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The impact of air pollutants on human health is a major issue that developing nations are facing in last decade. Effect of particulate matter especially PM2.5 and PM10 has been severely affecting mortality and morbidity in Rajasthan state as per global lead medical journal Lancet recent publication. Twelve air pollutant-monitoring sta tions in Jaipur city are not enough to predict the exact concentration of air pollutants in each of the 91 wards of Jaipur. In absence of accurate concentration at micro level, it becomes a major challenge for urban planners to remedial strategies. In this paper through GIS spatial distribution, a comparative study of particulate matter at each of the 91 wards during pre-lockdown for the year 2019 and post-lockdown 2020 was done. Results for 2020 showed slightly less pollution;similarly, air purity index, an indicator for healthier environment, was determined for each ward. © 2023 Scientific Publishers. All rights reserved.
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Due to the world's rapid population expansion, the demand for food is anticipated to increase significantly during the coming decade. Traditional farming practices cannot meet the need for the food crop. Conventional farming methods use resources like land, water, herbicides, and fertilisers rather inefficiently. When it comes to making the most effective and sustainable use of resources to increase production, automation in agriculture is garnering a lot of interest. How people and machines operate on farms has been changed by integrating the Internet of Things (IoT) with numerous sensors, controllers, and communication protocols. A comprehensive literature review of the key technologies involved in smart and sustainable agriculture, viz. various sensors, controllers, communication standards, IoT based intelligent machinery, were compared and presented. These sensors were continuously producing a significant quantity of data on the agricultural field. These data were transmitted to the central control unit for analysis to meet the demands for water, fertiliser, pesticides, etc. The architecture and importance of data analytics in agriculture IoT, case studies of current agricultural automation utilising IoT, key challenges and open issues in agriculture IoT technology were discussed. The findings provide support for the selection of IoT technologies for specific applications.
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Background: Cryptococcus lives in the environment all over the globe. Although it spreads via inhalation route still most of the exposed individuals never get sick as the majority of cases are seen in immunocompromised. Objective of this clinical case report is to highlight the rare fungal etiology associated with iliac bone abscess to avoid incorrect diagnosis and prompt management of case. Case Presentation: A 70-year-old elderly female presented with hip pain for a month duration, not relieved with analgesics in September, 2021. In MRI a well-defined irregularly marginated hyperintense focal lesion was found in left iliac bone with joint effusion suggestive of infective etiology, tubercular, or less likely metastasis. CT-guided biopsy reported occasional hyphae-like fragments giving an impression of acute on chronic osteomyelitis with suspicion of fungalinfection.Culture reported Cryptococcus ne oformans.Fungal markers and Beta-dglucan were indeterminate and Galactomannan was found negative for the sample. Extrapulmonary TB was ruled out by AFB staining, MGIT Culture, and GeneXpert MTB. Bone scan, tumor markers, and PET scan ruled out osteolytic lesion secondary to metastasis. Though PET Scan and HRCT thorax confirm pulmonary involvement giving a picture of bilateral interstitial lung disease along with multiple enlarged lymph nodes. Patient serum was found negative for HIV, HBV, and HCV. Liver and renal function tests were within normal range and in hematology, ESR was raised (50;normal range:0-20). Patient is hypertensive with HbA1c of 5.3. There was no history of travel, avian exposure, weight loss, and COVID-19 infection. Patient was started on voriconazole and considering generalized lymphadenopathy, a therapeutic trial of anti-tubercular therapy was started which was stopped within a week on patient non-compliance. Abscess resolved with voriconazole and patient was discharged. In February 2022, Patient presented with similar complaints. CT scan of this fluctuant nodule depicted hypoechoic lesion which was ultrasound-guided drained.Sections show many rounds of oval fungal organism which were found PASpositive with mucicarmine and alcian blue positive capsule.Budding yeast cells were seen on KOH mount and India ink preparation demon-strated capsule which was confirmed by Cryptococcal Antigen test giving an overall impression in favor of Cryptococcosis. Patient was started on oral fluconazole and Injection liposomal amphotericin B 250 mg for 14 days. Discussion and Conclusion(s): This is the first case of skeletal Cryptococcosis at our institution which was managed by antifungals without surgical debridement resulting in resolution of abscess. Isolated focal iliac bone cryptococcosis is unusual but may occur in immunocompetent with everyday exposure to the organism. Herein, Patient had bilateral lung involvement along with multiple lymphadenopathies with no evidence of TB bacilli which inferences that the isolate most likely originated from environmental bird droppings and has disseminated from pulmonary lesion to the iliac bone. The radiological findings of iliac cryptococcosis abscess were nonspecific.A definitive diagnosis was made on histopathological and fungal examinations of ultrasound-guided drained abscess. Patient will be followed in the near future for relapse or any other medical issues related to the case.
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Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) is one of the worst human health problems faced by humanity in recent centuries. An end to this health crisis relies on our ability to monitor viral transmission dynamics to check spread, develop therapeutics and preventatives for treatment of SARS-CoV-2 infection and understand the pathophysiology of the disease for better management of the patients. Omics technologies have played a crucial part in understanding the different aspects of COVID-19 disease. While whole-genome sequencing of SARS-CoV-2 isolates from across the globe has aided in the development of molecular diagnostic assays and informed about the viral evolution, knowledge of structure and function of viral proteome fueled the development of small molecule and biologicals therapeutics as well as vaccines. Concurrently, metabolomic profiling of samples from COVID-19 patients experiencing a varying level of disease severity has provided a snapshot of the pathophysiology of the disease helping device effective treatment regimen. This chapter deals with genomic, proteomic, and metabolomic profiling of SRAS-CoV-2. © 2022 Elsevier Inc. All rights reserved.
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CASE: An 81-year-old female with multiple co-morbidities including recent covid-19, presented to the emergency room with shortness of breath. On arrival, she was febrile with a temperature of 101F, pulse 100 beats/min, respiratory rate 14, blood pressure 196/163 and saturating at 75% on 10 L non-rebreather mask. Initial blood work showed WBC 10.9, lactic acid 1.7, BUN/creatinine 27/1.7 (consistent with her baseline), ABG showed pH 7.37, PCO2 49, PO2 88, HCO3 27.9. Chest x-ray demonstrated volume loss in the left hemithorax, airspace disease in the left mid lung and lung base. Due to suspicion for superimposed bacterial pneumonia and positive blood cultures for staphylococcus haemolyticus, she was started on vancomycin and azithromycin. Choice of antibiotics was challenging as she was allergic to penicillin and cephalosporins. During hospitalization, her kidney function deteriorated, vancomycin was substituted with tigecycline on day 3. Day 5 of treatment, she developed multiple episodes of vomiting with epigastric pain, lipase was 4523. Acute pancreatitis was diagnosed with tigecycline presumed to be the inciting agent in the absence of other risk factors such as gall stones, chronic alcohol use, elevated triglycerides, previous known episodes of pancreatitis or any other causative medications. Tigecycline was switched back to vancomycin and she received aggressive IV fluid hydration which also improved her kidney function. Within 48 hours, the patient had improved oxygen saturation, resolution of her abdominal pain, and good oral intake marking significant overall clinical progress. She was discharged on home oxygen and few more days of IV vancomycin for bacteremia. IMPACT/DISCUSSION: Tigecycline is a broad-spectrum glycylcycline antimicrobial agent belonging to the tetracycline class of antibiotics. Tetracyclines have been associated with acute pancreatitis in literature, and concerns about tigecycline-induced acute pancreatitis have been raised over the past decade in post marketing surveys, we described one such case above. Using the Naranjo Adverse Drug reaction probability scale, a score of 6 was achieved, indicating that the patient's pancreatitis was probably related to tigecycline. CONCLUSION: We recommend physicians monitor patients for signs and symptoms of pancreatitis including abdominal pain after initiating treatment with tigecycline. There should be a low threshold for ordering lipase levels and abdominal CT imaging where indicated. If the patient has symptoms concerning for acute pancreatitis, consider stopping tigecycline and switching to a different class of antibiotics immediately.
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Introduction: Although Coronavirus disease 2019 (COVID-19) primarily involves the respiratory system, it can also progress to a multisystem illness frequently involving the gastrointestinal tract. When an infection ensues and disrupts the checks and balances system within the liver, it can lead to injury, tissue damage, remodeling, and chronic liver disease. It is commonly observed that COVID elevates liver function tests (LFTs) during an acute infection, but not much has been published about the effects once the infection clears. We investigated the elevated LFT during COVID and different health and hospital related outcomes. To our knowledge, this is the first report of long term liver enzyme elevations in COVID patients. Method: A retrospective cohort study was performed examining patients with COVID between 7/1/2020-11/30/2020 within our hospital system. Of the 1370 patients, we compared LFTs at minimum 3 months prior to COVID, during COVID, and a minimum 3 months after COVID as well as their outcomes. 18 patients were excluded as they were outliers based on interquartile range. We defined elevated LFTs being 2x the upper limit of normal LFT values. We used pairwise Wilcoxon rank sum test to compare continuous variables and Chi-Square test to compare categorical variables. Unadjusted and adjusted association of elevated LFT were analyzed using logistic regression model. Result: A total of 1352 patients were analyzed, 657 (48.5%) were male and 695 (51.5%) were female. 249 patients were found to have elevated LFTs during hospitalization. Patients with elevated LFTs were more likely to have a longer length of stay (aOR 1.016, 95% CI 1.002 – 1.029, p <0.0001), more likely to be admitted to the ICU (aOR 1.54, 95% CI, 1.251 – 1.899, p <0.0001) and more likely to be intubated (aOR 2.34, 95% CI, 1.051 – 3.6, p< 0.0001) as compared to patients with normal LFTs. Patients with elevated LFTs also had significantly lower survival compared to patients with normal LFTs (aOR 0.38, 95% CI 0.25-0.59, p<0.0001). Pairwise comparisons of the LFTs before and after COVID showed no statistically significant difference between AST, ALT, ALP, and bilirubin, p = 0.43, 0.062, 0.25, and 0.58 respectfully. However, there was a significant difference between AST, ALT, and ALP during COVID as compared to before and after COVID infection (p<0.0001). Conclusion: COVID patients with elevated LFTs during hospitalization exhibited less survival and longer hospital stay and ventilation use and hospital care. Elevated LFTs lasted several months even after recovery from the respiratory infection. Larger prospective observational studies are needed to confirm these associations
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A 44-year-old man of Pakistani origin presented to emergency 6 days following his first dose of the AstraZeneca (AZ) SARSCoV- 2 vaccine. He developed flu-like symptoms followed by erythematous pruritic rash. Physical examination showed a maculopapular rash associated with purpura and targetoid lesions affecting his distal extremities, trunk and mucous membranes. He also had crusting and ulceration of his oral and genital mucosal areas. He had no other significant past medical history. A biopsy was taken from his right arm and sent for urgent histology and direct immunofluorescence. Histology revealed parakeratotic scale with interface dermatitis comprising basal layer vacuolation and lymphocyte exocytosis. The epidermis showed prominent dyskeratotic keratinocytes scattered throughout the epidermis. The papillary dermis showed a mild perivascular lymphocytic infiltrate including eosinophils and melanophages. Other investigations showed leucocytosis (12 × 109 L-1), high eosinophils (0.9 × 109 L-1), raised liver enzymes with alkaline phosphatase 159 U L-1 and alanine aminotransferase 172 U L-1. A full infection screen, including herpes simplex virus, SARS-CoV-2 and atypical viral infection, was negative. Immunology was also reported as negative. Based on the findings, a diagnosis of erythema multiforme (EM) secondary to AZ vaccine was made. He was treated with topical steroids and emollients, leading to resolution of his skin and mucosal areas in 4-6 weeks. Recently, there have been a few reported cases of EM in patients with COVID-19 (Jimenez-Cauhe J, Ortega-Quijano D, Carretero- Barrio I et al. Erythema multiforme-like eruption in patients with COVID-19 infection: clinical and histological findings. Clin Exp Dermatol 2020;45: 892-5) and two patients who have had the Pfizer-BioNTech vaccine [Kim M, Kim J, Kim M et al. Generalized erythema multiforme-like skin rash following the first dose of COVID-19 vaccine (Pfizer-BioNTech). J Eur Acad Dermatol Venereol 2021], but the information is limited. Our case emphasizes the need for further studies into the cutaneous adverse effects related to COVID-19vaccines.
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Background: SARS CoV-2 infection took the whole world by storm in the final month of 2019.Different measures have been taken to reduce its spread by timely and accurate detection of COVID 19(coronavirus disease 2019) infection in suspected patients and theircontacts. Aim: This study was conducted to assess commercially available five Rt pcr (reverse transcriptase polymerase chain reaction) kits from different manufacturers available in our center for diagnostic testing ofSARS CoV-2 infection .94 oropharyngeal clinical samples, previously confirmed as 64 positive and 30 negative for SARS CoV-2 were extracted and amplified separately by each of the five Rt pcr kitsand the results compared. Results:The performance of different kits was in was satisfactory and above 90 percent in agreement with the standard kit for samples (n=47) with low Ct values (Ct values<30) . There was a significant variation in performance among the five kits while testing high Ct values (Ct value >30) samples (n=17).Significant variation in Ct values of E gene ,RdRp gene and N gene was observed in the Rt pcr kits results . Conclusion: We conclude that it is necessary to assess the diagnostic performance of different Rt pcr kits for COVID 19 clinical samples from time to time to study the variation in Ct values, sensitivity of different gene targets of SARS CoV2 virus, with proper co -ordination with other laboratories , for development of reliable COVID 19 diagnostic centers at every level.
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BACKGROUND: An unprecedented rise in the number of COVID-19-associated mucormycosis (CAM) cases has been reported in India. Myriad hypotheses are proposed for the outbreak. We recently reported uncontrolled diabetes and inappropriate steroid therapy as significant risk factors for the outbreak. However, Mucorales contamination of hospital environment was not studied. AIM: To perform a multi-centre study across India to determine possible Mucorales contamination of hospital environment during the outbreak. METHODS: Eleven hospitals from four zones of India representing high to low incidence for mucormycosis cases were included in the study. Samples from a variety of equipment used by the patients and ambient air were collected during May 19th, 2021 through August 25th, 2021. FINDINGS: None of the hospital equipment sampled was contaminated with Mucorales. However, Mucorales were isolated from 11.1% air-conditioning vents and 1.7% of patients' used masks. Other fungi were isolated from 18% of hospital equipment and surfaces, and 8.1% of used masks. Mucorales grew from 21.7% indoor and 53.8% outdoor air samples. Spore counts of Mucorales in air were significantly higher in the hospitals of North and South zones compared to West and East zones (P < 0.0001). Among Mucorales isolated from the environment, Rhizopus spp. were the most frequent genus. CONCLUSION: Contamination of air-conditioning vents and hospital air by Mucorales was found. Presence of Mucorales in these areas demands regular surveillance and improvement of hospital environment, as contamination may contribute to healthcare-associated mucormycosis outbreaks, especially among immunocompromised patients.
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COVID-19 , Mucorales , Mucormycosis , Disease Outbreaks , Hospitals , Humans , India/epidemiology , Mucormycosis/epidemiologyABSTRACT
Introduction: Despite advances in treatment and vaccination, COVID-19 continues to have a significant toll on healthcare services. Identifying more modifiable risk factors for severe infection is of utmost importance to guide effective health care delivery. Recent studies show conflicting results regarding the association of gastric acid suppression with the risk of developing severe COVID-19 infection. Considering that acid-suppressive medications are among the most commonly consumed drugs in the United States, an understanding of the impact of these agents on COVID-19 outcomes is of significant importance and inconclusive. We aimed to investigate if pre-admission exposure to proton pump inhibitors (PPIs) is associated with worse outcomes among patients hospitalized with COVID-19. Methods: We retrospectively identified COVID-19 patients admitted to Ochsner LSU Health, Shreveport, from July 2020 to November 2020. Information on baseline demographics, comorbidities, presenting symptoms, PPI use and clinical course was abstracted. We compared outcomes for PPI users and non-users using univariate and multivariate logistic regression. Results: 1370 patients were included in this study, with 14 (22.9%) PPI users, and 1056 (77.1%) non-users. Baseline characteristics are shown in Table 1. PPI users were older (66.00 vs 61.24, p< .0001) and had a lower BMI (31.54 vs 32.39, p< .0085) compared to non-users. Both groups received similar treatment: steroids, antibiotics, remdesivir, convalescent plasma, and supplemental oxygen. There was no significant difference in the length of stay between these 2 groups. On univariate analysis, PPI users were significantly associated with developing secondary infection (OR 1.45, P=0.049) and acute kidney injury (AKI) (OR 1.45, P=0.015). The rate of developing other complications like deep venous thrombosis, pulmonary embolism, stroke, encephalopathy, shock, need for renal replacement therapy was similar in both groups. After adjusting for age, gender, race, BMI, comorbidities, PPI use was not associated with worse outcomes like ICU admission, ventilation requirement, mortality, or more complications (Figure 1). Conclusion: An interesting finding in this study was that PPI users were significantly associated with developing secondary infection but not with worse clinical outcomes or mortality. We recommend continuing PPI use when clinically indicated and educating users regarding their safety.
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After the unprecedented arrival of the COVID-19 pandemic, the Internet has become a crucial source of essential information on the virus. To prevent the spread of misinformation and panic, many authorities have resorted to exercising higher control over Internet resources. Although there is anecdotal evidence that websites containing information about the pandemic are blocked in specific countries, the global extent of these censorship efforts is unknown. In this work, we perform the first global censorship measurement study of websites obtained from search engine queries on COVID-19 information in more than 180 countries. Using two remote censorship measurement techniques, Satellite and Quack, we collect more than 67 million measurements on the DNS and Application layer blocking of 1,291 domains containing COVID-19 information from 49,245 vantage points in 5,081 ASes. Analyzing global patterns, we find that blocking of these COVID-19 websites is relatively low on average, 0.20%-0.34% of websites containing information about the pandemic experience interference. As expected, we see higher blocking in countries known for censorship such as Iran, China, and Kazakhstan. Surprisingly, however, we also find significant blocking of websites containing information about the pandemic in countries generally considered as "free" in the Internet space, such as Switzerland (DNS), Croatia (DNS), and Canada (Application layer). We discover that network filters in these countries flag many websites related to COVID-19 as phishing or malicious and hence restrict access to them. However, our investigation suggests that this categorization may be incorrect most websites do not contain serious security threats causing unnecessary blocking. We advocate for stricter auditing of filtering policies worldwide to help prevent the loss of access to relevant information.
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Introduction: Coronavirus Disease 2019 (COVID-19) has been haunting the world since December 2019 and has grown to pandemic proportions from March 2020. Even after a full year of research and study, the most effective way to control the spread of this infection is early diagnosis and isolation of the cases. Real-time Reverse Transcription Polymerase Chain Reaction (RT-PCR) is considered the standard test all over the world for the diagnosis of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection. All the sample collection guidelines have recommended stringent maintenance of the cold chain for the sample transport. However, it is not possible for the resource constrained developing countries with inadequate infrastructure to comply with these guidelines all the time. Aim: To determine necessity of these stringent transport criteria and the effect of temperature on the clinical sensitivity of a RT-PCR assay for diagnosis of SARS-CoV-2 infection. Materials and Methods: In this prospective experimental study conducted in November 2020, 49 positive samples were kept at ambient room temperature and were tested everyday with RT-PCR for the detection of SARS-CoV-2 Ribonucleic Acid (RNA). The samples were also kept under refrigeration at the 4°C and were also tested by RT-PCR and the results were compared with their respective counterparts kept at room temperature till nine days. Python Jupiter notebook SciPy and Anaconda software was used for statistical analysis. Results: It was observed that the positivity of the RT-PCR results were not deteriorated till five days and there was no significant deterioration even after nine days of samples being stored at room temperature suggesting that even if the viral RNA itself is not stable outside strict temperature control but small fragment or target genetic sequences are enough for detection of virus by RT-PCR. Conclusion: It is possible to keep samples at this ambient temperature for five days without any loss of positivity in RT-PCR.
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Background: Stroke in COVID-19 has been reported in critically ill patients globally. Stroke as a singular manifestation of COVID-19 in absence of typical symptoms (fever, cough and dyspnea) is under- recognized. Objective: Comparative study of clinical and laboratory parameters of COVID-19 stroke patients without typical symptoms at onset with stroke cases without COVID-19 infection. Methods: 28consecutive stroke patients, eight with coronavirus infection and twenty without COVID-19 admitted to neurology department of a tertiary care centre of North West India between 20 June,2020 and 19 July,2020 were enrolled in this retrospective study. Results: COVID-19 patients had higher frequency of seizures (4[50%]) vs 2[10%];p= 0.03)and altered mental status(6[75%] vs 6[30%] p= 0.04). Severity of ischemic stroke(NIHSS >20, 3[75 %] vs 2[18%])and mortality(p=0.04)despite comparable vascular risk factors for stroke between the two groups was higher in COVID-19 patients. Three out of four COVID-19 young strokes died. Two females with COVID-19 did not develop any typical symptoms, six males(75%) developed fever with dyspnea after a mean delay of 2.7 days(Standard deviation 1.7) from stroke onset. All six patients who developed fever subsequently expired. Inflammatory markers (neutrophil to lymphocyte ratio;p<0.001and ESR: p<0.001), transaminases(p=0.038) and creatinine (p=0.009) were significantly elevated in COVID-19 patients. Conclusion: Isolated cerebrovascular involvement can be a presentation of COVID-19.Stroke severity and mortality is higher in COVID-19 with young strokes being no exemption. Development of fever was associated with clinical worsening. COVID-19 pandemic is far from over in India, such atypical presentations need to be recognized early and warrant stringent diagnostic protocols.
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PURPOSE: To provide a precise summary and collate the hitherto available clinical evidence on the effect of vitamin D supplementation on clinical outcomes in COVID-19 patients. METHODS: PubMed/MEDLINE, Scopus, and Web of Science databases were systematically searched using appropriate keywords till June 8, 2021, to identify observational studies and randomized controlled trials (RCTs) reporting adverse clinical outcomes (ICU admission and/or mortality) in COVID-19 patients receiving vitamin D supplementation vs. those not receiving the same. Both prior use and use of vitamin D after COVID-19 diagnosis were considered. Unadjusted/adjusted pooled odds ratio (OR) with 95% confidence intervals (CI) were calculated (PROSPERO registration number CRD42021248488). RESULTS: We identified 13 studies (10 observational, 3 RCTs) pooling data retrieved from 2933 COVID-19 patients. Pooled analysis of unadjusted data showed that vitamin D use in COVID-19 was significantly associated with reduced ICU admission/mortality (OR 0.41, 95% CI: 0.20, 0.81, p = 0.01, I2 = 66%, random-effects model). Similarly, on pooling adjusted risk estimates, vitamin D was also found to reduce the risk of adverse outcomes (pooled OR 0.27, 95% CI: 0.08, 0.91, p = 0.03, I2 = 80%, random-effects model). Subgroup analysis showed that vitamin D supplementation was associated with improved clinical outcomes only in patients receiving the drug post-COVID-19 diagnosis and not in those who had received vitamin D before diagnosis. CONCLUSIONS: Vitamin D supplementation might be associated with improved clinical outcomes, especially when administered after the diagnosis of COVID-19. However, issues regarding the appropriate dose, duration, and mode of administration of vitamin D remain unanswered and need further research.
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COVID-19 Drug Treatment , SARS-CoV-2 , Treatment Outcome , Vitamin D/administration & dosage , COVID-19/epidemiology , COVID-19/mortality , Comorbidity , Dietary Supplements , Humans , Intensive Care Units , Odds Ratio , Vitamin D/adverse effects , Vitamin D Deficiency/epidemiologyABSTRACT
Background: The majority of COVID-19 morbidity and mortality occurs in patients who progress to mechanical ventilation. Therefore, therapeutic interventions targeting the mitigation of this complication would markedly improve outcomes and reduce healthcare utilization. Methods: Patients with COVID-19 from two hospitals in San Diego, California were randomized at a 1:1 ratio to receive standard of care (SOC) plus intravenous immunoglobulin (IVIG) at 0.5 g/kg/day x 3 days with solumedrol 40 mg 30 minutes before infusion (IVIG group) versus SOC alone. The primary composite endpoint was receipt of mechanical ventilation or death before receiving ventilation. Patients were followed until discharge to home or up to 30 days from time of enrollment. Results: Sixteen patients received IVIG plus SOC and 17 SOC alone. The median age was 54 years for SOC and 57 years for IVIG. Median time from hospital admission to study enrollment was 1 day (range 0-4) for SOC and 2 days (range 0-8) for IVIG. APACHE II scores and Charlson comorbidity indices were similar for IVIG and SOC (median 8 vs 7 and 2 for both, respectively). Seven SOC patients achieved the composite endpoint (6 ventilated, 1 death) versus 2 IVIG patients (2 ventilated), p=0.12, Fisher exact test. Among the subgroup with an estimated A-a gradient of >200 mm Hg at time of enrollment, the IVIG group showed a lower rate of progression to the composite endpoint (2/14 vs 7/12, p=0.04 Fisher exact test), shorter median hospital length (11 vs 24 days, p=0.001 Mann Whitney U), and shorter median intensive care unit (ICU) stay (3 vs 13 days, p=0.005 Mann Whitey U). Conclusion: This small, prospective, randomized, open-label study showed that when administered to hypoxic non-ventilated COVID-19 patients with an A-a gradient of >200 mm Hg (corresponding to a requirement of 6 liters O2 via nasal cannula to achieve an SpO2 of 92%), IVIG significantly decreased the rates of progression to mechanical ventilation, ICU length of stay, and total hospital length of stay. A Phase 3 prospective, randomized, placebo-controlled, multicenter trial is underway to further validate these findings.
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Pandemic situation such as COVID-19 boosted the demand for remote patient monitoring (RPM) system. The medical sensors attached to the human body in RPM system experience varying channel quality due to body movements. This paper analyzes the signal received from RPM sensors when a patient rotates by different angles while sitting on a chair as well as heed the use of a relay node placed on his/her body. Literature suggests many relay-based communication protocols to deliver physio-signals efficiently in an RPM application. However, limited studies have focused on the position of a relay node on the human body. In this paper, we empirically analyze the off-body communication path of sensor nodes by collecting data from different body orientations in a residential room. We estimate the path loss parameters for underweight, normal and overweight body mass index (BMI) categories. The estimated parameters are then used to simulate the physical layer of a home-based indoor RPM application. We inspect different relay node positions on the human body and allude an optimal position of the relay node that cover the transmission range of all sensors and provides an improved channel quality. We improve the Quality of Service (QoS) during non-line-of-sight (NLOS) situation and design an adaptive cross-layer communication protocol for WBANs. IEEE
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The magnitude and pace of global affliction caused by Coronavirus Disease-19 (COVID-19) is unprecedented in the recent past. From starting in a busy seafood market in the Chinese city of Wuhan, the virus has spread across the globe in less than a year, infecting over 76 million people and causing death of close to 1.7 million individuals worldwide. As no specific anti-viral treatment is currently available, the major strategy in containing the pandemic is focused on early diagnosis and prompt isolation of the infected individuals. Several diagnostic modalities have emerged within a relatively short period, which can be broadly classified into molecular and immunological assays. While the former category is centered around real-time PCR, which is currently considered the gold standard of diagnosis, the latter aims to detect viral antigens or antibodies specific to the viral antigens and is yet to be recommended as a stand-alone diagnostic tool. This review aims to provide an update on the different diagnostic modalities that are currently being used in diagnostic laboratories across the world as well as the up-coming methods and challenges associated with each of them. In a rapidly evolving diagnostic landscape with several testing platforms going through various phases of development and/or regulatory clearance, it is prudent that the clinical community familiarizes itself with the nuances of different testing modalities currently being employed for this condition.