SARS-CoV-2: comparison of IgG levels at 9 months post second dose of vaccination in COVID-survivor and COVID-naïve healthcare workers

Background: Natural (asymptomatic/symptomatic COVID-19 infection) and artificial (vaccination) exposure to the pathogen represent two modes of acquiring active immunity. No definitive guidelines exist regarding whether COVID-survivors (with infection/re-infection/re-re-infection in the three COVID-19 waves) require a modified vaccination schedule. Most countries are offering a third vaccine dose and many are contemplating a fourth dose. Our aim was to gauge the IgG-antibody levels 9m post second vaccination in healthcare workers (HCW) and compare these with IgG-levels 1m post-vaccination in the same cohort for any decline, and to compare the post-vaccination IgG-levels in COVID-survivors and COVID-naïve HCW at 9m.Methods: This prospective observational single-centric cohort study included 63 HCW of either sex, aged 18-70y who completed 9m post-vaccination. The IgG-titre was tested at 9-10m post second vaccination in COVID-survivors and COVID-naïve HCW.Results: At 1m and 9m post-vaccination IgG-levels in COVID-survivors (23.097±4.58 and 15.103±4.367 respectively; p<0.0001) and COVID-naïve HCW (16.277±6.36 and 9.793±6.928 respectively; p=0.0013) had unequal variance (Welsch test; p=0.0022 at 9m). 9/31 COVID-naïve HCW but none of the 32 COVID-survivors tested COVID-positive in the second wave post second vaccination. 11/31 and 3/32 HCW belonging to the former and latter groups developed COVID-19 in the third wave consequently deferring their third/precautionary vaccination.Conclusions: Although HCW with IgG-levels in all brackets developed COVID-19, the severity of symptoms corresponded with the IgG-levels. COVID-19 is here to stay, but in peaceful co-existence in endemic proportions. Considering evidence that immunity acquired by vaccination/natural infection is ephemeral, re-invention of vaccines to match the ever-mutating virus is foreseen.

Oxide Dispersion Strengthened Nickel Based Alloys via Spark Plasma Sintering

Oxide dispersion strengthened (ODS) nickel based alloys were developed via mechanical milling and spark plasma sintering (SPS) of Ni–20Cr powder with additional dispersion of 1.2 wt% Y2O3 powder. Furthermore, 5 wt% Al2O3 was added to Ni–20Cr–1.2Y2O3 to provide composite strengthening in the ODS alloy. The effects of milling times, sintering temperature, and sintering dwell time were investigated on both mechanical properties and microstructural evolution. A high number of annealing twins was observed in the sintered microstructure for all the milling times. However, longer milling time contributed to improved hardness and narrower twin width in the consolidated alloys. Higher sintering temperature led to higher fraction of recrystallized grains, improved density and hardness. Adding 1.2 wt% Y2O3 to Ni–20Cr matrix significantly reduced the grain size due to dispersion strengthening effect of Y2O3 particles in controlling the grain boundary mobility and recrystallization phenomena. The strengthening mechanisms at room temperature were quantified based on both experimental and analytical calculations with a good agreement. A high compression yield stress obtained at 800 °C for Ni–20Cr–1.2Y2O3–5Al2O3 alloy was attributed to a combined effect of dispersion and composite strengthening

Awareness of Glasgow Coma Scale in anaesthesiology post-graduates in India: A survey

Background: Glasgow Coma Scale (GCS) is a universal clinical means of quantifying the level of impaired consciousness. It has completed 40 years and has stood the test of time. The assessment is best when done by trained personnel. Anaesthesiologists often manage unconscious patients. Thus, they must be well versed with GCS. This survey aimed to assess the awareness of GCS in anaesthesiology post-graduates in India. Methods: A questionnaire-based survey was carried out in 250 anaesthesiology post-graduates attending a refresher course in September 2014. Subjects and Methods: The questionnaire had 14 questions. Four questions were about the respondent, 5 questions on theoretical information and 5 questions on clinical scenarios. The available data were analysed using Epi Info. Results were considered statistically significant when P < 0.05. Results: Response was received from 174 students (response rate: 70%). Ninety percent of students felt that GCS is important in assessing unconscious patients, 94% students used GCS for unconscious patients. Fifty-eight percent of students have been formally trained in GCS. Mean of correct answers to theoretical questions was 3.98 ± 0.71. Mean of correct answers to clinical questions was 3.2 ± 1.24. Difference between the two means is 0.78. This difference is considered to be statistically significant with P < 0.0001. Conclusions: While the post-graduates are well versed with ‘theoretical aspects’ of GCS, they need to strengthen their skills on clinical application. Hence, there is a need for reinforcement of GCS training for anaesthesiology post-graduates

Topical anesthesia

Topical anesthetics are being widely used in numerous medical and surgical sub-specialties such as anesthesia, ophthalmology, otorhinolaryngology, dentistry, urology, and aesthetic surgery. They cause superficial loss of pain sensation after direct application. Their delivery and effectiveness can be enhanced by using free bases; by increasing the drug concentration, lowering the melting point; by using physical and chemical permeation enhancers and lipid delivery vesicles. Various topical anesthetic agents available for use are eutectic mixture of local anesthetics, ELA-max, lidocaine, epinephrine, tetracaine, bupivanor, 4% tetracaine, benzocaine, proparacaine, Betacaine-LA, topicaine, lidoderm, S-caine patch™ and local anesthetic peel. While using them, careful attention must be paid to their pharmacology, area and duration of application, age and weight of the patients and possible side-effects

Novel reversal agents and laboratory evaluation for direct-acting oral anticoagulants (DOAC): An update

Novel oral anticoagulants (NOACs) are no longer “novel” but their reversal agents definitely are. Although NOACs enjoy high clinical efficacy, monitoring and reversal of their effect is a challenge which this review attempts to surmount. Ideally, for NOAC activity measurement, specific anti-Factor IIa levels and anti -Factor Xa levels should be monitored (chromogenic assays), but such tests are not readily available. Modifications of the existing coagulation tests catering to this unmet need for quantification of DOAC activity have been reviewed. The available United States Food and Drug Administration (FDA) approved reversal agents, idarucizumab for dabigatrin and andexanet alfa for anti-Xa direct acting oral anticoagulants have given promising results but are prohibitively priced. Medline, Embase, and Scopus databases were thoroughly searched for clinical trials on laboratory investigations and specific as well as non-specific reversal-agents for DOACs