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1.
Journal of Clinical and Diagnostic Research ; 16(9):DC12-DC17, 2022.
Article in English | EMBASE | ID: covidwho-2067199

ABSTRACT

Introduction: Bharat Biotech International Ltd in partnership with National Institute of Virology (NIV), has developed an indigenous whole virion inactivated Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) viral vaccine BBV-152 (Covaxin), formulated with Toll Like Receptors 7/8 agonist Imidazoquinoline (IMDG) molecule adsorbed to alum (Algel). Variety of factors other than environmental ones can affect vaccines efficiency outside the strict setting of clinical trials, like how the vaccine is stored or transported, and even how patients are vaccinated. In addition, the intrinsic capacity of the recipient to respond to a vaccine which is determined by sex, genetic factors, age, psychological stress, nutrition and other diseases are also likely to have an impact. Aim(s): To determine the safety, reactogenicity and immunogenicity of the inactivated whole virus vaccine (Covaxin) amongst hospital-based population groups. Material(s) and Method(s): The prospective analytical study was conducted in the Department of Microbiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India, from January 2021 to March 2021.The study primarily included Healthcare Workers (HCWs) employed at SMS Medical college and attached hospitals. In-vitro quantitative IgG antibodies against SARS-CoV-2 spike Receptor Binding Domain (RBD) were measured using Chemiluminescence Immunoassay (CLIA) based Advia centaur SARS-CoV-2 IgG, manufactured by Siemens Pvt Ltd, Munich, Germany, as per manufacture's instructions. Result(s): Out of total 223 individuals, 61.88 % (138/223) showed neutralising antibody titre of >1 index value by CLIA, rest 38.12% (85/223) were non reactive i.e., titre <1 index value, after four weeks of receiving first dose of Covaxin. After 2 to 4 weeks of receiving second dose 84.30% (188/223) showed neutralising antibody titre of >1 index value by CLIA, rest 15.70% (35/223) were non reactive i.e., titre <1 index value. After receiving first dose, 100% (223/223) of the participants developed localised pain and bodyache 33.63% (75/223). None of the participants showed any anaphylactic reaction or any emergency condition just after vaccination. Conclusion(s): Covaxin is a well-tolerated vaccine, and induces good humoral response against SARS-CoV-2 with a significant rise in the neutralising antibody titres. Copyright © 2022 Journal of Clinical and Diagnostic Research. All rights reserved.

2.
AEROSOL AND AIR QUALITY RESEARCH ; 22(8), 2022.
Article in English | Web of Science | ID: covidwho-1969624

ABSTRACT

Measurement of particulate matter (PM) constituent such as black carbon (BC) over urban sites is critically important owing to its adverse health and climate impacts. However, the impacts associated with BC are poorly understood primarily because of the scarcity and uncertainties of measurements of BC. Here, we present BC measurement at an urban site of Delhi using a characterized continuous soot monitoring system (COSMOS) for a year-long period, i.e., from September, 2019 to August, 2020. This measurement period covers events, i.e., period of crop residue burnings from nearby states, festive events, e.g., Diwali and New Year, and first COVID-19 lockdown period. Effects of these events combining with local emissions and meteorological conditions on BC mass concentration (MBC) are investigated to find the possible cause of severe pollution levels in Delhi. Mean MBC for the complete observation period was found to be 5.02 ?? 4.40 ??g m???3. MBC showed significant seasonal as well diurnal variations. Winter season (December to February) is observed to be the most polluted season owing to increased local emissions and non-favorable meteorological conditions. Regional emission from crop burning in nearby states during October and November is the main contributing factor for increased pollution in this postmonsoon season. Furthermore, analysis reveals that cracker burning during festivals can also be considered as contributing factor to high MBC for a short period in post-monsoon and winter seasons. Significant decrease in MBC due to COVID-19 lockdown is also observed. MBC in summer and monsoon are lower as compared to other seasons but are still higher than mean MBC levels in several other urban cities of different countries. Also, the BC data obtained from nearby sites surface black carbon (SBC) are compared against the MBC to evaluate coherency among the different datasets, and discussed in detail.

3.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927886

ABSTRACT

Introduction: In COVID-19-related acute respiratory distress syndrome (ARDS), two distinct subphenotypes have been identified with differential outcomes and responses to corticosteroid therapy. We aimed to evaluate (1) whether clinical data can identify subgroups in a broader group of patients with SARS-CoV-2 pneumonia and (2) the extent to which corticosteroids demonstrate heterogeneity of treatment effect across such subgroups. Methods: We retrospectively studied all SARS-CoV-2 patients hospitalized for >24 hours and requiring oxygen support across 11 BJC HealthCare hospitals from June-December 2020. We excluded the initial surge (March-May 2020), as clinical care was heterogeneous and corticosteroid use low during this period. Using prespecified routinely-collected vital sign and laboratory indicator variables, we sought distinct clinical subphenotypes of SARS-CoV-2 pneumonia through latent class analysis (LCA). Across LCA subphenotypes, we evaluated the relationship between corticosteroid treatment and patient outcomes. We used multivariable logistic regression (dependent variable = composite of death/hospice) to explore treatment interaction between corticosteroid exposure and LCA subphenotype, adjusting for age and maximal SOFA score within 24 hours of admission as surrogates for indication. Results: The 3-class LCA model best fit the 1845-patient cohort (p=0.007). Class-1 (n=1456) had mean standardized values of all indicator variables near zero;Class-2 (n=235) manifested profound isolated hypoxemia;and Class-3 (n=154) displayed multiorgan failure, shock, and neutrophilia (Figure-1A). Despite representing <25% of the cohort, Classes 2 (n=109, 46%) and 3 (n=70, 46%) comprised >50% of the primary outcome (vs Class-1: n=151, 10%;p<0.001). Corticosteroids were more frequently administered in Class-2 (n=215, 91%) than in Class-1 (n=1071, 74%) or Class-3 (n=110, 71%, p<0.001;Figure-1B). Adjusted analyses demonstrated interaction between LCA class and corticosteroid treatment for the primary outcome (Class-1, p=0.003;Class-3, p=0.002). Corticosteroids were associated with increased adjusted odds for the primary outcome in Class-1 (aOR 2.11, 95% CI 1.33-3.50, p=0.002) and decreased adjusted odds for the primary outcome in Class-3 (aOR 0.44, 95% CI 0.19-0.98, p=0.048). Class-2 showed no outcome differences between the corticosteroid and noncorticosteroid groups (aOR 1.03, 95% CI 0.38-2.81, p=0.95). Conclusions: Three distinct subphenotypes of SARS-CoV-2 pneumonia demonstrate different clinical outcomes and corticosteroid response. No clear effect was seen among patients with isolated hypoxemia, whereas those with multiorgan failure appeared to benefit. Our findings suggest that among hospitalised patients in our healthcare system, corticosteroid therapy was associated with increased risk of harm. Prospective studies are needed to evaluate the efficacy of corticosteroids in SARS-CoV-2 pneumonia in predictively-enriched trials.

4.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927857

ABSTRACT

Background: Latent class analyses in patients with acute respiratory distress syndrome (ARDS) have identified “hyper-inflammatory” and “hypo-inflammatory” phenotypes with divergent clinical outcomes and treatment responses. ARDS phenotypes are defined using plasma biomarkers and clinical variables. It is currently unknown if these phenotypes have distinct pulmonary biology and if pre-clinical models of disease replicate the biology of either phenotype. Methods: 45 subjects with ARDS (Berlin Definition) and 5 mechanically ventilated controls were selected from cohorts of mechanically ventilated patients at UCSF and ZSFG. Patients with COVID-19 were excluded from this analysis. A 3-variable classifier model (plasma IL-8, protein C, and bicarbonate;Sinha 2020) was used to assign ARDS phenotypes. Tracheal aspirate (TA) RNA was analyzed using established bulk and single-cell sequencing pipelines (Langelier 2018, Sarma 2021). Differentially expressed (DE) genes were analyzed using Ingenuity Pathway Analysis (IPA). Microbial community composition was analyzed with vegan. Fgsea was used to test for enrichment of gene sets from experimental ARDS models in genes that were differentially expressed between each phenotype and mechanically ventilated controls. Results: Bulk RNA sequencing (RNAseq) was available from 29 subjects with hypoinflammatory ARDS and 10 subjects with hyperinflammatory ARDS. 2,777 genes were differentially expressed between ARDS phenotypes. IPA identified several candidate upstream regulators of gene expression in hyperinflammatory ARDS including IL6, TNF, IL17C, and interferons (Figure 1A). 2,953 genes were differentially expressed between hyperinflammatory ARDS and 5 ventilated controls;in contrast, only 243 genes were differentially expressed between hypoinflammatory ARDS and controls, suggesting gene expression in the hypoinflammatory phenotype was more heterogeneous. Gene sets from experimental models of acute lung injury were enriched in hyperinflammatory ARDS but not in hypoinflammatory ARDS (Figure 1B). Single cell RNA sequencing (scRNAseq) was available from 6 additional subjects with ARDS, of whom 3 had hyperinflammatory ARDS. 14,843 cells passed quality control filters. Hyperinflammatory ARDS subjects had a markedly higher burden of neutrophils (Figure 1C), including a cluster of stressed neutrophils expressing heat shock protein RNA that was not present in hypoinflammatory ARDS. Expression of a Th1 signature was higher in T cells from hyperinflammatory ARDS. Differential expression analysis in macrophages identified increased expression of genes associated with mortality in a previous study of ARDS patients (Morell 2019). Conclusions: The respiratory tract biology of ARDS phenotypes is distinct. Hyperinflammatory ARDS is characterized by neutrophilic inflammation with distinct immune cell polarization. Transcriptomic profiling identifies candidate preclinical disease models that replicate gene expression observed in hyperinflammatory ARDS.

5.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927743

ABSTRACT

Rationale: The ROSE trial was a multicenter unblinded randomized clinical trial comparing early neuromuscular blockade (NMB) to usual care in patients with moderate to severe ARDS (NEJM 2019). This trial (n=1006) was stopped early for futility yet a subgroup analysis found that among Hispanic/Latino participants the NMB intervention group had a significantly lower mortality (32%) compared to those in the control group (53.7% p=0.02 for interaction). To evaluate potential contributors to these differences we compared baseline clinical and biological characteristics among Hispanic/Latino participants in the intervention vs control group. Methods: We compared demographics primary ARDS risk factor illness severity ventilatory parameters comorbidities and plasma biomarkers at baseline between the NMB intervention and control group for all 118 Hispanic/Latino patients recruited to the ROSE trial (11.6% of the trial population). We used multiple logistic regression to examine whether the mortality difference by treatment group would persist after controlling for the factors that differed significantly between groups. Results: At baseline Hispanic/Latino participants randomized to the control group had greater disease severity scores (APACHE III SOFA;p<0.05 for both) and a higher prevalence of shock (p=0.01) compared to those randomized to the intervention. There were no significant differences between groups in causes of lung injury or baseline ventilatory parameters. In an unadjusted logistic regression model the NMB intervention was significantly associated with mortality (OR 0.42;95%CI 0.20-0.89 p=0.02). The NMB intervention was no longer significantly associated with mortality when adjusting for severity of by illness by either SOFA score (OR 0.53;95%CI 0.24-1.20 p=0.13), APACHE III (OR 0.51, 95%CI 0.20- 1.30 p=0.16) or shock as defined by the need for vasopressors (OR 0.48, 95%CI 0.22-1.03, p=0.06). Hispanic/Latino participants in the control group had significantly higher interleukin-8 (p=0.02) and lower bicarbonate (p=0.045) than those in the intervention group. Conclusion: Together these clinical and biomarker data support the conclusion that the lower mortality associated with NMB in the Hispanic/Latino subgroup may have been partially due to baseline imbalances in systemic severity of illness. This finding underscores the need to cautiously interpret apparent treatment benefits within small subgroups. The COVID-19 pandemic has highlighted ethnic and racial disparities in ARDS. Future trials will benefit from increased representation of populations that are disproportionately affected to minimize the impact of spurious findings related to small sample sizes while creating more statistical power to prospectively address disparities.

6.
7.
Open Bioinformatics Journal ; 15(1), 2022.
Article in English | Scopus | ID: covidwho-1847028

ABSTRACT

Background: SARS-CoV-2, the causative agent of COVID-19, has mutated rapidly, enabling it to adapt and evade the immune system of the host. Emerging SARS-CoV-2 variants with crucial mutations pose a global challenge in the context of therapeutic drugs and vaccines developing globally. There are currently no specific therapeutics or vaccines available to combat SARS-CoV-2 devastation. Concerning this, the current study aimed to identify and characterize the mutations found in the Nsp13 of SARS-CoV-2 in Indian isolates. Methods: In the present study, the Clustal omega tool was used for mutational analysis. The impact of mutations on protein stability, flexibility, and function was predicted using the DynaMut and PROVEAN tools. Furthermore, B-cell epitopes contributed by Nsp13 were identified using various predictive immunoinformatic tools. Results: Non-structural protein Nsp13 sequences from Indian isolates were analyzed by comparing them with the firstly reported Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) protein sequence in Wuhan, China. Out of 825 Nsp13 protein sequences, a total of 38 mutations were observed among Indian isolates. Our data showed that mutations in Nsp13 at various positions (H164Y, A237T, T214I, C309Y, S236I, P419S, V305E, G54S, H290Y, P53S, A308Y, and A308Y) have a significant impact on the protein's stability and flexibility. Moreover, the impact of Nsp13 mutations on protein function was predicted based on the PROVEAN score that indicated 15 mutants as neutral and 23 mutants as deleterious effects. Immunological parameters of Nsp13, such as antigenicity, allergenicity, and toxicity, were evaluated to predict the potential B-cell epitopes. The predicted peptide sequences were correlated with the observed mutants. Our predicted data showed that there are seven high-rank linear epitopes as well as 18 discontinuous B-cell epitopes based on immunoinformatic tools. Moreover, it was observed that out of the total 38 identified mutations among Indian SARS-CoV-2 Nsp13 protein, four mutant residues at positions 142 (E142), 245 (H245), 247 (V247), and 419 (P419) were localised in the predicted B cell epitopic region. Conclusion: Altogether, the results of the present in silico study might help to understand the impact of the identified mutations in Nsp13 protein on its stability, flexibility, and function. © 2022 Kumari et al.

8.
International Journal of Pharmaceutical and Clinical Research ; 14(2):257-264, 2022.
Article in English | EMBASE | ID: covidwho-1777064

ABSTRACT

Background: Corona virus disease 2019 is a highly infectious disease which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2. SARS-CoV-2 is transmitted from person to person mainly by respiratory droplets and aerosols as well as by direct or indirect contact. Aims and objective: To compare different RNA extraction methods for detection of SARSCov-2 RNA from nasopharyngeal and oropharyngeal swabs using three different methods which are based on different techniques. Material and methods: This analytical observational study was conducted in the department of Microbiology, Sawai Man Singh Medical College Jaipur, Rajasthan from December 2020 to January 2021. We selected 200 confirmed positive (extracted by Easy Mag automated system) (remnant) samples showing a wide range of different Ct values and 20 confirmed negative samples stored in Viral Transport Media VTM for this study. In order to compare quality of three extractions methods, all samples were aliquoted separately for each extraction technique. (1) Extraction by manual method (spin column base): was done by as per manufacturer’s instructions. (2) Extraction by QIA cube HT (vaccum column base): was done by as per manufacturer’s instructions. (3) Extraction by Perkins Elmer chemagic 360: (magnetic beads based). Result: A panel consisting of 200 Covid-19 positive and 20 Covid-19 negative samples were extracted by three methods (i.e. Manual column based, automated column-based and automated magnetic beads-based method). The extracted material/elutes were put for realtime RT-PCR assay for the detection of SARS CoV-2 RNA. There was no major difference seen in individual samples’ ct values between three extraction system. CONCLUSION: In conclusion, we recommended all three RNA extraction methods (i.e. magnetic beads & silica column-based) are interchangeable in a diagnostic workflow for the SARS CoV-2 by RTPCR and can be taken into account for SARS CoV-2 detection in possible future shortage of one kit or times of crisis in such pandemic time.

9.
Indian Journal of Medical Microbiology ; 39:S127-S128, 2021.
Article in English | EMBASE | ID: covidwho-1734530

ABSTRACT

Background:Influenza is an important respiratory infection, causing 250,000 to 500,000 deaths annually. Influenza virus A is the most virulent and associated with winter epidemics in temperate regions, more persistent transmission in the tropics, and occasional large-scale global pandemics. But, there is variability in the pattern, and the H1N1 pandemic of 2009-2010 was unusually with a large spike in spring and a sharp decline continuing throughout winter. Varying in pattern is due to antigenic shift and drift and reassortment of the virus. Methods:A prospective study was carried out in Advance Basic Sciences & Clinical Research Lab, Department of Micro- biology in SMS Medical College & Hospital, Jaipur for diagnosis of Influenza A virus as well as subtyping was done using RT-PCR technique over 1 year period (July 2019 to June 2020) and demographic data was noted. Results:Total of 7213 samples were tested, out of which 498 (6.90%) were positive for Influenza A which is less from the previous year’s 22.46%. Out of total positive cases Influenza a (H1N1) pdm09 was 24.9% and InfA H3N2 was 75.10%. InfA H3N2 was the prominent circulating strain in all months while Influenza a (H1N1) pdm09 was prominent strain pre- vious year. Majority of positive cases were found in March 2020 (43.17%), September 2019 (28.51%). Most of these cases 36.14% were from age group between 20 to 40 years. Conclusions: A decline in the positivity of influenza infection compared to last year is seen which could be in part due to circulation of SARS COV 2 and measures of prevention undertaken by community to prevent it. Demographic parame- ters and seasonal variation of Influenza A virus give ideas to create awareness and to improve control strategies to mini- mize the morbidity, mortality and spread of disease.

10.
Journal of Clinical and Diagnostic Research ; 15(9):DC11-DC15, 2021.
Article in English | Web of Science | ID: covidwho-1700969

ABSTRACT

Introduction: The emergence of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic has been troublesome particularly for developing countries that lack infrastructure and capacities to produce the kits locally. Simplification of the method can increase diagnostic efficiency which can benefit patients and help in infection control, consequently saving time and lives. Aim: To evaluate the diagnostic value of four methods (that omit extraction step) for detection of SARS-CoV-2 against the traditional extraction method. Materials and Methods: This was a cross-sectional analysis for evaluating diagnostic accuracy of four methods for detection of SARS-CoV-2 by real-time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR), conducted in the Department of Microbiology, SMS Medical College, Jaipur, Rajasthan, India, in October 2020. Ninety four SARS-CoV-2 RT-PCR positive samples and 20 negative samples were taken for this study. Automated extraction system was used for Ribonucleic Acid (RNA) extraction and four different approaches were compared to the traditional extraction method for detection of SARS-CoV-2 by RT-PCR. Data was entered and analysed using Statistical Package for the Social Sciences (SPSS) statistical software version 24.0. Results: The automated RNA extraction method was compared to the method of direct addition of samples with (Heat processed Direct Viral transport medium Sample (HDVS)) and without heating (Direct Viral transport medium Sample (DVS)), directs addition of diluted (1:5) sample with (Heat processed diluted VTM sample (HdVS)) and without heating (Diluted VTM sample (dVS)) as well as after addition of Proteinse K (PK) to the diluted samples that came either negative/invalid. Out of four methods, the HdVS method gave the best results, considering extraction with Perkin Elmer as standard, this method showed sensitivity of 96.74%, specificity of 100%. Conclusion: In current pandemic, molecular testing is critically challenged by the limited supplies of reagents of nucleic acid extraction alternative method like diluting and heating of Viral Transport Media (VTM) samples and using them directly as elutes serve as an easy, fast and inexpensive alternative.

13.
American Journal of Respiratory and Critical Care Medicine ; 203(9):1, 2021.
Article in English | Web of Science | ID: covidwho-1407291
14.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277339

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) pandemic has led to a rapid increase in the incidence of acute respiratory distress syndrome (ARDS). The distinct features of pulmonary biology in COVID-19 ARDS compared to other causes of ARDS, including other lower respiratory tract infections (LRTIs), are not well understood. Methods: Tracheal aspirates (TA) and plasma were collected within five days of intubation from mechanically ventilated adults admitted to one of two academic medical centers. ARDS and LRTI diagnoses and were verified by study physicians. Subjects were excluded if they received immunosuppression. TA from subjects with COVID-ARDS was compared to gene expression in TA from subjects with other causes of ARDS (OtherARDS) or mechanically ventilated control subjects without evidence of pulmonary pathology (NoARDS). Plasma concentrations of IL-6, IL-8, and protein C also were compared between these groups. Upstream regulator and pathway analysis was performed on significantly differentially expressed genes with Ingenuity Pathway Analysis (IPA). Subgroup analyses were performed to compare gene expression in COVID to ARDS associated with other viral LRTIs and bacterial LRTIs. The association of interferon-stimulated gene expression with SARS-CoV2 viral load was compared to the same association in nasopharyngeal swabs in a cohort of subjects with mild SARS-CoV2. Results: TA sequencing was available from 15 subjects with COVID, 32 subjects with other causes of ARDS (OtherARDS), and 5 mechanically ventilated subjects without evidence of pulmonary pathology (NoARDS). 696 genes were differentially expressed between COVID and OtherARDS (Figure 1A). IL-6, IL-8, B-cell receptor, and hypoxia inducible factor-1a signaling were attenuated in COVID compared to OtherARDS. Peroxisome proliferator-activated receptor (PPAR) and PTEN signaling were higher in COVID compared to OtherARDS (Figure 1B). Plasma levels of IL-6, IL-8, and protein C were not significantly different between COVID and OtherARDS. In subgroup analyses, IL-8 signaling was higher in COVID compared to viral LRTI, but lower than bacterial LRTI. Type I/III interferon was higher in COVID compared to bacterial ARDS, but lower compared to viral ARDS (Figure 1C). Compared to nasopharyngeal swabs from subjects with mild COVID-19, expression of several interferon stimulated genes was less strongly correlated with SARS-CoV2 viral load in TA (Figure 1D). IPA identified several candidate medications to treat COVID-19, including dexamethasone, G-CSF, and etanercept. Conclusions: TA sequencing identifies unique features of the host response in COVID-19. These differentially expressed pathways may represent potential therapeutic targets. An impaired interferon response in the lung may increase susceptibility to severe SARS-COV2.

15.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277034

ABSTRACT

Introduction: Pneumonia due to SARS-CoV-2 (Coronavirus Disease 2019, COVID-19) has frequently been compared to other viral pneumonias, including influenza. While some data suggest significant differences in biological responses, dissimilarities in the clinical course and characteristics between SARS-COV-2 and influenza pneumonia remain unknown. We evaluated differences in clinical predictors of outcomes and early clinical subphenotypes in COVID-19 and influenza pneumonia. Methods: We performed a retrospective cohort study of all patients hospitalized for > 24 hours, requiring oxygen support, at Barnes-Jewish Hospital with COVID-19 (March-July 2020) or influenza (Jan 2012-Dec 2018). In-hospital mortality or hospice discharge was the primary outcome. First, supervised machine learning classifier models (XGBoost) were trained using bootstrap replications of each viral cohort to predict the primary outcome. 28 candidate predictor variables among the most extreme vital signs and laboratory values within 24 hours of hospitalization were preselected, excluding highly correlated variables. We compared each model's internal discrimination to its performance in the alternate cohort and evaluated differences in variable importance between the two viral pneumonia models. Next, we evaluated differences in clinical subphenotypes in two ways: 1) a previously-validated algorithm to group patients into four distinct subphenotypes based on temperature trajectories within 72 hours of hospitalization;2) latent class analysis (LCA) to identify unmeasured subgroups within each viral cohort based on the predictor variables described above. In both analyses, we compared frequency of subphenotype membership and each subphenotype's primary outcome between viral cohorts. Results: We evaluated 321 unique hospitalizations with COVID-19 and 535 with influenza. The primary outcome was experienced in 23% and 9.5% of patients, respectively. Influenza predictor model discriminated outcomes worse in COVID-19 than on internal evaluation (Panel A), suggesting prognostic variables differ between the viral pneumonias. Only one of the top five contributory variables was shared between the two models (Panel B). Prevalences of temperature trajectory subphenotype also differed significantly between viral pneumonias. All COVID-19 temperature trajectory subphenotypes experienced the primary outcome more frequently than their influenza counterparts (Panel C). LCA identified two distinct classes in each cohort, with each viral pneumonia's minority class experiencing worse outcomes than the majority class. Of each model's top 5 classdefining variables, only 2 were shared (Panel D). Conclusions: COVID-19 and influenza pneumonia differ markedly in predictors of outcome and in clinical subphenotypes. These findings emphasize observable pathogen-specific differential responses in viral pneumonias and suggest that distinct management approaches should be investigated for these diseases. (Table Presented).

16.
Journal of Retailing and Consumer Services ; 62, 2021.
Article in English | Scopus | ID: covidwho-1275533

ABSTRACT

Fast fashion trends have led to an enormous local brand proliferation in India. Brand proliferation has further led to an overchoice effect among the Indian consumers due to which, they are now increasingly less satisfied with their apparel purchases. These factors have created immense stress on the small fashion retailers (SFR) which are currently responsible for about 80% of retailing in India. In the pre-COVID times, SFR's followed the practice of overstocking many brands for capturing the maximum market and then clearing the inventory at the end of the season through heavy discounting. This strategy became ineffective after the COVID-19 disruption. SFR's must now optimize their brand portfolio to minimize the overchoice effect and maximize the inventory turnover ratio. To this effect, we propose an efficient fuzzy probability-based brand portfolio optimization model, which relies on primary data analysis to classify brands in groups of substitutes. Brands with maximum market share from each group must be included in the portfolio. We demonstrate the efficacy of our model through a case study on SFR. Our results show that the inventory turnover ratio was increased from 2 to 4. We further show that our grouping strategy can be used to identify competitive brands for a local band. © 2021 Elsevier Ltd

17.
European Journal of Molecular and Clinical Medicine ; 8(3):2331-2345, 2021.
Article in English | EMBASE | ID: covidwho-1197819

ABSTRACT

Plants are the oxygen support for our planet and all living things. They can be considered as "mothers of medicine". As mothers take care of a child, Plants do the same for all human beings and animals. Medicinal plants have therapeutic properties that produce a beneficial pharmacological effect on the animal and human body. In recent years plants are surveyed as new drugs and gain attention to the discovery of new bioactive compounds. Hippocrates quoted "Let thy food be thy medicine, and thy medicine shall be thy food". The flavor, aroma, taste, and nutritional properties make the Cinnamon offers a wide range of health benefits. The present study explores the connection between the Cinnamon plant and medicine, our food, modern science.

18.
International Psychogeriatrics ; 32(SUPPL 1):130, 2020.
Article in English | EMBASE | ID: covidwho-1108870

ABSTRACT

Introduction: Older adults are at disproportionate risk of serious disease and mortality due to the novel coronavirus (COVID-19) pandemic. Further, the global response to the lockdown has rendered older adults particularly vulnerable to loneliness and social isolation due to the physical distancing and shelter in place mandate. We hypothesized that both these factors would lead to an increase in geriatric mental health problems during the COVID-19 pandemic. Material and Methods: We undertook a clinical audit of all geriatric patients (above 60 years of age) attending the psychiatry emergency services at a tertiary care hospital. This audit was conducted over a period of 52 days dating from the cessation of non-essential services at the hospital as part of the national response to the COVID-19 pandemic (lockdown). We used descriptive statistics to summarize the number, age, sex, presenting complaint and diagnoses of our patients. We further compared the average number of geriatric patients attending the psychiatry emergency services in the hospital during the lockdown to that of geriatric patients attending the same in the year before the lockdown. Results: A total of 112 geriatric patients attended the psychiatry emergency services during the lockdown period. Of these, 62 were male and 50 female. The average number of geriatric patients attending the emergency services daily during this period (μ1 2.15) was significantly higher (z 5.36, p ≤ 0.01) than the average number of patients attending the emergency services in the year preceding the lockdown (μ2 1.34). The most common presenting complaint was agitation in the preceding weeks. The most common diagnoses were late onset schizophrenia spectrum disorders followed by affective disorders and major neurocognitive disorders. Discussion: The COVID-19 pandemic and the global response to the same constitute life events for older adults. They may contribute to biological, psychological and social risk factors for mental health problems in older adults during this period. The increase in geriatric patients attending our emergency services, despite an increase in restrictions on mobility which act as barriers in the pathway to care, is worrying. Under stimulation in older adults during this period may contribute to an increase in agitation.

19.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-6307

ABSTRACT

We performed comparative lower respiratory tract transcriptional profiling of 52 critically ill patients with the acute respiratory distress syndrome (ARDS) from COVID-19 or from other etiologies, as well as controls without ARDS. In contrast to a cytokine storm, we observed reduced proinflammatory gene expression in COVID-19 ARDS when compared to ARDS due to other causes. COVID-19 ARDS was characterized by a dysregulated host response with increased PTEN signaling and elevated expression of genes with non-canonical roles in inflammation and immunity that were predicted to be modulated by dexamethasone and granulocyte colony stimulating factor. Compared to ARDS due to other types of viral pneumonia, COVID-19 was characterized by impaired interferon-stimulated gene expression (ISG). We found that the relationship between SARS-CoV-2 viral load and expression of ISGs was decoupled in patients with COVID-19 ARDS when compared to patients with mild COVID-19. In summary, assessment of host gene expression in the lower airways of patients with COVID-19 ARDS did not demonstrate cytokine storm but instead revealed a unique and dysregulated host response predicted to be modified by dexamethasone.

20.
Asian Journal of Pharmaceutical and Clinical Research ; 13(12):165-172, 2020.
Article in English | EMBASE | ID: covidwho-1006746

ABSTRACT

Objective: The study aimed to assess knowledge, attitude, practices, and perception (KAP) toward COVID-19 among the population of eight North Eastern (NE) states of India. Methods: A cross-sectional study from June 30 to July 13, 2020 was carried out through a self-reported, structured questionnaire that was circulated online to participants of age group of 18 years or above. Convenient sampling was used to recruit respondents for the study. Results: The study received responses from 8309 participants. Key findings revealed that most respondents had good knowledge of preventive measures and common symptoms of COVID-19. The majority of the respondents showed a good attitude and adopted preventive practices. The mean score of knowledge was 7.137, attitude was 16.132, practice was 9.379, and perception was 13.583. The scores of four KAP categories significantly differed across most of the demographic variables (p<0.001). The majority of people took homoeopathic medicine as prophylaxis for immune booster. Conclusion: The study highlights that the focus on behavioral change communication in all the NE states could be strengthened, especially in rural areas. Advocacy based on the comprehensive list of symptoms for COVID-19 may also be bolstered. There is scope for strategically promoting knowledge, immunity boosting, and self-care practices suggested in the AYUSH systems of medicine.

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