Clinical Efficacy and Safety of Remdesivir among Hospitalised Adult Patients with RT PCR Confirmed COVID 19 Requiring ICU Care in Kalyana Karnataka

BACKGROUND

Despite global efforts, COVID 19 pandemic is still posing a serious challenge with dearth of effective treatment options. Remdesivir has got FDA approval as the first COVID-19 anti-viral agent in adult and paediatric patients (aged ≥12 years and weighing at least 40 kg) requiring hospitalization.

OBJECTIVE

The present prospective, observational, cross sectional study was planned to evaluate the impact of early initiation of Remdesivir on clinical outcomes in moderate to severe COVID 19 patients requiring ICU care. <span style="font-size: 1rem;"> Materials and Methods: In this study, 100 consecutive symptomatic RT-PCR positive COVID 19 patients requiring admission to Intensive care unit based on predefined criteria were included for evaluation. All such moderate to severely ill patients were given Remdesivir intravenously as a 200-mg loading dose on day 1, followed by a 100-mg maintenance dose for the next four days along with other standard care. The main outcome measure analysed was the impact of early initiation of Remdesivir on recovery assessed by number of days in hospital, recovery, biochemical improvements and death.</span> Results: Out of total 100 patients, 84 patients recovered with Remdesivir along with supportive treatment and were discharged from the hospital. Mean age of patients at presentation 53.5± 14.8 years with 5:1 male preponderance. Mean duration of hospital stay was 11.6 ± 5.9 days. D-dimer, CRP, Ferritin, IL-6 decreased significantly post treatment with P values &lt;0.05, &lt;0.001, &lt;0.001, &lt;0.01 respectively when compared to values at admission. No significant side effects were seen with remdesivir infusion.

CONCLUSION

This real-world experience suggests that in the subset of hospitalized patients with moderate to severe pneumonia, early use of Remdesivir can lead to better clinical outcomes and help in reduction of associated mortality and morbidity of COVID-19.

Monitoring SARS-CoV-2 decontamination by dry heat and ultraviolet treatment with a swine coronavirus as a surrogate

The critical need for reliable methods to validate decontamination protocols for personal protective equipment (PPE) for re-use during the SARS-CoV-2 pandemic is limited by the need for specialized containment facilities to handle the virus. Hence, we have herein validated the use of a swine coronavirus as a surrogate, and tested the effectiveness of dry heat and ultraviolet (UV) rays for PPE decontamination. Exposure of experimentally contaminated N95 masks and hospital gowns to 60°C for 20 min, and UVC at 1800 mJ/cm² resulted in a 4-log reduction and inactivation of the surrogate virus. This study provides a novel alternative to validate PPE reprocessing methods.

Optical Flow-Based Weighted Magnitude and Direction Histograms for the Detection of Abnormal Visual Events Using Combined Classifier

Movement information of persons is a very vital feature for abnormality detection in crowded scenes. In this paper, a new method for detection of crowd escape event in video surveillance system is proposed. The proposed method detects abnormalities based on crowd motion pattern, considering both crowd motion magnitude and direction. Motion features are described by weighted-oriented histogram of optical flow magnitude (WOHOFM) and weighted-oriented histogram of optical flow direction (WOHOFD), which describes local motion pattern. The proposed method uses semi-supervised learning approach using combined classifier (KNN and K-Means) framework to detect abnormalities in motion pattern. The authors validate the effectiveness of the proposed approach on publicly available UMN, PETS2009, and Avanue datasets consisting of events like gathering, splitting, and running. The technique reported here has been found to outperform the recent findings reported in the literature.

Population assessment and habitat distribution modelling of the threatened medicinal plant Picrorhiza kurroa Royle ex Benth. in the Kumaun Himalaya, India

Kumaun Himalaya is a home to various threatened medicinal and aromatic plants.  Picrorhiza kurroa is a threatened medicinal plant useful in curing many diseases in Indian Himalayan region.  Due to overharvesting from the wild its population is decreasing at an alarming rate.  The present study attempted to assess its availability and predict highly suitable areas for in situ conservation in the alpine region of Kumaun.  Availability of P. kurroa across various meadows was evaluated through rapid mapping exercise.  MaxEnt model was used to predict the geographical distribution of the species using various environmental and physiographic parameters, and 29 primary distribution points.  The results reveal that potential habitat of P. kurroa is located near forest fringes.  Of the 3,828km2 area (vegetated) of the alpine region of Kumaun, about 202km2 is recorded highly suitable, 489km2 less suitable and the rest not suitable for the species.  It is also revealed that Napalchu nala, Panchachuli base, Chhipla Kedar, Rongkong, Ralam, Milam, Dwali, and Pindari areas are highly suitable areas for distribution of  P. kurroa.

Utility of silent magnetic resonance angiography in the evaluation and characterisation of intracranial dural arteriovenous fistula

AIM

To evaluate the utility of silent magnetic resonance angiography (MRA) in the diagnosis, characterisation, and therapeutic planning of intracranial dural arteriovenous fistula (DAVF).

MATERIALS AND METHODS

Twenty consecutive patients with DAVF were enrolled prospectively and were evaluated using silent MRA and digital subtraction angiography (DSA) as a part of routine work-up. The diagnosis and location of fistula, Borden and Cognard classification, entire arterial feeders, and venous drainage were analysed. A therapeutic strategy was formulated, and the accessible route and vessel were predicted, which was confirmed on endovascular treatment.

RESULTS

Silent MRA was 100% sensitive and accurate for location and classification of fistulas. Silent MRA showed a sensitivity of 82% and 76.5% for entire arterial feeders and draining veins, which improved to a sensitivity of 90% and 94% when prominent feeders and immediate venous drainage was considered. Among the missed veins, thrombosed sinus, slow sinus flow, small calibre, reduced image quality were the causes. The therapeutic decision matched with DSA in all cases and silent MRA accurately identified the potential accessible feeder in 94% cases.

CONCLUSION

Silent MRA is a promising MR technique that can provide both diagnostic and therapeutic information similar to that obtained from DSA.

Severe dissecting scalp cellulitis successfully treated with serial excisions in combination with anti-TNF therapy

The management of dissecting scalp cellulitis involves medical treatment with oral antibiotics and isotretinoin, as well as surgical input in more severe cases. In extensive disease, a full scalpectomy with reconstruction can be required. We report a case of severe dissecting scalp cellulitis in a 34-year-old man who underwent serial scalp excisions over three years, with wounds being left to heal by secondary intention. Initially, the excisions helped to control symptoms but, once the patient was on concurrent anti-TNF therapy, further excisions were successful in reducing disease load and inducing remission. He remained disease free at the 20 months follow-up. This case is the first of its kind to be described in the literature and it highlights how a conservative, staged surgical approach, in combination with anti-TNF therapy, can be effective in the management of severe dissecting scalp cellulitis. In doing so, it offers an alternative to full scalpectomy with reconstruction.

POS1143 GOUT AND JOINT REPLACEMENTS IN THE US

Background:

Irreversible joint damage in gout has been linked to a possible increase in knee and hip joint replacements1. In addition, the strong association between gout and osteoarthritis2,3 could also lead to an increased risk of joint replacements in patients with gout. Population-based data from the UK and Taiwan have shown hazard rates of 1.14 and 1.16 respectively for knee replacements in patients with gout compared to age and gender matched controls1. However, there is little national data in the US on clinical and economic burden of joint replacements in patients with gout.

Objectives:

To evaluate total or partial hip and knee joint replacements in patients with gout in the US and to estimate their economic impact

Methods:

The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. Detailed information including clinical and nonclinical data elements on each hospital stay including International Classification of Diseases (ICD)10 diagnosis and procedure codes, age, gender, length of stay, payer, charges, comorbidities etc. is available. We examined hospitalizations in patients with gout with hip and knee joint replacements in NIS 2018, the most recent year of data.

Results:

In 2018, there were 914,510 hospitalizations with primary or secondary diagnosis of gout in the US. Of these 43,615 were for joint replacement surgeries (knee (24,840) and hip (18,755)). Patients with knee replacement were on an average 68.5 years old (95% confidence intervals 68.2 years -68.8 years). Patients with hip replacement were slightly older (mean age 70.3 years, 95% confidence intervals 69.8 years -70.7 years). Unlike general population statistics, men formed a majority of these joint replacements (68% for the knee and 72% for the hip). The average charge per hospitalization was $69,279 and $72,944 for knee and hip replacement respectively. The total annual national cost estimate was $3.09 billion, with government insurances (Medicare and Medicaid) responsible for 67% of knee replacement and 70% of hip replacement costs.

Conclusion:

Joint replacements in gout patients have a large clinical and economic burden in the US. This calls for an increased awareness and management of associated hip and knee arthritis in patients with gout.

References:

[1]Kuo CF, Chou IJ, See LC, et al. Urate-lowering treatment and risk of total joint replacement in patients with gout. Rheumatology. Dec 1 2018;57(12):2129-2139.

[2]Howard RG, Samuels J, Gyftopoulos S, et al. Presence of gout is associated with increased prevalence and severity of knee osteoarthritis among older men: results of a pilot study. Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases. Mar 2015;21(2):63-71.

[3]Roddy E, Zhang W, Doherty M. Are joints affected by gout also affected by osteoarthritis? Annals of the rheumatic diseases. Oct 2007;66(10):1374-1377.

Disclosure of Interests:

Gurkirpal Singh Shareholder of: Pfizer, Merck, Sanofi, Grant/research support from: Horizon, Maanek Sehgal: None declared, Alka Mithal: None declared.

Role of calcium phosphate and bioactive glass coating on in vivo bone healing of new Mg-Zn-Ca implant

Present investigation focuses on development and detailed characterization of a new Mg alloy sample (BM) with and without coating of hydroxyapatite (BMH) and bioactive glass (BMG) by air plasma spray method. After detailed mechano-physico-chemical characterization of powders and coated samples, electrochemical corrosion and SBF immersion tests were carried out. Detailed in vitro characterizations for cell viability were undertaken using MG-63 cell line followed by in vivo tests in rabbit model for studying bone healing up to 60 days. Starting current density increases from BM to BMH to BMG indicating highest resistance towards corrosion in case of BMG samples, however BMH also showed highest i_corr value suggesting slowest rate of corrosion than BM and BMG samples. Dissolution of calcium ion in case of BMH and BMG control formation of apatite phases on surface. Ca²⁺ ions of coatings and from SBF solution underwent reduction reaction simultaneously with conversion of Mg to MgCl₂ releasing OH^- in the solution, which increases pH. Viability and propagation of human osteoblast-like cells was verified using confocal microscopy observations and from expression of bone specific genes. Alkaline phosphatase assay and ARS staining indicate cell proliferation and production of neo-osseous tissue matrix. In vivo, based on histology of heart, kidney and liver, and immune response of IL-2, IL-6 and TNFα, all the materials show no adverse effects in body system. The bone creation was observed to be more for BMH. Although both BMH and BMG show rays of possibilities in early new bone formation and tough bone-implant bonding at interface as compared to bare Mg alloy, however, BMG showed better well-sprayed coating covering on substrate and resistance against corrosion prior implanting in vivo. Also, better apatite formation on this sample makes it more favourable implant.

Application of remote sensing in alpine grasslands cover mapping of western Himalaya, Uttarakhand, India

Grasslands are the world's most extensive terrestrial ecosystem, which provides a variety of services for humans, such as carbon storage, food production, crop pollination, pest regulation, and are a major feed source for livestock. However, grasslands are today one of the most endangered ecosystems due to land-use change, agricultural intensification, land abandonment, as well as climate change. Grasslands are an integral part of human societies across the globe, which are broadly known as tropical savannah and temperate grasslands. In the Himalayan region, grasslands are found in more than 55% of the area and different climatic conditions lead to different varieties of grasslands like Danthonia grasslands, kobresia sedge meadow, etc. Grasslands deal with the spatial and temporal distribution of heterogeneous landscapes, which support a high diversity of various species. Owing to very rugged terrain and inaccessibility, the information on the extent of alpine grassland and percent grass cover (%) across the meadows is limited. Therefore, the present attempt was made to assess the current status of grassland in the alpine region of Uttarakhand above 3000 m asl. LANDSAT-8 (OLI and TIRS sensors) satellite data were used to delineate the grasslands using normalized difference vegetation indices (NDVIs) of the alpine region with the help of over 179 ground truth points out of which 50 points are testing points and 129 points are training points. Grass covers (%) were also assessed in the whole alpine region of Western Himalaya of Uttarakhand which nearly consists of over 75 meadows by using random plots (1 × 1 m, total 10 per site) in each meadow. Overall, 89.52% accuracy was achieved based on 50 randomly selected testing points. A total of 4949.25 sq. km area is under the different percentage of grass cover in the alpine region of Uttarakhand, Western Himalaya. Danthonia grasslands below 4000 m and Kobresia sedge meadows above 4000 m elevation are dominant in the state. In the alpine region, over 1056 sq. km grassland area have less than 10% grass cover indicating higher degraded and cold desert areas and only 565.69 sq. km area have more than 60% grass cover, which is highly favorable for rich biodiversity and grazing.

On the detection of surface spin freezing in iron oxide nanoparticles and its long-term evolution under ambient oxidation

Exchange bias (EB) effects linked to surface spin freezing (SSF) are commonly found in iron oxide nanoparticles, while signatures of SSF in low-field temperature-dependent magnetization curves have been much less frequently reported. Here, we present magnetic properties of dense assemblies of similar-sized (∼8 nm diameter) particles synthesized by a magnetite (sample S1) and a maghemite (sample S2) method, and the influence of long-term (4 year) sample aging under ambient conditions on these properties. The size of the EB field of the different sample (fresh or aged) states is found to correlate with (a) whether a low-temperature hump feature signaling the SSF transition is detected in out-of-phase ac susceptibility or zero-field-cooled (ZFC) dc magnetization recorded at low field and with (b) the prominence of irreversibility between FC and ZFC curves recorded at high field. Sample S1 displays a lower magnetization than S2, and it is in S1 where the largest SSF effects are found. These effects are significantly weakened by aging but remain larger than the SSF effects in S2, where the influence of aging is considerably smaller. A non-saturating component due to spin disorder in S1 also weakens with aging, accompanied by, we infer, an increase in the superspin and the radius of the ordered nanoparticle cores. X-ray diffraction and Mössbauer spectroscopy provide indication of maghemite-like stoichiometry in both aged samples as well as thicker disordered particle shells in aged-S1 relative to aged-S2 (crystallographically-disordered and spin-disordered according to diffraction and Mössbauer, respectively). The pronounced diminution in SSF effects with aging in S1 is attributed to a (long-term) transition, caused by ambient oxidation, from magnetite-like to maghemite-like stoichiometry, and a concomitant softening of the spin-disordered shell anisotropy. We assess the impact of this anisotropy on the nature of the blocking of the nanoparticle superspins.

Serine-glycine-betaine, a novel dipeptide from an endophyte Macrophomina phaseolina: isolation, bioactivity and biosynthesis

AIMS

Endophytes are a rich source for structurally complex chemical scaffolds with interesting biological activities. Endophytes associated with Brugmansia aurea L. (family: Solanaceae), a medicinal plant, have not yet explored for the bioactive metabolites.

METHOD AND RESULTS

Hence, Macrophomina phaseolina, a fungal endophyte, was isolated from the roots of the plant. Its methanolic extract was found active against human cancer cell lines with IC₅₀ <20 µg ml^-1 . Later, a di-peptide compound, serine-glycine-betaine, was isolated and characterized. Serine-glycine-betaine consists of a unit of an N-trimethyl glycine attached to serine. It exhibited potent activity against MIA PaCa-2 and HCT-116 cell lines with IC₅₀ 8·9 and 15·16 μmol l^-1 , respectively. Furthermore, it induced apoptosis in MIA PaCa-2 cells confirmed by microscopy. The apoptotic cell death in MIA PaCa-2 cells was evidenced biochemically with the generation of intracellular reactive oxygen species level and leading to loss of mitochondrial membrane potential due to activation of the intrinsic pathway. This study describes the plausible biosynthesis of serine-glycine-betaine based on genomics (genome sequencing, annotation and genes alignment).

CONCLUSIONS

A novel di-peptide, serine-glycine-betaine isolated from M. phaseolina induced apoptosis in MIA-Pa-Ca-2 cells.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study confirms that dipeptides like serine-glycine-betaine and tyrosine-betaine might be specific to fungal genera, hence being used for diagnostic purposes.

Erratum to "Fragmentation dynamics of single agglomerate-to-wall impaction" [Powder Technology 378 (2021) 561-575, DOI: 10.1016/j.powtec.2020.10.021]

[This corrects the article PMC8724865.].