Optimizing the Cas13 antiviral train: cargo and delivery.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in 2020 highlighted the need for rapid, widespread responses against infectious disease. One such innovation uses CRISPR-Cas13 technology to directly target and cleave viral RNA, thereby inhibiting replication. Due to their programmability, Cas13-based antiviral therapies can be rapidly deployed to target emerging viruses, in comparison with traditional therapeutic development that takes at least 12-18 months, and often many years. Moreover, similar to the programmability of mRNA vaccines, Cas13 antivirals can be developed to target mutations as the virus evolves.

Analysis and Prediction of COVID-19 Multivariate Data Using Deep Ensemble Learning Methods.

The global economy has suffered losses as a result of the COVID-19 epidemic. Accurate and effective predictive models are necessary for the governance and readiness of the healthcare system and its resources and, ultimately, for the prevention of the spread of illness. The primary objective of the project is to build a robust, universal method for predicting COVID-19-positive cases. Collaborators will benefit from this while developing and revising their pandemic response plans. For accurate prediction of the spread of COVID-19, the research recommends an adaptive gradient LSTM model (AGLSTM) using multivariate time series data. RNN, LSTM, LASSO regression, Ada-Boost, Light Gradient Boosting and KNN models are also used in the research, which accurately and reliably predict the course of this unpleasant disease. The proposed technique is evaluated under two different experimental conditions. The former uses case studies from India to validate the methodology, while the latter uses data fusion and transfer-learning techniques to reuse data and models to predict the onset of COVID-19. The model extracts important advanced features that influence the COVID-19 cases using a convolutional neural network and predicts the cases using adaptive LSTM after CNN processes the data. The experiment results show that the output of AGLSTM outperforms with an accuracy of 99.81% and requires only a short time for training and prediction.

COVID-19 Public Opinion: A Twitter Healthcare Data Processing Using Machine Learning Methodologies.

The COVID-19 pandemic has shattered the whole world, and due to this, millions of people have posted their sentiments toward the pandemic on different social media platforms. This resulted in a huge information flow on social media and attracted many research studies aimed at extracting useful information to understand the sentiments. This paper analyses data imported from the Twitter API for the healthcare sector, emphasizing sub-domains, such as vaccines, post-COVID-19 health issues and healthcare service providers. The main objective of this research is to analyze machine learning models for classifying the sentiments of people and analyzing the direction of polarity by considering the views of the majority of people. The inferences drawn from this analysis may be useful for concerned authorities as they work to make appropriate policy decisions and strategic decisions. Various machine learning models were developed to extract the actual emotions, and results show that the support vector machine model outperforms with an average accuracy of 82.67% compared with the logistic regression, random forest, multinomial naïve Bayes and long short-term memory models, which present 78%, 77%, 68.67% and 75% accuracy, respectively.

Analysis of trimodal pattern of mortality among hospitalized COVID-19 patients- Lessons from tertiary care hospital.

Background and Aims: Many patients with COVID-19 become critically ill and requireICU admission. Risk factors associated with mortality have been studied, but this study provides insight regarding disease progression and hence help to plan rescue strategies to improve patient outcome. Material and Methods: This retrospective, observational study included all patients with diagnosis of COVID-19 from March1 to June30,2021 who died in hospital. Results: During the study period, 1600 patients were admitted, with 1138 (71%) needing ICU care. There were 346 (21.6%) deaths, distributed as 15.8%(n = 55) within 48h of admission, 46.2%(n = 160) in next 10 days, and 37.8%(n = 131) thereafter. This trimodal mortality pattern of distribution was similar to polytrauma patients. Patients were divided into categories according to time duration from admission to death. In our cohort, 235 (14.7%) patients required mechanical ventilation, with a mortality of 85.4%(n = 201). Tachypnea was significantly (P < 0.001) associated with death at all times; however, hypotension was associated with early death and low oxygen saturation with poor outcome upto 10 days (P < 0.001). Refractory hypoxia was cause of death in all three groups, while other causes in group II were AKI (28%), sepsis (18%), and MODS (10%). Group III patients had different causes of mortality, including barotrauma (9%), pulmonary thromboembolism (8%), refractory hypercarbia (12%), MODS (13%), AKI (10%), sepsis (7%), and cardiac events (6%). Conclusion: While physiological dearrangements are associated with rapid progression and early death, complications related to hyper-coagulable state, lung injury, and organ failure lead to death later. Providing quality care to a high volume of patients is a challenge for all, but posthoc analysis such as air crash investigation can help find out potential areas of improvement and contribute to better outcomes and mortality reduction.

How trainee doctors and nurses react to simulated scenarios of violence against healthcare workers: A cross-sectional study.

Medical and nursing students may have to face healthcare-related violence, especially now as they may be doing clinical duty during the Covid-19 pandemic. This study was conducted to analyse the perceptions and attitudes of medical and nursing students towards violence against healthcare workers (HCWs), when presented with audio-visual depiction of simulated scenarios. This cross-sectional study was conducted over a period of six months (April to September 2019) among the undergraduate medical and nursing students of first, second, pre-final and final years making it a total of 800 students. Video clips were shown to the students pertaining to HCWs' interactions with patients and relatives, and their responses were noted. Among 615 participants who completed the proforma, 248 (40%) students reported having observed or experienced violence in their clinical postings. Overall, 70.7% of medical and 68.5% of nursing students said that they would report incidents of violence to the authority. The questionnaire based on video-based simulated scenarios brought forth the perception that in triggering an act of violence, both the healthcare worker and the attendant could be at fault and full disclosure of complications was a necessary step in preventing such an act of violence. Sensitisation about the same should be incorporated into the teaching curriculum by using simulated scenarios to prepare them to manage such incidents.

Percutaneous Tracheostomy in COVID Era: Time to Adapt and Improvise.

BACKGROUND: Percutaneous dilatation tracheostomy (PDT) is required in patients with novel coronavirus disease-2019 (COVID-19) with severe respiratory involvement, but the procedure needs modification to minimize the risk of aerosol exposure to caregivers. AIM AND OBJECTIVE: To share the experience of apnea approach of PDT in COVID patients. Also, to demonstrate the safety of the technique for healthcare workers (HCWs) and patients with respect to hemodynamic and oxygenation parameters. The incidence of adverse events and difficulties during the procedure were also recorded. MATERIALS AND METHODS: According to this modified approach, percutaneous tracheostomy was performed with apnea technique during open tracheal steps (video attached) and the endotracheal tube was withdrawn to the level of cords under video-laryngoscopic guidance. STUDY DESIGN: A retrospective data analysis of all the tracheostomy procedures (PDT) performed with the apnea technique during the COVID era (June-September) in non-COVID and COVID patients in intensive care units (ICUs). RESULTS: During these 4 months, 74 PDT procedures were performed in both COVID and non-COVID patients in the ICUs of our hospital. Out of these, PDT with apnea technique was performed in 45 patients (61%). This technique was successful in 44 patients (97.7%) with mean apnea time of 110 + 8.6 seconds. There was no significant (p < 0.05) change in mean arterial pressure and oxygen saturation of 15 COVID patients in pre-PDT and immediate post-PDT period. None of the six team members performing PDT had symptoms or tested positive for COVID-19. CONCLUSION: PDT with apnea technique can be performed to minimize the risk of aerosol exposure and does not compromise the quality of care. It is safe both for the patient and HCWs. HOW TO CITE THIS ARTICLE: Paul G, Gautam PL, Sharma S, Sravani MV, Krishna MR. Percutaneous Tracheostomy in COVID Era: Time to Adapt and Improvise. Indian J Crit Care Med 2021;25(6):642-647.

Thrombotic Microangiopathy in a Patient With COVID-19 Infection and Metastatic Cholangiocarcinoma.

This is a case report of a 63-year-old African American female with a past medical history most significant for metastatic cholangiocarcinoma that presented for evaluation of persistent shortness of breath. Initial workup was remarkable for refractory anemia, moderate schistocytes on peripheral smear and lab work suggestive of a hemolytic anemia. Due to concern for thrombotic thrombocytopenic purpura (TTP), she subsequently underwent several rounds of plasma exchange without significant improvement. Secondary to progressive renal failure, patient eventually had a renal biopsy with findings remarkable for thrombotic microangiopathy (TMA). Simultaneously, patient was also diagnosed with coronavirus disease 2019 (COVID-19) infection. After a few weeks of supportive care, she was stable for discharge. Unfortunately, she did become dialysis dependent. Prior to hospital admission, she was being treated for metastatic cholangiocarcinoma and had received chemotherapy with gemcitabine. Her last chemotherapy session was approximately 3 weeks prior to her first hospitalization. Furthermore, although her hemolytic work did suggest TMA, it was not consistent with the diagnosis of TTP. She was transferred to a tertiary care center where hemolytic labs were trended, and supportive care was maximized. In light of the current COVID-19 pandemic, it is crucial to further investigate the pathophysiology of TMA in patients with active malignancies and COVID-19 infections. To our knowledge, this is the first case of TMA in a patient with both metastatic cholangiocarcinoma and COVID-19 infection.

Tracking COVID-19 burden in India: A review using SMAART RAPID tracker.

OBJECTIVE: India has seen a rapid rise in COVID-19 cases. Examine spatiotemporal variation of COVID-19 burden Tracker across Indian states and union territories using SMAART RAPID Tracker. METHOD: We used SMAART RAPID Tracker to visually display COVID-19 spread in space and time across various states and UTs of India. Data gathered from publicly available government information sources. Data analysis on COVID-19 conducted from March 1 2020 to October 1 2020. Variables recorded include COVID-19 cases and fatality, 7-day average change, recovery rate, labs and tests. Spatial and temporal trends of COVID-19 spread across Indian states and UTs is presented. RESULT: The total number of COVID-19 cases were 63, 12,584 and total fatality was 86,821 (October 1 2020). More than 85,000 new cases of COVID-19 were reported. There were 1,867 total COVID-19 labs throughout India. More than half of them were Government labs. The total number of COVID-19 tests was 76,717,728 and total recovered COVID-19 cases was 5,273,201. Results show an overall decline in the 7-day average change of new COVID-19 cases and new COVID-19 fatality. States such as Maharashtra, Chandigarh, Puducherry, Goa, Karnataka and Andhra Pradesh continue to have high COVID-19 infectivity rate. DISCUSSION: Findings highlight need for both national guidelines combined with state specific recommendations to help manage the spread of COVD-19. CONCLUSION: The heterogeneity represented in India in terms of its geography and various population groups highlight the need of state specific approach to monitor and combat the ongoing pandemic. This would further facilitate the tailored approach for each state to mitigate and contain the spread of the disease.

Media news on vaccines and vaccination: The content profile, sentiment and trend of the online mass media during 2015–2020 in India

Background The immunization coverage progress in India is relatively slower than anticipated. The rising internet and media penetration and online news contents are likely to shape the public vaccine sentiments and attitude. The measles-rubella immunization campaign in India experienced challenges in some states due to the social media and messaging. This study studied the profile and vaccine sentiments of the online media news in India. Methods We retrieved the online news on immunization and vaccines published in English during November 2015 to May 2020. The news were analysed for contents and categorised as positive, negative and neutral sentiments. Results Out of 2626 news retrieved, 1788 eligible ones were analysed. The news focused on immunization program in 59.1% and vaccine hesitancy in 7.7% items. While 42.5% news originated from national level, 33.2% were from six states. Measles-rubella was the leading vaccine in the news (23.2%) followed by coronavirus (12.8%), poliomyelitis (10.4%) and rotavirus (5.1%) vaccines. While 71.4% news conveyed positive sentiment, 23.8% and 4.7% had negative and neutral sentiments, respectively. The negative sentiments focused on adverse events, vaccine hesitancy and resistance. The news volume and negative sentiments were largely linked to the measles-rubella vaccination campaign phases in India. Conclusions Negative vaccine news constitute a sizable proportion of the online news and can influence the public vaccine sentiment and attitude. The experiences of public response towards measles-rubella, pentavalent and human papillomavirus vaccines suggest necessity of comprehensive media mapping and tracking to guide appropriately to sustain the public vaccine confidence and improve coverage.

Assessment of knowledge gaps and perceptions about COVID-19 among health care workers and general public-national cross-sectional study.

BACKGROUND AND AIMS: COVID-19 has impacted everyone's life and livelihood in one way or the other. Individual response to measures taken to control the rapid spread of this disease depend on their knowledge and perceptions. Hence, we proposed to evaluate responses about COVID-19 among the health care workers (HCWs) as well as general public participants (GPPs). MATERIAL AND METHODS: This was a cross-sectional, observational survey conducted during the peak of the pandemic. The 35-items questionnaire was prepared using Google forms and distributed through e-mails and social media. RESULTS: The 1,026 responses comprised of 558 HCWs (54.4%) and 468 GPPs (45.6%). The most reliable source of information was TV news for 43% GPPs, whereas it was HCWs/Local health authorities for 36.8% HCWs. HCWs had sufficient knowledge regarding COVID-19, while it was relatively low among GPPs (average correct response 65% and 53%, respectively). Intra-group analysis with respect to age, sex, qualification, and socioeconomic status showed that knowledge about mode of transmission by airborne aerosols was significantly low with respect to qualification among GPPs while younger age group (<40 years) HCWs had significantly more knowledge about mode of transmission and asymptomatic carriers. Paranoia of contracting the infection was significantly higher in GPPs with upper and middle socioeconomic status and younger HCWs. CONCLUSION: HCWs had moderate level of knowledge, whereas GPPs had low to moderate knowledge, with large scope of improvement in both groups. Continued education, both at professional and community level will not only be helpful but also necessary to improve knowledge, avert negative attitudes and control the devastating pandemic.

COVID-19: A Concern for Cardiovascular Disease Patients.

Coronavirus disease 2019 (COVID-19) is declared as a pandemic that has spread worldwide, affecting 205 countries. The disease affected 1, 40, 43, 176 individuals and caused 5, 97, 583 deaths around the globe. The organism responsible for the cause of disease is Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). SARS-CoV-2 enters into the cell via receptors present on the cell surface named angiotensin-converting enzyme 2 (ACE2) receptor. Notwithstanding ACE2 receptors acts as a gateway for infection, and most of the cardiovascular patients are treated with the ACE inhibitors. Thus, the role of ACE inhibitors or angiotensin receptor blockers may play a critical role in the severity or outcome of disease. Also, the effect of ACE inhibitors varies with the polymorphism in ACE2 receptors present in the individuals. Hence, it is the need of the hour to investigate the mechanisms which could better aid in the treatment of COVID-19-infected cardiovascular disease (CVD) patients.