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Drug repurposing is an up-and-coming concept in the world of medicine. It is an efficient way to use already existing drug formulations in the treatment of diseases besides the ones which were initially intended for. This circumvents the tedious process of drug development and approval and helps to conserve resources. While multiple drugs have already been repurposed, their utility and reintroduction into the market is still a new concept. Even though it optimizes the use of resources, lab testing and animal model trials form a crucial aspect of determining the efficacy of these drugs in different diseases. This review encompasses the methods and trends in the repurposing of drugs while highlighting the use of animal models and the benefits of repurposing drugs during the COVID-19 pandemic. © Springer Nature Singapore Pte Ltd. 2023.
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Background: SARS-CoV-2 has a high mutation rate, resulting in the emergence of multiple variants in a shorter time frame, starting with Wuhan strain during first wave, then Delta during second wave and Omicron during third wave. World faced distressing spread of novel corona virus. The reason for this study was to look at the third flood of SARS-CoV-2, clinical highlights and risk factors in northern India. Method(s): This study involved 1,43,983 individuals for testing the presence of SARS-CoV-2 infection during January 2022 by RT-PCR. The epidemiological record was collected as per the guidelines of ICMR from the patient forms. Result(s): A total of 12.24% individuals were found positive with mean age of 29+/-10 years. Large portion of positive population (63.87%) was asymptomatic. Among the positive population, higher positivity rate was observed in males (57.51%) with age band of 21-40 years (51.17%). Significant association (p value = <0.00001) was found between positivity rate with age, gender and status (symptomatic/ asymptomatic). SARS-CoV-2 was shown to be more prevalent in Patiala, (49.66%) district followed by Ludhiana (24.24%), Sangrur (10.06%), Mansa (7.06%), Shaheed Bhagat Singh Nagar (6.90%) and Malerkotla (2.08%) during second and third week of January 2022. Hypertension and bronchial asthma were the most well-known comorbidities found in the current study. Conclusion(s): In totality, current study showed positivity rate of 12.24% from large population size for SARS CoV-2 from period of 1st January 2022 to 31 January 2022. Current findings include younger age group (21-40 years), high percent of asymptomatic individuals, less disease severity and a little need of hospitalization.Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.
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Background: The COVID-19 pandemic has substantially affected the antibiotic stewardship activities in most hospitals of India. Aims: We conducted an antibiotic point prevalence survey (PPS) immediately after the decline of a major COVID-19 wave at a dedicated COVID-19 hospital. By doing so we aimed to identify the antibiotic prescription patterns, identify factors influencing the choice of antibiotics, and identify/develop strategies to improve the antibiotic stewardship program in such setups. Methods: The PPS was single-centred, cross-sectional, and retrospective in nature. Patients admitted in various wards and intensive care units (ICUs) between September 2021 to October 2021 were included in our PPS. Results: Of the included 460 patients, 192 were prescribed antibiotics. Of these 192 patients, ICU-admitted patients had the highest number of antibiotics prescribed i.e. 2.09 ± 0.92. Only a minor fraction (7.92 %) of antibiotics prescriptions were on the basis of culture reports. Most of the antibiotics were prescribed empirically by the parenteral route. The most common group of antibiotics prescribed were third-generation cephalosporins. Carbapenems were the most common designated antibiotics prescribed. A large number of patients (22.40 %) were prescribed a double anaerobic coverage. Conclusion: The strategies that we identified to improve the antibiotic stewardship program at our institute included reviving the culture of sending culture reports to prescribe antibiotics, improving surgical prophylaxis guidelines, training resident doctors to categorize antibiotic prescriptions appropriately, closely monitoring prescriptions providing double anaerobic coverage, and improving the electronic medical record system for improving prescription auditing.
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Introduction: Coronavirus disease 2019 (COVID-19) causes abnormalities in the hemostatic system, which are referred to as COVID-associated coagulopathy. Whole blood viscoelastic studies, such as thromboelastography (TEG), are the best way to determine the dynamics of clot formation. The hypercoagulable state seen in COVID-19 patients is aggravated by a severe state of fibrinolysis shutdown, which is caused by overexpression of plasminogen activator inhibitor 1 and thrombin activated fibrinolysis inhibitor. Method(s): An automated thromboelastogram was used to perform TEG on 28 COVID-19 patients. Based on TEG parameters such as R-time, K-time, alpha angle, maximum amplitude (MA), and clotting index (CI), the hemostatic state was classified as hypercoagulable in 17 (63 percent), hypocoagulable in 2 (7 percent), or normal in 8 (30 percent) patients. Result(s): Twenty-seven patients were included, with a median age of 50 years (IQR 40-60 years) and a male to female ratio of 0.9:1. COVID-19 was mild in 6 (22.2%), moderate in 2 (7.4%), and severe in 19 (70.4%) patients. Fibrinolytic shutdown was detected in 4 (15%) patients. TEG analysis revealed that they were hypercoagulable. All four patients showed high D-dimer levels and a LY-30 of 0%, as well as decreased K-time and increased alpha angle or MA. Conclusion(s): Despite thromboprophylaxis, hypercoagulable states and severe inflammatory states are prevalent in COVID-19 patients. Patients with hypocoagulable and hypercoagulable conditions had greater 28-day mortality than those with normal coagulation. (Log-rank test, P=0.002). Only two of the four patients who had their fibrinolytic systems turned down survived. These patients had no clinically evident thrombosis.
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Introduction: Coronavirus disease 2019 (COVID-19) causes abnormalities in the hemostatic system, which are referred to as COVIDassociated coagulopathy. Whole blood viscoelastic studies, such as thromboelastography (TEG), are the best way to determine the dynamics of clot formation. The hypercoagulable state seen in COVID-19 patients is aggravated by a severe state of ''fibrinolysis shutdown,'' which is caused by overexpression of plasminogen activator inhibitor 1 and thrombin activated fibrinolysis inhibitor. Aims & Objectives: We aimed to study the coagulation pattern in COVID-19 patients on TEG and explored the predictors of outcomes in our patients. Material(s) and Method(s): An automated thromboelastogram was used to perform TEG on 28 COVID-19 patients. Based on TEG parameters such as R-time, K-time, alpha angle, maximum amplitude (MA), and clotting index (CI), the hemostatic state was classified as hypercoagulable in 17 (63 percent), hypocoagulable in 2 (7 percent), or normal in 8 (30 percent) patients. Result(s): Twenty-seven patients were included, with a median age of 50 years (IQR 40-60 years) and a male to female ratio of 0.9:1. COVID-19 was mild in 6 (22.2%), moderate in 2 (7.4%), and severe in 19 (70.4%) patients. Fibrinolytic shutdown was detected in 4 (15%) patients. TEG analysis revealed that they were hypercoagulable. All four patients showed high D-dimer levels and a LY-30 of 0%, as well as decreased K-time and increased alpha angle or MA. Conclusion(s): Despite thromboprophylaxis, hypercoagulable states and severe inflammatory states are prevalent in COVID-19 patients. Patients with hypocoagulable and hypercoagulable conditions had greater 28-day mortality than those with normal coagulation. (Logrank test, P = 0.002). Only two of the four patients who had their fibrinolytic systems turned down survived. These patients had no clinically evident thrombosis.
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Introduction: Mucormycosis is a life threatening fungal infection commonly seen in diabetics and immunocompromised individuals. It is caused by one of the members of mucoraceae family which includes mucor, rhizopus, rhizomucor, absidia and others. Its prevalence has become more common in covid pandemic. Methods: We report a rare case of large cavitatory Rhizopus infection in a renal transplant recipient. Patient was initiated on antitubercular therapy for tubercular lymphadenitis two months prior to transplant. He was given rabbit ATG as induction agent and was on triple maintenance immunosuppression with tacrolimus/ mycophenolate mofetil/ steroids. Patient developed post transplant Diabetes mellitus. Four months post transplant he presented with cough, fever and left sided chest and shoulder pain for 10 days. Covid RT PCR was done twice and it came out to be negative. High Resolution Computed tomography Chest revealed thick walled cavity abutting the chest wall (10.3 x 7.1cm) in left upper lobe. Blood culture was sterile after five days of incubation. Serum Beta galactomannan was negative. He was empirically started on broad spectrum antibiotics and antifungals (oral voriconazole). He underwent bronchoscopy on day 4 of admission. As tuberculosis was a differential, gene expert, tubercular culture and AFB stain was obtained on Bronchoalveolar(BAL) fluid which all came out to be negative. Microbiological sample from BAL Fluid revealed growth of Rhizopus species. He was started on Liposomal amphotericin B. Since the cavitatory lesion occupied almost the entire left lung, surgical resection was offered to the patient to which patient refused. Results: He improved symptomatically after 10 days of Liposomal amphotericin B. Total of 10 weeks of Liposomal amphotericin B was given. Follow up CT after 40 days showed significant reduction in size of cavity to 7.5cm. A surprising complete resolution of the lung cavity was seen after 4 months. Conclusions: This case is one of the very few reported cases of invasive pulmonary rhizopus infections. It emphasizes how medical treatment alone can lead to complete resolution of such large cavitatory lesions without surgical intervention. No conflict of interest
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This paper studies the impact of COVID-19 on Indian stock market through examining the responses of BSE sector indices: Auto, Healthcare, IT, FMCG and Capital Goods sectors from the period of 1st January, 2019 to 16th January, 2021. This period is further divided into four time-windows;Comparison window, Pre-lockdown window, during Lockdown and Unlock phase window to thoroughly analyse COVID-19 impact. Conventional t-test is applied to analyse and compare the daily returns of sectors during different time windows. Our empirical results showed that (a) COVID-19 has a significant and negative impact on the Indian market, but that impact is short-lived only during the Pre-lockdown window. (b) In the Pre-lockdown window, all sectors' returns are significantly negative, while during the Lockdown returns are significantly positive. The results indicate that the fear among the investors impacted the returns during the Pre-lockdown window. However, during the Lockdown window, all sector returns significantly increased suggesting that investors are optimistic about the future growth of the economy once COVID-19 pandemic ends, and the whole economy returns to its normal pace. The positive returns of Auto and Capital goods sector indicate that investors are either over optimistic for Vaccine discovery or not taking the pandemic seriously. This paper suggests that stock market is not representing the real economy. The findings have implications for the investors and market regulators. © 2022 Thammasat University. All Rights Reserved.
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Background: Long-COVID syndrome is now a real and pressing public health concern. We cannot reliably predict who will recover quickly or suffer with mild debilitating long COVID-19 symptoms or battle life-threatening complications. In order to address some of these questions, we studied the presence of (post covid) symptoms and various correlates in COVID-19 patients who were discharged from hospital, 3 months and up to 12 months after acute COVID-19 illness. Methods: This is an observational follow-up study of RT-PCR confirmed COVID-19 patients admitted at 3 hospitals in north India between April – August 2020. Patients were interviewed telephonically using a questionnaire regarding the post-COVID symptoms. The first tele-calling was done in the month of September 2020, which corresponded to 4- 16 weeks after disease onset. All those who reported presence of long COVID symptoms, were followed-up with a second call, in the month of March 2021, corresponding to around 9-12 months after the onset of disease. Results: Of 990 patients who responded to the first call, 615 (62.2%) had mild illness, 227 (22.9%) had moderate and 148 (15.0%) had severe COVID-19 illness at the time of admission. Nearly 40% (399) of these 990 patients reported at least one symptom at that time. Of these 399 long-COVID patients, 311 (almost 78%) responded to the second follow-up. Nearly 8% reported ongoing symptomatic COVID, lasting 1-3 months and 32% patients having post-COVID phase with symptoms lasting 3-12 months. Nearly 11% patients continued to have at least one symptom even at the time of the second interview (9-12 months after the disease onset). Overall, we observed Long-COVID in almost 40% of our study group. Incidence of the symptoms in both the follow-ups remained almost same across age-groups, gender, severity of illness at admission and presence of comorbidity, with no significant association with any of them. Most common symptoms experienced in long COVID phase in our cohort were fatigue, myalgia, neuro-psychiatric symptoms like depression, anxiety, “brain fog” and sleep disorder, and breathlessness. Fatigue was found to be significantly more often reported in the elderly population and in those patients who had a severe COVID-19 illness at the time of admission. Persistence of breathlessness was also reported significantly more often in those who had severe disease at the onset. The overall median duration of long COVID symptoms was 16.9 weeks with inter-quartile range of 12.4 to 35.6 weeks. The duration of symptom resolution was not associated with age, gender or comorbidity but was significantly associated with severity of illness at the time of admission (P=0.006). Conclusions: Long-COVID was seen in almost 40% of our study group with no correlation to age, gender, comorbidities or to the disease severity. The duration of symptom resolution was significantly associated with severity of illness at the time of admission (P = 0.006). In our study, all patients reported minor symptoms such as fatigue, myalgia, neuro-psychiatric symptoms like depression, anxiety, “brain fog” and sleep disorder and persistence of breathlessness.
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Background: MIS-A, a hyperinflammatory condition in individual aged >21 years, is a rare condition seen in association with COVID-19 illness. Very few cases of MIS-A has been reported till date, and it still remains a box of mystery. Case Presentation: We report a case of 44 Year old male, with an evidence of prior COVID-19 illness, presented with 3 weeks of fever with polyarthralgia along with 3 days of palpitation, shortness of breath, conjunctivitis and soreness of mouth. Laboratory evidence of inflammation, features of myocarditis in 2D-Echocardiography was noted at the time of admission, with no evidence of any active infection and lung pathology. He was diagnosed as a case of MIS-A as per the CDC definition. Improvement in clinical and laboratory parameters and normalization of cardiac function was noted after treatment with IV methylprednisolone, and Intravenous Immunoglobulin. Conclusion: In adults presenting with fever and multisystem involvement, in Post-Covid period, with raised inflammatory markers, a high index of suspicion for MIS-A is required in order to start timely treatment and prevent potentially fatal outcome.
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Background: COVID-19 has become a dreadful pandemic. One of the important complication is the development of pneumothorax/ pneumomediastinum which gets further complicated by bronchopleural fistula. Case Study: A 44year male patient with severe COVID pneumonia developed Left sided pneumothorax and treated conservatively with ICD and negative suctioning for 2 months and referred to us with persistent pneumothorax with BPF. As patient was unfit for surgery, bronchoscopic management was planned. With flexible bronchoscope, 6F Fogarty balloon was passed and inflated, leak site was identified in left upper lobe upper division. A Watanabe spigot size 5 was deposited at the opening of upper division and manipulated to apical segment. Other small openings were sealed with cyanoacrylate glue and autologous blood patch. After procedure negative suction was reapplied. Repeat Xray showed resolution of pneumothorax. Pleurodesis was done with talc slurry, post pleurodesis showed no pneumothorax and ICD was removed. Patient was discharged, follow up X ray after 4weeks showed no evidence of pneumothorax. Discussion: In most cases of BPF, leak seals after tube thoracostomy, only 3-5% will continue to have persistent leak. For medically inoperable cases, bronchoscopic balloon occlusion of site and subsequent injection with fibrin glue, liquid bioadhesive or blood patch can be done. For large leak;Amplatzer device, stents, spigots, coils are used. Conclusion: Bronchoscopic treatment can work well for a medically inoperable, complicated pneumothorax in COVID-19 disease.
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Introduction: Immune thrombocytopenia (ITP) after COVID-19vaccination is being increasingly reported worldwide.Aims &Objectives: We present five cases of ITP following theAstraZeneca Covishield vaccination.Materials &Methods: We retrospectively collected data on patientspresenting with immune thrombocytopenia post-Covishield vaccination at the Department of Hematology, AIIMS, New Delhi.Result: 5 patients diagnosed with ITP followingAstraZeneca Covishieldvaccination were included. Themedian age at diagnosis in our cohortwas44 years (21-67 years). Of the 5 patients, 2 are female and 3 aremale. Allof them received the Astrazeneca Covishield vaccine. Most of thepatients presented with petechiae and wet purpura with the onset ofsymptoms between 7-20 days (median 15 days) post-vaccination. All ofthese patients had severe thrombocytopenia at presentationwith amedianplatelet count of 7 × 109/l (range 1-14 × 109/l). Anti PF4 antibodytesting was done in two patients which were negative.Therapy details include IVIG (3), steroids (4), eltrombopag (2),azathioprine (1), and platelet transfusions (2). Of these, two patientshad no response to first-line therapies. One patient did not respond toIVIG, steroids, azathioprine, and subsequently developed anintracranial bleed. He was managed with platelet transfusions, IVIG,steroids, and eltrombopag. His platelet counts have stabilized at50 × 109/l and he did not have further bleeding manifestations. Atthe last follow-up, 80% (n = 4) of our patients have achieved aresponse.Conclusions: Immune thrombocytopenia is being increasingly recognized post-COVID vaccination. All our patients had severethrombocytopenia requiring therapy. The question of whether thesecases are actually primary ITP coinciding with the administration ofthe vaccine or ITP secondary to vaccination remains unanswered.Additional surveillance is needed to determine the true incidence ofCOVID-19 vaccine-induced ITP.
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[Figure: see text].
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Coronavirus disease is an infectious disease which is caused by a virus called coronavirus. The people who are infected with this disease will experience respiratory illness. This disease has been declared pandemic by ‘World Health Organization (WHO)’. There are many sectors that have been affected due to the lockdown practiced in the entire country, among agricultural sector, manufacturing sector, service sector, education sector, business sector, etc. In our research, we examined the impact of COVID-19 in India vis-a-vis different sectors. For the purposes of this research, we shortlisted two particular sectors, i.e. education and service sectors. These two sectors form the backbone of our country. While the impact on education sector has led to many young minds and vulnerable school kids being affected in an adverse way and has left them to cope with new practices such as online classes during the lockdown period, and on the other hand, in the service sector, employees are working from home which in some case has had an impact on the effectiveness and efficiency of their work. In this paper, we assessed the impact on these two sectors on Indian economy by analyzing the responses given by our respondents through the questionnaires (Google form), and we then combined the data points to study how students and employees are being affected during the present lockdown period, imposed due to COVID-19. This chapter will help the readers to get to know more about the thinking of the students and employees in lockdown, and how much they are affected by this pandemic. Towards the trailing part of our research, we have discussed about the possible steps that can be adopted in future, by the employers and educational institutions, in order to limit the damage to the sector and to make recovery in the future. © 2021, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Aims & Objectives: To assess the responses of Acquired Aplastic Anaemia patients who have received Eltrombopag in addition to Immunosuppressive therapy (ATG → Cyclosporine A) at our tertiary care center. Patients/Materials & Methods: We retrospectively analysed the responses of Acquired Aplastic Anaemia patients who have received Eltrombopag, Antithymocyte globulin, and Cyclosporine A from Jan 2019 to March 2020. Results: Thirty-eight patients were included in our study. The median age is 27.6 years (7-68). Male to Female ratio 1.2:1. 6 patients were less than 13 years of age and, 31 patients were between>13 years to<60 years and 1 patient was>60 years. PNH clone was positive in 6 patients(15%). Majority of our patients were Severe Aplastic Anemia (76.3%), and Non Severe Aplastic Anemia (10.5%), Very Severe Aplastic Anaemia(13.1%).All of our patients received Cyclosporine and Danazol before ATG. The median duration from diagnosis to treatment is 12.2 months(1-60 months). Except for one who received Rabbit ATG, everyone received Equine ATG. Eltrombopag was given at a dose of 75 mg in 13.15% (5) and 150 mg in 86.85% (33). Complete Response, Partial Response, No response were seen in 15.8%,57.8%,26.5% respectively. 3 patients expired within three months of treatment, 3 more patients expired by 6 months(1, COVID-19). Discussion & Conclusion: Overall Response rates of 75% in an Indian cohort of acquired aplastic anemia patients treated with ATG and Cyclosporine plus Eltrombopag is comparable to that reported in studies from US and Europe. Median duration of disease prior to ATG based IST was 1 year in our cohort of AA patients.Addition of eltrombopag to ATG and Cyclosporine was able to overcome the delayed initiation of IST in AA patients.Treatment was well tolerated in our patients.
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Background and Aims: This study was planned to compare intubating conditions with aerosol box, while attempting intubation with either direct laryngoscope (DL) using Macintosh blade or McGrath MAC (TM), videolaryngoscope (VL). Methodology: Sixty adult patients coming for the emergency surgeries during COVID-19 pandemic were divided equally by consecutive sampling into either Group 1 (DL) or Group 2 (VL). General anesthesia was administered with aerosol box covering the head and trunk of the patient. The laryngoscopy was attempted based on the group allocation with either VL or DL through aerosol box. Following observations were noted, total intubation time, number of attempts, Cormack-Lehane (CL) view, intubation difficulty scale (IDS), use of airway adjuncts, and external laryngeal maneuver. Results: Mean (standard deviation) time taken to intubate was 25.36 (6.22) sec in DL group and 21.9 (5.56) sec in VL group. Median IDS scoring was 1 in DL group and 0 in VL group indicating toward ease of intubation with the videolaryngoscope. Improved glottic view (CL Grade 1) was attained commonly with VL group and higher CL grades (2b) were common with DL group (23.3%). No intubation aids were required in VL group although 30% in DL required bougie for the intubation. External laryngeal maneuver was applied in 40% subjects undergoing DL with no maneuvers needed in VL group. First pass success of intubation was comparable in both the groups. Conclusion: Intubating conditions are favorable with VL when aerosol box is included which requires acquisition of the skills depending on its availability. However, the intubation should be attempted with the technique the clinician has the expertise during this pandemic.