A Comparative Study of Rapid SARS-Cov-2 Antigen Detection Assay against RT-PCR Assay for Diagnosis of COVID-19 in a Tertiary Hospital of Kathmandu.

Background The Coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has spread worldwide since its first recorded case in the city of Wuhan, China, in December 2019. SARS-CoV-2 infection causes asymptomatic to sever pneumonia. Severe cases may develop acute respiratory disease symdrome (ARDS), with an average mortality rate of 6.9%. Real Time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR) assay is the current reference standard laboratory method for the diagnosis of SARS-CoV-2 infection. However, it takes around 6-8 hours to get the result and is time consuming. Therefore, rapid and accurate tests for SARS-CoV-2 screening are essential to expedite disease prevention and control. Lateral flow immunoassay using monoclonal anti SARS-CoV-2 antibodies which target for SARS-CoV-2 antigen can be complimentary screening test if their accuracy were comparable to that of the real time reverse transcriptionpolymerase chain reaction (RT-PCR) assay. Objective To find the sensitivity and specificity of a rapid antigentest kit in comparison to reverse transcription-polymerase chain reaction (RT-PCR). Method A cross-sectional hospital based study was carried out at Shree Birendra Army Hospital, Kathmandu for a period of four months. Result Our finding shows sensitivity and specificity of rapid diagnostic tests (RDT) Ag kit as 60.6% and 96.4% respectively. Positive and negative predictive value was 83.7% and 89.0%. Likewise, positive and negative likelihood ratio was 17.0 and 0.4. The overall accuracy of the antigen kit was 88.1% in comparison to reverse transcriptionpolymerase chain reaction (RT-PCR) as the gold standard. Conclusion Our study concluded the use of rapid antigen kit is mainly useful for screening purposes.

Raw Honey Of Apiscerana Indica Spp. Induces Transition, In Vitro

On the verge of Covid-19 pandemic accompanied by the vaccination research, proposed research focuses on continuous cell lines which are actually extensively applied as essential as well as economical methods for fundamental scientific analysis, chemical rate of metabolism, analysis about degree of toxicity and formation of biological formula just like vaccines. Mouse spleen cells used are well known to survive only as primary cultures. The availability of non-cancerous long-term cell cultures is scarcely available for in vitro research studies. In order to overcome this limitation, the proposed research attempted to establish a naive, long term-continuous cell culture from Balb/c mouse. This continuous cell culture derived and established from a primary mouse spleen has the potential as a model cell culture for various applications of in vitro testing. This research can be useful for further research in the specified domain.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

A Global Survey of Impact of Violence against Healthcare Workers in Critical Care Settings: Vishwas

INTRODUCTION: A rise in the incidents of violence against Health Care Workers (HCWs) in recent years calls for improvement in modes of spreading awareness and educating the public. We aimed to conduct a large global cross-sectional survey called ViSHWaS- Violence Study of Healthcare Workers and Systems in the departments of Anesthesiology, Critical Care Medicine, and Emergency medicine. METHOD(S): A global survey after tool validation, was created using REDCap forms and distributed from June 5th to July 24th, 2022. Communication tools including emails, phone calls, SMS, and social media applications like WhatsApp, Twitter, and LinkedIn were used in securing responses. This study was deemed eligible for category-2 Institutional Review Board exempt status. RESULT(S): Total of 598 responses from 69 countries, out of these 445 (74%) were complete. The maximum responses were from India (N=49), followed by the USA (N=44) and while those from the other 67 countries ranged from N=1-30. Out of these, 221 (50%) were female, the majority (56%) were in the 26-35 years category, followed by (19%) in 36-45 years. The participants encompassed 156 (35%) consultants, 97 (22%) nurses and the rest were residents/fellows in training, auxiliary/ staff, advanced registered nurse practitioners (ARNP), physician assistants (PA), researcher and others. The vast majority (73%) reported facing violence within the past year;Verbal (63%) and physical (39%) were the most commonly reported. Total 126 (28.3%) reported that patient and/or family member as the type of aggressor they/ their colleague encountered most frequently. A majority (75%) reported that the incidence of violence has either stayed the same (39%) or increased (36%) during COVID-19 pandemic. Because of violent episodes, 48% felt less motivated/ had decreased job satisfaction;an additional 25% were willing to quit. While half of respondents were familiar with Occupational Safety and Health standards, only 20% felt prepared to handle aggressive situation. CONCLUSION(S): In this global cross-sectional survey, a majority of HCWs reported to have faced violence. They felt that it either increased or stayed the same during the COVID-19 pandemic. It has led to decreased job satisfaction. Majority of those, who responded, felt unprepared to handle the violence.

To Compare the Outcome of Conservative Management Versus Open Appendicectomy in Early Presentation of Acute Appendicitis in Children during Covid-19 Pandemic

Objective: Aim was to compare the outcome of conservative management versus open appendicectomy in early presentation of Acute Appendicitis in children during Covid-19 pandemic. Study Design: Retrospective study Place and Duration: The Children's Hospital PIMS. March 2020 to Sep 2020 Methods: This research comprised 80 children of both sexes who were diagnosed with acute appendicitis during the Covid-19 epidemic. Following the collection of written informed consent, complete demographic data, including age, sex, and sickness severity, was collected from all recruited patients. There were two sets of patients, and both were treated similarly. Forty individuals in Group I underwent for open appendicectomy, whereas the same number in Group II underwent conservative treatment (intravenously injection Tanzo, Flagyl, Amikacin). Complications after therapy and antibiotic resistance were analysed and compared between the two groups. All of the data was analyzed using SPSS 22.0. Result(s): There were majority males 47 (58.8%) and 33 (41.2%) females in this study. Mean age of the patients was 9.09+/-5.29 years. Disease severity was found in 67 (83.8%) cases. Although there was no statistically significant difference between the groups, the more conservatively treated group had a higher risk of complications. Between the two groups, there was no discernible difference in the average length of hospitalization. Surgery patients had significantly higher white cell counts (WCCs) and Alvarado scores (p=0.010 and p=0.018, respectively) at arrival. We found higher readmission and reoperation during Covid-19 pandemic among both groups. Conclusion(s): We concluded in this study that severity of acute appendicectomy was higher during pandemic wave of coronavirus. Both conservative and open appendicectomy was effective in terms of minimum complications and decrease hospital say while readmission and reoperation was higher among both groups because of pandemic disease Covid-19. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

A Comparative Study of Rapid SARS-Cov-2 Antigen Detection Assay against RT-PCR Assay for Diagnosis of COVID-19 in a Tertiary Hospital of Kathmandu

Background The Coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has spread worldwide since its first recorded case in the city of Wuhan, China, in December 2019. SARS-CoV-2 infection causes asymptomatic to sever pneumonia. Severe cases may develop acute respiratory disease symdrome (ARDS), with an average mortality rate of 6.9%. Real Time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR) assay is the current reference standard laboratory method for the diagnosis of SARS-CoV-2 infection. However, it takes around 6-8 hours to get the result and is time consuming. Therefore, rapid and accurate tests for SARS-CoV-2 screening are essential to expedite disease prevention and control. Lateral flow immunoassay using monoclonal anti SARS-CoV-2 antibodies which target for SARS-CoV-2 antigen can be complimentary screening test if their accuracy were comparable to that of the real time reverse transcription-polymerase chain reaction (RT-PCR) assay. Objective To find the sensitivity and specificity of a rapid antigentest kit in comparison to reverse transcription-polymerase chain reaction (RT-PCR). Method A cross-sectional hospital based study was carried out at Shree Birendra Army Hospital, Kathmandu for a period of four months. Result Our finding shows sensitivity and specificity of rapid diagnostic tests (RDT) Ag kit as 60.6% and 96.4% respectively. Positive and negative predictive value was 83.7% and 89.0%. Likewise, positive and negative likelihood ratio was 17.0 and 0.4. The overall accuracy of the antigen kit was 88.1% in comparison to reverse transcription-polymerase chain reaction (RT-PCR) as the gold standard. Conclusion Our study concluded the use of rapid antigen kit is mainly useful for screening purposes. Copyright © 2022, Kathmandu University. All rights reserved.

Correlation between Chest CT Severity Scores and Clinical Parameters in Patients with COVID-19 Pneumonia: A Comparative Study between 1st and 2nd Wave

Aim and objective: To correlate a chest CT score in COVID-19 pneumonia with clinical severity and inflammatory biomarkers and overall patient's outcome. Materials and methods: In this retrospective single-center analysis, we collected data of 200 patients admitted to Fortis hospital during the peaks of the two waves of the COVID-19 pandemic. Data for 1st wave were collected between July and September 2020 (100 patients) and 2nd wave from March to April 2021 (100 patients). We collected clinical and laboratory data for analysis, derived from the electronic medical record system for the above durations. Only symptomatic patients within 10 days of onset of symptoms who had CT imaging done at admission were included in the study. A team of experienced radiologists analysed the images to determine the CT severity score based on the extent of lobar involvement. Each lung lobe was visually scored from 0-5, 0-no involvement, 1: <5% involvement, 2: 5-25% involvement;3: 26-50% involvement;4: 51-75% involvement;5: >75% involvement. The total CT score was the sum of individual lobar scores ranging from 0 (no involvement) to 25 (maximum involvement). The results of the chest HRCT images were collected and evaluated using the picture archiving and communication systems (PACS). Patient's chest CT score, P/F ratio, O2 requirement, and need for ventilatory support and mortality were compared. Descriptive statistics of patients demographics, clinical, and laboratory results were reported as numbers and relative frequencies. Frequencies of CT scores were calculated and compared with other clinical variables. The Pearson correlation coefficient test was used for correlations, considering p < 0.05 statistically significant. Results: Our study highlights the clinical implication of initial CT findings as a prognostic indicator in patients with COVID-19. In terms of demographic distribution median age was 57.5 and 58 years, respectively, and both the waves had a median male predominance of 65%. Wave 1 had more patients with lower CT scores and higher P/F ratio, whereas wave 2 had a significant lower P/F ratio for the same CT scores as compared to wave 1, especially at higher CT scores. CT score of >18/25 is associated with increased probability of ventilatory requirement and hence increased mortality in both the waves which was found to be statistically significant with p = 0.005. Also, higher CT scores were found to be positively correlated with lymphopenia, increased serum CRP, d-dimer, and ferritin levels. Conclusion: Chest CT imaging has played an important role in monitoring disease progression and predicting prognosis during the COVID-19 pandemic. They can be pivotal in assisting clinicians in diagnosing the severity, predicting the outcomes and most of all, in the management plan for the concerned patient. In our analysis of one of the largest single-centre studies conducted during the two waves of the COVID-19 pandemic in India, CT severity score was directly proportional with inflammatory lab markers, length of hospital stays, and oxygen requirement in patients with COVID-19 infection. CT Chest score of >18/25 on admission is associated with poor prognosis and increased mortality.

Proning on Veno-venous ExtraCorporeal Membrane Oxygenation in Treatment of Severe ARDS in COVID-19: A Retrospective Case Series

Aim and background: Infection due to SARS-CoV-2 may lead to an atypical ARDS, requiring in the most severe cases VV ECMO. The management of persistent severe hypoxemia under VV ECMO requires a multistep clinical approach including prone positioning which could improve oxygenation. Objective: To assess the synergistic effect of prone ventilation and VV-ECMO in addition to lung-protective ventilation to improve patient outcomes in severe ARDS. Materials and methods: Fortis hospital has been an established ECMO center prior to the COVID-19 pandemic but has now become a primary referral center for ECMO retrieval of critically ill patients. In the past 10 months, we had 19 ECMO patients. All patients who underwent ECMO insertion had CT imaging done on the day of ECMO insertion. Patients with inhomogeneous lung opacities on imaging were postulated to potentially benefit from proning on ECMO. We would like to present a case series of 3 patients (2 retrievals and 1 in-house) subjected to prone ventilation immediately after initiation of VV ECMO in view of ARDS with refractory hypoxia, high driving pressures, and Murray score of >3. Femoro-jugular configuration of VV ECMO was used with adequate anticoagulation. All patients were subjected to proning and supining with a dedicated team of 8-10 members including a senior intensivist and airway expert at the head end and perfusionist taking care of the ECMO circuit along with 6 support staff on side of the patient and 1-2 staff for placing/removing the head support, chest, and pelvic bolsters. All patients received immunomodulation with methylprednisolone for the persistent maladaptive hyperinflammatory states. Ventilatory parameters on conventional lung-protective ventilation were compared to parameters on ECMO at the initiation of proning and after completion of prone sessions. Any complications associated with proning were noted. Results: We describe 3 patients with severe COVID-19 bronchopneumonia with refractory hypoxemia who received prone ventilation on VV ECMO. The median age of patients was 40 years with 1 male and 2 female patients. The median time from symptom onset to mechanical ventilation was 7 days and from mechanical ventilation to VV ECMO initiation was 1.5 days. The median duration on VV-ECMO was 5 days with a duration of prone sessions lasting 18 hours. The mean driving pressure has reduced by 17.6% with an improvement in compliance by 26.3%. The paO2 and P/F ratio improved by 63.2% and 260%, respectively, on ECMO support and these changes were sustained post-ECMO decannulation. None of the patients had any major complications associated with proning. The median duration of hospital stay was 30 days. Days to discharge were prolonged due to sepsis from secondary infection. All 3 patients survived to hospital discharge with minimal to no oxygen requirement, mobilized to an adequate functional capacity to perform activities of daily living. Conclusion: ECMO is often used in patients with severe ARDS and refractory hypoxemia to improve oxygenation and survival. Prone positioning concurrently with ECMO in selected patients can further aid in optimizing alveolar recruitment and reducing ventilator-induced lung injury, which ultimately may be associated with a reduction in-hospital mortality.

Effectiveness and safety of thymosin alpha-1 in patients with severe COVID-19: A prospective open-label study

Introduction: Thymosin alpha 1 has been utilized for immunomodulation in viral infections. There has been a limited clinical evidence for the benefits of COVID-19. Objectives: To assess the effectiveness and safety of thymosin alpha 1 in patients with severe COVID-19. Materials and methods: Thymosin alpha 1 was administered, as two injections (each 1.6 mg)/thrice daily subcutaneously for seven consecutive days, along with standard of care (SOC), in 15 consecutive patients diagnosed as COVID-19 positive based on the RT-PCR results. The study duration was from August 27, 2020, till November 2, 2020. The patients were enrolled in the study if any of the following clinical conditions were present;respiratory distress with respiratory rate ≥ 30 breath/minute, SpO2 (oxygen saturation) ≤ 90% on room air, PaO2 (arterial blood oxygen partial pressure)/FiO2 (fraction of inspired oxygen) ≤ 200 mm Hg (1 mm Hg = 0.133 kPa), respiratory failure and the need for mechanical ventilation support. The study is registered with the Clinical Trials Registry of India (Clinical Trial registration number: CTRI/2020/08/027061) and was approved by the institutional ethics committee on August 7, 2020. Results: The mean duration (days) of the hospitalisation, ICU stay, ventilator support, was 13.2 ± 4.38, 4.4±0.51, 2.87±2.20, respectively. The total lymphocyte count (thousand/mm3), CD4 count (cells/mm3), CD8 count (cells/ mm3), increased significantly to 4410 ± 1200 from 2010±680 (p < 0.0001), 558.07±177.55 from 367.20 ± 166.94 (p = 0.0008), 720.07 ± 230.38 from 509.67±199.42 (p = 0.0008), respectively. The CD4/CD8 ratio improved from 0.72 to 0.77. LDH (Lactic Acid Dehydrogenase) levels (units per liter), C reactive protein (CRP) (mg/L), D-dimer levels (mg/L), ferritin (ng/mL), IL-6 (pg/mL) decreased to 329.33 ± 175.62 from 369.00 ± 186.80 (p = 0.0182 NS);23.66±22.64 from 76.31 ± 78.38 (p = 0.0.105);0.72 ± 0.37 from 1.42 ± 1.36 (p = 0.0428), 347.09 ± 185.16 from 491.75 ± 230.86 (p = 0.0082), 4.09 ± 1.64 from 18.03±4.91 (p < 0.0001), respectively. The oxygen saturation (SpO2%) increased to 97.60 ±0.74 from 84.93 ±1.79 (p < 0.0001). WHO 8-point ordinal scale decreased (improved) to 3.2 ±0.41 from 5.4 ±0.51 (p < 0.0001). Five patients reported adverse events which were of mild severity, which were unrelated to thymosin alpha 1. There was no mortality reported during the study period. Discussions: The study demonstrates a statistically significant reduction in cytokines including CRP, D-dimer, ferritin, and IL-6, with a numerically superior reduction in LDH. The significant improvement in the lymphocyte count along with the enhanced CD4 and CD8 count indicates the ability of thymosin alpha 1 to induce a distinctive immunological capacity, to replenish and reverse the phenomenon of exhaustion of the T cells. The improved biochemical parameters are corroborated with the improved SpO2 and the WHO 8-point ordinal scale. The results of our study are corroborative with the earlier clinical evidence which demonstrates the role of thymosin alpha 1 for the clinical improvement by immune reconstitution by inducing thymus output in COVID-19 patients with SARS-CoV-2 infection. Conclusion: The results of this first prospective study from India indicates that thymosin alpha 1, along with the standard of care approach, appears to be a potential treatment for patients affected by the SARS-CoV-2 infection. Thymosin alpha-1 is a novel therapeutic armamentarium to improvise the clinical outcomes in patients with severe COVID-19.