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Introduction: Enteral feeding is a physiologic process of providing adequate nutrition and has been shown to improve both mortality and quality of life in patients with inadequate oral intake. Improved critical care medicine and recent wave of Coronavirus Disease 2019 (COVID-19) has left us with a large proportion of patients needing alternative enteral nutrition. Although rare, intussusception is an important differential for patients presenting with acute abdominal pain post makeshift percutaneous endoscopic gastrostomy (PEG) tube placement. Case Description/Methods: A 58-year-old male was admitted to the hospital for coffee ground emesis over three days accompanied with epigastric pain. He had right sided hemiparesis secondary to cerebrovascular accident with PEG tube for enteral nutrition. Examination was significant for epigastric tenderness with normal bowel sounds. PEG tube aspiration revealed bile-tinged fluid. Significant labs included white blood cell count of 11,600 /mm3, hemoglobin 10.2 g/dL, and lactic acid of 2.3 mmol/L. A computerized tomography of the abdomen with IV contrast showed a small segment duodeno-duodenal intussusception at the horizontal segment around the distal end of the tube was noted (Figure A). An urgent esophagogastroduodenoscopy (EGD) revealed a Foley catheter acting as a makeshift PEG tube extending across the pylorus into the duodenum. The distal tip of the Foley catheter was visualized with an inflated balloon seen in the third portion of the duodenum (Figure B) The inflated catheter balloon acted as a lead point causing intussusception in a ball-valve effect. The balloon was deflated, and the catheter was replaced (Figure C) with a 20 Fr PEG tube. Discussion(s): Gastric outlet obstruction is an uncommon complication reported in few cases caused by migration of the gastrostomy tube. Rarely this migrating gastrostomy tube can invaginate the duodenum or the jejunum causing intussusception. Only handful of cases have been reported in the literature. Patients usually present with epigastric pain, vomiting or rarely hematemesis. CT scan of the abdomen is the investigation of choice. Amidst the pandemic and supply shortage, Foley catheters have been deemed as a viable alternative to gastrostomy tubes and are being used more often. It is important to recognize this rare complication and use of balloon catheter should raise further suspicion. Timely endoscopic intervention can help avoid bowel necrosis and surgical intervention.
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COVID-19 will be a continuous threat to human population despite having a few vaccines at hand until we reach the endemic state through natural herd immunity and total immunization through universal vaccination. However, the vaccine acts as a practical tool for reducing the massive public health problem and the emerging economic consequences that the continuing COVID -19 epidemic is causing worldwide, while the vaccine efficacy wanes. In this work, we propose and analyze an epidemic model of Susceptible-Exposed-Infected-Recovered-Vaccinated population taking into account the rate of vaccination and vaccine waning. The dynamics of the model has been investigated, and the condition for a disease-free endemic equilibrium state is obtained. Further, the analysis is extended to study the COVID-19 spread in India by considering the availability of vaccines and the related critical parameters such as vaccination rate, vaccine efficacy and waning of vaccine's impact on deciding the emerging fate of this epidemic. We have also discussed the conditions for herd immunity due to vaccinated individuals among the people. Our results highlight the importance of vaccines, the effectiveness of booster vaccination in protecting people from infection, and their importance in epidemic and pandemic modeling.
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Increasing data on the infection indicate that maternal infections are severe. Under the realms of vaccine development, virus-like particles (VLP)/nanoparticles (NPs) hold the promise of targeted control of therapeutics transfer across the placental barrier with the potential to trigger innate immune responses. Though the placenta is known to act as a barrier against exogenous materials, viruses exploit the transport systems and overcome the barrier properties. VLPs can be strategically designed to obtain the necessary mechanisms for navigation across the placenta and immune response. However, several knowledge gaps on the chemical, viral transmission strategies and the host defense response exist owing to the highly dynamic etiology of the placental barrier. This further complicates the toxicological analysis of the developed therapeutics. Herein, placental physiology and functions are discussed in significance with chemical toxicology, viral infections, and the host defense. Further, the promising applications of VLPs and perspective on their design to overcome the placental gatekeeper to gain the necessary immune response or therapy are provided. Finally, a holistic approach to various bioengineering models for studying chemical toxicants, viral infections, and effects of VLPs is provided to facilitate better translation of these VLPs to clinical applications.
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Drying is one of the oldest known techniques for preservation of fishes. Dry fish is a commodity which has demand both within and outside India. Indian dry fish exports contribute 7.45% to the total marine product exports valued at USD 156.94 million during 2020-21. The COVID-19 imposed lockdown led to disruptions in several segments of the economy and dry fish sector was no exception. The dry fish production is carried out as a small-scale activity along the coastal belt of the country providing source of livelihood for thousands of fisherfolk especially women. The dry fish value chain involves many players starting from fresh fish supplier, dry fish processor, dry fish agent, wholesaler, retailers and consumers. Owing to the outbreak of COVID-19 and the subsequent lockdown enforced from 24th March 2020, small scale dry fish processors suffered losses which have been estimated to the tune of Rs.0.5 to 1 lakh per month depending on the capacity of the unit. Women involved in household drying of fish experienced losses amounting to Rs.10,000 to Rs.12,000 per month. The dry fish exports from India, although seasonal has also registered a decline during the first three months of the pandemic and ensuing lockdown period. This paper presents an assessment of the impacts on the dry fish sector in the country.
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India was under a grave threat from the second wave of the COVID-19 pandemic particularly in the beginning of May 2021. The situation appeared rather gloomy as the number of infected individuals/active cases had increased alarmingly during the months of May and June 2021 compared to the first wave peak. Indian government/state governments have been implementing various control measures such as lockdowns, setting up new hospitals, and putting travel restrictions at various stages to lighten the virus spread from the initial outbreak of the pandemic. Recently, we have studied the susceptible-exposed-infectious-removed (SEIR) dynamic modeling of the epidemic evolution of COVID-19 in India with the help of appropriate parameters quantifying the various governmental actions and the intensity of individual reactions. Our analysis had predicted the scenario of the first wave quite well. In this present article, we extend our analysis to estimate and analyze the number of infected individuals during the second wave of COVID-19 in India with the help of the above SEIR model. Our findings show that the people's individual effort along with governmental actions such as implementations of curfews and accelerated vaccine strategy are the most important factors to control the pandemic in the present situation and in the future.
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We consider the pandemic spreading of COVID-19 in India after the outbreak of the coronavirus in Wuhan city, China. We estimate the transmission rate of the initial infecting individuals of COVID-19 in India using officially reported data at the early stage of the epidemic with the help of the susceptible (S), exposed (E), infected (I), and removed (R) population model, the so-called SEIR dynamical model. Numerical analysis and model verification are performed to calibrate the system parameters with official public information about the number of people infected, and then to evaluate several COVID-19 scenarios potentially applicable to India. Our findings provide an estimation of the number of infected individuals in the pandemic period of timeline, and also demonstrate the importance of governmental and individual efforts to control the effects and time of the pandemic-related critical situations. We also give special emphasis to individual reactions in the containment process.