVID-19. Five patients were admitted during the first wave, and all were asymptomatic. Twenty-one patients presented during the second wave (March 2021 onward), among which four were asymptomatic and 17 symptomatic (all with severe pneumonia). Three patients presented in the second trimester, all with critical disease, out of which one did not survive. Two patients had twin gestation, and others were singleton pregnancies. Seven patients (27%) were primigravida, and five patients (19.2%) had more than third pregnancy. Twenty critically ill women (77%) delivered during the hospital stay. Six patients died during the second wave, and four deaths (66.7%) were because of COVID-19 acute respiratory distress syndrome (ARDS). Conclusions: The number of admissions and mortality related to COVID-19 ARDS was higher in the second wave than in the first. We report the safe use of remdesivir and tocilizumab in our patients.

Are covid-19 related deaths taking time? A Retrospective analysis in a state covid 19 centre at tirupathi

The COVID-19 pandemic, also known as the corona virus pandemic, is an ongoing phenomenon caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). Older people and those with underlying comorbidities like cardiovascular disease, diabetes, chronic respiratory disease, or cancer are more likely to develop serious illness. India reported its first case of COVID-19 on 30thJanuary 2020. Since that lakhs of persons have been infected with COVID-19 and thousands died in India as well. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Deep Learning-Based Trend Analysis on Indian Stock Market in COVID-19 Pandemic Scenario and Forecasting Future Financial Drift

This present study has used the long-short-term memory (LSTM) network-based deep learning architecture to analyze the influence of the current widespread COVID-19 on the Indian stock market. The major contribution of this work is as follows: (1) Designing LSTM-based deep neural network is used to study the effect of the COVID-19 outbreak and Lockdown on the Indian stock exchange (Nifty 50), and (2) designing a prediction model to capture the effect of various COVID-19 waves in India on Indian Stock exchange. The outcomes of the analysis show that the increase in daily new confirmed cases, recovered cases, and death cases have a significant adverse impact on the trend of the stock market. Moreover, the results of the work have also analyzed the impact of government policy such as ‘lockdown city’ with a reaction to increased Pandemic cases. This work is briefly summarized as follow: (1) LSTM-based deep neural network is used for this study to analyze the effect of the COVID-19 outbreak on the Indian stock exchange. (2) The Indian Stock exchange affected by the COVID-19 pandemic has been studied. Here, the analysis is based on the impact of COVID-19 including the effect of lockdown. (3) A prediction model has been proposed for the study of the behavior of the Indian stock index (Nifty 50) during the COVID-19 pandemic. (4) Comparison of the efficacy of the suggested approach with other existing baseline regression models. © 2022, The Institution of Engineers (India).

Impact of COVID-19 on Indian Education System: Practice and Applications of Intelligent Technologies

Novel COVID-19 (SARS-COV-2) has emerged as one of the most hazardous pandemics across the globe. Due to the spread of this virus, there was a forcible postponement of physical education. This moved the whole education system into a fringe condition for a certain period with hopeless progress shortly. Though few countries have opted for online education, a country like India has partially succeeded. In this paper, a detailed study has been executed on the impact of COVID-19 at all levels of education with their pros and cons. The article is four-folded: Firstly, the impact of COVID-19 on the global education system is thoroughly studied with a special focus on Indian education. Second, a brief study on acceptance and adaptation of the online education process to fill the gap of schedules is done. Thirdly, an impactful analysis on the growth of development of online educational apps to fulfil the absence of offline education is emphasized. Fourthly, an insightful study on the role of intelligent computing approaches for analysing such a study is deeply investigated. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Role of BCG and Measles vaccination in protection against COVID-19 infection and severity of the disease: A pilot case-control study

Background: The role of BCG and MMR/Measles vaccination in reducing the burden of COVID-19 has been based on ecological data mostly. We planned this explorative pilot case-control study to under-stand the role of vaccination with Bacillus Calmette–Guerin (BCG) and measles administered as part of MMR vaccine on COVID 19. Methodology: A case-control study was conducted in AIIMS Patna during December 2020 and January 2021. A total of 100 COVID-19 patients confirmed by RT-PCR test were taken as cases, and for each case, age and gender-matched SARS-COV-2 negative individual was taken as control. A study tool containing a pre-tested semi-structured questionnaire was used. Results: The unadjusted odds of COVID-19 were found to be significantly higher among BCG vaccinated [1.88(1.03-4.4)] and MMR vaccinated individuals [5.06(2.34-10.90]. BCG vaccine was not found to have an independent effect on COVID-19 after adjusting for tobacco use, MMR vaccination status, unprotected contact with SARS-COV-2 positive patients, and co-morbidities. But Measles vaccine was found to inde-pendently increase the risk of COVID-19 [AOR: 4.505(1.8-11.3)]. Conclusion: BCG vaccination status was not found to be an independent predictor of COVID-19. Further studies with large sample size and better study design (cohort, randomized trials) need to be conducted. © 2022, MedSci Publications. All rights reserved.

Universities ought to be Innovative, Creative and Enterprising to Play a Vital Role in the Generation of Hi-Tech Employment in Emerging Skills in the Changing World: A Study

National Education Policy [NEP-2020] has emphasised the need and importance of research, innovation and entrepreneurship in university education. It prescribes that Indian professors in universities and colleges need to be oriented and trained now in teaching emerging skills of innovation and skills for entrepreneurship. Professors are competent in their respective fields of specialization but now in the rapidly changing world environment they need to change their mind set in favour of skills for research, innovation and entrepreneurship. They ought to acquire and teach the needed emerging skills ably to their students so that they become creative and innovative and remain so life-long. Online education, the world over, due to Covid-19 is becoming a necessity. Training programs and schemes for professional growth being run by staffs in colleges must now be redesigned to include these emerging skills in the changing world. Governing bodies of universities and colleges need to urgently give high priority, to teaching innovation and entrepreneurship. Government ought to give boost to these institutions and provide adequate funds. The paper invites attention of the government to improving the service conditions of professors enabling them to grow to the level they are capable of. Universities ought essentially to groom professors in innovation, patenting and entrepreneurship to world class standard, for without them universities cannot play a vital role in the generation of hi-tech employment in emerging skills in the changing world. The experience of Japan, USA, UNESCO, and the European Union in support of the theme of the paper is given in brief. Interaction of Indian professors with their counterparts in world's best universities is advocated. Innovative universities will undoubtedly give good momentum to the mission of Atma Nirbhar Abhiyan.

Clinical and Postoperative Outcomes of Cancer Surgeries during the COVID-19 Pandemic: A Comparative Study with its Pre-COVID Surgical Audit at Five Major Tertiary Care Hospitals' Cancer Departments in India

Introduction There has been an exponential rise in number of coronavirus disease 2019 (COVID-19)-positive infections since March 23, 2020. However, cancer management cannot take a backseat. Objective The aim of this study was to identify any difference in the complication and mortality rates for the cancer patients operated during the ongoing COVID-19 pandemic. Materials and Methods This was a retrospective study of a prospectively maintained database of five centers situated in different parts of India. Variables such as demographics, intraoperative, and postoperative complications were compared between COVID-19 (group A-March 23, 2020-May 22, 2020) and pre-COVID time period (group B-January 1 to January 31, 2020). Results One-hundred sixty-eight cancer surgeries were performed in group B as compared with 148 patients who underwent oncosurgeries in group A. Sixty-two percent lesser cancer surgeries were performed in the COVID-19 period as compared with the specific pre-COVID-19 period. There was no significant difference in age group, gender, comorbidities, and type of cancer surgeries. Except for the duration of surgery, all other intraoperative parameters like blood loss and intraoperative parameters were similar in both the groups. Minimally invasive procedures were significantly lesser in group A. Postoperative parameters including period of intensive care unit stay, rate of infection, need for the change of antibiotics, and culture growth were similar for both the groups. While minor complication like Clavien-Dindo classification type 2 was significantly higher for group A, all other complication rates were similar in the groups. Also, postoperatively no COVID-19-related symptoms were encountered in the study group. A subset analysis was done among the study groups between those tested preoperatively for COVID-19 versus those untested showed no difference in intraoperative and postoperative parameters. No health-care worker was infected from the patient during the time period of this study. Conclusion Our study shows that there is no significant difference in the incidence of postoperative morbidity and mortality rates in surgeries performed during COVID-19 pandemic as compared with non-COVID-19 time period.

Evaluation of utility and usefulness of webinars on COVID-19 management: a questionnaire-based survey

BackgroundThe COVID-19 pandemic and its consequent “social distancing” has fueled the use of social media platforms for educational purposes. Since the start of the pandemic, a plethora of experts and self-proclaimed experts have been keenly delivering webinars on COVID. This begs the question “Do webinars on COVID-19 really help in the improvement of knowledge base or management skills?”. The questionnaire was designed to assess information regarding COVID-webinars and their usefulness from the end-user standpoint. The response to the questions was measured using a 4- or 5-point Likert scale. The survey was open for a 4-week period with the extension of 1 week.ResultsThe response rate was 54% as 270 out of 500 participants responded to the questionnaire. The majority of the respondents were anesthesiologists in-training, post-graduates, fellows, and seniors belonging to tertiary care settings with fewer percentages belonging to physicians and others. Most of the doctors had attended an average of 2 webinars per week. The tests of model effects showed a significant negative correlation of webinar quality ratings for district hospital healthcare setting of the attendees (of p value of 0.013) and for the number of COVID-related webinars attended per week (p value of 0.009).ConclusionsMost respondents had favorable perceptions of webinars happening during the pandemic. However, there is a need for improvisation in the volume of webinars, target-audience-based delivery, and participant interaction to add value to this new dimension of teaching-learning.

Performance of Health Care Workers in Doffing of Personal Protective Equipment Using Real-Time Remote Audio-Visual Doffing Surveillance System: Its Implications for Bio-Safety Amid COVID-19 Pandemic.

Background Very little has been reported about health care workers' (HCWs) adherence to the Centers for Disease Control and Prevention (CDC) guidelines of doffing personal protective equipment (PPE) amid the COVID-19 pandemic. Real-time remote audio-visual doffing surveillance (RADS) system for assisting doffing might reduce the risk of self-contamination. We used this system to determine the incidence of the breach in biosafety during doffing of PPE among HCWs involved in the care of Covid-19 patients. Methods A total of 100 HCWs were enrolled in this observational study who performed duties in the COVID intensive care unit (ICU) of our tertiary care centre. With a real-time RADS system, trained observers from remote locations assisted HCWs during doffing of PPE and noted breach at any step using the CDC doffing checklist. The breach was considered major if committed during removal of gloves/gown/N-95 or if ≥3 errors occurred in any other steps. Results Overall, 40% of the HCWs committed a breach during doffing at least one step. The majority of the errors were observed during hand hygiene (34%), followed by glove removal (12%) and N-95 removal (8%). Nineteen percent of HCWs committed the major breach, out of which 37.5% were done by house-keeping sanitation staff (p = 0.008 and RR 2.85; 95% CI of 1.313-6.19), followed by technicians (22.5%), nursing staff (16.7%) and resident doctors (6.5%). Conclusions Performing doffing using a real-time RADS system is associated with a relatively low incidence of a breach in biosafety compared with earlier studies using an onsite standard observer. Overall adherence of HCWs to the CDC guidelines of doffing PPE was satisfactory. This study highlights the importance of the RADS system during doffing of PPE in a health care setting amid the COVID-19 pandemic.

Does bcg vaccine prevent contract and severity of covid-19 infection in india? A situational analysis

Background: The COVID-19 pandemic has created worldwide emergency with morbidities, mortality and panic. The BCG vaccine, usually given to prevent childhood tuberculosis, surfaced as an option as suggested by some ecological observations. However, some others studies could not establish and explain the protective effects of BCG vaccination against COVID-19 pandemic. India is one country with high BCG vaccination coverage and is among the countries with lowest COVID-19 case fatality rate. Aims and Objectives: We examine the relationship between the BCG coverage and COVID-19 burden in various states/UTs of India. Materials and methods: The information on BCG coverage and morbidity and mortality of COVID-19 was obtained from NFHS and www.covid19India.org respectively. Results: The analysis suggested very weak positive relationship of BCG coverage with cases and deaths due to COVID-19. Moderate positive relationship was observed between BCG coverage and COVID-19 case fatality rate even after adjusting for health system performance. Conclusion: The conclusion of the study is against the role of BCG vaccination in containing the COVID-19 pandemic. The positive correlation which is not significant may be spurious and affected by many confounding factors like co-morbid conditions, testing strategies, population level immunity for other viral infections etc. Hence, the states and UTs should not be complacent by the hypothesized role of BCG vaccine in COVID-19 control. Rather, they should continue with the principles of social distancing, contact tracing, treating and surveillance of COVID-19. © 2021, Indian Association of Preventive and Social Medicine. All rights reserved.

Perceived risk of tobacco use in COVID-19 disease causation and severity among healthcare professionals: a Pan India online survey

Background: Risk perception for a disease significantly influence practice related to it. The study examined the perceived risk of tobacco use in COVID-19 disease causation and severity among healthcare professionals (HCPs) of India.

Preparing Intensive Care Unit in Resource-Constraint Setting Amid COVID-19 Pandemic: Our Experience and Review.

COVID-19 pandemic is an emerging, rapidly evolving public health emergency where a nation's health-care system can face a marked surge in demand for intensive care unit (ICU) beds and organ support. In regions with insufficient medical resources, it may further aggravate the existing shortage, limiting an ICU's ability to provide the normal standard of care. It can present ethically or legally demanding questions about how to prioritize the allocation of life-saving medical resources. In developing countries like India, still many hospitals are challenged by competing priorities and remain underprepared. In the wake of COVID-19 pandemic, to guide the intensive care disaster planners in regions with low resources and to ensure ICU readiness, this review shares our experience and strategies for preparing ICU with existing and alternative resources, focusing on space, equipment, and health-care workers' safety and training.

Blue patient and brown blood-a case series

Introduction: With multiple contradictory reports on the efficacy of hydroxychloroquine (HCQ) on COVID-19, the Indian Council of Medical Research (ICMR) recommends its' use for prophylaxis and treatment of mild cases. Amidst all the controversies, there have been few cases reported of significant methemoglobinemia and hemolysis in COVID-19 cases being treated with HCQ. But, none has been reported from India, possibly because of underestimation in our population. The diagnosis of methemoglobinemia amidst this COVID crisis is really challenging owing to similar clinical manifestations. Materials and methods: We present a case series where methemoglobinemia was promptly detected and managed efficiently. Results: Timely detection and management resulted in the uneventful discharge of all three cases. Discussions: This is to be understood that undiagnosed cases of methemoglobinemia can be potentially fatal due to hypoxic stress on the body. If the condition is not being detected timely, leading to dangerous levels of untreated methemoglobinemia may result in case fatality falsely attributed to COVID-19. Conclusion: Clinical vigilance is very important while treating critically ill patients.

Pulmonary embolism confounded with COVID-19 suspicion in a catatonic patient presenting to anesthesia for ECT: a case report.

Catatonic patients may develop deep vein thrombosis (DVT) and pulmonary embolism (PE) due to prolonged periods of immobility. These life-threatening conditions demand prompt recognition and management. We describe the case of a patient with catatonia who presented to anesthesia for electroconvulsive therapy (ECT) at the outset of the current coronavirus disease 2019 pandemic. She complained of breathing difficulty and was suspected to have COVID-19 infection. On further evaluation, she was found to have DVT and PE and required oxygen therapy and intensive care management. The diagnostic delay in our patient would have probably not occurred, had it not been for the existing pandemic situation.

Analysis of seasonal variation in particulate matter and relevant pollutants for three stations of andhra pradesh (India) during the period (2018-2020) using multivariate regression analysis

Collocated particulate matter concentration data of three stations Vi-sakhapatnam, Amaravathi and Tirupathi belonging to state of Andhra Pradesh in India was analysed for the period 2018 − 2020. These stations were selected based on their geographical, demographical and industrial conditions. Regression analysis was done by taking PM2.5 and PM10 as dependent and N O, CO, SO2, O3, T (Temperature) and RH(Relative Humidity) as independent variables for all three stations along with analysis of seasonal variation. The observed average values of PM2.5 and PM10 concentrations are 84.84 µg/m3 and 106.52 µg/m3 for Visakhapatnam followed by 34.99 µg/m3 and 71.98 µg/m3 for Amaravathi follwed by 24.96 µg/m3 and l57.01 µg/m3 for Tirupathi between January 2018 to Sep-tember 2020. The observed mean values of PM2.5 and PM10 concentrations for Visakhapatnam are 73.37 µg/m3 and 146.52 µg/m3 during winter, 29.7 µg/m3 and 90.48 µg/m3 during summer and l35.11 $µg/m3 and 93.00 µg/m3 during monsoon. Their values for Amaravthi are 61.42 µg/m3 and 108.28 µg/m3 during winter, 20.07 µg/m3 and 63.19 µg/m3 during summer and 18.37 µg/m3 and 45.55 µg/m3 during monsoon. Similarly for Tirupathi these values are 39.65 µg/m3 and 73.07 µg/m3 during winter, 29.22 µg/m3 and 63.08 µg/m3 during summer and 15.11 µg/m3 and 47.07 µg/m3 during monsoon. These observa-tions indicate higher particulate matter concentration during winter season. Summer concentrations should be minimum but slightly more than monsoon which might be due to COVID-19 lock-down during 2020 summer. © 2020, Research Publication. All rights reserved.