Cloud-Based Architecture for Effective Surveillance and Diagnosis of COVID-19

Coronavirus disease 2019 (COVID-19) has spread in multiple countries and caused major worldwide concern. The continual increase in the number of COVID-19 cases is overwhelming the world economy and has become a serious concern to global health. It is supposed to as an absolute to severe acute respiratory syndrome (SARS), formally known as beta-coronavirus, which was termed as COVID-19 through World Health Organization (WHO). Even with its deadly recurrence, several actions have been taken to diagnose and treat the disease as fast as possible. Rigorous quarantine efforts and global containment are being performed. Apart from this, the incidence of pandemics, similar to COVID-19, had been into existence a few decades back. Various techniques and technologies are being introduced previously, by various authors, to tackle the pandemic. Health authorities, worldwide, concluded with surveillance and tracking of individuals, while others opted for application-based techniques to keep track of the infected individuals, etc. The study proposed a cloud-based network to manage pandemic situations like COVID-19. With this proposed scenario and detailed survey, government authorities and researchers (worldwide) can opt for appropriate ways to control its recurrence;and will help to stop further propagation using dynamic surveillance. © 2023 Scrivener Publishing LLC.

Skill and Simulation Lab in Dentistry - A Futuristic Era

Simulation is a technique where the situation or a process is imitated. This process makes one to pretend the scenario. Aviation industry is one of the oldest industry which uses simulation technique to simulate the aviation technique. The main aim of having simulation lab is to make students acquire psychomotor skills before they actually treat the patients. Presently the National Medical Council of India has made it mandatory to have a skill lab but desirable to have a simulated mannequin for the training of medical students before actually treating the patients. Various advantages and disadvantages are appreciated in simulation technique. It is not very far that Dental council of India may make compulsory training of certain simulated modules in dentistry before treating the patient. Simulation lab in the pandemic like COVID has really helped people to undergo extensive training before treating patients, especially one who were catering the COVID ward or intensive care units. The simulation in dentistry is not a very old technique, certain technique are already in practice, but this article tries to highlight the necessity and gray areas where simulation can be improved for the benefit of students to learn and for the benefit of patients in view of safety. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

DREAMM-9: PHASE I STUDY OF BELANTAMAB MAFODOTIN PLUS STANDARD OF CARE IN PATIENTS WITH TRANSPLANT-INELIGIBLE NEWLY DIAGNOSED MULTIPLE MYELOMA

Background: The bortezomib, lenalidomide, and dexamethasone (VRd) regimen is a standard of care for newly diagnosed multiple myeloma (NDMM). Belantamab mafodotin (belamaf) is a B-cell maturation antigen-binding antibody-drug conjugate that eliminates myeloma cells by a multimodal mechanism: direct cell kill and anti-myeloma tumor immune response. Belamaf has demonstrated deep and durable responses as a monotherapy in the DREAMM-2 study of patients (pts) with relapsed/refractory multiple myeloma (RRMM). Preclinical evidence of belamaf in combination with bortezomib or lenalidomide suggests enhanced anti-myeloma activity, providing rationale for this treatment combination. Aims: To evaluate the safety and tolerability of this combination in adult pts with transplant-ineligible (TI) NDMM and establish the recommended Phase III dose. Methods: DREAMM-9 (NCT04091126) is an ongoing Phase I, open-label, randomized study of belamaf + VRd. The belamaf dose cohorts currently being evaluated are Cohort 1 (1.9 mg/kg Q3/4W), Cohort 2 (1.4 mg/kg Q6/8W), Cohort 3 (1.9 mg/kg Q6/8W), Cohort 4 (1.0 mg/kg Q3/4W), and Cohort 5 (1.4 mg/kg Q3/4W). Belamaf is given with VRd Q3W until Cycle 8, and with Rd Q4W thereafter. After evaluation of safety data for Cohort 1, Cohorts 2-5 were opened in parallel and enrolled pts were randomized 1:1:1:1. Primary endpoint is safety. Secondary endpoints include efficacy, tolerability, and pharmacokinetics (PK). Results: As of data cutoff (07 Dec 2021), 64 pts were analyzed across all cohorts. Median age (range) was 73.0 (51- 88) years, 55% were male, 80% were white, 8% had extramedullary disease, 59% were International Staging System stage II or III, 20% had amp1q, and 17% had high-risk cytogenetics (≥1 of: t(4;14), t(14;16), del17p). The median duration of follow-up varied: Cohort 1 (17.4 months [mo]), Cohort 2 (5.9 mo), Cohort 3 (6.1 mo), Cohort 4 (4.7 mo), Cohort 5 (5.8 mo). Median number of belamaf cycles were: Cohort 1 (6), Cohort 2 (3), Cohort 3 (3.5), Cohort 4 (4.5), and Cohort 5 (5). Most common adverse events (AEs) across cohorts included thrombocytopenia (49%), constipation (43%), diarrhea (32%), and peripheral sensory neuropathy (30%). AEs related to study treatment were experienced by 61 (97%) pts. Belamaf-related grade 3/4 AEs occurred in 24 (38%) pts. Belamaf dose reductions occurred in 11 (18%) pts, with dose delays in 10 (16%) pts. Three pts experienced a fatal severe AE (unrelated to study treatment);2 due to COVID-19 infection, 1 due to pancreatic adenocarcinoma. Early deep responses were observed;67-92% pts achieved ≥very good partial response (VGPR) (Table), with median time to VGPR of 2.1-2.9 months across cohorts. Of pts with ≥VGPR, 17 were minimal residual disease (MRD) negative, 10 in Cohort 1. As of data cutoff, 8-75% of pts achieved best response of complete response (CR) or stringent CR (sCR). Grade 3 corneal exam findings were reported in 25-58% of pts;grade 3 visual acuity changes were reported in 21-75% of pts. No grade 4 corneal exam findings or visual acuity changes were reported in pts receiving belamaf Q6/8W, compared with 0-17% and 0-8%, respectively, in the Q3/4W cohorts. Belamaf PK profile was similar to that in pts with RRMM, accounting for baseline characteristics. Image: Summary/Conclusion: Belamaf + VRd demonstrated high response rates in pts with TI NDMM, with a high rate of MRD negativity indicating deep responses. No new safety signals were observed relative to DREAMM-2. Study is ongoing to evaluate the safety and efficacy of variable dose intensities of belamaf in combination with VRd.

Sentiment Analysis of COVID-19 Tweets

Sentiment analysis is the field of computer science that studies people's behaviour or attitude towards objects, events, organizations, and products. Organizations make use of this to improve their products. This paper aims to study people's behaviour towards COVID 19. We have taken data from Twitter to analyse the sentiments. The results show that people don't have positive sentiments towards this coronavirus. © 2022 IEEE.

DREAMM-9: PHASE I STUDY OF BELANTAMAB MAFODOTIN PLUS STANDARD OF CARE IN PATIENTS WITH TRANSPLANT-INELIGIBLE NEWLY DIAGNOSED MULTIPLE MYELOMA

Background: The bortezomib, lenalidomide, and dexamethasone (VRd) regimen is a SoC for NDMM. Belamaf, a B-cell maturation antigen (BCMA)-targeting antibody-drug conjugate, demonstrated durable responses in patients with relapsed/refractory multiple myeloma. Preclinical studies of belamaf in combination with bortezomib/ lenalidomide suggest enhanced antimyeloma activity. We report preliminary findings of belamaf + VRd for patients with TI NDMM. Materials and Methods: DREAMM-9 (NCT04091126) is an ongoing Phase I, open label, randomized, dose and schedule evaluation trial. Adults with TI NDMM and ECOG status 0-2 are eligible. VRd is administered Q3W until Cycle 8, followed by lenalidomide + dexamethasone (Rd) Q4W. Belamaf + VRd is administered until Cycle 8, and with Rd thereafter. The currently evaluated belamaf dose cohorts are: Cohort 1 (1.9 mg/kg Q3/4W), Cohort 2 (1.4 mg/kg Q6/8W), Cohort 3 (1.9 mg/ kg Q6/8W), Cohort 4 (1.0 mg/kg Q3/4W), and Cohort 5 (1.4 mg/kg Q3/4W). Primary endpoint is safety. Secondary endpoints include efficacy, tolerability, and pharmacokinetics (PK). Results: Overall 36 patients were treated across the 5 cohorts. The median (range) age was 74.0 (63-80) years;56% patients were male, 17 (47%) had stage 2 disease, 3 (8%) had extramedullary disease, 6 (17%) patients had high risk cytogenetic abnormalities;the median number of belamaf cycles ranged from 1-9. No new safety signals were observed. Across Cohorts 1-5, all patients experienced AEs related to study treatment;1 patient in Cohort 1 died due to COVID-19 infection. The most common AEs leading to dose modification were thrombocytopenia, neutropenia, and corneal events. Patients in Cohort 2 and 3 had the lowest number of Grade ≥3 corneal events (3 and 2 events, respectively). All 12 patients in Cohort 1, all 6 in Cohorts 3 and 5, and 5/6 patients in Cohorts 2 and 4 have responded to the treatment;≥half of patients in each cohort achieved very good partial response or better. As of data cut-off, 3/12 patients in Cohort 1, 2/6 in Cohort 4, and 1/6 patients each in Cohorts 3 and 5 remained in complete response. Belamaf PK profile was similar to that observed in patients with RRMM taking into consideration baseline patients characteristics. Conclusions: Preliminary data suggest addition of belamaf to VRd did not reveal new safety signals and demonstrates high response rates, albeit with short follow-up. The trial is ongoing to confirm safety and evaluate the efficacy of belamaf + VRd. .

Role of Physical Therapy and Virtual Rehabilitation during and after COVID-19 Disease

Early physical therapy rehabilitation protocols have shown improved functional outcomes and a reduction in mortality rates. Virtual rehabilitation (VR) has allowed practitioners to provide safe treatment without any risk of viral contamination. This review aimed to evaluate the importance of physical therapy and rehabilitation during and after the infection of coronavirus (COVID-19). To do so, four electronic databases such as PubMed, ResearchGate, Science Direct, and Google Scholars were searched to retrieve articles published after the outbreaks of the COVID-19 pandemic. Six studies were included in the final review. It is a compilation and examination of physical therapy treatments provided by various hospitals and organizations during and after CO-VID-19. The present review throws light on physical therapy, going hand in hand with VR, to play a promising role in patients with mild to moderate symptoms, thus improving their quality of life. The necessary references, as well as the statistics gathered from the published articles, are available. A total of 12 046 patients were included. Of the total patients, 3085 (25.6%) had fatigue symptoms and 1866 (15.5%) had arthralgia/myalgia. Within an hour of being in the prone position, patients were found to have an increase in the oxygen saturation (SpO2) level from 94% to 98%. The pace of breathing also improved, dropping from 31 to 22 per minute. Physical therapy and VR have improved daily activities while assisting in the recovery of health, lifestyle, and lowering post-illness physical and mental deficiencies. ©Copyright 2022 by Anatolian Journal of Family Medicine

SPECTRUM OF CT FINDINGS IN CLINICALLY SUSPECTED CASES OF MUCORMYCOSIS - A STUDY AT TERTIARY HEALTH-CARE CENTER (RAJINDRA HOSPITAL PATIALA) DURING SECOND WAVE OF COVID PANDEMIC

Objective: Rhinocereberal mucormycosis is an acute, fulminant, and often lethal opportunistic infection typically affecting diabetic or immunocompromised patients. Early diagnosis is vital in these infections because delay in initiation of the treatment can be life-threatening. Computed tomography (CT) with axial and coronal sections is a highly accurate and non-invasive modality to accurately image sinonasal mycosis. The aim of the study was to describe the imaging findings in suspected cases of mucormycosis on CT. Methods: This study was conducted in Radiodiagnosis Department of Rajindra Hospital, Patiala. The data of 22 patients who were referred for CT with a clinical suspicion of mucormycosis were collected and all these patients were followed up to know about the prognosis of the disease. Results: In our study, there were 54.60% females and 45.40% males. Maximum number of patients (45.45%) belonged to 40-49 year age group. Diabetes mellitus was found to be the most commonly (90.90%) found comorbidity followed by hypertension (36.36%). In our study, involvement of unilateral nasal cavity was observed in 36.36% cases. Among the paranasal sinuses, maxillary and ethmoid sinuses were the most commonly involved in 95.45% and 77.27% cases. Conclusion: Prompt diagnosis and treatment of rhino-orbital mucormycosis are the sine qua non as antifungal drugs and surgical debridement can successfully control the infection and thus reduce the high mortality and morbidity associated with mucormycosis.

India’s Household Leverage and the COVID-19 Crisis Ramifications for the Post-pandemic Recovery Phase

The outbreak of the COVID-19 crisis has deepened the recession in the Indian economy and caused a significant leap in household financial savings given their cutbacks in consumption and reduced demand for credit amid rising income uncertainties. Banks have also tightened lending due to asset quality concerns. This shift in household financial behaviour was caused by the continuous amplification of household leverage in the pre-COVID-19 years, resulting from a sharp increase in household financial liabilities on account of the robust growth in personal loans. As demonetisation created surplus liquidity in the banking system, it brought about a persistent build-up of unsecured household debt. This paper analyses trends in credit deployment across different sectors of the economy to illustrate the rising share of household credit concentrated in credit card receivables and other personal loans post demonetisation. © 2022 Economic and Political Weekly. All rights reserved.

DREAMM-9: Phase I Study of Belantamab Mafodotin Plus Standard of Care in Patients with Transplant-Ineligible Newly Diagnosed Multiple Myeloma

Introduction: The bortezomib, lenalidomide, and dexamethasone (VRd) regimen is an acceptable standard of care (SoC) for both transplant-eligible and transplant-ineligible newly diagnosed multiple myeloma (TI NDMM). Ongoing development of novel therapies and combinations strive to improve survival outcomes beyond what is expected from SoC. Belantamab mafodotin (belamaf) is a B-cell maturation antigen-binding antibody-drug conjugate that eliminates myeloma cells by a multimodal mechanism and has demonstrated durable responses in patients with relapsed/refractory multiple myeloma (RRMM). Preclinical evidence of belamaf in combination with bortezomib or lenalidomide suggests enhanced anti-myeloma activity, providing rationale for this treatment combination. We report the preliminary findings of belamaf + VRd for TI NDMM patients. Methods: DREAMM-9 (NCT04091126) is an ongoing Phase I, open-label, randomized, dose and schedule evaluation study of belamaf + VRd in patients with TI NDMM. Eligible patients include those ≥18 years old with ECOG status 0-2 and adequate organ system functions. The study evaluates safety and tolerability of belamaf + VRd in up to 8 cohorts, up to 144 patients, to establish the recommended phase 3 dose (RP3D). VRd is administered Q3W until cycle 8, followed by lenalidomide + dexamethasone (Rd) Q4W. Belamaf + VRd is administered until cycle 8, and then in combination with Rd thereafter. The belamaf dose cohorts currently being evaluated are: cohort 1 (1.9 mg/kg Q3/4W), cohort 2 (1.4 mg/kg Q6/8W), cohort 3 (1.9 mg/kg Q6/8W), cohort 4 (1.0 mg/kg Q3/4W), and cohort 5 (1.4 mg/kg Q3/4W). After evaluation of safety data for cohort 1, cohorts 2-5 were opened in parallel and enrolled patients were randomized 1:1:1:1. Safety data, clinical activity, and drug concentrations will be assessed, and used to determine the belamaf RP3D. This analysis reports the preliminary results from cohort 1. Primary endpoints include number of patients with adverse events (AEs). Secondary endpoints include establishing relative dose intensity of lenalidomide and bortezomib in combination with belamaf, cumulative dose of belamaf, pharmacokinetics (PK) profile of belamaf when combined with VRd, overall response rate (ORR), complete response (CR), stringent complete response (sCR), complete response rate ([CRR];% of patients with a confirmed CR or better), and rate of very good partial response or better (≥VGPR). Exploratory endpoints include assessing minimal residual disease (MRD) in patients who achieve ≥VGPR, and safety and efficacy exposure-response relationships. Results: Twelve patients in cohort 1 were included in this preliminary analysis. Eight patients (67%) were male;median age (range) was 72.5 years (63-77). Ten patients (83%) were white and 2 (17%) were Asian. Nine patients (75%), were ISS stage II or III, and 4 (33%) patients had high-risk cytogenetics (consisting of one or more of the following: t(4;14), t(14;16), del17p, 17p13del). AEs related to study treatment were experienced by all 12 patients. Dose reductions occurred in 12 (100%) patients, all of whom also experienced a dose delay. Most common AEs leading to dose modification were thrombocytopenia, neutropenia, and corneal events. Grade 3 or 4 AEs related to belamaf occurred in 9 (75%) patients. During the trial, one patient experienced a fatal severe AE due to COVID-19 infection (unrelated to study treatment;Table). All patients, 100% (n=12;95% CI: 73.5-100) achieved ≥VGPR. Early deep responses were observed;2 (17%) patients achieved VGPR as early as 4 weeks. As of data cut-off, 5 (42%) remain in CR and 3 (25%) in sCR. Based on real-time data captured in the clinical database, 7 out of 9 patients achieved MRD-negative status at the first test after VGPR. Belamaf PK profile was similar to that observed in patients with RRMM taking into consideration baseline patients characteristics. Conclusion: Preliminary data suggest addition of belamaf to VRd did not reveal new safety signals and demonstrates high response rates, albeit with short follow up. The study is ongoing to confirm safety and evaluate the efficacy of belamaf + VRd. Updated data for cohort 1 will be reported at the congress. Funding: GSK (Study 209664);belamaf drug linker technology licensed from Seagen;belamaf monoclonal antibody produced using POTELLIGENT Technology licensed from BioWa. [Formula presented] Disclosures: Usmani: Pharmacyclics: Consultancy, Research Funding;Seattle Genetics: Consultancy, Research Funding;Takeda: Consultancy, Research Funding, Speakers Bureau;Merck: Consultancy, Research Funding;SkylineDX: Consultancy, Research Funding;Sanofi: Consultancy, Research Funding, Speakers Bureau;Janssen: Consultancy, Research Funding, Speakers Bureau;Janssen Oncology: Consultancy, Research Funding;Bristol-Myers Squibb: Research Funding;EdoPharma: Consultancy;GSK: Consultancy, Research Funding;Celgene/BMS: Consultancy, Research Funding, Speakers Bureau;Array BioPharma: Consultancy, Research Funding;Abbvie: Consultancy;Amgen: Consultancy, Research Funding, Speakers Bureau. Quach: Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding;Karyopharm: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding;GlaxoSmithKline: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding;Janssen/Cilag: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees;Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding;Sanofi: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Bristol Myers Squibb: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Antengene: Consultancy, Membership on an entity's Board of Directors or advisory committees;Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees;CSL: Consultancy, Membership on an entity's Board of Directors or advisory committees. Koh: Pfizer: Consultancy;Jassen: Honoraria;AstraZeneca: Honoraria;Novartis: Honoraria;GSK: Honoraria;Roche: Honoraria;Takeda: Honoraria. Guenther: Novartis: Consultancy;Celgene: Consultancy, Honoraria;Roche: Consultancy;Takeda: Consultancy, Honoraria;Amgen: Consultancy, Honoraria;AbbVie: Consultancy;Jazz Pharmaceuticals: Honoraria;Janssen Pharmaceuticals: Consultancy, Honoraria. Zhou: GlaxoSmithKline: Current Employment. Kaisermann: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Mis: GlaxoSmithKline: Current Employment. Williams: GlaxoSmithKline: Current Employment. Yeakey: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Ferron-Brady: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Figueroa: GlaxoSmithKline: Current Employment. Kremer: GlaxoSmithKline: Current Employment. Gupta: Novartis: Current equity holder in publicly-traded company;GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Janowski: Celgene: Consultancy;AstraZeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees;Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees;Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees;BMS: Membership on an entity's Board of Directors or advisory committees.

Nurse and nurse practitioner-lead monoclonal antibody initiative for solid organ transplant (SOT) recipients with COVID-19

Purpose: Monoclonal antibody (mAB) infusion (bamlanivimab or casirivimab/ imdevimab) for symptomatic, non-hypoxemic, high-risk outpatients with COVID-19 infection, is an available early intervention for COVID-19+ SOT recipients. We aimed to assess efficiency in time from diagnosis to treatment, and outcomes in a retrospective cohort of SOT recipients with COVID-19 who received mAB. Methods: We developed a Nurse Coordinator-led initiative to screen, refer, and facilitate mAB infusion for COVID-19+ SOT recipients within 10 days of symptom onset. SOT recipients received electronic messaging to promptly report potential COVID-19 symptoms to the transplant team. Data were collected on time from symptom onset to diagnosis, mAB infusion, and follow-up > 21 days, and hospital admissions, disease severity, mortality, and rejection. Results: 34 out of 36 referred SOT recipients with symptomatic COVID-19 disease without hypoxia received mAB therapy (3 heart, 8 lung, 16 kidney, 2 Liver-Kidney, 2 Pancreas-Kidney, 3 Kidney-Heart). Median time from symptom onset to diagnosis was 2 days and from date of diagnosis to mAB infusion was 4 days. Of those 34, 88% did not require hospitalization and recovered uneventfully. 12% required hospitalization for COVID disease progression, two on the same day as mAB infusion, and the other 2, more than 26 days post infusion. Of these, 2 patients had mild-moderate hypoxia, and 2 had critical disease. Only 1 patient died from COVID-19 complications and no episodes of rejection or graft loss were observed. Conclusions: The Nurse Coordinator-led initiative efficiently facilitated mAB therapy for COVID-19+ SOT recipients and was associated with excellent outcomes. Compared to prior published COVID-19 outcomes in SOT recipients, patients who received mAB may have reduce hospitalization and low mortality. As mAB therapy may be underutilized in the general population, these results support efforts to educate transplant centers to implement efficient interventions for the screening and referral of COVID+ SOT recipients for mAB therapy.

Controversial role of corticosteroids on mortality in COVID-19: Systematic review and metaanalysis

INTRODUCTION: Corticosteroid use in COVID 19 patients has been a much debated topic, and there has been no clear evidence so far supporting it as an effective medication to reduce the inflammatory response and improve mortality rates. We aim to review the data on mortality benefits observed with the use of corticosteroids in COVID-19. METHODS: A comprehensive literature search was conducted across the three largest COVID 19 database provided by WHO, CDC, and LitCovid PubMed Database from inception to July 19th, 2020. We included studies that compared the risk of death among patients with and without use of systemic corticosteroids. We then summarized risk estimates into two random-effect metaanalyses;one with randomized controlled trials and another one with observational studies. We analyzed data in Review Manager Software, version 5.2 (Nordic Cochrane Center, Copenhagen, Denmark), to evaluate combined odds ratio (OR) for RCTs and observational studies with respective 95% confidence intervals (CI) using a random-effects model. RESULTS: Out of total 23 articles, 11 studied were included in final meta-analysis. Among these, 3889 patients were treated with corticosteroids and 5954 were not. The metaanalysis of five clinical trials/prospective studies indicated that administration of corticosteroid significantly reduces the mortality compared to the no corticosteroid use (OR 0.52, 95% CI 0.31-0.87, p-value 0.01;I2=76%). However the meta-analysis of six retrospective observational studies/case series showed summed odds ratio of 2.69;95% CI 0.66 to 10.99, p-value 0.17, I2=94%, suggesting increased risk of mortality with use of systemic steroids. CONCLUSIONS: We observed mortality benefits from metaanalysis on available RCTs. On the contrary, a meta-analysis of observational studies suggested a higher risk of death in similar patients;however, the grade of confidence in this subgroup's results is lower due to inherent methodological limitations.

Clinical outcomes of remdesivir in COVID-19: A systematic review and meta-analysis

INTRODUCTION: In the current COVID-19 pandemic, as no proven effective treatment is available, the most efficient strategy is to re-purpose existing antiviral drugs. Remdesivir has demonstrated broad spectrum antiviral activity against an array of RNA virus families. Our systematic review and metaanalysis provides a detailed overview of existing literature on remdesivir in COVID-19 to evaluate the benefits and adverse events of this potential drug. METHODS: A systematic search was conducted for articles published between inception and July 31, 2020 focusing on the use of remdesivir in COVID-19. The primary outcomes were defined as mortality rate and median days to recovery and the secondary outcome was pooled adverse events rate and pooled drug discontinuation rate. Statistical analysis was performed using the Comprehensive Meta-Analysis software package (Bio stat, Englewood, NJ, USA). RESULTS: Six studies were included in our meta-analysis. A total of 1858 patients were included. In patients treated with remdesivir, the median recovery time was 15.84 days (95% CI 11.68-20.00, p<0.0001) and the pooled mortality rate was 9.9% (95% CI 7.0%- 13.8%, p <0.0001). The results of three clinical trials indicated that administration of remdesivir significantly reduces the mortality compared to the placebo (OR 0.70, 95% CI 0.58-0.84, p-value 0.000) as well as shortens the recovery time (OR 1.32;95% CI 1.12 to 1.55, p <.001). However, treatment with remdesivir was associated with adverse effects (62.5%, 95% CI 35.9%- 83.3%, p=0.36) eventually warranting the discontinuation of the drug (16.7%, 95% CI 7.2%- 34.3%, p<0.001). CONCLUSIONS: The results of our meta-analysis suggests that pooled mortality rate of patients of COVID-19 with remdesivir is low. The median recovery time was found to be over two weeks. Our meta-analysis suggests that there may be a favorable risk-benefit profile for remdesivir compared with placebo in severe COVID-19 infection.

Lung transplantation for severe lung damage in patients with end-stage COVID-19: A systematic review

INTRODUCTION: In the current COVID-19 pandemic, no proven effective treatment is available. Critical patients with COVID-19, have been noted to progress to irreversible fatal respiratory failure. Lung transplantation could be a life-saving procedure for COVID-19 patients with extensive pulmonary fibrosis. We aim to highlight this therapeutic surgical management in terms of its indications, efficacy and safety. METHODS: A systematic search was conducted for articles published between inception and July 18th, 2020 focusing on lung transplant as a therapeutic approach for severe lung damage in patients with COVID-19. The primary outcomes defined were efficacy and safety of lung transplant based on the pooled available data along with the peri-operative management RESULTS: Four studies (two case reports and two case series) were included in systematic review. A total of seven patients were included, with a female: male ratio of 0.75: 1. The mean age of the patients was 56.8 years. All of these patients suffered from end stage respiratory failure due to irreversible lung damage even after sero-conversion. Six patients underwent bilateral lung transplant and one patient underwent only right lung transplant. The median (IQR) interval between the diagnosis of COVID-19 and lung transplant surgery was 39.2 (28-56) days. Post-operatively, five patients had no complications and recovered well. One patient had acute rejection of the graft which was managed by steroid pulse therapy while one patient succumbed to death on post-operative day-one. CONCLUSIONS: Lung transplantation could be considered as a treatment option for end-stage COVID-19 patients with extensive pulmonary fibrosis leading to respiratory failure. It could be the potential last resort in sero-converted patients without multiple organ dysfunction.

Treatment of multiple myeloma in the covid19 era: Experience from a tertiary care cancer centre in India

Aims & Objectives: There is limited data on the incidence and outcomes of COVID-19 infection in Multiple Myeloma (MM) patients. This study aimed to analyze the incidence, outcomes and risk factors for COVID-19 infection and mortality in patients with MM. Patients/Materials & Methods: The study included all the MM patients receiving treatment at our center during a period of five months (15/5/2020 -15/10/2020;N = 52). All patients visiting our center undergo a COVID-19 RT-PCR at each visit, at least 14 days apart or earlier on clinical suspicion of infection. Patients who tested positive for COVID-19 infection were treated in an isolation facility. The primary end points were recovery from the infection and death due to the infection. Results: We enrolled 52 MM patients, of which 9 were newly diagnosed multiple myeloma (NDMM), 10 were relapsed refractory multiple myeloma (RRMM) and 33 patients were in remission. 13 patients were seen weekly (bortezomib + lenalidomide + dexamethasone;cyclophosphamide + bortezomib + dexamethasone;carfilzomib + pomalidomide + dexamethasone), 6 patients every two weekly (bortezomib) and 2 patients monthly (daratumumab or bendamustine). The remaining 29 patients were on oral therapy (lenalidomide, Lenalidomide + dexamethasone and Melphalan) with monthly OPD visits or tele-medicine consultation. 5 patients (9.6%) contracted COVID-19 infection during the study period. 4 patients died (mortality rate 80%) of which 3 patients had NDMM, and one patient had RRMM. The only patient who recovered from the infection was in remission. Among the patients who died, the mean time from the onset of symptoms to death was two days. Discussion & Conclusion: Patients with MM are at a high risk of death if infected with the SARS-CoV-2 virus. Patients with active disease are particularly prone to adverse outcomes with rapid progression of the infection and a very narrow window of opportunity for therapeutic interventions. Such patients may be switched to oral therapy whenever possible. Prevention, early detection and aggressive management of COVID-19 infection is very important in patients with MM.

Risk and Outcomes of COVID-19 Patients with Asthma: A Meta-Analysis

Objective: The outbreak of SARS-CoV-2 disease (COVID-19) emerged in 2019, and ultimately spread worldwide, being defined as a pandemic by the World Health Organization on March 11, 2020. The respiratory disease related to COVID-19 can range from being asymptomatic to presenting as devastating ARDS and death. The elderly and individuals with comorbidities and immunocompromised states are at a higher risk. Asthma is an inflammatory spasm of the airways with ACE2 overexpression at the alveolar level. ACE2 and TMPRSS2 expression mediate SARS-CoV-2 infection of host lung cells and hence might increase disease susceptibility in asthmatics. Materials and Methods: A literature review was done by searching the databases of Pubmed, WHO, clinicaltrials.gov, and Google Scholar, using the keywords of -COVID-19, SARS-CoV-2, coronavirus, asthma, and their combinations, following the timeline of December 2019 to August 10, 2020. We included patients with asthma diagnosed with COVID-19 while excluding non-COVID-19 patients, pregnant patients, and patients with other diseases or comorbidities. Primary outcomes included mortality and ICU admissions of both groups. Based on the available data, we conducted a meta-analysis via RevMan 5.4 using a random-effects model and 95% confidence intervals. Results: Patients with and without asthma were compared for risk outcomes of mortality. For the 755 COVID-19 patients with asthma and 4969 non-asthmatic COVID-19 patients, we found that the risk of mortality would increase by 9% in the asthmatic group (RR=1.09, CI= 0.58 to 2.03, I2=72%). There was an increased proportion of ICU admissions among the asthmatic group (RR=1.39, CI = 0.80 to 2.42). There was high heterogeneity among the studies (I-2 = 79%). Medications such as corticosteroids improve the mortality and ICU admission rates. Conclusion: Our results indicate that the number of COVID-19 cases in patients with asthma has been lower than those of the nonasthmatic group. COVID-19 patients with asthma were at increased risk of mortality and ICU admission due to underlying factors or predisposition. Finally, corticosteroids are considered safe and may confer protection against the severity of COVID-19 infection.

ONLINE TEACHING PERCEPTIONS AMIDST COVID-19

The world is facing one of the worst situations, battling with COVID 19 and education sector is not an exception. COVID-19 has resulted in a countrywide lockdown in India, which led to closure of schools and colleges. University Grant Commission (UGC), an apex educational body has come up with several guidelines for Higher Education Institution (HEI).This study is an attempt to understand the perception of respondents towards the online teaching, which is the new way of teaching adopted by each educational institute after the pandemic. The study shows that overall, the respondents are satisfied by the online teaching .From the study it may be concluded that the online classes favour the impact on the students and diversification in teaching methodology is imperative apart with the regular lecture teaching.