Bacillus tequilensis influences metabolite production in tomato and restores soil microbial diversity during Fusarium oxysporum infection

This study evaluates cellular damage, metabolite profiling, and defence-related gene expression in tomato plants and soil microflora during Fusarium wilt disease after treatment with B. tequilensis PBE-1. Histochemical analysis showed that PBE-1 was the primary line of defence through lignin deposition and reduced cell damage. GC-MS revealed that PBE-1 treatment ameliorated stress caused by F. oxysporum infection. PBE-1 also improved transpiration, photosynthesis, and stomatal conductance in tomato. qRT-PCR suggested that the defence-related genes FLS2, SERK, NOS, WRKYT, NHO, SAUR, and MYC2, which spread infection, were highly upregulated during F. oxysporum infection, but either downregulated or expressed normally in PBE-1 + P treated plants. This indicates that the plant not only perceives the bio-control agent as a non-pathogen entity but its presence in normal metabolism and gene expression within the host plant is maintained. The study further corroborated findings that application of PBE-1 does not cause ecological disturbances in the rhizosphere. Activity of soil microflora across four treatments, measured by Average Well Colour Development (AWCD), showed continuous increases from weeks 1 to 4 post-pathogen infection, with distinct substrate usage patterns like tannic and fumaric acids impacting microbial energy source utilization and diversity. Principal Component Analysis (PCA) and diversity indices like McIntosh, Shannon, and Simpson further illustrated significant microbial community shifts over the study period. In conclusion, our findings demonstrate that B. tequilensis PBE-1 is an ideal bio-agent for field application during Fusarium wilt disease management in tomato.

Clinicopathological Profile and Survival Outcomes in Patients with Localised Extremity Synovial Sarcomas

AIMS

Synovial sarcoma is a rare but aggressive variant of soft-tissue sarcoma. Literature is sparse and reported mostly from the West. We analysed the clinical profiles and prognostic factors of extremity synovial sarcoma patients in order to study their clinical journey.

MATERIALS AND METHODS

This was a retrospective analysis. All patients with extremity synovial sarcoma treated between 1992 and 2020 were included. Patients with metastases at presentation were excluded. A descriptive analysis of demographic and clinicopathological features of patients undergoing limb salvage surgery (LSS) or amputation was carried out. Overall survival and disease-free survival were calculated for the entire cohort as well as for the LSS and amputation groups. Factors prognostic for survival were identified.

RESULTS

In total, 157 patients had localised extremity synovial sarcoma. Predominantly, young adults (median 31 years) and males (61%) were affected. Over 70% of patients presented after recurrence or unplanned surgeries. Sixty-seven per cent of tumours were >5 cm, 69% were deep and 23% involved bone. The limb salvage rate was 64%. In the LSS group, adjuvant radiotherapy and chemotherapy were given to 72% and 68% of patients, respectively. In the amputation group, 72% of patients received adjuvant chemotherapy. In a median follow-up of 59 months, 39.4% of patients had recurrences, the majority (61.2%) were systemic. Five-year overall survival and disease-free survival were 53.4% and 49.8%, respectively. Overall survival was 63.9% and 29.7% in the LSS and amputation groups, respectively. On multivariate analysis, tumour size, depth, omission of radiotherapy and bone invasion were found to be the adverse prognostic factors.

CONCLUSION

This is one of the largest studies on extremity synovial sarcoma. Mostly males and young adults were affected. The limb salvage rate was 64%, despite most being referred after unplanned surgery. Almost 70% of patients received radiotherapy and chemotherapy. Overall survival was inferior in the amputation group. Tumour size >5 cm, depth and bone invasion were negative, whereas adjuvant radiotherapy was a positive prognostic factor for survival. Chemotherapy had no impact on survival.

Interventions to reduce Salmonella and Campylobacter during chilling and post-chilling stages of poultry processing: a systematic review and meta-analysis

Salmonella and Campylobacter are common bacterial hazards causing foodborne illnesses worldwide. A large proportion of Salmonella and Campylobacter illnesses are attributed to contaminated poultry products that are mishandled or under cooked. Processing interventions such as chilling and post-chill dip are critical to reducing microbial contamination of poultry. A comprehensive search of the literature published between 2000 and 2021 was conducted in the databases Web of Science, Academic Search Complete, and Academic OneFile. Studies were included if they were in English and investigated the effects of interventions against Salmonella and/or Campylobacter on whole carcasses and/or parts during the chilling or post-chill stages of poultry processing. Random-effects meta-analyses were performed using the "meta" package in the R programming language. Subgroup analyses were assessed according to outcome measure reported, microorganism tested, processing stage assessed, and chemical treatment used. The results included 41 eligible studies. Eighteen studies reported results of 28 separate interventions against Salmonella and 31 reported results of 50 separate interventions against Campylobacter. No significant difference (P> 0.05) was observed when comparing the combined mean difference of all interventions targeting Salmonella to the combined mean difference of all interventions targeting Campylobacter or when comparing chilling times within each pathogen subgroup. For analyses examining antimicrobial additives, peroxyacetic acid (PAA) had the largest reduction against Salmonella population regardless of chilling time (P< 0.05). PAA also had the largest reduction against Campylobacter population and prevalence during primary chilling (P< 0.01). Air chilling showed a lower reduction for Campylobacter than any immersion chilling intervention (P< 0.05). Chilling time and antimicrobial used during poultry processing had varying effects depending on the pathogen and outcome measure investigated (concentration or prevalence). High heterogeneity and low sample numbers in most analyses suggest that more high-quality research that is well-designed and has transparent reporting of methodology and results is needed to corroborate the results.

Making bioinformatics training FAIR: the EMBL-EBI training portal

EMBL-EBI provides a broad range of training in data-driven life sciences. To improve awareness and access to training course listings and to make digital learning materials findable and simple to use, the EMBL-EBI Training website, www.ebi.ac.uk/training, was redesigned and restructured. To provide a framework for the redesign of the website, the FAIR (findable, accessible, interoperable, reusable) principles were applied to both the listings of live training courses and the presentation of on-demand training content. Each of the FAIR principles guided decisions on the choice of technology used to develop the website, including the details provided about training and the way in which training was presented. Since its release the openly accessible website has been accessed by an average of 58,492 users a month. There have also been over 12,000 unique users creating accounts since the functionality was added in March 2022, allowing these users to track their learning and record completion of training. Development of the website was completed using the Agile Scrum project management methodology and a focus on user experience. This framework continues to be used now that the website is live for the maintenance and improvement of the website, as feedback continues to be collected and further ways to make training FAIR are identified. Here, we describe the process of making EMBL-EBI's training FAIR through the development of a new website and our experience of implementing Agile Scrum.

Comparative assessment of immunogenicity of recombinant insulin Aspart from BioGenomics and its originator NovoRapid® in adult patients with type 2 diabetes mellitus

OBJECTIVES

To assess and compare the immunogenicity of recombinant Insulin Aspart [manufactured by BioGenomics Limited (BGL-ASP)] with its originator NovoRapid® (manufactured by Novo Nordisk) in adult patients with type 2 diabetes mellitus.

RESEARCH DESIGN AND METHODS

BGL-IA-CTP301 study was a randomized, open label, parallel group, multicenter phase-III clinical study to compare the efficacy and safety of recombinant Insulin Aspart 100 U/mL [manufactured by BioGenomics Limited (BGL-ASP)] with its reference medicinal product (RMP); NovoRapid® [manufactured by Novo Nordisk], in adult patients with Type 2 diabetes mellitus (T2DM). The primary objective of the study was to compare the immunogenicity of BGL-ASP and RMP; NovoRapid® in patient serum samples collected from phase-III clinical study. Immunogenicity was studied as the incidence of patients positive for anti-insulin Aspart (AIA) antibodies, developed against BGL-ASP/RMP at baseline, end of 12 week and end of 24 week of the treatment period. The changes in incidence of patients positive for AIA antibodies post-baseline were also studied to assess and compare the treatment-emergent antibody response (TEAR) between the treatment groups (BGL-ASP and RMP). Statistical evaluation was done by Fisher's exact test to compare the overall incidence of patients positive for AIA antibodies and the TEAR positives observed post-baseline in both the treated groups. An in-vitro neutralizing antibody assay (Nab assay) was also performed to study the effect of AIA antibodies in neutralizing the biological activity/metabolic function of the insulin. The neutralizing potential of AIA was studied by its effect on %glucose uptake. We also evaluated the association between AIA antibody levels and its impact on biological activity by studying the correlation between them.

RESULTS

Analysis of immunogenicity data suggested that the percentage of patients positive for AIA antibodies until week 24 was similar and comparable in both the treatment groups, BGL-ASP and RMP; NovoRapid®. The changes in incidence of patients positive for AIA post-baseline in terms of TEAR positives were also similar and comparable between the treatment groups. The results of the Nab assay with confirmed positive AIA samples from BGL-ASP- and RMP-treated groups did not have any negative impact on %glucose uptake by the cells in Nab assay, confirming the absence of neutralizing antibodies in both the treatment groups. The correlation studies also showed absence of association between AIA antibody levels and percentage glucose uptake in both BGL-ASP and RMP-NovoRapid® treatment groups. CONCLUSIONS: The immunogenicity assessment based on the overall incidence of patients positive for AIA, changes in incidence of patients positive for AIA post-baseline, TEAR rates and absence of neutralizing antibodies, were found to be apparently similar and comparable in both the treatment groups (BGL-ASP and RMP). We conclude from our studies that the immunogenicity of BGL-ASP is similar and comparable to RMP and the observed immunogenicity in terms of anti-insulin Aspart antibody levels had no impact on the biological activity of insulin.

Gasless laparoscopy in rural India-registry outcomes and evaluation of the learning curve

BACKGROUND

A program of gasless laparoscopy (GL) has been implemented in rural North-East India. To facilitate safe adoption, participating rural surgeons underwent rigorous training prior to independent clinical practice. An online registry was established to capture clinical data on safety and efficacy and to evaluate initial learning curves for gasless laparoscopy.

METHODS

Surgeons who had completed the GL training program participated in the online RedCap Registry. Patients included in the registry provided informed consent for the use of their data. Data on operative times, conversion rates, perioperative complications, length of stay, and hospital costs were collected. Fixed reference cumulative sum (CUSUM) model was used to evaluate the learning curve based on operative times and conversion rates published in the literature.

RESULTS

Four surgeons from three rural hospitals in North-East India participated in the registry. The data were collected over 12 months, from September 2019 to August 2020. One hundred and twenty-three participants underwent GL procedures, including 109 females (88.6%) and 14 males. GL procedures included cholecystectomy, appendicectomy, tubal ligation, ovarian cystectomy, diagnostic laparoscopy, and adhesiolysis. The mean operative time was 75.3 (42.05) minutes for all the surgeries. Conversion from GL to open surgery occurred in 11.4% of participants, with 8.9% converted to conventional laparoscopy. The main reasons for conversion were the inability to secure an operative view, lack of operating space, and adhesions. The mean length of stay was 3 (2.1) days. The complication rate was 5.7%, with one postoperative death. The CUSUM analysis for GL cholecystectomy showed a longer learning curve for operative time and few conversions. The learning curve for GL tubal ligation was relatively shorter.

CONCLUSION

Gasless laparoscopy can be safely implemented in the rural settings of Northeast India with appropriate training programs. Careful case selection is essential during the early stages of the surgical learning curve.

Relationship of the Poultry Microbiome to Pathogen Colonization, Farm Management, Poultry Production, and Foodborne Illness Risk Assessment

Despite the continuous progress in food science and technology, the global burden of foodborne illnesses remains substantial, with pathogens in food causing millions of infections each year. Traditional microbiological culture methods are inadequate in detecting the full spectrum of these microorganisms, highlighting the need for more comprehensive detection strategies. This review paper aims to elucidate the relationship between foodborne pathogen colonization and the composition of the poultry microbiome, and how this knowledge can be used for improved food safety. Our review highlights that the relationship between pathogen colonization varies across different sections of the poultry microbiome. Further, our review suggests that the microbiome profile of poultry litter, farm soil, and farm dust may serve as potential indicators of the farm environment's food safety issues. We also agree that the microbiome of processed chicken samples may reveal potential pathogen contamination and food quality issues. In addition, utilizing predictive modeling techniques on the collected microbiome data, we suggest establishing correlations between particular taxonomic groups and the colonization of pathogens, thus providing insights into food safety, and offering a comprehensive overview of the microbial community. In conclusion, this review underscores the potential of microbiome analysis as a powerful tool in food safety, pathogen detection, and risk assessment.

A systematic review and meta-analysis of the sources of Campylobacter in poultry production (preharvest) and their relative contributions to the microbial risk of poultry meat

A systematic review and meta-analysis were conducted to idetnify the relative contributions of the sources of Campylobacter in poultry live production to Campylobacter prevalence of broiler meat. The keywords of Campylobacter, prevalence, live production, and broiler were used in Google Scholar to address the research interest. A total of 16,800 citations were identified, and 63 relevant citations were included in the meta-analysis after applying predetermined inclusion and exclusion criteria. A generalized linear mixed model approach combined with logit transformation was used in the current meta-analysis to stabilize the variance. The analysis revealed that Campylobacter is ubiquitous in the poultry house exterior environment including surroundings, wildlife, domestic animals, and farm vehicle, with a predicted prevalence of 14%. The recovery of Campylobacter in the interior environment of the poultry house is far less abundant than in the exterior, with a prevalence of 2%, including litter, water, insects, mice, feed, and air. A lack of evidence was observed for vertical transmission due to the day-old chicks being free of Campylobacter from 4 studies identified. Live birds are the predominant carrier of Campylobacter, with a predicted prevalence of 41%. Transportation equipment used for live haul had an overall prevalence of 39%, with vehicles showing a predicted prevalence of 44% and crates with a predicted prevalence of 22%. The results of this meta-analysis highlight the need to implement effective biosecurity measures to minimize the risk of Campylobacter in poultry meat, as human activity appears to be the primary factor for Campylobacter introduction.

Synthesis and in silico studies of some new pyrrolidine derivatives and their biological evaluation for analgesic and anti-inflammatory activity

BACKGROUND

An array of commercially viable intermediate molecules necessary for the synthesis of a variety of bioactive molecules are chemically synthesized by pyrrolidine and its derivatives, which play a significant role in drug design and development process.

AIM

The aim of the present research work was to explore the synthesis of some new pyrrolidine derivatives and to perform their in silico studies and finally evaluation of analgesic and anti-inflammatory activity.

OBJECTIVE

The purpose of this study was to synthesis new pyrrolidine derivatives, examine how they affected the COX-1 and COX-2 enzymes computationally, and to screen their in vivo analgesic and anti-inflammatory activity on laboratory animals.

METHOD

The new pyrrolidine derivatives were synthesized by condensing N-(3-acetylphenyl)-2-(pyrrolidin-1-yl)acetamide with substituted aniline in ethanol in the presence of catalytic amounts of glacial acetic acid. The structures of novel pyrrolidine derivatives were characterised using IR, NMR, and mass spectroscopy. Several molecular properties of the newly synthesized derivatives were calculated in order to evaluate the nature of the drug-like candidate. A specific reference cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzyme was used to dock the newly synthesized pyrrolidine derivatives.

RESULTS

From the observed data, it was noted that amongst all newly synthesized compounds, A-1 and A-4 exhibited the highest anti-inflammatory and analgesic effects, respectively.

CONCLUSION

On the basis of findings of present research, it was concluded that A-1 and A-4 might be utilized as a promising new lead compound for Non-Steroidal Anti-Inflammatory Drug (NSAIDs) development.

Assessing the Risk of Seasonal Effects of Campylobacter Contaminated Broiler Meat Prepared In-Home in the United States

Campylobacter has consistently posed a food safety issue in broiler meat. This study aimed to create a quantitative microbial risk assessment model from retail to consumption, designed to evaluate the seasonal risk of campylobacteriosis associated with broiler meat consumption in the United States. To achieve this, data was gathered to build distributions that would enable us to predict the growth of Campylobacter during various stages such as retail storage, transit, and home storage. The model also included potential fluctuations in concentration during food preparation and potential cross-contamination scenarios. A Monte Carlo simulation with 100,000 iterations was used to estimate the risk of infection per serving and the number of infections in the United States by season. In the summer, chicken meat was estimated to have a median risk of infection per serving of 9.22 × 10^-7 and cause an average of about 27,058,680 infections. During the winter months, the median risk of infection per serving was estimated to be 4.06 × 10^-7 and cause an average of about 12,085,638 infections. The risk assessment model provides information about the risk of broiler meat to public health by season. These results will help understand the most important steps to reduce the food safety risks from contaminated chicken products.

Impact of chlorine or peracetic acid on inactivation of Salmonella, Escherichia coli, and Listeria monocytogenes in agricultural water

Preharvest agricultural water has been recognized as one of the routes of contamination for foodborne pathogens during fruit and vegetable production. Several strategies have been proposed to reduce the risk of pathogens, including preharvest water chemigation, but literature is lacking with regards to microbiological inactivation of common bacterial foodborne pathogens associated with fresh produce contamination, Salmonella enterica, Shiga-toxigenic Escherichia coli (STEC), and Listeria monocytogenes, in surface irrigation water after exposure to chlorine and peracetic acid (PAA). Surface water supplied by a local irrigation district was collected over the summer of 2019. Water was autoclaved, divided into 100 mL samples, and inoculated with a cocktail of five Salmonella, STEC, or Listeria monocytogenes strains or a single strain non-pathogenic E. coli. Samples were then treated with 3, 5, or 7 ppm of free chlorine or PAA, and surviving populations were evaluated using a time-kill assay. A first-order kinetic model was used to fit the inactivation data and obtain the D-values. A secondary model was used to explain the changes due to the type of water, treatment, and microorganism. At a concentration of 3 ppm, the observed and predicted D-values of free chlorine treatments were higher than that of PAA treatments for ground and surface water. Results indicated that PAA was more effective inactivating bacteria than sodium hypochlorite at concentrations of 3 and 5 ppm for both water sources (surface and ground). However, at 7 ppm, the effectiveness of PAA and sodium hypochlorite showed no statistically significant difference for both surface and groundwater. Findings will provide information regarding efficacy of chemical sanitizers like chlorine and PAA for inactivation of Salmonella, Listeria, and STEC in surface water from which treatments can be derived. Ultimately benefitting growers in the selection of an appropriate method for in-field treatment of irrigation water if deemed necessary.

A systematic review and meta-analysis of the sources of Salmonella in poultry production (pre-harvest) and their relative contributions to the microbial risk of poultry meat

Salmonella is a major foodborne pathogen associated with poultry and poultry products and a leading cause for human salmonellosis. Salmonella is known to transmit in poultry flocks both vertically and horizontally. However, there is a lack of knowledge on relative contribution of the factors on Salmonella prevalence in poultry live production system including hatchery, feed, water, environment-interior, and -exterior. Therefore, a systematic review and meta-analysis was conducted to quantify the potential sources of Salmonella during preharvest and their relative contributions to the microbial risk of poultry meat. A total of 16,800 studies identified from Google Scholar and 37 relevant studies were included in the meta-analysis for relative contributions to Salmonella positivity on broilers after applying exclusion criteria. A generalized linear mixed model approach combined with logit transformation was used in the current study to stabilize the variance. The analysis revealed that the hatchery is the most significant contributor of Salmonella with a prevalence of 48.5%. Litter, feces, and poultry house internal environment were the other 3 major contributing factors with a prevalence of 25.4, 16.3, and 7.9%, respectively. Moreover, poultry house external environment (4.7%), feed (4.8%), chicks (4.7%), and drinker water also contributed to the Salmonella positivity. Results from this meta-analysis informed the urgent need for controls in live production to further reduce Salmonella in fresh, processed poultry. The control strategies can include eliminating the sources of Salmonella and incorporating interventions in live production to reduce Salmonella concentrations in broilers.

Antibiotic resistance associated lactic acid cross tolerance in Shiga-toxin producing E. coli

Introduction

The occurrence of antibiotic resistant (ABR) bacteria in foods is a growing public health challenge. We evaluated sanitizer cross-tolerance among ABR Escherichia coli (E. coli) O157:H7 and non-O157:H7 Shiga-toxin producing E. coli (STEC) serogroups. Sanitizer tolerance in STEC could be a public health concern as mitigation strategies against the pathogen might be compromised.

Methods

Resistance to ampicillin and streptomycin were evolved in E. coli serogroups: O157:H7 (H1730, and ATCC 43895), O121:H19 and O26:H11. Resistance to antibiotics was evolved chromosomally through incremental exposure to ampicillin (amp C) and streptomycin (strep C). Transformation using a plasmid was performed to confer resistance to ampicillin to generate amp P strep C.

Results

The minimum inhibitory concentration (MIC) of lactic acid for all strains evaluated was 0.375% v/v. Analysis of bacterial growth parameters in tryptic soy broth amended with 0.0625% v/v, 0.125% v/v, and 0.25% v/v (subMIC) lactic acid indicated that growth correlated positively with the lag phase duration, and negatively with both the maximum growth rate and change in population density for all strains evaluated except for the highly tolerant variant- O157:H7 amp P strep C. Strains O121 NR (non-ABR), O121 amp C, O121 amp P strep C, O157:H7 H1730 amp C and O157:H7 H1730 amp P strep C were not inactivated after exposure to 1% and 2.5% v/v lactic acid for 300 s. No recovery of cells was observed after the strains were exposed to 5% v/v lactic acid for 300 s. ABR strains O157:H7 H1730 amp C and O157: H7 H1730 amp P strep C demonstrated a high tolerance to lactic acid (P ≤ 0.05).

Conclusion

ABR in isolate E. coli O157: H7 H1730 may improve tolerance to lactic acid. Increased tolerance may be discerned by evaluating growth parameters of bacteria in presence of sub-MIC levels of lactic acid.

Influence of antibiotic-resistance and exudate on peroxyacetic acid tolerance in O157 and non-O157 Shiga toxin producing E. coli

Shiga toxin producing Escherichia coli (STEC) continues to cause foodborne outbreaks associated with beef and beef products despite consistent use of antimicrobial interventions. In this study, the influence of antibiotic resistance (ABR) in E. coli O157:H7 H1730, O157:H7 43,895, O121:H19 and O26:H11 on tolerance to peroxyacetic acid (PAA) was evaluated. Further, bactericidal concentrations of PAA in the presence of nutrient rich media (Tryptic Soy Broth, TSB and beef exudates) and nutrient deficient media (Sterile Deionized Water, SDW and Phosphate Buffered Saline, PBS) were evaluated for all bacterial strains. Antibiotic resistance to ampicillin (amp C), or ampicillin and streptomycin (amp P strep C) was generated in each bacterial strain through incremental exposure to the antibiotics or by plasmid transformation (n = 12 total strains). The mean bactericidal concentrations of PAA were higher (p ≤ 0.05) in nutrient rich media (205.55 ± 31.11 in beef exudate and 195.83 ± 25.00 ppm in TSB) than in nutrient deficient media (57.91 ± 11.97 ppm in SDW and 56.66 ± 9.56 ppm in PBS). Strain O157: H7 ampP strepC was the most tolerant to PAA (p ≤ 0.05). At 200 ppm in nutrient rich media and 60 ppm in nutrient deficient media, all bacterial strains declined in population to below the limit of detection. Analysis of the beef exudates indicated the presence of diverse amino acids that have been associated with acid tolerance. The results from this study indicate that beef exudates could contribute to acid tolerance and suggest that some STEC bacterial strains with certain ABR profiles might be more tolerant to PAA.

Decreased Trochlear Length Associated with Increased Anterior Knee Pain Following Total Knee Arthroplasty: A New Anatomical Perspective

BACKGROUND

Anterior Knee Pain (AKP) and patello-femoral crepitus (PFCr) continue to plague total knee arthroplasty (TKA) patients despite advances and modifications to implant design and surgical techniques. We present our study of the femoral trochlear length measurement pre- and post-implantation and its association with AKP/PFCr and clinical scores.

METHODS

Using computer navigation, we obtained several measurements in 263 TKA (posterior-stabilized) patients, which included femoral native trochlear measurement (NTM) and difference in trochlear length (DTL) between implant and native trochlea. We report their association with Knee Society Score (KSS), Western Ontario McMaster University Arthritic Index(WOMAC), and AKP/PFCr at 1 year postoperatively.

RESULTS

Mean KSS and WOMAC Scores were significantly worse in patients who had AKP (P=0.005 and P=0.002 respectively). Receiver Operating Characteristic (ROC curve) showed a statistically significant association between native trochlear measurement and AKP (Area under the curve[AUC] =0.609, P=0.014). Lower the native trochlear measurement, greater was the incidence of AKP. Analysis of the ROC curve identified the cut-off value of NTM to be ≤ 25.5 with sensitivity of 76.7(95% Confidence Interval (CI)- 57.7 - 90.1) and specificity of 46.9(95%CI- 41.9 - 55.1). Patients who had NTM of ≤25.5 had an odds ratio of 3.09 to have AKP. The DTL ranged from 7.4 to 32.1 millimeters, indicating that post-implantation there was lengthwise overstuffing along the trochlea in every patient.

CONCLUSION

We found that the shorter the native femoral trochlea and greater the difference between implanted and native trochlea, the higher was the occurrence of AKP. A mismatch in trochlear measurement pre- and post-implantation resulted in lengthwise overstuffing in the anterior knee causing AKP and PFCr.

Changes in chemical characteristics and modeling sensory parameters of stored pecan nutmeats

Pecan is a major specialty crop produced in the United States. Sensory evaluation and chemical analyses of pecan nutmeats are integral components of shelf life and have been employed to investigate changes during storage, but there remains a lack of knowledge regarding storage stability. Specifically, the association between shelf life and chemical characteristics has not been investigated. We aimed to investigate the chemical changes in pecan nuts during a range of storage treatments (temperature, relative humidity, packaging material, and modified atmosphere). The results of the chemical analyses were used to build a volatile compound-based sensory prediction model. The work has utility as a rapid method to measure lipid oxidation in pecan, which is of value to the pecan industry. The research also determined a possible association between pecan nut volatile compounds and sensory attributes of pecans, and their perception by human subjects. Building a sensory-based prediction model would reduce dependency on expensive and time-consuming sensory methods.

An analysis of the dynamic role of lipids in the progression and development of cardiovascular disease

The main cause of mortality around the globe is cardiovascular disease (CVD). There are several indications followed by experimental validation that dysfunctional lipotoxicity is one of the primary causes of cardiovascular illnesses such as atherosclerosis, “coronary heart disease”, (CHD), and hypertension. Obesity and diabetes raise the number of circulating lipids, which may enhance the production of harmful intermediates and cause issues related to cardiovascular disorders. Effective and affordable medicines to lower cardiovascular risk are desperately required. Lipids or lipoprotein particles play a critical role in atherosclerosis, the pathophysiology behind CVD. They also have an effect on inflammatory processes, vascular or cardiac cell function, leukocyte activity, and ultimately the health of the heart and blood arteries. In this paper, an attempt was made to identify the cause of lipid buildup that led to the pathophysiology of cardiovascular disorders as well as the processes behind lipotoxicity. A summary of current and developing treatment approaches to decrease the incidence of lipid-induced cardiovascular disease is also compiled through previous studies.

Potential protective effects of isoflavones in effective management of cardiovascular diseases

For human life, health, and biological growth, nutrition is crucial. A prominent example of a food that is nutrient rich at the moment is "Soybean”. In Asian nations, it is thought to be a significant source of proteins and may be used in place of dairy products and meat. When compared to other food legumes, soybeans offer several nutritional benefits in terms of their composition in macro- and micronutrients. As more information on negative effects of chemical treatments is being available to people, they are now is search of potential phytocompounds. The aim of the present review is to provide potential evidence of isoflavones in management of cardiovascular diseases like heart failure, myocardial infarction, hypertension and coronary artery disease. Nevertheless, soy isoflavones can have certain adverse consequences since they are endocrine disruptors. Thyroid function abnormalities have sparked concerns. In light of the aforementioned findings, an effort has been undertaken to examine the literature on the beneficial and harmful roles of isoflavones, soy-derived bioactive compounds.

Primary synovial chondromatosis of the hip joint (PrSC of the hip): A retrospective cohort analysis and review of the literature

Introduction

Primary synovial osteochondromatosis (SOCM) or Synovial chondromatosis (SC) of the hip is a benign metaplastic condition of the synovium that is rare and may present with a spectrum of clinical features and radiological findings.

Patients and methods

A retrospective search using the keyword 'Synovial chondromatosis' (SC) of the hip was performed at a tertiary care orthopaedic referral centre in the UK and a hospital in India. The radiology images were collected from our Picture Archiving and Communication System (PACS) and Radiology Information System (RIS), over 15 years. The patient's data was collated with Electronic Patient Records (EPR), RIS, and correlated with histo-pathology laboratory records where available. The demographic details of the patients, their clinical symptoms, imaging details, and management outcomes were collected.

Results

We found 15 cases, with a mean age of 36.53 years (range: 14-50 years). There were 9 male and 6 female patients. The follow-up ranged from 1 year to 6 years. Predominantly unilateral presentation with insidious onset of symptoms was found. A spectrum of radiological Imaging was undertaken. Management strategies included supervised observation, arthroscopic or open synovectomy, and hip arthroplasty. No malignant transformation was found in the analysed cohort.

Conclusion

Primary 'Synovial chondromatosis' of the hip had a male preponderance in our cohort, presenting with a range of clinical features. Radiologically, Magnetic Resonance Imaging (MRI) was the commonest modality of cross-sectional imaging utilised and crucial for the diagnosis, evaluating underlying articular involvement including guiding appropriate patient management presenting with Primary 'Synovial chondromatosis' of the hip.

Non-destructive insights into photosynthetic and photoprotective mechanisms in Arabidopsis thaliana grown under two light regimes

Probing insights into understanding photosynthetic processes via non-invasive means has an added advantage when used in phenotyping or precision agriculture. We employed Raman spectroscopy and fluorescence-based methods to investigate both the changes in the photosynthetic processes and the underlying protective mechanisms on Arabidopsis thaliana wild-type (WT), and ros1, which is a mutant of a repressor of transcriptional gene silencing, both grown under low light (LL: 100 μmol m^-2s^-1) and high light (HL: 400 μmol m^-2s^-1) regimes. Raman imaging detected a lower carotenoid intensity after two weeks in those plants grown under HL, compared to those grown under the LL regime; we interpret this as the result of oxidative damage of β-carotene molecules. Further, the data revealed a significant depletion in carotenoids with enhanced phenolics around the midrib and tip of the WT leaves, but not in the ros1. On the contrary, small necrotic zones appeared after two weeks of HL in the ros1 mutant, pointing to the starting oxidative damage. The lower maximum quantum yield of the photochemistry (F_v/F_m) in the WT as well as in the ros1 mutant grown in HL (compared to those in the LL two weeks post-exposure), indicates the HL partially inactivated photosystems. Chlorophyll a fluorescence imaging further showed high non-photochemical quenching (NPQ) in the plants grown under the HL regime for both the WT and the ros1 mutant, but the spatial heterogeneity of NPQ images was much higher in the HL-grown ros1 mutant. Fluorescence screening methods revealed significantly high values of chlorophyll proxies in the WT as well as in the ros1 mutant two weeks after in the HL compared to those under LL. The data generally revealed an increased accumulation of phenolics under HL in both the WT and ros1 mutant plants, but the proxies of anthocyanin and flavonols were significantly lower in the ros1 mutant than in the WT. The comparatively low accumulation of anthocyanin in the ros1 mutant compared to the WT supports the Raman data. We conclude that integrated use of these techniques can be efficiently applied for a better understanding of insights into photosynthetic mechanisms.

Sunlight Parameters Influence the Survival and Decline of Salmonella and Escherichia coli in Water

ABSTRACT

The effect of variations in temperature, UV radiation, and sunlight intensity on Escherichia coli, E. coli O157:H7, Salmonella Newport, and antibiotic resistant (ABR) variants of E. coli O157:H7 and Salmonella Newport exposed to sunlight was evaluated. Bacterial strains suspended in sterile deionized water at a concentration of 8 log CFU/mL were exposed to sunlight on three different days for 180 min; control treatments were stored in the dark. The mean temperature of 30.08 and 26.57°C on day 1 and day 3, respectively, was significantly different (P < 0.05). The UV intensity was significantly different on all 3 days, and sunlight intensity significantly differed on day 3 (P < 0.05). Bacterial population decline positively correlated with temperature, sunlight, and UV intensity. Differences in bacterial population declines differed among species, ABR profile, and day of exposure (P < 0.05). On day 1 and day 2, the populations of E. coli dropped below the limit of detection (1 log CFU/mL), whereas the percentage of live cells was 67 and 6.6%, respectively. The artificial neural network model developed to predict bacterial survival under different environmental conditions suggested that Salmonella cells were more resistant than E. coli cells. The ABR strains had significantly higher numbers of viable cells after sunlight exposure (P < 0.05). Sunlight-exposed cells resuscitated in tryptic soy broth varied in maximum population density and maximum specific growth rate based on bacterial species and presence of ABR. Morphological changes such as viable but nonculturable state transition and filament formation were detected in subpopulations of sunlight-exposed bacteria. Daily fluctuations in UV and sunlight intensity can result in significant variations in bacterial decline and recovery.

HIGHLIGHTS

The Effectiveness of SARS-CoV-2 Vaccination in Preventing Severe Illness and Death - Real-world Data from a Cohort of Patients Hospitalized with COVID-19

Background

While long-term studies on the correlates of protection, vaccine effectiveness, and enhanced surveillance are awaited for SARS-CoV-2 vaccine, studies on breakthrough infections help understand the nature and course of this illness among vaccinated individuals and guide in public health preparedness. This study aims to compare the differences in the hospitalization outcomes SARS-CoV-2 infection of fully vaccinated individuals with with those of unvaccinated and partially vaccinated individuals.

Materials and Methods

Single institution observational cohort study. This study compared the differences in clinical, biochemical parameters and the hospitalization outcomes of 53 fully vaccinated individuals with those of unvaccinated (1464) and partially vaccinated (231) individuals, among a cohort of 2,080 individuals hospitalized with SARS-CoV-2 infection. Descriptive statistics and propensity-score weighted multivariate logistic regression analysis adjusting for clinical and laboratory parameters were used to compare the differences and to identify factors associated with outcomes.

Results

Completing the course of vaccination protected individuals from developing severe COVID-19 as evidenced by lower proportions of those with hypoxia, abnormal levels of inflammatory markers, requiring ventilatory support, and death compared to unvaccinated and partially vaccinated individuals. There were no differences in these outcomes among patients who received either vaccine type approved in India.

Conclusions

Efforts should be made to improve the vaccination rates as a timely measure to prepare for the upcoming waves of this highly transmissible pandemic. Vaccination rates of the communities may also guide in the planning of the health needs and appropriate use of medical resources.

Inactivation of Escherichia coli in apple cider using atmospheric cold plasma

Atmospheric cold plasma (ACP) is a promising non-thermal technology that has the potential to inactivate microorganisms in foods. In this work, the inactivation of E. coli K12, acid-adapted E. coli K12, and E. coli O157:H7 in apple cider by ACP was investigated using feed gases as simulated air (SA) (80 % N₂ + 20 % O₂) and a mixture of 90 % N₂ + 10 % O₂ with various processing times (0 to 180 s). We obtained the reduced the populations of both acid-adapted and non-adapted E. coli K12 by 5 log CFU/mL within 120 s, and E. coli O157:H7 within 90 s. Additionally, no significant changes in the °Brix, pH, temperature, or titratable acidity (TA) of apple cider were observed after exposure to ACP. However, processing times longer than 120 s resulted in significant changes in the pH values. The highest concentration of ozone and hydrogen peroxide reached to 0.22 ± 0.1 mg/L for CG in 180 s and 0.07 ± 0.01 mg/L for SA in 150 s, respectively. Both acid-adapted and non-acid adapted E. coli K12 was found to be more resistant to ACP processing than E. coli O157:H7 after the 90 s, so it could serve as a surrogate for E. coli O157:H7. When we compared the effect of the gas type on inactivation, non-selective media, the results showed no significant differences between the gas types, while selective media demonstrated significant differences. In optical absorption spectroscopy measurements of plasma species, primarily ozone peaks were observed. Furthermore, the optical absorption spectroscopy also revealed that the inactivation of the bacteria could be attributed to some plasma species with wavelengths between 190 and 308 nm. The findings provided a perspective on the use of ACP as a method for decontaminating fruit juices as a non-thermal processing.

Feasibility and impact of a one-stop thyroid clinic in a low- and middle-income country

BACKGROUND

The study was done to evaluate the feasibility, safety and outcomes of a one-stop thyroid clinic (OSTC) in a low- and middle-income country (LMIC) setting.

METHODS

This was a prospective non-randomised case control study consisting of patients with thyroid nodules evaluated and managed at a tertiary referral centre in an LMIC between February 2019 and January 2020. Patients were divided into two groups based on the kind of preoperative evaluation protocol: OSTC group (n = 118) - OSTC protocol, and control group (CG, n = 108) - routine protocol.

RESULTS

Baseline clinical characteristics of the two groups including median age (p = 0.13) and gender distribution (p = 0.76) were comparable. The majority of patients in both groups belonged to a low-income group (46.6% vs 47.3%; p = 0.91), followed by a middle-income group (35.6% vs 30.5%; p = 0.41). The median number of outpatient department visits (1 vs 3 days; p = < 0.001), waiting time for neck ultrasonography (1 vs 3 days; p = < 0.0001), fine needle aspiration cytology (1 vs 2 days; p = < 0.0001), and out of pocket expenditure (INR 3 965 vs 6 624; p = < 0.001) was significantly less in the OSTC group compared to the CG. Patients in the OSTC group reported better satisfaction levels (p = < 0.0001). Accuracy of diagnosis did not differ between the two groups (p = 0.14).

CONCLUSION

OSTC practice is feasible, provides comparative clinical outcomes and seems cost effective in an LMIC. This protocol can be adopted as a routine practice in any health system.

Antibiotic Resistance Influences Growth Rates and Cross-Tolerance to Lactic Acid in Escherichia coli O157:H7 H1730

Escherichia coli O157:H7-contaminated beef has been implicated in numerous foodborne outbreaks. Contamination occurs despite the use of antimicrobial interventions such as lactic acid (LA). In addition, resistance to antibiotics such as ampicillin and streptomycin among isolates has been frequently reported. The influence of antibiotic resistance (ABR) on growth rates and cross-tolerance of lettuce isolate E. coli O157:H7 H1730 to LA was evaluated. Antibiotic-resistant strain variants were generated by conferring resistance to either ampicillin (ampC) or streptomycin (strepC) or both ampicillin and streptomycin (ampC strepC) through incremental exposure to the antibiotics. Ampicillin resistance was also conferred by plasmid transformation to generate the ampP and ampP strepC strains. The minimum inhibitory concentration of LA on all the strains evaluated was 0.375% v/v. The lag phase duration of all strains except E. coli O157:H7 ampP strepC increased with increasing concentration of LA. The ampP strepC and ampC strains were most tolerant to 5% LA with declines in the cell population of 2.86 and 2.56 log CFU/mL, respectively (p < 0.05). The ampP strepC strain was the most tolerant when evaluated by the live/dead viability assay. The addition of the efflux pump inhibitor, carbonyl cyanide m-chlorophenylhydrazone, with 2.5% LA resulted in a significant increase in sensitivity in the no resistance (NR) wild-type and ampC strains, resulting in 6.62 and 6.65 log CFU/mL reduction, respectively, while the highly tolerant ampP strepC strain had a 2.90 log CFU/mL decrease. Tolerance to LA was significantly influenced by both the ABR profile of the strain and LA concentration. The results from this study indicate that E. coli O157:H7 strains with certain ABR profiles might be more tolerant to LA.

Enteric viruses replicate in salivary glands and infect through saliva

Enteric viruses like norovirus, rotavirus and astrovirus have long been accepted as spreading in the population through fecal-oral transmission: viruses are shed into feces from one host and enter the oral cavity of another, bypassing salivary glands (SGs) and reaching the intestines to replicate, be shed in feces and repeat the transmission cycle1. Yet there are viruses (for example, rabies) that infect the SGs2,3, making the oral cavity one site of replication and saliva one conduit of transmission. Here we report that enteric viruses productively and persistently infect SGs, reaching titres comparable to those in the intestines. We demonstrate that enteric viruses get released into the saliva, identifying a second route of viral transmission. This is particularly significant for infected infants, whose saliva directly transmits enteric viruses to their mothers' mammary glands through backflow during suckling. This sidesteps the conventional gut-mammary axis route4 and leads to a rapid surge in maternal milk secretory IgA antibodies5,6. Lastly, we show that SG-derived spheroids7 and cell lines8 can replicate and propagate enteric viruses, generating a scalable and manageable system of production. Collectively, our research uncovers a new transmission route for enteric viruses with implications for therapeutics, diagnostics and importantly sanitation measures to prevent spread through saliva.

Does Postoperative Intravenous Ferric Carboxymaltose Hasten the Recovery of Hemoglobin in Patients Post Total Knee Arthroplasty?

BACKGROUND

Timely and effective iron supplementation may help reduce the incidence of postoperative anemia and its associated problems. In this study, we aim to assess the efficacy of intravenous ferric carboxy maltose (FCM) on improving hemoglobin(Hb) level posttotal knee arthroplasty (TKA).

METHODS

We retrospectively reviewed 263 patients who had undergone unilateral TKA with 157 patients in the study group (year 2019) and 106 in the control group (year 2016). Patients in the study group received FCM (500 mg IV) on postoperative day 1, whereas patients in the control group did not receive FCM or any other iron supplementation postoperatively. Hb levels were recorded preoperatively (Pr-Hb), postoperatively on day 3 (Day3-Hb) and postoperatively at 5(+1) weeks (Week5-Hb). Statistical analysis was performed using student's paired and unpaired t-tests.

RESULTS

Pr-Hb and Day3-Hb levels were comparable in the control and study group, while Week5-Hb levels were significantly higher (P < .001) in the study group. The drop in Hb at Day3 from preoperative values was comparable between the two groups (P = 1.0). The rise in Hb from Day3 to 5 weeks was significantly higher in the study group as compared to the control group (P < .001). The difference between Pr-Hb and Week5-Hb was significantly lower (P < .001) in the study group compared to the control group. However, Week5-Hb in both groups remained lower than Pr-Hb (P < .001) in all patients.

CONCLUSION

Intravenous FCM (500 mg) was found to be a safe method of iron supplementation to improve hemoglobin levels rapidly and consistently, post-TKA. We need to further study the additive effect of higher dose FCM (1000 mg) on hemoglobin recovery.

Silent Hypoxia in Coronavirus disease-2019: Is it more dangerous? -A retrospective cohort study

BACKGROUND

Hypoxia in patients with COVID-19 is one of the strongest predictors of mortality. Silent hypoxia is characterised by the presence of hypoxia without dyspnoea. Silent hypoxia has been shown to affect the outcome in previous studies.

METHODS

This was a retrospective study of a cohort of patients with SARS-CoV-2 infection who were hypoxic at presentation. Clinical, laboratory and treatment parameters in patients with silent hypoxia and dyspnoeic hypoxia were compared. Multivariate logistic regression models were fitted to identify the factors predicting mortality.

RESULTS

Among 2080 patients with COVID-19 admitted to our hospital, 811 patients were hypoxic with SpO₂ <94% at the time of presentation. Among them, 174 (21.45%) did not have dyspnoea since the onset of COVID-19 symptoms. Further, 5.2% of patients were completely asymptomatic for COVID-19 and were found to be hypoxic only on pulse oximetry. The case fatality rate in patients with silent hypoxia was 45.4% as compared to 40.03% in dyspnoeic hypoxic patients (P = 0.202). The odds ratio of death was 1.1 (95% CI: 0.41-2.97) in the patients with silent hypoxia after adjusting for baseline characteristics, laboratory parameters, treatment and in-hospital complications, which did not reach statistical significance (P = 0.851).

CONCLUSION

Silent hypoxia may be the only presenting feature of COVID-19. As the case fatality rate is comparable between silent and dyspnoeic hypoxia, it should be recognised early and treated as aggressively. Because home isolation is recommended in patients with COVID-19, it is essential to use pulse oximetry in the home setting to identify these patients.

ECG Data Analysis with Denoising Approach and Customized CNNs

In the last decade, the proactive diagnosis of diseases with artificial intelligence and its aligned technologies has been an exciting and fruitful area. One of the areas in medical care where constant monitoring is required is cardiovascular diseases. Arrhythmia, one of the cardiovascular diseases, is generally diagnosed by doctors using Electrocardiography (ECG), which records the heart's rhythm and electrical activity. The use of neural networks has been extensively adopted to identify abnormalities in the last few years. It is found that the probability of detecting arrhythmia increases if the denoised signal is used rather than the raw input signal. This paper compares six filters implemented on ECG signals to improve classification accuracy. Custom convolutional neural networks (CCNNs) are designed to filter ECG data. Extensive experiments are drawn by considering the six ECG filters and the proposed custom CCNN models. Comparative analysis reveals that the proposed models outperform the competitive models in various performance metrics.

Enhanced lung image segmentation using deep learning

With the advances in technology, assistive medical systems are emerging with rapid growth and helping healthcare professionals. The proactive diagnosis of diseases with artificial intelligence (AI) and its aligned technologies has been an exciting research area in the last decade. Doctors usually detect tuberculosis (TB) by checking the lungs' X-rays. Classification using deep learning algorithms is successfully able to achieve accuracy almost similar to a doctor in detecting TB. It is found that the probability of detecting TB increases if classification algorithms are implemented on segmented lungs instead of the whole X-ray. The paper's novelty lies in detailed analysis and discussion of U-Net +  + results and implementation of U-Net +  + in lung segmentation using X-ray. A thorough comparison of U-Net +  + with three other benchmark segmentation architectures and segmentation in diagnosing TB or other pulmonary lung diseases is also made in this paper. To the best of our knowledge, no prior research tried to implement U-Net +  + for lung segmentation. Most of the papers did not even use segmentation before classification, which causes data leakage. Very few used segmentations before classification, but they only used U-Net, which U-Net +  + can easily replace because accuracy and mean_iou of U-Net +  + are greater than U-Net accuracy and mean_iou , discussed in results, which can minimize data leakage. The authors achieved more than 98% lung segmentation accuracy and mean_iou 0.95 using U-Net +  + , and the efficacy of such comparative analysis is validated.

The RAIS Device for Global Surgery: Using a Participatory Design Approach to Navigate the Translational Pathway to Clinical Use

Background: Over 5 billion people worldwide have no access to surgery worldwide, typically in low-resource settings, despite it being a primary life-saving treatment. Gas Insufflation-Less Laparoscopic Surgery (GILLS) can address this inequity, by improving current GILLS instrumentation to modern surgical standards. Objective: to develop and translate a new Retractor for Abdominal Insufflation-less Surgery (RAIS) into clinical use and thus provide a context-appropriate system to advance GILLS surgery. Methods: A collaborative multidisciplinary team from the UK and India was formed, embedding local clinical stakeholders and an industry partner in defining user and contextual needs. System development was based on a phased roadmap for ‘surgical device design in low resource settings’ and embedded participatory and frugal design principles in an iterative process supported by traditional medical device design methodologies. Each phase of development was evaluated by the stakeholder team through interactive workshops using cadaveric surgical simulations. A Commercialisation phase undertook Design to Manufacture and regulatory approval activities. Clinical validation was then conducted with rural surgeons performing GILLS procedures using the RAIS system. Semi-structured questionnaires and interviews were used to evaluate device performance. Results: A set of user needs and contextual requirements were defined and formalised. System development occurred across five iterations. Stakeholder participation was instrumental in converging on a design which met user requirements. A commercial RAIS system was then produced by an industry partner under Indian regulatory approval. This was successfully used in clinical validation to conduct 12 surgical procedures at two locations in rural India. Surgical feedback showed that the RAIS system provided a valuable and usable surgical instrument which was appropriate for use in low-resource contexts. Conclusions: Using a context-specific development approach with close engagement of stakeholders was crucial to develop the RAIS system for low-resource regions. The outcome is translation from global health need into a fully realized commercial instrument which can be used by surgeons in low-resource regions across India.

Clinical features, demography, and predictors of outcomes of SARS-CoV-2 infection at a tertiary care hospital in India: A cohort study

Background:

The “second wave” of the COVID-19 pandemic hit India from early April 2021 to June 2021. We describe the clinical features, treatment trends, and baseline laboratory parameters of a cohort of patients with SARS-CoV-2 infection and their association with the outcome.

Methods:

This was a retrospective cohort study. Multivariate logistic regression models were fitted to identify clinical and biochemical predictors of developing hypoxia, deterioration during the hospital stay, and death.

Results:

A total of 2080 patients were included. The case fatality rate was 19.5%. Among the survivors, the median duration of hospital stay was 8 (5–11) days. Out of 853 (42.3%%) of patients who had COVID-19 acute respiratory distress syndrome at presentation, 340 (39.9%) died. Patients aged >45 years had higher odds of death as compared to the 18–44 years age group. Vaccination reduced the odds of death by 40% (odds ratio [OR] [95% confidence interval [CI]]: 0.6 [0.4–0.9], P = 0.032). Patients with hyper inflammation at baseline as suggested by leukocytosis (OR [95% CI]: 2.1 [1.5–3.1], P < 0.001), raised d-dimer >500 mg/dL (OR [95% CI]: 3.2 [2.2–4.7], P < 0.001), and raised C-reactive peptide >0.5 mg/L (OR [95% CI]: 3.7 [2.2–13], P = 0.037) had higher odds of death. Patients who were admitted in the 2^nd week had lower odds and those admitted in the 3^rd week had higher odds of death.

Conclusion:

This study shows that vaccination status and early admission during the inflammatory phase can change the course of illness of these patients. Improving vaccination rates and early admission of patients with moderate and severe COVID-19 can improve the outcomes.