Importance of cardiac magnetic resonance imaging in cardiomyopathies in present scenario

Cardiomyopathy includes a heterogeneous group of diseases and conditions that are caused by mechanical and/or electrical dysfunction and shows inappropriate hypertrophy or dilatation which may be due to various causes, mostly genetic, can be confined only to heart or may be a part of systemic disorders. It includes hypertrophic, dilated, arrhythmogenic right ventricular cardiomyopathy, restrictive, and unclassified type. Cardiac magnetic resonance imaging (C-MRI) is currently the gold standard examination due to its high temporal and spatial resolution. In late gadolinium enhancement (LGE) studies, the gadolinium contrast which is administered, it has a slower washout rate in abnormal areas of increased extracellular space and fibrosis. The normal myocardium gets nulled and the abnormal areas are seen as bright areas on LGE. According to the Global Burden of Diseases, injuries, and risk factors study 2016, cardiomyopathy contributed to 0.12% of total deaths, 0.11% of total disability-adjusted life years in India. The main objective of the article is to review the role of MRI in cardiomyopathies (CMPs), especially after post-COVID-19 pandemic with the purpose whether this can be one shop modality with reference to echocardiography. With the advancement in MRI technology and availability of state of art cardiac coils and cardiac software C-MRI has emerged as modality of choice in diagnosis as well as in follow-up cases of CMPs diseases as it is nonoperator dependent as well as radiation-free modality.

Role of cardiovascular magnetic resonance imaging in COVID-19 recovered patients: A short-term follow-up study.

OBJECTIVE: Cardiac involvement in recovered COVID-19 patients assessed by cardiac magnetic resonance imaging (MRI). METHODS: Subjects recently recovered from COVID-19 and with an abnormal left ventricular global longitudinal strain were enrolled. Cardiac MRI in all the enrolled subjects was done at baseline (within 30-90 days following recovery from COVID-19) with a follow-up scan at 6 months in individuals with an abnormal baseline scan. Additionally, 20 age-and sex-matched individuals were enrolled as healthy controls (HCs). RESULTS: All the 30 enrolled subjects were symptomatic during active COVID-19 disease and were categorized as mild: 11 (36.7%), moderate: 6 (20%), and severe: 13 (43.3%). Of the 30 patients, 16 (53.3%) had abnormal CMR findings. Myocardial edema was reported in 12 (40%) patients while 10 (33.3%) had late gadolinium enhancement (LGE). No difference was observed in terms of conventional left ventricular (LV) parameters; however, COVID-19-recovered patients had significantly lower right ventricular (RV) ejection fraction, RV stroke volume, and RV cardiac index compared to HCs. Follow-up scan was abnormal in 4/16 (25%) with LGE persisting in three patients (who had severe COVID-19 [3/4;75%]). Subjects with severe COVID-19 had a greater frequency of LGE (53.8%) and myocardial edema (61.5%) as compared to mild and moderate cases. Myocardial T1 (1284 ± 43.8 ms vs. 1147.6 ± 68.4 ms; p < .0001) and T2 values (50.8 ± 16.7 ms vs. 42.6 ± 3.6 ms; p = .04) were significantly higher in post COVID-19 subjects compared to HCs. Similarly, T1 and T2 values of severe COVID-19 patients were significantly higher compared to mild and moderate cases. CONCLUSIONS: An abnormal CMR was seen in half of the recovered patients with persistent abnormality in one-fourth at 6 months. Our study suggests a need for closer follow-up among recovered subjects in order to evaluate for long-term cardiovascular sequelae. COVID-19 causes structural changes in the myocardium in a small segment of patients with partial spontaneous resolution.

Eyes: conduit to COVID-19, relevance of eye protection, and face shield in ophthalmology waiting areas

COVID-19 pandemic caused by highly contagious Severe Acute Respiratory Syndrome Coronavirus 2 has affected the health and economy of the population worldwide. A major route of transmission of coronavirus is through respiratory system by aerosols and microdroplets. Virus can also spread by direct or indirect touching of the inmate objects harboring live virus. Virus can gain access through the nasal and oral ororopharyngeal mucosa. Coronavirus has been isolated from the ocular surface and tearfilm. Severe Acute Respiratory Syndrome Coronavirus 2 has been documented to drain from the ocular surface to oropharyngeal mucosa through tears. In the preventive measures, the mask acts as a barrier to touch and aerosol transmission and its use has been advocated all over the world. Transmissions through eyes (ocular surface and tear film) are possible, however, compared to the aerosol transmission the risk may be small. The use of glasses, safety goggles and face shields may provide protection to eyes from contamination and minimizes the risk of transmission from the ocular surface and tear film. In this review, the authors aim to highlight the role of the ocular surface and tear film in the transmission and possible measure to prevent the infection through the eyes. [ FROM AUTHOR] Copyright of Asian Journal of Medical Sciences is the property of Manipal Colleges of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

A review of the role of graphene-based nanomaterials in tackling challenges posed by the COVID-19 pandemic

In 2020, the World Health Organization (WHO) declared a pandemic due to the emergence of the coronavirus disease (COVID-19) which was resulted by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Significant efforts have been devoted by many countries to develop more advanced medicines and vaccines. However, along with these developments, it is also extremely essential to design effective systems by incorporating smart materials to battle the COVID-19. Therefore, several approaches have been implemented to combat against COVID-19. Recently, due to its superior physicochemical properties along with other fascinating properties, graphene-based materials have been explored for the current COVID-19 and future pandemics. Therefore, in this review article, we discuss the recent progress and the most promising strategies related to graphene and related materials and its applications for detection, decontamination, diagnosis, and protection against COVID-19. In addition, the key challenges and future directives are discussed in detail for fundamental design and development of technologies based on graphene and its related materials and lastly, our personal opinions on the appropriate approaches to improve these technologies respectively.

An efficient immunoassay for the B cell help function of SARS-CoV-2-specific memory CD4+ T cells.

The B cell "help" function of CD4+ T cells is an important mechanism of adaptive immunity. Here, we describe improved antigen-specific T-B cocultures for quantitative measurement of T cell-dependent B cell responses, with as few as ∼90 T cells. Utilizing M. tuberculosis (Mtb), we show that early priming and activation of CD4+ T cells is important for productive interaction between T and B cells and that similar effects are achieved by supplementing cocultures with monocytes. We find that monocytes promote survivability of B cells via BAFF and stem cell growth factor (SCGF)/C-type lectin domain family 11 member A (CLEC11A), but this alone does not fully recapitulate the effects of monocyte supplementation. Importantly, we demonstrate improved activation and immunological output of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific memory CD4+ T-B cell cocultures with the inclusion of monocytes. This method may therefore provide a more sensitive assay to evaluate the B cell help quality of memory CD4+ T cells, for example, after vaccination or natural infection.

Inactivated whole-virion vaccine BBV152/Covaxin elicits robust cellular immune memory to SARS-CoV-2 and variants of concern.

BBV152 is a whole-virion inactivated vaccine based on the Asp614Gly variant. BBV152 is the first alum-imidazoquinolin-adjuvanted vaccine authorized for use in large populations. Here we characterized the magnitude, quality and persistence of cellular and humoral memory responses up to 6 months post vaccination. We report that the magnitude of vaccine-induced spike and nucleoprotein antibodies was comparable with that produced after infection. Receptor binding domain-specific antibodies declined against variants in the order of Alpha (B.1.1.7; 3-fold), Delta (B.1.617.2; 7-fold) and Beta (B.1.351; 10-fold). However, pseudovirus neutralizing antibodies declined up to 2-fold against the Delta followed by the Beta variant (1.7-fold). Vaccine-induced memory B cells were also affected by the Delta and Beta variants. The SARS-CoV-2-specific multicytokine-expressing CD4+ T cells were found in ~85% of vaccinated individuals. Only a ~1.3-fold reduction in efficacy was observed in CD4+ T cells against the Beta variant. We found that antigen-specific CD4+ T cells were present in the central memory compartment and persisted for at least up to 6 months post vaccination. Vaccine-induced CD8+ T cells were detected in ~50% of individuals. Importantly, the vaccine was capable of inducing follicular T helper cells that exhibited B-cell help potential. These findings show that inactivated vaccine BBV152 induces robust immune memory to SARS-CoV-2 and variants of concern that persists for at least 6 months after vaccination.

An efficient immunoassay for the B-cell help function of SARS-CoV-2 specific memory CD4+ T cells

The B cell “help” function of CD4+ T cells is an important mechanism of adaptive immunity. Here, we describe improved antigen-specific T-B co-cultures for quantitative measurement of T cell-dependent B cell responses, with as few as ∼90 T cells. Utilizing Mtb, we show that early priming and activation of CD4+ T cells is important for productive interaction between T and B cells, and that similar effects are achieved by supplementing co-cultures with monocytes. We find that monocytes promote survivability of B cells via BAFF and SCGF/CLEC11A, but this alone does not fully recapitulate the effects of monocyte-supplementation. Importantly, we demonstrate improved activation and immunological output of SARS-CoV-2 specific memory CD4+ T - B cell co-cultures with the inclusion of monocytes. This method may therefore provide a more sensitive assay to evaluate the B cell help quality of memory CD4+ T cells, for example after vaccination or natural infection. Graphical Ansari et al. describe an efficient T-B cell co-culture assay to assess B-cell help function of antigen-specific T helper cells in healthy and COVID-19 recovered individuals, based on the inclusion of monocytes. Increased B cell output in this assay may provide extra sensitivity to evaluate immunological responses in different contexts.

Barriers faced by health-care workers in use of personal protective equipment during COVID pandemic at tertiary care hospital Uttarakhand, India: A qualitative study.

BACKGROUND: To reduce the likelihood of transmission of infection to health-care workers (HCWs), personal protective equipment is used. However, wearing personal protective equipment (PPE) increases the risk of heat stress and loss of dexterity, leads to poor compliance to PPE. To address the issues of poor compliance to PPE, it was necessary to gain a deeper understanding about the factors that influence compliance. Thus this qualitative study was planned to explore barriers faced by HCWs while using PPE during a pandemic situation in a tertiary care hospital, Uttarakhand, India. MATERIALS AND METHODS: A exploratory qualitative study was undertaken among health care workers involved in the care of COVID patients. FGDs were done and an unstructured interview guide with open-ended questions was used which helped to explore the factors which can be potential barriers to the HCWs while working wearing PPE. RESULTS: Organizational and individual factors acting as barriers such as unavailability of essential personal protective equipment, a disharmonious work environment, lack of comfort, inadequate size, and quality of PPE were identified as the major barriers in the present study. CONCLUSION: Future efforts to optimize PPE use should focus on to adequate supplies both in quality and quantity can help in avoidance of such barriers. Resources should be prioritized with the needs of the HCWs in the times of pandemic. Regular training and feedbacks are necessary for the satisfaction of HCWs and improving PPE compliance.

Generalizability of Homeopathic Prognostic Factor Research Outcome in COVID-19 Treatment: Comparison of Data.

BACKGROUND/OBJECTIVE: During the coronavirus disease 2019 (COVID-19) pandemic, several homeopathic prognostic factor research (PFR) projects have been undertaken. We found two projects with comparable outcomes to assess consistency and possible flaws. METHODS: Two comparisons were made. (1) Outcome of a PFR data collection from the Liga Medicorum Homoeopathica Internationalis (LMHI) by about 100 doctors with 541 cases was compared with a previous analysis of 161 cases in the same database. (2) The updated LMHI database was also compared with a data collection carried out in India by four doctors with a total of 1,445 cases. Differences that resulted in conflicting outcomes (indication in one, contraindication in the other) were examined for possible causes. RESULTS: There was only a single outcome in the updated LMHI database that conflicted with the previous dataset, and this could have been due to statistical variation. The Indian data contained many cases, from few doctors, while the LMHI database had few cases per doctor, but many doctors. The overlap between the projects (individual cases entered in both) was between zero and 22%. In 72 comparisons we found six (8.3%) conflicting outcomes. Possible causes were statistical error due to small numbers of cases and/or observers, confirmation bias, and keynote prescribing if this resulted in symptoms being inadequately checked. CONCLUSION: There was little conflict between the outcomes of the two versions of one project and between the two different PFR projects. Differences could mostly be explained by causes that can be managed. This consistency should primarily be interpreted as showing a strong overall consensus between homeopathic practitioners worldwide, but with variation of consensus between small groups of practitioners.

Impact of Bias in Data Collection of COVID-19 Cases.

BACKGROUND: Prognostic factor research (PFR), prevalence of symptoms and likelihood ratio (LR) play an important role in identifying prescribing indications of useful homeopathic remedies. It involves meticulous unbiased collection and analysis of data collected during clinical practice. This paper is an attempt to identify causes of bias and suggests ways to mitigate them for improving the accuracy in prescribing for better clinical outcomes and execution of randomized controlled studies. METHODS: A prospective, open label, observational study was performed from April 2020 to December 2020 at two COVID Health Centers. A custom-made Excel spreadsheet containing 71 fields covering a spectrum of COVID-19 symptoms was shared with doctors for regular reporting. Cases suitable for PFR were selected. LR was calculated for commonly occurring symptoms. Outlier values with LR ≥5 were identified and variance of LRs was calculated. RESULTS: Out of 1,889 treated cases of confirmed COVID-19, 1,445 cases were selected for pre-specified reasons. Nine medicines, Arsenicum album, Bryonia alba, Gelsemium sempervirens, Pulsatilla nigricans, Hepar sulphuricus, Magnesia muriaticum, Phosphorus, Nux vomica and Belladonna, were most frequently prescribed. Outlier values and large variance for Hepar sulphuricus and Magnesia muriaticum were noticed as indication of bias. Confirmation bias leading to lowering of symptom threshold, keynote prescribing, and deficiency in checking of all symptoms in each case were identified as the most important sources of bias. CONCLUSION: Careful identification of biases and remedial steps such as training of doctors, regular monitoring of data, checking of all pre-defined symptoms, and multicenter data collection are important steps to mitigate biases.

Immune Memory in Mild COVID-19 Patients and Unexposed Donors Reveals Persistent T Cell Responses After SARS-CoV-2 Infection.

Understanding the causes of the diverse outcome of COVID-19 pandemic in different geographical locations is important for the worldwide vaccine implementation and pandemic control responses. We analyzed 42 unexposed healthy donors and 28 mild COVID-19 subjects up to 5 months from the recovery for SARS-CoV-2 specific immunological memory. Using HLA class II predicted peptide megapools, we identified SARS-CoV-2 cross-reactive CD4+ T cells in around 66% of the unexposed individuals. Moreover, we found detectable immune memory in mild COVID-19 patients several months after recovery in the crucial arms of protective adaptive immunity; CD4+ T cells and B cells, with a minimal contribution from CD8+ T cells. Interestingly, the persistent immune memory in COVID-19 patients is predominantly targeted towards the Spike glycoprotein of the SARS-CoV-2. This study provides the evidence of both high magnitude pre-existing and persistent immune memory in Indian population. By providing the knowledge on cellular immune responses to SARS-CoV-2, our work has implication for the development and implementation of vaccines against COVID-19.

An immune epigenetic insight to COVID-19 infection.

Severe acute respiratory syndrome coronavirus-2 is a positive-sense RNA virus, a causal agent of ongoing COVID-19 pandemic. ACE2R methylation across three CpG sites (cg04013915, cg08559914, cg03536816) determines the host cell's entry. It regulates ACE2 expression by controlling the SIRT1 and KDM5B activity. Further, it regulates Type I and III IFN response by modulating H3K27me3 and H3K4me3 histone mark. SARS-CoV-2 protein with bromodomain and protein E mimics bromodomain histones and evades from host immune response. The 2'-O MTases mimics the host's cap1 structure and plays a vital role in immune evasion through Hsp90-mediated epigenetic process to hijack the infected cells. Although the current review highlighted the critical epigenetic events associated with SARS-CoV-2 immune evasion, the detailed mechanism is yet to be elucidated.

Rapid determination and optimisation of berberine from Himalayan Berberis lycium by soxhlet apparatus using CCD-RSM and its quality control as a potential candidate for COVID-19.

SARS-CoV-2 (or COVID-19) has become a global risk and scientists are attempting to investigate antiviral vaccine. Berberis are important plants due to the presence of bioactive phytochemicals, especially berberine from the protoberberine group of benzylisoquinoline and recent studies have shown its potential in treating COVID-19. B. lycium Royle growing in subtropical regions of Asia had wide applications in Indian system of medicine. Rapid determination and novel optimisation method for berberine extraction has been developed by Soxhlet extraction utilising central composite design-response surface methodology (CCD-RSM). Berberine was detected by high-performance liquid chromatography (HPLC), and the highest yield (13.39%) was obtained by maintaining optimal extraction conditions i.e., extraction time (7.28 hrs), ethyl alcohol (52.21%) and solvent to sample ratio (21.78 v/w). Investigation of two geographic regions (Ramnagar and Srinagar) showed high berberine content in lower altitude. This novel optimisation technique has placed berberine as a potential candidate for developing pharmaceutical products for human health care.

COVID-19 Virulence in Aged Patients Might Be Impacted by the Host Cellular MicroRNAs Abundance/Profile.

The World health organization (WHO) declared Coronavirus disease 2019 (COVID-19) a global pandemic and a severe public health crisis. Drastic measures to combat COVID-19 are warranted due to its contagiousness and higher mortality rates, specifically in the aged patient population. At the current stage, due to the lack of effective treatment strategies for COVID-19 innovative approaches need to be considered. It is well known that host cellular miRNAs can directly target both viral 3'UTR and coding region of the viral genome to induce the antiviral effect. In this study, we did in silico analysis of human miRNAs targeting SARS (4 isolates) and COVID-19 (29 recent isolates from different regions) genome and correlated our findings with aging and underlying conditions. We found 848 common miRNAs targeting the SARS genome and 873 common microRNAs targeting the COVID-19 genome. Out of a total of 848 miRNAs from SARS, only 558 commonly present in all COVID-19 isolates. Interestingly, 315 miRNAs are unique for COVID-19 isolates and 290 miRNAs unique to SARS. We also noted that out of 29 COVID-19 isolates, 19 isolates have identical miRNA targets. The COVID-19 isolates, Netherland (EPI_ISL_422601), Australia (EPI_ISL_413214), and Wuhan (EPI_ISL_403931) showed six, four, and four unique miRNAs targets, respectively. Furthermore, GO, and KEGG pathway analysis showed that COVID-19 targeting human miRNAs involved in various age-related signaling and diseases. Recent studies also suggested that some of the human miRNAs targeting COVID-19 decreased with aging and underlying conditions. GO and KEGG identified impaired signaling pathway may be due to low abundance miRNA which might be one of the contributing factors for the increasing severity and mortality in aged individuals and with other underlying conditions. Further, in vitro and in vivo studies are needed to validate some of these targets and identify potential therapeutic targets.