Waste management model for COVID-19: recommendations for future threats.

The change in habits and lifestyle of citizens during health crisis like COVID-19 pandemic has resulted in an unprecedented increase in the struggles for solid waste management across the globe. Not only underdeveloped and developing economies are struggling with the challenges posed by mounting piles of infectious waste but even developed countries are adversely affected in similar manner. The routine waste management strategies followed by various countries are overturned due extremely altered trends in the amount and type of waste generated by households and medical facilities. The aim of this paper is to study and list the best available waste management policies adopted by some developing, developed and underdeveloped economies. The listed case studies were selected due to some unique steps undertaken for solid waste disposal during pandemic. The findings revealed that the guidelines issued by WHO for waste management of corona virus infected waste were followed by these nations and certain additional preventive steps were taken. Due to unavailability of single framework as prescribed by international authorities, various sustainable steps taken by individual countries to curb the pandemic menace can be useful in the present context. Few of these measures can be permanently adopted at global level by other nations for handling the pandemic like situations efficiently in pandemic situations.

Higher pro-inflammatory cytokines are associated with anti-SARS-CoV-2 spike protein-specific seroconversion after two doses of COVAXINTM, COVISHIELDTM vaccination in renal transplant recipients

Introduction: Generating adequate cellular and humoral responses are essential principle of vaccination. Immune system of renal transplant recipient remained compromised and speculated to less likely to develop antibody after vaccination. SARS-CoV-2 neutralizing antibody after anti-SARS-CoV-2 vaccination is required for the protection from subsequent viral infection. During COVID-19 disease, anti-SARS-CoV-2 specific antibody formation was correlated with the inflammatory cytokines level. Although, there is limited informations about serum cytokines and antibody formation after COVAXINTM, COVISHIELDTM vaccination in RTRs. Therefore, in the current study, we have evaluated the inflammatory cytokines response and anti-SARS-CoV-2 specific antibody formation in renal transplant recipient. Method(s): In this study, we have recruited 171 live-related renal transplant recipients vaccinated with two doses of either COVAXINTM (whole inactivated virus-based vaccine) or COVISHIELDTM (Simian adenovirus containing full-length spike protein-based vaccine). A 5 ml blood sample was collected after two weeks of 2nd dose of vaccination. The serum was separated and stored at -200C till the analysis. Anti-SARS-CoV-2 spike protein-specific IgG antibody titer was determined by chemiluminescent microparticle immunoassay methods and Cytokines IL-10, TGF-beta, IFN-gamma, IL-6 were measured by the ELISA techniques. Result(s): The overall anti-SARS-CoV-2 spike protein specific seroconversion after vaccination was observed in 149/171(87.13%) of RTRs with median IgG titer in seroconversion group 1191.90 (IQR, 398.70-2652.45) au/ml. The median and interquartile serum cytokines IL-10 level in seroconversion (n=149) vs non-seroconversion (n=22) group was 88.89 (IQR, 55.5-125.92) vs 92.59 (IQR, 48.14-148.14) pg/ml. The median TGF-beta level in seroconversion vs non-seroconversion group was 692.10 (IQR, 446.05-927.63) vs 1001.31 (IQR, 813.15-1125.65) pg/ml. The median IL-6 level in seroconversion vs non-seroconversion group was 46.66 (33.3-66.66) vs 28.33 (16.66-34.16) pg/ml. The median IFN-gamma level in seroconversion vs non-seroconversion group was 98.0 (IQR, 57.40-111.60) vs 50.0 (IQR, 30.55-52.55) pg/ml. The cytokines IL-6 and IFN-gamma level was positively correlated with anti-SARS-CoV-2 specific protein antibody titer (r=0.192;p=0.012), IFN-gamma (r=0.188;p=0.014). TGF-beta and IL-10 were negatively correlated with anti-SARS-CoV-2 specific protein antibody titer. For IL-10 (r=-0.065;p=0.39), for TGF-beta (r=-0.246;p=0.002). Further IFN-gamma was negatively correlated with TGF-beta (r=-0.268;p<0.001). Conclusion(s): Higher pro-inflammatory cytokines (IL-6, IFN-gamma) levels were associated with anti-SARS-CoV-2 spike protein-specific seroconversion, whereas higher anti-inflammatory cytokines IL-10 and TGF-beta were negatively associated with seroconversion after vaccination in renal transplant recipients. No conflict of interestCopyright © 2023

Association of urinary mitochondrial DNA with COVID-19 related acute kidney injury, mitochondrial stress, and inflammation in renal transplant recipients

Introduction: ACE-receptors are profusely expressed in the renal cell, making it highly susceptible for severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection. After entering the cells, the virus induces high levels of cytokines, chemokines, and inflammatory responses, resulting neutrophilic infiltration, activation, and profuse reactive oxygen species (ROS) formation, leading to cellular necrosis and acute tubular injury. Proximal convoluted tube cell are rich in mitochondria and susceptible for developing acute kidney injury (AKI) due to mitochondrial stress. Early detection of AKI may helpful in its management, limiting the severity, avoiding nephrotoxic medicines and modifying the drug dose depending on renal function. Therefore, in the current study, we have determined the utility of urinary mitochondrial DNA (umt-DNA) and neutrophil gelatinase-associated lipocalin (NGAL) in predicting COVID-19-associated acute kidney injury (AKI) and mitochondrial stress and demonstrated the inflammatory response of urinary mt-DNA. Method(s): Live-related RTRs(n=66), who acquired SARS-CoV-2 infection and were admitted to a COVID hospital were included and subclassified into AKI (N=19) with > 25% spike in serum creatinine level from the pre-COVID-19 serum creatinine level, and non-AKI (N=47) whose serum creatinine value remained stable similar to the baseline value, or a rise of < 25% of the baseline values of pre-COVID-19. A 50ml urine sample was collected and umt-DNA and N-GAL was determined by the RT-PCR and ELISA methods respectively. A 10ml blood sample from 10 healthy volunteers was also collected for PBMC isolation and inflammatory response demonstration. A 1x106 PBMC was stimulated for 24hrs. with 1microg/ml of urinary DNA or TLR9 agonist CpG oligodeoxynucleotide (5'-tcgtcgttttcggcgc:gcgccg-3') in duplicate. Unstimulated PBMCs served as control. The gene expression of IL-10, IL-6, MYD88 was analyzed by the RT-PCR and IL-6, IL-10 level in supernatants by the ELISA. Result(s): Both the urinary mitochondrial gene ND-1 and NGAL level was significantly higher in AKI group compared to non-AKI. The mean ND-1 gene Ct in AKI group was (19.44+/-2.58 a.u) compared to non-AKI (21.77+/-3.60;p=0.013). The normalized ND-1 gene Ct in AKI was (0.79+/-0.11 a.u) compared to non-AKI (0.89+0.14;P=0.007). The median urinary NGAL level in AKI group was (453.53;range, 320.22-725.02, 95% CI) ng/ml compared to non-AKI (212.78;range, 219.80-383.06, 95%CI;p=0.015). The median urine creatinine normalized uNGAL was 4.78 (0.58-70.39) ng/mg in AKI group compared to 11.26 ng/mg (0.41-329.71) in non-AKI group. The area under curve of ND-1 gene Ct was 0.725, normalized ND-1 Ct was 0.713 and uNGAL was 0.663 and normalized uNGAL was 0.667 for detecting the AKI and mitochondrial stress. The IL-10 gene expression was downregulated in umt-DNA treated PBMCs compared to control (-3.5+/-0.40vs1.02+/-0.02, p<0.001). IL-6 and Myd88 gene expression was upregulated. The culture supernatant IL-10 and IL-6 level in umt-DNA treatment PBMCs vs control was 10.65+/-2.02 vs 30.3+/-5.47, p=0.001;and 200.2+/-33.67 vs 47.6+/-12.83, p=0.001 pg/ml respectively. Conclusion(s): Urinary mt-DNA quantification can detect the Covid19 associated AKI and mitochondrial distress with higher sensitivity than uNGAL in RTRs. Urinary mt-DNA also induces a robust inflammatory response in PBMCs, which may exacerbate the Covid19 associated allograft injury. No conflict of interestCopyright © 2023

kNN-SVM with Deep Features for COVID-19 Pneumonia Detection from Chest X-ray

Most attention has been paid to chest Computed Tomography (CT) in this burgeoning crisis because many cases of COVID-19 demonstrate respiratory illness clinically resembling viral pneumonia which persists in prominent visual signatures on high-resolution CT befitting of viruses that damage lungs. However, CT is very expensive, time-consuming, and inaccessible in remote hospitals. As an important complement, this research proposes a novel kNN-regularized Support Vector Machine (kNN-SVM) algorithm for identifying COVID-induced pneumonia from inexpensive and simple frontal chest X-ray (CXR). To compute the deep features, we used transfer learning on the standard VGG16 model. Then the autoencoder algorithm is used for dimensionality reduction. Finally, a novel kNN-regularized Support Vector Machine algorithm is developed and implemented which can successfully classify the three classes: Normal, Pneumonia, and COVID-19 on a benchmark chest X-ray dataset. kNN-SVM combines the properties of two well-known formalisms: k-Nearest Neighbors (kNN) and Support Vector Machines (SVMs). Our approach extends the total-margin SVM, which considers the distance of all points from the margin;each point is weighted based on its k nearest neighbors. The intuition is that examples that are mostly surrounded by similar neighbors, i.e., of their own class, are given more priority to minimize the influence of drastic outliers and improve generalization and robustness. Thus, our approach combines the local sensitivity of kNN with the global stability of the total-margin SVM. Extensive experimental results demonstrate that the proposed kNN-SVM can detect COVID-19-induced pneumonia from chest X-ray with greater or comparable accuracy relative to human radiologists. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Association of Bone Metabolic Profile With Severity and Mortality in SARS-COV-2 Patients

Vitamin D, a fat-soluble vitamin helps the body to absorb and retain calcium and phosphorus.Apart from this primary activity, it exhibits potent antimicrobial and antiinflammatory effects viaimmune-modulatory properties. Vitamin D has shown inhibitory effects on the production of pro-inflammatory cytokines, including TNF-alpha and IL- 6, by various mechanisms, includingdown-regulating viralinduced NFkB activation So, this present study aimed to study the relations of serum calcium, phosphorus and Vitamin D levels in association with severity and mortality in SARSCoV- 2 patients. A total of 150 individuals infected with COVID-19 and 50 healthy individuals were recruited. Cases were divided based on severity (mild, moderate and severe) and outcome (discharged or deceased). Serum Ca, Po4, and ALP were analysed by the direct colourimetric method. Vitamin D was measured using the chemiluminescent immunoassay (CLIA). The median serum calcium, Phosphorus, ALP and vitamin D levels in COVID 19 patients were 8.02 mgldL (IQR, 7.24-8.71), 3.93 mgldL (IQR, 2.97- 4.36), 115 IU/L(IQR, 94-146) and 17.2 ng/mL (IQR, 11.6- 25.9) respectively. On comparing the different severity groups a significant difference was found in Vitamin D (p<0.002), ALP (p<0.00001) and calcium (p<0.0001). The serum calcium levels were significantly positively correlated with Vitamin D levels and negative correlation with the inflammatory markers like IL-6. Similarly, patients with low calcium and vitamin D were found to have a fatal outcome. 838 The multivariable analysis showed that a combination of low calcium and vitamin D with higher age are associated with mortality in COVID-19 patients. Serum calcium and Vitamin D were associated with the clinical severity and prognosis of patients with COVID-19.

Overview of COVID-19 Pandemic: Its Management and Prevention in Light of the Indian Traditional Medicine System

With the global death toll nearing 3.3 million, India being amongst the top 4 countries, the condition is more than fearsome. World Health Organization (WHO) recommends one doctor per 1000 population ratio, but India lags it by one doctor to 1456 people, which sets a lot of pressure on the healthcare system. Traditional remedies are becoming increasingly popular in India as a re-sult of the lack of a proper medical system. Due to the rich diversity of medicinal herbs and drugs, India has been managing health issues with its 5000 years old medication system. Amidst all this, the traditional medicine system has given relief to plenty of diseases and remains the primary de-fence system against COVID-19. Therefore, COVID-19 is also managed by its different medicinal systems, which are collectively known as the AYUSH regime. It had been a recognized system to tackle diseases in the past. In this mini-review, we performed a deep study of the Indian traditional medicine system in managing the COVID-19 situation.Copyright © 2023 Bentham Science Publishers.

Human Leukocyte Antigen Association with Anti-SARS-CoV-2 Spike Protein Antibody Seroconversion in Renal Allograft Recipients - An Observational Study

Cellular and humoral responses are required for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) eradication. Antigen-presenting cells load SARS-CoV-2 peptides on human leukocyte antigen (HLA) with different avidities and present to T- and B-cells for imposing humoral and cellular responses. Due to immunosuppression, renal transplant recipient (RTR) patients are speculated to poorly form the antibody against the SARS-CoV-2. Therefore, determining the association of specific HLA alleles with anti-SARS-CoV-2 spike protein antibody formation will be helpful in managing the RTR having specific HLA alleles from SARS-CoV-2 infection and vaccination. Material(s) and Method(s): In this study, anti-SARS-CoV-2 spike protein antibody in 161 RTRs was determined by the chemiluminescent microparticle immunoassay methods, and HLA alleles were determined by the polymerase chain reaction-single-strand oligonucleotide methods and analyzed to study the HLA allele association with anti-SARS-CoV-2 spike protein-specific humoral response and severity of COVID-19 symptoms in recently SARS-CoV-2-infected RTRs. Result(s): The anti-SARS-CoV-2 spike protein specific antibody seroconversion rate in RTRs was 90.06% with a median titer of 751.80 AU/ml. The HLA class I alleles, A*11 in 22.1%, A*24 in 21.37%, A*33 in 20.68%, HLA B*15 in 11%, B*07 in 8.27%, HLA-C*30 in 20.93%, C*70 in 23.25% and HLA Class II alleles, DRB1*07 in 18.62%, DRB1*04 in 13.8%, HLA-DRB1*10 in 14.48%, HLA-DQA1*50 in 32.55% of RTRs were associated with the seroconversion. The mean SARS-CoV-2 clearance time was 18.25 +/- 8.14 days. Conclusion(s): RTRs with SARS-CoV-2 infection developed a robust seroconversion rate of 90.0% and different alleles of HLA-B, DRB1, and DQA1 were significantly associated with the seroconversion. Copyright © 2022 Indian Journal of Transplantation.

Imagining Caring Futures for Frontline Health Work

Care workers are increasingly using digital technology in their daily lives, for monitoring, financial compensation, training, coordination, and more. State and corporate actors have invested significant resources to enable this digital shift, particularly during the COVID-19 pandemic. However, care work has remained chronically underpaid, and continues to rely on women from minoritized and marginalized backgrounds. Our paper examines how care workers carefully navigate digitization, precarity, and complex social relationships, in an attempt to care for their communities and each other. We analyze the emerging digital ecosystem for frontline health workers in India during the COVID-19 pandemic where these dynamics have been highly visible. Our research draws attention to four interconnected ways in which workers practiced care, by directing their efforts towards survival, resilience, advocacy, and/or resistance. We suggest these also as care orientations that can be adopted by researchers and practitioners, to critically reflect on and direct technology design towards enabling more caring futures, for (and with) workers and communities. © 2022 Owner/Author.

A clinicoepidemiological study of orbital mucormycosis in COVID-19 pandemic at a tertiary healthcare hospital, North-West Rajasthan, India

Background Mucormycosis is an opportunistic fungal infection with high morbidity and mortality. Purpose The aim of this study was to determine the risk factors, clinical presentation, management, and outcome of management of orbital mucormycosis during the coronavirus disease 2019 (COVID-19) pandemic. Patients and methods This is a prospective hospital-based observational study that was conducted on cases of rhino-orbital cerebral mucormycosis (ROCM) presented to a tertiary health-care center in North-West Rajasthan, India, during the second wave of COVID-19 over a period of 1 month (May 26, 2021 to June 25, 2021). The patients were followed up for 3 months. A total of 40 cases fulfilling the clinical, radiological, and pathological or microbiological criteria for the diagnosis of ROCM were included in the study. Results Out of a total of 126 mucormycosis patients, 40 had ocular manifestations ranging from lid edema, chemosis, and ptosis to severe manifestations such s ophthalmoplegia, optic neuritis, and cavernous sinus thrombosis. Rare presentations of corneal eschar and corneal ulcer were also reported. Among the 40 patients of orbital mucormycosis, 57.5% were in the age group of 51-65 years, 65% were males, 62.5% were COVID positive, 37.5% had a history of oxygen therapy during the COVID-19 illness, and 85% were not vaccinated against COVID-19. All patients with orbital involvement had rhinitis at presentation. Intravenous Amphotericin B was given to all patients. Functional endoscopic sinus surgery was done in 92.5% of the cases and orbital exenteration was done in 35% of the patients to prevent the spread of mucor and to reduce mortality. In 32.5% of the patients, retrobulbar Amphotericin B was given. The mean length of hospital stay was 24.62±11.70 days and 70% of the patients were discharged from the hospital on oral antifungal therapy. A total of 30% of the patients with cerebral involvement passed away. During the follow-up of 3 months, three (7.5%) more patients who discontinued treatment progressed to advanced disease and died, while 62.5% (25 out of 40) patients were alive with stable/regressed disease. The survival rate with retrobulbar Amphotericin B was 92.30% and with exenteration was 92.85%, which was statistically significant compared with the 5% survival rate in the cases in whom no such intervention was done. Conclusion Early diagnosis and treatment of ROCM reduced morbidity and mortality in mucormycosis patients. © 2022 Delta Journal of Ophthalmology ;Published by Wolters Kluwer - Medknow.

Association of Human Leucocyte Antigens with Anti-Sars-Cov-2 Spike Protein Antibody Formation in Response to Vaccination in Renal Allograft Recipient

BACKGROUND: Cellular and humoral response are required for SARS-CoV-2 eradication. Antigen-presenting cell loads SARS-CoV-2 peptides on human leukocyte antigen with different avidity and present to T and B cell for humoral and cellular activity. Due to immunosuppression, renal transplant recipient patients are speculated to poorly form the antibody against SARS-CoV-2 virus. Therefore, determining the association of specific HLA alleles with anti-SARS-CoV-2 spike protein antibody formation will be helpful in managing the renal transplant recipient patients having specific HLA alleles from SARS-CoV-2 infection and vaccination. AIM OF THE STUDY: To study the association of human leukocyte antigens with anti-SARS-CoV-2 spike protein antibody formation in response to vaccination in renal allograft recipient METHODS: In this study, anti-SARS-CoV-2 spike protein antibody in 78 renal allograft recipient patients were determined by the chemiluminescent microparticle immunoassay methods and human leukocyte antigen alleles were determined by the polymerase chain reaction-single strand oligonucleotide methods and analyzed to study the association of human leukocyte antigens with anti-SARS-CoV-2 spike protein antibody formation in response to vaccination in renal allograft recipient RESULTS: The mean age of the patients in seroconversion vs non-seroconversion (45.88 +/- 8.86 vs 45.55 +/- 8.74, p value - 0.90). The post-transplant interval in seroconversion vs non-seroconversion (103.63 +/- 57.57 vs 77.45 +/- 35.25, p value - 0.14). The duration between the vaccination with both the doses and sample collection of renal transplant recipients in seroconversion vs non- seroconversion (47.58 +/- 30.18 vs 45.55 +/- 35, p value - 0.85). The anti-SARS-CoV-2 spike protein antibody seroconversion rate in renal allograft recipients were 85.9% with median titer in seroconversion vs non- seroconversion 3175.00 (IQR, 798.50 - 8391.70) vs 5.50 (IQR, 4.10 - 8.20, p value - 0.001). In covishield vs covaxin group 2500.70 (IQR, 146.40 - 7705.60) vs 1828.70 (IQR, 665.00 - 3765.10, p value - 0.63). The frequency of HLA class I alleles A*26 was 18.18%, B*08 was 18.18%, C*05 was 25% and Class II HLA alleles - DRB1*03 was 18.18%, and HLADQA1* 20 was 25% of patient were significantly associated with non-seroconversion and C*06 was 18.75% were significantly associated with seroconversion. CONCLUSION(S): Renal transplant recipients with anti-SARSCoV- 2 vaccination developed a robust seroconversion rate of 85.9% and alleles of A*26, B*08, C*05, DRB1*03, and DQA1*20 were significantly associated with non-seroconversion.

A Review on Hyperglycemiaandother Factors in Patients with Post Covidmucormycosis

Mucormycosis in people with COVID-19 or who are immunocompromised in any other way has become a worldwide issue, resulting in severe morbidity and mortality. Infection is incapacitating. and deadly, resulting in organ loss and emotional anguish. Mucormycosis is a rare angioinvasive illness that primarily affects immunocompromised people and is caused by the prolife ration of Mucorales. There are no radiographic symptoms. However a diagnosis can be made by microscopically examining materials recovered from necrotizing lesions Because the fungus enters the body through the skin, treatment involves a multidisciplinary approach. The use of the several antifungal medicines available is restricted by resistance and toxicity factors. The lipid formulation of amphotericin-B (liposomal Am-B) is the first-line treatment for mucormycosis in COVID-19 patients. high cost and limited availability have prompted a shift toward surgery, so surgical debridement to remove all necrotic lesions remains the keystone of effective mucormycosis treatment in COVID-19. This study concentrates on the pathophysiology, clinical manifestations, and therapy of HyperglycemiaAndIts Contributing Factors In Patients With Post Covid - 19 Mucormycosis. Copyright © 2022, Anka Publishers. All rights reserved.

Outbreak Prediction of COVID-19 3rd Wave in Asia

Coronavirus is a pandemic for whole world and infected more than 200 countries of the world. Spreading of coronavirus started from china at the end of December and within three months, it infected whole world. Coronavirus is belonging to beta coronavirus family. Common symptoms of coronavirus are fever, dry cough, fatigue, and respiratory-related problem. This paper tries to study the infection rate of coronavirus in Asian countries, rest of world countries, and overall world countries. Asia is largest continent of the world which contains approximate 50 countries and highest contributes in GDP. Population of Asian countries 446.27 crore, that is 60 percentage of whole world population and covers 30 percent geographical area of world. China and India are the most populated countries in Asia. Total confirmed cases 2,056,051, recovered cases 502,045, and death cases 134,177 in the world. Scholar also divides the Asia continent into six regions such East, South, Central, North, Southeast and Western Asia for better understanding infection of coronavirus. This paper analyzes the confirmed cases, recovered cases, and death cases in Asia and understands the infection pattern date wise and countries wise. Machine learning algorithm is used for prediction infection in the world and also predicts future infection rate and death rate in Asian countries and world. Prophet is used for future prediction of confirmed and death cases in the Asian countries. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Safety Concerns Of Drugs And Vaccines Used In The Treatment Of COVID-19

The Novel Coronavirus disease 2019 pandemic which is named as COVID-19 or '2019 n CoV ' or 2019 novel coronavirus by WHO is a highly contagious viral respiratory disease caused due to SARS- CoV-2. Various drugs used to treat this pandemic are Hydroxychloroquine, Remdesivir, Favipiravir, Dexamethasone, etc. These drugs are effective, but they have also shown adverse drug reactions (ADRs) during the treatment of COVID-19 and when an ADR arises due to their use, they add an additional level of complexity in the management of COVID-19 disease. This review aims to demonstrate the mechanism of action as well as the safety issues associated with the drugs used for COVID-19. It also focuses on the safety issues related with two vaccines manufactured by Pfizer and AstraZeneca, respectively. A comprehensive search in PubMed, Science direct, Drug bank, PubChem, CDC, WHO, FDA database was accomplished for research regarding ADR case reports associated with the drugs and vaccines for COVID-19.

Ferroelectric polarization of beta-polyvinylidene fluoride as control and mitigator of infectious organisms

In this work, Polyvinylidene fluoride (PVDF), a ferroelectric polymer thin film, was prepared by the solution casting method. The growth of polymer films was optimized to achieve the ferroelectric beta-phase with PVDF and, most importantly, ferroelectric domains with dominant planar polarization components. The ferroelectric po-larization of these polymers is known to hold surface charges with/without field. The polymer is expected to interact with microbial organisms whose physiological metabolism depends on surface charges. The current COVID-19 pandemic has motivated us to carry out a fundamental study of the interaction between the polari-zation of the ferroelectric polymers and microbes. The antimicrobial studies were performed, making these polymer films interact with bacterial, viral, and fungal growth environments. Electroded PVDF films were kept in contact with bacterial colonies, and a dc-voltage of 1.5 V was applied across the electrodes. The film was sub-jected to 1.5 V and kept in contact with the culture before the growth initiation, and the microbial growth was hindered entirely. It never occurred either beneath or over the surface of the films. Thus, in the presence of the electric field, the microbial growth was inhibited, even in a conducive environment.

ARE ABO INCOMPATIBLE KIDNEY TRANSPLANT RECIPIENTS AT HIGHER RISK OF INFECTIONS?-A SINGLE CENTER EXPERIENCE

Introduction: Because of the limited donor pool, transplants are being done across the blood group and even HLA incompatibility barriers. But this comes at the cost of increased immunosuppression and the side effects. Effect of this intensified immunosuppression on the incidence of post transplant infections and the type of infection has not been studied extensively. Methods: We retrospectively analysed the incidence of infection in ABO incompatible transplants (ABOi) and compared it with propensity matched cohort of ABO compatible transplants(ABOc) over the same timeframe i.e. 2011 to April 2019. using hospital eHIS record system. Patients were matched with 1:2 ratio (ABOi: ABOc) for age (<60yr, >60yrs),sex, number of previous transplants, pretransplant infections, history of prior immunosuppression, diabetic status, NODAT, and induction agent used. Desensitization protocol for ABO incompatible transplant includes rituximab with double filtration plasmapheresis, plasmapharesis or immunoadsorption to target anti blood group titre of 8. Patient with high immunological risk (e.g.second transplant, HLA incompatible) receive ATG induction while others receive basiliximab induction. Valganciclovir prophylaxis was given only in patients with ATG induction. Results: [Formula presented] [Formula presented] During the study period 89 patients underwent ABOi transplants which were compared with 178 ABOc transplants. (Table1)Mean follow up duration was 50.45months (SD 26.8) in ABOi group and 49.47months (SD28.7) in ABOc group. 17% patients lost to follow up with their last follow up being more than 2 years before. Incidence of overall infections was similar in both the groups (59% (43/89) Vs 44.3% (79/178);p=0.6). (Table2) Incidence of urinary tract infections(UTI)was significantly more in ABOi group vs ABOc group.(23.5% (21/89) vs 11.79% (21/178);p=0.019). Cytomegalovirus infections (CMV) were significantly more in ABOi group 12.3% (11/89) as compared to ABOc group 5% (9/187) (p=0.04). All the patients with CMV infection were CMV IgG positive pretransplant except 2, one from ABOc group who was CMV IgG negative and another from ABOi group who’s pretransplant CMV serology was unavailable. There was no significant difference in incidence of fungal infection, pneumocystis infection, diarrheal infections (other than CMV),pneumonia (other than CMV, PCP, fungal), Herpes, BKV infection. Incidence of post-transplant tuberculosis (3.3% (3/89) Vs 2.8% (5/178);p=1.0) and SARS COV2 infections (12.3% (11/89) vs 9% (16/178);p=0.39 was similar in both the groups. Patient survival was similar in both the groups i.e.95.5% but death censored graft loss was significantly more in ABOi group 0.9% (8/89) as compared ABOc group 0.3% (5/178) p=0.03. Reason of graft loss in all the patients was immunological and not infection. Infection was cause for death in three ABOi patients and four ABOc patients. Conclusions: Overall incidence of infections in ABOi transplants was similar to Abo compatible transplant. Incidence of UTIs and CMV infections were significantly higher in ABOi group. No conflict of interest

Carcinoembryonic antigen (CEA) and other surrogate inflammatory biomarkers in COVID-19

It has been two years since the global outbreak of the highly contagious and deadly corona virus disease (COVID-19) caused by SARS-CoV-2 first emerged in China. Since then, various diagnostic, prognostic and treatment strategies undertaken to address the pandemic have been dynamically evolving. Predictive and prognostic role of various biomarkers in COVID-19 has been a subject of intense exploration. We aimed to determine the association of Carcinoembryonic antigen (CEA) and various surrogate inflammatory biomarkers with the severity of COVID-19 disease. This retrospective cohort study was carried out on 98 patients admitted in Jaypee Hospital, Noida with COVID-19 disease. Information regarding demographics, laboratory parameters and clinical history was collected from Hospital Information System. Serum levels of CEA and other biomarkers such as Neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), Interleukin-6 (IL-6), Ferritin, and Procalcitonin (PCT) were assessed. Correlation analyses were performed between the parameters and acute respiratory distress syndrome (ARDS) stages. Logistic regression and ROC curve analysis were performed to assess the various parameters for distinguishing COVID-19 patients requiring ICU admission. Mean hospital stay, NLR, CEA, IL-6, CRP, Ferritin (P <0.0001) and PCT (P = 0.01) were significantly higher in ICU patients when compared to general ward patients. NLR, median serum CEA, IL-6, and CRP levels were significantly higher in non-survivor compared to the survivors (P <0.0001, 0.0341 and 0.0092). CEA correlated well with disease severity based upon ARDS classification and was a better marker to differentiate patient according to ARDS stages (ARDS 0 vs 2 P = 0.0006;0 vs 3 P <0.0001;ARDS 1 vs 2 P = 0.0183;1 vs 3 P = 0.0006). The area under the Receiver operating characteristic (ROC) curve for CEA was 0.7467 (95% CI-0.64885-0.84459) which revealed the potential of CEA as a biomarker to distinguish COVID-19 patients requiring ICU admission. CEA can be used to predict the severity of COVID-19 associated ARDS as well as patients requiring ICU admission. Along with routine inflammatory biomarkers (NLR, CRP, IL-6, PCT, and ferritin), CEA should be used for early identification of critical COVID-19 positive patients and for assessing prognosis. © 2022, National Institute of Science Communication and Information Resources. All rights reserved.

Impact of the COVID-19 Pandemic on Gastroenterology Training in India

Introduction The coronavirus disease 2019 (COVID-19) pandemic has affected the healthcare system. The residents who are at the frontline of this pandemic have suffered the most. The extent of the training loss due to the COVID-19 pandemic on gastroenterology (GE) training is not studied in India. Methods We designed a 36-question based google survey and distributed it to the GE residents all across India, via email. All the responses collected were analyzed using appropriate statistical methods. Results A total of 140 responses were received. No significant decrease in teaching sessions/ classes was reported. Most of the residents (83.5%) reported inability to complete the target thesis enrolment. The number of patients seen by the residents in outpatient department, patients managed in wards and endoscopic procedures done by residents have decreased significantly (p -valve <0.001 for all). An overwhelming 89.9% (n = 125) of the GE residents were posted for COVID-19 duties. Almost half (50.4%) of them were COVID-19 positive. Conclusion The COVID-19 pandemic has affected the training of GE residents in India immensely and an extension period of 3 months may be offered to them.