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Aim: To determine the long-term impact of telemedicine in child neurology care during the COVID-19 pandemic and with the reopening of outpatient clinics. Method(s): We performed an observational cohort study of 34 837 in-person visits and 14 820 telemedicine outpatient visits across 26 399 individuals. We assessed differences in care across visit types, time-period observed, time between follow-ups, patient portal activation rates, and demographic factors. Result(s): We observed a higher proportion of telemedicine for epilepsy (International Classification of Diseases, 10th Revision G40: odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3-1.5) and a lower proportion for movement disorders (G25: OR 0.7, 95% CI 0.6-0.8;R25: OR 0.7, 95% CI 0.6-0.9) relative to in-person visits. Infants were more likely to be seen in-person after reopening clinics than by telemedicine (OR 1.6, 95% CI 1.5-1.8) as were individuals with neuromuscular disorders (OR 1.6, 95% CI 1.5-1.7). Self-reported racial and ethnic minority populations and those with highest social vulnerability had lower telemedicine participation rates (OR 0.8, 95% CI 0.8-0.8;OR 0.7, 95% CI 0.7-0.8). Interpretation(s): Telemedicine continued to be utilized even once in-person clinics were available. Pediatric epilepsy care can often be performed using telemedicine while young patients with neuromuscular disorders often require in-person assessment. Prominent barriers for socially vulnerable families and racial and ethnic minorities persist.Copyright © 2022 Mac Keith Press.
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Background: Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a widely known, prolonged, multifactorial limb movement disorder wherein patients have an insatiable desire to move their legs. This is frequently associated with abnormal, non-painful sensations that begin at rest and improve with activity and pain may be the distressing symptom in a few. Ropinirole, a dopamine agonist, is a proven drug for this disease. Method(s): In this study of thirty-two post covid restless leg syndrome, selected by well-established criteria, a course of ropinirole 2 mg in the night was given for three weeks. The drug compliance was maintained more than 95% by telephonic interview. The pain scores (VAS 0- 10), Likert scores of satisfactions, were observed after three weeks and three months. Result(s): The scores significantly decreased after three weeks which maintained the same and an insignificant decrease after three months. The median score decreased from 7 to 3 (three weeks) to 2 in three months. The Likert satisfaction scores improved to 1.81 from three (p value= 0.00). There was improvement in scores from three weeks to three months. There were no side effects. Conclusion(s): In this single centre, quasi experimental study on the efficacy of ropinirole on post covid restless syndrome, we found the drug dosage of 2 mg in the night for three weeks is effective in the control of symptoms. The drug gives better satisfaction which prolonged to three months even if the drug is stopped in three weeks. There were no clinically significant side effects. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Background: Severe acute respiratory syndrome (SARS-CoV-2), a zoonotic virus, is the pathogenic causal agent for the ongoing pandemic. Despite the lethality of the disease, there are no therapeutic agents available to combat the disease outbreak, and the vaccines currently accessible are insufficient to control the widespread, fast-mutating virus infection. Objective(s): This research study focuses on determining potential epitopes by examining the entire proteome of the SARS-CoV-2 virus using an in-silico approach. Method(s): To develop a vaccine for the deadly virus, researchers screened the whole proteome of the SARS-CoV-2 virus for potential epitopes in order to find a powerful peptide candidate that is both unique and fulfils the vaccine's objective. It is mandatory to identify the suitable B-cell and T-cell epitopes of the observed SARS-CoV-2 surface glycoprotein (QKN61229.1). These epitopes were subjected to various tests, including antigenicity, allergenicity, and other physicochemical proper-ties. The T-cell epitopes that met the criteria were subjected to population coverage analysis. It helped in better understanding epitope responses to the target population, computing peptide con-servancy, and clustering epitopes based on sequence match, MHC binding, and T-cell restriction sites. Lastly, the interactions between the T-cell receptor (TCR) and a peptide-MHC were studied to thoroughly understand MHC restriction to design a peptide-vaccine. Result(s): The findings revealed that four B-cell epitopes, two MHC-I epitopes, and four MHC-II epitopes qualified for all of the tests and so have antigen affinity. Conclusion(s): Based on the results obtained from this study, the estimated peptides are promising candidates for peptide-vaccine design and development. Copyright © 2022 Bentham Science Publishers.
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The world is witnessing a pandemic of a severe infectious nature known as COVID-19. Many countries have used partial or complete lockdown to slow the spread of the virus, which has devastated the economies all over the world, and made hundreds of millions of people unemployed overnight. The lockdown measures and work from home practices as a response to the spread of the new coronavirus threaten the existence of many innovative startups. In fact, many software startups are either with no projects on hand and only a few of them are able to attract customers for even maintenance projects. In this paper, we provide a decision framework to help software startups choose projects which will increase their chance of success given their historically low success rate and diminished level of IT investment. © 2022 The Author(s)
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Nowadays, vaccination plays the major role in controlling the death rates in COVID-19. However, certain people don’t have a trust on vaccines like Covaxin and Covishield. In order to make the decision on these vaccines like Covaxin and Covishield, decision support system (DSS) is necessary using machine learning approach. Many researchers find the supervised learning model gives best prediction among many machine learning models for COVID-19 situation. Supervised learning model has regression and classification models. Here, supervised machine learning models like logistic regression, decision tree and random forest are used to create a decision support system (DSS). With the use of this machine learning models, people can understand the uses of COVID-19 vaccines. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Introduction: COVID-19 has been linked to an increased risk of new-onset diabetes mellitus and increased incidence of diabetic ketoacidosis (DKA) either as a new presentation or with pre-existing diabetes. Various mechanisms such as impaired insulin secretion, impaired glucose disposal or increased counter regulatory responses are proposed.2 Case report: A 57-year-old man diagnosed with COVID-19 one month prior presented with epigastric pain, shortness of breath and weight loss. Investigations confirmed DKA (pH 7.22, bicarbonate 2.6 mmol/L, blood glucose 11.6 mmol/L, blood ketones 5.8 mmol/L) with HbA1c of 95 mmol/mol. Initial treatment was started as per national DKA guidelines. Upon discharge, the patient was prescribed a basal-bolus regime (total 30 units of insulin) and a FreeStyle Libre flash glucose monitoring (FGM) device. Rapid improvement in blood glucose levels was observed, with regular down titration of insulin and complete discontinuation after 24 days. HbA1c was 37 mmol/mol 96 days later. C-peptide normalised at 3 months for paired glucose at 837 pmol/L. Discussion: The use of diabetes technology (FGM device) with remote monitoring of blood glucose was instrumental in the safe and effective management of this patient. Given that the available literature suggests transient beta-cell dysfunction in the majority of COVID-19 patients resulting in DKA,3 we propose that patients who have been diagnosed with COVID-19 presenting with DKA should be discharged with insulin and FGM from secondary care. This enables remote insulin titration with ease, de-escalation of treatment with confidence and avoiding hypoglycaemia in the recovery phase of the illness in those with transient beta-cell dysfunction due to COVID-19.
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Covid-19 has proliferated across the nations with increasing number of cases each day. Thus, IT companies are now forced to operate from remote places with limited IT resources. However, these companies across the globe are on continuous touch with their software development and maintenance teams to ensure that they are productive and are able to deliver their services on the projects on time. We study the challenges faced by the IT companies at this juncture and the need for a different software development approach to complete the projects successfully even during such crisis. In this context, when the IT industries are making attempts to complete their on-going software projects and also to attend to some critical up-gradation in their previously delivered products, the challenges faced by them due to acute shortage of IT resources and transforming the working model from physical setup to remote platform needs to be studied. This calls for studying the existing software development models and practices and defining an alternate one that would suit the present IT scenario.
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Introduction: New York City has been one of the largest epicenters of the COVID-19 pandemic. This provided a wealth of data to examine the characteristics of COVID-19 patients in this multi-ethnic city, while assessing the contributions of cardio-metabolic burden and pulmonary conditions as potential “at-risk” conditions for COVID- 19. We assessed the relative contribution of common upper and lower airway pulmonary diseases in determining the likelihood of COVID- 19-related mortality independent of other medical conditions, health risks, and sociodemographic factors. Methods: We analyzed data from one of the largest US-based case series of patients with COVID-19, captured from an academic health network in NYC. A total of 11,512 hospitalized patients (March 2-May 24, 2020) were tested with 4,446 (38.62%) receiving a positive diagnosis for COVID-19. EHR queries yielded age at time of testing, sex, race/ethnicity aggregated as non-Hispanic black, Asian and Hispanic referenced to non-Hispanic white;cardio-metabolic conditions (hypertension, hyperlipidemia, diabetes, obesity, peripheral artery disease, and coronary artery disease);pulmonary disease (e.g., COPD, sleep apnea, or asthma);autoimmune disease;and cancer. Mortality was based on the patient state (alive or deceased) at the moment of discharge. We included only patients who had been discharged alive or had expired. Anaconda Python 3.7 was used to perform all analyses. Results: Among patients testing positive, 959 (21.57%) died of COVID-19-related complications at the hospital. Multivariateadjusted Cox proportional hazards modeling showed mortality risks were strongly associated with greater age (HR=1.05;95%CI:1.04- 1.05), ethnic minority (HR=1.26;95%CI:1.10-1.44), low household income (HR=1.29;95%CI:1.11, 1.49), and male sex (HR=0.85;95%CI:0.74, 0.97). Higher mortality risks were also associated with a history of COPD (HR=1.27;95%CI:1.02-1.58), obesity (HR=1.19;95%CI:1.04-1.37) and peripheral artery disease (HR=1.33;95%CI:1.05-1.69). We observed a significantly higher rate of COVID- 19 cases (43.8% vs 39.6%, p<0.05) among patients with sleep apnea (7.72%). However, they did not have a significantly higher mortality rate (13.0% vs 11.8%, NS), although they experienced a longer hospital stay (7.1±7.7 vs 6.1±7.5, p<0.01). Conclusion: Patients with COPD had the highest odds of COVID- 19 mortality. Sociodemographic factors including increased age, male sex, low household income, ethnic minority status were also independently associated with greater mortality risks.
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The pandemic of coronavirus disease 2019 (COVID-19) struck the globe in December 2019, killing lakhs of people and it is continuing in many countries to create havoc. There are lakhs of publications creating evidence about the management of the disease. After seeing thousands of cases, we formed opinions in each field of management and these findings may look more logical. We accept that our opinions differ subtly from the evidence. Regarding the transmission of the disease, it is spread from person to person through inhaled aerosols. If this is going to be 100% true, then the need for personal protective equipment covering the legs seems illogical. Povidone-iodine is antiviral and spreading the same as an ointment inside the nose must be effective to decrease viral load. The other antivirals with questionable efficiency like remdesivir are being used frequently, especially in the pulmonary phase. There are no clear-cut guidelines for primary contacts. Any protective drug intake could have decreased the transmission. It’s a simple logic that the act of sneezing will decrease the viral load. The practice of inhaling turmeric smoke to induce sneezing in the outdoor could have decreased the viral load. We opine that a lymphopenia of <15% can predict a worse outcome in the next 2 days. A computerized computed tomography scan of the chest is to be taken 7 days after the onset of symptoms as the disease usually enters the pulmonary phase only then. The date of onset of symptoms rather than the positive testing date should be considered for timeline management of the case. The undue tachycardia in the 1st week and desaturation below 92% in the 2nd week are the warning signs. The steroids are to be usually prescribed after the 5–6 days. The roles of psychiatric counseling and nutrition were largely underplayed.
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Patients with COVID-19 pneumonia are at higher risk of developing thromboembolic events including pulmonary embolism, deep vein thrombosis, ischemic stroke, and myocardial infarction. We report a case of a patient who developed a right sided ventricular thrombus despite being on therapeutic anticoagulation. A 49-year-old man with no past medical history was admitted to the hospital due to COVID-19 pneumonia. He was started on therapeutic Enoxaparin due to D-dimer of 17710ng/ml. Lower extremity duplex was negative for deep vein thrombosis. Patient was enrolled in Sarilumab trial and received the intervention on day 3 and 4 of admission. Initially patient's oxygen requirements decreased, and D-dimer levels trended down. But on day 11, patient was hypotensive, hypoxic to 84% on 5L NC. Differentials included-Pulmonary embolism, Progression of COIVD-19 pneumonia, ARDS, superimposed bacterial pneumonia. Further workup included repeat chest x-ray which showed resolving bilateral infiltrates. D-dimer was 4388ng/ml. A bedside echocardiogram showed right ventricular dilation and a large mobile echo-dense mass measuring 12mm∗11mm compatible with a Right Ventricular thrombus. CT chest revealed right lower lobe pulmonary embolus and evidence of right heart strain. Patient was transferred to the ICU. Enoxaparin was stopped, a bolus of tissue plasminogen activator (tPA) 50mg was administered over 2 hours followed by a 1mg/hr infusion. Heparin drip with a PTT goal of 30-50 seconds was administered simultaneously for 24 hours. Fibrinogen levels were checked every 6 hours to ensure levels remained above 150 mg/dl. After 24 hours, echocardiogram showed persistent RV mobile thrombus and McConnell's sign. The above infusion protocol was repeated for 24 hours. After tPA infusion patient O2 requirements down trended from nonrebreather 15L to NC 5L. Repeat echo showed resolution of RV thrombus. Repeat CTPE had no new filling defects. There were no bleeding events. Patient was transitioned to apixaban and transferred stable to the floors. Patients with COVID-19 are at higher risk of developing hypercoagulability and it is associated with a worse prognosis. Bedside echocardiogram is a rapid accessible test that can be used in acute decompensating patients. Consecutive doses of tPA appear to be a safe and effective option for the treatment of right heart thrombus. Infusion endpoint for such patients include significant bleeding, drop in hemoglobin by 2 g/dl, fibrinogen <150mg/dl, and/or thrombus resolution on echocardiogram. Our patient showed improvement after tPA infusion perhaps by the thrombus lysis or lysis of the microthromboemboli and fibrin deposits of the pulmonary microvasculature.
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Objective: In early 2020, our research teams at Northwestern University, NorthShore University HealthSystem, University of Michigan, and Fox Chase Cancer Center prepared to launch the final year of interventions for an NCI-funded RCT titled REASSURE ME (R01 CA193331). This study examines the extent to which training in mindfulness helps men diagnosed with prostate cancer on active surveillance and their partners be able to cope with the uncertainties of this treatment approach. Challenges associated with COVID-19 and shelter-in-place orders abruptly halted in-person study activities, prompting our team to quickly pivot and rethink how best to proceed. Methods: Our strategy consisted of four primary components:( 1) examining COVID-19's impact on the research (what affect, if any, it had on the study's purpose, design, procedures, findings);(2) re-evaluating plans underway before COVID-19 struck (including recruitment, interventions, data collection, multisite communications);(3) determining if video-conferencing would be a viable delivery solution, and if so, how to adapt content for that platform;and (4) identifying best resources/practices for the virtual environment. Results: Preparations for an additional year of the study included: (1) holding site meetings to determine funding needs, (2) requesting an NIH no-cost extension, and (3) submitting modifications to each site's Institutional Review Board. Procedural changes/additions included: (a) online intervention trainings and creation of tutorial aids for the research team;(b) video-conferencing training sessions, tutorial aids, and ongoing technical assistance for research participants;(c) development of online versions of the treatment and control interventions;(d) postal delivery of paper-based intervention materials/supplies to research participants;(e) electronic/postal qualitative data collection;and (f) establishing a coordinating assistant to be on call for intervention facilitators during sessions. Conclusion: The unprecedented constraints of COVID-19 presented our team with the opportunity to re-envision and develop a new approach for online delivery of mindfulness that can be used by future researchers.
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Chocolate has been a dietary supplement cherished by people of all ages. Home made chocolates are rare to get in many places. Zinc as a nutritional additive is being promoted as a booster of self-immunity to fight the corona pandemic. We tried to make a chocolate with natural additives rich in zinc along with the traditional method of making the chocolate. The normal chocolate was prepared according to described techniques. The zinc fortification was done with calculated doses of pumpkin seeds and decorticated sesame. (Zinc chocolate) The preparation of chocolate was similar with the same amounts of the other ingredients. After getting the recipe both were sent for zinc estimation. The zinc content in zinc chocolate was 34.65 mg/kg while in the other normal variety was only 13.42. The value was almost three times the normal chocolate. The taste was almost similar and cannot be distinguished by ten volunteers. We accept that we have not fed the volunteers with this recipe continuously and further estimate the blood zinc level to prove our results. We suggest that fortification with pumpkin seeds and decorticated sesame can be done in many recipes including chocolate to provide supplemental zinc in covid times.
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Covid 19 is a pandemic affecting many countries with countless deaths and morbidities. There are many drugs, and immune-boosting nutraceuticals developed to tackle the same. There are no strict guidelines still yet described. We propose a guideline or a protocol termed as Partha’s protocol to counter every type of patient and contacts. In our early preliminary pilot study of 76 patients which included contacts, all were segregated into groups and received the drugs according to the protocol from Categories A to D. The basic strate-gies like social distancing and face masks continued. We had 19 positive cases and the rest as contacts. There was a need for minimal oxygen in two patients. Otherwise, there was no mortality. Among the contacts, there were only a few people (4 in number) who turned symptomatic, and none turned swab posi-tive. This protocol seems to look like polypharmacy, but all these drugs were being used for different indications safely for many years. Hence it’s unlikely to encounter any significant side effects. We also advise taking antibody titre of IgG in the post-exposure group. If it turns out to be positive, we suggest avoiding repeated quarantine on recurrent exposures. We did not measure viral load as we considered early symptoms with exhaustion as a marker. To wait for evidence and then to tackle contacts and less sick patients may be detrimental to countries like India because of its vast population. © International Journal of Research in Pharmaceutical Sciences.
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The use of N95 masks is being recommended for the control of transmission of the dreaded corona virus. As this mask is relatively costly in the Indian set up, the reuse of masks has been suggested. One of the common methods of sterilization is keeping the mask dry for three days. As a different modifica-tion of the technique, we suggest (Partha’s technique) that it can be kept in a box with camphor crystals. The smell of the camphor has soothing effects in the nose with virucidal actions. Hence a simple drying can be done in a box with camphor vapour which has got added beneficial effects. Application of povidone iodine in the nose and the throat is known to have virucidal effects. But the commonly present gargles are more watery to stay in the nasophar-ynx. Here we suggest a paint prepared as Mandl’s paint (an old preparation) which is more viscous to stay in the nasopharynx for a few hours to have a potent virucidal effect. The technique (Partha’s technique) of application was by a throat swab with the paint followed touching the back of the two nostrils with cotton buds soaked in Mandl’s paint. © International Journal of Research in Pharmaceutical Sciences.
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The corona virus pandemic is causing the worst ever health disaster in the recent decades. Continuously newer drugs are being tried for the same with variable success. There has been much talk about one’s immunity and the corona survival. There are a lot of traditional food items which can increase the immunity with an additional benefit of some antiviral properties. Citrus fruits, sitaphal, apple papaya are among the fruits. Vegetables including broccoli, onion, garlic and green leaves are a few vegetables. Nuts, ginger, turmeric, pepper, egg yolk, shell fish, mushroom are some of the miscellaneous dietary supplements which have both properties. In a pandemic scenario, diet and nutrition can be an important supplement to pharmacy to counter viruses. We have tried to give complete menu for a day with such properties. The major hiccup may be the non-availability of certain foods. Hence, we have also suggested many alternate recipes to tackle this problem. This sample menu and their alternatives are being given for a normal adult. Needy changes should be contemplated according to age, sex, body mass index and daily physical activities.