EFFICACY OF BARICITINIB IN PATIENTS TREATED WITH CORTICOSTEROIDS FOR SEVERE COVID-19 PNEUMONIA: A RETROSPECTIVE OBSERVATIONAL COHORT STUDY

Intro Current evidence is still lacking in use of baricitinib among COVID-19 patients that require low flow oxygen and have systemic inflammation. Therefore, we are keen to evaluate the efficacy of baricitinib therapy among this group of patients, in preventing progression into high flow oxygen devices, mechanical ventilation and reducing mortality. Methods All hospitalised COVID-19 patients that required low flow oxygen with evidence of elevated inflammatory markers (either CRP > 50mg/L or ferritin > 500 mcg/L) were enrolled. It compared those that received standard of care (SOC) between April 2021 and May 2021, with another cohort of patients that received baricitinib and SOC between August 2021 and September 2021. Statistics were propensity score matched for age, gender, comorbidities, oxygen level, CRP and SPO2/FiO2 ratio. Findings Five-hundred fifty patients were included in the standard of care arm (SOC, n=275) and baricitinib-treated arm (BCT-SOC, n=275). Subjects in baricitinib-treated arm received a median 7 days of baricitinib. There was a significant reduction in the need for mechanical ventilation with baricitinib- treated arm compared with SOC arm (11.3% [31/275] BCT-SOC, 18.9% [52/275] SOC;HR 0.55, 95%CI 0.35-0.86;p=0.009). We found more patients in baricitinib- treated arm progressed into non-invasive ventilation or other high flow oxygen devices (26.9% [74/275] BCT-SOC, 19.6% [54/275] SOC;HR 1.45, 95%CI 1.02- 1.46;p=0.037). There was no significant difference in 28-day mortality among 2 groups (8% [22/275] BCT-SOC, 6.9% [19/275] SOC, HR 1.16, 95%CI 0.63-2.1;p=0.646). Discussion In our cohort of COVID-19 patients that require low flow oxygen and have systemic inflammation, a short course of baricitinib used in conjunction with SOC reduced needs of mechanical ventilation. This could help relieve our intensive care burden during COVID-19 crisis. Conclusion Despite showing reduced needs of invasive ventilation, it did not translate into mortality benefits. Thus, prospective randomized study is required to determine the optimal timing for initiation of baricitinib.

Processing of Wisconsin Breast Cancer Data using Ebola Optimization Algorithm with Mixture Kernel SVM

Being a deadly disease, breast cancer is becoming the more progressive one in providing higher mortality for females around the world. Thereby, the need for an appropriate strategy is always required for earlier breast cancer diagnosis. The physicians utilize the Computer-Aided Diagnosis (CAD) tool for effective and tireless detection of such cancers. In this regard, the work is intended to design a CAD system for breast cancer diagnosis in a timely manner. The implementation starts with the use of Wisconsin Breast Cancer dataset. After performing preprocessing and visual analysis of the input dataset, feature selection is performed to improve the efficiency of the CAD system. This can be done by using the recently evolved Ebola Optimization Algorithm (EOA). This algorithm is based on an effective approach used in the propagation of the Ebola virus among individuals. After feature selection, the dominant features are then classified with the aid of a mixture Kernel Support Vector Machine (mK-SVM) algorithm. Additionally, the work utilized the Linear SVM, and KNN algorithms for the experimental analysis and comparison. As a result, the mK-SVM together with EOA provides maximum accuracy of 97.19% in classifying the input as either benign severity or malignant case. © 2022 IEEE.

Clinical severity of COVID-19 with omicron variant predominance in relation to vaccination status, age, comorbidities- a single center in Selangor, Malaysia.

INTRODUCTION: Recently, the rapid surge of reported COVID-19 cases attributed to the Omicron variant of severe acute respiratory syndrome coronavirus (SARS-CoV-2) created an immediate concern across nations. Local information pertaining to the new variant of concern (VOC) is lacking. We aimed to determine the clinical characteristics of COVID-19 during a period of Omicron prevalence among patients hospitalised from February 1 to 21, 2022 at Sungai Buloh Hospital and to estimate the risks of disease progression presumably caused by this variant in association with gender, age, comorbidity, and vaccination status. MATERIALS AND METHODS: In this retrospective, singlecentered, retrospective cohort study, all hospitalised adults with laboratory-confirmed COVID-19, aged 18 and above, were recruited from February 1 to 21, 2022. Clinical characteristics, investigations, and outcomes were assessed. RESULTS: A total of 2279 patients aged 18 years and above with laboratory-proven COVID-19 were recruited and analysed, excluding 32 patients owing to incomplete data. Majority of the study population had a mean age of 41.8 ± 17.7, was female-predominant (1329/2279, 58.6%), had completed a primary series of vaccination with a booster (1103/2279, 48.4%), and had no underlying medical conditions (1529/2279, 67.4%). The risk of COVID-19-related disease progression was significantly lower in hospitalised patients under the age of 50 who were female, had no comorbidity, and had completed two doses of the primary series with or without a booster. [respectively, OR 7.94 (95% CI 6.16, 10.23); 1.68 (1.34, 2,12); 2.44 (1.85, 3.22); 2.56 (1.65, 3.97), p< 0.001]. CONCLUSION: During the period of Omicron prevalence, a favourable outcome of COVID-19 was strongly associated with female gender, age below 50, a comorbidity-free condition, and having completed immunization. With this new observation, it could help improve public health planning and clinical management in response to the emergence of the latest VOC.

National Blood Centre (NBC) experience on development of the guideline for collection, processing and the use of convalescent plasma (CP) for experimental treatment of COVID-19

Background: COVID-19 is an emerging infectious disease, caused by a novel coronavirus, now named SARS-CoV-2. It emerged in Wuhan city, Hubei province, China in December 2019 and continued peaking thereafter. There were only a few available antiviral treatments, which have limited efficacy on COVID-19 during the initial stage of the pandemic, which urged us to look into the use of convalescent plasma (CP) as an option Historically, CP had been applied to improve the survival rate of patients during various viral epidemics, including SARS, MERS, influenza and Ebola virus disease. It may also be a potentially effective treatment strategy for COVID-19 disease. Aims: This paper illustrated our experiences and strategies with regards to the development of the guideline for collection, processing and use of convalescent plasma (cp) for experimental treatment of covid-19. Methods: This guideline was created by a working group at the National Blood Centre Kuala Lumpur (NBCKL) with the collaboration of infectious disease (ID) experts from Sungai Buloh Hospital, who carefully examined the evidence and the combinations before suggesting the intervention. Results: The development of the guideline involved few phases. These include identification of the problem, systematic literature review for evidence on the guidelines, translation of evidence into a clinical practice guideline and finally, reviewing and submission of the guideline for publication to the Ministry of Health (MOH), Malaysia. Summary/Conclusions: In conclusion, we managed to publish the guideline for CP therapy as a potential treatment for COVID-19. The published guideline was readily assessable on the MOH website. It was a great collaboration between the transfusion and the infectious disease fraternity had made this possible.

Identification of warning signs in Malaysian patients having COVID-19 infection who progress to severe form of the illness

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a novel coronavirus, now widely known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has caused 3 major pandemic waves in Malaysia. We aimed to identify the warning signs as indicators that predict the progression of disease. MATERIALS AND METHODS: This is a retrospective cohort study of adult patients more than 12 years of age presenting with laboratory-confirmed COVID-19 admitted in three separate hospitals around the country. RESULTS: Of the 228 patients initially admitted with mild illness, 47 had progressed requiring oxygen. The median time from admission to deterioration was 3 days (IQR 2 - 5). Age more than ≥50years old (median age = 42.5, IQR = 28.8 - 57.0), higher temperature (mean = 37.3, IQR 36.8 - 38.0), MEWS score >3 (9, 19.1%), Neutrophil-to-lymphocyte ratio (NLR) >3.13 , (18, 38.3%) C-reactive protein (CRP) >5. (12, 27.3%), multiple zonal involvement on the chest radiography on admission (2, IQR 1-3) were more common in the deteriorated group on admission. On multivariate analysis, multiple comorbidities (HR = 7.40, 95 percent CI 2.58-21.2, p0.001), presence of persistent fever (HR = 2.88, 95 percent CI 1.15 - 7.2, p = 0.024), MEWS scoring >3 (HR of 6.72 ;95 percent CI 2.81-16.0, p0.001) were associated with progression to severe illness. CONCLUSION: In our cohort, we found that several factors were associated with the severity of COVID19. Early detection of these factors could correctly identify patients who need more intensive monitoring, and early referral for ICU care.

Case series of COVID-19 with spontaneous pneumomediastinum

Spontaneous pneumomediastinum is a rare condition in viral pneumonia. However, it can arise spontaneously in COVID-19 patients with no other risk factors. Here we present four cases of spontaneous pneumomediastinum in patients with COVID-19 pneumonia with no other precipitating factors.

Environmental surface sampling of SARS-CoV-2 in selected hospitals in Malaysia.

COVID-19 has spread rapidly worldwide. The role of fomites in facilitating onward transmission is plausible. This study aimed to determine the presence of viable virus and its persistence on the surfaces of fomites in wards treating COVID-19 patients in Malaysia. This study was conducted in two stages. First, environmental sampling was performed on random days in the intensive care unit (ICU) and general wards. Then, in the second stage, samples were collected serially on alternate days for 7 days in two selected general wards. In Stage 1, a total of 104 samples were collected from the surfaces of highly touched and used areas by patients and healthcare workers. Only three samples were tested positive for SARS-COV-2. In Stage 2, three surface samples were detected positive, but no persistence of the virus was observed. However, none of the SARS-CoV-2 RNA was viable through tissue culture. Overall, the environmental contamination of SARS-CoV-2 was low in this hospital setting. Hospitals' strict infection control and the compliance of patients with wearing masks may have played a role in these findings, suggesting adherence to those measures to reduce occupational exposure of COVID-19 in hospital settings.

Monsoon Impact on the Air Quality During SAR-CoV-2 Pandemic Spread in Central Peninsular Malaysia and Sabah: Pre, During and Post Lockdown Scenarios

Malaysia is considered as one of the countries with the highest novel corona virus (COVID-19) infected cases in Southeast Asia. Recent studies have identified that the air quality of a region also governs the transmission of the virus through pollutants. Hence, a study was conducted to assess the influence of air quality on the COVID-19 pandemic spread in central Peninsular Malaysia and Sabah. An attempt was also made to infer the effect of monsoonal precipitation on air quality. Central Peninsular Malaysia consists of major cities like Kuala Lumpur, Selangor and Putrajaya. These cities are highly populated, with the expansion of industrial activities, rapid urbanisation and greater usage of vehicles has resulted in air quality deterioration. Such conditions have led to related public health issues, compared to Sabah in east Malaysia. In this study, COVID-19 infected cases, air quality index (AQI) and precipitation data were collected from 25 January to August 2020 to infer the relationship of air quality to the pandemic spread before, during and after the implementation of lockdown periods in the country, referred as movement control order (MCO). The lockdown periods fall under various monsoon climate patterns in the country. Interpretation of data reveals that the variation in air quality correlates with the infected cases. Improved air quality was observed during the last phase of MCO with a lesser number of infected cases. The HYSPLIT model was adopted to study the backward air mass trajectories for different time frames to identify the variation in the sources of pollutants reaching the study area. The study determined that the air pollutants have reached the study area from various directions, reflecting a mixed contribution from the ocean and land area. The relationship between high precipitation (during inter-monsoon and SW monsoon) and improved air quality reveals the washout effect of air pollutants. The outcome of this study inferred that the variation of air quality and precipitation rates facilitate the pandemic spread in this region in addition to the other meteorological factors, apart from individual immune capacity and social distancing. [ABSTRACT FROM AUTHOR] Copyright of Journal of Climate Change is the property of IOS Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The PanSurg-PREDICT Study: Endocrine Surgery During the COVID-19 Pandemic.

BACKGROUND: In the midst of the COVID-19 pandemic, patients have continued to present with endocrine (surgical) pathology in an environment depleted of resources. This study investigated how the pandemic affected endocrine surgery practice. METHODS: PanSurg-PREDICT is an international, multicentre, prospective, observational cohort study of emergency and elective surgical patients in secondary/tertiary care during the pandemic. PREDICT-Endocrine collected endocrine-specific data alongside demographics, COVID-19 and outcome data from 11-3-2020 to 13-9-2020. RESULTS: A total of 380 endocrine surgery patients (19 centres, 12 countries) were analysed (224 thyroidectomies, 116 parathyroidectomies, 40 adrenalectomies). Ninety-seven percent were elective, and 63% needed surgery within 4 weeks. Eight percent were initially deferred but had surgery during the pandemic; less than 1% percent was deferred for more than 6 months. Decision-making was affected by capacity, COVID-19 status or the pandemic in 17%, 5% and 7% of cases. Indication was cancer/worrying lesion in 61% of thyroidectomies and 73% of adrenalectomies and calcium 2.80 mmol/l or greater in 50% of parathyroidectomies. COVID-19 status was unknown at presentation in 92% and remained unknown before surgery in 30%. Two-thirds were asked to self-isolate before surgery. There was one COVID-19-related ICU admission and no mortalities. Consultant-delivered care occurred in a majority (anaesthetist 96%, primary surgeon 76%). Post-operative vocal cord check was reported in only 14% of neck endocrine operations. Both of these observations are likely to reflect modification of practice due to the pandemic. CONCLUSION: The COVID-19 pandemic has affected endocrine surgical decision-making, case mix and personnel delivering care. Significant variation was seen in COVID-19 risk mitigation measures. COVID-19-related complications were uncommon. This analysis demonstrates the safety of endocrine surgery during this pandemic.