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Introduction: Peripartum women are at increased risk for severe illness with coronavirus disease (Covid-19) infection. Recent medical literature has drawn attention to the possible influence of COVID-19 on the course of pregnancies and its long-term effects.1-5 Objective: This case series aimed to observe the clinical course of peripartum women with confirmed Covid-19 admitted to a critical care unit in the North-west of England. Method(s): Since the start of the pandemic, all pregnant women with Covid-19 infection admitted to the critical care unit were monitored and followed up. Demographic profile, medical co-morbidities, treatment received, respiratory support and vaccination status were noted. Result(s): From March 2020 until February 2022, 8 women in our practice were shifted to the critical care unit post-partum in view of worsening work of breathing & increasing oxygen requirement after initial management in the delivery suite. All admissions were during the 3rd wave of the pandemic in the UK, between June to October 2021. 5 patients underwent Caesarean section under spinal anesthesia & 3 were shifted post normal vaginal delivery. Mean age in the study population was 33.25 years (SD +/- 3.99) and mean length of stay in the ICU was 6.62 days (SD +/- 3.99). Only one woman required intubation & mechanical ventilation for 10 days and the rest were managed on High Flow Nasal Cannula (HFNC) or Continuous Positive Airway Pressure (CPAP) hood and self-proning manoeuvres. 50% of the patients received Tocilizumab. All women were discharged home and there were no maternal deaths. Pre- admission none of the women were vaccinated, but on follow up 5 out of the 8 had completed their vaccination. All women were emotionally distraught due to being isolated from their family and new born. When reviewed at 12 weeks, one patient experienced post traumatic stress disorder (PTSD) and one had features of long Covid syndrome. On follow up, all new born babies were doing well. Conclusion(s): From the limited amount of data available, psychological stress was common to all patients. Being isolated from their new-born and family was the most difficult emotional aspect for the mothers in addition to finding it difficult to breathe and uncertainty about the future. Most mothers and new-born babies were discharged from the hospital without any serious complications. However, further observation and long term follow up is imperative. Use of guidelines in peripartum patients will aid in appropriate escalation of care. Key words: COVID-19, Pregnancy, Peri-partum, Long Covid syndrome.
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Online platforms are being utilized effectively for sharing the knowledge and imparting education. The affordability of the mobiles, laptops or other devices is a major problem for the weaker section of the society. Engineering branches like mechanical, civil and electrical are most severely affected in this lockdown. Chemical engineering is an interdisciplinary area of engineering. It include many interdisciplinary subjects such as thermodynamics, fluid mechanics and heat transfer. Performing the practical to validate the estimates from models or formulae is very important aspect of experimental analysis. Also, students are not able to perform the project work physically. Project work contains the application of all the subjects learned until the final year for identifying, quantifying, modelling and solving industrial and societal problems. Stakeholders in engineering education like students, teachers, parents, managements have been affected adversely due to the lockdown. This chapter provides an insight into these effects. Also this chapter provides a pre-COVID-19 e-learning scenario in developing countries, especially India and post-COVID-19 developments that have taken place in this digital education. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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Aim: To evaluate the knowledge and attitude of dentists toward geriatric dental care during the coronavirus 2019 (COVID-19) pandemic. Materials and methods: An online questionnaire survey was conducted among a self-selected sample of dentists from different parts of India. The first part of the questionnaire comprised 12 items that collected information regarding knowledge, and the second part comprised 14 items that assessed the attitude of participants toward geriatric dental care during the COVID-19 pandemic. Results: Evaluating knowledge–65% of participants were aware of guidelines by the Ministry of Health and Family Welfare (MOHFW) for dentists that should be practiced during the COVID-19 pandemic, and 93.6% were aware of post-COVID complications present in older adults after recovering from the acute phase of the disease. Evaluating attitude: A total of 69.8% of them found it difficult to deliver dental care to geriatric patients after following all the COVID-19 practice guidelines, and 97.1% of participants were willing to treat a post-COVID older adult in the dental clinic. Conclusion: A total of 69.8% of them found it difficult to deliver dental care to geriatric patients after following all the COVID-19 practice guidelines. Around 31.4% of dentists were not aware of the precautions to be taken to treat older adults with post-COVID complications. Hence there is a need for further studies on post-COVID complications and guidelines for treating the elderly during the pandemic. Clinical significance: As a consequence of newly emerged barriers and post-COVID complications, much poorer oral health outcomes might occur among geriatric patients in the near future. Hence it is important to understand the knowledge and attitude of dentists towards geriatric dental care in order to equip the already small workforce interested in geriatric oral health care. © The Author(s). 2023.
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Background: COVID-19 vaccine booster uptake remains low and preventable COVID-19 deaths continue to occur, making access to oral antivirals for those most at risk of severe COVID-19 outcomes essential. Method(s): We estimated age and gender adjusted prevalence ratios of oral nirmatrelvir-ritonavir (NMV/r) uptake by sociodemographics, clinical characteristics, and prescription eligibility (based on age, underlying medical conditions, body mass index, physical inactivity, pregnancy, or smokers), among participants in a large U.S. national prospective cohort who were infected with SARS-CoV-2 between December 2021 and October 2022. Among participants who reported NMV/r uptake, we also described the proportion who reported (1) taking NMV/r as directed and (2) NMV/r was helpful for reducing COVID-19 symptoms. Result(s): Among 1,594 participants with a SARS-CoV-2 infection as of October 2022, 1,356 were eligible for NMV/r prescription;of whom 209 (15.4% [95%CI:13.5-17.3]) reported receiving NMV/r. NMV/r uptake increased from 2.2% (95%CI:1.0-3.4) between December 2021 and March 2022 to 16.5% (95% CI:13.0-20.0) between April and July 2022 and 28.6% (95%CI:24.4-32.8) between August and October 2022, respectively. Participants >=65 years of age reported the highest uptake of NMV/r (30.2% [95%CI:22.2-38.2]). Black non-Hispanic participants (7.2% [95%CI:2.4-12.0]) and those in the lowest income group (10.6% [95%CI:7.3-13.8]) had lower uptake than white non-Hispanic (15.8% [95%CI:13.6-18.0]) and high-income individuals (18.4% [95%CI:15.2-21.7]), respectively. Participants with type 2 diabetes had greater uptake (28.8% [95%CI:20.4-37.3]), compared to those without it (12.4% [95%CI:4.8-20.0]). Among a subset of 278 participants who had a prior SARSCoV-2 infection, those who had a history of long COVID reported greater uptake (22.0% [95%CI:13.9-30.1]) for a subsequent SARS-CoV-2 infection than those without a history of long COVID (7.9% [95%CI:3.9-11.8]). Among all participants who were prescribed NMV/r (N=216), 89% (95%CI:85-93) reported that they took NMV/r as directed and 63% (95%CI:57-70) stated NMV/r was helpful for reducing COVID-19 symptoms. Conclusion(s): Uptake of NMV/r increased over time coinciding with national efforts to increase awareness and access. However, most individuals who were eligible for NMV/r did not receive it. Lower NMV/r uptake among racial/ethnic minorities and individuals with lower household income suggests a need to improve awareness and address barriers to uptake in these populations.
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Background: Infection with SARS-CoV-2 triggers reprogramming through global transcriptomic changes that drive the development of Coronavirus disease 2019 (COVID-19). Although the expression and functions of proteincoding transcripts have been widely studied in SARS-CoV-2 infection, most of the transcriptome consists of non-protein-coding RNAs (ncRNAs). Long noncoding RNAs (lncRNAs), which constitute a large proportion of the transcriptome, regulate immune responses and play prominent roles in health and disease. However, the impact of lncRNAs on SARS-CoV-2 infection is poorly understood. Our study will provide fundamental insights into the role of lncRNAs in SARS-CoV-2 infection. Method(s): We hypothesized that SARS-CoV-2-induced lncRNAs are critical regulators of viral replication and immune response. To test our hypothesis, we identified lncRNAs with significant differential expression in SARS-CoV-2 infected vs. uninfected cells across two cell types (A549-hACE2 and Calu) from published transcriptome data. We silenced the expression of the top lncRNA Bre- AS1 (BA) a human lung epithelial cell model (A549 cells stably expressing hACE2 and hTMPRSS2, A549AT) using lncRNA-specific ASO (lncsi) or negative control (NC) and compared viral replication in lncsi vs. NC cells. BA-silencing (BA-si) increased SARS-CoV-2 replication. and inhibited the expression of antiviral interferon-stimulated genes (ISG). (Tyr 705) pSTAT3 forms suppressor molecular complexes (pSTAT3-pSTAT1 or pSTAT3-PLSCR2) that inhibit ISG transcription. Using molecular methods such as gene-silencing, immunoprecipitation, western blot, and measuring promoter activity, we further show that Bre-AS1 inhibits the phosphorylation of STAT3 and enhances ISG transcription. Result(s): Our data show that cellular lncRNA, Bre-AS1 enhances antiviral interferon-stimulated genes (ISG) expression and inhibits replication of SARSCoV- 2. Our data show that Bre-AS1 inhibits the (Tyr705) phosphorylation of STAT3 that forms ISG repressor complexes (pSTAT3-pSTAT1 or pSTAT3-PLSCR2) and thus enhances ISG transcription. Conclusion(s): Cellular lncRNA Bre-AS1 enhances expression of antiviral interferon-stimulated genes and inhibits the replication of SARS-CoV-2. Our data show that cellular lncRNAs could play significant roles in immune response and viral propagation. Thus, unraveling the mechanisms of lncRNA-mediated regulation of virus replication and immune response may lead to identifying new, highly selective therapeutic targets Bre-AS1 inhibits STAT3 phosphorylation and enhances ISG transcription.
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Background: Diabetes Mellitus (DM) and hyperglycaemia (HG) have been identified as risk factors for morbidity and mortality in coronavirus disease 19 (COVID-19) infection. However, a detailed study of various categories of HG and the impacts and characteristics of each of these on COVID-19 was considered important to address this metabolic disorder in COVID-19. Aim(s): This study aimed to describe the patterns of HG and its impact on the clinical outcomes in hospitalised patients with COVID-19 infection. Methodology: Data on 1000 consecutive patients with COVID-19 were analysed using Statistical Package for Social Sciences (SPSS) version 20.0 software (SPSS Inc., Chicago, IL, USA). Result(s): A total of 1000 patients were included for analysis The overall mean age of the study group was 52.77 + 19.71 with 636 (63.6%) male patients;261 had mild, 317 moderate, and 422 severe infections;and 601 had HG (New-onset DM 66, known DM 386, steroid-induced HG 133 and stress HG 16). The HG group has significantly higher levels of inflammatory markers and worse outcomes. Blood glucose levels were higher in patients with known DM. The ROC cut-off of total steroids to predict mortality in the HG group was 84 mg versus 60 mg in the normoglycaemia group. The ROC cut-off of FBS to predict mortality in the overall HG group was 165, with AUC 0.58 (95% CI 0.52, 0.63, P = 0.005), whereas that for pre-existing DM and steroid HG were 232 and 166, which were also significant. There was a wide variation in mean glucose levels against time. Conclusion(s): HG is an independent predictor of mortality, with the highest significance in the steroid-induced category. COVID-19 morbidity and mortality can be minimised by identifying the blood glucose range for best results and instituting appropriate treatment guidelines.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Due to pandemic vaccines are developed at a rapid pace. There is a requirement to ensure proper post-market pharmacovigilance. The proposed model will help speed up this process by classifying the Adverse Drug Reactions (ADRs) of the vaccines based on the severity. This will help vaccine manufacturers take necessary and timely action. The model will input the patient data (such as symptoms, vaccination details, and patient health details), which will be preprocessed and cleaned. The ADR will then be classified as a minor, major, or deadly reaction. The system made use of Count Vectors (CV), Word TF-IDF, N-gram TFIDF, and Character TF-IDF feature with Naive Bayes, Random Forest, Logistic Regression, Gradient Boost, and Adaboost machine learning classifiers. Using Random Forest with word-level TF-IDF comparatively a higher accuracy of 93.83% and an F1 score of 0.92 was achieved. © 2022 IEEE.
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Lufotrelvir was designed as a first in class 3CL protease inhibitor to treat COVID-19. Development of lufotrelvir was challenged by its relatively poor stability due to its propensity to epimerize and degrade. Key elements of process development included improvement of the supply routes to the indole and lactam fragments, a Claisen addition to homologate the lactam, and a subsequent phosphorylation reaction to prepare the prodrug as well as identification of a DMSO solvated form of lufotrelvir to enable long-term storage. As a new approach to preparing the indole fragment, a Cu-catalyzed C-O coupling using oxalamide ligands was demonstrated. The control of process-related impurities was essential to accommodate the parenteral formulation. Isolation of an MEK solvate followed by the DMSO solvate ensured that all impurities were controlled appropriately. © 2023 American Chemical Society.
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Healthcare organizations must operate efficiently to provide affordable care without compromising their sustainability and competitiveness. The purpose of this is to measure the profit efficiency of select Indian Corporate Hospitals during the COVID-19 pandemic. Further, the study attempts to analyze the productivity changes in select corporate hospitals during COVID-19 and postimplementation of the national insurance policy in India. The study used the Data envelopment analysis (DEA) technique to measure the efficiency of corporate hospitals. It utilizes Constant Return to Scale (CRS), and Variable Return to Scale (VRS) to estimate profit inefficiency. DEA-based Malmquist Productivity Index (MPI) was used to examine the productivity change during the last three years since the outbreak of COVID-19. The DEA-MPI model is iterated for panel data for Financial Year 2018–2021. with year-wise employee benefits and operating expenses as the input parameters and year-wise net sales as the output parameter. The study reveals surprising results and requires critical analysis. Out of select hospitals, 80% of hospitals were found inefficient using CRS while 70% of the hospitals were found inefficient using VRS. The findings of this study are useful for healthcare administrators and managers to highlight improvement programs for efficiency maximization. © 2023 Informa UK Limited, trading as Taylor & Francis Group.
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Simulation-based Inference (SBI) is a widely used set of algorithms to learn the parameters of complex scientific simulation models. While primarily run on CPUs in High-Performance Compute clusters, these algorithms have been shown to scale in performance when developed to be run on massively parallel architectures such as GPUs. While parallelizing existing SBI algorithms provides us with performance gains, this might not be the most efficient way to utilize the achieved parallelism. This work proposes a new parallelism-aware adaptation of an existing SBI method, namely approximate Bayesian computation with Sequential Monte Carlo(ABC-SMC). This new adaptation is designed to utilize the parallelism not only for performance gain, but also toward qualitative benefits in the learnt parameters. The key idea is to replace the notion of a single ‘step-size’hyperparameter, which governs how the state space of parameters is explored during learning, with step-sizes sampled from a tuned Beta distribution. This allows this new ABC-SMC algorithm to more efficiently explore the state-space of the parameters being learned. We test the effectiveness of the proposed algorithm to learn parameters for an epidemiology model running on a Tesla T4 GPU. Compared to the parallelized state-of-the-art SBI algorithm, we get similar quality results in <inline-formula><tex-math notation="LaTeX">$\sim 100 \times$</tex-math></inline-formula> fewer simulations and observe <inline-formula><tex-math notation="LaTeX">$\sim 80 \times$</tex-math></inline-formula> lower run-to-run variance across 10 independent trials. IEEE
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Background: People's adherence to recommended control measures is influenced by their Knowledge, attitude and practices they are following in COVID-19 Pandemic. So study was carried out to assess Knowledge, attitude and practices regarding COVID-19 among Indian citizens. Methods: A cross-sectional study was carried out among Indian citizens above 18 years of age using snowball sampling method. Data were collected through Google Forms containing structured questionnaire. Results: Totally 678 citizens responded across 20 states of India. More females reported fever, dry cough, tiredness, difficulty in breathing, headache as most common symptoms of covid-19 and sneezing, coughing as way of its transmission than male. This difference was statistically significant. Most of the study participants had favorable attitude and behavior toward COVID-19 infection. Conclusion: Majority of the participants have good knowledge, favorable attitude, and practices regarding COVID-19 during this ongoing pandemic situation. Still, continuous awareness with regard to new evidence gathered is needed to break chain of transmission to contain COVID-19 disease. Individual's attitude toward health-care worker and police personnel needs to be improved through behavior change communication activities that enable health-care workers and frontline workers to work proficiently to win the fight against COVID-19. © 2022 Medical Journal of Dr. D.Y. Patil Vidyapeeth ;Published by Wolters Kluwer - Medknow.
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The changing scenario between society's lookout toward the medical profession has taken a bad turn. The stress of education, practice starting, increasing to a peak of one's performance in the early years and later on to maintain it after the age of 50 is a great challenge. Recent tragic events have brought up the role of social elements, media, press, politicians, police, and prosecutors under the lens. We as professionals and organizations must find out the weakest link which enforces someone to indulge in self-harm. We also should try to strengthen the chain of healthcare delivery system with the motto of "A healthy physician only can impart quality healthcare. His image, interests, and intentions must be protected by our own profession, society, policymakers—government agencies.” Doctor–patient relationship has always been the foundation of healthcare system. Since the times of Hippocrates, relationship of doctor–patient has been extensively debated, receiving attention pertaining to its sociological, literary, and philosophical aspects. At present, doctor–patient–society relationship is undergoing a progressively dangerous phase of distrust leading to increased violence against doctors. Especially after the spread of coronavirus disease pandemic in December 2019 (COVID-19), giving an altogether new dimension to it. The tragic suicide of Dr Archana Sharma has brought doctor–patient relationship into focus, whether positive? Or negative? Who is to decide? Over the last 2 decades, the trust which was gained over centuries and cultivated the relationship of doctors and their patients has started eroding and has been demonized during COVID-19 pandemic outbreak. © 2022 Journal of Association of Physicians of India. All rights reserved.
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Ayurveda is the ancient medical system in India that uses nasal therapy. During COVID -19 pandemic, the ministry of AYUSH provided guidelines to boost immunity. The Nasya (nasal delivery) was one of the recommendations by the AYUSH ministry to boost immunity. Nasya has been still in practice for various ailments like chronic rhinitis, headache, cervical spondylosis, Dyspnea, etc., but the knowledge about how Nasya works is still unclear. This review article discusses the practice and current advances in nasal delivery in modern science. It also discusses the possible mechanism of how Nasya can act and boost immunity and what research can be done in the form of clinical and experimental studies to increase the knowledge and understanding of Nasya. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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The COVID-19 pandemic has driven the population to be extremely vigilant towards personal as well as shared hygiene necessitating use of facemask, maintaining social distancing, frequent hand wash and vehicle sanitization. Humans are exposed to pollutants such as Particulate Matter (PM), oxide of Sulphur (SOx), oxides of Nitrogen (NOx), Carbon Monoxide (CO), Ozone (O3), Total Volatile Organic Compound (TVOC) and pathogens such as fungi, bacteria, viruses (FBV) either through air or by direct contact with contaminated surfaces. In a vehicle cabin, occupants are exposed to both fresh and recirculating air through air-conditioning system and they also come in contact with touch points such as seats, steering wheel and armrest, which may be contaminated. In order to safeguard the occupants, Vehicle Interior Air Quality (VIAQ) enhancers like high efficiency cabin air filters (N95/ HEPA) with activated carbon/ anti-allergen/ anti-microbial layers, ionizers and anti-bacterial trims are being deployed by OEMs. In many cases, validation of these VIAQ enhancers is done on a bench setup. Once a VIAQ enhancer is integrated into the vehicle architecture, a series of additional subjective and objective validations will need to be carried out, which is the topic of this study. This paper proposes a novel two pronged approach to validate a VIAQ enhancer. The two approaches are subjective and objective assessments on the vehicle. The subjective assessment comprises calibration of human noses as per EN 13275 standard, training the calibrated noses for identification of odor character (OC), quantifying odor intensity (OI) and its hedonic tone (HT) as per VDI 3882. Whereas, the objective assessment comprises of use of handheld equipment for sampling and measurement of pollutants such as PM, SOx, NOx, CO, O3 and TVOC. With the above novel approach, the effectiveness of VIAQ enhancers can be assessed prior to its deployment on vehicle programs for real world application. Adopting this approach will ensure the vehicle cabin is maintained within permissible limits for measurable parameters (PM, SOx, NOx, CO, O3, TVOC, FBV) and subjectively perceived odor (OC, OI and HT). © 2022 SAE International. All rights reserved.
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The study of exploring the improvement of efficiency in e-Health is done by means of regulating an access to electronic health records (EHRs). In the absence of appropriate apex bodies, EHR will continue to stay as lopsided and discrete network of lagging systems without much ability to attain accuracy and consistency, and thereby efficiencies. A multinational corporation (MNC) model is prescribed to cut down health-care (HC) expenses and execute a coherent system wherein data, technology, and training are consistently upgraded to remove any interoperability-related problems. The literature review reveals that EHR interoperability issues may be met by generating architectures that drive fragmented systems to interoperate on the guidelines of watch dog agencies. This chapter suggests a fundamental technologydriven model predicting the need to get over interoperability problems, and followed by suggesting an organizational model that would be the most suitable solution catering to the needs of a coherent system where data, technology, and training are consistently and regularly upgraded. Hence, an artificial intelligence (AI)-driven model is prescribed to facilitate the improvement in the efficiency of e-Health to standardize HER. This treatise deliberates on the research opportunities to provide sustainable e-health solutions particularly during pandemic like COVID-19 and keeping in view diabetes HC as a case study. © The Institution of Engineering and Technology 2022.
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Introduction: Hypertension appears to be one of the commonest comorbidities in COVID-19 patients, although whether hypertensive individuals have a higher risk of severe COVID-19 compared with non-hypertensives is unclear. It is also unclear whether the absolute level of systolic blood pressure, or the type of antihypertensive medication is related to this risk. Method(s): Analyses were conducted using data from the UK Biobank and linked health records. Logistic regression models were fitted to assess the impact of hypertension, systolic blood pressure and medications on the risk of severe COVID-19. Result(s): 17,094 individuals tested positive for severe acute respiratory syndrome-coronavirus, 22% (n = 3,774) developed severe COVID-19 and 40% (n = 6,899) were hypertensive. Hypertension was associated with 25% higher odds of severe COVID-19 (OR 1.25;95% CI 1.15, 1.36), compared with normotension after adjusting for confounding variables. In those taking anti-hypertensive medications, elevated systolic blood pressure showed a dose-response relationship with severe COVID-19 (150-159mmHg versus 120-129 mmHg (OR 1.51;95% CI 1.15, 1.97), >180+mmHg versus 120-129mmHg (OR 2.10;95% CI 1.21, 3.67)). Systolic blood pressure <120 mmHg was associated with greater odds of severe COVID-19 (OR 1.37;95% CI 1.08, 1.74). Angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers were not associated with altered risk of severe COVID-19. Conclusion(s): Hypertension is an important risk factor for COVID-19. A better understanding of the underlying mechanisms is warranted in case of more severe strains or other viruses in the future.
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Purpose: Kidney transplant recipients (KTRs) have poor outcomes vs non-KTRs with acute COVID-19. To provide insight into management of immunosuppression during acute COVID-19, we studied peripheral blood transcriptomes during and after COVID-19 from a multicenter KTR cohort. Method(s): Clinical data were collected by chart review. Paxgene blood RNA was polyA-selected and sequenced at enrollment. Result(s): A total of 64 KTRs with COVID-19 were enrolled (31 Early cases (<4weeks from a positive SARS-CoV-2 PCR test) and 33 late cases). Out of the 64 patients, eight died and three encountered graft losses during follow-up. Due to presence of mRNA reads in the blood transcriptome unmapped to the human genome, we aligned the mRNA short reads to the SARS-CoV-2 genome. Surprisingly, our strategy detected the SARS-Cov2 mRNA, especially Spike mRNA in 27 (87%) early cases, and 18 (54%) of late cases (Fig 1A and B). We then analyzed the raw reads from a public dataset of non-KTRs with Paxgene RNA (GSE172114). The SARS-CoV-2 Spike mRNA was detected in 2/47 (4.2%) critically ill COVID-19 cases and 0/25 noncritically ill cases in this non-KTR dataset (compared to KTRs, Chi-square P<0.001;Fig 1B). Among our KTRs, the amount of Spike mRNA was associated positively with the COVID-19 severity score (scale of 1 to 7 of increasing severity;Fig 1C) and inversely with time from initial positive PCR (Fig 1D). More interestingly, 7/64 patients had detectable Spike RNA-emia beyond 60 days after COVID-19 diagnosis. Of the 3 graft losses in our cohort, 2 occurred among these 7 patients. Conclusion(s): Blood transcriptome of KTRs with COVID-19 demonstrated a risk for persistent viremia with implications for pathogenesis of COVID-19 disease. This finding also supports using passive immune strategies in COVID-KTRs. (Figure Presented).
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Introduction: Acute Disseminated Encephalomyelitis (ADEM) is a rare, immune-mediated, demyelinating disorder of the central nervous system characterized by acute encephalopathy with neurologic deficits and MRI findings consistent with multifocal demyelination requiring immunosuppression for therapy.1,2 Patients seldom develop hypoxia during the course of the illness, requiring prone ventilation to improve oxygenation which is the first line of therapy and a proven standard of care in patients with ARDS.3,4We would like to present a case of ADEM where a patient developed unexplained hypoxia requiring prone ventilation. Case description: A 35-year-old male with no significant past medical history presented to our neuro-specialist centre with one day history of severe lower back pain associated with lower limb weakness and numbness. His symptoms, which commenced 10 days post his Covid vaccination, rapidly progressed over 2 days of hospital admission to involve right upper limb & facial weakness. MRI scan of brain and spine showed features of ADEM and pulse Methylprednisolone was initiated. CT thorax and abdomen on admission was unremarkable. He was transferred to the critical care unit in view of progressive ascending paralysis and was intubated on his 5th inpatient day due to involvement of respiratory muscles. Following 4 cycles of plasma exchange with albumin (day 6,7,9 and 10 of hospital admission), he developed unexplained hypoxic episodes which eventually resulted in sustained hypoxia, requiring 100% oxygen. Airway pressures and lung compliance were within normal range. Bedside ultrasound demonstrated good lung sliding in all lung fields and good left ventricular contractility with no evidence of right ventricular dilatation. There was no evidence of pericardial/pleural effusion. CT thorax repeated on day 9 showed no features of acute thromboembolic disease and there were no signs of lung parenchymal involvement. Formal echocardiography with bubble test showed normal heart with no evidence of patent foramen ovale. Multi-disciplinary discussions involving cardiology, respiratory, neurology teams and regional ECMO centre could not explain the enigma of impaired oxygenation. The patient responded well to 16 hours of prone ventilation on day 10 with decreasing oxygen requirements. In the subsequent 3 months of his inpatient stay, he was weaned off oxygen and was tracheostomised in view of his neurological illness. He continues to receive physiotherapy and neuro rehabilitation which had led to clinical improvement. Conclusion: The possible reason for hypoxia could be impaired tissue oxygenation post plasma exchange. However, it could be a coincidental finding and there is not much literature to explain this phenomenon and warrants further research.5.
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Background: Significant challenges exist in recruiting newly diagnosed ductal carcinoma in situ (DCIS) patients to participate in presurgical intervention trials. Perceived motivators and barriers to participation have not been formally studied from the patient or healthcare provider (HCP) perspective. Based on our experience in the Promise Study (NCT02694809), we hypothesized that delaying surgery and concern for side effects are barriers to trial participation and that access to new treatments and financial benefits are motivators. To improve recruitment, we conducted focus groups to better understand barriers and motivators for trial participation in our patient population. Methods: Three focus groups with post-menopausal women (PMW) without history of DCIS, one focus group with patients previously treated for DCIS, and two HCP focus groups were conducted. Due to COVID-19, the focus groups took place online via videoconferencing and included participants from across the United States. A thirdparty facilitator generated discussion on predetermined topics including knowledge of DCIS, clinical trial recruitment materials, hormone replacement therapy, healthcare delivery and clinical trials during COVID-19, and perceived motivators and barriers to trial participation in general and specifically for women with DCIS. Here, we focus on comparing perceived influential factors for patient participation in DCIS clinical trials in PMW and HCP focus groups. Qualitative thematic analysis was completed on focus group transcripts in NVivo. Results: PMW had no knowledge of DCIS prior to the focus groups and believed DCIS should be removed promptly. PMW believed barriers to DCIS clinical trial participation included the potential for the study drug to cause harm, distrust of medicine, and the fact that DCIS is not life-threatening. PMW identified helping future DCIS patients, accessing better treatment, and easing anxiety as motivators for DCIS trial participation. HCPs believed patients were motivated by increased monitoring by the medical team, financial incentive, and access to newer treatment. HCPs believed that delays in DCIS surgery, the potential for the intervention to be harmful or ineffective, and the trial causing patient anxiety were barriers. Neither group emphasized time commitment as a barrier to DCIS trial participation. PMW were not motivated by financial incentives. Conclusions: Knowledge about DCIS is lacking in PMW. PMW and HCPs agreed that the risk of harm caused by study interventions is a deterrent to trial participation and that access to superior treatment is a motivator. However, PMW and HCPs did not agree on other motivators and barriers which could lead to missed recruitment opportunities. Providing educational materials on DCIS and addressing motivators and barriers to clinical trial participation may increase recruitment to presurgical DCIS trials.
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Mucormycosis started during COVID 19 when patients were treated with number of steroids oxygen, that further lead to increase in diabetes mellitus which was main cause of mucormycosis increase in black fungus further caused rhino-orbito-cerebral mucormycosis and angio invasive behavior of fungal hype that is from Mucoraceae family is main cause of the infection increases rapidly also damages the facial tissues vigorously uncontrolled diabetes, immunosuppressive, steroids poor glycemic control are main causes MRI is a technique that is been used for observing the growth of fungal hype from Epidermiological data its been proven that the mucormycosis is been spreading in countries such as India, Nepal, and Bangladesh rapidly its serious health concern in future.