Predicting the Disease Severity and Mortality in COVID-19 Patients based on Disease Characteristics: An Observational Study in Indian Setting

Introduction: The emergence of newer mutated variants of COVID-19 virus has posed a significant challenge. The present study is aimed at investigating the clinical characteristics of COVID-19 and the parameters that may serve as predictors of severity and mortality related to COVID-19 in an Indian setting. Method(s): The observation study was carried-out by using the data of COVID-19 patients admitted between July 2020 to June 2021 at JLN Medical College, Ajmer, Rajasthan, India. The demographic and clinical data of clinically significant parameters were collected. The statistical difference between recovery and death and between patients who required long-term oxygen and those who did not was evaluated for various demographic and clinical variables. Chi-square and Fisher exact test were performed for categorical variables and t-test for continuous variables. Regression analyses were also carried-out for different variables with respect to survival and death, and for oxygen dependency. Result(s): Variables namely age, duration of hospital stay, overweight, breathlessness, O2 mask therapy, BiPAP support, and ventilator usage were found to be significantly different between recovered and expired subjects (P 0.00). The study has noted hypertension (25.06%) and diabetes (23.73%) as the common comorbidities noted in COVID patients, followed by coronary artery disease (2.98%) and asthma. The study has validated the role of oxygen saturation and requirement of oxygen in predicting mortality among COVID-19 patients. The study identified age as a significant predictor of mortality, obesity as a risk factor in COVID-19 patients, gender as a factor influencing the requirement of oxygen, and fever as an independent factor related to oxygen therapy. Bilevel positive airway pressure was given to majority of expired patients (83%) compared to 10% in recovered patients. Conclusion(s): Variables namely age, BMI, duration of hospital stay, breathlessness, O2 mask therapy, BiPAP support, and ventilator usage could be predictive in COVID-19 severity and mortality. The variables to be considered for predicting oxygen dependency are age, urban/rural, gender, duration of hospital stay, weight, height, BMI, fever, cough, breathlessness, diabetes, hypertension, and CAD. Copyright © 2022, Indian Academy of Clinical Medicine. All rights reserved.

The impact of expanded telehealth availability on primary care utilization.

The expanded availability of telehealth due to the COVID-19 pandemic presents a concern that telehealth may result in an unnecessary increase in utilization. We analyzed 4,114,651 primary care encounters (939,134 unique patients) from three healthcare systems between 2019 and 2021 and found little change in utilization as telehealth became widely available. Results suggest telehealth availability is not resulting in additional primary care visits and federal policies should support telehealth use.

Exploring the Potential of Chemical Inhibitors for Targeting Post-translational Glycosylation of Coronavirus (SARS-CoV-2)

The Spike (S) protein of SARS-CoV-2 expressed on the viral cell surface is of particular importance as it facilitates viral entry into the host cells. The S protein is heavily glycosylated with 22 N-glycosylation sites and a few N-glycosylation sites. During the viral surface protein synthesis via the host ribosomal machinery, glycosylation is an essential step in post-translational modifications (PTMs) and consequently vital for its life cycle, structure, immune evasion, and cell infection. Interestingly, the S protein of SARS-CoV-2 and the host receptor protein, ACE2, are also extensively glycosylated and these surface glycans are critical for the viral–host cell interaction for viral entry. The glycosylation pathway of both virus (hijacked from the host biosynthetic machinery) and target cells crucially affect SARS-CoV-2 infection at different levels. For example, the glycosaminoglycans (GAGs) of host cells serve as a cofactor as they interact with the receptor-binding domain (RBD) of S-glycoprotein and play a protective role in host immune evasion via masking the viral peptide epitopes. Hence, the post-translational glycan biosynthesis, processing, and transport events could be potential targets for developing therapeutic drugs and vaccines. Especially, inhibition of the N-glycan biosynthesis pathway amplifies S protein proteolysis and, thus, blocks viral entry. The chemical inhibitors of SARS-CoV-2 glycosylation could be evaluated for Covid-19. In this review, we discuss the current status of the chemical inhibitors (both natural and synthetically designed inhibitors) of viral glycosylation for Covid-19 and provide a future perspective. It could be an important strategy in targeting the various emerging SARS-CoV-2 variants of concern (VOCs), as these inhibitors are postulated to aid in reducing the viral load as well as infectivity.

The Primacy of Moringa (Moringa oleiferaLam.) in Boosting Nutrition Statusand Immunity Defence Amidst the COVID-19 Catastrophe: A Perspective br

A severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) led novel coronavirus disease (COVID-19)outbreak spread through China has become the biggest global public health challenge today. The virus upon sev-eral mutations has led to the resurgence of more infectious and lethal variants infecting over 298 million peoplewith more than 5.46 million deaths worldwide by the end of December, 2021. Though vaccines are available, var-ious preventive measures particularly a high body immunity is still extremely important which determines thelikelihood of disease severity and subsequent recovery in the current and future pandemics. This review acknowl-edges the potentiality of miraculousMoringa oleiferaLam. against recently evolved novel coronavirus and accom-panying health complications. Moringa a well-proven super-food, densely packed with an abundant quantity of92 minerals, several vitamins, 46 antioxidants, and numerous bioactive compounds, thus own a massive thera-peutic potential for healing all levels of nutritional deficiencies and poor immunities and cure above 300 diseases.Moringa acts as anti-asthmatic, anti-cancerous, anti-diabetic, anti-inflammatory, hypotensive, hepatic, renal andcardio-protective, and anti-viral in nature. Thus it may reduce the severity of COVID-19 infections and associatedserious medical emergencies. In addition, self-isolation at home or the workplace has put people at increased riskof physical and mental sicknesses, which could be simply addressed by integrating this wonderful plant intoeveryday diet. Furthermore, the immune-modulatory properties and viral inhibiting nature of moringa contributeto reduced risk of COVID-19 infection and quicker recovery from its symptoms. As per the existing pieces of literature, it is a great time to harness the esteemed moringa for safeguarding people from the terrible ongoingCOVID-19 situation and other future pandemics

Antiviral Potential of Indian Medicinal Plants Against Influenza and SARS-CoV: A Systematic Review

The COVID-19 pandemic has posed a significant threat to human health due to the lack of drugs that can potentially act against SARS-CoV-2. Also, even after the emergency approval of WHO, the vaccines’ efficacy is still a question, and people are getting reinfections. Previous studies have demonstrated the efficacy of traditional medicinal plants against influenza and SARS coronavirus. The present article aims to review potential phytochemicals from Indian medicinal plants that may be used against SARS-CoV-2. Articles published in the English language between 1992 and 2021 were retrieved from Embase, PubMed, and Google scholar using relevant keywords, and the scientific literature on efficacies of Indian medicinal plants against SARS-CoV and influenza virus were analyzed. The initial search revealed 1304 studies, but, on subsequent screening, 115 eligible studies were reported. Twenty research articles investigating traditional medicinal plant extracts and metabolites against SARS-CoV and influenza A virus in in vitro and in vivo systems satisfied the search criteria. The studies reported that plant extracts and active compounds such as glycyrrhizin, 14-α-lipoyl andrographolide, and curcumin from medicinal plants such as Yashtimadhu (Glycyrrhiza glabra), Bhunimba (Andrographis paniculata), and Haridra (Curcuma longa) are effective against the various phases of the virus life cycle, viz., virus-host cell attachment, viral replication, 3CL protease activity, neuraminidase activity, adsorption and penetration of the virus. As per ancient Indian literature, plants in Ayurveda possess Rasayana (revitalizing) and Jwara hara (antipyretic, anti-inflammatory) properties. This evidence may be used to conduct experimental and clinical trials to study the underlying mechanisms and efficacy of antiviral properties of Indian medicinal plants against SARS-CoV-2.

Optimization and validation of RT-LAMP assay for diagnosis of SARS-CoV2 including the globally dominant Delta variant.

BACKGROUND: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19 pandemic, has infected more than 179 million people worldwide. Testing of infected individuals is crucial for identification and isolation, thereby preventing further spread of the disease. Presently, Taqman™ Reverse Transcription Real Time PCR is considered gold standard, and is the most common technique used for molecular testing of COVID-19, though it requires sophisticated equipments, expertise and is also relatively expensive. OBJECTIVE: Development and optimization of an alternate molecular testing method for the diagnosis of COVID-19, through a two step Reverse Transcription Loop-mediated isothermal AMPlification (RT-LAMP). RESULTS: Primers for LAMP were carefully designed for discrimination from other closely related human pathogenic coronaviruses. Care was also taken that primer binding sites are present in conserved regions of SARS-CoV2. Our analysis shows that the primer binding sites are well conserved in all the variants of concern (VOC) and variants of interest (VOI), notified by World Health Organization (WHO). These lineages include B.1.1.7, B.1.351, P.1, B.1.617.2, B.1.427/B.1.429, P.2, B.1.525, P.3, B.1.526 and B.1.617.1. Various DNA polymerases with strand displacement activity were evaluated and conditions were optimized for LAMP amplification and visualization. Different LAMP primer sets were also evaluated using synthetic templates as well as patient samples. CONCLUSION: In a double blind study, the RT-LAMP assay was validated on more than 150 patient samples at two different sites. The RT-LAMP assay appeared to be 89.2% accurate when compared to the Taqman™ rt-RT-PCR assay.

Remdesivir for COVID-19: a review of pharmacology, mechanism of action, in-vitro activity and clinical use based on available case studies

Remdesivir as a drug attracted a very serious consideration of whole Globe in treatment of the pandemic disease COVID-19. More recently published in-vitro inhibition activity and in-vivo case studies were showing promising clinical results and outcome of effective inhibition of SARS-CoV-2 virus by the use of remdesivir. However at the same time, use of the remdesivir showed substantial detrimental adverse events in patients which needs a special attention during treatment course of COVID-19. Thus, the use of remdesivir in treatment of COVID-19 is having current international interest although some more clinical evidences are still necessary in order to understand the actual efficiency and mechanism of remdesivir against COVID-19. In view of this, the present literature study spotlight the current ongoing research related to use of remdesivir which includes (i) pharmacology of remdesivir, (ii) mechanism of action of remdesivir (iii) in-vitro inhibition of remdesivir against SARS-CoV-2 virus, (iv) in-vivo analysis and clinical use of remdesivir against COVID-19. Finally possible adverse events (of use of remdesivir) are also discussed considering the pharmacovigilance concern.

Activities which people do during lockdown - Covid 19 - A survey

AIM: The aim of the survey was to know the various activities which people do during lockdown - COVID 19 INTRODUCTION: A major disaster in the year 2020 is COVID 19. It has a high rate of spread and affected almost all countries. During this period lockdown is very essential (quarantine). People do various activities during this time to keep themselves entertained. A lot of extracurricular activities and in-house activities are being done during this. People do this to keep themselves engaged. MATERIALS AND METHOD: The questionnaire was prepared with the help of Google forms and circulated. A total of 104 responses were received.The data was collected, analysed by SPSS and the results were plotted with the help of pie chart and bar graph.Chi-Square test was carried out and p < 0.05 was considered as significant. RESULTS AND DISCUSSION: People try to stay at home, trying to keep themselves engaged, play different games, and do different activities during the lockdown. 81.73% of the people said that lockdown was necessary and 18.27% said it was not necessary. The sleep time has changed for most of the people during this lockdown. There is an equal percentage of people who say that their appetite has increased when compared to a decrease during the lockdown. CONCLUSION: Almost all people try to follow the rules and keep themselves quarantined, and they keep themselves occupied by doing various activities and spending time with their family. © 2020 Ubiquity Press. All rights reserved.

Public perception on the management and prevention of COVID-19 in India-a survey

COVID 19 is a significant virus that causes zoonotic infection. It belongs to the family Coronaviridae. Covid-19 Leads to Severe Acute Respiratory Syndrome. Hydroxychloroquine, which is a commonly used anti-malarial drug that is commonly used to treat the COVID-19. Remdesivir is also used to treat the COVID-19. Coronavirus not only causes ARDS in adults but it also causes cytokine storm syndrome in patients. This survey was taken up when Covid-19 has become pandemic in nature. The aim of the study was to know the public perception in the management and prevention of COVID-19 in India A questionnaire was prepared about the public perception to manage and prevent the COVID-19 in India with the help of Google forms and was circulated through social networking. 106 responses were obtained from the survey. The data were analyzed using SPSS software and the outcome was expressed with the help of pie charts and bar diagrams. Chi-Square test was carried out and p value < 0.05 was considered as statistically significant. Various figures and questions are explained from the public's opinion obtained through the survey. 80.2 % of people said that social distancing helps to prevent the community spread of COVID-19 in India. 11.3 % of people told that maybe social distancing would help them to prevent the spread of COVID-19 in India and the remaining 8.5 % of people told that social distancing does not help to prevent the community spread of COVID-19 in India.Therefore the results concluded that wearing a facemask, frequent hand wash, and other factors help to prevent and manage the prevention of COVID-19 in India. This survey could create further awareness among the general public in such pandemic conditions.

Perception on online classes-a questionnaire survey

Online classes allow students to study from anywhere and gain knowledge, it also saves and reduces time. Most advanced education establishments are moving to inculcate online training in their programs. In a pandemic like Covid-19, online classes got great significance. All educational institutions are depending on online classes to update the academic activity so that students will be not only engaged in academic activity but also make them engaged in active learning.The influence of online learning shows a great certification with parents and students and increases their motivation, and self-assessment when compared with the old and conventional method.The aim of the survey was to assess the perception of the students and parents about the on online classes.The questionnaire was prepared with the help of Google forms and circulated. A total of hundred responses were received.The data was collected, analysed by SPSS and the results were plotted with the help of pie chart and bar graph. Chi-square test was carried out for statistical analysis and P < 0.05 was considered as statistically significant. 52% responded saying online classes were necessary and 48% said it was not necessary.Therefore the reports have concluded that online classes are necessary, useful and this will be helpful in improving the knowledge of the student but contact classes are preferred over the online classes.

Rapid development of visualization dashboards to enhance situation awareness of COVID-19 telehealth initiatives at a multihospital healthcare system.

The COVID-19 pandemic has led to the rapid expansion of telehealth services as healthcare organizations aim to mitigate community transmission while providing safe patient care. As technology adoption rapidly increases, operational telehealth teams must maintain awareness of critical information, such as patient volumes and wait times, patient and provider experience, and telehealth platform performance. Using a model of situation awareness as a conceptual foundation and a user-centered design approach we describe our process for rapidly developing and disseminating dashboard visualizations to support telehealth operations. We used a 5-step process to gain domain knowledge, identify user needs, identify data sources, design and develop visualizations, and iteratively refine these visualizations. Through this process we identified 3 distinct stakeholder groups and designed and developed visualization dashboards to meet their needs. Feedback from users demonstrated the dashboard's support situation awareness and informed important operational decisions. Lessons learned are shared to provide other organizations with insights from our process.

Novel Coronavirus 2019 (2019-nCoV) Infection: Part II - Respiratory Support in the Pediatric Intensive Care Unit in Resource-limited Settings

The 2019-novel coronavirus predominantly affects the respiratory system with manifestations ranging from upper respiratory symptoms to full blown acute respiratory distress syndrome (ARDS). It is important to recognize the risk factors, categorize severity and provide early treatment. Use of high flow devices and non-invasive ventilation has been discouraged due to high chances of aerosol generation. Early intubation and mechanical ventilation areessential to prevent complications and worsening, especially in resource-limited settings with very few centers having expertise to manage critical cases. Hydrophobic viral filter in the ventilator circuit minimizes chances of transmission of virus. Strategies to manage ARDS in COVID-19 include low tidal volume ventilation with liberal sedation-analgesia. At the same time, prevention of transmission of the virus to healthcare workers is extremely important in the intensive care setting dealing with severe cases and requiring procedures generating aerosol. We, herein, provide guidance on non-invasive respiratory support, intubation and management of ARDS in a child with COVID-19.