A serum interleukin-6-based analysis of patients with nasopharyngeal swab reverse-transcriptase polymerase chain reaction negative for SARS-CoV-2 infection with CO-RADS 4 and 5 on computed tomography of the chest

Background: Serum interleukin 6 (IL-6) levels have been studied in the diagnostic evaluation of patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease (COVID-19). Methods: We studied the utility of treatment with tocilizumab in COVID-19 patients (n=19) with a negative nasopharyngeal swab real time reverse transcriptase polymerase chain reaction (RT-PCR) test for SARS-CoV-2 who had suggestive computed tomography (CT) findings, namely, COVID-19 Reporting and Data System (CO-RADS) 4,5. Results: Receiver operator characteristic (ROC) curve analysis showed that serum IL 6 at a cut-off of >56.9 pg/L was a predictor of mortality in nasopharyngeal swab RT-PCR negative patients with suggestive CT findings. Tocilizumab had no significant effect on the mortality. Conclusions: In nasopharyngeal swab RT-PCR negative patients with suggestive chest CT findings, elevated serum IL-6 levels > 56.9 pg/L predicted mortality. However, treatment with tocilizumab had no effect on mortality.

Blockchain-based voter registry management system

Aims: Excess mortality during the SARS-CoV-2 pandemic has been studied in many countries. Accounting for population aging has important implications for excess mortality estimates. We show the importance of adjustment for age trends in a small-scale mortality analysis as well as the importance of analysing different pandemic phases for mortality in an urban population. Methods: Population data for Frankfurt/Main for 2016-2021 were obtained from the Municipal Office of Statistics, City of Frankfurt/Main. Mortality data from 2016 to 2021 were provided by the Hessian State Authority. For standardized mortality ratios (SMR=observed number of deaths divided by the expected number of deaths), the expected number of deaths was calculated in two ways: For SMRcrude, the mean mortality rate from the years 2016-2019 was multiplied by the total number of residents in 2020 and 2021 separately. For SMRadjusted, this procedure was performed separately for five age groups, and the numbers of expected deaths per age group were added. Results: SMRcrude was 1.006 (95% CI: 0.980-1.031) in 2020, and 1.047 (95% CI: 1.021-1.073) in 2021. SMRadjusted was 0.976 (95% CI: 0.951-1.001) in 2020 and 0.998 (95% CI: 0.973-1.023) in 2021. Excess mortality was observed during pandemic wave 2, but not during pandemic waves 1 and 3. Conclusion: Taking the aging of the population into account, no excess mortality was observed in Frankfurt/Main in 2020 and 2021. Without adjusting for population aging trends in Frankfurt /Main, mortality would have been greatly overestimated. © The Authors.

Corrigendum: Impact of a tobacco sales ban on the frequency of tobacco consumption in India during the COVID-19 pandemic.

[This corrects the article DOI: 10.18332/tid/161855.].

Impact of a tobacco sales ban on the frequency of tobacco consumption in India during the COVID-19 pandemic

INTRODUCTION Measures to address the COVID-19 pandemic in India included a ban on the sale and use of tobacco products during 2020 when stay at home guidance (lockdown) was in place. In this study we examined the extent of reduction in frequency of tobacco consumption across all products. METHODS Telephone survey was conducted between July and August 2020 across an existing cohort of tobacco users (n=801) residing in Delhi (55.4%) and Chennai (44.6%), India. The participants were recruited irrespective of their gender and use of any kind of tobacco product(s). The survey questionnaire was based on the STOP (Studying Tobacco users Of Pakistan) survey and adapted to the context of smoking and smokeless tobacco use in India. RESULTS Cigarette consumption declined from a median value of 5.0 (IQR: 2–10) sticks in the pre-lockdown period to 2.0 (IQR: 0.4–5) sticks during the lockdown period. Reductions were reported in the daily use of bidis, from 8 (IQR: 4–12) sticks to 5 (IQR: 2–10) sticks and for smokeless tobacco users from 3.5 (IQR: 2–5) packs to 2 (IQR: 1–4) packs during the lockdown. Furthermore, the number of daily cigarette smokers in our cohort decreased from 32.6% (n=261) in the pre-lockdown period to 27.5% (n=220) during lockdown and smokeless tobacco users decreased from 35.8% (n=287) in pre-lockdown period to 30.3% (n=243) during the lockdown period. CONCLUSIONS The decrease in tobacco use can be attributed to various societal and environmental factors. However, the pandemic-linked lockdown provided an opportune condition to reduce the use of tobacco products, which could be due to restricted access and increase in health awareness during the COVID-19 lockdown.

Early living donor liver transplantation for alcohol-associated hepatitis.

INTRODUCTION AND OBJECTIVES: Lately, there has been a steady increase in early liver transplantation for alcohol-associated hepatitis (AAH). Although several studies have reported favorable outcomes with cadaveric early liver transplantation, the experiences with early living donor liver transplantation (eLDLT) are limited. The primary objective was to assess one-year survival in patients with AAH who underwent eLDLT. The secondary objectives were to describe the donor characteristics, assess the complications following eLDLT, and the rate of alcohol relapse. MATERIALS AND METHODS: This single-center retrospective study was conducted at AIG Hospitals, Hyderabad, India, between April 1, 2020, and December 31, 2021. RESULTS: Twenty-five patients underwent eLDLT. The mean time from abstinence to eLDLT was 92.4 ± 42.94 days. The mean model for end-stage liver disease and discriminant function score at eLDLT were 28.16 ± 2.89 and 104 ± 34.56, respectively. The mean graft-to-recipient weight ratio was 0.85 ± 0.12. Survival was 72% (95%CI, 50.61-88) after a median follow-up of 551 (23-932) days post-LT. Of the 18 women donors,11 were the wives of the recipient. Six of the nine infected recipients died: three of fungal sepsis, two of bacterial sepsis, and one of COVID-19. One patient developed hepatic artery thrombosis and died of early graft dysfunction. Twenty percent had alcohol relapse. CONCLUSIONS: eLDLT is a reasonable treatment option for patients with AAH, with a survival of 72% in our experience. Infections early on post-LT accounted for mortality, and thus a high index of suspicion of infections and vigorous surveillance, in a condition prone to infections, are needed to improve outcomes.

The WHO's 75th anniversary: WHO at a pivotal moment in history.

The World Health Organisation (WHO) was inaugurated in 1948 to bring the world together to ensure the highest attainable standard of health for all. Establishing health governance under the United Nations (UN), WHO was seen as the preeminent leader in public health, promoting a healthier world following the destruction of World War II and ensuring global solidarity to prevent disease and promote health. Its constitutional function would be 'to act as the directing and coordinating authority on international health work'. Yet today, as the world commemorates WHO's 75th anniversary, it faces a historic global health crisis, with governments presenting challenges to its institutional legitimacy and authority amid the ongoing COVID-19 pandemic. WHO governance in the coming years will define the future of the Organisation and, crucially, the health and well-being of billions of people across the globe. At this pivotal moment, WHO must learn critical lessons from its past and make fundamental reforms to become the Organisation it was meant to be. We propose reforms in WHO financing, governance, norms, human rights and equity that will lay a foundation for the next generation of global governance for health.

Stability analysis and approximate solution of interval mathematical model for the COVID-19 pandemic

In this paper, an interval solution has been constructed for the system of differential equations (SDEs) governing the COVID-19 pandemic with uncertain parameters, namely, interval. The imposition of lockdown on infective has been considered as an interval parameter. As a result, the complete system of first-order differential equations is transformed into interval form. The resulting interval system of differential equations (ISDEs) has been solved with help of the parametric concept and the Runge–Kutta method of order 4. Obtained results are compared with existing crisp results, and they are found to be in good agreement. © 2023 John Wiley & Sons, Ltd.

COVID-19 forecasting and investigating the impact of the lockdown in India

This study aimed to forecast the growth pattern of COVID-19 in India and evaluate the impact of the lockdown on its transmission and mortality. Different models were compared for short-term forecasts, and it was found that the hybrid autoregressive integrated moving average (ARIMA) with error-remodelling using fast Fourier transform produced more accurate estimates. Furthermore, the study utilized data from the first phase of the lockdown, which generated more precise predictions. The impact analysis revealed a significant trend break on 3 March for confirmed cases and 11 March for deaths. Overall, the study highlights the effectiveness of the lockdown measures in reducing the spread of COVID-19 in India and emphasizes the need for continued monitoring and surveillance to control its transmission.

Child mental health in the milieu of online education

The aim of this chapter is to examine the impact of online education on mental health of children, and explore methods to improve the same. With the advent of COVID-19 pandemic, major overhauls were made in day-to-day life including work, home, and education. Shift to online mode of instruction became the primary, if not the only, channel of education. This drastic shift has led to issues like limited social interaction, learning gaps due to insufficient in-person interaction, excessive screen time on devices, and decreased physical activity, which can impact mental health of children. This chapter will explore the impact of online learning on the mental health of children from both mental ill-health and well-being perspectives, the role of parents, teachers, and educational systems, and challenges and opportunities presented by the situation. Further to this, the ways to safeguard and improve mental health of children in the milieu of online education will be discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Liver and Biliary Tract Disease in Patients with Coronavirus disease-2019 Infection.

Coronavirus disease-2019 (COVID-19) had become a global pandemic since March 2020. Although, the most common presentation is of pulmonary involvement, hepatic abnormalities can be encountered in up to 50% of infected individuals, which may be associated with disease severity, and the mechanism of liver injury is thought to be multifactorial. Guidelines for management in patients with chronic liver disease during COVID-19 era are being regularly updated. Patients with chronic liver disease and cirrhosis, including liver transplant candidates and liver transplant recipients are strongly recommended to receive SARS-CoV-2 vaccination because it can reduce rate of COVID-19 infection, COVID-19-related hospitalization, and mortality.

Effectiveness of Remdesivir Treatment Protocols Among Patients Hospitalized with COVID-19: A Target Trial Emulation.

BACKGROUND: Remdesivir is recommended for certain hospitalized patients with COVID-19. However, these recommendations are based on evidence from small randomized trials, early observational studies, or expert opinion. Further investigation is needed to better inform treatment guidelines with regard to the effectiveness of remdesivir among these patients. METHODS: We emulated a randomized target trial using chargemaster data from 333 US hospitals from 1 May 2020 to 31 December 2021. We compared three treatment protocols: remdesivir within 2 days of hospital admission, no remdesivir within the first 2 days of admission, and no remdesivir ever. We used baseline comorbidities recorded from encounters up to 12 months before admission and identified the use of in-hospital medications, procedures, and oxygen supplementation from charges. We estimated the cumulative incidence of mortality or mechanical ventilation/extracorporeal membrane oxygenation with an inverse probability of censoring weighted estimator. We conducted analyses in the total population as well as in subgroups stratified by level of oxygen supplementation. RESULTS: A total of 274,319 adult patients met the eligibility criteria for the study. Thirty-day in-hospital mortality risk differences for patients adhering to the early remdesivir protocol were -3.1% (95% confidence interval = -3.5%, -2.7%) compared to no early remdesivir and -3.7% (95% confidence interval -4.2%, -3.2%) compared to never remdesivir, with the strongest effect in patients needing high-flow oxygen. For mechanical ventilation/extracorporeal membrane oxygenation, risk differences were minimal. CONCLUSIONS: We estimate that, among hospitalized patients with COVID-19, remdesivir treatment within 2 days of admission reduced 30-day in-hospital mortality, particularly for patients receiving supplemental oxygen on the day of admission.

Child mental health in the milieu of online education

The aim of this chapter is to examine the impact of online education on mental health of children, and explore methods to improve the same. With the advent of COVID-19 pandemic, major overhauls were made in day-to-day life including work, home, and education. Shift to online mode of instruction became the primary, if not the only, channel of education. This drastic shift has led to issues like limited social interaction, learning gaps due to insufficient in-person interaction, excessive screen time on devices, and decreased physical activity, which can impact mental health of children. This chapter will explore the impact of online learning on the mental health of children from both mental ill-health and well-being perspectives, the role of parents, teachers, and educational systems, and challenges and opportunities presented by the situation. Further to this, the ways to safeguard and improve mental health of children in the milieu of online education will be discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

COVID-19 Forecasting and Investigating the Impact of the Lockdown in India

The paper attempts to forecast the growth pattern of the COVID-19 spread in India and examines the impact of the lockdown on its spread and deaths. Comparing different models for short-term forecasts—hybrid autoregressive integrated moving average with error-remodelling using fast Fourier transform—has been found to have better accuracy. It is observed that the data set starting from the first phase of the lockdown generates more accurate estimates. The impact analysis shows a clear trend break on 3 March for confirmed cases and 11 March for the deaths. © 2023 Economic and Political Weekly. All rights reserved.

Impacts of COVID-19-induced lockdown and key reforms in the Indian fisheries sector-a stakeholders' perspective.

The COVID-19 pandemic-induced lockdown has indisputably affected the aquaculture industry across the globe. India imposed a nationwide lockdown to contain the outbreak of COVID-19 that disrupted normalcy and economic activities. The fisheries sector was also highly affected. Hence, a study was conducted from July to December 2020 to understand the stakeholders' perception of the impact of COVID-19 lockdown, wherein 517 stakeholders participated (online) in the first stage. The policy reforms suggested by the stakeholders were referred to the fisheries experts in the second stage for prioritization towards implementation. Data analysis depicted that a majority (81%) of the stakeholders were aware of COVID-19 lockdown impacts on their businesses. Due to this unprecedented lockdown, labour availability was hampered, transport facilities were fully halted and access to inputs like seed, feed, and advisory were largely affected. Importantly, all stakeholders unanimously adduced to the uncertainty over the future of the fisheries sector. Moreover, fishery experts feel that enabling policies for the promotion of awareness, appropriate training, and transparency in the implementation of schemes, credit facilities, and price regulation can have a massive positive impact. Furthermore, the study also recommends utilizing the potential of e-resources (ICTs and IoT) to digitize the business networking of fishery sector stakeholders.

Low Serum Albumin at Admission Is Associated with Mortality among Inpatients with Cirrhosis: A Multi-National Experience

Background: MELD and Child-Pugh scores have traditionally been used as prognostic indicators in patients with cirrhosis. Albumin infusions in outpatients have been associated with improved outcomes, but not in transplant waitlisted patients or inpatients. This aim of this study was to assess whether low serum albumin (sAlb) on admission alone is a poor prognostic indicator among cirrhotic inpatients from a new multi-national cohort. Method(s): The CLEARED study is a global study that enrolled consecutive non-electively admitted inpatients without organ transplant or COVID-19 from 6 continents. Admission demographics, medical history, laboratory data, inpatient course, death/hospice transfer and mortality at 30 days post-discharge were recorded. Patients were divided into 3 groups: sAlb <28gm/L(A), sAlb >=28 but <35gm/L (B), and sAlb>=35gm/L (C) were compared. Multi-variable logistic regression was performed using inpatient mortality and overall 30-day mortality as outcomes. Result(s): 2429 patients were enrolled from 21 countries worldwide. The distribution was A:49%, B:39%, C:12%. Gp A patients were significantly younger (54yrs vs. 57yrs vs 58yrs p<0.0001) but with similar gender distribution, and higher MELD-Na score of 25 vs. 20 vs. 17 (p<0.0001). Gp A patients were more likely to have alcohol as etiology of cirrhosis (49% vs. 45% vs 38%, p=0.004), and were more likely to have either infection (27% vs. 18% vs. 13%, p<0.0001), HE (39% vs. 33% vs. 23%, p=0.005) or fluid related issues as a reason for admission (p<0.0001). More patients in Gp A received albumin infusion during their hospital stay (120gm vs. 100gm vs. 100gm p=0.0004), mostly for the indications of AKI (47% vs. 49% vs. 47%, p=0.79) and performance of large volume paracentesis (44% vs. 42% vs. 41%, p=0.80), followed by bacterial peritonitis indication (22% vs. 17% vs. 11%, p=0.01). Group A patients had longer hospital stays (9 days vs. 8 days vs. 7 days (p<0.001), but similar ICU transfer (23% vs. 22% vs. 20%, p=0.55). group A patients were more likely to die while inpatients (19% vs. 11% vs. 5%, p<0.0001), or by 30 days post-discharge (29% vs. 20% vs. 9%, p<0.0001). Table shows the admission variables associated with a poor outcome. Conclusion(s): Hypoalbuminemia is extremely common among admitted cirrhotic patients, with sAlb of <28gm/L occurring in almost half. Together with MELD-Na score and infection at admission, a low sAlb is associated with a poor outcome in these patients. Future studies will need to validate these findings and to assess whether albumin infusions will improve the outcome of these patients. (Figure Presented).

Differences in Mortality Rates in Inpatients with Cirrhosis Depends on the Low, Middle or High Income Country Location: Multi-National Cleared Consortium Experience

Background: Although cirrhosis is a major cause of mortality worldwide, there could be disparities in outcomes. This needs a global consortium to study disparities in inpatient cirrhosis care Aim: Define the impact of location in prediction of outcomes in inpts with cirrhosis. Method(s): CLEARED prospectively enrolled non-electively admitted cirrhosis pts without COVID from all continents. To ensure equity, we allowed only 50 pts/site. Admission details, cirrhosis history, inpatient & 30-day course were recorded. World bank classification of low/low middle income (LMI), upper middle (UMI) & High income (HI) were used. Cirrhosis details, inpatient & 30-day outcomes were compared between groups. Multi-variable regression was performed using inpatient & 30-day mortality as outcomes. Result(s): 2758 pts from 21 countries from all continents, including Africa & Australia, were included.727 were L/LMI, 1050 UMI & 981 pts were from HICs. More men & younger pts were in LMI. Cirrhosis details: More pts in HI gp had 6M hospitalizations & infections, HE & ascites while prior variceal bleeding was higher in LMI . Prior HCC & transplant listings were lower in LMI but similar in UMI/HI. Alcohol & NASH was highest in HI. Viral hepatitis & cryptogenic were highest in UMI.Admissions: Admission MELD was highest in LMI. LMI pts were admitted more for GI Bleed, HE, & DILI, while anasarca & HBV flares were higher in UMI. Higher SBP (36% vs 24% vs 21% p<0.0001) & lowest skin/soft-tissue infections were in LMI (5% vs 5% vs 10% p=0.008);rest were similar. Nosocomial infections, driven by UTI were highest in LMI & HI pts (15% vs 14% vs 11% UMI, p=0.03). Admission diuretics, PPIs, Lactulose & statins were highest & antivirals lower in HI. SBP prophylaxis & rifaximin were highest in LMI pts. Outcome(s): More LMI pts needed ICU & had more organ failures (Fig B). Discharge MELD was highest in LMI. In-hospital mortality was highest & transplant lowest in LMI. This extended to 30-day mortality & transplant in LMI patients vs HI pts.Regression: In-hospital mortality was linked with age, infections, MELD & being in a LMI/UMI vs HIC while being on a transplant list, diabetes, & SBP prophylaxis were protective (Fig C). 30-day mortality predicted by age, ascites, HCC, discharge MELD, organ failures, LMI/UMI vs HIC but rifaximin was protective(Fig D). In-hospital transplant was higher with high MELD, admission rifaximin & listed pts &lower in LMI (OR 0.26) & UMI (OR 0.22) & age. 30-day transplant was higher in those with hyponatremia, ascites & HRS, on the list & on rifaximin and lower in LMI (OR 0.24) & UMI (OR 0.59) vs HI. Conclusion(s): In a global study of inpatients with cirrhosis, there were major differences in outcomes. Not being in a high-income country significantly increased the risk of inpatient and 30-day mortality independent of demographics, medications, in-hospital course, and cirrhosis severity likely due to disparities in access to transplant, which should be accounted for in global models. (Figure Presented).

NEURAL NETWORK AIDED OPTIMIZED AUTO ENCODER AND DECODER FOR DETECTION OF COVID-19 AND PNEUMONIA USING CT-SCAN

Most of the countries in the world are now fighting against Covid-19 and many of the people are losing their life because of the less immunity or due to the late diagnostics and it is especially in the case of old age people and people with other medical issues. The concept of early detection of disease is really important in the case of the Covid-19 scenario because along with the infected people, the other people who are in close contact with the infected persons will also have life risk. During this pandemic, pneumonia and Covid-19 people suffers from almost the same symptoms. So, the proposed work designs an automated system that can perform multi-classification on general health, pneumonia and Covid-19 through Chest X-Rays by designing an optimized auto encoder- decoder network. Most of the earlier approaches which are used to perform the binary classification couldn't differentiate the Covid-19 and Pneumonia effectively because the traditional CNN extract the high level features, which are similar in case of COVID-19 & Pneumonia. These two have variations in the case of low level features. The major focus of this paper is to construct a hyper-parameterized auto encoder-decoder system that can help the user to detect level of lung infection. The level of infection helps the model to accurately classify the model. This method helps doctors and other medical-related people with the early diagnosis of disease. © 2022 Little Lion Scientific.

COVID-19 and Clotting: A Wave of Acute Limb Ischemia

Introduction: A surge in the number of patients with acute limb ischemia (ALI) was seen during the first and second waves of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. This has been ascribed to the hypercoagulable state seen in COVID infections. The aim of this study is to report our experience and outcomes of ALI associated with SARS-CoV-2 infection. Materials and Methods: It was a single-center observational retrospective study from a prospectively maintained database of patients with SARS-CoV-2 infection presenting with ALI between July 2020 and December 2020 with 1-year follow-up. Results: Thirty-nine acutely ischemic limbs were treated in 32 patients including three upper limbs. The mean age of patients was 55.75 (range: 27-80). There were 23 (71.87%) males and 9 (28.12%) females. Majority of the limbs were in Class IIB of ALI, whereas 20.51% had irreversible ischemia. Of the 39 affected limbs in 32 patients, 22 limbs were revascularized, 9 had primary amputation, and 8 were managed conservatively with anticoagulation. The overall limb salvage was 26 out of 39 limbs (66.7%), whereas it was 81.8% for the limbs that had an intervention. The overall mortality was 9.4%. There was no further limb loss or mortality during 1-year follow-up. Interestingly, 15 patients did not have any symptoms suggestive of SARS-CoV-2 infection other than ALI. The severity of COVID infection did not correlate with the severity of ALI. Conclusion: COVID-19 infection can be associated with arterial thrombosis and ALI, which, if treated early with appropriate intervention, can result in a satisfactory limb salvage rate. Prophylactic anticoagulation in COVID-19-infected patients may not prevent arterial thrombosis, and the clinical severity of the COVID-19 infection is not a predictor of arterial thrombosis.

Covid Contact Tracing App

The new eruption of COVID-19 has overpowered the world, convinced lockdowns and pushed general clinical consideration systems. Covid is known to be a significantly overpowering disease, and spoiled individuals at first don't show signs, while some stay asymptomatic. The new eruption of COVID-19 has overpowered the world, convinced lockdowns and focused on general clinical consideration structures. Covid is known to be significantly compelling contamination, and corrupted individuals at first don't show signs, while some stay asymptomatic. In like manner, various assemblies have shown uncommon interest in cell contact following applications that help with robotizing the inconvenient task of following all new contacts of late perceived polluted individuals. We give an overview of several suggested methods following results in the increase, many of which have been distributed nationally, and discuss the concerns clients have expressed about their use. © 2022 IEEE.

Travel data collection using a smart phone for the estimation of multimodal travel times of intra-city public transportation

All the available modes of travel and their respective travel parameters must be known to the commuters before their trip. Otherwise they may either spend more money or more time for the trip. In addition to this, recent pandemic, rapidly spreading novel corona virus is demanding a smart solution for contactless commuting. This paper suggests a practical solution to make both the above possible and it emphasizes the applicability of two developed android applications, one for travel data collection and another to predict travel time for a multimodal trip within the study area. If the whole trip is by a single mode, the user can get the corresponding travel time estimate from “Google maps”. But, if the trip is by multiple modes, it is not possible to get the total travel time estimate for the whole trip at a time from “Google maps”. A separate travel mode for “auto” is unavailable in “Google maps” alongside drive, two-wheeler, train or bus and walk alternatives. It is also observed that the travel time estimate of “Google maps” for the city buses is inaccurate. Hence, the two modes (Buses and Autos) were chosen for the study. Unless and until the travel times and stopping times of the two modes are known, it is not possible to predict their trip times. Hence, the mobility analysis was performed for the two modes in the study area to find their respective average travel rate at peak hours, across 15 corridors and the results were presented. © 2022. Kanala Teja Vinay Kumar Reddy, Surya Prakash Challagulla.