Second Wave Of Coronavirus Disease 2019 Research Articles

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<0.001) was significantly reduced in cases compared with CTRLs. An amount of 11 (7%) postCOVID-19 cases showed impaired GLS values < −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.

A comparative study of conjunctivitis in COVID-19 patients between the first and second wave of COVID-19 at a tertiary care center

Background: SARS CoV-2 has become a household name since early 2019 and till very recently has shown many mutations, some of which were predictable in behavior whereas some have been quite bizarre. With all these surreal mutants of the virus, the basic signs and symptoms of the infection also were diversified. A few studies compared the conjunctivitis features of the first and second wave of coronavirus disease 2019 (COVID-19) outbreak. Aims and Objectives: The purpose of this study was to compare the evidence of conjunctivitis between the first and second wave of COVID-19 patients. Materials and Methods: In this retrospective and observational research, clinical and laboratory characteristics of the patients with COVID-19 admitted to a tertiary care hospital in Western Maharashtra. We evaluated the patients including detailed history taken from the medical records and ocular evaluation was carried out by a trained ophthalmologist who was posted in the COVID-19 ward at that time. The patient’s symptoms were compared with the severity of COVID-19 disease classified as mild, moderate, and based on oxygen support given to the patient. Results: A total of 150 patients were evaluated in this study, of which 50 patients were from the first wave and 100 were from second wave of COVID-19. Among the total patients, about (80%) of patients with mild severity of COVID-19 disease were from in first wave v/s (61%) patients with mild severity of disease were from the second wave. Furthermore, it was observed that disease severity with moderate patients from the first wave was around (20%) v/s (39%) in the second wave. Among the total patients’ data, 66% of patients infected with conjunctivitis were in the first wave of COVID-19 and approximately 56% of patients infected with conjunctivitis were found in the second wave, respectively. About 18% of patients from the first wave and 39% of patients from the second wave with moderate severity required oxygen support. The fluorescein staining, as well as congestion, showed no significant difference in the number of patients between both waves. Conclusion: The present study concludes that both the waves only reported dryness and no clinical signs of conjunctivitis. The present study concludes that increased oxygenation support may act as one of the contributing factor for increased dryness and thereby may lead to various ocular infections.

POS-029 ACUTE KIDNEY INJURY IN CRITICALLY ILL PATIENTS OF COVID-19: A SINGLE CENTRE STUDY FROM INDIA

The second wave of coronavirus disease 2019 (COVID-19) in India was characterised by rapid surge in cases, higher rates of hospitalisation and mortality. Acute kidney injury (AKI) is a common complication of severe COVID-19 infection and has been associated with increased morbidity and mortality. The pathophysiology and risk factors of AKI in COVID –19 is inadequately studied especially in the setting of the second wave. There is scarcity of data from India regarding incidence, risk factors and outcome of AKI in critically ill COVID-19 patients. This was a prospective observational study conducted during the second wave of COVID-19 at a teaching hospital in south India. All the adult patients (>18 years old) with COVID-19 confirmed by a positive reverse-transcriptase-polymerase-chain reaction (RT-PCR) test and admitted to the intensive care unit (ICU) were included in this study. Severe COVID-19 was defined as SpO2 <94% in room air, PaO2/FiO2 <300 mm Hg, respiratory rate >30/min or lung infiltrates>50%. The study was conducted from 1st April 2021 to 31st July 2021. AKI was defined according to KDIGO (Kidney Disease: Improving Global Outcomes) criteria. Patients who were on maintenance dialysis prior to admission and those without a positive COVID RT PCR report were excluded. All patients were followed up until discharge or death as applicable. A total of 76 patients were admitted during the study period. 74 were included in the study (Figure 1). The average age of the patients was 55.6 ± 13.8 years. 78.4% of the patients were male. 34 (45.9%) of 74 patients developed AKI. Out of them 47.1% had stage 1 AKI, 17.6% had stage 2 AKI, 11.8% had stage 3 AKI and 23.5 % had stage 3 AKI requiring dialysis. When the baseline characteristics were compared between those who developed AKI versus those who did not develop AKI, the former had more co-morbidities as indicated by higher Charlson co-morbidity index (CCI score) p=0.001, higher proportion of diabetes mellitus (p=0.01) and pre-existing chronic kidney disease (CKD) (p= 0.04). The patients who developed AKI had more severe illness with 41.1% of them requiring non-invasive ventilation (NIV) and 44.1% mechanical ventilation (p= 0.001 and p= 0.04 respectively). 50% of patients who developed AKI required inotropic support as compared to 20% of those without AKI (p=0.007). Serum lactate dehydrogenase (LDH) and serum ferritin were significantly elevated in patients who developed AKI as compared to those who did not develop AKI (Figure 2). On stepwise multivariate regression analysis, presence of diabetes mellitus (OR (95% CI): 6.8 (1.50-30.96), p=0.013), serum LDH >/= 386 (OR (95% CI): 12.38 (1.66-92.46) p= 0.014, serum ferritin >/=835 (OR (95% CI): 3.84 (0.86-17.14) p=0.07 and delay from symptom onset to admission in days (OR (95% CI): 3.55 (0.89-14.15), p=0.07 were independent risk factors for development of AKI in our study population. The overall mortality rate of the study population was high at 56.7%, with 64.7% in the AKI group and 50% in the non- AKI group (p=0.20) Fig 1: Details of study population Fig 2: Box and whisker plots of serum LDH and serum ferritin in those with AKI and those without AKI View Large Image Figure ViewerDownload Hi-res image Download (PPT) There is high incidence of AKI in critically ill patients of COVID-19 admitted to ICU. Diabetes mellitus, high serum LDH and serum ferritin were found to be independent predictors for AKI development.

Study of Molds in Post COVID -19 Patients: An experience from Tertiary Care Centre

Introduction: Coronavirus disease 2019 (COVID-19) pandemic has emerged as a global health crisis in the century with a heavy toll on human life. The second wave of COVID-19 was lethal for the patients as they had to combat the virus along with the opportunistic fungal and bacterial infections triggered by it. Mucormycosis gained attention for its widespread existence during this period of the second wave of COVID-19. Material &amp; Methods: Various clinical samples like biopsy tissues from paranasal sinuses, deep nasal swabs, bronchoalveolar lavage, sputum, etc. were studied for the presence of fungal elements by KOH examination and culture on Sabouraud’s dextrose agar. Identification of fungal isolate was done by growth characteristics, LPCB wet mount, and slide culture. Result: During the study period, a total of 214 samples were received of which 17 (7.9%) were positive for fungal growth. Rhizopus arrhizus was most frequently isolated. Diabetes mellitus and the use of steroid during COVID-19 hospitalization was observed to be common risk factors. Rhino-cerebral mucormycosis was found to be the commonest type. Conclusion: Invasive mould infections can lead to fatal outcomes, if not detected timely. Accurate identification of the fungus is important for the administration of appropriate antifungal therapy.

Effect of the COVID-19 Pandemic Lockdown on the Management of Diabetic Retinopathy: A Cross-Sectional Study.

IntroductionWorldwide, diabetic retinopathy (DR) is one of the leading causes of vision loss. Early treatment and screening for DR have a major role in reducing the rate of the disease and the coronavirus disease 2019 (COVID-19) pandemic-related restrictions have altered real-world practice patterns in managing DR.Aims and objectivesTo evaluate the impact of the COVID-19 pandemic on the management of DR amongst patients presenting to a tertiary eye care center in Gujarat, India.MethodsThis is a cross-sectional study comparison of ophthalmic findings of 72 patients who presented to a tertiary care hospital with the manifestation of DR before and after the COVID-19 outbreak and subsequent lockdown. All the patients underwent detailed ophthalmic examinations, including optical coherence tomography (OCT) and fundus fluorescein angiography (FFA).ResultsThe mean age of participants was 54.5 years, with the mean duration of diabetes being five years since first detected. Diabetes was present in 26 patients out of 72. The number of follow-up visits to an ophthalmologist before COVID-19 was at least every one to three months, which significantly decreased after the lockdown of COVID-19. We found a significant progression of DR and clinically significant macular edema (CSME) in patients with diabetes. Before COVID-19, there were two mild non-proliferative diabetic retinopathy (NPDR), seven moderate NPDR, 15 severe NPDR, and 15 very severe NPDR, which were increased post lockdown to three, nine, 27, and 21, respectively. The proliferative diabetic retinopathy (PDR) vitreous hemorrhage (VH) and tractional retinal detachment (TRD) were also increased to 12 after lockdown as compared to only six before the COVID-19 lockdown. The causes for progression are inability to attend regular check-ups, inability to take proper treatment of diabetes and DR, poor control of diabetes, episode of COVID-19, history of high dose of steroid use, poor kidney function, and not knowing that there is a progression of the disease. A common reason for not visiting an ophthalmologist was fear of the unknown due to COVID-19.ConclusionsCOVID-19 has severely impacted the routine follow-up of DR and, in the subsequent years, there might be an increased incidence of severe outcomes due to DR. The second wave of COVID-19 and its lockdown have had very significant effects on the visual outcome of untreated DR patients.

Challenges during the second wave of COVID-19 in Brunei Darussalam: National Isolation Centre to National COVID-19 Hospital.

Soon after the start of the second wave of coronavirus disease 2019 (COVID-19) in Brunei Darussalam, which was confirmed to be due to the more infectious Delta strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it became apparent that the National Isolation Centre (NIC) was not coping. The NIC was the only isolation and treatment centre for COVID-19 in Brunei Darussalam. During the first wave and the first 11 days of the second wave, all confirmed cases were admitted to the NIC for isolation and treatment in line with the management strategy to isolate all confirmed cases to control the outbreak. The Ministry of Health opened five community isolation centres and two quarantine centres to divert asymptomatic and mild cases from the NIC. The community isolation centres also functioned as triage centres for the NIC, and the quarantine centres accommodated recovered patients who did not have their own quarantine facilities. The community isolation and quarantine centres diverted cases from the NIC and enabled recovered cases to be transferred to these step-down facilities. This reduced the NIC's occupancy to a safe level and enabled the reorganization of the NIC to function as a treatment centre and a national COVID-19 hospital. During any disease outbreak, health facilities must be prepared to adapt to changing situations. Strong leadership, stakeholder commitments, teamwork and constant communication are important in this process.

COVID-19 Infection in Pregnancy: A Descriptive Cross-sectional Study

Introduction: There is diverse evidence regarding the maternal and fetal effect of coronavirus disease 2019 (COVID-19) in pregnancy.&#x0D; Objectives: The objective of this study was to assess the effect of COVID-19 in mother and fetus during pregnancy.&#x0D; Methodology: A descriptive cross-sectional study was conducted during the second wave of COVID-19 in the Department of Obstetrics and Gynaecology at Birat Medical College Teaching Hospital from April 3 to July 3, 2021. All pregnant women admitted in the antenatal ward were sent real-time reverse transcription polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The patients with RT-PCR confirmed SARS-CoV-2 infection were enrolled in the study and followed up until discharged.&#x0D; Results: The COVID-19 positivity rate was 18.0%.The mean age was 24.38 years. Majority of the patients were asymptomatic (79.7%) Among symptomatic patients, 73.3% had fever and respiratory symptoms and 95.9% of women didn't give any history of contact with COVID-19 patients. After confirmed SARS-CoV-2 infection, all pregnant women were immediately shifted to COVID ward, another COVID hospital or advised home isolation. Only one patient had pre-existing hypertension. Among the pregnancy complications, preterm labour was seen in 12.2% followed by premature rupture of membranes in 6.8 %, fetal distress in 5.4%, and still birth in 2.7% of the pregnant women with SARS-CoV-2 infection. The minimum days of hospital stay was one and maximum days of hospital stay were 29 days. Average days of hospital stays was 2.24 days. Only 5.4% of patients who had severe disease required an intensive care unit (ICU) and one patient needed a mechanical ventilator. There was one maternal mortality due to Acute Respiratory Distress Syndrome (ARDS).&#x0D; Conclusion: Symptom, clinical course and severity of COVID-19 in pregnancy is comparable with non-pregnant women with COVID-19 but associated with increases the risk of Preterm labour, Premature rupture of membranes, foetal distress and stillbirth.

HRCT chest in patients suffering from COVID-19: Experience from a tertiary care centre in India during second wave of the pandemic

Abstract Aim The objective of the present study is to describe high-resolution CT (HRCT) chest manifestations of coronavirus disease 2019 (COVID-19) patients during second wave of the pandemic in a tertiary care hospital in New Delhi, India. We also aim to compare the findings on the HRCT chest during the second wave of COVID-19 with the data form earlier outbreaks and to look for any features specific to the second wave and thus indirectly to the delta variant of SARS-CoV-2. We also assessed the severity of the pulmonary involvement based on HRCT findings. Methods We analysed HRCT chest findings in 237 patients with COVID-19 admitted at our institute from 1st April 2021 to 31st May 2021. Covid-19 infection was confirmed by reverse transcription polymerase chain reaction (rt-PCR) or rapid antigen test (RAT) in all these patients. Results The mean age in our study group was 51.3 ± 12.1 years (range 19–79 years) comprising of 136 males (57.4%) and 101 females (42.6%). The majority of the patients showed bilateral (95.3%) and peripheral (42.6%) distribution of the disease. Ground glass opacities were the most common finding, seen in 214 (90.3%) patients, followed by interlobular septal thickening in 202 (85.8%) and crazy paving in 194 (81.3%) patients. Majority (36.7%) of these patients had a CT severity score above 20 indicating severe disease. Conclusion A typical pattern of peripheral subpleural often bilateral distribution of ground glass opacities on HRCT chest usually points to the possibility of COVID-19 pneumonia. The higher incidence of abnormalities on HRCT chest in patients with infection mainly from the delta variant of SARS-Cov-2 was mainly because of the more severe disease in the population. More research is needed to further evaluate the role of HRCT chest in the diagnosis of COVID-19 caused by different strains of the virus.

Would Illness Representations of COVID-19 and COVID-19 Fears During Clinic Visits Promote or Reduce Behavioral Intention to Seek Medical Consultations for Flu Symptoms? A Random Telephone Survey in Hong Kong, China.

BackgroundThe study investigated the level of behavioral intention to consult doctors for flu symptoms (BICDFS) during the Coronavirus Disease 2019 (COVID-19) pandemic and examined its associations with illness representations of COVID-19 and fear of COVID-19 during clinic visits in a general Chinese adult population.MethodsA random telephone survey was conducted among 300 residents in Hong Kong, China in April 2020 when the second wave of COVID-19 was just ended in the region. The participants were asked about their intention to consult doctors if they had mild or severe flu symptoms in the next week (from 1 = definitely no to 5 = definitely yes). Illness representations of COVID-19 were measured by the Chinese version of the Brief Illness Perception Questionnaire (BIPQ). The fear of COVID-19 during clinic visits were assessed by two single items. Linear regression adjusted for background variables and hierarchical strategies were employed.ResultsOf the participants, 52.3 and 92.0% showed an intention to consult doctors for mild and severe flu symptoms, respectively. Adjusted for background factors, COVID-19-related cognitive representations (consequences: standardized b = 0.15, p = 0.010; understanding: standardized b = 0.21, p = 0.001) and emotional representations (concern: standardized b = 0.17, p = 0.001; negative emotions: standardized b = 0.19, p = 0.001) were positively associated with BICDFS. In the hierarchical model, independent significant factors of BICDFS included understanding (standardized b = 0.16, p = 0.013) and negative emotions (standardized b = 0.17, p = 0.008). The fear-related variables showed non-significant associations with the BICDFS.ConclusionsPromotion of care-seeking behaviors for flu symptoms during the COVID-19 pandemic should consider improving people's understanding of COVID-19 and providing advice on related coping strategies for emotional responses to COVID-19.

An issue of concern: unique truncated ORF8 protein variants of SARS-CoV-2.

Open reading frame 8 (ORF8) shows one of the highest levels of variability among accessory proteins in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of Coronavirus Disease 2019 (COVID-19). It was previously reported that the ORF8 protein inhibits the presentation of viral antigens by the major histocompatibility complex class I (MHC-I), which interacts with host factors involved in pulmonary inflammation. The ORF8 protein assists SARS-CoV-2 in evading immunity and plays a role in SARS-CoV-2 replication. Among many contributing mutations, Q27STOP, a mutation in the ORF8 protein, defines the B.1.1.7 lineage of SARS-CoV-2, engendering the second wave of COVID-19. In the present study, 47 unique truncated ORF8 proteins (T-ORF8) with the Q27STOP mutations were identified among 49,055 available B.1.1.7 SARS-CoV-2 sequences. The results show that only one of the 47 T-ORF8 variants spread to over 57 geo-locations in North America, and other continents, which include Africa, Asia, Europe and South America. Based on various quantitative features, such as amino acid homology, polar/non-polar sequence homology, Shannon entropy conservation, and other physicochemical properties of all specific 47 T-ORF8 protein variants, nine possible T-ORF8 unique variants were defined. The question as to whether T-ORF8 variants function similarly to the wild type ORF8 is yet to be investigated. A positive response to the question could exacerbate future COVID-19 waves, necessitating severe containment measures.

The COVID-19 pandemic and stock market performance of transportation and travel services firms: a cross-country study

This paper examined the firm-specific abnormal returns of transportation and travel services sectors from the USA, UK, France, China, India, Mexico, Turkey, and Thailand in response to Coronavirus Disease 2019 (COVID-19) using event study methodology. Our results revealed that investors in developed countries provide significant long term abnormal returns for the first 101 days. Furthermore, no significant cumulative average abnormal returns (CAAR) were found in response to the COVID-19 outbreak, travel restrictions, lockdown, stimulus package, and historical decline in oil prices except in the case of the USA. It is concluded that with the gradual increase in new cases and deaths, abnormal returns are also adjusted, making the effects of these events insignificant at the time of their occurrence. Results also showed that firms in developing countries recognized significant negative abnormal returns in response to the second wave of COVID-19. These results are useful for investors in devising investment strategies relevant to contextual settings.

Clinicopathological Study of Mucormycosis in COVID-19 Patients: Experience From a Tertiary Care Center in South India.

Background: The coronavirus disease 2019 (COVID-19) pandemic has taken the world to different dimensions. With the surge of the second wave in India, the number of cases with mucormycosis has increased. Mucormycosis is a potentially life-threatening, opportunistic, invasive, fungal infection that can occur in immunocompromised states. The aim of the study is to analyze the clinicopathological parameters of patients with mucormycosis in the surge of the second wave of COVID-19.Materials and Methods: All cases of mucormycosis reported in the Department of Pathology in a tertiary care centre in South India from March 2021 to June 2021 were included in the study. The patient details were retrieved from the Medical Records section. The patient characteristics, location, associated comorbidities, management and treatment outcomes were analyzed and compared to similar studies reported worldwide.Results: Of 58 cases, 38 (65%) were males and 20 (35%) were females. The ages ranged from 34 to 77 years. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in 46 patients in reverse transcription polymerase chain reaction (RT-PCR) with high-resolution computed tomography (HRCT) Chest changes noted in 54 patients. Associated comorbidities were noted in 52 patients, with uncontrolled diabetes mellitus (46 patients; 88%) being the most common. Location was commonly in nasal and paranasal sinuses (43%), followed by orbital (2%), cerebral (10%) and pulmonary (8%) areas. Among the paranasal sinuses, the maxillary sinus was commonly involved. Mixed fungal infections (Aspergillus sp. and Candida sp.) were noted in eight (14%) cases. Oxygen therapy was given in 85% of cases; 30% of cases needed ventilator support; corticosteroid therapy was initiated in 49 patients, tocilizumab in six patients as treatment for mucormycosis. Amphotericin B was administered in 59% of patients based on clinical findings alone. After histopathological confirmation, 90% of them received amphotericin. Functional endoscopic sinus surgery (FESS) was done in 96% of cases, among them 45% underwent extensive surgical debridement and 15% underwent orbital decompression. Orbital exenteration (2%) was the other modality of management.Conclusion: Detailed analysis of clinicopathological features suggests the possibilities of immunosuppression (due to diabetes and use of corticosteroids in treatment of COVID-19) and COVID-19 (endothelial damage, cytokine storm) being the pathogenesis associated with the sudden surge of mucormycosis.

Epidemiology of Mucormycosis Cases During the Second Wave of COVID-19 in a Tertiary Care Institute in Western Rajasthan, India.

Introduction: Mucormycosis is a serious but rare fungal infection that showed a sharp surge during the second wave of coronavirus disease 2019 (COVID-19) in India. This study aimed to describe the epidemiological aspects of mucormycosis cases presenting to a tertiary care centre of Western Rajasthan, India, as well as to identify potential risk factors for Mucormycosis.Methods: This cross-sectional descriptive study included 55 patients admitted with a diagnosis of mucormycosis between May and June, 2021, covering the second wave's post-COVID-19 period. Data was collected using a pre-designed, semi-structured questionnaire and hospital case sheets.Results: The mean age of the patients was 54.4±12.53 years, with a male-to-female ratio of 1.89:1. Of the patients, 49% were obese and had no prior history of diabetes. Most COVID-19 patients (54.6%) were treated at home and did not require oxygen support during their COVID-19 course. The majority (89%) were on steroid medication, which was mainly intravenous (93.8%) and lasted 5-10 days in most patients. Rhinoorbitocerebral mucormycosis was the most common type seen in this setting, with symptoms appearing 15-30 days after the onset of COVID-19 symptoms. During the fungal infection, about 61.8% of patients had random blood sugar readings of more than 140 mg/dl. Mortality occurred in 14.5% of patients with mucormycosis. Mortality was observed to be associated with high BMI, raised glycated haemoglobin (HBA1C), and urban residency.Conclusion: Mucormycosis appears to be caused by impaired glycemic control due to pre-existing or new-onset diabetes, which may be exacerbated by unintentional glucocorticoid use. It is necessary to use steroids with caution and maintain care for at least 15-30 days after the onset of COVID-19 symptoms.

Knowledge, Attitude, and Practice Toward Mask-Wearing Behaviors During Covid-19 Pandemic Among Mangalore Residents: A Cross-Sectional Study

Abstract Objectives The objective of this study is to assess the knowledge, awareness, and practice toward mask-wearing behaviors of Mangalore residents during the coronavirus disease 2019 (COVID-19) outbreak. Materials and Methods This survey was conducted at A B Shetty Memorial Institute of Dental Sciences in Mangalore. The questionnaire consisted of 18 questions that were prepared as an online form (Google Forms), and a total of 172 responses were received among the residents of Mangalore who visited the hospital.The questions were distributed based on knowledge, attitude, and practice regarding the mask-wearing behaviors, and the distribution of responses was presented as frequency and percentages. Prior to the inception of the study, the nature and purpose of the study were explained to each respondent, and informed consent was obtained by all participants in this study.Statistical analysis was done using SPSS software version 23. Results It was evident that the COVID-19 knowledge scores were found to be significantly associated with a lower likelihood of negative attitudes and potentially dangerous practices toward the COVID-19 epidemic in this study. These findings clearly indicate the importance of improving residents' COVID-19 knowledge via health education, which may also result in improvements in their attitudes and practices toward COVID-19. Conclusion In summary, our findings suggest that Mangalore residents have fair knowledge and optimistic attitudes, despite the current lockdown measures undertaken during the second wave of COVID-19, The positivity rate in Mangalore has not reduced satisfactorily. Self-protection, testing, and vaccination would help to reduce the spread and mortality rate due to coronavirus. The residents of Mangalore should abide by the COVID -19 preventive measures and implement this knowledge into their daily practices.

Mass media utilization to promote public behavior change during COVID-19 situation: A population survey of Dhaka city

A huge amount of information associated with the novel coronavirus disease 2019 (COVID-19) outbreak was circulated by mass media in Bangladesh. There has been a rare example so far of how media intervention during the epidemic can affect the public behaviour of Bangladesh. We aimed to assess mass media's influence on changing public behaviour during the second wave of COVID-19. An online cross-sectional survey among 416 Bangladeshi respondents was conducted between August and September 2021. Besides descriptive statistics, datasets were analyzed through a set of statistical methods such as Pearson’s correlation coefficient, and stepwise multiple regression model. The results showed that knowledge level change towards COVID-19 (10 items) had the highest association with behaviour change towards COVID-19 (16 items), indicating a high adoption of public behavior change. There was a positive significant relationship between the behaviour change towards COVID-19 (16 items) with the media's role in making awareness regarding COVID-19 (r= 0.342, p &lt; .001), while there was a negative relationship between the behaviour change towards COVID-19 (16 items) of the respondents with age of participants (r= -.234, p &lt; .001). The results also disclosed that knowledge level, media credibility, and media check-in had the largest contribution to influence the public behavior change. We also found that social media was highly used media as expected during the COVID-19 outbreak. The outcomes of the survey have vital implications for public behavior change and may support infectious disease suppression and control. Our outcomes also stress the significance of the reliability of information shared via mass media outlets and practical strategies to counter misinformation during the COVID-19 outbreak.

Evaluating the Association Between Comorbidities and COVID-19 Severity Scoring on Chest CT Examinations Between the Two Waves of COVID-19: An Imaging Study Using Artificial Intelligence.

BackgroundCoronavirus disease 2019 (COVID-19) has accounted for over 352 million cases and five million deaths globally. Although it affects populations across all nations, developing or transitional, of all genders and ages, the extent of the specific involvement is not very well known. This study aimed to analyze and determine how different were the first and second waves of the COVID-19 pandemic by assessing computed tomography severity scores (CT-SS).MethodologyThis was a retrospective, cross-sectional, observational study performed at a tertiary care Institution. We included 301 patients who underwent CT of the chest between June and October 2020 and 1,001 patients who underwent CT of the chest between February and April 2021. All included patients were symptomatic and were confirmed to be COVID-19 positive. We compared the CT-SS between the two datasets. In addition, we analyzed the distribution of CT-SS concerning age, comorbidities, and gender, as well as their differences between the two waves of COVID-19. Analysis was performed using the SPSS version 22 (IBM Corp., Armonk, NY, USA). The artificial intelligence platform U-net architecture with Xception encoder was used in the analysis.ResultsThe study data revealed that while the mean CT-SS did not differ statistically between the two waves of COVID-19, the age group most affected in the second wave was almost a decade younger. While overall the disease had a predilection toward affecting males, our findings showed that females were more afflicted in the second wave of COVID-19 compared to the first wave. In particular, the disease had an increased severity in cases with comorbidities such as hypertension, diabetes mellitus, bronchial asthma, and tuberculosis.ConclusionsThis assessment demonstrated no significant difference in radiological severity score between the two waves of COVID-19. The secondary objective revealed that the two waves showed demographical differences. Hence, we iterate that no demographical subset of the population should be considered low risk as the disease manifestation was heterogeneous.

Post-traumatic Stress and Growth Among the Children and Adolescents in the Aftermath of COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has enkindled many mental health problems across the globe. Prominent among them is the prevalence of post-traumatic stress (PTS) with hosts of its precipitating factors being present in the surrounding. With India witnessing severe impact of the second wave of COVID-19, marked by a large number of hospitalizations, deaths, unemployment, imposition of lockdowns, etc., its repercussions on children and adolescents demand particular attention. This study aims to examine the direct and the indirect exposure of COVID-19-related experiences on children and adolescents and its subsequent relationship with PTS and post-traumatic growth (PTG). The direct exposure was operationalized in terms of death or hospitalization in the family, while the indirect exposure was gauged in terms of exposure to media reports of the COVID situation. Data from 412 children and adolescents aged 9–20 years, collected online, revealed 68.9% of them with PTS. Interestingly, 39.8% of those reporting PTS were also experiencing PTG. Arousal appeared to be the most frequently reported characteristics of trauma. The multivariate analysis of variance (MANOVA) endorses significant difference between those with direct and indirect exposures to hospitalization. Those with direct exposure to hospitalization reported higher PTS. The indirect exposure of COVID-19-related news through electronic media was also significantly associated with higher PTS. Exposure through print media did not lead to significant difference in PTS, but those reading only magazines reported significantly higher PTG than not reading magazines. The findings are analyzed in the light of unfolding of events during the second wave of COVID-19 in India.