Managing COVID in Homecare – Approach to Treatment, Monitoring, and Follow-up by the Family Physician.

Introduction: The 2nd wave of COVID caused an unprecedented burden on health care workers and resources, calling for structured and effective management of most COVID patients in-home care by general and family physicians via digital and virtual monitoring. Methodology: A systematic treatment approach evolved from COVID diagnosis, homecare determination and isolation, oxygen saturation and temperature monitoring documentation, guidance on proning and breathing techniques, diet and lifestyle measures, evaluating comorbidities, and prescribing appropriate medicines. Timely decision making and stratification to assess disease course and need for hospitalization based on meticulous monitoring, clinical signs and appropriate tests were followed. A balanced approach avoiding unnecessary medication and tests, and allaying panic resulting from multiple information sources, was the novel challenge for physicians. Post-COVID follow up was done for three months. Results: The recovery rate in homecare with this approach was 97%, with only 11% needing corticosteroids in the second week. The need for hospitalization was in 3%. In the first month, > 90% had post-COVID symptoms, mainly lower energy, fatigue, weakness, reduced smell/taste and reduced work capacity. However, by the 3rd month, this reduced to 33%, with only 6% showing symptoms beyond three months. Management was conservative in the majority. Conclusion: A systematic and rational approach to treating, monitoring and managing COVID patients at home can enable better care and recovery and limit unnecessary hospitalization. Diet and lifestyle measures, documentation of oxygen saturation and temperature monitoring, proning and breathing techniques, and psychological support are of great importance that aid recovery and enable sound clinical evaluation

Efficacy and safety of dabigatran in prevention of venous thromboembolism in patients undergoing major orthopedic surgeries: a review

Thromboprophylaxis with anticoagulants can significantly reduce the risk of patients developing symptomatic deep vein thrombosis (DVT), pulmonary embolism (PE) and VTE related mortality post major orthopedic surgeries like total hip and knee replacement surgeries. Dabigatran, a directly acting oral anticoagulant (DOAC) and direct thrombin inhibitor, is an available option for VTE prophylaxis having comparable efficacy to low molecular weight heparins (LMWH), other DOACs and Warfarin, once daily dosing, and comparable safety and bleeding risk to both LMWH and Aspirin. Dabigatran is currently the only DOAC with an available and marketed reversing agent. A review of Dabigatran’s clinical efficacy and safety is presented here. Therefore, Dabigatran represents a balanced thromboprophylaxis option for VTE prevention in patients undergoing major orthopedic surgeries.

A SINFONI Integral Field Spectroscopy Survey for Galaxy Counterparts to Damped Lyman-alpha Systems - III. Three Additional Detections

We report three additional SINFONI detections of H-alpha emission line from quasar absorbers, two of which are new identifications. These were targeted among a sample of systems with log N(HI)>19.0 and metallicities measured from high-resolution spectroscopy. The detected galaxies are at impact parameters ranging from 6 to 12 kpc from the quasar's line-of-sight. We derive star formation rates (SFR) of a few solar masses per year for the two absorbers at z_abs~1 and SFR=17 solar masses per year for the DLA at z_abs~2. These three detections are found among a sample of 16 DLAs and sub-DLAs (5 at z_abs~1 and 7 at z_abs~2). For the remaining undetected galaxies, we derive flux limits corresponding to SFR<0.1--11.0 solar masses per year depending on redshift of the absorber and depth of the data. When combined with previous results from our survey for galaxy counterparts to HI-selected absorbers, we find a higher probability of detecting systems with higher metallicity as traced by dust-free [Zn/H] metallicity. We also report a higher detection rate with SINFONI for host galaxies at z_abs~1 than for systems at z_abs~2. Using the NII/H-alpha ratio, we can thus compare absorption and emission metallicities in the same high-redshift objects, more than doubling the number of systems for which such measures are possible.Comment: 16 pages, 8 figures, accepted for publication in MNRA

Vaccination in Adults with 23 valent Pneumococcal Polysaccharide Vaccine –ABC: Awareness, Benefits and Clinical Aspects

Pneumococcus is an important cause of community acquired pneumonia and the commonest cause of community acquired bacterial pneumonia. It also causes invasive pneumococcal disease that increases hospitalization rates, economic burden, morbidity and mortality. Apart from children below 5 years, adults 65 years or more, and all adults with underlying medical conditions or immunodeficiency are at increased risk of pneumococcal infection. For these adult groups pneumococcal vaccination that includes the 23-valent polysaccharide vaccine (PPSV23) is recommended that has shown to reduce risk of severe pneumococcal pneumonia, invasive pneumococcal disease, hospitalization rates, and mortality. However, awareness and practical implementation of adult pneumococcal vaccination is concerningly low. Surveys, awareness programs, and counseling, at the community level, as well as with physicians in primary care, have shown significant improvements in adult pneumococcal vaccination rates

Synchronizing pharmacotherapy in acne with review of clinical care

Acne is a chronic inflammatory skin disease that involves the pathogenesis of four major factors, such as androgen-induced increased sebum secretion, altered keratinization, colonization of Propionibacterium acnes, and inflammation. Several acne mono-treatment and combination treatment regimens are available and prescribed in the Indian market, ranging from retinoids, benzoyl peroxide (BPO), anti-infectives, and other miscellaneous agents. Although standard guidelines and recommendations overview the management of mild, moderate, and severe acne, relevance and positioning of each category of pharmacotherapy available in Indian market are still unexplained. The present article discusses the available topical and oral acne therapies and the challenges associated with the overall management of acne in India and suggestions and recommendations by the Indian dermatologists. The experts opined that among topical therapies, the combination therapies are preferred over monotherapy due to associated lower efficacy, poor tolerability, safety issues, adverse effects, and emerging bacterial resistance. Retinoids are preferred in comedonal acne and as maintenance therapy. In case of poor response, combination therapies BPO-retinoid or retinoid-antibacterials in papulopustular acne and retinoid-BPO or BPO-antibacterials in pustular-nodular acne are recommended. Oral agents are generally recommended for severe acne. Low-dose retinoids are economical and have better patient acceptance. Antibiotics should be prescribed till the inflammation is clinically visible. Antiandrogen therapy should be given to women with high androgen levels and are added to regimen to regularize the menstrual cycle. In late-onset hyperandrogenism, oral corticosteroids should be used. The experts recommended that an early initiation of therapy is directly proportional to effective therapeutic outcomes and prevent complications

New Insight of Tetraphenylethylene-based Raman Signatures for Targeted SERS Nanoprobe Construction Toward Prostate Cancer Cell Detection

We have designed and synthesized novel tetraphenylethylene (TPE) appended organic fluorogens and unfold their unique Raman fingerprinting reflected by surface-enhanced Raman scattering (SERS) upon adsorption on nanoroughened gold surface as a new insight in addition to their prevalent aggregation-induced emission (AIE) and aggregation-caused quenching (ACQ) phenomena. A series of five TPE analogues has been synthesized consisting of different electron donors such as (1) indoline with propyl (TPE-In), (2) indoline with lipoic acid (TPE-In-L), (3) indoline with Boc-protected propyl amine (TPE-In-Boc), (4) benzothaizole (TPE-B), and (5) quinaldine (TPE-Q). Interestingly, all five TPE analogues produced multiplexing Raman signal pattern, out of which TPE-In-Boc showed a significant increase in signal intensity in the fingerprint region. An efficient SERS nanoprobe has been constructed using gold nanoparticles as SERS substrate, and the TPE-In as the Raman reporter, which conjugated with a specific peptide substrate, Cys-Ser-Lys-Leu-Gln-OH, well-known for the recognition of prostate-specific antigen (PSA). The designated nanoprobe TPE-In-PSA@Au acted as SERS “ON/OFF” probe in peace with the vicinity of PSA protease, which distinctly recognizes PSA expression with a limit of detection of 0.5 ng in SERS platform. Furthermore, TPE-In-PSA@Au nanoprobe was efficiently recognized the overexpressed PSA in human LNCaP cells, which can be visualized through SERS spectral analysis and SERS mapping

Bio-based packaging materials

This chapter summarizes the current state of bio-based materials in food packaging sector. Driven by the increasing needs of sustainability, huge effort has been given to development of new materials that are obtained from renewable sources and can potentially replace petroleum-derived materials on market. A range of main bio-based polymers targeted for food packaging industry are presented focusing on structural properties of bio-based polymers, general processing techniques, main limitations of these materials, and current state on market. Moreover, the chapter examines the new technological approaches in upgrading the properties of bio-based packaging materials to a commercial application, together with potential solutions, as well as discusses the major industry players who are bringing these materials to the market