Polarised social media discourse during COVID-19 pandemic: evidence from YouTube

The onset of the COVID-19 pandemic has attracted significant attention on social media platforms as these platforms provide users unparalleled access to ‘information' from around the globe. In spite of demographic differences, people have been expressing and shaping their opinions using social media on topics ranging from the plight of migrant workers to vaccine development. However, the social media induced polarisation owing to selective online exposure to information during the COVID-19 pandemic has been a major cause of concern for countries across the world. In this paper, we analyse the temporal dynamics of polarisation in online discourse related to the COVID-19. We use random network theory-based simulation to investigate the evolution of opinion formation in comments posted on different COVID-19-related YouTube videos. Our findings reveal that as the pandemic unfolded, the extent of polarisation in the online discourse increased with time. We validate our experimental model using real-world complex networks and compare consensus formation on these networks with equivalent random networks. This study has several implications as polarisation around socio-cultural issues in crises such as pandemic can exacerbate the social divide. The framework proposed in this study can aid regulatory agencies to take required actions and mitigate social media-induced polarisation.

Nebulized Heparin to Reduce COVID-19-induced Acute Lung Injury: A Prospective Observational Study.

Background: High mortality due to COVID-19 disease has been a serious concern, a few of the causes being disseminated intravascular coagulation (DIC) and venous thromboembolism. Considering this, some experts have used heparin. However, its role still needs to be validated. Materials and methods: This study predicts the role of nebulized heparin in decreasing the severity of lung injury caused by COVID-19. Thirty patients admitted with COVID-19 acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU) of All India Institute of Medical Sciences, Rishikesh, were included in this study, which was conducted over a period of 3 months. Patients were nebulized with 2 mL of heparin 5,000 units/mL IV formulation diluted with 3 mL of 0.9% sodium chloride, every 6 hours for a total duration of 7 days. Improvement in oxygenation (ratio of partial pressure of oxygen in blood and fraction of inspired oxygen delivered, pO2/FiO2 ratio) was calculated as the primary outcome. Other parameters like effect on inflammatory markers (neutrophil-lymphocyte ratio, total leukocyte count, interleukin (IL-6), and D-dimer values), time to liberate from mechanical ventilation, and hospital stay were calculated as secondary outcomes. Results: In our study population, the mean age was 54.5 years and the majority of patients were males (79.0%). All patients received prone ventilation and none of them required tracheostomy. However, 5 patients (16.6%) succumbed to illness. After nebulization with unfractionated heparin, no statistically significant difference was seen in the neutrophil-lymphocyte ratio (mean = 6.87, p = 0.318) and interleukin (IL-6) levels (mean = 62.85, p = 0.6) over 7 days. Similarly, the D-dimer level also had no statistically significant change (mean = 1853.73 p = 0.570). However, there was a statistically significant improvement in oxygenation (pO2/FiO2 ratio) over 7 days (mean = 184.96, p = 0.00). Similarly, there was a significant improvement in PaO2 (84.17 ± 33.82) and SO2 (92.30 ± 3.49). Although, no significant changes were seen in the partial pressure of carbon dioxide on nebulized heparin administration. Conclusion: Administration of nebulized heparin in COVID-19 pneumonia with mild ARDS may improve oxygenation and result in the improvement of inflammatory markers with variable sensitivity and specificity. How to cite this article: Gupta B, Chandrakar S, Gupta N, Jain G. Nebulized Heparin to Reduce COVID-19-induced Acute Lung Injury: A Prospective Observational Study. Indian J Crit Care Med 2023;27(3): 222-224.

Role of Thromboelastography and Thromboelastometry in Predicting Risk of Hypercoagulability and Thrombosis in Critically Ill COVID-19 Patients: A Qualitative Systematic Review.

Thromboelastography and rotational thromboelastometry are the viscoelastic point of care devices that use whole blood samples to assess coagulation and fibrinolysis. These devices give information from initiation of the coagulation cascade, activation of clotting factors to fibrin cross-linking, and contribution of fibrinogen and platelet to clot strength and clot lysis. Viscoelastic point of care tests are well established in hypocoaguable states like trauma, cardiac surgery, liver transplantation, and their use in critical care settings with coronavirus disease 2019 (COVID-19) is not so well-known. We performed a systematic review of studies on thromboelastography and rotational thromboelastometry and their modifications to assess their role in critically ill patients with COVID-19. Inclusion criteria were any kind of studies using thromboelastography or rotational thromboelastometry during coronavirus disease critical illness published in English. Ninety-three articles, from December 1, 2019, to August 31, 2020, were identified in the initial search, out of which 12 articles (a total of 380 patients) satisfied the inclusion and exclusion criteria. Thromboelastography and rotational thromboelastometry were observed to detect the hypercoagulable changes and fibrinolysis shutdown associated with COVID-19. Hypercoagulability is associated with an increased risk of venous thrombosis and micro-thrombosis. This review identifies the role of thromboelastography and rotational thromboelastometry in studying the mechanisms contributing to coagulopathy and incidence of thrombosis in COVID-19.

Effect of Remdesivir Administration on Occurrence of Major Adverse Cardiac Events in Critically Ill COVID-19 Pneumonia: A Retrospective Observational Study.

Background and objectives: Major adverse cardiac events (MACE) are frequent in coronavirus disease-2019 (COVID-19). Remdesivir is used worldwide for treatment in COVID-19. In this retrospective observational study, our primary objective was to assess the impact of remdesivir administration on the incidence of MACE and associated 28 day survival in critically ill patients admitted for moderate to severe COVID-19 pneumonia. Patients and methods: We analyzed the data of 437 patients admitted in intensive care unit (ICU) and divided them into two groups: R group (received remdesivir at ICU admission) and NR group (nonremdesivir) or based on the occurrence of MACE in ICU. We followed the data until discharge, death, or 28 days postadmission. Our primary objective was to investigate the log-odds of survival with remdesivir administration and a correlation/regression analysis of MACE with remdesivir administration in all included patients. Results: The incidence of MACE was 72 among 437 patients, with 17 (9.3%) patients in R group vs 55 (21.8%) in NR group (p <0.001). On performing correlation analysis between MACE and remdesivir administration, significant correlation coefficient of -0.168 (p = 0.004) was obtained. On regression analysis, the odds ratio for occurrence of MACE with remdesivir administration was 0.362 (regression coefficient: -1.014, p <0.001). It indicates a 64% decrease in the log-odds of MACE and a 16% increase in the log-odds of survival with remdesivir administration. All 72 patients with MACE had expired, suggesting a high mortality risk with cardiac complications. The odds ratio for mortality due to MACE with remdesivir administration was 0.216 (regression coefficient: -1.530, p -<0.001). It indicates a 79% decrease in the log-odds of death due to MACE with remdesivir administration. Conclusion: Our study showed significant reduction in MACE and mortality benefit in patients who received remdesivir in comparison to standard treatment. How to cite this article: Panda R, Singh P, Jain G, Saigal S, Karna ST, Anand A, et al. Effect of Remdesivir Administration on Occurrence of Major Adverse Cardiac Events in Critically Ill COVID-19 Pneumonia: A Retrospective Observational Study. Indian J Crit Care Med 2022;26(9):993-999.

Airway management training program for nurses via online course in COVID-19 preparedness.

BACKGROUND: Nursing officers are an integral component of any medical team. They participate in taking care of basic airway management and assist in advanced airway management, specifically amidst the current coronavirus disease 2019 (COVID-19) pandemic. AIM: To assess the efficacy of a standardized web-based training module for nurses in preparedness to fight against COVID-19. METHODS: The training was held in three sessions of 1 h each, consisting of live audio-visual lectures, case scenarios, and skill demonstrations. The sequence of airway equipment, drug preparation, airway examination, and plans of airway management was demonstrated through mannequin-based video-clips. RESULTS: Pre- and post-test scores as well as objective structured clinical examination scores were analyzed using Student's t-test and the Likert scale was used for feedback assessment. It was found that the mean score out of the total score of 20 was 8.47 ± 4.2 in the pre-test, while in the post-test it was 17.4 ± 1.8 (P value < 0.001). The participants also felt self-reliant in executing the roles of airway assistant (63.3%) and drug assistant (74.3%). Fear of self-infection with COVID-19 was also high, as 66% of participants feared working with the patient's airway. CONCLUSION: Amidst this COVID-19 emergency, when the health care systems are being persistently challenged, training of nursing staff in the safe conduct of airway management can ensure delivery of life-saving treatment.

Recurrent COVID-19 in Hemodialysis: A Case Report of 2 Possible Reinfections.

Patients receiving in-center hemodialysis are at high risk for infections due to relative immunosuppression, limited ability to physically distance, and frequent encounters with the health care setting. This has been particularly evident during the coronavirus disease 2019 (COVID-19) pandemic. We describe 2 patients with suspected recurrent COVID-19 infection, each with documented clearance of virus between episodes. The duration between a negative reverse-transcription polymerase chain reaction test result for severe acute respiratory syndrome coronavirus 2 and symptomatic reinfection was 31 and 55 days, respectively, in the 2 patients. A higher risk for infection with COVID-19 and poor outcomes if infected, including ≥20% short-term mortality risk, is worrisome in this patient population. Continued measures such as infection prevention, community outreach, and early testing may play a role in establishing protocols to protect the vulnerable dialysis population.

Repurposing pharmaceutical excipients as an antiviral agent against SARS-CoV-2.

The limited time indorsed to face the COVID-19 emergency and large number of deaths across the globe, poses an unrelenting challenge to find apt therapeutic approaches. However, lead candidate selection to phase III trials of new chemical entity is a time-consuming procedure, and not feasible in pandemic, such as the one we are facing. Drug repositioning, an exploration of existing drug for new therapeutic use, could be an effective alternative as it allows fast-track estimation in phase II-III trials, or even forthright compassionate use. Although, drugs repurposed for COVID-19 pandemic are commercially available, yet the evaluation of their safety and efficacy is tiresome and painstaking. In absence of any specific treatment the easy alternatives such as over the counter products, phytotherapies and home remedies have been largely adopted for prophylaxis and therapy as well. In recent years, it has been demonstrated that several pharmaceutical excipients possess antiviral properties making them prospective candidates against SARS-CoV-2. This review highlights the mechanism of action of various antiviral excipients and their propensity to act against SARs-CoV2. Though, repurposing of pharmaceutical excipients against COVID-19 has the edge over therapeutic agents in terms of safety, cost and fast-track approval trial burdened, this hypothesis needs to be experimentally verified for COVID-19 patients.

Arterial Blood Gas as a Predictor of Mortality in COVID Pneumonia Patients Initiated on Noninvasive Mechanical Ventilation: A Retrospective Analysis.

Background: The alveolar-arterial oxygen (A-a) gradient measures the difference between the oxygen concentration in alveoli and the arterial system, which has considerable clinical utility. Materials and methods: It was a retrospective, observational cohort study involving the analysis of patients diagnosed with acute COVID pneumonia and required noninvasive mechanical ventilation (NIV) over a period of 3 months. The primary objective was to investigate the utility of the A-a gradient (pre-NIV) as a predictor of 28-day mortality in COVID pneumonia. The secondary objective included the utility of other arterial blood gas (ABG) parameters (pre-NIV) as a predictor of 28-day mortality. The outcome was also compared between survivors and nonsurvivors. The outcome variables were analyzed by receiver-operating characteristic (ROC) curve, Youden index, and regression analysis. Results: The optimal criterion for A-a gradient to predict 28-day mortality was calculated as ≤430.43 at a Youden index of 0.5029, with the highest area under the curve (AUC) of 0.755 (p <0.0001). On regression analysis, the odds ratio for the A-a gradient was 0.99. A significant difference was observed in ABG predictors, including PaO2, PaCO2, A-a gradient, AO2, and arterial-alveolar (a-A) (%) among nonsurvivors vs survivors (p-value <0.001). The vasopressor requirement, need for renal replacement therapy, total parenteral requirement, and blood transfusion were higher among nonsurvivors; however, a significant difference was achieved with the vasopressor need (p <0.001). Conclusion: This study demonstrated that the A-a gradient is a significant predictor of mortality in patients initiated on NIV for worsening respiratory distress in COVID pneumonia. All other ABG parameters also showed a significant AUC for predicting 28-day mortality, although with variable sensitivity and specificity. Key messages: COVID-19 pneumonia shows an initial presentation with type 1 respiratory failure with increased A-a gradient, while a subsequent impending type 2 respiratory failure requires invasive ventilation. A significant difference was observed in ABG predictors, including PaO2, PaCO2, A-a gradient, AO2, and a-A (%) among nonsurvivors vs survivors. (p-value <0.001). The vasopressor requirement, need for renal replacement therapy, total parenteral requirement, and blood transfusion need were higher among nonsurvivors than survivors; however, a significant difference was achieved with the vasopressor need (p <0.001). How to cite this article: Gupta B, Jain G, Chandrakar S, Gupta N, Agarwal A. Arterial Blood Gas as a Predictor of Mortality in COVID Pneumonia Patients Initiated on Noninvasive Mechanical Ventilation: A Retrospective Analysis. Indian J Crit Care Med 2021;25(8):866-871.

Post-COVID-19 Gastrointestinal Invasive Mucormycosis.

Thrombo-embolic episodes and invasive mucormycosis (IM) have shown a sudden surge after the second wave of novel coronavirus infection in India. Acute mesenteric ischemia secondary to coronavirus-19 is rare and that too due to invasive mesenteric mucormycosis has not yet been reported in Indian literature. We present a case of post-COVID diabetic woman who was on steroids and had mesenteric thrombosis with IM. The disease is associated with high mortality. Treatment of choice is wide surgical resection and iv liposomal amphotericin B. Since the pre-operative as well as intra-operative diagnosis is difficult, high index of suspicion for IM is necessary in post-COVID-19 patients presenting with mesenteric ischemia or bowel perforation.

Transformational Effect of COVID Pandemic on Postgraduate Programme in Oral and Maxillofacial Surgery in India-A Trainee Perspective.

Background and purpose: The purpose of the survey was to evaluate transformation in mode of teaching during the COVID pandemic on a postgraduate program in oral and maxillofacial surgery in India. Methods: A standardised e-questionnaire was created on Google Forms™ and was shared using emails and WhatsApp™. A total of 103 postgraduate students of oral and maxillofacial surgery from different universities participated in this cross-sectional survey. The collected data were analysed using bivariate and multivariate analysis. Results: A total of 95.1% of postgraduates in the survey believed that their overall regular speciality work was deprived during first 5 months of COVID. 90.3% participants accepted that webinar/online teaching program become more beneficial for their academics. But 78.1 % participants think that because of overburdening of these academic sessions, they have reduced the enthusiasm in attending them. Conclusion: This survey highlighted the intense negative impacts of this pandemic on the postgraduate program from the eyes of the trainees themselves. This triggers us to hasten this process of medical education transformation in a way to cope with any such calamity with minimal consequences.

Epidemiology, virology and clinical aspects of hantavirus infections: an overview.

At the end of 2019 and 2020s, a wave of coronavirus disease 19 (COVID-19) epidemics worldwide has catalyzed a new era of 'communicable infectious diseases'. However, the world is not currently prepared to deal with the growing burden of COVID-19, with the unexpected arrival of Hantavirus infection heading to the next several healthcare emergencies in public. Hantavirus is a significant class of zoonotic pathogens of negative-sense single-stranded ribonucleic acid (RNA). Hemorrhagic renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS) are the two major clinical manifestations. Till date, there is no effective treatments or vaccines available, public awareness and precautionary measures can help to reduce the spread of hantavirus disease. In this study, we outline the epidemiology, virology, clinical aspects, and existing HFRS and HCPS management approaches. This review will give an understanding of virus-host interactions and will help for the early preparation and effective handling of further outbreaks in an ever-changing environment.

Role of phytoconstituents in the management of COVID-19.

BACKGROUND: COVID-19, a severe global pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has emerged as one of the most threatening transmissible disease. As a great threat to global public health, the development of treatment options has become vital, and a rush to find a cure has mobilized researchers globally from all areas. SCOPE AND APPROACH: This review focuses on deciphering the potential of different secondary metabolites from medicinal plants as therapeutic options either as inhibitors of therapeutic targets of SARS-CoV-2 or as blockers of viral particles entry through host cell receptors. The use of medicinal plants containing specific phytomoieties could be seen in providing a safer and long-term solution for the population with lesser side effects. Key Findings and Conclusions: Considering the high cost and time-consuming drug discovery process, therapeutic repositioning of existing drugs was explored as treatment option in COVID-19, however several molecules have been retracted as therapeutics either due to no positive outcomes or the severe side effects. These effects call for exploring the alternate treatment options which are therapeutically effective as well as safe. Keeping this in mind, phytopharmaceuticals derived from medicinal plants could be explored as important resources in the development of COVID-19 treatment, as their role in the past for treatment of viral diseases like HIV, MERS-CoV, and influenza has been well reported. Considering this fact, different phytoconstituents such as flavonoids, alkaloids, tannins and glycosides etc. Possessing antiviral properties against coronaviruses and possessing potential against SARS-CoV-2 have been reviewed in the present work.

Clinical Characteristics, Comorbidities,and Outcome among 365 Patients of Coronavirus Disease 2019 at a Tertiary Care Centre in Central India

RATIONALE: The knowledge about the presenting characteristics, comorbidity, and outcomes of Indian patients for COVID-19 is limited. OBJECTIVE: To describe the clinical characteristics and outcomes of COVID-19 patients in Central India and to evaluate risk factors leading to requirement of oxygen, mechanical ventilation and mortality. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective, we included 365 RT-PCR confirmed cases of 2019-nCoV in Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh from March 25, 2020 to May 15, 2020. RESULTS: A total of 365 patients - 329 adults (Median age 49 years, 58.66% males) and 36 pediatric patients (Median age 10.5 years) were included. There was presence of comorbidity in 47.11% adults with most common being hypertension (24.92%), and diabetes (25.18%). 45.28% of adult patients were asymptomatic at presentation, with fever as the most common symptom (38.29%) and epidemiological contact history present in 69.90%. During hospitalization, 14.52% adults (median age, 50 years;49.05% male) were on oxygen support, and 13% received mechanical ventilation (median age, 54 years;63.26% male). As of May 15 2020, 8.4% adult patients died(median age, 57 years;67.74% male). Presence of Lymphopenia, and Comorbid condition were identified as risk factors for requirement of oxygen, mechanical Ventilation and death. CONCLUSIONS AND RELEVANCE: This case series provides characteristics and outcomes of COVID-19 patients in Indore region.