Ramification of Covid-19 pandemic : Occurrence and impact of fungal Infections in a tertiary care hospital

Coronavirus disease 2019 (Covid-19) pandemic has been prevailing for more than a year associated with increased number of opportunistic invasive fungal infections in patients who have been critically ill or immunocompromised. In this retrospective study, details of various clinical specimens received from suspected patients of fungal infections were processed according to standard protocol were studied. The fungal infections were present in 64% (51/79) COVID-19 positive patients and 43% (163/381) COVID-19 negative patients) during the year 2021 during the second wave of COVID-19. Among Covid infected patients, the fungal infection mostly observed was Candidiasis (63%) followed by Aspergillosis (15% ) and Mucormycosis (6%). The maximum samples positive in Covid patients were urine samples followed by Serum (for Aspergillus Galactomannan). Among the urine and respiratory samples (BAL, Tracheal aspirate, Sputum) in Covid-19 positive patients, maximum positivity of Candida species was seen. Mucormycosis in Covid-19 positive patients was isolated in Nasal samples followed by tissue sample with Rhizopus arrhizus and Rhizopus homothallicus. There has been an increase in fungal co-infections during the COVID-19 pandemic which is a matter of great concern. Early diagnosis is essential for effective management of these patients.

Electrocardiographic Changes among Moderate and Severe COVID-19 Patients in a Tertiary Care Teaching Hospital at Shahdol, Madhya Pradesh, India: A Record-based Study

Introduction: Electrocardiographic (ECG) abnormalities in Coronavirus Disease 2019 (COVID-2019) patients are largely unknown. ECG changes in COVID-19 disease may guide to initiate therapeutic anticoagulation, more so in moderate and severe disease. Aims: To identify various ECG changes in moderate and severe COVID-19 patients and to ascertain the association between initial ECG changes and disease outcome. Materials and Methods: This was retrospective record-based study was conducted in the Department of Internal Medicine, Birsa Munda Medical College, Shahdol, Madhya Pradesh, India, on 216 patients with laboratory-confirmed COVID-19 in a tertiary care teaching hospital from March 2021 to June 2021. Demographic and clinical data including ECG were extracted from medical records of the patients and if needed, the patients were followed-up till outcome. COVID-19 disease severity was considered based on oxygen saturation at room air (moderate: 94%-90%;severe: <90%). Data were entered using the Epicollect5 mobile application to minimise errors. Results: A total of 216 patients were included (35 to 54 years), the majority were male. Mortality rate was 46.3%. Total 57.4% of ECG changes were classified as abnormal. Sinus tachycardia was the most common abnormality followed by ischaemic changes. Left axis deviation in ECG was more commonly seen than right axis deviation. Total 53.2% of patients with abnormal ECG findings and 36.9% with normal ECG findings died. Mortality was very high in patients with ischaemic changes. Conclusion: COVID-19 patients with ischaemic changes in ECG were significantly associated with increased mortality. Hence, early detection of these changes in COVID-19 patients is vital and will help primary care physicians to intervene early and help in deciding therapeutic anticoagulation requirements in patients with COVID-19. [ FROM AUTHOR] Copyright of Journal of Clinical & Diagnostic Research is the property of JCDR Research & Publications Private Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

COVID-19: A Comprehensive Review of Learning Models.

Coronavirus disease is communicable and inhibits the infected person's immune system. It belongs to the Coronaviridae family and has affected 213 nations and territories so far. Many kinds of studies are being carried out to filter advice and provide oversight to monitor this outbreak. A comparative and brief review was carried out in this paper on research concerning the early identification of symptoms, estimation of the end of the pandemic, and examination of user-generated conversations. Chest X-ray images, abdominal computed tomography scan, tweets shared on social media are several of the datasets used by researchers. Using machine learning and deep learning methods such as K-means clustering, Random Forest, Convolutional Neural Network, Long Short-Term Memory, Auto-Encoder, and Regression approaches, the above-mentioned datasets are processed. The studies on COVID-19 with machine learning and deep learning models with their results and limitations are outlined in this article. The challenges with open future research directions are discussed at the end.

Anti SARS-CoV-2 Antibody Kinetics up to 6 months of follow-up: Result from a Nation-wide Population-based, Age Stratified Sero-Epidemiological Prospective Cohort Study in India (preprint)

Repeated serological testing tells about the change in the overall infection in a community. This study aimed to evaluate changes in antibody prevalence and kinetics in a closed cohort over six months in different sub-populations in India. The study included 10,000 participants from rural and urban areas in five states and measured SARS-CoV-2 antibodies in serum in three follow-up rounds. The overall seroprevalence increased from 73.9% in round one to 90.7% in round two and 92.9% in round three. Among seropositive rural participants in round one, 98.2% remained positive in round two, and this percentage remained stable in urban and tribal areas in round three. The results showed high antibody prevalence that increased over time and was not different based on area, age group, or sex. Vaccinated individuals had higher antibody prevalence, and nearly all participants had antibody positivity for up to six months.

Neuroimaging Spectrum in COVID-19 Infection: A Single-Center Experience.

Background and Purpose The ongoing coronavirus disease 2019 (COVID-19) pandemic is a multisystemic disease and involvement of the nervous system is well established. The neurological and neuroimaging features of the disease have been extensively evaluated. Our study aimed to elucidate the neuroradiological findings in COVID-19 infected patients admitted to our institute during the first and second waves of the pandemic in India. Methods This was a single-center retrospective study of all COVID-19 positive patients who underwent neuroimaging between March 2020 and May 2021. The presenting neurological complaints, the imaging findings in computed tomography (CT) imaging, and/or magnetic resonance imaging (MRI) were recorded. They recorded the findings in the subheadings of ischemic stroke, hemorrhagic stroke, parainfectious demyelination, acute encephalitis syndrome, and changes of global hypoxic changes. Patients with age-related, chronic, and incidental findings were excluded. Results The study comprised of 180 COVID-19 positive patients who underwent neuroimaging. CT scan was performed for 169 patients, MRI for 28, and a combination of both CT and MRI was performed for 17 patients. Seventy percent of patients were males, and median age was 61.5 years (interquartile range: 48.25-70.75). Out of the 180 patients, 66 patients had nonspecific findings that could not be attributed to COVID-19 infection. In the remaining 114 patients, 77 (42.7%) had ischemic findings, while 22 (12.2%) had hemorrhagic stroke. Hypoxic ischemic changes were noted in five patients. The rest of the patients had a spectrum of changes including, cerebellitis (3), tumefactive demyelination (1), COVID-19-associated encephalitis (1), hemorrhagic acute demyelinating encephalomyelitis (1), transverse myelitis (1), cytotoxic lesions of corpus callosum (1), Guillain-Barre syndrome (1), and COVID-19-associated microhemorrhages (1). Conclusion Neurological manifestations of COVID-19 infection are not uncommon, and our understanding of this topic is expanding. A complex interplay of neurotropism and direct central nervous system invasion, immune activation and cytokine storm, vasculitis, and parainfectious processes are implicated in the pathophysiology. While the most common imaging finding was ischemic stroke, followed by hemorrhagic stroke, a diverse range of parainfectious findings was also noted in our study.

Ramification of COVID-19 pandemic : Occurrence and impact of fungal infections in a tertiary care hospital (preprint)

Coronavirus disease 2019 (COVID-19) pandemic has been prevailing for more than a year associated with increased number of opportunistic invasive fungal infections in patients who have been critically ill or immunocompromised. In this retrospective study, details of various clinical specimens received from suspected patients of fungal infections were processed according to standard protocol were studied. The fungal infections were present in 64% (51/79) COVID-19 positive patients and 43% (163/381) COVID-19 negative patients) during the year 2021 during the second wave of COVID-19. Among COVID-19 infected patients, the fungal infection mostly observed was Candidiasis (63%) followed by Aspergillosis (15% ) and Mucormycosis (6%). The maximum samples positive in COVID-19 patients were urine samples followed by Serum (for Aspergillus Galactomannan). Among the urine and respiratory samples (BAL, Tracheal aspirate, Sputum) in COVID-19 positive patients, maximum positivity of Candida species was seen. Mucormycosis in COVID-19 positive patients was isolated in Nasal samples followed by tissue sample with Rhizopus arrhizus and Rhizopus homothallicus. There has been an increase in fungal co-infections during the COVID-19 pandemic which is a matter of great concern. Early diagnosis is essential for effective management of these patients.

Immunomodulator vitamin C: an adjuvant therapy in second wave of coronavirus disease 2019

Since its sudden outbreak in December 2019 in Wuhan, A pandemic of SARS-CoV-2 has been announced. Vitamin C is a water-soluble vitamin with anti-oxidant and immunity-boosting properties. Vitamin C acts as a nutritional supplement profoundly impacting the immune response to the second or third wave of the coronavirus disease (COVID-19). Vitamin C efficacy as an adjuvant treatment for inflammation and symptoms associated with COVID-19 infection should be investigated further. This report sheds light on the available information on the current clinical trials and pharmacotherapy related to COVID-19. Information available on Pubmed, EMBASE, Scopus, Web of Science databases and EU clinical trials regarding the use of therapeutic agents in patients with COVID-19 was used to perform analysis. Data was taken from 18 clinical trials available in the U.S. National Library of Medicine. All trials that are active, completed, or in the process of recruiting are included in data. Because of majority of clinical trials are still ongoing, specific results and high-quality clinical evidence are lacking. Before being standardised for use, the protocol must undergo large randomised clinical studies using a variety of existing medications and potential therapies. The pivotal role played by vitamins C in maintaining our immune system, is quite apparent. This review is an attempt to summarize the available information regarding the use of vitamin C as an adjuvant therapy in Covid -19 patients.

The Role of Edge Computing in Pandemic and Epidemic Situations with Its Solutions

Managing sensory data captured in leveraging is a challenge, especially during a pandemic when trying to capture the psychological, emotional, and physiology standards. The advanced technology of edge computing and IIoMT together help to reach promising outcome results from the home environment using psychological feelings and somatic health equivalent data. The basic application of Deep Learning leads to the asset-constraint of edge computing, which provides a way to move the data that is collected from IIoMT devices to various locations. All kinds of data related to health can exist in a particular place of user edge while assuring the security, privacy, and low latency of the inference system. In this article, an Internet of Medical system is developed that uses Deep Learning to detect risky types of health-related symptoms and generates reports and alerts for pandemic and epidemic situations, which helps in decision-making support. In these pandemic and epidemic situations, a lot of applications have been identified and implemented with their descriptions for the upcoming support for the real-time trials. We have developed smart applications in edge computing manuals. The overall output clearly allows us to view the fixed smart systems during the pandemic with the Smart Health Management system (SHMs). © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.

Acute limb ischaemia: not an uncommon complication of COVID-19 infection

A new variant of coronavirus (2019-nCoV) causing acute respiratory distress in humans was identified for the first time in 2019, in Wuhan, China. One of the many complications of infection with this coronavirus is hypercoagulopathy, resulting in acute thrombosis;often leading to acute limb ischaemia. Herein, we report 20 cases of COVID-19 with peripheral arterial thrombosis involving either upper or lower limbs. Some patients underwent vascular procedures and most had to undergo amputation at some level. All the cases (n=20) were referred to us during the 8-month period June 2020 to March 2021. The most common age group was between 51 and 60 years, of whom 80% were males;all the patients had diabetes. The right lower limb was most affected (50%);15 patients underwent embolectomy. Twenty-five per cent of patients presented with wet gangrene. One patient with upper limb thrombosis recovered after embolectomy and did not require any amputation. Eighty-five per cent of patients underwent some form of amputation and the mortality rate was 10%. Arterial thrombosis is one complication patients may develop during COVID-19 illness, which may affect the outcome. Patients with comorbid conditions like diabetes are at higher risk of developing arterial thrombosis during COVID-19 infection. Susceptibility to coagulopathy may continue even after patient discharge and it is important that both patients and treating physicians are aware of this limb-threatening complication and seek early medical attention.

In silico study on spice-derived antiviral phytochemicals against SARS-CoV-2 TMPRSS2 target.

Corona Virus Disease (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a pandemic that has claimed so far over half a million human life across the globe. Researchers all over the world are exploring various molecules including phytochemicals to get a potential anti-COVID-19 drug. Certain phytochemicals present in some spices are claimed to possess antiviral, anti-bacterial, and anti-fungal properties. Hence, an in-silico study was done by selecting eighteen well reported antiviral phytochemicals from some spices commonly used in Indian kitchen viz. Curcuma longa (Turmeric), Nigella sativa (Black cumin), Piper nigrum (Black pepper), Trachyspermum ammi (Carom) and Zingiber officinale (Ginger) to find out whether they can prevent SARS-CoV-2 infection. Firstly, we predicted the structure of TMPRSS2 (transmembrane protease serine 2), a host protein that truncates spike protein of SARS-CoV-2 thereby facilitating its endocytosis, and then docked against its catalytic domain the selected phytochemicals and camostat (a well-known synthetic inhibitor of TMPRSS2). Thereafter, stability of seven best docked phytochemicals and camostat were scrutinized by Molecular Dynamic Simulation (MDS). MDS analysis indicated bisdemethoxycurcumin (BDMC), carvacrol and thymol as better inhibitors than the camostat due to their stable binding with TMPRSS2 in its oxyanion hole and inducing subtle modification in the spatial arrangement of the catalytic triad residues. Among these three phytochemicals, carvacrol appeared to be the best inhibitor, followed by BDMC, whereas thymol was least effective.Communicated by Ramaswamy H. Sarma.

The Impact of COVID-19 Pandemic on Cancer Care in a Tertiary Care Facility.

Background Coronavirus disease 2019 (COVID-19) pandemic had an overwhelming impact on health care worldwide. Cancer patients represent a subgroup that is vulnerable and is under high risk. It is, therefore, necessary to analyze factors that predict outcomes in these patients so that they can be triaged accordingly to mitigate the effects of COVID-19 on cancer management. To date, the impact of COVID-19 on cancer patients remain largely unknown. Methods Data of 291 cancer patients undergoing active treatment from March 23 to August 15, 2020 were retrospectively reviewed; the incidence, demographic and clinical characteristics, treatment, and outcomes of cancer patients infected by COVID-19 were included in the analysis. Discussion During the index period (March 23-August 15, 2020), 4,494 confirmed cases of COVID-19 were admitted at our institute. In the department of medical oncology out of 578 patients presented to outpatient department, 291 patients were admitted for active treatment. Considering the cancer patients, infection rate was 7.9% (23/291) and mortality 13% (3/23). Median age was 40 years and the majority of patients were male (60%). The most common cancer type was acute lymphoblastic leukemia presented at various stages of treatment. Twenty patients (86.9%) were discharged after full clinical recovery and negative real-time polymerase chain reaction on a nasopharyngeal swab. Anticancer treatment was modified according to the type of cancer under intensive surveillance. Conclusion Although mortality rate in COVID-19 cancer patients is elevated, our results support the feasibility and safety of continuing anticancer treatment during pandemic by endorsing consistent preventive measures, but however should be modified based on the type and prognosis of cancer.

Finding potent inhibitors for COVID-19 main protease (Mpro): an in silico approach using SARS-CoV-3CL protease inhibitors for combating CORONA.

SARS-CoV-2 is liable for the worldwide coronavirus disease (COVID-19) exigency. This pandemic created the need for all viable treatment strategies available in the market. In this scenario, computer-aided drug design techniques can be efficiently applied for the quick identification of promising drug repurposing candidates. In the current study, we applied the molecular docking approach in conjugation with molecular dynamics (MD) simulations to find out potential inhibitors against Mpro of SARS-CoV-2 from previously reported SARS-3CL protease inhibitors. Our results showed that N-substituted isatin derivatives and pyrazolone compounds could be used as a potent inhibitor and may possess an anti-viral activity against SARS-CoV-2. However, further experimental investigation and validation of the selected hits are required to find out their suitability for clinical trials. Communicated by Ramaswamy H. Sarma.

A Comprehensive Review of mRNA Vaccines.

mRNA vaccines have been demonstrated as a powerful alternative to traditional conventional vaccines because of their high potency, safety and efficacy, capacity for rapid clinical development, and potential for rapid, low-cost manufacturing. These vaccines have progressed from being a mere curiosity to emerging as COVID-19 pandemic vaccine front-runners. The advancements in the field of nanotechnology for developing delivery vehicles for mRNA vaccines are highly significant. In this review we have summarized each and every aspect of the mRNA vaccine. The article describes the mRNA structure, its pharmacological function of immunity induction, lipid nanoparticles (LNPs), and the upstream, downstream, and formulation process of mRNA vaccine manufacturing. Additionally, mRNA vaccines in clinical trials are also described. A deep dive into the future perspectives of mRNA vaccines, such as its freeze-drying, delivery systems, and LNPs targeting antigen-presenting cells and dendritic cells, are also summarized.

Technology Entrepreneurship in Developing Countries: Role of Telepresence Robots in Healthcare

Developing countries represent about three-quarters of the world's population and have become the main driver for the global population and economic growth. Technology entrepreneurship plays an important role in sustainable development of vulnerable social groups and element. These efforts can channel technological benefits to underdeveloped regions. We discuss technology entrepreneurship in developing countries, with a focus on mobile health (mHealth) and telepresence robots. Specifically, we discuss how mHealth can help aged and disadvantaged developing country populations cope with normal life difficulties and challenges—but also in the extreme case and threat of a pandemic. Using past practices and lessons in telepresence robots, we propose FLEXTRA, a flexible robot mechanism to support instant video calls, smart medicine dispensation, and remote control. We also illustrate the applications of FLEXTRA in healthcare, e.g., fighting against COVID-19.

Overcoming the post-processing barriers for 3D-printed medical models

Purpose>The purpose of this study is to identify, analyse and model the post-processing barriers of 3D-printed medical models (3DPMM) printed by fused deposition modelling to overcome these barriers for improved operational efficiency in the Indian context.Design/methodology/approach>The methodology used interpretive structural modelling (ISM), cross-impact matrix multiplication applied to classification (MICMAC) analysis and decision-making trial and evaluation laboratory (DEMATEL) to understand the hierarchical and contextual relations among the barriers of the post-processing.Findings>A total of 11 post-processing barriers were identified in this study using ISM, literature review and experts' input. The MICMAC analysis identified support material removal, surface finishing, cleaning, inspection and issues with quality consistency as significant driving barriers for post-processing. MICMAC also identified linkage barriers as well as dependent barriers. The ISM digraph model was developed using a final reachability matrix, which would help practitioners specifically tackle post-processing barriers. Further, the DEMATEL method allows practitioners to emphasize the causal effects of post-processing barriers and guides them in overcoming these barriers.Research limitations/implications>There may have been a few post-processing barriers that were overlooked by the Indian experts, which might have been important for other country's perspective.Practical implications>The presented ISM model and DEMATEL provide directions for operation managers in planning operational strategies for overcoming post-processing issues in the medical 3D-printing industry. Also, managers may formulate operational strategies based on the driving and dependence power of post-processing barriers as well as the causal effects relationships of the barriers.Originality/value>This study contributes to identifying, analyzing and modelling the post-processing barriers of 3DPMM through a combined ISM and DEMATEL methodology, which has not yet been reviewed. This study also contributes to decision makers developing suitable strategies to overcome the post-processing barriers for improved operational efficiency.

Online anatomy teaching during the COVID-19 pandemic: assessing the perceptions of undergraduate veterinary medical students.

Objective: To explore veterinary students' perceptions of online anatomy teaching during the COVID-19 pandemic. Materials and Methods: A cross-sectional study was conducted at the School of Veterinary Medicine, where we collected data from year 1 and 2 undergraduate students. A Google Form link to the questionnaire and an introductory message were sent via email to all 68 students who had participated in an online anatomy class between March 2020 and May 2021. Results: The response rate was 82.2% (56/68). Most students were female (71.43%) and between the ages of 18 and 22 years old (83.93%). Overall, 58.1% of the students found it difficult to learn online anatomy, and most (82%) agreed that it was difficult to learn practical topics online. Nevertheless, 58.9% of the responding students recommended the continued use of online strategies in teaching this subject. Students reported that they could communicate with the lecturer and receive feedback. Perceived benefits of online learning included the convenience of attending class at home and having more available time, as well as the availability of prerecorded videos of course topics. Conclusions: During the pandemic, students got the opportunity to attend online classes from home. Students thought that online practical anatomy was less useful, and this is an area where new ideas can be suggested to help students see how anatomical structures work.

Determination of salivary cortisol and salivary pH level in gaming teenagers - A cross-sectional study.

Introduction: Internet gaming disorder and cybervictimization has a disproportionate increase during the COVID 19 pandemic. Teenagers and adolescents have high risk for addiction to online gaming. Online gaming increases the stress level of the users affecting the general and the oral health. The study aims to determine the salivary cortisol and salivary pH among the gaming teenagers. Materials and methods: The cross-sectional study recruited 45 gaming teenagers with the mean age of 15.5 years. The participants were stratified according to the type of online gaming played as mind, aggressive and betting gaming. Their salivary pH and salivary cortisol were assessed. The collected data was analyzed using SPSS version 23. Results: The mean salivary pH was found to be less among females playing aggressive games (7.11 ± 0.30) and males playing mind games (7.24 ± 0.16). Salivary cortisol level was found to be statistically high in males (6.66 ± 1.33) and females (7.82 ± 0.66) playing aggressive games. The sub-group analysis of salivary pH and cortisol for gender showed a significant difference in the mean salivary cortisol level (p < 0.05) with no difference in the salivary pH (p > 0.05). Based on the number of hours spent in online gaming, there was a significant increase in the mean salivary cortisol level among the participants playing >3 h (p < 0.05). Conclusion: Salivary cortisol is high among individuals playing aggressive games compared to mind and betting games. Also, salivary cortisol is high in females compared to males with no change in salivary pH.

Mucormycosis in the COVID-19 Environment: A Multifaceted Complication.

The second wave of coronavirus disease 2019 (COVID-19) caused severe infections with high mortality. An increase in the cases of COVID-19-associated mucormycosis (CAM) was reported predominantly in India. Commonly present in immunocompromised individuals, mucormycosis is often a life-threatening condition. Confounding factors and molecular mechanisms associated with CAM are still not well understood, and there is a need for careful research in this direction. In this review, a brief account of the diagnosis, management, and advancement in drug discovery for mucormycosis has been provided. Here, we summarize major factors that dictate the occurrence of mucormycosis in COVID-19 patients through the analysis of published literature and case reports. Major predisposing factors to mucormycosis appear to be uncontrolled diabetes, steroid therapy, and certain cancers. At the molecular level, increased levels of iron in COVID-19 might contribute to mucormycosis. We have also discussed the potential role and regulation of iron metabolism in COVID-19 patients in establishing fungal growth. Other factors including diabetes prevalence and fungal spore burden in India as contributing factors have also been discussed.