Online viva voce as a formative assessment method in forensic medicine during COVID-19 pandemic.

BACKGROUND: Conducting online classes and assessment during the COVID-19 pandemic is not without challenges. The world of medical education is adapting online training and assessment because of COVID-19 pandemic restrictions. The present study was conducted to assess the students' perception regarding the process, difficulties encountered and perceived effectiveness of online assessment. MATERIALS AND METHODS: Online viva-voce (theory and visual based) was conducted in a government medical college in Karwar, Karnataka, India using videoconferencing application (Google Meet) to 149 second MBBS students as a formative assessment in 2020 over 3 months. Ten students per day joined Google Meet, 10 questions were asked to each student and assessed using a tutor marking system (on-spot). A feedback questionnaire (Google Form) was administered to students who attended online Viva-Voce. Data was analysed using descriptive and inferential statistics (Student's t-test). RESULTS: Out of 149 students, 132 participated and responded to a feedback questionnaire. Majority of the participants (91%) agreed that questions covered all topics kept for viva, 82% of them felt it would be helpful for performance in final examinations. Thirty percent of students faced network issues at their places, 45% felt nervous while facing viva in the presence of other students and 35% of participants preferred online methods over traditional viva voce. Online viva voce can be transparent (90%) and less biased (88%) if done in structured format. CONCLUSION: Online viva-voce may become relevant and effective in medical education assessment with transparent marking system for students' performance.

Delivering essential care services during COVID lockdowns: GP experiences and approaches

Background: While the UK's Royal College of General Practitioners developed guidance concerning the delivery of essential services during the COVID pandemic, no such guidance was available in Australia and little is known about the experiences or approaches taken by general practitioners (GPs) for the delivery of care in Australia. Aims/Objectives: To describe GPs' experiences and approaches to delivering essential clinical services (ECS) during COVID lockdowns. Method(s): A survey of GPs who had practiced during lockdowns in Melbourne and Sydney. Questions focused on changes made to care delivery including what services were continued: (1) regardless of outbreak scale, (2) if capacity allowed, or (3) postponed. Finding(s): Of 274 completed surveys, 95% of participants reported increased use of telehealth for diagnosis, investigation, and management of clinical conditions, and 97% for follow-up. Time-sensitive services such as provision of care for symptoms consistent with cancer or those with immediate health impact (e.g., immunisations, prolia injections) were generally continued even if requiring face-to face delivery. Consultations involving screening or health assessments or those necessitating face-to-face care but not clinically urgent (e.g., low risk cervical cancer screening and IUD insertions), were more likely to be postponed, as were visits to homebound and nursing home patients. Implications: The almost universal uptake of telehealth by GPs supported continuity of service provision during lockdown. Australian GPs acted autonomously to triage and provide ECS face to face through the lockdowns. To optimise future preparedness, local guidance for safe delivery of ECS must be developed considering contextual factors relevant to the Australian primary healthcare system.

Admission Neutrophil-lymphocyte Ratio for Prediction of Severity and Mortality in COVID Patients: A Systematic Review and Meta-analysis

Aims and objectives: Multiple studies have suggested that neutrophil-lymphocyte ratio (NLR) derived from differential white cell count might be a useful marker for COVID-related disease severity and mortality. We conducted a systematic review and meta-analysis and investigated if the same can be predicted with on-admission NLR values and also evaluated the prognostic significance of NLR on disease outcomes in patients with COVID-19. Materials and methods: We searched PubMed, EMBASE, MEDLINE, and SCOPUS databases for published articles in peer-reviewed journals from 01 March 2020 and 01 March 2021. Meta-analysis was performed to determine the pooled standardized mean difference (SMD) for the mean values of NLR. A random-effects meta-regression was performed for the following potential confounders: age, gender, and comorbidities. Results: After study screening, systematic review included 68 studies comprising 15,818 patients in total, 2260 with severe disease and 1198 patients with mortality outcomes. The meta-analysis showed significant difference in mean NLR between severe and non-severe patients {SMD was 2.88 (95% CI: 2.32 to 3.44)} and between survivors and non survivors {SMD was 7.89 (95% CI: 3.37 to 12.42)}. Both outcomes were heterogeneous (Q = 1912.85, P < 0.0001, tau2 = 3.14, I2 = 98.35% and Q = 5898.15, p < 0.0001, tau2 = 116.65, I2 = 99.92% for severity and mortality, respectively). Meta-regression analysis showed that the association between NLR values on admission and severity in COVID-19 patients was not influenced by age (p = 0.893), cardiovascular diseases (p = 0.259), diabetes mellitus (p = 0.545), or hypertension (p = 0.104). Conclusion: On admission, NLR predicts both severity and mortality in COVID-19 patients and is not affected by age or comorbidities. Further high-quality studies are needed to confirm these findings. Results2: After study screening, systematic review included 68 studies comprising 15,818 patients in total, 2260 with severe disease and 1198 patients with mortality outcomes. A summary receiver operating characteristic (SROC) curve to determine a pooled estimate of the prognostic accuracy of NLR for severity showed that the pooled sensitivity, specificity and AUC were 80.2% (95% CI: 74.0-85.2%), 75.8% (95% CI: 71.3-79.9%), and 0.833, respectively, with the pooled diagnostic odds ratio of 13.63 (95% CI: 9.71-19.02). According to the Q-test, the true outcomes appeared to be heterogeneous for both severity and mortality (Q = 1912.85, P < 0.0001, tau2 = 3.14, I2 = 98.35% and Q = 5898.15, p < 0.0001, tau2 = 116.65, I2 = 99.92%, respectively). The same was done for NLR and mortality showed the pooled sensitivity, specificity, and diagnostic odds ratio were 78.8% (95% CI: 73.5-83.2%), 73.0% (95% CI: 68.4-77.1%), and 11.483 (95% CI: 7.814-16.875), respectively, with AUC of 0.820. Meta-regression analysis showed that the association between NLR values on admission and severity in COVID-19 patients was not influenced by age (p = 0.893), cardiovascular diseases (p = 0.259), diabetes mellitus (p = 0.545), or hypertension (p = 0.104).

Online viva voce as a formative assessment method in forensic medicine during COVID-19 pandemic

BACKGROUND: Conducting online classes and assessment during the COVID-19 pandemic is not without challenges. The world of medical education is adapting online training and assessment because of COVID-19 pandemic restrictions. The present study was conducted to assess the students' perception regarding the process, difficulties encountered and perceived effectiveness of online assessment. MATERIALS AND METHODS: Online viva-voce (theory and visual based) was conducted in a government medical college in Karwar, Karnataka, India using videoconferencing application (Google Meet) to 149 second MBBS students as a formative assessment in 2020 over 3 months. Ten students per day joined Google Meet, 10 questions were asked to each student and assessed using a tutor marking system (on-spot). A feedback questionnaire (Google Form) was administered to students who attended online Viva-Voce. Data was analysed using descriptive and inferential statistics (Student's t-test). RESULTS: Out of 149 students, 132 participated and responded to a feedback questionnaire. Majority of the participants (91%) agreed that questions covered all topics kept for viva, 82% of them felt it would be helpful for performance in final examinations. Thirty percent of students faced network issues at their places, 45% felt nervous while facing viva in the presence of other students and 35% of participants preferred online methods over traditional viva voce. Online viva voce can be transparent (90%) and less biased (88%) if done in structured format. CONCLUSION: Online viva-voce may become relevant and effective in medical education assessment with transparent marking system for students' performance.

First surveillance of SARS-CoV-2 and organic tracers in community wastewater during post lockdown in Chennai, South India: Methods, occurrence and concurrence.

Surveillance of SARS-CoV-2 and organic tracers (OTs) were conducted in the community wastewater of Chennai city and the suburbs, South India, during partial and post lockdown phases (August-September 2020) as a response to the coronavirus disease 2019 (COVID-19) pandemic. Wastewater samples were collected from four sewage treatment plants (STPs), five sewage pumping stations (SPSs) and at different time intervals from a suburban hospital wastewater (HWW). Four different methods of wastewater concentrations viz., composite (COM), supernatant (SUP), sediment (SED), and syringe filtration (SYR) were subjected to quantitative real time-polymerase chain reaction (qRT-PCR). Unlike HWW, STP inlet, sludge and SPS samples were found with higher loading of SARS-CoV-2 by SED followed by SUP method. Given the higher levels of dissolved and suspended solids in STPs and SPSs over HWW, we suspect that this enveloped virus might exhibit the tendency of higher partitioning in solid phase. Cycle threshold (Ct) values were < 30 in 50% of the HWW samples indicating higher viral load from the COVID-19 infected patients. In the STP outlets, a strict decline of biochemical oxygen demand, >95% removal of caffeine, and absence of viral copies reflect the efficiency of the treatment plants in Chennai city. Among the detected OTs, a combination of maximum dynamic range and high concurrence percentage was observed for caffeine and N1 gene of SARS-CoV-2. Hence, we suggest that caffeine can be used as an indicator for the removal of SARS-CoV-2 by STPs. Our predicted estimated number of cases are in line with the available clinical data from the catchments. Densely distributed population of the Koyambedu catchment could be partly responsible for the high proportion of estimated infected individuals during the study period.

SARS-coronavirus disease 19 and comorbidities- a systematic review

Introduction: Coronavirus 19 (COVID-19) pandemic is evolving rapidly worldwide. It has led to a worldwide research to identify the people who are at more risk for developing the infection, increasing severity and mortality. Aim: The aim of this systematic review was to evaluate the risk of some of the common and major comorbidities on the outcome of the disease. Materials and Methods: A literature search was conducted using EMBASE, PUBMED, Web of science, SCOPUS and Cochrane database. Medical Subject Headings (MeSH) used were “COVID-19” or “SARS CoV 2” or “Coronavirus disease 19” and “Comorbidities” or “Risk factors”. Individual risk factors were also used as keywords such as “Diabetes”, Hypertension”, “Obesity”, “Chronic kidney disease”, “Elderly”, “Cardiovascular disease”, “Lung disorders” and “Malignancy”. Two researchers conducted the search independently. Results: After extensive search, 57 articles were shortlisted for complete review. It was found that patients with comorbidities had more severe disease than those without comorbidities. Patients with more number of comorbidities had more severe disease than patients with single comorbidity. Initial reports suggested that elderly were at more risk than the younger population. The most common comorbidity was hypertension followed by diabetes and obesity. Conclusion: A meticulous triage of patients should be carried out after acquiring proper medical history because this will help to identify patients who are at an increased risk of poor outcome of the infection. Also, they should be given more aggressive treatment upon diagnosis of infection.

An update on COVID-19: SARS-CoV-2 life cycle, immunopathology, and BCG vaccination.

The causative agent of novel coronavirus disease (COVID-19) is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The SARS-CoV-2 possesses RNA as a genetic material with 79% of the match with the bat SARS-CoV genome, which became epidemic in 2002. The SARS-CoV-2 peripheral Spike-Fc protein binds specifically to the ACE2 receptors present on bronchial epithelial cells and alveolar pneumocytes to downmodulates its expression which leads to severe acute respiratory failure. The disease is super infectious from human to human and the symptoms are similar to flu. The old aged and immunocompromised population are severely affected, and healthcare providers globally applied various strategies for treatment including the repurposing of drugs including antimalarial drug, hydroxychloroquine and anti-viral drugs.Herein, we described the SARS-CoV-2 pandemic, immune responses, possible drug targets, vaccines under the trials and correlated the possibility of trained immunity induced by BCG vaccination over control of SARS-CoV-2 infection. The countries with constraint BCG vaccination policy are struggling badly compared to countries with BCG vaccination policy. The BCG vaccination policy supports either lowering the total number of COVID-19 cases or the increasing recovery rate.