Medicine

This narrative review of the literature aims to assess the impact of COVID-19 on the younger age group in terms of the Global mortality of COVID-19 in comparison to Nepal. An extensive literature survey of English literature was conducted using Pubmed, Medline, Google Scholar, Embase, WHO Nepal Situation Updates on COVID-19, Situation update report, Ministry of Health and Population-Nepal from January 25, 2020 to June 20, 2020. According to the Ministry of Health and population of The Government of Nepal, as of June 20 , 2020, out of a total of 8,605 laboratory confirmed cases reported to date, the pattern shows that most of the cases fell into the cohort of 21-30 years (37.72%), followed by 11-20 years (24.35 %), 31-40 years (21.97%) and 41-50 years (9.2%). To date Nepal has recorded a total of twenty-two deaths. At first evaluation these figures may not strike one as alarming, but on further investigation it is noted that the mean age is 42. 32 ± 19.632 SD years, and out of which male patients accounted for 77.3% and female accounted for 22.7%. The current situation of COVID-19 and how it develops in Nepal should be closely monitored and could be of international concern as it may be the early indicator of a changing pattern in COVID-19 infections. Nepal may therefore act as a global watch dog, due to the fact that the world could very possibly expose the younger age group under the notion that they are more resilient to the virus, when in reality that notion may be changing. This trend must be monitored and further investigated in order to establish the risk of the events unfolding in Nepal.
Keywords: Coronavirus; COVID-19; Mortality; Nepal; SARS-COV-2; Youth

Background
Blood group antigens are present on the red blood cell surface. O, A, and B are the major blood groups. A, B, AB, and A1 are the antigens. An ample amount of research supports the close association of blood groups with diseases. A new school of thought and finding seems to be indicating that certain blood groups are more susceptible to the COVID-19 infection in comparison to others. Current evidence suggests that SARS-CoV-2 positive cases are more prevalent in individuals with blood group A as compared to those with blood group O. This finding, however, was only relevant for the Rh (+ve) positive blood types. Genetic association reveals that the ABO blood group locus and a chromosome 3 gene cluster are associated with severe acute respiratory syndrome in coronavirus (SARS-CoV-2) respiratory failure patents. This was found in an Italian- Spanish genome-wide association analysis. Various associations between the patients' blood groups when comparing the data with that of physiologically healthy individuals from the same geographical region helped to get a clear comparative picture. Associations that were cross- replicating in nature were determined at chromosome 3p21.31 and chromosome 9q34. The association at chromosome 9q34 was identified at the ABO blood group locus. The difference in the susceptibility could be correlated to the circulating anti‐A antibodies, which inhibit or interfere with the virus-cell adhesion process

Background
A multitude and wide array of various drugs have been postulated and some even attempted to be used as effective treatments against the virus. The drugs have ranged from antimalarials used in India as a prophylaxis to the disease; namely chloroquine and hydroxychloroquine, to the use of broad-spectrum antiviral drugs such as Remdesivir. Dexamethasone, a cheap, widely available, long acting corticosteroid has been gaining popularity and to some extent fame in the treatment of COVID19 patients.
The benefits and use thereof were made apparent after very successful research conducted by the University of Oxford. The Recovery trial, which is one of the world’s largest clinical trials. This trial reported on June 16, 2020 that patients on Dexamethasone at a dosage of 6 mg per day for 10 days have a dramatically reduced mortality particularly in the COVID patients on ventilators. The dexamethasone proved very beneficial in the milder cases of the disease as well and reduced death by 20% in those cases. The proposed mechanism of action by which the dexamethasone drug acts is via impeding the dangerous cytokine storm, an intense immune response that severely renders the lungs damaged. This intense cytokine storm is attributed to the severe complications and respiratory failure noted in COVID19 patients. The long acting dexamethasone would suppress this autoimmune destruction and intense inflammatory reaction, thereby sparing the lungs and the patient’s life.

Introduction: Many hours of a student's life are spent in a lecture hall, "the supposed place of education, growth, and understanding." Likewise, countless hours are spent by faculty and staff in preparation for these lectures. The objective of the study was to discover the perceptions of medical students on current trends in lecture delivery. The study also arises from the fact that there is a dearth of data in Mauritius. Methods: A cross-sectional observational analytic pilot study was conducted via the method of a semi-structured closed-ended questionnaire. A 5-point Likert scale (strongly disagree, disagree, neither agree nor disagree, agree, strongly agree) was used to record the responses. Two male and two female students were chosen via a convenience sampling technique from all the semesters viz. Semester one to semester ten. Results: Lectures reduced anxiety with regards to study material was "strongly agreed" by 46.4% Indians, whereas 62.5% of South Africans and 50% Mauritians opted the "agree" option. As far as faculty as role models were concerned, 15 (37.5%) of students [males 7 (35%); females 8 (40%)] strongly agreed with the option. Preference of structural approach and the correlation with gender was found to be statistically significant P <0.05. Conclusion: The data both suggest and prove that students are ultimately still in favor of lectures; however, duration, content, and lecture formats were critically appraised. Although the study is a pilot study, which was conducted on a small sample size, the findings can be utilized as baseline data for further investigations.

Citation: Banerjee I, Robinson J, Munoosingh B, Jain N, Amsadevi RS. Meaning of Success: perception of medical students, and faculty-A Qualitative Study from a medical school in Mauritius. Nepal J Epidemiol. 2020;10(3); 905-914. Abstract: Background: The objective of this study was to find what undergraduate medical students and teaching faculty perceive success to be. Methods: A descriptive phenomenological qualitative study was designed and conducted on faculty and medical students in Sir Seewoosagur Ramgoolam Medical College, Mauritius. NVivo 12 (Windows) Plus software was implemented for data analysis and thematic analysis was performed. Results: The codes/nodes namely being: Satisfaction, Accomplishment, Actions, Motivations, Extrinsic Factors and Intrinsic Factors were identified in the transcribed data. Satisfaction was described as the positive emotions and notions intimately related as well as synonymously associated with success. Accomplishment as the attainment and fulfilment of any physical, mental, emotional, social, occupational, personal goal or desire by an individual. Actions was the arsenal of physical processes, acts of planning, goal setting or forethinking exercised by the individual. Motivations was the drive to attain the preset goal or notion be it positive or negative. This applies to factors that enable a subject to strive forwards. Extrinsic Factors were the external determinants and definition of success perceived by the subject. Intrinsic Factors were the subject's internal organic, comprehension and definition of success. The themes generated were: Products of Success, Mechanisms of Success and Concepts of success. Conclusion: A tangible demarcation is noticeable between the preconceived general impression of success and the vast multifactorial cohort of intrinsic and extrinsic factors coupled to the highly emotional aspects which were brought forth.

SARS-CoV-2 is the highly infectious new coronavirus, which has been associated with the pandemic COVID-19. The majority of those pathogenic coronaviruses are benign, namely HCoV-229E, HCoV-NL63, HCoV-OC43 and HCoV-HKU1, and they have been linked to common cases of flu. Two of these viruses namely SARS coronavirus and MERS coronavirus are known to have caused more severe infections. Based on phylogenetic analysis, the Coronaviruses are divided into four groups, which are: Alpha-CoV, Beta -CoV, Gamma-CoV, and Delta -CoV. The Beta- CoV genus is further classified into four lineages, which are referred to as Groups A, B, C, and D. At the genomic level, SARS-CoV-2 has been identified to match with the lineage B of Beta coronavirus. This infection affects the respiratory tract, mainly the lungs' alveoli, and can cause a wide variety of symptoms ranging from discharge from the nose and a sore throat to respiratory distress, septic shock, and failure of multiple organs. To date, millions of people have been affected by the virus. The current mortality rate is around 6%. Early diagnosis is essential to prevent the spread of the infection.  An extensive literature review was done using Pubmed, Medline, Pubmed Central, Embase, Goggle Scholar databases from January 20, 2020, till October 20, 2020.

Conclusion: COVID-19 is the third outbreak of a pathogenic human coronavirus, after MERS and SARS. Its high rate of transmissibility has taken a toll on citizens' personal and professional lives globally. The peculiarities of SARS-CoV-2, regarding its genomic uniqueness and the role of Malayan pangolins as intermediate hosts, still demands more research to determine the degree to which they partake in the generation of the pathogenicity and infectiousness of the virus.