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Objectives: The novel coronavirus disease 2019 (COVID-19) pandemic has caused a turmoil in the health-care delivery system and challenged consumers' sense of well-being. This study examines the evolving consumer expectations and explores the key interventions that health-care providers can employ to increase engagement with consumers and prepare organisations to cope with post-pandemic challenges. Materials and Methods: We conducted a cross-sectional survey of 715 randomly selected patients visiting three secondary diabetes care centres across Andhra Pradesh - Vijayawada, Tenali and Tirupati between December 2020 and January 2021. We collected participants demographic data and history of comorbidities. Results: During lockdown, 59.3% of the respondents were concerned about health management, 63.9% expressed fear of contracting infections while visiting hospitals. Majority (70%) did not prefer visiting hospitals treating COVID-19 patients, while 18.3% reluctantly consider only if COVID-19 ward was kept isolated. Measures such as wearing personal protective equipment sanitisation and thermal screening and social distancing in outpatient settings/waiting areas were demanded by 89.7%, 84.5% and 60% of respondents, respectively. Concurrently, there is an increasing trend (from 2.8% to 24.9%) in teleconsultation. About 31.7% show an inclination to continue teleconsultations even after COVID-19 era with 51.7% recognising telemedicine as a time-saving option. Among interested patients (54%) with no prior experience of telemedicine, 41.5% reported concerns due to lack of technical equipment and improper training. About 23.1% were skeptical of effective personalised treatment. Sample collections at home (75.3%), home monitors (63.3%), medication delivery (47.3%) and telemedicine (31.7%) are preferred choices. Conclusion: On a real-time basis, participants are willing to share their health status-related data with their healthcare team. Succumbing to the worldwide COVID-19 experience, both health-care providers and patients need to adopt and devise a 'new normal', a paradigm for addressing both health-care providers' and patients' requirements. © 2022 Published by Scientific Scholar on behalf of Indian Journal of Physiology and Pharmacology.
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Background Patients with hematologic malignancies have poor outcomes from COVID infection with associated mortality of up to 30-40%. Studies have shown that these patients are less likely to mount an antibody response after COVID infection 1. The Pfizer-BioNTech and Moderna COVID mRNA vaccines have been shown to be 94% effective in preventing severe disease in the general population. There is limited data on the efficacy of these vaccines in lymphoma patients, and to suggest the optimal timing of vaccination to elicit immunity in patients receiving immunochemotherapy. Methods This is a retrospective study of adult lymphoma patients who received the COVID vaccine between 12/2020 and 04/2021. The primary endpoint was a positive anti-COVID spike protein antibody titer following 2 doses of the COVID mRNA vaccines or 1 dose of the COVID adenovirus vaccine. Additional outcomes of interest included key variables, such as lymphoma subtype and treatment with anti-CD20 monoclonal antibodies. Subgroups were compared using Fisher's exact test, and unadjusted and adjusted logistic regression models were used for univariate (UVA) and multivariate (MVA) analyses. Results One-hundred thirty-seven patients were identified with baseline characteristics as shown in Table 1. Overall, the study population was older at a median age of 69 (IQR 59-78) years old, 52% of patients were male, and 72% of patients were white. The most frequent comorbidities were cardiovascular disease (39%) and former smoking history (34%), and 45 (33%) patients were obese (BMI >= 30). Testing for anti-COVID spike protein antibodies occurred at a median 48 (IQR 25-62) days [range 6-120] after second vaccination. Lymphoma subtypes in our cohort were: indolent lymphomas (35%), CLL/SLL (20%), 27 (20%) patients with Burkitt's, DLBCL, PMBCL combined, and 25 (18%) patients with Hodgkin's and T-cell lymphomas (HL/TCL) combined. Majority of patients received COVID mRNA vaccines, and we were able to confirm the specific type in 71 (52%) patients. Only 1 person received the COVID adenovirus vaccine. Ninety-two patients (67.2%) developed anti-COVID spike protein antibodies after receiving a COVID vaccine. Of 27 patients who received an anti-CD20 monoclonal antibody-containing regimen in the last 12 months prior to vaccination, 14 (52%) patients produced antibodies. This rate was numerically lower than 72% (26/36) of those who developed antibodies and received an anti-CD20 antibody greater than 12 months prior to vaccination. There were differences observed in the ability to produce serology towards the COVID vaccine amongst lymphoma subtypes. Of 28 patients with CLL, 12 (43%) produced antibodies. There were 6 CLL patients receiving anticancer treatment at the time of vaccination, of which 2 patients produced antibodies. CLL/SLL patients were less likely to mount an antibody response to the COVID vaccine when compared to those with other types of lymphoma, and this difference was significant on UVA (OR 0.270, 95% CI 0.112-0.648), p=0.003) and MVA (OR 0.259, 95% CI 0.104-0.643, p=0.004). For patients with HL/TCL, 22 of 25 (88%) patients produced antibodies. Among the 3 HL/TCL patients that did not produce antibodies, 1 patient had HIV/AIDS post-transplant, 1 had relapsed AITL, and 1 received rituximab. All HL/TCL patients who received anticancer treatment in the last 6 months (10 of 10) produced antibodies at a median titer of 120 AU/mL (reference >=15 AU/mL), with 4 patients having a robust response of antibody titers >400 AU/mL. On statistical analysis, HL/TCL patients were more likely to elicit an antibody response to the COVID vaccine when compared to those with other types of lymphoma, and this response was significant on UVA (OR 4.084, 95% CI 1.149-14.515, p=0.03) and MVA (OR 4.442, 95% CI 1.219-16.191, p=0.024). Conclusion Lymphoma patients are capable of mounting a humoral response to the COVID mRNA vaccines. CLL/SLL appears predictive of a negative antibody response to the COVID vaccine, while HL/TCL histologies appeared to correlate to a positive antibody response even with treatment within 6 months of vaccination. Our study suggests anti-CD20 monoclonal antibody therapy in the last 12 months may affect the ability to produce serology towards a COVID vaccine. Further studies are required to confirm our findings, including whether T-cell immunity would be of clinical relevance in this patient population. 1. Passamonti et al, Br J Haematol 2021 [Formula presented] Disclosures: Leslie: Kite, a Gilead Company: Consultancy, Honoraria, Speakers Bureau;Abbvie: Consultancy, Honoraria;BeiGene: Consultancy, Honoraria, Speakers Bureau;PCYC/Janssen: Consultancy, Honoraria, Speakers Bureau;TG Therapeutics: Consultancy, Honoraria, Speakers Bureau;Janssen: Consultancy, Speakers Bureau;AstraZeneca: Consultancy, Honoraria, Speakers Bureau;Seagen: Consultancy, Honoraria, Speakers Bureau;Epizyme: Consultancy, Honoraria, Speakers Bureau;Karyopharm Therapeutics: Honoraria, Speakers Bureau;Celgene/BMS: Consultancy, Honoraria, Speakers Bureau;Merck: Consultancy;Pharmacyclics: Consultancy, Honoraria, Speakers Bureau;ADC Therapeutics: Consultancy. Goy: Acerta: Consultancy, Research Funding;Bristol Meyers Squibb: Membership on an entity's Board of Directors or advisory committees;AstraZeneca: Membership on an entity's Board of Directors or advisory committees;Genentech/Hoffman la Roche: Research Funding;AbbVie/Pharmacyclics: Membership on an entity's Board of Directors or advisory committees;Gilead: Membership on an entity's Board of Directors or advisory committees;Kite Pharma: Membership on an entity's Board of Directors or advisory committees;Janssen: Membership on an entity's Board of Directors or advisory committees;Vincerx pharma: Membership on an entity's Board of Directors or advisory committees;Rosewell Park: Consultancy;LLC(Targeted Oncology): Consultancy;Elsevier's Practice Update Oncology, Intellisphere, LLC(Targeted Oncology): Consultancy;Michael J Hennessey Associates INC: Consultancy;Hoffman la Roche: Consultancy;Xcenda: Consultancy;Medscape: Consultancy;Physicians' Education Resource: Consultancy, Other: Meeting/travel support;Vincerx: Honoraria, Membership on an entity's Board of Directors or advisory committees;AbbVie/Pharmacyclics: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding;Bristol Meyers Squibb: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees;Incyte: Honoraria;MorphoSys: Honoraria, Other;Novartis: Consultancy, Honoraria;OncLive Peer Exchange: Honoraria;Xcenda: Consultancy, Honoraria;AstraZeneca: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding;Elsevier PracticeUpdate: Oncology: Consultancy, Honoraria;Celgene: Consultancy, Honoraria, Research Funding;Genomic Testing Cooperative: Current holder of stock options in a privately-held company, Membership on an entity's Board of Directors or advisory committees, Other: Leadership role;COTA (Cancer Outcome Tracking Analysis): Current holder of stock options in a privately-held company, Membership on an entity's Board of Directors or advisory committees, Other: Leadership role;Hackensack Meridian Health, Regional Cancer Care Associates/OMI: Current Employment;Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding;Kite, a Gilead Company: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding;Infinity/Verastem: Research Funding;Janssen: Research Funding;Karyopharm: Research Funding;Phamacyclics: Research Funding;Constellation: Research Funding. Feldman: Alexion, AstraZeneca Rare Disease: Honoraria, Other: Study investigator.
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SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV2) has lead to unprecedented morbidity and mortality seen in modern times. In addition to acute respiratory distress syndrome (ARDS), there is a range of multi-organ dysfunction complications including fulminant myocarditis. CASE PRESENTATION: A 61 year old male presented with 6 days of fever, malaise, dyspnea, and cough. He was previously seen with similar symptoms and discharged on azithromycin with instructions to self-isolate. Medical history includes hypertension and hypothyroidism. On exam he was in respiratory distress with severe hypoxia on non-re-breather mask requiring emergent intubation and bilateral crepitations. EKG showed sinus tachycardia with diffuse ST depressions. Labs revealed leukocytosis 12K/uL, lactic acidosis 7.8mmol/L, procalcitonin 17.8ng/mL, troponin peaked at 17.7ng/mL, thyroid function was normal, and d-dimer was >20ug/mL. Chest x-ray showed diffuse bilateral interstitial opacities and small left pleural effusion. Echocardiogram revealed global hypokinesis with left ventricular ejection fraction 30% and small pericardial effusion with visceral thickening. SARS-COV2 PCR testing was positive. Testing for influenza, S. pneumonia, and legionella were negative. He developed shock and was placed on norepinephrine, furosemide, cefepime, doxycycline, hydroxychloroquine, therapeutic dose enoxaparin, and high dose methylprednisone. His ventilator settings were placed with high positive end-expiratory pressures and low tidal volumes. He was deemed too unstable to prone;extracorporeal membrane oxygenation (ECMO), as well as, intravenous immunoglobulin treatment were being considered. Unfortunately, he had cardiac arrest and died despite resuscitation efforts. DISCUSSION: Viral myocarditis is a recognized cause of heart failure and cardiogenic shock. Ideally, ischemic cardiomyopathy should be excluded via coronary angiogram but non-invasive methods such as echo or cardiac MRI may be suggestive (acute global hypokinesis or regional wall motion abnormalities that do not match coronary vessel anatomy).1 The proposed mechanisms of myocyte damage include: active replication of live virus within the myocardium, cytokine release due to innate immune response, viral proteins that cause direct myocardial injury, lymphocyte-mediated myocardial injury, inhibition of heme metabolism, and hypercoagulable state leading to microthrombi in small coronary vessel thrombosis as well as pulmonary emboli.2 Current treatment options involve anti-platelets/anticoagulation, antivirals and anti-malarials, high dose steroids, immunoglobulin, ECMO, and plasma exchange.3 CONCLUSIONS: The management of critically ill patients with SARS-COV2 is challenging and multifaceted. The course may be complicated by fulminant myocarditis with cardiogenic shock for which the prognosis can be grave despite the current treatment methods. Reference #1: Michael Jeserich, Stavros Konstantinides, Gabor Pavlik, Christoph Bode, and Annette Geibel. Non-invasive imaging in the diagnosis of acute viral myocarditis. Clin Res Cardiol. 2009 Dec;98(12): 753–763. Published online 2009 Sep 11. doi: 10.1007/s00392-009-0069-2 Reference #2: Toshitaka Yajima and Kirk U. Knowlton. Viral Myocarditis. Circulation. 2009;119:2615–2624 https://doi.org/10.1161/CIRCULATIONAHA.108.766022 Reference #3: Riccardo M. Inciardi, MD;Laura Lupi, MD;Gregorio Zaccone, MD;et al. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. Published online March 27, 2020. doi:10.1001/jamacardio.2020.1096 DISCLOSURES: No relevant relationships by Lakshmi Ayyagari, source=Web Response No relevant relationships by Jason Lofters, source=Web Response No relevant relationships by John Lui, source=Web Response No relevant relationships by Gene Otuonye, source=Web Response No relevant relationships by Matthew Tavares, ource=Web Response