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The coronavirus disease 2019 (COVID-19) pandemic initiated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has encouraged the repurposing of various drugs to treat the morbidity, mortality, and extent of the disease. Nowadays, the COVID-19 pandemic is a major health concern as it has already affected the whole world in all aspects. Drug repurposing is considered a new potential strategy as it is a cost-effective and less time-consuming process to establish a new indication for existing drugs. The present chapter has focused on the pathophysiology of COVID-19 and the reuse of the drugs based on pharmacological mechanisms. In the literature, various drugs like favipiravir, lopinavir, ritonavir, arbidol, chloroquine, hydroxychloroquine, interferons, etc. have been reported for repurposing purposes against COVID-19. Most of them are effective in in vitro and clinical studies. Drugs act mainly on viral entry, viral replication, angiotensin-converting enzyme-2 (ACE2), inflammatory mechanisms, etc. Based on viral pathogenesis and the mechanism of drugs using in silico, in vitro, and clinical studies, repurposing medicines might be considered an excellent opportunity to cure COVID-19. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023.
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Background: MELD and Child-Pugh scores have traditionally been used as prognostic indicators in patients with cirrhosis. Albumin infusions in outpatients have been associated with improved outcomes, but not in transplant waitlisted patients or inpatients. This aim of this study was to assess whether low serum albumin (sAlb) on admission alone is a poor prognostic indicator among cirrhotic inpatients from a new multi-national cohort. Method(s): The CLEARED study is a global study that enrolled consecutive non-electively admitted inpatients without organ transplant or COVID-19 from 6 continents. Admission demographics, medical history, laboratory data, inpatient course, death/hospice transfer and mortality at 30 days post-discharge were recorded. Patients were divided into 3 groups: sAlb <28gm/L(A), sAlb >=28 but <35gm/L (B), and sAlb>=35gm/L (C) were compared. Multi-variable logistic regression was performed using inpatient mortality and overall 30-day mortality as outcomes. Result(s): 2429 patients were enrolled from 21 countries worldwide. The distribution was A:49%, B:39%, C:12%. Gp A patients were significantly younger (54yrs vs. 57yrs vs 58yrs p<0.0001) but with similar gender distribution, and higher MELD-Na score of 25 vs. 20 vs. 17 (p<0.0001). Gp A patients were more likely to have alcohol as etiology of cirrhosis (49% vs. 45% vs 38%, p=0.004), and were more likely to have either infection (27% vs. 18% vs. 13%, p<0.0001), HE (39% vs. 33% vs. 23%, p=0.005) or fluid related issues as a reason for admission (p<0.0001). More patients in Gp A received albumin infusion during their hospital stay (120gm vs. 100gm vs. 100gm p=0.0004), mostly for the indications of AKI (47% vs. 49% vs. 47%, p=0.79) and performance of large volume paracentesis (44% vs. 42% vs. 41%, p=0.80), followed by bacterial peritonitis indication (22% vs. 17% vs. 11%, p=0.01). Group A patients had longer hospital stays (9 days vs. 8 days vs. 7 days (p<0.001), but similar ICU transfer (23% vs. 22% vs. 20%, p=0.55). group A patients were more likely to die while inpatients (19% vs. 11% vs. 5%, p<0.0001), or by 30 days post-discharge (29% vs. 20% vs. 9%, p<0.0001). Table shows the admission variables associated with a poor outcome. Conclusion(s): Hypoalbuminemia is extremely common among admitted cirrhotic patients, with sAlb of <28gm/L occurring in almost half. Together with MELD-Na score and infection at admission, a low sAlb is associated with a poor outcome in these patients. Future studies will need to validate these findings and to assess whether albumin infusions will improve the outcome of these patients. (Figure Presented).
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Background: Although cirrhosis is a major cause of mortality worldwide, there could be disparities in outcomes. This needs a global consortium to study disparities in inpatient cirrhosis care Aim: Define the impact of location in prediction of outcomes in inpts with cirrhosis. Method(s): CLEARED prospectively enrolled non-electively admitted cirrhosis pts without COVID from all continents. To ensure equity, we allowed only 50 pts/site. Admission details, cirrhosis history, inpatient & 30-day course were recorded. World bank classification of low/low middle income (LMI), upper middle (UMI) & High income (HI) were used. Cirrhosis details, inpatient & 30-day outcomes were compared between groups. Multi-variable regression was performed using inpatient & 30-day mortality as outcomes. Result(s): 2758 pts from 21 countries from all continents, including Africa & Australia, were included.727 were L/LMI, 1050 UMI & 981 pts were from HICs. More men & younger pts were in LMI. Cirrhosis details: More pts in HI gp had 6M hospitalizations & infections, HE & ascites while prior variceal bleeding was higher in LMI . Prior HCC & transplant listings were lower in LMI but similar in UMI/HI. Alcohol & NASH was highest in HI. Viral hepatitis & cryptogenic were highest in UMI.Admissions: Admission MELD was highest in LMI. LMI pts were admitted more for GI Bleed, HE, & DILI, while anasarca & HBV flares were higher in UMI. Higher SBP (36% vs 24% vs 21% p<0.0001) & lowest skin/soft-tissue infections were in LMI (5% vs 5% vs 10% p=0.008);rest were similar. Nosocomial infections, driven by UTI were highest in LMI & HI pts (15% vs 14% vs 11% UMI, p=0.03). Admission diuretics, PPIs, Lactulose & statins were highest & antivirals lower in HI. SBP prophylaxis & rifaximin were highest in LMI pts. Outcome(s): More LMI pts needed ICU & had more organ failures (Fig B). Discharge MELD was highest in LMI. In-hospital mortality was highest & transplant lowest in LMI. This extended to 30-day mortality & transplant in LMI patients vs HI pts.Regression: In-hospital mortality was linked with age, infections, MELD & being in a LMI/UMI vs HIC while being on a transplant list, diabetes, & SBP prophylaxis were protective (Fig C). 30-day mortality predicted by age, ascites, HCC, discharge MELD, organ failures, LMI/UMI vs HIC but rifaximin was protective(Fig D). In-hospital transplant was higher with high MELD, admission rifaximin & listed pts &lower in LMI (OR 0.26) & UMI (OR 0.22) & age. 30-day transplant was higher in those with hyponatremia, ascites & HRS, on the list & on rifaximin and lower in LMI (OR 0.24) & UMI (OR 0.59) vs HI. Conclusion(s): In a global study of inpatients with cirrhosis, there were major differences in outcomes. Not being in a high-income country significantly increased the risk of inpatient and 30-day mortality independent of demographics, medications, in-hospital course, and cirrhosis severity likely due to disparities in access to transplant, which should be accounted for in global models. (Figure Presented).
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Background: Given the COVID-19 pandemic, international travel restrictions have been in effect since March 2020 in Canada. As a result, some patients requiring international travel for medical care have experienced delays. Therefore, innovative techniques were required to provide care that would not routinely be performed in Canada, as in the case of Orbera® gastric balloon retrieval. Aims: To describe an approach to gastric balloon retrieval amidst COVID-19 related travel restrictions Methods: Case review of three cases of gastric balloon retrieval was performed Results: 1: A 41-year-old (yo) woman had an Orbera® gastric balloon placement in Washington state in September 2019. She lost 42lbs. Retrieval was scheduled for March 2020, but was delayed due to COVID-19 restrictions. In May 2020, she developed symptoms of balloon dysfunction. The patient was referred to a Canadian tertiary care centre. Gastroscopy was performed under conscious sedation. The Orbera® balloon was in the distal gastric body. The balloon was punctured with a 19G EUS FNA needle;600cc of blue tinted liquid was aspirated. The emptied balloon was retrieved successfully using rat tooth forceps. 2: A 35-yo woman had an Orbera® gastric balloon placed in October 2019 in Toronto at a private health facility. She lost 20lbs. Retrieval of the balloon was scheduled for March 2020, but due to COVID-19 restrictions, it was not possible at the original facility. She did not have symptoms related to the balloon. Gastroscopy was performed under general anesthesia (GA) on October 8, 2020. The balloon was intact in the distal gastric body. The balloon was punctured with a 19G Cook Echotip Needle and vacuum suction applied;400cc of blue tinted fluid was removed. Alligator forceps were used to create holes in the underside of the balloon, allowing excess fluid to be expelled as the balloon was pulled up against the GEJ. Once the balloon was deflated, it was removed successfully through the mouth. 3: A 38-yo man had an Orbera® gastric balloon placed in his native Columbia in March 2020. He did not achieve weight loss. Due to COVID-19 restrictions, he was unable to return for planned removal. He did not have symptoms related to the balloon. Gastroscopy was performed under GA on October 8, 2020. The balloon was intact in the distal gastric body. The balloon was punctured with a 19G Cook Echotip Needle and vacuum suction applied;600cc of blue tinted fluid was removed. Alligator forceps were used in retroflexion to tear the underside of the flattened balloon to ensure all liquid and air had escaped from the balloon. Once the balloon was deflated, it was removed successfully through the mouth. Conclusions: Although Orbera® gastric balloon retrieval is not routinely performed in Canada, we demonstrate that gastroscopy with balloon puncture and forcepsretrieval is a safe option.
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Background: The COVID-19 pandemic is affecting patients and healthcare providers worldwide. During the first wave of the pandemic, healthcare delivery shifted from in-person to virtual clinics. Non-urgent and some emergent procedures, including endoscopies, surgeries, and imaging, were delayed to limit the spread and divert resources to COVID-19. Aims: To assess the impact of the COVID-19 pandemic in care to IBD patients Methods: A survey study was conducted to assess the impact of the COVID-19 pandemic on IBD care. All patients had a virtual clinic appointment between March to July 2020 at either: University of Alberta Hospital or the University of Calgary Clinic. A section of the survey assessed patient experience of virtual clinics and delays in access to IBD care during the COVID-19 pandemic. Results: A total of 1581 patients were contacted to complete the survey. 628 patients agreed to participate in the survey, however not all patients completed each component. The mean age of patients who participated in the survey was 48 years (SD = 15.19). 408 patients responded to satisfaction/future use questions: 84.3% (344) patients agree/strongly agree they were comfortable communicating to the physician using the remote system, 77.5% (316) of patients agree/strongly agree that virtual clinic is an acceptable way to receive healthcare services, 84.8% (346) of patients agree/strongly agree they would use virtual care services again, and 82.6% (337) agree/strongly agree they were satisfied with the telehealth system. Additional challenges were reported by 228 patients. Fear and stress (infection risk/mental health concerns/unemployment) was reported by 57.4% (131) patients. Access to healthcare services, PPE, and community resources was a challenge experienced by 26.3% (60) patients. Additionally, 16.2% (37) patients experienced uncertainty around IBD-specific care, including procedures, treatments, labs, and medications. Overall, 17.3% of patients reported some type of delay in care by July 2020. Table 1 shows the proportion of patients with a delay by type of care and the median delay: 5.7% of patients with IBD had surgery delayed by a median of 10 weeks (8-16 weeks). Conclusions: While some delays in healthcare delivery occurred during the first wave of the pandemic, overall 82.7% of patients with IBD maintained their care without disruption. Sustaining healthcare delivery to the IBD community required adaptation to virtual care;however, patient satisfaction was overwhelming positive among patients with IBD.
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Introduction: Rhino-orbito-cerebral Mucormycosis (ROCM) is an uncommon but devastating fungal infection caused by Mucoraceae family fungi, which are angiotropic and filamentous, with significantly high morbidity and mortality despite treatment. Post Coronavirus Disease-2019 (COVID-19), there was a sudden surge in ROCM cases nationwide due to immunologically and metabolically compromised status. Aim: To describe retinal manifestations in ROCM in a tertiary eye care centre of Northern India. Materials and Methods: An analytic, cross-sectional and hospital-based study was conducted in Regional Institute of Ophthalmology, PGIMS Rohtak, Haryana, India, from May 2021 to September 2021. This study was conducted on 200 admitted patients of RCOM in the institute, which was only designated Nodal centre in Haryana, India. Detailed history was recorded in every patient regarding presenting symptoms, history of COVID-19, hospital stay, oxygen inhalation, steroid intake and immunisation. Thorough ocular examination was done in every patient including visual acuity, ocular movements and pupillary reactions. Dilated fundus examination was done by Indirect Ophthalmoscopy (IDO) for posterior segment evaluation. Contrast Enhanced Magnetic Resonance Imaging (CE-MRI) brain with orbit and Paranasal Sinus (PNS) was done in every patient to see the extent of spread and planning further management. Results: Out of 200 patients of ROCM, majority of patients (64/200) were of 51-60 year age group (32%) followed by 41-50 year age group (28%). Out of 200 cases of ROCM, 146 patients (73%) had history of COVID-19 infection in past and 134 (67%) patients had history of hospital stay during COVID-19 infection. Oxygen (O2) supplementation was given to 98 patients either at home or during hospital stay. History of steroid intake was present in 34 patients and 46 patients received injection Remedsivir. Only 12 patients had vaccine against COVID-19 and none of them were fully vaccinated. Most common presenting symptom was unilateral nasal stiffness (22%) followed by loss of vision (17%). Most common predisposing factor was Diabetes Mellitus (DM) in 78 patients (39%) followed by steroid intake in 34 patients (17%). Out of 200 patients, only 60 patients had retinal manifestations and most common was Central Retinal Artery Occlusion (CRAO) (35/60) and the main mechanism is the direct infiltration of central retinal artery due to angioinvasion of fungi from the orbit. Conclusion: CE-MRI brain with orbit is an important tool in diagnosing and monitoring progression of RCOM but it cannot provide information regarding retinal findings like CRAO, central retinal venous occlusion (CRVO), disc pallor and optic atrophy. Thus, the fundus examination of every ROCM patient should be emphasised, as it not only helps in categorising ROCM but also tells about the visual potential of affected eye. Patients with CRAO and combined vascular occlusion should be considered for exenteration on urgent basis, so that intracranial spread can be prevented and patient's life can be saved.
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In the unprecedented times today, brought about by the outbreak of the COVID-19 pandemic globally, the education sector has been affected, just like the other industries. Many educational institutes have shut down and suspended traditional physical classroom activities. There has been a shift to the online mode of teaching-learning or 'e-learning,' a web-based digital system that incorporates innovative information and communication technology to facilitate interactive and learner-centred learning environments. The strengths, drawbacks, and opportunities offered by various popular online educational platforms are explored and compared in this study. For the research, data is collected from teachers and students across different courses from various colleges in Delhi through surveys, with questions about their perspectives and experiences concerning online educational platforms. Based on the response, few suggestions concerning the adoption of Google Meet or Microsoft Teams online teaching-learning platform with an easy-to-use interface, the blended model of conducting classes, and improving participation and interaction with students are made. This can contribute to the effective implementation and growth of e-learning approaches in the future.
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BACKGROUND The COVID-19 pandemic is affecting patients and healthcare providersworldwide. During the first wave of the pandemic, healthcare delivery shifted from inpersonto virtual clinics. Non-urgent and some emergent procedures, including endoscopies,surgeries, and imaging, were delayed to limit the spread and divert resources to COVID-19. AIMS To assess the impact of the COVID-19 pandemic in care to IBD patients METHODSA survey study was conducted to assess the impact of the COVID-19 pandemic on IBDcare. All patients had a virtual clinic appointment between March to July 2020 at either:University of Alberta Hospital or the University of Calgary Clinic. A section of the surveyassessed patient experience of virtual clinics and delays in access to IBD care during theCOVID-19 pandemic. RESULTS A total of 1581 patients were contacted to complete thesurvey. 628 patients agreed to participate in the survey, however not all patients completedeach component. 423 patients reported which hospital they receive their care: 71.2% (301)were from the University of Alberta, 24.6% (104) were from the University of Calgary, and2.9% (18) did not list either hospital. 429 patients provided a postal code, where 71.8%(308) were from either the Calgary or Edmonton metropolitan area. The mean age of patientswho participated in the survey was 48 years (SD = 15.19). 408 patients responded tosatisfaction/future use questions: 84.3% (344) patients agree/strongly agree they were comfortablecommunicating to the physician using the remote system, 77.5% (316) of patientsagree/strongly agree that virtual clinic is an acceptable way to receive healthcare services,84.8% (346) of patients agree/strongly agree they would use virtual care services again, and82.6% (337) agree/strongly agree they were satisfied with the telehealth system. Table 1shows additional challenges experienced by patients. Overall, 17.3% of patients reportedsome type of delay in care by July 2020. Table 2 shows the proportion of patients with adelay by type of care and the median delay: 5.7% of patients with IBD had surgery delayedby a median of 10 weeks (8-16 weeks). Of note, 73.9% (51) of patients were from theUniversity of Alberta, 23.2 (16) were from the University of Calgary, and 2.9% (2) patientsdid not associate with either hospital. Additionally, 75.4% (52) of patients who experienceddelays live within the Calgary/Edmonton metropolitan area. CONCLUSION: While somedelays in healthcare delivery occurred during the first wave of the pandemic, overall 82.7%of patients with IBD maintained their care without disruption. Sustaining healthcare deliveryto the IBD community required adaptation to virtual care;however, patient satisfaction wasoverwhelming positive among patients with IBD.(Table Presented)Table 1: Additional Challenges Experienced by Patients (N = 228)(Table Presented)Table 2: Proportion of IBD Patients with delays in care (N=398)