COVID-19 Vaccines: Fabrication Techniques and Current Status

The year 2020 was the most challenging period due to the havoc caused by the outbreak of novel coronavirus SARS-CoV-2. Scientists and researchers all around the world have endeav-ored every possible approach to find solutions in context to therapeutics and vaccines to control the spread of this life-threatening virus. The acceleration instigated by the outbreak of SARS-CoV-2 and its mutated strains has leveraged the use of numerous platform technologies for the development of vaccines against this unfathomable disease. Vaccines could play an important role in miti-gating the effects of COVID-19 and reducing the ongoing health crisis. Various innovative plat-forms like proteins, nucleic acids, viruses, and viral vectors have been exploited to fabricate vaccines depicting almost 90% of efficacy like BNT162b2, AZD1222, Ad5-nCoV, etc. Some of these vaccines are multipotent and have shown potent activity against newly emerged malicious strains of SARS-CoV-2 like B.1.351 and B.1.1.7. In this review article, we have gathered key findings from various sources of recently popularized vaccine candidates, which will provide an overview of potential vaccine candidates against this virus and will help the researchers to investi-gate possible ways to annihilate this menace and design new moieties.Copyright © 2022 Bentham Science Publishers.

Determination of Alteration in Micromeritic Properties of a Solid Dispersion: Brunauer-Emmett-Teller Based Adsorption and Other Structured Approaches.

The present study is focused on the use of solid dispersion technology to triumph over the solubility-related problems of bexarotene which is currently used for treating various types of cancer and has shown potential inhibitory action on COVID-19 main protease and human ACE2 receptors. It is based on comparison of green locust bean gum and synthetic poloxamer as polymers using extensive mechanistic methods to explore the mechanism behind solubility enhancement and to find suitable concentration of drug to polymer ratio to prepare porous 3rd generation solid dispersion. The prepared solid dispersions were characterized using different studies like X-ray diffraction (XRD), thermal gravimetric analysis (TGA), scanning electron microscopy (SEM), Brunauer-Emmett-Teller (BET), differential scanning calorimetry (DSC), and particle size analysis in order to determine the exact changes occurred in the product which are responsible for enhancing solubility profiles of an insoluble drug. The results showed different profiles for particle size, solubility, dissolution rate, porosity, BET, and Langmuir specific surface area of prepared solid dispersions by using different polymers. In addition to the comparison of polymers, the BET analysis deeply explored the changes occurred in all dispersions when the concentration of polymer was increased. The optimized solid dispersion prepared with MLBG using lyophilization technique showed reduced particle size of 745.7±4.4 nm, utmost solubility of 63.97%, pore size of 211.597 Å, BET and Langmuir specific surface area of 5.6413 m2/g and 8.2757 m2/g, respectively.

Seroprevalence of SARS-COV2 Antibodies among the Serving Personnel of South Western Command: A Multi-Centric Study

Background: Serological diagnosis has become an important tool to understand the extent of COVID-19 in the community. Thus, this study was conducted to estimate the prevalence of SARS-CoV-2 antibodies and to analyze various characteristics (risk factors) associated with SARS-CoV-2 infection among serving personnel in a large geographical area straddling four North Indian states. Materials and Methods: This multicentric, cross-sectional analytical study was conducted among serving personnel in eight stations spread over Punjab, UP, Haryana, and Rajasthan in October-November 2020. A total of 3680 (410 x 8 = 3280 general participants and 50 x 8 = 400 purposive samples) individuals were enrolled and tested using IgG ELISA kit (in four stations) and RAPID CARD-based tests (in the rest four stations). Results: While the overall seroprevalence was found to be 16.57% (610/3680 participants being positive), the seropositivity was found to be 12.01% (10.92%-13.70%) and 54% (52.35%-56.45%) among the study participant's and purposive sampling groups, respectively. While statistically significant association was found between seronegativity and attending any lecture on COVID-19 before the survey (P < 0.001) or following recommended protocols for the prevention of COVID-19 (P < 0.001), a similar association was found between seropositivity and occupation with high exposure to serving personnel or civilians (P < 0.001), having close contact (less than one meter) with COVID-19 confirmed cases in the past (P < 0.001) and being tested positive for COVID-19 in the past (P < 0.05). Conclusion: Our study found a moderate overall seroprevalence with low seroprevalence in few stations and high in the rest.

Immune Thrombocytopenia Post Covishield Vaccination

Introduction: Immune thrombocytopenia (ITP) after COVID-19vaccination is being increasingly reported worldwide.Aims &Objectives: We present five cases of ITP following theAstraZeneca Covishield vaccination.Materials &Methods: We retrospectively collected data on patientspresenting with immune thrombocytopenia post-Covishield vaccination at the Department of Hematology, AIIMS, New Delhi.Result: 5 patients diagnosed with ITP followingAstraZeneca Covishieldvaccination were included. Themedian age at diagnosis in our cohortwas44 years (21-67 years). Of the 5 patients, 2 are female and 3 aremale. Allof them received the Astrazeneca Covishield vaccine. Most of thepatients presented with petechiae and wet purpura with the onset ofsymptoms between 7-20 days (median 15 days) post-vaccination. All ofthese patients had severe thrombocytopenia at presentationwith amedianplatelet count of 7 × 109/l (range 1-14 × 109/l). Anti PF4 antibodytesting was done in two patients which were negative.Therapy details include IVIG (3), steroids (4), eltrombopag (2),azathioprine (1), and platelet transfusions (2). Of these, two patientshad no response to first-line therapies. One patient did not respond toIVIG, steroids, azathioprine, and subsequently developed anintracranial bleed. He was managed with platelet transfusions, IVIG,steroids, and eltrombopag. His platelet counts have stabilized at50 × 109/l and he did not have further bleeding manifestations. Atthe last follow-up, 80% (n = 4) of our patients have achieved aresponse.Conclusions: Immune thrombocytopenia is being increasingly recognized post-COVID vaccination. All our patients had severethrombocytopenia requiring therapy. The question of whether thesecases are actually primary ITP coinciding with the administration ofthe vaccine or ITP secondary to vaccination remains unanswered.Additional surveillance is needed to determine the true incidence ofCOVID-19 vaccine-induced ITP.

COVID-19: Mutated Strain, Treatment Options and Vaccine Development

The ongoing outbreak of the cOviD-19 is a significant threat to global health and the economy. This disease is a highly contagious pathogenic disease caused by severe acute respiratory syndrome coronavirus 2 (sARs-cov-2). The virus has a high reproduction rate, due to that it is highly transmittable and has turned into a catastrophe. scientists and researchers worldwide are exaggerating every possible approach to limit the spread of this malicious disease. An abrupt rise has been reported in the number of cases due to newly mutated strains like sARs-cov-2 vUi 2020/12/01. to date, no specific drug is effective in the complete eradication of this dangerous disease but, some broad-spectrum antivirals such as Remdesivir and lopinavir are being used in the management of this ailment. Also, every possible effort has been made in the development of vaccines for preventing the outbreak of this deadly virus. The BNt162b2 by Pfizer and m-RNA-1273 by Moderna have been recently launched into the market, which have shown undesirable effects in geriatrics leading to mortality. in this review, we have tried to highlight important aspects of the cOviD-19 that will aid in global awareness and will help the researchers to investigate possible ways to eradicate this menace and design new moieties for its effectual management. © 2021 Society of Pharmaceutical Sciences of Ankara (FABAD). All rights reserved.

Assessing the impact of a renal care management program on disease progression prior to and during the COVID-19 pandemic

Background: The transition to dialysis among chronic kidney disease (CKD) patients marks a significant change in health accompanied by increases in morbidity and health care costs. Delaying this transition means extending the patient's quality of life and cost savings. The effects of renal care management on the transition to dialysis and whether having access to the program impacts the risk of transitioning to dialysis as well as the timeline of transitioning to dialysis is necessary to study given the increased role of case management programs with the advent of the COVID-19 pandemic. Understanding the role of disease management programs provide direction for management programs across the globe Methods: The design is a retrospective, cohort study of patients in the US drawn from a national claims database who were identified as having CKD 4 or 5 on July 1, 2018. The data was analyzed to determine whether program access affected the rate of transition to dialysis and the likelihood of transitioning to dialysis from 2018 to 2020. Results: We followed the cohort of 7,992 participants (3,561 with access to Kidney Resource Services and 4,431 without access to Kidney Resource Services) during a two year period from 2018 to 2020. Those with access to Kidney Resource Services transitioned to dialysis later than those without access to the program. Further, after controlling for patient risk and characteristics, patients with access to the program had a 22 percent reduced risk of initiating dialysis compared to those without access. Conclusions: Patients with stage 4 or 5 CKD who have access to renal care management have a reduced risk of transitioning to dialysis as well as a later transition to dialysis compared to CKD patients without access to renal care management. Further research is needed given the increased need for education during and post the COVID-19 pandemic to address social and clinical determinants of health.

Development of a COVID-19 Multiplex for Serological Screening of Nonhuman Primate Colonies

In the fall of 2019, a novel beta coronavirus was detected in humans in Wuhan, China. The infection spread globally causing a pandemic in the human population. This novel virus is most closely related to severe acute respiratory syndrome (SARS-CoV aka SARS-CoV1), which spread globally in 2002-2004, and has been formally named as SARS-CoV2 or more commonly referred to as COVID19. A new high throughput COVID-Plex serology assay has been developed that utilizes 6-antigen coupled beads, 2 specific for detecting SARSCoV2 antibodies and 1 antigen for each of the 4 human seasonal coronavirus strains (229E, NL63, HKU1 and OC43). Recombinant SARS-CoV2 proteins for the full length spike (S1 + S2 subunits) and nucleoprotein (NP) as well as full length spike proteins for 229E, NL63, HKU1 and OC43 were coupled to Luminex magnetic beads. Samples were interpreted as COVID19 antibody positive if both SARS-CoV2 beads (spike and NP) scored above the assay cutoffs. Sensitivity of the COVID-Plex assay was assessed by using 50 positive human sera with 47/50 scoring positive for COVID antibodies. Three negative samples either scored only on the alpha coronavirus seasonal strain beads or completely negative on all 6 coupled beads (COVID as well as the 4 seasonal spike protein coupled beads). These samples were also confirmed negative by a commercial COVID19 spike protein ELISA. Specificity of the assay was tested by screening pre-2019 human and macaque samples with 0/8 and 0/24 positive samples, respectively. Recently collected sera in 2020 from rhesus and cynomolgus macaque colonies (n=322) representing several different institutions resulted in only one positive finding resulting in 99.7% assay specificity. These studies confirm that COVID-Plex, a blood based test using serum/plasma is sensitive and specific for screening of COVID19 (SARS-CoV2) antibodies in NHPs. Also the COVID-Plex can be performed in a user-friendly and high throughput format while screening for other infectious SPF agents using the same sample.

Nanotechnology-based Herbal Formulations: A Survey of Recent Patents, Advancements, and Transformative Headways.

Nanotechnology in association with herbal medicine can lead to enhanced therapeutic and diminished adverse effects of medication. In turn, it can lead to synergistic effects of administered compound overcoming its demerits. Nowadays, the trend of herbal compounds to treat even a small illness is gaining momentum. Gone are the days when the ineffectiveness of a compound was impossible to be dealt with. Nevertheless, in this competitive era of science and innovative technology, it has become possible to maximize the usefulness of ineffective yet potent herbal compounds. The demand for herbal compounds is getting amplified because of their ability to treat a myriad of diseases, including COVID-19, showing fewer side effects. The merger of nanotechnology with traditional medicine augments the potential of herbal drugs for devastating dangerous and chronic diseases like cancer. In this review article, we have tried to assimilate the complete information regarding the use of different nanocarriers to overcome the drawbacks of herbal compounds. In addition, all the recent advancements in the herbal field, as well as the future exploration to be emphasized, have been discussed.

Addition of eltrombopag to immunosuppressive therapy (ATG, cyclosporine) in acquired aplastic anemia: A tertiary care center experience

Aims & Objectives: To assess the responses of Acquired Aplastic Anaemia patients who have received Eltrombopag in addition to Immunosuppressive therapy (ATG → Cyclosporine A) at our tertiary care center. Patients/Materials & Methods: We retrospectively analysed the responses of Acquired Aplastic Anaemia patients who have received Eltrombopag, Antithymocyte globulin, and Cyclosporine A from Jan 2019 to March 2020. Results: Thirty-eight patients were included in our study. The median age is 27.6 years (7-68). Male to Female ratio 1.2:1. 6 patients were less than 13 years of age and, 31 patients were between>13 years to<60 years and 1 patient was>60 years. PNH clone was positive in 6 patients(15%). Majority of our patients were Severe Aplastic Anemia (76.3%), and Non Severe Aplastic Anemia (10.5%), Very Severe Aplastic Anaemia(13.1%).All of our patients received Cyclosporine and Danazol before ATG. The median duration from diagnosis to treatment is 12.2 months(1-60 months). Except for one who received Rabbit ATG, everyone received Equine ATG. Eltrombopag was given at a dose of 75 mg in 13.15% (5) and 150 mg in 86.85% (33). Complete Response, Partial Response, No response were seen in 15.8%,57.8%,26.5% respectively. 3 patients expired within three months of treatment, 3 more patients expired by 6 months(1, COVID-19). Discussion & Conclusion: Overall Response rates of 75% in an Indian cohort of acquired aplastic anemia patients treated with ATG and Cyclosporine plus Eltrombopag is comparable to that reported in studies from US and Europe. Median duration of disease prior to ATG based IST was 1 year in our cohort of AA patients.Addition of eltrombopag to ATG and Cyclosporine was able to overcome the delayed initiation of IST in AA patients.Treatment was well tolerated in our patients.

Benefits of telephonic case management: Increased home dialysis and decreased hospitalizations

Background: Home dialysis has been noted to improve quality of life in patients receiving dialysis. Patients at risk for COVID-19 include those on dialysis. The pandemic has resulted in additional focus on social distancing and home dialysis offers this distinct advantage compared to in center hemodialysis. The ASN also similarly has supported advancing education around home dialysis, and COVID is being noted as a true catalyst to home dialysis care. Our study on a commerical poppulation analyzed cost of care with regards to home versus in center dialysis. Methods: The KRS Case Management program identified and educated commerical patients with this case management benefit regarding the options for home versus in center hemodialysis. Patients were enrolled in the program and educated on the benefits of home dialysis, the benefits of permanent access, and the benefits of transplantation. Cost of care analysis was conduted using claims paid until February 2020, and variables studied included in-patient cost, skilled nursing facility cost, professional cost for dialysis service, facility cost for dialysis service, non dialysis outpatient cost and professional cost for physician visits. Patients were educated telephonically of the benefits of home dialysis and permanent access placment, and demographics including age and gender were also calculated. Results: A total of 6692 members were analyzed. Of these patients 1793 members were attributed to home based dialysis. It as noted that when adjusting for per diseased member per month, there was a 62% decrease in cost of care for in-patient hospitalizations in the home dialysis group. In addition, there was a striking reduction of 247% in skilled nursing facility costs for the home dialysis group as well. After adjusting for all variables, there as a 5% cost savings in the home dialysis group as compared to in-center. Conclusions: There are cost of care benefits to home dialysis. Further studies are needed to help identify barriers to home dialysis, and given the advent of COVID-19, it is important to consider home dialysis for all patients more now than ever before.

Judicial policy for the covid-19 pandemic in comparative legal perspective

The right to health and equity is the paramount concern of the State, especially in times of epidemic and pandemic. The nationwide lockdown and COVID-19 has witnessed a series of judicial inte3rvention in health right and equity. Although there is a settled jurisprudence concerning health right and entitlement, the current streak of judicial innovation represents a novel discourse in the understanding of the public health administration and governance in India. An inquiry into the judicial policy of the epidemic-pandemic in the comparative jurisdiction seems fascinating in deepening our understanding of the state expediency and citizens liberty. The precedents in Gibbons v. Ogden, Louisiana State Board of Health Case, Jew Ho v. Williamson and Wong Wai v. Williamson deepens the understanding of the public health administration and governance. The rulings of Indian Supreme Court in Alakh Alok Srivastava v. Union of India, Shashank Deo Sudhi v. Union of India, suo motu cognizance of COVID-19 Testing and Sachin Jain v. Union of India also open a new vista of health right and justice in India. © 2020, Advanced Scientific Research. All rights reserved.