Cross-sectional study to describe the severity, bio-chemical associations, and final outcomes of COVID-19-associated rhino-orbital-cerebral mucormycosis in a tertiary hospital of East India.

Purpose: The second wave of coronavirus disease 2019 (COVID-19) pandemic triggered a mucormycosis epidemic in India. Diabetes mellitus and dysregulated immune response were contributors, and rhino-orbital-cerebral mucormycosis (ROCM) was the most common presentation. It is however not known whether bio-chemical parameters at presentation correlate with stage of ROCM or final outcome in terms of vision or mortality. Methods: This retrospective, hospital-based study included all in-patients of mucormycosis with ophthalmic manifestations at presentation admitted during June 1, 2021 to August 31, 2021. It aimed to evaluate the association between severity of infection, serum levels of HbA1c, ferritin, interleukin-6 (IL-6), C-reactive protein (CRP), and D-dimer levels at presentation and outcome. Results: There were altogether 47 eligible cases having a mean age of 48.8 ± 10.9 years with a male:female ratio of 2.6:1; forty-two (89.4%) had pre-existing diabetes, and five (10.6%) had steroid-induced hyperglycemia. The mean HbA1c among diabetics was 9.7 ± 2.1. HbA1c and serum CRP showed an increase over subsequent stages, which was not statistically significant (P = 0.31). IL-6 values for all stages were similar (P = 0.97). Only serum ferritin levels showed a statistically significant increase over stages (P = 0.04). IL-6 was significantly lower (P = 0.03) in patients who survived, whereas CRP levels were significantly lower in patients who had final visual acuity (VA) better than only perception of light (P = 0.03). Conclusion: Uncontrolled diabetes mellitus is a significant association of ROCM. Serum ferritin levels at presentation best correlate with extent of the disease. CRP levels are best to prognosticate cases that will have sufficient VA to carry on activities of daily living, whereas IL-6 levels are best associated with survival.

Effect of educational intervention on knowledge and attitude about the role of vitamins, minerals and nutraceuticals in COVID-19 and other disorders among medical and nursing undergraduates of a tertiary care teaching hospital.

PURPOSE: There must be a perfect balance between Food and Dietary supplements (DS) to ensure optimal well-being. The purpose of this study was to evaluate the impact of a webinar on the change in knowledge and attitude about the role of vitamins, minerals and DS among medical and nursing undergraduates so that they could bring about a positive change in popular practices, as well-informed Health Care Professionals (HCPs). MATERIALS AND METHODS: The study was a cross-sectional analytical study comprising 12 knowledge and 11 attitude questions administered to medical and nursing undergraduates with the help of semi-structured and pre-validated google form both before and after a webinar explaining the role of key nutrients and also the evidence and recommendations surrounding DS. Data were analyzed using STATA.12 to assess the impact of the webinar. RESULTS: There were 415 participants, with 265 medical and 150 nursing students. There was a significant improvement both in the knowledge (4.95 (±1.45), 7.76 (±1.69) and attitude scores (pre-webinar mean score 31.8 (±5.57) post-webinar mean score 27.7 (±4.90))of the participants after the webinar. An overall positive correlation before the webinar changed to a more significant negative correlation, indicating a positive impact of the webinar (0.0054-0.0701). CONCLUSION: The study suggests that continuing education informing various HCPs and undergraduate students about the absolute necessity of a diet rich in nutrients, vitamins, minerals, and probiotics is the need of the hour. Additionally, the efficacy and safety concerns, appropriate indications and dosages of various DS should be adequately stressed so that informed decisions can be made. Such training programs might have a far-reaching impact on the nutrition choices of the population at large.

Variation in biochemical parameters in COVID-19 patients admitted at a tertiary care dedicated COVID hospital: A prospective study.

Introduction: COVID-19 infection has a myriad of presentation. Rural India and other developing nations are relatively resource poor, not having access to modern specialized investigations. In this study, we tried to evaluate only biochemical parameters in predicting the severity of the infection. The aim of this study was to find a cost-effective means to predict the clinical course at the time of admission and thereby to reduce mortality and, if possible, morbidity by timely intervention. Materials and Methods: All COVID-19-positive cases admitted at our hospital from March 21 to December 31, 2020, were recruited in this study. The same acted as sham control at recovery. Results: We observed a significant difference in biochemical parameters at the time of admission and discharge, between mild/moderate disease and severe disease. We found slightly deranged liver function tests at admission, which becomes normal at the time of discharge. Urea, C-reactive protein (CRP), procalcitonin, lactate dehydrogenase, and ferritin concentrations in severe/critical patients were significantly higher than that in the mild/moderate group. Receiver operating characteristic curves were plotted to predict the severity on the basis of biochemical parameters independently, of the patients based on these values. Conclusion: We proposed cutoff values of certain biochemical parameters, which will help in judging the severity of the infection at admission. We developed a predictive model with a significant predictive capability for CRP and ferritin values, using normal available biochemical parameters, routinely done in resource-poor centers. Clinicians working in resource-poor situations will be benefitted by having an idea of the severity of the disease. Timely intervention will reduce mortality and severe morbidity.

Résumé Introduction: L'infection au COVID19 a une myriade de présentations. L'Inde rurale et d'autres pays en développement sont relativement pauvres en ressources, non avoir accès aux enquêtes spécialisées modernes. Dans cette étude, nous avons essayé d'évaluer uniquement les paramètres biochimiques pour prédire la gravité de l'infection. Le but de cette étude était de trouver un moyen rentable de prédire l'évolution clinique au moment de l'admission et ainsi de réduire la mortalité et, si possible, la morbidité par une intervention rapide. Matériels et méthodes: Tous les cas positifs au COVID19 admis à notre hospitalisés du 21 mars au 31 décembre 2020, ont été recrutés dans cette étude. La même chose a agi comme un contrôle factice lors de la récupération. Résultats: Nous avons observé une différence significative dans les paramètres biochimiques au moment de l'admission et de la sortie, entre une maladie légère/modérée et une maladie grave. Nous avons trouvé des tests de la fonction hépatique légèrement dérangés à l'admission, qui deviennent normaux au moment de la sortie. Urée, protéine Créactive (CRP, les concentrations de procalcitonine, de lactate déshydrogénase et de ferritine chez les patients sévères/critiques étaient significativement plus élevées que chez les patients légers/modérés groupe. Les courbes caractéristiques de fonctionnement du récepteur ont été tracées pour prédire la gravité sur la base de paramètres biochimiques indépendamment, deles patients en fonction de ces valeurs. Conclusion: Nous avons proposé des valeurs seuils de certains paramètres biochimiques, qui permettront de juger de la gravité de l'infection à l'admission. Nous avons développé un modèle prédictif avec une capacité prédictive significative pour les valeurs de CRP et de ferritine, en utilisant les paramètres biochimiques normaux disponibles, systématiquement effectués dans les centres pauvres en ressources. Les cliniciens travaillant dans des situations où les ressources sont limitées bénéficier d'avoir une idée de la gravité de la maladie. Une intervention rapide réduira la mortalité et la morbidité grave. Mots-clés: COVID19, ferritine, lactate déshydrogénase, urée.

Association between ivermectin treatment and mortality in COVID-19: A hospital-based case-control study.

Purpose: This study was designed to test the hypothesis that exposure to ivermectin in early disease prevents mortality due to COVID-19. A secondary objective was to see if the drug has any impact on the length of hospital stay among the survivors. Methods: It was a hospital-based retrospective case-control study conducted at a tertiary teaching hospital in India. All patients with a diagnosis of COVID-19 who were admitted between 1st April and 15th May 2021 and received inpatient care were included. Important variables like demographic details, dates of admission and discharge or death, symptoms at the time of admission, comorbidities, severity of illness at the time of admission, whether ivermectin was administered or not during the course of the illness and other treatments received as part of the standard of care were retrieved from the medical records. Results: Of the 965 patients who received inpatient care, 307 died during their hospital stay while 658 were successfully discharged. The proportion of cases treated with ivermectin was 17.26% among the non-survivors (53/307) and 17.93% among the survivors (118/658). The effect was statistically insignificant (crude OR = 0.954; 95% CI: 0.668-1.364, P = 0.80). Among the survivors, the median length of stay was 11 days for patients who received ivermectin (IQR: 7-15) as well as for those who did not (IQR: 7-16). Conclusion: This study did not show any effect of ivermectin on in-patient mortality in patients with COVID-19 and there was no effect of the drug on the length of hospital stay among the survivors.

Evaluation of C4b as an adjunct marker in symptomatic RT-PCR negative Covid-19 cases.

Introduction: Detecting low viral load has been a challenge in this pandemic, which has led to its escalated transmission. Complement activation has been implicated in pathogenesis of Covid-19 infection. Thus, evaluation of complement activation in suspected Covid-19 infection may help to detect infection and limit false negative cases thus limiting transmission of infection. We speculate that measuring C4b, produced from an activated complement system due to the presence of Covid-19 may help in its detection, even when the viral titers are low. Methods: Plasma C4b levels of symptomatic RT-PCR positive patients (cases, n = 40); symptomatic RT-PCR negative patients (n = 35) and asymptomatic RT-PCR negative controls (n = 40) were evaluated. Plasma C5b-9, IL-6, D-dimer and C1-Inhibitor (C1-INH) were also measured in cases and controls. ELISA kits were used for all measurements. Statistical analyses were carried out using Stata, version 12 (Stata Corp., Texas, USA). Results: C4b levels were found to be significantly increased in RT-PCR positive patients as compared to asymptomatic RT-PCR negative controls. RT-PCR negative but symptomatic patients still showed increased C4b levels. The significantly higher levels of C4b in cases with a cut-off value of ≥ 116 ng/ml with optimum sensitivity and specificity of 80% and 52% respectively is indicative of its possible use as an adjunct marker. Increased levels of D-dimer, IL6, along with decreased levels of C1-INH were found in cases compared to controls. Whereas, C5b-9 levels were not significantly raised in cases. Conclusions: The results of our study suggests that plasma C4b may help to detect infection in false negative cases of RT-PCR that escape detection owing to low viral load. However, to confirm it a large-scale study is needed. Supplementary Information: The online version contains supplementary material available at 10.1007/s12291-022-01033-z.

Interim Analysis of Impact of Adding Low Dose Pulmonary Radiotherapy to Moderate COVID-19 Pneumonia Patients: IMpaCt-RT Study.

Background: Treatment for coronavirus disease 2019 (COVID-19) pneumonia remains largely supportive till date and multiple clinical trials took place within the short span of time to evaluate the role of investigational therapies. The anti-inflammatory effect of low dose whole lung radiation in treating pneumonia has been documented earlier. This clinical trial analyzed the effect of low dose radiation therapy (LDRT) in a moderately affected COVID-19 pneumonia patient cohort and has evaluated its effect in stopping the conversion of moderate disease into severe disease. Methods: Patients with moderate COVID-19 pneumonia as characterized by the Ministry of Health and Family Welfare (MOHFW), Government of India, were randomized (1:1) to low dose whole lung radiation versus no radiation. All treatment of patients was concurrently being given as per institutional protocol. Patients were followed up with clinical and laboratory parameters monitored on Days 1, 3, 7, and 14. Computed tomography scan (CT scan) of thorax was performed on Days 1 and 7. Patients were evaluated for conversion of moderate into severe disease as per National Early Warning Score-2 (NEWS-2 score) as the primary end point. The secondary endpoints included changes in ratio between peripheral capillary oxygen saturation and fraction of inspired oxygen (SpO2/FiO2), biochemical markers, 25-point CT severity score, and radiation induced acute pulmonary toxicities. Findings: At the interim analysis, there were seven patients in the radiation arm and six in the control. A whole lung LDRT improved the outcome of SpO2/FiO2 at Day 3; however it did not convert into a statistically significant improvement for the NEWS-2 score. The serum levels of LDH, CRP, Ferritin and D-dimer were significantly reduced on 14 days in the LDRT arm in comparison to the baseline value but were not significant between the two groups. Interpretation: LDRT seems to have the potential to prevent moderate COVID-19 pneumonia from a deteriorating to severe category. However, further randomized clinical trial with an adequate number of such patients is warranted to establish the definitive role of LDRT in the management of COVID-19 pneumonia. Funding: An intramural research project bearing code: I-27/621, was sanctioned from the All India Institute of Medical Sciences, Patna, India. Clinical Trial Registration: Clinical Trials Registry-India (CTRI/2021/06/033912, 25th May 2021) ctri.nic.in/Clinicaltrials/login.php.

Risk of self-contamination because of improper doffing of personal protective equipment: A randomised cross-over study.

Background and Aims: Many health care staff have been pressed into coronavirus disease-19 patient care with little experience of working in bio-hazard zones because of the overwhelming requirements of manpower. They wear personal protective equipment (PPE) and follow all rules for their safety. However, despite precautions, during doffing, they carry a risk of self-contamination. This randomised cross-over study assessed the risk of self- contamination because of improper doffing of PPEs. Methods: A colourless lotion that glows with a bright-green fluorescent hue under ultraviolet light was applied to simulate germ contamination in various health care workers (HCWs) who volunteered for the study. The primary objective of this study was to know the percentage of HCWs getting self-contaminated. The secondary objectives were to assess which portions of the body get maximally contaminated and infestation of germs on which portions of the PPE carry more risk of self-contaminating after doffing. Results: A total of 152 doffings by 76 participants were analysed, and the volunteers self-contaminated in 43 doffings (28.28%). In 18 of these 43 doffings, self-contamination was noted at more than one location. The most commonly contaminated areas were the arms (33%), clothes on the abdomen (24%), and areas in the lower limb (23%). Germ infestation on the upper parts of a PPE is 2.39 times more likely to cause self-contamination after improper doffing. Conclusion: Faulty doffing resulted in self-contamination in 28.28% of all doffings. Risk is 2.39 times more when germs are nested in the upper body portions of the PPE suit.

Sero-epidemiological survey of SARS-Cov2 in urban slums of a capital city: A cross- sectional study.

Introduction: Slums are the most vulnerable settlements for COVID-19 infection due to overcrowding and unsanitary conditions. Thus, this study was undertaken to determine the level of seroprevalence for SARS-CoV-2 infection among slum dwellers. Material and Methods: A community-based cross-sectional seroepidemiological survey was conducted at several slums of Patna over four weeks, that is, January 20-February 20, 2021. A total of 650 participants were recruited in the study by applying a two-stage random sampling technique. Results: Seroprevalence for SARS-CoV-2-specific IgG antibody was found to be 31.5% (95% Confidence Interval (CI): 27.9-35.1). The seropositivity prevalence was found to be statistically higher among participants belonging to the age group of 18-30 years (41.1%), male gender (67.9%), high-risk occupation (70%), below poverty line (BPL) economic status (62.1%), and residing in a hut (51.2%) and kutcha house (42.4%). Further, 262 participants reported having COVID-like symptoms in the preceding 1 month of the survey, which was found to be significantly associated with the seropositivity status. Conclusion: The finding of the study reflects that a moderate seroprevalence level of COVID-19 infection was acquired in the slum settings of Bihar. Unchecked spread in these informal communities will pose a serious threat to the rest of the bigger sections of urban populations. This indirectly calls for early intervention in the form of preference in the roadmap of COVID-19 vaccination.

An Epidemiological Investigation to evaluate the link between hypovitaminosis D and COVID-19.

Background: The COVID-19 pandemic has become a global threat, with an inexplicable course of action and suboptimal response to the multitudes of therapies being tried. Vitamin D's pleiotropic effects (immunomodulatory, anti-inflammatory, and antiviral) have lately received considerable attention in the scientific community, and it has been shown to be helpful in the defense against viral respiratory infections. Aim: To find out the association between vitamin D and COVID-19. Methods: Overall, 360 (156 COVID-19 +ve and 204 COVID-19 -ve) subjects were investigated in this hospital-based case-control study. The study participants were taken from the COVID-19 wards and Flu clinic of a dedicated COVID hospital between August 1 and September 15, 2020. The demographics and clinical data including alcohol and smoking history along with serum vitamin D levels were recorded. Binary logistic regression analysis was performed to assess the association between age, gender, alcohol intake, smoking history, vitamin D status, and COVID-19. Results: There was no significant difference in the mean vitamin D levels between cases and controls. Bivariate analysis of predictors and COVID-19 revealed that predictors such as advanced age, BMI, alcohol intake, smoking habit, diabetes, hypertension, and vitamin D deficiency were significantly associated with COVID-19. Conclusions: This study showed that serum vitamin D status might be able to reduce the impact of COVID-19, although more studies are required to establish clear causality.

Evaluation of C4b as an adjunct marker in symptomatic RT-PCR negative Covid-19 cases

Introduction Detecting low viral load has been a challenge in this pandemic, which has led to its escalated transmission. Complement activation has been implicated in pathogenesis of Covid-19 infection. Thus, evaluation of complement activation in suspected Covid-19 infection may help to detect infection and limit false negative cases thus limiting transmission of infection. We speculate that measuring C4b, produced from an activated complement system due to the presence of Covid-19 may help in its detection, even when the viral titers are low. Methods Plasma C4b levels of symptomatic RT-PCR positive patients (cases, n = 40);symptomatic RT-PCR negative patients (n = 35) and asymptomatic RT-PCR negative controls (n = 40) were evaluated. Plasma C5b-9, IL-6, D-dimer and C1-Inhibitor (C1-INH) were also measured in cases and controls. ELISA kits were used for all measurements. Statistical analyses were carried out using Stata, version 12 (Stata Corp., Texas, USA). Results C4b levels were found to be significantly increased in RT-PCR positive patients as compared to asymptomatic RT-PCR negative controls. RT-PCR negative but symptomatic patients still showed increased C4b levels. The significantly higher levels of C4b in cases with a cut-off value of ≥ 116 ng/ml with optimum sensitivity and specificity of 80% and 52% respectively is indicative of its possible use as an adjunct marker. Increased levels of D-dimer, IL6, along with decreased levels of C1-INH were found in cases compared to controls. Whereas, C5b-9 levels were not significantly raised in cases. Conclusions The results of our study suggests that plasma C4b may help to detect infection in false negative cases of RT-PCR that escape detection owing to low viral load. However, to confirm it a large-scale study is needed. Supplementary Information The online version contains supplementary material available at 10.1007/s12291-022-01033-z.

Clinicodemographic profile and predictors of poor outcome in hospitalised COVID-19 patients: a single-centre, retrospective cohort study from India.

OBJECTIVES: Primary objective was to study the clinicodemographic profile of hospitalised COVID-19 patients at a tertiary-care centre in India. Secondary objective was to identify predictors of poor outcome. SETTING: Single centre tertiary-care level. DESIGN: Retrospective cohort study. PARTICIPANTS: Consecutively hospitalised adults patients with COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome variable was in-hospital mortality. Covariables were known comorbidities, clinical features, vital signs at the time of admission and on days 3-5 of admission, and initial laboratory investigations. RESULTS: Intergroup differences were tested using χ2 or Fischer's exact tests, Student's t-test or Mann-Whitney U test. Predictors of mortality were evaluated using multivariate logistic regression model. Out of 4102 SARS-CoV-2 positive patients admitted during 1-year period, 3268 (79.66%) survived to discharge and 834 (20.33%) died in the hospital. Mortality rates increased with age. Death was more common among males (OR 1.51, 95% CI 1.25 to 1.81). Out of 261 cases analysed in detail, 55.1% were in mild, 32.5% in moderate and 12.2% in severe triage category. Most common clinical presentations in the subgroup were fever (73.2%), cough/coryza (65.5%) and breathlessness (54%). Hypertension (45.2%), diabetes mellitus (41.8%) and chronic kidney disease (CKD; 6.1%) were common comorbidities. Disease severity on admission (adjusted OR 12.53, 95% CI 4.92 to 31.91, p<0.01), coagulation defect (33.21, 3.85-302.1, p<0.01), CKD (5.67, 1.08-29.64, p=0.04), high urea (11.05, 3.9-31.02, p<0.01), high prothrombin time (3.91, 1.59-9.65, p<0.01) and elevated ferritin (1.02, 1.00-1.03, p=0.02) were associated with poor outcome on multivariate regression. A strong predictor of mortality was disease progression on days 3-5 of admission (adjusted OR 13.66 95% CI 3.47 to 53.68). CONCLUSION: COVID-19 related mortality in hospitalised adult patients at our center was similar to the developed countries. Progression in disease severity on days 3-5 of admission or days 6-13 of illness onset acts as 'turning point' for timely referral or treatment intensification for optimum use of resources.

Interim Analysis of Impact of Adding Low Dose Pulmonary Radiotherapy to Moderate COVID-19 Pneumonia Patients: IMpaCt-RT Study

Background Treatment for coronavirus disease 2019 (COVID-19) pneumonia remains largely supportive till date and multiple clinical trials took place within the short span of time to evaluate the role of investigational therapies. The anti-inflammatory effect of low dose whole lung radiation in treating pneumonia has been documented earlier. This clinical trial analyzed the effect of low dose radiation therapy (LDRT) in a moderately affected COVID-19 pneumonia patient cohort and has evaluated its effect in stopping the conversion of moderate disease into severe disease. Methods Patients with moderate COVID-19 pneumonia as characterized by the Ministry of Health and Family Welfare (MOHFW), Government of India, were randomized (1:1) to low dose whole lung radiation versus no radiation. All treatment of patients was concurrently being given as per institutional protocol. Patients were followed up with clinical and laboratory parameters monitored on Days 1, 3, 7, and 14. Computed tomography scan (CT scan) of thorax was performed on Days 1 and 7. Patients were evaluated for conversion of moderate into severe disease as per National Early Warning Score-2 (NEWS-2 score) as the primary end point. The secondary endpoints included changes in ratio between peripheral capillary oxygen saturation and fraction of inspired oxygen (SpO2/FiO2), biochemical markers, 25-point CT severity score, and radiation induced acute pulmonary toxicities. Findings At the interim analysis, there were seven patients in the radiation arm and six in the control. A whole lung LDRT improved the outcome of SpO2/FiO2 at Day 3;however it did not convert into a statistically significant improvement for the NEWS-2 score. The serum levels of LDH, CRP, Ferritin and D-dimer were significantly reduced on 14 days in the LDRT arm in comparison to the baseline value but were not significant between the two groups. Interpretation LDRT seems to have the potential to prevent moderate COVID-19 pneumonia from a deteriorating to severe category. However, further randomized clinical trial with an adequate number of such patients is warranted to establish the definitive role of LDRT in the management of COVID-19 pneumonia. Funding An intramural research project bearing code: I-27/621, was sanctioned from the All India Institute of Medical Sciences, Patna, India. Clinical Trial Registration Clinical Trials Registry-India (CTRI/2021/06/033912, 25th May 2021) ctri.nic.in/Clinicaltrials/login.php

Assessment of depression, anxiety and stress experienced by health care and allied workers involved in SARS-CoV2 pandemic.

Introduction: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) causing coronavirus disease 2019 (COVID-19) has led to a global health crisis. Health workforce has been working vigorously in COVID-19 management. So, we have planned this study with an aim to assess the psychological profile of healthcare and allied workers involved in SARS-CoV2 pandemic and to look for associated factors. Methodology: A cross-sectional observational study was planned at All India Institute of Medical Sciences, Patna. Study population comprised of Health care workers and allied health care workers involved in COVID-19 management. Results: Data from 254 study participants have been included in the study. The prevalence of severe and extremely severe depression among study participants was 8.3 and 3.1 percent. Severe and extremely severe anxiety prevalence was found to be 9.4 and 13.8 percent. The prevalence of severe and extremely severe stress was 2.4 and 2.4 percent each. Education till post-graduation, unmarried, occupation of doctor, Comorbidity of headache and occurrence of influenza-like illness in last 3 months had a statistically significant association with high depression score. With high Anxiety score and high-stress score statistically significant association was seen in education till postgraduation, unmarried, occupation of doctor, duration of 1 COVID-19 duty of ≥8 hours. Conclusion: The study highlights high psychological comorbidities in the form of depression, anxiety and stress among health care workers and allied health care workers working in COVID-19 pandemic. Prevalence of psychological morbidity is higher among doctors compared to nurses and allied health workers. COVID-19 duty of ≥8 hours have been found to be hampering mental health.

Pandemic resilience and health systems preparedness: lessons from COVID-19 for the twenty-first century.

The pandemic of COVID-19 disease has acted like a stress test on every aspect of life, but particularly exposed weaknesses of health systems design and capacity. There have been similar pandemics in the past, and the threat of more frequent future pandemics in the twenty-first century is real. It is therefore important to learn the right lessons with regard to health systems preparedness and resilience. The five design features that this paper discusses are related to the organization of primary care services, planned surge capacity in secondary and tertiary care, a robust disease surveillance system that is integrated with the health management information system, adequate domestic capacity in being able to innovate and scale up production and logistics of much needed medical products and a governance approach that recognizes the importance of the health systems being able to continuously learn and adapt to meet changing needs. In addition to this, the organizational capacity of the system to deliver required services would need more investment in financial resources, and a suitable health human resource policy.

Evidences suggesting a possible role of Vitamin D in COVID 19: The missing link.

The severe acute respiratory syndrome coronavirus 2 is spreading like wildfire with no specific recommended treatment in sight. While some risk factors such as the presence of comorbidities, old age, and ethnicity have been recognized, not a lot is known about who the virus will strike first or impact more. In this hopeless scenario, exploration of time-tested facts about viral infections, in general, seems to be a sound basis to prop further research upon. The fact that immunity and its various determinants (e.g., micronutrients, sleep, and hygiene) have a crucial role to play in the defense against invading organisms, may be a good starting point for commencing research into these as yet undisclosed territories. Herein, the excellent immunomodulatory, antiviral, and anti-inflammatory roles of Vitamin D necessitate thorough investigation, particularly in COVID-19 perspective. This article reviews mechanisms and evidence suggesting the role Vitamin D plays in people infected by the newly identified COVID-19 virus. For this review, we searched the databases of Medline, PubMed, and Embase. We studied several meta-analyses and randomized controlled trials evaluating the role of Vitamin D in influenza and other contagious viral infections. We also reviewed the circumstantial and anecdotal evidence connecting Vitamin D with COVID-19 emerging recently. Consequently, it seems logical to conclude that the immune-enhancing, antiviral, anti-inflammatory, and lung-protective role of Vitamin D can be potentially lifesaving. Hence, Vitamin D deserves exhaustive exploration through rigorously designed and controlled scientific trials. Using Vitamin D as prophylaxis and/or chemotherapeutic treatment of COVID-19 infection is an approach worth considering. In this regard, mass assessment and subsequent supplementation can be tried, especially considering the mechanistic evidence in respiratory infections, low potential for toxicity, and widespread prevalence of the deficiency of Vitamin D affecting many people worldwide.

Clinical and Laboratory Predictors of Mortality in COVID-19 Infection: A Retrospective Observational Study in a Tertiary Care Hospital of Eastern India.

Introduction COVID-19 is associated with huge morbidity and mortality in India. Identification of factors associated with mortality would make a difference in the management of COVID-19 infection-related illness. Objective To assess clinical & laboratory parameters associated with adverse outcomes among 984 patients with COVID-19 infection admitted to a tertiary care hospital in eastern India. Materials and methods All patients with real-time polymerase chain reaction (RTPCR) or rapid antigen positive for COVID-19 admitted at our All India Institute of Medical Sciences (AIIMS) Patna between 1st July to 30th Aug 2020 were included for analysis. Statistical analysis was performed using Stata, version 10 (Stata Corp, College Station, USA). Four subgroup regression models have been analyzed to predict the odds of death. Results A total of 984 COVID-19 cases admitted to our hospital during the given period were analyzed. Out of 984 cases, 762 (77.44%) were males and 222 (22.56%) females. The overall case-fatality rate among admitted cases was 254 (25.81%) [males (26.64%) and females (22.96%)]. The final logistic regression model showed that patients presenting with severe COVID-19 disease (adjusted odds ratio [aOR]: 17.81), cough (aOR: 3.83), dyspnea (aOR:2.35), age 60-75 (aOR:1.47), age >75 years (aOR:3.97), presence of chronic kidney disease (CKD) (aOR:2.95), were found to be significantly associated with a high risk of mortality after controlling for the confounders (p<0.05). Among lab variable, total leukocyte count (TLC) (>10,000/mm3) (aOR: 1.74), neutrophil-lymphocyte ratio (NLR) (>3.3) (aOR:2.37), serum albumin (<3.4 g/dl) (aOR : 2.3), blood urea (>43 gm/dl) (aOR:3.72), ferritin (>322) (aOR:2.39), and D-dimer (>0.5) (aOR:5.58) were significantly associated with higher mortality (p<0.05) Conclusion Age 60 years plus, presence of CKD, and severe covid infection carried the highest risk of mortality. Lab markers such as raised TLC, ferritin, D-dimer, and low albumin were associated with worse outcomes in our subset of COVID-19-related illness.

Epidemiological, Clinical, and Laboratory Predictors of In-Hospital Mortality Among COVID-19 Patients Admitted in a Tertiary COVID Dedicated Hospital, Northern India: A Retrospective Observational Study.

INTRODUCTION: COVID-19 pandemic still poses a serious challenge to health system worldwide. This study was planned to determine exposure characteristics, in-hospital mortality, and predictors of in hospital mortality among COVID-19 patients. MATERIAL AND METHODS: We retrospectively investigated epidemiological, clinical, and laboratory profile of confirmed COVID-19 patients admitted from 25th March to 31st August 2020. COVID-19 patient profiles were collected from Medical Record Section of the hospital. RESULTS: In hospital mortality occurred in 159 (11%) cases. Increasing respiratory rate, higher temperature, higher total leukocyte count, and high blood urea levels were found to be independent risk factors for in hospital mortality whereas higher hemoglobin and higher oxygen saturation at the time of hospital admission were found to be protective against in hospital mortality. CONCLUSION: In hospital mortality among COVID-19 patients is almost 1 in 10 in tertiary care hospital. Patients with advancing age (AOR: 1.048; 95% CI: 1.021-1.076), higher respiratory rate (AOR: 1.248; 95% CI: 1.047-1.489), higher temperature (AOR: 1.758; 95% CI: 1.025-3.016), higher leukocyte count (AOR: 1.147; 95% CI: 1.035-1.270), and higher urea levels (AOR: 1.034; 95% CI: 1.005-1.064) at the time of admission are important predictors of COVID-19 in-hospital mortality.

COVID 19 and Online Learning in Post Graduate Management Programme: An Empirical Analysis of Students' Perception

In University regulated Tier IIB Schools in India, the prominent mode of instruction has been traditional face to face, teaching. The extent of technology to be incorporated in educational pedagogy was always debated. However, with the sudden COVID-19 pandemic, all institutions were compelled to adopt online teaching methodologies. With this background, this paper attempts to analyze the perception of students of Post Graduate Management Programmes from the four different Universities in state of Maharashtra, India, about their online learning experience during the pandemic. The study also attempts to identify various factors that have a bearing on student 's perceptions regarding the effectiveness of online teaching. For the purpose of quantitative analysis, factor analysis and multiple regression have been used. Based on the results of quantitative analysis, appropriate qualitative conclusions have been derived. The results of the study in terms of perception of students regarding online learning can contribute significantly in developing a blended approach for management education as per the latest UGC guidelines (2020).

Equity and elderly health in India: reflections from 75th round National Sample Survey, 2017-18, amidst the COVID-19 pandemic.

BACKGROUND: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) outbreak, called coronavirus disease - 2019 (COVID-19), has affected more than 200 countries across the globe with a higher fatality rate among the elderly population. Aim of the study is to highlight the vulnerability of the aged amidst the current COVID-19 pandemic, and in the light of the recent international evidence, suggests what government could do to mitigate their vulnerability. METHODS: Data from the recently released (November 2019) 75th Round National Sample Survey (NSS), which was conducted from July 2017 to June 2018, across 8077 rural villages and 6181 urban wards was used for this study. Data collected from 555,115 individuals (rural: 325,232; urban: 229,232) included 42,762 elderly individuals (60 years or above). Bivariate and multivariate analyses were used for the calculation. RESULTS: Of the total sample of elderly individuals, 27.7% reported suffering from an ailment in the last 15 days, whereas 8.5% had been hospitalized during the last 365 days. Among the elderly, hospitalization rate was higher in the urban areas (OR: 1.23), general social category (OR: 1.18), richest economic quintile (OR: 1.69), and among those living alone (OR: 2.40). Also, among the elderly, 64% of those in the scheduled tribe (social group) and 51% in the poorest economic quintile utilized public facilities for hospitalization. Cardiovascular ailments were the major cause for hospitalization (18.1%) and outpatient visit (32%) among the elderly. Ailments related to diabetes and hypertension constituted 55% of outpatient visit for the elderly. Only 18.9% of the elderly had health insurance though chances of facing catastrophic health expenditures were high among the elderly. 6.6% of elderly female and 1.6% male live alone, and 27.5% of age 80 years and above are immobile. 50% of male and 90% of female are financially dependent on others and more so in poorer economic quintiles. CONCLUSIONS: The vulnerability of India's elderly increases across economic levels, and other dimensions such as the place of residence, gender, social group (caste), marital status, living arrangements, surviving children, and economic dependence. The current COVID-19 pandemic poses a greater risk of social isolation among the elderly, which may cause detrimental health impact. TRIAL REGISTRATION: Not applicable since the study is based on secondary data.