Prognosis Score for Overall Survival with CAR-T Therapy in Aggressive Lymphoma

Background: Despite the transformative potential of chimeric antigen receptor T (CAR-T) therapy, more tools to assist with identifying patients with increased likelihood of benefitting from this therapy will be helpful, particularly given the logistical complexity and socio-economic demands for CAR-T relative to other therapies. Health care resource restriction during the COVID-19 pandemic highlights the need for these tools. We present a simple survival score that uses 3 readily available clinical labs: platelet (plt), absolute lymphocyte count (ALC), and Lactate dehydrogenase (LDH), to predict the risk of dying within 6 months of CAR-T therapy in patients with aggressive lymphoma. Method(s): We conducted a retrospective chart review of patients with aggressive non-Hodgkin lymphoma (NHL) who received FDA-approved CAR-T between Jan 2018 to Jan 2022 at Mayo Clinic Rochester.(Table Presented)Results: Among a total of 110 pts who received CAR-T, 27 (25%) pts died within the first 6 months post CAR-T infusion (OS <= 6 months). Disease progression was the main cause of death (18/25, 72%), followed by infection (4/25, 16%), CAR-T related (HLH/MAS, 2/25, 8%), second primary malignancy (1/25, 4%) and unknown (2/25, 8%).Baseline demographics were comparable between the OS>6months and <=6months groups (Table 1). Patients' ECOG, Karnofsky performance status and 11 labs at the time of evaluation for CAR-T therapy (initial eligibility assessment, prior to leukapheresis) were compared between those who died from any cause within 6 months of CAR-T infusion and those who did not. Hemoglobin, plt, ALC, absolute monocyte count, CRP, ferritin, and LDH were selected as clinically and/or statistically significant variables for multivariate testing. Multivariate regression with boot-strap testing identified plt, ALC, and LDH as the most predictive variables with 80.9+/-11.7% accuracy for predicting death within 6 months of CAR-T infusion. Patients were scored 0-3 using these 3 labs, with 1 point assigned for plt <= 100 X109/L, ALC <= 0.4 X109/L, or LDH > 222 U/L (upper limit of normal). OS by this survival score is shown in Figure 1.(Figure Presented)Discussion: Due to the curative potential of CAR-T, patients with broader characteristics than those treated on registration studies have been treated in standard of care practice. While an estimated 5%-10% risk of CAR-T associated deaths in the first 3 months is seen across all patients in clinical trials, predictors for early death after CAR-T in real-world patient populations can provide additional context for pts and providers when selecting treatment. This survival score is important proof of concept that a simple model using readily accessible clinical labs at the time of CAR-T evaluation could provide additional context to help with additional clinical decision-making. Multicenter prospective studies will help define and validate the definitive survival scoring system.Copyright © 2023 American Society for Transplantation and Cellular Therapy

Medical Profession in the 21(st) Century. Is it Still Alluring??

Introduction: The world, particularly India, is in the midst of one of the worst pandemics ever. The second wave of the COVID-19 pandemic has hit the country like a tsunami, taking a toll on life. A robust health-care industry with competent, productive, and positive manpower is needed like never before. The productivity of doctors is directly related to the fulfillment they experience in their jobs. Aims and Objectives: The study will try to explore the satisfaction level of doctors working in Haryana. It will also delve into major determinants of satisfaction and dissatisfaction. Materials and Methods: The cross-sectional survey-based analysis was conducted in FMHS SGTU on doctors employed in Haryana. The prevalidated questionnaire was administered via Google Forms. Results: A total of 515 filled pro forma were obtained. 71.6% of doctors were found to be satisfied in their chosen profession. Discussion: The discontentment among doctors is now globally acknowledged. It stems from a wide array of issues such as the growing incidents of workplace violence, lack of security measures, deteriorating doctor-patient relationship, erratic work hours, monumental workload in stressful environment, inadequate infrastructure, and pitiful pay. Conclusion: There is marked diminution in doctors' morale who regret being in this profession more and more. However, with the joint efforts of society and competent authorities, this grim situation can be rectified. Steps should be taken to build a strong doctor-patient relationship based on trust and boost infrastructure so that medical profession can be made alluring in the 21(st) century.

Perception Towards Blended Learning at the Time of Covid-19 Pandemic

Blended learning mixes offline learning activities and resources with online learning activities and resources. The goal of blended learning is to minimise the time spent sitting in class, which is a significant advantage for a College / university. It might aid university officials with enhancing programmes that have low enrollment, reducing expenditures, and fulfilling staff teaching responsibilities. The study is focusing on the perception of the college students towards the online learning program during the pandemic. The blended learning is the unavoidable and safety method of teaching learning process during the pandemic. It is a qualitative study made in Chennai city. The students of higher educational institutions (Arts & Science and Engineering colleges) are considered as samples. 250 sample respondents are selected from the study are using simple random technique. The Google forms was circulated and collected the primary data. Assessment is a very important instrument for measuring the degree of knowledge that a student has in relation to the topic in which they are enrolled in any level of education. Teachers are able to give the lecture and measure student learning via the use of unique and inventive approaches when they use blended learning strategies.Copyright © 2022 Ubiquity Press. All rights reserved.

Serum Interleuk.in-6 as a Potential Indicator of Severity In Covid-19 Patients: A Cohort Study

The outbreak of corona virus disease 2019 (COVID-19) in December 2019, caused by the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). It poses a severe threat to global public health. Interleukin-6 (IL-6) was proposed to be associated with the severity of corona virus disease. The present study aimed to explore the role of IL-6 levels with severity in adult CO VID-19 patients. To correlate the serum level of IL-6 with severity of COVID-19 and monitoring of the disease in adult COVID-19 patients.A retrospective study was carried out after obtaining approval from the relevant Ethics Committee. Patients established with COVID-19 infection as shown by positive real-time quantitative PCR test were included. This study was conducted first time in Hadoti region of Jhalawar, Rajasthan. In this study, we have divide patients into three groups common (N=30), severe (N=30) and critical (N=30).The diagnosis and severity classification was based on Clinical Guidance for management of adult Covid-19 patients (Ministry of Health & Family welfare) and WHO interim guideline. The mean concentration of IL-6 were 1.75 +/-0.5 pg/ml, 9.45+/-0.1.5 pg/ml, and 21.55 +/-2.5 pg/ml for the common, severe, and critical groups respectively (P < 0.001 ). Our result shows that serum IL-6 levels increased as disease progress toward critical condition. Serum IL-6 should be included in diagnostic work-up to stratify disease severity. Therefore, full monitoring the severity of COVID-19 and effective early intervention are the fundamental measures for reducing mortality.

Violence Against Healthcare Workers During COVID-19 Pandemic In India

Purpose: The violence against healthcare workers is one of the world's serious public health and patient care challenges. This is often exacerbated during emergencies, and the same has been observed during COVID-19. Method(s): The study reported an analysis of media reports during the first and second waves of the COVID-19 pandemic from India. We searched and analysed violent incidents against healthcare workers reported in English & Hindi online media. Our media analysis also reported perpetrators and triggers to mitigate violence against healthcare workers. Finding(s): We studied 51 incidents of violence, during March 2020-August 2021, as per our inclusion criteria. The majority of this reported violence occurred from the government hospitals (45.1%), followed by the community (29.4%), private hospitals (19.6%), quarantine facilities (4.0%), and burial grounds (1.9%). Doctors were targeted in the majority (82.3%), followed by other hospital staff (security and support) (33.3%), nurses (9.8%), ANMs (3.9%), and ASHA (2.0%). The majority of reported incidents were related to physical violence (58.9%), followed by verbal and physical combined (23.5%), sexual harassment (9.8%), and verbal (7.8%). The preparators of violence were family members (53.0%), community (31.4%), police officials (7.8%), and patients (7.8%). Conclusion(s): The actions required to mitigate the violence against healthcare workers require a multipronged approach with the introduction of strict policy measures and their implementation. The mandatory training of healthcare workers in soft and communication skills, protection, and coping mechanisms to prevent and de-escalate such incidents.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Violence Against Healthcare Community During COVID-19 Pandemic In India

Background: The COVID-19 pandemic poses a threat to everyone, including the healthcare community. The increasing number of incidents against the healthcare providers engaged in COVID-19 response have been reported worldwide, to which India is no exception. India had taken a great initiative by passing the Epidemic Disease (Amendment) Ordinance 2020, to protect healthcare workers and personnel, the most important service providers in the critical time of COVID-19 pandemic. Purpose/objective: To analyze the various incidents of violence against healthcare professionals during the COVID-19 pandemic and to suggest strategies to mitigate this violence. Method(s): All the reported incidents of violence against health care workers or professionals by the print and online media (English) from all states of India, during March-June, 2020, were searched and analyzed. Result(s): We found 31 incidents of violence during this period from 13 states and union territories of India. Majority of these reported violence was in the community (74.2%), followed by hospital (19.4%) and quarantine facility (6.4%). Medical (17), paramedical (10), community health workers (4) and frontline health worker (1) were the target. The majority were verbal (87%) and psychological (13%) violence. We did not find any reported incident of violence in May-June 2020 as Epidemic Disease Ordinance, 2020 was promulgated on April 22, 2020. Conclusion(s): The multipronged approach with introduction of strict policy measures is a need of an hour to mitigate the violence against healthcare professionals. In order to ensure safety, there is also a need to provide right quantity and quality of personal protective equipment along with medical care.

Perception Towards Blended Learning at the Time of Covid-19 Pandemic

Blended learning mixes offline learning activities and resources with online learning activities and resources. The goal of blended learning is to minimise the time spent sitting in class, which is a significant advantage for a College / university. It might aid university officials with enhancing programmes that have low enrollment, reducing expenditures, and fulfilling staff teaching responsibilities. The study is focusing on the perception of the college students towards the online learning program during the pandemic. The blended learning is the unavoidable and safety method of teaching learning process during the pandemic. It is a qualitative study made in Chennai city. The students of higher educational institutions (Arts & Science and Engineering colleges) are considered as samples. 250 sample respondents are selected from the study are using simple random technique. The Google forms was circulated and collected the primary data. Assessment is a very important instrument for measuring the degree of knowledge that a student has in relation to the topic in which they are enrolled in any level of education. Teachers are able to give the lecture and measure student learning via the use of unique and inventive approaches when they use blended learning strategies. Copyright © 2022 Ubiquity Press. All rights reserved.

In-silico analysis of multiepitope based vaccine targeting respiratory viruses SARS, MERS and SARS-CoV-2

BACKGROUND: Recurrent outbreaks of respiratory viruses like SARS-CoV (severe acute respiratory syndrome-coronavirus, 2002), MERS (Middle East respiratory syndrome, 2012) including the ongoing SARS-CoV-2 (2019) pandemic warrants for a single-broad-spectrum vaccine against these respiratory viruses. METHOD(S): In the present study, phylogenetic analysis followed by in-silico identification of vaccine candidates for SARS, MERS and SARS-CoV-2 was performed by exploiting T-cell and B-cell mapping to ascertain the best possible epitopes for effector humoral- and cell-mediated immune response. Further, population-coverage analysis of the identified epitopes followed by the designing of chimera of epitope-based vaccine was done using linkers and adjuvants. Docking study was done to appraise the interaction of the proposed vaccine with ACE2 (angiotensin converting enzyme-2) receptor (SARS and SARS-CoV-2) and HLA-B7 (human leukocyte antigen) receptor (MERS). The stability of the vaccine chimera was confirmed by molecular dynamics performed for 20 ns;this was followed by codon optimization and in-silico cloning. RESULT(S): Phylogenetic analysis revealed similarity among SARS-CoV-2, SARS-CoV and bat SARS-like coronavirus. Both, SARS-CoV and SARS-CoV-2 were from different class than MERS, whereas SARS-CoV-2 showed more relatedness with Bat SARS-like coronaviruses. The most suitable epitopes found were LSFELLNAPATVCGP (SARS), LVTLAILTALRLCAY (SARS-CoV-2) and YTSAFNWLL (MERS) with nearly 98% population coverage. Molecular docking followed by simulation studies revealed high number of hydrogen bonds, stable RMSD values and acceptable RMSF flexibility scores, indicating stable interactions of the vaccine with ACE2 and MHC receptors (Major histocompat-ibility complex). Expression of the designed multiepitope vaccine in E. coli (Escherichia coli) expression system was confirmed by in-silico cloning/codon optimization. CONCLUSION(S): Further, in-vitro and in-vivo experimental validation studies are required to endorse our current findings. Copyright © 2022 EDIZIONI MINERVA MEDICA.

Treatment with anti-spike monoclonal antibodies in allogeneic HCT and CAR T-cell recipients with mild to moderate COVID-19: The Mayo Clinic experience

Background: Prognosis of COVID-19 is poor in the setting of immunosuppression. Casirivimab/imdevimab (REGEN-COV), bamlanivimab, and sotrovimab are investigational monoclonal antibodies (MoAbs) authorized for treatment of mild/moderate COVID-19 for patients (pts) 12 years or older and who are at high-risk for progression to severe COVID-19. These neutralizing antibodies, against SARS-CoV-2 spike proteins, have been shown to decrease risk of progression to severe disease. Recipients of allogeneic stem cell transplants (allo-SCT) or chimeric antigen T cell therapy (CAR T cell) represent a high risk population. However, treatment outcomes with these MoAbs in these pts are not well described. Methods: This retrospective study included 33 consecutive adult pts who developed mild/moderate COVID-19 and received anti-spike SARS-CoV-2 MoAbs between December 2020 and November 2021. Allo-SCT (N=27) or CAR T cell (N=6) recipients were included, and outcomes were analyzed separately. Pts received REGEN-COV (N=19), bamlanivimab (N=11), or sotrovimab (N=1), missing (N=2). Results: In the allo-SCT cohort (N=27), median age at time of COVID-19 was 55 (23-76) years. Median time from allo-SCT to COVID-19 was 31 (22-64) months. Two pts received CAR T-cell therapy prior to allo-SCT. Diagnoses included leukemia or myeloid diseases (82%), lymphoma (11%), or myeloma (7%). Transplant characteristics are summarized (Table). Thirteen pts were vaccinated against SARS-CoV-2 prior to breakthrough COVID-19. Events considered included hospitalization due to COVID- 19, disease progression, or death from any cause. The 6-month event-free and overall survivals were 81% and 91%, respectively. In the CAR T cell recipients cohort (N=6), 4 pts received axicabtagene ciloleucel for diffuse large B-cell or follicular lymphoma and 2 received brexucabtagene autoleucel for mantle cell lymphoma. The median follow-up was 8 (1-11) months. Two pts received autologous SCT prior to COVID-19. Median time from CAR T cell therapy to COVID-19 was 10 (3-24) months. Three pts were vaccinated prior to COVID-19. Only 1 pt was hospitalized due to severe COVID- 19 requiring mechanical ventilation leading to death. Conclusions: These results show a potential benefit of MoAbs in high-risk pts, namely allo-SCT or CAR T cell recipients. Future studies should evaluate the role of prophylactic use MoAbs in these populations. A comparative analysis with a matched control cohort (who did not receive MoAbs) will be provided at the meeting.

Resuming Elective Laparoscopic Surgery during COVID-19 Pandemic: Our Experience and Challenges Faced

Background: SARS-CoV-2 virus infection was detected and discovered in Wuhan, China, in December 2019, and it was declared a pandemic by WHO in March 2020. Since then a lot of changes were noticed in surgical practice. Various recommendations were released by eminent surgical associations all over the world. This study was designed to study and analyze the findings and experience after resuming elective minimal invasive surgery during the pandemic. Materials and methods: This observational study was conducted at St Joseph’s Hospital, Ghaziabad, from May 2020 to May 2021. Various preoperative and postoperative findings were noticed and analyzed. The presence of SARS-CoV-2 virus was also analyzed in endotracheal aspirate and surgical smoke. Observation and results: A total of 287 cases underwent surgery. Most commonly performed surgery was laparoscopic cholecystectomy. The positivity rate for SARS-CoV-2 during preoperative work-up was 2.87%. Slightly more than 5% of cases in postoperative period had COVID-19-like symptoms. None of those patients were found positive on RT-PCR, and X-ray/CT findings were also suggestive of early postoperative changes only. Presence of SARS-CoV-2 virus was not detected in either endotracheal aspirate or surgical smoke. Neither surgery team nor OT staff had infection during this period. There was no mortality, and only 1 patient was found to be infected 2 weeks after discharge. Conclusion: Minimal invasive surgery for elective cases can be safely performed by taking precautions like PPE and smoke evacuation system during the COVID-19 pandemic. There is no evidence of transmission of infection through endotracheal aspirate or surgical smoke.

Predicting the antecedents of consumers' intention toward purchase of mutual funds: A hybrid PLS-SEM-neural network approach

The current study intends to identify the behavioural antecedents of investors' attitude and investment intention toward mutual funds using a robust SEM-ANN approach. It focuses on novel factors in the purview of the COVID-19 pandemic, increasing digitalization and social media usage. The research outcome indicates that attitude (ATB), awareness (AW) and investment decision involvement (IDI) have a significant positive relation with investment intention (BI). In contrast, perceived barrier (PBR) negatively relates to investment intention. Herd behaviour (HB) and social media influence (SMI) do not influence investment intention toward mutual funds. Moreover, all the tested predictors share direct relation with the attitude toward mutual fund investment, barring perceived risk (PR), which has an inverse relationship. As per the outcome of ANN sensitivity analysis, attitude is the most crucial determinant of investment intention. It is followed by awareness (AW), perceived barriers (PBR) and investment decision involvement (IDI). Among the significant determinants of attitude, self-efficacy (SE) is the most important determinant, followed by perceived usefulness (PU), perceived emergency (PEMER), subjective norms (SN) and perceived risk (PR). © 2022 John Wiley & Sons Ltd.

COVIZONE: A Deep Transfer Learning-Based System for Automatic Detection of Covid-19 using Chest X-Ray

With increasing rise of COVID-19 infected patients in India and worldwide, examining and detecting COVID-19 among such large number of populations is becoming a humongous task for the medical practitioners and civic authorities. RT-PCR, real time reverse transcription-polymerase chain reaction technique is widely accepted and one of the reliable methods for detection of novel COVID-19.However, being a time consuming, laborious and expensive method for declaring results for the patients in over 6-8 hours to even 3 days in remote places, this technique is not being widely used. The high and very fast spread rate of COVID-19 and low availability of RT-PCR kit, is making the use of computer assisted technologies an inevitable and a potentially faster response mechanism catering to a large population with least human error and a cost-effective solution. Therefore, an intelligent system COVIZONE has been presented, in the proposed work, designed using state of the art pre-trained CNN model to analyze and detect COVID-19 presence in the lungs using Chest X-Ray and CT-Scan Images. In the proposed work, a multi-class classification (Normal, Pneumonic and COVID-19) of patients using ResNet and ResNext CNN model has been done. Both the models show similar performance with high accuracy of 96% and 97% respectively on public dataset of COVID-19, Pneumonia and Normal CXR and CT-Scans. To avoid skewness due to lesser number of COVID-19 CXR images, dataset used has limited Pneumonia and Normal CXR images to train the system and achieved noticeable high accuracy. The proposed COVID-19 detection model i.e. COVIZONE, even if not used as a primary Covid testing and detection tool, can still be a very helpful tool for screening potentially infected persons and help the physicians who are yet not trained for this pandemic diagnosis. © 2021 IEEE

COVID'19 in India: Emotion of the Nation A novel Spatio-Temporal Unsupervised Sentiment Analysis

The coronavirus was originated in Wuhan City in China in 2019, and it led to something for which the world was not prepared. In the world where the extent of COVID'19 was ubiquitous, India was one of the countries that witnessed multiple phases of its spread. Moreover, since India has one of the largest populations, this made analyzing the sentiment of people during this time a task that held significance. COVID'19 brought a mix of emotions across the different periods in its first 18 months. During this time, social media was flooded with tweets and hashtags expressing both favorable and negative opinions about COVID'19, pandemic, lockdown, and vaccines. © 2021 IEEE.

CRITICAL APPRAISAL OF GI ENDOSCOPY CLINICAL PRACTICE GUIDELINES DURING THE COVID-19 PANDEMIC

Background Clinical Practice Guidelines (CPGs) are integral during a pandemic, offering guidance to clinicians through uncertainty. Existing literature has established that the need for rapid publication of CPGs during previous infectious disease outbreaks resulted in less rigorous guidelines. CPGs were rapidly developed since the onset of the pandemic in December 2019, providing guidance in gastrointestinal (GI) endoscopy, an area where COVID-19 may pose risk of transmission. Aims To evaluate the quality of GI endoscopy guidelines developed during the COVID-19 pandemic and to compare these with (a) endoscopy CPGs developed prior to the pandemic;(b) CPGs for other endoscopic topics unrelated to COVID-19;and, (c) non-endoscopic CPGs published during the pandemic. Methods We systematically searched Medline, Embase and Scopus for CPGs published by GI societies from January 1, 2018 to December 31, 2020. A grey literature search was conducted. Two authors screened full-texts. In this interim analysis, CPGs were grouped based on publication year: before 2020, or 2020. Endoscopy CPGs published in 2020 were categorized as COVID or non-COVID related. Two authors independently assessed the CPGs using the AGREE II tool, consisting of six domains for evaluating guidelines. A domain score of 60 was set as a threshold to indicate good quality. Results There were 70 endoscopy guidelines and 27 CPGs focused on other GI topics. The mean overall scores were 69% (±12%) for endoscopy CPGs published before 2020 (n=28), and 51% (±23%) for CPGs published in 2020 (n=42). For individual AGREE II domains, mean scores for pre-2020 CPGs ranged from 33.11 (±17.39) in Applicability to 81.55 (±10.37) in Clarity of Presentation. For CPGs published during COVID-19, mean domain scores ranged from 34.18 (±10.52) in Applicability to 75.26 (±13.85) in Clarity of Presentation. 21 of 42 CPGs published in 2020 were related to COVID. Mean overall scores were 35% (±20%) for COVID-related CPGs and 67% (±13%) for non-COVID-19 CPGs. For COVID-19 CPGs, scores ranged from 27.88 (±20.31) in Rigour of Development to 69.58 (±10.81) in Scope and Purpose. For non-COVID CPGs, the scores ranged from 37.30 (±8.93) in Applicability to 84.52 (±5.93) in Clarity of Presentation. Conclusions The difference in overall scores between COVID-19 endoscopy CPGs and non-COVID endoscopy CPGs may suggest that the urgency to disseminate COVID-19 information decreased CPG quality or completeness of reporting. This interim analysis is limited by the lack of distinction between peer-reviewed CPGs and non-peer reviewed recommendations. Given the importance of CPGs in clinical decision making, it is important to ensure that the rapid development of guidelines does not compromise quality and rigour. Funding Agencies None

COVIDetect-DESVM: Explainable framework using Differential Evolution Algorithm with SVM classifier for the diagnosis of COVID-19

The SARS-CoV-2 (COVID-19) epidemic has a huge impact on the health and daily life of people. More than 200 countries are impacted due to this pandemic. To light the COVID-19 virus we need a powerful monitoring system to identify the patients and isolate them. The current detection tests are either done by measuring the body temperature or spotting the genetic material of the SARS-CoV-2. These techniques are time-consuming and have a poor detection rate. Radiological images like chest X-rays are also highlighted and help in the diagnosis of COVID-19 patients. Initial studies suggest that COVID-19 patients have abnormalities in their chest X-rays and can be used in the diagnosis of COVID-19. Based on this literature research, various solutions have been proposed utilizing chest X-rays to detect the SARS-CoV-2. Most of these solutions use non-public datasets and complicated structures with fewer accurate results. In our study, we propose a self-learning, interpretable model for real-time detection of COVID-19. This model utilizes a Differential evolution algorithm for feature selection and Support Vector Machine (SVM) as a classifier. The aim is to obtain higher accuracy in detecting COVID-19 infected patients using X-ray images. We have also used the LIME explanation algorithm to explain the predictability of our model and this makes our design very robust and sustainable. This fully transparent, Interpretable, and explainable model can be used in hospitals where there is a huge demand for rapid tests and radiologists are busy. © 2021 IEEE.

Response to COVID-19 Vaccination Post-CAR T Therapy in Patients with Non-Hodgkin Lymphoma and Multiple Myeloma

Background:COVID-19 adversely affects individuals with cancer. Several studies have found that seroconversion rates among patients with hematologic malignancies are suboptimal when compared to patients without cancer. Among patients with hematologic malignancies, seroconversion rates also appear to be influenced by recent treatment and the type of treatment they have received. Patients with non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) are immunocompromised due to impaired humoral and cellular immunity in addition to prescribed immunosuppressive therapy. Chimeric antigen receptor T-cell (CAR T) therapy is now widely used for NHL and MM, but little is known about seroconversion rates after COVID-19 vaccination among these populations. Current national guidelines recommend COVID-19 vaccination to be offered to CAR T recipients as early as three months thereafter. We retrospectively evaluated SARS-CoV-2 spike-binding IgG antibody levels following COVID-19 vaccination among NHL and MM CAR T therapy recipients. Methods:This retrospective study was conducted at three Mayo Clinic sites on NHL and MM patients that received CAR T infusions from Sept 2016 to June 2021. Baseline characteristics were ascertained from medical records. All NHL and MM patients who had received CAR T at any point and were alive at the time that the COVID-19 vaccine first became available were eligible for inclusion for antibody response evaluation. For antibody response to vaccination, antibody spike values > 0.80 U/mL were considered positive. Results: Out of 104 CAR T infusions, 73 patients are alive at the time of this submission. We have had 7 patients with known COVID-19 pre-CAR T and all 7 are currently alive (5 have antibody titers and 2 have not been tested yet). Nineteen patients developed known COVID infection post-CAR T (13 alive and 6 deceased). The mortality of COVID post-CAR T in our sample was 31.5%. Furthermore, of the 13 patients that survived COVID-19, they received CAR T an average of 416 days prior to COVID-19 infection (median = 337, range = 54 - 1406);the 6 patients who died from COVID-19 had received CAR T an average of 250 days prior to COVID-19 infection (median = 164, range = 7 - 846). All 6 deceased patients did not receive COVID-19 vaccination pre-CAR T. Out of 17 CAR T patients tested for antibody spike titers post COVID-19 vaccination, 76.4% were able to mount an antibody response. More patients with MM had a higher titer response to the vaccine (>250 U/mL) compared to the NHL counterparts (0.80-249 U/mL). All patients that received the vaccine, regardless of antibody response, were alive at the time of this submission. Conclusions:The majority of CAR T recipients with NHL and MM are able to mount an antibody response following COVID-19 vaccination in our relatively small sample. The frequency of seroconversion among CAR T recipients seems to be similar to patients with hematologic malignancy who had received a hematopoietic cell transplant reported elsewhere. These findings are limited by our small sample size and may be influenced by the timing of vaccination relative to CAR T. Furthermore, almost half of our patients received IVIG post CAR T which could potentially cause false positive antibody results as pooled immunoglobulin preparations may contain COVID-19 antibodies from vaccinated healthy donors. To better understand the characteristics of the immunologic response against SARS-CoV-2 in patients post-CAR T, larger multicenter studies exploring both humoral and cellular immunity will be needed. JEWN, MI and JM are co-first authors and PV, HM and AR are co-senior authors. [Formula presented] Disclosures: Munoz: Physicians' Education Resource: Honoraria;Seattle Genetics: Honoraria;Bayer: Research Funding;Gilead/Kite Pharma: Research Funding;Celgene: Research Funding;Merck: Research Funding;Portola: Research Funding;Incyte: Research Funding;Genentech: Research Funding;Pharmacyclics: Research Funding;Seattle Genetics: Research Funding;Janssen: Research Funding;Millennium: Research Funding;Gilea /Kite Pharma, Kyowa, Bayer, Pharmacyclics/Janssen, Seattle Genetics, Acrotech/Aurobindo, Beigene, Verastem, AstraZeneca, Celgene/BMS, Genentech/Roche.: Speakers Bureau;Pharmacyclics/Abbvie, Bayer, Gilead/Kite Pharma, Pfizer, Janssen, Juno/Celgene, BMS, Kyowa, Alexion, Beigene, Fosunkite, Innovent, Seattle Genetics, Debiopharm, Karyopharm, Genmab, ADC Therapeutics, Epizyme, Beigene, Servier: Consultancy;Targeted Oncology: Honoraria;OncView: Honoraria;Kyowa: Honoraria. Bergsagel: Oncopeptides: Consultancy, Honoraria;Novartis: Consultancy, Honoraria, Patents & Royalties: human CRBN mouse;Pfizer: Consultancy, Honoraria;Celgene: Consultancy, Honoraria;Janssen: Consultancy, Honoraria;Genetech: Consultancy, Honoraria;GSK: Consultancy, Honoraria. Wang: Incyte: Membership on an entity's Board of Directors or advisory committees, Research Funding;LOXO Oncology: Membership on an entity's Board of Directors or advisory committees, Research Funding;Genentech: Research Funding;InnoCare: Research Funding;Novartis: Research Funding;MorphoSys: Research Funding;Eli Lilly: Membership on an entity's Board of Directors or advisory committees;TG Therapeutics: Membership on an entity's Board of Directors or advisory committees. Fonseca: Juno: Consultancy;Kite: Consultancy;Aduro: Consultancy;OncoTracker: Consultancy, Membership on an entity's Board of Directors or advisory committees;GSK: Consultancy;AbbVie: Consultancy;Patent: Prognosticaton of myeloma via FISH: Patents & Royalties;Caris Life Sciences: Membership on an entity's Board of Directors or advisory committees;Scientific Advisory Board: Adaptive Biotechnologies: Membership on an entity's Board of Directors or advisory committees;BMS: Consultancy;Amgen: Consultancy;Sanofi: Consultancy;Merck: Consultancy;Mayo Clinic in Arizona: Current Employment;Celgene: Consultancy;Takeda: Consultancy;Bayer: Consultancy;Janssen: Consultancy;Novartis: Consultancy;Pharmacyclics: Consultancy. Palmer: Sierra Oncology: Consultancy, Research Funding;CTI BioPharma: Consultancy, Research Funding;Protagonist: Consultancy, Research Funding;Incyte: Research Funding;PharmaEssentia: Research Funding. Dingli: Novartis: Research Funding;GSK: Consultancy;Apellis: Consultancy;Alexion: Consultancy;Sanofi: Consultancy;Janssen: Consultancy. Kapoor: Sanofi: Research Funding;AbbVie: Research Funding;Takeda: Research Funding;Karyopharm: Consultancy;Cellectar: Consultancy;BeiGene: Consultancy;Pharmacyclics: Consultancy;Sanofi: Consultancy;Amgen: Research Funding;Ichnos Sciences: Research Funding;Regeneron Pharmaceuticals: Research Funding;Glaxo SmithKline: Research Funding;Karyopharm: Research Funding. Kumar: Roche-Genentech: Consultancy, Research Funding;Oncopeptides: Consultancy;Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;BMS: Consultancy, Research Funding;Beigene: Consultancy;Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding;Novartis: Research Funding;Adaptive: Membership on an entity's Board of Directors or advisory committees, Research Funding;Astra-Zeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Tenebio: Research Funding;Merck: Research Funding;Carsgen: Research Funding;KITE: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Amgen: Consultancy, Research Funding;Bluebird Bio: Consultancy;Antengene: Consultancy, Honoraria;Sanofi: Research Funding. Paludo: Karyopharm: Research Funding. Bennani: Kymera: Other: Advisory Board;Vividion: Other: Advisory Board;Kyowa Kirin: Other: Advisory Board;Daichii Sankyo Inc: Other: Advisory Board;Purdue Pharma: Other: Advisory Board;Verastem: Other: Advisory Board. Ansell: Bristol Myers Squibb, ADC Therapeutics, Seattle Genetics, Regeneron, Affimed, AI Therapeutics, Pfizer, Trillium and Takeda: Research Funding. Lin: Kite, a Gilead Company: Consultancy, Research Funding;Merck: Research Funding;Gamida Cell: Consultancy;Takeda: Research Funding;Juno: Consultancy;Bluebird Bio: Consultancy, Research Funding;Celgene: Consultancy, Research Funding;Novartis: Consultancy;Janssen: Consultancy, Research Funding;Sorrento: Consultancy;Legend: Consultancy;Vineti: Consultancy. Murthy: CRISPR Therapeutics: Research Funding.

Outcome of patients with upper gastrointestinal bleeding during the covid-19 pandemic

Introduction: The COVID-19 pandemic has created challenges in upper gastrointestinal bleeding (UGIB) management due to concerns regarding aerosolization during endoscopy and patient hesitancy in presenting to hospital. The impact of the pandemic on UGIB outcomes is not well described. Methods: We described adults with UGIB admitted to general medicine services or intensive care units (ICU) during the first wave of the COVID-19 pandemic (March 1-June 30 2020) at 7 hospitals in Toronto and Mississauga, Ontario. The historical control group consisted of patients admitted to these hospitals from March 1-June 30, 2018 and March 1-June 30, 2019. We compared primary (inhospital mortality) and secondary outcomes (ICU utilization, transfusion requirements, persistent bleeding, and need for angiographic/surgical management of bleeding) using multivariable regression models, controlling for patient demographic factors, comorbidities, severity and etiology of bleeding, and admitting hospital. Results: There were 363 admissions for UGIB from March 1-June 30, 2020 (COVID-19 period) and 950 admissions from March 1-June 30 2018 and 2019 (historical control period). There were no differences between the two groups with respect to baseline variables of age, sex, underlying cirrhosis, Charlson comorbidity index, and the modified Glasgow-Blatchford and pre-endoscopy Rockall mortality risk scores (Table 1). Patients in the COVID-19 time period were less likely to undergo endoscopy (64% vs. 71%, p=0.015). There were no differences between the two groups for the primary outcome of in-hospital mortality or any secondary outcomes (Table 1). On multivariable analysis, patients admitted with UGIB during the COVID-19 time period did not have greater inhospital mortality (odds ratio [OR]50.72, 95% confidence interval [CI] 0.30-1.57), or any differences in ICU utilization, number of red blood cell units transfused, persistent bleeding, and angiographic/ surgical management. Conclusion: Although fewer patients admitted to hospital with UGIB during the first wave of the COVID-19 pandemic received endoscopy, there was no difference in clinical outcomes.

Role and impact of digital technologies in E-learning amidst COVID-19 pandemic

Research has focused on the implementation of E-Learning amidst the COVID-19 pandemic. During COVID-19, the school and educational institutions were closed due to lockdown. During this period the classes of students are taken online. The digital technology used for e-learning during the COVID-19 pandemic has gained popularity in a very short period. Online classes are taken using Microsoft team, any desk, Zoom, WhatsApp applications. Educational contents are transferred frequently over the internet. Research is considering the impact of e-learning amidst COVID-19 and considering issues such as performance and security during transmission of digital content. The education is provided over cloud environment in a more secure manner with better performance. It has been observed that there have been several kinds of research in the area of cloud computing to provide online education. Issues in such research are performance and security of data. There is a need for a high-speed network to transfer educational content from one place to another. The educational contents needed to be secured and compressed at the time of data transfer. Cloud computing applications and the role of the cloud in e-learning are considered during research. The proposed work is supposed to integrate the proposed mechanism in the educational module. The proposed system is supposed to be secure and fast because data is compressed first then data is encrypted on the sender side. On receiving end the data is decrypted and decompressed. Delay in transmission issue is resolved because the size of data is less during transmission. Moreover, the packet dropping ratio gets reduced. The probability of cracking encrypted files also gets reduced as the data is encrypted after compression. © 2021 IEEE.

A survey regarding awareness, fear & psychosis among dentists after pandemic COVID-19

Background: Dentists are at a greater risk for infection and transmission of COVID -19 with increased psychological stress in comparison to general population. Aim: To investigate the awareness, psychological aspects as well as financial burden on dental professionals during the rapid rise in COVID-19 pandemic. Methodology: A total of 3248 participants from different cities, towns across India enrolled and submitted the online 30-item questionnaire divided into different sections. Only 188 forms were unfilled or partially filled which were excluded and final analysis was comprised of responses from 3060 participants. Questionnaire was comprised of closed ended - dichotomous questions and likert scale statements. Results: 1948 (64%) males and 1112 (36%) females participated in study. Out of these 1443(47.2%) were Private Practitioners, 564 (18.4%) were Academicians and 822(26.8%) were indulged both in private practice and academics. Significant proportions of participants expressed a fear of practicing dentistry after the outbreak of COVID 19 infection. Private practitioners and academicians have good knowledge and awareness for pandemic (COVID 19) and its infection control measures to ensure safe dental practice. Conclusion: Psychological and economic impact of COVID-19 on the dental professionals is more problematic so, psychological interventions must be designed in order to improve mental health among dentists. This survey indicates that there is a sturdy need to implement periodic educational interventions and training programs on infection control practices for COVID-19 across all healthcare professions.

Combining Exogenous and Endogenous Signals with a Semi-supervised Co-attention Network for Early Detection of COVID-19 Fake Tweets

Fake tweets are observed to be ever-increasing, demanding immediate countermeasures to combat their spread. During COVID-19, tweets with misinformation should be flagged and neutralised in their early stages to mitigate the damages. Most of the existing methods for early detection of fake news assume to have enough propagation information for large labelled tweets – which may not be an ideal setting for cases like COVID-19 where both aspects are largely absent. In this work, we present ENDEMIC, a novel early detection model which leverages exogenous and endogenous signals related to tweets, while learning on limited labelled data. We first develop a novel dataset, called ECTF for early COVID-19 Twitter fake news, with additional behavioural test-sets to validate early detection. We build a heterogeneous graph with follower-followee, user-tweet, and tweet-retweet connections and train a graph embedding model to aggregate propagation information. Graph embeddings and contextual features constitute endogenous, while time-relative web-scraped information constitutes exogenous signals. ENDEMIC is trained in a semi-supervised fashion, overcoming the challenge of limited labelled data. We propose a co-attention mechanism to fuse signal representations optimally. Experimental results on ECTF, PolitiFact, and GossipCop show that ENDEMIC is highly reliable in detecting early fake tweets, outperforming nine state-of-the-art methods significantly. © 2021, Springer Nature Switzerland AG.