THE CONTRIBUTION OF THE 3RD AND 4TH BOOSTER BNT162B2 MRNA VACCINES TO PREVENT SEVERE COVID-19 AMONG AUTOIMMUNE INFLAMMATORY RHEUMATOID DISEASES (AIRD) PATIENTS DURING THE OMICRON OUTBREAKS

BackgroundThe 3rd booster of mRNA vaccines against SARS COV2 was highly efficient against delta variant but data regarding the efficacy of the 3rd and 4th boosters against the omicron variants, among AIRD pts are scarce.ObjectivesWe aimed to assess the effect of the 3rd and 4th booster mRNA vaccines against SARS CoV2, in preventing severe COVID-19, in AIRD patients (pts) treated with immunomodulating drugs.Methods212 pts (mean age(SD) 57(13), disease duration 11.2(7.4), who received the 3rd booster (Pfizer) were included in the study. We performed serology tests 24 weeks after the second dose of vaccine and 4-8 weeks after the 3rd booster. IgG Antibodies (Ab) against SARS COV2 virus were detected using the SARS-Cov-2 IgG II Quant (Abbott) assay. The test was considered positive above 50 AU/ml. Data regarding COVID-19 infection during the 5th outbreak (omicron) were collected from the medical files. The length of observation period was defined as the time from the 3rd booster to the last hospital visit or COVID 19 diagnosis, whichever occurred first.ResultsThe 3rd booster administration (Pfizer) significantly augmented the humoral response (from mean(SD) 1121(4723) AU/ml to 12153(13687)). 58 patients received the 4th booster and 18 the 5th booster. COVID-19 was diagnosed in 103 pts (49%) within mean(SD) 224.8(106.5) days after the 3rd booster vaccination. 109 pts remained free of disease during mean(SD) follow-up 230.6(133.9). Following the 4th booster, 26 (45%) out of 58pts contracted COVID-19 within mean(SD) 97.6(78.7) days after the vaccination. One 70 year old patient (vaccinated 3 times) died and 2 other pts (rituximab treated) had severe COVID-19. The IgG Ab titer after the 3rd booster was lower in pts who contracted COVID 19 compared to those uninfected (mean(SD), median 8777.9(11716.4),3475 AU/ml vs 15348.1(14649.1),10801, p=0.004).There were no statistically significant differences between the pts with COVID-19 and those without, regarding age, type of disease, treatment and humoral response 24 weeks after the 2nd vaccination.ConclusionDespite an enhanced humoral response obtained after the 3rd booster, 49% of AIRD pts vaccinated with 3 doses and 45% of pts vaccinated with 4 doses had COVID-19 during the omicron outbreaks. Higher humoral response to the 3rd booster was associated with a lower rate of COVID19. The booster vaccines conferred 99% protection against severe COVID-19.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Primary Care Physicians' Knowledge, Attitude and Practice towards Bariatric Operations in the Kingdom of Bahrain

Background: Obesity is an epidemic treatable disease. In Bahrain, the prevalence of obesity was 36.2%. Bariatric surgery should be considered for patients with BMI >= 40, or >= 30 with obesity-related comorbidities. Family physicians have a key role in identifying and counseling patients who may qualify for bariatric surgery. The most common reason for physicians' refusal of referral for bariatric surgeries is fear of complications followed by concern of ineffective weight loss following the surgery. Doctors are not comfortable providing post bariatric operation care. Aim(s): To study the PCPs' knowledge, attitude and practice towards bariatric surgeries in the kingdom of Bahrain. Method(s): this is a cross-sectional study of a convenient sample of physicians working in the Kingdom of Bahrain health centers, using an electronic and manual questionnaire to test the knowledge, attitude and practice towards bariatric surgery. Result(s): The sample included a total of 222 participants. 56.1% agreed that the BMI >= 40 without weight related comorbidities is an indication for bariatric surgery and 92.3% of them referred patients for bariatric surgery, with BMI (88.6%) as the most influential factor followed by presence of comorbidities (87.8%). On the other hand, lack of resources was the main cause for not referring patient for bariatric surgery (29.4%) followed by concerns with follow up (23.5%). 80.6% are comfortable to initiate conversations with their patients about bariatric surgery, while 36.1% feel comfortable explaining the procedural options to a patient. 83.8% agreed that additional medical education in bariatric surgical care would be useful. Conclusion(s): Primary care physicians showed well knowledge about the referral criteria to bariatric surgeries and that's reflected by the high referral rate (92.3%). But there is a gap in the knowledge mean score across different age groups and experience. Less than half of the physicians are not comfortable dealing with patients. Continuous medical education is essential to address the gap and to establish comprehensive obesity management guidelines for primary care physicians.Copyright © 2023, Bahrain Medical Bulletin. All rights reserved.

The Indonesian Dentist Practice on The Coronavirus Disease-19 Pandemic: A Pilot Survey

Introduction: As a profession highly predisposed to coronavirus disease (COVID)-19, dentists should be aware of the possibility of cross-infection. The purpose of this study was to investigate descriptive statistics of dental practice during the covid-19 pandemic. Materials and Methods: This survey was conducted online using self-reported questionnaires created with Google Form®, among dentists in Indonesia. Descriptive statistics were used to summarize the survey results. Results: In total 102 participants completed the survey. The mean age was 42.71 (6.65) years. 19 males (18.8%) and 83 females (81.44%). Of all respondents, 80 (78 %) dentists provided dental services to patients during COVID-19 pandemic. Of those who had provided dental services, the most commonly indicated reasons were due to the emergency procedural 66 (82 %). We also found 51 (64%) dentists prefer online consultation. All of the provided temperature checking and will postpone the service with the symptomatic patient. Additionally, our survey found no significant difference between dentists who provided services to patients during COVID-19 pandemic or not based on gender, age, years in practice (all p> 0.05, respectively). The majority of research participants continued to give dental treatments during the COVID-19 pandemic. Conclusions: Personal protective equipment was essential, as well as a dental-care-safety environment. The small sample size of our survey limits its generalizability to the field of dentistry and needs further investigation. © 2023 UPM Press. All rights reserved.

A cross-cultural analysis of ridesharing intentions and compliance with COVID-19 health guidelines: The roles of social trust, fear of COVID-19, and trust-in-God

Ridesharing services such as Uber and Lyft have been substantially affected by the ongoing COVID-19 pandemic. Drawing on social capital theory, the current research investigates how social trust relates to three types of trust in compliance with COVID-19 guidelines and consumers' ridesharing intentions. Analyzing data from two economically and culturally distinct countries, the results suggest that social trust positively affects trust in platform companies' compliance with COVID-19 guidelines (TPC), but not (or to a lesser extent) trust in drivers' (TDC) and other riders (TRC) compliance with COVID-19 guidelines in both the United States and Bangladesh. Importantly, TPC, TDC, and TRC are positively related with consumers' ridesharing intentions in the United States but not in Bangladesh. Furthermore, the analysis reveals two counterintuitive moderating effects of fear of COVID-19 and trust in God. The results provide important insights on factors affecting the ridesharing industry in the context of the COVID-19 pandemic, and they emphasize the importance of considering cultural context in understanding consumers' intentions to engage in the sharing economy. © 2022 Elsevier Ltd

Enterprise strategic management under COVID-19: evidence from South Africa

In our research, we mainly looked at the questions on how enterprise strategic management is affected during COVID-19 period in South Africa, from the context of stakeholder theory, legitimacy theory, and based on organisational culture. For both stakeholder theory and legitimacy theory, as the pandemic continues to unfold, palpable social pressure has pointed to both a shift from short-term to long-term outcome, and renewed importance of CSR. This is due to the short-term impact of this very special pandemic, prior to which, the term 'social distancing' was unheard of. On top of short-term impacts identified in this research, it was also identified that enterprise strategic management that gives focus to stakeholder management are more resilient to major external shocks like COVID-19 pandemic.

Demand and Supply Disruptions During the Covid-19 Crisis on Firm Productivity

This paper explores the supply chain (SC) disruption impacts to the performance outcomes of a semiconductor company during the Covid-19 pandemic and proposes appropriate risk mitigation strategies to overcome the crisis. The research uses a single case study methodology and 24 SC employees from Belgium and Germany who take part in the survey. To measure the effect of SC disruptions to the firm's financial performance, some quarterly financial statement data are used from 2018 to 2021. The regression analysis results show that there is no significant impact of SC disruptions to the firm's productivity and non-financial performance. The paired samples t-test suggests that there is no significant change in the firm's financial performance before and during Covid-19 either due to the market's political and economic stability or the semiconductor company develops effective SC risk management strategies. © 2022, The Author(s) under exclusive licence to Global Institute of Flexible Systems Management.

Clinical Profile, Treatment and Outcome of Pediatric ''Coffee Bean'' Histiocytosis: A Single Center Experience

Introduction: Langerhans Cell Histiocytosis is a group of diseases with a myriad of clinical manifestations and biological behavior, characterized by proliferation and accumulation of Langerhans cells in different organs. Aims & Objectives: This study is to demonstrate the varied clinical presentations and the treatment outcome of the children in one of the few pediatriccenters in North India that cater to various benign and malignant blood disorders of children. Material(s) and Method(s): The study describes the 4-year experience of our center in managing children with LCH. The clinical presentations, relevant laboratory, and radiological findings, treatment, and outcome of all the 14 children presenting between December 2018 and August 2022 were retrieved from our Hospital Information system. The LCH IV protocol was taken as the backbone for classification, risk organ involvement, stratum allocation, for deciding on treatment strategy, treatment response, and outcome. Result(s): A total of 14 children were diagnosed with LCH during the study period. The mean age at diagnosis was 36 months(range: 10-110 months, median: 34 months). The male: female ratio was 9:5. 12 children had multisystem LCH while 2 children had single system LCH. Lymphadenopathy was the most common clinical presentation while the skeletal system was the most common system involved, affecting 64% of the children. There were a total of 8(57%) children who were in complete remission, of which 1 child expired and one relapsed, though went into the second remission. One child had a progressive disease. Three(21%) children left against medical advice while 1 child abandoned treatment 2 weeks into therapy. One of the children became covid positive after diagnosis and expired before the treatment could be initiated. Conclusion(s): The wide array of clinical manifestations warrants the need for a high index of suspicion for an earlier diagnosis of LCH. The morphological identification of Langerhan's cells and positive IHC for CD1a, S100, and/or CD207 are necessary for definitive diagnosis. All patients with LCH should undergo BRAF-V600E mutational testing to aid in diagnosis and treatment.

Mantle Cell Lymphoma: A Single Centre Experience from a Tertiary Care Centre in North India

Introduction: Mantle cell lymphoma (MCL) is an aggressive lymphoma with an incidence of 2.4-6% among all non-Hodgkin's lymphoma. Though with the addition of rituximab to standard chemotherapy backbone with autologous stem cell transplant (ASCT) consolidation and novel small molecule inhibitors, the outcome of MCL has improved, however, not many patients undergo ASCT due to financial constraints. Aims & Objectives: To study the clinical profile of all patients of MCL over a period of 6 years and assess their outcome. Material(s) and Method(s): This study was a retrospective cohort study which included all patients diagnosed with mantle cell lymphoma, between January 2016 to January 2022, conducted in the Department of Haematology, Sanjay Gandhi Institute of Medical Sciences, Lucknow, India. A total of 53 cases were included in the study. SPSS-23 was used for the data analysis. Result(s): The median age was 59 years (ranging from 39-81 years), with a male to female ratio of 5.3:1. The ECOG performance status was of 0-2 was seen in 85.2%. The median haemoglobin, leukocyte count and platelet count at presentation was 10.6 g/dL, 7400/mm3 and 1,52,000/mm3 respectively. Of the 53 patients, 48% presenting with B symptoms. The median Lactate dehydrogenase levels were 521 (ranging from 220-1230). 72% patients presented with stage IV disease and MIPI score was high, intermediate and low risk in 43.4%, 32.1% and 24.5% low risk. 48% patients received RCHOP/RDHAP regimen, 36% received RCHOP and 16% received R-Benda. 5 patients underwent ASCT. 13 patients relapsed, 1 was refractory and 1 died post-transplant due to Covid sepsis. The third patient, who had relapsed, received R Benda, was found to have multiple myeloma 1 year after therapy, and succumbed to sepsis. 63% were put on Rituximab maintenance. Conclusion(s): MCL is a rare, aggressive B cell lymphoma with a lesser incidence in Indian population compared to the world. While aggressive chemotherapy with monoclonal antibody has improved the response rate of patients with nodal MCL, wait and watch strategy remains the backbone of management of leukaemic NNMCL.

Epidemiologic Assessement of Pediatric Inflammatory Bowel Disease Presentation in Nyc during Covid-19 Suggests Increased Ibd Presentation

SARS-nCoV2 may have increased capacity to generate autoimmune disease;multiple reports suggest increased risk of Type 1 Diabetes, and case reports suggest other autoimmune linkages. Inflammatory Bowel Disease (IBD) pathogenesis appears to be a mix of genetic susceptibility, microbial populations, and immune triggers such as infections. Given the perceived role of infection in pathogenesis, decreased incidence of all infections during the pandemic secondary to non-pharmaceutical interventions should decrease IBD incidence rates. The aim of this study was to evaluate the association between the Covid-19 pandemic and IBD presentation in NYC using data from new diagnoses at a consortium of institutions. Using EMR systems all diagnoses at 4 collaborating institutions were retrieved from 2015-2021. We fit time series model (ARIMA) to the quarterly number of cases of each disease for January 2016-March 2020 and forecast the subsequent 21 months. We not only did not observe a decline in pediatric IBD secondary to absent viral illness but noted a statistically significant increase in Crohn's Disease approximately 6 months after the initial 2020 COVID wave in NYC, and trends suggesting increases overall in IBD diagnoses above the existing trend towards increased disease presentation that pre-dated the pandemic. We also note suggestive but not significant trends towards overall increases in UC diagnostic rate. This data suggests that there may be a linkage between SARS-nCoV2 infection rates and subsequent pediatric IBD presentation, warranting further evaluation in the aftermath of the Omicron wave. (Figure Presented).

REVERSAL of DECLINE in HUMORAL RESPONSE to BNT162B2 MRNA COVID-19 VACCINE after BOOSTER ADMINISTRATION in AUTOIMMUNE INFLAMMATORY RHEUMATOID DISEASES (AIRD) PATIENTS

Background: Previous studies proved that mRNA vaccinations against SARS CoV2 induced signifcant humoral responses in AIRD patients (pts). However, the humoral response was blunted in pts treated with CD20 depleting antibodies. There are limited data regarding the long-term outcome of the humoral response and the contribution of the booster vaccine, in immunosuppressed AIRD pts. Objectives: To assess the long-term outcome of the humoral response to mRNA vaccine against SARS CoV2, in AIRD pts treated with immunomodulating drugs, and the contribution of the booster vaccination. Methods: Consecutive pts treated at the Rheumatology Institute at Rambam Hospital who received their frst SARS-CoV-2 (Pfzer) vaccine were recruited to the study, at their routine visit. The visit included AIRD activity assessment and questioning regarding vaccine side effects. We performed serology test 4-6 weeks and 24 weeks after receiving the second dose of vaccine. Pts who received the booster (3rd vaccine) were invited for serology tests 4-8 weeks afterwards. The immunomodulating treatment was not modifed, either before or after the vaccination. IgG Antibodies (Ab) against SARS COV2 virus were detected using the SARS-Cov-2 IgG II Quant (Abbott) assay based on a chemi-luminescent microparticle immunoassay (CMIA) on the ARCHITECT ci8200s-ystem from Abbott. This assay is measuring IgG antibodies against the spike receptor-binding domain (S-RBD) of the virus. The test was considered positive above 50 AU/ml. Results: 262 pts (mean age(SD) 57(13), disease duration 11.2(7.4), were recruited. The cohort included 152 pts with infammatory joint disease, 26 pts with systemic lupus erythematosus, 62 pts with other connective tissue disease and 22 pts with vasculitis;27 % received csDMARDs only, 35%-b/tsDMARDs only, 30%-combined therapy (csDMARDs+b/tsDMARDs) and 26% received steroids. 225 pts (86%) were seropositive for IgG Ab against SARS CoV2 virus (median 2832.5 AU/ml, IQR 58-29499). 37 (14%) pts had negative tests, 23 (62.2%) of them were rituximab treated. The IgG levels correlated with the medication used to treat the AIRD, the patients' age but not with the type of the AIRD (Figure 1). 24 weeks afterwards, the median IgG level dropped to 282 AU/ml and 15% of the pts with previous seropositive tests became negative. The booster administration (Pfzer) signif-cantly augmented the humoral response (median 8328 AU/ml, IQR 375-40000). De novo serologic response was observed in 10 out of 37 pts (4/23 rituximab treated pts). The reported side effects of the vaccine were minor (muscle sore, headache, low grade fever). The AIRD remained stable in all pts following all three vaccinations. Conclusion: Although the vast majority of AIRD pts developed a substantial humoral response following the administration of the second dose of the Pfzer mRNA vaccine against SARS CoV2 virus, the humoral response signifcantly declined 24 weeks afterwards. An enhanced response was obtained after the third booster vaccination. Only minor side effects were reported and no apparent impact on AIRD activity was noted. Notably, 62% of the non-responders were treated with B cell depleting agents.

Strategic Evaluation of Implementing Artificial Intelligence Towards Shaping Entrepreneurial Development During Covid- 19 Outbreaks

Artificial intelligence (AI) shape the business enterprises and enable in realizing enhanced growth and development. It has been observed that the application of AI enables in influencing the organizational culture in an effective manner thereby enhancing the working environment which will lead to better productivity and output. The implementation of AI support in enhancing the entrepreneurial aspects through enhancing the cultural and ethical aspects and influence better decision making, create new business practices which will harness human capital and effective leadership capabilities. It has been regarded that the implementation of AI possesses the overall ability to quickly understand the business process and address the issues efficiently for superior performance. The companies which apply AI enable in enhancing the service delivery, understand customer requirements, forecast the business patterns for realizing growth and development. It has been regarded that the current organizational environment is focusing in implementing effective and dynamic capabilities which will influence in attaining growth and success in an effective manner Therefore, the overall success to these initiatives is mainly based on the changes in the internal and external environment, and culture & ethical aspects are being applied in the organizational context. The application of effective leadership support in enhancing the organizational culture and which will create better entrepreneurial aspect for effective performance. This study is focused in addressing the critical strategic evaluation of implementing Artificial Intelligence towards shaping Entrepreneurial Development during COVID- 19 Outbreaks. In its pure essence it is focused in understanding the critical nature of culture and ethical aspect which will enable in creating better programs and support entrepreneurial spirit. © 2022 IEEE.

SURVEY OF NYC PEDIATRIC INSTITUTIONS SUGGESTS POSSIBLE INCREASE IN PEDIATRIC INFLAMMATORY BOWEL DISEASE DIAGNOSIS ASSOCIATED WITH PREVALENCE OF COVID INFECTION

Background: One of the myriad issues COVID-19 has generated is a concern for increased capacity to generate autoimmune disease. (Saad et al, 2020, Ehrenfeld et al 2020). Recent case reports have potentially linked new onset UC associated with recent COVID infection (Aydin et al 2020), which raises concern for potential impact of COVID-19 infection rates on pediatric IBD diagnosis rates. As non-pharmaceutical interventions massively decreased the incidence of infectious illnesses in the first year of the pandemic (Sullivan et al, 2020), IBD rates would likely be expected to stay stable or decrease. We have formed a consortium of New York City pediatric institutions aimed at characterizing this change, and here report findings from the Children's Hospital of Montefiore, Maimonides Medical Center, SUNY Downstate, and New York University. Methods: New IBD diagnoses were identified between 2016-2019, as well as new diagnoses documented between 3/2020 and 3/2021. Data was examined using a direct comparison of new diagnostic rate 3/20-3/21 to mean diagnostic rate from 2013-2019. Results: an overall secular increase in IBD diagnostic rate of approximately 5% was noted, consistent with prior findings demonstrating increased incidence of IBD annually (Ye et al, 2020). Direct comparison with mean diagnostic rate over the preceding 4 years noted a substantial increase in diagnostic rate in the pandemic year relative to previous year average, with 109 new diagnoses in our consortium compared to an average of 79. Our data demonstrates this increase is driven by the institutions in the Brooklyn and the Bronx, with a 51% increase in diagnoses (78 compared to mean of 51.5, 95% CI 10.19). NYU diagnostic rate was 31 (previous mean of 27.5, 95% CI 5.29). This aligns well with published rates of COVID-19 in these regions, with the outer boroughs averaging 14,169 cases/100k and Manhattan 10,516/100k. Discussion: Our results suggest a possible increase in IBD diagnostic rate in the outer boroughs of New York City, aligning with density of COVID-19 infections, despite surveillance data from NYC DOH demonstrating almost nonexistent pediatric influenza-like-illness. There are many possible confounding factors in this initial work with substantial further evaluation needed, but this data is suggestive of a possible capacity for COVID19 to generate new onset IBD in excess of normal infections and normal rates of presentation. Next steps will include expanding data collection to additional NYC institutions, subgroup analysis by disease type, gender, age of presentation, more detailed analysis of biomarkers, and geospatial analysis given geographic variations in COVID19 infection density.

Cashless preferences during the COVID-19 pandemic: investigating user intentions to continue UPI-based payment systems in India

Purpose This study aims to examine the factors influencing user satisfaction with unified payment interface (UPI)-based payment systems during the COVID-19 pandemic in India. The study also aimed to examine whether the user satisfaction with UPI-based payment systems during the COVID-19 pandemic will transform into their continuance intention post-COVID-19 pandemic. Design/methodology/approach The study was performed in three phases, i.e. pre-testing (for developing questionnaire), pilot study (using exploratory factor analysis to ensure unidimensionality) and the main study. The main study was based on the feedback from a sample of 369 internet users who first used the UPI-based payment system during the COVID-19 pandemic. Data generated were analysed using the structural equation modelling approach. Findings The study findings suggest that the users who are satisfied with UPI-based transactions during the COVID-19 pandemic are likely to continue their use of this payment mode in future. Factors such as post-adoption perceived value, perceived usefulness and post-adoption perceived risk were observed to be key constructs in explaining user satisfaction and continued intention for UPI-based payment systems. Originality/value The study is one of the pioneering studies, in the sense that it investigated the continuance intention of UPI-based payment systems, which, surprisingly, did not gain much attention from past researchers.

Toward analyzing the impact of healthcare treatments in industry 4.0 environment-a self-care case study during COVID-19 outbreak

Coronavirus infection is proceeding with its spread over the world, with more than 2.7 million affirmed instances of coronavirus now in 185 nations. In any event, 190, 000 individuals have kicked the bucket. The United States has multiple occasions of the same number of affirmed cases as some other nation. The infection, which causes the respiratory disease coronavirus disease 2019 (COVID-19), was first identified in the city of Wuhan, China, in late 2019. It is spreading quickly in numerous nations and the number of passings is as yet climbing. The world is pretty upside down the present moment, as a result of the worldwide frenzy around coronavirus infection (COVID-19). In case you are feeling overpowered or worried about everything, then be consoled this is an extremely ordinary reaction. Notwithstanding, it is critical to back off of yourself and to set aside effort for self-care. We have assembled this rundown list (self-care dataset) of self-care exercises that you can do from home;this is the message the corresponding author got in morning wishes during his stay in China. In the fight against the pandemic, nations effectively utilized computerized innovations, for example, artificial intelligence, big data, cloud computing, blockchain, and 5G, which have adequately improved the proficiency of nations’ endeavors in scourge checking, infection following, counteraction, control and treatment, and asset assignment. The chapter discusses a couple of the ways in which data innovations were successfully utilized toward impact of healthcare treatments in Internet of Things (IoT) environment for analyzing a self-care contextual investigation during the coronavirus outbreak. © 2022 Elsevier Inc.

Role of currency notes in the transmission of SARS-Cov-2 infection

Background:Droplet transmission is the main mode of transmission for SARS-CoV-2. Contact transmission through fom- ites is another important mode of transmission. Amongst fomites, currency notes carry a high risk of SARS-CoV-2 trans- mission because of frequent handling. They also provide ample surface area to harbor micro -organisms. As there is lim- ited data currently available on this subject, the study was planned to determine the presence of SARS -COV-2 on com- monly circulating currency notes by detecting viral RNA using real time PCR. Methods:A total of 71 creased and visibly well circulated notes of monetary value Rs. 10, 100 and 500 were included in the study, collected through normal monetary transaction from the busy shops in designated areas in Delhi (inside and outside containment zones). Two nylon flocked swabs moistened with viral transport medium were rubbed on the ob- verse and reverse sides of the notes and then kept in screw capped tubes containing 1 ml of VTM till further processing at 2-8. RNA extracted was tested for the presence of SARS-CoV-2 by real time PCR as per NIV protocol. Results:Among the 71 currency notes tested for the presence of SARS-CoV-2 RNA by RT-PCR, three samples tested posi- tive for SARS-CoV-2 RNA (4.2%). All the three positive samples were collected from containment zones. Conclusions:Currency notes may be a potential mode of human-to-human transmission. Considering the widespread magnitude of the pandemic and the remarkable stability of the virus on smooth surfaces, caution is warranted while handling currency notes. Hence, contactless transactions/ digital transactions should be recommended as the best op- tions in the ongoing pandemic

Variation in immunosuppressant impact onsevere COVID-19 outcome: Preliminary results fromthe COVID-19 Scottish Registry of AutoimmuneRheumatic Diseases (SCAR-19)

Background/AimsThe novel infectious disease COVID-19 is associated with a widespectrum of clinical severity amongst the general population. Patientswith autoimmune rheumatic diseases (ARD) are more likely toexperience serious COVID-19 related events, although risk factorsfor such outcomes have yet to be established. In particular, the riskprofiles of specific ARD therapies are unknown.MethodsA Scottish wide registry was rapidly developed in March 2020. Clinicalcharacteristics and outcomes of infected cases were collated acrossall Scottish health boards, leveraging the Scottish Systemic VasculitisNetwork and Scottish Society for Rheumatology. Eligible patientsincluded any adult ARD patients with a confirmed (clinically or PCR)diagnosis of COVID-19. Simple descriptive statistics were employed toevaluate associations between ARD therapies and a serious COVID-19disease outcome, as defined by a requirement of invasive or noninvasive ventilation, and/or death.ResultsA total of 69 patients (59% female;mean age 65.6, SD15.5) wererecruited to the registry , 92% of which required hospitalisation. Caseswere most commonly diagnosed with rheumatoid arthritis (n = 32, 46.4%) followed by spondyloarthritis (n = 19, 27.5%) and systemicvasculitis (n = 9, 13.0%). Anti-TNF therapy (n = 8, 11.6%) andmethotrexate (n = 31, 44.9%) were the commonest biologic andconventional disease modifying drug (bDMARD and csDMARD) usedrespectively. N = 20 (29%) received background corticosteroid therapy (15.9% prednisolone >5mg, 13% prednisolone 5mg). A severeoutcome was observed in n = 25(31.9%);n = 11 required assistedventilation and n = 19 died. With the exception of Leflunomide, conventional and biologic DMARDs did not appear to confer ahigher risk for severe outcome (table 1). Of note, anti-TNF therapywas associated with a non-serious outcome (p = 0.04) and prednisolone>5mg with a serious outcome (p = 0.08). ConclusionPreliminary data from this Scotland-wide ARD COVID-19 registryevidences variation in the impact of standard ARD therapies on theseverity of COVID-19 outcome. In general, background csDMARD andbDMARD use does not appear to be a risk factor for severe outcomes.However, anti-TNF therapy may confer a favourable outcome, whileleflunomide and corticosteroids may have the opposite effect.Rheumatologists should be aware of these possible risk factors andcontinue to contribute to registries to help establish whether theseputative signals are clinically relevant.

ADVANCED PERSISTENT THREATS (APT): AN AWARENESS REVIEW

COVID-19 pandemic has become a major threat to all institutions, irrespective of its economic role, private and public, by threatening all the functions capitalizing on the Information and Communications Technology (ICT) infrastructure, networks, systems and Internet-based solutions including Internet of Things and Cloud computing. The field is open to advanced persistent threats (APTs) whereby the outcomes may become very costly to all institutions and governments across the globe. This paper aims to shed light on the premises of APT in order to provide awareness to what it is, understanding its functions and how to mitigate its impact on institutions of all sizes. The approach is based on descriptive analysis based on secondary data reported in books, journals, websites and blogs. The outcomes are presented as an eye opener to the current status-quo of systems and networks and how to remedy the aforementioned threats.

Clinical profile of covid 19 infection in patients with hematological malignancies: A single centre experience from North India

Aims & Objectives: Patients with haematological malignancies are very different from other malignancies because of direct affection of immune system and therapy involving significant myelosuppression and lymphocyte depletion. Therefore, in this era of COVID 19 pandemic, where even healthy individuals can have severe COVID pneumonia, it is important to identify, how patients with haematological malignancies tolerated the disease. We analysed the clinical characteristics and risk factors of these patients of haematological malignancies and COVID 19. Patients/Materials & Methods: It is a retrospective study of patients of haematological malignancies who presented to our institute, between March 2020 till October 2020 with positive RT PCR reports for COVID 19 or who were referred to us for further management or who were incidentally found to be covid positive during admission in our hematology ward were included in the study. Asymptomatic patients and patients with mild COVID pneumonia were managed with home isolation and the rest were managed as per severity and protocol in Rajdhani Corona Hospital. The following clinical data was retrieved from medical records: clinical profile, baseline disease characteristics, hemogram, chemotherapy received and the severity of covid pneumonia were analysed. Results: Out of 21 COVID positive patients encountered during the study period, male: female ratio was 1.3:1, with median age of 34 years. The most common underlying malignancy was Acute Lymphoblastic leukemia (ALL)(38%), followed by Non Hodgkin Lymphoma(NHL) (23.8%)7(33.3%). Fever was the most common symptom present in almost all patients and diabetes (19%) was the most common underlying co morbidity apart from the malignancy. Cytopenias, especially lymphopenia was associated with worse outcome. Seven patients (33.3%) succumbed to COVID pneumonia despite protocolised measures in our covid speciality centre. Discussion & Conclusion: Our study highlights that hematological malignancies might be a poor prognostic factor for COVID19, especially in the presence of have a worse outcome cytopenias and that the risk of nosocomial infection of COVID19 is high. Our series data suggest that strong proactive measures are necessary to reduce likelihood of infection and improve early identification in this vulnerable patient population.

The impact of coronavirus disease 2019 on the practice of thoracic oncology surgery: a survey of members of the European Society of Thoracic Surgeons (ESTS).

OBJECTIVES: There is widespread acknowledgement that coronavirus disease 2019 (COVID-19) has disrupted surgical services. The European Society of Thoracic Surgeons (ESTS) sent out a survey to assess what impact the COVID-19 pandemic has had on the practice of thoracic oncology surgery. METHODS: All ESTS members were invited (13-20 April 2020) to complete an online questionnaire of 26 questions, designed by the ESTS learning affairs committee. RESULTS: The response rate was 23.0% and the completeness rate was 91.2%. The number of treated COVID-positive cases per hospital varied from fewer than 20 cases (30.6%) to more than 200 cases (22.7%) per hospital. Most hospitals (89.1%) postponed surgical procedures. All hospitals performed patient screening with a nasopharyngeal swab, but only 6.7% routinely tested health care workers. A total of 20% of respondents reported that multidisciplinary meetings were completely cancelled and 66%, that multidisciplinary decisions were not different from normal practice. Trends were recognized in prioritizing surgical patients based on age (younger than 70), type of surgery (lobectomy or less), size of tumour (T1-2) and lymph node involvement (N1). Sixty-three percent of respondents reported that surgeons were involved in daily care of COVID-19-positive patients. Fifty-three percent mentioned that full personal protective equipment was available to them when treating a COVID-19-positive patient. CONCLUSIONS: The COVID-19 pandemic has created issues for the safety of health care workers, and surgeons have been forced to change their routine practice. However, there was no consensus about surgical priorities in lung cancer patients, demonstrating the need for the production of specific guidelines.