Recurrent/Subsequent Stroke and Associated Outcomes in Geriatric Patients with OSA and Prior Stroke Events: A Retrospective Study Using the 2019 National Inpatient Sample.

Background: Obstructive sleep apnea (OSA) increases the risk of stroke and cardiovascular diseases. However, its impact on geriatric patients with a prior history of stroke/transient ischemic attack (TIA) has not been adequately studied. Methods: We utilized the 2019 National Inpatient Sample in the US to identify geriatric patients with OSA (G-OSA) who had a prior history of stroke/TIA. We then compared subsequent stroke (SS) rates among sex and race subgroups. We also compared the demographics and comorbidities of SS+ and SS- groups and utilized logistic regression models to assess outcomes. Results: Out of 133,545 G-OSA patients admitted with a prior history of stroke/TIA, 4.9% (6520) had SS. Males had a higher prevalence of SS, while Asian-Pacific Islanders and Native Americans had the highest prevalence of SS, followed by Whites, Blacks, and Hispanics. The SS+ group had higher all-cause in-hospital mortality rates, with Hispanics showing the highest rate compared to Whites and Blacks (10.6% vs. 4.9% vs. 4.4%, p < 0.001), respectively. Adjusted analysis for covariates showed that complicated and uncomplicated hypertension (aOR 2.17 [95% CI 1.78-2.64]; 3.18 [95% CI 2.58-3.92]), diabetes with chronic complications (aOR 1.28 [95% CI 1.08-1.51]), hyperlipidemia (aOR 1.24 [95% CI 1.08-1.43]), and thyroid disorders (aOR 1.69 [95% CI 1.14-2.49]) were independent predictors of SS. The SS+ group had fewer routine discharges and higher healthcare costs. Conclusions: Our study shows that about 5% of G-OSA patients with a prior history of stroke/TIA are at risk of hospitalization due to SS, which is associated with higher mortality and healthcare utilization. Complicated and uncomplicated hypertension, diabetes with chronic complications, hyperlipidemia, thyroid disorders, and admission to rural hospitals predict subsequent stroke.

Magnet-Retained closed bulb hollow obturator and orbital prosthesis for patient with maxillectomy and orbital exenteration following COVID-Associated mucormycosis.

The rehabilitation of facial deformities is a challenging endeavour that necessitates customising the procedure for each patient. Significant physical and psychological impacts might arise as a result of the deformity in the orofacial region. Post-COVID rhino-orbital mucormycosis has led to rise in extraoral and intraoral defects since 2020. To avoid further surgery, an economical maxillofacial prosthesis is an excellent choice as it is aesthetic, durable, long-lasting and retentive. This case report describes the prosthetic rehabilitation of the patient with post-COVID mucormycosis maxillectomy and orbital exenteration using a magnet-retained closed bulb hollow acrylic obturator and room-temperature vulcanising silicone orbital prosthesis. To enhance retention, a spectacle and medical-grade adhesive were also used.

Severity and mortality associated with COVID-19 among children hospitalised in tertiary care centres in India: a cohort study

Background It is critical to identify high-risk groups among children with COVID-19 from low-income and middle-income countries (LMICs) to facilitate the optimum use of health system resources. The study aims to describe the severity and mortality of different clinical phenotypes of COVID-19 in a large cohort of children admitted to tertiary care hospitals in India, Methods Children aged 0-19 years with evidence of SARS-CoV-2 infection (real time polymerase chain reaction or rapid antigen test positive) or exposure (anti-SARS-CoV-2 antibody, or history of contact with SARS-CoV-2) were enrolled in the study, between January 2021 and March 2022 across five tertiary hospitals in India.. All study participants enrolled prospectively and retrospectively were followed up for three months after discharge. COVID-19 was classified into severe (Multisystem Inflammatory Syndrome in Children (MIS-C), severe acute COVID-19, ‘unclassified') or non-severe disease. The mortality rates were estimated in different phenotypes. Findings Among 2468 eligible children enrolled, 2148 were hospitalised Signs of illness were present in 1688 (79%) children with 1090 (65%) having severe disease. High mortality was reported in MIS-C (18·6%), severe acute COVID-19 (13·3%) and the unclassified severe COVID-19 disease (12·3%). Mortality remained high (17·5%) when modified MIS-C criteria was used. Non-severe COVID-19 disease had 14·1% mortality when associated with comorbidity. Interpretation Our findings have important public health implications for low resource settings. The high mortality underscores the need for better preparedness for timely diagnosis and management of COVID-19. Children with associated comorbidity or coinfections are a vulnerable group and need special attention. MIS-C requires context specific diagnostic criteria for low resource settings. It is important to evaluate the clinical, epidemiological and health system-related risk factors associated with severe COVID-19 and mortality in children from LMICs. Funding Department of Biotechnology, Govt of India and Department of Maternal, Child and Adolescent Health and Aging, WHO, Geneva.

Biogenic Zinc Oxide Nanoparticles and Their Biomedical Applications: A Review.

Nanotechnology has inscribed novel perception into the material science and one of the most extensively used nanomaterials is Zinc oxide nanoparticles (ZnO NPs) with healthcare and biomedical applications. Because of its outstanding biocompatibility, low toxicity, and low cost, ZnO NPs have become one of the most prominent metal oxide NPs in biological applications. This review highlights the different aspects of ZnO NPs, like their green synthesis as a substitute of conventional route due to avoidance of threat of hazardous, costly precursors and subsequent mostly therapeutic applications. Due to their wide bandwidth and high excitation binding energy, ZnO NPs have undergone extensive research. In addition to their potential applications as antibiotics, antioxidants, anti-diabetics, and cytotoxic agents, ZnO NPs also hold a promising future as an antiviral treatment for SARS-CoV-2. Zn has antiviral properties and may be effective against a variety of respiratory virus species, particularly SARS-CoV-2. This review includes a variety of topics, including the virus's structural properties, an overview of infection mechanism, and current COVID-19 treatments. Nanotechnology-based techniques for the prevention, diagnosis, and treatment of COVID-19 are also discussed in this review.

Post maxillectomy rehabilitation and amelioration of quality of life of post-COVID rhinocerebral mucormycosis patients using obturator: A case series.

Mucormycosis, a rare fungal infection seen in diabetes, is now very frequent owing to the deadly triad of COVID-19 infection, diabetes, and rampant use of corticosteroids. Early diagnosis and treatment can reduce the mortality and morbidity of this lethal fungal infection. Treatment principles may include antifungal agents along with surgical debridement or resection. The surgically removed palate can have a devastating effect on the appearance and speech of the patient. Obturators allow patients to eat and drink without any suspicion of food entering the oroantral cavities/pharynx during mastication. This case series presented the prosthodontic rehabilitation of nine post-COVID rhinocerebral mucormycosis-infected patients with complete or partial defects.

Analyzing GAVI the Vaccine Alliance as a Global Health Partnership Model: A Constructivist Analysis of the Global Health Crisis

The ongoing debate on the conceptual underpinnings of constructivism and global health partnerships (GHPs) in global health studies has a dimension that deserves closer attention. This paper attempts to draw attention to a few aspects of the debate using Finnemore's constructivist analysis. According to this study, global actors need to rethink their paradoxical notions of pandemic crisis survival in light of the growing demand for mobilizing diverse global health agents and the necessity of constructing complex GNPs to address challenges of international significance. A global response based on solidarity and multilateralism is the only way to effectively combat this pandemic. Against this backdrop, the article analyses this development through an ideational ontological case study of the GAVI, the Vaccine Alliance. This article contributes to the debate by explaining how the GAVI Alliance fostered global collaboration and can serve as a template for future GHPs.

Tourist's satisfaction with local food effect behavioral intention in COVID-19 pandemic: a moderated-mediated perspective

Purpose>This study explored the relationship between local food consumption value and satisfaction with local food, leading to behavioral intention. Moreover, tourist's involvement is used as a mediator, and COVID-19 fear moderates between satisfaction with local food and behavioral intention.Design/methodology/approach>Structural equation modeling (SEM) technique presents researchers with extra flexibility and better research conclusions. This study used Partial Equation Modeling SEM to test the proposed hypotheses. The convenience sampling technique was used to collect data, and 339 questionnaires were part of the final analysis.Findings>The results reveal that local food consumption value is positively associated with local food satisfaction except for emotional value. Satisfaction on local food significantly determined tourist's involvement and behavioral intention. Tourist's involvement is positively related to behavioral intention. Despite this, COVID-19 fear significantly decreases behavioral intention. Tourist's involvement significantly mediates, and COVID-19 fear moderates between satisfaction with local food and behavioral intention significantly.Practical implications>The results of our research will support scholars and practitioners to recognize the importance of factors that influence people's intention to eat local food. Besides, our research offers a significant policy to get maximum benefits for the tourism industry in Pakistan.Originality/value>To the author's knowledge, our study initially incorporates a research model in the COVID-19 pandemic and covers local food consumption value, satisfaction on local food, tourist's involvement and COVID-19 fear to determine the behavioral intention of people to eat local food. Besides, consumption value theory was used to build a research framework.

Tryptophan in Nutrition and Health.

Tryptophan is a rate-limiting essential amino acid and a unique building block of peptides and proteins [...].

Algal Metabolites Can Be an Immune Booster against COVID-19 Pandemic.

The world has faced the challenges of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) for the last two years, first diagnosed at the end of 2019 in Wuhan and widely distributed worldwide. As a result, the WHO has proclaimed the illness brought on by this virus to be a global pandemic. To combat COVID-19, researcher communities continuously develop and implement rapid diagnoses, safe and effective vaccinations and other alternative therapeutic procedures. However, synthetic drug-related side effects and high costs have piqued scientists' interest in natural product-based therapies and medicines. In this regard, antiviral substances derived from natural resources and some medicines have seen a boom in popularity. For instance, algae are a rich source of compounds such as lectins and sulfated polysaccharides, which have potent antiviral and immunity-boosting properties. Moreover, Algae-derived compounds or metabolites can be used as antibodies and vaccine raw materials against COVID-19. Furthermore, some algal species can boost immunity, reduce viral activity in humans and be recommended for usage as a COVID-19 preventative measure. However, this field of study is still in its early stages of development. Therefore, this review addresses critical characteristics of algal metabolites, their antioxidant potential and therapeutic potential in COVID-19.

Molecular Docking Studies to Identify Promising Natural Inhibitors Targeting SARS-CoV-2 Nsp10-Nsp16 Protein Complex

Objectives: Unavailability of potential drugs/vaccines in the outbreak of the pandemic severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) have devastated the human population globally. Several druggable targets have been analyzed against different viral proteins such as the spike protein. The study aims to explore the potential of natural compounds as an effective drug against a novel nsp10-nsp16 complex of SARS-CoV-2 using in silico approaches. Materials and Methods: In silico screening (Docking analysis) was performed for 10 shortlisted natural compounds viz. allicin, ajoene, carvacrol, coumarin, curcumin, menthol, eugenol, theaflavin, ursolic acid, and catechin against a novel target of SARS-CoV-2, that has been anticipated to provide valuable lead molecules and potentially druggable compounds for the treatment of SARS-CoV-2. Results: Theaflavin and catechin, the natural components of black tea and green tea, out of 10 shortlisted compounds have shown excellent performance in our docking studies with the minimum binding energy of -11.8 kcal/mol and -9.2 kcal/mol respectively, against a novel nsp10-nsp16 complex of SARS-CoV-2 that indicates their potential for inhibitory molecular interactions against the virus to assist rapid drug designing from natural products. Conclusion: Either consumption of black tea and green tea or repurposing them as drug candidates may help individuals to fight against SARS-CoV-2, subject to their in vivo and in vitro further experimental validations.

India’s Neighbourhood Vaccine Diplomacy During COVID-19 Pandemic: Humanitarian and Geopolitical Perspectives

In recent years, India has established itself as the world?s ?pharmacy hub?, and this claim was proven once again when it delivered COVID-19 vaccines to its citizens, neighbouring nations and across the globe. Following the philosophy of humanitarianism through the principle of ?Vasudhaiva Kutumbakam?, India has decided to provide the COVID-19 health assistance to its immediate neighbouring countries. India?s immediate neighbourhood refers to the countries that are geographically adjacent to it. In addition, India?s vaccine diplomacy has exposed geopolitical fault lines in South Asia as China?s vaccine diplomacy aims to outpace India in the region. Against this background, the main objective of this paper is to explain and examine India?s vaccine diplomacy as an instrument of its ?Neighbourhood First? policy during the COVID-19 pandemic. It argues that India?s health-focused approach has proved effective and aligned with its national interests. This review demonstrates that India?s health diplomacy has had an impact on medical and humanitarian assistance reciprocation at the regional and international levels. As a result of this strategy, during the second wave of the pandemic, India received medical devices and vaccines from other countries in dealing with COVID-19.

A Sustainable environmental change and ESG initiatives by the manufacturing and others service Industries during COVID19 Pandemic

Covid-19 has improved the economy’s ESG plan. The ESG rating of an industry is crucial for stakeholders and will influence future business practices. ESG is commonly understood to refer to a set of criteria for making long-term investments in the areas of the environment, social welfare, and governance. Climate change is a systemic concern, and governments, companies, and society are increasingly determined to meet it. Climate change, according to the ESG, is the world’s most complicated challenge, posing collective risk and ambiguity to society. The impact of ESG elements and climate risk in the insurance business is investigated in this research. The research will also look into how insurers are responding to climate change. The research will also look into how insurers are pursuing climate-friendly activities such as creating green jobs, supporting socially responsible investing, and prioritizing environmental, social, and governance (ESG) and commercial sustainability in their operations. As a result, the study’s major recommendation is that potential clients and insurers increase their horizons of ESG risk awareness.

Discontinuation of Antihypertensive Medications on the Outcome of Hospitalized Patients With Severe Acute Respiratory Syndrome-Coronavirus 2.

[Figure: see text].

COVID-19 Pandemic and Reimagination of Multilateralism through Global Health Diplomacy

The ongoing pandemic COVID-19 has made it very clear that no one is safe until everyone is safe. But how can everyone be safe when the pandemic has broken every nerve of the economy and put an extra burden on the already crippled healthcare systems in low-income countries? Thus, the pandemic has changed the orientation of domestic as well as global politics, with many geopolitical shifts. The exponential growing infected cases and more than four million deaths has demanded a global response in terms of multilateralism. However, declining multilateralism and the need for its reforms was a much-delayed response. Given this context, this paper aimed to link the decline of multilateralism in the face of the pandemic by highlighting various instances of its failure and success;and highlighting the need for its revival. The article critically examines and evaluates the responses of multilateralism and global health diplomacy (GHD) during the pandemic. The ongoing black swan kind of event (an unexpected event) has obligated global leadership to think in terms of the revival of multilateralism through GHD. Historically, multilateralism through GHD has been shown to play an important role in managing and combating pandemics. The article further discusses various theoretical aspects such as sovereignty and hegemonic stability theory as reasons for the failing of multilateralism. The paper concludes by emphasizing the importance of foresight in reviving multilateralism in the pursuit of a more sustainable future.

Emergence and expansion of highly infectious spike protein D614G mutant SARS-CoV-2 in central India.

COVID-19 has emerged as global pandemic with largest damage to the public health, economy and human psyche.The genome sequence data obtained during the ongoing pandemic are valuable to understand the virus evolutionary patterns and spread across the globe. Increased availability of genome information of circulating SARS-CoV-2 strains in India will enable the scientific community to understand the emergence of new variants and their impact on human health. The first case of COVID-19 was detected in Chambal region of Madhya Pradesh state in mid of March 2020 followed by multiple introduction events and expansion of cases within next three months. More than 5000 COVID-19 suspected samples referred to Defence Research and Development Establishment, Gwalior, Madhya Pradesh were analyzed during the nation -wide lockdown and unlock period. A total of 136 cases were found positive over a span of three months that included virus introduction to the region and its further spread. Whole genome sequences employing Oxford nanopore technology were generated for 26 SARS-CoV-2 circulating in 10 different districts in Madhya Pradesh state of India. This period witnessed index cases with multiple travel histories responsible for introduction of COVID-19 followed by remarkable expansion of virus. The genome wide substitutions including in important viral proteins were identified. The detailed phylogenetic analysis revealed the circulating SARS-CoV-2 clustered in multiple clades including A2a, A4 and B. The cluster-wise segregation was observed, suggesting multiple introduction links and subsequent evolution of virus in the region. This is the first comprehensive whole genome sequence analysis from central India, which revealed the emergence and evolution of SARS-CoV-2 during thenation-wide lockdown and unlock.

An international study on psychological coping during COVID-19: Towards a meaning-centered coping style.

BACKGROUND/OBJECTIVE: This study examined the role of different psychological coping mechanisms in mental and physical health during the initial phases of the COVID-19 crisis with an emphasis on meaning-centered coping. METHOD: A total of 11,227 people from 30 countries across all continents participated in the study and completed measures of psychological distress (depression, stress, and anxiety), loneliness, well-being, and physical health, together with measures of problem-focused and emotion-focused coping, and a measure called the Meaning-centered Coping Scale (MCCS) that was developed in the present study. Validation analyses of the MCCS were performed in all countries, and data were assessed by multilevel modeling (MLM). RESULTS: The MCCS showed a robust one-factor structure in 30 countries with good test-retest, concurrent and divergent validity results. MLM analyses showed mixed results regarding emotion and problem-focused coping strategies. However, the MCCS was the strongest positive predictor of physical and mental health among all coping strategies, independently of demographic characteristics and country-level variables. CONCLUSIONS: The findings suggest that the MCCS is a valid measure to assess meaning-centered coping. The results also call for policies promoting effective coping to mitigate collective suffering during the pandemic.

ANTECEDENTES/OBJETIVO: Este estudio examinó el papel de diferentes estrategias de afrontamiento psicológico en la salud mental y física durante las fases iniciales de la crisis de COVID-19. MÉTODO: 11,227 personas de 30 países representando todos los continentes participaron en el estudio y completaron medidas de malestar psicológico (depresión, estrés y ansiedad), soledad, bienestar, salud física, medidas de afrontamiento centrado en el problema y en la emoción, y una medida denominada Escala del Afrontamiento Centrado en el Sentido (MCCS) que fue desarrollada en este estudio. El análisis de validación de la MCCS se realizó en todos los países, y los datos se evaluaron mediante un modelo multinivel. RESULTADOS: La MCCS mostró una estructura unifactorial en 30 países con buenos resultados de validez test-retest, concurrente y divergente. Los análisis mostraron resultados mixtos en cuanto a las estrategias de afrontamiento centradas en la emoción y en el problema. La MCCS fue el predictor positivo más fuerte de salud física y mental, independientemente de las características demográficas y las variables a nivel de país. CONCLUSIONES: Los resultados sugieren que la MCCS es un insrumento fiable para medir afrontamiento centrado en el sentido. Estos resultados pueden servir para dirigir políticas que promuevan un afrontamiento eficaz con el fin de mitigar el sufrimiento colectivo durante la pandemia.

Antihypertensives and their relation to mortality by SARS-CoV-2 infection.

The role of antihypertensives, especially Renin-Angiotensin-Aldosterone System inhibitors, is still debatable in COVID-19-related severity and outcome. Therefore, we search for a more global analysis of antihypertensive medication in relation to SAS-CoV-2 severity using prescription data worldwide. The association between the percentage use of different types of antihypertensive medications and mortality rates due to a SARS-CoV-2 infection during the first 3 weeks of the pandemic was analyzed using random effects linear regression models for 30 countries worldwide. Higher percentages of prescribed angiotensin receptor blockers (ARBs) (ß, 95% confidence interval [CI]; -0.02 [-0.04 to -0.0012]; p = .042) and calcium channel blockers (CCBs) (ß, 95% CI; -0.023 [-0.05 to -0.0028]; p = .0304) were associated with a lower first 3-week SARS-CoV-2-related death rate, whereas a higher percentage of prescribed angiotensin-converting enzyme inhibitors (ACEis) (ß, 95% CI; 0.03 [0.0061-0.05]; p = .0103) was associated with a higher first 3-week death rate, even when adjusted for age and metformin use. There was no association between the amount of prescribed beta-blockers (BBs) and diuretics (Diu) and the first 3-week death rate. When analyzing the combination of drugs that is used by at least 50% of antihypertensive users, within the different countries, countries with the lowest first 3-week death rates had at least an angiotensin receptor blocker as one of the most often prescribed antihypertensive medications (ARBs/CCBs: [ß, 95% CI; -0.02 [-0.03 to -0.004]; p = .009], ARBs/BBs: [ß, 95% CI; -0.03 [-0.05 to -0.006]; p = .01]). Finally, countries prescribing high-potency ARBs had lower first 3-week ARBs. In conclusion, ARBs and CCB seem to have a protective effect against death from SARS-CoV-2 infection.

Alarmingly Increased Public Interest in "Chest Pain" During the COVID-19 Pandemic: Insights From Google Trends Analysis.

Background The coronavirus disease 2019 (COVID-19) pandemic has been linked to a myriad of cardiac symptoms and disorders. Reports also suggest decreased hospital visits by patients with known cardiovascular disorders. Methodology To better elucidate the public interest in the information regarding "chest pain" during the COVID-19 pandemic, we conducted a Google Trends analysis from March 2019 to March 2021 to compare the internet searches between pre-COVID era and during the pandemic with country-wise [the United States (US) versus the United Kingdom (UK) versus India] variation. Results We observed a significantly rising public interest in "chest pain" internet searches during the peak COVID-19 pandemic. Rising trends were most prominent in the UK, followed by USA and India. Our analysis noted a spike in the trend of "chest pain" search in early March in the UK and USA, whereas in March and June 2020 for India. This shows an important temporal association between the surge of COVID-19 cases and the search for "chest pain" online. Conclusion Google Trends analyses indicate rising public interest in chest pain during the pandemic months and the possible association between COVID-19 and chest pain. These findings warrant further research, especially with increasing reports suggesting contradictory reports of decreased hospital visits by patients with known cardiovascular diseases.

Current Understanding of Novel Coronavirus: Molecular Pathogenesis, Diagnosis, and Treatment Approaches

An outbreak of “Pneumonia of Unknown Etiology” occurred in Wuhan, China, in late December 2019. Later, the agent factor was identified and coined as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the disease was named coronavirus disease 2019 (COVID-19). In a shorter period, this newly emergent infection brought the world to a standstill. On 11 March 2020, the WHO declared COVID-19 as a pandemic. Researchers across the globe have joined their hands to investigate SARS-CoV-2 in terms of pathogenicity, transmissibility, and deduce therapeutics to subjugate this infection. The researchers and scholars practicing different arts of medicine are on an extensive quest to come up with safer ways to curb the pathological implications of this viral infection. A huge number of clinical trials are underway from the branch of allopathy and naturopathy. Besides, a paradigm shift on cellular therapy and nano-medicine protocols has to be optimized for better clinical and functional outcomes of COVID-19-affected individuals. This article unveils a comprehensive review of the pathogenesis mode of spread, and various treatment modalities to combat COVID-19 disease.