A study of outcome in COVID-19 patients receiving casirivimab-imdevimab

Objectives: In December 2019, coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China, as a respiratory tract infection causing symptoms, such as fever, chills, dry cough, fatigue, and shortness of breath. Despite the low mortality rate of COVID-19, patients with comorbidities such as hypertension, cardiovascular disease, and diabetes mellitus seem to be prone to more severe symptoms and to a higher mortality rate than others. Such patients are shown to benefit from usage of monoclonal antibodies. Casirivimab-imdevimab is a cocktail made up of two non-competing, neutralizing human immunoglobulin G1 antibodies that target the receptor binding domain of the severe acute respiratory syndrome coronavirus 2 spike protein and block viral entry into human cells. We assessed the clinical profile and outcome of 42 patients who received the antibody cocktail. Materials and Methods: Casirivimab-imdevimab was administered to COVID-positive patients with mild severity. Forty-two patients who satisfied the inclusion criteria received casirivimab-imdevimab and were included in the study. Demographic and clinical data were tabulated in Microsoft Excel and statistics were run in OpenEpi software. Results: No adverse reactions were seen in any of the patients. Among the 42 patients, there were no deaths. Twentytwo (52.3%) patients improved, while 20 (47.6%) worsened after receiving the antibody cocktail. Out of 21 (50%) patients who did not have any comorbidity, 13 (30.9%) worsened after receiving the drug and 8 (19%) improved, while among those with comorbidities, 7 (16.6%) worsened and 14 (33.3%) improved (P < 0.05). Thirteen (30.9%) unvaccinated patients improved, while 14 (33.3%) worsened, whereas 6 (14.2%) fully vaccinated patients improved while only 2 (4.7%) worsened. Among the patients who were administered the cocktail within 5 days of onset of symptoms, 12 (28.5%) improved and 10 (23.8%) worsened, whereas among those who received the drug between 6 and 10 days of symptom onset, ten improved, and ten worsened. There was no statistically significant association between vaccination status and outcome, and infusion interval and outcome in these patients. Conclusion: None of the 42 patients developed any reaction to casirivimab-imdevimab. There were no deaths in the study population. About 52.3% of the patients improved and 47.6% worsened after receiving the cocktail. About 33.3% of the comorbid patients improved. There was no statistically significant association between vaccination status and outcome, and infusion interval and outcome in these patients.

Fecundity Studies Of Andrographis Paniculata On Drosophila Melanogaster

Objective: Andrographis paniculata is widely used in Asia for various medicinal purposes. The plant has a major bioactive chemical constituent Andrographolide, which exhibits various essential pharmacological properties. Recently, to enhance immunity against viral fevers especially dengue viral fever during monsoon season, Tamil Nadu state government has advised rural health centres to provide a tea or kashayam made from a mixture containing this plant leaf along with selected plant roots and leaves. However, there is concern among the general public population that this plant extract may have a negative impact on potency. This study is being done to investigate the toxic effects of Andrographis paniculata on fecundity and physiological properties of Drosophila melanogaster. Methods: The flies were treated and mated in pure and mixed form of Andrographis paniculata separately. Results: The results were obtained in the form of egg count, which was compared to control and the conclusion was obtained that Andrographis paniculata might affect the fecundity and at the same time, it was observed that the developmental span from an egg to an adult fly increased upon treatment in successive generations. More importantly, the effect of pure form plant on the fecundity was found to be significant, while that of the mixed form was not. On mating a treated male with an untreated female and an untreated male with a treated female when the treatment is being discontinued, it can be very well seen that there is no effect on the fecundity of the flies. Conclusion: Since the continuity of the treatment played a major role on the effect of fecundity, highlighting the importance of the period of treatment and the exposure time of the compound on the fly system, therefore this research suggests that the conception of tea or kashayam extracted from mixed plant content could not have the same effect as the similar concentration of pure Andrographis paniculata and it does not have any acute effect on the fecundity when being consumed over a short period of time in Drosophila melanogaster model.

A review on Noncommunicable Diseases (NCDs) burden, its socio-economic impact and the strategies for prevention and control of NCDs in India

Noncommunicable diseases (NCDs) have become a major public health problem in India accounting for 62% of the total burden of foregone DALYs and 53% of total deaths. Out-of-pocket expenditure associated with the acute and long-term effects of NCDs is high resulting in catastrophic health expenditure for the households. A large national survey in India found that spending on NCDs accounted for 5.17% of household expenditure. According to a macroeconomic analysis, it is estimated that each 10% increase in NCDs is associated with a 0.5% lower rate of annual economic growth. The income loss due to hypertension is the highest, followed by diabetes and cardiovascular diseases. The macroeconomic impact of NCDs is profound as they cause loss of productivity and decrease in gross domestic product. Since the health sector alone cannot deal with the “chronic emergency” of NCDs, a multisectoral action addressing the social determinants and strengthening of health systems for universal coverage to population and individual services is required.

Tigecycline.

Infection with resistant pathogens can adversely affect clinical, microbiological and economic outcomes. New agents for the treatment of many such serious infections are acutely needed in hospital practice. Tigecycline is a novel glycylcycline antimicrobial for intravenous use. It has an expanded broad-spectrum antibacterial activity including multi-drug resistant pathogens, like methicillin-resistant Staphylococcus aureus , vancomycin-resistant enterococci , multi-drug resistant Streptococcus pneumoniae , extended-spectrum beta-lactamase-producing gram-negative bacteria and Acinetobacter baumannii . Tigecycline however is not active against Proteus, Providencia and Pseudomonas species. Its currently approved indications include complicated skin and skin structure infections and complicated intra-abdominal infections. It has also been found to be effective for the treatment of community- as well as hospital-acquired and ventilator-associated pneumonia and bacteremia, sepsis with shock and urinary tract infections. Tigecycline appears to be a valuable treatment option for the management of superbugs, especially where conventional therapy has failed.

Estimation of mortality due to AIDS--a review.

HIV/AIDS has emerged as a major public health problem since its recognition as an emerging disease a couple of decades ago. While detection of HIV/AIDS cases remains a problem, ascertainment of AIDS deaths has emerged as a bigger challenge and concern. Despite a plethora of literature focusing on the methods to estimate AIDS deaths, none seems to be fulfilling the requirements for universal acceptance. In this paper, we give a systematic review of various methods used by experts to have a reliable estimate of the number of deaths due to AIDS. Initial assessments were derived from morgue based estimates in Africa which showed that AIDS was a leading cause of death. Its impact on demography was noticed in some of the studies conducted wherein age and sex specific mortality rates, standardized mortality ratios, potential years of life lost and decrease in life expectancy were calculated. "Excess mortality factor" as observed in 1980s and 1990s also indicated the approximate number of AIDS deaths. Besides, orphan hood method and verbal autopsy technique too, emerged as reliable means to identify mortality due to AIDS. Some indirect methods like estimation of deaths due to opportunistic infections like tuberculosis could also be a good indicator. The paper reviews the merits and possible biases encountered with each of the methods.

Occurrence, significance & molecular epidemiology of cholera outbreaks in West Bengal.

BACKGROUND & OBJECTIVE: Diarrhoeal disease outbreaks are causes of major public health emergencies in India. We carried out investigation of two cholera outbreaks, for identification, antimicrobial susceptibility testing, phage typing and molecular characterization of isolated Vibrio cholerae O1, and to suggest prevention and control measures. METHODS: A total of 22 rectal swabs and 20 stool samples were collected from the two outbreak sites. The V. cholerae isolates were serotyped and antimicrobial susceptibility determined. Pulsed- field gel electrophoresis (PFGE) was performed to identify the clonality of the V. cholerae strains which elucidated better understanding of the epidemiology of the cholera outbreaks. RESULTS: Both the outbreaks were caused by V. cholerae O1 (one was caused by serotype Ogawa and the other by serotype Inaba). Clinically the cases presented with profuse watery diarrhoea and dehydration. All the tested V. cholerae isolates were sensitive to tetracycline, gentamycin and azithromycin but resistance for ampicillin, co-trimoxazole, nalidixic acid, and furazolidone. PFGE pattern of the isolates from the two outbreaks revealed that they were clonal in origin. Stoppage of the source of water contamination and chlorination of drinking water resulted in terminating the two outbreaks. INTERPRETATION & CONCLUSION: The two diarrhoeal outbreaks were caused by V. cholerae O1 (Inaba/Ogawa). Such outbreaks are frequently seen in cholera endemic areas in many parts of the world. Vaccination is an attractive disease (cholera) prevention strategy although long-term measures like improvement of sanitation and personal hygiene, and provision of safe water supply are important, but require time and are expensive.

Annual sentinel surveillance for HIV infection--issues and challenges.

HIV surveillance has been held in the country since 1986,but the procedure has been standardized and adopted uniformly across the country since 1998 and is known as Annual Sentinel Surveillance for HIV infection. The method conforming to method laid down by WHO/UNAIDS follows the Unlinked Anonymous Strategy for blood collection from attendees of STD, ANC clinics or female sex workers (FSW), men having sex with men (MSM), intravenous drug users (IVDU) coming to drop in centres. The sites have been increasing over the years and at 703 in 2005, still lack coverage and adequate representation from all segments of the population and rural areas. The challenges are being addressed in the next round.

Process of estimating the number of people living with HIV in India.

This article attempts to appraise the methodology of estimating the people living with AIDS in India. In this estimation, the primary demographic data were obtained from Registrar General of India and Sample Registration System. HIV prevalence data was drawn from HIV Sentinel Surveillance conducted at 704 sites in 2005.The HIV prevalence at each site was estimated using the formula p +/- 1.645O(pq/n), where p represents the proportion of HIV positives and n the number of attendees at the site. Statewise prevalence for each risk group was estimated with the help of the formula giving 90% confidence internal for median prevalence as Median of the proportion positive +/- 1.645 x 1.2533O(pq/n), where 1.2533 was the adjustment for large variations involved. If the estimated median prevalence comes out to be zero, it was replaced by the actual prevalence of the low prevalent states for each risk group. In case of general population, the urban-rural ratio came out to be 1:1 in case of high prevalence states and 2.4:1 in case of other states. Having adjusted for age, the sex differential was 1.2:1 in gereralised epidemic states, 2:1 in concentrated epidemic states and 3:1 in low epidemic states. Overall additions were made for FSW by applying to them the HIV prevalence observed in FSWsites under TI. Prevalence in child population was done by applying the GFR to the women with HIV and then multiplying it by 0.3 (percentage infected).

Multifocal giant cell tumour of bone in a skeletally immature patient--a case report.

Giant cell tumor of bone is usually seen in adults affecting a single bone. Multiple giant cell tumour of bone occurring in skeletally immature patients is extremely rare. Multifocal giant cell tumor of bone in a ten year old boy involving upper end of humerus and tibia is being reported for its extreme paucity in literature.

Fallot's tetralogy presenting with variceal bleed.

The erythrocytosis of Fallot's tetralogy may lead to spontaneous thrombosis at any site, but splenic vein thrombosis and variceal bleed is rarely a presentation of Fallot's tetralogy. A case of a 48 years old female with undiagnosed Fallot's tetralogy, presenting with variceal bleed due to splenic vein thrombosis, is reported. It is also interesting to note that the patient survived till this age without any medical or surgical treatment.

Outbreak of cholera caused by Vibrio cholerae 01 intermediately resistant to norfloxacin at Malda, West Bengal.

During the end of September 1997, an unusual outbreak of severe dehydrating watery diarrhoea cases and deaths were reported from Malda town. Vibrio cholerae 01 El tor, the causative agent responsible for this episode was isolated from 56.5% of cases sampled. Three of the five drinking water samples were also positive for V cholerae 01. Majority of cases were adults. Isolated strains were uniformly resistant to furazolidone and intermediately to norfloxacin. Indiscriminate use of antibiotic should be discouraged for development of multidrug resistant strains.

Multi-drug resistant non-typhoidal Salmonella spp. associated with acute diarrhoeal disease.

The prevalence of different serotypes of non-typhoidal Salmonella spp. among patients suffering from acute diarrhoea admitted to the Infectious Diseases Hospital, Calcutta was investigated. The predominant serogroup was C and Salmonella infantis was the major serotype isolated followed by S. worthington, S. enteritidis, S. typhimurium, S. weltevereden and S. newport. All the Salmonella strains were isolated from adults. Multidrug resistance to various antimicrobial agents was observed in 37.5 per cent of the strains. All the strains were sensitive to ciprofloxacin, norfloxacin and gentamycin.

An El Tor cholera outbreak in Maldah district, West Bengal.

An outbreak of cholera occurred in Maldah district, West Bengal during July-August 1998. Attack rate was 34/1000. Cases were more (59.3%) amongst adults (> 15 years.). V. cholerae 01 biotype E1 Tor serotype ogawa was isolated as a single pathogen from 52.9% (9/17 samples examined). All V. cholerae strains belonged to phage type 2 (Basu and Mukherjee scheme) and type 27 (new phage type scheme). The strains were resistant to co-trimoxazole, furazolidone, ampicillin, streptomycin and nalidixic acid.