Hypothalamo-pituitary adrenal axis in survivors of Sars Cov-2 infection- 3 months after acute infection

Introduction: Coronavirus disease 2019 (COVID-19) mainly involves the lungs;it also affects the endocrine system including the hypothalamic-pituitary adrenal axis (HPA). Aims: To assess and compare the changes in the HPA axis in survivors of SARS CoV-2 infection 3 months after recovery. Methods: A cross-sectional, descriptive study was undertaken at JIPMER, including 69 patients 318 years of age, after 3 months after the diagnosis of COVID-19. At baseline, a fasting sample was collected for basal cortisol, thyroid function, and biochemical investigations between 8.00-9.00 AM. A low dose Synacthen test (1 mg) was performed in all patient's blood samples for serum cortisol collected after 30 and 60 minutes of intravenous administration. Results: The mean age (SD) was 49.74 ± 12.05 years, 24 (34.78%) were female and 45 (65.2%) were male patients. 20 (28.98%) patients had mild, 10 (14.4%) had moderate and 39 (56.52%) patients had severe COVID-19 infection. 62 (89.85%) patients had post covid symptoms. Out of the sixty-nine patients with COVID-19, nine patients (9/69, 13.04%) had peak serum cortisol <18 mg/dL suggestive of secondary adrenal insufficiency. Peak serum cortisol did not differ according to disease severity [Mild, (13.03 ± 4.08 mg/dL) vs moderate, [(11.52 ± 2.40 mg/dL) vs severe, (13.70 ± 1.43 mg/dL), P = 0.67]. In addition, there was no difference in peak serum cortisol in patients with or without adrenal insufficiency [(12.99 ± 2.54 mg/dL) vs (22.44±5.52 mg/dL), P = 0.09 respectively. Conclusion: HPA axis is affected in 13.04% of patients 3 months after presentation with COVID-19. These findings have important implications for the clinical care and long-term follow-up of patients after COVID-19.

Thyroid function abnormalities in hospitalized patients with COVID-19 infection - A cross-sectional study

Background: Thyroid gland expresses ACE-2 receptors. It is thus a potential target for involvement by the COVID virus. Also, the cytokine storm and various drugs used in the treatment for COVID-19 can affect the thyroid function tests. Aim: To study thyroid function abnormalities in hospitalized patients with COVID19 infection. Objective: To study the proportion of patients with thyroid function abnormalities in hospitalized patients with COVID-19 infection. Results: Total 271 Covid -19 patients were included in the study, of which 27 were asymptomatic, 158 mild, 39 moderate and 47 severe categories classified according to the MOHFW criteria. The mean age was 49 ±17 years, 64.9% were male. Abnormal thyroid function test was present in 37.2% (101/271) patients. Low fT3, low fT4 and low TSH were present in 21.03%, 15.9% and 4.5%, respectively. Mean fT3 and fT3/fT4 ratio decreased with increasing severity of COVID-19 illness (p=0.000). In multivariate analysis, low fT3 was associated with increased risk of mortality (OR 12.36, 95% CI: 1.23- 124.19;P=0.033). Conclusion: Low fT3 and fT3/fT4 ratio helps to predicts disease severity. Low fT3 is associated with increased risk of mortality.

Challenges and opportunities in conducting research with older adults with dementia during COVID-19 and beyond.

The coronavirus disease 19 (COVID-19) pandemic has created significant and new challenges for the conduct of clinical research involving older adults with Alzheimer's disease and related dementias (ADRD). It has also stimulated positive adaptations in methods for engaging older adults with ADRD in research, particularly through the increased availability of virtual platforms. In this paper, we describe how we adapted standard in-person participant recruitment and qualitative data collection methods for virtual use in a study of decision-making experiences in older adults with ADRD. We describe key considerations for the use of technology and virtual platforms and discuss our experience with using recommended strategies to recruit a diverse sample of older adults. We highlight the need for research funding that supports the community-based organizations on which improving equity in ADRD research participation often depends.

The mediating role of work-life balance on the relationship between job resources and job satisfaction: perspectives from Indian nursing professionals

Purpose: The purpose of this study is to empirically investigate the mediating effect of work-life balance (WLB) in the relationship between three significant job resources (namely, job autonomy, supervisor support and co-worker support) and job satisfaction experienced by frontline nursing professionals during the COVID-19 pandemic in an Indian setting using the theoretical foundation of job demands-resources theory. Design/methodology/approach: Structured questionnaire survey has been used to get the responses from 452 nursing professionals in India during the COVID-19 pandemic. To carry out data analysis structural equation modeling has been used. Findings: The results reveal the relationship between the framed hypotheses. Surprisingly, the relationship between all three job resources and WLB was found to be positive, and also WLB was positively associated with nursing professionals’ job satisfaction during pandemic situations. However, WLB partially mediated the relationship only between two job resources (namely, job autonomy and supervisor support) and job satisfaction. Originality/value: The research paper addresses Indian nursing professionals’ perceptions of job resources, WLB and job satisfaction during the COVID-19 pandemic. This paper seeks to examine such a relationship when nursing professionals’ worked round the clock with intuitive expertise and cautiousness to provide quality care and responded more efficiently to scarce resource situations. © 2021, Emerald Publishing Limited.

Exploring the SARS-Cov-2 Main Protease (Mpro) and RdRp Targets by Updating Current Structure-based Drug Design Utilizing Co-crystals to Combat COVID-19.

The unprecedented pandemic of COVID-19 caused by the novel strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) engulfs millions of death worldwide. It has directly hit the socio-economic status of the affected countries. There are more than 219 countries badly affected by the COVID-19. There are no particular small molecule inhibitors to combat the dreadful virus. Many antivirals, antimalarials, antiparasitic, antibacterials, immunosuppressive antiinflammatory, and immune stimulatory agents have been repurposed for the treatment of COVID-19. But the exact mechanism of action of these drugs towards COVID-19 targets has not been experimented with yet. Under the effect of chemotherapeutics, the virus may change its genetic material and produces various strains, which are the main reasons behind the dreadful attack of COVID-19. The nuclear genetic components are composed of main protease and RNA-dependent RNA polymerase (RdRp) which are responsible for producing nascent virion and viral replication in the host cells. To explore the biochemical mechanisms of various small molecule inhibitors, structure-based drug design can be attempted utilizing NMR crystallography. The process identifies and validates the target protein involved in the disease pathogenesis by the binding of a chemical ligand at a well-defined pocket on the protein surface. In this way, the mode of binding of the ligands inside the target cavity can be predicted for the design of potent SARS-CoV-2 inhibitors.

Effective use of online Teaching-Learning Platform and MOOC for Virtual Learning

The process of Teaching-Learning has evolved tremendously within the last 5-10 years. The mode of teaching is changed from normal blackboard classroom teaching to technological teaching. Due to the COVID-19 outbreak, the education system has been disrupted especially;it affects more for Higher Educational Institutes where students have come from various regions. The immediate lockdown in the country made the outside students reach their homes without any prior knowledge of its effects. Most of the education sector has switched to distance learning. Our institute has also adopted Virtual Learning. Various virtual platforms are available as the Learning Management System. We have adopted the use of ICT in education for the last 3-4 years. This helped us to handle the Teaching-Learning during a pandemic outbreak. We have used Moodle Learning Management System for Virtual Learning. Learners Centric MOOCs (LCM) model is implemented through LMS and the effectiveness is improved by adding Feedback and Assessment to it. The LCM model consists of structural elements: Learning Dialogs (LeD) in the form of short 10 to 12 minutes Videos, Learning by Doing (LbD) in the form of an assignment question or activity to do, Learning Experience Interactions (LxI) in the form reflection spot and discussion on the video provided and Learning Extension Trajectories (LxT) in the form of a small quiz on the video and resources. The major challenge for Virtual Learning is learner’s engagement. We have added feedback to improve the teaching-learning process. The model is effectively applied for Third Year Computer Science and Engineering class. The course of Compiler Construction is taken in to account for the implementation. A total of 73 students were involved in this activity. The results of feedback from students are satisfactory. More than 83% of the learners have given positive feedback towards this technological change of teaching. Learner’s engagement has improved to 30%.

An overview of immunological response, anti-viral therapy and vaccine development against severe acute respiratory syndrome coronavirus (Sars-cov)-2

SARS-CoV-2, the causative agent of COVID-19 disease belongs to the group beta-coronavirus, which have infected around 120 million people so far with a 2.65 million death toll worldwide. Coronaviruses are enveloped viruses having positive sense, single-stranded RNA genome (26-32 kb size). This paper mainly reviews/focuses on the existing development on the vaccination and drugs developed against severe acute respiratory syndrome coronavirus (SARS-CoV). SARS-CoV, Middle East respiratory syndrome coronavirus (MERS-CoV), and the novel SARS-CoV-2 have come out as highly fatal strains of coronavirus for human beings. Novel SARS-CoV-2 requires angiotensin-converting enzyme 2 (ACE2) as its foothold receptor to gain entry into the host cells. Infected patients develop symptoms of fever, nonproductive cough, fatigue, dyspnea, sometimes diarrhoea and radiographic evidence of pneumonia. The immune system reacts violently against the virus spread inside the body which gives rise to a condition known as a cytokine storm. The potential anti-viral medicines suggested for COVID-19 treatment were hydroxychlo-roquine, Lopinavir/Ritonavir etc. which showed some combined effects, positive and negative. Many vaccines candidates are under different phases of trials all over the world against SARS-CoV-2. The main cause which enabled the quick development of vaccine technologies against SARS-CoV-2 was that an already established knowledge of the structure and function of its close associates namely SARS and MESRS was present. Molecular platforms used in vaccine development against SARS-CoV-2 are live attenuated vaccines, DNA based vaccines, RNA based vaccines, protein subunits and replicating viral vector vaccines. © IJCRR.

Asymptomatic SARS-CoV-2 Infection and COVID-19 Mortality During an Outbreak Investigation in a Skilled Nursing Facility.

BACKGROUND: Outbreaks of coronavirus disease 2019 (COVID-19) have been reported in nursing homes and assisted living facilities; however, the extent of asymptomatic and presymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in this high-risk population remains unclear. METHODS: We conducted an investigation of the first known outbreak of SARS-CoV-2 at a skilled nursing facility (SNF) in Illinois on 15 March 2020 and followed residents for 30 days. We tested 126/127 residents for SARS-CoV-2 via reverse-transcription polymerase chain reaction and performed symptom assessments. We calculated the point prevalence of SARS-CoV-2 and assessed symptom onset over 30-day follow-up to determine: (1) the proportion of cases who were symptomatic, presymptomatic, and asymptomatic and (2) incidence of symptoms among those who tested negative. We used the Kaplan-Meier method to determine the 30-day probability of death for cases. RESULTS: Of 126 residents tested, 33 had confirmed SARS-CoV-2 on 15 March. Nineteen (58%) had symptoms at the time of testing, 1 (3%) developed symptoms over follow-up, and 13 (39%) remained asymptomatic. Thirty-five residents who tested negative on 15 March developed symptoms over follow-up; of these, 3 were re-tested and 2 were positive. The 30-day probability of death among cases was 29%. CONCLUSIONS: SNFs are particularly vulnerable to SARS-CoV-2, and residents are at risk of severe outcomes. Attention must be paid to preventing outbreaks in these and other congregate care settings. Widespread testing and infection control are key to help prevent COVID-19 morbidity and mortality in these high-risk populations.

First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first detected in China in December, 2019. In January, 2020, state, local, and federal public health agencies investigated the first case of COVID-19 in Illinois, USA. METHODS: Patients with confirmed COVID-19 were defined as those with a positive SARS-CoV-2 test. Contacts were people with exposure to a patient with COVID-19 on or after the patient's symptom onset date. Contacts underwent active symptom monitoring for 14 days following their last exposure. Contacts who developed fever, cough, or shortness of breath became persons under investigation and were tested for SARS-CoV-2. A convenience sample of 32 asymptomatic health-care personnel contacts were also tested. FINDINGS: Patient 1-a woman in her 60s-returned from China in mid-January, 2020. One week later, she was hospitalised with pneumonia and tested positive for SARS-CoV-2. Her husband (Patient 2) did not travel but had frequent close contact with his wife. He was admitted 8 days later and tested positive for SARS-CoV-2. Overall, 372 contacts of both cases were identified; 347 underwent active symptom monitoring, including 152 community contacts and 195 health-care personnel. Of monitored contacts, 43 became persons under investigation, in addition to Patient 2. These 43 persons under investigation and all 32 asymptomatic health-care personnel tested negative for SARS-CoV-2. INTERPRETATION: Person-to-person transmission of SARS-CoV-2 occurred between two people with prolonged, unprotected exposure while Patient 1 was symptomatic. Despite active symptom monitoring and testing of symptomatic and some asymptomatic contacts, no further transmission was detected. FUNDING: None.