Retrospective Analysis of Neutralizing Antibody Cocktail (Casirivimab and Imdevimab): A Game Changer in Treating Mild COVID-19 Patients

Our retrospective study aimed to evaluate the effectiveness of monoclonal antibodies (casirivimab and imdevimab) on mild cases of coronavirus disease 2019 patients admitted to the tertiary care center. A total of 161 patients were evaluated of which the test group consisted of 79 and the control group of 82. In the test group the patients had been administered with diluted 250 ml of 0.9 % sodium chloride along with co-formulated casirivimab (600 mg) and imdevimab (600 mg) solution intravenously and in the control group the patients were administered standard coronavirus disease 2019 treatment protocol. The monitoring of patients in both groups was done at least 1 h after drug infusion in the designated room. Post-treatment designed interviews were taken to evaluate the effectiveness of treatment. This retrospective analysis discovered a significant association of symptoms with the group at 48 h for injected and non-injected patients and 1 mo from the chi-square test after injecting monoclonal antibodies. There is no significant association of symptoms with the groups at 3 mo. A significant difference in the symptom distribution through different time points in the injected group and not injected group was observed. From the pairwise McNemar's test, a significant difference in the symptoms between each time in 48 h, the difference was p=0.0075 and after 1 mo, p<0.001 points in both groups. The combination of casirivimab and imdevimab could be considered a treatment of choice for vaccinated, non-vaccinated and mild to highrisk coronavirus disease 2019 patients.

Remote Employee Monitoring and Management

Organizations have moved towards tracking their employees’ devices and keeping track of their work. We intend to develop a system that not only respects the privacy of employees but also helps employers manage their employees and also get a reliable productivity report. We have been able to monitor the background activities and log in the application names and their active time. The employee authentication process is implemented via a face recognition system which helps in maintaining authenticity. A total of 135 desktop apps and websites were opened while using the application and out of that 125 were successfully logged and their time was recorded accurately and productivity was calculated. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Determining the Impact of the COVID-19 Pandemic on Hand Surgery Fellowship Education

The purpose of this study is to report the impact of COVID-19 on hand surgery fellow learning and preparedness for practice. A multi-dimensional questionnaire was distributed to current hand fellows and fellowship directors across the United States. Survey questions included fellowship location, institutional response, impact on practice, education and job search. Thirty-two hand surgery fellows and 14 fellowship directors completed the survey. Of fellows, 59% reported a greater than 75% decrease in case volume. Mean hours worked per week per fellow decreased by 52%. All fellowship directors and 94% of fellows did not expect COVID-19 to impact their ability to graduate, and nearly all fellows felt prepared to start practice after fellowship training. However, many fellows expressed concern about job opportunities. The work hours and exposure of hand surgery fellows to elective surgical cases have been adversely impacted by COVID-19. Nevertheless, current hand fellows feel prepared to enter practice. (Journal of Surgical Orthopaedic Advances 31(1):048-052, 2022).

SAFETY AND CRITERIA FOR PERCUTANEOUS LEFT ATRIAL APPENDAGE OCCLUSION SAME DAY DISCHARGE

Background: Left Atrial Appendage Occlusion (LAAO) with the Watchman device is considered an elective procedure, and thus often deferred during outbreak peaks associated with the COVID-19 pandemic. Patients with bleeding issues on anticoagulation may require additional hospitalization for bleeding episodes or suffering increased risk of stroke by postponing occlusion while anticoagulation is discontinued. We chose to develop a protocol for screening, same day discharge, and follow up of selected LAAO patients and continuing to provide quality clinical outcomes while accounting for decreased bed and staff capacity due to the pandemic. Methods: Utilizing Knowledge to Action (KTA) nursing framework, a protocol was developed and reviewed with key stakeholders. Criteria for Same Day Discharge (SDD) includes: support at home, stable vitals and access site hemostasis prior to DC, agreeable to SDD, tolerant of oral intake, ability to urinate and safely ambulate prior to DC. Exclusion for SDD includes: Liver disease, Plt count <70,000, ESRD or CKD IV or any site or procedure complications. With Perclose usage patients must have 3 hours of bedrest, with manual pressure closure must have bedrest for 6 hours and purse string suture removed. This is followed by a next day phone call to ensure the patient is taking appropriate medicines and have no medical issues. Results: 38 out of 113 patients were screened as SDD candidates from January 2021-October 2021. Average patient age was 76, 31% female, with average CHA2DS2-VASc of 5. One patient required overnight hospitalization due to underlying asthma and need for nebulizer. One patient presented to an outpatient ED on a weekend with chest pain and underwent heart catheterization due to elevated troponin and did not require intervention. There were no access site complications. No patients contracted SARS-Cov-2 within 6 weeks post procedurally, compared with 2 of the overnight stays during the same period (75 patients). Conclusion: SDD in a carefully selected patient population is a feasible and safe strategy for LAAO patients. These patients had a clinically significant, though underpowered decrease in incidence of COVID-19 diagnosis within 6 weeks post implant.

A Survey on Covid-19 Face-Mask Detection Techniques

This survey primarily focuses on 9 research papers which revolve around Covid-19 Face Mask Prediction. Since Covid has affected our lives a lot in the past year, the primary motive for this survey was to applaud the work done by various people to identify the current scenario and bring valuable solutions to this problem. In this way, even we could contribute to society's betterment. The face mask has proved to be a lifesaver throughout this pandemic, where various countries have made wearing masks compulsory. The rise of the Covid-19 pandemic has led to significant betterment in computer vision, face mask detection and Image processing. Many studies have been done in the face detection or facial expression recognition domain, but there are hardly any papers describing face mask detection. The highest training accuracy was obtained in the case of MTCNN along with FaceNet which was 100% [1], and highest test accuracy was achieved by Facemasknet Architecture which was 98.6%. [2]. This paper offers a concise description and summary of previous studies in the subject detection of face masks, as well as a comparative overview of works in this domain, outlining their gaps and areas for potential development. © 2021 IEEE.

The influence of universal face mask use on endophthalmitis risk after intravitreal antivascular endothelial growth factor injections during the COVID-19 pandemic

Purpose : Routine use of face masks for both patients and physicians during intravitreal anti-vascular endothelial growth factor (VEGF) injections has increased with the emergence of the COVID-19 pandemic. This study evaluates the impact of physician, ancillary staff, and patient face mask use on rates and outcomes of post-injection endophthalmitis. Methods : In this retrospective comparative cohort study, all eye receiving intravitreal antiVEGF factor injections from 10/1/2019 to 7/31/2020 were included from twelve centers. Cases were divided into a no face mask group if no face masks were worn by the physician or patient during intravitreal injections or a universal face mask group if face masks were worn by the physician, ancillary staff, and patient during intravitreal injections. The main outcome measures were rate of endophthalmitis, visual acuity, and microbial spectrum. Results : Of 505,968 intravitreal injections administered, 85 of 294,514 (0.0289%;1 in 3,464 injections) cases of endophthalmitis occurred in the no face mask group, and 45 of 211,454 (0.0213%;1 in 4,699 injections) cases occurred in the universal face mask group (odds ratio, 0.74;95%CI, 0.51-1.18;p=0.097;Table 1). In the no face mask group, there were 27 cases (0.0092%;1 in 10,908 injections) of culture-positive endophthalmitis compared to 9 cases (0.004%;1 in 23,494 injections) in the universal face mask group (OR, 0.46;95%CI, 0.22-0.99;p=0.041). Three cases of oral flora-associated endophthalmitis occurred in the no face mask group (0.001%;1 in 98,171 injections) compared to one (0.0005%;1 in 211,454) in the universal face mask group (p=0.645). At endophthalmitis presentation, mean logMAR visual acuity was 2.04 for no face mask group compared to 1.65 for the universal face mask group (p=0.022), although no difference was observed three months after treatment (p=0.764;Table 2). Conclusions : Universal face mask use during intravitreal anti-VEGF injections did not show a statistically significant reduction in presumed endophthalmitis, but there was a reduced rate of culture-positive endophthalmitis. Future studies are warranted to assess the role of face mask use to reduce endophthalmitis risk, particularly that due to oral flora.

A rare case of methemoglobinemia in a patient with COVID 19

Introduction: COVID-19 caused by SARS-COV-2 has spread worldwide infecting 76.9 Million global population and 1.7 Million people died, leading to an ongoing most fatal pandemic. It has shown to cause multi-organ involvement leading to various pathologies. We are discussing here a case of methemoglobinemia from an unknown cause in a patient with COVID-19. Description: 62 year old African American male with history of DM and HTN, visited the ER with a fever for one week along with generalized weakness and pleuritic chest pain. He was found to be COVID-19 positive on admission and was hypoxic requiring a low flow nasal cannula. Within 48 hours his condition deteriorated with worsening hypoxia requiring invasive mechanical ventilation. He was initiated on Dexamethasone 6 mg IV daily, Remdesivir and Tocilizumab. He developed septic shock requiring vasopressin and oliguric acute kidney injury requiring continuous renal replacement therapy. He developed severe ARDS and was treated with a goal P: F ratio of <150 and placed in prone position. Serial ABG's showed a rising trend in the Meth Hb levels from 3.8 to 6.3. The secondary causes of methemoglobinemia including G6PD deficiency and inciting drugs were ruled out. He was administered a high dose of IV Vitamin C 1.5g Q6H for three days. Meth Hb levels trended down after starting vitamin C. Discussion: Normally, iron exists in the Fe+2 state. Oxidation of iron from fe+2 to fe+3 state leads to methemoglobinemia. The most common causes of acquired methemoglobinemia are exposure to oxidizing agents. Drugs reported include nitrates, nitrite derivatives, Sulfa drugs, local and topical anesthetics. In this case, the patient did not receive any of the above drugs (including hydroxychloroquine). He did receive dexamethasone, Remdesivir, and Tocilizumab. These medications could be a possible inciting factor. He had no history of sickle cell disease or G6PD deficiency. COVID-19 has presented the healthcare professionals with many challenging aspects in taking care of their patients with challenging pathophysiology along with complicated treatment plan and at times unfortunately without any answer. In this case, we were unable to identify the cause, which raised the possibility of coronavirus related hemoglobin changes. The mechanism remains unknown. The mechanism of methemoglobinemia in COVID-19 needs further research but we demonstrated that IV Vitamin C can be used to successfully manage such patients. Further investigation and retrospective analysis would be beneficial to see if COVID-19 is the causing factor in patients with methemoglobinemia.

Changing dynamics and travel evading: a case of Indian tourists amidst the COVID 19 pandemic

Purpose: This study aims to analyse the factors that caused Indian tourists to avoid travelling abroad because of the recent outbreak of COVID-19 in 2020. It will also identify the relationship between the perceived risk of travelling and the probability of travel evading in India owing to COVID-19. Design/methodology/approach: This study used an online structured questionnaire to collect data from Indian tourists to study six independent variables linked with their behavioural intentions (travel evading). The health belief model was used to examine tourist behaviour. Findings: The results revealed a positive correlation between the perceived risk associated with COVID-19 and travel avoidance. Familiarity with COVID-19 was positively correlated with travel evading behaviours. Practical implications: This study will assist stakeholders from around the world to adequately identify and thoroughly plan for logistical problems associated with travel such as travel insurance and pre-travel booking expenses to reduce travel evading behaviour and promote travel. Originality/value: While a few studies have been conducted related to pandemics (Ebola, MERS-CoV, SARS), there is a paucity of literature that examines the factors which influence tourists’ travel evading behaviour owing to COVID-19. Moreover, most of the previous literature on pandemics is concentrated on American and European countries, whereas studies on the Indian sub-continent are very scarce. This study will fill this gap and will identify the factors which influence tourists in India to evade travel in response to COVID-19. © 2020, Vikas Gupta, Ignatius Cahyanto, Manohar Sajnani and Chetan Shah.

COVID-19 Infection Dynamics for India-Forecasting the Disease using SIR models

A retrospective cohort study of novel Coronavirus disease (COVID-19) on India data and predicting the disease outcome (Infected Recovered) using SIR compartment model.An existing literature survey of SIR modeling on coronavirus disease was probed and further improvised the finding and methodologies used in modeling were performed over the existing India data set. Numerous papers were surveyed and the model was trained to understand the optimal value of hyperparameters (β and γ) and the approach to forecast the coronavirus disease.As on 30th June 2020 a total of 215k Active cases and 17k deaths were reported. A sample(N) of 2% of the overall population (133 cr.) was considered and the initial date of infection to model the disease was 1st May 2020. Further comparison was made using 5% and 10% Susceptible population to check the model efficacy. The reported number of Initial Suspected(S0), Infected(I0) and Recovered(R0) cases were 25,965k, 24,755 9,065 respectively. The optimal values of Beta(β) and Gamma(γ) were estimated to be 0.093 and 0.055 respectively. The overall Infected MAPE(Mean percentage absolute error) was 12.23% Recovered MAPE was 6.48% on 2% Susceptible population.The research presented the current trends of Covid-19 disease in India from 1st May'20 to 30th June'20. The trajectory of the disease was also forecasted for next days from 30th June 2020.Rapid growth of the disease has been seen in the month of June with maximum peak reaching on 164th Day (Mid Oct'20) with 25.5 Lakh infected cases considering 2% Susceptible, 64.75 lakh cases considering 5% Susceptible 1.3 cr. cases considering 10% Susceptible. The estimated R0 (β/γ) value is 1.69. However further research and addition of compartments like Exposed, Critical can be made to improve the forecast. © 2020 IEEE.

Navigating through the Financial Crisis that may Occur during and after the COVID-19 Pandemic for Gastroenterologists

Introduction Considering the specific set of gastrointestinal endoscopy practitioners, it is witnessed that the number of patients forelective procedures are being deferred by the patients amid various concerns ranging from financial constraint to the fear of infection from the dreaded coronavirus. With Routine endoscopy procedures recommended to be safely postponed, the impact on the practice of Gastrointestinal Endoscopists shall be magnified. Assessment and Strategy The article discusses impact and remedial actions that may be taken by Gastrointestinal Endoscopists, which classified into:-Anindependent practitioner-A consultant-An employee The article further touches upon the difficulties that might be envisaged by the Gastrointestinal Endoscopists, and obtain a financial understanding of what could potentially lead to an existential crisis? Those with cash reserves sit in a pleasant position i.e. they can buy assets at an attractive price, experiment with new ideas, research and development, etc. It is imperative in these times to understand the uncertainty cast on operations of Gastrointestinal Endoscopists and prepare a response plan for coming out of this economic crisis. A roadmap also has been devised which provides a possible outline of a plan that can be implemented for handling the economic crisis. It is also important to answer these two questions: 1. Who do I want to be during the crisis? 2. Who do I want to be when this is over?