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   Table of Contents - Current issue
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July 2021
Volume 10 | Issue 4
Page Nos. 135-178

Online since Tuesday, July 20, 2021

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REVIEW ARTICLE  

Artificial intelligence for COVID-19 and future pandemics: A mini-review p. 135
Abhrajit Debroy, Nancy George
DOI:10.4103/2221-6189.321588  
The pandemic of severe acute respiratory syndrome coronavirus 2 has spread very quickly all over the world and has become an unparalleled public health crisis. This unforeseen and exceptional situation has instigated a wave of research to investigate the virus, track its spread, and study the disease it causes. Current methods of diagnosis and monitoring largely rely on polymerase chain reactions and enzyme-linked immunesorbent assay methods. In this hour of crisis, researchers are looking for new technologies to monitor and control such disease outbreaks. Artificial intelligence (AI) is one such technology. Being an evidence-based tool, this technology has the potential to upgrade our disease management strategies and help us to restrict the spread of such diseases. AI can play an effective role in tracking the spread of diseases, screening of the population, identifying patients and developing treatments of diseases. Through this review, we aim to analyze the role of AI in the diagnosis, monitoring and treatment of diseases like coronavirus disease 2019, with most recent updates and assess the prospects of this technology in the management of such diseases.
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ORIGINAL ARTICLES Top

Healthcare utilization patterns and economic burden of animal bites: A cross-sectional study p. 142
Vahid Bay, Aziz Rezapour, Mehdi Jafari, Mohammad Reza Maleki, Irvan Masoudi Asl
DOI:10.4103/2221-6189.320962  
Objective: To determine the healthcare utilization patterns and estimate the economic burden of animal bites in Golestan province, north part of Iran. Methods: This cross-sectional study was performed based on the data of 12 181 animal-bite patients from Golestan province who were referred to the rabies prophylaxis centers between March 2019 and March 2020. The study was a societal perspective, and all patients were investigated by census method. The micro-costing method with a bottom-up approach as well as the human capital approach were used to estimate the economic burden. Results: In our study, the economic burden caused by animal bites was estimated at $1 383 639 (275 354 672 060 Rials). The largest share of costs was related to direct healthcare costs, direct non-healthcare costs, and indirect costs accouting for 91%, 5%, and 4%, respectively. In addition, the average cost of a animal-bite patient was estimated at $113.5 (22 605 260 Rials) (The average cost of a case in type 2 and 3 exposures was $45 and $412.8, respectively). The largest share of direct healthcare costs was related to immunoglobulin, vaccine, and personnel expenses accounting for 61.3%, 19.8%, and 11.65%, respectively. Conclusions: Our study shows that animal bites in Golestan province, north of Iran impose a high economic burden on the communities, especially the healthcare system, which indicates the need to review management and control programs of animal bites and rabies based on animal-bite patterns of the area.
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Prevalence of SARS-CoV-2 among central retinal artery occlusion patients: A case series-HORA study report No. 3  Highly accessed article p. 147
Sunny Chi Lik Au, Callie Ka Li Ko
DOI:10.4103/2221-6189.318644  
Introduction: COVID-19 patients are susceptible to hypercoagulability, thromboembolic, and vasculitis state; central retinal artery occlusion (CRAO) could be caused by hyperviscosity syndrome, thromboembolic accidents, and vasculitis. Evolving case reports are correlating CRAO with COVID-19 patients. Our case series aims to reveal the prevalence of SARS-CoV-2 among CRAO patients under the COVID-19 pandemic. Methods: Medical records of all CRAO patients who attended our tertiary referral hospital, during COVID-19 local outbreak (March to November 2020), were reviewed. Respiratory tract samples were tested for SARS-CoV-2 by the validated Xpert Xpress SARS-CoV-2 assay. If patients were able to cooperate, oropharyngeal saliva samples were obtained. Otherwise, nasopharyngeal and deep throat swabs were taken by registered nurses. Results: A total of 15 CRAO patients (7 males, 8 females) were identified during the 9-month study period. The mean age was 72.1-years (range 45-88 year). None of the patients were infected by SARS-CoV-2 before their CRAO disease episodes. Three patients had a history of CRAO over the contralateral eye. No patient was diagnosed with COVID-19 up to their last follow-up (mean 255.4 days, range 152-341 days). Without any COVID-19 positive case, correlation statistical tests on SARS-CoV-2 infection and CRAO were not established. Conclusions: Some of the presumed COVID-19 related CRAO cases may be just coincident with at-risk patients, as COVID-19 is prevalent across the world. More in-depth research, with adjustment to known confounding risk factors, is needed to establish a genuine correlation.
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Spatiotemporal analysis, hotspot mapping, and clustering of confirmed cases of COVID-19 in the initial phase of the pandemic in Qom province, Iran p. 150
Abolfazl Mohammadbeigi, Shahram Arsang-Jang, Ehsan Sharifipour, Alireza Koohpaei, Mostafa Vahedian, Narges Mohammadsalehi, Masoud Jafaresmaeili, Moharam Karami, Siamak Mohebi
DOI:10.4103/2221-6189.320963  
Objective: To identify the incidence rate, relative risk, hotspot regions and incidence trend of COVID-19 in Qom province, northwest part of Iran in the first stage of the pandemic. Methods: The study included 1 125 officially reported PCR-confirmed cases of COVID-19 from 20 February 2020 to 20 April 2020 in 90 regions in Qom city, Iran. The Bayesian hierarchical spatial model was used to model the relative risk of COVID-19 in Qom city, and the segmented regression model was used to estimate the trend of COVID-19 incidence rate. The Poisson distribution was applied for the observed number of COVID-19, and independent Gamma prior was used for inference on log-relative risk parameters of the model. Results: The total incidence rate of COVID-19 was estimated at 89.5 per 100 000 persons in Qom city (95% CI: 84.3, 95.1). According to the results of the Bayesian hierarchical spatial model and posterior probabilities, 43.33% of the regions in Qom city have relative risk greater than 1; however, only 11.11% of them were significantly greater than 1. Based on Geographic Information Systems (GIS) spatial analysis, 10 spatial clusters were detected as active and emerging hotspot areas in the south and central parts of the city. The downward trend was estimated 10 days after the reporting of the first case (February 7, 2020); however, the incidence rate was decreased by an average of 4.24% per day (95%CI:-10.7, -3.5). Conclusions: Spatial clusters with high incidence rates of COVID-19 in Qom city were in the south and central regions due to the high population density. The GIS could depict the spatial hotspot clusters of COVID-19 for timely surveillance and decision-making as a way to contain the disease.
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Knowledge, attitude, and practice regarding COVID-19 among COVID-19 patients and their correlation with the outcomes: A cross-sectional study p. 155
Hardeva Ram Nehara, Kritika Khanna, Atma Ram Chhimpa, Sahaj Agrawal, Avadusidda Arakeri, Pramendra Sirohi
DOI:10.4103/2221-6189.320964  
Objective: To assess the knowledge, attitude, and practice (KAP) regarding COVID-19 among COVID-19 patients and their relation with the outcomes. Methods: This cross-sectional study was carried out among COVID-19 patients (18-year-old or older) consecutively admitted to a dedicated COVID-19 hospital located in northwest Rajasthan, India. Data regarding socio-demographic parameters, KAP, and primary composite outcome (admission to intensive care unit, mechanical ventilation, or in-hospital death) were collected. KAP scores were compared between different demographic variables and primary composite outcomes. Association between different demographic variables, primary composite outcomes, and KAP scores were determined through multivariate linear regression. Besides, the correlation among KAP scores was analyzed. Results: Out of the total 222 patients, most of them (65.76%) had average KAP scores towards COVID-19. The mean scores for knowledge were 7.88, with an overall correct rate of 71.63%; the mean attitude scores were 2.42, with an overall correct rate of 60.50%; the mean practice scores were 5.12, with an overall correct rate of 64.00%. Patients who met the primary composite outcomes had higher knowledge scores, but lower attitude and practice scores. The result showed a significant positive correlation between the level of education, socioeconomic class, and knowledge, attitude, and practice towards COVID-19. Knowledge towards COVID-19 was significantly associated with a positive attitude and good practice. Conclusions: Our findings show that adult COVID-19 patients have average KAP towards COVID-19 among COVID-19 patients. Poor attitude and practice towards COVID-19 are associated with adverse outcomes, so it is suggested to strengthen attitude and practice towards COVID-19 to improve the outcomes.
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Dynamics of transmission of COVID-19 cases and household contacts: A prospective cohort study p. 162
Priyanka Rajmohan, Ponnu Jose, Jubina Bency Anthoora Thodi, Joe Thomas, Lucy Raphael, Swathi Krishna, Unnikrishnan Uttumadathil Gopinathan, Praveenlal Kuttichira
DOI:10.4103/2221-6189.321590  
Objective: To study the transmission dynamics of coronavirus disease 2019 (COVID-19) among 101 confirmed cases and their 387 household contacts and to determine risk factors associated with secondary attack among the household contacts. Methods: A prospective cohort study was conducted from January 1st 2021 to February 28th 2021, among 101 SARS-CoV-2 cases and 387 household contacts who were followed up for 14 days from the last day of contact with the index case of COVID-19. The dynamics of disease transmission was estimated, and factors affecting transmission risk were analyzed. Besides, the association between various factors and household secondary attack rate was determined. Results: The median incubation period was found to be 5 days, and the observed reproductive number (R) was found to be 1.63 (95% CI: 1.28-1.98). The mean household secondary attack rate was 40.7%. Contacts with comorbidities like diabetes mellitus, hypertension, dyslipidemia, and hypothyroidism had significantly higher attack rates (P<0.05). Conclusions: As new variants of SARS-CoV-2 emerges, it is crucial to know the trasmission dynamics. This study shows a high secondary attack rate of COVID-19 among household contacts that must be closely monitored.
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Effect of basic life support training on the knowledge and skills of first aid of first year medical students p. 169
Esra Karaman, Nazire Avcu, Ozlem Guneysel
DOI:10.4103/2221-6189.321591  
Objective: To determine the timing of first aid training in the medical school curriculum and the training method with the 8-hour first aid training given to the first-grade students of the faculty of medicine. Method: The study was conducted prospectively with 168 first year medical students at Faculty of Medicine, Maltepe University in October 2019. An 8-hour course plan consisting of theoretical and practical applications was prepared. Theoretical courses included cardiopulmonary resuscitation, basic life supports, epileptic seizures, heatstroke, aspiration, and drowning issues, while practical applications included cardiopulmonary resuscitation techniques, basic life support scenarios, Heimlich’s Maneuver and the coma position. Students were sent a link consisting of 17 questions created with Google forms at the beginning and the end of the course. Learned knowledge was measured with the posttest, and pre-and post-training results were compared. Results: A significant increase was found in the rate of correct answers compared to the pre-training period. Even the rate of correct post-test answers increased significantly in all questions; the increase in the questions related to the subjects supported by practical applications was more remarkable. It was found that more incorrect answers were given to questions about environmental injuries. Conclusions: It is possible to improve the public recognition of first aid, even with one day of theoretical and practical training. Thus, adding first aid practical courses to the first-year medical school curriculum and raising awareness at an earlier age will play an essential role in medical education.
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CASE REPORT Top

A simple appendicitis? An anatomical pitfall: A case report p. 173
Slawomir Wajman, Magdalena Gewartowska, Robert Antoniak, Marek Stanczyk
DOI:10.4103/2221-6189.318643  
Rationale: We present a case of appendicitis with an uncommon course due to rare anatomical location of the appendix in the right retroperitoneal space below the diaphragm and above the liver. Patient’s concern: A 32-year-old, previously healthy male with a history of congenital diaphragmatic hernia repair in childhood, presented with 3 days of mild, colicky, central abdominal pain associated with fever, nausea and vomiting. At presentation, pain was localized to the right lower quadrant. Diagnosis: Even though diagnosis of appendicitis was clear, we decided to confirm it with computer tomography (CT). CT revealed elevation of the right dome of the diaphragm and perforated appendix located above the liver. Intervention: Appendectomy was performed via right subcostal approach instead of usual incision in the right lower quadrant. Outcome: Patient recovered well and was discharged on the 5th day after operation. Lessons: Previous congenital diaphragmatic hermia repair may change the location of the appendix. The appendix at rare locations could lead to an uncommon course of appendicitis. On this very note, surgeons should have a high index of suspicion, and CT may help avoid inadvertent complications.
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LETTER TO EDITOR Top

Anti-fibrotic drugs dealing with pulmonary fibrosis after COVID-19-associated acute respiratory distress syndrome p. 177
Abhijit S Nair, Sai Kaushik Pulipaka, Praveen Kumar Kodisharapu, Asiel Christopher
DOI:10.4103/2221-6189.318642  
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