Antibiotics in Paediatrics: A Boon or a Bane?

Antibiotics play an essential role in antimicrobial therapy. Among all the medications in children, the most commonly prescribed therapy is antibiotics and is currently the indispensable means to cure transmissible diseases. Several categories of antibiotics have been introduced into clinical practice to treat microbial infections. Reducing the unnecessary use of antibiotics is a global need and priority. This article aims to provide better knowledge and understanding of the impact of the early use of antibiotics. This article highlights the proper use of antibiotics in chil-dren, detailing how early and inappropriate use of antibiotics affect the gut microbiome during normal body development and consequently affect the metabolism due to diabetes mellitus, obe-sity, and recurrence of infections, such as UTI. Several new antibiotics in their development stage, newly marketed antibiotics, and some recalled and withdrawn from the market are also briefly discussed in this article. This study will help future researchers in exploring the latest information about antibiotics used in paediatrics.Copyright © 2023 Bentham Science Publishers.

Effectiveness of Preparedness Training Delivered to Pre-final and Final Year Nursing Undergraduates to Combat COVID-19: A Need-based Initiative.

A major concern during the COVID-19 pandemic has been the shortage of manpower for patient care. The recommendation of various authorised bodies encouraged the training of students from medical, nursing, and allied fields to manage COVID-19 cases by tele-consultation and monitoring of mild cases under the supervision of faculty. Anticipating a further shortage of human resources, leading to dire consequences, preparedness training for the final year and pre-final nursing undergraduates was initiated. The current study was conducted to evaluate the effectiveness of and feedback on COVID-19 preparedness training delivered to final-and pre-final-year undergraduate nursing students. A 3-day training was given to pre-final and final year nursing undergraduates on ECG, COVID-19 management protocols, personal protective equipment "donning and doffing", "hand hygiene", "biomedical waste management", "contact tracing" and cleaning and disinfection and simulation-based skills. Scores before and after training were conducted and mean scores were compared using a paired t-test. In total, 154 nursing students participated in the training program. Mean pre-test and post-test scores included: general instructions (21.69±2.5 and 25.09±3.29); skill procedures (5.4±1.21 and 6.3±1.2) and COVID management (22.84±3.26 and 26.48±2.06). There was a statistically significant improvement in knowledge and skills in all training sessions (p=0.0001). The mean post-test scores obtained at the OSCE stations for cardiac monitoring, prone positioning, compression-only CPR, airway, ECG and ABG ranged from 97.0% to 100.0% and all participants scored >70.0%. About 92.8% of the students felt that hands-on training enhanced their learning experiences. A need-based initiative of training final-and pre-final-year nursing students in COVID-19 support care effectively and efficiently created a skilled workforce.

SIRTEM: Spatially Informed Rapid Testing for Epidemic Modeling and Response to COVID-19

COVID-19 outbreak was declared a pandemic by the World Health Organization on March 11, 2020. To minimize casualties and the impact on the economy, various mitigation measures have being employed with the purpose to slow the spread of the infection, such as complete lockdown, social distancing, and random testing. The key contribution of this article is twofold. First, we present a novel extended spatially informed epidemic model, SIRTEM, Spatially Informed Rapid Testing for Epidemic Modeling and Response to COVID-19, that integrates a multi-modal testing strategy considering test accuracies. Our second contribution is an optimization model to provide a cost-effective testing strategy when multiple test types are available. The developed optimization model incorporates realistic spatially based constraints, such as testing capacity and hospital bed limitation as well.

Added value of the measles-rubella supplementary immunization activity in reaching unvaccinated and under-vaccinated children, a cross-sectional study in five Indian districts, 2018-20.

INTRODUCTION: Supplementary immunization activities (SIAs) aim to interrupt measles transmission by reaching susceptible children, including children who have not received the recommended two routine doses of MCV before the SIA. However, both strategies may miss the same children if vaccine doses are highly correlated. How well SIAs reach children missed by routine immunization is a key metric in assessing the added value of SIAs. METHODS: Children aged 9 months to younger than 5 years were enrolled in cross-sectional household serosurveys conducted in five districts in India following the 2017-2019 measles-rubella (MR) SIA. History of measles containing vaccine (MCV) through routine services or SIA was obtained from documents and verbal recall. Receipt of a first or second MCV dose during the SIA was categorized as "added value" of the SIA in reaching un- and under-vaccinated children. RESULTS: A total of 1,675 children were enrolled in these post-SIA surveys. The percentage of children receiving a 1st or 2nd dose through the SIA ranged from 12.8% in Thiruvananthapuram District to 48.6% in Dibrugarh District. Although the number of zero-dose children prior to the SIA was small in most sites, the proportion reached by the SIA ranged from 45.8% in Thiruvananthapuram District to 94.9% in Dibrugarh District. Fewer than 7% of children remained measles zero-dose after the MR SIA (range: 1.1-6.4%) compared to up to 28% before the SIA (range: 7.3-28.1%). DISCUSSION: We demonstrated the MR SIA provided considerable added value in terms of measles vaccination coverage, although there was variability across districts due to differences in routine and SIA coverage, and which children were reached by the SIA. Metrics evaluating the added value of an SIA can help to inform the design of vaccination strategies to better reach zero-dose or undervaccinated children.

Management of Heart Failure Patients With Reduced Ejection Fraction Who Have COVID-19

Patients with heart failure (HF) who contract coronavirus disease 2019 (COVID-19) are at increased risk for morbidity and mortality. Numerous pathophysiologic mechanisms exist by which COVID-19 infection inflicts cardiovascular damage. For HF patients with reduced ejection fraction (HFrEF), guideline-directed medical therapy should be maintained and optimized in the absence of contraindications. Clinicians should assess currently authorized COVID-19 treatment options prior to initiation. Pharmacists play an essential role in managing patients who have HFrEF and recommending preventive therapy, such as lifestyle modifications and vaccinations, with the goal of optimizing health outcomes during the COVID-19 pandemic. Copyright © 2022, Jobson Publishing Corporation. All rights reserved.

Revised workflow practices in the management of acute invasive fungal sinusitis during the coronavirus disease 2019 pandemic.

OBJECTIVE: To document changes in evaluation protocols for acute invasive fungal sinusitis during the coronavirus disease 2019 pandemic, and to analyse concordance between clinical and histopathological diagnoses based on new practice guidelines. METHODS: Protocols for the evaluation of patients with suspected acute invasive fungal sinusitis both prior and during the coronavirus disease 2019 period are described. A retrospective analysis of patients presenting with suspected acute invasive fungal sinusitis from 1 May to 30 June 2021 was conducted, with assessment of the concordance between clinical and final diagnoses. RESULTS: Among 171 patients with high clinical suspicion, 160 (93.6 per cent) had a final histopathological diagnosis of invasive fungal sinusitis, concordant with the clinical diagnosis, with sensitivity of 100 per cent, positive predictive value of 93.6 per cent and negative predictive value of 100 per cent. CONCLUSION: The study highlights a valuable screening tool with good accuracy, involving emphasis on 'red flag' signs in high-risk populations. This could be valuable in situations demanding the avoidance of aerosol-generating procedures and in resource-limited settings facilitating early referral to higher level care centres.

Impact of Online Class during Covid-19 Lockdown

Covid 19 along with all its impacts resulted in schools' closure across the world. As a consequence, system of education changed with the exclusive rise of e learning. Online classes which emerged as a result of this, have both the advantages and disadvantages. The present study aimed at assessing the impact of online classes during Covid 19 lockdown. The type of study is quantitative in nature. The descriptive research design was used for the study. With regard to selection of students, researcher has chosen two Post-Graduation Centres, which belong to semi urban and urban areas. With regard to selection of the school's researcher has chosen purposive sampling method and for the selection of students, researcher used convenience sampling. Both male and female students studying in first-and second-year Post graduation courses were taken into consideration for the study. Data was collected virtually using google forms. The total populations of the study were 200 students. Questionnaire method was used as a tool to collect the data from students. The result revealed that the students had different mind set towards the classes and examination method. It was also evident in the data that the responses varied according to age and gender.

Impact of covid-19 vaccination on glycemic control in people with type 1 diabetes

Aims: Vaccination against the coronavirus disease (covid- 19) is prioritized in people with diabetes. This study aimed to investigate the impact of the vaccination on glycemia which is currently unknown. Methods: The glucose metrics and vaccination records of 297 adults with type 1 diabetes were collected using the Ambulatory Glucose Profile (AGP) reports and the Dose Adjustment for Normal Eating (DAFNE) Kuwait research database respectively. All subjects were using continuous glucose monitoring (CGM) devices for ≥ 70% of the time. The primary outcomes were HbA1c, Time in Range (TIR), Time above Range (TAR), Time below Range (TBR) and Glucose Measurement Indicator (GMI) before and after the first and second doses of covid-19 vaccine. The secondary outcome measures were the average glucose, the Glucose Variability (CV), and the number of daily CGM scans collected at the same timepoints. Results: The Mean (SD) HbA1c were 63.9 (14.6)mmol/mol before and 62.3 (13.3)mmol/mol after the second doses of vaccine (p = 0.009). The differences of TAR >10mmol/L [mean differences (md = 1.02%)], TAR >13.9mmol/L (md = -0.86), TIR 3.9-10mmol/ L (md = -1.06%), TBR < 3.9mmol/L (md = 0.08%), and TBR <3.0mmol/L (md = 0.06%) were not significant after the second dose of vaccine. There was also no significant change in percentage of GMI, CV, and no episodes of severe hypoglycemia, diabetic ketoacidosis (DKA), or hospitalization after the vaccination was recorded. Conclusions: The covid-19 vaccination did not significantly affect the glycemic control among people with type 1 diabetes.

Applicability of double Channel Technique in AlGaN/GaN HEMT for future biosensing applications

Sensing COVID-19, GOx (glucose oxidase enzyme) in exhaled breath condensate/saliva, bio-molecules like KIM (Kidney Injury Molecule) in human body and pH value in human body fluids have gained huge attention in the present scenario as well as in the past decade. Hence, for the first time, double channel technique in AlGaN/GaN High Electron Mobility Transistor (HEMT) is proposed and its applicability is demonstrated by biosensing application. Simulation using SILVACO Technology Computer Aided Design (TCAD) based on numerical solid state models has been extensively used for investigation and analysis. The sensitivity of double channel device is compared with single channel device and its performance is evaluated in terms of the transconductance. Unlike the single channel device, double channel device exhibited wide range of transconductance with respect to gate bias. The device recorded a sensitivity of 136%, which is 74% higher than the sensitivity of single channel device. Hence, it is inferred that the sensitivity enhances with the use of multiple channels and could be increased by increasing the number of channels. The results of this research show that the proposed sensor stands a promising candidate for future biosensing applications that demand high detection limits. © 2021

1492P A longitudinal cohort study on assessing the impact COVID-19 pandemic on the mental health of cancer care providers: Developing world scenario

Background: COVID-19 is one of the most unfortunate events seen in the 21st century due to its outrageous spread and ordeal effect on people. Cancer care providers (CCPs) are under immense mental burden due to the unpredictable pandemic and compromised cancer care amongst patients. Pandemic has taken a toll on the caregivers, be it physically, mentally, or psychosocially. Methods: A prospective longitudinal study was conducted from May 2020 to September 2020 to assess the pandemic's impact on mental health amongst the CCP. DASS 21 & PCL5 instruments were used to identify the temporal change with pandemic evolution on mental health. An online survey was administered at three different periods with 6-week intervals through email. Collected data is analyzed using the SPSS 26. Independent variables are presented as categorical data and analyzed using chi-square. Temporal change in the mean scores analyzed using independent t-tests. Various demographic factors were correlated with the DASS 21 scores and PCL 5 scores using logistic regression. Results: The questionnaire was emailed to 240 CCP's;115 responses were valid. Mean age is 29.9 +/- 5.86, 62.6% were male and 27.4% were female respondents. 41.7% were nursing staff, and 58.3% were doctors;67% had less than five years of medical experience. Respondents who stayed with family had significant depression levels in the first and third surveys (OR: 0.37, CI- 0.15-0.91, P=0.03), (OR: 0.17, CI-0.026-1.1, P=0.04). Stress levels were significantly high in the caregivers staying with family in the first survey (OR: 4.38, CI: 1.2-15.7, P=0.02). On analyzing three surveys, 55 respondents in both the first and second survey 21,8,17 respondents persisted in having depression, stress, and anxiety. There was an increase in the stress levels in the third survey when compared to the second survey. Conclusions: In any disaster or an unnatural event, time helps the human mind to adapt to the new conditions;it is similar to our initial results that show improvement in the depression, stress, and anxiety levels with the second survey. It is essential to assess and address the mental health status-related problems to ensure HCW's personal well-being and deliver quality health care to the patients. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Modeling Control Measure Score of COVID-19 Outbreak Using Fuzzy c-Means-Based Adaptive Neuro-Fuzzy Inference System

The current outbreak of COVID-19 continues to threaten across the globe even after 9 months of its starting. The preventive measures and self-protecting measures are the suggested and viable solution to mitigate the spread of pandemic till new vaccine is discovered. The preventive measures are framed based on the detailed analysis of the current data of the ongoing pandemic. The correctness of the policies relies on the quality of the data and its analysis with a meaningful interpretation. In this paper, the present status of the epidemic across the world is analyzed using a control measure score which is computed using adaptive neuro-fuzzy inference system (ANFIS) where partition of data is performed using fuzzy c-means clustering. We have used transmission rate and recovery rate independently obtained from the discrete version of the Susceptible-Infected-Recovered (SIR) model to predict the score. Since the transmission parameters depends on incubation period, recovery and death, the parameter has been calculated based on active cases where its mean value changes significantly. It is observed that the recovery rate is more than the transmission rate of all Gulf countries at present which shows that the outbreak reached its highest value. The current control measure score emphasizes on the normal working atmosphere keeping strict social distancing measures. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Development of safe and effective indigenous intensive care unit ventilators for COVID-19 pandemic

Severe acute respiratory syndrome-coronavirus 2 has spread rapidly worldwide infecting >= 4 million people including >= 2.9 million deaths and overwhelming health-care systems globally. It has prompted governments to open field medical facilities to decongest hospitals and triage patients. Governments are preparing for a stage 3 surge in cases leading to a situation of "severe shortage" of mechanical ventilators due to an overwhelming number of cases. Health authorities are looking into measures for mass production of ventilators with locally available materials. However, when deploying these devices on patients, it is imperative to ascertain if they are safe and do not perpetuate a vicious circle of worsening lung injury and death. The Association for the Advancement of Medical Instrumentation and the Medicines and Healthcare Products Regulatory Agency have brought out guidelines that emergency ventilators manufactured for the current epidemic need to satisfy.

MedRobo Medicine Delivering and Patient Parameter Monitoring Robot

In this paper, we propose a robot named MedRobo with some functionality of providing medicine as well as to measure the vital parameters (Heart rate, Pressure, Temperature and SpO2) of the patient. During the current scenario, reducing the human to human contact in hospitals is required. In a bid to prevent doctors and medical staff from getting affected by Coronavirus the role of medicine delivering robots are evolving. We can attain the locomotion procedure of the robot using the principle of Radio-frequency identification (RFID) that automatically identifies and tracks tags attached to the objects. The movement and finding the path to patient location is done through a line follower and with RFID tag. Line following method is used to identify the path with help of two infrared sensors. The robot will move towards the patient's room by following a non reflective line and use RFID cards to identify the patient's room number. Using the vending machine the medicine delivery is made possible to the patients. All the measured parameters will be stored to the cloud using the application of the Internet of Thinking (IoT). All the data will successfully be sent to the cloud through the Node MCU. If the read values varied from threshold then a message will be sent to doctors through GSM Module. © 2021 IEEE.

Patient satisfaction with telemedicine in a virtual lung transplant clinic

Rationale: During the COVID-19 pandemic telemedicine has emerged as an alternative medical care platform, being used more frequently in an effort to decrease the risk of exposure to both the patients and their health care providers. Close monitoring of lung transplant patients is crucial, as they are at a particularly vulnerable population due to chronic immunosuppression and coexisting comorbidities. Our study evaluates the patient satisfaction and technical feasibility of telemedicine visits after lung transplantation. Methods: A retrospective analysis was performed at the University of Maryland Lung Transplant center during the COVID-19 pandemic. The primary outcome was patient satisfaction with the clinic visit measured by a Telemedicine Satisfaction Questionnaire (23 questions). The telemedicine clinics were conducted between March 2020 and November 2020. The survey was designed after a forum discussion with a representative group of lung transplant patients and was initially sent to all lung transplant patients seen in this timeframe;a second follow-up survey was sent six month later. Results: In March 2020, 148 lung transplant patients received an initial survey via email. Fiftythree patients who completed the survey were included in the study. From the survey responses, 94% of patients considered the care they received via the telemedicine program to be very good to excellent;in subsequent follow-up satisfaction was still high at 89% of patients. In the first and second surveys, 96% and 94% of patients reported a good understanding of the use electronic devices, respectively. The majority of patients (59%) reported decreased travel-associated costs during the first survey, which then increased to 85% of patients during the follow-up survey. Conclusion: High levels of patient satisfaction were seen in lung transplant patients after the implementation of a telemedicine program in the context of the COVID-19 pandemic. Decreased travel-associated costs were reported by the majority of patients, especially in the 6-month follow-up survey. Our study suggests that a telemedicine program may decrease the travel-associated costs while maintaining high levels of satisfaction in a very complex population of lung transplant patients. Studies evaluating the role of telemedicine on clinical outcomes require further investigation.

Performance of Donor Derived Cell-Free DNA in Routine Clinical Care of Lung Transplant Recipients, a Multi-Center Study

Purpose Prior observational data suggest that donor-derived cell-free DNA (dd-cfDNA) increases in lung transplant acute rejection and infection. The performance of dd-cfDNA in routine clinical care remains undefined. In response to the COVID-19 pandemic, to mitigate the risk of exposing patients to infection, four centers used dd-cfDNA for surveillance instead of surveillance bronchoscopy, providing a unique opportunity to assess the performance of dd-cfDNA in routine clinical care. Methods As part of routine care during the COVID-19 pandemic, four lung transplant centers implemented a home-based surveillance program using plasma dd-cfDNA (Allosure®) in preference to surveillance bronchoscopy. Based on prior data, dd-cfDNA > 1% triggered further work-up including bronchoscopy. dd-cfDNA testing was also performed in response to a decline in forced expiratory volume in 1 second (FEV1), symptoms or treatment follow up. Data was retrospectively analyzed from 4/1/2020 - 9/1/2020 to assess the performance of dd-cfDNA in diagnosing a composite of ACR, AMR and/or infection. Results 169 patients underwent 380 dd-cfDNA measurements over the study period. The mean age was 58.5 years, 54% of patients were male and 82% bilateral lung transplants. 99 (58%) patients were <1 year post-transplant. 327 of 380 dd-cfDNA values were drawn for surveillance reasons. 31 patients had a surveillance level > 1%. Of these, 19/31 (61%) had evidence of ACR, AMR or infection. 115 patients had surveillance levels that remained < 1% over the study period with 109/115 (95%) displaying no clinical evidence of ACR, AMR, infection or decline in FEV1 or symptoms. The remaining 23 patients had levels drawn for clinical indications (non-surveillance). 45 surveillance bronchoscopies were performed with concomitant dd-cfDNA (23 triggered by dd-cfDNA > 1%). For diagnosis of ACR, AMR or infection in these patients, dd-cfDNA > 1% yielded a sensitivity of 84%, specificity of 77%, positive predictive value of 73% and negative predictive value of 87%. Conclusion In this study, dd-cfDNA identified ACR, AMR and/or infection in asymptomatic lung transplant patients that may not have been identified by clinically indicated biopsy alone. Low levels of dd-cfDNA may also be useful in ruling out AMR, ACR and/or infection, supporting its use as a potential non-invasive marker for surveillance monitoring.

Revisiting electronic systems and gadgets for patient management in COVID-19 Intensive Care Units

Monitoring and highly sophisticated care of the Covid-19 pandemic patients has taught us many new lessons. The ever-changing management strategies and the therapies for the disease containment is one aspect of the wide spectrum of innovations and refinements, which were the result of global effort by the scientists and the healthcare workers;the self-protection of front-line workers soon became immensely important to save them from contracting the disease and thus prevent rapid reduction in their numbers. Personal protective measures were vehemently enforced and means and measures to reduce (if not eliminate) direct contact with the known as well as yet unknown Covid positive patients were advocated. Different countries adopted different measures according to their customs and resources, but all with the same purpose. This paper is written to highlight the same and present our approach at our center. © 2021 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.

Artificial Intelligence Based Phonocardiogram Proposed for Cardiac Screening of School Children

Diagnosis/ prediction of cardiovascular diseases at the early stages in a cardiac patient is of great importance because monitoring and treatment will be easy at this stage rather than at the elderly stage. As far as under developed countries are concerned, it is practically impossible for physicians to check the cardiovascular status of all children of school age. With this intention, a phonocardiogram (PCG) set up along with an Artificial Intelligence (AI) based MATLAB program for automatic diagnosis of cardiac status, i.e. either normal or abnormal, has been developed and tested with the project group members themselves and results are disseminated. Due to the safety issues related to COVID-19, testing with School children is under pending. © 2020 IEEE.