New cardiovascular events in the convalescent period among survivors of SARS-CoV-2 infection.

BACKGROUND: Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may have an increased risk of acute cardiovascular events in the convalescent period. AIMS: To determine whether patients with SARS-CoV-2 infection have an increased risk of cardiovascular events during the convalescent period. METHODS: We analyzed 10,691 hospitalized adult pneumonia patients with SARS-CoV-2 infection and contemporary matched controls of pneumonia patients without SARS-CoV-2 infection. The risk of new cardiovascular events following >30 days pneumonia admission (convalescent period) was ascertained using Cox proportional hazards regression analysis to adjust for potential confounders. RESULTS: Among 10,691 pneumonia patients with SARS-CoV-2 infection, 697 patients (5.8%; 95% CI, 5.4-6.2%) developed new cardiovascular events (median time interval of 218 days post pneumonia admission; interquartile range Q1 = 117 days, Q3 = 313 days). The risk of new cardiovascular events was not significantly higher among pneumonia patients with SARS-CoV-2 infection compared with those with pneumonia without SARS-CoV-2 infection (hazard ratio (HR), 0.90, 95% CI, 0.80-1.02) after adjustment for potential confounders. In addition, no significant difference in the rate of a new ischemic stroke (HR, 0.84; 95% CI, 0.70-1.02) or ischemic heart disease (HR, 1.00; 95% CI, 0.87-1.15) was observed between the pneumonia patients with and without SARS-CoV-2 infection. CONCLUSION: Our study suggests that new cardiovascular events rate in the convalescent period among pneumonia patients with SARS-CoV-2 infection was not significantly higher than the rate seen with other pneumonias.

Postbiotics: From emerging concept to application

The microbiome innovation has resulted in an umbrella term, postbiotics, which refers to non-viable microbial cells, metabolic byproducts and their microbial components released after lysis. Postbiotics, modulate immune response, gene expression, inhibit pathogen binding, maintain intestinal barriers, help in controlling carcinogenesis and pathogen infections. Postbiotics have antimicrobial, antioxidant, and immunomodulatory properties with favorable physiological, immunological, neuro-hormonal, regulatory and metabolic reactions. Consumption of postbiotics relieves symptoms of various diseases and viral infections such as SARS-CoV-2. Postbiotics can act as alternatives for pre-probiotic specially in immunosuppressed patients, children and premature neonates. Postbiotics are used to preserve and enhance nutritional properties of food, elimination of biofilms and skin conditioning in cosmetics. Postbiotics have numerous advantages over live bacteria with no risk of bacterial translocation from the gut to blood, acquisition of antibiotic resistance genes. The process of extraction, standardization, transport, and storage of postbiotic is more natural. Bioengineering techniques such as fermentation technology, high pressure etc., may be used for the synthesis of different postbiotics. Safety assessment and quality assurance of postbiotic is important as they may induce stomach discomfort, sepsis and/or toxic shock. Postbiotics are still in their infancy compared to pre- and pro- biotics but future research in this field may contribute to improved physiological functions and host health. The current review comprehensively summarizes new frontiers of research in postbiotics. Copyright © 2022 Aggarwal, Sabharwal, Kaushik, Joshi, Aayushi and Suri.

Awareness, Perceived Risk, and Protective Behavior Towards Covid-19 Among Undergraduate Students of Delhi and NCR, India

Preventive measures are the best cure for any disease as they reduce the infection rate. Preventive measures are affected by knowledge, attitudes, and practices towards the disease. Therefore, this study aimed to assess the awareness, perceived risk, and protective behavior toward COVID-19 among undergraduate students of the Delhi and National Capital Region, India. An online questionnaire-based random survey was conducted amongst 605 undergraduate students to assess the demographic characteristics of participants, their level of awareness, perceived risk, and protective behavior regarding COVID-19. The overall awareness, perceived risk, and protective behavior for COVID-19 were found high in undergraduate students (0.000***,0.000***,0.000***). When variable (Gender, area of living, and subject studies) based analysis was performed among participants, a non-statistical significance difference was observed in total awareness among them (p>0.05) towards COVID-19 (p=0.996, 0.121, 0.937). Whereas Female, urban, and science participants were found to perceive the risk for COVID-19 more accurately in comparison to male, rural and non-science participants in total perceive risk analysis (p= 0.016**, 0.035**, 0.036**). However, urban participants showed more Total protective behavior as compared to the rural participants (p=0.048**) and there was no statistical significance difference in protective behavior in terms of Male/Female and Science/ non-science participants (p=0.189, 0.100). These findings will contribute to the continued regional/ global efforts to better understand preventive crisis response to the COVID-19 pandemic. This study emphasizes the need for conducting periodic webinars for educational intervention for all college students which could be useful to create more awareness.

Efficacy of Indian Diabetes Risk Score in Dietetics Practice;a Qualitative Perspective Study

Background: The prevalence of pre-diabetes is increasing over time across all segments of the population in India. Early detection is the key to effective primary prevention as diabetes may remain asymptomatic for a long duration of time. COVID-19 has made it imperative for healthcare professionals, nutritionists, and patients to manage health virtually to a large extent. To reduce the visit of the patients to outpatient departments of the hospitals and clinics, it is essential to implement a non-invasive diabetes screening tool for timely detection and primary prevention of type 2 diabetes. Aim: This study aims to qualitatively explore the current practices regarding the use of the Indian Diabetes Risk Score (IDRS) as a type 2 diabetes mellitus screening tool among nutritionists and to determine predominant variables associated with its implementation. Method: This study included informal, semi-structured, in-depth interviews conducted with nutritionists from the urban area in the city Gurugram, India. Total 29 nutritionists with over 5 years of experience in private or hospital setting were included in the study. The sessions were recorded and transcribed diligently. The thematic analysis of data was carried out for key points. Results: It was found that the majority of the respondents practiced informal, semi-structured assessment methods for risk assessment of diabetes. The practices were underpinned by the ease of assessment, time taken, cost factor, and need per profile basis. The observation method was preferred for Informal assessment for providing additional cues about behavior patterns. The study revealed that the subjects were apprehensive about validity and insufficiency of interpretation for the screening tool Indian Diabetes Risk Score (IDRS). Discussion: The current use of the non-invasive Indian Diabetes Risk Assessment score as a screening tool, for the detection of Type 2 diabetes, appears to be limited in the dietetics practice. Informal or semi-structured assessment is widely practiced in addition to biochemical assessment for its reliable data. The usage of the tool needs to be promoted among practicing dieticians.

A Statistical Study for Optimizing the Challenges in Vaccine Supply Chain During Critical Times Using DEMATEL Method

With the advent of COVID-19, having a vaccine and running an efficient vaccination program has become a vital means to protect the population against these life threatening diseases. The ongoing COVID-19 vaccination program is seen as a vital step to contain the outbreak of this infectious disease. However, right from developing the antibodies of the virus for developing the vaccine to monitoring the vaccinated population, there are a lot of challenges along different aspects which are recognized as potential road blockages in running a successful vaccination supply chain. In general however, supply chain inculcates all the processes which are involved either at the front end or at the back end in fulfilling a consumer’s requirement. This paper aims to analyze the challenges faced in the vaccination supply chain during critical times such as COVID-19 and modeling those challenges in order to understand the highly prioritize factors which impact the vaccination of general public. The entire study is based on the feedback collected from 60 individuals working in the field of healthcare, supply chain, and local end consumers of vaccine. The entire study is done in a procedural manner where the first part was focused on identifying critical challenges, collecting responses from various stakeholders, and then finally modeling those challenges using the statistical tool DEMATEL (Decision Making Trial and Evaluation Laboratory) method. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Acute Ischemic Stroke and COVID-19: An Analysis of 27 676 Patients.

BACKGROUND AND PURPOSE: Acute ischemic stroke may occur in patients with coronavirus disease 2019 (COVID-19), but risk factors, in-hospital events, and outcomes are not well studied in large cohorts. We identified risk factors, comorbidities, and outcomes in patients with COVID-19 with or without acute ischemic stroke and compared with patients without COVID-19 and acute ischemic stroke. METHODS: We analyzed the data from 54 health care facilities using the Cerner deidentified COVID-19 dataset. The dataset included patients with an emergency department or inpatient encounter with discharge diagnoses codes that could be associated to suspicion of or exposure to COVID-19 or confirmed COVID-19. RESULTS: A total of 103 (1.3%) patients developed acute ischemic stroke among 8163 patients with COVID-19. Among all patients with COVID-19, the proportion of patients with hypertension, diabetes, hyperlipidemia, atrial fibrillation, and congestive heart failure was significantly higher among those with acute ischemic stroke. Acute ischemic stroke was associated with discharge to destination other than home or death (relative risk, 2.1 [95% CI, 1.6-2.4]; P<0.0001) after adjusting for potential confounders. A total of 199 (1.0%) patients developed acute ischemic stroke among 19 513 patients without COVID-19. Among all ischemic stroke patients, COVID-19 was associated with discharge to destination other than home or death (relative risk, 1.2 [95% CI, 1.0-1.3]; P=0.03) after adjusting for potential confounders. CONCLUSIONS: Acute ischemic stroke was infrequent in patients with COVID-19 and usually occurs in the presence of other cardiovascular risk factors. The risk of discharge to destination other than home or death increased 2-fold with occurrence of acute ischemic stroke in patients with COVID-19.

University students’ perceptions through e-learning implementation during covid-19 pandemic: Positive or negative features dominate?

English language instruction that moves away from offline to online should become the EFL lecturers’ concern for their students’ successful learning outcome. The students must be kept in the lecturers’ mind when they plan and program the instruction. This study aims at investigating the students’ perceptions and preferences on English instruction through e-learning implementation during the COVID-19 pandemic. This research applies a qualitative approach in a descriptive method design by involving 106 English class students from three different higher educations in Aceh, Indonesia. The thematic and comparative analyses are applied in analyzing the data. The findings of the study show that 50% of the students impress negative features concerning the internet network, a high need of internet quotas, the limitation of learning material explanation and absorption, and the social media influences. The study also reveals that 59.6% of positive features dominate the findings associated with the students’ interest in e-learning implementation as a new learning experience/exploration, engagement and enthusiasm, the flexibility of time and place, and the advance of digital technology usage and adaptation. Besides, WhatsApp, Opensimka, Google Classroom, and Google Meet have become the four most preferable e-learning platform among the respondents. It implies that e-learning implementation during the COVID-19 pandemic gives a variety of practical benefits to university students in the virtual English class. Yet, this still requires sufficient mentoring and extra supporting digital tools for the students and the lecturers. © 2021, Syiah Kuala University. All rights reserved.

Early mandated social distancing is a strong predictor of reduction in peak daily new COVID-19 cases.

OBJECTIVES: Mandated social distancing has been applied globally to reduce the spread of coronavirus disease 2019 (COVID-19). However, the beneficial effects of this community-based intervention have not been proven or quantified for the COVID-19 pandemic. STUDY DESIGN: This is a regional population-level observational study. METHODS: Using publicly available data, we examined the effect of timing of mandated social distancing on the rate of COVID-19 cases in 119 geographic regions, derived from 41 states within the United States and 78 other countries. The highest number of new COVID-19 cases per day recorded within a geographic unit was the primary outcome. The total number of COVID-19 cases in regions where case numbers had reached the tail end of the outbreak was an exploratory outcome. RESULTS: We found that the highest number of new COVID-19 cases per day per million persons was significantly associated with the total number of COVID-19 cases per million persons on the day before mandated social distancing (ß = 0.66, P < 0.0001). These findings suggest that if mandated social distancing is not initiated until the number of existing COVID-19 cases has doubled, the eventual peak would result in 58% more COVID-19 cases per day. Subgroup analysis on those regions where the highest number of new COVID-19 cases per day has peaked showed increase in ß values to 0.85 (P < 0.0001). The total number of cases during the outbreak in a region was strongly predicted by the total number of COVID-19 cases on the day before mandated social distancing (ß = 0.97, P < 0.0001). CONCLUSIONS: Initiating mandated social distancing when the numbers of COVID-19 cases are low within a region significantly reduces the number of new daily COVID-19 cases and perhaps also reduces the total number of cases in the region.

Mandated societal lockdown and road traffic accidents.

BACKGROUND: The effect of mandated societal lockdown to reduce the transmission of coronavirus disease 2019 (COVID-19) on road traffic accidents is not known. For this reason, we performed an in-depth analysis using data from Statewide Traffic Accident Records System. MATERIALS AND METHODS: We reviewed data on total 2292 road traffic accident records in Missouri from January 1, 2020 through May 15, 2020. We treated March 23 as the first day of mandated societal lockdown and May 3 as the first day of re-opening. RESULTS: We have found that there was a significant reduction in road traffic accidents resulting in minor or no injuries (mean 14.5 versus 10.8, p < 0.0001) but not in accidents resulting in serious or fatal injuries (mean 3.4 versus 3.7, p = 0.42) after mandated societal lockdown. Furthermore, there was a significant reduction in road traffic accidents resulting in minor or no injuries after the mandated social lockdown (parameter estimate -5.9, p = 0.0028) in the time series analysis. There was an increase in road traffic accidents resulting in minor or no injuries after expiration of mandatory societal lockdown (mean 10.8 versus 13.7, p = 0.04). CONCLUSION: The mandated societal lockdown policies led to reduction in road traffic accidents resulting in non-serious or no injuries but not those resulting in serious or fatal injuries.

Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel.

BACKGROUND AND PURPOSE: On 11 March 2020, World Health Organization (WHO) declared the COVID-19 infection a pandemic. The risk of ischemic stroke may be higher in patients with COVID-19 infection similar to those with other respiratory tract infections. We present a comprehensive set of practice implications in a single document for clinicians caring for adult patients with acute ischemic stroke with confirmed or suspected COVID-19 infection. METHODS: The practice implications were prepared after review of data to reach the consensus among stroke experts from 18 countries. The writers used systematic literature reviews, reference to previously published stroke guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate practice implications. All members of the writing group had opportunities to comment in writing on the practice implications and approved the final version of this document. RESULTS: This document with consensus is divided into 18 sections. A total of 41 conclusions and practice implications have been developed. The document includes practice implications for evaluation of stroke patients with caution for stroke team members to avoid COVID-19 exposure, during clinical evaluation and performance of imaging and laboratory procedures with special considerations of intravenous thrombolysis and mechanical thrombectomy in stroke patients with suspected or confirmed COVID-19 infection. CONCLUSIONS: These practice implications with consensus based on the currently available evidence aim to guide clinicians caring for adult patients with acute ischemic stroke who are suspected of, or confirmed, with COVID-19 infection. Under certain circumstances, however, only limited evidence is available to support these practice implications, suggesting an urgent need for establishing procedures for the management of stroke patients with suspected or confirmed COVID-19 infection.