Pathophysiology of thromboembolism in patients with COVID-19

Introduction and aim. A small number of critically ill patients with coronavirus disease (COVID-19) develop thromboembolism (arterial or venous), both micro- and macrovascular complications such as deep vein thrombosis, pulmonary embolism, and pulmonary arterial thrombosis. The objective of the study is to describe the pathophysiology of venous thromboembolism in patients with COVID-19. Material and methods. In this article a narrative review regarding pathophysiology of thromboembolism in patients with COVID-19. Analysis of the literature. The development of coagulopathy is a consequence of the intense inflammatory response associated with hypercoagulability, platelet activation, and endothelial dysfunction. The pathophysiology that relates pulmonary thromboembolism (PTE) with COVID-19 is associated with a hypercoagulable state. PTE is suspected in hospitalized patients presenting dyspnea, decreased oxygen requirement, hemodynamic instability, and dissociation between hemodynamic and respiratory changes. In COVID-19-associated coagulopathy, initially, patients present with elevated levels of fibrinogen and D-dimer, with minimal changes in prothrombin time and platelet count. The main risk factor for the development of pulmonary embolism is the increase in D-dimer that is associated with the development of PTE. The administration of iodine-based contrast agent to patients with COVID-19 would affect P-creatinine and renal function, where Ultrasound is viewed as cost-effective and highly portable, can be performed at the bedside. Conclusion. Acute respiratory distress syndrome severity in patients with COVID-19 can explain PTE as a consequence of an exaggerated immune response. © 2022 Publishing Office of the University of Rzeszow. All Rights Reserved.

Use of novel oxygenated right ventricular assist device hybrid ECLS for adolescents with refractory hypoxemic respiratory dailure due to Covid-19 pneumonia

Objectives: To describe institutional experience using Oxygenated Right Ventricular Assist Device (OxyRVAD) Hybrid ECLS for adolescents with respiratory failure due to SARS-CoV-2 pneumonia. Method(s): Between September and December 2021, 44 Covid-19+ patients were admitted to our regional Pediatric Intensive Care Unit (PICU), including 4 adolescents who required Extracorporeal life support (ECLS) due to refractory hypoxemia. Two patients were initially cannulated onto Veno-Venous (VV) ECLS and converted to Oxy-RVAD ECLS due to refractory hypoxemia;the others were cannulated directly onto Oxy-RVAD ECLS. Two patients had observed right ventricular (RV) dysfunction or failure on echocardiography. Cannulations were performed in the cardiac catheterization suite by an interventional cardiologist using percutaneous technique under fluoroscopy. Circuit construction was varied and included the use of a dedicated RVAD cannula or standard cannula used for VA/VV ECLS. All patients were connected to Cardiohelp systems with built in centrifugal pumps and oxygenators. Result(s): Two patients were initially placed on VV-ECLS and converted to Oxy-RVAD ECLS days into their course due to severe, refractory hypoxemia with one having improvement in hypoxemia after the conversion. Two patients received renal replacement therapy (RRT) without complications, the others did not have indications for renal support. Two patients underwent tracheostomy on ECMO though none were able to separate from mechanical ventilation. Three patients survived to discharge. No incidents of circuit air or clotting were noted. The patient with the longest ECLS run required one circuit change and was the only patient to develop a superinfection: a successfully-treated fungal infection. All patients were mobilized on ECLS to sitting in a chair;one was able to ambulate. Conclusion(s): Oxy-RVAD hybrid ECLS can be used to effectively support adolescents with severe respiratory disease from conditions associated with RV dysfunction. Pediatric providers can collaborate with adult critical care colleagues to use novel methods to support these patients. RRT can also be used with this circuit. While more experience and data on this modality is needed, Oxy-RVAD ECLS should be considered in patients with severe RV dysfunction and associated refractory hypoxemia. (Figure Presented).

A Range of Informality Across Cities and Slums: Understanding Precarity in Patna's Slums Before and During the COVID-19 Pandemic

This article proposes a framework for understanding why slum residents are particularly vulnerable to economic downturns. We centre evidence from Bihar's capital city, Patna, to examine how downturns are experienced more severely in some cities and slums than others. We argue slums are zones of pervasive informality, remaining largely disconnected from formal institutions and dependent on discretionary supports. But the extent of informality, and vulnerability, varies within and across cities. Relative to those in the cities we compare to, Patna's slum residents are poorer, less upwardly mobile and have weaker property rights and shallower institutional connections. We argue this makes them particularly vulnerable to downward shocks and we present evidence from the case of the coronavirus pandemic to show that they experienced this disaster particularly severely. Our results have important policy implications: in general, slum residents require greater policy and institutional support, but there is important variation in their vulnerability and needs within and across cities. Moreover, while most research on slums focuses on mega- and first-tier cities, we emphasize the urgent need for more attention to second- and third-tier cities—where the degree of informality, and consequently, the vulnerability to downward spirals, can be greater. © 2023 The Author(s).

Use of Novel Oxygenated Right Ventricular Assist Device Hybrid ECLS for Adolescents with Refractory Hypoxemic Respiratory Failure due to Covid-19 Pneumonia

Objective: To describe institutional experience using Oxygenated Right Ventricular Assist Device Oxy-RVAD) Hybrid ECLS for adolescents with respiratory failure due to SARS-CoV-2 pneumonia. Method(s): Between September and December 2021, 44 Covid-19+ patients were admitted to our regional Pediatric Intensive Care Unit (PICU) including 4 adolescents who required Extracorporeal life support (ECLS) due to refractory hypoxemia. Two patients were initially cannulated onto Veno-Venous (VV) ECLS and converted to Oxy-RVAD ECLS due to refractory hypoxemia;the others were cannulated directly onto Oxy-RVAD ECLS. Two patients had observed right ventricular dysfunction (RV) or failure on echocardiography. Cannulations were performed in the cardiac catheterization suite by an interventional cardiologist using percutaneous technique under fluoroscopy. Circuit construction was varied and included the use of a dedicated RVAD cannula or standard cannula used for VA/VV ECLS. All patients were connected to CardiohelpTM systems with built-in centrifugal pumps and oxygenators. Result(s): Two patients were initially placed on VV-ECLS and converted to Oxy-RVAD ECLS days into their course due to severe, refractory hypoxemia with one having improvement in hypoxemia after the conversion. Two patients were cannulated directly to Oxy-RVAD ECLS support. Two patients received renal replacement therapy (RRT) without complications, the others did not have indications for renal support. Two patients underwent tracheostomy on ECMO though none were able to separate from mechanical ventilation. Three patients survived to discharge. No incidents of circuit air or clotting were noted. The patient with the longest ECLS run required one circuit change and was the only patient to develop a superinfection: a successfully-treated fungal infection. All patients were mobilized on ECLS to sitting in a chair;one was able to ambulate. Conclusion(s): Oxy-RVAD hybrid ECLS can be used to effectively support adolescents with severe respiratory disease from conditions associated with RV dysfunction. Pediatric providers can collaborate with adult-focused colleagues to use novel methods to support these patients. RRT can also be used with this circuit. While more experience and data on this modality is needed, Oxy-RVAD ECLS should be considered in patients with severe RV dysfunction and associated refractory hypoxemia.

The impact of Covid-19 on household poverty: examining impacts and resilience in a 40-year timeframe in rural Rajasthan (India)

To what extent has chronic poverty increased during the pandemic? In July and August 2021, we revisited seven villages of southern Rajasthan (India), where we had studied household poverty dynamics in 2002. We find that in the two decades before the pandemic (2002–2020), people's structural positions improved vastly, chronic poverty fell from nearly half to less than 20% of households. These gains in resilience helped people cope with the pandemic. The majority suffered deep income losses between February 2020 and August 2021, but there is no evidence of any substantive rise in chronic poverty. © 2023 Oxford Department of International Development.

Plug & Play Device for Hybrid Smart Classroom: A Prototype Development

The demand for a smart classroom has been compounded by Covid-19, which allows students to have a meaningful learning experience while staying home. Students who join a classroom in online mode don't have the opportunity to experience a classroom setting because of the hybrid mode of teaching (both online and offline classes). As a result, they have problems such as not being able to see the board clearly, not being able to follow the lecturer because he or she is out of frame, and thus having difficulty learning. Furthermore, this results in lower interaction between the online students and the professor. To teach effectively, the professor is unable to use the entire length of the board as it would not be visible to students joining in online mode. As students and instructors, we identified the issue and developed a plug-and-play device which is portable to address the aforesaid problem during this testing and difficult period of time of the pandemic. The paper outlines the practical implementation of a plug-and-play device that meets the aforementioned requirements. The model also considers power usage, as it can dynamically control energy-consuming resources such as lighting and air conditioning in response to the environment and the presence of students. © 2022 IEEE.

Plug-and-Play Oxygen Auto-flow Regulator for Low Flow Oxygen Therapy: A Prototype Development

COVID-19 has exacerbated the need for viewing medical oxygen as a precious drug and thus work towards its conservation which ensures optimal supply to the patient. This paper describes the practical implementation of a 'plug-and-play' automatic oxygen flow-rate controller for clinical use suitable for low-flow oxygen therapy. A microcontroller based electronic controller drives the extent of opening/closing of a proportional valve in line with the clinical oxygen supply line. The controller output is based on the pulse oximeter readings and the mode of operation chosen by the caregiver. It controls the oxygen flow-rate with an accuracy of 0.1 liters per minute (LPM) around the desired flow-rate. In the automatic mode, The flow-regulator is programmed through the control algorithm to enhance oxygen conservation. To ensure patient comfort, sudden changes in flow-rate are avoided and the rate of change of flow-rate is capped at 1 LPM per minute. © 2022 IEEE.

Impact of Covid-19 Disease on Health Care Services of Leprosy Patients Attending a Tertiary Care Centre, Telangana

Covid-19 disease was declared as a pandemic by World Health Organization in March 2020. Subsequently, a nationwide lock down for variable intensity and periods was announced in India to contain the disease. Leprosy patients faced difficulties during this pandemic owing to their long-term health care requirements and lack of access to leprosy services during covid time. This resulted in deprivation of multi-drug therapy (MDT), steroids and other drugs to leprosy patients, which is detrimental to the patients as well as to the society. This study was conducted to analyze the impact of covid-19 pandemic induced lock downs and movement restrictions on leprosy patients attending a tertiary care centre. This provides data to assess their impact on leprosy healthcare services. The study observed a marked decrease in the number of leprosy patients attending the leprosy out patient care and also a reduction in the number of new cases registered during the year 2020. Quarterly analysis showed maximum reduction of cases occurring during the lockdown period and peak covid-19 infection periods. As there is a likelihood of this pandemic continuing and similar other disruptions may occur again, there is a need to assure that MDT and health care services reach leprosy patients by various other means. Some of the modifications can be a) supplying a 3 to 6 month course at a time as A-MDT, b) home delivery of drugs by health workers c) promotion of telemedicine services for leprosy patients d) optimal utilization of social media to educate and counsel leprosy patients on both covid-19 and leprosy. It is also important that leprosy clinics and drug delivery services should be continued both in Covid and Non-covid hospitals at par with Revised National TB Control Programe (RNTPC) renamed as National Tuberculosis Elimination Programme (NTEP) and Anti-Retroviral Treatment (ART) services. © Hind Kusht Nivaran Sangh, New Delhi.

Reinfection of SARS-CoV-2 in kidney transplant recipient

Coronavirus disease-2019 (COVID-19) which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported from Wuhan, China, and later became a pandemic. While infection is very common, reinfection with SARS-CoV-2 is rare because immune responses from past infection reduce the risk of reinfection. In this report, we describe the case of a kidney transplant recipient who was reinfected with SARS-CoV-2 after successfully recovering from moderate COVID-19, 6 months ago. The first infection occurred in September 2020 while the reinfection occurred in April 2021. Our case highlights that kidney transplant recipients can be reinfected with COVID-19, and therefore, recovery from a primary infection should not be taken as license to shun COVID-related precautions. The disease severity, clinical course, and outcome of reinfection may be different from the first infection.

Application of a Non-Linear multi-model Ayurveda Intervention in elderly COVID-19 patients- a retrospective case series.

The COVID-19 pandemic is ravaging the world, leaving the mainstream medical system handicapped with no proven treatment at one end and the ambiguities regarding the efficacies of vaccines at the other. The elderly population is at greater risk in terms of complications and death. The use of complementary and alternative medicine (CAM) against COVID-19 has already been documented in countries like China with a national participation rate of 90%. In this regard, the practice of CAM especially Ayurveda is relevant in India. The current report is a case series of 64 elderly COVID-19 patients managed through a Non-Linear multi-modal Ayurveda Intervention (NLMAI) via online consultation. NLMAI is a combination of herbal and herbo-mineral drug interventions, lifestyle modifications, and psychological support done in 2 phases. The post-management analysis revealed a mean duration of 11 symptoms of COVID-19 assessed through survival function as 0.577 days [SE=0.39] with a CI of 95% [0.500-0.653] which was considerably low when compared to global statistics. Moreover, none of the cases advanced to complications or death. Hence, novel approaches like NLMAI can be utilized to counter the gravity of the COVID-19 after scientific validation.

COVID-19 Article Classification Using Word-Embedding and Extreme Learning Machine with Various Kernels

The impact of the COVID-19 pandemic on the socially networked world cannot be understated. Entire industries need the latest information from across the globe at the earliest possible. The business world needs to cope with a very volatile market due to the pandemic. Businesses need to be swift in sensing potential profit opportunities and be updated on the changing consumer demands. Technological advances and medical procedures that successfully deal with COVID-19 can help save lives on the other side of the world. This seamless passage of crucial information, now more than ever, is only possible through the networked world. There are on average 821 articles published online on COVID-19 a day. Manually going through around 800 articles in a day is not feasible and highly time-consuming. This can prevent the industries and businesses from getting to the relevant information in time. We can optimize this task by applying machine learning techniques. In this work, six different word embedding techniques have been applied to the title and content of the articles to get an n-dimensional vector. These vectors are inputs for article classification models that employ Extreme Learning Machine (ELM) with linear, sigmoid, polynomial, and radial basis function kernels to train these models. We have also used feature selection techniques like the Analysis of Variance (ANOVA) test and Principal Component Analysis (PCA) to optimize the models. These models help to filter out relevant articles and speed up the process of getting crucial information to stay ahead of the competition and be the first to exploit new market opportunities. The experimental results highlight that the usage of word embedding techniques, feature selection techniques, and different ELM kernels help improve the accuracy of article classification. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Appropriate Screen Time Use to Prevent Speech and Language Delay in Toddlers during the Covid-19 Pandemic: A Brief Report

With the COVID-19 lockdown and other limitations, screen time has increased for everyone, even young children. Children’s screen use has a deleterious influence on a variety of cognitive functions, including language delay. Various Paediatrics organizations have noticed these harmful impacts, and suggestions for parents were released to limit screen usage. These agencies have provided suggestions on the duration of screen usage for specific age groups. This study tries to address screen time from a qualitative standpoint. Suggestions for successful ways to participate in screen time are presented. Interactive screen time, including co-viewing and enough language engagement, may assist to mitigate the negative effects of screen time on language development. The screen has its own restrictions and several severe repercussions if they are exceeded. As a result, wherever feasible, screen time should be avoided, and language-rich quality time with children should be prioritized. © 2022, Vrije University. All rights reserved.

POS-162 'COLA COLOURED URINE' : NOT ALWAYS GLOMERULAR HEMATURIA

Introduction: Hematuria is a common condition for which a patient seeks nephrology consultation. The presence of gross hematuria is a frightening experience for patient. The reasons for this gross hematuria can be various like nephrolithiasis, malignancies, glomerular diseases, trauma, urinary tract infections, drugs, hemoglobinuria, etc. To differentiate between the various causes of gross hematuria one must begin by taking good history and clinical examination, followed by urine examination and then other tests. Glomerular hematuria is smoky or cola coloured and is usually accompanied by signs and symptoms of fluid overload, high blood pressure, and proteinuria. However cola coloured urine should not be considered synonymous with glomerular hematuria Methods: We report a case of 22 year old pregnant female who was Gravida-3 (22 weeks gestation) but no live issues. Her previous 2 pregnancies ended up in Intra Uterine Death (IUD) of foetus at 6 months gestation. She was referred to us in view of history of cola coloured urine. History of similar episodes of hematuria in previous 2 pregnancies were also present.The history taking was limited because of the prevailing 2ndpeak of COVID-19 pandemic in India and hence most history taking was done indirectly via phone. Clinically she had mild pedal edema and her BP was 110/70 mm of Hg. Her workup showed that she had severe anaemia. Her Complete Blood Count showed Hb-5.8 gm/dL,TLC-3600/mm3,Plt-1.64lakh/mm3,PBS-Microcytic hypochromic with target cells. Renal function was normal. Liver function showed mild indirect hyperbilirubinemia. Urinalysis showed 3+ protein, 50-60 RBCs, 5-10 Pus cell, No casts. Urine culture was sterile. 24 hour urine protein was 1.29 grams. Ultrasonography-bilateral normal sized kidneys. Her COVID-19 RTPCR was negative Results: Differentials we considered were : Primary Glomerulonephritis;Pregnancy Induced Hypertension (PIH);Anti-Phospholipid Antibody Syndrome (APLA) & Atypical Hemolytic Uremic Syndrome (a-HUS). These were ruled out based on further relevant tests.Kidney biopsy was not offered as there was no nephrotic syndrome. Anti-Nuclear Antigen was negative. Complements were normal. APLA antibodies were negative.BP was always normal making PIH less likely. However LDH was raised (2700 U/L) & serum haptoglobulin was low. So a clear cut evidence of hemolytic anaemia but normal renal function, compelled us to revisit the history by calling the patient in-person despite the pandemic. She admitted that anaemia was present since her childhood days and she had suppressed this history due to social issues. Also the hematuria was episodic with clear urine in between. Hence Flowcytometry for Paroxysmal Nocturnal Hemoglobinuria was done which confirmed the diagnosis as PNH. Conclusions: Our case report highlights the fact that while evaluating cases of hematuria one must keep all possibilities open. Especially when dealing with cola coloured urine it should not be assumed to be glomerular hematuria It also stresses the well established fact that history taking is the key to making any diagnosis. In situations where social factors may lead to suppression of facts,efforts must be made to gain the confidence of patient and provide a conducive environment for complete history. Finally, even after diagnosis of PNH, the definitive treatment is still out of reach for many patients in this part of world. No conflict of interest

A Novel Framework for Facemask Detection Using R-Convolution Neural Network

Covid-19 virus has changed the total life style of human beings. This coivd-19 started in the country china and spread all over the world. World health organization (WHO) suggested the face masks to be covered which can reduce the spread of corona virus. All countries made it compulsory to wear masks to cut-off the covid spread. Hence detection of wearing masks or not has become an important area to work on for computer vision. Many woks are being done on face mask detection, but mostly basis on the classification of mask and no-mask. Here in this paper. a novel approach is proposed which not only classifies mask and no-mask people, but also identifies whether a mask is properly covered or not. Thus in this paper use of R-CNN (Convolution Neural Network) is proposed which results to achieve an accuracy up to 0.93. © 2021 IEEE.

Supportive therapy: An option to enhance host immunity against COVID-19

The threat posed by COVID 19 outbreak, which is considered to be a global pandemic, is immeasurably affecting all the communities worldwide. COVID-19 is a zoonotic disease, which can affect birds, humans and, other animals. The emergence of this pandemic has been creating a tragic situation worldwide by affecting more people through human-human transmission. The burden (both healthwise and economic) placed by the disease is so huge that any measures to improve the current situation, to fasten up the recovery of already affected patients and, to reduce the risk of death and health deterioration should be considered. Vaccination, being the hope in the scenario, helps in preventing the condition to an extent, but in the absence of availability of a proper drug regimen to fight off COVID 19, the requirement of the need to find a system to control the severity of the infection is a necessity Nutritional supplementation helps in boosting up the immune system especially, vitamins like vitamin C, Vitamin D, Zinc, Omega 3 fatty acids, etc. They also exhibit established immunomodulatory, antiviral as well as anti-inflammatory effects. Pieces of evidence have also highlighted the importance of supportive therapy using nutrient supplements in covid patients as it helps in prominent decreasing of SARS CoV2 load of the virus and also significantly reduces the hospitalization period. Hence the nutritional levels of each of the infected person must be assessed before initiating the anti-viral therapy. The search criteria used were PubMed, Medscape, google scholar, etc. The keywords used to search were COVID 19 Supportive therapy, Vitamin D, Vitamin C, Nutrient supplementation, Host immunity, etc. The range of years is between 1978 and 2021. © 2021 The Authors. Published by Innovare Academic Sciences Pvt Ltd.

Detection of COVID-19 by X-rays Using Machine Learning and Deep Learning Models

In India, test for COVID-19 is very expensive and not everybody can afford it. This document provides knowledge and awareness to the reader on COVID-19 screening of a person using radio chest x-ray images. Here Machine Learning and Deep Learning algorithms like CNN and max-pooling are used. These algorithms identifies different features in the images and help us to distinguish between a COVID-19 and non COVID-19 chest X-ray. This paper also describes the data set of COVID19 open image X-rays.It was created by collecting medical images from websites and publications. Our model accuracy is following a trend of greater than 95% on every run time. Machine learning models can’t have 100% accuracy and hence, this is the best one can get. © 2021, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Detection of covid-19 patients using chest x-ray images with convolution neural network and mobile net

In the year 2020, a novel corona virus has emerged as a very pandemic disease which affects the public health throughout the world. It has become necessary to screen large number people to identify the infected ones and reduce the spread of disease. A real time PCR (polymerise chain reaction) is a standard tool for diagnosis for pathological testing. There are failure cases for this tool as it gives more false test results which make path to look for alternate tool. Chest x-rays is a better alternative for PCR for COVID-19 screening. But here accuracy of results matters a lot.Here a diagnosis recommender system for examining lung images is proposed which can assist the doctors and reduce the burden over them. Deep neural network technique CNN (convolution neural network)is used for achieving best accuracy results. © 2020 IEEE.