Study of Clinical Profile and Outcome among COVID-19 Patients during Hospitalization in a Tertiary Care Hospital in Central India

Background: The COVID-19 outbreak in 2019 has presented in the form of pneumonia of unknown etiology in Wuhan. The complete clinical profile including the prevalence of different clinical symptoms of COVID-19 infection among Indian patients who develop a severe disease is largely unknown. This study is aimed to provide a detailed clinical characterization of the cohort of patients who visited our institute with signs and symptoms of COVID-19. Material(s) and Method(s): This was for inpatient hospital (inpatient) based prospective cohort study involving 520 COVID-19 patients admitted to the hospital. The adverse outcome included death and mechanical ventilation. Result(s): Total 520 participants enrolled in the study, (6.9%) participants died, (8.3%) participants required ICU and (5.5%) participants required mechanical ventilation. only signs and symptoms suggestive of severe respiratory system involvement or widespread infection were associated with adverse outcomes, T presence of dyspnoea, cyanosis and hypoxia. The most common chronic disease among patients with adverse outcomes were diabetes, hypertension and pre-existing respiratory disease, personal habit both smoking, and alcoholism was also associated with adverse clinical outcome. Conclusion(s): The adverse clinical outcome among COVID-19 patients is determined by several factors including advanced age, multi-morbidities, and the presence of severe respiratory symptoms.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Radiological Features on HRCT Associated with Poor Outcomes among COVID-19 Patients

Background: Ever since the beginning of the COVID-19 pandemic, physicians started investigating the clinical features and lab markers that can assist in predicting the outcome among hospitalized COVID-19 patients. Aim(s): This study aimed to investigate the association between initial chest CT scan findings and adverse outcomes of COVID-19. Material(s) and Method(s): This was a single centre;hospital (inpatient) based prospective cohort study involving 497 COVID-19 patients admitted to the hospital. The adverse outcome included death and mechanical ventilation. We collected data about 14 identifiable parameters available for the HRCT scan. Result(s): Among 14 studied parameters, only 8 features differed significantly among the patients who had favourable and unfavourable outcomes. These features included number of lobes of lungs involved (3 versus 5, p = 0.008), CT Severity score (16 versus 20, p = 0.004), air bronchogram (p=0.003), crazy paving (p=0.029), consolidation (p=0.021), and pleural effusion (p=0.026). We observed that high CT scores coupled with the diffuse distribution of lung lesions were responsible for poor prognosis in most patients. Conclusion(s): Several features of HRCT when combined can accurately predict adverse outcomes among participants and help in triaging the patient for admission in ICU.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Community Health Nurses' Role in Genetic Sequencing: A Prospect for Health Team Preparedness Against Covid-19

Genetic sequencing is a scientific process of reading genetic material using advanced technology. Through genetic sequencing, we can better comprehend super-spreader events and outbreaks, and strengthen national public health responses. A better understanding of the transmission of viruses, the severity of patient illness, and mortality rates can be gained by combining this information with that from the IDSP and patient reports. Connecting the dots between the data and the host's genetics, immunology, clinical outcomes, and risk factors is also possible. Many roadblocks must be overcome before raw sequence data can be put to direct clinical application. Since DNA sequencing has so many potential applications in the field of nursing, it ought to be a required topic for students in the profession. Group wellness Preparing patients for procedures, identifying those most at risk, doing sentinel surveillance, and conducting in-depth studies are all areas in which nurses can be of assistance. The goals of this paper are twofold: (1) to present the notion of genetic sequencing and (2) to highlight the role of Community health nurses. To reduce the impact of pandemics and endemics and improve nursing care, Western countries are seeing an uptick in the participation of nurse scientists in genetic sequencing;the case of newborn screening provides a particularly apt example.Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.

Health Impact Assessment of Air Pollution in India During COVID-19 Lockdown by Using Satellite Remote Sensing and Deep Learning

Air pollution produces major environmental health problems with a vast number of entropies that can affect healthy, sustainable environments across the globe. Millions of people are dying prematurely each year as a direct cause of poor air quality. According to recent studies, living within 50 meters of any significant road can increase the risk of lung cancer by up to 10%. World Health Organization declares that approximately 3.7 million people died worldwide in 2012 due to outdoor air pollution. In this analysis, we analyzed air pollutants that were released into the air from a wide range of sources, such as motor vehicles, industrial combustion processes, etc. We analyzed the Sentinel-5 precursor data, which provides time series data on a multitude of trace gaseous compounds such as CO, NO2, SO2, O3, PM10, PM2.5 aerosols, etc. with efficient statistics and special resolution. For better comparison, we have trained our statistical atmospheric data with deep learning methodology and analyzed them to obtain a reference for air quality in India. This study describes the scientific aspects and probable atmospheric composition entropy due to pollution. We also presented the overall operational product outcomes and emissions from the energy sectors, which involves the advancement of data analysis in a particular coordinate system. © 2022 Technoscience Publications. All rights reserved.

Teach less and Practice more: Flipped Learning for Nursing Education

It is essential that students and teachers work together to acquire even the most basic nursing care skills to the full extent of the Nursing Process. The nursing procedure is not something that can be learnt in a single day by any student. There were various difficulties for both learners and mentors during the COVID-19 outbreak when e-learning was used as a mode of instruction. This project was designed to efficiently address learning needs during a pandemic. In this study, baccalaureate nursing students were taught the nursing process using a flipped classroom methodology with the goal of developing knowledge and skill in the nursing process.To teach the nursing process during the covid-19 pandemic;A Flipped learning program was planned with 4 online modules to teach the nursing process. To see the effectiveness one group posttest only design was adopted for 36 students selected by consecutive sampling. The whole program was planned with an integrated pedagogy in pre-classroom, during the classroom, and post-classroom activities to attain the objective of comprehensive knowledge & skills acquisition for delivering the nursing process. Teaching for theory was done virtually with prerecorded Video-lecture, PowerPoint Presentation, Pdf. asynchronous & synchronous discussion and demonstration of procedures were done face to face in the skill lab. The final assessment was performed by a self-structured knowledge questionnaire and a practicum exa mination through OSCE in the laboratory.The result shows that students scored mean knowledge of 15.2 out of 20 with a standard deviation of 2.6 and a practice score of 9.42 out of 12 with a standard deviation of 3.1.If the pedagogy is engaging, from simple to complex, and the whole process is accompanied by self-learning material on computers, the nursing process can be made easier. Students' critical thinking and synthesizing abilities have been boosted by classroom activities. This course has provided students with the opportunity to self-learning with computers so that they can use that knowledge to improve nursing services in the future. © 2022 IEEE.

Can new education policy 2020 serve as a paradigm shift to the employability gap in India? A viewpoint

Employment and employability have lately surfaced as a significant concern for India that stands as the world's second central higher education system. The post-COVID-19 era further demanded a comprehensive policy at the national level. The Indian government approved the new education policy (NEP), bringing changes to higher education in the country on 29th July 2020. After an exhaustive reading of all education policies published in Indian literature, the authors present this viewpoint chapter, contributing to the extant literature on education policies in the following three ways. The first purpose is to evaluate and compare the current NEP 2020 to the last two educational policies of 1968 and 1986 to understand how far each policy could realize the goal of employability. The second purpose is to adumbrate the gaps between industry and academia in the proposed NEP 2020 to propose some transformative steps to fill the outlined gap. Thirdly, the main findings are depicted through a graphical representation to give some directions for future policy and research in employability. © 2022, IGI Global. All rights reserved.

SWARNA PRASHAN HAS A PRESSING NEED FOR TIME AMONG YOUNG ONES

Covid-19 calls for immunity boosters especially among children and the young generation. Ayurvedic preparations are another safer choice to build immunity naturally. Swarna Prashan is a safe ayurvedic combination that is beneficial for the normal growth and development of a child. Swarna Prashan is introducing Swarna (GOLD METAL) alone or along with herbs in the liquid form as an oral vaccine by children. Swarna Prashan is one of the samskaras in Ayurveda. Swarna Prashan is initiated from infancy till Adolescence. To review the components of swarnaprashna, clinical trials, and evidence of benefits for children. Ayurveda has deep roots for the Current and old method of introduction of Swarnaprashna among children below 16 y of age group in India. Overall results of all studies showed improved growth and development after the introduction of Swarna Prashan within a year without any side effects and a happy childhood which shows not only health but also wellbeing.

Harnessing the capability of CADD methods in the prediction of anti-COVID drug likeliness

The COVID-19 pandemic has claimed many lives and added to the social, economic, and psychological distress. The contagious disease has quickly spread to almost 200 countries following the regional outbreak in China. As the number of infected populations increases exponentially, there is a pressing demand for anti-COVID drugs and vaccines. Virtual screening provides possible leads while extensively cutting down the time and resources required for ab-initio drug design. The chapter aims to highlight the various computer-aided drug design methods to predict an anti-COVID drug molecule. © 2021, IGI Global.

Preferences for Accessing Patient Reported Outcomes and Health Information Among Thrombotic Thrombocytopenic Purpura Survivors

Introduction: Our previous qualitative studies of immune-mediated thrombotic thrombocytopenic purpura (iTTP) survivors revealed that patients did not communicate to their hematologists about residual cognitive and fatigue issues. A way to overcome this communication barrier is implementation of patient-reported outcomes (PROs) in routine care. Integration of PROs into the clinical care of other diseases has resulted in improved patient-provider communication, symptom management, quality of life and overall patient satisfaction. However, decisions about the mode of administration are challenging. Although 92% of the United States population has access to the internet, studies have shown minorities prefer alternative modes of administration. Given that iTTP disproportionately affects Black women, understanding patient preference is critical for integrating PRO instruments into routine care. The primary study goal was to determine the preferred mode of administration of PRO instruments in iTTP. Furthermore, many individuals use the internet as a source of medical information/advice. A study of iTTP literacy reported that only 34% of survivors correctly identified disease relapse risk factors suggesting a critical knowledge gap. A secondary goal was to describe iTTP survivors' behaviors regarding using the internet for medical information or support. Methods: We utilized a cross-sectional study design. iTTP survivors were recruited from August 2019 until present. Eligibility included: 1) age >18 years, 2) documented ADAMTS13 deficiency (< 10% activity) at diagnosis or during a relapse and 3) > 1-year clinical remission. Multi-center recruitment of survivors included: Oklahoma University, Ohio State University, University of Minnesota, Johns Hopkins University, University of Rochester, University of Pennsylvania, University of Alabama at Birmingham, University of Utah and the University of Vermont. Following informed consent, survivors were administered the PROMIS ® cognitive function ability, anxiety and fatigue instruments via their preferred mode (online, telephone, or self-administered). Typical internet usage, behaviors regarding searching for health information online and demographics were also obtained. Results: To date, 94 survivors have completed the study (83% female;54% White;34% Black;median age 49 years [range 26-85 years]). A majority (54%) preferred completing PROMIS ® surveys online vs. self-administered or telephone administered. However, among Black survivors, only 38% preferred online administration and among survivors aged ≥65 years only 22% preferred online administration. Interestingly, there was an overall shift in a preference toward online administration following the onset of the COVID-19 pandemic (45% (21/47) preferred online pre vs 66% (31/47) preferred online post). Ninety-one percent (86/94) of survivors reported at least occasional internet use vs 8 (9%) reported none. Similarly, 82% (70/85) had searched the internet for health/medical information for themselves in the past year. Also 62% (53/86) of the survivors selected ‘strongly agree’ or ‘agree’ to the statement that the internet helps them determine if symptoms are important enough to see a doctor. Likewise, 62% used the internet to interpret doctor's recommendations. Additionally, 47% (40/86) ‘strongly agree/agree’ the internet helped determine if they would take a medication/seek alternative treatment. Moreover, 64% (55/86) agreed the internet was a good way to find others experiencing similar health problems. However, when asked about behaviors over the past year, only 42% (36/85) used online social networking sites like Facebook to look for health information or find others with iTTP and only 36% (31/85) had actually participated in online iTTP support groups. Conclusions: Overall iTTP survivors preferred online PRO administration;however, Black and older survivors preferred other methods. Recognizing these preferences is a vital step toward integrating PROs into routine care. Furthermore, iTTP survivors are us ng the internet as a source of medical support and information. Therefore, it is critical to not only educate iTTP survivors about credible online resources but also to create additional content. Also, future studies are needed to further explore the impact of the COVID-19 pandemic on online health behaviors. Disclosures: Terrell: Sanofi: Consultancy;Takeda: Consultancy. Journeycake: HEMA Biologics: Honoraria;LFB: Honoraria. Mazepa: Answering TTP Foundation: Research Funding;Sanofi Aventis: Other. Cuker: Spark Therapeutics: Research Funding;Sanofi: Research Funding;Pfizer: Research Funding;Takeda: Research Funding;Novo Nordisk: Research Funding;Novartis: Research Funding;Bayer: Research Funding;Alexion: Research Funding;UpToDate: Patents & Royalties;Synergy: Consultancy. Chaturvedi: Dova: Other: Advisory board member;UCB: Other: Advisory board participation;Argenx: Other: Advisory board member;Alexion: Other: Advisory board member;Sanofi Genzyme: Other: Advisory board member. Lim: Hema Biologics: Honoraria;Sanofi Genzyme: Honoraria;Dova Pharmaceuticals: Honoraria. Gangaraju: Alexion: Consultancy;Sanofi Genzyme: Consultancy. Cataland: Alexion: Consultancy, Research Funding;Sanofi Genzyme: Consultancy;Ablynx/Sanofi: Consultancy, Research Funding;Takeda: Consultancy.

Global impact of the COVID-19 pandemic on stroke care and intravenous thrombolysis

Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods. Background: The COVID-19 pandemic led to widespread repercussions on the delivery of health care worldwide. Design/Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by ICD-10 codes and/or classifications in stroke center databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI,-11.7 to-11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI,-13.8 to-12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI,-13.7 to-10.3, p=0.001). There were greater declines in primary compared to comprehensive stroke centers (CSC) for stroke hospitalizations (-17.3% vs-10.3%, p<0.0001) and IVT (-15.5% vs-12.6%, p=0.0001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) months of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and CSC. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months, with greater recovery in hospitals with lower COVID-19 hospitalizations, high volume stroke centers, and CSCs.

Alveolar Air Leak Syndrome a Potential Complication of COVID- 19-ARDS - Single Center Retrospective Analysis

Background: Alveolar air leak comprising of pneumothorax, pneumomediastinum, and subcutaneous emphysema in the ongoing COVID 19 pneumonia have been increasingly reported in literature. These air leaks were also recognized in the severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and H1N1 viral pandemics. Here we review the incidence and outcomes of alveolar air leaks over 400 patients admitted to our tertiary care institution for moderate-severe COVID-19 pneumonia. Methods: We performed a retrospective audit of moderate to severe COVID-19 cases admitted to our hospital. Patients who were recognized as either a spontaneous pneumothorax, pneumomediastinum, pneumopericardium and subcutaneous emphysema were identified. Their clinical features and characteristics were thoroughly documented and clinical outcomes were gathered. Each case has been presented as a brief synopsis. Results: During the audit period, we reviewed over 670 patients, out of these 419 patients required intensive care for moderate to severe disease. 10 patients developed Pneumothorax, pneumomediastinum, pneumopericardium and/ or subcutaneous emphysema - referred to as Alveolar Air leak syndrome;The incidence of alveolar air leak was found to be 2.39%. 6 patients did not survive the resultant complication. Conclusion: Spontaneous alveolar air leaks are a rare but definite complication of COVID-19 viral pneumonia and may occur in the absence of mechanical ventilation. ICU Clinicians must be alert about the diagnosis and treatment of this complication.

Effective Teaching Practices for Success During COVID 19 Pandemic: Towards Phygital Learning

Following the outbreak of COVID 19 in February 2020, Indian universities were shut down and used digital platforms to teach their students since then. Drawing from Kolb’s Learning Theory, John Dewey’s theory, Jack Mezirows transformative learning theory, and Jean Piaget’s theory, the authors in this paper offer a viewpoint on some of the practical teaching practices which can be adapted in business schools in India to be successful in this emerging blended or phygital environment. Using a Community of Inquiry (CoI) framework, the authors reflect on the effective teaching practices based on their own experience, theoretical knowledge gained from an exhaustive web search of various databases of the period, particularly from February to August 2020. The authors performed a careful manual content analysis of the selected research papers. They concluded seven principal teaching methods to create an effective blended environment for students and faculties in Indian business schools: a) reframing virtual spaces in India through online knowledge repository and virtual labs b) using reflective thinking for andragogical and pedagogical Indian approach c) Indian teachers’ readiness to offer various genres of courses on demand d) reinforcing resilience in Indian schools through meaningful participation and conflict resolution e) purposeful learning and inquiry-based learning for Indian students f) experiential learning through an inclusive online pivot in India g) useful apps are discussed to reach out to Indian parents community. These initiatives can influence academicians, educationists, podcasters, and the entire teacher fraternity to design an efficient and adequate teaching plan for the student community in India. © Copyright © 2021 Chaturvedi, Purohit and Verma.

The impact of comorbidities on clinical course and outcome, in kidney transplant recipients with COVID-19: A systematic review and analysis

Background: The literature on the impact of comorbidities on the severity and outcome of COVID-19 in kidney transplant patients is limited. We aimed to review the same. Methods: We conducted this review as per Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. PUBMED, Embase, Scopus, and Science Direct were searched for studies, available online till May 31, 2020. Studies reporting comorbidities, clinical course, and outcome of each kidney transplant patient with COVID-19 were included. Studies on any other organ transplant, recommendations, or review articles were excluded. The impact of comorbidities on severity and outcome was assessed. The study appraisal was done using Joanna Briggs Institute Critical Appraisal Checklist. Continuous variables were compared using Mann-Whitney U-test. Categorical variables were compared using Fisher's exact test. A univariate and multivariate logistic regression for predictors of severity and outcome, was done. P < 0.05 was considered statistically significant. The study protocol was registered with PROSPERO (CRD42020190114). Results: We analyzed 19 studies (56 patients) out of the 355 identified. The most common comorbidity was hypertension (83.92%). Nearly 30.35% of the patients had severe clinical course. The mortality rate was 19.64%. Advanced age was statistically significantly associated with severe course (P = 0.0173) and death (P = 0.0005). Men were more likely to have nonsevere course (P < 0.0001). No comorbidity had any impact on the severity or outcome. Patients with severe disease had higher odds of dying (P = 0.002). Conclusions: Comorbidities were not found to have any significant impact, hence the contribution of immunosuppression toward the severity of COVID-19 needs to be studied. Ours is the first review to assess the impact of comorbidities in kidney transplant patients with COVID-19 but limited by the number of patients.