Fears, Challenges and Opportunities During COVID-19: A Frontliner's Perspective in Healthcare System

The current coronavirus (COVID-19) pandemic has challenged the healthcare systems worldwide. In India, when the whole country went into lockdown, the medical fraternity geared up for the battle against the invisible enemy, which was knocking at the doors. The major hurdles faced by doctors as frontline workers in this battle were the fear and anxiety of contracting the disease;logistics and resource crunch—both trained manpower and equipment—and lack of knowledge about this new disease. Despite all the snags, the dedication, zeal and commitment shown by the medical fraternity have been commendable. The doctors especially the resident staff, nursing and technical staff have been working tirelessly overcoming their own fears. Fighting this battle has brought the best out of the healthcare workers in the form of leadership qualities and teamwork. Within a short span of time, well-equipped COVID units were created. This period saw a surge in research and innovation worldwide. In this chapter, we share our experience amid the COVID crises. This is an ode to all the frontline warriors who started this battle with some fears, gradually acclimatized to the new scenario and put their best foot forward. © The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd. 2021.

Machine Learning for Diabetes, Heart Disease, Pneumonia, and Covid-19 Diagnostics

Machine Learning, a part of artificial intelligence which is applied in numerous health-related sector which includes the development of innovative medical procedures, the treatment of chronic diseases and the management of medical data. If a patient can recognize the disease at an early stage from the ease of home, they can start their medication sooner and consult a doctor accordingly for their treatment. This paper attempts to detect various diseases in the healthcare field such as Covid-19 and Pneumonia using Image processing technique with the help of Convolutional Neural Network, and other diseases such as Heart Disease and Diabetes using Random Forest, XGBoost, Support Vector Machine and K-Nearest Neighbour Classifiers. © 2022 IEEE.

Assessment of methemoglobin, hemoglobin, ferritin and lactate dehydrogenase in COVID-19 patients

Today world is trying to cope with the biggest pandemic caused by Coronavirus disease 2019 (COVID-19). The disease is graded as mild, moderate, serious and critical illness. Very few studies are done with methemoglobin along with other parameters for the assessment of the severity of COVID-19 disease. The objectives of the study were to estimate methemoglobin (Met-Hb), hemoglobin (Hb), ferritin and lactate dehydrogenase (LDH) levels in patients with COVID-19 disease and to investigate the interaction between these parameters and the severity of the disease. This observational study was conducted in three groups of COVID-19 patients- moderate, severe and critical, each group containing 30 patients, between June 2021 and September 2021 in the biochemistry department of a tertiary care hospital. For all patients, Met-Hb, Hb, ferritin, and LDH levels were estimated on the 2nd-3rd day of hospital admission. Patients in the critical group were older and had significantly high values of Met-Hb, ferritin and LDH and significantly low values of Hb (P<0.05). In multivariate ordinal regression analysis, older age (OR-3.08;95%CI:1.19-7.19;P-0.019), higher values of LDH (OR-8.66;95%CI:2.53-29.5;P-0.001) and ferritin (OR-3.08;95%CI:1.09-8.7;P-0.033) were independently associated with severity of the disease. A cut-off value of 410.50 U/L for LDH predicted the severity of the disease with 90% sensitivity and 88.3% specificity. In conclusion, higher levels of LDH and ferritin were related to the severity of the disease in COVID-19 cases. Although Met-Hb showed a minimal increase without any association with severity, it may be an underlying cause of hypoxia that may go unnoticed. So, monitoring of all these parameters should be done at intervals.

A study on the morbid histopathological changes in COVID-19 patients with or without comorbidities using minimally invasive tissue sampling

Introduction: COVID-19 causes morbid pathological changes in different organs including lungs, kidney, liver,etc especially in those who succumb. Though clinical outcomes in those with comorbidities are known to be different from those without - not much is known about the differences at histopathological level. Aim(s): It was to compare the morbid histopathological changes in COVID-19 patients between those who were immunocompromised(Gr 1), malignancy(Gr 2) or had cardiometabolic conditions (hypertension, diabetes or coronary artery disease)(Gr 3). Method(s): Post-mortem tissue sampling (MITS) was done from the lungs, kidney, heart, and liver using biopsy gun within two hours of death. Routine (H & E stain) and special stains (AFB, SM, PAS) were done besides immunohistochemistry. Result(s): A total of 100 patients underwent MITS and data of 92 were included (immunocompromised: 27, maligancy:18, cardiometabolic conditions:71). Within lung histopathology, capillary congestion was more in those with malignancy while others like diffuse alveolar damage, microthrombi, pneumocyte hyperplasia etc was equally distributed. Within liver, architecture distortion was significantly different in immunocompromised while steatosis, portal inflammation, Kupffer cell hypertrophy, confluent necrosis were equally distributed. There was a trend towards higher acute tubular injury in those with cardiometabolic conditions as compared to the other groups. No significant histopathological differences in heart was discerned. Conclusion(s): Certain histopathological features are markedly different in different groups (Gr 1,2 and3)of COVID-19 patients with fatal outcome.

Role of Journalism in Promoting Yoga and Meditation in India during Covid Period

Purpose: The purpose of the study is to examine the role of journalism in promoting yoga and meditation in India. Design/Methodology/Approach: The primary quantitative method has been used where the survey procedure is included. Through this method, the graphical representation of other viewpoints has been highlighted. Finding(s): It has been noticed that meditation and yoga provides helps in culming the mind of an individual and strengthen the immune system. The journalism motivates people on the inclusion of the yoga and meditation in daily lives. Research, practical work, and social implication: The study helps to highlight the benefits of involving yoga and meditation in the daily life. Originality/ Value: The value of the study is that it gives a better understanding about the yoga and meditation on improving the immune system during Covid period. Copyright © 2022, Anka Publishers. All rights reserved.

POSSIBLE DESTRUCTION OF SARS-COv-2 BY SODIUM DEOXYCHOLATE

The objective of this study was to focus on the antiviral activity of a bile salt, namely sodium deoxycholate. There is a possibility of killing severe acute respiratory syndrome corona virus-2 due to the destruction of its protein and lipid overcoat by sodium deoxycholate alone or with drugs those showing response against severe acute respiratory syndrome corona virus-2. Destruction of inner viral constituents and hence disintegration of the virion is possible at very small concentration. This study can be an important platform for further investigations. Copyright © 2022 Indian Drug Manufacturers' Association. All rights reserved.

New Onset Anti-GBM Glomerulonephritis on a Background of IgA Nephropathy Post-SARS-CoV-2 Vaccination: A Double Hit Phenomenon?

Introduction: Anti-glomerular basement membrane (anti-GBM) nephritis is a rare, but potentially fatal pathology that occurs due to development of IgG autoantibodies against an autoantigen expressed in the basement membrane of kidneys. We present a case of anti-GBM nephritis as an uncommon immune-mediated adverse effect post mRNA Covid-19 vaccination. Case Description: This is a 41-year-old South Asian female with a history of hypothyroidism, who was tested positive for Covid-19 in April 2021. Post-covid, she received the Pfizer-SARS-CoV vaccine in June and July 2021. Few weeks later, she presented with anemia to her primary care physician, and a couple of months after, a urinalysis revealed significant microscopic hematuria and proteinuria. Further workup revealed a blood urea nitrogen (BUN) of 70 mg/dL and serum creatinine of 9.8 mg/dL which subsequently led to hospitalization for workup of acute kidney injury. Her labs were significant for hemoglobin 6.8 g/dL, BUN/Creatinine 81/10.13 mg/dL, potassium of 5.4, metabolic acidosis (HCO3 16mmol/L), and a urinalysis showing >50 red blood cells (RBCs) per high power field (HPF) with a protein of 300 mg/dL and 24-hour protein excretion of 5.7 g/dL. Complete review of systems was unremarkable with no signs of extrarenal manifestations and negative chest imaging. Immunological workup was negative except for elevated anti-GBM titer at 4.6 (normal <1) and elevated IgG and IgA serum proteins. A renal biopsy was performed to confirm the diagnosis, which showed acute anti-GBM nephritis - crescentic glomerulonephritis with 2-3+ linear IgG staining with incidental mesangial IgA deposits. She was initiated on IV pulse steroids, plasma exchange therapy, and IV Cyclophosphamide. Renal function gradually improved on this treatment regimen. Discussion(s): The occurrence of anti-GBM nephritis with concomitant IgA nephropathy post-SARS-CoV-2 mRNA vaccination has been rarely reported in literature. The etiology remains speculative;however, these cases highlight the need to exercise vigilance in patients presenting with symptoms or lab findings suggesting acute kidney injury with a preceding history of recent vaccination. Early identification and intervention may prevent progression of disease.

A Workshop on Disability Inclusive Remote Co-Design

The COVID-19 pandemic forced researchers to find new ways to continue research, as universities and laboratories experienced closure due to nationwide lockdowns in many countries worldwide, including conducting experiments, workshops, and ethnographic work online. While this had a significant impact on the majority of research work across SIGCHI, research relating to disability and ageing was most impacted due to the additional challenges of recruiting participants, finding accessible online platforms, and ensuring seamless participation while juggling platform accessibility issues, facilitation, and supporting participants' needs. These challenges were more extreme for disabled researchers. In this workshop, we aim to bring together researchers, designers, and practitioners to explore effective strategies and brainstorm actionable guidelines for supporting disability inclusive online research methods and platforms. © 2022 ACM.

Impact of the Pandemic on Mental Health Among the Youth of India

The restrictions due to the pandemic have impacted mental health worldwide. The pandemic instigated health and financial pressure on everyone. The research aims to analyse the impact of the lockdown and pandemic on the mental health of the youth in India, understand the reasons behind it and try to examine whether it should be continued after the lockdown. The study also seeks to understand whether the government response to the distress created mentally by the coronavirus pandemic has been adequate or not. This study is based on primary data collected from the youth of tier-one cities in India, using web-based surveys, focus group discussions, and semi-structured interviews. Through the research, variables that impact mental health have been identified, which include sleep patterns, generalized anxiety, screen time, social media usage, life satisfaction, work pressure, the environment at home, work satisfaction, sense of productivity, physical activities, and interpersonal conflicts. There has been an inadequate promotion of the initiatives undertaken by the government, leading to unawareness of these schemes. The research observed, an increased work pressure, screen time, and generalized anxiety, and a decrease in work satisfaction, productivity, sleep time, and personal space. This research is essential to understand the ‘how’ and ‘why’ of mental health deterioration and to come up with methods to help curb these problems in the long run. The research, however, has shortcomings including small sample size, and an under-representation of the marginalized income group. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Safety and Immunogenicity Outcomes of an Inactivated Viral Vaccine against SARS-CoV-2 (Covaxin)

Introduction: Bharat Biotech International Ltd in partnership with National Institute of Virology (NIV), has developed an indigenous whole virion inactivated Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) viral vaccine BBV-152 (Covaxin), formulated with Toll Like Receptors 7/8 agonist Imidazoquinoline (IMDG) molecule adsorbed to alum (Algel). Variety of factors other than environmental ones can affect vaccines efficiency outside the strict setting of clinical trials, like how the vaccine is stored or transported, and even how patients are vaccinated. In addition, the intrinsic capacity of the recipient to respond to a vaccine which is determined by sex, genetic factors, age, psychological stress, nutrition and other diseases are also likely to have an impact. Aim(s): To determine the safety, reactogenicity and immunogenicity of the inactivated whole virus vaccine (Covaxin) amongst hospital-based population groups. Material(s) and Method(s): The prospective analytical study was conducted in the Department of Microbiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India, from January 2021 to March 2021.The study primarily included Healthcare Workers (HCWs) employed at SMS Medical college and attached hospitals. In-vitro quantitative IgG antibodies against SARS-CoV-2 spike Receptor Binding Domain (RBD) were measured using Chemiluminescence Immunoassay (CLIA) based Advia centaur SARS-CoV-2 IgG, manufactured by Siemens Pvt Ltd, Munich, Germany, as per manufacture's instructions. Result(s): Out of total 223 individuals, 61.88 % (138/223) showed neutralising antibody titre of >1 index value by CLIA, rest 38.12% (85/223) were non reactive i.e., titre <1 index value, after four weeks of receiving first dose of Covaxin. After 2 to 4 weeks of receiving second dose 84.30% (188/223) showed neutralising antibody titre of >1 index value by CLIA, rest 15.70% (35/223) were non reactive i.e., titre <1 index value. After receiving first dose, 100% (223/223) of the participants developed localised pain and bodyache 33.63% (75/223). None of the participants showed any anaphylactic reaction or any emergency condition just after vaccination. Conclusion(s): Covaxin is a well-tolerated vaccine, and induces good humoral response against SARS-CoV-2 with a significant rise in the neutralising antibody titres. Copyright © 2022 Journal of Clinical and Diagnostic Research. All rights reserved.

APN-Driven COVID-19 Monitoring Model for Kidney Transplant Patients

Purpose: COVID-19 infection in kidney transplant (KT) recipients is characterized by an unpredictable course and can be life-threatening. Prompt adjustment of immunosuppression and hospitalization when decompensated are potential strategies to increase survival. Our objective is to determine if advanced practice nurse (APN)-driven COVID-19 monitoring would result in better health outcomes for KT recipients. Method(s): We performed a retrospective study on KT patients diagnosed with COVID-19 between 4/1/2020 and 11/30/2021. The patients were stratified into two groups: (1) a control group who initially presented to the emergency department (ED) with COVID-19 symptoms, (2) an intervention group where patients were diagnosed with COVID-19 outside of the ED and followed by the APN team. The APNs monitored this group daily via telephone and/or video call for symptom assessment, immunosuppression adjustment, health counseling, and emotional support. If the patients were distressed, the APNs arranged admission to the nearest hospital or transplant center. Data were analyzed using Pearson Chi-squared for comparisons and linear or logistic regression modeling with adjustment for age, ethnicity, diabetes, and obesity Results: In our cohort, there were 102 KT patients that were infected with the SARS-CoV-2 virus. The majority were Hispanic ethnicity and male gender who presented with fever and flu like symptoms. Fourty-four patients required oxygen therapy. Immunosuppression was adjusted earlier in the intervention group . When the APNs recommended hospitalization, those patients experienced less acute kidney injury (AKI), shorter duration of illness, lower readmission rates, and greater survival than the control group. Conclusion(s): In this single transplant center study, KT recipients diagnosed with COVID-19 had better clinical outcomes when intervention occurred in a timely manner by the APN team. Possible explanations include earlier withdrawal of antimetabolites, prompt triage for hospitalization, and enforcing of nursing practices (dietary educations, blood pressure/glucose management, emotional support). Interpretation and generalization of these findings should be cautious due to a small sample size. As more treatment options for COVID-19 emerge, earlier interventions and close monitoring as demonstrated in our APN-driven model has the potential to achieve better health outcomes.

EFFICACY AND SAFETY OF THERAPEUTIC VERSUS PROPHYLACTIC ANTICOAGULATION IN PATIENTS WITH COVID-19 INFECTION: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS

SESSION TITLE: Treatment Debates in Critical Care SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Studies have reported various estimates of the incidence of venous thromboembolism (VTE) and major bleeding among hospitalized patients with COVID-19, with varying doses and types of anticoagulation used in each study. While patients hospitalized with COVID-19 may have a higher incidence of VTE, there may also be an increased incidence of bleeding. The risk of VTE needs to be weighed against the increased risk of bleeding when considering higher than standard dose prophylactic anticoagulation. This review examines the incidence and risk of thromboembolism and major bleeding in hospitalized patients with COVID-19 pneumonia across randomized controlled trials. METHODS: Online databases including PubMed, CINAHL, Ovid, and Cochrane were searched from the inception of literature through January 11th, 2022, following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Only articles published in the English language were included. s, case reports, and case series were excluded from this systematic analysis. Out of 168 studies, 8 randomized controlled trials were selected for a systematic review. RESULTS: In the 8 studies considered for this review, a total of 4,913 COVID patients were randomized to either prophylactic or therapeutic dose anticoagulation. Thrombotic events, major bleeding, and overall mortality were set as endpoints. Seven out of eight studies used heparin/low molecular weight heparin and only one used rivaroxaban. All except one study (Perepu et. al) reported a lower percentage of thrombotic events in the therapeutic group. Similarly, all except one study (Sholzberg et. al) reported a higher percentage of major bleed in the therapeutic group. In 4 out of 8 studies higher overall mortality was reported in the therapeutic group. However, only two values reported were statistically significant. Syropoulos et al reported a lower thrombotic event percentage in the therapeutic group with a p-value of <0.001% and Sholzberg et al reported a lower mortality percentage in the therapeutic group with the p-value of 0.006%. CONCLUSIONS: Therapeutic anticoagulation in COVID is a double-edged sword, decreased incidence of thrombotic events and an increased incidence of major bleeding was seen in the patients on therapeutic dose anticoagulation. Only one study reported a statistically significant decreased mortality in the therapeutic group and none of the studies reported a statistically significant major bleeding in the therapeutic group. CLINICAL IMPLICATIONS: Based on the finding of this study we would recommend against the use of therapeutic anticoaguation in hospitalized patients with COVID-19. DISCLOSURES: No relevant relationships by Faiz Anwer No relevant relationships by Ahmed Elkhapery No relevant relationships by Unaiza Faizan No relevant relationships by Deeptanshu Jain

Title-Perspective of methemoglobin, hemoglobin, lactate dehydrogenase and C reactive protein levels in covid-19 patients with diabetes mellitus

Objectives: Dynamics of COVID-19 disease are changing with the emergence of the new variant of the COVID virus. Still, the severity of this disease is associated with comorbid conditions like diabetes mellitus (DM), hypertension, etc. and several biomarkers are studied. The objectives of the study were to estimate methemoglobin (Met-Hb), hemoglobin(Hb), lactate dehydrogenase (LDH) and C reactive protein(CRP) levels in COVID-19 patients with DM and without DM and then to compare between two groups. Materials and methods: This observational study was conducted in 40 COVID-19 patients with DM and 40 COVID-19 patients without DM from June 2021 to October 2021 in the biochemistry department of a tertiary care hospital. For all patients, estimation of Met-Hb, Hb, LDH and CRP levels were estimated on the 2nd-3rd day of hospital admission. Results: Met-Hb, LDH and CRP levels were significantly high and Hb levels were significantly low in elderly COVID-19 patients with DM than in those without DM (P<0.05). There was a significant positive correlation between Met-Hb with LDH and Met-Hb with CRP in both groups and a significant negative correlation was found between Met-Hb with Hb in the diabetic group. Conclusion: In elderly patients, diabetes is one of the important and independent risk factors for the severity of COVID-19 disease. Derangement of Met-Hb along with LDH and CRP shows the need for routine monitoring of Met-Hb. This may open new options in the treatment of COVID-19 disease with DM and improve outcomes in the future.

A Phase II Study of Metformin with Pemetrexed/Carboplatin in Patients with Metastatic Non-Squamous Non-Small Cell Lung Cancer

Introduction: There is a subset of NSCLC patients ineligible for benefit from TKIs/Immunotherapy (e.g. STK11 mutation conferring resistance to Immunotherapy). Besides, many patients cannot afford these therapies. Metformin has anticancer properties acting both on glycolytic metabolism and tumor microenvironment. In vitro studies suggest synergism between metformin and pemetrexed. STK11 deficient cell lines are more sensitive to metformin. Clinical studies combining metformin with chemotherapy are limited by small sample size. We conducted an exploratory phase-2 clinical trial of metformin with pemetrexed/carboplatin in advanced non-squamous NSCLC. Methods: This was a single center, open label, single arm phase 2 clinical trial with a Simon’s two stage design. The null hypothesis was that the combination would not improve the 6-month PFS rate by 15%, from 50%. Treatment-naive, non-diabetic patients aged 18-75 years with NSCLC (adenocarcinoma/not-otherwise-specified) with stage IV disease having ECOG PS 0-2 with unmutated EGFR/ALK and without brain metastasis or with asymptomatic brain metastases were treated with pemetrexed-carboplatin chemotherapy and metformin for six months. The primary outcome was 6-month progression free survival (PFS) rate. Secondary outcomes were safety, overall survival (OS), overall response rate (ORR), proportion of STK 11 mutation and effect of STK 11 mutation on 6-month PFS rate. PFS and OS were estimated using the Kaplan-Meier method. Targeted sequencing was attempted for available tissue specimens. Results: The first interim analysis was performed after enrollment of 26 patients for the first stage (before the target accrual of first stage was reached) due to slow accrual, in view of COVID pandemic. The study was terminated after first stage for futility. The median age of patients in the study was 52 years (range, 30 to 68) and 18 patients (69.0%) were males. Half of the patients had ECOG-PS 2. Brain metastases were present in eight (31%) patients and among these four (50%) were symptomatic at presentation. The median follow-up time was 25 months. The median PFS was four months. 6-month PFS rate was 28% (95% CI - 0.12 to 0.46). Of the 25 evaluable patients, five (20%) had a partial response, and eight (32%) had stable disease;13 (52%) of the patients had disease control. The median OS was 16 months. During combined therapy, 14 (54%) and 3 (11%) patients had any grade and grade 3 anemia respectively. One patient had grade 3 neutropenia. Among non-hematological toxicities, gastrointestinal toxicities (nausea, vomiting and diarrhea) were the most common. No grade 4 toxicities were reported. There were no treatment discontinuations, however treatment delay due to grade three toxicities was present in two patients. Dose modification for Metformin was required in four patients. Targeted Sequencing was possible in nine cases. Two of these patients had STK11 mutation and an associated bad outcome (PFS < 2 months). Conclusions: We could not demonstrate the benefit of combination of Metformin with pemetrexed-carboplatin in terms of improvement in 6-month PFS rate. The addition of metformin to pemetrexed-carboplatin has an acceptable safety profile. Future trials should test metformin in specific subsets (STK11 mutated) and in combination with immunotherapy and TKIs. Keywords: Metformin, NSCLC, STK11

Bilateral open tibia fracture fixed with external fixator with COVID -19

Road Traffic accidents is one of the major causes of musculoskeletal injuries. Tibia is the weight bearing joint which transmits axial weight to ankle joint. The Major bones of lower limb include Tibia, Fibula and femur. Tibia is the long bone which connects knee joint and ankle joint. In an Open fracture External fixation is the choice of treatment because of the soft tissue and bone loss and communication and contamination. A 39-year-old male, driver by profession admitted in orthopaedic male ward was referred to physiotherapy department. He was bought to the emergency department with bilateral tibia visible on observation, severe pain in tibial region and soft tissue and blood loss. Investigations were done RT-PCR for COVID-19 and Xray. This case report is of a 39 year male with COVID-19 and bilateral open fracture of tibia fibula operated with external fixator. Rehabilitation aim was to make the patient ambulate as soon as possible and to avoid secondary complication. Physiotherapy has significant effect on maintaining the strength of the muscles as well the endurance of prolong bedridden patients. Early physiotherapy should be started to maintain the strength and endurance. © 2022 MEDIC SCIENTIFIC. All right reserved.

A Robust Approach of COVID-19 Indian Data Analysis Using Support Vector Machine

COVID-19, as the name suggests it is coronavirus disease 2019, comes from severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS) virus family, which is a life-threatening disease. The place of origin of disease has been from country China. It was first spread in Wuhan's city in China and was declared as a pandemic in March 2020 by WHO. To date, no vaccination exists to kill the virus;however, it is being cured and prevented using medicines like hydroxychloroquine, Metformin, dexamethasone, and plasma therapy. In this paper, we have analyzed the state-wise as well as district-wise dataset of country India and classified the states as profoundly affected states and less affected states by performing preprocessing and applying support vector machine model for classification on the state-wise dataset. We also have classified districts into the red, orange, and green zone after analyzing and preprocessing district-wise COVID-19 dataset using Weka Framework. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Impact of Covid'19 on Indian Stock Prediction by Technical Indicators

For stock investors, stock traders, mutual fund managers, and applied researchers, time series analysis is an ever-challenging subject of interest on the stock exchange. Many researchers have come up with solutions by using hybrid methodologies and assessing sentiments on social media and well-known financial websites. The impact of Covid'19 is all over the world in almost every sector and eventually in stock market too. This paper is mainly focused on the impact of Covid'19 over the Indian stock market by experimental evaluation with popular technical indicators operated on few strong fundamental stocks listed in National Stock Exchange (NSE) India during pandemic period of Covid'19. In the future, the researchers can look at other technical indicators to see if they can predict when a crisis will occur. © 2022 IEEE.

Comparison of Different RNA Extraction Methods for Detection of SARS-Cov-2by RT-PCR

Background: Corona virus disease 2019 is a highly infectious disease which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2. SARS-CoV-2 is transmitted from person to person mainly by respiratory droplets and aerosols as well as by direct or indirect contact. Aims and objective: To compare different RNA extraction methods for detection of SARSCov-2 RNA from nasopharyngeal and oropharyngeal swabs using three different methods which are based on different techniques. Material and methods: This analytical observational study was conducted in the department of Microbiology, Sawai Man Singh Medical College Jaipur, Rajasthan from December 2020 to January 2021. We selected 200 confirmed positive (extracted by Easy Mag automated system) (remnant) samples showing a wide range of different Ct values and 20 confirmed negative samples stored in Viral Transport Media VTM for this study. In order to compare quality of three extractions methods, all samples were aliquoted separately for each extraction technique. (1) Extraction by manual method (spin column base): was done by as per manufacturer’s instructions. (2) Extraction by QIA cube HT (vaccum column base): was done by as per manufacturer’s instructions. (3) Extraction by Perkins Elmer chemagic 360: (magnetic beads based). Result: A panel consisting of 200 Covid-19 positive and 20 Covid-19 negative samples were extracted by three methods (i.e. Manual column based, automated column-based and automated magnetic beads-based method). The extracted material/elutes were put for realtime RT-PCR assay for the detection of SARS CoV-2 RNA. There was no major difference seen in individual samples’ ct values between three extraction system. CONCLUSION: In conclusion, we recommended all three RNA extraction methods (i.e. magnetic beads & silica column-based) are interchangeable in a diagnostic workflow for the SARS CoV-2 by RTPCR and can be taken into account for SARS CoV-2 detection in possible future shortage of one kit or times of crisis in such pandemic time.

Evaluation of the Effectiveness of Autologous Bone Marrow Mesenchymal Stem Cells in the Treatment of Chronic Low Back Pain Due to Severe Lumbar Spinal Degeneration: A 12-Month, Open-Label, Prospective Controlled Trial

Background: Regenerative medicine interventions are applied to assist in the repair, and to potentially replace or restore damaged tissue through the use of autologous/allogenic biologics and it continues to expand. The anti-inflammatory, immunomodulatory, and regenerative properties of bone marrow mesenchymal stem cells (BM-MSCs), and investigation into their therapeutic efficacy and safety in patients with severe chronic low back pain, have not been demonstrated in controlled studies. Multiple pain generators have been hypothesized to be responsible in severe spinal degeneration and it is difficult to identify a single pain generator;consequently, resulting in inadequate therapeutic results. Objectives: The study was undertaken to evaluate the effectiveness of autologous bone marrow MSCs in the treatment of chronic low back pain due to severe lumbar spinal degeneration with involvement of multiple structures. Study Design: Prospective, open-label, nonrandomized, parallel-controlled, 2-arm exploratory study. Setting: A private, specialized, interventional pain management and regenerative medicine clinic. Methods: The treatment group patients received a one-time bone marrow concentrate injection into spinal structures (i.e., discs, facets, spinal nerves, and sacroiliac joints), along with conventional treatment, whereas, the control group received conventional treatment with nonsteroid antiinflammatory drugs, over-the-counter drugs, structured exercise programs, physical therapy, spinal injections and opioids, etc., as indicated. Outcomes Assessment: Outcomes were assessed utilizing multiple instruments, including the Oswestry Disability Index (ODI), Numeric Rating Scale (NRS-11), EuroQOL 5-Dimensional Questionnaire (EQ-5D-3L), Global Mental Health (GMH), and Global Physical Health (GPH). Multiple outcomes were assessed with primary outcomes being minimal clinically important differences (MCID) in ODI scores between the groups and/or a 2-point reduction in pain scores. In the study group, total nucleated cells, colony forming units-fibroblast, CD34-positive cell numbers and platelets were also recorded, along with post-procedure magnetic resonance imaging changes. Outcomes were assessed at 1, 3, 6, and 12 months. Results: Significant improvement was achieved in functional status measured by ODI, pain relief measured by NRS-11, and other parameters measured by EQ-5D-3L, GMH, and GPH, in the study group relative to the control group at all time periods. The results showed significant improvements at 12-month follow-up with 67% of the patients in the study group achieving MCID utilizing ODI when compared to 8% in the control group. Greater than 2-point pain reduction was seen in 74% of the patients at 3 months, 66% of the patients at 6 months, and 56% of the patients at 12 months. Both MCID and pain relief of 2 points were significantly different compared to the control group. Opioid use decreased in the investigational group, whereas, there was a slight increase in the control group. Age, gender, opioid use, and body mass index did not affect the outcomes in the stem cell group. Limitations: Single center, nonrandomized study. Conclusions: The first available controlled study utilizing BM-MSCs in severe degenerative spinal disease with interventions into multiple structures simultaneously, including disc, facet joints, nerve roots, and sacroiliac joint based on symptomatology, showed promising results.