Incautious Use of Antibiotics During Covid-19

Background:The novel severe acute respiratory syndrome corona virus 2 (also known as 2019-nCoV) is a highly infectious agent and is declared as a global public health emergency by the World Health Organisation. The main known transmission route of severe acute respiratory syndrome corona virus 2 is through respiratory air droplets. Although recent studies have revealed that the virus is detectable in the throat, blood, urine, anal swabs, tears and even faeces; however, modes of transmission other than respiratory droplets has not been studied much. Knowledge on the presence of the virus in the female genital tract may help determine the risk of sexual transmission as well as the risk of mother-to-child transmission. However, not much data are available yet regarding the presence of the virus in the female genital system. Hence, to explore the presence of the virus in the female genital system and possibility of sexual transmission, a study was conducted where in we tried to detect severe acute respiratory syndrome corona virus 2 in cervico-vaginal secretions.Methods:From July 2020 to September 2020, 35 COVID-19-positive female patients admitted to tertiary care teaching institute of Eastern India, which is now declared dedicated Corona Hospital and Centre of Excellence for COVID-19 care, who consented for the research were enrolled in this prospective observational study. Proper gynaecological history, clinical records along with laboratory findings of the patient was recorded. The possibility of the sexual transmission of the virus from female to her male partner was to be ascertained by testing the presence of severe acute respiratory syndrome corona virus 2 in the vaginal, cervical secretions by reverse transcriptase polymerase chain reaction.Results:All 35 COVID-19-positive female patients were tested for severe acute respiratory syndrome corona virus 2 in their vaginal and cervical secretions by reverse transcriptase polymerase chain reaction. All the samples were tested negative for the virus.Conclusion:Findings from this study reveals that severe acute respiratory syndrome corona virus 2 is not present in the cervical and vaginal secretions, and the possibility of transmission from female to her male partner by vaginal sexual intercourse is unlikely.

Coronavirus belongs to the family of Coronaviridae and is structurally enveloped with positive sense single strand. The virus undergoes replication by transcription of a minus strand template by RNA dependent RNA polymerase. The search is ongoing for the specific targeted treatment of corona virus infection. Among the available drugs to treat viral infections, there are few with promise to treat or reduce viral load. Never the less prevention is the best method to tackle the viral infection. The drugs used in the treatment of CoVid 19 according to the evidence available from the past with management of Severe Acute Respiratory Syndrome Corona Virus (SARS Covid 2) and Middle East Respiratory Syndrome Corona Virus (MERS Covid). The options available for treatment of Covid 19 are antiviral drugs and supportive interventions. The currently available drugs used in viral infections are explored for their additional benefit in treating CoVid 19 along with the immune boosters which include vitamins, essential minerals and biological response modifiers. Keywords: Covid 19, potential drugs, Severe Acute Respiratory Syndrome, Middle Eastern Respiratory Syndrome, Immune boosters

Severe Acute Respiratory Syndrome Corona Virus 2019, a novel coronavirus first reported from China in 2019, is the causative agent of pandemic corona virus disease 2019. Antibody response and its dynamics may provide information about natural immunity conferred upon by corona virus disease 2019. A health-center-based follow up study of confirmed Severe Acute Respiratory Syndrome Corona Virus-2 infected patients was conducted from December 2020 to June 2021. Patients were followed up to period of 28 weeks during the study. An electrochemiluminescence immunoassay was used to test antibodies elicited by Severe Acute Respiratory Syndrome Corona Virus-2. Socio-demographic and clinical information was collected from each patient. A total of 40 patients (18 males and 22 females) were enrolled in the study, with 90 % seropositivity of SARS-CoV-2 antibody. Antibody level was tracked up to 28 weeks following the infection, and persistence was observed till the end. Antibody level peaked on the 3rd to 4th month, after symptom onset. The male population was found to have higher antibody levels compared to females. Age-wise trend analysis showed lower antibody levels in the younger people (15-30 years) than those older (31-60 years). We demonstrated that Severe Acute Respiratory Syndrome Corona Virus-2 specific antibodies in corona virus disease 2019 patients persist for at least 28 weeks, peaking at 13 to 20 weeks. Statistically, there was no correlation of antibody levels with the age and sex of individuals. Further study on a larger population is needed for determining long-term immunity.

Background: Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome corona virus. The original source of viral the transmission to humans remains unclear, as does whether the virus became pathogenic before or after the spillover event. COVID-19 has impacted many populations, with distinct clinical repercussions correlated with age groups. Because of the rapid spread of the COVID-19 pandemic, affected countries have taken a heterogeneous and evolving approach to the diagnosis of infection in patients, and continue to have different and, in some cases, evolving strategies to determine what segments of the population should be tested.Objectives: To confirm the COVID-19 infection through complete blood count test, to evaluate the CBC test parameters in COVID-19 patients, to identify complete blood count predictors of test positivity in order to support the management of patients requiring swab tests.Main Body: Laboratory blood tests have not been assessed with regard to their sensitivity or specificity for the diagnosis of COVID-19, nor their value as prognostic indicators. A complete blood count (CBC) is a blood test used to evaluate your overall health and detect a wide range of disorders. The following hematological parameters are measured in CBC: White Blood Cell (WBC), Red Blood Cell (RBC), hemoglobin (Hb), hematocrit (Het), Mean Cell Volume (MCV), Mean Cell Hemoglobin (MCH), mean Cell Hemoglobin Concentration (MCHC), Red Cell Distribution Width (RDW), platelet count (Plt), and Mean Platelet Volume (MPV). Decreased platelet, lymphocyte, hemoglobin, eosinophil, and basophil count, increased neutrophil count and neutrophil-lymphocyte and platelet-lymphocyte ratio have been associated with COVID-19 infection and a worse clinical outcome. Platelet (PLT) count is an important parameter included in In COVID-19 infection, it is found in approximately 60% of severe patients. The lymphocyte count of the severe COVID-19 group was found to be significantly lower than in the common COVID-19 and influenza groups (P<0.001 and P = 0.012).Conclusion: Coronavirus disease 2019 (COVID-19) is a highly contagious illness caused by severe acute respiratory syndrome SARS-CoV-2. It has had a devastating effect on the world's demographics resulting in more than 5.3 million deaths worldwide. The severity of the disease increased with age and men were more likely to die from disease complications. Most CBC parameters were found to be significantly increased in patients. Significantly increased neutrophils and decreased lymphocytes were the most relevant predictors of severe disease and death. The only CBC parameter that was not associated with the disease was basophil count.

Corona viruses (RNA viruses) belongs to Coronaviridae family, comes under Nidoviridae family. It becomes important public health concern since the Severe Acute Respiratory Syndrome Corona Virus (SARS-CoV) outbreak in 2002 from Guangdong Province of Southern China. Continuous evolution of corona viruses was further highlighted with the emergence of Middle-East Respiratory Syndrome(MERS-CoV) outbreak in 2012 from Saudi-Arabia. Currently major concern is about the 2019 Novel CoV-2(SARS-CoV-2) that was initially identified in city of Wuhan, Hubei Province of China in December 2019. After the index case notified in China, First case of CoViD-19 was confirmed in January 2020 from India, and in March 2020 from Uttarakhand. In India there are about 800,000 active cases and about 150,000 deaths because of CoViD-19 by October 2020. Despite of that 70,00,000 cases recovered and get discharged from the CoViD centres. Uttarakhand contributed about 6000 active cases, 52000 recoveries and 1000 deaths by October 2020.Nonetheless, as the SARS-CoV and MERS-CoV were zoonotic infections but Recently, evidence of Inter-human only transmission of SARS-CoV-2 has been accumulated and thus, the outbreak seems to be spreading among humans throughout a large parts of Uttarakhand even in the hilly areas also. Here we are providing an update on features of CoViD-19, and Providing possible solutions how to halt expansion of this pandemic and also some updates on Convalescent Plasma.

Corona virusis a large group of viruses that cause respiratory and gastrointestinal illnesses. Originating in Wuhan, China, in December 2019, the 2019-novel Corona virus pandemic has spread around the globe and raised concerns. Due to the large number of individuals affected worldwide, the illness has rendered isolated areas uninhabitable, forcing residents to stay inside their homes in an effort to contain its spread. The 2019 corona virus, the severe acute respiratory syndrome corona virus, and the first human pandemic of the twenty-first century have identical human cellular receptors. Nevertheless, compared to the severe acute respiratory syndrome corona virus, the 2019-novel corona virus is more powerful, highly infectious, and changeable. The spike glycoprotein is the best place to create a 2019 corona virus vaccine. Where would be best to develop a vaccine against the 2019 novel Numerous mechanisms, including receptor binding, membrane fusion via conformational changes, viral internalization, host tissue tropism, and spike deactivation due to antibody-induced instability, depend on the spike glycoprotein known as corona virus. After the first breakout in December 2019, everyone in the world felt momentarily comforted when the death ratio began to decline around the end of 2020. People believed that the summer was one of the best seasons to combat illness and prevent its spread. However, in recent months, a global outcry over new 2019 Corona virus infection variations has garnered attention, putting people's lives, regardless of age or community, at risk. Scholars must concentrate on the findings and advancements. In addition, we have worked to increase awareness of the need for the creation of an international virtual community in order to enable smooth communication across all parts of the world and support mankind in the case of a category 5 coronavirus outbreak.

Severe acute respiratory syndrome corona virus 2 infection causes severe pneumonia (coronavirus disease 2019 [COVID-19]), but the mechanisms of subsequent respiratory failure and complicating renal and myocardial involvement are poorly understood. In addition, a systemic prothrombotic phenotype has been reported in patients with COVID-19. A total of 62 subjects were included in our study (n=38 patients with reverse transcriptase polymerase chain reaction-confirmed COVID-19 and n=24 non-COVID-19 controls). We performed histopathologic assessment of autopsy cases, surface marker-based phenotyping of neutrophils and platelets, and functional assays for platelet, neutrophil functions, and coagulation tests, as well. We provide evidence that organ involvement and prothrombotic features in COVID-19 are linked by immunothrombosis. We show that, in COVID-19, inflammatory microvascular thrombi are present in the lung, kidney, and heart, containing neutrophil extracellular traps associated with platelets and fibrin. Patients with COVID-19 also present with neutrophil-platelet aggregates and a distinct neutrophil and platelet activation pattern in blood, which changes with disease severity. Whereas cases of intermediate severity show an exhausted platelet and hyporeactive neutrophil phenotype, patients severely affected with COVID-19 are characterized by excessive platelet and neutrophil activation in comparison with healthy controls and non-COVID-19 pneumonia. Dysregulated immunothrombosis in severe acute respiratory syndrome corona virus 2 pneumonia is linked to both acute respiratory distress syndrome and systemic hypercoagulability. Taken together, our data point to immunothrombotic dysregulation as a key marker of disease severity in COVID-19. Further work is necessary to determine the role of immunothrombosis in COVID-19.

Objective: To determine clinical presentations and source among severe acute respiratory syndrome corona virus 2 positive health care workers of tertiary care hospital.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Combined Military Hospital Rawalpindi, from Mar to Jun 2020.
 Methodology: A cross sectional study was conducted by using a questionnaire for risk assessment regardingexposure to Corona Virus Disease 2019 (COVID-19) virus and practices of participants. Health care workers whowere exposed or had fever, cough, shortness of breath, were asked to undergo semi-quantitative real-time reverse transcriptase–polymerase chain reaction test for Severe Acute Respiratory Syndrome Corona Virus 2 onnasopharyngeal and oro-pharyngeal swabs.
 Results: Out of the 92 health care workers who tested positive, 80/92 (86.95%) were males, 12/92 (13.04%)females. Asymptomatic cases were 53/92 (57.60%) and 39/92 (42.40%) were symptomatic, 10/92 (10.8%) of theparticipants were doctors, 06/92 (6.52%) nurses, 36/92 (39.14%) paramedics and 40/92 (43.47%) were hospitalauxiliary staff. Among symptomatic cases, 28/39 (71.79%) developed fever with myalgia, 22/39 fever alone,23/39 (58.97%) headache, 13/39 (33%) sore throat, 15/39 (38%) runny nose, 11/39 (28.20%) mild shortness ofbreath on exertion, 7/39 (17.94%) diarrhea and 5/39 (12.82%) experienced loss of taste.
 Conclusion: As the Corona Virus Disease 2019 pandemic continues, chances of health care workers gettinginfected are high so it is critical to improve the knowledge of Health care workers. Educational interventions and further studies are warranted in this regard.

In December 2019, a novel corona virus (CoV) pandemic, caused by the severe acute respiratory syndrome corona virus–2 (SARS-CoV-2) emerged from China. This virus causes the corona virus disease 2019 (COVID-19). The ocular implications of human CoV infections have not been widely studied. There are few reports on the association of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) with ocular abnormalities. Understanding ocular manifestations of patients with COVID-19 by ophthalmologists and others may facilitate the diagnosis and prevention of transmission of the disease. The review article will also highlight CoVs and their associated ocular infections. We hope that this article will serve as further research into the ocular implications of human CoV infections. As the current pandemic continues, a better understanding of the virus will emerge, hopefully with more emphasis on research into the relationship between human CoVs and the eye. This understanding will not only help us to guide infection control measures but can also provide insights on the feasibility of using ocular tissue or even tears as a medium of diagnosis. Meanwhile, ophthalmologists and other health-care workers should continue to work on the side of caution and continue to prevent the possible transmission of CoVs through ocular tissue.

Objective: To share the epidemiological, clinical and laboratory -based evidence of severe acute respiratory syndrome Corona Virus-2 with focus on the cases of re-infection; an update after one year of the ongoing pandemic.
 Study Design: Prospective observational study.
 Place and Duration of Study: Department of Pathology, in collaboration with Department of Medicine, Combined Military Hospital, Malir, from Mar 2020 to Feb 2021.
 Methodology: Total 5190 nasopharyngeal swabs were collected and transported to the laboratory in viral transport media for severe acute respiratory syndrome Corona Virus-2, from all symptomatic patients with a history of exposure/traveling from endemic areas and those requiring admission in hospital and were screened for COVID-19 as per hospital standing protocols.
 Results: 561(10.8%) patients were PCR positive for severe acute respiratory syndrome Corona Virus-2. The mean age of patients was 39.45±31.9 years and a majority of patients were males 426 (76%). The most common symptoms were fever and dry cough followed by myalgia and shortness of breath. 37 (9%) patients died due to the severity of the illness. Total 6 (1.46%) cases of laboratory-confirmed reinfection of severe acute respiratory syndrome Corona Virus-2 were reported. 2(33%) cases of reinfection were observed in health care workers, mortality was seen in a single patient associated with old age and comorbidities.
 Conclusion: In our study, the severity of the disease was directly related to the age of patients and underlying comorbidities. Reinfection was associated with increased viral load and exposure to the infected environment.

Post-coronavirus disease (post-COVID) symptoms arise mostly from impaired function of respiratory tract although in many patients, the dysfunction of gastrointestinal tract and liver among other organ systems may persist. Primary data collection was based on a short gastrointestinal symptom questionnaire at the initial screening. A brief telephone survey within the patient and control group was performed 5-8 months after the initial screening. R ver. 4.0.5 and imbalanced RandomForest (RF) machine-learning algorithm were used for data explorations and analyses. A total of 590 patients were included in the study. The general presence of gastrointestinal symptoms 208.2 days (153-230 days) after the initial acute severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection was 19% in patients with moderate-to-serious course of the disease and 7.3% in patients with mild course compared with 3.0% in SARS-CoV-2 negative controls (P < 0.001). Diarrhea and abdominal pain are the most prevalent post-COVID gastrointestinal symptoms. RF machine-learning algorithm identified acute diarrhea and antibiotics administration as the strongest predictors for gastrointestinal sequelae with area under curve of 0.68. Variable importance for acute diarrhea is 0.066 and 0.058 for antibiotics administration. The presence of gastrointestinal sequelae 7 months after the initial SARS-CoV-2 infection is significantly higher in patients with moderate-to-severe course of the acute COVID-19 compared with asymptomatic patients or those with mild course of the disease. The most prevalent post-COVID gastrointestinal symptoms are diarrhea and abdominal pain. The strongest predictors for persistence of these symptoms are antibiotics administration and acute diarrhea during the initial infection.

Dear Editor, We congratulate the authors for the excellent documentation of their cases.[1] We would like to share our experiences dealing with similar cases and would also like to seek clarifications from the authors. We have also been routinely doing reverse transcriptase polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome Corona virus (SARS-CoV-2) in our patients with retinal vascular occlusion, endogenous endophthalmitis, panophthalmitis (unpublished data), and with posterior uveitis.[23] The authors statement “To the best of our knowledge, no study to date evaluated the intraocular fluids for the presence of SARS-CoV-2 in live humans is not correct.” Bilgic et al.[4] have isolated the SARS-CoV-2 in patients with endophthalmitis from the vitreous sample. In an another study by Koo et al.[5], six (19.4%) patients demonstrated detectable SARS-CoV-2 RNA in the aqueous sample, and fortunately, all these individuals did not have any systemic symptoms. We were not able to isolate the SARS-CoV-2 virus in either aqueous or vitreous sample. We have been adopting the following procedure for processing the samples. Our samples are collected in a 1 mL tubeculin syringe and capped, transported in an viral transport medium available from Bhat Bio-Scan™ to the laboratory maintaining a temperature between 2 and 8°C. TaqPath™ Corona Virus Disease-19 (COVID-19) Multiplex Diagnostic Solution from Thermo Fisher Scientific™ is used for multiplex real-time RT-PCR test. This helps in qualitative detection of nucleic acid from SARS-CoV-2. Three regions of the SARS-CoV-2 single-stranded RNA genome – The Orf1ab, N gene, and S gene – are amplified and detected with the help of primer and the probe. It is of importance as SARS-CoV-2 is either not detected or detected in a very low percentage, of ocular samples in patients who have COVID-19.[6] We would also like to suggest that a positive control may be useful by adding a known quantity of viral RNA to ocular fluid to rule out the presence of polymerase chain reaction inhibitors. It would also be useful if the authors could share if SARS-CoV-2 antibodies and other inflammatory markers were raised in their seven patients. Our patients who were not vaccinated had raised levels of antibodies in addition to raised levels of D-dimer, serum ferritin, and lactate dehydrogenase. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Background End-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD) are highly vulnerable to severe manifestations of coronavirus disease 2019 (COVID-19) as increased risk of thromboembolic disease and worsened neuropsychiatric status. Aim To assess the long-term thrombotic and neuropsychiatric sequelae of severe acute respiratory syndrome corona virus 2 in post-COVID-19 ESRD patients on MHD. Patients and methods We followed for 12 months, 35 clinically stable HD patients on MHD who were confirmed or highly suspected for COVID-19 by positive severe acute respiratory syndrome corona virus 2 RT-PCR and/or high probability on high-resolution computed tomography chest imaging. We recorded demographics, HD and COVID-19 related data, thromboembolic history, and psychiatric history. We recorded baseline and follow-up complete blood count with differential counts, D-dimer, prothrombin time, international normalized ratio, and high-resolution computed tomography chest findings. We assessed post-COVID-19 neuropsychiatric sequelae using the Arabic versions of Hamilton’s depression rating scale and Taylor’s manifest anxiety scale. Results Total leukocytic count, lymphocytes, and platelets were significantly lower during infection than preinfection, 6 months, and 1-year postinfection (P&lt;0.001, P=0.003, P=0.014, respectively). Six months after infection, d-dimer levels were higher than normal values. The incidence of vascular access thrombosis was 25.7%. The scores of Hamilton’s depression rating scale and Taylor’s manifest anxiety scale were high [25 (interquartile range; 17–28) and 26 (interquartile range; 19–33)], respectively, and the prevalence of depression and anxiety symptoms were 94.3 and 85.7%, respectively. Conclusions During infection, ESRD patients showed significantly lower total leukocytic count, lymphocytes, and platelets than preinfection, 6 months, and 1-year postinfection. They had high levels of d-dimer 6 months postinfection and a high risk for vascular access thrombosis. Their psychological wellbeing was markedly impaired by the pandemic resulting in depression and anxiety.

The Corona virus disease 2019 (COVID 19) badly affected the health of millions of people around the World. Efforts by clinical researchers to look for more effective ways to prevent the virus spread and curb the disease effect led to the speedy development of novel vaccines which developed contraindications in some individuals. Currently, there is no specific antiviral drug for the treatment of the disease. Consequently, the objective of this paper was to screen and identify nine (9) selected natural compounds as potential drug candidate for inhibition of RNA-dependent RNA polymerase (RdRP) of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) using appropriate procedures including Bioavailability test and toxicological prediction using Swiss ADME, Toxtree version 2.6.6 and pkCSM softwares. Result obtained from the study showed low inhibition constant (Ki) for Anthraquinone (53.83µM), Quercetin (55.3µM), Curcumin (80.5µM), Myricitrin (131.96µM), 8- gingerol (256.43µM) and DL-limonene (335.1µM) when compared with Remdesivir (4.5mM) which was used as control. The binding free energy for aloe-emodin (-5.99Kcal/mol) Anthraquinone (-5.83kcal/mol), Quercetin (-5.81Kcal/mol) and Curcumin (-5.59Kcal/mol) were low compared to others. ADME analysis established that Anthraquinone, Curcumin, 8-gingerol and DL-limonene did not violate any or more than 2 of the Lipinski rule however toxicity prediction revealed that only DL-limonene showed low risk of toxicity. This study, therefore suggests that DL-limonene could be a possible drug candidate for the inhibition of RdRP of SARS-CoV 2.

An unexpected outbreak of pneumonia of unfamiliar aetiology in Wuhan,Hubei, China was reported in December 2019. World Health Organization identified the pathogen and named it COVID-19. COVID-19 madethe world go through a cisis. The impact of this viral disease is now an issue of major concern. Respiratory infections, dry cough with fever are the major symptoms which are due to beta coronavirus, namely Severe Acute Respiratory Syndrome corona virus 2 (SARS-CoV-2). Within a short spell, COVID-19 spread all over China. Since January to today 24 March 2020 this epidemic turned into pandemic with continuous rise of cases and deaths. Italy, Germany, Spain, USA, Iran, France are the countries where the disease is spreading in a community level and rest of the countries over the globe the positive cases are also comingin. As the disease is communicable, it is highly necessary to take measures before it starts spreading in countries like India where the population is very high. The treatment of this severe acute respiratory syndrome corona virus 2 is not clear so far. Prevention is the only way to stop spreading this fatal disease. In view of this, the total state of knowledge regarding COVID-19 and the suggestive prevention are discussed by considering countries (considering India) where the population is high and this pandemic has just started spreading.