COVID-19 pandemic has resulted in 16,114,449 cases with 646,641 deaths from the 217 countries, or territories as on July 27th 2020. Due to multifaceted issues and challenges in the implementation of the safety and preventive measures, inconsistent coordination between societies-governments and most importantly lack of specific vaccine to SARS-CoV-2, the spread of the virus that initially emerged at Wuhan is still uprising after taking a heavy toll on human life. In the present study, we mapped immunogenic epitopes present on the four structural proteins of SARS-CoV-2 and we designed a multi-epitope peptide based vaccine that, demonstrated a high immunogenic response with a vast application on world’s human population. On codon optimization and in-silico cloning, we found that candidate vaccine showed high expression in E. coli and immune simulation resulted in inducing a high level of both B-cell and T-cell mediated immunity. The results predicted that exposure of vaccine by administrating three injections significantly subsidized the antigen growth in the system. The proposed candidate vaccine found promising by yielding desired results and hence, should be validated by practical experimentations for its functioning and efficacy to neutralize SARS-CoV-2.
Purpose: To evaluate the intraocular pressure (IOP)—lowering efficacy and safety of incisional goniotomy as an adjunct to phacoemulsification in primary angle-closure glaucoma (PACG) patients. Methods: Consecutive patients with PACG (high or borderline IOP) deemed fit for phacoemulsification were enrolled. After phacoemulsification, incisional goniotomy was performed with or without goniosynechialysis. Patient demographic profile, clinical data, and adverse events, if any, were analyzed during at least a 6-month follow-up period. Success was defined as IOP of 18 mm Hg or lesser with or without medications. Setting: Tertiary care Ophthalmic hospital. Design: Prospective interventional case series. Results: Of 46 eyes (38 patients) included, 69.6% eyes were classified as having advanced glaucoma. The mean treated IOP decreased by 7.3 ± 1.0 (SE) mm Hg (95% CI, 5.2-9.3) from 21.4 ± 6.6 to 14.2 ± 3.7 mm Hg at a mean duration of 11.7 ± 5.5 months (6-22 months) postoperatively (P < .001, paired t test). There was 66.6% reduction in median number of hypotensive medications (P < .001, Wilcoxon signed-rank test). Observed complications included hyphema (13 eyes [28%]), IOP spike (3 eyes [6.5%]), and cyclodialysis (1 eye [2.17%]). High treated IOP and number of medications were significantly associated with failure in univariate analysis (P < .05, Fisher exact test). The cumulative survival probability for qualified success at 22 months was 87.8% ± 0.07 (95% CI, 0.65-0.96). Conclusions: Incisional goniotomy as an adjunct with phacoemulsification resulted in a significant and sustained reduction in IOP along with decrease in number of glaucoma medications in chronic PACG eyes, irrespective of the disease stage.
Background Prone positioning is known to reduce mortality in intubated non-COVID-19 patients suffering from moderate to severe acute respiratory distress syndrome (ARDS). However, studies highlighting the effect of awake proning in COVID-19 patients are lacking. We aim to conduct a systematic review of the available literature to highlight the effect of awake proning on the need for intubation, improvement in oxygenation and mortality rates in COVID-19 patients with ARDS. Method – A systematic search of 2 medical databases (PubMed, Google Scholar) was performed until July 5, 2020. Thirteen studies fulfilled the inclusion criteria, and 210 patients were included for the final analysis. Result –Majority of the patients were above 50 years of age with a male gender predominance (69%). Face mask (26%) was the most common interface used for oxygen therapy. The intubation and mortality rates were 23.80% (50/210) and 5.41% (5/203) respectively. Awake proning resulted in improvement in oxygenation (reported by 11/13 studies): improvement in SpO 2 , P/F ratio, PO 2 and SaO 2 reported by 7/13 (54%), 5/13 (38%), 2/13 (15%) and 1/13 (8%) of the studies. No major complications associated with prone positioning were reported by the included studies. Conclusion Awake prone positioning demonstrated an improvement in oxygenation of the patients suffering from COVID-19 related respiratory disease. Need for intubation was observed in less than 30% of the patients. Thus, we recommend early and frequent proning in patients suffering from COVID-19 associated ARDS, however, randomized controlled trials are needed before any definite conclusions are drawn.
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