Multi-Facet analysis of analytical and numerical models to resolve sustainable artificial recharge rates in unconfined aquifers.

Managed aquifer recharge (MAR) has emerged as a potential solution to resolve water insecurity, globally. However, integrated studies quantifying the surplus source water, suitable recharge sites and safe recharge capacity is limited. In this study, a novel methodology is presented to quantify transient injection rates in unconfined aquifers and generate MAR suitability maps based on estimated surplus water and permissible aquifer recharge capacity (PARC). Subbasin scale monthly surplus surface runoff was estimated at 75% dependability using a SWAT model. A linear regression model based on numerical solution was used to capture the aquifer response to injection and to calculate PARC values at subbasin level. The available surplus runoff and PARC values was then used to determine the suitable site and recharge rate during MAR operation. The developed methodology was applied in the semi-arid region of Lower Betwa River Basin (LBRB), India. The estimated surplus runoff was generally confined to the monsoon months of June to September and exhibited spatial heterogeneity with an average runoff rate of 5000 m3/d in 85% of the LBRB. Analysis of the PARC results revealed that thick alluvial aquifers had large permissible storage capacity and about 50% of the LBRB was capable of storing over 3500 m3/d of water. This study revealed that sufficient surplus runoff was generated in the LBRB, but it lacked the adequate safe aquifer storage capacity to conserve it. A total 65 subbasins was identified as the best suited sites for MAR which had enough surplus water and storage capacity to suffice 20% of the total water demand in the LBRB. The developed methodology was computationally efficient, could augment the field problem of determining scheduled recharge rates and could be used as a decision-making tool in artificial recharge projects.

Mannose-binding lectin gene 2 variant DD (rs 5030737) is associated with susceptibility to COVID-19 infection in the urban population of Patna City (India).

The study aimed to measure plasma levels of Mannose-Binding Lectin (MBL) and MBL-associated serine protease-2 (MASP-2) and their polymorphisms in COVID-19 patients and controls to detect association. As MBL is a protein of immunological importance, it may contribute to the first-line host defence against SARS-CoV-2. MBL initiates the lectin pathway of complement activation with help of MASP-1 and MASP-2. Hence, appropriate serum levels of MBL and MASPs are crucial in getting protection from the disease. The polymorphisms of MBL and MASP genes affect their plasma levels, impacting their protective function and thus may manifest susceptibility, extreme variability in the clinical symptoms and progression of COVID-19 disease. The present study was conducted to find plasma levels and genetic variations in MBL and MASP-2 in COVID-19 patients and controls using PCR-RFLP and ELISA, respectively.The present study was conducted to find plasma levels and genetic variations in MBL and MASP-2 in COVID-19 patients and controls using PCR-RFLP and ELISA, respectively. Our results indicate that median serum levels of MBL and MASP-2 were significantly low in diseased cases but attained normal levels on recovery. Only genotype DD was found to be associated with COVID-19 cases in the urban population of Patna city.

Evaluation of C4b as an adjunct marker in symptomatic RT-PCR negative Covid-19 cases.

Introduction: Detecting low viral load has been a challenge in this pandemic, which has led to its escalated transmission. Complement activation has been implicated in pathogenesis of Covid-19 infection. Thus, evaluation of complement activation in suspected Covid-19 infection may help to detect infection and limit false negative cases thus limiting transmission of infection. We speculate that measuring C4b, produced from an activated complement system due to the presence of Covid-19 may help in its detection, even when the viral titers are low. Methods: Plasma C4b levels of symptomatic RT-PCR positive patients (cases, n = 40); symptomatic RT-PCR negative patients (n = 35) and asymptomatic RT-PCR negative controls (n = 40) were evaluated. Plasma C5b-9, IL-6, D-dimer and C1-Inhibitor (C1-INH) were also measured in cases and controls. ELISA kits were used for all measurements. Statistical analyses were carried out using Stata, version 12 (Stata Corp., Texas, USA). Results: C4b levels were found to be significantly increased in RT-PCR positive patients as compared to asymptomatic RT-PCR negative controls. RT-PCR negative but symptomatic patients still showed increased C4b levels. The significantly higher levels of C4b in cases with a cut-off value of ≥ 116 ng/ml with optimum sensitivity and specificity of 80% and 52% respectively is indicative of its possible use as an adjunct marker. Increased levels of D-dimer, IL6, along with decreased levels of C1-INH were found in cases compared to controls. Whereas, C5b-9 levels were not significantly raised in cases. Conclusions: The results of our study suggests that plasma C4b may help to detect infection in false negative cases of RT-PCR that escape detection owing to low viral load. However, to confirm it a large-scale study is needed. Supplementary Information: The online version contains supplementary material available at 10.1007/s12291-022-01033-z.

Pharmaceuticals in water as emerging pollutants for river health: A critical review under Indian conditions.

The wastewaters from pharmaceutical manufacturing units, hospitals, and domestic sewage contaminated with excretal matters of medicine users are the prime sources of pharmaceutical pollutants (PPs) in natural water bodies. In the present study, PPs have been considered one of the emerging pollutants (EPs) and a cause of concern in river health assessment. Beyond the reported increase in antibiotic-resistant bacteria (ABRB), PPs have been found adversely affecting the biotic diversity in such water environments. Considering Algae, Macroinvertebrates, and Fishes as three distinct trophic level indicators, the present study puts forward a framework for showing River Health Condition (RHC) based on the calculation of a River Health Index (RHI). The RHI is calculated using six Indicator Group Scores (IGS) which individually reflect river health in a defined category of water quality characteristics. While Dissolved Oxygen Related Parameters (DORP), Nutrients (NT), and PPs are taken as causative agents affecting RHCs, scores of Algal-Bacterial (AB) symbiosis, Macroinvertebrates (MI), and Fishes (F) are considered as an effect of such environmental conditions. Current wastewater treatment technologies are also not very effective in the removal of PPs. The objective of the present study is to review the harmful effects of PPs on the aquatic environment, particularly on the chemical and biotic indicators of river health. Based on predicted no-effect concentrations (PNEC) for algae, macroinvertebrates, and fishes in the aquatic environment and measured environmental concentration (MEC) in the river, the estimated risk quotient (RQ) for norfloxacin in the Isakavagu-Nakkavagu stream of river Godavari, Hyderabad is found 293 for algae, 39 for MI, and 335 for fish. Among PPs, in Indian rivers, the presence of caffeine is the most frequent, with algae at the highest level of risk (RQmax= 24.5). Broadly six PPs, including azithromycin, caffeine, diclofenac, naproxen, norfloxacin, and sulfamethoxazole are found above PNEC values in Indian rivers. The application of IGS and RHI in understanding and presenting the river health condition (RHC) through colored hexagons has been demonstrated for the river Ganga near Varanasi (India) as an example. Identification of critical indicator groups, based on IGS provides a scientific basis for planned intervention for river health restoration to achieve an acceptable category.

Biochar Adsorbents for Arsenic Removal from Water Environment: A Review.

Arsenic intake can cause human health disorders to the lungs, urinary tract, kidney, liver, hyper-pigmentation, muscles, neurological and even cancer. Biochar is potent, economical and ecologically sound adsorbents for water purification. After surface modifications, adsorption capacity of biochar significantly increased due to high porosity and reactivity. Adsorption capacities of the biochar derived from the municipal solid waste and KOH mixed municipal solid waste were increased from 24.49 and 30.98 mg/g for arsenic adsorption. Complex formation, electrostatic behavior and ion exchange are important mechanisms for arsenic adsorption. Organic arsenic removal using biochar is a major challenge. Hence, more innovative research should be conducted to achieve one of the 17 sustainable development goals of the United Nations i.e. "providing safe drinking water for all". This review is focused on the arsenic removal from water using pristine and modified biochar adsorbents. Recent advances in production methods of biochar adsorbents and mechanisms of arsenic removal from water are also illustrated.

Does Long-term Oxygen Therapy and Noninvasive Ventilation Predispose Rhino-orbital-cerebral Mucormycosis in COVID-19 Patients?

How to cite this article: Kumar A, Kumar A, Kumar N, Kumar A, Sinha C, Singh PK. Does Long-term Oxygen Therapy and Noninvasive Ventilation Predispose Rhino-orbital-cerebral Mucormycosis in COVID-19 Patients? Indian J Crit Care Med 2022;26(9):1063-1064.

Effectiveness of COVID-19 vaccine in preventing infection and disease severity: a case-control study from an Eastern State of India.

Effectiveness of corona virus disease-19 (COVID-19) vaccines used in India is unexplored and need to be substantiated. The present case-control study was planned to elicit the effectiveness of COVID-19 vaccines in preventing infection and disease severity in the general population of Bihar, India. This case-control study was conducted among people aged ≥45 years during April to June 2021. The cases were the COVID-19 patients admitted or visited All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India, and were contacted directly. The controls were the individuals tested negative for severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) at the Virology laboratory, AIIMS-Patna and contacted telephonically for collection of relevant information. The vaccine effectiveness (VE) was calculated by using the formula (VE = 1 - odds ratio). The adjusted VE for partial and full vaccination were estimated to be 52.0% (95% confidence interval (CI) 39.0-63.0%) and 83.0% (95% CI 73.0-89.0%) respectively for preventing SARS CoV-2 infection. The sub-group analyses of the cases have shown that the length of hospital stays (LOS) (partially vaccinated: 9 days vs. unvaccinated: 12 days; P = 0.028) and the severity of the disease (fully vaccinated: 30.3% vs. partially vaccinated: 51.3% and unvaccinated: 54.1%; P = 0.035) were significantly low among vaccinated compared to unvaccinated individuals. To conclude, four out of every five fully vaccinated individuals are estimated to be protected from contracting SARS CoV-2 infection. Vaccination lowered LOS and chances of development of severe disease.

Metallic contamination of global river sediments and latest developments for their remediation.

This review article represents the comparative study of heavy metal concentration in water and sediments of 43 important global rivers. The review is a solitary effort in the area of heavy metal contamination of river-sediments during last ten years. The interpretation of heavy metal contamination in sediments has been verified with different indices, factors, codes and reference guidelines, which is based on geochemical data linked to background value of metals. It is observed that health hazards arise due to dynamics of movement of metals between water and sediments, which is primarily influenced by several factors such as physical, chemical, biological, hydrological and environmental. Also, the reason behind accumulation and assimilation of heavy metals on river water system is explained with appropriate mechanisms. Several factors e.g. pH, ORP, organic matter etc. are mainly involved in the distribution, accumulation and assimilation of metals in the sediment phase to water phase. Remediation technologies such as in-situ and ex-situ have been discussed for the removal of heavy metals from contaminated sediments. We have also compared the performance efficiencies of the technologies adopted by different researchers during the period 2003 to 2019 for the removal of metal bound sediments. Many researchers have preferred in-situ over ex-situ remediation due to low cost and time saving remediation effects. In this work we have also incorporated the safety measures and strategies which can prevent the metal accumulation in sediments of river system.

Anesthetic management of premature conjoined twins posted for nonseparation emergency surgery.

Craniopagus conjoined twins are rare, and the chance that an anesthesiologist might face the challenge of providing anesthesia for this condition is very rare. The incidence of conjoined twins ranges from 1 : 50 000 to 1 : 200 000 births. We describe the anesthetic management of a pair of premature craniopagus conjoined twins posted for emergency surgery prior to their separation.

A decision support system for localized planning of reclaimed water around wastewater treatment plants.

Exploding population, industrialization, and an increase in water pollution has led to acute shrinkage in freshwater availability. Numerous countries have started exploring municipal wastewater as a new potential source of water to bring a paradigm shift from linearity to obtaining circularity in human water cycle management. This study aims to develop a decision support system for integrated water and wastewater management (DSS_IWWM), targeted towards reuse-focused selection of appropriate wastewater treatment technology, and localized planning around STPs in terms of reclaimed water demand identification, estimation, allocation, and sustainable pricing. The developed DSS_IWWM comprises of a repository of fourteen reuse purposes, reuse quality criteria, and 25 wastewater treatment technologies (WWTTs) in 360 combinations. It is sensitive to local resource scenarios and applies a socioeconomic and technology-focused methodology for addressing the interests of the community and investing agencies and viably. To validate the application of the DSS_IWWM, it is first tested with data from three cities in the state of Uttar Pradesh (India)-Lucknow, Prayagraj, and Agra-and then extended to nine more Indian cities with varying influent quality characteristics, resource inputs, existing STP technologies, and same target quality and decision criteria prioritization, to present a comparison of appropriate WWTTs and associated average prices obtained in different scenarios. It is concluded that influent quality, existing technology, and target quality criteria play significant role in selection of appropriate WWTTs. The traditional technologies such as UASB and ASP are required to be augmented and supplemented with high-performing WWTTs, such as BIOFOR-F with (C + F + RSF) and SBT + WP to obtain desired effluent quality. High-performing advanced oxidation process (AOP)-based systems such as A2O, SBR, and BIOFOR-F require WWTTs with relatively lower average costs (such as SBT and OP). The developed DSS_IWWM may prove to be very useful and beneficial for policymakers, government officials, engineers, and scientific community as it will facilitate rational decision-making for efficient investment planning in reuse focused wastewater treatment towards achieving circular economy in sustainable water resource management.

Ecological impact of pharmaceutical pollutants and options of river health improvements - A risk analysis-based approach.

Pharmaceuticals are one of the emerging pollutants (EPs) in river waters across the world. Due to their toxic effects on aquatic organisms, they have drawn the global attention of the scientific community concerned with river ecosystems. This paper reviews the existing occurrence data for various pharmaceutical pollutants (PPs) reported in river waters in some part of the world and their ecological impacts. Using algae, macroinvertebrates (MI), and fish as biotic indicator groups in water to reflect river health conditions, an attempt has been made to assess the ecological risk due to the presence of PPs in the water environment. After ascertaining the predicted no-effect concentration (PNEC) of PPs for selected groups of aquatic organisms, the risk quotient (RQ) is estimated based on their measured environmental concentration (MEC). When MEC > PNEC and RQ > 1 for any of the biotic indicator, ecologically it is 'high risk' condition. The determination of PNEC uses a minimum assessment factor (AF) of 10 due to uncertainty in data over the no observed effect level (NOEL) or lowest observed effect level (LOEL). Accordingly, MEC 10 times higher than PNEC, (RQ = 10) represents a threshold risk concentration (RCT) beyond which adverse effects may start showing observable manifestations. In the present study, a new classification system of 'high risk' conditions for RQ = 1-10 has been proposed, starting from 'moderately high' to 'severely high'. For RQ > 10, the ecological condition of the river is considered 'impaired'. For river health assessment, in the present study, the whole range of physico-chemical characteristics of river water quality has been divided into three groups based on their ease of measurement and frequency of monitoring. Dissolved oxygen related parameters (DORPs), nutrients (NTs), and EPs. PPs represent EPs in this study. A framework for calculating separate indicator group score (IGS) and the overall river health index (RHI) has been developed to predict indicator group condition (IGC) and river health condition (RHC), respectively. Color-coded hexagonal pictorial forms representing IGC and RHC provide a direct visible perception of the existing aquatic environment and a scientific basis for prioritization of corrective measures in terms of treatment technology selection for river health improvements. The analyses indicate that many rivers across the world are under 'high risk' conditions due to PPs having MEC > PNEC and RQ > 1. Up to RCT, (where RQ = 10), the 'high risk' condition varies from 'moderately high' to 'severely high'. In many instances, RQ is found much more higher than 10, indicating that the ecological condition of river may be considered as 'impaired'. Algae is the most frequently affected group of biotic indicators, followed by MI and fish. A review of treatment methods for selection of appropriate technology to reduce the pollution load, especially PPs from the wastewater streams has been summarized. It appears that constructed wetlands (CWs) are at present the most suitable nature-based solutions, particularly for the developing economies of the world, to reduce the concentrations of PPs within limits to minimize the ecological impacts of pharmaceutical compounds on biotic indicators and restore the river health condition. Some suggestive design guidelines for the CWs have also been presented to initiate the process.

Spatial distribution of heavy metals in the sediments of River Ganges, India: Occurrence, contamination, source identification, seasonal variations, mapping, and ecological risk evaluation.

Present study analyzed the seasonal and spatial distribution patterns, sources, and ecological risks of seven heavy metals (Cr, Fe, Ni, Cu, Zn, Cd and Pb) in the sediments of River Ganges, finding that the majority of concentrations were lithologic, except for Cd, which was significantly higher than background standards. Elevated values of geochemical indices viz. Igeo, CF, RI, Cd, mCd, HQ, mHQ, and PN suggest moderate to high ecological risk in the benthic environment and its organisms due to the synergistic effect of heavy metals. The PEC-Qmetals revealed 8-10 % toxicity in the upstream and downstream sites, due to the influence of agricultural activities. Multivariate statistical techniques (PCM and PCA) indicated that Cd and Pb predominantly originated from anthropogenic sources, while other metals primarily derived from geological background. These geochemical findings may help to understand the potential risks and recommend strategies to mitigate the effects of metallic contamination in river sediments.

Clinicodemographic profile and predictors of poor outcome in hospitalised COVID-19 patients: a single-centre, retrospective cohort study from India.

OBJECTIVES: Primary objective was to study the clinicodemographic profile of hospitalised COVID-19 patients at a tertiary-care centre in India. Secondary objective was to identify predictors of poor outcome. SETTING: Single centre tertiary-care level. DESIGN: Retrospective cohort study. PARTICIPANTS: Consecutively hospitalised adults patients with COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome variable was in-hospital mortality. Covariables were known comorbidities, clinical features, vital signs at the time of admission and on days 3-5 of admission, and initial laboratory investigations. RESULTS: Intergroup differences were tested using χ2 or Fischer's exact tests, Student's t-test or Mann-Whitney U test. Predictors of mortality were evaluated using multivariate logistic regression model. Out of 4102 SARS-CoV-2 positive patients admitted during 1-year period, 3268 (79.66%) survived to discharge and 834 (20.33%) died in the hospital. Mortality rates increased with age. Death was more common among males (OR 1.51, 95% CI 1.25 to 1.81). Out of 261 cases analysed in detail, 55.1% were in mild, 32.5% in moderate and 12.2% in severe triage category. Most common clinical presentations in the subgroup were fever (73.2%), cough/coryza (65.5%) and breathlessness (54%). Hypertension (45.2%), diabetes mellitus (41.8%) and chronic kidney disease (CKD; 6.1%) were common comorbidities. Disease severity on admission (adjusted OR 12.53, 95% CI 4.92 to 31.91, p<0.01), coagulation defect (33.21, 3.85-302.1, p<0.01), CKD (5.67, 1.08-29.64, p=0.04), high urea (11.05, 3.9-31.02, p<0.01), high prothrombin time (3.91, 1.59-9.65, p<0.01) and elevated ferritin (1.02, 1.00-1.03, p=0.02) were associated with poor outcome on multivariate regression. A strong predictor of mortality was disease progression on days 3-5 of admission (adjusted OR 13.66 95% CI 3.47 to 53.68). CONCLUSION: COVID-19 related mortality in hospitalised adult patients at our center was similar to the developed countries. Progression in disease severity on days 3-5 of admission or days 6-13 of illness onset acts as 'turning point' for timely referral or treatment intensification for optimum use of resources.

Clinico-Epidemiological Profile of Breakthrough COVID-19 Infection among Vaccinated Beneficiaries from a COVID-19 Vaccination Centre in Bihar, India.

BACKGROUND: When the whole world is fighting in an unprecedented pace against COVID-19 pandemic, the breakthrough COVID infections poise to dampen the rapid control of the same. We carried out this project with two objectives; first, to estimate the proportion of breakthrough COVID-19 infection among completely vaccinated individuals and second, to study the clinico-epidemiological profile of breakthrough COVID-19 infections among them. METHODS: This cross-sectional analytical study was conducted among 2703 fully vaccinated individuals from AIIMS, Patna COVID Vaccination Centre (CVC), Bihar, India. The participants were selected randomly using a systematic sampling technique from the list of beneficiaries maintained at the CVC. Telephonic interviews were made to collect the information by trained data collectors. RESULTS: A total of 274 fully vaccinated beneficiaries [10.1% (95% CI: 9.1%, 11.4%)] were diagnosed with breakthrough COVID-19 infection. The infections were more among males (10.4%) and the individuals aged ≤29 years (12.5%). The beneficiary categories, the healthcare-worker and the frontline-worker, were identified as predictors of the breakthrough COVID infections. Only one in three participants had adopted adequate COVID appropriate behaviour following the full vaccination. The majority of the breakthrough infections occurred during the second wave of COVID-19. The majority of the individuals with breakthrough infections were asymptomatic and no death was reported among them. CONCLUSION: One in every ten fully vaccinated individuals can get the breakthrough COVID infections. The healthcare-worker and the frontline-worker had independent risk of getting the breakthrough infections. Very few with breakthrough infections were serious and no death was reported among them.

Nitrate contamination in water resources, human health risks and its remediation through adsorption: a focused review.

The level of nitrate in water has been increasing considerably all around the world due to vast application of inorganic nitrogen fertiliser and animal manure. Because of nitrate's high solubility in water, human beings are getting exposed to it mainly through various routes including water, food etc. Various regulations have been set for nitrate (45-50 mgNO3-/L) in drinking water to protect health of the infants from the methemoglobinemia, birth defects, thyroid disease, risk of specific cancers, i.e. colorectal, breast and bladder cancer caused due to nitrate poisoning. Different methods like ion exchange, adsorption, biological denitrification etc. have the ability to eliminate the nitrate from the aqueous medium. However, adsorption process got preference over the other approaches because of its simple design and satisfactory results especially with surface modified adsorbents or with mineral-based adsorbents. Different types of adsorbents have been used for this purpose; however, adsorbents derived from the biomass wastes have great adsorption capacities for nitrate such as tea waste-based adsorbents (136.43 mg/g), carbon nanotube (142.86 mg/g), chitosan beads (104 mg/g) and cetyltrimethylammonium bromide modified rice husk (278 mg/g). Therefore, a thorough literature survey has been carried out to formulate this review paper to understand various sources of nitrate pollution, route of exposure to the human beings, ill effects along with discussing the key developments as well as the new advancements reported in procuring low-cost efficient adsorbents for water purification.

Investigation of an acute surge of COVID-19 associated mucormycosis (CAM) cases reported to a tertiary health care institution in Bihar, India.

Introduction: Acute surge in coronavirus disease-2019 (COVID)-associated mucormycosis (CAM) cases was reported during mid-May 2021, which was later declared an epidemic in various states of India including Bihar. Objective: We carried out a rapid investigation of CAM cases to describe the epidemiological and clinical profiles and find plausible predictors to guide the initiation of public health actions. Methods: A team of public health specialists contacted all the CAM cases reported to our hospital to collect relevant information using a case-investigation-form. In addition, the team visited the Flu Clinic and Ear, Nose, and Throat (ENT) outpatient department (OPD) to capture CAM cases on daily basis during the period of the acute surge of CAM cases. Results: About 88% of 130 CAM cases reported during the period of the acute surge were in the advanced stage of mucormycosis. The majority of the CAM cases were younger (less than 60 years) [76.2%], diabetics [65.4%], un-vaccinated [86.9%], and had used steroids for management of COVID-19 [64.6%]. Other findings of public health importance were summarized and possible public health actions were recommended for the prevention of outbreaks in future. Conclusion: Optimum management of diabetes including screening for each COVID case, rational use of steroids only when necessary, strict adherence to COVID appropriate behavior by health professionals as well as the public, increasing COVID vaccine coverage, CAM awareness, and setting up a CAM surveillance mechanism may be the key to prevent and control CAM outbreaks in future.

Persistent positivity of SARS-CoV-2 nucleic acid in asymptomatic healthcare worker: infective virion or inactive nucleic acid?

Asymptomatic individuals positive for SARS-CoV-2 RNA constitute a significant proportion of the infected population and play a role in the transmission of the virus. We describe a healthcare worker who presented with fever and malaise and was diagnosed with mild COVID-19. The symptoms resolved within 4 days but there was persistent positivity of viral RNA in the upper respiratory tract for more than 58 days, which is the longest reported duration of persistence of SARS-CoV-2 in a healthcare worker. In this case report, we discuss clinical and administrative issues such as the role of asymptomatic cases in the transmission of the virus to patients and coworkers as an occupational hazard, interpretation of persistent positivity of nucleic acid test, duration of isolation and return-to-work guidelines pertinent to researchers and global health policymakers.

Favourable outcome of severe COVID-19 patients in hyperinflammatory phase with high dose dexamethasone pulse therapy: A series of 10 cases.

The hyperinflammatory phase of COVID-19 occurring because of cytokine storm is the leading cause of mortality and morbidity in the affected patients. Various drugs with no definite cure are being tried to tackle the cytokine storm. Recently high dose corticosteroids are being used to arrest the surge of cytokines. In the current case series, we will be discussing the outcome of high dose dexamethasone pulse therapy in 10 cases of COVID-19 in hyperinflammatory phase who were cured of the disease along with improvement in laboratory parameters without any complications to the therapy.

Seroprevalence of IgG against SARS-CoV-2 and its determinants among healthcare workers of a COVID-19 dedicated hospital of India.

Healthcare workers (HCWs) due to their job profile are at utmost risk of contracting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Serological survey is an useful tool for vulnerability mapping in an infectious disease pandemic. The aim of the current study was to assess seroprevalence of IgG against SARS-CoV-2 and its determinants among HCWs of a tertiary healthcare facility of India. It was an observational study, cross-sectional in design conducted among 919 HCWs of All India Institute of Medical Sciences, Patna, Bihar, India during September, 2020. In results, IgG seroprevalence for SARS-CoV-2 among the study subjects was 13.3% [95% confidence interval (CI): 11.2-15.6%]. In univariate logistic regression analysis; gender, occupation, place of posting, use of full personal protective equipment (PPE), prior corona virus disease (COVID)-19 infection, influenza like illness (ILI), use of steam inhalation, consumption of azithromycin, zinc and vitamin C were the significant attributes which affected the IgG seropositivity for SARS-CoV-2. In the multivariable logistic regression model; occupation, place of posting, prior COVID-19 infection and ILI were significant determinants of IgG seropositivity for SARS-CoV-2. To conclude, majority of the HCWs were found to be IgG seronegative for SARS-CoV-2. Till availability of effective vaccine all of the HCWs should abide by infection prevention and control (IPC) measures to keep themselves and their contacts protected from SARS-CoV-2.

Low flow nasal oxygen supplementation in addition to non-rebreathing mask: An alternative to high flow nasal cannula oxygenation for acute hypoxemic COVID-19 patients in resource limited settings.

Approximately 14% COVID-19 patients, develop acute hypoxic respiratory failure. A high flow nasal cannula device might be preferred to obtain an oxygen saturation above 90% in these cases. In resource limited settings, where high flow nasal cannula is not an option, additional low flow oxygen therapy through nasal prongs could be added to non-rebreathing mask with a reservoir bag. The possible mechanisms of the improved oxygenation could be: 1. improved oxygen-air mixing in large airways, 2. increased oxygen concentration inside the non-rebreathing mask, 3. decrease in rebreathing of carbon-dioxide from the non-rebreathing mask. This method of oxygen supplementation is easy to assemble, cost-effective and helpful in management of acute hypoxemic COVID-19 patients, whenever there is crisis of high flow nasal cannula machine. Its effectiveness needs to be assessed by a randomized controlled trial.