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Background Coronavirus disease-2019 (COVID-19) causes various cardiopulmonary manifestations. Bedside ultrasound helps in the rapid diagnosis of these manifestations. Vscan Extend™ (GE, Wauwatosa, WI, USA) is a handheld ultrasound device with a dual probe and an artificial intelligence application to detect ejection fraction. It can help in reducing the time for diagnosis, duration, and the number of healthcare workers exposed to COVID-19. This is a prospective observational study comparing the cardiorespiratory parameters and time duration for assessment between Vscan Extend™ and the conventional ultrasound machine. Materials and methods Paired observations were made in 96 COVID-19 patients admitted to the intensive care unit by two intensivists. Intensivist A used the Vscan Extend™ device to assess the cardiac function, lung fields, diaphragm, deep veins, and abdomen. Intensivist B used clinical examination, X-ray chest, ECG, and conventional echocardiogram for assessment. The agreement between the findings and the time duration required in both the methods was compared. Results The use of handheld ultrasound has significantly decreased the duration of bedside examination of patients than the conventional method. The median duration of examination using handheld ultrasound was 9 (8.0–11.0) minutes, compared to 20 (17–22) minutes with the conventional method (P < 0.001). The Cohen's kappa coefficient was 1.0 for left ventricular systolic function, most of the lung fields, and diaphragmatic movement. Conclusion Vscan Extend™ helps in the rapid identification and diagnosis of cardiopulmonary manifestations in COVID-19 patients. The agreement between the handheld device and the conventional method proves its efficacy and safety. CTRI Number CTRI/2020/07/026701 How to cite this article Maheshwarappa HM, Mishra S, Kulkarni AV, Gunaseelan V, Kanchi M. Use of Handheld Ultrasound Device with Artificial Intelligence for Evaluation of Cardiorespiratory System in COVID-19. J Crit Care Med 2021;25(5):524–527.

The incorporation of artificial intelligence (AI) in point-of-care ultrasound (POCUS) has become a very useful tool to quickly assess cardiorespiratory function in coronavirus disease (COVID)-19 patients. The objective of this study was to test the agreement between manual and automated B-lines counting, left ventricular outflow tract velocity time integral (LVOT-VTI) and inferior vena cava collapsibility index (IVC-CI) in suspected or confirmed COVID-19 patients using AI integrated POCUS. In addition, we investigated the inter-observer, intra-observer variability and reliability of assessment of echocardiographic parameters using AI by a novice.Two experienced sonographers in POCUS and one novice learner independently and consecutively performed ultrasound assessment of B-lines counting, LVOT-VTI and IVC-CI in 83 suspected and confirmed COVID-19 cases which included both manual and AI methods.Agreement between automated and manual assessment of LVOT-VTI, and IVC-CI were excellent [intraclass correlation coefficient (ICC) 0.98,AI-guided assessment of LVOT-VTI, IVC-CI and B-lines counting is reliable and consistent with manual assessment in COVID-19 patients. Novices can reliably estimate LVOT-VTI and IVC-CI using AI software in COVID-19 patients.

Immunity refers to the process by which body defends itself from infection or any unwanted biological invasion. It can be actively acquired following exposure to an antigen or following immunization with vaccines. Passive immunity develops following administration of IgG antibodies or transfer of maternal antibodies. Active immunity is usually long lasting or life-long. Depending on the nature of the organism injected, they can be live attenuated vaccine, killed vaccine, sub-unit vaccine or toxoid. Pregnancy is associated with change in immune function and thus may contribute to susceptibility to infection. Ideally, women should be vaccinated against preventable diseases before pregnancy. In general, inactivated virus vaccines, toxoids and immunoglobulins are considered safe for administration in pregnancy. List of vaccines recommended and contraindicated in pregnancy along with evidence on risk and benefit is discussed in the chapter. Similarly, travellers are frequently exposed to various pathogens and hence are at increased risk of developing illness. Need for vaccination depends on immune status, age, presence of chronic illness, duration of stay and country of visit. Focus has now shifted towards the use of vaccines for chronic non-communicable disease such as cancer, atherosclerosis. Cancer vaccines may be preventive or therapeutic vaccines. While preventive vaccines have shown to be effective, therapeutic vaccines are largely under study. Vaccines for atherosclerosis are currently under study and target either lipid related or non-lipid related antigens.

The Spanish influenza pandemic of 1918 globally claimed death between 50 and 100 million lives. In India, it was referred to as “The Bombay Fever,” and accounted for a fifth of the global death toll at that time. The current outbreak of the novel coronavirus disease 2019 (COVID-19), a new human-infecting beta coronavirus, has demonstrated that the size of an organism does not reflect on its ability to affect almost an entire human population. COVID-19, first detected in December 2019 in Wuhan, China, that spread rapidly worldwide. In humans, this disease ranged from flu-like symptoms to severe acute hypoxic respiratory failure. By appearance, this virus closely related to two bat-derived severe acute respiratory syndrome (SARS) coronaviruses. Although bats were likely the original host, animals sold at the Huanan seafood market in Wuhan might have been the intermediate host that enabled the emergence of the virus in humans. Under the electron microscope, the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus grips its receptor tighter than the virus behind the SARS outbreak in 2003 to 2004. The viral particle docks onto the angiotensin-converting enzyme 2 (ACE2) receptor and initiates viral entry. This review discusses the various aspects of the SARS-CoV-2 virus, its structure, pathophysiology, mechanism of interaction with human cells, virulence factors, and drug involved in the treatment of the disease.

Objective Metabolic syndrome is a constellation of risk factors with increased predilection towards occurrence of cardiovascular diseases. Currently physical exercise and management with metformin are the prevailing treatment modalities for metabolic syndrome. Patients with metabolic syndrome have been found to have reduced exercise capacity over a period of time. Likewise metformin has been shown to decrease exercise capacity among healthy volunteers. Hence this study aims to evaluate the effect of metformin on the exercise capacity of patients with metabolic syndrome. Design Prospective study with 6 weeks follow up. Methods Newly diagnosed patients with metabolic syndrome and to be started on Table Metformin 500 mg twice a day were recruited for the study after obtaining written informed consent. Cardiopulmonary Exercise Testing (CPET) was done at baseline before the subjects were started on metformin and after 6 weeks of treatment using cardiopulmonary exercise testing apparatus (ZAN600). Results Fifteen treatment naive patients with metabolic syndrome completed six weeks of therapy with metformin. In these patients oxygen uptake [VO2] showed statistically significant decrease from 1.10 ± 0.44 at baseline to 0.9 ± 0.39 (l/min) after six weeks of treatment with metformin [mean difference of −0.20 (−0.31 to −0.09); P = 0.001]. Similarly oxygen uptake/kg body weight [VO2/Kg] showed a significant decrease from 14.10 ± 4.73 to 11.44 ± 3.81 (ml kg−1 min−1) at the end of six weeks of treatment [mean difference of −2.66 (−4.06 to −1.26); P = 0.001]. Conclusion Six weeks of treatment with metformin significantly decreases exercise capacity in newly diagnosed patients with metabolic syndrome.

Objective: To evaluate the pattern of adverse drug reactions (ADRs) reported in cancer patients receiving anticancer drugs in an adverse drug reaction monitoring centre (AMC). Methods: The anticancer drug related ADRs received in AMC through spontaneous reporting and active surveillance methods from January 2014 to June 2016 were analyzed for demographic profile, organ system and department wise distribution of ADRs, common ADRs encountered, drugs responsible for causing ADRs, ADRs reported by healthcare professionals, number of ADR/ ADRs developed per patient and causality assessment of reported ADRs. Descriptive statistics were used for analysis and the values were expressed in numbers and percentages. Results: 2209 ADRs were reported from 1869 patients comprising of 764 males (40.88%) and 1105 females (59.12%). In our study, the most common ADRs observed were anemia (12.68%), neuropathy (11.18%) and neutropenia (6.07%). Causality assessment of ADRs by WHO-UMC causality scale revealed that 90.9% of ADRs were possible followed by 4.48% probable and 2.39% possible. The most common organ system wise classified ADRs were blood (24.22%) related reactions followed by gastrointestinal system (14.17%) related adverse effects. The most common drugs associated with ADRs were imatinib (13.94%) followed by docetaxel (9.55%), gemcitabine (8.56%) and paclitaxel (7.38%). Amidst 1869 patients, 301(13.63%) patients had developed two ADRs while 39 (1.76%) patients experienced three ADRs. Conclusion: The average ADR encountered per patient due to anticancer drug was about 1.18 in this study. Anemia, neuropathy and neutropenia were the most common ADRs reported. Key words: Anticancer drugs, Chemotherapy, Tertiary care hospital, ADR monitoring centre (AMC).

Migraine is a recurrent, disabling, complex and highly prevalent neurological disorder. The mystery behind the cause of migraine is continuously evolving, according to the scientific understanding of the disease. This growing understanding helps to identify novel therapeutic targets for the management of migraine to treat the ailing migraineurs. The role of serotonin (5HT) in migraine is recognized to be the cornerstone for the currently available therapeutic options namely ergot alkaloids and triptans. The role of mediators such as Calcitonin Gene-Related Peptide (CGRP), nitric oxide and excitatory neurotransmitter glutamate, has been realized and ignited the development of drugs targeting these factors. Lasmiditan, known as a Neurally Active Anti- Migraine Agent (NAAMA) is a specific 5HT1F agonist, developed as a new group named as 'ditans'. The drug was designed and developed to meet the unmet needs of currently available medications to circumvent the vascular adverse effects. Having a group of drugs with a nonvascular mechanism of action, devoid of unwanted effects with a different spectrum of indication and contraindications, is the need of the hour to expand the armamentarium available to tackle acute migraine attack.

Mitochondrion, “the power house” of the cell plays a vital role in generating energy for the intricate functions of the cells. Mitochondria also play important roles in various apoptotic pathways. Around 80-90% of the ATP generated in cells is contributed by these organelles through the process of oxidative phosphorylation. Though this process is essential for the functioning of cells it also generates various Reactive Oxygen Species (ROS), which are toxic to cells. Hence mitochondrial dysfunction is hypothesized to be an important factor in the occurrence of disorders related to aging such as neurodegeneration and malignancies. Several commonly used drugs in clinical practice exert their action by interacting with mitochondrial pathways. This review attempts to focus on the various groups of drugs which act on mitochondria and are utilized for therapy of conditions like cancer, diabetes mellitus, neurodegeneration and so on.

Background: Vitamin D which is involved in the maintenance of bone mineral homeostasis has been found to portray various pleiotropic effects. Although it has been widely accepted that serum 25-hydroxy Vitamin D level above 30 ng/ml is considered optimal for the biological actions of Vitamin D, there is a need to explore the levels of Vitamin D reported among Indians from various regions of the country. Hence, this systematic review aims to appraise the status of Vitamin D levels reported from apparently healthy Indians across various parts of India. Methodology: A comprehensive literature search was carried out to identify the range of Vitamin D levels among apparently healthy individuals from various parts of India, with the search term “Vitamin D and India” in the search portals of PubMed, Google Scholar, Indmed, and ScienceDirect. A total of 2998 articles were retrieved by the above search strategy, of which only forty studies fulfilled the criteria to be included in the systematic review. Studies done in various states were compiled under the respective zones based on the classification of Indian zones as specified in Zonal maps of India. Results: The level of Vitamin D from all the forty included studies ranged from 3.15 ± 1.4 to 52.9 ± 33.7 ng/ml. The effect size of Vitamin D level was higher in the South Zone compared to other zones. Conclusion: The present study shows that Vitamin D deficiency is prevalent among apparently healthy Indians living in different regions of India, irrespective of their exposure to sunlight.