A review of potential pharmacological treatments of COVID-19: an evidence-based perspective

Coronaviruses (CoVs) typically manifest as mild to severe respiratory tract infections. No drug is approved by US food and drug administration (FDA) for the treatment of patients with coronaviruses infection. With growing COVID-19 pandemic globally, need of hour is to work on potential prophylactic and therapeutic drugs to prevent local and community transmission. A literature search for eligible studies published till March 2020 was conducted in the PubMed, Medline, EMBASE, OVID, and Google Scholar databases by two reviewers. Therapeutic efficacy and safety of different drug regimens targeting treatment pathway acting against corona virus-2019 (COVID-19) were reviewed. Possible mechanism of actions of these potential repurposed drugs against COVID-19 were reviewed to develop effective prevention and treatment strategies. Many potential pharmacological therapies are being studied in various clinical trials. No FDA-approved repurposed drugs have shown safety and efficacy in randomized controlled trials for patients with COVID-19. Vaccines are under development and only few vaccines are under clinical evaluation. This review highlights potential drug actions against COVID-19 and their safety issues. It could help researchers and physicians to use these potential agents judiciously in clinical trials as well as in treatment protocols

Wewnątrznaczyniowe zamknięcie pękniętego tętniaka przeszczepu z odwróconej żyły odpiszczelowej w poddanej zabiegowi naprawczemu przetoce tętniczo-żylnej — kwestie techniczne

A 49-year-old diabetic woman who had end stage renal disease associated with membranous glomerulonephritis, was undergoing dialysis through a left brachiocephalic arteriovenous fistula. After sometime, fistula became infected and stopped functioning. It was closed and arterial segment was resected and repaired with reverse saphenous vein graft. After 6 months interval, she presented with painful, expansile swelling with intermittent bleeding. Arteriogram showed ruptured aneurysm of reverse saphenous vein graft with a proximal venous stenosis. It was successfully closed with 6 × 60 mm Fluency Plus self-expanding vascular stent graft (Bard, Tempe, AZ) with resolution of her symptoms.Kobieta w wieku 49 lat, chora na cukrzycę, w schyłkowym stadium niewydolności nerek związanej z błoniastym zapaleniem kłębuszków nerkowych, była dializowana z dostępu przez przetokę tętniczo-żylną ramienno-odpromieniową po lewej stronie. Po pewnym czasie przetoka przestała działać z powodu zakażenia. Przetokę zamknięto, a segment tętniczy wycięto i zastąpiono przeszczepem z odwróconej żyły odpiszczelowej. Po 6 miesiącach chora zgłosiła się z powodu bólu, znacznego obrzęku i okresowego krwawienia. Arteriogram ukazał pęknięty tętniak przeszczepu z żyły odpiszczelowej ze zwężeniem żyły w odcinku proksymalnym. Pęknięcie zamknięto za pomocą samorozprężalnego stentu naczyniowego Fluency Plus 6 × 60 mm (Bard, Tempe, AZ), co spowodowało ustąpienie objawów

Anti-thrombotics and their impact on inpatient epistaxis management : a tertiary centre experience

Peer reviewedPublisher PD

Factors Influencing Suicidal Behaviour among University Students: A Cross-Sectional Study from North India

In the majority of the affected nations, suicidal behavior against COVID-19 leads to various concerns. This study aimed to analyze determinants affecting suicidal behaviour among university students in Uttarakhand. An online cross-sectional survey of 18-year-old university students in Uttarakhand was conducted between April 2 and May 13, 2022. The questionnaire comprised socio-demographic information, the Suicidal Behaviors’ Questionnaire-Revised (SBQ-R) scale, and elements related to the physical and psychological health of COVID-19 (CRPPF). The statistical study included demographic information, basic statistics in terms of frequency and percentage, and logistic regression. In comparison to students with fewer than seven family members, students with more than seven family members were less likely to participate in suicide behaviour (AOR = 2.21; 95% CI: 1.79 to 2.67) and vice versa (AOR = 0.81; 95% CI: 0.56 to 0.97). According to the study, a substantial majority of students (76.35%) claimed that the lockdown implemented to stop the spread of COVID-19 was extremely upsetting for them and that the pandemic had caused them to miss their graduation (73.90%). Adjusted multivariate logistic regression shows that feelings of a burden on family, (AOR= 1.98, 95% CI: 1.09 to 2.82), distancing from family or friends, (AOR =1.66; 95% CI: 1.26 to 2.01), having relationship dilemmas, (AOR= 2.31; 95% CI: 1.84 to 2.97), and being anxious during the lockdown, (AOR= 1.84; 95% CI: 1.08 to 2.27), are significant factors among participants that are linked to higher risk of engaging in suicidal behaviour. The possibility of university students engaging in suicide behaviour was significantly affected by numerous factors. In addition to defending the students' mental health, the concerned authorities should devise and implement strategies to safeguard the students' physical health

Effect of leader placement on robotic swarm control

Human control of a robotic swarm entails selecting a few in-fluential leaders who can steer the collective efficiently and robustly. However, a clear measure of influence with respect to leader position is not adequately studied. Studies with animal systems have shown that leaders who exert strong couplings may be located in front, where they provide energy benefits, or in the middle, where they can be seen by a larger section of the group. In this paper, we systematically vary number of leaders and leader positions in simulated robotic swarms of two different sizes, and assess their effect on steering effectiveness and energy expenditure. In particular, we analyze the effect of placing leaders in the front, middle, and periphery, on the time to converge and lateral acceleration of a swarm of robotic agents as it performs a single turn to reach the desired goal direction. Our results show that swarms with leaders in the middle and periphery take less time to converge than swarms with leaders in the front, while the lateral acceleration between the three placement strategies is not different. We also find that the time to converge towards the goal direction reduces with the increase in percentage of leaders in the swarm, although this value decays slowly beyond the percentage of leaders at 30%. As the swarm size is increased, we find that the leaders in the periphery become less effective in reducing the time to converge. Finally, closer analysis of leader placement and coverage reveals that front leaders within the swarm tend to expand their coverage and move towards the center as the maneuver is performed. Results from this study are expected to inform leader placement strategies towards more effective human swarm interaction systems

MRI of diffuse liver disease: characteristics of acute and chronic diseases

Diffuse liver disease, including chronic liver disease, affects tens of millions of people worldwide, and there is a growing need for diagnostic evaluation as treatments become more readily available, particularly for viral liver diseases. Magnetic resonance imaging (MRI) provides unique capabilities for noninvasive characterization of the liver tissue that rival or surpass the diagnostic utility of liver biopsies. There has been incremental improvement in the use of standardized MRI sequences, acquired before and after administration of a contrast agent, for the evaluation of diffuse liver disease and the study of the liver parenchyma and blood supply. More recent developments have led to methods for quantifying important liver metabolites, including lipids and iron, and liver fibrosis, the hallmark of chronic liver disease. Here, we review the MRI techniques and diagnostic features associated with acute and chronic liver disease

MRI of diffuse liver disease: the common and uncommon etiologies

Diffuse liver disease, including all causes of chronic liver disease, affects tens of millions of people worldwide. There is a growing need for diagnostic evaluation as treatments become more readily available, particularly for viral liver disease. Magnetic resonance imaging (MRI) provides unique capabilities for noninvasive characterization of liver tissue that rival or surpass the diagnostic utility of liver biopsies. There has been incremental improvement in the use of standardized MRI sequences, acquired before and after administration of contrast for the evaluation of diffuse liver disease, and this includes study of the liver parenchyma and blood supply. More recent developments have led to methods for quantifying important liver metabolites, including fat and iron, and liver fibrosis, which is the hallmark for chronic liver disease. In this study, we review the MRI techniques and diagnostic features associated with common and uncommon etiologies of diffuse liver diseases, including processes that lead to abnormal perfusion (e.g. Budd-Chiari syndrome, congestive hepatomegaly), deposition diseases (e.g. fatty liver, hemochromatosis, Wilson’s disease), and abnormalities that are related to inflammation and fibrosis (e.g. primary sclerosing cholangitis, sarcoidosis)

A dosemetric and radiobiological impact of VMAT and 3DCRT on lumbosacral plexuses, an underestimated organ at risk in cervical cancer patients

Background: The purpose of this study was to evaluate dosimetric and radiobiological difference between volumetric modulated arc therapy (VMAT) and 3-dimensional conformal radiotherapy (3DCRT) in organ at risk (OAR) lumbosacral plexus (LSP) in cervical cancer patients. Materials and methods: 30 patients of cervical cancer who were treated using 3DCRT or VMAT along with chemotherapy followed by brachytherapy were enrolled. LSP was delineated retrospectively. Dosimetric and radiobiological difference was evaluated. Patients were followed for radiation induced lumbosacral plexopathy (RILSP). Results: Median follow-up was 12 months (3–16 months). 53.3% of patients were treated by 3DCRT and 46.7% by VMAT. The mean (±SD) LSP volume: 119.03 ± 15 cm3. The mean volume percentages (%) of the LSP: V5, V10, V20, V30, V40, V50, V55, and V60 were 100%, 99.8%, 99.2%, 94.3%, 84.03%, 59.7%, 0%, 0%, respectively. All patients received doses to the LSP in excess of 50 Gy, one patient received 55 Gy. A statistically significant difference was observed in the median value of V20, V30, V40, V50, D50, P2, P4, P7, P8, P9, and P10 across two different techniques of radiotherapy — VMAT and 3DCRT. None of the patients presented with RILSP. NTCP value was less in VMAT plans compared to 3DCRT, which is also statistically significant. Conclusion: RILSP is a rare and often refractory complication of pelvic radiotherapy. Advance radiotherapy technique with proper OAR delineation and constraint can prevent the occurrence of RILSP. VMAT has potential benefits for the probability of dose reduction in LSP. Further studies are required focusing on dose distribution in LSP–OAR and radiotherapy modality

MRI of hepatocellular carcinoma: an update of current practices

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and liver transplantation is the optimal treatment for selected patients with HCC and chronic liver disease (CLD). Accurate selection of patients for transplantation is essential to maximize patient outcomes and ensure optimized allocation of donor organs. Magnetic resonance imaging (MRI) is a powerful tool for the detection, characterization, and staging of HCC. In patients with CLD, the MRI findings of an arterial-enhancing mass with subsequent washout and enhancing capsule on delayed interstitial phase images are diagnostic for HCC. Major organizations with oversight for organ donor distribution, such as The Organ Procurement and Transplantation Network (OPTN), accept an imaging diagnosis of HCC, no longer requiring tissue biopsy. In patients that are awaiting transplantation, or are not candidates for liver transplantation, localized therapies such as transarterial chemoembolization and radiofrequency ablation may be offered. MRI can be used to monitor treatment response. The purpose of this review article is to describe the role of imaging methods in the diagnosis, staging, and follow-up of HCC, with particular emphasis on established and evolving MRI techniques employing nonspecific gadolinium chelates, hepatobiliary contrast agents, and diffusion weighted imaging. We also briefly review the recently developed Liver Imaging Reporting and Data System (LI-RADS) formulating a standardized terminology and reporting structure for evaluation of lesions detected in patients with CLD