Radiotherapy in COVID-19: a review

The World Health Organization (WHO) stated the novel coronavirus (COVID-19) a global pandemic on 11th March 2020. The virus-infected patients suffered from a respiratory disease called Severe Acute Respiratory Syndrome Coronavirus 2 (SAR-CoV-2). A proteinaceous exudate, alveolar edema, and hyperplasia associated with monocytes and lymphocytes alveolar inflammatory infiltration was observed in the affected patient's lungs. Virus broadens a systemic inflammatory reaction with a cytokine release syndrome which is characterized with the aid of using unexpected growth in many pro-inflammatory cytokines especially IL-6, IL-1, and TNF-a through activated M1 macrophage phenotype. Virus block IL-6 with tocilizumab and the usage of respirator device appears to be very vital. Radioactivity is the process by which unstable atomic nucleus losses energy by radiation, mainly using alpha, beta, and gamma rays. SARS-CoV-2 affected lungs can be treated by a low dose of radiotherapy. It was found that minute dose chest radiation therapy can be able to wean patients off a ventilator as it can reduce inflammation inside the lungs of severely infected COVID-19 patients. Numerous such clinical trials are underway and researchers may work to cure the COVID-19 lung infections by radiotherapy.

EFFECTIVENESS OF CASIRIVIMAB-IMDEVIMAB AND SOTROVIMAB MONOCLONAL ANTIBODY TREATMENT AMONG HIGH-RISK PATIENTS WITH SARS-CoV-2 INFECTION: A REAL-WORLD EXPERIENCE (preprint)

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can evade neutralizing antibodies, raising concerns about the effectiveness of anti-spike monoclonal antibodies (mAb). METHODS: This study reports a retrospective data analysis in Banner Health Care System. Out of 109,788 adult patients who tested positive for COVID-19, the study cohort was split into patients who received Casirivimab-Imdevimab (Cas-Imd) (N=10,836; Delta-predominant period 6/2021-11/2021) and Sotrovimab (N=998; Omicron-predominant period 12/2021-1/2022) mAb compared to propensity-matched control groups (N=10,836 and N=998), respectively. Index date was the date of mAb administration or the date of positive COVID-19 testing. The primary and secondary outcomes were the incidence of composite outcome (all-cause hospitalization and/or mortality) and ICU admission at 30-days following index date, respectively. RESULTS: Compared to the propensity-matched untreated control cohort, the Cas-Imd mAb reduced the composite outcome (from 7.5% to 3.7%; difference: -3.8% [95% CI: (-4.4%, -3.2%)], p <0.01) regardless of their vaccination status, while Sotrovimab mAb did not (5.0% vs. 3.8%; difference: -1.2% [95% CI: (-3.1%, 0.7%)], p =0.22). In terms of the secondary outcome, similarly Cas-Imd mAb decreased ICU admission during the first hospitalization (from 1.5% to 0.5%; difference: -1.0% [95% CI: (-1.3%, -0.7%)], p <0.01) compared to the control group, whereas Sotrovimab mAb did not (0.9% vs. 0.6%; difference: -0.3% [95% CI: (-1.2%, 0.6%)], p =0.61). Comparing the periods, the Omicron-predominant period was associated with lower composite outcome than that during the Delta-predominant period. CONCLUSIONS: Cas-Imd mAb was effective against the SARS-CoV-2 Delta variant, however sotrovimab lacked efficacy in patients with SARS-CoV-2 Omicron-predominant period.

Lack of effectiveness of Bebtelovimab Monoclonal Antibody Among High-Risk Patients with SARS-Cov-2 Omicron During BA.2, BA.2.12.1 and BA.5 Subvariants Dominated Era (preprint)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron subvariants are expected to be resistant to Bebtelovimab (BEB) monoclonal antibody (MAb) and the real-world experience regarding its effectiveness is scarce. This retrospective cohort study reports a data analysis in Banner Healthcare System (a large not-for-profit organization) between 4/5/2022 and 8/1/2022 and included 19,778 Coronavirus disease-19 (COVID-19) positive (by PCR or direct antigen testing) patients who were selected from Cerner-Electronic Health Record after the exclusions criteria were met. The study index date for cohort was determined as the date of BEB MAb administration or the date of the first positive COVID-19 testing. The cohort consist of COVID-19 infected patients who received BEB MAb (N=1,091) compared to propensity score (PS) matched control (N=1,091). The primary outcome was the incidence of 30-day all-cause hospitalization and/or mortality. All statistical analyses were conducted on the paired (matched) dataset. For the primary outcome, the event counts and percentages were reported. Ninety-five percent Clopper-Pearson confidence intervals for percentages were computed. The study cohorts were 1:1 propensity matched without replacement across 26 covariates using an optimal matching algorithm that minimizes the sum of absolute pairwise distance across the matched sample after fitting and using logistic regression as the distance function. The pairs were matched exactly on patient vaccination status, BMI group, age group and diabetes status. Compared to the PS matched control group (2.6%; 95% confidence interval [CI]: 1.7%, 3.7%), BEB MAb use (2.2%; 95% CI: 1.4%, 3.3%) did not significantly reduce the incidence of the primary outcome (p=0.67). In the subgroup analysis, we observed similar no-difference trends regarding the primary outcomes for the propensity rematched BEB MAb treated and untreated groups, stratified by patient vaccination status, age (<65 years or [≥]65), and immunocompromised status (patients with HIV/AIDS or solid organ transplants or malignancy including lymphoproliferative disorder). The number needed to treat (1/0.026-0.022) with BEB MAb was 250 to avoid one hospitalization and/or death over 30 days. The BEB MAb use lacked efficacy in patients with SARS-CoV-2 Omicron subvariants (mainly BA.2, BA.2.12.1, and BA.5) in the Banner Healthcare System in the Southwestern United States.

A European pharmacotherapeutic agent Roflumilast exploring integrated preclinical and clinical evidences for SARS CoV-2 mediated inflammation to organ damage (preprint)

COVID-19 has spread globally, affecting almost 160 million individuals. Elderly and pre-existing patients (such as diabetes, heart disease and asthma), seems more susceptible to serious illness with COVID-19. Roflumilast was licensed for usage in the European Union in July 2010 as a phosphodiesterase-4 (PDE4) inhibitor. Roflumilast has been shown to decrease bleomycin-induced lung fibrosis, lung hydroxyproline, right heart thickning in animal prophylactic. The current study reviewed existing data that the PDE-4 inhibitor protects not just renal tissues but also other major organ systems after COVID-19 infection by decreasing immune cell infiltration. These immune-balancing effects of roflumilast were related with a decrease in oxidative and inflammatory burden, caspase-3 suppression, and increased PKA/cAMP levels in renal and other organ tissue.

An eye opener COVID-19 complication in oro-maxillofacial region: Case report

The aim of this report is to discuss an eye-opening case about the complication in oromaxillofacial region in COVID-19 recovered youth. The aftermath of COVID infection lead to various complexities in multiple organs. Recurrent follow ups of such recovered patients are necessary to identify early dreadful effects and combat them in time. Hence, present study throws a light on one such post-COVID complication occurring in oromaxillofacial region, its pathophysiology and treatment to overcome its worsening upshot.

Projecting the Criticality of COVID-19 Transmission in India Using GIS and Machine Learning Methods

There is a new public health catastrophe forbidding the world. With the advent and spread of 2019 novel coronavirus (2019-nCoV). Learning from the experiences of various countries and the World Health Organization (WHO) guidelines, social distancing, use of sanitizers, thermal screening, quarantining, and provision of lockdown in the cities being the effective measure that can contain the spread of the pandemic. Though complete lockdown helps in containing the spread, it generates complexity by breaking the economic activity chain. Besides, laborers, farmers, and workers may lose their daily earnings. Owing to these detrimental effects, the government has to open the lockdown strategically. Prediction of the COVID-19 spread and analyzing when the cases would stop increasing helps in developing a strategy. An attempt is made in this paper to predict the time after which the number of new cases stops rising, considering the strong implementation of lockdown conditions using three different techniques such as Decision Tree, Support Vector Machine, and Gaussian Process Regression algorithm are used to project the number of cases. Thus, the projections are used in identifying inflection points, which would help in planning the easing of lockdown in a few of the areas strategically. The criticality in a region is evaluated using the criticality index (CI), which is proposed by authors in one of the past of research works. This research work is made available in a dashboard to enable the decision-makers to combat the pandemic.

Incidence, Characteristics and Outcomes of Large Vessel Stroke in COVID-19 Cohort: A Multicentric International Study. (preprint)

Importance: Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is a global pandemic that has been an immense burden on the healthcare systems all over the world. While there are case reports of acute ischemic stroke (AIS) the overall incidence of acute ischemic stroke in COVID -19 patients is yet to be determined. Also, whether the hypercoagulability seen in COVID-19 patients leads to larger thromboemboli and hence increase large vessel occlusion stroke (LVOs) is unclear. Design, Setting, and Participants: This is a retrospective, international multicenter case series of LVOs. Data was collected from March 1, 2020, to May 1, 2020, at 12 stroke centers located in COVID-19 hotspots from 4 different countries. Detailed data was collected on consecutive LVOs hospitalized patients with laboratory-confirmed diagnosis of severe acute respiratory syndrome coronavirus 2 infection.Main Outcomes and Measures: We measured the incidence of AIS and LVOs in the hospitalized COVID-19 patients. Among patients who underwent Mechanical thrombectomy, we measured the stroke outcomes ( site of occlusion, tandem occlusion, revascularization rates, time to present to the hospital), along with COVID-19 symptoms, and overall outcomes in these patients. Results Of 6698 patients admitted with COVID-19 patients in 10 centers, the incidence of stroke was noted in 1.3 % (range .6-2.6 %). The median age of patients who presented with LVOs was 51 years mean (range 27-87years and in the US centers, African Americans comprised 28% of the race-ethnic distribution. 10 patients (16 %) were less than 50 y of age with no significant risk factors for LVOs in the majority of them. Among the LVOs eligible for MT, the average time to presentation from symptom onset to emergency room was 9.3 hours. Successful revascularization was achieved in 81% of patients and the intracranial hemorrhage rate was 14% with no symptomatic hemorrhages. 21 (50%) patients were either discharged to home or to acute rehabilitation facilities. Conclusions and Relevance: LVOs was predominant in patients with AIS and COVID-19, occurring at a significantly younger age and affecting African Americans disproportionately.