Vitamin-D deficiency, the hidden pandemic in sunshine sufficient countries, exacerbating hypocalcaemia in a health worker undergoing thyroidectomy - a global perspective and review of literature

Introduction: Vitamin D deficiency (VDD) is common in young adults even in sunlight sufficient countries. It manifests with subtle and trivial symptoms that are often ignored. Nutritional deficiency due to improper dietary habits, poverty, long hours at work and study are factors. The lockdown during COVID has exacerbated the incidence. We had a patient with VDD who became symptomatic after routine thyroidectomy prompting our review into literature on the global health perspective of VDD. Material and method: - A 21-year-old nursing student developed hypocalcaemia within 24 hours after a routine thyroidectomy. VDD was detected and patient improved after supplementation. Literature was reviewed from Pubmed database for the medical aspects of the problem, from Government archives like the Scientific Advisory Committee on Nutrition, ICMR etc for cause and medical archives including those of paediatric and general health for the impact of disease at the state, national and global level. A global health problem list was prepared and data was reviewed. Discussion: Vitamin D is protective against respiratory infections due to viral aetiology including COVID. However, complete lockdown to prevent spread of COVID, online learning, and work from home culture has reduced sunlight exposure and increased incidence of VDD. Post thyroidectomy hypocalcaemia is common in VDD. Conclusion: Since there is a high prevalence of asymptomatic VDD even in sunshine sufficient countries, it is recommended to screen all patients especially young adults for VDD during routine preoperative work up.

Teleophthalmology : A Case of Eye Care Delivery

As a result of COVID-19, a new approach for delivering eye care services to rural underprivileged areas were needed to improve eye disease outcomes. Sitapur Eye Hospital used a door-to-door model of medical delivery to alleviate the inability of rural residents from not receiving appropriate eye care during the COVID-19 pandemic. Sitapur Eye Hospital utilizes a healthcare delivery model that involves visiting patients door-to-door. The total number of patients that Sitapur Eye Hospital examined went from screening no patients in the months of April and May to screening 31,017 patients via the door-to-door service that was implemented in June 2020. Sitapur Eye Hospital managed to keep the prevalence of people who had severe eye impairment at pre-pandemic levels by offering a door-to-door service to patients who were unable to access appropriate medical care. The door-to-door healthcare model shows that leveraging telehealth and ride-hailing services alleviate certain barriers that make it difficult for people in rural areas to access eye care.

COVID-19 and Cardiovascular Disease.

Coronavirus disease 2019 (COVID-19) is a global pandemic affecting 185 countries and >3 000 000 patients worldwide as of April 28, 2020. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2, which invades cells through the angiotensin-converting enzyme 2 receptor. Among patients with COVID-19, there is a high prevalence of cardiovascular disease, and >7% of patients experience myocardial injury from the infection (22% of critically ill patients). Although angiotensin-converting enzyme 2 serves as the portal for infection, the role of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers requires further investigation. COVID-19 poses a challenge for heart transplantation, affecting donor selection, immunosuppression, and posttransplant management. There are a number of promising therapies under active investigation to treat and prevent COVID-19.

Cognitive dysfunction associated with COVID-19: Prognostic role of circulating biomarkers and microRNAs.

COVID-19 is renowned as a multi-organ disease having subacute and long-term effects with a broad spectrum of clinical manifestations. The evolving scientific and clinical evidence demonstrates that the frequency of cognitive impairment after COVID-19 is high and it is crucial to explore more clinical research and implement proper diagnostic and treatment strategies. Several central nervous system complications have been reported as comorbidities of COVID-19. The changes in cognitive function associated with neurodegenerative diseases develop slowly over time and are only diagnosed at an already advanced stage of molecular pathology. Hence, understanding the common links between COVID-19 and neurodegenerative diseases will broaden our knowledge and help in strategizing prognostic and therapeutic approaches. The present review focuses on the diverse neurodegenerative changes associated with COVID-19 and will highlight the importance of major circulating biomarkers and microRNAs (miRNAs) associated with the disease progression and severity. The literature analysis showed that major proteins associated with central nervous system function, such as Glial fibrillary acidic protein, neurofilament light chain, p-tau 181, Ubiquitin C-terminal hydrolase L1, S100 calcium-binding protein B, Neuron-specific enolase and various inflammatory cytokines, were significantly altered in COVID-19 patients. Furthermore, among various miRNAs that are having pivotal roles in various neurodegenerative diseases, miR-146a, miR-155, Let-7b, miR-31, miR-16 and miR-21 have shown significant dysregulation in COVID-19 patients. Thus the review consolidates the important findings from the numerous studies to unravel the underlying mechanism of neurological sequelae in COVID-19 and the possible association of circulatory biomarkers, which may serve as prognostic predictors and therapeutic targets in future research.

Implementing Virtual Nursing in Health Care: An evaluation of effectiveness and sustainability

As SARS-COV-2 or COVID-19 (COVID) increasingly spread across the world, nurses in the United States increasingly became at risk for contagion, as well as experiencing higher levels of anxiety and concerns related to safety in the workplace. The rise of COVID and the underlying desire to secure protections for healthcare workers created a higher demand for technology and online workspaces where clinicians can provide sustainable care for patients while also reinforcing the need for staff safety. To streamline the patient discharge process, increase patient safety, comprehension, and satisfaction, while simultaneously preventing undesirable readmission rates, a Virtual Nurse application, via remote monitoring and video capabilities, is expected to take over indirect patient tasks such as patient education, discharge instructions, pain monitoring, telemonitoring, communication with the primary nurse and others. By automation, the Virtual Nurse will alleviate repetitive and time-consuming tasks, thus, freeing up nurses to focus on direct patient care tasks and human-to-human quality interaction. This study strives to investigate the feasibility of the implementation of a Virtual Nurse role in the patient discharge process performed at a large healthcare system. This study will start by presenting a brief literature review focused on the technologies currently being employed in healthcare settings around the U.S. Our study aims to present the methodologies utilized in data acquisition and analysis, as well as population sample characteristics. © 2022 IEEE.

Analyzing Security and Privacy Concerns of Contact Tracing Applications

The spread of COVD-19 has affected normal life like no other pandemic in the 21st century. This has seen the evolution and adoption of digital contact tracing applications, majority of which rely on google and apple exposure notification and can easily be downloaded for use in any smartphone. It is imperative to protect personal health information transmitted in these apps. Developers have been criticized for slacking in protecting personal health information and on being non-compliant to HIPAA. Using MobSF, we interact with these apps to detect security vulnerabilities and demonstrate whether they are complying with their privacy policies. Our analysis showed that contact tracing applications have poor security features and not safe.

Alert System for Epileptic Seizure (preprint)

Covid 19 has given way to a disruptive and transformative digital automation in health sector worldwide with multi fold investments for upgradation. Benefits could extend across health management with more innovations. Epilepsy, the fourth most common chronic neurological disorder, characterized by recurrent involuntary seizures affects everyone. Worldwide, 70 million people are affected, including 12 million in India, about one-sixth of the global burden. Epilepsy is unpredictable with violent seizures leading to sudden fluctuations in heart rate and involuntary muscle movements leading to death. Therefore, prompt medical attention is essential. Collectively, epilepsy has an effect on the quality of life, career development, and social behaviour, due to an imbalance of the patient’s nervous system. Pre-Covid epilepsy management is largely traditional with little advancement in smartwatches, apps like Apple smartwatches, Android apps, and more. expensive. Covid's new normal has led many to develop cost-effective digital health technology using existing smartphones with smartwatches built in. Epilepsy management systems can also be made affordable. We propose to take advantage of current advancements in smartwatches and smartphone apps by integrating them and adding new features such as video camera activation, photos and automation in sending alerts to, friends and care takers.

Smart Virtual Trial Room For Apparel Industry

In accordance with the development of new technologies, e-commerce is revolutionizing the world, especially in the COVID-19 pandemic. It becomes a major part of the industry in improving revenue. A lot of potential time-consuming in traditional purchasing may lead to failing customer's trust in apparel industry. So, in e-commerce purchasing, customers get more new collections of apparel, saving money and time. Buying apparel through e-commerce has certain limitations of trying apparel before buying it. However, the proposed system allows customers to experience the fit virtually according to their needs. The main motive of the project is experiencing customer's outfits before purchasing so that customers can improve their decision-making process. A virtual trial room system improves the accessibility of the garments virtually without any discomfort, enhances customers to feel free to try the fit, comfortable to engage with the environment and there are fewer chances of returning and cancelling products. It detects the customer's posture and provides 2D virtual garments that are adjusted according to the posture, thus predicting the right fit by measuring the height and width of the body. This application provides interactive, rich and engaging surroundings to the clients. © 2022 IEEE.

Real-world use of inhaled nitric oxide therapy in patients with COVID-19 and mild-to-moderate acute respiratory distress syndrome.

Background: Inhaled nitric oxide (iNO) has been studied in patients with severe acute respiratory distress syndrome (ARDS) due to COVID-19 when it may be too late to impact disease course. This article aims to describe real-world iNO use and outcomes in patients with COVID-19 with mild-to-moderate ARDS in the United States. Methods: This was a retrospective medical chart review study that included patients who were ≥18 years old, hospitalized for COVID-19, met the Berlin ARDS definition, received iNO for ≥24 hours continuously during hospitalization, and had a partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio (P/F ratio) of >100 to ≤300 mmHg at iNO initiation. Outcomes included oxygenation parameters, physician-rated Clinical Global Impression-Improvement (CGI-I) scale scores, and adverse events. Response to iNO was defined as >20% improvement in P/F ratio. Results: Thirty-seven patients at six sites were included. A P/F ratio of ≤100 was the most common reason for exclusion (n=146; 83% of excluded patients). The mean P/F ratio (SD) increased from 136.7 (34.4) at baseline to 140.3 (53.2) at 48 hours and 151.8 (50.0) at 72 hours after iNO initiation. The response rate was 62% (n=23). During hospitalization, no patient experienced adverse events, including methemoglobinaemia, airway injury, or worsening pulmonary oedema associated with iNO. At discharge, 54.0% (n=20) of patients improved or remained stable according to the CGI-I. Conclusion: In patients hospitalized with COVID-19 and mild-to-moderate ARDS, iNO was associated with improvement in the P/F ratio with no reported toxicity. This study provides additional evidence supporting a favourable benefit-risk profile for iNO in the treatment of mild-to-moderate ARDS in patients with COVID-19 infection.

Book review: Slavoj Žižek, Pan(dem)ic! Covid 19 Shakes the World

Slavoj ?i?ek, Pan(dem)ic! Covid 19 Shakes the World. New York and London: OR Books, 2020, 146 pp., $15 (hardback). ISBN: 978-1-68219-301-3.

A year into the pandemic: A mathematical model and study of covid-19 in india

COVID-19 has been declared as a global pandemic by the World Health Organization (WHO) since its outbreak in December 2019. In India, as of May 12th 2021, the total number of coronavirus cases and associated deaths are 2,35,57,676 and 2,56,617 respectively. To control the spread of the virus effectively, social distancing, self-isolation and quarantine, lockdowns and mass inoculation are vital. In this paper we propose a deterministic epidemic model which is an extension of the SEIR model to understand the disease dynamics.The proposed model has eight compartments, Susceptible1, Susceptible2, Exposed, Infected, Quarantined, Isolated, Recovered and Dead and is termed as the S1S2EIQJRD model. The basic reproduction number Ris derived for the proposed model and it is shown that for the disease dies out and for the disease is endemic. Numerical simulations for the growth of the virus across India through the span of the outbreak are obtained. The simulation is done on real data and the results obtained may be used to make suitable inferences about the dynamics of the disease and appropriate measures can be taken to control its spread.

Current understanding of gut microbiota in tackling COVID-19

SARS-CoV-2 is a global pandemic that mainly affects the respiratory system by binding to host cell transmembrane protease serine-2 (TMPRSS-2) and ACE2 (angiotensin-converting enzyme) receptors on alveolar epithelial cells. The gut microflora plays an important role in maintaining human health and of greatest concern in covid affected individuals. Dysbiosis may be a consequence for lung infection that has been linked to the severity of SARS-CoV-2. Recent studies identified the presence of SARSCoV-2 RNA in the faeces of COVID-19 patients, which has been associated with several gastrointestinal tract ailments and multiorgan dysfunction. Diet, lifestyle, and genetics plays a vital role in determining the gut microbiota and immune compromise to the virus infection. COVID-19 is attributed to the variations in gut microbiota diversity which often decreases with age and, hence the lethality in elderly patients. Intestinal microbiota profile can be enhanced by improved diet and supplementation, which has been shown to increase immunity in elderly and immune-compromised patients. Diet has an incredible impact on the gut microbiome, allowing for a new state of homeostasis to be achieved through intake timing, frequency, and duration. This review article focuses on gut, lung microbiota, and immunomodulation. with an emphasis on gut microbiota-induced immune activation.

Olfactory and Gustatory Dysfunctions in Patients With Laboratory-Confirmed COVID-19 Infection: A Change in the Trend.

To study the presence of olfactory and gustatory dysfunctions in patients with laboratory-confirmed COVID-19 infection in our set up. Longitudinal study, 1st March 2020-15th August 2020, at a tertiary care hospital. RT PCR positive for SARSCoV-2 patients, above 18 years age included. Excluding patients with previous history of changes in smell or taste sensation, severely ill at the time of admission, history of taking drugs at the time of COVID 19 infection that affect the smell or taste sensation. 435 patients included after obtaining an institutional ethical clearance. After an informed consent, these patients were followed up telephonically, to record any subjective improvement in olfactory or gustatory symptoms and an approximate duration of recovery. Olfactory and/or gustatory dysfunction 10.8% (47/435). Mean (SD) age-34.53(10.8) years. Females affected significantly more [X2 (1, N = 435) = 7.45, p value is 0.006, significant at p < 0.05]. Olfactory dysfunction significantly associated with gustatory dysfunction [X2 (1, n = 435) = 182.29, p < 0.00001]. 19.8% (N = 435) of individuals remained asymptomatic. Nasal symptoms rare (4%, N = 47). Mean (SD) recovery olfactory and gustatory dysfunction 12.1 (7.7) and10.8 (6.3) days respectively. Subjective loss of smell or taste dysfunction was far less common. Women and younger population reported olfactory or gustatory dysfunction commonly. Olfactory and gustatory changes without nasal symptoms, suspicion of COVID-19 infection is relevant. Recovery is complete and early.

Actionable Knowledge Extraction Framework for COVID-19

In response to the COVID-19 pandemic, the White House and a coalition of leading research groups have prepared the COVID-19 Open Research Dataset (CORD-19) containing over 51,000 scholarly articles, including over 40,000 with full text, about COVID-19, SARS-CoV-2, and related coronaviruses. Medical professional including physicians frequently seek answers to specific questions to improve guidelines and decisions. The huge resource of medical literature is important sources to generate new insights that can help medical communities to provide relevant knowledge and overall fight against the infectious disease. There are ongoing attempts to develop intelligent systems to automatically extract relevant knowledge from many unstructured documents. In this paper, we propose an efficient question answering framework based on automatically analyzing thousands of articles to generate both long text answers (sections/ paragraphs) in response to the questions that are posed by medical communities. In the process of developing the framework, we explored natural language processing techniques like query expansion, data preprocessing, and vector space models early. We show the initial results of an example query answering for the incubation period. © 2020 IEEE.

Admission Cardiac Diagnostic Testing with Electrocardiography and Troponin Measurement Prognosticates Increased 30-Day Mortality in COVID-19.

Background Cardiovascular involvement in coronavirus disease 2019 (COVID-19) is common and leads to worsened mortality. Diagnostic cardiovascular studies may be helpful for resource appropriation and identifying patients at increased risk for death. Methods and Results We analyzed 887 patients (aged 64±17 years) admitted with COVID-19 from March 1 to April 3, 2020 in New York City with 12 lead electrocardiography within 2 days of diagnosis. Demographics, comorbidities, and laboratory testing, including high sensitivity cardiac troponin T (hs-cTnT), were abstracted. At 30 days follow-up, 556 patients (63%) were living without requiring mechanical ventilation, 123 (14%) were living and required mechanical ventilation, and 203 (23%) had expired. Electrocardiography findings included atrial fibrillation or atrial flutter (AF/AFL) in 46 (5%) and ST-T wave changes in 306 (38%). 27 (59%) patients with AF/AFL expired as compared to 181 (21%) of 841 with other non-life-threatening rhythms (P<0.001). Multivariable analysis incorporating age, comorbidities, AF/AFL, QRS abnormalities, and ST-T wave changes, and initial hs-cTnT ≥20 ng/L showed that increased age (HR 1.04/year), elevated hs-cTnT (HR 4.57), AF/AFL (HR 2.07), and a history of coronary artery disease (HR 1.56) and active cancer (HR 1.87) were associated with increased mortality. Conclusions Myocardial injury with hs-cTnT ≥20 ng/L, in addition to cardiac conduction perturbations, especially AF/AFL, upon hospital admission for COVID-19 infection is associated with markedly increased risk for mortality than either diagnostic abnormality alone.

An Evaluation of Biometric Monitoring Technologies for Vital Signs in the Era of COVID-19.

The novel coronavirus disease 2019 (COVID-19) global pandemic has shifted how many patients receive outpatient care. Telehealth and remote monitoring have become more prevalent, and measurements taken in a patient's home using biometric monitoring technologies (BioMeTs) offer convenient opportunities to collect vital sign data. Healthcare providers may lack prior experience using BioMeTs in remote patient care, and, therefore, may be unfamiliar with the many versions of BioMeTs, novel data collection protocols, and context of the values collected. To make informed patient care decisions based on the biometric data collected remotely, it is important to understand the engineering solutions embedded in the products, data collection protocols, form factors (physical size and shape), data quality considerations, and availability of validation information. This article provides an overview of BioMeTs available for collecting vital signs (temperature, heart rate, blood pressure, oxygen saturation, and respiratory rate) and discusses the strengths and limitations of continuous monitoring. We provide considerations for remote data collection and sources of validation information to guide BioMeT use in the era of COVID-19 and beyond.

Indications for and Findings on Transthoracic Echocardiography in COVID-19.

BACKGROUND: Despite growing evidence of cardiovascular complications associated with coronavirus disease 2019 (COVID-19), there are few data regarding the performance of transthoracic echocardiography (TTE) and the spectrum of echocardiographic findings in this disease. METHODS: A retrospective analysis was performed among adult patients admitted to a quaternary care center in New York City between March 1 and April 3, 2020. Patients were included if they underwent TTE during the hospitalization after a known positive diagnosis for COVID-19. Demographic and clinical data were obtained using chart abstraction from the electronic medical record. RESULTS: Of 749 patients, 72 (9.6%) underwent TTE following positive results on severe acute respiratory syndrome coronavirus-2 polymerase chain reaction testing. The most common clinical indications for TTE were concern for a major acute cardiovascular event (45.8%) and hemodynamic instability (29.2%). Although most patients had preserved biventricular function, 34.7% were found to have left ventricular ejection fractions ≤ 50%, and 13.9% had at least moderately reduced right ventricular function. Four patients had wall motion abnormalities suggestive of stress-induced cardiomyopathy. Using Spearman rank correlation, there was an inverse relationship between high-sensitivity troponin T and left ventricular ejection fraction (ρ = -0.34, P = .006). Among 20 patients with prior echocardiograms, only two (10%) had new reductions in LVEF of >10%. Clinical management was changed in eight individuals (24.2%) in whom TTE was ordered for concern for acute major cardiovascular events and three (14.3%) in whom TTE was ordered for hemodynamic evaluation. CONCLUSIONS: This study describes the clinical indications for use and diagnostic performance of TTE, as well as findings seen on TTE, in hospitalized patients with COVID-19. In appropriately selected patients, TTE can be an invaluable tool for guiding COVID-19 clinical management.

The Prognostic Value of Electrocardiogram at Presentation to Emergency Department in Patients With COVID-19.

OBJECTIVE: To study whether combining vital signs and electrocardiogram (ECG) analysis can improve early prognostication. METHODS: This study analyzed 1258 adults with coronavirus disease 2019 who were seen at three hospitals in New York in March and April 2020. Electrocardiograms at presentation to the emergency department were systematically read by electrophysiologists. The primary outcome was a composite of mechanical ventilation or death 48 hours from diagnosis. The prognostic value of ECG abnormalities was assessed in a model adjusted for demographics, comorbidities, and vital signs. RESULTS: At 48 hours, 73 of 1258 patients (5.8%) had died and 174 of 1258 (13.8%) were alive but receiving mechanical ventilation with 277 of 1258 (22.0%) patients dying by 30 days. Early development of respiratory failure was common, with 53% of all intubations occurring within 48 hours of presentation. In a multivariable logistic regression, atrial fibrillation/flutter (odds ratio [OR], 2.5; 95% CI, 1.1 to 6.2), right ventricular strain (OR, 2.7; 95% CI, 1.3 to 6.1), and ST segment abnormalities (OR, 2.4; 95% CI, 1.5 to 3.8) were associated with death or mechanical ventilation at 48 hours. In 108 patients without these ECG abnormalities and with normal respiratory vitals (rate <20 breaths/min and saturation >95%), only 5 (4.6%) died or required mechanical ventilation by 48 hours versus 68 of 216 patients (31.5%) having both ECG and respiratory vital sign abnormalities. CONCLUSION: The combination of abnormal respiratory vital signs and ECG findings of atrial fibrillation/flutter, right ventricular strain, or ST segment abnormalities accurately prognosticates early deterioration in patients with coronavirus disease 2019 and may assist with patient triage.

Systematic Review of Clinical Insights into Novel Coronavirus (CoVID-19) Pandemic: Persisting Challenges in U.S. Rural Population.

(1) Introduction. A recent viral outbreak of novel coronavirus (CoVID-19) was declared as a pandemic by the World Health Organization (WHO) due to its global public health concern. There has been an aggressive growth in the number of emerging cases suggesting rapid spread of the virus. Since the first reported case of CoVID-19, there has been vast progress in understanding the dynamics of CoVID-19. However, there is an increasing evidence of epidemiological disparity in disease burden between urban and rural areas, with rural areas having minimal pandemic preparedness and their own healthcare challenges. Therefore, this review aims to provide insight on the pathogenesis and the transmission dynamics of CoVID-19 along with pharmacological and non-pharmacological intervention strategies to mitigate the clinical manifestation of this virus. This review also aims to assess existing challenges of the CoVID-19 pandemic in rural areas based on past pandemic experiences and the effect on rural population. (2) Methods. A literature review was conducted using databases such as PubMed, Science Direct, Academic Search Premier, ProQuest, and Google Scholar, along with information from governmental organizations such as Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO). (3) Results. The causative virus, with its likely zoonotic origin, has demonstrated high pathogenicity in humans through increasing human-to-human transmission leading to extensive mitigation strategies, including patient quarantine and mass "social distancing" measures. Although the clinical manifestation of symptoms is mild in majority of the virus-inflicted population, critical patients may present with pneumonia and acute respiratory distress syndrome, exacerbated by pre-existing comorbidities, eventually leading to death. While effective coronavirus disease (CoVID-19)-specific vaccines and drugs are under clinical trials, several pharmacological and non-pharmacological interventions have been adapted to manage symptoms and curtail the effect of the virus to prevent increasing morbidity and mortality. Several persisting challenges have been noted for mitigating CoVID-19 in rural areas, including the poor healthcare infrastructure, health literacy, pandemic preparedness along with the fact that majority of rural population are frail subjects with pre-existing comorbidities. (4) Discussion. The increasing rate of incidence of CoVID-19 presents its own challenges, burdening healthcare institutions and the global economy, and impacting the physical and mental health of people worldwide. Given the clinical insights into CoVID-19 and the challenges presented in this review for the U.S. rural population, mitigation strategies should be designed accordingly to minimize the morbidity and mortality of this contagion.