Mucormycosis in COVID-19 patients: A tertiary care experience

Introduction: Zygomycetes consisting of Mucorales order is a group of fungal infections. These species cause life threatening opportunistic fungal infections mucormycosis. This infection is highly prevalent in immunocompromised. During the 2 nd wave of Covid 19 pandemic corticosteroid treatment was used which has been linked to development of Mucormycosis. In our tertiary care teaching hospital we saw that patients suffering from Covid-19 infections developed mucormycosis. We present these cases in our study. To study the clinical, demographical,and Laboratory parameters in Covid-19 patients with Mucormycosis. Material(s) and Method(s): Retrospective Study. All biopsy proven cases of Mucormycosis (which developed after Covid-19 infection) were included. Relevant Clinical Demographics and Laboratory data was retrieved from the available case sheets. The data was tabulated in Excel sheet and further reviewed. Result(s): A total of 22 patients were diagnosed as suffering from mucormycosis majority were unvaccinated. 11 patients out of 22 (50%) started manifesting mucormycosis within one week of COVID infection. All the patients who had only single comorbidity (22.72%) suffered from mild disease and patient who had more than one comorbidity suffered from moderate (27.27%) to severe (50%) COVID infection. Conclusion(s): It is suggested that patients with Covid-19 infection are at risk for development of opportunistic fungal infections like Mucormycosis. Hence the physicians who are involved in treating such patients must be mindful of the fact that mucormycosis can develop in them. Histopathology helps in establishing a concrete diagnosis of Mucormycosis.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Technology-enhanced learning interventions on skin-ofcolour dermatology for dermatology trainees and fellows: are they effective or sustainable?

The COVID-19 pandemic diverted medical education within dermatology towards technology-enhanced learning (TEL) delivery. Concurrent societal movements also raised awareness of racial inequalities in health outcomes. This has been highlighted as a priority within dermatology research and education (Guckian J, Ingram J, Rajan N, Linos E. Dermatology is finally talking about race. Br J Dermatol 2021;185: 875-6). The British Association of Dermatology acknowledges that 'the education of undergraduate and postgraduates. . .needs to be updated to better include skin of colour' (https://www.bad. org.uk/healthcare-professionals/inclusivity-and-representation). Numerous distance courses in this domain have been piloted, but there is little published evidence regarding efficacy or sustainability. This study evaluated whether TEL methodologies can facilitate effective and sustainable ethnic dermatology education. The study explored the existing competence and confidence of a cohort of dermatology trainees towards managing dermatology conditions affecting skin of colour, specifically central centrifugal cicatricial alopecia (CCCA) and keloid scarring. The short- and long-term impact of TEL interventions upon trainees' confidence and competence of managing these conditions was investigated. A prospective cohort study was designed and included 14 dermatology registrars and regional fellows across Yorkshire. A Zoom teaching session was provided, covering keloid scarring and CCCA, supported by a 'flipped-classroom' approach via pre-reading materials. Survey methodology was used;three questionnaires were circulated: presession (survey 1), postsession (survey 2) and 6 weeks afterwards (survey 3). These featured multiple choice questions gathering data regarding participant knowledge and questioned confidence and competence. Multiple-choice questions were normed by 15 external trainees to ensure suitable difficulty. Presession, 64% participants felt that, on completion of specialty training, they would be competent in treating patients with ethnic skin. Ninety-three per cent believed that formal outcomes related to ethnic dermatology should be included in the curriculum. Postsession, 42% strongly agreed that the teaching course would change their practice. Fifty per cent felt that the teaching content was 'somewhat new'. Average knowledge scores demonstrated an initial rise then fall (survey 1: 5.67/10;survey 2: 7.83/10;survey 3: 6.36/10). Despite an innovative TEL education session, trainee knowledge did not significantly improve and improvement did not prove sustainable 6 weeks after teaching. Trainees were not confident in adopting newly acquired knowledge on skin of colour into their practice. Results show that the benefit of providing TEL education on ethnic dermatology may prove transient, and there is disparity in the perceived and actual benefit of ethnic dermatology education. Systemic solutions may be warranted, combining both education and human factors, including tackling systemic injustices and social inequalities.

The Layoff Decision at Swiggy

This case discusses the post-layoff challenge faced by Swiggy, one of India’s major food aggregators, during the Covid-19 pandemic. The nationwide lockdown announced on March 25, 2020, to combat Covid-19 had left the online food ordering and delivery business in limbo, forcing many food aggregators, including Swiggy, to re-align their businesses. This case analyses Swiggy CEO Sriharsha Majety’s decision to layoff 1100 employees and the company’s business model, values, and people policy. The case provides valuable insights on managing the motivation and morale of the surviving employees amidst an economic or financial crisis. Instructors of employee motivation, people management, strategy, and leadership programmes may find this case useful for teaching challenges business leaders face when managing layoffs, and strategies to keep the surviving workforce’s morale and performance high, alternatives to layoffs, and workforce management during periods of realignment. © 2021, NeilsonJournals Publishing. All rights reserved.

Accelerating Spatial Autocorrelation Computation with Parallelization, Vectorization and Memory Access Optimization

Geographic information systems deal with spatial data and its analysis. Spatial data contains many attributes with location information. Spatial autocorrelation is a fundamental concept in spatial analysis. It suggests that similar objects tend to cluster in geographic space. Hotspots, an example of autocorrelation, are statistically significant clusters of spatial data. Other autocorrelation measures like Moran's I are used to quantify spatial dependence. Large scale spatial autocorrelation methods are compute-intensive. Fast methods for hotspots detection and analysis are crucial in recent times of COVID-19 pandemic. Therefore, we have developed parallelization methods on heterogeneous CPU and GPU environments. To the best of our knowledge, this is the first GPU and SIMD-based design and implementation of autocorrelation kernels. Earlier methods in literature introduced cluster-based and MapReduce-based parallelization. We have used Intrinsics to exploit SIMD parallelism on x86 CPU architecture. We have used MPI Graph Topology to minimize inter-process communication. Our benchmarks for CPU/GPU optimizations gain upto 750X relative speedup with a 8 GPU setup when compared to baseline sequential implementation. Compared to the best implementation using OpenMP + R-tree data structure on a single compute node, our accelerated hotspots benchmark gains a 25X speedup. For real world US counties and COVID data evolution calculated over 500 days, we gain upto 110X speedup reducing time from 33 minutes to 0.3 minutes.

Accelerating Spatial Autocorrelation Computation with Parallelization, Vectorization and Memory Access Optimization: With a focus on rapid recalculation of COVID related spatial statistics for faster geospatial analysis and response

Geographic information systems deal with spatial data and its analysis. Spatial data contains many attributes with location information. Spatial autocorrelation is a fundamental concept in spatial analysis. It suggests that similar objects tend to cluster in geographic space. Hotspots, an example of autocorrelation, are statistically significant clusters of spatial data. Other autocorrelation measures like Moran's I are used to quantify spatial dependence. Large scale spatial autocorrelation methods are compute-intensive. Fast methods for hotspots detection and analysis are crucial in recent times of COVID-19 pandemic. Therefore, we have developed parallelization methods on heterogeneous CPU and GPU environments. To the best of our knowledge, this is the first GPU and SIMD-based design and implementation of autocorrelation kernels. Earlier methods in literature intro-duced cluster-based and Map Reduce-based parallelization. We have used Intrinsics to exploit SIMD parallelism on x86 CPU architecture. We have used MPI Graph Topology to minimize inter-process communication. Our benchmarks for CPU/GPU optimizations gain upto 750X relative speedup with a 8 GPU setup when compared to baseline sequential implementation. Compared to the best implementation using OpenMP + R-tree data structure on a single compute node, our accelerated hotspots benchmark gains a 25X speedup. For real world US counties and COVID data evolution calculated over 500 days, we gain upto 110X speedup reducing time from 33 minutes to 0.3 minutes. © 2022 IEEE.

Children in India opportunities and challenges

This publication focuses on the situation, opportunities and challenges in providing children an optimal environment for growth and development in India. Issues like early childhood care and education, nutrition opportunities through infancy, and physical and mental health of children are explored. An attempt has also been made to shed light on emerging challenges such as child development amidst pandemics like COVID-19, the increasing influence of media in the child’s development, and tackling the triple burden of malnutrition. Implementation of related policies and programs, both by governmental and non-governmental agencies, has been detailed for lessons learnt. The contributors to this edition are experienced researchers, practitioners, and academicians with extensive work in their respective areas of expertise. There is a good representation from different parts of the country which gives the reader a flavor of the regional diversity while dealing with children and their issues. The book provides a comprehensive updated reference for the scientific community. In addition, students and researchers in public health, social work, epidemiology, community medicine, public nutrition, human development, anthropology and sociology are the target audience. Stakeholders involved in policy planning, program implementation and advocacy will also benefit from this publication. © 2021 by Nova Science Publishers, Inc.

Covid-19 and its impact on children

The COVID-19 pandemic has impacted populations the world over, including India. Children have been particularly affected by the pandemic and the associated lockdown measures adopted by the government. Closure of educational institutions, public spaces for play and other activities, confinement to homes, lack of interaction with peers have serious consequences on the psychological and mental health, sociability and personality development of young children, with lifelong implications. Online education has its own limitations with both the academic system as well as the learners not being adequately equipped to deal with the sudden transition. The lockdown affected the marginalised and more impoverished communities to a larger extent with loss of employment and income, poor access to nutritionally diverse diets etc. Malnutrition rates set to rise post-Covid, could be due to the shutting down of supplementary nutrition through the ICDS or Midday Meal programmes. Health facilities like immunisation, growth monitoring or antenatal care were impacted during the lockdown and will have long-term consequences on maternal and child health and nutritional status. Careful planning is needed to reintroduce children to schools when they reopen. Alternate forms of community health and nutrition interventions, such as take-home rations, cash transfers, and home visits have been adopted in some Indian states to provide maternal care and childcare. © 2021 by Nova Science Publishers, Inc.

Heart rate: Activity mismatch as a prognostic marker of survival in metastatic non-small cell lung cancer (NSCLC)

Background: Performance status (PS) is the foundation for clinical trial eligibility criteria and the basis for treatment decisions in the treatment of NSCLC, but it is limited by subjectivity and potential miscommunication between patient, physician, and family. Activity trackers use is widespread and offers the potential to collect a broad range of patient generated data (steps, activity, heart rate, calories, sleep, etc.) to supplement the assessment of PS while minimizing subjectivity. Here we evaluated a clinical observation that elevated heart rate at rest is prognostic of survival. Methods: Patients with metastatic NSCLC were asked to participate in a prospective, observational study of potential prognostic survival factors that included wearing a FitBit tracker with a goal to measure HR-Activity mismatch measured by 2 parameters: 1) Heart Rate-Activity Mismatch (HAM) by percent of time when HR is high and activity is moderate or low over a day;2) inappropriate HR (iHR) is the ratio of time with elevated HR/sedentary minutes average over a week. Correlation and regression analyses were performed for the initial 55 patients enrolled prior to COVID restrictions using data limited to the average of 7 days with wear > 500 minutes closest to date of consent. Results: We enrolled 55 patients with metastatic NSCLC. There were 35 females and 20 males with a median age of 67 years. A majority of patients were never (38%, n = 21) or former smokers (40%, n = 22);adenocarcinoma (83%, n = 83%) was the most common histology. 30% (n = 17) patients were on 2 or greater line of therapy. 52 were included for survival analysis and 21 expired with median survival 226 days (149, NA). As average daily steps increased by 1000, the hazard of death decreased by a factor of 0.65 (95% CI: 0.45, 0.93, p = 0.018). As daily average distance increased by 1 mile, the hazard of death decreased by 0.55 (95% CI: 0.33, 0.91, p = 0.019). For HAM, the risk of death increased by 1.14 (95% CI: 1, 1.13, p = 0.046) for every 10% increase in HAM. For iHR < 1 (i.e. high HR when sedentary), the risk of death was 2.84 (95% CI: 1.05, 7.67, p = 0.04) compared those with iHR > 1. Steps, Distance, HAM and iHR were not statistically different by gender. Conclusions: Tracker-based measures of steps/distance and HR-Activity are prognostic of survival in NSCLC and may be useful to supplement evaluation of PS in clinical trials and practice.

Potential surrogates for performance status and survival in metastatic non-small cell lung cancer (NSCLC)

Background: Performance status (PS), a physician-based, subjective assessment of a patient's symptoms and ambulatory state, is an eligibility criterion for most clinical trials and a key clinical decision tool for treatment of NSCLC. Methods: Patients with metastatic NSCLC were asked to participate in a prospective, observational study of potential prognostic factors that includes demographics, laboratory, patient reported outcomes (PROs) by the patient reported outcomes measurement information system (PROMIS), PS reported by patient, PS assessed by physician, FitBit tracker (includes steps, distance, heart rate (HR), calories, METs), physical challenge and proteomics (Veristratâ). Correlation and regression analyses were performed for the initial 55 patients enrolled prior to COVID restrictions. Tracker data was collected and averaged over the first 7 days with wear > 500 minutes/day. Other data were collected at baseline. Results: We enrolled 55 patients with metastatic NSCLC. There were 35 females and 20 males with a median age of 67 years. A majority of patients were never (38%, n = 21) or former smokers (40%, n = 22);adenocarcinoma (83%, n = 83%) was the most common histology. 30% (n = 17) patients were 2 or greater line of therapy. 52 were included for survival analysis and 21 expired with median survival 226 days (149, NA). There were minimal gender related differences in the study population except a higher incidence of adenocarcinoma in women (94% vs 65%, p = 0.012 and longer FiTBit assessed daily "very active minutes" (defined as METs > = 6) in men compared to women (4.21 vs 0.43, p = 0.036). Patient-A nd physician assessed PS were not statistically different, although patients tended underestimated their PS relative to physicians. Physician assessed PS, patient assessed PS, two-minute walk distance, proteomics by Veristratâ, total daily steps, total daily distance covered, and heart rate/activity mismatch were independent predictors of survival. Age, gender, smoking, BMI, histology, and various CBC-based indices were not prognostic. Conclusions: Patient-A nd physicianassessment of PS do not always match, many alternate measures to PS are prognostic of survival and tracker-based methods are objective and feasible in clinical practice.

Feasibility of a virtual renal transplant simulation model for surgical trainees in the COVID era

Purpose: The COVID-19 pandemic and social distancing requirements has affected our resident education curriculum. We developed a virtual renal transplant simulation session to simulate renal vascular anastomoses (RVA). We hypothesize that this tool can be used to continue surgical skills education and enhance resident comfort with RVA in the COVID era. Methods: We employed a well described model to mimic RVA to the iliac vessels using a mock kidney and penrose drains in a 5x8x11inch transparent container to simulate operating in the iliac fossa. Additionally, each kit included camera stands for mobile phones. General surgery residents with varying levels of experience participated. Our virtual workshop started with a demonstration and took place via a live video interface from several remote locations. An attending surgeon observed each resident and provided real time feedback. Pre and post simulation surveys were sent out to elicit comfort levels with procedure on a scale from 0 (not comfortable) to 100(very comfortable) and fidelity as a tool to improve general surgery residency training in renal transplantation. Results: 16 surgical residents participated in the simulation. 12 (75%) had previously rotated on transplant surgery service. 75% of residents reported performing <10 vascular anastomoses. There was a statistically significant increase in mean comfort level score with performing a vascular anastomosis after the simulation compared to before (52 vs 23, P <0.01). There was also a statistically significant increase in mean comfort level score for assisting with a vascular anastomosis after compared to before (70 vs 38, p<0.01). 100% of residents reported that the model was useful for practicing needle control and precision, practicing knot tying, and learning the steps for completing renal vascular anastomoses. All residents recommended that this training model be used prior to rotating on the transplant service. Conclusions: We demonstrated the feasibility of virtual sessions that surgical residents found to be effective in improving their technical skills. This method can be modified for other elements of surgical simulation while maintaining social distancing measures. (Table Presented).

A review: divergent emerging strategies to tackle challenging COVID-19

Background: Contemplating the severity of pandemic sequel for public health many researchers are working recklessly for new targeted drugs and vaccines. Despite the challenging opportunities, the setup for the development of new effective remedy against COVID-19 is unforeseeable.

Effect of Yoga on Quality of Life of Oral Healthcare Professionals during Covid19 Pandemic

Yoga is a holistic approach to mental and physical health and is classified by the national institutes of health as a form of complementary and alternative medicine for human life. COVID-19 pandemic has impacted the quality of life of oral health care professionals. Our aim was to assess the effect of yoga on the quality of life of these professionals. Thirty participants (12 male/18 female) with a mean age 40.5 +/- 2.5 years were prepared utilizing a 45-minute common yoga protocol module.All members went to 24 sessions over a 4-week regimen. A standard WHOQOL-BREF survey was utilized to evaluate the QOL in 4 areas (physical, psychological, social and environmental). The responses in terms of scores from the survey were investigated utilizing independent student 't' test. The change in the QOL following a 4-week yoga session was our studied outcome. After 4 weeks there was a significant change in physical domain (p=0.001), psychological domain (p=0.045) and in the total mean WHOQOL score (p=0.028).It was found that integrating yoga in daily curriculum does enhance the quality of life of oral healthcare professionals in the current COVID 19 Pandemic

Novel corona virus and its risk to periodontists- how do we protect ourselves?

The Coronavirus Disease (COVID, commonly known as "COVID-19 Pandemic" has affected around 218 countries and territories across the globe. Coronavirus is a deadly virus which gains entry into the human body through various modes and causes symptoms such as dry cough, fatigue, coughing sputum, shortness of breath. The doctors are among the various frontline workers, who are at the greatest risk of contracting the COVID-19 infection. One of the major modes of transmission of coronavirus is the oral cavity. Hence, oral health care workers are at higher risk. Periodontitis is one of the most prevalent chronic inflammatory diseases of the oral cavity and is associated with much common comorbidity making it a community health concern. Periodontal procedures are aerosol generating procedures and COVID-19 is a highly contagious disease, so it can be easily contracted during aerosol generating procedures. Periodontitis and COVID-19 have both been associated with much common comorbidity so there is a possible association between them. The role of periodontists in preventing transmission of COVID-19 is critically important. Periodontists face direct exposure to oral fluids such as saliva and blood. So, precautionary measures are imperative for the periodontists so as to protect ourselves. Knowledge about the virus would be helpful in taking the necessary precautions. The aim of this review article was to understand the risk associated with the coronavirus and protection for periodontists in an unprecedented situation.

John Cunningham Virus (JCV) in renal allograft recipients (RAR)

Introduction: Both JCV and BK virus belong to Polyoma virus (PV) family and can lead to opportunistic infection in RAR. BK nephritis in RAR is well described in literature (incidence 1- 10 %) in contrast to JCV nephropathy (JCVN) which is a rare entity. Here we describe two cases of JCV in RARs. Case Description: Case 1: 44-year-old woman with PMH of HTN and ESRD received her first renal transplant in 2009 followed by antibody mediated rejection (AMR) resulting in graft dysfunction. She received a preemptive second renal transplant in 12/2015 followed by multiple RA biopsies within first few months due to elevated serum creatinine (s.cr). The biopsies showed borderline CMRs, acute AMRs and eventually chronic active AMR. Treatment regimen included steroids, rituximab, IVIG and plasmapheresis. Despite repeated treatments, her s.cr remained elevated leading to another biopsy in 6/2016 showing viral cytopathic changes suspicious for PVN. SV40 stain was negative as was serum BK titer. Immunosuppression (IS) was reduced and a biopsy was repeated in 8/2016 that stained positive for SV40. Given repeatedly negative serum BK, serum JCV titer was sent, which was positive and peaked at 350659 copies/ml on 9/2016. Titer improved to 66153 after 2 doses of Cidofovir however, later deteriorated to 334240. She had no neurological involvement. Despite Cidofovir, her renal function deteriorated rapidly requiring bilateral RA nephrectomies with pathology showing JCVN. IS was discontinued following which JCV titer became undetectable. Case 2: 59-year-old man with PMH of HTN and ESRD who received renal transplant in 4/2013 followed by baseline s.cr of 1.6 mg/dl. He was on Myfortic, Sirolimus and Prednisone for IS. He presented with rising s.cr in 9/2019 (2.1mg/dl). He underwent RA biopsy in 11/2019 showing viral cytopathic changes, positive SV40 consistent with PVN. BK by PCR resulted negative x 2 but JCV titer returned at 3896 copies/ml. Myfortic was discontinued. Repeat JCV titer trended down to 2603 in 3/2020. Further follow up was delayed due to COVID-19 pandemic. Discussion: The diagnosis of JCVN is challenging and easy to miss. Index of suspicion should be high with positive viral cytopathic changes (+/- SV40 stain) on allograft biopsy and negative serum BK. Currently there is no definitive therapy for JCV. Early diagnosis and reduction in IS are critical. Cidofovir may be of utility.

Infertility Treatment in COVID-19 Pandemic

The Coronavirus pandemic has had a great impact on various health sectors including pregnancy and infertility treatments like in vitro fertilization (IVF), in utero insemination (IUI), ovulation-induction, laparoscopy, hysteroscopy, and assisted reproductive techniques (ART). Due to the current situation in the COVID-19 pandemic and the relaxation permitted by the government, allowing nonessential services in a gradual manner, infertility services are being resumed according to the guidelines set by the ministry of health and family welfare. To meet the demands of current situation, the patient and the staff should be triaged. Only those patients should be undertaken who are tested or screened negative. Diagnostic evaluation is done using RT-PCR and the testing should be done at the commencement of treatment, that is, on day 2 of IVF/intracytoplasmic sperm injection (ICSI) cycle. Repeat test is done before the hCG trigger. The husband also needs testing at least once during the cycle, preferably at the start of the cycle. If the donor tests positive for COVID-19, the cycle should be cancelled. Universal good practices should be followed in laboratory also by each staff, which includes use of proper personal protective equipment (PPE) like eye protectors, FFP-2 or N-95 face masks, double gloves, shoe covers, disposable impermeable gowns, and face shields. The sanitization of the laboratory environment, equipment and devices should be done with appropriate nonembryotoxic disinfectants at the end of each procedure. COVID-19 has actually changed the way infertility treatment is being provided, keeping in view the safety of both the doctors and the patient.