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COVID-19 has created a misbalance in the global economy by affecting multiple sectors. It has also affected the mindset and, consequently, the behavior of economic agents, one of whom is the investors. This study aims to learn about investors' investment behavior in COVID-19 by looking at their preferred sources of information, which influence investment decisions, and their preferred investment avenues. A deep learning model is also proposed for accurately predicting stock market movement. For this study, data was collected from 50 investors. Factors such as the respondents' age, salary, educational background, investment experience, and income were considered when selecting the sample. According to the findings, most investors trust modern investment vehicles such as stocks and mutual funds. For most investors, liquidity and fund safety have emerged as the most important factors influencing their investment goals. A deep learning model proposed is a combination of CNN network plus bidirectional LSTM network.
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Introduction: Severe COVID-19 infection in a subset of patients is associated with hyperinflammation similar to hemophagocytic lymphohistiocytosis (HLH) however it may not fulfill the required diagnostic criteria (HLH 2004 criteria or H score). We compared clinical, laboratory parameters, bone marrow findings and disease outcome of severe COVID-19 infection related HLH with HLH secondary to causes other than severe COVID-19 to describe features specific to severe COVID-19 associated HLH and limitations of currently available diagnostic criteria of HLH in context to severe COVID -19 infection induced hyperinflammation. Method(s): We analyzed 69 patients diagnosed as HLH of which 47 had severe COVID-19 and 22 had HLH secondary to causes other than COVID-19. Clinical, hematological and biochemical parameters were compared using Mann-Whitney U test. Bone marrow examination (BME) was done in all for presence of hemophagocytosis. Immunohistochemical staining for CD68 and CD163 were done for identification of histiocytes. Occurrence of COVID-19 related HLH was taken as the dependent variable to determine predictors of COVID-19 HLH. Result(s): Organomegaly was seen in only 4.3% (2/47) cases with COVID-19 related HLH as compared to 54.5% (12/22) with non-COVID HLH (p< 0.001). Amongst the quantitative variables, a significant difference in COVID-19 related and non-COVID-19 related HLH was found in the following parameters: Age (p< 0.001), Triglyceride (p=0.009), Fibrinogen (p< 0.001), Ferritin (p< 0.001), Hemoglobin (p< 0.001), Total leukocyte count (p=0.003), Absolute neutrophil count (p< 0.001), Neutrophil lymphocyte ratio (p< 0.001) and H score (p< 0.001). BME of all patients showed presence of hemophagocytes. Only 6.4% (3/47) cases with COVID related HLH had 5/8 HLH 2004 criteria as compared to 63.6% (14/22) cases with non-COVID related HLH (p< 0.001). H-Score >=169 was also significantly less common in COVID HLH as compared to non-COVID HLH (40.42% vs 86.36%, p=0.001). Conclusion(s): Organomegaly, cytopenias, hypofibrinogenemia and hypertriglyceridemia which are part of HLH diagnostic criteria are rare in severe COVID-19 making it difficult to diagnose. Demonstration of hemophagocytes in bone marrow should be recommended in suspicious cases for initiation of early immunosuppressive therapy. (Figure Presented).
ABSTRACT
Hemophagocytic lymphohistiocytosis (HLH) is an inflammatory condition where there is marked cytopenia and large-scale activation of macrophages and CD8+ cytotoxic T cells. HLH may be of two types - primary HLH caused by genetic abnormalities and secondary HLH due to infections, malignancies, autoimmune disorders, rheumatologic disorders, and metabolic dysfunctions. We describe a case of HLH following the first dose of the ChAdOx1 nCoV-19 Corona Virus vaccine. In this patient, there was no clear precipitant of HLH. The most probable explanation could be intense immune activation by vaccine constituents producing aberrant activation of inflammatory cytokines. There were no signs of infection or malignancy. Since our patient was clinically stable, his symptoms had resolved and HLH parameters had improved, no HLH-specific therapy was given.
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Introduction: The second wave of COVID-19 in India was followed by large number of mucormycosis cases. Indiscriminate use of immunosuppressive drugs, underlying diseases like diabetes cancers, or autoimmune diseases was thought to be the cause. However, the mortality was not as high as that seen in non-COVID mucormycosis. Aims & Objectives: To study the detailed characteristics of T-cells for evaluating the underlying differences in the T-cell immune dysfunction in post-COVID and non-COVID mucor patients. Material(s) and Method(s): The study included histopathologically confirmed cases of mucor (13 post-COVID, 13 non-COVID) and 15 healthy individuals (HI). Expression of T-cell activation (CD44, HLADR, CD69, CD38) and exhaustion (CTLA, PD-1, LAG-3 and TIM-3) markers was evaluated by flow cytometry. Result(s): All cases showed significant depletion of T-cells compared to HI. Both post-COVID and non-COVID groups showed increased activation and exhaustion as compared to HI. Non-COVID mucor group showed significant activation of CD4 + T cells for HLADR and CD38 ((P = 0.025, P = 0.054) and marked T-cell exhaustion in form of co-expression of PD-1 and LAG-3 on both CD4 + and CD8 + T cells in comparison to post-COVID patients (P = 0.002, P = 0.001). Additionally, co-expression of PD-1 & CTLA and LAG-3 & TIM-3 on CD8 + T cells was statistically significant in non- COVID mucor patients ((P = 0.031, P = 0.003). Conclusion(s): Immunosuppression in non-COVID mucor showed pronounced exhaustion of T-cells in comparison to post-COVID mucor cases implicating T-cell immune dysfunction is much more severe in non-COVID mucor which are in a state of continuous activation followed by extreme exhaustion leading to poorer outcome.
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This review aims to examine the writing in order to assist specialists and scientists in better understanding and dealing with the impact of Coronavirus on the tourism sector. The study examines the situations and questions created as a result of the pandemic to see why and how Coronavirus - 19 has impacted people's lives. As a result, the report identifies the qualities, establishments, and preconceptions that the travel industry should question, as well as the activities that should be made to take a step ahead. The study also looks into the considerable loss the travel sector is experiencing throughout the Coronavirus stages and proposes a solution based on the Salesforce platform to address some of the issues. This provides an overview of how the Coronavirus affects the travel business, as well as recommendations for the industry, examining and settling some of them with 'Travel Log Analysis utilizing Salesforce'. © 2022 IEEE.
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Aim and background: COVID-19 pandemic has affected the whole world. Besides COVID, many infections may emerge during the course of the disease. Lymphopenia, use of immunosuppressants underlying comorbidities, and immune dysregulation secondary to SARS-CoV-2 could be the likely cause of the emergence such infections. We hereby describe a case of COVID-19 disease which presented with pancytopenia and was found to have Leptospirosis and Herpes Simplex Virus co-infection. Case summary: A 23-yearold postpartum female with no comorbidities and uneventful obstetric history was referred to our hospital 2 weeks after a full-term normal vaginal delivery. She developed generalized convulsive status epilepticus on the 10th day of her delivery, which was managed elsewhere with anti-epileptic drugs (AEDs). During her hospital stay, RTPCR for COVID-19 turned out to be positive but she remained asymptomatic throughout the course of her illness and seizures remained well-controlled on AEDs. On admission to our hospital, she was fully conscious, alert with no focal neurological deficits. Notable findings on evaluation were pancytopenia with megaloblastic features, bilateral pedal edema, and hepatosplenomegaly. NCCT brain was done which was suggestive of subarachnoid hemorrhage (SAH) along bilateral parietooccipital region for which conservative management was planned. 2D echocardiography was normal. Ultrasonography of abdomen revealed gross splenomegaly and mild hepatomegaly with mesenteric lymphadenopathy. NCCT thorax and abdomen were unremarkable apart from hepatosplenomegaly. In the panel sent for pancytopenia workup, IgM anti-HSV 1 antibodies turned out to be positive in blood. In addition, tropical workup was suggestive of Leptospirosis (IgM antibodies were positive). Workup for tuberculosis was negative. Bone marrow workup revealed features of trilineage hematopoiesis with micronormoblastic maturation consistent with iron deficiency anemia with no evidence of hemophagocytosis. Subsequently, IV acyclovir, IV doxycycline, and iron replacement were added. She improved clinically after these therapies and was subsequently discharged in a stable condition. MRI brain with MR angiography and venography done before discharge showed T1 sulcal hyperintensities along bilateral parietooccipital regions suggestive of SAH which was not progressing (as compared to NCCT brain scan done at admission). On day 60 of telephonic follow-up, patient was doing well and leading normal life without any persistence or emergence of symptoms.
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Aim and background: Cases of thrombotic thrombocytopenia induced by coronavirus disease 2019 (COVID-19) vaccines have been reported recently. Herein, we describe hemophagocytic lymphohistiocytosis (HLH) following COVID-19 vaccination. Case report: A 35-year-old male, chronic alcoholic, 3 years into abstinence received first dose Covishield vaccine. He started developing a fever, testicular pain, diminished sensorium requiring invasive ventilation, and decreased urine output 4 days after getting vaccinated. Initial workup for NCCT brain and HRCT chest was normal, tropical fever panel was negative, cultures for blood and endotracheal aspirate were sterile, liver and renal functions showed mild derangement, CSF study was normal. Ultrasound examination of the abdomen revealed mild hepatosplenomegaly, mild testicular swelling, and suprainguinal lymphadenopathy, with no focus of infection. Subsequently, he developed bicytopenia with haemoglobin 9.0 g/dL and platelet counts 50 × 109/L, ferritin 2130 μg/L, triglyceride 353 mg/dL, and decreased fibrinogen 1.41 g/L. Bone marrow as well as lymph node biopsy showed haemophagocytosis with engulfment of neutrophils, lymphocytes, and normoblasts making HLH a likely diagnosis. Soluble CD25 and NK cell function could not be performed. Extensive evaluation was done to look into the etiology of HLH. SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) test was negative. RT-PCR test for Epstein-Barr virus (EBV), influenza A (H1N1, H3N2), influenza B, cytomegalovirus (CMV) performed from endotracheal aspirate (ETA) was negative. Similarly, the RT-PCR test from serum samples for EBV, Parvo B-19, CMV, and from CSF sample for EBV, Parvo B-19, CMV, and HSV-1 was negative. Hepatitis B, C, and HIV serologies were negative. Culture and sensitivity repeated from blood, ETA and urine was sterile. Autoimmune panel including complements levels were negative. Peripheral smear, bone marrow, and lymph node biopsy were normal and did not reveal abnormal or malignant cells. He had persistent fevers to 38.6°C during the first 6 days of his admission, with a rise in his ferritin to 1950 μg/L. The patient received steroids but not etoposide. By the 8th day, his fevers resolved, with improvement in his lethargy and malaise. Two weeks later, his ferritin had reduced to 510 μg/L, platelet count rose to 180 × 109/L, and repeat ultrasound abdomen demonstrated resolution of his splenomegaly. In our patient, there was no clear precipitant of HLH other than the Covishield vaccine. There was no evidence of an infection or malignancy. Due to our patient's clinical stability, resolution of symptoms, and improvement of HLH parameters he did not require HLH specific therapy. It is unclear if he had a pre-existing genetic predisposition to HLH as genetic testing is pending, however, it is unlikely as he has reached the age of 35 and suffered from previous viral infections without developing HLH.
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Aim and background: The novel coronavirus-2019 (COVID-19) pandemic is raging all across the world. As we are delving more into the management of COVID-19, many new challenges are emerging, which may pose additional threats. One of these is the emergence or re-activation of concomitant viral infections owing to lymphopenia, use of immunosuppressants, underlying comorbidities, and immune dysregulation. Although we have come across the threat of fungal infections and resistant bacterial infections, experience regarding reactivation or co-infection with other viral infections is still limited. We hereby describe a case of COVID-19 disease with cytomegalovirus (CMV) co-infection. Case summary: COVID-19 with Cytomegalovirus (CMV) Co-infection. A 55-year-old male, COVID unvaccinated, chronic smoker, overweight, and hypertensive patient was admitted to our ICU with a 1-week history of fever, cough, and breathlessness. SARSCoV- 2 reverse transcriptase-polymerase chain reaction (RT-PCR) test was positive. At admission, he had hypoxaemia (SpO2 86% on room air), respiratory rate (RR) 35-40/minute, and ground-glass opacities in chest X-ray involving 50% of bilateral lung parenchyma suggestive of severe COVID-19 pneumonia. He was managed with lung-protective invasive mechanical ventilation, restrictive fluid strategy, 16-18 hour/day proning sessions (4-5), intravenous (IV) remdesivir, IV dexamethasone 6 mg 12 hourly, and enoxaparin thromboprophylaxis. After 2 weeks of ICU stay, weaning was attempted but the weaning attempts failed due to underlying neuromuscular weakness. On examination, bilateral (B/L) cranial nerve palsies, areflexia, and motor power 0/5 in bilateral upper and lower limbs were noticed. A possibility of Guillain-Barre Syndrome (GBS) was kept and IV immunoglobulin therapy was empirically administered for 5 days with some improvement in power up to 1/5 in upper limbs. On day 35 of hospitalization, he developed pancytopenia along with features of deranged liver function and gut dysfunction (in the form of paralytic ileus and abdominal distension). In evaluation, polymerase chain reaction (PCR) for CMV turned out to be positive in blood with a very high viral load.Bone marrow aspiration and biopsy showed hemopoiesis with viral inclusion bodies and haemophagocytosis (HLH). Histological evidence of CMV inclusion bodies was present in the bone marrow besides viremia (detected by PCR for CMV), which confirmed the diagnosis of CMV co-infection. IV ganciclovir was initiated along with steroids in view of HLH. There was a decrease in CMV viral load after initiation of IV gancyclovir with subtle clinical recovery. However, the patient continued to deteriorate and succumbed to his illness in the 8th week of the ICU stay.
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Introduction: COVID-19 pandemic has affected the whole world. Besides COVID, other viral infections may emerge during the course of the disease owing to lymphopenia, use of immunosuppressants, underlying comorbidities, and immune dysregulation, which may pose additional threats.1 We hereby describe two cases of COVID- 19 with viral co-infections belonging to the Herpesviridae family with undulating clinical course. Case 1: Cytomegalovirus (CMV) Co-infection: A 55-year-old male, COVID unvaccinated, chronic smoker, overweight and hypertensive was admitted to our ICU with a 1-week history of fever, cough, and breathlessness. SARSCoV- 2 reverse transcriptase-polymerase chain reaction (RT-PCR) test was positive. At admission, he had hypoxaemia (SpO2 86%on room air), respiratory rate 35-40/minute, and ground-glass opacities in chest X-ray involving 50% of bilateral lung parenchyma suggestive of severe COVID-19 pneumonia. He was managed with lung-protective invasive mechanical ventilation, restrictive fluid strategy, 16-18 hour/day proning sessions (4-5), intravenous (IV) remdesivir, IV dexamethasone 6 mg 12 hourly, and enoxaparin thromboprophylaxis. After 2 weeks of ICU stay, weaning was attempted but the weaning attempts failed due to underlying neuromuscular weakness. On examination, bilateral (B/L) cranial nerve palsies, areflexia, and motor power 0/5 in bilateral upper and lower limbs were noticed. possibility of Guillain-Barre syndrome (GBS) was kept and IV immunoglobulin therapy was empirically administered for 5 days with some improvement in power up to 1/5 in upper limbs. On day 35 of hospitalization, he developed pancytopenia along with features of deranged liver function and gut dysfunction. In evaluation, PCR for CMV turned out to be positive in blood. Bone marrow aspiration and biopsy showed hemopoiesis with viral inclusion bodies and hemophagocytosis (HLH) [Figs 1 and 2]. A diagnosis of secondary HLH related to CMV was contemplated and IV ganciclovir was initiated along with steroids. Histological evidence of CMV co-infection was present and moreover, the quantitative viral load of CMV showed a decreasing trend after initiating IV gancyclovir. However, the patient continued to deteriorate and succumbed to his illness in the 8th week of the ICU stay. Case 2: Herpes Simplex Virus (HSV) Co-infection: Twenty-three years postpartum female with no comorbidities and uneventful obstetric history was referred to our hospital two weeks after a full-term normal vaginal delivery. She developed generalized status epilepticus on the 10th day of delivery, which was managed with anti-epileptic drugs (AEDs). During the hospital stay, RTPCR for COVID-19 turned out to be positive but she remained asymptomatic and seizures were well-controlled on AEDs. On admission to our hospital, she was fully conscious and alert with no neurological deficits. Notable findings were pancytopenia with megaloblastic features, B/L pedal edema, and hepatosplenomegaly. NCCT brain revealed mild subarachnoid hemorrhage (SAH) along the bilateral parietooccipital region for which conservative management was planned. 2D echocardiography was normal. Ultrasonography of the abdomen showed gross splenomegaly and mild hepatomegaly with mesenteric lymphadenopathy. NCCT thorax and abdomen were unremarkable apart from hepatosplenomegaly. In pancytopenia workup, IgM anti-HSV-1 antibodies turned out to be positive in blood. In addition, tropical workup was suggestive of Leptospirosis (IgM antibodies positive). Serological evidence was suggestive of acute HSV-1 infection (based on antibody titers). Bone marrow workup had features of trilineage hematopoiesis with micronormoblastic maturation consistent with iron deficiency anemia without any evidence of hemophagocytosis. IV acyclovir, IV doxycycline, and iron replacement were added, after which she improved clinically and was discharged in stable condition. Tables 1 and 2 show a detailed description of these cases. Discussion: Herpesviridae family is the most important group of viruses responsible for persistent vi al infections in humans, of which CMV contributes to 60-90% of infections in adults, especially in developing countries.2 In healthy individuals, these viruses are kept dormant by the body's immune mechanisms but in an immunocompromised population, reactivation from the latent state can occur. SARS-CoV-2 infection predisposes patients to concomitant viral co-infections, owing to T-cell lymphopenia, decreased NK cell number, and use of immunosuppressive medications.3,4 The first case of CMV co-infection was first reported by D'Ardes and co-workers in 2020.5 Since then, many studies have been emerging in this area. In an observational study from France, 38 COVID-19 patients on >7 days of MV were studied for HSV and CMV pulmonary co-infections (by quantitative real-time PCR in tracheal samples) out of which 47% of patients had one of these infections (24% HSV, 5% CMV, 18% both).6 Another study looking for HSV-1 in patients on invasive MV found HSV-1 reactivation between days 11 and 40, which correlated with immunological markers of decreased innate immunity.7 A case series looking for CMV infection (by PCR in plasma or BAL) in COVID-19, also found CMV reactivation between day 7 and 45 of illness. Most of these patients were above 60 years of age and immunosuppressed (HIV, diabetes mellitus, medications).8 Although immunocompromised individuals are more vulnerable, healthy immunocompetent adults who are critically ill or on prolonged MV may also be susceptible to these infections.9-12 This may be explained by a state of immunoparalysis inherent to prolonged critical illness. In case 1, an ICU stay of around 9 weeks complicated with recurrent nosocomial infections, multiple blood product transfusions, and steroid usage could have the likely triggers. Whether viral co-infections are merely bystanders or truly pathogenic is difficult to comment but timely management is essential to avoid end-organ damage (EOD) which may occur directly (by enhanced viral load secondary to compromised host immunity) or indirectly (by inflammatory changes consequent to prolonged cell-mediated immunity required to maintain viral dormancy).2-4,13 It also seems imperative to study if a viral co-infection has a proclivity to develop more severe hematological anomalies (besides the inherent risk of HLH with COVID) as was seen in case 1, in which the patient had a downward spiral of illness with multiorgan dysfunction.14-15 Limitations: Dynamics of PCR trends and virology studies of samples from trachea, gut, and urine could not be analysed in our patients. Conclusion: Viral co-infections can occur in COVID-19 disease as these patients are often immunocompromised and critically ill. A high index of suspicion and prompt management is needed to improve the outcome of patients. Patients with organ dysfunctions especially hematologic abnormalities with bone marrow involvement should be worked up in detail to look for concomitant viral co-infections. In the future, large-scale research is needed to better elucidate the relationship between SARS-CoV-2 and other viral co-infections.
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Despite the drastic change to school environments due to the COVID-19 pandemic, it is still important that educational technology researchers conduct school-based research to understand the impact of technology in an authentic learning context, even remotely. However, the transition to remote research has made it challenging for researchers to collect classroom data, observe teacher-student-technology interactions, and facilitate study sessions. To explore how researchers can effectively plan and conduct technology-based educational studies in the new, evolving classroom research environment, we interviewed seven US teachers, investigating their perceptions of participating in remote classroom studies. Based on the findings and the authors’ experience of running classroom studies, we propose a framework that educational technology researchers can refer to when planning and conducting research in the evolving classroom research environment. Specifically, the framework informs researchers of several types of questions they can explore with teachers, students, and researchers themselves to be better prepared to address potential confusion, unexpected issues, and practical benefits in remote classroom research. Our work contributes by providing a practical guide for running technology-based research remotely, which may remain as a means of classroom research in the future. Some of the findings and the framework would also be applied to in-person classroom research setting. © 2021, Springer Nature Switzerland AG.
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We report a familial cluster of 24 individuals infected with SARS-CoV-2. The index case had a travel history &spent twenty four days in the house before being tested and was asymptomatic. Physical overcrowding in the house provided a favourable environment for intra-cluster infection transmission. Restriction of movement of family members due to countrywide lockdown limited the spread in community. Among the infected, only 4 individuals developed symptoms. The complete genome sequences of SARS-CoV-2 was retrieved using next-generation sequencing from eight clinical samples which demonstrated a 99.99% similarity with reference to Wuhan strain and the phylogenetic analysis demonstrated a distinct cluster, lying in the B.6.6 pangolin lineage.
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The current SARS coronavirus-2 (SARS-CoV-2) pandemic has raised serious concerns regarding the inefficiency of available diagnostic methods for rapid and efficient detection of the disease. It is agreed widely that Real-time Polymerase Chain Reaction (RT-PCR) and antibody-based assays have several limitations that did not help much in preventing the exponential spread of the disease in a short span of period. Unarguably, the world needs “new-generation diagnostic intervention(s)” against rapidly spreading disease like SARS-CoV-2. We have presented an aptamer-based strategy as a possible point of care testing for the diagnosis of the disease. It has several advantages over current tools available and can be used for efficient combating by the mean of quick,cost-effective and much more accurate diagnostic against the enigmatic SARS-CoV-2 disease and similar pandemic which world may possibly encounter in the future.
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Introduction: Surgical practice has undergone extensive changes during the COVID-19 crisis, mostly because of the close contact nature of surgical procedures putting surgeons at higher risk. In the past 3 months, almost 3 million surgeries have been canceled worldwide. Hospitals are being reconfigured in expectation of surges in COVID-19 cases to provide more space for trauma and critically ill patients. All the non-urgent health services were delayed. However, with few changes, trauma and emergency services continue to work according to the existing protocols. Trauma treatment during the pandemic is focused on clinical urgency, patient protection as well as healthcare workers, and resource conservation. In this study, we addressed our understanding of trauma victim triage and treatment during the pandemic, emergency surgery indications, and intensive care. Objectives: To assess the impact of COVID virus infection on critically ill trauma patients. Materials and methods: The study included the patients managed in the Intensive Care Unit of Trauma Centre linked with Medical Institution between April and September 2020. The data regarding the protocols followed, perioperative measures taken and management protocol in intensive care unit in accordance with COVID protocol. The demographic data, clinical data, and final outcome were recorded in the study protocol. The final statistical correlation was done. Results: The standard precautions taken in accordance with COVID protocol have a significant role in the prevention of the spread of the COVID virus. The COVID infection seems to have little impact on the final outcome on patients. Discussions: The COVID pandemic has made the situation very difficult for hospitals across the globe to ensure patients care and management. There has been an issue related to initial management in an emergency department as well as in the ICU setting. Not only the patient management but also there has been a risk of spread of infection to healthcare workers. Conclusion: It is therefore recommended that there is a need for strict adherence to the precautions needed to prevent the spread of COVID virus infection. The COVID infection may have an impact on the outcome of patients infected with the COVID virus which must be studied in detail.
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A world crisis brings forth new, often unexpected responses that are fascinating to investigate from both scientific and social standpoints. A comprehensive bibliometric investigation of such an event can offer insights into politics of the pandemic, not just providing incentives for improving scientific quality and productivity, but also dissecting the role of global competition and marginalization in terms of funding and peerage. The sheer numbers of publications witnessed in less than 10 months of the novel coronavirus outbreak, indicates how scientists from all walks of life, irrespective of their respective fields of interests, shifted to COVID19 research, leading to discoveries and new directions of research for many. However, this shift has also resulted in shocking factoids based on incomplete interpretations of scientific data, which have continued to be foisted on the public at an alarming rate during the past nine months of COVID, the most colossal of these being the Lancet HCQ story. In this work, we use the 2020 COVID-19 publications to identify bibliometric communities that we compare temporally across two major epidemics of SARS and MERS. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Surgical practice during the coronavirus disease 2019 (COVID-19) pandemic has changed significantly, without supporting data. With increasing experience, a dichotomy of practice is emerging, challenging existing consensus guidelines. One such practice is elective tracheostomy. Here, we share our initial experience of head and neck cancer surgery in a COVID-19 tertiary care centre, emphasizing the evolved protocol of perioperative care when compared to pre-COVID-19 times. This was a prospective study of 21 patients with head and neck cancers undergoing surgery during the COVID-19 pandemic, compared to 193 historical controls. Changes in anaesthesia, surgery, and operating room practices were evaluated. A strict protocol was followed. One patient tested positive for COVID-19 preoperatively. There was a significant increase in pre-induction tracheostomies (28.6% vs 6.7%, P=0.005), median hospital stay (10 vs 7 days, P=0.001), and postponements of surgery (57.1% vs 27.5%, P=0.01), along with a significant decrease in flap reconstructions (33.3% vs 59.6%, P=0.03). There was no mortality and no difference in postoperative morbidity. No healthcare personnel became symptomatic for COVID-19 during this period. Tracheostomy is safe during the COVID-19 pandemic and rates have increased. Despite increased rescheduling of surgeries and longer hospital stays, definitive cancer care surgery has not been deferred and maximum patient and healthcare worker safety has been ensured.