Ethnopharmacologically important highly subsidized Indian medicinal plants: Systematic review on their traditional uses, phytochemistry, pharmacology, quality control, conservation status and future prospective

ETHNOPHARMACOLOGICAL RELEVANCE

India has an extensive reservoir of traditional wisdom and a diverse range of medicinal plants that enrich its heritage. Plants have actively been used for healthcare practices globally since the time immemorial. Medicinal uses of plants have been well recognized in India, evident from plant species documented in different traditional medicinal systems such as Ayurveda (1400-1800 species), Siddha (500-900 species), Unani (400-700 species), Homeopathy (about 372 species), and Sowa-Rigpa (about 250 species), etc. AIM OF THE STUDY: The primary purpose of this review is to provide systematic updated information on thirteen medicinal plants prioritized by the Indian government (providing75 % subsidy on cultivation cost) based on the availability and market demand of these plants. Updated information regarding the traditional uses, phytochemistry, pharmacology, quality control, and conservation status of these plants will help in understanding their pharmacological and commercial importance. This will also help in developing new strategies for their conservation.

MATERIAL AND METHODS

Online databases such as SciFinder, Web of Science, Pubmed, and Google Scholar were used to collect the electronically available literature on targeted thirteen plants. Also, different Indian government official websites such as AYUSH (https://www.ayush.gov.in); NMPB (National Medicinal Plants Board) (https://nmpb.nic.in); e.charak (https://echarak.in) were used for collecting information related to the amount of subsidy, trade and price related information of these plants.

RESULTS

To promote medicinal plant cultivation, the Indian government provides subsidies for cultivating some traditionally important medicinal plants. These plants are divided into three categories according to the subsidy provided to farmers, i.e., 30%, 50%, and 75% of the cost of cultivation. Thirteen medicinal plants which are provided 75% subsidy are Aconitum ferox Wall., Aconitum heterophyllum Wall., Aquilaria agallocha Roxb., Berberis aristata DC., Commiphora wightii (Arn.) Bhandari, Nardostachys jatamansi (D.Don) DC., Oroxylum indicum (L.) Benth. ex Kurz, Picrorhiza kurroa Royle ex Benth., Podophyllum hexandrum Royle, Pterocarpus santalinus L.f., Santalum Album L., Saussurea costus (Falc.) Lipsch., and Swertia chirayita (Roxb.) H.Karst. The literature survey reveals the enormous traditional medicinal importance, wide geographical distribution, diverse range of natural products, and broad spectrum of pharmacological activities of these plants.

CONCLUSION

A comprehensive literature survey revealed that although remarkable progress has been made in isolation, bioactivity evaluation, quality assessment, and conservation, there is still a lot of scope for further scientific interventions. Scientific validation of traditionally claimed medicinal potential is lacking for various bioactivities. Some of the bioactivities are performed just on extracts/fractions, so there is a need for proper phytochemical studies to identify active constituents responsible for the specific bioactivity. Further, quality assessment methods using both targeted and non-targeted tools are required to evaluate the quality of these highly-priced medicinal plants and their adulterants. Ultimately, to encourage the cultivation of these endangered medicinal plant species, it is imperative to implement proper legislation and employ in-situ and ex-situ conservation tools.

Cyperus rotundus L.: Invasive weed plant with insecticidal potential against Aphis craccivora Koch and Planococcus lilacinus (Cockerell)

Cyperus rotundus L. is a widely distributed invasive weed plant with vast traditional medicinal uses. Herein, the methanolic root extract of C. rotundus and its fractions (n-hexane, chloroform, n-butanol, and aqueous) were evaluated for insecticidal activity against nymphs of Aphis craccivora Koch and crawlers of Planococcus lilacinus (Cockerell) to find promising lead (s). In contact topical assay, among extract/fractions, n-hexane fraction exhibited more toxicity against A. craccivora (LD50 = 1.12 μg/insect) and P. lilacinus (LD50 = 0.94 μg/insect). The chemical analysis of n-hexane fraction revealed a volatile composition similar to that of the essential oil (EO) of C. rotundus roots. Hence, EO was extracted using water and deep eutectic solvents (DESs) as cosolvent, which revealed enhancement in EO yield (from 0.28 to 0.46% w/w) on implementing DESs. A total of 35 diverse volatile metabolites were identified in all EO samples, accounting for 85.0 to 91.8% of chemical composition, having cyperotundone, cyperene mustakone, isolongifolen-5-one, boronia butenal as major constituents. The EO obtained with DES-7 [choline chloride: ethylene glycol (1:4)] and DES-6 [choline chloride: lactic acid (1:3)] were found effective against A. craccivora (LD50 = 0.62-0.87 μg/insect) and P. lilacinus (LD50= 0.59-0.67 μg/insect) after 96 h. NMR analysis of EO revealed cyperotundone as a major compound, which was isolated along with cyperene and cyperene epoxide. All the molecules were found effective against P. lilacinus, whereas against A. craccivora cyperotundone, cyperene and cyperene epoxide showed promising toxicity (LD50 = 0.74-0.86 μg/insect). Extract/fractions, EO, and isolated molecules showed a significant reproductive inhibition rate of A. craccivora at higher concentrations. All the tested concentrations of cyperotundone showed significant inhibition of acetylcholinesterase (AChE) and glutathione-S-transferase (GST) in A. craccivora and P. lilacinus. Based upon the present study, C. rotundus can be recommended to control targeted insects in the greenhouse/field conditions after performing bio-efficacy and phytotoxicity studies.

Psychological health of postmenopausal women: a bibliometric analysis in the recent decade

The aim of this study is to analyze the publication trends on the psychological health of postmenopausal women by performing a bibliometric and visualization analysis that can be used as a foundation for understanding current and future research plans. Publications were retrieved from Dimensions database from 2012 to June 2022. VOSviewer software was used for data mining and visualization. A total of 1718 papers were selected by keyword search and delimiting criteria. To evaluate the productive nations, authors, journals, articles and frequent joint citations, citation analysis, author keyword co-occurrence analysis, co-authorship analysis and co-citation analysis were performed. Results depict that the USA contributed the most papers (n = 457). Maximum articles (n = 192) were published in 2021. The highest number of articles are published in Menopause: The Journal of the North American Menopause Society and Climacteric: The Journal of the International Menopause Society. Out of the top 10 contributing organizations in the field, six organizations were from the USA. R. Nappi of Italy is the most productive author with 20 articles and 1138 citations. From the point of average citations per article, H. Joffe has the highest score (71.5). The data reported in this analysis contribute to discussions about the development, growth and current state of psychological health of postmenopausal women as well as its impact. These findings offer helpful guidance for researchers in choosing their potential fields of study and integrating different approaches to solve complicated issues, finding potential co-authors and choosing the right institutions for supporting academic studies or collaborative research.

Chemodiversity and α-Glucosidase Activity of Eucalyptus Species from Northwestern Himalaya, India

The aim of current work was to determine essential oils (EOs) composition from three Eucalyptus species, including E. citriodora, E. camaldulensis and E. globulus and assess their α-glucosidase inhibitory activity. The EOs were collected using the hydrodistillation technique and characterized by GC/MS, GC-FID and NMR. The isolated EOs from leaves parts of Eucalyptus species varied from 0.56 to 1.0 % on fresh weight basis. The content of the EOs was distinct according to the species. The most abundant metabolites were identified as citronellal (0-83.0 %), 1,8-cineole (0.2-44.8 %), spathulenol (0.4-16.1 %) α-pinene (0.4-15.9 %), p-cymene (3.7-11.9 %), citronellol (0-8.6 %), β-eudesmol (5.3-8.6 %) and β-pinene (0-7.1 %). The EOs obtained from targeted samples exhibited strong α-glucosidase inhibitory activity. These results are encouraging and underline that the EOs of Eucalyptus species may be a promising alternative source of natural antidiabetic.

A Machine Learning Approach to Classify Biomedical Acoustic Features for Baby Cries

Communication is imperative for living beings for exchanging information. But for newborns, the only way of communicating with the world is through crying, and it is the only medium through which caregivers can know about the needs of their children. Timely addressing baby cries is very important so that the child is relieved at the earliest. It has been a challenge, especially for new parents. The literature says newborn babies use The Dustan Baby Language to communicate. According to this language, there are five words to understand a baby's needs, which are "Neh" (hungry), "Eh" (burp is needed), "Owh/Oah" (fatigue), "Eair/Eargghh" (cramps), "Heh" (feel hot or wet, physical discomfort). This research aims to develop a model for recognizing baby cries and distinguishing between different kinds of baby cries. Here we more broadly focus on whether the infant is in pain due to hunger or discomfort. The study proposes a comparative approach using four classification models: random forest, support vector machine, logistic regression, and decision tree. These algorithms learn from the spectral features: chroma_stft, spectral_centroid, bandwidth, spectral_rolloff, mel-frequency cepstral coefficients, linear predictive coding, res, zero_crossing_rate extracted from the infant cry. The support vector machine model outperforms other classifiers for correctly classifying infant cries.

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

BACKGROUND

Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.

METHODS

This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries.

RESULTS

In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.

CONCLUSION

This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.

Assessment of the efficacy of reduced-radiation noncontrast computed tomography scan compared with the standard noncontrast computed tomography scan for detecting urolithiasis: A prospective single-center study

Background

Noncontrast computed tomography (CT) scan of the kidneys, ureter and bladder is the standard investigative modality for diagnosing and following up patients with urolithiasis. With each scan, a patient receives radiation of 18-34 mGy. Dose considerations become pertinent because of a 10% lifetime incidence rate and higher than 50% risk of recurrence, necessitating repeated imaging in the lifetime of a stone former. Hence, this study aimed to assess the sensitivity of "reduced-radiation" CT imaging by altering scan settings to lower than the "standard" norms.

Materials and methods

Altogether, 222 patients (255 "kidney-ureter" stone-bearing units or "renal units") with urolithiasis and patients undergoing CT for other reasons with incidental findings of renal/ureteric calculi between 2017 and 2019 were included. All patients were subjected to 3 sequential scans at tube current settings of 250 mA (CT-N/Standard), 100 mA (CT-100), and 50 mA (CT-50) at a constant voltage of 120 kV. Their clinicodemographic and radiological findings were recorded and assessed for significance.

Results

Of the 255 renal units, 117 were between 30 and 44 years of age, 75% were men. Of the 255 patients, 178 (70.1%) reported a first stone episode and 77 had recurrence. Lower ureteric calculi were predominant (40.4%). All calculi were identified on CT-N; CT-100 failed to detect calculi in 1 patient, and CT-50 failed in 3 patients, where all calculi were <3 mm in size. Meanwhile, none were undetected among patients with obesity. The sensitivity was 99.61% for the CT-100 and 98.82% for the CT-50, which indicated a 2.5 and 5 times lower radiation and dose/length, respectively, than CT-N.

Conclusions

The reduced-radiation CT scan is safe, sensitive, and accurate for the diagnosis and follow-up of patients with urolithiasis with significantly lower radiation exposures. Our study lays the foundation to accept low-dose CT in general and CT-50 in particular, as the new "standard of care," and attempt further dose reduction without loss of diagnostic efficacy.

Intravascular Lithotripsy for Acute Stent Under-Expansion and In-Stent Restenosis: A Case Series

Coronary in-stent restenosis (ISR) has an incidence of about 10% of percutaneous coronary interventions (PCIs) performed in the United States. Traditional management strategies for ISR include balloon angioplasty with non-compliant or use of cutting/scoring balloons or atheroablative therapies (like laser and rotational atherectomy), all of which are inherently limited in their ability to treat stent under-expansion or calcification around the stent. Shockwave intravascular lithotripsy (IVL) has recently demonstrated safe and efficacious treatment of severely calcified coronary stenoses with reported cases of treating ISR as an off-label use. In this case series, we describe the successful use of IVL for 6 cases of ISR and 1 case of stent under-expansion using 40-80 IVL pulses per lesion. Angiographic success was obtained in all seven patients, and there were no intra-procedural complications or adverse cardiac events at a mean follow-up of 200 days. Our report indicates that IVL can be safely and effectively used to treat ISR and stent under-expansion.

Chemical Diversity and α-Glucosidase Inhibitory Activity in Needles Essential Oils of Four Pinus Species from Northwestern Himalaya, India

This work describes the study of the chemical profiling and α-glucosidase inhibitory activity of essential oils (EOs) from four Pinus species (P. wallichiana, P. patula, P. roxburghii and P. gerardiana). The identification and quantification of EOs metabolites were performed by GC/MS, GC-FID and ¹³ C-NMR. The needles of P. wallichiana and P. gerardiana presented the highest oil yields (0.35 % and 0.36 %, respectively). Twenty-four constituents were characterized in among samples exhibiting 93.8-97.7 % of the total EOs. The components and yields of the targeted samples were varied according to the species. Major components of the oils were α-pinene (20.5-34.1 %), β-pinene (1.4-53.0 %), δ-3-carene (0.2-47.0 %), limonene (1.7-13.4 %), β-phellandrene (0.2-23.4 %), β-myrcene (1.8-7.2 %) and α-terpinolene (0.6-7.9 %). The extracted EOs showed strong α-glucosidase inhibitory activity, which was close to the positive control, acarbose. This study showed that the EOs of Pinus species may be used as natural antidiabetic.

Modeling and analysing the barriers to the acceptance of energy-efficient appliances using an ISM-DEMATEL approach

Purpose

Electricity savings from energy-efficient appliances (EEAs) may have a significant impact on reducing global warming. There are several barriers confronted by EEAs, which have lowered their acceptance rate. The current study aims to identify and highlight key barriers to strengthening domestic sector adoption of EEAs in developing countries.

Design/methodology/approach

In the current study, 13 barriers were discovered by an in-depth literature review and the judgement of experts as well. Further, integrated “interpretive structural modeling” (ISM) and “decision-making trial and evaluation laboratory” (DEMATEL) approaches are used to evaluate barriers. The ISM technique is implemented to categorize barriers into distinct hierarchy levels and “cross-impact matrix multiplication applied to classification” (MICMAC) analysis to divide barriers among four clusters “independent, linkage, dependent and autonomous.” Moreover, the DEMATEL methodology is applied to classify the barriers among cause and effect clusters.

Findings

The integrated ISM and DEMATEL approach suggests that the topmost influencing barriers to the acceptance of EEAs are the lack of Government policies and initiatives, lack of attractive loan financing and subsidized energy prices.

Practical implications

This study would help researchers, regulators, producers, policymakers and consumers to comprehend the need for additional developments and understand that the adoption of EEAs is a current need. Overall, the results of this study expedite stakeholders with the key barriers that may assist to enhance the acceptance of EEAs within the domestic sector.

Originality/value

An extensive literature survey showed a dearth of studies for the identification, modeling and analysis of barriers collectively. Therefore, the current work used the ISM and DEMATEL approaches to fill the gap and to provide more comprehensive knowledge on barriers related to the acceptance of EEA.

Hypercalcemia in Urological Malignancies: A Review

Hypercalcemia is an uncommon occurrence in urological malignancies except for renal cell carcinoma. However, when seen, it is usually associated with advanced disease and both the osteolytic as well as humoral mechanisms may be causative.

Owing to its rarity, hypercalcemia can be easily missed during the initial evaluation of a patient with urologic malignancy.

Our article aims to highlight the mechanisms associated with hypercalcemia in malignancy, in general, and review the available literature on hypercalcemia in urological malignancies. We also aim to discuss the management options in case of such an unusual occurrence in any urological cancer.

Antiplasmodial diterpenoid alkaloid from Aconitum heterophyllum Wall. ex Royle: Isolation, characterization, and UHPLC-DAD based quantification

ETHNOPHARMACOLOGICAL RELEVANCE

Aconitum heterophyllum Wall. ex Royle is a traditionally important medicinal plant having numerous therapeutic actions as documented in Ayurveda. This plant is traditionally known for combating worm infestation, fever, respiratory tract disease, vomiting, diarrhoea, diabetes, skin disorders, anaemia, and joint disorders. Further, it has been used alone and in combination with other plants to prepare various anti-malarial formulations. However, there is no report on the assessment of its anti-plasmodial activity, and the metabolite(s) responsible for this activity.

AIM OF THE STUDY

The main aim of this study was to conduct phytochemical investigation of A. heterophyllum roots for the preparation of extract, fractions, and isolation of pure molecules to identify active fractions/molecules responsible for the anti-plasmodial activity, and development of UHPLC-DAD based analytical method which can be used for the quantification of marker compounds in the extracts and fractions.

MATERIALS AND METHODS

Hydroalcoholic extract (1:1 v/v) and fractions (n-hexane, chloroform, ethyl acetate, n-butanol, and water) were prepared from the dried powdered roots of A. heterophyllum. Fractions were further subjected to silica gel column chromatography to isolate pure specialized secondary metabolites from this plant. All extracts, fractions, and pure molecules were evaluated against the chloroquine resistant Pf INDO and chloroquine sensitive Pf3D7 strains in culture for calculating their IC₅₀ values. UHPLC-DAD based analytical method was also developed for the first time for the quantification of marker compounds and quality assessment of this commercially important Himalayan medicinal plant.

RESULTS

Phytochemical investigation of A. heterophyllum root led to the isolation of six specialized metabolites viz. 2-O-cinnamoyl hetisine (1), atisinium (2), 4-oxabicyclo [3.2.2] nona-1(7),5,8-triene (3), atisinium cinnamate (4), aconitic acid (5), and atisinium formate (6). Compound 1 is a new hetisine type diterpenoid alkaloid, compounds 4 and 6 are new counter ionic forms observed with atisinium ion, and compound 3 is being reported for the first time from this genus. Chloroform fraction was found to be the most active with IC₅₀ (μg/mL) 1.01 (Pf INDO) and 1.32 (Pf3D7). The molecule 2-O-cinnamoyl hetisine (1), a new diterpenoid alkaloid isolated from chloroform fraction, showed promising antiplasmodial activities with IC₅₀ (μM) 1.92 (Pf INDO) and 10.8 (Pf 3D7). The activity of chloroform fraction was further validated by the developed UHPLC-DAD based method as the quantity of 2-O-cinnamoyl hetisine (1) was higher in the chloroform fraction (≅200 mg/g) than in all other fractions (<7 mg/g). Atisinium (2) and 2-O-cinnamoyl hetisine (1) were found to be the main marker compounds of this plant based on quantity and antiplasmodial activity, respectively.

CONCLUSION

This study provides the scientific rationale for the traditional use of this plant in treating malaria. Further, this study revealed that the anti-malarial potential of this plant might be due to the presence of diterpenoid alkaloids.

Subcutaneouscardiac Rhythm Monitors: A Comprehensive Review

Subcutaneous loop recorders (SCRMs) are subcutaneous electronic devices which have revolutionized the field of arrhythmia detection. They have become increasingly appealing due to advances such as miniaturization of device, longer battery life, bluetooth capabilities and relatively simple implantation technique without the need for complex surgical suites. They can be implanted in the office, patient bedside without the need to go to the operating room. One of the most common indications for their implantation is detection of atrial fibrillation (AF) after a cryptogenic stroke. They have also been utilized for assessing the success of rhythm control strategies such post pulmonary venous isolation. More recently studies have assessed the utility of SCRMs for detecting silent AF in at risk populations such as patients with sleep apnea or those on hemodialysis. In this paper, we review the evolution of SCRMs, the clinical studies assessing their value for different indications, their role incurrent clinical practice and future avenues in the era of smart wearable devices like apple watch etc.

Disparities in case frequency and mortality of coronavirus disease 2019 (COVID-19) among various states in the United States

OBJECTIVE

To utilize publicly reported, state-level data to identify factors associated with the frequency of cases, tests, and mortality in the USA.

MATERIALS AND METHODS

Retrospective study using publicly reported data collected included the number of COVID-19 cases, tests and mortality from March 14th through April 30th. Publicly available state-level data was collected which included: demographics comorbidities, state characteristics and environmental factors. Univariate and multivariate regression analyses were performed to identify the significantly associated factors with percent mortality, case and testing frequency. All analyses were state-level analyses and not patient-level analyses.

RESULTS

A total of 1,090,500 COVID-19 cases were reported during the study period. The calculated case and testing frequency were 3332 and 19,193 per 1,000,000 patients. There were 63,642 deaths during this period which resulted in a mortality of 5.8%. Factors including to but not limited to population density (beta coefficient 7.5, p < .01), transportation volume (beta coefficient 0.1, p < .01), tourism index (beta coefficient -0.1, p = .02) and older age (beta coefficient 0.2, p = .01) are associated with case frequency and percent mortality.

CONCLUSIONS

There were wide variations in testing and case frequencies of COVID-19 among different states in the US. States with higher population density had a higher case and testing rate. States with larger population of elderly and higher tourism had a higher mortality. Key messages There were wide variations in testing and case frequencies of COVID-19 among different states in the USA. States with higher population density had a higher case and testing rate. States with larger population of elderly and higher tourism had a higher mortality.

Deep Learning and Particle Swarm Optimisation-Based Techniques for Visually Impaired Humans' Text Recognition and Identification

Blind people can benefit greatly from a system capable of localising and reading comprehension text embedded in natural scenes and providing useful information that boosts their self-esteem and autonomy in everyday situations. Regardless of the fact that existing optical character recognition programmes seem to be quick and effective, the majority of them are not able to correctly recognise text embedded in usual panorama images. The methodology described in this paper is to localise textual image regions and pre-process them using the naïve Bayesian algorithm. A weighted reading technique is used to generate the correct text data from the complicated image regions. Usually, images hold some disturbance as a result of the fact that filtration is proposed during the early pre-processing step. To restore the image's quality, the input image is processed employing gradient and contrast image methods. Following that, the contrast of the source images would be enhanced using an adaptive image map. The stroke width transform, Gabor’s transform, and weighted naïve Bayesian classifier methodologies have been used in complicated degraded images to segment, feature extraction, and detect textual and non-textual elements. Finally, to identify categorised textual data, the confluence of deep neural networks and particle swarm optimisation is being used. The text in the image is transformed into an acoustic output after identification. The dataset IIIT5K is used for the development portion, and the performance of the suggested come up is evaluated using parameters such as accuracy, recall, precision, and F1-score.

Modeling and analysis of barriers in controlling TB: developing countries' perspective

Purpose

Tuberculosis (TB) continues to c-exist with humans despite many TB control programs and elimination strategies. This depicts that some barriers are not allowing achieving the desired results. The current study aims to focus on identification and ranking of such barriers to facilitate TB control programs in developing countries.

Design/methodology/approach

In the present study, 13 barriers that can influence success rate of TB elimination strategies have been recognized with an in-depth assessment of related literature and opinions of specialists from medical industry and academic world. The interpretive structural modeling (ISM) and decision-making trial and evaluation laboratory (DEMATEL) techniques have been employed for the ranking of barriers.

Findings

Based on driving power of barriers, the study coined that underinvestment is a major barrier followed by poor implementation of government policies and programs, poverty and poor primary health care infrastructure.

Research limitations/implications

The findings may guide healthcare service providers and researchers in analyzing the barriers and understanding the necessity of further advancements to decrease the count of already existing and incident cases.

Practical implications

Policy- and decision-makers may utilize the information on dependence and driving power of barriers for better planning and effective execution of TB control strategies.

Originality/value

Although a lot of literature is available on different barriers that are affecting success of TB strategies, the current study analyzes all the key barriers collectively for the prioritization of barriers.

Serum biomarkers for prediction of mortality in patients with COVID-19

BACKGROUND

There is limited information regarding the role of biomarker levels at predicting mortality in patients with the coronavirus disease (COVID-19) pandemic. The purpose of this study is to determine the differences in serum biomarker levels in adults with COVID-19 who survived hospitalization from those who did not.

METHODS

A comprehensive search was completed on PubMed, EMBASE and Cochrane libraries to identify studies of interest. Endpoints of interest were blood counts, hepatic function test, acute phase reactants, cytokines and cardiac biomarkers.

RESULTS

A total of 10 studies with 1584 patients were included in the pooled analyses. Biomarkers that were noted to be significantly higher in those who died from coronavirus disease included: white blood cell count, neutrophil count, C-reactive protein, high sensitivity C-reactive protein, procalcitonin, ferritin, D-dimer, interleukin-6, lactate dehydrogenase, creatine kinase, prothrombin time, aspartate aminotransferase, alanine aminotransferase, total bilirubin and creatinine. Lymphocyte count, platelet count and albumin were significantly lower in patients who died.

CONCLUSION

This pooled analysis of 10 studies including 1584 patients identified significant differences in biomarkers on admission in patients who survived from those who did not. Further research is needed to develop risk stratification models to help with judicious use of limited health-care resources.

Primary renal Ewing's sarcoma in an adult: an enigma

Objectives

Extraskeletal Ewing’s sarcoma is a rarity, with a renal primary in an adult, being even rarer. There is no consensus on the optimal imaging modality, as well as best therapeutic option, making them an enigma for clinicians.

Case presentation

We report the case of a 34-year-old lady, a known case of invasive lobular carcinoma of the left breast (ER,PR positive, Her2neu negative), having completed treatment in 2017, wherein, on an ultrasound evaluation for left flank pain, was incidentally found to have a left renal mass. A CT scan corroborated with the ultrasound, with an additional Level 1, left renal vein thrombus. She underwent an open left radical nephrectomy with renal vein thrombectomy. Histopathology of the resected tumor revealed features of Ewing’s sarcoma of the kidney, confirmed by Fluorescent In Situ Hybridisation (FISH) and Immunohistochemistry (IHC).

Conclusion

Primary renal Ewing’s sarcoma in an adult is a rare occurrence, with no characteristic imaging features, and no universally accepted guideline based management protocols. Akin with standard Ewings sarcoma treatment strategies, a margin negative- radical nephrectomy with adjuvant chemotherapy, seems the most apt treatment strategy.

Temporal Trends, Predictors, and Outcomes of Acute Ischemic Stroke in Acute Myocardial Infarction in the United States

Background

There are limited contemporary data prevalence and outcomes of acute ischemic stroke (AIS) complicating acute myocardial infarction (AMI).

Methods and Results

Adult (>18 years) AMI admissions using the National Inpatient Sample database (2000–2017) were evaluated for in‐hospital AIS. Outcomes of interest included in‐hospital mortality, hospitalization costs, length of stay, discharge disposition, and use of tracheostomy and percutaneous endoscopic gastrostomy. The discharge destination was used to classify survivors into good and poor outcomes. Of a total 11 622 528 AMI admissions, 183 896 (1.6%) had concomitant AIS. As compared with 2000, in 2017, AIS rates increased slightly among ST‐segment–elevation AMI (adjusted odds ratio, 1.10 [95% CI, 1.04–1.15]) and decreased in non–ST‐segment–elevation AMI (adjusted odds ratio, 0.47 [95% CI, 0.46–0.49]) admissions (P<0.001). Compared with those without, the AIS cohort was on average older, female, of non‐White race, with greater comorbidities, and higher rates of arrhythmias. The AMI‐AIS admissions received less frequent coronary angiography (46.9% versus 63.8%) and percutaneous coronary intervention (22.7% versus 41.8%) (P<0.001). The AIS cohort had higher in‐hospital mortality (16.4% versus 6.0%; adjusted odds ratio, 1.75 [95% CI, 1.72–1.78]; P<0.001), longer hospital length of stay, higher hospitalization costs, greater use of tracheostomy and percutaneous endoscopic gastrostomy, and less frequent discharges to home (all P<0.001). Among AMI‐AIS survivors (N=153 318), 57.3% had a poor functional outcome at discharge with relatively stable temporal trends.

Conclusions

AIS is associated with significantly higher in‐hospital mortality and poor functional outcomes in AMI admissions.

A Profile of Heart Failure with Preserved Ejection Fraction in a Teaching Hospital

Objective: Heart failure with preserved ejection fraction (HFPEF) is fast becoming animportant public health issue. Nearly fifty percent of all heart failure cases are due to HFPEF.There are many associated comorbidities has been associated with this condition which maybe pathophysiologically related. There is no specific treatment yet. The focus remains onsymptomatic treatment of heart failure along with carefully managing the associated conditions.The present study was aimed at analyzing the comorbidities in HFPEF in a tertiary care centre. Method: Patient diagnosed with heart failure wereechocardiographically analyzed. Thoseshowing diastolic dysfunction on tissue Doppler imaging were diagnosed as HFPEF. Patientswith chronic obstructive pulmonary disease, valvular heart disease, constrictive pericarditis,restrictive/ hypertrophic cardiomyopathy and sepsis related diastolic dysfunction were excluded.One hundred such patients fulfilling the inclusion and exclusion criteria were enrolled. Plasma Btype natriuretic peptide(BNP) level was assayed in all participants. Institutional Ethics Committeeapproval was taken beforehand. Written informed consent was taken from each patient. Result: The mean age of the patients in the study group was 63.06yrs. HFPEF was more commonin females(62%). The common comorbidities observed were hypertension(82%), high bodymass index (80%),anaemia (76%), hyperlipidemia (30%) diabetes mellitus(28%). The plasmaBNP was elevated in all except 2 patients. The BNP level was higher in those with higherleft atrial size and those showing more severe diastolic dysfunction on tissue doppler imaging.Conclusion- HFPEF can be diagnosed clinically with the help of echocardiography. Plasma BNPlevel assay may be done when diagnosis is in doubt. The patients with HfpEf are heterogeneousand treatment need to be individualized depending on the associated comorbidities. Furtherstudies with larger sample size are required to define the profile of this disease. Bangladesh Journal of Medical Science Vol.20(1) 2021 p.39-44

Factors associated with deep venous thrombosis in patients infected with coronavirus disease 2019: a meta-analysis

Coronavirus disease 2019 (COVID-19) has affected more than 6 million patients worldwide. Deep venous thrombosis (DVT) has been increasingly recognized complication in these patients and is associated with increased morbidity and mortality. However, the factors associated with development of DVT in patients with COVID-19 have not been elucidated due to the novelty of the virus. We performed a meta-analysis of published studies comparing laboratory results in COVID-19 patients with and without DVT with the aim of identifying risk factors. We searched major databases for studies evaluating DVT in COVID-positive patients and performed a meta-analysis of baseline laboratory markers associated with development of DVT. A total of six studies with 678 patients were included in the pooled analyses. Of the 678 patients, 205 of patients had a DVT. Patients diagnosed with DVT were more likely to be older [mean difference 4.59 years, 95% confidence interval (CI) 1.25-7.92], and needing admission to ICU (relative risk 1.96, 95% CI 1.09-3.51). Patients with DVT had significantly higher white cell count (mean difference 1.36 × 109/l, 95% CI 0.33-2.40) and d-dimer levels (mean difference 3229.8, 95% CI 1501.5-4958.1). Lymphocyte count was lower in patients with DVT (mean difference -0.19 × 109/l, 95% CI -0.37 to -0.02). Patients with COVID-19 who develop DVT are more likely to be older and have leukocytosis with lymphopenia. Moreover, d-dimer is statistically higher and patients that are admitted to the ICU are at great risk to develop DVT.

Perioperative pharmacotherapy to prevent cardiac complications in patients undergoing noncardiac surgery

Introduction: Despite advances in surgical and anesthetic techniques, perioperative cardiovascular complications are a major cause of 30-day perioperative mortality. Major cardiovascular complications after noncardiac surgery include myocardial ischemia, congestive heart failure, arrhythmias, and cardiac arrest. Along with surgical risk assessment, perioperative medical optimization can reduce the rates and clinical impact of these complications.Areas Covered: In this review, the authors discuss the pharmacological basis, existing evidence, and professional society recommendations for drug management in preventing cardiovascular complications in patients undergoing noncardiac surgery.Expert opinion: Perioperative management of cardiovascular disease is an increasingly important and growing area of clinical practice. Societal guidelines regarding the use of most routine cardiovascular medications are based on a number of large clinical studies and provide a basic foundation to guide management. However, the heterogeneous nature of patients, as well as surgeries, makes it practically impossible to devise a 'one size fits all' recommendation in this setting. Thus, the importance of a more individualized approach to perioperative risk stratification and management is being increasingly recognized. The underlying comorbidities and cardiac profile as well as the risk of cardiac complications associated with the planned surgery must be factored in to understand the nuance of the management strategies.

Cohorting to isolate asymptomatic spreaders: An agent-based simulation study on the Mumbai Suburban Railway

The Mumbai Suburban Railways, locals, are a key transit infrastructure of the city and is crucial for resuming normal economic activity. Due to high density during transit, the potential risk of disease transmission is high, and the government has taken a wait and see approach to resume normal operations. To reduce disease transmission, policymakers can enforce reduced crowding and mandate wearing of masks. Cohorting - forming groups of travelers that always travel together, is an additional policy to reduce disease transmission on locals without severe restrictions. Cohorting allows us to: (i) form traveler bubbles, thereby decreasing the number of distinct interactions over time; (ii) potentially quarantine an entire cohort if a single case is detected, making contact tracing more efficient, and (iii) target cohorts for testing and early detection of symptomatic as well as asymptomatic cases. Studying impact of cohorts using compartmental models is challenging because of the ensuing representational complexity. Agent-based models provide a natural way to represent cohorts along with the representation of the cohort members with the larger social network. This paper describes a novel multi-scale agent-based model to study the impact of cohorting strategies on COVID-19 dynamics in Mumbai. We achieve this by modeling the Mumbai urban region using a detailed agent-based model comprising of 12.4 million agents. Individual cohorts and their inter-cohort interactions as they travel on locals are modeled using local mean field approximations. The resulting multi-scale model in conjunction with a detailed disease transmission and intervention simulator is used to assess various cohorting strategies. The results provide a quantitative trade-off between cohort size and its impact on disease dynamics and well being. The results show that cohorts can provide significant benefit in terms of reduced transmission without significantly impacting ridership and or economic & social activity.

Using Mobility Data to Understand and Forecast COVID19 Dynamics

Disease dynamics, human mobility, and public policies co-evolve during a pandemic such as COVID-19. Understanding dynamic human mobility changes and spatial interaction patterns are crucial for understanding and forecasting COVID-19 dynamics. We introduce a novel graph-based neural network(GNN) to incorporate global aggregated mobility flows for a better understanding of the impact of human mobility on COVID-19 dynamics as well as better forecasting of disease dynamics. We propose a recurrent message passing graph neural network that embeds spatio-temporal disease dynamics and human mobility dynamics for daily state-level new confirmed cases forecasting. This work represents one of the early papers on the use of GNNs to forecast COVID-19 incidence dynamics and our methods are competitive to existing methods. We show that the spatial and temporal dynamic mobility graph leveraged by the graph neural network enables better long-term forecasting performance compared to baselines.

Diabetes mellitus association with coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis

Highlights There are ~ 2-fold increased odds of severe coronavirus disease 2019 (COVID-19) and a ~ 2-fold increased risk of odds of mortality in patients with history of diabetes mellitus compared to those without diabetes mellitus. Patients with a history of diabetes mellitus should be closely monitored if they get infected with COVID-19. Results of meta-analysis showing association of diabetes mellitus with severity (Panel A) of disease and mortality (Panel B) in coronavirus disease 2019 (COVID-19) patients.

Interplay of global multi-scale human mobility, social distancing, government interventions, and COVID-19 dynamics

This work quantifies mobility changes observed during the different phases of the pandemic world-wide at multiple resolutions -- county, state, country -- using an anonymized aggregate mobility map that captures population flows between geographic cells of size 5 km ² . As we overlay the global mobility map with epidemic incidence curves and dates of government interventions, we observe that as case counts rose, mobility fell and has since then seen a slow but steady increase in flows. Further, in order to understand mixing within a region, we propose a new metric to quantify the effect of social distancing on the basis of mobility.Taking two very different countries sampled from the global spectrum, We analyze in detail the mobility patterns of the United States (US) and India. We then carry out a counterfactual analysis of delaying the lockdown and show that a one week delay would have doubled the reported number of cases in the US and India. Finally, we quantify the effect of college students returning back to school for the fall semester on COVID-19 dynamics in the surrounding community. We employ the data from a recent university outbreak (reported on August 16, 2020) to infer possible R _eff values and mobility flows combined with daily prevalence data and census data to obtain an estimate of new cases that might arrive on a college campus. We find that maintaining social distancing at existing levels would be effective in mitigating the extra seeding of cases. However, potential behavioral change and increased social interaction amongst students (30% increase in R _eff ) along with extra seeding can increase the number of cases by 20% over a period of one month in the encompassing county. To our knowledge, this work is the first to model in near real-time, the interplay of human mobility, epidemic dynamics and public policies across multiple spatial resolutions and at a global scale.

Medical education focus in published articles related to COVID-19

OBJECTIVE

The ongoing pandemic of Coronavirus Disease 2019 (COVID-19) has affected >2 million patients with approximately 900,000 cases in the United States alone. Medical education has possibly suffered during this time, due to disease mitigation strategies and stress on both students and teachers. We aimed to quantify the publications describing the impact of COVID-19 on medical education in the early stage of the pandemic.

MATERIALS AND METHODS

Abstract and titles related to COVID-19 listed in PubMed were reviewed for an educational focus. Articles with an educational focus were further evaluated for characteristics of content.

RESULTS

Out of a total of 3641 articles related to COVID-19, only 26 (0.7%) articles had an educational theme. Thirteen articles were pertaining to residency and fellowship education and twelve articles were focused on medical student education. Only one article referred to nursing education.

CONCLUSIONS

Publications pertaining to medical education during the ongoing COVID-19 pandemic are few. There is an urgent need for scholarship to understand the best processes and develop innovative methods that can help improve the educational experience of students and trainees during this extraordinary time.

Acute myocardial infarction in the young with diabetes mellitus- national inpatient sample study with sex-based difference in outcomes

BACKGROUND

Mortality after AMI is on the decreasing trend; however, this favorable trend is not observed in the young, especially women. Therefore, we conducted a retrospective analysis using the Nationwide Inpatient Sample (NIS) to identify sex-based outcomes following AMI in young with diabetes.

METHODS

NIS 2010-2014 was used to identify all patients with AMI using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Men (N = 30,950) and women (N = 17,928) patients diagnosed with diabetes were identified and stratified as young if age >18 and <45 years.

RESULTS

Young women with AMI and concomitant diabetes having a higher burden of overall traditional and non-traditional comorbidities. NSTEMI was the major presentation in women as compared to men. Young women with AMI and concomitant diabetes were less likely to receive revascularization with PCI [51.1% vs. 58.2%; OR 0.86, CI 0.78-0.94] or CABG [7.9% vs. 10.1%; OR 0.64, CI 0.54-0.75]. Adjusted all-cause in-hospital mortality did not differ significantly between the two groups [OR 1.06, CI 0.74-1.52]. Women had lower odds of developing cardiogenic shock, ventricular arrhythmias, and AKI, and were more likely to develop major bleeding requiring transfusion, and mitral regurgitation.

CONCLUSION

There were significant differences between young men and women with diabetes in terms of baseline characteristics and clinical presentation, use of revascularization, and cardiac complications, yet overall, in-hospital mortality does not appear to differ. More studies are needed to identify the interaction of sex and diabetes in young AMI population, and areas for practice improvement.

Cardiovascular Safety of Potential Drugs for the Treatment of Coronavirus Disease 2019

Coronavirus disease 2019 (COVID-19) has become a global pandemic. It is still uncontrolled in most countries and no therapies are currently available. Various drugs are under investigation for its treatment. The disease is known to have worse outcomes in patients who have underlying cardiovascular disease. Chloroquine/hydroxychloroquine, azithromycin, remdesivir and lopinavir/ritonavir are currently being studied in trials and show some promise. Conduction disorders, heart failure, and mortality have been reported with the use of these drugs. It is important to have knowledge of potential cardiotoxic effects of these drugs before using them for COVID-19 patients for better allocation of healthcare resources and improvement in clinical outcomes.

Representation of specialties in Coronavirus Disease 2019 (COVID-19) research: analysis of published literature in the first 3 months

OBJECTIVE

Coronavirus disease 2019 (COVID-19) has infected more than 1.5 million patients worldwide and is associated with high morbidity and mortality. The volume of research published in a specialty, which may shed light on the perceived impact that a topic plays within that discipline, is unknown for the present pandemic.

MATERIALS AND METHODS

We analyzed all articles published in the first 3 months on COVID-19 and categorized them by journal type and article content.

RESULTS

There was a ~100-fold difference in articles published on COVID when categorized by journal type and ~65-fold difference when grouped by article content.

CONCLUSIONS

There is a wide variation in research published withing various specialties regarding COVID-19. Researchers across specialties need to urgently realize the impact of COVID-19 and publish articles that can help improve understanding of this ongoing pandemic.

Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis

Coronavirus disease 2019 (COVID-19) infection has now reached a pandemic state, affecting more than a million patients worldwide. Predictors of disease outcomes in these patients need to be urgently assessed to decrease morbidity and societal burden. Lactate dehydrogenase (LDH) has been associated with worse outcomes in patients with viral infections. In this pooled analysis of 9 published studies (n = 1532 COVID-19 patients), we evaluated the association between elevated LDH levels measured at earliest time point in hospitalization and disease outcomes in patients with COVID-19. Elevated LDH levels were associated with a ~6-fold increase in odds of developing severe disease and a ~16-fold increase in odds of mortality in patients with COVID-19. Larger studies are needed to confirm these findings.

Clinical features, laboratory characteristics, and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19): Early report from the United States

Background Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV2), is an ongoing pandemic that has already affected millions of patients worldwide, and is associated with significant morbidity and mortality burden. Although the clinical and laboratory characteristics of this illness have been reported in patients from China and Europe, data are scant in the United States. Methods We extracted data regarding all patients hospitalized at our hospital with COVID-19 infection between March 1 and April 4, 2020. Presenting signs and symptoms, laboratory and imaging findings, treatment, and complications were recorded from electronic medical records (EMRs). The primary composite endpoint was admission to intensive care unit (ICU), shock, or death. Results We had a total of 43 patients tested for COVID-19 at the emergency room (ER) or during hospitalization, 16 (37%) of whom were admitted with COVID-19 infection. The mean age was 65.5 years and 75% were males. The most common presenting symptoms were fever (94%), cough (88%), and dyspnea (81%). A loss of smell and taste sensations were reported by three (19%) patients. Low oxygen saturation was present in 38% of patients, whilst 31% were hypotensive on admission. Hyponatremia (50%), elevated C-reactive protein (CRP; 100%), and lactate dehydrogenase (LDH; 80%) were common. Acute renal failure, myocardial injury, and elevation in aminotransferases occurred in 69%, 19%, and 38% patients, respectively. The primary composite endpoint occurred in 50% of patients. A total of three patients died; all were aged 70 years or older. Conclusions Laboratory abnormalities and acute renal failure were common in hospitalized patients with SARS-CoV2 infection in our center. Admission to ICU and mechanical ventilation were common.

Association of Cardiovascular Disease With Coronavirus Disease 2019 (COVID-19) Severity: A Meta-Analysis

Observational studies have reported an association between underlying cardiovascular diseases (CVD) and worse prognosis in COVID-19 patients, but this still remains unclear. We conducted a meta-analysis of recent studies that reported the association of CVD with worse prognosis and increased mortality in COVID-19 patients. Literature search through PubMed, the Cochrane Library, and Embase was completed by 2 reviewers from November 1, 2019 to April 20, 2020. Inclusion criteria were observational case-control or cohort studies on COVID-19 patients with a history of CVD included, which reported outcomes of COVID-19 infection severity, clearly outlined the definition of “severe disease” and with sample size >10. Data were abstracted independently by 2 authors. Studies were divided into 2 separate cohorts for analysis: severity (severe vs nonsevere) and mortality (nonsurvivors vs survivors). Data was pooled into a meta-analysis to estimate pooled odds ratio (OR) with 95% confidence interval (95% CI) for each outcome. A total of 18 studies (n = 4858 patients) were included. Sixteen studies were from China, while 2 were from the United States. Pre-existing CVD was associated with a significantly increased risk of a severe form of COVID-19 (OR = 3.14; 95% CI 2.32-4.24; I² = 0%; Q = 8.68, P= 0.73) and overall risk of COVID-19 all-cause mortality (OR = 11.08; 95% CI: 2.59-47.32; I² = 55%; P = 0.11). However, this study did not find a significant association between previous history of CVD and mortality in severe COVID-19 disease (OR = 1.72; 95% CI: 0.97-3.06, I² = 0%, P = 0.46). Pre-existing CVD is associated with worse outcomes among patients with COVID-19. Clinicians and policymakers need to take account of these findings in implementing risk stratification models.

Cerebrovascular disease is associated with an increased disease severity in patients with Coronavirus Disease 2019 (COVID-19): A pooled analysis of published literature

INTRODUCTION

There is an urgent need to identify patients at high risk during the ongoing coronavirus disease (COVID-19) pandemic. Whether a history of stroke is associated with increased severity of disease or mortality is unknown.

METHOD

We pooled studies from published literature to assess the association of a history of stroke with outcomes in patients with COVID-19.

RESULTS

A pooled analysis of 4 studies showed a ∼2.5-fold increase in odds of severe COVID-19. While a trend was observed, there was no statistically significant association of stroke with mortality in patients with COVID-19 infection.

DISCUSSION

Our findings are limited by a small number of studies and sample size.

CONCLUSION

There is a ∼2.5-fold increase in odds of severe COVID-19 illness with a history of cerebrovascular disease.

Comparisons of Speech Parameterisation Techniques for Classification of Intellectual Disability Using Machine Learning

Classification of intellectually disabled children through manual assessment of speech at an early age is inconsistent, subjective, time-consuming and prone to error. This study attempts to classify the children with intellectual disabilities using two speech feature extraction techniques: Linear Predictive Coding (LPC) based cepstral parameters, and Mel-frequency cepstral coefficients (MFCC). Four different classification models: k-nearest neighbour (k-NN), support vector machine (SVM), linear discriminant analysis (LDA) and radial basis function neural network (RBFNN) are employed for classification purposes. 48 speech samples of each group are taken for analysis, from subjects with a similar age and socio-economic background. The effect of the different frame length with the number of filterbanks in the MFCC and different frame length with the order in the LPC is also examined for better accuracy. The experimental outcomes show that the projected technique can be used to help speech pathologists in estimating intellectual disability at early ages.