Effect of Elevator Design on the Risk Associated with COVID Transmission – A Comparative Study between a Sliding Door and a Collapsible Gate Elevator

The ominous spread of the COVID-19 pandemic is attributed to the droplets respired during coughing, sneezing or speaking. These droplets undergo evaporation to become aerosols, which, along with the larger droplets, are believed to ultimately spread the virus. In this current work, a small, enclosed region like an elevator (containing a COVID infected passenger) is considered where the risk of infection is high as the commonly practiced norm of social distancing is not possible. Numerical simulations are performed using OpenFOAM. Two different types of elevators – one equipped with a sliding door and the other with a collapsible gate, are considered and the change in droplet behavior is examined. Certain parameters pertaining to the risk of virus transmission have been quantified and assessed thoroughly, such as the percentage of droplets floating in the height range from a person's waist height to his mouth height, the radial span of the floating droplets from the infected passenger's mouth. From these parameters, the safety measures to be adopted by other copassengers can be determined. After an extensive study, it has been found that the collapsible gate elevator is safer than the sliding door elevator along with added advantages in the context of disease transmission. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Federated Learning for Healthcare Domain - Pipeline, Applications and Challenges

Federated learning is the process of developing machine learning models over datasets distributed across data centers such as hospitals, clinical research labs, and mobile devices while preventing data leakage. This survey examines previous research and studies on federated learning in the healthcare sector across a range of use cases and applications. Our survey shows what challenges, methods, and applications a practitioner should be aware of in the topic of federated learning. This paper aims to lay out existing research and list the possibilities of federated learning for healthcare industries.© 2022 Copyright held by the owner/author(s).

Social Media Driven Big Data Analysis for Disaster Situation Awareness: A Tutorial

Situational awareness tries to grasp the important events and circumstances in the physical world through sensing, communication, and reasoning. Tracking the evolution of changing situations is an essential part of this awareness and is crucial for providing appropriate resources and help during disasters. Social media, particularly Twitter, is playing an increasing role in this process in recent years. However, extracting intelligence from the available data involves several challenges, including (a) filtering out large amounts of irrelevant data, (b) fusion of heterogeneous data generated by the social media and other sources, and (c) working with partially geo-tagged social media data in order to deduce the needs of the affected people. Spatio-temporal analysis of the data plays a key role in understanding the situation, but is available only sparsely because only a small fraction of people post relevant text and of those very few enable location tracking. In this paper, we provide a comprehensive survey on data analytics to assess situational awareness from social media big data.

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

A Single Centre Experience of Post Renal Transplant Infections in a Tertiary Care Centre in Eastern India

Introduction: In developing countries, Post renal-transplant infections is the leading cause of mortality, morbidity and decreased allograft survival. Our aims and objectives was to determine the incidence and prevalence patterns of clinically or microbiologically confirmed infection in the post renal transplant patients of our population and profiling of infections in relation to time period from the Transplant and the induction agent, also to develop strategies to counter risk of post transplant infection. Method(s): This was a retrospective observational study. Time period: January 2020- April 2022. Post renal transplant recipients presenting with infections (with informed consent) was enrolled in this study. Recurrent episodes of infection by different organisms in a same patient treated as a separate event. Data was tabulated using MS excel and all results projected in bar graphs, pie charts, histograms. Differences of quantitative parameters between groups were assessed using the t test(for data that were normally distributed) or nonparametric test (for data that were not normally distributed). Differences of qualitative results were compared using chi2 test. Kaplan-meier was used for survival analysis. P < 0.05 was considered significant. Result(s): 213 incidents of post renal transplant infections were documented in 148 patients between the study period. Of the 85 patients who underwent renal transplant(57 living donor and 28 cadaveric) in this time period 33(38.8%) patients presented with 42 incidents of infections. Majority (74.3%) : Males. Mean age: 36.3+/-5.6 years. Most common cause of native kidney disease was chronic glomerulonephritis(30%). 121 (81.7%) had living donor transplant and 27(8.3%) patients had cadaveric transplant. Induction agent was basiliximab in 97 patients (65.5%) had 133 infections (62.4%) and ATG was used in 51 patients (34.5%) had 80(37.6%) infections. In recent transplant (last 2 yrs) cases-In Basiliximab group: infection rate 4.1 in 100 patient months and in ATG group infection rate was 5.7 in 100 patient months. (p=0.28). 37.5%cases had infections with graft dysfunction most commonly AKI. Immediate post transplant infections (<1 month) were 34 (15.9%), most commonly UTI (44.11%) followed by pneumonia (15.9%). 48(%) infections occurred between 1-6 months, most commonly pneumonia(27.08%) followed by UTI(22.9%) and superficial fungal infection. Pulmonary tuberculosis was in 14 (6.6%) cases. 3 cases had disseminated TB. Infectious diarrhea was in 18(8.4%) cases, most common organism isolated was EAEC and EPEC. CMV colitis found in 3 cases. 27 (18.2%) patients had NODAT/PTDM. ParvoB19 was in 11(5.16%), CMV in 5 and BKVN in 3 cases. 41(19.2%) cases had severe sepsis requiring intensive care support. New baseline s.cr was achieved in 29.1% cases. Infection related death was 24(16.2%). COVID 19 infection was in 41 cases, 31.7% developed graft dysfunction and 18 (43.9%) required hospital admission due to moderate or severe disease. 2 patients had mucormycosis, one of them died after admission. [Formula presented] Conclusion(s): Profiling of infection in our centre is essential to formulate future strategies for infection control especially as the DDKT & ABOi KT is on the rise. Proper survillence, screening protocol, vaccination and patient education are essential to reduce the burden of post transplant infection and for better graft and patient survival. No conflict of interestCopyright © 2023

Outcome of Tunneled Cuffed Catheter as Hemodialysis Access;a Single Centre Experience in a Tertiary Care Centre in Eastern India

Introduction: Although AVFs are preferred vascular access for hemodialysis, tunneled cuffed catheters(TCC) are increasingly being used as dialysis access in certain clinical situations such as in AVF failure or lack of suitable vessels for AVF creation or bridge to living donor transplant. Aim and objective of this study was to study the characteristics of the population having benefited from tunneled cuffed catheters, to identify the different indications as well as the complications secondary to tunneled cuffed catheters in hemodialysis patients and to determine the catheter and patient survival rate and the factors associated with complications and survival. Method(s): This was an retrospective Observational study done after institutional ethics committee approval. All data was captured using standard proforma. The data was tabulated using MS excel and all results projected in form of bar graphs, pie charts, histograms or tables. Kaplan- meier analysis was used for survival. All patients included in the study consented for the procedure as well as collection of data. 527 TCC placement were done in 498 patients by nephrologists without fluoroscopy in a percutaneous fashion between jan 2021 to march 2022. Minimum follow up was 12 months. 37 patients lost to follow up. Result(s): 316 (68.5%) were males and mean age was 48.3+/-12.6 years. Staggered tip MAHURKAR MaxidTM Covidien, was used in every patient. Most common native kidney disease was cresentic GN 176(38.1%). Most common Site of TCC was right internal jugular 88.9%(441/496), followed by left internal jugular 10.48%(52/496), femoral TCC done in 0.6%. Mean blood flow achieved was 311+/- 32ml/min. Most common indication of TCC placement was starting of HD after 1/2 temporary access- 162(32.66%), followed by awaiting Maturation of autogenous AVF 66 (13.3%) and awaiting living-related transplantation 54(10.88%). Total catheter related infective episodes (CRBSI) were 229 (1.07 episodes/1000catheter days),Exit site infection was in 57 cases (0.26 /1000 catheter days), Tunnel infection was in 51(0.19/1000 catheter days), Infective endocarditis was seen in 3 cases. Catheter loss due to CRBSI was 23 (12.16%). Most common organism was Enterococci (29.7%), followed by s.aureus (24.32%). Most common immediate complication was tunnel bleeding (5.9% ), followed by improper tip position 4.68%. Late complications due to TCC thrombosis/ fibrin sheath was 74(15.07%). Recanalisation with urokinase was successful in 36.84%. Central venous stenosis was in 26 cases. successful recanalisation after central venoplasty was 16/19 (84.21%). Mean catheter survival was 201.9 +/- 114.9 days (3day to 12 months). Catheter survival at the end of 3 months was 75.76%, at 6 months 63.4%, at 12months 32.17%. Patient survival at 6 months was 86.7%, at 12 months- 77.5%. Most common cause of death was unrelated to TCC - cardiovascular cause (77.6%). Direct TCC related death was in 5 cases. Most common cause of catheter drop out was patient death (33.03%), followed by maturation of AVF (22.82%), catheter thrombosis/fibrin sheath (22.2%). [Formula presented] Conclusion(s): Though AVF is the best access, for late unplanned HD initiation in many CKD patients, TCC insertion becomes next best option. In access crisis patients, TCC may remain one feasible option for bridge to available live donor transplant. With strict asepsis protocol and technical aptitude TCC placement is safe with few side effects. No conflict of interestCopyright © 2023

Shaping a New Shopping Experience for the Post COVID-Era

As cities worldwide are striving to cope with the ongoing crisis of the COVID-19 pandemic, switching to digital platforms has sparked interest in many stakeholders in response to pandemic recovery. The uncertainty of such future shocks questions our way of addressing urban issues at a micro and Macro-Level. The virus makes physical proximity vulnerable to risks. Hence, urgency is required to shift operations to an online mode to ensure COVID-19 safety norms, maintain continuity in operation and productivity at a distance. It may indicate that worldwide, e-commerce giants have grown during the pandemic for their ability to operate through contactless platforms. On the other hand, local stores and markets suffered due to such giants' growth and Covid restrictions. This research explores challenges in the local retail sector caused by the pandemic and proposes a Design-Based solution. Considering Industry 4.0, mobile apps hold the potential to ease workflow and are easily accessible to all. Our final proposition would be to design a mobile app prototype (which would also be co-designed with the users). Methodologically, we have followed a Bottom-Up model approach and performed exhaustive user research and a heuristic evaluation with a probable user group. Only through understanding and accommodating the ‘larger' community can we all cope with the after-effects of this crisis. This research presents an opportunity for consumers to show solidarity with the small Indian retailers and shop the old, local and sustainable way again. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Pandemics and Their Business Impacts: A Global Perspective

In the long and medium term, the evolution of pandemics and the resulting harm to the global economy have been alarming. Pandemics have a variety of detrimental effects on the economy. They impact families, companies, and the government by reducing labor supply, worker productivity, and population income, increasing company expenditures and public healthcare infrastructure costs. This research aims to examine and organize the present body of knowledge in the field of pandemics and their economic effect. With the help of a systematic literature review and bibliometric analysis, the study presents the status and development in this area of research. All business sectors, including supply chain, logistics, travel & tourism, entertainment, recreation and fitness, hospitality, have been negatively impacted worldwide. The paper contributes to the existing state of literature by examining the impact of significant pandemics on various business activities around the globe. However, there is a surge in telecommunication, including data providers and e-commerce businesses.

Anti-Gbm Disease One and Half Years Experience in a Tertiary Care Centre

BACKGROUND: Anti-glomerular basement membrane (GBM) antibody GN is a rare glomerular disease (0.5-1 per million population) with poor outcome in terms of renal survival. It is caused by auto-antibodies against the non-collagenous domain of the a3 chain of type IV collagen and usually present as a rapidly progressive crescentic GN. Anti-GBM GN may present either as an isolated kidney disease or as a pulmonary-renal syndrome (Goodpasture's syndrome) in 40%-60% of patients. Linear staining of the GBMs for immunoglobulin ( Predominantly IgG & rarely IgA ) in renal biopsy with anti-GBM antibodies in serum is pathognomonic of Anti-GBM disease. Initiating immunosuppression with steroids and cyclophosphamide plus plasmapheresis are the cornerstone of treatment whereas no treatment is recommended if dialysis dependent at presentation 100% crescents or >50% global glomerulosclerosis in an adequate biopsy sample or not having pulmonary hemorrhage. AIM OF THE STUDY: To study demographic and clinical profile treatment administered and outcome (in terms of renal survival) in the patients with biopsy-proven anti-GBM disease. METHOD(S): Single-center prospective observational study (January 2021 to June 2022 ) and study population being the admitted patients in Nephrology Department of I.P.G.M.E.R and SSKM hospital Kolkata. RESULT(S): Total 7 patients were diagnosed as having Anti- GBM disease in this time period with median age of 42 yrs ( range from 11 yrs to 68 yrs), and Female : Male ratio was 5:2. Rapidly Progressive Renal Failure with Oliguria (71.4% ) was the most common presentation and 85.7% required Hemodialysis on presentation. 57.1% patients had 100% crescent in renal biopsy. 1 out of 7 patients had overlap with MPO and did not required RRT at presentation. 1 out of 7 patients had associated pulmonary hemorrhage. 28.5% patients received PLEX while others were treated supportively as per protocol. 28.5% patients previously had COVID 19 infection which was diagnosed retrospectively by detecting COVID 19 IgG antibody in serum. 71.4% patients end up in HD requiring renal failure while 1 patient succumbed to death. CONCLUSION(S): Most of the patients aged between 20 yrs to 60 yrs and were female (both 71.4%). Most of the patients (71.4%) received supportive treatment as per protocol. Only 1 patient (with MPO overlap) is dialysis free with discharge creatinine of 3.3 and receiving EUVAS protocol. Most of the patients who presented late with HD requiring renal failure end up in ESRD.

A novel approach to preventing SARS-CoV-2 transmission in classrooms: A numerical study

The education sector has suffered a catastrophic setback due to the ongoing COVID pandemic, with classrooms being closed indefinitely. The current study aims to solve the existing dilemma by examining COVID transmission inside a classroom and providing long-term sustainable solutions. In this work, a standard 5 × 3 × 5 m3 classroom is considered where 24 students are seated, accompanied by a teacher. A computational fluid dynamics simulation based on OpenFOAM is performed using a Eulerian-Lagrangian framework. Based on the stochastic dose-response framework, we have evaluated the infection risk in the classroom for two distinct cases: (i) certain students are infected and (ii) the teacher is infected. If the teacher is infected, the probability of infection could reach 100% for certain students. When certain students are infected, the maximum infection risk for a susceptible person reaches 30%. The commonly used cloth mask proves to be ineffective in providing protection against infection transmission, reducing the maximum infection probability by approximately 26% only. Another commonly used solution in the form of shields installed on desks has also failed to provide adequate protection against infection, reducing the infection risk only by 50%. Furthermore, the shields serve as a source of fomite mode of infection. Screens suspended from the ceiling, which entrap droplets, have been proposed as a novel solution that reduces the infection risk by 90% and 95% compared to the no screen scenario besides being completely devoid of fomite infection mode. The manifestation of infection risk in the domain was investigated, and it was found out that in the case of screens the maximum infection risk reached the value of only 0.2 (20% infection probability) in 1325 s. © 2023 Author(s).

Aftermath of COVID-19 Pandemic-A Comparative Retrospective Single Center Study during the First, Second and Third Wave of COVID-19 in Tertiary Care Institute in North India

Background: At the onset of Covid-19 pandemic, it was an unknown entity in terms of risk status of the pregnant women for fetomaternal outcome. Both fetus and pregnant women were considered as groups under special concern due to their unique physiological characteristics. Method(s): A retrospective study was conducted in department of Obstetrics & Gynaecology along with Paediatrics department in Maharishi Markandeshwar Medical College and Hospital, Solan on pregnant females admitted to the Covid-19 Ward/ ICU over a period from August 2020 till 31st March 2022. Participants were included into 3 waves of pandemic based upon time of presentation and these 3 groups were further studied for the various fetomaternal parameters such as maternal age, symptom status, need for respiratory support, maternal mortality, abortions, still births, gestational age and weight of newborn and other morbidity and mortality in newborns. Result(s): A total of 171 pregnant were included in the study, of whom 47, 64 and 60 were seen in 1st, 2nd and 3rd waves respectively. Majority of subjects were asymptomatic in 1st, 2nd & 3rd wave, (p=0.30). Age wise distribution of the patients showed majority subjects in the age group of 20-30 years (p= 0.94). LSCS rates in 3 waves were not different significantly (p = 0.67). Maternal mortality rates and need for respiratory support were in similar proportions in all 3 waves (p=0.71) and (p=0.73) respectively. No significant difference was seen in maternal morbidity and neonatal outcome. Conclusion(s): The study showed no significant difference between the waves of Covid-19 pandemic in terms of fetomaternal outcome except no maternal mortality in 3rd wave. Copyright © 2022 Ubiquity Press. All rights reserved.

Impacts of pandemic on education sector in Thailand

The pandemic has impacted education sector at various levels. The institutions across the world either closed for few weeks/months or changed their session time to cope with the pandemic situations. The institutes are also struggling to change the education governance adapting to the new normal situation and education continuity. Along with the world Thailand has also faced a major transformation in education system from physical classroom teaching to virtual online learning platforms. The present exploratory study discusses on the different methods/strategies that the educational institute followed for the quick adaptation to this new era of digital education. The longer term disruption in the education and its disproportionate impacts exacerbate the prolonged social disparities rather than alleviate it. The study also discusses the direct and indirect impacts of COVID-19 on education sector at the community level in Thailand. © 2022 Elsevier Inc. All rights reserved.

Effect of ventilation and climatic conditions on COVID-19 transmission through respiratory droplet transport via both airborne and fomite mode inside an elevator

A numerical analysis using OpenFOAM has been performed in this work to investigate the infection risk due to droplet dispersal in an enclosed environment resembling an elevator, since infection risk in such confined places is very high. The effect of two scenarios on droplet dispersal, namely, the quiescent and the fan-driven ventilation, both subjected to various climatic conditions (of temperature and humidity) ranging from cold-humid (15 °C, 70% relative humidity) to hot-dry (30 °C, 30% relative humidity) have been studied. A risk factor derived from a dose-response model constructed upon the temporally averaged pathogen quantity existing around the commuter's mouth is used to quantify the risk of infection through airborne mode. It is found that the hot, dry quiescent scenario poses the greatest threat of infection (spatio-averaged risk factor 42%), whereas the cold-humid condition poses the least risk of infection (spatio-averaged risk factor 30%). The proper fan speed is determined for the epidemiologically safe operation of the elevator. The fan ventilation scenario with 1100 RPM (having a spatio-averaged risk factor of 10%) decreases the risk of infection by 67% in a hot, dry climatic condition as compared to a quiescent scenario and significantly in other climatic ambiences as well. The deposition potential of aerosolized droplets in various parts of the respiratory tract, namely, the extrathoracic and the alveolar and bronchial regions, has been analyzed thoroughly because of the concomitant repercussions of infection in various depths of the respiratory region. In addition, the airborne mode of infection and the fomite mode of infection (infection through touch) have also been investigated for both the ventilation scenarios. © 2022 Author(s).

Shaping a New Shopping Experience for the Post COVID-Era

As cities worldwide are striving to cope with the ongoing crisis of the COVID-19 pandemic, switching to digital platforms has sparked interest in many stakeholders in response to pandemic recovery. The uncertainty of such future shocks questions our way of addressing urban issues at a micro and Macro-Level. The virus makes physical proximity vulnerable to risks. Hence, urgency is required to shift operations to an online mode to ensure COVID-19 safety norms, maintain continuity in operation and productivity at a distance. It may indicate that worldwide, e-commerce giants have grown during the pandemic for their ability to operate through contactless platforms. On the other hand, local stores and markets suffered due to such giants’ growth and Covid restrictions. This research explores challenges in the local retail sector caused by the pandemic and proposes a Design-Based solution. Considering Industry 4.0, mobile apps hold the potential to ease workflow and are easily accessible to all. Our final proposition would be to design a mobile app prototype (which would also be co-designed with the users). Methodologically, we have followed a Bottom-Up model approach and performed exhaustive user research and a heuristic evaluation with a probable user group. Only through understanding and accommodating the ‘larger’ community can we all cope with the after-effects of this crisis. This research presents an opportunity for consumers to show solidarity with the small Indian retailers and shop the old, local and sustainable way again. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Analysis and Insights for Myths Circulating on Twitter During the COVID-19 Pandemic

The current COVID-19 pandemic and its uncertainty have given rise to various myths and rumours. These myths spread incredibly fast through social media, which has caused massive panic in society. In this paper, we comprehensively examined the prevailing myths related to COVID-19 in regard to the diffusion of myths, people's engagement with myths and people's subjective emotions to myths. First, we classified the myths into five categories: spread of infection, preventive measures, detection measures, treatment and miscellaneous. We collected the tweets about each category of myths from 1 January to 7 July in the year 2020. We found that the vast majority of the myth tweets were about the spread of the infection. Next, we fitted myths spreading with the SIR epidemic model and calculated the basic reproduction number R-0 for each category of myths. We observed that the myths about the spread of infection and preventive measures propagated faster than other categories of myths, and more miscellaneous myths raised and quickly spread from later June 2020. We further analyzed people's emotions evoked by each category of myths and found that fear was the strongest emotion in all categories of myths and around 64% of the collected tweets expressed the emotion of fear. The study in this paper provides insights for authorities and governments to understand the myths during the eruption of the pandemic, and hence enable targeted and feasible measures to demystify the most concerned myths in due time.

Effect of Prone Positioning on Oxygen Saturation in COVID-19 Patients in Sri Aurobindo Hospital, Indore

Background: Physiotherapeutic intervention body positioning have been observed to increase oxygen saturation. In COVID-19 patients, we intended to investigate how the prone position worked in conjunction with conventional respiratory physiotherapy. The objective was to determine the effect of prone position along with conventional respiratory physiotherapy on SpO2 of COVID-19 patients in Aurobindo hospital, Indore district. Methods: The Ministry of Health, Government of India, authorized the rules for collecting data from infected patients. In this study, 400 patients between the ages of 20 and 80 years old were recruited from Sri Aurobindo Hospital in the Indore district, all of them had a confirmed diagnosis of COVID-19 and required oxygen treatment. SpO2 data was collected as a baseline. Patients were helped into the prone position after baseline data collection and conventional respiratory physiotherapy. Clinical data was obtained again after using the prone posture in conjunction with conventional respiratory physiotherapy. To demonstrate the various prone variations, a patient information sheet was supplied. At 0 and 60 minutes after the exercise, oxygen saturation was measured. Results: Between April 2020 to June 2020, we assessed SpO2 of 400 Patients pre and post prone position along with conventional respiratory physiotherapy. Prone positioning was feasible. Oxygenation was significantly improved from supine to prone position. The data were processed for mean and standard deviation. It was analyzed that there was difference in pre to post value of mean, from 95.685 to 98.123 with standard deviation from 1.645to 1.445. The result shows significant improvement in SpO2 after applying prone positioning in patients infected with COVID-19. The findings suggest that prone positioning is both possible and beneficial in increasing blood oxygenation in awake COVID-19 patients. Further study is needed to find the technique's potential value in terms of enhancing overall respiratory and global outcomes. Conclusion: The difference between the saturation of the two position was significant.

Prospective evaluation of virtual consultations in paediatric surgery and urology: Lessons from the pandemic times

Aim: Virtual consultation (VC) became the new norm for providing outpatient clinics during the COVID-19 pandemic. This is likely to be adopted in some form going forward. This study prospectively evaluated the effectiveness&safety of VC undertaken at a UK tertiary paediatric surgical centre during the pandemic. Method: Data on paediatric surgery/urology outpatient video/telephone consultations between May-June 2020 was prospectively collected. VC episodes were given outcomes (1,2or3) depending how well surgeons were able to make definitive diagnoses/plans. 6months later, findings at later face-to-face visit were retrospectively compared with earlier VC to assess accuracy of decision-making using VC. Telephone survey of patient experience was done. Results: 186VC were evaluated. 95 (51%) were paediatric general surgical patients and 91 (49%) urology. 118 (63%) were follow-ups and 68 (37%) new. In 70% of cases, clinicians were able to make definitive diagnosis/ plan using VC (outcome1) while 26% could be delayed till face-toface consultation is safe (outcome2). 7 patients (4%) needed to be brought in urgently (outcome3). Clinicians were significantly more able to make definitive diagnosis/plan in urology and follow-up patients. Of those brought back for scheduled follow-up/surgery, there was 93% correlation between findings at physical consultation compared to the definitive plans made at VC. Patient survey showed 92% overall satisfaction rate. 75% felt VC is comparable to face-to-face/would use VC again. Conclusions: This study provides evidence that VC is an effective&safe way to structure paediatric surgical outpatient care and it highlights the patient categories in which VC is most suitable.

Fuzzy regression based patient life risk rate prediction using oxygen level, pulse rate and respiration rate in Covid-19 pandemic (FRPRPS)

Today, the general situation worldwide is that the hospitals, sanatoriums and medical colleges are running out of beds, oxygen, medical staff, ventilators and other required paraphernalia that is mandatory for the treatment of the vicious pandemic [1]. The requirement is for a system that takes in some input parameters like Oxygen level of the patient, pulse rate and respiration rate and in turn predicts the Life Risk Rate of that patient [2]. The model used here is a fuzzy regression model that gives the prediction of Life Risk Rate between 1 and 10 units. The lower the predicted Life Risk Rate, the better the chances of survival of the Covid patient. But if the predicted Life Risk Rate is more than the mean of the observations of the Risk in the dataset, then immediate emergency is needed. The benefit of this system is that the patients requiring immediate admission and treatment can be filtered and medical aid in hospital be thereby provided for critical patients. Rest may be home quarantined and domestic medical aid may be given to them until in some unfortunate situation their Risk Rate is near alarming. This paper aims to provide some help in this crucial situation. © 2021 Gnedenko Forum. All right reserved.

Malrotation of small bowel with midgut volvulus in a covid-19 positive young male: A rare case report

Malrotation of small bowel with midgut volvulus has a very low incidence of 0.2% in adults. Symptomatic malrotation in neonates occur in one in 6000 live births. The normal 270 degrees counter-clockwise gut rotation around the axis of superior mesenteric artery is absent in such cases. A 20-year-old male presented with intermittent colicky abdominal pain since four to five months, post-prandial bilious vomiting since one week and obstipation since two days. He also had difficulty breathing since two days. Abdominal examination revealed vague lump in right lower abdomen with no signs of peritonitis. Radiological investigations Ultrasonography (USG) and Contrast Enhanced Computed Tomography (CECT) abdomen demonstrated over distended stomach with dilated D1 and D2 showing changes in relation to superior mesenteric artery and superior mesenteric vein with rotation of mesentery in whirlpool pattern. His Reverse Transcriptase-Polymerase Chain Reaction Test (RT-PCR) was positive for Coronavirus Disease-2019 (COVID-19). Conservative trial for two days was followed by surgical exploration which revealed gut malrotation with mid-gut volvulus. Ladd's procedure was performed. Malrotation with midgut volvulus is an acute surgical emergency that demands high index of suspicion in an adult. Associated COVID-19 pneumonia can increase mortality. Patient was followed-up after three weeks with fruitful results, proving that an early diagnosis and definitive surgical correction of malrotation with midgut volvulus is essential.