Increased basal levels of 17- Hydroxyprogesterone in the COVID era: Must we change the cut-off point to request acth test?

Background: 17-hydroxyprogesterone (17-OHP) basal levels greater than 2ng/ml has been related to the need to request an ACTH test to dismiss non-classic congenital adrenal hyperplasia. We have seen an increase in baseline levels in 2021 compared to 2020. Objective(s): To determine how many of the tests that were requested due to a high basal 17-OHP value, were positive. Assess the need to modify the cut-off points to request an ACTH test. To determine the possible relationship of the increase in basal levels of 17-OHP with the BMI SDS. Material(s) and Method(s): retrospective descriptive study of all patients who underwent an ACTH test between January 1, 2020 and December 31, 2021, in a region of northern Spain. We analyze: sex, age, Tanner stage, BMI SDS, baseline 17-OHP and ACTH test results and main reason for requesting. The test was considered: diagnostic with a peak of 17-OHP at 60 minutes higher than 15 ng/ ml, and suggestive if 10-15ng/ml. Laboratory method for the determination of 17-OHP: chemiluminescence immunoassay in Maglumi 2000 Analyzer (Snibe-Diagnostic). The trial meets the quality criteria certified by EQAS QCNet (BioRad-Laboratories, Inc, UK). Result(s): 149 ACTH tests were performed, 45 in 2020 and 104 in 2021. 116 women (77.9%). Mean age: 10.1 years (range 2.2-15.9 years). 114 had already started puberty. 21 BMI>2SDS. Main reason for requesting the ACTH test: elevated baseline 17-OHP 38%(20% in 2020, 45% in 2021), accelerated bone age (>2 years)48%, pubarche 9%. Mean baseline 17-OHP was 2.93ng/ ml(+/-3.6ng/ml), median 1.26ng/ml(range 0.1-26ng/ml) in 2020 and 2.67ng/ml(range 0.56-16.2ng/ml) in 2021, difference not statistically significant (p 0.67), but clinically relevant. ACTH test results: mean peak at 60 minutes was 4.98ng/ml(range 0.1-64). The determination of baseline 17-OHP was above 2ng/ml in 61 patients, and above 4ng/ml in 24. But only in 7 cases the test was positive (diagnostic or suggestive), all them with basal 17OHP>4ng/ml. This cut-off point shows a higher specificity with the same sensitivity. Comparing 2020 with 2021, we found no difference in BMI SDS (p 0.27). Relationship between BMI SDS and basal 17OHP was not confirmed (p 0.81). Conclusion(s): Our study confirms a significant increase in the number of ACTH tests performed, as well as in the basal level of 17-OHP in the last year. A baseline value of 17-OHP greater than 4ng/dl seems to be the most appropriate as the main indicator of the need to perform the test.

Covid-19 Vaccination and Case Fatality Rate in India

India has experienced two severe waves of infection with COVID-19. Since there isn't any effective drug, emerging variants of the virus, an unknown epidemiological life cycle, lockdown and restrictions at public places slowed the spread of novel corona virus in the country. However, a large number of new COVID-19 cases and deaths have been reported from across the country. We carried out a study to evaluate the effectiveness of vaccination in India, randomly selected five states and a union territory to control the severity of COVID-19 (case fatality rate). During the study period, March 21st 2020 to 6th August 2021, with the initiation of vaccination, the case fatality rate was reduced to less than 1.0% in the selected states and union territory. Thus, vaccination for COVID-19 infection is found to be effective in decreasing the severity of the disease. The eligible population should get themselves inoculated at the nearest health facilities. © The Electrochemical Society

Prevalence and prospective evaluation of cognitive dysfunctions after SARS due to SARS-CoV-2 virus. The COgnitiVID study.

OBJECTIVE: COVID-19 due to SARS-CoV-2 virus is a new cause of severe acute respiratory syndrome (SARS). Little is known about the short-term cognitive prognosis for these patients. We prospectively evaluated basic cognitive functions shortly after care in the intensive care unit (ICU) and three months later in post-ICU COVID-19 patients. MATERIAL AND METHODS: We performed a prospective single-center study in our institution in Paris. Patients with SARS-CoV-2 SARS were prospectively recruited via our ICU. Patients were evaluated using standardized cognitive tests at baseline and at three months' follow-up. Our primary endpoint was the evolution of the following five global tests: MMSE, FAB, oral naming test, Dubois five words test and MADRS. RESULTS: We explored 13 patients at baseline and follow-up. All patients had cognitive impairment at baseline but they all improved at three months, significantly on two of the five global tests after Bonferroni correction for multiple testing: MMSE (median 18 (IQR [15-22]) and 27 (IQR [27-29]) respectively, P=0.002) and FAB test (median 14 (IQR [14-17]) and 17 (IQR [17,18]) respectively, P=0.002). CONCLUSIONS: We report here the first longitudinal data on short-term cognitive impairment after intensive care in COVID-19 patients. We found acute and short-term cognitive impairment but significant improvement at three months. This pattern does not seem to differ from other causes of post-intensive care syndrome.

The Transmission Dynamic of the COVID 19 Outbreak: A Predictive Dashboard

COVID 19 outbreak gives a great impact worldwide. The disaster of this pandemic has resulted in a large number of human lives being lost. As all countries implemented quarantine and social distancing, the great lockdown all over the world lead to multiple crises including health, economy, financial, and collapse in industrial and educational activities. Movement Control Order (MCO) and social distancing which have been implemented as control measures in Malaysia also affected many sectors. The landscape now has successfully reduced the number of infected people. However, from the economic point of view, the Retail Group Malaysia (RGM) has projected the country’s retail industry suffers a negative growth rate for the first time in 22 years. If the epidemic continues, society will reach an impasse, a time when the lockdown will become more than some of them can tolerate. As recognized by the World Health Organization (WHO), modelling the outbreak based on the prior input data is more appropriate than the ‘risk of bias’ for decision-makers. Thus, this research is conducted to model the outbreak of the disease using the susceptible-infected-recovery-death (SIRD) compartmental model accompanying with the varying infection rate due to changes in MCO measures. The model assumes under the unavailability of the vaccine, recovered people can be reinfected. The epidemic parameters and reproduction numbers are estimated and fitted from the transmission model to the actual data using the Monte Carlo Markov Chain (MCMC) of Metropolis-Hasting. The model is solved using a numerical algorithm of the Runge-Kutta method. The predictive dashboard of a graphical user interface (GUI) is developed, hence monitoring and predicting the outbreak under the control measures of the two different types of MCO scenarios (which are called constant and alternate scenarios) can be performed. GUI for the dynamic transmission of the COVID 19 provides insight for the future outbreak, hence may help the respective stakeholders to propose the best policy of a new norm for all sectors. From the GUI, we can see that, when no or loose MCO is implemented or compliance of the public to the COVID 19 standard operating procedure (SOP), the infected case will increase rapidly up to 7.5 million. With strict MCO regulation or public obedient to the SOP, the infected case will decrease rapidly, but even after a long period of strict regulation, once the quarantine is stopped, the infected case will rise again. An alternative MCO scenario is suggested where a cyclic pattern of strict and loose MCO regulation is upheld, and it shows to flatten the curve while allow periods of less restricted lifestyle. This can be one of the alternatives to balance the life and livelihood. © 2021 Penerbit Universiti Kebangsaan Malaysia. All rights reserved.

Hand sanitizer: A comprehensive narrative review

Hand Hygiene is considered as one of the basic and effective way to prevent spread of various contagious diseases including Covid-19. Among the hand sanitizers, alcohol based hand sanitizers are commonly used as they are found to possess good antimicrobial activity against different pathogens. The present review provides a comprehensive overview of the literature regarding hand sanitizers and their ability to prevent various infections. Hand hygiene is one of the basic and very necessary tool to combat various infections including covid-19. However, selection of right type of hand sanitisation is a very important criterion to be considered. An extensive awareness program is required to educate common people related to the appropriate use and serious health hazards of hand sanitizer. During the pandemic lockdown, the decreased availability of alcoholic beverages made a major impact on many lives. People tend to consume alcohol based hand sanitizers in various regions, which are serious concern. Consumption of alcohol based hand sanitizers can lead to serious health hazards and even poisoning. The governing bodies need to update guidelines regarding restriction on number of times to be used on the daily basis and plays an important role in the global pandemic of Covid-19 infection.

Investigation of coronavirus deposition in realistic human nasal cavity and impact of social distancing to contain COVID-19: A computational fluid dynamic approach

The novel coronavirus responsible for COVID-19 has spread to several countries within a considerably short period. The virus gets deposited in the human nasal cavity and moves to the lungs that might be fatal. As per safety guidelines by the World Health Organization (WHO), social distancing has emerged as one of the major factors to avoid the spread of infection. However, different guidelines are being followed across the countries with regards to what should be the safe distance. Thus, the current work is an attempt to understand the virus deposition pattern in the realistic human nasal cavity and also to find the impact of distance that could be termed as a safety measure. This study is performed using Computational Fluid Dynamics as a solution tool to investigate the impact of COVID-19 deposition (i) On a realistic 3D human upper airway model and (ii) 2D social distancing protocol for a distance of 0.6, 1.2, 1.8, and 2.4 m. The results revealed that the regional deposition flux within the nasal cavity was predominantly observed in the external nasal cavity and nasopharyngeal section. Frequent flushing of these regions with saltwater substitutes can limit contamination in healthy individuals. The safe distancing limit estimated with 1 m/s airflow was about 1.8 m. The extensive deposition was observed for distances less than 1.8 m in this study, emphasizing the fact that social distancing advisories are not useful and do not take into account the external dynamics associated with airflow. © 2020 Tech Science Press. All rights reserved.