The Value of Pooling in Last-Mile Delivery

Last-mile delivery services have become ubiquitous in the recent past. Delivery services for food (eg., DoorDash, Grubhub, Uber Eats) and groceries (eg., Instacart, Cornershop) earned a combined revenue of $25B in 2020, and are expected to exceed $72B in revenues by 2025. The COVID-19 pandemic accelerated the growth of such services by making their value proposition even more attractive. The lower risk of contact coupled with the convenience of ordering from the comfort of their homes led to widespread customer adoption. Even so, most last-mile delivery services are not profitable. The high cost of delivery is cited as the major cause of losses. Thus, analyzing the factors influencing delivery costs is crucial for understanding the long-term viability of these services. The pooling of orders is a critical source of efficiency in last-mile delivery. We propose a queuing-based spatial model for the delivery process to analyze the value created by pooling. We demonstrate how the trade-off between delivery times and the cost of delivery, mediated by the extent of pooling, dictates which services will be economically viable. Our simulation study of a typical grocery delivery service in Los Angeles, California suggests that delivery times of less than 1 hour are unprofitable for most regions in the US. We find that driver wages account for 90% of the delivery cost. We also discuss the potential impact of technological innovations such as automated delivery and labor regulations on the profitability of last-mile delivery services. © 2022 IEEE.

Assessment of the Risk Factor to Mortality in Hospitalized Covid-19 Patients, Pune

Background: There have been scientific papers in the Indian setting that describe demographics, clinical characteristics, hospital course, morbidity, and death in patients with coronavirus disease 2019 (COVID-19);however, they are based on limited numbers of cases. The current study of patients with known outcomes enabled us to acquire a better understanding of the disease process and progression in COVID-19 individuals, as well as correlate the factors affecting the outcome. Method(s): This study was carried out at a COVID-19 tertiary care facility at Dr. D. Y.Patil Medical College, Hospital and Research Centre, Pune. The demographic and clinical information, laboratory parameters of admitted COVID19 patients were collected were subsequently analysed. Categorical variables were analysed using either the chi-square test or Fisher's exact test. The level of significance was set at p<0.05. Result(s): Out of 603, 515 (85.4%) patients were discharged while 88 (15.8%) patients were died. The mean age of dead COVID-19 patients was significantly higher as compared to discharged COVID-19 patients. Serum urea, Serum Creatinine, serum AST, Serum total bilirubin, Serum Conjugated Bilirubin, serum LDH, Serum CRP and Serum Ferritin, Hb, PCV, TLC, neutrophils, eosinophils, basophils, lymphocytes, monocytes, neutrophils to lymphocyte ratio, platelets to lymphocyte ratio, ESR and D-dimer were differ significantly between discharged and dead COVID-19 cases whereas the levels of Serum ALT, Serum ALP, Serum Unconjugated bilirubin, MCV,MCH platelet count, PT and aPTT were remained comparable between discharged and dead COVID-19 cases. Multivariate analysis showed that Serum urea, D-dimer, ESR, NLR, PLR neutrophil and TLC were the significant predictors of COVID-19 death in our study. Conclusion(s): This study revealed that in hospitalised COVID-19 patients, older age, male sex, hypertension, diabetes, serum LDH, and urea levels were strongly linked to an increased risk of mortality. To enhance patient care and results, healthcare professionals should identify these aspects at the time of diagnosis. Copyright © 2022 Authors. All rights reserved.

Brain phaeohyphomycosis secondary to immunosuppressant therapy due to Rhinocladiella mackenziei

Two cases of Rhinocladiella mackenziei have been noted in our institute, the first case in 2015 (post-renal transplant) and the second case in 2021 (post-COVID infection). Both the patients had received immunosuppressants for varying dura-tion. Both the cases presented to the hospital with neurological deficit secondary to brain abscess. On initial assessment, the melanized fungus was noted which was later identified as Rhinocladiella on culture and further confirmed with molecular meth-ods. Both the cases were treated with injection of L AmB, voriconazole and 5FC for a prolonged duration and later discharged when the condition improved. The renal transplant patient was advised lifelong voriconazole since he would continue to be on immunosuppressants. To our knowledge, the second patient diagnosed post-COVID could be the first case report of invasive dematiaceous fungal infection in an apparently immunocompetent individual. Both cases also highlight the challenges in man-agement such as designing an appropriate regimen, deciding the optimum duration of antifungal therapy, and managing the toxicities associated with long-term antifungal use. R. mackenziei is a frequently fatal melanized neurotropic fungus known to carry almost 100% mortality despite the combination of antifungal agents and surgery. Central nervous system infections due to R. mackenziei have been exclusively reported from the Middle East, except for cases recently reported from India.

Awake Craniotomy for Cerebral Abscess with Pulmonary Arteriovenous Malformation

A cerebral abscess can be a life-threatening complication of pulmonary arteriovenous malformations (PAVM), thus posing significant morbidity if left untreated. We report a case of an incidental finding of a PAVM in a patient diagnosed with cerebral abscess. A 22-year-old male presented to the emergency department with acute onset right-sided weakness in both upper and lower limbs for 1 week. Magnetic resonance imaging showed a ring-enhancing lesion within the left parasagittal frontoparietal region s/o intracerebral abscess. High-resolution computed tomography was done as a protocol in patients posted for surgery due to coronavirus disease 2019 and coincidentally, it showed a single well-defined parenchymal nodule, 4 x 3.4 cm in the lateral basal segment of the left lower lobe. The knowledge of the pathophysiology of PAVM and expected complications during general anesthesia (GA) and positive pressure mechanical ventilation is essential. In such conditions, awake craniotomy under conscious sedation and scalp block may be considered as an alternative to GA.

Direct Admission Versus Secondary Transfer for Patients Treated with Mechanical Thrombectomy in Our Comprehensive Stroke Centre - Has Our Relocation Been Justified?

Background and Aims: Mechanical thrombectomy can only be performed in comprehensive stroke centres (CSC) which provide onsite interventional radiology and neurosurgical services. The benefits of direct admission to a CSC versus secondary transfer following initial admission to a stroke unit without MT service are heavily contested. Nottingham University Hospitals provides the East Midlands' Mechanical Thrombectomy (MT) service in the United Kingdom. With an aim to reduce the number of transfers for patients eligible for MT within the region, we relocated our stroke services from Nottingham City Hospital (NCH) to Queens' Medical Centre (QMC), a major trauma centre with on-site interventional services in July 2020. Method(s): We compared timings of stroke assessment and outcomes for consecutive patients transferred from NCH to those who were directly admitted to QMC after the change in our service model. Result(s): 101 patients admitted from Nottingham underwent MT between January 2019 and January 2022. For patients transferred (n=48) and patients directly admitted (n=53) respectively: average time from CT scan to groin puncture were 163 and 151 minutes;reperfusion rates (TICI>2a) were 100% and 96%. The median modified Rankin Score on discharge were 3.5 and 3.6 respectively. Conclusion(s): Although shorter imaging-to-groin puncture time was demonstrated post-relocation, comparable functional outcomes were seen between patients transferred and directly admitted to our CSC. This could be attributed to an increased time window of MT eligibility from 6 to 24 hours post symptom onset after our relocation. Further studies are required to establish its effects and explore the impacts of the COVID-19 pandemic on our stroke service.

A quality improvement (QI) innovation during the COVID-19 pandemic: Improving early diagnosis of type 1 diabetes (T1D) in children and young people (CYP) in Cardiff & Vale University Health Board

Introduction: Most CYP present with symptoms of T1D for the first time to primary care. Delayed diagnosis is common and associated with risk of life threatening diabetic ketoacidosis (DKA). In Cardiff, we had a pre-pandemic QI project to improve early diagnosis. As the pandemic changed delivery of healthcare, we introduced systems to facilitate early diagnosis of T1D. Objective(s): To facilitate early diagnosis of T1D via effective pathways during the pandemic. The primary objective is to reduce the incidence of DKA at diagnosis. Method(s): We worked with partners in primary care to identify barriers and develop initiatives at the start of the pandemic. This included an updated referral pathway, training for triage staff, revising online algorithms, and raising public awareness. Retrospective case note analysis of all newly diagnosed CYP covering prepandemic (1/4/2018-31/3/2020) and pandemic (1/4/2020- 31/3/2022). Key points included delayed diagnosis, presentation, appropriate testing, and prompt referral. Result(s): Pre-pandemic, 6/7 with delayed diagnosis had delayed triage and 1 had fasting blood glucose (BG). 25/28 had POC BG testing and 2 had a urine test. During the pandemic, 2/4 with delayed diagnosis had delayed triage. 46/49 had POC BG test and 3 a urine test. The 4 in severe DKA had delayed presentation but promptly diagnosed, of which 2 were presumed to have COVID. During the pandemic 91% had POC testing and prompt referral to secondary care compared with 75% pre pandemic. There was no increase in the DKA rates during the pandemic despite a significant increase in the number newly diagnosed. Conclusion(s): During the pandemic, we demonstrated an improvement in prompt diagnosis following the QI initiatives between primary and secondary care. Delayed presentation has resulted in severe DKA despite public awareness campaigns. Data analysis, feedback, training and public awareness campaigns across other health boards is planned.

STOBE: A Long-COVID Syndromic Study using Real-World data in Brazil : Heitor Cavalini

Background The COVID-19 pandemic has changed the way infectious diseases are perceived. Global healthcare systems have faced challenges since the start of the COVID-19 epidemic, particularly in developing countries. Some individuals with an acute COVID-19 diagnosis have developed symptoms persisting beyond 90 days. Long-Covid is the new term for this syndrome (LC). LC, on the other hand, is poorly known and appears to cause a wide range of symptoms, particularly among Brazilian patients. As a result, utilizing retrospective data from patients in Petrolina, Brazil’s largest city in the northeast, we conducted an exploratory epidemiology study. Methods A retrospective, cohort study design was used with a real-world dataset. The primary aim was to evaluate the prevalence of LC within Petrolina. The sample size was 1,164 LC patients. A comparative and subgroup analysis was conducted to evaluate demographics, comorbidities, clinical symptoms, and mortality. A k means model was used to assess disease severity using a clustering analysis based on the presence of comorbidities. Results The prevalence of physical symptoms identified was 69·5%. The strongest physical symptom was fever with resultant of 64·09% followed by pain, 43·64%. The prevalence of autonomic and neurological symptomatology was 8·59% and 8·16% respectively. A higher prevalence of autonomic symptoms were reported among older men of Black and Caucasian in comparison to Pardo. Disease severity within the sample could be associated with the presence of comorbidities which were identified based on medication history. Pregnant women have high rate of comorbidities. 529 patients have at least one comorbidity and 28·73% of them are pregnant. Conclusions It is useful to evaluate symptoms although a definitive diagnosis of LC is essential. This study provides insightful information around LC within a Brazilian population to develop better infection control protocols, as well as future management of similar pandemics. Key messages • This study could potentially improve the prognosis and mortality among LC patients with comorbidities. • Our findings could be combined with other regional datasets to predict pattern inferences of LC spread, prognosis and morbidity, including for multimorbidity and pregnant patients.

Impact of COVID-19 on the Performance of Indian Stock Market: An Empirical Analysis

The outbreak of COVID-19 epidemic had not only brought destruction to the human lives but also destabilized the financial markets across the world. Although there were some studies conducted on the impact of COVID-19 on the financial markets in the developed economies, very few studies were conducted on the developing economies like India. Hence, this study intends to measure the impact of COVID-19 on the Indian stock market, especially on NIFTY50, and all the major sectorial indices of National Stock Exchange (NSE). The study also makes an attempt to analyze the impact of COVID-19 on the Indian stock market in various time periods (lockdown, pre-lockdown, and full sample time periods). For this purpose, the researchers have used EGARCH and regression models to measure the sectoral impact of COVID-19 on NIFTY. The study finds asymmetrical reactions on positive and negative shocks in the Indian stock market.The β2 coefficient, which explains asymmetric volatility, is significant and positive for FMCG, realty, oil and gas, and consumer durables, suggesting the presence of asymmetric effect, but has no leverage effect. It implies that positive news has greater effects on volatility than negative news. In other words, investors are more prone to positive shocks than negative shocks with the same magnitude. While β2 is found to be significant and negative for NIFTY, bank, information technology, and financial services, which clearly depicts the presence of leverage effect. It suggests the presence of asymmetrical reactions on unfavorable shocks in these indices.

Longitudinally extensive transverse myelitis following ChAdOx1 nCoV-19 vaccine.

Transverse myelitis (TM) has been reported in association with various vaccinations. Herein we describe a case of longitudinally extensive transverse myelitis (LETM) associated with vaccination with ChAdOx1 nCoV-19 (COVISHIELD) vaccine. A 59-year-old woman with no prior co-morbidities presented with lower extremity numbness, weakness, acute urinary retention, and constipation. Numbness gradually extended up to the lower costal margin with band like sensation. She had received the vaccine 5 days prior to the onset of the symptoms. Extensive diagnostic evaluation effectively ruled out causes other than vaccination-associated transverse myelitis. Following treatment with intravenous methylprednisolone, the patient made a significant recovery. TM may be associated with vaccination against the novel ChAdOx1 nCoV-19 vaccine and we believe this to be the first report from India of LETM associated with this vaccine.

Hematological profile of COVID-19 patients in Ramanagar district, Karnataka-A cross sectional study

Introduction and Aim: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which rapidly evolved into a pandemic infecting humans all over the world. Whether hematologic and immunologic responses play a crucial role in progression of COVID-19 is still not clear. Increasing scientific evidence has shown that abnormalities in routine hematological tests, have the potential to diagnose SARS-CoV-2 infection in an economical way. Major laboratory changes indicating systemic inflammation and multi-organ impairment including hematopoietic system leading to lymphocytopenia, neutrophilia, eosinopenia, mild thrombocytopenia and ratios derived from these hematological parameters indicated severe disease and/or fatal outcomes. The aim was to study the hematological profile of Covid-19 patients admitted at a tertiary care hospital at Ramanagar district. Materials and Methods: This retrospective study included 260 confirmed cases of Covid-19 diagnosed at a tertiary health care centre. Demographic, clinical, laboratory, treatment, and outcome data were extracted from the institutional electronic medical records after obtaining permission from the concerned authorities. From CBC test results obtained neutrophil lymphocyte ratio was derived. Results: The present study revealed that majority of Covid positive patients presented with lymphopenia. While a significant association was observed between N/L ratio and disease severity, no significant association was seen between platelet count and severity of the disease. Conclusion: Since the results of the present study features lymphopenia among large proportion of patients and elevated N/L ratio among critically ill patients these markers could be utilized as useful prognostic indicators during the initial assessment of disease severity and thus appropriate management can be planned for such patients before the condition of the patient deteriorates.

DIABETES MELLITUS IN COVID-19;A HOSPITAL-BASED LONGITUDINAL ANALYTICAL STUDY

Objectives: The aim of the study was (1) to assess and compare the profile of COVID-19 patients with diabetes and without diabetes and (2) to determine the outcome of COVID-19 patients with diabetes mellitus. Methods: A hospital-based longitudinal analytical study was conducted on a total of 2000 patients in Bengaluru during the study period from August 2020 to July 2021. The patients fulfilling the inclusion criteria were enrolled for the study after obtaining informed consent. Patients were divided into diabetic and non-diabetic groups and inflammatory markers were compared between these two groups and outcome of these patients was noted. Results: Of the 2000 COVID-19 patients included, 358 were diabetics in this study. Mean age of non-diabetic patients was 41.71 (±15.37) years and diabetic patients were 54.37 (±11.95) years. The inflammatory markers such as Lactate Dehydrogenase (LDH), Ferritin, C-Reactive Protein (CRP), and Neutrophil-Lymphocyte ratio (NLR) were significantly high in patients with diabetes compared to the non-diabetic patients with COVID-19 (p<0.05). Conclusion: This study shows that diabetes is a major risk factor and contributes to the severity and mortality of patients with COVID-19. Our recommendations are for the strict glycemic control in patients affected by COVID-19 during treatment for the same.

Current management of children with COVID-19 in hospitals in India;Pilot study and findings

Introduction: To date, the focus on COVID-19 among children, especially in low- and middle-income countries, has been to address key issues including poor vaccination rates. However, the focus is changing with new variants and concerns regarding the development of hyperinflammatory syndromes. There have also been concerns with the overuse of antibiotics to treat patients with COVID-19, with the Indian Government developing guidelines, including those for children, to improve patient care. Consequently, a need to document the current management of children with COVID-19 in India and use the findings for future guidance. Materials and Methods: Pilot study assessing the management of children with COVID-19 among five hospitals in India using purposely developed case report forms, which had been piloted in Bangladesh. Results: Low numbers of children in hospital with COVID-19 (11.9% of in-patient beds). The majority were boys (58.3%) and between 11 and 18 years (55.5%). Reasons for admission were in line with previous studies and included respiratory distress/breathing difficulties. 69.4% of children with COVID-19 were prescribed antibiotics empirically, typically those on the Watch list, and administered parenterally, with only limited switching to oral therapy. A minority were prescribed antimalarials, antivirals and anti-parasitic medicines. There was appreciable prescribing of immune boosters and steroids. Conclusion: It was encouraging to see low hospitalisation rates. However, concerns with high empiric use of antibiotics and limited switching to oral formulations need to be addressed potentially, by instigating antimicrobial stewardship programmes. Similarly, other antimicrobials where these are not recommended.

Level of awareness of preventive protocols amongst special educators in schools during COVID-19

Objective: The objective of the study was to assess the knowledge of special educators on COVID-19, impart evidence based scientific information through health education program and reassess the knowledge through a self-constructed close ended questionnaire. The aim to educate and recommend alternate ways of maintaining COVID safe environments in special school's post pandemic. Material and methods: A total of 42 special educators participated in the study. The knowledge of special educators on COVID-19 was assessed through self-constructed pre-test form. Post health education, knowledge gained was reassessed with help of the same close ended questionnaire. A power point presentation on COVID-19, including evidence based scientific information was done. This was followed by an interactive session. The obtained responses were tabulated evaluated for the correct and incorrect responses. The results obtained were subjected to statistical analysis.

Prevalence of SARS CoV-2 spike antibody in post COVID or post vaccinated individuals

Background &Objective : SARS-CoV-2 pandemic is causing high morbidity and mortality burden worldwide with unprecedented strain on health care systems. Data on the prevalence of the SARS-CoV-2 antibody is expanding with growing research. The initial data on antibodies was available for nucleocapsid target proteins however with advancing research and development of vaccines against the Spike RBD domain of the virus, antibody assays are being focussed to the Spike RBD proteins. The current study aims to understand the prevalence of Anti-Spike SARS cov2 antibodies. Method: A commercially available assay targeting the SPIKE RBD domain of the virus using a chemiluminescent microparticle immunoassay was used for the qualitative and quantitative determination of IgG antibodies to SARS-CoV-2 in a total of 260 individuals. Results: A total of 260 individuals were screened which included 147 males and 113 females with a mean age of 51+16 years. A positive seroprevalence was observed in 85.3% (222/260) individuals. Vaccination details were available for 225 individuals wherein 194 were seropositive. Around 12% did not show presence of antibodies (26/211) even after 21 days of vaccination. A few non-vaccinated individuals were seropositive due to prior history of Covid infection. However, 7 individuals with past history of Covid infection and 2 post vaccination were negative for antibodies. Conclusion: Serological testing plays a vital role in understanding and ultimately combating viral outbreaks and can help identifying individuals with an adaptive immune response to SARSCoV-2, indicating recent or prior infection. A high prevalence of positive spike antibodies is observed in most individuals.

Is Non-Restorative Cavity Treatment a Practical Choice in Primary Teeth?

For years, "extension for prevention" was considered as the standard protocol for the restoration of caries. With advances in the field of cariology regarding the biofilm and improvement in materials, this perspective is being challenged. This is being challenged by more biological and less-invasive approaches, where the emphasis is on biofilm alteration to arrest carious lesions. This minimally invasive intervention is based on the concept that biofilm overlying the carious lesion is a driving force for the carious process and not the bacteria present in the infected dentin. Hence, daily removal or disruption of this biofilm will slow down the carious process or bring it to halt. One such approach is non-restorative cavity treatment, where no caries is removed but lesions are made self-cleansable that allows it to be brushed by the parent or the child. This wholesome approach targets the disease at a causal level. This review of literature describes the various advantages and limitations of this technique and the practicability of its use in pediatric patients during the pandemic COVID-19.

White Blood Cells in COVID-19: A Study on Viral Induced Cytopathic Changes in the Peripheral Smear

Introduction: Laboratory parameters are crucial in diagnosis and prognosis of Coronavirus Disease 2019 (COVID-19). It would be of interest to explore morphological changes in infected White Blood Cells (WBCs). A detailed examination of peripheral smears may shed light on pathophysiology of infected cell lines and differentiate them from those in established viral infections like dengue and infectious mononucleosis. Aim: To study morphological changes of WBCs in peripheral smears of severe and non severe cases of COVID-19 patients. Materials and Methods: This cross-sectional study was conducted at a tertiary care centre, Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research, Ramanagara, Karnataka, India, from April 2021 to August 2021 on 120 peripheral smears of adult COVID-19 positive cases. Abnormal morphological features were graded by counting 100 cells in each of neutrophils, lymphocytes and monocyte lineage. Changes were compared and analysed between severe and non severe groups using Statistical Package for Social Sciences (SPSS) software version 26.0. A p-value <0.05 was considered as significant. Results: The study included total of 120 cases (59 severe and 61 non severe) with a mean age of 47 years. Male to female ratio in severe and non severe categories were 1:1.2 and 1:0.6, respectively. Severe category patients (n=59) were associated with statistically significant leucocytosis (p-value=0.04), absolute neutrophilia (p-value=0.03) and higher grades of morphological changes- abnormal nuclear morphology (p-value=0.002) and Pseudo-Pelger-Huët anomaly in neutrophils (p-value=0.029), plasmacytoid lymphocytes (p-value=0.03), cytoplasmic granularity and atypical lymphocytes (p-value=0.04). Monocytes showed large coalescent vacuoles and cytoplasmic granules (p-value=0.03). Though present in non severe category (n=61), they were proportionately of lesser grades. Conclusion: Viral cytopathic effects in WBC cell lines on peripheral smear had significant clinical implications on disease severity, undermining need for a comprehensive study of viral induced morphological changes in hospitalised COVID-19 patients.

Awareness among dental practitioners about oil pulling u Its effect on the Corona Virus and immunocompromised patients: A questionnaire-based survey

Background: The ongoing pandemic has posed limitations to dental practice. In the current scenario of the coronavirus disease-2019 (COVID-19) pandemic, many patients present with symptoms like burning of the eyes, nose, throat, xerostomia, and mouth ulcers. For this, the Ministry of AYUSH is promoting oil pulling as a preventive measure. Aim: The aim of this study was to increase the awareness and confidence of dental practitioners in prescribing a simple technique for ameliorating common symptoms of COVID-19 infection u by oil pulling, in routine clinical practice. Methods: This study entailed designing a standardized web-based questionnaire for conducting a survey among dental practitioners from all specializations. Here, 100 participants answered 14 questions related to the role of oil pulling in treating oral symptoms common among COVID-19 patients and immunocompromised radiation patients. Statistical analysis was carried out after receiving all responses. Frequencies and percentages were calculated. Results: The results of the present survey indicated that 8.6% of total participants had good awareness (16 Qs);56.3% of total participants showed moderate awareness (10u16 Qs);while 35.2% had poor awareness (<10 Qs). Conclusion: Oil pulling can be deemed as an effective method of treating oral symptoms of COVID-19. Dentists should acquire adequate knowledge regarding the role and importance of this simple preventive measure.