Online Education System in the Age of Pandemics: A Statistical Analysis of Current Covid-19 to the Teaching and Learning Pedagogies in India

Over one billion students from 150 countries are impacted due to the COVID-19 driven lockdown and educational institution closure as per the report shared by UNESCO. Innumerous efforts have been put up by the Governments of every country to control the impact of the COVID-19 but unfortunately, there is no vaccine available till now so social distancing is the only way to have an upper hand on it. The COVID-19 pandemic has affected the educational systems worldwide and led to the widespread closures of Educational Institutions across the globe. Numerous educational reformers have long-held out the expectation that information and computer technologies (ICTs) will play a crucial and integral role in bringing the long-needed revolution to teaching and learning pedagogies. The situation which took place due to COVID-19, the Online Education Systems and Platforms (OESP) are playing an important role to continue with the teaching processes in the educational institutions during the worldwide closure. Statistical analysis of the covid situation on the teaching-learning process has been depicted in this paper. The present paper focuses on the change of action in the education system and the exponential growth that happened in the Online Education Segment in the 21st century. © 2022 American Institute of Physics Inc.. All rights reserved.

COVID VACCINE-INDUCED RHABDOMYOLYSIS. A CASE OF RECURRENT RHABDOMYOLYSIS

CASE: A 46-year-old African-American female was evaluated for generalized body aches five days after receiving second dose of COVID mRNA-1273 (Moderna) vaccine. Six months prior, she received her first dose of Ad26 (Johnson & Johnson) vaccine without sequelae, Family history includes maternal systemic lupus erythematous. Patient has a history of cystic acne and, most notably, frequent episodes of muscle aches and weakness. In 2006 and 2016, patient was hospitalized for episodes of rhabdomyolysis after receiving influenza vaccine. Autoimmune myositis was ruled out. She has never received statin medication. In late 2017, she was admitted for rhabdomyolysis after upper respiratory tract infection. She reported dark urine but no rash or arthralgia. Patient had elevated CK 107,737 U/L, AST 379 U/L, and ALT 115 U/L. Her renal function, sed rate, TSH, HIV, influenza, direct Coombs, protein electrophoresis, and antinuclear antibodies were negative or within normal limits. She was treated with IV fluids, pain medication, and discharged. In her current admission for rhabdomyolysis, she presented with dark urine, CK 130,702 U/L, AST 692 U/L, ALT 208 U/L, and D-dimer 1,544 ng/mL. No acute renal injury was noted. Patient was treated with intravenous crystalloids and pain medication. CK and transaminases steadily trended down. Patient was discharged as she was asymptomatic and CK had dropped significantly. IMPACT/DISCUSSION: Rhabdomyolysis can be an adverse event to vaccine administration, most commonly influenza vaccination. Detection of SARS-CoV-2 inside skeletal muscle has not been documented. Reports on COVID- 19 vaccine-induced rhabdomyolysis focus on the type of vaccine the patient received, the number of doses that triggered the event, CK level, and presence of risk factors for developing rhabdomyolysis. Although no pathophysiologic mechanism has been established, several hypotheses exist to explain muscle damage including genetic factors, autoimmune reactions to the virus nucleic material, or external adjuvant. This has been described as autoimmune/inflammatory syndrome induced by adjuvants. Our patient had a history of recurrent episodes of rhabdomyolysis after receiving influenza and COVID immunizations, as well as viral infection. CONCLUSION: The mechanism of our patients' reaction is unknown. Reported cases support autoimmunity as the major risk factor for vaccinerelated rhabdomyolysis. This patient had elevated CK level on subsequent episodes of rhabdomyolysis fitting the pattern where a more exaggerated response of the immune system is observed every time patient is re-exposed to known insult. Genetic predisposition may also play a role. AfricanAmericans have higher prevalence of slow acetylation and carnitine palmitoyltransferase II deficiency, a disorder of fatty acid. The myopathic form presents with high CK values. Therefore, patients should be counseled to seek medical attention when symptoms occur and physicians should consider vaccination as a possible cause.

Long Term Health Consequences of COVID-19 in Hospitalized Patients from North India: A follow up study of upto 12 months

Background: Long-COVID syndrome is now a real and pressing public health concern. We cannot reliably predict who will recover quickly or suffer with mild debilitating long COVID-19 symptoms or battle life-threatening complications. In order to address some of these questions, we studied the presence of (post covid) symptoms and various correlates in COVID-19 patients who were discharged from hospital, 3 months and up to 12 months after acute COVID-19 illness. Methods: This is an observational follow-up study of RT-PCR confirmed COVID-19 patients admitted at 3 hospitals in north India between April – August 2020. Patients were interviewed telephonically using a questionnaire regarding the post-COVID symptoms. The first tele-calling was done in the month of September 2020, which corresponded to 4- 16 weeks after disease onset. All those who reported presence of long COVID symptoms, were followed-up with a second call, in the month of March 2021, corresponding to around 9-12 months after the onset of disease. Results: Of 990 patients who responded to the first call, 615 (62.2%) had mild illness, 227 (22.9%) had moderate and 148 (15.0%) had severe COVID-19 illness at the time of admission. Nearly 40% (399) of these 990 patients reported at least one symptom at that time. Of these 399 long-COVID patients, 311 (almost 78%) responded to the second follow-up. Nearly 8% reported ongoing symptomatic COVID, lasting 1-3 months and 32% patients having post-COVID phase with symptoms lasting 3-12 months. Nearly 11% patients continued to have at least one symptom even at the time of the second interview (9-12 months after the disease onset). Overall, we observed Long-COVID in almost 40% of our study group. Incidence of the symptoms in both the follow-ups remained almost same across age-groups, gender, severity of illness at admission and presence of comorbidity, with no significant association with any of them. Most common symptoms experienced in long COVID phase in our cohort were fatigue, myalgia, neuro-psychiatric symptoms like depression, anxiety, “brain fog” and sleep disorder, and breathlessness. Fatigue was found to be significantly more often reported in the elderly population and in those patients who had a severe COVID-19 illness at the time of admission. Persistence of breathlessness was also reported significantly more often in those who had severe disease at the onset. The overall median duration of long COVID symptoms was 16.9 weeks with inter-quartile range of 12.4 to 35.6 weeks. The duration of symptom resolution was not associated with age, gender or comorbidity but was significantly associated with severity of illness at the time of admission (P=0.006). Conclusions: Long-COVID was seen in almost 40% of our study group with no correlation to age, gender, comorbidities or to the disease severity. The duration of symptom resolution was significantly associated with severity of illness at the time of admission (P = 0.006). In our study, all patients reported minor symptoms such as fatigue, myalgia, neuro-psychiatric symptoms like depression, anxiety, “brain fog” and sleep disorder and persistence of breathlessness.

COVID-19 COMPLICATED BY THE INVASION OF ASPERGILLUS TERREUS

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Coronavirus associated pulmonary aspergillosis (CAPA) appears to be emerging on a global scale. Studies have consistently indicated that CAPA is associated with significantly higher mortality rates, when compared to patients with COVID-19 alone [1]. Unfortunately, definitive guidelines regarding the surveillance, diagnosis, & treatment of CAPA are currently lacking. CASE PRESENTATION: A 59 year old male with hypertension & diabetes presented with dyspnea & cough. On arrival, he was initially afebrile, though hypoxic & tachycardic. He tested positive for COVID-19 & influenza B on admission. Dexamethasone & remdesivir were initiated, along with oseltamivir & empiric antibiotics. CT of the chest was notable for bilateral ground glass opacities. On hospital day 11, he developed respiratory failure on BiPAP therapy, prompting intubation & ICU transfer. He subsequently succumbed to septic shock requiring hemodynamic support. Given concern for bacterial superinfection, antibiotic therapies were escalated. Despite the initial defervescence, he continued to have persistent febrile recrudescence. Blood & sputum cultures remained negative. He ultimately required tracheostomy and PEG tube placement. On day 38, his lower respiratory culture revealed growth of Aspergillus terreus. Voriconazole was initiated. On day 43, his fever returned again. Repeat CT of the chest revealed progressive fibrosis, with a cavitation in the right lower lung. He remained ventilator dependent, given his persistently high FiO2 requirements. On day 52, he became markedly hypoxemic with copious mucoid secretions, prompting emergent bronchoscopy. Despite clearance, he eventually became bradycardic & developed PEA arrest. The patient ultimately expired. DISCUSSION: CAPA remains a diagnostic challenge, fraught by logistical burdens & a variety of crudely defined criteria. Cases may currently be underreported, undertreated, or clinically overlooked. Obscure species such as A. terreus are of particular concern, given the proposed lethality of this strain & it's widely reported resistance to amphotericin B [3]. Unfortunately, guidelines for the surveillance of superinfections are currently insufficient. This is troublesome, considering the well documented risk of invasive pulmonary aspergillosis with the use of immunosuppressive agents, such as tocilizumab & corticosteroids [2]. Co-infection with influenza may augment this risk further. CONCLUSIONS: CAPA presents clinicians with a multitude of clinical uncertainties, which necessitate further analysis & investigation. Given the heightened risk of mortality, we propose a lower threshold for the suspicion, diagnosis & treatment of CAPA in patients with refractory respiratory distress, and/or febrile recrudescence despite the appropriate therapies. Surveillance should be particularly stringent, in those treated with immunosuppressive agents, or concomitantly diagnosed with influenza. REFERENCE #1: Apostolopoulou A, Esquer Garrigos Z, et al. Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature. Diagnostics. 2020;10(10):807. REFERENCE #2: Koehler, P., Bassetti, M, et al. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. The Lancet. Infectious diseases. 2020, Dec 20 REFERENCE #3: Steinbach, W, Benjamin, D, et al. Infections Due to Aspergillus terreus: A Multicenter Retrospective Analysis of 83 Cases, Clinical Infectious Diseases, Volume 39, Issue 2, 15 July 2004, Pages 192–198 DISCLOSURES: No relevant relationships by Huda Asif, source=Web Response No relevant relationships by Sunil Bali, source=Web Response No relevant relationships by Christopher Siriphand, source=Web Response No relevant relationships by Christopher Wood, source=Web Response

A Social Network Under Social Distancing: Risk-Driven Backbone Management During COVID-19 and Beyond

As the COVID-19 pandemic reshapes our social landscape, its lessons have far-reaching implications on how online service providers manage their infrastructure to mitigate risks. This paper presents Facebook's risk-driven backbone management strategy to ensure high service performance throughout the COVID-19 pandemic. We describe Risk Simulation System (RSS), a production system that identifies possible failures and quantifies their potential severity with a set of metrics for network risk. With a year-long risk measurement from RSS we show that our backbone resiliently withstood the COVID-19 stress test, achieving high service availability and low route dilation while efficiently handling traffic surges. We also share our operational practices to mitigate risk throughout the pandemic. Our findings give insights to further improve risk-driven network management. We argue for incorporating short-term failure statistics in modeling failures. Common failure prediction models based on long-term modeling achieve stable output at the cost of assigning low significance to unique short-term events of extreme importance such as COVID-19. Furthermore, we advocate augmenting network management techniques with non-networking signals. We support this by identifying and analyzing the correlation between network traffic and human mobility.

Gold nanoparticle based lipoidic oral vaccine against respiratory viruses including sars-cov 2

Defective functioning of the primary immune cells is now considered as the most important cause of the delayed response and hyper-inflammatory lung reactions seen in the patients that become seriously ill during infection with SARS CoV-2. These immune defects are seen either in the inefficient recognition of PAMPs by the Dendritic cells or manifested in the delayed and hyper-inflammatory cytokine release by the macrophages in the lung. The innate immune system response is now being postulated as the critical factor in the body‘s ability to survive the attack by the virus. Gold Nanoparticles (GNP) have been studied over past few years because of their ability to act as carriers of vaccines and chemotherapeutic agents. Use of GNP in rats has been noticed to increase lymphocyte cell populations and cause enhanced activation of macrophages and dendritic cells. Gold ash (elemental gold) formulations have been used in India for ages, for medical conditions ranging from fevers and senility to memory loss . If employed with suitable modifications, such formulations can play the significant role of oral vaccine against the vast range of influenza and corona viruses.. © 2021, Annals of R.S.C.B. All rights reserved.