Second Wave Of Coronavirus Disease 2019 Research Articles

Metagenomic insights into fungal community composition of the nasopharyngeal region of COVID-19 associated mucormycosis patients from India.

Coronavirus disease 2019 (COVID-19) associated mucormycosis (CAM) was reported predominantly from India during the second wave of COVID-19 and has a high mortality rate. The present study aims to understand the fungal community composition of the nasopharyngeal region of CAM-infected individuals and compare it with severe COVID-19 patients and healthy controls. The fungal community composition was decoded by analyzing the sequence homology of theinternal transcribed spacer-2-(ITS-2)region of metagenomic DNA extracted from the upper respiratory samples. The alpha-diversity indices were found to be significantly altered in CAM patients (p < 0.05). Interestingly, a higher abundance of Candida africana, Candida haemuloni, Starmerella floris, and Starmerella lactiscondensi was observed exclusively in CAM patients. The interindividual changes in mycobiome composition were well supported by beta-diversity analysis (p < 0.05). The current study provides insights into the dysbiosis of the nasal mycobiome during CAM infection. In conclusion, our study shows that severe COVID-19 and CAM are associated with alteration in mycobiomeas compared to healthy controls. However, the sequential alteration in the fungal flora which ultimately leads to the development of CAM needs to be addressed by future studies.

Determinants for university students’ location data sharing with public institutions during COVID-19: The Italian case

Abstract Data on real-time individuals’ location may provide significant opportunities for managing emergency situations. For example, in the case of outbreaks, besides informing on the proximity of people, hence supporting contact tracing activities, location data can be used to understand spatial heterogeneity in virus transmission. However, individuals’ low consent to share their data, proved by the low penetration rate of contact tracing apps in several countries during the coronavirus disease-2019 (COVID-19) pandemic, re-opened the scientific and practitioners’ discussion on factors and conditions triggering citizens to share their positioning data. Following the Antecedents → Privacy Concerns → Outcomes (APCO) model, and based on Privacy Calculus and Reasoned Action Theories, the study investigates factors that cause university students to share their location data with public institutions during outbreaks. To this end, an explanatory survey was conducted in Italy during the second wave of COVID-19, collecting 245 questionnaire responses. Structural equations modeling was used to contemporary investigate the role of trust, perceived benefit, and perceived risk as determinants of the intention to share location data during outbreaks. Results show that respondents’ trust in public institutions, the perceived benefits, and the perceived risk are significant predictor of the intention to disclose personal tracking data with public institutions. Results indicate that the latter two factors impact university students’ willingness to share data more than trust, prompting public institutions to rethink how they launch and manage the adoption process for these technological applications.

Korean adolescents' coping strategies on self-harm, ADHD, insomnia during COVID-19: text mining of social media big data.

Since the Coronavirus disease 2019 (COVID-19), public safety measures, including social distancing and school closures, have been implemented, precipitating psychological difficulties and heightened online activities for adolescents. However, studies examining the impact of the pandemic on adolescent mental health and their coping strategies in Asian countries are limited. Further, most studies have used survey measures to capture mental health challenges so far. Accordingly, this study aimed to examine the psychological challenges South Korean adolescents experienced and their coping strategies during the pandemic using the Natural Language Processing (NLP) and Text mining (TM) technique on adolescents' social media texts/posts. The data were gathered from social media texts/posts such as online communities, Twitter, and personal blogs from January 1, 2019, to October 31, 2021. The 12,520,250 texts containing keywords related to adolescents' common psychological difficulties reported during the pandemic, including self-harm, Attention-Deficit/Hyperactivity Disorders (ADHD), and insomnia, were analyzed by TM, NLP using information extraction, co-occurrence and sentiment analysis. The monthly frequency of the keywords and their associated words was also analyzed to understand the time trend. Adolescents used the word "self-harm" in their social media texts more frequently during the second wave of COVID-19 (August to September 2020). "Friends" was the most associated word with "self-harm." While the frequency of texts with "Insomnia" stayed constant throughout the pandemic, the word "ADHD" was increasingly mentioned in social media. ADHD and insomnia were most frequently associated with ADHD medications and sleeping pills, respectively. Friends were generally associated with positive words, while parents were associated with negative words. During COVID-19, Korean adolescents often expressed their psychological challenges on social media platforms. However, their coping strategies seemed less efficient to help with their difficulties, warranting strategies to support them in the prolonged pandemic era. For example, Korean adolescents shared psychological challenges such as self-harm with friends rather than their parents. They considered using medicine (e.g., sleeping pills and ADHD medication) as coping strategies for sleep and attention problems.

Prehospital Time Intervals in Thailand during COVID-19

Objective: To determine the effect of the coronavirus disease, 2019 (COVID-19) pandemic on the prehospital time intervals of emergency medical services (EMS) in Thailand. Material and Methods: This retrospective cohort study analyzed the prehospital time intervals of EMS in Thailand; from January 1, 2019 to September 30, 2021 using data obtained from the national EMS database. Patients with incomplete medical records, prehospital time intervals &lt;1 or &gt;300 minutes, and those admitted between January 1 and March 31, 2020 were excluded. Data were compared between the following groups: Group 1, pre-COVID-19; Group 2, first- and second-wave of COVID-19; and Group 3, third-wave of COVID-19: Kruskal–Wallis, Wilcoxon rank-sum, and chi-square tests were used. Results: A total of 3,863,153 patients were enrolled into this study. The median total prehospital time was significantly longer in Group 2 when compared to Group 1, [25 (17,34) vs. 24 (17,33) minutes, p-value&lt;0.001]; longer on-scene time, [4 (2,7) vs. 3 (2,6) minutes, p-value&lt;0.001]; shorter transportation time, [10 (6,17) vs. 11 (6,18) minutes, p-value&lt;0.001]. The median total prehospital time [27 (19,37) vs. 25 (17,34) minutes, p-value&lt;0.001], response time [8 (5,14) vs. 7 (4,11) minutes, p-value&lt;0.001], and transportation time were significantly longer in Group 3 than in Group 2 [11 (6,18) vs. 10 (6,17) minutes, p-value&lt;0.001]. Conclusion: The EMS prehospital time intervals in Thailand during COVID-19 were significantly longer in both the non-trauma and trauma subgroups. Appropriate pre-hospital strategies and monitoring should be developed to manage future pandemics.

Coronavirus disease (COVID-19)-associated mucormycosis (CAM): The unholy triad of COVID-19, diabetes mellitus, and corticosteroid therapy.

The whole world has battled with multiple waves of coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 virus. However, the second wave of COVID-19 had caused a worldwide havoc in terms of disease transmissibility, severity, and mortality. India has been among the worst hit countries during the second wave, which substantially overburdened and overwhelmed the Indian health care system. While secondary infections and co-infections among COVID-19 patients were increasingly being reported, COVID-19-associated mucormycosis (CAM) emerged as a new challenge particularly from India and became a matter of immediate concern. The most common causes attributed to the rise of CAM were undiagnosed/uncontrolled diabetes mellitus, excessive use of corticosteroids, and prolonged hospital stay, all of which create a perfect environment for mucormycosis infection to set in.

The Second COVID-19 Wave Is a Tsunami With Aftershocks: Mucormycosis Ire as Seen in a Tertiary Care Hospital in Uttarakhand, India.

During the spread of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) or the coronavirus disease 2019 (COVID-19) pandemic in recent times, an upsurge of invasive fungal infections (IFIs) such as mucormycosis was witnessed by many countries like India. This COVID-19-associated mucormycosis (CAM) has presented as a menace to the already creaking health infrastructure. Clinical manifestations, risk factors, and end clinical outcomes varied for every other region/country. The aim of this study is to delineate and analyze plausible clinical and epidemiological factors and associated predictors of CAM in suspected patients presenting to a tertiary care hospital in Uttarakhand, India, during the second wave of COVID-19 in India. A total of 200 cases of suspected post‑COVID-19 mucormycosis were enrolled. Data were collected taking into account parameters such as hospitalization and ICU admissions during the episode of COVID-19 infection, steroid/antibiotics/oxygen requirement, and comorbidities such as diabetes mellitus, hypertension, or any chronic illness and outcome. Participants diagnosed with CAM using KOH examination and fungal culture were analyzed in the study (n=46). The median age of patients included was 48, 73.9% were males, and 26% were females. The major predisposing factor was found to be diabetes mellitus type 2. Our work suggests that the mean duration between COVID-19 episodes and CAM was 11.86 days with a significant statistical association. Oxygen requirement and imprudent use of steroids/antibiotics were also allied with mucormycosis. The burden of such IFIs is expected to be unveiled in tropical countries during pandemics such as COVID-19, which lead to immunosuppression in masses post-treatment. Comorbidities such as diabetes, chronic kidney disease, and hypertension add to the risk of acquiring other infectious disease. Such times require competent healthcare professionals such as diagnosticians, physicians, and surgeons who are skilled to manage such IFIs timely.

Sinonasal and Orbital Imaging Findings in COVID-Associated Rhino-Orbito-Cerebral Mucormycosis During the Second Wave of COVID-19: A Retrospective Cohort Study in a Tertiary Hospital in Central India.

Background Mucormycosis is a consequence of the angioinvasive disease caused by filamentous fungi that belong to the order Mucorales, particularly Mucor, Rhizopus, and Rhizomucor. Rhizopus oryzae is the most prevalent form. The invading hyphae lead to damage of blood vessels leading to thrombosis and consequent tissue necrosis. The incidence of this disease entity witnessed a significant rise during the second wave of the coronavirus disease 2019 (COVID-19) pandemic. Timely diagnosis and prompt treatment are crucial to diminish both the mortality and morbidity associated with this disease. Imaging plays a pivotal role in diagnosing the ailment, evaluating its extent, identifying complications such as thrombosis, and facilitating surgical planning. It demonstrates exceptional sensitivity in detecting the disease at its early stages, often before symptoms manifest. Due to the angioinvasive nature of Mucor, early detection assumes utmost importance as it necessitates intensive antifungal therapy and the removal of devitalized tissue through debridement. Methodology We conducted a retrospective cohort study to analyze computed tomography (CT) imaging findings in patients with COVID-associated rhino-orbito-cerebral mucormycosis (ROCM) confirmed by histopathological examination. We compared these findings with CT findings of the nose and paranasal sinuses in patients without mucor following COVID-19 sinusitis (non-ROCM). Results All 16 cases in the non-ROCM group were in stage 1 disease. In contrast, in the ROCM group, three patients had stage 1 disease, five patients had stage 2 disease, and 10 patients had stage 3 disease (p = 0.0001). The pterygopalatine fossa was significantly affected in 10 of 18 ROCM patients and in none of the non-ROCM patients. Conclusions Imaging plays a crucial role in the early detection of mucormycosis. It assists treating physicians in initiating prompt and aggressive treatment, thereby improving the prognosis of this frequently fatal disease.

Effects of the coronavirus disease 2019 pandemic on anxiety and spirituality in patients with cancer undergoing chemotherapy: A cross-sectional study.

e24200 Background: The objective of this study was to evaluate anxiety and spirituality levels in oncology patients during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This short-term cross-sectional study applied a previously validated General Anxiety Disorder-7 (GAD7) scale and spirituality inventory to 230 patients undergoing antineoplastic chemotherapy during the second wave of COVID-19 in Brazil. The means ± SD of the scales were calculated and correlated (Spearman's rho). After categorization, chi-square and multinomial regression models were used to identify risk factors (p &lt; 0.05). Results: The levels of anxiety (6.16±5.11) and spirituality (17.22±2.66) were moderately and inversely correlated (p = 0.001, r = -0.212). Women (p = 0.025), fatigue (p = 0.048), and insomnia (p = 0.001) were associated with an increased incidence of anxiety; however, spirituality was associated with a reduced incidence of fatigue (p = 0.032). Death of family or friends due to COVID-19 increased the risk of high levels of anxiety (p &lt; 0.05), while in multivariate analysis, insomnia (p = 0.030) and sleep difficulty (p = 0.031) were also directly associated with anxiety and spirituality reduced the interruption of chemotherapy during the COVID-19 pandemic (p = 0.036). Conclusions: Fear of the COVID-19 pandemic altered the psychoemotional environment of patients undergoing chemotherapy, resulting in increased levels of anxiety. However, spirituality was an important coping strategy in patients undergoing cancer treatment.

Highlighting the Need for MD-PhD Programs in Developing Countries

In certain developing countries, research output in the medical field has been rising rapidly in the last few decades due to an increased focus on medical research development through different avenues.[1] These indicated an increase in the expenses on research projects, the launch of more research centers, and others.[1] [2] However, this is not the case for most developing countries. Compared with developing countries, developed countries have contributed a lot more to scientific publications in health research.[3] [4] Furthermore, the health research productivity of postgraduate students in low- and middle-income countries was found to be low.[5] In detail, the majority of students infrequently publish their theses. In addition, most published studies are cross-sectional in design, with hardly any clinical trials.[5] The reasons behind that vary, but many of them are common, including limited funding and resources, weak linkage between universities and stakeholders, limited facilities for research training and education, and limited access to health information and literature sources.[3] [6] Such problems have affected medical education in developing countries negatively. For example, in one of the low-income countries, Mozambique, for the period between 2004 and 2010, only 11% of Mozambican University faculty members had a PhD degree, and the shortage of human resources for teaching and mentoring in that country is still an ongoing problem.[7] It has also become clear that developing nations' clinical research needs to be improved if important issues are to be resolved and effective pandemic management tactics are to be selected. As an illustration, the coronavirus disease 2019 (COVID-19) pandemic, which started in the Chinese city of Wuhan in 2019 and is brought on by the severe acute respiratory syndrome coronavirus 2 virus that mostly affects the respiratory tract,[8] has had a major impact on public health in India. Following the second wave of COVID-19 in India, it has been argued that conducting research is essential for low- and middle-income countries so that resources can be allocated properly where they are needed and health systems can develop a greater understanding of what causes good and bad outcomes.[9]

BF.7 Omicron subvariant in India and China: a raising concern - correspondence.

Highlights Covid-19 cases has been increased in China and India because of BF.7 Omicron sub-variant. R0 i.e., basic reproduction number of BF.7 Omicron sub-variant is 10 to 18.6, whereas Delta variant had RO of 5 to 6 approximately BF.7 is being reported from 91 countries like USA, UK, Europe, South Korea, Brazil, and India Dear Editor, There has been a recent outburst of coronavirus disease 2019 (COVID-19) cases in China because of the BF.7 Omicron subvariant. The massive crisis started after ‘Zero COVID policy’ in place since the first wave in 2019 was refuted; people were susceptible as herd immunity had not developed owing to stringent lockdown measures. The health care facilities are overfilled with cases, while crematoriums have long lines for the last rites of deceased family members. BF.7 cases have been reported in the USA and Europe since October. Experts have made projections that the situation in China will get worse by March 2022. BF.7 is known to re-infect frequently and also infect the vaccinated population. Its R0, that is, the basic reproduction number, is 10–18.6, whereas the Delta variant had an R Nought of ~5–61. BF.7 is being reported from 91 countries, including the USA, UK, Europe, South Korea, Brazil and India. India has started screening international passengers for COVID-19 at airports. As per the Cabinet Health Minister, the government might make testing for all international arrivals mandatory, if needed. Till now, India has four confirmed cases of the BA.5.2.1.7, that is, the BF.7 subvariant of Omicron: three in the state of Gujarat and one in Odisha in the east. BF.7 has a short incubation period; it has potential to spread fast. The Prime Minister of India summoned a high-level meeting on 22 December 2022, to assess the COVID-19 situation and stressed the need arrange for adequate infrastructure, medicines, ventilators and oxygen supplies. After reignited surge in COVID-19 cases in China, people were requested to wear masks, and get booster vaccination if needed. As many as 185 new Coronavirus cases have been reported on 22 December 2022, in India, with four cases proven to have the BF.7 subvariant. Direct flights from China have been banned, yet there are connecting flights from neighbouring countries like Sri Lanka, Nepal and Myanmar. WHO is very concerned about an unprecedented wave of cases in China, which might impact other countries soon2. The Health Ministry of India ordered to escalate testing samples from suspected cases and also to ensure that all positive samples are sent for genome sequencing to 50 sequencing laboratories set up under INSACOG (Indian SARS-CoV2 Genomics Consortium). INSACOG was set up in the year 2020 to monitor various COVID virus variants circulating in the country. Early isolation, detection and timely management of cases are of crucial importance to curb the outbreaks. Keeping in view the upcoming ‘New Year’, government can announce new guidelines for passengers travelling in and outside the country3. Genome sequencing can help avoid a wave similar to the second wave; the delta variant had spread at that time and nearly collapsed the Indian health care infrastructure in the year 2021. Positive samples retrieved from airports will be sequenced within 48 hours by INSACOG Laboratories. This will prove instrumental in mapping COVID-19 in the country. The expanding genome sequencing facilities will aid immensely in policy formulation to fight back the infections. India will impose airport testing and home quarantine, even for completely vaccinated individuals arriving in the country from areas with Omicron cases. The National Institute of Virology, Pune, India, will also put in efforts to isolate Omicron to help the ‘Bharat Biotech International’ and ‘the Serum Institute of India’, the two vaccine manufacturing giants of India, make vaccines for the new subvariant. An advisory has already been issued against mass gatherings. India had suffered much during the second wave of COVID-19, which killed at least 500 000 people and infected nearly 40 million people. The dynamics of the second wave in the country were a lesson for administration, the public and scientific organisations like the Indian Council of Medical Research that have helped draught policies to combat such pandemics so that India should never suffer through similar things again2. The country is more prepared compared to the last time if similar upsurge is observed in India. Caseload is still low in India, and more efforts can be put into the sequencing and surveillance of the cases for the time being. Apart from that, lags in reporting that are not happening in real time are concerning; therefore, more efforts are required to avoid such lags so as to isolate infectious cases in a timely manner4. Ethical approval Not applicable. Sources of funding None. Authors contribution R.S., A.M., R.R. and B.K.P. developed the original draft, review and edit the manuscript. All authors read and approve for the final manuscript. Conflict of interest disclosure None. Research registration unique identifying number (UIN) 1. Name of the registry: NA. 2. Unique identifying number or registration ID: NA. 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): NA. Guarantor Ranjit Sah. Data availability All data are included in the manuscript.

Transmission dynamics and high infectiousness of Coronavirus Disease 2019

&lt;p style='text-indent:20px;'&gt;Coronavirus disease 2019 (COVID-19) has rapidly spread around the world since the early 2020. Recently, a second wave of COVID-19 has resurged in many countries. The transmission dynamics and infectiousness of the COVID-19 pandemic remain unclear, and developing strategies to mitigate the severity of the pandemic is a top priority for global public health. According to the infection mechanism of COVID-19, a novel susceptible-asymptomatic-symptomatic-recovered (SASR) model with control variables in a patchy environment was proposed not only to consider the key characteristics of asymptomatic infection and the effects of seasonal variation but also to incorporate different control measures for multiple transmission routes. The basic reproduction number &lt;inline-formula&gt;&lt;tex-math id="M1"&gt;\begin{document}$ R_{0} $\end{document}&lt;/tex-math&gt;&lt;/inline-formula&gt; was established to describe the spreading behavior in the natural state over a long time horizon, and the natural reproduction number &lt;inline-formula&gt;&lt;tex-math id="M2"&gt;\begin{document}$ R_{n} $\end{document}&lt;/tex-math&gt;&lt;/inline-formula&gt;, which describes the development trend of the disease during a short time in the future, was defined according to the actual propagation characteristics. In addition, the effective reproduction number &lt;inline-formula&gt;&lt;tex-math id="M3"&gt;\begin{document}$ R_{e} $\end{document}&lt;/tex-math&gt;&lt;/inline-formula&gt; considering the control strategies was proposed to evaluate the impact of non-pharmaceutical interventions. The results of numerical simulations for COVID-19 cases in Wuhan, China, based on the SASR model indicate that &lt;inline-formula&gt;&lt;tex-math id="M4"&gt;\begin{document}$ R_{0} $\end{document}&lt;/tex-math&gt;&lt;/inline-formula&gt; was 3.58, &lt;inline-formula&gt;&lt;tex-math id="M5"&gt;\begin{document}$ R_{n} $\end{document}&lt;/tex-math&gt;&lt;/inline-formula&gt; ranged from 2.37 to 4.91, and &lt;inline-formula&gt;&lt;tex-math id="M6"&gt;\begin{document}$ R_{e} $\end{document}&lt;/tex-math&gt;&lt;/inline-formula&gt; decreased gradually from 4.83 on December 8, 2019 to 0.31 on March 8, 2020, reaching 1.40 on January 23, 2020, when the lockdown was lifted in Wuhan. We further concluded that the total number of infections, including asymptomatic infections, was approximately 301, 804 as of March 8, 2020, in Wuhan, China. In particular, this article proposes a dynamic method to distinguish the impact of natural factors and human interventions on the development of the pandemic, and provides a theoretical basis for fighting the global COVID-19 pandemic.&lt;/p&gt;

An Epidemiological Analysis of Severe Acute Repiratory Syndrome Coronavirus 2 Genome Sequencing: A Hospital-based Retrospective Study

Introduction: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a positive-sense enveloped single-stranded Ribonucleic Acid (RNA) virus. Structural proteins help the virus package its RNA, while other proteins enable viral replication by facilitating host entry. Through constant mutation, the virus changes its emergence profile, and combinations of mutations can lead to increased transmissibility and receptor binding capacity, altering its surface structure. Whole genome sequencing is an important tool for studying these changes. In this study, the authors report on the genome sequencing of patients who tested positive for SARS-CoV-2 using real-time Reverse TranscriptasePolymerase Chain Reaction (RT-PCR) tests. Aim: To identify the different lineages circulating in specific districts of West Bengal, India, and perform an epidemiological analysis of the patients to control disease severity during the second wave of Coronavirus Disease-2019 (COVID-19). Materials and Methods: This retrospective hospital-based study was conducted at the Virus Research and Diagnostic Laboratory (VRDL) at RG Kar Medical College and Hospital, West Bengal, India from January 2021 to October 2021. Data collection started in January 2021 and was analysed in October 2021. Nasopharyngeal and oropharyngeal swabs were taken from patients with SARS-CoV-2, and the samples were tested using RT-PCR. Positive samples were sent to the Regional Virus Research and Diagnostic Laboratory-National Institute of Cholera and Enteric Diseases (NICED) for sequencing. Samples were collected from patients in different districts of West Bengal who were reported to the VRDL of RG Kar Medical College and Hospital. A total of 172,550 samples were tested for SARSCoV-2, and out of 13,764 positive samples, 230 were sent for genome sequencing. The primary inclusion criteria were SARSCoV-2 positive patients with CT values between 25 and 30 who were vaccinated. Patient information, address, gene variant, and gene mutation of the samples were analysed. Statistical analysis was performed using t-test with Statistical Package for Social Sciences (SPSS) software. Results: Whole-genome sequencing helped identify new trends and their prevalence in specific areas, aiding in prevention efforts. The most common type of mutation observed after double vaccination was the delta variant (B.1.617.2), followed by the kappa variant (B.1.617.1) and the alpha variant (B.1.1.7). Conclusion: Epidemiological genome sequencing studies help to identify emerging and changing viral trends, contributing to the mitigation of the spread of new variants. The delta, kappa, and alpha variants were the three primary sequences discovered in this study. The identification of these lineages facilitates the design of novel vaccines and diagnostic medications. Continuous monitoring and analysis of sequences from new cases in India and other affected countries are crucial for understanding the genetic evolution and substitution rates of SARS-CoV-2.

Prevalence of Adverse Events in Healthcare Professionals Using Personal Protective Equipment to Treat COVID-19: A Web-based Survey

Introduction: Healthcare Professionals (HCPs) involved in managing Coronavirus Disease 2019 (COVID-19) pandemic were instructed to wear Personal Protective Equipment (PPE) to protect themselves from contracting virus. However, PPE use can sometimes lead to adverse events which create greater impact on health status of HCPs. Thus, the prevalence of adverse events and associated risk factors should be estimated for taking necessary preventive measures. Aim: To evaluate the prevalence of adverse events in HCPs due to PPE use during second wave of COVID-19 in Tamil Nadu, India. Materials and Methods: A cross-sectional study was conducted in different levels of healthcare centres in Tamil Nadu, India, from April to May 2021. Data were collected using a pre-validated questionnaire from HCPs of any discipline who were directly involved in managing COVID-19 patients. A total of 282 responses were collected through Google forms and proportion of HCPs who experienced adverse events due to PPE and percentage of different adverse events associated with PPE wearing were assessed. Data were analysed using Chi-square test. Results: Out of 282 respondents of the survey included 224 doctors, 34 nurses and 24 lab technicians with a mean age of 30 years. There were 164 females and 118 males. A total of 177 (62.76%) participants experienced adverse events which included dehydration, thirst and heat, headaches, inability to go to restroom and other urinary/respiratory problems. With respect to duration of exposure to PPE, 163 (57.8%) HCPs had &gt;6 hours/day and 102 (36.2%) had 4-6 hours/day. It was observed that factors such as age, gender, profession, various wards posted for COVID-19 duty and duration of PPE worn daily were significantly associated with adverse events to PPE (p-value&lt;0.05). Conclusion: The results of the study concluded that higher prevalence of adverse events with PPE was seen among doctors and nurses. Most common encountered adverse events were dehydration, headache and skin problems, which have been associated with prolonged use of PPE.

Haematological, Clinical and Radiological Prognostic Markers in Young COVID19 Patients during the Second Wave: A Prospective Cohort Study

Introduction: The devastating outbreak of the second wave of Coronavirus Disease-2019 (COVID-19), resulting in numerous deaths among young individuals, has been the deadliest pandemic witnessed in this century. It caught us off guard by affecting young people and those without any underlying health conditions, leaving profound psychological and economic scars. Aim: To investigate various prognostic markers (haematological and clinicoradiological) in young COVID-19 patients during the second wave. Materials and Methods: This prospective, cohort study was conducted at a tertiary care centre in Karnataka, India from May 1st, 2021, to June 30th, 2021. All COVID-19 patients between the ages of 18 and 45, regardless of their pre-existing health status, who tested positive on Real-time Reverse TranscriptasePolymerase Chain Reaction (RT-PCR)/Rapid Antigen Test (RAT) or showed typical Computed Tomography (CT) changes, were included. Patients with COVID-19 symptoms but negative RT-PCR/RAT results and without typical CT changes were excluded. Clinical, haematological, and radiological parameters were compared between the survivor group and non survivor group, and the results were analysed using measures of central tendency (mean, median, and mode), Chi-square test, and Independent t-test Statistical Package for Social Sciences (SPSS) version 21.0. Results: A total of 624 cases aged between 18 and 45 were included in the study. Among them, 481 (77.08%) patients survived, while 143 (22.92%) patients were dead. Of the 624 cases, 376 (60.26%) were males, 247 (39.58%) were females, and 1 (0.16%) was transgender. Factors associated with increased mortality included older age (&gt;40 years), presentation with cough (119 patients, 83.2%) and dyspnoea (120 patients, 83.9%), asthma (7 patients, 1.1%), clinical classification based on respiratory rate, oxygen saturation, CT changes, and requirement for mechanical ventilation (78 patients, 54.5% in the Severe category and 54 patients, 37.8% in the Critical category), increased white blood cell count (mean μ=9685.8±5470.9), increased neutrophils (μ=8216±4986.9), elevated levels of CRP (μ=96.7±65.84 mg/dL), serum ferritin (μ=571.4±353.15 ng/ mL), LDH (μ=1268.7±835 U/L), D-dimer (μ=74.87±527), serum globulin, ALT (μ=67.6±58.5 U/L), AST (μ=76.4±62 U/L), ALP (μ=120±89 U/L), urea, creatinine, decreased levels of albumin, total protein, haemoglobin, and lymphopenia (μ=1096.1±795.9). Additionally, a CT score &gt;15 was associated with increased mortality. Conclusion: The aforementioned clinical, haematological, and radiological predictive biomarkers were associated with poor outcomes in young COVID-19 patients. Therefore, prompt and intensive management should be implemented to improve the prognosis of these patients.

MALDI-TOF-MS for Rapid Detection of Fungi causing Mucormycosis during COVID-19 Pandemic from a Tertiary Care Hospital in Southern India: A Retrospective Cohort Study

Introduction: Mucormycosis is an opportunistic fungal infection that became a public health emergency during the second wave of Coronavirus Disease-2019 (COVID-19). It is an acute, angioinvasive, opportunistic, and emerging mycosis caused by mucormycetes, resulting in a significantly fatal fungal infection among immunocompromised and/or immunosuppressed individuals. Mucormycosis has a specific predilection for blood vessels (angioinvasive) and tissues, leading to extensive necrosis and thromboembolic events. Globally, the incidence rate of mucormycosis varies from 0.005 to 1.7 per million people. Early diagnosis and appropriate therapy are crucial for clinical outcomes. Aim: To evaluate the mycological profile of mucormycosis during the COVID-19 pandemic using automated Matrix Assisted Laser Desorption Ionisation Time of Flight Mass Spectroscopy (MALDI-ToF-MS) in comparison with conventional fungal identification methods. Materials and Methods: A retrospective cohort study was conducted, collecting data from July 2020 to June 2022, involving 1,176 patients from various clinical departments who attended PSG Hospitals affiliated with PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India. Data analysis was performed from July 2022 to August 2022. Clinical specimens, including Bronchoalveolar Lavage (BAL), Sputum, Cerebrospinal Fluid (CSF), nasal swabs, tracheal aspirates, pus, blood, corneal scraping, eye discharge, and necrotised tissues, were subjected to Potassium Hydroxide (KOH) mount, conventional culture coupled with micrometry-aided microscopy, and MALDI-ToF-MS among suspected mucormycosis cases. The results were collected in Microsoft Excel, and data analysis was conducted using the International Business Machines Statistical Package for the Social Sciences statistical software (IBM SPSS) version 24.0. The study variables were expressed as descriptive statistics: frequency (N) and percentage (%). The incidence of mucormycosis, mycological profile, and diagnostic utility of conventional micrometry-aided microscopy-assisted culture were compared with the automated MALDI-ToF-MS protein signature method of testing. Results: Fungal elements were positive in 130 (11.05%) out of a total of 1,176 clinical samples, such as necrotised tissue, biopsy, and sputum, in the KOH mount. Fungal culture was positive in 258 (21.94%) out of 1176 samples, with mucormycosis detected in 73 (28.29%) of the culture-positive samples. The incidence of mucormycosis in this study was 73 (6.21%) out of 1176. A total of 101 (8.59%) samples showed positive results for mucormycetes through KOH, culture, and MALDI-ToF-MS. MALDI-ToF-MS could rapidly and specifically identify and confirm the causative agents of mucormycosis at their genus and species levels compared to KOH or culture. Conclusion: Simple, low-cost, and less laborious conventional culture coupled with micrometry-aided microscopy can detect Mucorales at the species level, where KOH microscopy could not differentiate between species. MALDI-ToF-MS can be employed for the rapid detection and confirmation of mucormycosis agents at the genus or species level

Full Mouth Rehabilitation of a Post COVID-19 Mucormycosis Treated Patient using BarRetained Prosthesis: A Case Report

During the second wave of Coronavirus Disease-2019 (COVID-19), the Indian subcontinent had witnessed a steep rise in the postCOVID mucormycosis cases with an alarming rate of about 70 times than that of the rest of the world. Maxillofacial defects amounted to various post-surgical hindrances such as difficulty in mastication, impaired speech, nasal regurgitation, mental despair and socially awkward situations. Dentists all over the world were challenged for fabricating a well-retained and functionally comfortable prosthesis that would contribute in improving the condition of a physiologically-debilitating and psychologically-impaired patient. Here the authors present a case of 65 years old male patient, full mouth rehabilitation of post-COVID mucormycosis treated patient wherein a bar-retained prosthesis was delivered which was not only non-invasive but highly retentive and even pocket-friendly for the patient. This case report also shows that through meticulous planning and execution of the treatment plan, one can achieve the desired results and meet the patient’s expectations.

Emerging Syndemic: Black Fungus—A Post-COVID-19 Mucormycosis

Novel coronavirus has created a havoc in India; about 30 million cases have been reported and 0.4 million deaths are recorded till now due to coronavirus disease 2019 (COVID-19). But nowadays, some patients of COVID-19 in India are battling a very rare but fatal disease, that is, mucormycosis or “black fungus” disease. The consciousness about the black fungus disease in many people of India is due to its rising cases of COVID-19-associated mucormycosis (CAM) mostly among the people who have recovered from COVID-19. Following recovery from COVID-19, thousands of cases of several complications of patients regarding CAM are reported especially during the second wave of COVID-19 in India. Mucormycosis or “black fungus” is a rare disease caused by fungi belonging to the order Mucorales. It is a disease observed following infection with the novel coronavirus in India and has already taken the form of a pandemic in many states.[1] [2] Therefore, scientists have chosen to name the disease as a syndemic since this is synergistically created with the pandemic. The ubiquitous molds of mucormycosis having a worldwide dispersal, including the Rhizopus, Apophysomyces, Mucor, and Lichtheimia species, are found in plants, soil, decaying fruits and vegetables, and even in air. If contact occurs with airborne spore, then it germinates into hyphae and is regarded a very rare occurrence. This preferentially takes place inside the bucconasal cavity. After germination, it can invade the neighboring tissue and blood vessels that results in characteristic hemorrhage followed by black color development. The visualization of these dark necrotic tissues on skin and blood vessels of the affected person is termed as black fungus disease. Till now five major forms of mucormycosis have been identified, for example, rhinocerebral (44–49%), cutaneous (10–16%), pulmonary (10–11%), disseminated (6–11.6%), and gastrointestinal (2–11%) forms. Among these, the most common rhinocerebral form usually occurs in immunocompromised individuals. It exhibited a “pattern paranasal infection” with a porch into the oral cavity often. It is a quickly emerging angioinvasive infection, with rhinoorbital-cerebral and pulmonary manifestations. According to the Indian government, there are over 11,700 reported cases and over 126 casualties as of May 2021.[3] There is a surge in terms of infection rates. Though mucormycosis is generally regarded as harmless to an immunocompetent host, it may be fatal in some cases in its combination form with factors like indiscriminate use of steroids or other immunosuppressants, even in subjects presenting with mild symptoms of COVID-19. Immunocompromised patients like people with hematological malignancies, damaged mucosal layer, uncontrolled diabetes, ketoacidosis, and viral induced lymphopenia are the prime victims of this deadly fungus.[4] It is a fatal disease if unnoticed as it is invasive to blood vessels, distant organs, nose, mouth, eyes, sinus, and even brain. If untreated, the infection usually develops speedily, and leads to death within a few days of contamination.

India's efforts to achieve 1.5 billion COVID-19 vaccinations: a narrative review.

The initial case of coronavirus disease 2019 (COVID-19) in India was reported on January 30, 2020, and subsequently, the number of COVID-19-infected patients surged during the first wave of April 2020 and the second wave in the same month of 2021. The government of India imposed a strict nationwide lockdown in April 2020 and extended it until May 2020. The second wave of COVID-19 in India overwhelmed the country's health facilities and exhausted its medical and paramedical workforce. This narrative review was conducted with the aim of summarizing the evidence drawn from policy documents of governmental and non-governmental organizations, as well as capturing India's COVID-19 vaccination efforts. The findings from this review cover the Indian government's vaccination initiatives, which ranged from steps taken to combat vaccine hesitancy to vaccination roadmaps, deployment plans, the use of digital health technology, vaccination monitoring, adverse effects, and innovative strategies such as Har Ghar Dastak and Jan Bhagidari Andolan (people's participation). These efforts collectively culminated in the successful administration of more than 1.8 billion doses of COVID-19 vaccines in India. This review also provides insights into other countries' responses to COVID-19 and guidance for future pandemics.

Mid- and long-term atrio-ventricular mechanics in children after recovery from asymptomatic or mildly symptomatic SARS-CoV-2 infection

Abstract Background Clinical manifestations of children's coronavirus disease-2019 (COVID-19) were initially considered less severe compared with adult patients. However, there is now increasing evidence of a “long-tail” of COVID-19 related symptoms lasting for several months after recovery from the acute infection. Long COVID-19-related symptoms and mechanisms are poorly characterized and understood, with several phenotypes reported, often driven by long-term tissue damage (such as lung, heart and brain) and pathological inflammation due to viral persistence and/or immune deregulation. Purpose The objective of this study was to evaluate atrio-ventricular mechanics, by means of two-dimensional speckle-tracking echocardiography, in previously healthy children recovered from asymptomatic or mildly symptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in a long-term follow-up. Methods We analysed a cohort of 157 paediatric patients, mean age 7±4 years, who had a confirmed diagnosis of SARS-CoV-2 infection and were asymptomatic or mildly symptomatic for COVID-19. Patients underwent standard transthoracic echocardiogram and speckle tracking echocardiographic study 148±68 days after diagnosis. One hundred seven age, sex, and body surface area comparable healthy subjects were used as control group. Results Left ventricular ejection fraction was within normal limits in postCOVID-19 cases and CTRL with no significant differences between the two groups (postCOVID-19: 65.6±4% vs CTRL: 65.0±5%, p=0.182). Left ventricular (LV) global longitudinal strain (postCOVID-19: −20.5±2.9%; CTRL: −21.8±1.7%; p&amp;lt;0.001) was significantly reduced in cases compared with CTRLs. An amount of 11 (7%) postCOVID-19 cases showed impaired GLS values &amp;lt; −17% and 95 subjects (60%) presented with a strain lower than −16% in more than 2 segments. These subjects did not show any difference regarding symptoms or serological findings. Moreover, GLS was significantly reduced in children with disease's onset during the second wave of COVID-19 pandemic, compared with those during the first wave (second wave: −20.2±2.6%; first wave: −21.2±3.4%; p=0.048). Finally, peak left atrial systolic strain was within the normal range in the postCOVID-19 group with no significant differences compared to CTRL (postCOVID-19: 49.1±12%; CTRL: 49.5±18%). Conclusions SARS-CoV-2 infection may affect left ventricular deformation in children despite an asymptomatic or only mildly symptomatic acute illness. Our data show an amount of 60% of children, recovering from asymptomatic or mildly symptomatic COVID-19, with still mild subclinical systolic cardiac impairment in the mid- and long-term follow-up after the infection. This subtle impairment was seen to be worse in children recovering from the second wave of COVID-19 compared to the first one. A follow-up is needed to verify the reversibility of these alterations and their impact on long-term outcomes. Funding Acknowledgement Type of funding sources: None.

Citizens’ use of public urban green spaces at the time of the COVID-19 pandemic in Italy

Since early 2020, Coronavirus Disease 2019 (COVID-19) has spread rapidly, quickly becoming a global pandemic. To counter the COVID-19 outbreak, national governments have issued different measures and restrictions, forcing citizens to adapt to a whole new lifestyle. These restrictions have impacted on the use of green spaces by citizens owing to many factors: more available free time, increased flexibility in the work environment, and a need to relax in Nature to relieve anxiety and stress. Urban green spaces provide many benefits for the physical and psychological well-being of citizens (e.g., habitat conservation, pollution control, recreational and leisure opportunities). To understand if citizens’ habits have changed due to the COVID-19 restrictions, this study provides insights from a web-based survey monitoring the use of such spaces before and during the COVID-19 lockdowns in Italy. A web-based questionnaire was conducted via “Facebook Messenger” and “WhatsApp” at the end of the second wave of COVID-19 (May–June 2021). Data collection having been concluded, 1075 completed questionnaires were collected and processed. The results show that while many reduced their weekly frequentation of green areas (−16.5%), the number of people frequenting green areas near their home every day increased (+7.7%). Two main groups of people were identified: the first, those who intensified their visits to green areas being those who desired to spend time in contact with Nature; the second, those who were reluctant to visit green areas for fear of being infected. The results also show most of the respondents felt urban green areas were either very important (82.1%) or important (14.4%). Overall, the results reveal that COVID-19 induced a positive perception of the benefits provided by urban green areas, with a consequent greater use of them, which seems destined to last even once the public health emergency has passed.