Incidence and Outcomes of Clinically Significant Bleeding Events in Critically Ill Covid-19 Patients Receiving Therapeutic Dose Anticoagulants: A Retrospective Cohort Study (Interact Study)

Aim and background: The high mortality associated with the thrombotic events in hospitalised COVID-19 patients resulted in the usage of anticoagulants in varying doses. Whether the high-dose anticoagulants have led to better outcomes or higher incidence of clinically significant bleeding events is still debatable. Objectives: To find the incidence of clinically significant bleeding events in moderate to severe COVID-19 patients on therapeutic anticoagulation and the factors influencing these events. Materials and methods: In our retrospective, single-centre, cohort study of 155 critically ill COVID-19 patients we observed the incidence of clinically significant bleeding. Multivariate regression models were used to evaluate the association between anticoagulant regimen, coagulation, and inflammatory markers with the incidence of bleeding and thrombotic events. Results: The incidence of Clinically Relevant Non-Major Bleeding (CRNMB) was 33.5% (26.17-41.46%,) and major bleeding was 9.03% (5.02-14.69%). The anticoagulation intensity at baseline had a very high odds of major bleeding when Enoxaparin and dual antiplatelet therapy were used together (adjusted OR of 434.09 [3.81-49502.95], p < 0.05). At admission, bleeders had a poorer P/F ratio with more patients on invasive ventilation. At the time of bleeding, the bleeders had a higher d-dimer, ferritin, CRP, and procalcitonin. The subhazard ratio (SHR) for death in bleeders was 3.35 (95% CI, 1.97-5.65;p < 0.001). Conclusion: The incidence of bleeding in critically ill COVID-19 patients on therapeutic anticoagulation increases with the severity of the disease as well as with concurrent use of dual antiplatelets. Major bleeding may also contribute to higher mortality.

Single, High Dose Vitamin D Supplementation in Vitamin D Deficient Severe COVID-19: Randomized, Double-Blind, Placebocontrol Study (Shade-S)

Aim and background: Efficacy of therapeutic vitamin D3 supplementation for ICU outcomes in severe COVID-19 is sparingly studied. Objective: Effect of single high-dose vitamin D3 supplementation on sequential organ failure assessment (SOFA) score in patients with moderate to severe COVID-19 disease. Materials and methods: A single centre, randomized, doubleblind, placebo-controlled study was carried out among 90 patients with moderate to severe COVID-19 ARDS defined by PaO2/FiO2 <200. Participants received 0.6 million IU vitamin D3 (oral nanoformulation) (intervention) or placebo (equal volume, oral). SOFA score on day-3, -7, -10, and -14 was measured. The primary outcome was a change in day-7 SOFA score from admission. Pre-specified secondary outcomes were day 10 and day-14 SOFA score, change in PaO2/FiO2 ratio, in-hospital all-cause mortality, and inflammatory cytokine levels. Results: A total of 358 patients were screened and 90 patients (45 in each group) were included. 25(OH)D3 levels were 12.0 (10.0-16.0) and 12.7 (12-18) ng/mL (p = 0.059) at study entry;60 (54.40 to 65.59) ng/mL and 3.8 [1.05 to 6.55] at day-3 in the intervention and placebo group, respectively. The SOFA score on day-7 was better in the treatment group [intergroup difference was -2 (95% CI, -3.99 to -0.01, p = 0.009) with effect-size of r = 0.35 (95% CI, 0.09-0.55). The all-cause mortality with intervention was 24.4% compared to 44.4% (p = 0.046) in the control group. A significant improvement in the day-7 PaO2/FiO2 ratio [200.50 (101.01-291.30) and 110.70 (66.20-166.50), p = 0.003;intergroup difference -98.6 (40.70 to 156.49)], a decrease in CRP [-48.63 (-80.78 to -16.48) and 5.4 (-17.62 to 28.42), p = 0.042)], ferritin [-412.3 (-736.29 to -88.31) and 41.5 (-293.68 to 376.68), p = 0.018] was observed in the intervention and placebo groups, respectively. Conclusion: Single high-dose oral cholecalciferol supplementation to increase vitamin D3 >50 ng/mL improves the SOFA score and reduces in-hospital mortality in vitamin-D deficient patients with severe COVID-19.

Mobilizing Digital Volunteers to Support Underserved Communities in India During COVID-19 Lockdowns

As community-driven organizations sought to support their constituents through the COVID-19 crisis, many drew on digital volunteers to expand their capacity and reach. However, coordinating the efforts of virtual volunteers is a challenging task with few empirical studies of the associated risks and best practices. In this paper, we report on the activities of CGNet Swara, a citizen journalism platform that published 401 distress calls from vulnerable communities stranded in India due to the imposition of a nationwide lockdown. CGNet mobilized 11 digital volunteers to help these contributors over a period of nearly 2 months. We found that a lack of proper guidance to digital volunteers and outdated organizational policies resulted in demonstrable harms to vulnerable communities. We discuss risks that are inherent in collaborations between organizations extending themselves to crisis response and emergent groups of digital volunteers, and how they can be mitigated by real-time monitoring and development of standard operating procedures relating to impact metrics, verification standards and disclosure policies. © 2022 ACM.

Assessment of immunohaematological profile of COVID- 19 patients and its correlation with the clinical and laboratory parameters

Background: Covid-19 like other viruses, can change the immunohematological profile of the infected patients and timely identification of these changes can help in the management of these patients. There are various reports which have shown decline in haemoglobin in covid patients due to autoimmune red cell hemolysis. One recent study has shown that patients admitted in ICU have higher chances of DAT positivity as compared to non-covid patients. Aims: • To assess the Immunohematological profile of COVID-19 positive patients. • To find any correlation between the immunohematological profile and clinical spectrum of COVID-19 disease. Methods: It was a prospective observational study. Blood grouping, Direct antiglobulin test (DAT) and antibody screening (ABS) were performed on RT-PCR confirmed COVID-19 positive and COVID-19 negative patients admitted in Intensive care units and General wards of our institute. The immunohematological findings were also correlated with the patient clinical laboratory profiles. Results: A total of 205 patients were recruited. Out of which 102 were RT-PCR Covid-19 positive and 103 were negative. There was difference in blood group distribution with significantly less O group individuals in RT-PCR negative group. The overall DAT positivity was seen in 24.4% of the total 203 patients enrolled in the study. The DAT positivity was significantly higher (p value 0.01) in COVID-19 positive patients (32%) than COVID-19 negative patients (16.7%). However, there was no significant difference in the percentage of DAT positivity among patients admitted in ICU or general ward patients. Among COVID-19 positive patients, the mean haemoglobin was statistically significantly (p value 0.02) lower in DAT positive (Mean Hb: 8.5gm/dl) as compared to DAT negative patients (Mean Hb 9.6gm/dl). Also, DAT positive patients among COVID-19 positive patients were found to have significantly higher C-Reactive protein levels (p value: 0.05). There was no significant difference in other biochemical parameters between COVID-19 positive and COVID-19 negative individuals. DAT positivity was not associated with any drug intake or co-morbid state. Summary/Conclusions: Like other bacterial and viral infections, COVID-19 is also associated with DAT positivity indicating some autoimmune phenomenon due to exposure of the crypt antigens. The specificity of antibodies involved in DAT are mainly IgG and hence it may present as autoimmune hemolytic anaemia. And its association with increased inflammatory makers can help us in decision making by blood transfusion services and better management of COVID-19 patients requiring blood transfusion. .

Adopting Online Teaching and Learning Utilizing AI Technology Enhancements Throughout the COVID-19 Pandemic and Beyond

Since 2019 the Covid-19 Pandemic has had a significant impact on the daily lives of the populations of the world. Education was no exception, this was a sharp change to online teaching, which was the only available option to keep the education system working. At that time, the education sector was rapidly adapting and attempting to use a variety of online tools, such as Microsoft Teams, Blackboard Collaborate Ultra and Zoom to name a few. Therefore, using these tools for online teaching and learning required significant operational change, that had to happen at pace, as current teaching and learning was scheduled for Face-to-Face (F2F). In addition, greater use was made of Learning Content Management Systems (LCMSs) such as Moodle and Blackboard, which was an existing set of tools. Contemporaneously, these tools were adapting to the teaching and learning by adding additional features, based upon feedback for users. This paper examines some experiences of delivering higher education courses during the COVID-19 pandemic, where it examines the online teaching and learning tools Microsoft Teams and Blackboard Collaborate Ultra, and explores how AI can be used to enhance the process of teaching and learning online. Finally concludes with a summary of the main outcomes.

A cross-sectional study on cutaneous side-effects associated with mask usage among doctors during covid-19 pandemic

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has brought major changes in people's lifestyle, especially in health care workers. Healthcare workers caring for COVID-19 patients are spending long hours wearing Personal Protective Equipment (PPE). There are reports of adverse skin reactions secondary to wearing PPE, especially face masks. However, it is essential to wear the protective equipment. Aim: To assess the proportion of doctors who report adverse skin reaction after the use of face masks and enlist the skin reactions reported. And to study the relationship between certain suspected factors and occurrence of skin reactions. Materials and Methods: This was a cross-sectional study conducted using a questionnaire containing both open and closed ended questions which was distributed through online platform. The questionnaire contained details on the type of mask, duration of usage, frequency of change and dermatological manifestations experienced. Sample population constituted doctors who were willing to participate in the study. IBM Statistical Package for the Social Sciences (SPSS) version 17.0 was used for analysis of data. Results: The male to female ratio among the 220 doctors studied was 1:1.59. Maximum number of doctors (56.4%) wore N95 masks. 33.63% of them used one new mask every day. 60.90% of them used the mask for more than 6 hours continuously on a day. Acne was the most commonly reported problem accounting for 48.2%. Doctors using N95 masks reported acne more commonly. Conclusion: N95 masks were the most commonly used masks. Total 88.18% of the doctors reported cutaneous manifestations. Acne was the most common dermatological problem reported. It was associated with the use of N95 masks and longer duration of use of N95 masks.

COVID-19 risk management: A mobile application to notify alerts and provide real-time covid-19 updates

The sudden outbreak of coronavirus has left people unanswered till date. COVID-19 virus cases are drastically increasing day by day. The only way to protect ourselves from COVID-19 is by maintaining social distancing and taking preventive measures. A mobile application-based solution is proposed for risk management of COVID-19. The objective of the proposed model is to help people with the status of cases in their region. The proposed model notifies the user regularly about the COVID-19 cases in nearby locations which help him/her to be cautious. Android studio and Google Firebase are used to develop the mobile application. COVID-19 information and state-wise cases are updated in the database regularly, and users are notified. The results are good in terms of response time and delivery of static alerts. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021.

Cardiological society of India document on safety measure during echo evaluation of cardiovascular disease in the time of COVID-19.

An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-à-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India.

Cardiological Society of India: Document on acute MI care during COVID-19.

The unprecedented and rapidly spreading Coronavirus Disease-19 (COVID-19) pandemic has challenged public health care systems globally. Based on worldwide experience, India has initiated a nationwide lockdown to prevent the exponential surge of cases. During COVID-19, management of cardiovascular emergencies like acute Myocardial Infarction (MI) may be compromised. Cardiological Society of India (CSI) has ventured in this moment of crisis to evolve a consensus document for care of acute MI. However, this care should be individualized, based on local expertise and governmental advisories.