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2.
Indian J Crit Care Med ; 25(10): 1137-1146, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1547601

ABSTRACT

In acute respiratory failure due to severe coronavirus disease 2019 (COVID-19) pneumonia, mechanical ventilation remains challenging and may result in high mortality. The use of noninvasive ventilation (NIV) may delay required invasive ventilation, increase adverse outcomes, and have a potential aerosol risk to caregivers. Data of 30 patients were collected from patient files and analyzed. Twenty-one (70%) patients were weaned successfully after helmet-NIV support (NIV success group), and invasive mechanical ventilation was required in 9 (30%) patients (NIV failure group) of which 8 (26.7%) patients died. In NIV success vs failure patients, the mean baseline PaO2/FiO2 ratio (PFR) (147.2 ± 57.9 vs 156.8 ± 59.0 mm Hg; p = 0.683) and PFR before initiation of helmet (132.3 ± 46.9 vs 121.6 ± 32.7 mm Hg; p = 0.541) were comparable. The NIV success group demonstrated a progressive improvement in PFR in comparison with the failure group at 2 hours (158.8 ± 56.1 vs 118.7 ± 40.7 mm Hg; p = 0.063) and 24 hours (PFR-24) (204.4 ± 94.3 vs 121.3 ± 32.6; p = 0.016). As predictor variables, PFR-24 and change (delta) in PFR at 24 hours from baseline or helmet initiation (dPFR-24) were significantly associated with NIV success in univariate analysis but similar significance could not be reflected in multivariate analysis perhaps due to a small sample size of the study. The PFR-24 cutoff of 161 mm Hg and dPFR-24 cutoff of -1.44 mm Hg discriminate NIV success and failure groups with the area under curve (confidence interval) of 0.78 (0.62-0.95); p = 0.015 and 0.74 (0.55-0.93); p = 0.039, respectively. Helmet interface NIV may be a safe and effective tool for the management of patients with severe COVID-19 pneumonia with acute respiratory failure. More studies are needed to further evaluate the role of helmet NIV especially in patients with initial PFR <150 mm Hg to define PFR/dPFR cutoff at the earliest time point for prediction of helmet-NIV success. How to cite this article Jha OK, Kumar S, Mehra S, Sircar M, Gupta R. Helmet NIV in Acute Hypoxemic Respiratory Failure due to COVID-19: Change in PaO2/FiO2 Ratio a Predictor of Success. Indian J Crit Care Med 2021;25(10):1137-1146.

4.
Mult Scler Relat Disord ; 55: 103217, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1356370

ABSTRACT

BACKGROUND: Risk factors associated with coronavirus disease 2019 (COVID-19) severity in patients with multiple sclerosis (MS) have been described. Recent improvements in supportive care measures and increased testing capacity may modify the risk of severe COVID-19 outcome in MS patients. This retrospective study evaluates the severity and outcome of COVID-19 in MS and characterizes temporal trends over the course of the pandemic in the United States. METHODS: We conducted a comparative cohort study using de-identified electronic health record (EHR) claims-based data. MS patients diagnosed with COVID-19 between February 2, 2020 and October 13, 2020 were matched (1:2) to a control group using propensity score analysis. The primary outcome was a composite of intensive care unit (ICU) admission, mechanical ventilation, and/or death. RESULTS: A total of 2,529 patients (843 MS and 1,686 matched controls) were included. Non-ambulatory and pre-existing comorbidities were independent risk factors for COVID-19 severity. The risk for the severe composite outcome was lower in the late cohorts compared with the early cohorts. CONCLUSIONS: The majority of MS patients actively treated with a disease-modifying therapy (DMT) had mild disease. The observed trend toward a reduction in severity risk in recent months suggests an improvement in COVID-19 outcome.


Subject(s)
COVID-19 , Multiple Sclerosis , Cohort Studies , Humans , Multiple Sclerosis/epidemiology , Multiple Sclerosis/therapy , Registries , Retrospective Studies , SARS-CoV-2 , United States/epidemiology
5.
Frontline Gastroenterol ; 12(5): 444, 2021.
Article in English | MEDLINE | ID: covidwho-1346076
6.
Multimed Syst ; : 1-34, 2021 Jul 13.
Article in English | MEDLINE | ID: covidwho-1309042

ABSTRACT

The COVID-19 pandemic is rapidly spreading across the globe and infected millions of people that take hundreds of thousands of lives. Over the years, the role of Artificial intelligence (AI) has been on the rise as its algorithms are getting more and more accurate and it is thought that its role in strengthening the existing healthcare system will be the most profound. Moreover, the pandemic brought an opportunity to showcase AI and healthcare integration potentials as the current infrastructure worldwide is overwhelmed and crumbling. Due to AI's flexibility and adaptability, it can be used as a tool to tackle COVID-19. Motivated by these facts, in this paper, we surveyed how the AI techniques can handle the COVID-19 pandemic situation and present the merits and demerits of these techniques. This paper presents a comprehensive end-to-end review of all the AI-techniques that can be used to tackle all areas of the pandemic. Further, we systematically discuss the issues of the COVID-19, and based on the literature review, we suggest their potential countermeasures using AI techniques. In the end, we analyze various open research issues and challenges associated with integrating the AI techniques in the COVID-19.

7.
Computer Standards & Interfaces ; : 103521, 2021.
Article in English | ScienceDirect | ID: covidwho-1064988

ABSTRACT

Increasing demand for automation and instant solution leads the technological world towards massive applications such as the Internet of drones, Autonomous Vehicles (AVs), border surveillance, telesurgery, Augmented Reality (AR), which requires a vast upgrade in technology with improved processing and computation power. Centralized Cloud Server (CSS) provides the facility to compute critical tasks at the central data server, but it consumes more time in case of the remote distance between CSS and edge device. In this article, we have discussed the advantages of edge computing over cloud computing to overcome latency and reliability issues in critical applications. Moreover, the idea of processing and analyzing massive applications at the edge comes up with the requirement of building intelligence at the edge to compute complex tasks within a negligible time. Edge intelligence provides intelligence at the edge to process large datasets for critical computations and to overcome storage issues. Also, the performance tolerant connectivity and low-speed rate issues with 4G and 5G can be solved using a 6G wireless network. 6G connected edge intelligence application offers ultra-low-latency, security, and reliability mechanisms that could be helpful in COVID-19 pandemic situations. We have also discussed a demonstration of the aforementioned massive application in the form of a case study on combating COVID-19 situations using 6G-based edge intelligence. The case study depicts the benefits of using 6G (latency: 10−100μs) over 4G (latency: <10ms) and 5G (latency: <5ms) communication networks. The proposed 6G-enabled scheme is compared against the traditional 4G and 5G networks to designate its efficiency in terms of communication latency and network mobility. Eventually, we then analyzed various open issues and research challenges in this emerging research area for future gains and insights.

8.
Am J Transplant ; 21(6): 2279-2284, 2021 06.
Article in English | MEDLINE | ID: covidwho-1052266

ABSTRACT

COVID-19 (coronavirus disease 2019) has impacted solid organ transplantation (SOT) in many ways. Transplant centers have initiated SOT despite the COVID-19 pandemic. Although it is suggested to wait for 4 weeks after COVID-19 infection, there are no data to support or refute the timing of liver transplant after COVID-19 infection. Here we describe the course and outcomes of COVID-19-infected candidates and healthy living liver donors who underwent transplantation. A total of 38 candidates and 33 potential living donors were evaluated from May 20, 2020 until October 30, 2020. Ten candidates and five donors were reverse transcriptase-polymerase chain reaction (RT-PCR) positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pretransplant. Four candidates succumbed preoperatively. Given the worsening of liver disease, four candidates underwent liver transplant after 2 weeks due to the worsening of liver disease and the other two candidates after 4 weeks. Only one recipient died due to sepsis posttransplant. Three donors underwent successful liver donation surgery after 4 weeks of COVID-19 infection without any postoperative complications, and the other two were delisted (as the candidates expired). This report is the first to demonstrate the feasibility of elective liver transplant early after COVID-19 infection.


Subject(s)
COVID-19 , Liver Transplantation , Organ Transplantation , Humans , Pandemics , SARS-CoV-2 , Transplant Recipients
9.
Endosc Ultrasound ; 10(1): 77-78, 2021.
Article in English | MEDLINE | ID: covidwho-1011663
10.
J Biomol Struct Dyn ; : 1-19, 2020 Dec 09.
Article in English | MEDLINE | ID: covidwho-967865

ABSTRACT

A recent surge in finding new candidate vaccines and potential antivirals to tackle atypical pneumonia triggered by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) needs new and unexplored approaches in solving this global pandemic. The homotrimeric transmembrane spike (S) glycoprotein of coronaviruses which facilitates virus entry into the host cells is covered with N-linked glycans having oligomannose and complex sugars. These glycans provide a unique opportunity for their targeting via carbohydrate-binding agents (CBAs) which have shown their antiviral potential against coronaviruses and enveloped viruses. However, CBA-ligand interaction is not fully explored in developing novel carbohydrate-binding-based antivirals due to associated unfavorable responses with CBAs. CBAs possess unique carbohydrate-binding specificity, therefore, CBAs like mannose-specific plant lectins/lectin-like mimic Pradimicin-A (PRM-A) can be used for targeting N-linked glycans of S glycoproteins. Here, we report studies on the binding and stability of lectins (NPA, UDA, GRFT, CV-N and wild-type and mutant BanLec) and PRM-A with the S glycoprotein glycans via docking and MD simulation. MM/GBSA calculations were also performed for docked complexes. Interestingly, stable BanLec mutant (H84T) also showed similar docking affinity and interactions as compared to wild-type BanLec, thus, confirming that uncoupling the mitogenic activity did not alter the lectin binding activity of BanLec. The stability of the docked complexes, i.e. PRM-A and lectins with SARS-CoV-2 S glycoprotein showed favorable intermolecular hydrogen-bond formation during the 100 ns MD simulation. Taking these together, our predicted in silico results will be helpful in the design and development of novel CBA-based antivirals for the SARS-CoV-2 neutralization.Communicated by Ramaswamy H. Sarma.

11.
Science ; 370(6519): 913-914, 2020 Nov 20.
Article in English | MEDLINE | ID: covidwho-936866
12.
J Antimicrob Chemother ; 76(2): 283-285, 2021 01 19.
Article in English | MEDLINE | ID: covidwho-889571

ABSTRACT

Severe COVID-19 is a biphasic illness, with an initial viral replication phase, followed by a cascade of inflammatory events. Progression to severe disease is predominantly a function of the inflammatory cascade, rather than viral replication per se. This understanding can be effectively translated to changing our approach in managing the disease. The natural course of disease offers us separate windows of specific time intervals to administer either antiviral or immunomodulatory therapy. Instituting the right attack at the right time would maximize the benefit of treatment. This concept must also be factored into studies that assess the efficacy of antivirals and immunomodulatory agents against COVID-19.


Subject(s)
Antiviral Agents/administration & dosage , COVID-19/drug therapy , Immunomodulation/drug effects , Immunosuppressive Agents/administration & dosage , Time-to-Treatment , Antiviral Agents/therapeutic use , COVID-19/immunology , COVID-19/virology , Cytokines/blood , Disease Progression , Humans , Immunomodulation/immunology , Immunosuppressive Agents/therapeutic use , SARS-CoV-2/drug effects , Virus Replication/drug effects
13.
Curr Protein Pept Sci ; 21(11): 1085-1096, 2020.
Article in English | MEDLINE | ID: covidwho-781783

ABSTRACT

With the emergence of the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the whole world is suffering from atypical pneumonia, which resulted in more than 559,047 deaths worldwide. In this time of crisis and urgency, the only hope comes from new candidate vaccines and potential antivirals. However, formulating new vaccines and synthesizing new antivirals are a laborious task. Therefore, considering the high infection rate and mortality due to COVID-19, utilization of previous information, and repurposing of existing drugs against valid viral targets have emerged as a novel drug discovery approach in this challenging time. The transmembrane spike (S) glycoprotein of coronaviruses (CoVs), which facilitates the virus's entry into the host cells, exists in a homotrimeric form and is covered with N-linked glycans. S glycoprotein is known as the main target of antibodies having neutralizing potency and is also considered as an attractive target for therapeutic or vaccine development. Similarly, targeting of N-linked glycans of S glycoprotein envelope of CoV via carbohydrate-binding agents (CBAs) could serve as an attractive therapeutic approach for developing novel antivirals. CBAs from natural sources like lectins from plants, marine algae and prokaryotes and lectin mimics like Pradimicin-A (PRM-A) have shown antiviral activities against CoV and other enveloped viruses. However, the potential use of CBAs specifically lectins was limited due to unfavorable responses like immunogenicity, mitogenicity, hemagglutination, inflammatory activity, cellular toxicity, etc. Here, we reviewed the current scenario of CBAs as antivirals against CoVs, presented strategies to improve the efficacy of CBAs against CoVs; and studied the molecular interactions between CBAs (lectins and PRM-A) with Man9 by molecular docking for potential repurposing against CoVs in general, and SARSCoV- 2, in particular.


Subject(s)
Antiviral Agents/metabolism , Antiviral Agents/pharmacology , COVID-19/drug therapy , Carbohydrate Metabolism , Drug Repositioning , Antiviral Agents/chemistry , Antiviral Agents/therapeutic use , COVID-19/metabolism , Humans
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