Urgent Basis Research Articles

Favorable Outcome Twenty-Two Months after Delbet Type Ib Capital Femoral Transepiphyseal Fracture and Posterior Column Acetabular Fracture in a Fifteen-Year-Old Male

Case A fifteen-year-old male patient sustained a posteriorly dislocated right capital femoral Delbet type Ib epiphyseal fracture-separation and a right acetabular posterior column fracture after a low-energy trip and fall. The capital femoral epiphysis was closed reduced and fixed with cannulated screws on an urgent basis. He underwent acetabular osteosynthesis via a Kocher-Langenbeck approach two days thereafter. Twenty-two months after injury, he was weight-bearing on the right lower extremity without radiologic evidence of avascular necrosis or clinical evidence of pain or functional deficit. Conclusion Fracture-separation of the capital femoral epiphysis comprises only 8% of skeletally immature femoral neck fractures in the Delbet and Colonna classification. Prognosis is worse with ipsilateral hip dislocation due to the risk of avascular necrosis from disruption of the medial femoral circumflex artery. Urgent referral to a trauma center and treatment by appropriate specialists enables good long-term results after this uncommon traumatic injury pattern.

Impact of COVID-19 on Mental Health Issues in India: Understanding the factors of suicides due to pandemic

The present study seeks to evaluate how the COVID-19 pandemic is not just impacting tremendously the physical health, rather has a serious effect on the psychological health as well as the mental health of individuals which needs to be addressed at an urgent basis. The paper looks forward to delve into the various kinds of repercussions the current pandemic is having with regards to the deterioration of mental health conditions among individuals, resulting in suicide. The outbreak of Coronavirus has brought about massive changes in the country. A lot of misinformation is also floating around and this has subsequently led to the creation of anxiety issues among individuals as well.

Outcome of adult cardiac surgery following COVID-19 infection in unvaccinated population in a national tertiary centre.

Ever since COVID-19 was declared a pandemic, the world medical landscape has changed dramatically. As cardiac surgeons we not only have the duty to protect our patients and staff from COVID-19 infection, but we are also tasked with the responsibility to ensure those cardiovascular patients awaiting surgery are not harmed from an extended delay in surgery as the world comes to a halt from COVID-19. Currently there is limited literature on the outcome of cardiac surgery in the pre-operative Covid positive group. In this study we aim to assess the safety and outcome of patients undergoing cardiac surgery following Covid-19 infection. This was a single centre retrospective observational study. All patients undergoing open heart surgery at Institut Jantung Negara from June 2020 to July 2021 were included in this study. Patients who were Covid positive pre-operatively were identified. Data from patient medical records collected contemporaneously were reviewed and analysed, supplemented by telephone call interviews after discharge. 2368 patients underwent open heart surgery from June 2020 until July 2021 in our centre. Of these, 0.5% (12 patients) were identified as Covid positive pre-operatively. Mean age of patients were 59.1 ± 14.8 years old. Mean Ejection Fraction was 46.4 ± 12.9. Most patients (75%) were asymptomatic with covid infection and only one patient were admitted to hospital for Covid infection. Mean duration from Covid PCR positive swab to surgery were 46.3 ± 32.7days. Most of the patients (66.7%) underwent operation on an emergency or urgent basis. Median time to extubation was 1 day. Median ICU length of stay was 1 day. 25% patients required non-invasive ventilation post-operatively and one patient was discharged home on long term oxygen therapy. There were 2 deaths- none of which were covid related mortality. Cardiac surgery could be performed safely in patients with pre-operative Covid-19 infection after a period of recovery, especially in the asymptomatic to mild category of infection. Multi-disciplinary team approach may be useful in deciding the timing of surgery for complex cases.

Escherichia coli Isolates Harboring blaNDM Variants and 16S Methylases Belonging to Clonal Complex 131 in Southern Punjab, Pakistan

The emergence of carbapenem-resistant Escherichia coli (CREC) especially harboring the New Delhi Metallo-β-lactamase (blaNDM) variants are increasingly being reported from many countries, however, the data from Pakistan is limited. In the present study, 109 CREC isolates were obtained from 4,091 E. coli isolates in five tertiary care hospitals in southern Punjab, Pakistan. The antimicrobial susceptibility profiling and screening for the resistance determinants were performed followed by blaNDM typing and multilocus sequence typing (MLST) to characterize the CREC strains. Among the carbapenemases, 57 CREC isolates were found to harbor blaNDM. The blaNDM-1, blaNDM-5, blaNDM-7, and blaNDM-4 variants were identified in 30 (52.6%), 18 (31.6%), (12.3%), 2 (3.5%) isolates, respectively. The ESBL genes, such as blaCTX-M and blaTEM, were also found in different combinations, whereas the 16S methylases that is, rmtB and armA were found in 69 (63.3%) and 55 (50.5%) CREC isolates, respectively. The MLST of blaNDM carrying E. coli revealed eight different sequence types (STs) with ST131 belonging to 21 isolates being the most prevalent. The clonal complex 131 was the predominant complex corresponding to 47 (82.5%) of blaNDM-positive strains. Large-scale surveillance studies coupled with active infection control policies are suggested on an urgent basis to avoid an epidemic in the future.

Staff awareness of pelvic floor muscle training (PFMT) in tertiary care – a qualitative cross-sectional study

Pelvic floor muscle training (PFMT) is proven to protect against pelvic-floor weakness in the form of urinary incontinence (UI) and pelvic organ prolapse (POP). National Institute for Health and Care Excellence (NICE) guidelines advise supervised PFMT as first-line treatment of stress or mixed UI and POP. Healthcare professionals play a crucial role in educating patients. Our aim is to study the extent of awareness of PFMT amongst healthcare professionals by a single-centre cross-sectional study of voluntarily participating 44 healthcare professionals. The term ‘pelvic floor exercise’ had varied explanations; 53% staff thought they knew how to undertake pelvic-floor assessment, although there was no standard method or terminology to describe the technique or outcome. Staff were unaware of PERFECTR method, Modified Oxford Grading, slow and fast contractions which form the basic criteria of standardised pelvic floor assessment and training. Only 43% staff were aware of online resources. Impact Statement What is already known on this subject? There have been many studies confirming the effectiveness of pelvic floor muscle training (PFMT) in the prevention and treatment of long-term morbidities like urinary incontinence, pelvic organ prolapse and sexual dysfunction. However, there have been no studies in the published literature about staff awareness of this important evidence based health intervention in women’s health services. What do the results of this study add? We believe the awareness among health care staff about PFMT is still limited. Our study is the first of its kind in literature to highlight that staff awareness about this health intervention is still poor which in turn means staff are not well equipped to offer the support and guidance the patients need. What are the implications of these findings for clinical practice and/or further research? The lack of awareness of staff needs addressing on an urgent basis. Knowledge of PFMT is essential for health care staff to provide appropriate patient education and support. We recommend including information of PFMT and assessment methods in local and national guidelines to help increase awareness of staff and patients alike and help achieve better global pelvic health.

Mitral valve repair is better than mitral valve replacement in native mitral valve endocarditis: Results from a prospective matched cohort

In native mitral valve infective endocarditis (NMIE), the respective values of mitral valve repair (MVRep) and replacement (MVR) are still debated. To compare MVRep and MVR in a large prospective matched cohort. Between 2010 and 2017, all consecutive patients operated on for NMIE in our centre were included prospectively. Clinical and outcome features were compared between the two groups. Primary endpoint was event-free survival, including death, reoperation and relapse. Univariate and multivariable survival analyses and a propensity score analysis were performed. Among 152 patients, 115 (75.7%) underwent MVRep, and 37 (24.3%) MVR. Median follow-up was 28±22months. Surgery was performed during the active phase in 75.0% of patients (25.7% on an urgent basis). Compared with the MVRep group, patients in the MVR group were more frequently intravenous drug abusers (10.8% vs. 0.9%; P=0.016), had a more frequent history of rheumatic fever (13.5% vs. 0%; P=0.001), more aortic abscesses (16.7% vs. 3.5%; P=0.018), larger vegetations (16.6±8.1mm vs. 12.6±9.9mm; P=0.042) and poorer New York Heart Association status (P=0.006). Overall mortality was lower in the MVRep group than in MVR group (11.3% vs. 29.3%; P=0.018). Event-free survival was better in the MVRep group than in the MVR group in univariate analysis (hazard ratio: 2.72, 95% confidence interval: 1.34-5.52; P=0.004). Survival analysis in the propensity-matched cohort showed that MVRep was safer than MVR (log rank test: P=0.018). Multivariable analysis using the Cox proportional hazard model confirmed this finding (hazard ratio: 3.48, 95% confidence interval: 1.15-10.61; P=0.03). MVRep is feasible in most cases of NMIE and, when technically possible, should be preferred, even in urgent surgery.

Increased suicidal behaviors among students during COVID-19 lockdowns: A concern of student's mental health in Bangladesh.

The COVID-19 pandemic has brought an unprecedented natural event on life. The mental health of students has been impacted due to the long-term closure of educational institutions. The suicide rate had been significantly increased during the COVID-19 pandemic compared to previous years among Bangladeshi students. Several COVID-19 responses might be responsible for this increased suicidality among students. Therefore, family members should give them mental supports to reduce additional burdens due to the pandemic. The government and non-government organizations can take suicide prevention programs such as awareness campaigns, student counseling, internet-based interventions, etc. Also, the authority should vaccinate students, teachers, and other staff to reopen the academic institutions on an urgent basis.

POLITICAL REALITY OF RURAL WEST BENGAL IN COVID-19 LOCKDOWN: CHALLENGING HUMAN RIGHTS

The present study offers an understanding of the current situation in Indian rural areas due to the outbreak of COVID-19, a new form of coronavirus. With just a four-hour notice, the honourable Prime Minister of India announced a complete 21-day (first phase) lockdown throughout India on 24 March 2020, which was later extended to the second and third phases to contain the spread of novel coronavirus. The impact of the sudden lockdown has been remarkable in people’s everyday lives and lives particularly on village dwellers. This study has tried to explore how people were becoming victims of this situation and suffering from human rights violations. Their experiences will explain the reality generated out of the COVID-19 outbreak and will contextualize the condition of the rural areas within its political reality. The study has followed ethnographic techniques within a constructivist paradigm for data collection. Phone calls and video calls are the only ways to understand the contradictions, complexity, and multiplicity of the realities during the lockdown phase in India. Interpretative analyses have facilitated the comprehension of facts and exploring the meanings based on the understanding of the participant’s interpretation of their experiences. Further, trouble was added as they were in some way connected to the medical professionals or profession. Lockdown on an urgent basis has influenced to refuse people’s right to look for security or return to safe places from where they face harassment or torture.

Challenges in setting up a diagnostic microbiology laboratory during coronavirus disease 2019 crisis and impact on the diagnosis of communicable diseases.

The coronavirus disease 2019 (COVID-19) pandemic has left the health-care workers exhausted and the system dwindling. The challenges have been immense everywhere and even worse in developing countries. Despite the Indian Government's forethought and active investment in various national programs, the pandemic has brought unconceivable repercussions on the management and notification of several other lethal infectious diseases including human immunodeficiency virus (HIV) and tuberculosis. Although the phenomenal capacity building for COVID-19 testing and diagnosis over a short time is admirable, the journey has been arduous. From convincing the hospital managements to create the recommended infrastructure, to the procurement of necessary equipment and consumables on an urgent basis, and providing services round the clock with limited workforce, the laboratory personnel throughout the country have done a remarkable job in their quest to combat the pandemic. However, the work needs to be pursued further in apprehension and preparedness for any emerging agents.

Use of the modified early obstetric warning system chart as a predictor of peri-partum obstetric morbidity in a rural teaching institute: A two-year cross-sectional study.

The occurrence of obstetric morbidity is on the rise in developing countries. The peri-partum period is very crucial as most of the deaths occur during labour or in the first 24 hours of the post-partum period. Early recognition and treatment of disease entities leading to obstetric morbidity can be performed by the "track and trigger" system of parameters on a chart, thus preventing the obstetric morbidity and mortality. Therefore, the MEOWS chart (Modified Early Obstetric Warning System chart) was recommended by the Confidential Enquiry into Maternal and Child Health report in order to evaluate the patient at an urgent basis with timely diagnosis and treatment. We conducted an observational study in a rural tertiary care centre based in central India over the span of 2 years from September 2017 till August 2019. Physiological parameters of 1000 patients which included pregnant women in labour >28 weeks of gestation were recorded on the MEOWS chart. Trigger was defined as either one red zone (any one parameter that was markedly abnormal, with values in the red zone) or two yellow zones (when simultaneously any two parameters were moderately de-ranged with values in yellow zones). Based on trigger, patients were categorised as triggered and non-triggered groups. Further based on the obstetric morbidity during hospital stay, triggered and non-triggered groups were divided into category 1 (patients who did not have any obstetric morbidity during hospital stay) and category 2 (patients who had any obstetric morbidity during hospital stay). Out of the total 1000 patients, 24.8% patients had an abnormal MEOWS chart and were categorised into the triggered group. Out of a total of 248 patients in the triggered group, 47.5% (118) patients had obstetric morbidity during hospital stay (category 2). The MEOWS chart was found to be 85.51% sensitive and 84.92% specific with a positive predictive value of 47.58% and a negative predictive value of 97.34%. The accuracy of the MEOWS chart was 85%. It was concluded that there was a significant difference between obstetric morbidity in normal (non-triggered) and abnormal (triggered) MEOWS chart findings. The sensitivity and specificity of the MEOWS chart were high. The negative predictive value of the chart was very high. Thus, the MEOWS chart can be used as a bedside screening tool for predicting obstetric morbidity.

Retinal Manifestations in Rhinoorbito-cerebral Mucormycosis: A Cross-sectional Study

Introduction: Rhino-orbito-cerebral Mucormycosis (ROCM) is an uncommon but devastating fungal infection caused by Mucoraceae family fungi, which are angiotropic and filamentous, with significantly high morbidity and mortality despite treatment. Post Coronavirus Disease-2019 (COVID-19), there was a sudden surge in ROCM cases nationwide due to immunologically and metabolically compromised status. Aim: To describe retinal manifestations in ROCM in a tertiary eye care centre of Northern India. Materials and Methods: An analytic, cross-sectional and hospitalbased study was conducted in Regional Institute of Ophthalmology, PGIMS Rohtak, Haryana, India, from May 2021 to September 2021. This study was conducted on 200 admitted patients of RCOM in the institute, which was only designated Nodal centre in Haryana, India. Detailed history was recorded in every patient regarding presenting symptoms, history of COVID-19, hospital stay, oxygen inhalation, steroid intake and immunisation. Thorough ocular examination was done in every patient including visual acuity, ocular movements and pupillary reactions. Dilated fundus examination was done by Indirect Ophthalmoscopy (IDO) for posterior segment evaluation. Contrast Enhanced Magnetic Resonance Imaging (CE-MRI) brain with orbit and Paranasal Sinus (PNS) was done in every patient to see the extent of spread and planning further management. Results: Out of 200 patients of ROCM, majority of patients (64/200) were of 51-60 year age group (32%) followed by 41-50 year age group (28%). Out of 200 cases of ROCM, 146 patients (73%) had history of COVID-19 infection in past and 134 (67%) patients had history of hospital stay during COVID-19 infection. Oxygen (O2 ) supplementation was given to 98 patients either at home or during hospital stay. History of steroid intake was present in 34 patients and 46 patients received injection Remedsivir. Only 12 patients had vaccine against COVID-19 and none of them were fully vaccinated. Most common presenting symptom was unilateral nasal stiffness (22%) followed by loss of vision (17%). Most common predisposing factor was Diabetes Mellitus (DM) in 78 patients (39%) followed by steroid intake in 34 patients (17%). Out of 200 patients, only 60 patients had retinal manifestations and most common was Central Retinal Artery Occlusion (CRAO) (35/60) and the main mechanism is the direct infiltration of central retinal artery due to angioinvasion of fungi from the orbit. Conclusion: CE-MRI brain with orbit is an important tool in diagnosing and monitoring progression of RCOM but it cannot provide information regarding retinal findings like CRAO, central retinal venous occlusion (CRVO), disc pallor and optic atrophy. Thus, the fundus examination of every ROCM patient should be emphasised, as it not only helps in categorising ROCM but also tells about the visual potential of affected eye. Patients with CRAO and combined vascular occlusion should be considered for exenteration on urgent basis, so that intracranial spread can be prevented and patient’s life can be saved.

Multiprobe Radiation Simulation Method for Phased Array Radar Performance Evaluation

The phased array radar exhibits improved tracking accuracy and anti-jamming performance with multi-beam tracking, beam agility, and adaptive beam-forming capabilities. The performance evaluation of the phased array radar is essential for the product designing and development stage. However, the conventional injection simulation and triad radiation simulation methods are not suitable for phased array radars. Therefore, new methods for radiation simulation are required on an urgent basis for the performance evaluation of phased array radars in a reliable, reliable, and repeatable way. This paper focuses on designing a practical anechoic chamber system of multi-probe radiation suitable for phased array radars. The appropriate test distance, the physical size of the anechoic chamber, the multi-probe radiation signal model, and the number of probes required were discussed. Furthermore, an inversion method based on least squares was proposed to solve the complex weights of the probes, thereby simulating the desired apparent center position. The simulation results demonstrated the effectiveness of the proposed method.

Does Social Media Provoked to Cyber Deception? An Illustrative Based Study of Youth

Purpose: The present study was conducted with the sole aim to explore the role of social media in promotion of cyber deception among youth which further lead to deviance among the existing societal order. Methodology: sample size of 354 respondents (youth) were randomly selected for taking primary data through structured questionnaire technique. Further, the primary data was coded into SPSS for further analysis in terms of descriptive and inferential statistics Findings: Based on the study results, the study explored that cyber deception caused by the excessive usage of social media which further lead to psychological and physical problems among youth. Moreover, virtual social world and social games are the stakeholders of cyber deception; online shopping of various companies intentionally did cyber deception; content communities and social networking users are the major deception; youth are sharing fake picture from their profile for deception. Likewise, the study also explored that manipulation of sender identity information. Female are more indulged in deceptive behavior than male, usually girl’s misuse of social media sites to influence and cash wealthy and loved ones and kidnaping is done through cyber deception Implications: Thus keeping in view the above results, the government should make such polices to overcome on the premises of the study in an urgent basis with corroboration to busy the future generation in more positive ground on sustainable development projects were the order of the day, along with parents must focus on their youth in terms of proper check and balance on weekly basis with corroboration of proper socialization will subjugate the tumbling factor in today world i.e., cyber deception

O-EGS02 Effective use of afternoon Day Case Theatre Lists for Emergency Laparoscopic Cholecystectomy on Emergency Surgery Ambulatory Care (ESAC) Pathway

Abstract Background Gallstone disease is a common entity and affects up to 10-15% of the European population. The majority of these cases are asymptomatic but approximately 20% will develop complications such as severe biliary colic, cholecystitis, choledocholithiasis and pancreatitis. Early cholecystectomy in patients suffering from symptomatic gallstones can improve post-operative outcomes, avoid re-attendance and reduce overall length of hospital stay. We describe how two afternoon day case theatre lists were successfully utilised to prevent surgical admissions by enabling laparoscopic cholecystectomy on an urgent basis. Methods A sustainable pathway for symptomatic gallstones was introduced to Emergency Surgery Ambulatory Care (ESAC). Patients presenting with acute symptoms, well enough for ambulatory care, were referred to ESAC for diagnosis and management. Patients fit for surgery underwent pre-operative assessment before being operated on one of two weekly afternoon lists. A standardised, evidence-based approach was used for all laparoscopic cholecystectomies to ensure homogeneity of technique and patient care. This included pre-incision local anaesthetic, low flow and pressures intra-operatively, adequate analgesia to-take-home, and follow-up telephone consultation at 48hrs. Prospective data collection began in 2019 looking at hospital admission rate and 30-day re-presentation. Results Analysis was performed on data collected from September 2019 to July 2021. 151 patients had laparoscopic cholecystectomies, 107 were female and 44 male. Age range was 18-83 (median age 49) and median time to operation was 3 days. Overall, the spectrum of gallstone disease was 81 biliary colic, 44 cholecystitis, 20 pancreatitis and 6 choledocholithiasis. 18 patients were admitted post-operatively with length of stay ranging 1-6 days (median 1.5 days). 17 patients re-presented within 30 days, mainly for abdominal or pleuritic chest pain, although one patient required ERCP for CBD stones and another had pancreatitis. Conclusions Emergency surgery for symptomatic gallstone disease can be performed successfully on a day case basis. At our centre, the rate of post-operative admission was 12% and 30-day re-presentation was 11%. Standardisation of referrals, assessment and operative technique can achieve excellent outcomes with low rates of hospital admission and post-operative complications.

Protocolo de cribado de la COVID - 19 en paciente obstétrica para realización de técnica neuroaxial

The emergence of the SARS-CoV-2 pandemic has supposed a crisis in our national health system. Its rapid spread and the severity of the clinic have made the medical management of the disease very limited. Because of that it is essential to screen patients upon admission to hospital with an appropriate circuit to avoid contagion and the spread of SARS-CoV-2. This is a protocol proposal, in the approval phase by the medical direction of the Severo Ochoa Hospital, for the screening of COVID-19 obstetric patients who are admitted on a scheduled and / or urgent basis for labor.

Gastrointestinal and Hepatic manifestations of COVID-19 in patients attending tertiary care hospital

Introduction: To evaluate the frequency of Gastrointestinal (GI) symptoms and elucidate the association of GI symptoms and hepatic injury markers with the severity of COVID-19 and mortality.Methodology: Single-centered observational study recruited 160 confirmed COVID-19 positive patients who were admitted in Medical Unit-1/C1 of Civil hospital Karachi, Pakistan from 21 February to 30 April 2021. Data was ana-lyzed using SPSS version 23.0.Objective: To evaluate the frequency of GI symptoms and elucidate the as-sociation of GI and hepatic abnormalities with the severity of COVID-19 and its mortality.Results: Among 160 patients, 20% presented with digestive symptoms; ab-dominal pain (33.1%), and nausea (33.1%) being the most common. GI symptoms and liver injury markers notably ALT, AST, and GGT were signifi-cantly associated with severity of disease (p value<0.05), ICU admissions (p value<0.01), and poor outcomes (p value<0.01).Conclusion: COVID-19 infected patients presenting with GI symptoms and liver dysfunction have a worse prognosis and needs to be addressed on ur-gent basis to avoid complications and reduce mortality.Key words: Covid-19, Hepatic injury, Gastrointestinal symptoms, Liver dysfunction.

Systematic Review on Treatment Trials of Tocilizumab: A Repurposing Drug against COVID-19.

Coronavirus disease (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has become a global issue today. There exists an ongoing health crisis all over the world, and efficacious drugs against COVID-19 are not available yet. Therefore, on an urgent basis, scientists are looking for safe and efficacious drugs against SARSCoV- 2. The reported individual patient data and clinical outcomes, including the rate of recovery and mortality, patients' characteristics, and complications, are reviewed. Randomized controlled trials, single-center cohort studies, and different case studies are provided, and the PICO model is used to illustrate the outcomes. There exist several FDA (U.S Food and Drug Administration) approved anti coronavirus drugs that sometimes are unsuccessful in curing COVID-19 critical conditions. It has been observed that a humanized monoclonal antibody, Tocilizumab (licensed for the treatment of rheumatoid arthritis), targeting the interleukin-6 (IL-6) receptor, has an integral role in the treatment of COVID-19. The cause behind the mortality of COVID-19 patients was found to be the Cytokine Release Syndrome (CRS). Therefore, besides other antiviral drugs, the utilization of tocilizumab should also be considered as it can effectively block IL-6 and reduce the inflammatory signal.

Hybrid Quinoline-Thiosemicarbazone Therapeutics as a New Treatment Opportunity for Alzheimer's Disease‒Synthesis, In Vitro Cholinesterase Inhibitory Potential and Computational Modeling Analysis.

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder and the leading cause of dementia worldwide. The limited pharmacological approaches based on cholinesterase inhibitors only provide symptomatic relief to AD patients. Moreover, the adverse side effects such as nausea, vomiting, loss of appetite, muscle cramps, and headaches associated with these drugs and numerous clinical trial failures present substantial limitations on the use of medications and call for a detailed insight of disease heterogeneity and development of preventive and multifactorial therapeutic strategies on urgent basis. In this context, we herein report a series of quinoline-thiosemicarbazone hybrid therapeutics as selective and potent inhibitors of cholinesterases. A facile multistep synthetic approach was utilized to generate target structures bearing multiple sites for chemical modifications and establishing drug-receptor interactions. The structures of all the synthesized compounds were fully established using readily available spectroscopic techniques (FTIR, 1H- and 13C-NMR). In vitro inhibitory results revealed compound 5b as a promising and lead inhibitor with an IC50 value of 0.12 ± 0.02 μM, a 5-fold higher potency than standard drug (galantamine; IC50 = 0.62 ± 0.01 μM). The synergistic effect of electron-rich (methoxy) group and ethylmorpholine moiety in quinoline-thiosemicarbazone conjugates contributes significantly in improving the inhibition level. Molecular docking analysis revealed various vital interactions of potent compounds with amino acid residues and reinforced the in vitro results. Kinetics experiments revealed the competitive mode of inhibition while ADME properties favored the translation of identified inhibitors into safe and promising drug candidates for pre-clinical testing. Collectively, inhibitory activity data and results from key physicochemical properties merit further research to ensure the design and development of safe and high-quality drug candidates for Alzheimer’s disease.

The caring perspective during a COVID pandemic

Work as a private primary health care practitioner with a special interest in older persons has been a rollercoaster ride over the course of the pandemic with the need to improvise, provide a wider form of care and an inordinate amount of role changing. The initial recommendation was to stay away from any possible cases which may have remotely resembled COVID with a view to keeping physicians and their practice safe. This message was unheard after the start of the second wave as the health services struggled to cope, testing became ever more accessible and patients who did develop COVID-19 needed someone to care for them when state services were overstretched. Meanwhile, the availability of all forms of specialist care grew ever scarcer in the community and increasingly caregivers such as myself realised that boundaries were now blurred under such circumstances. As hospital wards became taken up with exclusively COVID-19 patients, other hospital care delivery became on an urgent only basis and this had an effect on care in the community for patients living with chronic diseases. Physicians such as myself became ever more involved in caring for persons with mental illness and with the plethora of anxiety prevalent in a community burdened with a pandemic, an overabundance of morbid media coverage and social media feeding on fear and doubt.

Preparedness for establishing COVID-19 services during acute emergency of COVID-19 pandemic: Experience of a tertiary care TB and respiratory diseases hospital

BackgroundThe ongoing coronavirus disease 2019 (COVID-19) calls for setting up of well-equipped and dedicated health facilities to manage sick patients while protecting healthcare workers and the environment. An ideal high-level isolation unit requires a high level of administrative commitment, availability of space, human resource and logistics. MethodThe experience of setting up COVID-19 care facilities on a noticeably short period in a tertiary TB and respiratory diseases institute in wake of the COVID-19 pandemic is being shared here. ResultAll the essential COVID-19 services were set up in record time of 8 days. A total of 115 COVID-19 patients were admitted. Out of these 89 patients were discharged in a satisfactory condition. There were 19 deaths, and 4 patients became critical and had to be referred to level 3 facility for ICU care. ConclusionThis experience will help other hospitals in planning out the strategies and solve the difficulties they may face while opening a COVID-19 care facility under limited resources on an urgent basis.