Characteristics and Outcomes of Patients with Severe Eosinophilic Asthma Treated with Benralizumab Enrolled in the Connect 360 Patient Support Programme

RATIONALE: Around 4.6 million people in the United Kingdom (UK) have asthma, with an estimated 5.7% treated for severe asthma. Benralizumab is indicated for the treatment of severe eosinophilic asthma (SEA) in adults inadequately controlled despite appropriate maintenance therapy. The Connect 360 Patient Support Programme (PSP) for patients on benralizumab includes options for home-based drug administration, education and adherence support by trained nurses - of particular relevance during the COVID-19 pandemic. Limited evidence exists on the benefit of PSPs for asthma patients or those administering biological therapies at home. This study aims to describe patient characteristics, key outcomes and experience with the PSP using UK data from Connect 360. METHODS: A non-interventional, retrospective cohort study of patients, enrolled in the PSP (Oct-2019 onwards) and consenting to the use of personal data for research purposes (“study cohort”). Patients opting for additional support services with at least one nurse interaction within described study timeframes formed the clinical cohort. Patients were observed up to 48 weeks post-PSP enrolment (interim data taken on 31-Mar-2021;data collection ongoing) with study endpoints assessed at baseline (0-4 weeks), 24 (±4) weeks and 48 (±8) weeks post-PSP enrolment. Characteristics at enrolment are described for the study cohort. Patient-reported clinical outcomes (hospitalisations, maintenance oral corticosteroid [mOCS] use, Asthma Control Questionnaire [ACQ-6] scores) and service satisfaction (1-5 point scale, 5 being most satisfied) were analysed where available from routine PSP nurse calls/visits. Analysis was descriptive;Kaplan-Meier estimators were used to estimate PSP discontinuation rates. RESULTS: The study cohort was 611 patients (mean enrolment age: 54.1 years, 63.2% female [N=323]). Most (98.9%) were benralizumab users on maintenance dosing (8-weekly) at enrolment. The clinical cohort consisted of 149 (baseline), 175 (24 weeks) and 195 (48 weeks) patients. PSP discontinuation rates were 4.4% and 11.6% at 24 and 48 weeks. Proportion of patients reporting mOCS use was 49.7%, 44.0% and 32.8% at each timepoint and hospitalizations were 10.9% and 4.1% at 24 and 48 weeks. Mean ACQ-6 scores decreased over time. Mean (SD) satisfaction scores were 4.6 (0.7) and 4.8 (0.5) at 24 and 48 weeks, respectively. (Table 1). CONCLUSIONS: Overall patients' experience with the PSP was positive, evidenced by high satisfaction with and persistence to the PSP. Where data were available, proportion of patients reporting mOCS and hospitalizations at 48 weeks were numerically lower than previous timepoints and mean ACQ-6 scores improved, suggesting a positive impact of benralizumab treatment within the PSP.

Designing a Mobile Intervention for Alzheimer's and Other Dementias

The number of the elderly experiencing cognitive disorders or dementia including Alzheimer's has been increasing worldwide. During COVID-19 pandemic, they are vulnerable not only to the coronavirus, but also to the social isolation with no family visits. The elderly are increasingly depressed, resisting care, refusing medications, and showing signs of agitation. These behavioral disturbances are leading to an increased use of psychotropic medications and/or increased hospitalizations to the already overloaded healthcare systems. To address this, the authors focus on a mobile intervention, named AlzhaTV, as a suite of mobile apps. The intervention, not requiring any technical interaction from the elderly, is available on both Android and iOS platforms. The mobile intervention has the potential to improve the quality of life and reduction in medications for the elderly. The results show that multiple personalized and non-personalized videos can be transmitted over existing wireless networks. During the current and future pandemics and disasters, AlzhaTV can actively support the elderly.

Influence of patient's age on the clinical presentation, morbidity, and mortality in COVID-19: A brief review

Currently, COVID-19 is spreading rapidly and presenting with different clinical features with different mortality rates worldwide. In the initial days of the pandemic, most of the patients presented with the complaints of lower respiratory tract infection of varying severity, and most of the deaths were also attributable to respiratory failure. As time progressed, more atypical presentations and causes of mortality were encountered according to different age groups. In the present scenario, a surge of COVID-19 cases is expected. Those new cases will also include patients with various problems requiring surgical interventions. In this brief review, we have discussed various presentations and mortality risks of COVID-19 infections in different age groups. We did literature searched on the PubMed database and included studies published in 2019 and 2020. Altogether, 503 articles were retrieved out of which 31 were analyzed to put up this summary. Important atypical findings in neonates and infants were axial hypotonia, drowsiness, moaning sound, intussusception, and late-onset neonatal sepsis with the cause of death being multi-organ failure. Frequently reported comorbidities among children were hydronephrosis, leukemia, and intussusception. Observed risk factors for unfavorable outcome in the adult population were obesity, HIV, tuberculosis, and the intake of immunosuppressive agents in the form of anticancer drugs and steroids. The factors adding to the vulnerability in the elderly population could be enumerated as diabetes, hypertension, ischemic heart diseases, obesity, and cancers. © 2020 Bali Journal of Anesthesiology ;Published by Wolters Kluwer-Medknow.

Convalescent plasma therapy for COVID-19: Current status and future directions

The ongoing pandemic of coronavirus disease 2019 (COVID-19) has triggered a global health crisis probably due to a lack of a reliable cure till date. Several clinical trials are ongoing, but initial results have not been overly promising. Convalescent plasma (CP), which refers to plasma collected from individuals recovered from an illness and developed antibodies against the pathogen, is also being proposed as a therapeutic option for COVID-19 treatment in severe cases to achieve short-term immunity against the virus. Use of CP is not new, and it has been used in various outbreaks over the past century, ranging from the Spanish influenza outbreak in 1918 to the recent Middle East respiratory syndrome (MERS). However, data available on its use in COVID-19 patients is limited. Use of CP so far is restricted to a rescue therapy and needs further trials to assess its possible use in other situations (prevention, postexposure prophylaxis) and patient populations (considering age and comorbid illnesses). In this review, we will try to summarize the current status of use of CP for COVID-19 and ongoing trials in India and elsewhere and will discuss the possible avenues for its use in future.

A supposed fifth wave of Latin American regionalism and human needs

This article analyzes the evolution, between 2010 and 2020, of the organizations created during the Latin American post–liberal regionalism wave. It describes their rise and decline and includes recent public opinion data to claim that there is no demand or supply for an eventual fifth wave of regionalism that would replicate the previous models. Considering the failure of national governments in fulfilling basic human needs, it nonetheless claims that the deepening of the critical social and economic conditions, especially in the COVID-19 pandemic context, could lead to a fifth wave of regionalism in Latin America. Nevertheless, to succeed, such a wave could be inspired by international and regional technical organizations in a way that would recall the principles of David Mitrany’s functionalist theory. © 2020