Global uncertainty in the diagnosis of neurological complications of SARS-CoV-2 infection by both neurologists and non-neurologists: An international inter-observer variability study.

INTRODUCTION: Uniform case definitions are required to ensure harmonised reporting of neurological syndromes associated with SARS-CoV-2. Moreover, it is unclear how clinicians perceive the relative importance of SARS-CoV-2 in neurological syndromes, which risks under- or over-reporting. METHODS: We invited clinicians through global networks, including the World Federation of Neurology, to assess ten anonymised vignettes of SARS-CoV-2 neurological syndromes. Using standardised case definitions, clinicians assigned a diagnosis and ranked association with SARS-CoV-2. We compared diagnostic accuracy and assigned association ranks between different settings and specialties and calculated inter-rater agreement for case definitions as "poor" (κ ≤ 0.4), "moderate" or "good" (κ > 0.6). RESULTS: 1265 diagnoses were assigned by 146 participants from 45 countries on six continents. The highest correct proportion were cerebral venous sinus thrombosis (CVST, 95.8%), Guillain-Barré syndrome (GBS, 92.4%) and headache (91.6%) and the lowest encephalitis (72.8%), psychosis (53.8%) and encephalopathy (43.2%). Diagnostic accuracy was similar between neurologists and non-neurologists (median score 8 vs. 7/10, p = 0.1). Good inter-rater agreement was observed for five diagnoses: cranial neuropathy, headache, myelitis, CVST, and GBS and poor agreement for encephalopathy. In 13% of vignettes, clinicians incorrectly assigned lowest association ranks, regardless of setting and specialty. CONCLUSION: The case definitions can help with reporting of neurological complications of SARS-CoV-2, also in settings with few neurologists. However, encephalopathy, encephalitis, and psychosis were often misdiagnosed, and clinicians underestimated the association with SARS-CoV-2. Future work should refine the case definitions and provide training if global reporting of neurological syndromes associated with SARS-CoV-2 is to be robust.

Exploring Crisis Leadership During COVID-19: A Case Study on OYO

The case explores the steps taken by the leadership team at OYO to mitigate the challenges faced due to the COVID-19 pandemic. As a young start-up on the growth trajectory, OYO was hit harder than some of its established competitors. With the onset of the pandemic, the hospitality industry had come to a grinding halt and occupancy rates were at an all-time low. It was necessary for the management to revamp organizational structures and processes, and exhibit strong leadership skills to drive the workforce through one of the most challenging periods that OYO would have to go through. A recurring theme observed throughout the case is the resilient leadership response to the crisis by the protagonist, that is, Ritesh Agarwal, the Founder and Group CEO of the company, and his unwavering involvement in ensuring to keep the company afloat. Several people-centric initiatives that were undertaken for different stakeholder groups are outlined throughout the case and a major focus is given to the importance of decentralized and distributed leadership in the face of a crisis. The case is a narrative on organizational crisis management on the face of a setback and the role of leaders and empowered employees to navigate it. © 2023 K. J. Somaiya Institute of Management Studies and Research.

Using modified DECAF Score in mortality prediction in acute exacerbation of COPD patients presenting to emergency department in a tertiary care hospital

Background: Chronic obstructive pulmonary disease (COPD) is a prominent cause of illness and mortality on a global scale. In 2019, it was predicted to rank as the sixth largest cause of mortality. COPD is one of the most prevalent non-communicable illnesses in the field of pulmonology. The DECAF score (Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation) is a risk stratification tool for patients with AECOPD that can be used at the bedside to guide treatment, such as hospital at home for low-risk patients. The purpose of this study is to predict the in-hospital mortality in acute exacerbation of COPD patients with modified DECAF scores. Modified DECAF score includes Dyspnea, Eosinopenia, Consolidation, Acidemia and Frequency of Hospitalization. Material(s) and Method(s): A total of 50 patients attending Emergency Medicine Department with Acute Exacerbation of COPD were recruited to this hospital based observational study. This study was conducted at the Department of Emergency medicine & Pulmonary medicine, at APOLLO GLENEAGLES HOSPITALS, Kolkata. Result(s): COPD was more prevalent in the age groups of 41-50 years (28%) and 61-70 years (28%) followed by those having age between 51-60 years (22%). Majority of the COPD patients were males (88%) compared to (12%) females. Majority of the COPD patients were males (88%) compared to (12%) females. Most common co-morbid condition associated with COPD washypertension (16%) followed by IHD (8%), pulmonary hypertension (6%) and diabetes mellitus (4%). Out of 50 patients with COPD, 11 (22%) had previous history of AECOPD, 38 (76%) were regular user of inhaler, 33 (66%) had history of influenza vaccination, 16 (32%) had Pneumococcal Vaccination and 2 (4%) patients had COVID-19 pneumonia. Out of 50 patients, 24 (48%) had Dyspnea (eMRCD) score of 5a whereas 26 (52%) had Dyspnea (eMRCD) score of 5b as well as 7 (14%) had Eosinopenia (<50 cells/mm3) and 20 (40%) had Consolidation. Conclusion(s): We conclude that the Modified DECAF score is both sensitive and specific in predicting in-hospital mortality in AECOPD patients. Modified DECAF is a simple tool that predicts mortality that incorporates routinely available indices. It effectively stratifies COPD patients admitted with acute exacerbations into mortality risk categories. Copyright © 2022 Ubiquity Press. All rights reserved.

Characterization and Analysis of Neurologic Adverse Events Associated with COVID-19 Vaccination

Objective: To characterize the incidence and spectrum of neurological adverse events (AE) after COVID-19 vaccination. Background: The devastating COVID-19 pandemic has led to 230 million people diagnosed and greater than 4.8 million deaths worldwide. Widespread vaccination efforts have resulted in administration of over 6 million vaccine doses to curb the significant health and socioeconomic impacts of the disease. While there are numerous reports of adverse events following COVID-19 vaccine, there is limited characterization of the spectrum of neurological AEs post-vaccination. Design/Methods: Data was gathered from the publicly available Vaccine Adverse Event Reporting System (VAERS), a passive reporting system not implying causality. Among individuals who received the J&J, Moderna, and Pfizer vaccines from 1/1/2021-6/14/2021, 314,610 adverse events were reported and these were reviewed by Neurology trained clinicians to determine the presence of various neurological AEs (40 conditions coded). Results: 306,473,169 COVID vaccine dose were administered in the USA during the study period with 314,610 total AEs (0.10%) and 105,930 neurological AEs (0.03%) reported. J&J vaccine was associated with the most AEs (17,670, 0.15%), followed by Moderna (42656, 0.03%) and Pfizer (42267, 0.03%). On average more events were reported in women (71%) and a majority occurred after the first dose (54%). < 1 events were reported per million vaccine doses for serious neurological conditions such as Bell's palsy (0.0007%), Guillain-Barre syndrome (0.00009%), cerebral venous thrombosis (0.00005%), transverse myelitis (0.00003%), and acute disseminated encephalomyelitis (0.00006%). Overall neurological complications following vaccine were drastically lower than complications post-COVID infection (14-80%). Conclusions: Adverse neurological events following COVID-19 vaccination are extremely rare and significantly less common than adverse neurological effects following SARS-CoV-2 infection. Current evidence suggests that along with being up to 100,000 times more likely to experience a major complication from COVID infection vs. vaccine, the risk of neurological complication is up to 5000 times more likely from infection itself.

Telemedicine practice guidelines in India: Medico legal implications

Providing in-person healthcare services is challenging, especially in a vast country like India, where most of its citizens reside in the rural area. In this scenario, telemedicine can provide faster and timely healthcare services to the needy ones where distance is the critical factor. Healthcare seekers need not travel long miles for obtaining treatment and consultation. In most situation, telemedicine services are beneficial to the patients. A person staying in far remote area may access healthcare facility through telemedicine, thus avoiding issues related to mobility of the patient especially in elderly and debilitated patients. On the other side, telemedicine has its own limitation due to its virtuality. The person staying in remote area may not have access of tools required to access telemedicine facility. Internet connectivity in remote area is another issue. Telemedicine services could change face of providing medical services to the person residing at distant or in remote area if implemented effectively. Proper infrastructure is must to achieve this target. Information technology related instruments and services needs to be strengthened up at grass root level to provide better coverage of telemedicine facilities to needy ones. Telemedicine provides the safety of physicians and the patients, especially where there is a high risk of infection spread, such as in the present COVOD-19 pandemic. Mainstreaming telemedicine in the health system will improve the efficiency and outcome of the country's healthcare system © 2021, Journal of Indian Academy of Forensic Medicine.All Rights Reserved.

SARS CoV-2 Re infection after natural infection compared with previously sero-negative: Descriptive longitudinal study

Background: WHO declared SARS-CoV-2 infection as pandemic on March 11, 2020. As cases recovered, it became important to know the rate of re-infection from the same virus and its severity. Therefore, the study was done to find out re-infection rate among the previously infected individuals. Aim: To find out re-infection rate among already exposed and nonexposed individuals. Materials and Methods: A cohort study was done over 5000 previously serosurveyed individual. They were followed up via telephone. Data was collected using a questionnaire with questions regarding infection post-serosurvey, severity of infection among relatives and vaccination status. Thus information collected was uploaded in Google form. Results: Re-infection rate among previously exposed individuals was 1.2%;at the same time period, 6% of nonexposed individuals got infected. All the re-infection cases were mild, whereas 80.74% of individuals who got infected for the first time had mild symptoms. Exposure to SARS-CoV-2 in relatives who were staying with participants was found to be 3.23% and 4.22% among previously exposed and non-exposed individuals respectively. 17% of previously nonexposed individuals were fully vaccinated, whereas 0.65% of exposed individual got fully vaccinated. Conclusion: Re-infection rate in the study was less and mild on the basis of severity. Infection rate among the nonexposed was at a higher side stating that chances of getting re-infected are much lesser. Previously exposed individuals did not show the same type of interest for vaccination compared to previously nonexposed individuals. © 2022 International Journal of Nutrition, Pharmacology, Neurological Diseases ;Published by Wolters Kluwer - Medknow.

Top Reported Data Security Risks in the Age of COVID-19

Data has been collected and stored for thousands of years. Securing data during the digital age has remained difficult. Research shows that in 2018 there was over 33 zettabytes of data, which is approximately an equivalent to 129 billion 256GB mobile devices of data. Risk management in recent years has made attempts at balancing data security risks with organizational business and budgetary requirements. This research examines high probability data security threats and mitigations. It then reports on the threats in connection with the top United States healthcare data breaches reported during the COVID outbreak to the Health and Human Services (HHS) between June 11, 2020 and June 11, 2021. The data analysis shows that there were nine breaches of over a million affected individuals reported to HHS affecting 15,936,679 individuals in total. Five-million individuals is approximately larger than the populations of Los Angeles, New York, and Chicago combined. We connect the common security risks with the reports of these incidents to gain insights into common network security concerns and inform future network architectures and risk mitigations. © 2021 IEEE.

A CRITICAL ANALYSIS OF WORK FROM HOME CHALLENGES DURING COVID-19 PANDEMIC BY THE STAKEHOLDERS IN EDUCATIONAL INSTITUTIONS

To prevent the COVID-19 pandemic spread Central Government started the lockdown and as such it affected whole nation and to major extent to higher education. The sudden closure of higher educational institutions resulted in not completion of syllabus, jeopardising the education and academic year. The disruption caused by the COVID -19 would be contained by social distancing, was initially planned, and because of the spurt of new cases impeded the immediate opening of the higher educational institutions for long time. Seriousness of COVID-19 is in fast spread through contact and having high death rate. The COVID-19 prompted the lockdown for whole of India from 24th march onwards;the higher educational Institutions had to continue with the imparting training to its students through digital platforms. The remote working or work from home was need of the hour, which the faculties from the higher educational institutions started utilizing digital platforms like Zoom, Microsoft teams, WebEx etc to continue with the training to complete the let over syllabus. The educational was more a classroom lecture-based but for few cases like MOOC, online certifications which students used to take at the comfort of their homes, more of recorded and text-based. The lecture-based was a norm for the academic session in the college environment. The present educational scenario is disrupted to a great extent by the COVID -19 pandemic, was forced by law for quarantine purpose. This study is to critically analyse the work from home challenges during COVID-19 pandemic by the stakeholders in Educational Institutions. The study had brought many pertinent challenges like internet connectivity issues 83 % even in the urban and semi-urban area stakeholders. The security issues of disruption during the Zoom did not hinder its overall popularity among the stakeholders due to its usability. The study highlighted that classroom based method most preferred when compared to the digital platforms during the COVID 19 platforms, maybe because the effective interactions.