Procalcitonin as a Predictive Marker in Covid- 19: A Systematic Review and Meta-analysis

Coronavirus disease 2019 has emerged as a global pandemic causing millions of critical cases and deaths. Early identification of at-risk patients is crucial for planning triage and treatment strategies. We performed this systematic review and meta-analysis to determine the pooled prognostic significance of procalcitonin in predicting mortality and severity in patients with COVID-19 using a robust methodology and clear clinical implications.We used Preferred Reporting Items for Systematic Reviews and MetaAnalyses and Cochrane Handbook for Systematic Reviews of Interventions guidelines. We included thirty-two prospective and retrospective cohort studies involving 13,154 patients. The diagnostic odds ratio of procalcitonin for predicting mortality were estimated to be 11 (95% CI: 7 to 17) with sensitivity, specificity, and summary area under the curve of 0.83 (95% CI: 0.70 to 0.91), 0.69 (95% CI: 0.58 to 0.79), and 0.83 (95% CI: 0.79 to 0.86) respectively. While for identifying severe cases of COVID-19, the odds ratio was 8.0 (95% CI 5.0 to 12.0) with sensitivity, specificity, and summary area under the curve of0.73 (95% CI 0.67 to 0.78), 0.74 (0.66 to 0.81), and 0.78 (95% CI 0.74 to 0.82) respectively.Procalcitonin has good discriminatory power for predicting mortality and disease severity in COVID-19 patients. Therefore, procalcitonin measurement may help identify potentially severe cases and thus decrease mortality by offering early aggressive treatment.

Lemierre's Syndrome in COVID Pandemic: Is there an Association?

Background: Lemierre's syndrome is an uncommon life-threatening condition characterized by septic thrombophlebitis of the internal jugular vein (IJV), anaerobic sepsis, and metastatic infections. Case description: A 57-year-old diabetic male presented to the emergency department with progressively increasing left-sided neck swelling. A contrast-enhanced computed tomography of the neck revealed an air-containing abscess showed a long-segment thrombus in the left internal jugular vein with septic embolization to the right upper lung. He was also positive for SARS-CoV-2 infection. He underwent emergency drainage of the abscess along with culture appropriate antibiotics. Two days postprocedure, he developed atrial fibrillation and received anticoagulation treatment for 3 months. Discussion(s): This case report adds to the growing body of literature of co-occurrence of Lemierre's syndrome in SARS-CoV-2 infection and discusses the possible associations between the two. Besides, it also highlights Klebsiella pneumoniae as an uncommon pathogen causing Lemierre's syndrome.Copyright © The Author(s). 2022 Open Access.

Detection and monitoring of the asymptotic COVID-19 patients using IoT devices and sensors

Purpose>Many investigations are going on in monitoring, contact tracing, predicting and diagnosing the COVID-19 disease and many virologists are urgently seeking to create a vaccine as early as possible. Even though there is no specific treatment for the pandemic disease, the world is now struggling to control the spread by implementing the lockdown worldwide and giving awareness to the people to wear masks and use sanitizers. The new technologies, including the Internet of things (IoT), are gaining global attention towards the increasing technical support in health-care systems, particularly in predicting, detecting, preventing and monitoring of most of the infectious diseases. Similarly, it also helps in fighting against COVID-19 by monitoring, contract tracing and detecting the COVID-19 pandemic by connection with the IoT-based smart solutions. IoT is the interconnected Web of smart devices, sensors, actuators and data, which are collected in the raw form and transmitted through the internet. The purpose of this paper is to propose the concept to detect and monitor the asymptotic patients using IoT-based sensors.Design/methodology/approach>In recent days, the surge of the COVID-19 contagion has infected all over the world and it has ruined our day-to-day life. The extraordinary eruption of this pandemic virus placed the World Health Organization (WHO) in a hazardous position. The impact of this contagious virus and scarcity among the people has forced the world to get into complete lockdown, as the number of laboratory-confirmed cases is increasing in millions all over the world as per the records of the government.Findings>COVID-19 patients are either symptomatic or asymptotic. Symptomatic patients have symptoms such as fever, cough and difficulty in breathing. But patients are also asymptotic, which is very difficult to detect and monitor by isolating them.Originality/value>Asymptotic patients are very hazardous because without knowing that they are infected, they might spread the infection to others, also asymptotic patients might be having very serious lung damage. So, earlier prediction and monitoring of asymptotic patients are mandatory to save their life and prevent them from spreading.

COVID and Mental Health: The Challenge and aftermath Abstract

Department of psychiatry, Armed Forces Medical College (AFMC), Pune was involved since beginning in addressing the issues of mental health due to the COVID-19 pandemic and conducting research. The department collaborated with various agencies including government of India (GOI) in their outreach activities. Col Jyoti Prakash, Professor Psychiatry, AFMC, Pune had an honour of running a Defence Research Development Organisation (DRDO) made COVID hospital in Bihar. Office of Principal Scientific Advisor to GOI, had selected our department to collaborate with C-DAC (Centre for development of advanced computing) &NIMHANS towards creation of 'National Digital Wellness Program' delivered over smart phones-MANAS-Mental health And Normalcy Augmentation System for YoungISTAN-Young Indians: Smart, Talented &Natural. Project MANAS is in progress. The department conducted research on mental health impact on general population, Healthcare workers, COVID patients and their families. Last but not the least, we have managed mental health issues including grief arising during the pandemic. This symposium aims to highlight myriad mental health challenges of COVID 19 and aftermath. The symposium will cover COVID-19 mental health impact, administrative role, shades of grief and positive mental health by four speakers.

Detection of Covid-19 Severity with CT Scan Images using Segmentation Techniques

The impact of COVID-19 is severe worldwide;detecting the Covid severity in a patient is a vital step. The further important actions such as isolating the patient from others and testing the people in frequent contact with the patient can only be done after the Covid-19 test results. Currently, different methods are used for detecting the Corona virus in a patient, they are Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test, Rapid Diagnostic Test (RDT), and Computed Tomography (CT) scan for lungs. However, a CT scan is the most accurate way to detect covid compared to other tests. The CT scan can produce images of the lungs within 15 to 20 minutes. Whereas traditional methods such as RT-PCR will take at least six to eight hours to deliver results. This paper aims to determine the severity level of Covid from the Computed Tomography (CT) scan image of the lungs. © 2022 IEEE.

PROSTATE ABSCESS: CLINICAL FEATURES, MANAGEMENT, AND OUTCOMES OF A MASKED INFECTION IN COVID 19 PERIOD: A CASE SERIES

INTRODUCTION AND OBJECTIVE: Prostate abscess (PA) is uncommon and the diagnosis is often delayed or missed. Traditionally, PA has resulted from acute prostatitis or ascending genitourinary (GU) infection due to gram-negative bacilli but S. aureus is an emerging cause. The objective is to study the clinical features, management and outcomes of PA in COVID 19 period. METHODS: A prospective review of all adult patients admitted with a diagnosis of PA between April 2020 and July 2021(in COVID period) were conducted. Inclusion criteria included age ≥18 years, a GU infection syndrome, and imaging consistent with PA. RESULTS: Fifteen patients with PA were identified. The median age was 54 years. Four patients (22.7%) were immunosuppressed and 11 (50%) had diabetes. Fever (66.6%), dysuria (60%), and urinary retention (20%) were the most common presenting symptoms. Pelvic CT revealed PAs in all patients with 8/15 (53.3%) were >2 cm in greatest diameter. Urine cultures were positive in 13/15 (86.6%) patients with 4/13 (30.7%) growing S. aureus (MRSA). Fourteen patients (93.3%) were managed with antibiotics alone whereas 1 (6.6%) underwent abscess drainage. The median duration of antibiotic therapy was 32 days. CONCLUSIONS: PA is relatively uncommon and may be difficult to distinguish clinically from conditions like acute prostatitis. Optimal management usually requires both antibiotics and drainage. With the advancement in the field of radiology, newer antibiotics and early diagnosis, effective conservative management of PA has become possible. Noticing the trend of frequent occurrence of S. aureus as a cause, coverage for MRSA should be a component of empiric treatment for PA.

SOT Consensus Statement for the Kidney Transplant Recipient and Living Donor with a Previous Diagnosis of COVID-19

The National Organ and Tissue Transplant Organization (NOTTO) has previously published transplant-specific guidelines with reference to COVID-19.([1]) The mortality is higher in dialysis patients with COVID-19 (12%-30%) than posttransplant COVID-19 patients (11.3%) and both are higher than the general population (<2%) in India.([2-5]) With the resumption of the kidney transplant program in various parts of India, new issues are expected to occur. There is uncertainty, regarding the safety of performing kidney,([ 6-8]) liver,([9-12]) and lunge([13]) transplantation in a recipient recently recovered from COVID-19. At present, we have limited evidence-based information about safety and feasibility of kidney transplantation from living donors, who have recovered from COVID-19.([4]) Recently, Indian Multi-center cohort studies have reported successful kidney transplantation in recipients from living donors with a previous diagnosis of COVID-19.([15, 16])

Effectiveness of short-term belly breathing training in individuals who work-from-home during the COVID-19 lockdown in India

COVID-19 impacted many lives around the globe, leading to a nationwide lockdown in India from the 25th of March 2020. Home confinement, physical and social isolation, the spread of false news through social media, fear of contracting the disease, lack of physical activity, and work-from-home situations have affected the mental status and sleep quality of individuals during the lockdown. We intended to identify the effect of belly breathing exercise in reducing the depression, anxiety and stress levels in individuals who work-from-home during the lockdown. A hundred participants were identified through snowball sampling and were divided into two equal groups. Group A received a health education program and belly breathing techniques, whereas group B was provided with a health education program alone. DASS 21 and single item Sleep Quality Scale was assessed before recruitment and after three weeks of intervention in both groups. Signiicant reduction in depression, anxiety, and stress levels were observed in group A (p<0.001) than that of group B. Participants who underwent belly breathing also reported signiicant improvement in sleep quality after three weeks of intervention. Belly breathing has found to be an effective and simple technique to instruct and perform, which significantly reduces depression, anxiety and stress levels in individuals who work from home and are in need of medical advice for their mental health status. We suggest the use of belly breathing in improving the mental status in any black swan events such as home quarantine or strict physical isolation measures, and even during any stressful situations.

Traces Detection Of Coronavirus Patients

COVID-19 is a disease caused by a new strain of coronavirus. With the rapid increase in the spread of COVID-19, many people are getting affected by it. As the disease cannot be detected until the affected person doesn't take the COVID-19 test, the person remains unaware that he has been infected by the coronavirus. The person would travel, go to shops, do other activities as well thereby infecting the other people and a potential threat to society. Thus it becomes difficult to trace all the people who have been infected. It is necessary to report all the close contacts of the infected person in the last 14 days. With the increase in the COVID-19 cases, it is very difficult to manually monitor and track down all the contacts of a COVID-19 positive patient. This calls for an autonomous application that will provide information about the person's traces, the people with whom he came in contact with and the places he visited in the last 14 days. This application will help in collecting the data for traces of a COVID-19 positive patient.

An IoT-based system for effective COVID patient health monitoring with SVM decision making

Coronavirus disease (COVID-19) epidemic has exaggerated billions of persons, where most of them have lost their survives. Self-quarantine and continuous monitoring is the primary solution to avoid spreading and death rate. Internet of Things (IoT) development takes new chances in many applications, like smart cities etc . IoT combined with machine learning offers a hopeful solution for continuous patient monitoring with alert. In this work, IoT based covid patient health monitoring system introduced using the Arduino controller. The proposed Arduino based system consists of a pulse sensor, oximeter and temperature sensor. In addition, the machine learning algorithm of Support Vector Machines or SVM used to predict or alert about health risk conditions of a patient. SVM model trained using data set collected from world health organization for various age patients. Implementations results prove that the proposed system achieves higher classification accuracy with minimum cost expenses.

TASTING TOURISM: A NEW PHASE TOWARDS EXPERIENCING INDIAN CUISINE AFTER THE PANDEMIC

Since the evolution of mankind, the need for food and drink has been a major concern for humans. It has been reported from the ancient records that human had to cultivate and the store food for consumption but as time passed humans started to travel from one place to another in search of food and drink which further in the modern era gave rise to the tourism sector where people travel for one place to another to explore new culture and experience the local cuisine which depicts about the place and its community living around the region. Due to this, there was a tremendous increase in the percentage of tourists every year in different continents where they only travel for leisure and availing the local cuisine that included both food and the local beverage of the location. Therefore, the essence of food is also a vital part of the lifestyle for every individual and tourists who travel to the destination and try to experience the local cuisine. If you see the world, most of the tourists are eagerly mad at traveling to India, wherein every 100 meters you will get a varied cuisine influence which fascinates the international tourists towards the country's culinary inheritance. Therefore, the role of promotion and marketing of the regional cuisine of a country as it showcases the cultural identity of the nation's heritage. Henceforth, the paper explores the framework of the tasting tourism as to create a new phase of tourism after the Covid-19 in order to increase the tourism sector by introducing a new segment where the cuisine will showcase the opportunity for providing an extensive knowledge for the regional cuisine and beverages available, where they can experience during their travel to the region. But due to the pandemic situation, it has been seen that the Indian tourism sector had a drastic change as the inflow of foreign tourists decreased, and also the food business sector is facing downfall due to the rapid spread of the virus.

Notto covid-19 vaccine guidelines for transplant recipients

In December 2019, novel coronavirus (SARS-CoV-2) infection started in Wuhan and resulted in a pandemic within a few weeks' time. Organ transplant recipients being at a risk for more severe COVID-19 if they get SARS CoV-2 viral infection, COVID-19 vaccine has a significant role in these patients. The vaccine is a safer way to help build protection and would either prevent COVID-19 infection or at least diminish the severity of the disease. It would also reduce the risk of the continuing transmission and enhance herd immunity. Immuno-compromised patients should not receive live vaccines as they can cause vaccine-related disease and hence the guidelines suggest that all transplant recipients should receive age-appropriate 'inactivated vaccine' as recommended for general population. Though trials have not been undertaken on transplant recipients, efficacy and safety of COVID-19 vaccine have been scientifically documented for few vaccines among the general population.

Impact of high-flow nasal oxygen therapy in COVID-19 critically ill patients with acute hypoxemic respiratory failure: A prospective observational study

Introduction: About 20 to 30% of COVID-19 patients admitted to ICU develop severe ARDS. Tracheal intubation in such patients carries a high risk of complications and mortality.1,2 High-flow nasal oxygen therapy (HFNOT) is an attractive option as it can reduce the requirement of intubation. Objectives: This study aimed to determine the impact of HFNOT on the oxygenation level as well as HFNOT failure. The primary objective was to determine the change in PaO2/FiO2 ratio from baseline to at 1 hour, 6 hours, and 7 days of HFNOT initiation in COVID-19 critically ill patients presenting with acute hypoxemic respiratory failure (AHRF). The secondary objective was to determine the HFNOT failure rate [i.e., the requirement of tracheal intubation or noninvasive ventilation (NIV)]. Materials and methods: After approval from the institutional ethics committee and written informed consent, a prospective observational study was performed over a period of 3 months at the COVID intensive care unit of a government institute-hospital in east India. Adult patients (aged >18 years) with confirmed COVID-positive status (SARS-CoV-2 detected in nasopharyngeal swab by real-time reverse transcription-polymerase chain reaction assay), having AHRF (PaO2/ FiO2 ratio <300) who are not able to maintain saturation above 90% on standard oxygen therapy were included in this study. On the HFNOT device, the initial flow rate and FiO2 were set at 60 L/minute and 100%, respectively. On case record form (CRF), demographic characteristics, vital signs, laboratory tests, and arterial blood gas tests were recorded. ROX index (ratio of SpO2/FiO2 to respiratory rate) was calculated at 2 hours of HFNOT. Continuous variables were reported as mean or median values when appropriate. The intergroup differences were analyzed using Student's t-test or Mann-Whitney U test. The intragroup differences between variables at different time points were analyzed using paired Student's t-test. p ≤ 0.05 was considered statistically significant. Statistical analysis will be performed using SPSS software. Results: A total of 265 patients were screened out of which 256 patients had AHRF. HFNOT was used as first line therapy in 122 patients in which only 108 found to be eligible for study inclusion. Mean age of the patients was 59.7 ± 15.1 years;male patients accounted for majority (79.6%) of HFNOT cohort. Key comorbidities were diabetes mellitus (48.1%) and hypertension (25.9%). Mean PaO2/FiO2 ratio at baseline was 96.8 ± 30.2) which significantly increased at 1 hour (114.8 ± 32.1, p < 0.001) at 6-hours (130.1± 36.5;p < 0.001) and at 7 days (178.7 ± 41.3;p < 0.001) Mean duration of HFNOT was 10.4 ± 4.9 days. Median (with range) APACHE II and SOFA scores were 22 (12-35) and 8 (4-12) respectively. HFNOT failure rate was 27.8%. NIV was used as ceiling respiratory support in 22.2% of HFNOT cohort. Mean ROX index was significantly higher for the patients who successfully continued on HFNOT compared to those who failed (3.4 ± 0.3 vs 2.8+0.3;p < 0.001). Mean admission glucose level, D dimer and IL-6 values were significantly higher in HFNOT failure group compared to HFNOT success group. Overall, 28-day mortality rate in this cohort was 25.9%. About 50% patients receiving HFNOT developed complications in which epistaxis (18.5%) and air hunger (16.7%) were the most common complications. Discussions: This study prospectively highlights the significant impact of HFNOT on oxygenation status over time points studied (i.e., at 1 hour, 6 hours, and 7 days). The baseline mean PaO2/FiO2 ratio was <100 (severe ARDS) when HFNOT was initiated. With such a low P/F ratio, HFNOT remarkably outperformed with a success rate of 72.2%. Significant improvement in the P/F ratio may be explained by adequate flow delivery and FiO2 meeting the patients' demand. The main strengths of the study were its prospective nature and large cohort. The main limitation is that being a single-center study, the results from the study need to be cautiously interpreted before extrapolating to patients in differ nt geographical locations. About 50% of patients developed mild complications, such as, epistaxis, air hunger, and abdominal distension;however, one patient also developed spontaneous tension pneumothorax which required immediate intercostal drain tube placement following which, the patient dramatically improved and survived hospital discharge. We observed admission hyperglycemia, high D-dimer value, and IL-6 levels in patients who failed HFNOT. These findings are consistent with other studies.3-5 Conclusion: HFNOT significantly improves oxygenation level in COVID-19 patients developing acute hypoxemic respiratory failure. The HFNOT failure rate was 27.8%.

NOTTO COVID-19 vaccine guidelines for transplant recipients

In December 2019 Novel corona virus (SARS-CoV-2) infection started in Wuhan and resulted in a pandemic within few weeks' time. Organ transplant recipients being at a risk for more severe COVID-19 if they get SARS CoV-2 viral infection, COVID 19 Vaccine has a significant role in these patients. The vaccine is a safer way to help build protection and would either prevent COVID -19 infection or atleast diminish the severity of the disease. It would also reduce the risk of the continuing transmission and enhance herd immunity. Immuno compromised patients should not receive live vaccines as they can cause vaccine related disease and hence the guidelines suggest that all transplant recipients should receive age appropriate 'inactivated vaccine' as recommended for general population. Though trials have not been undertaken on transplant recipients, efficacy and safety of COVID-19 vaccine have been scientifically documented for few vaccines among the general population. © 2021 Indian Journal of Transplantation ;Published by Wolters Kluwer - Medknow.

The Doctor Will "See" You Now - Unmet Expectations of Telemedicine in Plastic Surgery.

ABSTRACT: Social distancing protocols during the COVID-19 pandemic have resulted in a rapid expansion of telemedicine. It has allowed patients to save time and money on clinic visits, and physicians to communicate with patients who live remotely. Telemedicine has also been valuable in plastic surgery during initial consultations, transfers, and follow up visits. However, given the often-sensitive nature of plastic surgery, the professionalism and expectations of telemedicine have to be reviewed. A comprehensive literature search of the MEDLINE, PubMed, Google Scholar, EMBASE, and Cochrane Central Register of Controlled Trials was conducted for studies published through October 2020 with multiple search terms related to telemedicine and its use in plastic surgery. Data on the effectiveness, challenges, and professionalism of telemedicine were collected. Our review suggests that telemedicine can be an effective mode of communication in many realms of plastic surgery, including cleft care and craniofacial deformities. However, many plastic surgeons are unfamiliar with the existing platforms, and there are no clear guidelines on the most optimal platforms. Physicians have to recognize that patients might have low digital health literacy or may not even possess digital device for telemedicine. There also needs to be an overall improvement in patient education. Given that telemedicine use will continue to increase after the COVID-19 pandemic, regulations on Health Insurance Portability and Accountability Act-compliant platforms and specific guidelines on telemedicine visits, such as undressing, chaperones, privacy matters, need to be established while maintaining a professional relationship between the patient and the physician.

Impact on anxiety of COVID-19 and lockdown

Background: India was placed under "lockdown" since March 25, 2020, to curb the spread of COVID-19 pandemic. Faced with this unprecedented situation, many individuals reported mounting apprehensions and some sought medical relief of anxiety. This study was carried to assess the impact of anxiety on COVID-19 pandemic and lockdown on the general public (18-65 years of age) and to assess its correlates. Materials and Methods: An online survey was conducted during lockdown. Using a survey form, a link was circulated using social media and E-mail. The survey included bilingual informed consent, sociodemographic data, characteristics specific to lockdown, and a self-rating anxiety scale. The survey link was circulated from April 1, 2020, to April 30, 2020. Results: A total of 987 responses were collected and analyzed. The study revealed minimal-to-moderate anxiety in 28.5%, marked-to-severe anxiety in 3.3%, and extreme anxiety in 0.1% of the participants. Anxiety scores were significantly correlated with younger age, students, currently employed, male gender, and lower income. Conclusions: The current survey indicates that 31.9% are experiencing significant anxiety due to lockdown and COVID-19 pandemic. Younger age, students, currently employed, male gender, and lower income are associated with higher anxiety. These findings suggest that there is a need of expanding the mental health services in society during and immediately after the pandemic situation.