ABSTRACT
The world is undergoing its biggest health crisis named coronavirus disease, which is associated with increased proinflammatory cytokine storm, which ultimately leads to various medical complications including acute respiratory distress syndrome. The treatment protocol was always controversial due to the excessive use of corticosteroids in aggressive pneumonia and associated hyperinflammatory conditions.The excessive use, misuse, and rampant use of steroids may lead to various coinfection like mucormycosis which is referred to as black fungus that manifests within the skin and also affects the lungs and brain which may be more fatal. It is necessary to have early diagnosis and management to tackle the severity of post covid coinfection. Copyright © RJPT All right reserved.
ABSTRACT
Introduction: With the rise in COVID-19 cases round the world, we have the problem of COVID-19 positive pregnancies at hand. Various case series and reports around the world have shown a high incidence of cesarian deliveries in these patients. We have attempted to study the factors predicting an increase in cesarean section (CS) rates in COVID-19 positive pregnancies admitted to our institution. Methods: Retrospective analysis of all deliveries of COVID-19 affected pregnancies in a tertiary care center in north Kerala from 15 April 2020 to 31 October 2020. There were 253 deliveries during this period with 183 cases of cesarean and 70 vaginal deliveries. The data were entered in Microsoft Excel and analyzed with appropriate statistical software. Results: There was 71.42% cesarean section rate in women below 35 years of age compared to 100% in those above 35 years. The rate was higher among nullipara (77.77%) compared to 67.32% among multipara. There was also a positive correlation between cesarean with obesity [prepregnancy body mass index (BMI) more than 30]. There were 70.22% term cesareans compared to 89.28% in preterm. Induction of labor also seemed to increase rate of cesarean. Fetal growth restriction (88.88%) contributed more to cesarean rates unlike those without (71.06%) preterm rupture of membranes (PROM) and meconium staining of amniotic fluid (MSAF) was also seen to increase the possibility of cesarean. Cardiotocogram abnormalities (13.83%) were another important contributing factor. A total of 100% of patients with abnormal cardiotocogram (CTG) underwent cesarean section when compared to only 67.88% in those with normal CTG. In patients delivered while still positive, the incidence of cesarean section was 77.63%, while this reduced to 63.04% in those whom delivery was delayed till seronegativity achieved. A total of 75.95% cases were done in the morning. There were 19.67% cases of fetal distress which added to the cesarean numbers. Conclusions: We found increased maternal age, obesity, nulliparity, fetal growth restriction, PROM, MSAF as factors which contributed to increased cesarean section rates in COVID-19 positive pregnancies. Hence these pregnancies need careful monitoring. © The Author(s).
ABSTRACT
In the present study Moderate Resolution Imaging Spectroradiometer (MODIS) onboard Aqua and Terra satellite derived Aerosol Optical Depth (AOD) and the Ozone Monitoring Instrument (OMI) onboard Aura satellite derived Single Scattering Albedo (SSA) data sets were used to demonstrate the regional variation in aerosol radiative forcing during covid-19 imposed lockdown over the urban climate of Ahmedabad city. An analysis of short-wave (0.25um to 4.0 um) Instantaneous Direct Aerosol Radiative forcing (IDARF) is done using these satellite data as inputs to the Radiative Transfer model - SBDART. Result shows reduction in IDARF by the month of April-2020 and highest reduction in the month of May. Value of IDARF for May is around 22.785 Wm-2, which is 40.21% less than the mean value of IDARF from pre lockdown to post lockdown. Which indicates Negative Radiative Forcing (Net Cooling Effect). Magnitude of IDARF during lockdown and post lockdown are found to be 34.49 Wm-2 and 71.62 Wm-2 which is 87.94% higher than the mean value of IDARF from pre lockdown to post lockdown. Which suggest Positive Radiative Forcing (Net Warming Effect). © 2021 IEEE.
ABSTRACT
In the present study, the atmospheric concentrations of Carbon Monoxide (CO) over India during COVID-19 (2020) were studied by comparing it with 2019 and 2021. COVID-19 has created an undesirable impact all over the world. However, as a blessing in disguise, these measures have a positive effect on the environment due to closing the mass gathering places. The work has undergone using the TROPOMI instrument, on-board Sentinel-5 Precursor. The results, evidence that human activities like transportation in Delhi, Industrial activities near Indo-Gangetic Plain have sharply fallen during the lockdown phase. On Contrary, there is a sharp increment in the area of Thermal power plants being coal-based. On the whole, the mean concentration of CO over India has minimal change due to long lifetime (1~2 months), indicating the duration of the (68 days) lockdown did not capture prompt and short-term atmospheric change. © 2021 IEEE.
ABSTRACT
The present study focuses over Ahmedabad City of Gujarat State, India for the time period 1st March to 30th June comprising of the Pre-Lockdown Phase (PLP), the National Lockdown Phase - 1 (NLP1) and the Unlock Phase - 1 (ULP1). We have considered this time period over the years 2019, 2020 and 2021 to explore the effect of COVID induced lockdown on LST and understanding its variation. Satellite data acquired from AQUA - MODIS with a spatial and temporal resolution of 1 Km and 1-2 days respectively was used for the analysis of the LST. The average LST over Ahmedabad was 314.18 K, 311.79 K and 315.67 K for PLP over the years 2019, 2020 and 2021. For NLP1 the average LST over those years were 321.68 K, 318.73 K and 319.39 K respectively. And for the ULP1 the average LST over those years were 319.87 K, 314.07 K and 312.19 K respectively. We observe a 2.38 %, 2.22 % and 1.17 % increase in LST from the PLP to NLP1 during the years 2019, 2020 and 2021. The increase of LST during the NLP1 in 2020 showed that as the pollution decreased, the active elements that were present in the atmosphere which caused disturbance to the sensor on the satellite while calculating LST were reduced and we got a brighter top of surface. The decrease in LST from 2019 levels for the ULP1 is also observed indicating the effects of lockdown and onset of monsoon in 2020 and 2021. © 2021 IEEE.
ABSTRACT
Nitrogen Dioxide (NO2) monitoring is a necessary step towards the understanding of climate change and public health. In this study, we tried to understand the comparative analysis of variation of NO2 over the region of Ahmedabad city. We have extracted NO2 concentration data for the year 2019 and 2020. The data was collected from both ground-based measurements and satellite based measurements of NO2 concentrations values. The results highlighted complete dynamics of seasonal NO2 concentration during the year 2019 and 2020 including the lockdown effect of COVID-19 outbreak. The validation approach of satellite data, based on cross-correlation analysis with ground data, it provided value of the Pearson correlation factor of 0.613 and correlation coefficients (R2) of 0.376. The huge fall in seasonal trend of NO2 concentration because of the pandemic is also shown in this study. © 2021 IEEE.
ABSTRACT
INTRODUCTION: Neutrophil lymphocyte ratio (NLR) is elevated in response to stressful stimuli and has been shown to be associated with poor prognosis in both benign & malignant disorders. Literature regarding NLR as a prognostic marker in COVID19 are limited. Our study was aimed to investigate the relationship between NLR & survival outcomes in patients hospitalized with Coronavirus disease 2019 (COVID19). METHODS: Ours was a single center, retrospective observational study, which included 472 nasopharyngeal swab SARS-CoV-2 RT-PCR positive patients. NLR was derived from the admission complete blood count & was divided into 5 sub-groups as (0-0.99, 1-2.99, 3-9.99, 10-19.99, >20). Demographics, comorbid conditions, and outcomes such as need for mechanical ventilation, length of stay and inpatient mortality were assessed. Statistics were performed using STATA. Significance was assigned at p<0.05. RESULTS: The mean age was 71.16 years in NLR >10 group as compared to 60.3 years in patients with normal NLR 1-2.99. Male patients were found to have much higher NLR than females (65.12% vs 34.88% in NLR 10-19.99, 64.86% vs 35.14% in NLR>20;p-value: 0.05). Among comorbidities, COPD patients were found to have higher NLR (18.92% of NLR>20 vs 10.71% of NLR 1-2.99;p-value:0.02). Rate of endotracheal intubation and need for mechanical ventilation was significantly higher with increasing NLR (0% vs 7% vs 14% vs 17% vs 32%;p-value: 0.03). Inpatient mortality was significantly higher in patients who had NLR>20 (70.27% of NLR>20 vs 16.07% of NLR 1-3 p-value <0.0001). On multivariate regression, patients with NLR>20 had 4 times higher odds of mortality;however, the p-value was not significant (4.07±2.78 p-value: 0.175). CONCLUSIONS: Increasing NLR in COVID19 patients is associated with increased ICU admission, intubation & inpatient mortality. Further studies are warranted to establish NLR, which is readily available & inexpensive, as a potential prognostic indicator in COIVD19 patients.
ABSTRACT
INTRODUCTION: The host immune responses try to confront Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with all the potential cells and cytokines. Eventually, natural killer cells and T cells become exhausted, decreasing their counts, leading to lymphopenia. This study aims to assess the clinical utility of the absolute lymphocyte count (ALC) at admission in predicting outcome in patients with COVID-19. METHODS: Ours was a single-center, retrospective observational study, which included 463 nasopharyngeal swabs SARS-CoV-2 RT-PCR positive patients. Absolute lymphocyte count was retrieved from the admission complete blood count & was divided into 3 sub-groups (<500, <1000, and >1000 cells/μL). Demographics, comorbid conditions, and outcomes such as the need for mechanical ventilation, length of stay, and inpatient mortality were assessed. Statistics were performed using STATA. Significance was assigned at p<0.05. RESULTS: 13.82% of patients had ALC count<500, 44.71% had <1000 and 41.25% had more than 1000. Mean age in ALC group<500 was higher (71±1 years vs 65± 1.1 years in ALC group <1000 and 59.9+/-1.3 in ALC group >1000). Profound lymphopenia (<500 cells/μL) was more common in males compared to females (71.88 % vs 28% p value 0.01). ALC count <500, was associated with higher rate of non-invasive (45.31% vs 26.56% for ALC <1000, p-value: 0.01) as well as invasive ventilation (26.5% with ALC <500 vs 19% with ALC <1000 vs 10.4% with ALC with >1000;p-value: 0.01). Inpatient mortality was significantly higher in cohort with ALC <500 (51.56% with ALC <500 vs 33.3% with ALC <1000 vs 24.08% with ALC >1000;p-value 0.05). On multivariate regression, ALC was not a independent predictor of mortality (ALC<500, OR: 1.56±0.75, p-value: 0.44). CONCLUSIONS: Lymphopenia at admission in COVID19 patients is associated with an increased need for non-invasive & invasive ventilation & inpatient mortality. Currently, clinical trials assessing GM-CSF as a possible therapeutic option is underway.
ABSTRACT
INTRODUCTION: Coronavirus disease 2019 (COVID- 19) caused by the SARS-CoV-2 virus has emerged as one of the greatest challenges to humanity in recent history. Older people have shown to have poor outcomes in recent studies. Our study looks at the characters and outcomes in patients of different age groups admitted to our center. METHODS: Our study is a single-center, retrospective, observational study of 471 COVID-19 patients (confirmed with a positive nasopharyngeal swab for SARS-CoV2 RT PCR) admitted to our hospital. Patients were divided into 3 groups based on Age (0-45 years, 46-65 years, and >65 years). Demographic characteristics and in-hospital outcomes were compared between these groups. STATA was used to perform statistics. Statistical significance was assigned at p=<0.05. RESULTS: 471 patients were included in the study of which 79 (16.77%), 159 (33.76%), and 233 (49.47%) belonged to the age group of 0-45 years (Group A), 46- 65 years (Group B) and >65 years (Group C) respectively. On comparison of pre-existing comorbidities, patients in group B and group C had a higher incidence of baseline comorbidities (Diabetes, Hypertension, Heart failure, COPD rates were 33.96% vs 43.1%, 55.35% vs 81.12%, 9.01% vs 20.59%, 2.5% vs 11.21% respectively). On comparing in-hospital outcomes, the mean time to mechanical ventilation from admission was 3.25 (±1.31) days, 2.42 (±0.68) days and 2.75 (±0.53) days for group A, B and C respectively. 74 (15.71%) patients required intubation during hospitalization of which 7.5%, 32.5%, and 60% belonged to groups A, B, and C respectively. The overall mortality rate among intubated patients was 90.54% among which 8.15%, 31.08%, and 60.81% belonged to groups A, B, and C respectively. The inhospital mortality rate was 32.48% of which 3.27%, 17.65%, and 79.08% belonged to groups A, B, and C respectively. In-hospital mortality rate for group A, B and C were 6.33%, 16.98% and 51.93% respectively (p <0.0001). However, on multivariate regression analysis, age was not an independent predictor of in-hospital mortality for any age group. CONCLUSIONS: Patients >65 years of age have higher co-morbidities and worse in-hospital outcomes. However, age is not an independent predictor of mortality and each patient should be evaluated individually while making an important treatment decision.
ABSTRACT
INTRODUCTION: Systemic inflammation elicited by a cytokine storm is considered a hallmark of coronavirus disease 2019 (COVID-19). This study aims to assess the clinical utility of the lymphocyte-to-C-reactive protein (CRP) ratio (LCR), typically used for gastric & colorectal cancer prognostication. METHODS: Ours was a single center, retrospective observational study, which included 321 nasopharyngeal swab SARS-CoV-2 RT-PCR positive patients. LCR was derived from the admission complete blood count & was divided into 2 sub-groups (<99.99 vs >100). Demographics, comorbid conditions, and outcomes such as need for mechanical ventilation, length of stay and inpatient mortality were assessed. Statistics were performed using STATA. Significance was assigned at p<0.05. RESULTS: LCR <99.99 group had more elderly patients as compared to LCR >100 group (67.74% vs 54.01% of patients >60 years of age). Male patients were found to have lower LCR than females (60.75% vs 39.25% with LCR <99.99;p-value: 0.03). Among comorbidities, patients with history of cancer were found to have higher LCR (7.53% of LCR <99.99 vs 13.24% of LCR >100;p-value:0.03). Lower LCR was associated with higher rate of non-invasive (36.56% with LCR <99.99 vs 19.12% with LCR >100;p-value: 0.01) as well as invasive ventilation (17.74% with LCR <99.99 vs 11.76 with LCR >100;p-value: 0.01). Inpatient mortality was significantly higher in patients who had LCR <99.99 (39.25% with LCR <99.99 vs 22.63% with LCR >100;p-value <0.03). On multivariate regression, patients with LCR <99.99 had 2 times higher odds of mortality;however, this finding did not reach statistical significance. (2.27± 0.81 p-value: 0.15). CONCLUSIONS: Decreasing LCR in COVID19 patients is associated with increased need for non-invasive & invasive ventilation & inpatient mortality. Further studies are warranted to establish LCR, which is readily available & inexpensive, as a potential prognostic indicator in COIVD19 patients.
ABSTRACT
INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a multisystem infection caused by SARS-CoV-2 Virus. Recent studies have demonstrated poor outcomes in patients with diabetes mellitus (DM). We sought to assess the in-hospital outcomes of COVID19 patients with DM at our centre. METHODS: Ours was a single centre, retrospective, observational study of 470 COVID-19 patients admitted to our hospital. We divided these patients into 2 groups;those with DM and those without. We compared demographic characteristics, comorbid conditions, and in-hospital outcomes between the two groups. Statistics were performed using STATA. Statistical significance was assigned at p<0.05. RESULTS: Out of the 470 patients included in the study, 35.53% of patients had DM. Mean age of patients with and without DM was 68.35years±1.08 vs 61.71±1.05years respectively. 8.72% of patients were on pharmacological therapy. The diabetic cohort had a higher prevalence of hypertension, heart failure compared to the non-diabetic cohort (88.02 vs49.5% p-value:0.004, 22.9% vs 9.31% p-value: 0.04). Other comorbidities such as OSA, CKD, COPD, Asthma were comparable between both groups. The DM group had a higher level of inflammatory markers during the course of hospitalisation (D-dimer 3802.68± 1499 vs 3448.13 ±1139, CRP: 12.60±0.76 vs 11.85±0.60, ESR: 73.66±10.41 vs 58.04±7.10). The DM group had a significantly higher need for mechanical ventilation (18.56% vs 13.29%, p<0.03), and subsequent in-hospital mortality (43.35% vs 25.74% p<0.05). On multivariate regression, diabetics had 2.64 higher odds of in-hospital mortality, however, the p-value was not significant (Write ODDS Ratio and Confidence interval p-value: 0.116). CONCLUSIONS: Overall inpatient mortality was higher in patients with DM, likely driven by an increased need for mechanical ventilation. Our study positively adds to the existing literature that DM is a significant risk factor for higher morbidity and mortality in COVID-19 patients.
ABSTRACT
The COVID-19 pandemic has exposed inadequacies and fault lines in the healthcare ecosystem and the related regulations across the world. Countries are engaged in firefighting to save lives and to make available the essentials needed to meet the local demand. The virus that caused the pandemic has, however, shown the irrelevance of national boundaries and has necessitated a new global approach to adequately address the issues that have arisen since the breakout of the disease. Given this background, this discussion paper builds a case for a 'human-centred global healthcare partnership' based on the 'right to health' and 'health equity'. It then argues for global coordination on research and technology development, healthcare trade facilitation as well as on notifications relating to health and medical emergencies. Such a multi-disciplinary global framework would be crucial to counter the growing protectionism. In addition to helping in achieving the Sustainable Development Goals, it could also strengthen multilateralism and take forward globalisation in an equitable, inclusive and sustainable manner. This paper has included developments on the topic till early-June, 2020.
ABSTRACT
Novel coronavirus (nCovid-19) is a recent emerging, dangerous pathogen that has shaken the whole world. Present therapeutic strategies to deals with this infectious disease are only supportive. The discovery of a new drug within a short period of time is a great task. Structure predictions of several proteins associated with SARS-CoV-2, the virus that causes COVID-19, was made possible by Genomics. Docking is a computational method used in present days to identify a hit molecule by measuring the binding ability of molecular drugs within the binding pocket of the macromolecular target. In this study, we have selected five ligand molecules which are currently used as antiviral agents. The drugs selected are, namely, Acyclovir, Ganciclovir, Penciclovir, Valaciclovir, and deoxyguanosine. The protein with PDB id 6LU7 was retrieved from the protein data bank for the docking procedure. The 2D plot of interactions was obtained using discovery studio visualizer software, and energy calculations were done by summing up van der Waals, electrostatic, and Hydrogen bonding interactions. Acyclovir and its derivatives are found to be potential against nCovid-19 through molecular docking studies using iGEMDOCK. The scores obtained from the computational analysis indicated the best result for the antiviral drug, Ganciclovir, with a docking score of -96.21Kcal/mol.