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The Australian National COVID-19 Clinical Evidence Taskforce was established in March 2020 to maintain up-to-date recommendations for the treatment of people with coronavirus disease 2019 (COVID-19). The original guideline (April 2020) has been continuously updated and expanded from nine to 176 recommendations, facilitated by the rapid identification, appraisal, and analysis of clinical trial findings and subsequent review by expert panels.In this article, we describe the recommendations for treating non-pregnant adults with COVID-19, as current on 1 August 2022 (version 61.0). The Taskforce has made specific recommendations for adults with severe/critical or mild disease, including definitions of disease severity, recommendations for therapy, COVID-19 prophylaxis, respiratory support, and supportive care.The Taskforce currently recommends eight drug treatments for people with COVID-19 who do not require supplemental oxygen (inhaled corticosteroids, casirivimab/imdevimab, molnupiravir, nirmatrelvir/ritonavir, regdanvimab, remdesivir, sotrovimab, tixagevimab/cilgavimab) and six for those who require supplemental oxygen (systemic corticosteroids, remdesivir, tocilizumab, sarilumab, baricitinib, casirivimab/imdevimab). Based on evidence of their achieving no or only limited benefit, ten drug treatments or treatment combinations are not recommended; an additional 42 drug treatments should only be used in the context of randomised trials. Additional recommendations include support for the use of continuous positive airway pressure, prone positioning, and endotracheal intubation in patients whose condition is deteriorating, and prophylactic anticoagulation for preventing venous thromboembolism. The latest updates and full recommendations are available at www.covid19evidence.net.au.

BACKGROUND: Intrauterine growth restriction (IUGR) is still one of the most common causes of foetal morbidity and mortality, as well as neonatal mortality and morbidity. It's mostly accountable for the high number of perinatal deaths. IUGR is described as a rate of foetal growth smaller than the typical growth expected during a certain gestational age and can be caused by a variety of maternal, foetal, and placental variables. Birth weight less than two standard deviations or less than the 10th percentile of the mean for a certain gestational age is considered small for gestational age (SGA). Neonatal mortality has decreased signicantly in recent decades as a result of developments in antenatal and neonatal critical care, as well as management of low birth weight babies, although stillbirth rates have remained stable. These children in the later stage of life can develop developmental delays, cerebral palsy, mental retardation and long-term health issues. In the current article, we discuss regarding the incidence of IUGR in study population, and the associated maternal diseases along with perinatal outcome. METHOD: The study was done in a peri-urban tertiary care centre in Nagpur from January 2021 till December 2021 for a duration of 1 year, where 100 women with diagnosed Intra Uterine Growth Restriction were admitted and followed up. Demographic characters were noted and maternal and fetal monitoring was done regularly. Mode of delivery was planned according to gestational age, degree of IUGR, doppler changes. Maternal and perinatal outcome and complications were noted. RESULTS: 100 cases of IUGR were recruited for the study from January 2021 till December 2021 for a duration of 1 year out of total of 1246 deliveries which were recorded in the hospital during this time period. In the present study, the incidence of IUGR was 8.02%. Pregnancy Induced Hypertension was the most signicant risk factor associated with IUGR which was 53%, followed by anaemia- 12%. Previous pregnancies which had IUGR with IUGR in this pregnancy were found in 9 patients. Of the 64 LSCS, foetal distress was the commonest indication (33 cases, 51.5%) followed by abnormal Doppler ndings (17 cases 26.5 %). 86 % of babies had asymmetric IUGR while patients with symmetric IUGR were 14%. CONCLUSION: IUGR leads to the causes of neonatal and perinatal mortality and morbidity. It can be easily assessed at an early stage. Serial clinical, ultrasonographic and doppler follow up will help in diagnosing IUGR and decision making to avoid intrauterine demise, neonatal and perinatal mortality. Surveillance of high-risk pregnancies is also required.

BACKGROUND: There is a lack of consistent, evidence-based guidelines for the management of patients with fever after brain injury. The aim was to update previously published consensus recommendations on targeted temperature management after intracerebral haemorrhage, aneurysmal subarachnoid haemorrhage, and acute ischaemic stroke in patients who require admission to critical care. METHODS: A modified Delphi consensus, the Neuroprotective Therapy Consensus Review (NTCR), included 19 international neuro-intensive care experts with a subspecialty interest in the acute management of intracerebral haemorrhage, aneurysmal subarachnoid haemorrhage, and acute ischaemic stroke. An online, anonymised survey was completed ahead of the meeting before the group came together to consolidate consensus and finalise recommendations on targeted temperature management. A threshold of ≥80% for consensus was set for all statements. RESULTS: Recommendations were formulated based on existing evidence, literature review, and consensus. After intracerebral haemorrhage, aneurysmal subarachnoid haemorrhage, and acute ischaemic stroke in patients who require critical care admission, core temperature should ideally be monitored continuously and maintained between 36.0°C and 37.5°C using automated feedback-controlled devices, where possible. Targeted temperature management should be commenced within 1 h of first fever identification with appropriate diagnosis and treatment of infection, maintained for as long as the brain remains at risk of secondary injury, and rewarming should be controlled. Shivering should be monitored and managed to limit risk of secondary injury. Following a single protocol for targeted temperature management across intracerebral haemorrhage, aneurysmal subarachnoid haemorrhage, and acute ischaemic stroke is desirable. CONCLUSIONS: Based on a modified Delphi expert consensus process, these guidelines aim to improve the quality of targeted temperature management for patients after intracerebral haemorrhage, aneurysmal subarachnoid haemorrhage, and acute ischaemic stroke in critical care, highlighting the need for further research to improve clinical guidelines in this setting.

BackgroundVeno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a rapidly expanding therapy with a relatively limited evidence base. Due to both quantitative and qualitative acquired coagulopathies in VA-ECMO, bleeding remains a major complication and with potentially catastrophic outcomes. Simultaneously, coagulation activation occurs via blood contact with the extracorporeal circuit, which risks not only vital organ emboli, but also the circuit viability. This carries the risk of equally catastrophic complications. As such, VA-ECMO patients are routinely anticoagulated. A large variation in practice exists surrounding anticoagulation in VA-ECMO. Despite an increasing uptake in the therapy, the evidence base is limited and current guidelines surrounding anticoagulation practice are based on expert opinion. We will perform a study level systematic review and meta-analysis of VA-ECMO patients comparing anticoagulation strategies, including the agent of anticoagulation, the method of monitoring and the targeted degree of anticoagulation to assess the association between described anticoagulation strategies and bleeding and thrombotic complications.MethodsWe will perform a study level meta-analysis of randomised controlled trials (RCTs) and cohort studies that report on bleeding and thrombotic complications in VA-ECMO. Our primary objective is to describe the incidence of bleeding and thrombotic complications associated with individual anticoagulation strategies. In order to be included, a study must report the anticoagulant drug used, the method of monitoring used, or the anticoagulation target used, and at least one outcome of interest. Four databases will be systematically reviewed by two authors. Two authors will extract and assess for risk of bias using the Cochrane Risk of Bias tool for RCTs and the ROBINS-I tool for observational studies. Data will be analysed via incidence rates of bleeding and thrombotic complications, with a subgroup analysis of each anticoagulation strategy where able. The study will be reported in line with PRISMA guidelines.

BACKGROUND Intra-abdominal lymphadenopathy due to tuberculosis (TB) poses a diagnostic challenge due to difficulty in tissue acquisition. Although endoscopic ultrasound guided fine needle aspiration/biopsy (EUS-FNA/B) has shown promise in the evaluation of mediastinal lymph nodes, its role in the evaluation of intra-abdominal lymphadenopathy is not clear. AIM To assess the role of EUS-FNA/B in the evaluation of intra-abdominal lymphadenopathy due to TB. METHODS This was a retrospective study where patients with intra-abdominal lymphadenopathy who underwent evaluation with EUS-FNA/B were included. TB was diagnosed if the patient had any one of the following: (1) Positive acid fast bacilli (AFB) stain/TB GeneXpert/TB-polymerase chain reaction/AFB culture of tissue sample; and (2) Positive Mantoux test and response to anti-tubercular therapy. EUS-FNA reports, clinical reports and imaging characteristics of patients were recorded for a detailed analysis of patients with TB. RESULTS A total of 149 patients underwent an EUS-FNA/B from lymph nodes (mean age 51 ± 17 years, M:F = 1.2). Benign inflammatory reactive changes were seen in 45 patients (30.2%), while 54 patients (36.2%) showed granulomatous inflammation with/without caseation. Among these, 51 patients (94.4%) were confirmed to have TB as per pre-defined criteria. Patients with TB were more likely to have hypoechoic and matted nodes [40 patients (67.7%)]. EUS-FNA/B was found to have a sensitivity and specificity of 86% and 93% respectively, with a diagnostic accuracy of 88% in the evaluation of intra-abdominal lymphadenopathy due to TB. CONCLUSION EUS-FNA/B has a high diagnostic yield with a good sensitivity and specificity in the evaluation of intra-abdominal lymphadenopathy due to TB. However, the validity of these findings in populations with low prevalence of TB needs further evaluation.

Background and objective: Coronary artery disease (CAD) is highly prevalent and associated with adverse events. Challenges have emerged in the treatment of intermediate coronary artery stenoses. These lesions are often interrogated with fractional flow reserve (FFR) testing to determine if a stenosis is likely to be causative for ischemia in a cardiac territory. This invasive test requires insertion of a pressure wire into a coronary vessel. Recently computational fluid dynamics (CFD) has been used to noninvasively assess fractional flow reserve in vessels reconstructed from medical imaging data. However, many of these simulations are unable to provide additional information about intravascular hemodynamics, including velocity, endothelial shear stress (ESS), and vorticity. We hypothesized that vorticity, which has demonstrated utility in the assessment of ventricular and aortic diseases, would also be an important hemodynamic factor in CAD.Methods: Three-dimensional (3D), patient-specific coronary artery geometries that included all vessels >1 mm in diameter were created from angiography data obtained from 10 patients who underwent diagnostic angiography and FFR testing (n = 9). A massively parallel CFD solver (HARVEY) was used to calculate coronary hemodynamic parameters including pressure, velocity, ESS, and vorticity. These simulations were validated by comparing velocity flow fields from simulation to both velocities derived from in vitro particle image velocimetry and to invasively acquired pressure wire-based data from clinical testing.Results: There was strong agreement between findings from CFD simulations and particle image velocimetry experimental testing (p < 0.01). CFD-FFR was also highly correlated with invasively measured FFR (ρ = 0.77, p = 0.01) with an average error of 5.9 ± 0.1%. CFD-FFR also had a strong inverse correlation with the vorticity (ρ = -0.86, p = 0.001). Simulations to determine the effect of the coronary stenosis on intravascular hemodynamics demonstrated significant differences in velocity and vorticity (both p < 0.05). Further evaluation of an angiographically normal appearing non-FFR coronary vessel in patients with CAD also demonstrated differences in vorticity when compared with FFR vessels (p < 0.05).Conclusion: The use of highly accurate 3D CFD-derived intravascular hemodynamics provides additional information beyond pressure measurements that can be used to calculate FFR. Vorticity is one parameter that is modified by a coronary stenosis and appears to be abnormal in angiographically normal vessels in patients with CAD, highlighting a possible use-case in preventative screening for early coronary disease.

Hispanic or Latino (Hispanic) persons with HIV experience disparities in HIV health outcomes compared with some other racial and ethnic groups. A previous report found that the percentages of Hispanic persons who received HIV care, were retained in care, and were virally suppressed were lower than those among non-Hispanic White persons with HIV (1). HIV stigma and discrimination are human rights issues associated with adverse HIV outcomes; eliminating stigma and discrimination among persons with HIV is a national priority*

There are eight major categories of waste management, and each of them can be divided into numerous sub-categories. The categories include source reduction and reuse, animal feeding, recycling, composting, fermentation, landfills, incineration, and land application. Domestic waste is waste that is generated as a result of the ordinary day-to-day use of a domestic premise and is either taken from the premises by or on behalf of the occupier who generated the waste; without consideration (e.g., payment, reward or other benefit); or collected by or on behalf of a local government as part of a waste collection and disposal system. Objectives: • To assess the knowledge regarding the domestic waste management among the household in the selected community. • To assess the practice of the domestic waste management by the household in the selected community. Methodology: Research Approach Quantitative Research Study design: Descriptive design. Tool: Structured questionnaire Sampling Technique: convenient sampling. Research Setting: NC(E) Quarters of CHAFB. Result: The study revealed that 10% had a poor knowledge, 76.7% had a moderate knowledge and 13.3% had a good knowledge regarding domestic waste management. It also showed that 6.7% had poor practice, 53% had a moderate practice and 40% had satisfactory practice of domestic waste. Keywords: Knowledge, Practice, Domestic waste, domestic waste management, selected urban community.

Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) flows are titrated to achieve adequate perfusion while attempting to ideally maintain arterial pulse pressure (PP). We assessed risk in patients with low PP defined as Methods Demographics, haemodynamics, echocardiographic and radiological findings were recorded retrospectively in cases conducted between 2014 and 2016. Outcomes were hospital mortality, requirement for renal replacement therapy (RRT) and severe pulmonary oedema (PO). Results Of 101 patients, 66.3% were male, mean age was 56 (range 18–71 years), mean duration of support was 6.3 days ± 4.1 days, 37.6% died prior to hospital discharge, 39.6% needed RRT and 11.9% had severe PO. Areas under the receiver operating curves of PP at 48 h for hospital mortality, RRT and severe PO were (respectively): 0.69 (95% CI 0.58–0.80, p = .001), 0.64 (95% CI 0.50–0.77, p = .044), 0.69 (95% CI 0.55–0.82, p = .009). The odds ratio for mortality, RRT, severe PO for those with low PP were (respectively) 2.8 (95% CI 1.01–7.5, p = .04), 3.1 (95% CI 1.11–8.40, p = .026), 7.6 (95% CI 2.06–27.89, p = .001). Central venous pressure, mean arterial pressure were not predictive. Conclusion PP during the first 2 days of support is predictive of clinically important outcomes in patients supported with VA-ECMO.

OBJECTIVES To describe the incidence and outcomes of radiologically confirmed acute CNS complications in extracorporeal membrane oxygenation patients at an Australian extracorporeal membrane oxygenation referral center and identify associated patient characteristics. DESIGN Retrospective cohort study. SETTING Single-center tertiary institution. PATIENTS Four-hundred twelve consecutive adult patients supported with extracorporeal membrane oxygenation from 2009 to 2017. RESULTS Fifty-five patients (13.3%) had a CNS complication confirmed by CT or MRI, including ischemic stroke (7.0%), intracerebral hemorrhage (3.4%), hypoxic ischemic encephalopathy (3.6%), and spinal cord injury (1.2%). CNS complication rates in the venoarterial, venovenous, and veno-pulmonary artery extracorporeal membrane oxygenation subgroups were 18.0%, 4.6%, and 13.6%, respectively. Neurologic complications were independently associated with the use of venoarterial extracorporeal membrane oxygenation (p = 0.002) and renal replacement therapy (p = 0.04). Sixty-five percent of patients with a neurologic complication died during their hospital admission compared with 32% of patients without this complication (p < 0.001). Venoarterial extracorporeal membrane oxygenation, renal replacement therapy, and days of extracorporeal membrane oxygenation support were also associated with hospital mortality and remained so after adjustment in a multivariable regression model (p = 0.01, p < 0.001, and p = 0.003, respectively). CONCLUSIONS CNS complications appear to occur more frequently in patients requiring circulatory as opposed to respiratory support on extracorporeal membrane oxygenation and are independently associated with mortality. It remains unclear if these complications are causative of a poor outcome or a marker of severity of the underlying condition. Further research is required to better elucidate modifiable or preventable aspects through better patient selection and change in ongoing care.

The initiation of thrombus formation in transcatheter aortic valves (TAVs) is not well understood. The foreign material components of a TAV may play a key role in TAV thrombogenesis. The goal of this study was to evaluate the thrombogenic potential of a TAV (entire valve) and its stent (with skirt). Blood was collected from eight human donors with citrate anticoagulation and later reconstituted with calcium chloride. A low-volume steady flow loop (flow rate = 0.8 L/min) was designed to facilitate three separate conditions (experimental duration = 1 h) per donor blood: (1) control (n = 8), (2) stent-with-skirt (leaflets removed from a 23 mm SAPIEN XT valve; n = 8) and (3) entire valve (an intact 23 mm SAPIEN XT valve; n = 8). Samples were collected at the start and end of each experiment. Serum D-Dimer and thrombin–antithrombin (TAT) concentrations were measured as markers of thrombogenicity. There was no significant change in serum D-Dimer and TAT concentration with time for the control group. An increasing trend in D-Dimer and TAT concentration was observed with time for the stent-with-skirt group. Interestingly, there was a decreasing trend in serum D-Dimer and TAT concentration with time for the entire valve (leaflet dominating) group. Moreover, changes in D-Dimer and TAT concentration were significantly different between the stent-with-skirt and entire valve (leaflet dominating) groups. Stent-with-skirt was found to impart the most prominent thrombogenic effect, indicating the significance of blood-stent and blood-skirt interactions in TAV thrombosis.

Objectives Cerebral edema (CE) remains one of the most feared complications of diabetic ketoacidosis (DKA) with severe morbidity and mortality. The use of computerized tomography (CT) scan in the setting of suspected cerebral edema in DKA has been minimally studied. The objective of our study was to evaluate the utility of CT scans in children with suspected cerebral edema, and secondarily to analyze the various patient characteristics of those with and without cerebral edema. Methods We performed a retrospective chart review of all the children with DKA secondary to T1DM admitted to our tertiary PICU in order to obtain demographic data, laboratory results, and their treatment course. Differences between the groups of suspected CE and no suspected CE were compared using linear and logistic regression for continuous and binary variables respectively. Results We identified 251 patients with DKA, 12 of which had suspected CE; 67% (8/12) of those patients received head CT and 87.5% (7/8) of them were read as normal. On the other hand, 33% (4/12) did not receive CT scan of head, and yet three of the four patients were treated for CE. Conclusions In our cohort of patients, CT results did not influence CE treatment or lack thereof; most patients with suspected CE were treated with or without head CT findings of CE, indicating that imaging has very little utility in our cohort of patients. In some cases, the use of head CT delayed the onset of treatment for CE.

BACKGROUND Infertility is a wide spectrum of disorder affecting many couples and is defined as the inability of a couple to achieve pregnancy. A series of investigations are required to know the reason behind infertility, yet a small percentage (08–37%) of couples exist, in which no obvious cause is delineated. Infertility causes enormous emotional, physiological, psychological, sexual, social and financial burden on family. Different hormones, growth factors and interleukins are responsible for successful ovulation, implantation and further growth of embryo. Endometrial receptivity is an important predictor of the outcome of implantation and further growth of embryo. METHOD The study would be conducted in a tertiary care centre over a period of two years from July 2022 till July 2024 on non-pregnant unexplained infertile women (63) who will undergo In Vitro Fertilisation and Embryo Transfer (IVF-ET) in the following cycle and the result will be compared with the fertile women (21) with same demographic features. The levels of serum Vascular Endothelial Growth factor – A, Interleukin- 6 will be measured on day 21 of the menstrual cycle in both the group, simultaneously, transvaginal ultrasonography and doppler findings will be measured in both groups to see for endometrial receptivity. The values will be compared for any significance. RESULTS The values of Serum VEGF-a, IL6 and Doppler findings will be compared between fertile and infertile group to see for significance difference. The main reason behind doing research on this topic is to find a more cost effective, non-invasive and less time-consuming technique to find Endometrial Receptivity as compared to invasive Endometrial Receptivity Analysis (ERA) Technique. Also, a new scoring system will be developed considering these 3 parameters of endometrial receptivity (PREDICGIO scoring system) for better analysis of endometrial receptivity and to determine the method to be used in patients of infertility for getting pregnancy without much financial burden.