Autologous Conditioned Serum in Lumbar and Cervical Radiculopathy: A Systemic Review

Background: Intervertebral disc degeneration causing radiculopathy is driven by catabolic cytokines like IL-1β and TNFα. Autologous conditioned serum (ACS) was found to be rich in IL-1Ra (Interleukin-1 Receptor Antagonist), and thus, can impede disc degeneration. A systematic review of available literature was conducted to ascertain the potential therapeutic application of ACS in radiculopathy. Methods: Systematic literature reviews were conducted in PubMed, Scopus and Embase databases, up to September 2020. Randomised controlled trials (RCTs), prospective, retrospective studies and case series with lumbar or cervical radiculopathy and reporting use of ACS were included, with at least one of the outcome measures like VAS (Visual Analogue Scale) for pain, SF-12 (Short Form of Health Survey-12), Oswestry Disability Index, with a minimum follow up of 3 months. Animal studies, s, review articles and case reports were excluded. Results: A total of four studies, including 107 patients who received ACS were included based on the eligibility criteria. Two were RCTs and two were prospective non-comparative studies. Three studies evaluated the effect of IL-1Ra on lumbar radiculopathy and one on cervical radiculopathy. The mean age of patients in the studies ranged from 37.15 to 53.9. The dose of ACS used was 2-4 mL injection. In 1 RCT, methylprednisolone was used as control, in the other 5 mg and 10 mg triamcinolone was used. All studies reported a statistically significant reduction in pre-injection and post-injection VAS, there was also a significant difference as compared to 5 mg triamcinolone. Three studies reported significant improvement in ODI. Two studies reported statistically significant improvement in SF-12 scores post injection (p < 0.001). For cervical radiculopathy, Neck pain disability score showed a decrease of 73.76% from pre-injection to final follow up and Neck disability index showed a decrease of 74.47%. Conclusion: All of the four studies concluded that epidural perineural injection with ACS, reduced pain scores (VAS, NPDS) and improved functional scores (ODI, SF-12 and NPDS), as compared to placebo and other conventional therapeutic modalities like steroids, and analgesic-anaesthetic-steroid cocktail. Hence, ACS is a promising new therapeutic modality in both lumbar and cervical radiculopathy, and further studies can strengthen the present evidence regarding its efficacy and safety profile. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.

Online Threats vs. Mitigation Efforts: Keeping Children Safe in the Era of Online Learning

As the COVID-19 pandemic resulted in school closures since early 2020, children have spent more time online through virtual classrooms using educational technology (EdTech) and videoconferencing applications. This increased presence of children online exposes them to more risk of cyber threats. Here, we present a review of the current research and policies to protect children while online. We seek to answer four key questions: what are the online threats against children when learning online, what is known about children's cybersecurity awareness, what government policies and recommendations are implemented and proposed to protect children online, and what are the proposed and existing efforts to teach cybersecurity to childrenƒ Our study emphasizes the online risks to children and the importance of protective government policies and educational initiatives that give kids the knowledge and empowerment to protect themselves online. © 2023 IEEE.

Surgical outcomes of breast conserving surgery performed under local versus general anaesthesia

Background: Surgical resection remains the mainstay for early breast cancer. However, older patients with multiple co-morbidities may be deemed unsafe for general anaesthesia (GA). The Covid-19 pandemic necessitated some such surgery under local anaesthesia (LA) especially those who lacked anti-hormonal bridging therapy option. We present a retrospective study comparing outcomes following breast conserving surgery (BCS) under LA and GA. Method(s): 31 patients under LA (April 2018-March 2022) were compared with 31 age-matched patients under GA during the same period. Main outcomes were length of hospital stay and rates of margin positivity, re-operation, and post-operative complications within 1 month (including wound infections, seromas needing >=3 aspirations). Statistical analysis (with R-4.2.2) used two-tailed test with significant p-value (<0.05). Result(s): Only 5 LA cases were performed in the 2 years prior to first UK Covid-19 lockdown (March 2020), whilst 26 cases were performed in the 2 years after. [Formula presented] Conclusion(s): The number of BCS cases under LA increased five-fold following Covid-19 pandemic. Outcomes under LA were no worse than under GA. BCS under LA can allow BCS in patients unfit for or unwilling to have GA, especially older patients. Dedicated lists for BCS under LA may reduce need for resources such as hospital beds and overnight stays in the current resource and financially constrained health-care system.Copyright © 2023

Detection of Sars-Cov-2 from human chest CT images in Multi-Convolutional Neural Network's environment

This article focuses on the detection of the Sars-Cov2 virus from a large-scale public human chest Computed Tomography (CT) scan image dataset using a customized convolutional neural network model and other convolutional neural network models such as VGG-16, VGG-19, ResNet 50, Inception v3, DenseNet, XceptionNet, and MobileNet v2. The proposed customized convolutional neural network architecture contains two convolutional layers, one max pooling layer, two convolutional layers, one max pooling layer, one flatten layer, two dense layers, and an activation layer. All the models are applied on a large-scale public human chest Computed Tomography (CT) scan image dataset. To measure the performance of the various convolutional neural network models, different parameters are used such as Accuracy, Error Rate, Precision, Recall, and F1 score. The proposed customized convolutional neural network architecture's Accuracy, Error Rate, Precision Rate, Recall, and F1 Score are 0.924, 0.076, 0.937, 0.921, and 0.926 respectively. In comparison with other existing convolutional neural network strategies, the performance of the proposed model is superior as far as comparative tables and graphs are concerned. The proposed customized convolutional neural network model may help researchers and medical professionals to create a full-fledged computer-based Sars-Cov-2 virus detection system in the near future. © 2023 IEEE.

Changes after COVID-19 on welfare policies and services for people with learning disabilities and autism: A case study for England, United Kingdom

The aim of this chapter is to explore changes since the COVID-19 pandemic in welfare policies and services for people with learning disabilities and autism in England, focusing mainly on educational and health and social care sectors. A review of official policy documents published on GOV.UK from January 2020 to May 2021 has been conducted using keywords on the topic in question, and semi-structured interviews took place in 2022 with four key informants/stakeholders working in health and social care or education sectors of people with learning disability or autism in England. The main findings indicate a need to shift practices online due to the pandemic, for both education and health and social-care practice. It is also clear that reforms and adjustments were implemented in guidance, policies and frameworks for the support of persons with learning disabilities and autism. It has been increasingly difficult for people with disabilities to access healthcare services and medication during the pandemic, and this has had an impact on their overall health and wellbeing too. Experts suggested that smoother changes and more support are required, in terms of provision of services, research, access to healthcare, educational services, mental health, employment, as well as more public funding on such services for people with learning disabilities and autism. The main lessons learned were focusing on the use of online resources, digitalisation of services and access to them, but also difficulty of the system to adapt fast to major changes required in order to support people with disabilities. © 2023 Anjali Ghosh and Eleni Koutsogeorgou. All rights reserved.

Comprehensive In silico Investigation Validates Two Flavonoid Compounds of Derris robusta (Roxb. ex DC.) Benth. to Supplant Remdesivir as Natural Therapeutic Remedy Against a Range of Coronaviruses

Diversified Coronaviruses like MERS-CoV, SARS-CoV-1, SARS-CoV-2, etc., have badly affected human life by causing various respiratory syndromes. Natural bioactive products like flavonoids are well-known for their anti-viral property. Derris robusta (Roxb. ex DC.) Benth. is a reservoir of flavonoids, which encouraged the in silico study of the signature flavonoid compounds in it towards investigating the possible inhibitory effect of those flavonoid compounds against the viral replication of MERS-CoV, SARS-CoV-1, and SARS-CoV-2. Therefore, investigating the treatment methodology for alleviating these types of diseases is the ultimate priority for public health. In our in silico study, Flavonoids like Isosinensetin and Retusin inhibited the replication of all three viruses with greater binding affinity compared to the control drug Remdesivir in multiple instances. Physicochemical characterization of the compounds by following Lipinski's rule of fi ve and the ADMET study have helped recognize these compounds as a probable natural therapeutic drug against Coronaviruses. The present study exhibits the potential of alternative drug molecules as anti-viral compounds against these three types of Coronaviruses. Further in vitro and in vivo evaluation followed by clinical trials for developing and successfully implementing these two compounds as an effective inhibitory agents against Coronaviruses can be initiated. © 2022 by the authors.

HOUSEMAIDS AND THE HAPTIC CODE DURING COVID TIMES

This chapter focuses on the dominantly gendered house-help in India: the cooks, cleaners, and maids during the pandemic-triggered lockdowns in Delhi and its metropolitan areas. Even if we are scared to enter people's homes, we have to come out to work to sustain our lives. The case studies of these three women point to the precarity and 'unrepresentability' which turn the previously invisible figure of the maid to a new extreme: that of a suspect body, a source of contagion, whose very touch is questionable. Albeit Jaaware focuses on the phenomenology of touch and brings it outside the boundaries of caste studies, and even beyond India, his investigation of the codes of sociality is important to emphasize the structure that touch works on, enabling a value that is good or bad in different contexts. The experiences of the three women around Delhi's extended metropolitan spaces point to the discourse of what Francoise Kral calls "social invisibility”. © 2022 selection and editorial matter, Niharika Banerjea, Paul Boyce and Rohit K. Dasgupta;individual chapters, the contributors

Name Entity Recognition on Covid-19 Dataset using Machine Learning algorithms

The COVID-19 pandemic has been accompanied by such an explosive increase in media coverage and scientific publications that researchers find it difficult to keep up. So we are working on COVID-19 dataset on Omicron variant to recognise the name entity from a given text. We collect the COVID related data from newspaper or from tweets. This article covered the name entity like COVID variant name, organization name and location name, vaccine name. It include tokenisation, POS tagging, Chunking, levelling, editing and for run the program. It will help us to recognise the name entity like where the COVID spread (location) most, which variant spread most (variant name), which vaccine has been given (vaccine name) from huge dataset. In this work, we have identified the names. If we assume unemployment, economic downfall, death, recovery, depression, as a topic we can identify the topic names also, and in which phase it occurred. © 2022 IEEE.

Psychosocial and behavioural impact of COVID-19 pandemic in children and adolescents with autism spectrum disorder

Background: The children and adolescents with ASD around the world have experienced a major disruption of their everyday lives due to the COVID-19 pandemic. Social isolation has inflicted a negative impact on the psychological well-being of these children and adolescents. Aim(s): To investigate the impact of COVID-19 pandemic in children and adolescents with ASD in terms of comprehension and adherence to implemented measures and changes in their behavioural problem. Methodology: A retrospective cross-sectional (descriptive) study was done involving 16 ASD children and adolescents attending OPD of a tertiary care institute within a time period of 12 months for various behavioural problems using ISAA scale and Nisonger CBRF. Each subject was assessed on a single occasion for 3 different timelines-Pre-COVID (before March 2020), during full Lockdown (March-May 2020) and Post-Lockdown (January 2021-January 2022). Result(s): The ISAA scoring revealed significant increase in ASDrelated behaviours (i.e. inappropriate emotional response, difficulty in communication etc.) from before pandemic to during pandemic and Post-Lockdown (p value<0.05).The Nisonger Child Behaviour Rating Form revealed deterioration in Positive Social behaviour (p value<0.05).Significant increase in problem behaviour was seen in all the six domains (Conduct problem, Insecure/Anxious, Hyperactive, Self-injury/Stereotype, Self-isolated/Ritualistic and Overtly Sensitive) (p value<0.05). Conclusion(s): Disruption of daily routine and social distancing have led to increase in problem behaviours of the children and adolescents with ASD as well as an increase in deficits of positive behaviours.

A study of clinical and electrophysiological characteristics of Infrahisian Wenckebach

Objectives: To study the clinico-electrophysiological profile of patients with Infrahisian Wenckebach (IHW) conduction. Material(s) and Method(s): Patients with a clinical diagnosis of atrioventricular (AV) block who underwent permanent pacemaker implantation (PPI) based on standard indications from July 2021-June 2022 at The Madras Medical Mission were subjected to pre-implant Electrophysiology study to document conduction pathology. Result(s): A total of 94 patients underwent PPI for AV block during the study period. EPS was performed in all but one patient (COVID pneumonia). The incidence of IHW was 9/93 (9.6%) of patients with AV block. There is no gender predisposition (M-4, F-5) and their mean age was 71.4 +/- 11.7 years. As many as half of the patients (5/9) had an underlying narrow QRS. The mean QRS duration was 130 +/- 19.3. Ischemic heart disease affected half of the patients and cardiomyopathy in 4/9 patients (mean EF 45.1 +/- 13.7%). Presentation was syncope in all, mean NYHA class was 2.1. Presentation ranged from isolated 1st-degree AV block (1/9) to tri-fascicular block (3/9). In EP study, the mean basal HV interval was 94.7 +/- 27.1 ms. IHW was noted spontaneously in 4 patients and on atrial pacing in the remaining. In the literature, a total of 11 documented cases have been reported (8 case reports). Unlike typical Wenckebach, the increment in PRI is minimal in the 2nd beat of the train. Conclusion(s): Wenckebach periodicity is classically considered an AV nodal phenomenon. IHW is scarcely reported in the literature. Distinction becomes critical as IHW is harbinger of a complete AV block. This is the largest series and the first clinic-etiological profile of IHW patients published to date.

Homoeopathic treatment of a diabetic COVID-19 patient with the complication of bronchitis and pleural effusion - A case report

Introduction: COVID-19 is a novel SARS-CoV-2 disease that has caused a worldwide pandemic. It is highly contagious and produces severe acute respiratory syndrome. Many homoeopathic medicines have been suggested for treatment of COVID cases and reports have also been published. Case Summary: The present case report is of a 61-year-old COVID-positive, male, presenting with complications such as bronchitis and pleural effusion. He was treated for COVID-19 with a suitable homoeopathic medicine, based on the totality of symptoms, while the patient continued his regular regime of conventional medicine for diabetes mellitus and hypertension. The indicated remedy led to immediate relief of the symptoms, especially chest pain, along with a marked improvement in the laboratory investigations. The Modified Naranjo Criteria score after treatment was 8, which explicitly shows the positive causal attribution of the individualised homoeopathic medicine, Phosphorus, in this case. Homoeopathic treatment has shown favourable results in this case and demonstrates the scope of Homoeopathy in infectious cases. © 2022 The authors.

CCN activation of ultrafine biogenic-WSOC under restricted anthropogenic emissions: A study over eastern Himalaya in India

The present study was conducted to investigate the potential of water soluble organic carbon (WSOC) in CCN activation under restricted anthropogenic emissions over a high altitude station, Darjeeling (27.01° N and 88.15° E,∼2200 amsl and covered with huge coniferous forests) in the eastern parts of Himalaya in India. We measured CN, CCN, and ultrafine WSOC (WSOC0.1) during April–May 2020 (COVID-19 lockdown) and compared with the normal period (April–May 2019) to investigate the relative dominance of biogenic over anthropogenic emissions to the aerosol-CCN activation. Though an expected significant decline (53%) in CN concentration was observed, CCN exhibited ∼17% increase during the lockdown period. The activation ratio (AR: CCN/CN) jumped from 0.30 during normal to 0.72 during the lockdown period. The aerosol solubility was also found to be increased during the lockdown period (∼27% decrease in the k- parameter (k)). Lockdown-WSOC was higher (1.62 μg m−3) than the normal-WSOC (1.13 μg m−3) and exhibited better regression with CCN in absence of anthropogenic emissions (Lockdown: R2 = 0.83, p < 0.05;Normal: R2 = 0.40, p < 0.05). Here we hypothesize that under restricted fossil fuel emissions during lockdown (57% decline in NOx), surface ozone was increased by 31%, that in turn favored the photochemical oxidation of biogenic VOCs emitted only from coniferous forest cover to produce huge amount of SOC. The ultrafine "biogenic-only” WSOC (under restricted anthropogenic WSOC during lockdown) participated in CCN activation actively and with higher proficiency compared to the normal period. The study bears immense importance of the role of biogenic emissions in cloud droplet formation over this part of the Himalaya under restricted anthropogenic emissions. The present hypothesis could open a new route of aerosol formation and their CCN activation under high deficiency of anthropogenic emissions. © 2023 Elsevier B.V.

A retrospective and comparative study between quick sequential organ failure assessment, CURB-65, and early warning scorings in COVID-19 patients to predict the disease severity and outcome

Background: Predicting the severity of COVID-19 infection in advance is the key to success of its treatment outcome. Various scoring systems are used to detect the severity of this disease but this study targets three simple scoring systems based on the vital parameters and basic routine laboratory tests. Aims and Objectives: The aim of the study was to assess the predictability of three scoring systems (Quick sequential organ failure assessment [q SOFA], CURB-65, and Early Warning scoring system) for disease severity at presentation in a rural-based tertiary care center. Material(s) and Method(s): An observational, descriptive, retrospective, and cross-sectional study was conducted at Diamond Harbour Government Medical College Covid Hospital from January 2021 to January 2022 to assess the predictability of q SOFA, CURB-65, and Early Warning scoring system for disease severity at presentation. Result(s): The total number of participants was 561 among total admitted 1367 patients. A short descriptive analysis obtained from the variables to analyze the scorings showed among total sample collected, 57% were male and 43% were female. In this study, 87% of patients were survived and the rest 13% succumbed (death). There is no statistically significant difference in mortality between both genders. Age, pulse rate, and respiratory rate have a significant correlation with the outcome and altered sensorium is also highly associated with mortality. The accuracy was also found to be little higher for National Early Warning score (NEWS) score than CURB-65 scoring and q SOFA scoring (0.919, 0.914 and 0.907). Although all the scoring systems have high sensitivity (>90%) (CURB 65: Most sensitive [0.99]), the specificities of all three scoring systems are below 50%. Among these three-scoring systems, NEWS showed the highest specificity (0.492) than q SOFA (0.423) and CURB 65 (0.394). Conclusion(s): We suggest NEWS score and CURB-65 as a better predictor for in-hospital mortality in COVID-19 patients as it is significantly sensitive and reasonably specific. It can be recommended in less equipped hospitals where only basic laboratory facilities are available. qSOFA can be utilized where no laboratory facility is available like in safe home and isolation centers.Copyright © 2023, Mr Bhawani Singh. All rights reserved.

Challenges and strategies with international recruitment in early phase gene therapy trials

The Children's NIHR Clinical Research Facility at Royal Manchester Children's Hospital has been involved in numerous early phase gene therapy trials for diseases such as GM1 gangliosidosis, Gaucher disease, MPSIIIA and MPSII. These trials have necessitated international recruitment which brings challenges for both site and families. In addition, we also actively recruited participants during the Covid-19 global pandemic, amplifying these challenges. A typical patient journey on one of these trials would involve being approached soon after diagnosis due to the rapid progression of these diseases and the need for early intervention. The family would then relocate to the UK with relatively short notice and commence an intensive period of screening involving a lot of extensive information for them to retain and invasive procedures for the patient. Some of these families will speak no English at all which is an additional barrier to managing the parental anxiety and expectations of the trial and its outcome. Once eligibility is confirmed the families are then faced with an extended stay in the UK without the support of their extended family/community. This impacts parent's employment and other siblings who may or may not be with them and who may also be affected by the same disease. Following administration of the gene therapy, participants then commence intensive follow up often associated with immunosuppressants. Close working with the local clinicians is essential for patient safety and trial integrity. Good engagement with families once they have returned to their home country is vital in obtaining continuing trial data and ensuring retention and compliance with attending future visits. Follow up visits are essential for safety and efficacy data for the progression of gene therapy trials. Travel restrictions brought about by the covid 19 pandemic exacerbated these challenges but with good communication and engagement we have mostly overcome them.

Reduced Duration Intracavitary Brachytherapy in Cervix Malignancies: A Comparative Analysis from Single Institute

Purpose: The on-going pandemic has impacted the use of anesthesia and the operating room frequency thereby affecting the brachytherapy treatment in various institutions due to the COVID-19 protocols. This has led to single applications of Intracavitary brachytherapy (ICRT) being used to deliver entire treatment boost in cervix cancer. We present our dosimetric and early clinical outcomes comparing traditional weekly three-fractions ICRT with single application/ two-applications ICRT Material(s) and Method(s): In this retrospective analysis conducted in our department, a total of 39 cases, treated between January 2021 to January 2022 were evaluated for the study. Of these, 15 cases were treated with the traditional once a week applicator insertion for 3 fractions and 24 cases underwent lesser application - 20 cases underwent 2 insertions and 4 cases single insertion (all receiving total 3 fractions of 7Gy each). The dosimetric parameters were compared including CTV D90 and D95 along with rectum, sigmoid and bladder D2cc, 1cc and 0.1cc respectively. The acute toxicity assessment was done using the RTOG scale. The follow-up was undertaken as per the institutional protocol and Mann-Whitney U-test were applied to compare the cohorts. Result(s): With a median follow-up of 6 months, the median CTV was D90%: 81.2 vs. 80.9 Gy and the median CTV volume was 44.3 vs 42.9 cc respectively. The 0.1 cm3 and 2 cm3 to bladder, rectum, and sigmoid were 105.6 vs 104.2 Gy and 85.5 vs 85.9Gy, 89.4Gy vs 88.7Gy and 69.1 vs 67.8Gy, and 84.7 vs 84.1Gy and 71.7 vs 69.9Gy, respectively suggesting no significant difference in the dosimetric outcomes with the two forms of applications. The less than three applications had a shorter overall treatment time with median OTT of 43 days vs. 55 days (p = 0.02). On completion of treatment and 6 months follow-up, local control was achieved in all patients. There was no significant difference in the acute toxicities in terms of cystitis and proctitis in both forms of the application. Conclusion(s): The single application/ twice application ICRT procedure showed similar outcomes as the traditional three-week duration treatment in terms of dosimetric outcomes and acute toxicities and ultimately leading to shortened overall treatment time. It also helped reduce the anesthesia burden and various resources associated with the procedure. Copyright © 2022

Teaching vaccine development in schools: Learnings from a survey and curriculum design for a course

Although vaccines are being developed and administered to people for more than a century, the understanding of the steps involved in vaccine development is a relatively new subject to the general public. During the current pandemic, there has been an explosion of non-validated news about COVID-19 and vaccines. To enhance the understanding of this critical societal science, there is an urgent need to teach these topics in the early education systems. Defining the essential subjects and courses for high school and developing syllabi for undergraduate courses in immunology and vaccinology can be difficult, as students choose diverse career options after their studies. To define these curricula, understanding the current level of awareness regarding vaccinology and immunology among students becomes essential. Thus, we have undertaken an exploratory survey of 650 high school and undergraduate college students in India on their awareness of the processes of vaccine development. Our results confirmed our hypothesis that there is a very limited understanding of this topic among school-going students. In this article, we propose an outline for a course for teaching in high schools. We recommend that this course should be interdisciplinary and a mix and match of majors and minors. It should train students with soft skills and prepare them for their careers in biomedical research. Copyright © 2023 Ghosh, Lalsare, Chirmule, Khare, Kalakuntla, Zarkar, Pawar and Sheth.

Structural prediction of unknown SARS-CoV-2 protein through Homology Modelling

The COVID-19 pandemic has taken the world into a dark time. The number of infected people has crossed 12 crores and the death counts to more than 5 lakhs until July, 2020 worldwide[1]. Moreover, this lockdown is breaking the pillar of the economy of the countries and the condition is getting worse day by day. So, keeping these things in mind, a vaccine or medicine or some other method of cure is urgently needed. To make this possible, the study of the structure of the virus needs to be done very carefully. That is why we focused upon the structural proteins of the SARS-CoV-2 virus. We all know that in this short period of time it is nearly impossible to do XRD and to know the exact structures of all the proteins present in the discussed virus. So in this article, we have tried to predict the most accurate 3D structure of a yet-unmodelled protein of the SARS-CoV-2, so that in the future, our finding may appear helpful for researchers in case of performing XRD of this protein and further research. Copyright © 2020, Indian Pharmaceutical Association. All rights reserved.

Implementing Collaborative Online International Learning (COIL) in Regular Engineering Coursework

This Innovative Practice Full Paper is part of a collaboration between a US and a Chinese university, in which two different online engineering courses, situated at the US university, were taught to mixed classes of students from both. Course content remained the same as standard offerings, and assessments had both individual and group components, specifically instructor-selected mixed-university groups. The first course was run in the spring 2021 semester, followed by a different course in the fall 2021 semester.International education offerings have been hampered by disruptions due to Covid-19, in addition to the usual barriers. Alternate models like collaborative online international learning (COIL) provide an avenue to continue international partnerships and expand their modalities. The current project is based on the COIL model but differs in two ways: the courses were not specially developed for COIL but adapted to it without changing course objectives, and the courses were taught solely by the instructors at the US university though administrative support was provided by both universities.Data for this project was collected using student surveys, personal interviews, instructor reflections, and course assessments. Student survey data is qualitatively analyzed using thematic analysis, while personal interviews and instructor reflections are summarized by the authors. Student learning outcomes in both sections were compared to those in the sections offered only to on-campus students and found to be similar or slightly better. Student perceptions of the classes were positive despite substantial difficulties.Instructors and students in these classes faced significant challenges like time zone differences and scheduling issues, technological barriers, and cultural differences leading to miscommunication. However, the collaborative aspects of the courses made them attractive for both groups of students, and opportunities for easy communication during synchronous class meetings made things run smoothly.In addition to discussing the challenges and attractions, the authors make a series of recommendations on conducting a regular online course in STEM disciplines with students from two different education systems. © 2022 IEEE.

Clinico-Laboratory Profile, Intensive Care Needs and Short-Term Outcome of Multisystem Inflammatory Syndrome in Children (Mis-C): Experience during First and Second Waves from India

BACKGROUND AND AIM: The multisystem inflammatory syndrome in children (MIS-C) is a new entity and needs data to study its evolution. To describe the clinicolaboratory profile, intensive care needs, and outcome of MIS-C during the first and second waves. METHOD(S): Retrospective analysis of 122 children with MIS-C admitted to Pediatric emergency and PICU of a tertiary-teaching hospital during first and second wave of Covid-19. RESULT(S): Median (IQR) age was 7 (4-10) years with 67% boys. Common manifestations included fever (99%), abdominal symptoms (81%), rash (66%), conjunctival injection (65%), oral mucosa and respiratory involvement (43% each). Elevated CRP (97%), D-dimer (89%), procalcitonin (80%), IL-6 (78%), ferritin (56%), NT-pro- BNP (84%), and positive SARS-CoV-2 antibody (81%) were common laboratory abnormalities. Cardiovascular manifestations included myocardial dysfunction (55%), shock (48%), and coronary artery changes (10%). The treatment included intensive care support (57%), non-invasive (33%) and invasive (18%) ventilation, vasoactive drugs (47%), IVIG (83%), steroids (85%), and aspirin (87%). Mortality was 5% (n=6). Duration of hospital stay was 5 (3-8) days. During second wave, significantly higher proportion had positive SARS-CoV-2 antibody, contact with COVID-19 case, and oral mucosal changes;lower markers of inflammation (CRP, procalcitonin, ferritin, and IL-6);lower rates of shock, myocardial dysfunction, and coronary artery changes;lesser need of PICU, vasoactive drugs, and IVIG;and shorter hospital stay. CONCLUSION(S): MIS-C is febrile multisystemic disease characterized by hyperinflammation, cardiovascular involvement, relationship to SARS-CoV-2, and good outcome with immunomodulation and intensive care. During the second wave, the severity of illness, degree of inflammation, and intensive care needs was lesser.