Outcomes of COVID-19 in children with cancer - Report from the Indian Pediatric Oncology Group (InPOG) COVID-19 registry in India

Introduction: The clinical outcomes of COVID-19 infection in children with cancer have been variable worldwide. Therefore, we aimed to collect data from all regions in India through a national collaborative study and identify factors that cause mortality directly related to COVID-19 infection. Method(s): Data was collected prospectively on children across India on cancer therapy and diagnosed with COVID-19 infections from 47 centers from April 2020 to October 2021. Information was recorded on the demographics, the number of children that required intervention, and the outcome of the infection. In addition, we analyzed the impact of the delta variant in 2021. Result(s): A total of 659 children were studied, of whom 64% were male and 36% were female. The data from the eastern region was sparse, and this was a collection bias. COVID-19 infection was predominantly seen in children less than five years. The delta variant had a higher impact in the southern region, and this was statistically significant. Of the 659 children, 30 children died (4.5%), however only 7 of the deaths were directly attributed to COVID-19 infection (1%). Conclusion(s): The study reports the largest nationally representative cohort of children with cancer and COVID-19 to date in India. We identified demographic and clinical factors associated with increased all-cause mortality in patients with cancer. Complete characterization of the cohort has provided further insights into the effects of COVID-19 on cancer outcomes. The low mortality allows us to recommend that specific cancer treatments be continued without delays in therapy.Copyright © 2022

Pulmonary function abnormality in patients recovered from Covid 19 pneumonia, in a tertiary care hospital in India.

Background: One of the most dreaded complications of COVID pneumonia is post-COVID residual lung fibrosis and lung function impairment. Objectives: To find out the extent and type of pulmonary function abnormality using spirometry, diffusion capacity, and 6-minute walk test and to co-relate with the clinical severity at the time of infection, in patients who have recovered from COVID19 pneumonia, in a tertiary care hospital in India. Materials and Methods: This is a prospective, cross-sectional study with a total 100 patients. Patients who have recovered from COVID pneumonia after one month of onset of symptoms and before 3 months who come for follow-up and have respiratory complaints undergo pulmonary function test will be recruited in the study. Results: In our study, the most common lung function abnormality detected was restrictive pattern in 55% of the patients (N = 55) followed by mixed pattern in 9% of patients (N = 9), obstructive in 5% of patients (N = 5), and normal in 31% of patients (N = 31). In our study, total lung capacity was reduced in 62% of the patients and normal in 38% of the patients and diffusion capacity of lung was reduced in 52% of the patients recovered from 52% of the individuals. Also, a 6-minute walk test was reduced in 15% of the patients and normal in 85% of the patients. Conclusion: Pulmonary function test can serve as an important tool in both diagnosis and follow-up of post-COVID lung fibrosis and pulmonary sequalae.

Certain efficient techniques to solve the unreported cases of 2019-nCoV epidemic model

One of the furthermost intimidations that the death faced after the second World War is 2019-nCoV epidemic and most crucial large-scale health disaster of this century. We devote the current work to discuss the epidemic prediction for the epidemic model created for 2019-nCoV in Wuhan, China by certain approximate analytical methods such as differential transform method and variational iteration method. Further, we recognize unreported cases in numbers and the parameters of model are due to reported case data. For the considered system demonstrating the model of coronavirus, the series solution is conventional in the structure of the differential transform method. The obtained solutions are discussed in figures which show the performance of considered model. The results show that the used schemes are definite and trouble-free to execution for the system of nonlinear ODEs. The solutions exposed that the both schemes are in total agreement, correct and well-organized for solving systems of nonlinear differential equations.

Parenchymal lung abnormalities, clinical severity and outcomes in patients with COVID 19 pneumonia: a prospective longitudinal observational study

Background: Clinical outcome and parenchymal lung abnormalities (PLA) data from hospitalized patients with COVID 19 pneumonia are limited. Objective(s): (1) Understand and compare the patterns of PLA on high resolution computed tomographic (HRCT) at admission, 4-8 weeks post-admission in all patients and 10-12 weeks post-admission in a subgroup of patients (2) follow up their general health status on phone 6 months post admissionMethods: Prospective, observational study of consecutive adult patients hospitalized with RT-PCR confirmed COVID-19 pneumonia in a tertiary centre, India. Clinical data and HRCT image patterns and distribution of PLA at admission, 4-8 weeks in all patients and at 10-12 weeks in a subgroup of patients were analysed using a novel, composite radiological score (CRS). Surviving patients were followed up telephonically 6 months later. Finding(s): Of 179 patients, HRCT features were ground glass opacity (144, 80.4%), consolidation (23, 12.8%) and reticulation (7, 4%) at admission. 74% demonstrated resolving PLA with 14% showing complete resolution at 4-8 weeks. Fine reticulations were seen in 12% at 8 weeks and 20% in a subgroup of 44 patients who had persisting symptoms at 10-12 weeks. CRS correlated well with clinical severity and recovery (p=0.003). At 6 months, 144 responded to the phone follow up, reported no functional impairment and had returned to their pre-COVID health status. Conclusion(s): PLA resolved in 88% at 8 weeks and all the 144 patients who were followed up at 6 months reported return to pre-COVID 19 health status. This is quite reassuring amidst concerns of 'long COVID'.

Stroke in patients with COVID associated Mucormycosis: A Report of Two Cases

Mucormycosis is a rare and invasive fungal disease with potentially fatal outcome. It most commonly affects patients with compromised immunity, especiallly those with poorly controlled diabetes. The incidence of mucormycosis has increased after the COVID-19 pandemic and both COVID-19 and mucormycosis are associated with an increased incidence of stroke. We present a report of two cases of COVID associated mucormycosis who had stroke. A 50-year-old patient with uncontrolled diabetes developed swelling of left eye and face ultimately leading to complete ophthalmoplegia of left eye. Imaging studies of brain revealed infarcts. MRI/MRA brain showed left internal carotid artery thrombosis, cavernous sinus thrombosis and a brain abscess in left temporal lobe. A second patient was a 65-year-old diabetic and hypertensive male who had COVID and then developed right MCA territory infarct and right sided cavernous sinus thrombosis. Diagnostic nasal endoscopy and biopsy was suggestive of mucormycosis in both the cases. Both these cases were managed with combination of tight glycemic control, antifungal therapy, and surgery. Clinicians should be aware of the association of stroke with COVID and COVID associated mucormycosis (CAM). Copyright © 2022 International Medical Sciences Academy. All rights reserved.

Certain efficient techniques to solve the unreported cases of 2019−nCoV epidemic model

One of the furthermost intimidations that the death faced after the second World War is 2019-nCoV epidemic and most crucial large-scale health disaster of this century. We devote the current work to discuss the epidemic prediction for the epidemic model created for 2019-nCoV in Wuhan, China by certain approximate analytical methods such as differential transform method and variational iteration method. Further, we recognize unreported cases in numbers and the parameters of model are due to reported case data. For the considered system demonstrating the model of coronavirus, the series solution is conventional in the structure of the differential transform method. The obtained solutions are discussed in figures which show the performance of considered model. The results show that the used schemes are definite and trouble-free to execution for the system of nonlinear ODEs. The solutions exposed that the both schemes are in total agreement, correct and well-organized for solving systems of nonlinear differential equations. © 2022 Forum-Editrice Universitaria Udinese SRL. All rights reserved.

A Workshop on Disability Inclusive Remote Co-Design

The COVID-19 pandemic forced researchers to find new ways to continue research, as universities and laboratories experienced closure due to nationwide lockdowns in many countries worldwide, including conducting experiments, workshops, and ethnographic work online. While this had a significant impact on the majority of research work across SIGCHI, research relating to disability and ageing was most impacted due to the additional challenges of recruiting participants, finding accessible online platforms, and ensuring seamless participation while juggling platform accessibility issues, facilitation, and supporting participants' needs. These challenges were more extreme for disabled researchers. In this workshop, we aim to bring together researchers, designers, and practitioners to explore effective strategies and brainstorm actionable guidelines for supporting disability inclusive online research methods and platforms. © 2022 ACM.

Nano-magnetite supported N-heterocyclic carbene-gold complex with pendant ferrocenyl group as a multi- modal anti-breast cancer agent (preprint)

A novel nano-magnetite supported N-heterocyclic carbene-gold complex with pendant ferrocenyl group has been prepared by using a multi-step procedure. The complex displayed significantly higher anticancer activity against the MCF-7 breast cancer cell line with IC50 = 32.38 µg/mL as compared with standard drug 5-fluorouracil (IC50 = 25.29 µg/mL) in the MTT assay. The in-ovo antiangiogenic activity of the complex using chicken chorioallantoic membrane assay showed significant decrease in secondary blood vessels indicating that it is efficient angiogenesis inhibitor. The hyperthermia studies of the complex revealed a significant specific absorption rate (SAR) value of 246.974 Wg-1 with therapeutic temperature of 46.8 oC.  

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

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

The Year in Graduate Medical Education: Selected Highlights From 2021.

This special article is the first in a planned annual series for the Journal of Cardiothoracic and Vascular Anesthesia that will highlight significant literature from the world of graduate medical education (GME) that was published over the past year. The major themes selected for this inaugural review are the educational value of simulation and training workshops, the expanding role of social media and other information technologies in GME and recruitment, the state of residency and fellowship training before the COVID-19 pandemic, and the inevitable effects COVID-19 has had on graduate medical education. The authors would like to thank the editorial board for allowing us to shine a light on a small subset of the writing and research produced in this field, so that educators may understand how best to educate and train the next generation of anesthesiologists.

Radiological analysis of follow up CT of COVID Patients - Is scarring or fibrosis

Background: Covid 19 causes a spectrum of disease. Early changes may present radiologically as traction bronchiectasis, architectural lung distortion, crazy paving or thickened interlobular septa. Analogy from other fibrotic interstitial pneumonia suggest up regulation of TGF B, FGF and PDGF leading to lung fibrosis (1). Early data of post covid 19 pneumonia shows a residual restrictive pattern on pulmonary function testing (2). Also radiological persistence of GGO has been observed (3). The autopsy studies from acute COVID 19 pneumonia has demonstrated feature of Diffuse Alveolar Damage (DAD) and fibrotic organising pneumonia (4). The epidemics of SARS and MERS showed similar features, suggestive of developing lung fibrosis (5). The present study is designed to study the clinical and CT radiographic patterns at presentation and their outcome on follow up, which will enhance our current understanding of covid 19 manifestations and outcome with this prospective observational study. Methods: The CT scans (admission & 4-8 weeks follow up) were collected from Medanta the Medicity, and deidentified in the local image archive system (PACS). Three chest radiologists with > 15 years of experience, from three tertiary care centres performed independent reporting of the CT scans, to pre-specified radiologic criteria. They were blinded to the clinical severity of disease. For the reading process, the radiologists reviewed the cases online via screen sharing (Zoom). Results: A composite score of the density of lesions and the extent of lung involvement has been proposed to provide a more comprehensive picture of the radiological severity and its impact on clinical severity and outcome of disease. Final result yet to be analyzed.

Clinico-radiological correlation of COVID 19 - First wave patients

Background: COVID 19 causes a spectrum of disease. Majority affected are asymptomatic or have febrile mild upper respiratory symptoms. Pulmonary involvement leads to moderate and severe disease. The clinical symptoms range from mild cough and breathlessness to florid ARDS. Early inflammatory pulmonary phase is characterised by alveolitis and acinar shadows (consolidation and organising pneumonia). Methods: This is a prospective observational cohort study of 193 consecutive adult patients who were admitted with RT-PCR confirmed COVID-19 pneumonia to a tertiary hospital in Delhi NCR from March to December 2020, and subsequently presented for clinical follow-up. Demographic, clinical, laboratory parameters, radiological parameters and treatment details were recorded at the time of admission;HRCT Thorax was done at admission (CT1) and at 4-8 week follow up (CT2) in this group of 193 patients. A subset of patients with more severe disease had a follow up CT (CT3) which was done approximately 3 months after CT1. Treatment and Outcome: The treatment given to the patients, depending on the severity of their disease, as per national guidelines was recorded during admission and included the following - Level of oxygen support, steroid, HCQs, Ivermectin, Doxycycline, Remdesivir, Tocilizumab, plasma, LMWH. Oxygen support by the following modes - Nasal prongs, face mask, HFNC (High flow nasal canula), noninvasive ventilation (BiPAP) and ventilatory support was recorded. The outcome of patients was recorded - Those who recovered and those who did not survive. The correlation between clinical variables with clinical severity as well as with extent of lung disease was made.

A comparative study of clinical characteristics and outcomes in the first and second waves of COVID-19 pandemic in Northern India

Introduction: Coronavirus disease-19 (COVID-19)has become a global pandemic, giving rise to a serious health threat worldwide. So far, several countries have seen a two-wave pattern of reported cases. Methodology: This was a retrospective study of all hospitalized cases of SARS-CoV-2. All the patients admitted between March to December 2020 were considered to be in first wave and those admitted from April to June 2021were considered to be in second wave. All hospitalized patients had SARS-CoV-2 infection confirmed by RT-PCR. Results and Discussion: Total 4581 patients in first wave & 1565 in second wavetested positive for SARS-CoV-2 infection using RT-PCR at the hospital.In the first wave highest admissions occurred in the month of November 2020. In the second wave, the highest admissions occurred in the month of April 2021. In first wave 71% were male and 29% were female while in second wave 67% male and 33% were female. The mean age of first and second wave was 54.9±16.6 and 55.2±15.5. CT severity scores were 18.8±9.9 in wave 1 versus 21.4±10.4 in wave 2.(p=0.0001)A total of 54 (1.2%) deaths occurred in the first wave and 26 (1.7%) in the second wave. Conclusion: Lung involvement on CT scan was more extensive in wave 2 compared to wave. A large number of patients were admitted during the second wave, they were younger and fewer number of deaths was reported corresponding with results reported by previous research in several countries.

Transient Elastography of Liver and Serum Hyaluronic Acid Levels In Adult Transfusion Dependent Thalassemia Patients

Iron overload occurs as a result of multiple blood transfusions and increased iron absorption in thalassemia patients. Iron deposition in liver results in liver stiffness and fibrosis. Non invasive methods including imaging and serum biomarkers have been introduced for assessment of liver fibrosis. We aimed to study liver stiffness using transient elastography and serum hyaluronic acid levels and correlate them with serum ferritin levels in adult transfusion dependent beta thalassemia patients. MATERIAL: 70 transfusion dependent thalassemia patients of age ≥18 years, registered at Thalassemia Day Care Centre were subjected to investigations like CBC, Liver function tests, viral markers, serum ferritin, serum hyaluronic acid levels and transient elastography. Fibrosis indices like FIB-4, AAR and APRI were also calculated. 45 patients had T2*MRI reports with them;which were also included and analysed. Spearman coefficient r was used to test correlations between TE values and serum HA levels with other variables. OBSERVATION: 70 patients (41 male and 29 female) with mean age of 24.09±5.38 years and BMI 20.51 ±3.47 kg/m², were enrolled. Median values of hemoglobin, AST, ALT, TE, serum HA and serum ferritin were, 9.15 g/dl, 42 IU/L, 47.50 IU/L, 9.1 kPa, 284 ng/dl and 1841 ng/ml, respectively . TE values had significant positive correlation with serum ferritin (r=0.5, p < 0.001), ALT (r=0.59, p < 0.001), AST (r=0.58, p< 0.001), APRI (r=0.5, p<0.001) and FIB-4 (p=0.02), respectively and significant negative correlation with T2* MRI (ms) (r= -0.5, p<0.001). No significant correlation of HA was found with any variable. CONCLUSION: Transient elastography can be used as a non expensive, easily accessible and non invasive marker of liver iron overload. Further detailed studies are required to establish the role of serum Hyaluronic acid in thalassemia patients. © Journal of the Association of Physicians of India 2011.

Pandemic Precarity Life, Livelihood, and Death in the Time of the Pandemic

This paper focuses on the social experiences of migrant informal workers during the COVID-19 pandemic. It argues how institutions in the realms of the state, market, and civil society interacted and created conditions of precarity unique to the pandemic. How dominant frameworks that explain the praxis of entitlements fail to capture such infringement arising from the overlaps and intersections between the state, market, and civil society are highlighted in this paper. © 2022 Economic and Political Weekly. All rights reserved.

Coagulation and Transfusion Updates From 2021.

2021 and the COVID 19 pandemic have brought unprecedented blood shortages worldwide. These deficits have propelled national efforts to reduce blood usage, including limiting elective services and accelerating Patient Blood Management (PBM) initiatives. A host of research dedicated to blood usage and management within cardiac surgery has continued to emerge. The intent of this review is to highlight this past year's research pertaining to PBM and COVID-19-related coagulation changes.

A systematic review on SARS-CoV-2 remission: an emerging challenge for its management, treatment, immunization strategies, and post-treatment guidelines.

The COVID-19 disease caused by severe acute respiratory syndrome coronavirus -2 (SARS-CoV-2) has posed as a major health concern for people all across the globe. Along with the increasing confirmed patients being readmitted with complaints for fever, cough, cold, the effective monitoring of 'relapse' of the SARS-CoV-2 virus in the previously discharged patients have become the next area of focus. However, availability of limited data on reactivation of SARS-CoV-2 makes the disease prognosis as well as the effective control of re-infection an immense challenge. Prompted by these challenges, we assessed the possibility of re-infection in discharged patients and the risk of the transmission, proficiency of RT-PCR results and approximate period required for the quarantine, and the real challenges for the development of vaccine. In the present review, the published literature on all the possible cases of re-infection from February to July were reported, thereby selected 142 studies from a hub of overall 669 studies after full text screening. The incomplete virus clearance, poor sensitivity of the present diagnostic testing, emergence of mutant strains, insufficient mucus collection from the throat swab etc., are some of the possible causes of re-infection. The new protocols for management of COVID-19 discharged patients should be revised in the guidelines.

Comparative evaluation of cost effective extraction free molecular technique for detection of SARS-CoV-2 with reference to standard VTM based RT-qPCR method

Background and Objectives: The entire globe is undergoing an unprecedented challenge of COVID-19. Considering the need of rapid and accurate diagnostic tests for SARS-CoV-2, this study was planned to evaluate the cost effective extraction free RT-PCR technique in comparison to the standard VTM based RT-qPCR method. Materials and Methods: Paired swabs from nasopharynx and oropharynx were collected for SARS-CoV-2 testing, from 211 adult patients (>= 18 years) in VTM and plain sterile tubes (dry swabs). These samples were processed and RT-qPCR was carried out as per standard protocols. Results: 54.5% of the patients were females and 45.5% were males with sex ratio 1:1.19 (M: F). 38.86% were symptomatic, of which fever (86.59%), cough (79.23%) and breathlessness (46.34%) were the most common symptoms. The positivity by VTM based method and index method was 31.27% and 13.27% respectively. Of the 27 inconclusive results from index method, 37.04% were positive, 48.15% were negative by VTM based method. However, in 40 inconclusive results by VTM based method, 90% were negative and rest remained inconclusive by index method. The sensitivity and specificity of the index method were 39.39% and 85.71% respectively. The overall agreement between VTM based method and index method was 49.59% with estimated Kappa value of 0.19. Conclusion: VTM based method showed higher sensitivity compared to the index method. The higher positivity by VTM based method, suggests that VTM based method could plausibly be a better detection method of SARS-CoV-2. Still, the index method might add value in a resource limited setups for detection of SARS-CoV-2.