Continuous Glucose, Insulin and Lifestyle Data Augmentation in Artificial Pancreas Using Adaptive Generative and Discriminative Models.

Artificial pancreas requires data from multiple sources for accurate insulin dose estimation. These include data from continuous glucose sensors, past insulin dosage information, meal quantity and time and physical activity data. The effectiveness of closed-loop diabetes management systems might be hampered by the absence of these data caused by device error or lack of compliance by patients. In this study, we demonstrate the effect of output sequence length-driven generative and discriminative model selection in high quality data generation and augmentation. This novel generative adversarial network (GAN) based architecture automatically selects the generator and discriminator architecture based on the desired output sequence length. The proposed model is able to generate glucose, physical activity, meal information data for individual patients. The discriminative scores for Ohio T1DM (2018) dataset were 0.17 ±0.03 (Inputs: CGM, CHO, Insulin) and 0.15 ±0.02 (Inputs: CGM, CHO, Insulin, Heart Rate, Steps) and for Ohio T1D (2020) dataset was 0.16 ±0.02 (Inputs: CGM, CHO, Insulin) and 0.15 ±0.02 (Inputs: CGM, CHO, Insulin, acceleration). A mixture of generated and real data was used to test predictive scores for glucose forecasting models. The best RMSE and MARD achieved for OhioT1DM patients were 17.19 ±3.22 and 7.14 ±1.76 for PH=30 min with CGM, CHO, Insulin, heartrate and steps as inputs. Similarly, the RMSE and MARD for real+synthetic data were 15.63 ±2.57 and 5.86 ±1.69 respectively. Compared to existing generative models, we demonstrate that sequence length based architecture selection leads to better synthetic data generation for multiple output sequences (CGM, CHO, Insulin) and forecasting accuracy.

Influence of Hepatitis C virus genotype and other factors on the viral load.

Anti-HCV reactive subjects were selected and relevant data was collected. Viral load and genotype were determined for all patients and were divided into low (<800,000 IU/mL) and high viral load (>800,000 IU/mL). Correlation of viral load with parameters like age, gender, risk factors and genotype etc. was determined by binomial regression. Higher viral load was noted with genotype 4, males and high risk groups like People Who Inject Drugs (PWIDs), blood transfusion before routine testing or frequent transfusion, Intravenous drug therapy and MTP by unregistered medical practitioners (P ≤ 0.5). Prevention and treatment strategies for HCV should be tailored around these areas.

Community Screening for High-Risk Human Papilloma Virus Infection using Self-Sampling and 'Point-Of-Care' Test.

OBJECTIVE: HR-HPV types 16 and 18 are responsible for pre-invasive and invasive lesions of the cervix, accounting for 70-80% of the total subtypes. The aim of this study was to investigate the prevalence of high-risk HPV subtypes 16 and 18 in self-collected vaginal samples using real-time micro-PCR and to study the acceptability of self-sampling. METHODS: Eligible women (30-65 years) were screened from a semi-urban area of Uttarakhand (India) using self-sampling. High-risk HPV genotypes (16/31 and 18/45) were tested using real-time micro-PCR technique with results available in one hour. The positive results were validated by standard RT-PCR for high-risk HPV 16, 18, separately and for 12 other high-risk genotypes, combined. Ease of the procedure, level of comfort, and recommendation to other women were studied and the acceptability of self-sampling was analyzed using the Likert scale. RESULT: Of 975 eligible women screened, 45 participants tested positive for HR-HPV (16/31,18/45) using real-time micro-PCR with a prevalence of 4.6%. Positive samples were further tested through routine RT-PCR and 60% were found to be HR-HPV 16 and 18 positive. For self-sampling, 96.72% (n=943) participants were 'very satisfied' and 94.15% (n=918) found self-sampling to be 'very comfortable' and 88.51% (n=863) stated that they will strongly recommend this test to other eligible women in the community. CONCLUSION: We conclude that HR-HPV testing with limited genotyping showed a prevalence of 4.6%, 60% of these were HPV 16/18 positive. Point of care testing was feasible in the community and self-sampling was acceptable.

InsNET: Accurate Basal and Bolus Insulin Dose Prediction for Closed Loop Diabetes Management.

It has been demonstrated that closed-loop diabetes management results in better glycemic control and greater compliance than open-loop diabetes management. Deep learning models have been used to implement different components of artifical pancreas. In this work, a novel deep learning model InsNET has been proposed to estimate the basal and bolus insulin level and insulin bolus in patients with type I diabetes utilizing subcutaneous insulin infusion pumps for closed loop diabetes management system. The proposed InsNET is formed with a Wide-Deep combination of LSTM and GRU layers. Additionally, physical activity level has been included as an input in comparison to previous models where only past glucose levels (CGM), meal intake (CHO) and past insulin dosage were used as inputs. The proposed model was tested on In-silico data, and it achieved a Mean Absolute Error (MAE) of 0.002 and Root Mean Squared Error (RMSE) of 0.007 for UVA/Padova Dataset and MAE of 0.001 and RMSE OF 0.003 for mGIPsim Dataset.Clinical relevance- Insulin dose determination is an important as aspect of artificial pancreas. This work describes a deep learning model to determine accurate basal and bolus insulin dosage.

A study on the clinical spectrum of Hepatitis C virus infection from a tertiary care center in Sub-Himalayan India-spontaneous clearance, a neglected phenomenon.

Hepatitis C virus (HCV) infection has varied clinical manifestations. Noninvasive tools can be useful to assess the severity of liver disease and the rate of spontaneous clearance. HCV infection was determined by antibody or RNA-based tests over a period of 18 months in 8030 samples from the Gastroenterology department. Noninvasive indicators (AST-to-platelet ratio index and fibrosis-4 index) were computed. HCV RNA load was compared with Child-Turcotte-Pugh score. Rate of spontaneous clearance was estimated. About 3.2% of patients were found to have HCV. Fatigue, anorexia, and nausea were the primary complaints followed by ascites and encephalopathy. Extrahepatic features such as autoimmune hepatitis and non-Hodgkin's lymphoma were rare. There was an absence of advanced liver cirrhosis (κ = 0.96) in the majority of cases. Spontaneous HCV resolution was seen in 10.37%.

Heavy Load of Intestinal Fluke in a Four-Year-Old Child with Severe Acute Malnutrition: A Case Report.

Fasciolopsiasis, a food-borne intestinal parasitosis, occurs focally, and remains a significant public health problem in endemic areas. However, due to the wide spectrum of clinical presentation and unclear diagnosis or even misdiagnosis, it often goes unreported. The correlation between trematode infection and malnutrition is also often debated. We report a case of heavy infection of Fasciolopsis buski in a 4-year-old girl with severe acute malnutrition (SAM). The patient presented with a passage of many adult worms per stool following the consumption of some herbal concoction. A wet mount of the stool revealed ova of Fasciolopsis buski. She was treated successfully with praziquantel and food supplements. It raises the possibility of unidentified cases in this region and necessitates more extensive studies in the targeted population. This will also help raise awareness of fasciolopsiasis among clinicians, especially in vulnerable populations such as malnourished children.

Incidence of SARS-CoV-2 Co-infections During the Second Wave in Sub-Himalayan Region, India.

Introduction The second wave of the coronavirus disease 2019 (COVID-19) pandemic in India, which started from April 2021, has been more severe and deadly than the first wave. The aim of this prospective study was to determine the possibility of other respiratory pathogens contributing towards the severity and hospitalization in the current second wave. Materials and methods Nasopharyngeal and oropharyngeal swab samples were collected and processed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR). These samples were further processed for detection of co-infection in SARS CoV-2 patients by BioFire® Filmarray® 2.0 (bioMérieux, USA). Results We screened 77 COVID-19-positive patients admitted to All India Institute of Medical Sciences (AIIMS), Rishikesh and found cases of co-infections in five (6.49 %) patients. Conclusion Our finding suggests that co-infections had no or minimal role in augmenting the second wave of the COVID-19 pandemic in India, and the emergence of new variants may be the probable cause.

Antibacterial Potential of Gold Nanoparticles Synthesized From Leaf Extract of Syzygium cumini Against Multidrug-Resistant Urinary Tract Pathogens.

BACKGROUND: Urinary tract infection (UTI) is one of the most commonly encountered bacterial infections. Due to the misuse or excessive use of antibiotics, the upsurge of multidrug-resistance cases in UTIs has now become a global threat to public health. Exploring a newer or safer treatment using green synthesized nanoparticles (NPs) is another substitute for eliminating multidrug-resistant pathogens. METHODOLOGY: Leaf extract of Syzygium cumini was used for green synthesis of gold NPs. Synthesis of Syzygium cumini gold nanoparticles (ScAu-NPs) was achieved by optimizing various reaction parameters. These ScAu-NPs were characterized through UV-visible spectroscopy, transmission electron microscope, Fourier transform infrared spectroscopy (FTIR), and X-ray diffraction. ScAu-NPs were then processed for antibacterial activity against clinically isolated multidrug-resistant pathogens like Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, Acinetobacter baumannii, Staphylococcus aureus, and Enterococcus faecalis. RESULTS: Characterization of NPs revealed that biosynthesized NPs were spherical in shape. FTIR spectroscopy showed the presence of phenolics and aromatic compounds. Biosynthesized NPs exhibit good antibacterial activity with a significant bacterial reduction seen against all bacterial isolates compared to the controls. CONCLUSION: From the results of the present study, the formulation of biosynthesized ScAu-NPs can be utilized in drug development for eliminating infections caused by multidrug-resistant pathogens.

Knowledge, Attitude, Practice and Preparedness toward COVID-19 Pandemic among Healthcare Workers in Designated COVID Hospitals of a North-Eastern State of India.

The knowledge, attitude, and practice (KAP) of healthcare workers (HCW) toward the COVID-19 pandemic influence their preparedness to accept the preventative measures. This study investigates KAP toward COVID-19 among the HCWs working in two designated COVID hospitals. It was a cross-sectional study. The overall KAP scores were calculated, and the difference in mean scores among various demographic and other variables was tested using t-test and one-way ANOVA. The participants were knowledgeable about transmission modes and disease symptoms and were aware of the preventive measures like hand sanitisations for 96% and 91% for wearing masks. Among the knowledgeable group, 87% were aware of the control measures of COVID-19 infection like isolation and treatment of the infected; quarantine of their close contacts; and 92% had the acquaintance about the avoidance of public transport and crowded places as a safety measure. The HCWs also showed a positive attitude toward keeping distance and staying at home (81.13% strongly agreed) and regularly washing hands (agreed 91%). The mean knowledge, attitude, and practice scores of the study participants were 19.67(±1.85), 27.95(1.81) and 4.61(0.51), respectively. Nurses were found to have significantly better knowledge, attitude, and practice toward COVID-19 than laboratory technicians and pharmacists. HCWs having higher education levels were also found to have better knowledge about COVID-19. The majority of the HCWs who participated in the study also strongly agreed that the referred hospitals are well prepared for infection prevention and control (IPC). Better knowledge, attitude and practices toward COVID-19 may considerably decrease the risk of getting the disease.

Convalescent Plasma the Experience and Journey from Blockbuster to Incognito: A Single Centre Experience.

BACKGROUND: Convalescent plasma has been used to provide passive immunotherapy to patients with COVID-19 with a high level of safety. Very few efficacy studies were available, and due to COVID being a relatively new disease, its exact therapeutic role was unclear. This observational study on the impact of COVID convalescent plasma (CCP) on clinical outcomes attempts to evaluate the effectiveness of convalescent COVID-19 plasma therapy in the treatment of COVID-19 patients at the tertiary care center in the Uttarakhand state of India. METHODS: CCP was collected by plasmapheresis/whole blood from willing COVIDrecovered donors who underwent pre-donation testing including ABO and RhD grouping, mandatory blood screening tests for HIV, HBV, HCV, syphilis and Malaria, Haemoglobin estimation and COVID IgG assay. Hospitalized patients with severe COVID-19 pneumonia who received these CCP units were followed up and the outcome (Recovery/death) was observed. RESULTS: A total of 63 patients who received CCP were included in the study. Out of the total, 13 (20.7%) were females and 50 (79.3%) were males and their ages ranged from 24 to 80 years with a median age of 53 years. The period between the start of symptoms and hospitalization ranged from 1 to 14 days with an average duration of 4.7 days. Symptoms on presentation included Fever 53/63 (84.1%), Tachypnoea 60/63 (95.2%) and Cough 42/63 (66.7%). Among these patients, 22/63 (34.9%) were on non-invasive ventilation (NIV), 6/63 (9.5%) on non-rebreather mask (NRBM) and 32/63 (50.8%) were on Ventilator support. The infused convalescent plasma had a Mean IgG value of 57.3 AU with a range of (10-142 AU). A total of 37 (58.7%) patients were lost to COVID-19 infection and 26 (41.3%) were discharged from the hospital in a healthy state. CONCLUSION: The use of convalescent plasma in addition to standard treatment in our study on patients with severe pneumonia due to COVID-19 did not demonstrate reduced mortality of COVID-19 patients amidst numerous variables. The results showed that the use of convalescent plasma as a treatment option in the present conditions needs a serious re-evaluation. Studies on a strictly defined recipient group and transfusion of CCP units, with adequate antibody titer and/or neutralization activity, must be analyzed for future works.

Post-COVID pulmonary fungal infections: An unanticipated predicament or a ticking time bomb? Clinico-microbiological profile of cases encountered during the second wave of COVID-19 pandemic at a teaching hospital in the Himalayas with a brief literature review.

Introduction: This study attempts to generate preliminary data regarding post-COVID pulmonary fungal infections, namely, COVID-19-associated pulmonary aspergillosis (CAPA), COVID-19-associated pulmonary mucormycosis (CAPM), and mixed infections from the Himalayas and compares the micro-radio-clinical profile and outcomes of the affected patients. Materials and Methods: A retrospective data analysis was conducted, where clinical profiles, microbiological and radiological reports, and outcomes of n = 16 patients of post-COVID pulmonary infections were compared. Results: Of n = 16 patients, n = 7 had CAPA (n = 5 Aspergillus fumigatus, n = 1 Aspergillus flavus, and n = 1 Aspergillus niger), n = 5 CAPM (Rhizopus arrhizus), and n = 4 with mixed infections (n = 3 infected with Aspergillus fumigatus and Rhizopus spp. and n = 1 with Aspergillus flavus and Rhizopus arrhizus). Thick-walled cavitary lesions, air-fluid levels, and multiple centrilobular nodules were some of the common radiological findings reported among these patients. Conclusion: The immuno-compromised state following COVID-19 infection and treatment might be responsible for the progression of regular exposure to the dense Himalayan vegetation into an invasive pulmonary fungal infection. Suspecting post-COVID pulmonary fungal infection is necessary for primary care physicians to ensure timely referral to higher centers. Mixed pulmonary fungal infections (coinfection with Aspergillus spp. and Rhizopus spp.) are also emerging as important sequelae of COVID-19.

Drug resistance profile in postbiliary and gastrointestinal surgical-site infection cases from a tertiary care hospital.

In the developing world, surgical-site infection (SSI)-associated pathogens are becoming more drug resistant implicating higher morbidity and management cost. Here, we tried to analyze the drug resistance pattern in our SSI-related isolates. Over 2 years, 191 clinically diagnosed SSIs (postbiliary tract and postgastrointestinal surgery) were included, and wound swabs were processed by conventional aerobic and anaerobic culture. Antibiotic minimum inhibitory concentration (MIC) was determined by the Epsilometer testing. Multidrug-resistant phenotypes were detected as per guidelines. The rate of SSI was 5.3% with Klebsiella, Staphylococcus, and Pseudomonas, growing predominantly, and no anaerobe detectable. About 19.4% of Staphylococcus aureus were methicillin-resistant S. aureus, and one-third of them had raised macrolide MIC. About 58.2% of Enterobacteriaceae isolates were extended-spectrum beta-lactamase producers. Isolates with raised meropenem MIC were observed. Antibiotic-resistant level in SSI cases is alarmingly high, and in susceptible strains, MIC is approaching the resistant level. Urgent corrective action is an emergency necessity.

Trend of viral load during the first, second, and third wave of COVID-19 in the Indian Himalayan region: an observational study of the Uttarakhand state.

India had faced three waves throughout the Coronavirus disease 2019 (COVID-19) pandemic, which had already impacted economic lives and affected the healthcare setting and infrastructure. The widespread impacts have inspired researchers to look for clinical indicators of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection prognosis. Cyclic threshold values have been used to correlate the viral load in COVID-19 patients and for viral transmission. In light of this correlation, a retrospective study was conducted to assess the trend of viral load in clinical and demographic profiles across the three waves. Data of a total of 11,125 COVID-19-positive patients were obtained, which had a Ct value of <35. We stratified Ct values as follows: under 25 (high viral load), 25-30 (moderate viral load), and over 30 (low viral load). We found a significantly high proportion of patients with high viral load during the second wave. A significantly high viral load across the symptomatic and vaccinated populations was found in all three waves, whereas a significantly high viral load across age groups was found only in the first wave. With the widespread availability of real-time PCR and the limited use of genomic surveillance, the Ct value and viral load could be a suitable tool for population-level monitoring and forecasting.

Interference of Antinuclear Antibody (ANA) in Indirect Immunofluorescence Assay (IIFA)-Based Perinuclear Antineutrophil Cytoplasmic Antibody (pANCA) Interpretation.

Background: Indirect immunofluorescence assay (IIFA) based on antineutrophil cytoplasmic antibody (ANCA) testing is a commonly employed test for diagnosing autoimmune vasculitis. Antinuclear antibody (ANA) can give rise to a false interpretation of perinuclear-ANCA (pANCA) in ethanol-fixed granulocyte substrates. Analytical interference could frequently occur in setups where ethanol-fixed substrates are used alone. Here, we intend to investigate this ANA interference in pANCA interpretation. Methods: In this retrospective study, we studied anti-MPO-negative but ANA-positive and pANCA (IIFA based) samples. We also correlated immunoblot results (where data were available) and checked the association between grades of blot positivity (an indicator of the concentration of ANA) and frequency of pANCA interpretation. Data were analyzed by appropriate statistical techniques (Chi-square and kappa statistics). Results: About 19.2% of ANA blot (ENA-blot) positive samples displayed a pANCA positive pattern in the ethanol-fixed substrate, while this positivity in ENA-blot negatives was 6.5%. In positive ANA-IIFA samples, about 14.7% yielded pANCA patterns (on ethanol fixed substrates). Out of this, nuclear homogenous pattern yielding samples gave the highest frequency pANCA, that is, in 31.5% followed by speckled (11.1%), DFS (10.3%), and centromere (6.7%).The association of the nuclear homogenous pattern was statistically significant. Conclusions: ANA-positive results may interfere with the interpretation of pANCA as observed in ANA-IIFA and ENA-blot positive samples. ANA-IIFA patterns like nuclear homogenous may strongly associate this pANCA interpretation. This can help laboratories perform ANCA testing more effectively, ruling out ANA interference in ANCA screening.

Feasibility of Indirect immunofluorescence (IIF) alone as a screening method for antinuclear antibody in connective diseases in India's sub-Himalayan region.

Background: For the management of connective tissue disorders (CTDs), antinuclear antibody (ANA) testing is essential, both from diagnostic and prognostic points of view. Usually, patterns obtained by ANA-IIF testing correlates to specific autoantibodies as obtained from the test for ENA (by LIA/ELISA, etc.). But to apply these data from western studies, we may need validation in the local population like our subjects in sub-Himalayan (Garhwal region) area where CTDs are common. Also, suppose ANA-IFA pattern's correlation is reliably known in our population, it can minimize the cost of managing CTDs by limiting ENA testing, which is 10 times costlier than ANA-IIF. Hence, this study was undertaken to know the specific autoantibody targets (ENA by LIA) against ANA-IIF patterns in our local population. Materials and Methods: In this retrospective cross-sectional work, serum samples of CTDs were tested for ANA by IIF (Euroimmune AG) and ENA by LIA (Euroline ANA-3G) continuously for 36 months. The manufacturer's kit insert was followed, and results were analyzed applying appropriate statistical methods. Results: Major ANA-IIF patterns were found to be associated with specific autoantibodies, for example, Nuclear homogenous with dsDNA, nucleosomes, histones; speckled pattern with nRNP/Sm, Sm, SSA/Ro-52, SSB; nucleolar pattern with Scl-70, Pm-Scl 100 and centromere pattern with CENP-B. Anticytoplasmic (ACA) are found to be linked with some ANA negative (by IIF) samples, emphasizing the need for careful observation for ACA especially where ANA is not found. Conclusions: In most subjects, specific ENA targets correlated well with ANA-IIF patterns, implying effective cost minimization in CTD management. Similar future prospective studies (with clinical data) can provide a database and reference for our population.

Glucose Prediction using Wide-Deep LSTM Network for Accurate Insulin Dosing in Artificial Pancreas.

Closed-loop diabetes management has been shown to indicate improved glycaemic control and better compliance over open loop diabetes management. Currently, commercially available diabetes management devices rely on continuous glucose monitoring (CGM) sensors which monitor glucose levels from the interstitial fluid (ISF). As there exists a physiological delay between the blood glucose levels compared to the ISF glucose levels, it is crucial to predict or forecast glucose levels, in order to prevent hyperglycaemic events due to delayed insulin dosing. Accuracy of the forecast also needs to be optimum such that overdosing on insulin does not lead to hypoglycaemia. In this paper, we describe a novel Long Short Term Memory (LSTM) network which follows a wide and deep approach for different features to deliver an accurate glucose prediction output. It achieved a Mean Absolute Relative Difference (MARD) of 2.61 and Root Mean Squared Error (MSE) of 5.04. Clinical relevance- This work is relevant for closed-loop diabetes management devices, which are currently being used to manage Type 1 Diabetes (T1D).

Prevalence and Risk Factors of Intestinal Parasitic Infection in Under-Five Children With Malnutrition: A Hospital Based Cross-Sectional Study.

Background: Intestinal parasitic infections (IPIs) and malnutrition in under-five children contribute substantially to developing countries' childhood morbidity and mortality. This study assessed the prevalence and profile of IPI in under-five children and compared them with nutritional status and other socioeconomic factors. Methods: Anthropometric indices were used for checking the nutritional status of under-five children. Malnutrition was graded into four grades (I-IV) based on the Indian Academy of Pediatrics advocated Weight-for-Age criteria. Children whose Height-for-Age and Weight-for-Height were <-2, standard deviations were regarded as stunted and wasted, respectively. Stool samples were examined by direct wet mount (normal saline and iodine) and formol-ethyl acetate concentration technique to detect parasitic cyst and ova. Stool smears were made directly from the specimen and after concentration and stained by kinyoun's stain. Subsequently, the association of undernutrition was assessed with intestinal IPI using the Chi-square test. Results: The overall prevalence of Grade I, II, III, and IV malnutrition was 52%, 31.7%, 12.2%, and 4.1% while stunting and wasting IPIs were present in 60.2% and 36.6%, respectively. IPIs were present in 47.2%, and 11.4% showed polyparasitism. Soil-transmitted helminths were found to be the commonest (Ascaris lumbricoides: 21.1%; Trichuris trichiura: 13.0%; and hookworms: 8.1%) followed by the intestinal protozoa (Enterobius vermicularis: 7.3, Giardia lamblia: 6.5, and Cryptosporidium spp.: 2.4%). Increasing age upto 5 years, improper excreta disposal, low level of maternal education, and a higher number of childrenin the family were predictors of IPIs. The prevalence of IPI was significantly associated with Grade II and III undernutrition, stunting, and wasting. Individually, Ascaris and hookworms contributed significantly to stunting and cryptosporidium spp. to wasting. Conclusion: Prevalence of IPI in malnourished under-five children is high. Joint nutritional interventional strategies, early diagnosis/treatment of under-five children, and increased awareness among masses are imperative to break the vicious cycle of malnutrition and parasitic diseases.

The Mystery of Mucormycosis in COVID-19: A Multifactorial Menace or an Enigmatic Delta Variant Associated Phenomenon? An Exploratory Study from a Tertiary Care Centre in North India with a Brief Literature Review.

Background: There was a global surge in cases of mucormycosis in COVID-19 patients during the second wave of the pandemic in 2021, reported especially from India. Various predisposing factors such as diabetes mellitus, rampant use of corticosteroids, and COVID-19 per se may be responsible for this spike. Some public health experts have postulated that the epidemiological link between the Delta variant of SARS-CoV-2 and mucormycosis should be explored. Material and Methods: A retrospective exploratory study was conducted, in which data of 15 laboratory-confirmed cases of COVID-19 with mucormycosis and/or aspergillosis co-infections were collected after obtaining approval from the institute's ethics committee. These patients were admitted to the Mucor wards of our hospital. The positive COVID-19 status of these patients was confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR). The residual SARS-CoV-2 RNA containing elutes of these patients were stored at -80°C in deep freezers and subjected to whole-genome sequencing in June 2021 at the National Centre for Disease Control (NCDC), New Delhi, India as part of the Indian SARS-CoV-2 Genomic Consortia (INSACOG) program. Concomitant fungal infections in these patients were diagnosed by KOH wet mount and fungal culture as per standard guidelines. Descriptive statistics in the form of percentages and median were used to report the findings. Results: Periorbital swelling and ocular pain (14/15; 93.33%), followed by facial swelling (11/15; 73.33%) and nasal obstruction (9/15; 60%), were the most common clinical features observed in these patients. Rhizopus arrhizus was the most common causative fungal agent (12/15; 80%). The majority of the patients (9/13; 69.23%) were infected with the Delta variant of SARS-CoV-2. Conclusion: COVID-associated mucormycosis seems to be multifactorial in origin. Although there may be a possible association between mucormycosis and the Delta variant, more studies should be conducted to explore this seemingly reasonable proposition.

The intricate association of COVID-19 pandemic with ecological issues.

This critical narrative review is intended to emphasize the comprehensive ecological issues related to the evolution of the novel coronavirus, the environmental factors associated with the disease progress, and the impact the pandemic is having on the environment. Approximately 60% of the emerging infectious disease of the last century (including deadly viruses like HIV, Ebola, Influenza, coronavirus strains like SARS, MERS) are linked to zoonotic spillover. Therefore, to escape the emergence of newer cross-species infections, proper precautionary measures should be taken. Every country has specific rules to deal with the biomedical waste produced in hospitals. But the COVID-19 pandemic has posed a unique global challenge due to the overwhelming amount of biomedical waste generated from dedicated COVID hospitals, diagnostic facilities, quarantine centers, and home quarantine facilities. Moreover, inappropriate disposal of masks by the general public may contaminate the environment turning it into a potential health hazard. Therefore, strict adherence to Biomedical Waste Management Guidelines for proper disposal of masks and other medical waste by all concerned is a must. Lockdown has brought about tremendous improvement in conditions of the world's atmosphere, hydrosphere, and biosphere. Dramatic improvement in air quality index, decrease in water, and noise pollution are some of the positive aspects of lockdown. However, these effects are temporary. But these teach an important lesson to the world to take some permanent measures to bring down greenhouse gases and other toxic emissions. Some harmful effects of lockdown are illegal deforestation, wildlife trafficking, encroachment of reserved areas etc.

Laboratory Evaluation of Hepatitis C Virus Infection in Patients Undergoing Hemodialysis from North East India.

Introduction: Subjects undergoing hemodialysis have enhanced vulnerability to hepatitis C virus (HCV) infection due to invasive procedures and poor infection control practices. Early detection and treatment are essential to prevent cross-infection and mortality/morbidity. However, common use anti-HCV antibody tests lack the necessary accuracy, and alternative tests (e.g. core antigen detection kits) which are available need to be examined as a viable alternative. Method: A total of 270 continuous serum samples were collected from patients undergoing dialysis within 15 months of study period. Sequentially, multiple tests were performed - immunochromatography-based rapid test, third-generation ELISA i.e. (anti-HCV antibody detection), fourth-generation ELISA (HCV antigen-antibody combined detection assay), and HCV RNA quantitative real time polymerase chain reaction (qPCR) assay. Diagnostic parameters of serological kits were compared in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and so on. Statistical Package for the Social Sciences was used. Results: HCV-combined core antigen-antibody assays performed better than other serological assays in reference to the gold standard HCV RNA. This fourth-generation assay yielded a Kappa value of 0.947 compared with the value of 0.747 and 0.619 for anti-HCV ELISA and rapid detection test. Other parameters such as sensitivity, specificity, PPV, NPV, and so on were also better for fourth-generation ELISA compared with third-generation ELISA and other serological assays. HCV RNA was negative in 7.3% of anti-HCV-positive patients and was detected in 11.4% of anti-HCV ELISA-negative patients. In about 1.6% of HCV RNA-positive cases, fourth-generation ELISA was negative and had low HCV viral load (650 IU/ml and below). Fourth generation ELISA detected additional 7.4% HCV positive cases (compared to third generation kits) and upon cost effective analyis, additional cost to be bear for the better detection (by fourth generation kit) was found to be only INR 27 per 1% increased case detection. Conclusion: In resource scant setup, screening and follow-up of patients undergoing hemodialysis can be performed by fourth-generation HCV ELISA (antigen-antibody combined assay) instead of the current practice of anti-HCV antibody ELISA. Better yield in detection rate will compensate for slight addition to costs.