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1.
Microbiol Spectr ; : e0167022, 2022.
Article in English | Web of Science | ID: covidwho-2019793
2.
Indian Journal of Critical Care Medicine ; 26:S108, 2022.
Article in English | EMBASE | ID: covidwho-2006399

ABSTRACT

Aim and background: Due to the resurgence of COVID cases many doctors, medical students, and nurses from varied backgrounds, many a time novice to COVID management are deployed in turn from time to time at different COVID care centers and hospitals across India, before they are properly trained and skilled for effective management of COVID and post COVID syndromes, as the disease is relatively new, leading to non-uniform management and documentation. COVID being a contagious disease with newer symptomatology and ongoing research outputs suggesting new guidelines from time to time, which sometimes are conflicting in nature for novice healthcare workers. For uniform and appropriate management to reduce morbidity and mortality, it mandates a unique and effective solution towards guided and error-free disease management, authentic high volume data capture for future research and to trace patient to post COVID condition in the community outside the hospital, virtual patient counselling cum relative visit, generation of the daily patient bulletin, simultaneous teleround of multiple units, and sharing patient's data across multiple specialities and investigation areas. Objective: To have all these above-mentioned facilities over one platform, we aim to test run a cloud-based dynamic mobile application based dedicated device, the C O V I D Device (Covid Operation Vital Information Delivery device) across many hospitals in India simultaneously for COVID and post COVID syndrome management and data retrieval for research. Materials and methods: Two institutes, namely IMS and SUM Hospital and ITER have collaborated to design a cloud-based device having recent COVID guidelines on the management of adult COVID patients. The software has been incorporated into a dedicated handheld device (tablet or android mobile phone), the COVID Device in a dynamic way (when new symptomatology surfaces and new research outcomes on management are published). The important modules pertaining to this COVID Device are Web-based application for Registration Desk and Device-based application for Doctor's Module/Care-givers Module and Patient's/Patient's relative's module. Results: In a pilot, we have successfully test run the COVID device on virtual patients and 2 actual patients in a secondary level COVID ICU and HDU to examine the different functionality of the cloud-based application, namely error-free and guided patient management without missing any point, daily patient relative's counselling and virtual patient visiting by relatives, generating daily patient bulletin, simultaneous tele round of multiple units, and sharing patient's data across multiple specialities and investigation areas and tracing patient to the community after discharge to enquire about post COVID condition and retrieval of data across all module and incorporation of new guideline in a dynamic way and checking the facilities for incorporating other modules namely pediatric module. Conclusion: COVID Device (Adult module) is a very effective tool for COVID and post COVID condition management and research. It has the potential to incorporate other modules namely obstetric, pediatric, and neonatal modules. If used across all hospital of India, it will be a real boost to digital health mission and centralized COVID data management and research in India.

4.
Embase; 2021.
Preprint in English | EMBASE | ID: ppcovidwho-337391

ABSTRACT

The precise molecular mechanisms behind life-threatening lung abnormalities during severe SARS-CoV-2 infections are still unclear. To address this challenge, we performed whole transcriptome sequencing of lung autopsies from 31 patients suffering from severe COVID-19 related complications and 10 uninfected controls. Using a metatranscriptome analysis of lung tissue samples we identified the existence of two distinct molecular signatures of lethal COVID-19. The dominant “classical” signature (n=23) showed upregulation of unfolded protein response, steroid biosynthesis and complement activation supported by massive metabolic reprogramming leading to characteristic lung damage. The rarer signature (n=8) potentially representing “Cytokine Release Syndrome” (CRS) showed upregulation of cytokines such IL1 and CCL19 but absence of complement activation and muted inflammation. Further, dissecting expression of individual genes within enriched pathways for patient signature suggests heterogeneity in host response to the primary infection. We found that the majority of patients cleared the SARS-CoV-2 infection, but all suffered from acute dysbiosis with characteristic enrichment of opportunistic pathogens such as Staphylococcus cohnii in “classical” patients and Pasteurella multocida in CRS patients. Our results suggest two distinct models of lung pathology in severe COVID-19 patients that can be identified through the status of the complement activation, presence of specific cytokines and characteristic microbiome. This information can be used to design personalized therapy to treat COVID-19 related complications corresponding to patient signature such as using the identified drug molecules or mitigating specific secondary infections.

5.
Rev Neurol (Paris) ; 2022 May 13.
Article in English | MEDLINE | ID: covidwho-1851876

ABSTRACT

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.

6.
Pediatric Blood & Cancer ; 69:2, 2022.
Article in English | Web of Science | ID: covidwho-1849272
7.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-333583

ABSTRACT

While SARS-CoV-2 infection has pleiotropic and systemic effects in some patients, many others experience milder symptoms. We sought a holistic understanding of the severe/mild distinction in COVID-19 pathology, and its origins. We performed a whole-blood preserving single-cell analysis protocol to integrate contributions from all major cell types including neutrophils, monocytes, platelets, lymphocytes and the contents of serum. Patients with mild COVID-19 disease display a coordinated pattern of interferon-stimulated gene (ISG) expression across every cell population and these cells are systemically absent in patients with severe disease. Severe COVID-19 patients also paradoxically produce very high anti-SARS-CoV-2 antibody titers and have lower viral load as compared to mild disease. Examination of the serum from severe patients demonstrates that they uniquely produce antibodies with multiple patterns of specificity against interferon-stimulated cells and that those antibodies functionally block the production of the mild disease-associated ISG-expressing cells. Overzealous and auto-directed antibody responses pit the immune system against itself in many COVID-19 patients and this defines targets for immunotherapies to allow immune systems to provide viral defense. ONE SENTENCE SUMMARY: In severe COVID-19 patients, the immune system fails to generate cells that define mild disease;antibodies in their serum actively prevents the successful production of those cells.

8.
Blood ; 138(SUPPL 1):586, 2021.
Article in English | EMBASE | ID: covidwho-1770414

ABSTRACT

Introduction: Cases of de novo immune thrombocytopenia (ITP), including a fatality following SARS-CoV-2 vaccination in a previously healthy recipient, led to studying its impact in pre-existing ITP. Published reports are limited but suggest that most patients with ITP tolerate the COVID-19 vaccines well without frequent ITP exacerbations (Kuter, BJH, 2021). Data regarding risk factors for exacerbation and relationship of response to first dose to that of second dose are limited. Methods: Data for patients with pre-existing ITP were obtained via 3 sources. First, via a ten-center retrospective study of adults with ITP who received a SARS-CoV-2 vaccine between December 2020 and March 2021 and had a post-vaccination platelet count (n=117);9 centers were in the United States. Eighty-nine percent of patients received mRNA-based vaccines. The second and third sources of data were surveys distributed by the Platelet Disorder Support Association (PDSA) and the United Kingdom ITP Support Association. A 'stable platelet count' was defined as a post-vaccination platelet count within 20% of the pre-vaccination level. ITP exacerbation was defined as any one or more of: platelet decrease ≥ 50% compared to pre-vaccination baseline, platelet decrease by >20% compared to prevaccination baseline with platelet nadir < 30x10 9/L, receipt of rescue therapy for ITP. Continuous variables were described as mean ±SD or median [interquartile range];categorical variables were described as n (%). Relative risks and 95% confidence interval were calculated to estimate strength of association. Results: Among 117 patients with pre-existing ITP from 10 centers who received a SARS-CoV-2 vaccine, mean age was 63±17 years, 62% were female, with median 12 [4-23] years since diagnosis of ITP;patients had received a median of 3 [2-4] prior medical treatments. Sixtynine patients were on ITP treatment at the time of vaccination (Table 1). There was an almost even distribution of platelet count response following each vaccine dose. In 109 patients with data for dose 1, platelet counts increased in 32 (29%), were stable in 43 (39%), and decreased in 34 (31%);in 70 patients following dose 2, platelet counts increased in 24 (34%), were stable in 25 (36%), and decreased in 21 (30%) (Figure 1). Nineteen (17%) patients experienced an ITP exacerbation following the first dose and 14 (20%) of 70 after a second dose. In total, fifteen patients received and responded to rescue treatments (n = 6 after dose 1, n = 8 after dose 2, n = 1 after both doses). Of 7 patients who received rescue treatment after dose 1, 5 received dose 2 and only 1/5 received rescue treatment again. Rescue consisted of increased dose of ongoing medication, steroids, IVIG, and rituximab. Splenectomized persons and those who received 5 or more prior lines of medical therapy were at highest risk of ITP exacerbation. Only 1 of 47 patients who had neither undergone splenectomy nor received 5 or more lines of therapy developed ITP exacerbation after dose 1. There were 14 patients offtreatment at the time of dose 1 and 7 patients at time of dose 2;1 patient in each group developed ITP exacerbation with both these having had normal counts prior to vaccination and having undergone splenectomy. In 43 patients whose platelet counts were stable or increased after dose 1 and received dose 2, only 6 (14%) had platelet decreases to <50 x10 9/L after dose 2. Age, gender, vaccine type, and concurrent autoimmune disease did not impact post-vaccine platelet counts. In surveys of 57 PDSA and 43 U.K. ITP patients, similar rates of platelet change were seen (33% of participants reported decreased platelet count in both surveys) and prior splenectomy was significantly associated with worsened thrombocytopenia in each. Conclusions: Thrombocytopenia may worsen in pre-existing ITP post-SARS-CoV2-vaccination but when ITP exacerbation occurred, it responded well to rescue treatment. No serious bleeding events were noted. Rescue treatment was needed in 13% of patients. Proactive vaccination surveillance of patien s with known ITP, especially those post-splenectomy and with more refractory disease, is indicated. These findings should encourage patients with ITP to not only be vaccinated, but to receive the second dose when applicable to ensure optimal immunization. Rituximab interferes with vaccination response and ideally would be held until a minimum of 2 weeks after completion of vaccination.

9.
Indian Journal of Clinical Biochemistry ; 36(SUPPL 1):S143, 2021.
Article in English | EMBASE | ID: covidwho-1767679

ABSTRACT

Introduction : Coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It is a respiratory disease, which can develop into multi-organ dysfunction, leading to death. Due to SARS-CoV-2 infection, several biochemical alterations occurs in covid patients and have been associated with the severity of the disease. Objectives: To evaluate the biochemical alterations in covid-19 patients. Methodology: This study was carried out in 80 covid-19 patients who were admitted in covid tertiary care hospital after RT-PCR or RAT positive test for SARS-CoV-2. The moderate disease was defined as presence of dyspnoea with respiratory rate more than 24/min or maintain oxygen saturation between 90 and 94% on room air and the severe disease was defined as presence of dyspnoea with respiratory rate more than 30/min or oxygen saturation less than 90% on room air, presence of ARDS, severe sepsis or sepsis shock. Estimation of urea, creatinine, total bilirubin, total protein, alkaline phosphatase, SGOT, SGPT, CRP, ferritin, CPK, LDH and D-dimer were carried out using automated analyser. p<0.05 was considered as significant level. Results: A significant higher levels of urea, creatinine, total bilirubin, total protein, alkaline phosphatase, SGOT, SGPT, CRP, ferritin, CPK, LDH and D-dimer were found in severe COVID-19 patients as compared to moderate COVID-19 patients. A significant correlation was found between the levels of CRP and other biochemical parameters. Conclusions: Increased alteration of renal, liver, cardiac, inflammatory and coagulation parameters in COVID-19 patients due to SARS-CoV-2 infection indicate its multi-organ involvement and these alterations may helpful to predict the severity and development of disease in patients with COVID-19.

12.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-311980

ABSTRACT

Coronavirus (COVID19) appears to be an inflection point that is forcing a disruption in medical education. However, it is not clear what the responses of the institutions are to this pandemic and how the adaptation of new methods may impact medical education in the post COVID-19 era. Objective: The study aims to explore how medical schools in Egypt responded to COVID-19 pandemic regarding the teaching and learning/assessment for undergraduate students. Design: A mixed method exploratory two-phase study was conducted. A survey was prepared and disseminated to a convenient non-probability sample of the medical school faculty through various social platforms. Then, a focus group guide was conducted to explore in more depth the findings. Results: The staff level of preparedness for that unexpected shift was evaluated by 55.1% of the survey participants as optimum to high and a good leadership support was reported by 70 % of them. They reported conflicting views about the proper role of medical education units but reinforced the idea of Egyptian Knowledge Bank’s crucial role in this transition. Additionally, there is a communication problem with the students that leads to their detachment. Subsequently, 84.6 % of the participants reported that their schools used alternative teaching methods for small groups, large groups, pre-clinical and clinical clerkships. However, 64.1 % of the participants identified a clinical skills teaching challenge. Although, 68.4% reported that alternative methods were used for formative assessment but absence of alternative methods for summative assessment was declared by 76.3%. Conclusions: Individuals moved faster than bodies and relied on support existing outside the universities when catastrophe happened. However, institutes which have experience in adapting modern engaging learning methods should organize a better response for crisis. Online learning should be integrated in the curriculum with a fair percentage especially in the early years of medical study.

13.
Water Res ; 205: 117710, 2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1450241

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) likely emerged from a zoonotic spill-over event and has led to a global pandemic. The public health response has been predominantly informed by surveillance of symptomatic individuals and contact tracing, with quarantine, and other preventive measures have then been applied to mitigate further spread. Non-traditional methods of surveillance such as genomic epidemiology and wastewater-based epidemiology (WBE) have also been leveraged during this pandemic. Genomic epidemiology uses high-throughput sequencing of SARS-CoV-2 genomes to inform local and international transmission events, as well as the diversity of circulating variants. WBE uses wastewater to analyse community spread, as it is known that SARS-CoV-2 is shed through bodily excretions. Since both symptomatic and asymptomatic individuals contribute to wastewater inputs, we hypothesized that the resultant pooled sample of population-wide excreta can provide a more comprehensive picture of SARS-CoV-2 genomic diversity circulating in a community than clinical testing and sequencing alone. In this study, we analysed 91 wastewater samples from 11 states in the USA, where the majority of samples represent Maricopa County, Arizona (USA). With the objective of assessing the viral diversity at a population scale, we undertook a single-nucleotide variant (SNV) analysis on data from 52 samples with >90% SARS-CoV-2 genome coverage of sequence reads, and compared these SNVs with those detected in genomes sequenced from clinical patients. We identified 7973 SNVs, of which 548 were "novel" SNVs that had not yet been identified in the global clinical-derived data as of 17th June 2020 (the day after our last wastewater sampling date). However, between 17th of June 2020 and 20th November 2020, almost half of the novel SNVs have since been detected in clinical-derived data. Using the combination of SNVs present in each sample, we identified the more probable lineages present in that sample and compared them to lineages observed in North America prior to our sampling dates. The wastewater-derived SARS-CoV-2 sequence data indicates there were more lineages circulating across the sampled communities than represented in the clinical-derived data. Principal coordinate analyses identified patterns in population structure based on genetic variation within the sequenced samples, with clear trends associated with increased diversity likely due to a higher number of infected individuals relative to the sampling dates. We demonstrate that genetic correlation analysis combined with SNVs analysis using wastewater sampling can provide a comprehensive snapshot of the SARS-CoV-2 genetic population structure circulating within a community, which might not be observed if relying solely on clinical cases.


Subject(s)
COVID-19 , SARS-CoV-2 , High-Throughput Nucleotide Sequencing , Humans , Pandemics , Waste Water
14.
Pathogens ; 10(10)2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-1444290

ABSTRACT

Throughout the course of the ongoing SARS-CoV-2 pandemic there has been a need for approaches that enable rapid monitoring of public health using an unbiased and minimally invasive means. A major way this has been accomplished is through the regular assessment of wastewater samples by qRT-PCR to detect the prevalence of viral nucleic acid with respect to time and location. Further expansion of SARS-CoV-2 wastewater monitoring efforts to include the detection of variants of interest/concern through next-generation sequencing has enhanced the understanding of the SARS-CoV-2 outbreak. In this report, we detail the results of a collaborative effort between public health and metropolitan wastewater management authorities and the University of Louisville to monitor the SARS-CoV-2 pandemic through the monitoring of aggregate wastewater samples over a period of 28 weeks. Through the use of next-generation sequencing approaches the polymorphism signatures of Variants of Concern/Interest were evaluated to determine the likelihood of their prevalence within the community on the basis of their relative dominance within sequence datasets. Our data indicate that wastewater monitoring of water quality treatment centers and smaller neighborhood-scale catchment areas is a viable means by which the prevalence and genetic variation of SARS-CoV-2 within a metropolitan community of approximately one million individuals may be monitored, as our efforts detected the introduction and emergence of variants of concern in the city of Louisville. Importantly, these efforts confirm that regional emergence and spread of variants of interest/concern may be detected as readily in aggregate wastewater samples as compared to the individual wastewater sheds. Furthermore, the information gained from these efforts enabled targeted public health efforts including increased outreach to at-risk communities and the deployment of mobile or community-focused vaccination campaigns.

16.
Transfers-Interdisciplinary Journal of Mobility Studies ; 10(2-3):103-109, 2020.
Article in English | Web of Science | ID: covidwho-1291543

ABSTRACT

This article reflects on the dissenting act of mobility as articulated by migrant workers in India, who, during the nationwide lockdown amid the COVID-19 pandemic crisis, are walking back home, hundreds of miles away, in lieu of public transport. Their mobility-precisely, the act of walking-has thus acquired a metaphoric status, and laid bare the ideological practices of territorializing the city-space. This article argues that the migrant worker's mobility, from within the axiomatic of the prevalent "mobility regime," can be read as a powerful metaphor of our tensions within the global political-economic order that the pandemic has so starkly exposed. The article provokes less literal, but more literary, understandings of mobilities in general, in order to come to grips with the manifold contradictions, paradoxes, and counteractions in the way the world moves.

17.
Forensic Sci Int Synerg ; 3: 100153, 2021.
Article in English | MEDLINE | ID: covidwho-1265671

ABSTRACT

The year 2020 brought the COVID-19 pandemic, and increased focus on American racial injustice and victims' rights, spurring a reimagining of law enforcement and justice services. As forensic laboratories serve investigation and justice with objective data to drive investigations, prosecutions, and exonerations, it is worthwhile to also reimagine forensic science service. With comparators of cost and quality relatively fixed to the consumers of forensic service, service in the form of timeliness of turn-around-time is the main competitive measure of effectiveness. A total backlog can be defined as all cases submitted to the forensic laboratory where a report has not yet been issued. Within a total backlog are the in-analysis backlog and the awaiting start of analysis backlog. By eliminating the awaiting analysis backlog, analysis could begin immediately upon submission. This would provide analysis in as short a time as technology permitted, optimizing the value of forensic laboratory service.

18.
20.
Lecture Notes on Data Engineering and Communications Technologies ; 64:217-239, 2021.
Article in English | Scopus | ID: covidwho-1224981

ABSTRACT

Coronaviruses are mainly a big family of viruses that are highly capable of causing illness both in animals and humans. The scientific name of the most recently discovered corona virus disease is COVID-19. Most of the countries are performing the manual testing which is beneficial to know the actual situation, feature of the disease, so that appropriate decision can be taken. The main drawbacks of manual testing is that it is very expensive, sparse availability of testing kits, inefficient blood test, and minimum 5–6 h will require to generate the report of blood test. So in these circumstances, deep learning plays a crucial role to detect the positive cases as early as possible so as to prevent the further spread of this epidemic and provide fast and efficient treatment to the effected patients. The developed model consists of three groups: COVID-19, Influenza-A viral pneumonia, and healthy cases. Our proposed detection model got 98.78% accuracy. In this study, we propose a fast and efficient way to identify COVID-19 patients with multi-task deep learning (DL) methods from CT scan images. We have developed two models (a) Inception residual recurrent convolutional neural network with transfer learning (TL) approach for COVID-19 detection and (b) NABLA-N network model for segmenting the regions infected by COVID-19. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021.

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