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COVID-19 is a respiratory infection caused by a newer strain of coronavirus known as SARS-CoV-2. The major problem of COVID-19 infections is the ARDS, followed by respiratory failure, organ failure, and even death with multiple organ dysfunction, including cardiovascular collapse. Moreover, it affects the old age population with co-morbid conditions. The deficiency of diet, micronutrients, and vitamins also plays a key role in diminishing the immune power, and increases the rate of viral infectivity. The possible reasons and management methods are discussed in this review. The management methods enhance the host immune system via multi-functional and multi-targeted actions. The global rate of COVID-19 outbreak necessitates the need to develop newer medicines. The drug discovery process is based on the exposure of viral proteins, genome sequence, replication mechanisms, pathophysiological mechanisms, and host cell components (as a target) reactions. This article highlights the overview of coronavirus components, the replications process, and possible targets for the management of coronavirus infections. It may lead to the rapid development of newer medicines for the treatment of coronavirus in-fections.Copyright © 2022 Bentham Science Publishers.
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SARS-CoV-2 infection (COVID) is associated with high morbidity and mortality in solid organ transplants and vaccine efficacy is suboptimal. Tixagevimab and cilgavimab (T/C) are neutralizing antibodies used in the U.S. under emergency use authorization for COVID pre-exposure prophylaxis. However, T/C were developed when the Alpha and Omega variants were dominant. The purpose of this study is to look at real-world efficacy of T/C during the Omicron phase of the pandemic in heart transplants (HT). This was a retrospective study of adult HT recipients at a single center comparing those who received at least 3 doses of a COVID vaccine plus T/C versus those who only received the vaccine series (control) without prior infections. The primary outcome was development of COVID infection. Secondary outcomes included time from last vaccine to start of Omicron phase of pandemic, time from last vaccine to infection, and time from HT to infection. The Omicron phase was defined from 1/2022 to 2/2022. Chi-square and t-tests were used to assess for differences. Of the 244 patients identified, 44 received vaccination + T/C and 200 had vaccines only (Table 1). In the T/C group, patients were younger and more female (Table 1). In the control and T/C groups, 23% and 9.1% of patients, respectively, had documented COVID infections during the Omicron phase (p=0.039, Table 2). Months from last vaccine to start of Omicron phase, months from last vaccine to infection, and time from date of transplant to infection were similar between the two groups. Characteristics of the T/C patients who had breakthrough infections are shown in Table 3, none of whom required hospitalization or died. Patients who received vaccination + T/C had a significantly lower incidence of COVID infection compared to those who received vaccination alone in the Omicron era. T/C appeared to be protective in both recent and remote HT recipients, underscoring the utility of administering protective monoclonal antibodies in this population. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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India is turning inward. Domestic demand is assuming primacy over export orientation and trade restrictions are increasing, reversing a 3-decade trend. This shift is based on three misconceptions, which we dispel: that India's domestic market size is big, India's growth has been based on domestic not export markets, and export prospects are dim because the world is deglobalizing. In fact, India still enjoys large export opportunities, especially in labor-intensive sectors such as clothing and footwear. But exploiting these opportunities requires more openness and more global integration. Abandoning export orientation is thus akin to killing the goose that lays golden eggs. Indeed, given constraints on public, corporate and household balance sheets, abandoning export orientation is akin to killing the only goose that can lay eggs. © 2023, The Author(s) under exclusive licence to Editorial Office, Indian Economic Review.
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Mutation in viruses is known to be an unavoidable phenomenon. But at times, it may become a life-threatening pandemic just like in the case of the 2019 novel coronavirus, formally named as SARS-CoV-2, which consumed around 36,405 lives out of 750,890 infections as per the data available with the World Health Organization as of the end of March 2020. Found to be from the family of earlier known outbreaks (SARS and MERS) of the twenty-first century, it has now become a public health emergency of international concern (PHEIC). Countries around the world have spent millions of dollars to get a positive sign of finding vaccines, but still it remains an unsolved mystery. Even though there is implementation of strict lockdown measures from several affected countries around the globe, the trend line of COVID-19 epidemic is still increasing exponentially. Being in this scenario, this paper deals about the outbreak of 2019-nCoV and its structure, growing stages, global statistics, transmission modes, and most possible precautionary methods and also its emphasis on creating public awareness by answering few key clarifications about novel beta coronavirus disease. The machine learning method used in this study was taught using records from COVID-positive tests. Results from a week were included in the testing set (individuals who were confirmed to have COVID-19). This proposed model predicted the COVID-19 lab findings with high accuracy by only using eight numeric data, age 60, knowing contact with an infected individual, and the existence of five early clinical signs. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.
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Background. Determining if a patient with SARS-CoV-2 remains infectious is an infection control challenge in healthcare settings;specially, among critically ill or profoundly immunosuppressed patients. We use an assay that detects minus-strand RNA as a surrogate for actively replicating SARS-CoV-2. We report positive strand-specific assays in relationship to time since admission and describe patients with a detectable strand-specific assay >20 days since admission. Methods. We use a 2-step rRT-PCR specific to the minus strand of the SARS-CoV-2 envelope gene. The strand-specific assay is used to evaluate for infectivity in asymptomatic patients with a positive admission screening or pre-procedural test or if ongoing replication is suspected (critical illness or profound immunosuppression). We retrieved strand-specific test results for patients hospitalized at Stanford Healthcare during August 2020-March 2022. We describe clinical characteristics for patients with a detectable minus strand-specific test >20 days since admission. Results. A total of 774 strand-specific tests were collected from 624 hospitalized patients. A total of 523 patients had only one test (84%) and 101 (16%) had >=2 tests. The test positivity rate varied by time since admission: 19% in tests performed 0-5 days, 28% in 6-10 days, 22% in 11-20 days, and 41% in those >20 days since admission. Among 35 patients tested >20 days since admission, 13 (37%) had >=1 detectable minus strand-specific test. Most were male (n=8, 62%) and mean age was 59. Of 13 patients with a detectable assay, seven (54%) had prolonged viral replication with persistent symptoms and detectable minus strand assays for >20 days from symptom onset. Of these seven patients, four had a transplant (3 lung, 1 liver), 1 ovarian cancer, 1 CAR-T cell therapy, and 1 ESRD without immunosuppression. The remaining eight patients with a detectable assay >20 days since admission had illness onset while hospitalized. Conclusion. Among hospitalized patients with SARS-CoV-2 infection, we found a varying positivity rate according to the timing of testing, possibly reflecting different indications for the test. The strand-specific assay may help assess for infectiousness in profoundly immunocompromised patients.
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Background. Determining if a patient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains infectious can be challenging in patients with severe disease or those profoundly immunosuppressed. We use an assay that detects minus-strand RNA as a surrogate for actively replicating SARS-CoV-2. Here, we describe a cohort of patients who had strand-assay reversion: a detectable minus strandspecific assay after having had an undetectable value which may signify relapse of infection or reinfection. Methods. We used a 2-step rRT-PCR specific to the minus strand of the SARS-CoV-2 envelope gene. The strand-specific assay is used to evaluate for infectivity in asymptomatic patients with a positive screening admission or pre-procedural test or in cases when ongoing infection was suspected (critical illness or profound immunosuppression). We collected minus strand-specific assays performed at Stanford Healthcare during August 2020-April 2022. We describe basic demographics and clinical characteristics for patients who reverted from undetectable to detectable using the minus strand-specific assay. Results. A total of 2,505 strand-specific tests were collected from August 2020-April 2022 from 2,064 patients. A total of 292 (14%) had two or more strandspecific tests. Of them, 19 (7%) had an undetected minus strand-specific assay followed by a subsequent detectable value. Of them, seven (37%) had a minus strandspecific CT value of < 33.Most were male (n=4), median age was 54 (range: 8-62). All were profoundly immunosuppressed: Four had hematologic malignancies and three were post transplantation (kidney, lung, bone marrow). Median time from onset of symptoms or first positive test to reversion was 41 days (range:27-159). Median time from undetectable to detectable minus strand specific test was 26 days (range:4-34). All cases were considered relapses or ongoing infection rather than a new infection. Conclusion. Among patients with SARS-CoV-2 infection and consecutive strand-specific testing, a small proportion reverted from negative to positive. Most were profoundly immunosuppressed. The strand-specific assay can be an important tool in the evaluation of suspected cases of relapse or reinfection.
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SESSION TITLE: Biological Markers in Patients with COVID-19 Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: In December 2019, a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in a global pandemic. The literature has been slowly growing in the subgroup of pregnant women but the metabolic derangements of pregnancy and SARS-CoV-2 have not been well described. METHODS: In this case series, we review 9 patients with severe SARS-CoV-2 infections admitted to the medical ICU at a single institution between 2020-2022, during the delta variant wave. RESULTS: Of the nine critically ill patients, the mean age was 32 ± 6.4 years with fetal age on admission of 27 ±2.81 weeks and 29 ±2.91 weeks at delivery. Average CRP of 114 ± 25 mg/L. In eight of 9 patients (89%), there was an anion gap metabolic acidosis (AGMA) on admission. The average albumin-corrected anion gap was 18±1.93. 75% of patients had mild ketonuria based on urinalysis. However, 50% had documented symptoms of nausea, vomiting, or diarrhea. While betahydroxybutyrate was checked in 2 patients, neither were abnormal. One had lactic acidosis, but none required vasopressors at time of identification. No renal failure or diabetes was noted and only two had abnormal glucose tolerance tests. At delivery, average PEEP was 10± 4 cmH2O with an average respiratory rate of 28 ± 4 breaths per minute. All patients with AGMA delivered early resulting in preterm delivery. 75% of the fetuses showed signs of distress at the time of delivery, which was the primary indication for delivery in 37.5% of deliveries. 37.5% of deliveries were due to significant maternal hypoxia. The only patient without AGMA did not deliver early. CONCLUSIONS: After excluding renal failure, toxin ingestion, and lactic acidosis, only ketosis can weakly explain the AGMA. There have been several studies that highlighted the association between COVID and ketone production. In pregnancy, placental production of glucagon and human placental lactogen and subsequent insulin resistance increases susceptibility to ketosis. A recent study posited that COVID could cause placental abnormalities. Therefore, pregnant women may be more susceptible to significant ketosis because of COVID infection. In one of our cases, the combination of hypoxia and acidosis could not be managed safely by the ventilator and resulted in early delivery. CLINICAL IMPLICATIONS: Ketosis and an elevated anion gap could be a marker for more severe outcomes in pregnant patients with COVID. This case series highlights the challenges of managing the metabolic demands of critically ill pregnant patients infected with SARS-CoV-2. DISCLOSURES: No relevant relationships by Calli Bertschy no disclosure on file for Joey Carlin;No relevant relationships by Jessica Ehrig No relevant relationships by Shekhar Ghamande no disclosure on file for Jordan Gray;No relevant relationships by Abirami Subramanian
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SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Beyond conventional risk factors, studies suggest acute viral infections, including influenza, are a potential risk factor for development of acute cardiovascular (CV) related events such as acute coronary syndrome (ACS) and stroke. On Mar 31st, 2020, the Texas state governor instated a shelter-in-place or quarantine order. With social distancing and masking the exposure respiratory viral illnesses dropped. This study seeks to evaluate the impact of reduced viral infections on CV related events. METHODS: A retrospective chart review of patients admitted to 18 affiliated Baylor Scott & White Texas hospitals in north and central Texas from January 20th, 2020 to Jun 1st, 2020 and between January 20th, 2019 to Jun 1st, 2019. We defined the pre-quarantine period as January 20, 2020 – March 31, 2020. The quarantine period was defined as April 1, 2020 – Jun 1st, 2020. We investigated ACS and stroke risk associated with lab-confirmed respiratory virus panel- PCR (RVP) positivity using a self-controlled case series. RVP positivity was reviewed to determine the presence or absence of increased risk interval. Risk intervals were identified as 7 days after respiratory specimen collection and associated control intervals were one year before and one year after the risk intervals. RESULTS: There were 3,782 patients who had ACS or stroke from January 20th, 2020 to June 1st, 2020. Average monthly rate of positive viral infection was significantly lower during the state mandate social distancing period than before social distancing mandate (5.5 ± 4.6 vs 19.7 ± 4.2, p<0.0001). During the prequarantine period, for stroke, there was a significant difference in positive RVP between the prequarantine and quarantine period (10.8% vs 0%, P=0.009). For ACS, there was a significant difference in positive RVP between the prequarantine and quarantine period (16.2% vs 1%, P<0.001). Rhinovirus infections accounted for 67% of patients of stroke prequarantine. Influenza accounted for 40% of infections in patients with ACS. Admissions for CV related events were higher in the pre-quarantine period compared to the quarantine period (893 vs 695 strokes;1,227 vs 967 ACS). Patients in the pre-quarantine and quarantine were similar in age and gender. For stroke, there was no significant difference in the type of stroke between the two time periods with ischemic stroke occurring in 67% of patients. For ACS, there was no significant difference in type with non ST-elevation MI occurring in 44% of patients. There was no statistical difference of survival to discharge or readmission at 30 days between the two periods. CONCLUSIONS: In our multicenter study, we note significant decline in cardiovascular events due to viral illness. This study strengthens the association between viral infections and cardiovascular events. CLINICAL IMPLICATIONS: This study reveals implications of cardiovascular events following viral illness. DISCLOSURES: No relevant relationships by Tayler Acton no disclosure on file for Alex Arroliga;No relevant relationships by Jason Ettlinger No relevant relationships by Shekhar Ghamande No relevant relationships by Mufaddal Mamawala No relevant relationships by Abirami Subramanian No relevant relationships by Heath White
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Aim: Between January and September 2020 our base hospital recorded zero COVID-19 incidence in breast surgery patients, in 30 days post-op, with stringent admission protocols including 14 days self-isolation, PCR testing, 'green' wards and designated 'green' theatres. However, as the UK entered its third lockdown in January 6th2021 the decision was made to move breast cancer surgery off-site to a 'green hub' 43 miles away. The aim of this study was to assess the impact this had on patients. Method: Patients who had surgery moved off-site were requested to anonymously complete a questionnaire which was either posted or handed to them at follow-up. The questionnaire contained 11 Multiple Choice questions and a comments section. Results: 16 of 19 patients (84.21%) responded to the questionnaire. 16 of 16 (100%) understood the reason for the move. 2 (12.5%) stated that it increased anxiety/stress levels while 3 (18.75%) reported the opposite, and the remainder were neutral. 14 (87.5%) said the move made them feel safer, 1 (6.25%) did not feel safer, with the remaining 1 (6.25%) unsure. 15 (93.75%) felt they received enough information at base and 16 (100%) received sufficient discharge information at the 'green hub'. All 16 (100%) were satisfied with the move off-site but only 15 (93.75%) supported the decision. Conclusions: The responses indicate that the decision to move breast surgery off-site was supported and well understood. And while for a minority of patients this increased pre-operative anxiety/stress levels, it did make the majority feel safer.
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Background: With the advent of Covid[5], it became very difficult to cater to the 1.7 billion[6] students whose education was on a technical hold. With the online classes around it became difficult for the students to imbibe certain basic concepts of knowlede and they had to instead mug-up a lot of portions. All these also led to a deviation from the normal teacher-student relationship. As a consequence it affected the grades a student obtained during the time of lockdown.Hence this study with the ojectives to assess the psychological impact of lockdown on students,comparative assement of students before and during lockdown and the pattern of reading from home and college is of significance. Methodology: A cross sectional study was done for a period of one month on medical students for “Comparative Assessment of medical students before and during lockdown.”The students were selected by convenience sampling. A pretested semi structured questionnaire was sent through whatsapp and the data collected.It was entered in Microsoft Excel sheet,analysed using SPSS version 25 and findings were represented in the form of figures and tables. Conclusion: Even though the number of students gaining first class and second class marks have increased during the period of lockdown,the number of students securing distinction has considerably fallen.Many felt that their reading is far better when at hostel and in the presence of companions in the college campus and with the teacher-student relationship around with in room classes.As a matter of fact majority of them wanted to come back to campus as soon as possible and resume normal in-room classes.
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Objectives Multisystem inflammatory syndrome in children (MIS-C) is a post Severe Acute Respiratory Syndrome Coronavirus2 (SARS CoV2) immune dissonance seen in the pediatric population. The current study is an attempt to understand the subtleties of diverse phenotypes, immunotherapeutics, and short-term outcome parameters of MIS-C. Materials and Methods Children admitted to the pediatric intensive care unit (PICU) between 1 month and 18 years, satisfying MIS-C criteria, were enrolled in this retrospective observational study. They were stratified into different phenotypes like shock, Kawasaki disease, and nonspecific phenotypes. Respiratory, vasoactive support, and outcomes were analyzed using appropriate statistical methods. Results Seventy-five children presented with MIS-C during the study period. The mean age was 66 months with 54.6% females. Coronavirus disease (COVID) antibody was positive for 41 (54%), real time-reverse rranscription polymerase chain reaction (RT-PCR) positivity was positive in 16 (21.3%), and rapid antigen test was positive in 10 (13%). Common symptoms included fever (100%), rash (30%), conjunctival congestion (29.7%), and cardiovascular (68% with shock) involvement. Notable differences in shock phenotype were identified including Pediatric Risk of Mortality III score, inflammatory markers, cardiac involvement, need for inotropes, and ventilation. In total, 32% received intravenous immunoglobulin and 48% glucocorticoids. The overall mortality in children with MIS-C was 9 (12%). The need for mechanical ventilation (odds ratio 10.94, confidence interval [2.06, 58.06], p-value <0.005) was noted as an independent predictor of mortality by logistic regression. Conclusion MIS-C showed a significant cardiovascular involvement at presentation, necessitating intensive care and immunomodulatory therapies. There were higher odds of mortality in the ventilated cohort.
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Introduction: Between January and September 2020 our base hospital recorded zero COVID-19 incidence in breast surgery patients, in 30 days post-op, with stringent admission protocols including 14 days self-isolation, PCR testing, 'green' wards and designated 'green' theatres. However, as the UK entered its third lockdown on January 6th 2021, the decision was made to move breast cancer surgery off-site to a 'green hub' 43 miles away. The aim of this study was to assess the impact this had on patients. Methods: Patients who had surgery moved off-site were requested to anonymously complete a questionnaire, which was either posted or handed to them at follow-up. The questionnaire contained 11 Multiple Choice questions and a comments section. Results: 16 of 19 patients (84.21%) responded to the questionnaire. 16 of 16 (100%) understood the reason for the move. 2 (12.5%) stated that it increased anxiety/stress levels while 3 (18.75%) reported the opposite, and the remainder were neutral. 14 (87.5%) said the move made them feel safer, 1 (6.25%) did not feel safer, with the remaining 1 (6.25%) unsure. 15 (93.75%) felt they received enough information at base and 16 (100%) received sufficient discharge information at the 'green hub'. All 16 (100%) were satisfied with the move off-site but only 15 (93.75%) supported the decision. Conclusions: The responses indicate that the decision to move breast surgery off-site was supported and well understood. While for a minority of patients this increased pre-operative anxiety/stress levels, it did make the majority feel safer.
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Background:-The nationwide lockdown due to COVID-19 pandemic has impacted the global population in drastic ways. It was a health emergency in health care services impeding a lot of other services specially primary health care services and issue of proper referral of patients for adequate care. Methodology:-A cross-sectional study was conducted for duration of one month during August-September 2021 among 200 participants aged more than 18 years visiting Urban Primary Health Centre at Old Hubballi, selected by random convenient sampling. Data collected was entered in MS Excel and analyzed using SPSS version 25. Results:-72.5% respondents preferred PHC over government hospital or private clinics for their treatment. 15% respondents were not satisfied with the services provided in PHC due to COVID pandemic. The average number of OPD cases was reduced by 50% and routine immunization by 80% during lockdown. The routine laboratory investigations fell by 33% of the pre-COVID time. Conclusions:-The country’s primary health care system suffered a major setback in terms of its routine services like providing treatment, routine immunizations etc. as the concentration shifted to pandemic control. And now with time, as the country’s health care system is recovering, the progress is slow.
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Background: Candida infection is on the rise with an increasing number of nonalbicans species. Therefore, the need to speciate Candida rapidly and accurately is of the utmost importance. The purpose of this study was to speciate Candida using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), to analyze the correlation of the isolates with the clinical condition, and to study the outcome of the patient. Materials and Methods: PCR-RFLP using universal primers ITS1 and ITS4 was done to speciate all isolates of Candida;patient details were collected to analyze the clinical condition and the outcome of the patient. Results: The most common species of Candida isolated was Candida tropicalis 14 (56%) followed by Candida albicans 5 (20%), Candida auris 3 (14%), Candida parapsilosis 1 (4%), Candida orthopsilosis 1 (4%), and Candida kefyr 1 (4%). Majority of the samples that were collected were urine samples 15 (60%). The average duration of hospital stay was found to be 13.8 days. A number of underlying risk factors were present such as patients with diabetes, sepsis, malignancy, covid19 infection, surgical patients, preterm patients, elderly patients, and patients on long-term steroids. Conclusion: Candidemia is on the rise nowadays with nonalbicans species responsible for the majority of the infections. Since the outcome of the patient depends on rapid diagnosis and prompt initiation of antifungal agents PCR-RFLP proves to be a rapid and reliable test to identify most of the prevailing species of Candida. © 2021 Journal of Medical Society ;Published by Wolters Kluwer-Medknow.
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While recent studies have investigated how health messages on vaccine characteristics shift public intentions to get a COVID-19 vaccine, a few studies investigate the impact of real-world, widely shared vaccine misinformation on COVID-19 vaccine acceptance. Moreover, there is currently no research that investigates how exposure to hesitancy, as compared to misinformation, is associated with COVID-19 vaccination intentions. Based on data from a nationally representative survey experiment conducted in March 2021 (N= 1,083), exposure to outright COVID-19 vaccine misinformation as well as exposure to vaccine hesitancy induces a decline in COVID-19 vaccination intentions to protect self and to get the vaccine to protect others in NewZealand, compared to factual information from government authorities. Moreover, there is no significant difference in exposure to misinformation or hesitancy in the self-reported change in COVID-19 vaccination intentions. However, respondents are more likely to believe in vaccine hesitancy information and share such information with family and followers compared to misinformation. Implications for research in health communication campaigns on COVID-19 are presented. © Thaker and Subramanian.