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The outbreak situation of the COVID-2019 pandemic is an Unpredictable shock to the world economy. World Economy faces the slowdown of share market prices, especially the value of mutual fund value decreases. Companies and Businessmen primarily invested in the mutual funds to play a safer role, modify their risk into the return, and increase the Net Assets Value (NAV). This study attempts to describe the state of mutual funds in India during this COVID 2019 period. Thus the performance of mutual funds when compared with before and during COVID 2019, the proposed model specifies on testing the performance of mutual funds both in the public and private sectors and attains to access the impact of COVID 2019 on mutual funds. The author has used correlation for finding out the relation of COVID 2019 and Mutual Funds. This paper mainly addresses the causes of investors during economic fluctuation and the return of top mutual companies by comparing the return of 1 year and during these last three months. COVID 2019 is not only on particular sectors;it affects almost every sector like construction, manufacturing, business, agriculture. While all the sectors are affected by COVID 2019 pandemics, it hits the society and the economy;once the economy comes down, the inflation rate increase, the Forex rate will increase, and it affects our whole country. In this paper, the author included sectors that are affected and their performance now and how well the different types of funds are performing, which will be helpful for the reader to analyze the affected areas. The paper concluded with the help of a survey and statistical tools whether the investors can make a further payment and hold for some period or continue with the investment whatever situation crisis impacts our economy. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Objectives: Postpartum depression (PPD) has been described as "the thief that steals motherhood" by depriving women of the anticipated joy of a new infant. Through this study, we intend to see the incidence, treatment rates (TR), relative-treatment rate (TRR), absolute treatment rate (ATR), and number needed to treat (NNT) pre- and post-COVID-19 on treatment of women with PPD. Method(s): This retrospective cohort study included newly diagnosed patients with PPD in 2019 (1st Jan - 31st Dec [pre-pandemic]) and 2020 (1st Jan - 31st Dec [pandemic]) using ICD-10-CM codes from Optum's de-identified Clinformatics Data Mart. Only the patients having continuous eligibility between 12 months before (baseline period) to 12-months post (follow-up period) the first diagnosis of PPD (index date) were included in study. During the follow-up period, patients were then checked for pharmacological treatment received (SSRI, SNRI's and other anti-depressants) using NDC codes. To measure effects, percentages of patients getting treatment, TRR (TR in pandemic/TR in pre-pandemic), ATR (TR in pre-pandemic - TR in a pandemic), and NNT (1/ATR) were calculated before and during COVID. The significance of categorical variables was examined using the Chi-square test. Result(s): We observed 39% increase in incidence of PPD patients during pandemic (n=16,095) vs pre-pandemic (n=11,565). Only 51% TR (risk ratio) was observed during pandemic vs 60% TR (risk ratio) in pre-pandemic with any SSRI, SNRI, and anti-depressants (p<.01). Compared to patients receiving treatment during pandemic vs pre-pandemic: TRR was found to be 85% (relative risk) and ATR was 9% (absolute risk reduction). The NNT comparing pre- and during pandemic was 11. Conclusion(s): The results of the study demonstrated that treatment of women with PPD was impacted during pandemic vs pre-pandemic (9% women did not receive treatment during pandemic). Alternative methods or non-pharmacological treatments may be required to further alleviate non-treated patients and improve their condition. Copyright © 2022
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Objectives: This study aimed to explore the impact of COVID-19 on patients with PTSD and the burden of resource utilization in the pre- and during the COVID-19 pandemic. Method(s): This retrospective observational study included patients diagnosed with PTSD between 1st January 2018 to 31st December 2020 using ICD-10-CM codes from Optum's de-identified Clinformatics Data Mart database. In the study duration, distinct patients were identified and further classified by age, gender, and location of service. To determine the influence in pre- and during COVID-19 for each of the stratification variables, a year-wise comparison was done. Chi-square was performed as test of significance for categorical variables. Result(s): Overall we observed the number of PTSD patients increased by 7% (n=206,741) during the pandemic (1st January 2020 - 31st December 2020) vs pre-pandemic (1st January 2019 - 31st December 2019). A significant increase was seen across all age groups (p<.05). In the case of teenagers, PTSD was found to have increased by 22% whereas in adults and the elderly an 8% and 3% increase was seen respectively. When broken down by gender, a significant increase was observed. Females (+9% [n=143,032]) were seen to have been affected more compared to males (+4% [n=63,625]) during the pandemic vs pre-pandemic. In healthcare resources utilization overall, there was an observed 24% increase. For both inpatients and office, PTSD decreased significantly (-3% and -4% respectively) (p<.05);while ER visits, increased only by 1% (p<.05). A significant increase in outpatient and telehealth services was observed (122% and 454% respectively) (p<.05). Conclusion(s): An increased exacerbation in PTSD was observed during the pandemic with respect to burden across various stratification and resource utilization;especially in outpatient and telehealth services. Better treatment, psychotherapy and alternative care programs may be required to curb this impact and decrease the overall burden across various care setting. Copyright © 2022
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Objectives: This study aimed to explore the impact of COVID-19 on patients with SSA and the burden of resource utilization in the pre- and during the COVID-19 pandemic. Method(s): This retrospective observational study included patients diagnosed with SSA between 1st January 2019 to 31st December 2020 using ICD-10-CM codes from Optum's de-identified Clinformatics Data Mart. In the study duration, distinct patients were identified and further classified by age, gender, and location of service. To determine the influence in pre- and during COVID-19 for each of the stratification variables, a year-wise comparison was done. Chi-square test was performed to check the significance of categorical variables. Result(s): Overall we observed the number of SSA patients increased by 2% (n=266,329) during the pandemic (1st January 2020 - 31st December 2020). A significant increase was seen across all age groups (p<.01). In the case of teenagers, SSA was found to have increased by 80% whereas in adults and elderly an 15% and 8% increase was seen respectively during pandemic (p<.01). When stratified by gender, a significant increase was observed only in females (+9% [n=174,647]) where in males (-3% [n=91,573]) decrease was observed during pandemic. In healthcare resources utilization overall, there was an observed 12% increase during pandemic. For inpatients, office, and outpatient, SSA decreased significantly (-4%, -8%, and -1% respectively) during pandemic (p<.01). A significant increase in outpatient and telehealth services was observed (34% and 1,299% respectively) (p<.01). Conclusion(s): An increased exacerbation in SSA was observed during the pandemic with telehealth and outpatient services being impacted the highest. This may be attributed to facing near-death scenarios, and the loss of loved ones amongst other factors. With the increase in cases, health care resource utilization across various settings is pressed. Better treatment and programs may be required to curb this impact and decrease the overall burden. Copyright © 2022
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Objectives: This study examines use of telemedicine services and health outcomes in patients with hypertension (HTN) in pre- and post-COVID 19 periods in the US. Method(s): A retrospective analysis, using Optum de-identified Electronic Health Record dataset, was done among hypertensive patients on Medicare plans in three different time periods: 1st Jan 2018 - 30th June 2018, 1st Jan - 30th June 2019, and 1st Jan - 30th June 2020 (first two time periods are pre-COVID 19 and the last one is post-COVID 19). The date of first EHR with mention of HTN diagnosis was considered index date. Study participants were categorized into those who used only telemedicine services (Telemedicine group);only other places of service like outpatient, inpatient, or office (Other POS group);and those who used both telemedicine and other places of service (Both POS groups). Patients were followed for 6-months post-index to determine use of anti-HTN medications, resource utilization, and healthcare outcomes. Result(s): Fewer than 100 patients in each study period belonged to Telemedicine group. Majority (55%) patients in 2018 (pre-COVID 19) belonged to Other POS group, but in 2020 (post-COVID 19) majority (61%) patients belonged to Both POS group. About 70% patients in each of three groups were prescribed anti-HTN drugs and adherence was >90%. About ~60% patients in Telemedicine group had 2-6 healthcare encounters while ~80% in Other POS group and ~95% in Both POS groups had >6 healthcare encounters during follow-up period. Significantly more patients in Both POS groups received anti-HTN nutritional counseling as compared to other two groups. Also, blood pressure was controlled in significantly higher percentage of patients in Both POS groups as compared to other two groups. Conclusion(s): Patients who use telemedicine and other places of service are more likely to receive anti-HTN nutritional counseling and have better blood pressure control. Copyright © 2022
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Introduction: Knowledge regarding the development of protective immunity after COVID-19 vaccines is needed to guide medical, political and public health measures against the current and future pandemics. Objectives and Aims: To characterise and compare the safety, immunogenicity and efficacy of mRNA-COVID-19 vaccines in people with multiple sclerosis (pwMS) and healthy controls (HCs). Method(s): All pwMS vaccinated against COVID-19 in Norway were invited to participate in an ongoing observational cohort study (NevroVAX) from March 2021. Demographic-, immunisation-and disease-specific data were acquired from patient journals, web-questionnaires, the Norwegian Immunization Registry and Surveillance System for Communicable Diseases. Antibodies to full length spike protein and the receptor-binding domain (RBD) from SARS-CoV-2 were measured using a bead-based flow cytometric assay, while cellular immunity was investigated using high dimensional multiparameter analyses. Results and Conclusion(s): To date, 5545 pwMS were included with results available regarding humoral responses in 3021 (mean follow-up time 257 days), cellular responses in 140, and clinical efficacy in 900 pwMS. Those treated with anti-CD20 therapy or sphingosine-1-phosphate receptor modulators (S1PM) had weak humoral immune responses after two doses of mRNA-COVID-19 vaccines (80% and 91% <200 BAU/ml, respectively). Additional vaccine doses were safe and associated with a modest increase of anti-SARS-CoV-2 spike RBD IgG antibodies (72% and 83% <200 BAU/ml after three, 74% and 89% <200 BAU/ml after four doses). Humoral responses were weaker after all vaccine doses in pwMS (also in those without treatment) compared to HCs. Cellular responses were significantly attenuated in pwMS treated with S1PM. An elevated rate of non-omicron breakthrough infections was observed in the anti-CD20 (19%), S1PM (18%), and HSCT (14%) group, compared to pwMS on other high-or low-efficacy DMTs or without treatment (13%, 10%, and 7%, respectively). Among 900 pwMS treated at the same hospital, 12 (1%) were hospitalized due to COVID-19, one requiring intensive care. Our results show that antibody responses correlated with the rate of breakthrough infections but is not necessarily indicative of a failed cellular or clinical response to vaccination, and that pwMS have weaker humoral responses than HCs regardless of treatment status. Updated, real-world data from NevroVAX will be presented at ECTRIMS 2022.
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Introduction: Immune responses following SARS-CoV-2 vaccination in patients with inflammatory bowel disease (IBD) are not well characterised, and limited data is available regarding the humoral immune response related to the underlying bowel disease and serum concentrations of biologics and thiopurine metabolites. Aims & Methods: This prospective, observational study included adult patients with ulcerative colitis (UC) and Crohn's disease (CD), and healthy controls. Sera were analysed for antibodies binding the receptor binding domain (RBD) of the SARS-CoV-2 Spike protein, and anti-RBD >=70 AU/ml was defined as serologic response. Anti-RBD and serum concentrations of the ongoing immunosuppressive medications were measured prior to, and 2-5 weeks after the second vaccine dose. The aims of this study were to explore the serologic response associated with the underlying bowel disease and immunosuppressive medications including serum concentrations of biologics and thiopurine metabolites. Result(s): The study included 958 IBD patients (380 UC, 578 CD), median age 40 (Q1;Q3 29;52), and 323 healthy controls, age 44 (33;56). The type and frequency of ongoing immunosuppressive therapy was comparable between the UC and CD patients. The median (Q1;Q3) anti-RBD level (AU/ml) was lower in patients (618 (192;4370)) compared to controls (3355 (896;7849)) post vaccination (p<0.001), and the antibody levels were lower in CD (439 (174;3304)) compared to UC (1088 (251;5975)) (p<0.001). No association between serum concentration and serologic response was demonstrated in patients treated with tumor necrosis factor inhibitor (TNFi) monotherapy, TNFi + thiopurines, vedolizumab, and ustekinumab. Patients treated with TNFi + thiopurines with low 6-thioguanine nucleotides (6-TGN) levels (<3.5 pmol/8x108RBC) demonstrated a higher response rate (93%) than patients who had 6-TGN levels within the therapeutic range (>=3.5 pmol/8x108RBC) (53%) (p=0.003). In the multiple regression model, UC as compared to CD, higher BMI, and mRNA-1273 vaccine were associated with higher odds for serologic response (Table). Older age and patients on treatment with TNFi + thiopurines were associated with lower odds ratios for a serologic response (Table). Treatment with TNFi monotherapy, disease activity (CRP, calprotectin, disease indices) gender and smoking were not associated with serologic response. Conclusion(s): No association between serum drug concentrations for any biologics and the humoral immune response to SARS-CoV-2 vaccines were demonstrated. However, TNFi in combination with thiopurines were associated with an attenuated serologic response, and the serologic response in general was significantly reduced in CD compared to UC patients. Our results indicate that SARS-CoV-2 vaccines can be provided without consideration to the timing of biologic doses in IBD patients and will aid decision-making regarding re-vaccinations and tailoring of medication in order to keep vulnerable IBD patients protected against serious SARSCoV-2 infection.
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Introduction: Humoral vaccine responses to SARS-Cov-2 vaccines are impaired and short lasting in patients with immune-mediated inflammatory diseases (IMID). Concerns have been raised regarding their protection against severe COVID-19 disease. Knowledge regarding efficacy and safety of repeated vaccination in this large patient group is currently lacking. Aims & Methods: The prospective observational Nor-vaC study (NCT04798625) enrolled adult patients on immunosuppressive therapy for inflammatory bowel-and joint diseases. Healthy controls were health care workers from participating hospitals. All participants received standard vaccines according to the national vaccination program with three doses in patients and two doses in controls. The third dose was offered to IMID patients >4 weeks after the second dose. Anti-Spike antibodies were assessed 2-4 weeks, and 12 weeks following each dose. The main outcome was anti-Spike antibody levels 2-4 weeks following three-and two-dose vaccination in patients and controls, respectively. Levels were compared across groups by Mann-Whitney U test. Factors associated with anti-Spike antibody level following the third dose were assessed by uni-and multivariable linear regression adjusted for time between vaccine and sampling. The aim of the study was to evaluate humoral immune responses and safety of repeated vaccination in IMID patients. Result(s): Overall, 1100 patients (156 ulcerative colitis, 217 Crohn's disease, 366 rheumatoid arthritis, 177 spondyloarthritis, and 184 psoriatic arthritis;median age 54 [IQR 42-64];602 women [55%]) and 303 controls (median age 43 [IQR 33-55];226 women [75 %]) were included. Immunosuppressants were tumor necrosis factor inhibitor (TNFi) monotherapy (n=461), TNFi with concomitant immunomodulator (n=254), methotrexate (n=220), vedolizumab (n=46), janus kinase inhibitors (n=33), and other (n=86). Vaccine series were Pfizer BNT162b2 (54% patients, 54% controls), Moderna mRNA-1273 (17% patients, 23% controls), or combination of vaccines (29% patients, 23% controls)). Patients received the third vaccine dose a median of 126 (IQR 105-154) days after the second dose. Following three-dose vaccination, patients achieved median (IQR) antibody levels of 5720 BAU/ml (2138-8732) compared to 4495 (1591-6639) in controls receiving two doses, p=0.27. In patients, anti-Spike antibody levels increased by a median of 1932 BAU/ ml (IQR 150-4978) from the second to the third dose, p<0.001. Factors associated with response were a greater interval between the second and third vaccine dose (>5 months) (p=0.03), vaccination with mRNA-1273 (p<0.001), and a combination of vaccines (p<0.001). Antibody levels had a slower decline-rate following the third vaccine dose, as compared to after the second dose, with a significant difference (p<0.001). Adverse events were reported by 488 (53%) and 464 (47%) patients after second and third dose, respectively, and by 196 (68%) controls. Disease flares were reported by 50 (5%) and 70 (7%) patients following the second and third dose. Conclusion(s): This large observational study shows that additional vaccine doses to IMID patients contributes to strong and sustained immune-responses comparable to healthy persons vaccinated twice. This study highlights the importance of repeated vaccination of IMID patients to ensure a stronger and more durable protection from severe COVID-19.
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The current report describes successful treatment of a rapidly progressive severe breakthrough COVID-19 in a female physician, a known case of rheumatoid arthritis (RA). She received monoclonal antibody (Mab) combination cocktail (Casirivimab (TM) plus Imdevimab (TM)) infusion on day 4 after the onset of symptoms. RA was in prolonged remission with tofacitinib. She had completed vaccination 6 weeks earlier and worked in a COVID hospital. Post infusion, there was substantial improvement, and she was discharged after 3 days. However, she required intermittent domiciliary oxygen for a fortnight. Fatigue and ageusia persisted for 5 weeks. Several Mabs were recently approved for emergency use in mild-to-moderate ambulant COVID-19 patients. Controlled drug trials confirmed excellent efficacy and safety. Selected data on clinical relevance and limitations are currently described. RA is susceptible to COVID-19, and some vaccines may be less effective. Intervention with Mabs ought to be judicious and timely.
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SESSION TITLE: Occupational and Environmental Lung Disease Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: We describe a case of acute progression of chronic hypersensitivity pneumonitis (HP) in an adult, previously misdiagnosed as COPD for 13 years due to severe emphysematous changes seen on imaging. He was also found to have acutely worsened disease as a result of Covid-19. CASE PRESENTATION: A 64-year-old male presented to the pulmonary clinic with dyspnea on minimal exertion. He reported respiratory complaints for 13 years, treated with 2 L/min of oxygen overnight, and budesonide-formoterol and tiotropium inhalers. These complaints were previously associated with brief occupational mold exposure and possible COPD. His respiratory distress worsened one year ago when he was hospitalized for Covid-19. On discharge, his oxygen requirement had increased to 6 L/min. CT chest showed air-trapping in the mid-zones bilaterally, mosaic attenuation, and peri-bronchial thickening. PFTs showed an FEV1 33% and FVC 55% of predicted, consistent with severe obstruction and reduction in lung volume. As the patient was a lifetime non-smoker, alternative diagnoses were pursued. Alpha-1 antitrypsin levels and immunologic testing, including scleroderma and myositis panels, were within normal limits. Positive findings included CCP IgG/IgA antibodies at 96 units and HP panel positive for pigeon serum antibodies. Prompted by this testing, the patient revealed that he had parakeets in his home for the past 15 years. He also reported significant symptom improvement on occasions that he took a course of steroids. Based on these findings, a diagnosis of chronic fibrotic hypersensitivity pneumonitis with bronchiolitis obliterans was considered. The patient's severe airflow obstruction and respiratory failure precluded surgical lung biopsy. Empiric management was initiated with 30 mg of prednisone daily with a slow taper and instruction to eliminate exposure to exotic birds. DISCUSSION: HP is commonly caused by inhalation of and sensitization to an aerosolized environmental antigen;a common subtype is bird fancier's lung due to repetitive exposure of avian antigen. Continuous antigen exposure increases the risk for development of fibrosis, which was also seen in our patient. The most commonly described radiologic findings in HP are ground-glass opacities, ill-defined centrilobular nodules, and focal areas of air trapping resulting in mosaic attenuation and fibrosis. More than 20% lymphocytosis on bronchoalveolar lavage is also a sensitive tool in detecting alveolitis. The relationship between Covid-19 and disease progression in HP is not well studied. CONCLUSIONS: Chronic hypersensitivity pneumonitis from avian antigens, or Bird fancier's lung, can present with severe emphysematous changes on CT imaging, along with obstructive pattern of PFTs. This should be an important differential, especially in patients who are non-smokers. Covid-19 causes disease progression in HP, this relationship needs to be further explored. Reference #1: Funke M., Fellrath J.-M. Hypersensitivity pneumonitis secondary to lovebirds: a new cause of bird fancier's disease. Eur. Respir. J. 2008;32:517–521. DOI: 10.1183/09031936.00108507 Reference #2: Pereira C., Gimenez A., Kuranishi L., Storrer K. Chronic hypersensitivity pneumonitis. J. Asthma Allergy. 2016;9:171–181. DOI: 10.2147/JAA.S81540 Reference #3: C.S. Glazer, C.S. Rose, D.A. Lynch Clinical and radiologic manifestations of hypersensitivity pneumonitis J. Thorac. Imag., 17 (4) (2002), pp. 261-272. DOI: 10.1097/00005382-200210000-00003 Morell F, Roger A, Reyes L, Cruz MJ, Murio C, Muñoz X Bird fancier's lung: a series of 86 patients. Medicine (Baltimore). 2008;87(2):110-130. DOI: 10.1097/MD.0b013e31816d1dda DISCLOSURES: No relevant relationships by Momina Amjad No relevant relationships by Amit Chopra No relevant relationships by Rafeh Safdar