Constrained Optimization Model to Estimate Best Booster Allocation Strategy to Minimize Hospital Bed-Days Under a Fixed Healthcare Budget

Objectives: COVID-19 vaccine boosters are available in many countries. Public health policymakers face difficult choices over which booster brand to recommend, given limited budgets and the need to maximize health gains. Here, we provide a conceptual model to identify the best booster strategies for age-identified subpopulations under different conditions. Method(s): A constrained optimization model with an objective function to minimize bed-days was developed that varied population proportion receiving different booster options by age, to identify the best booster strategy that minimized bed-days with a constraint of maximum healthcare expenditure of US$2.10/person. It included a 3-month decision-tree model to calculate bed-days, with the following health states: healthy/asymptomatic;mild (not hospitalized);moderate (general ward);severe (intensive care unit [ICU], no mechanical ventilation);critical (requiring mechanical ventilation);and death. Medical resource utilization (MRU) costs and hospital bed-days were calculated for each health state. The base country was Brazil. Three booster options, B1 (US$1), B2 (US$2), and no-booster (NB, US>source ) were considered. Based on real-world effectiveness estimates, B1 and B2 were assumed to be 55% and 75% effective against mild/moderate COVID-19, respectively. Both reduced severe/critical COVID-19 by 90%. The target population was adults eligible for boosters, stratified by age. Result(s): The best booster strategy identified recommended 100% coverage of those eligible, with B1 for population <70 years and B2 for population >=70 years. Compared with NB, bed-days were reduced by 75%, hospitalizations by 68%, and ICU admissions by 90% leading to a 60% reduction in total costs (81% reduction in MRU costs). Within individual age-groups, costs were reduced by 57%-66% based on the age-specific disease risk. Conclusion(s): A constrained optimization model identifies the best age-specific booster allocation strategy to minimize hospital bed-days across different age groups without exceeding a predefined budget. Decision-makers could use this method to achieve the best possible health outcomes when healthcare resources are limited. Copyright © 2022

Indian Multicenter Phase Ii Randomised Controlled Study Comparing Post Stem Cell Maintenance Regimen for Newly Diagnosed Multiple Myeloma (Impose Bortecon Study)

Introduction: Autologous stem cell transplant (ASCT) remains the backbone therapeutic modality with the highest progression-free survival (PFS) and overall survival (OS) benefit even in the era of the novel agents in newly diagnosed multiple myeloma (NDMM). The survival post-transplant can be prolonged using maintenance therapies. The regimen with maximum benefit is still debated, with bortezomib showing PFS benefit even in the high-risk myeloma. Aims & Objectives: This randomized phase II trial is aimed at studying the efficacy (as measured by overall survival (OS), progression- free survival (PFS)), and safety of post-ASCT different maintenance regimens in patients with NDMM. Material(s) and Method(s): Multicentric open-label interventional study with randomized allocation, parallel assignment, with intention-totreat analysis. Recruitment was prospective starting 01 Jan 2017, including all NDMM patients eligible for the study. Remission status was evaluated at D100 and every 6 months for 2y post-ASCT, including MRD analysis by multicolor flow cytometry (MFC) and PET/CT. The four arms included (Arm-A) bortezomib alone (V), (Arm-B) bortezomib in combination with cyclophosphamide and dexamethasone (VCD), (Arm-C) bortezomib in combination with lenalidomide (VR), and (Arm-D) Lenalidomide starting D100 till 2y post-ASCT. Adverse events with CTACE grade<2 were defined as non-serious and the rest as serious. JMP ver. 13 was used for statistical analysis and p<0.05 was considered significant. Kaplan Meier statistics was used for survival analysis. Result(s): A total of 123 patients have enrolled of which 92 patients completed the study protocol and the rest 31 patients were excluded because of protocol deviation due to the COVID pandemic. The median age of the study population was 54.5y (35-76y) with a male preponderance (67%). There was no statistically significant difference between the four arms on the log-rank test in the OS (p-0.99), clinical PFS (p-0.65), biochemical PFS (p-0.6), or MFC-based PFS (p-0.83). There was a statistically significant difference between the four arms on the log-rank test (p-0.0185) on PET/CT-based PFS (PFS being in a descending order VCD>V>VR>R regimen). The all-cause mortality of the study participants was 19.57% (n-18) and the difference in deaths among the various groups was not statistically significant (p-0.85). The tolerability, serious and non-serious adverse were significantly higher amongst Arm D patients. Conclusion(s): We conclude that there was no difference in OS between the different regimens. Patients on Lenalidomide-only therapy had significantly inferior Imaging-PFS.

A Longitudinal Study to Reexamine the Mental Health Impact on Radiation Oncology Health Care Workers with the Launch of COVID-19 Vaccination Strategies in India

Introduction The novel coronavirus disease 2019 (COVID-19) catastrophe caused significant mental threats to health care workers (HCW), especially during the first wave of the pandemic. India successfully implemented vaccination strategies in January 2021 that is likely to ameliorate the mental health impact of HCWs. The current survey aims to identify the change in impact following vaccination and address the issues affecting mental health. Objective The primary objective is to reevaluate the stress levels of radiation oncology HCWs with vaccine implementation and compare it with the mental health status at the onset of the pandemic. The secondary objective is to identify the current causative factors influencing mental health. Materials and Methods Health care workers who participated in the initial mental health impact survey at the outset of the COVID-19 pandemic from May to July 2020 were included in this study. Two hundred eligible HCWs were reassessed of the total 363 initial assessments. The 7-item Generalised Anxiety Disorder (GAD-7), 9-item Patient Health Questionnaire (PHQ-9), and 22-item Impact of Events Scale-revised (IES-R) was again served for assessing anxiety, depression, and posttraumatic stress disorder. The Mc Nemar test was used to evaluate the change and significance of the mental health impact. Univariate and multivariate analyses were done to identify the causative factors affecting mental health. Results The cohort's median age was 30 years (interquartile range [IQR]: 27-33). The incidence of moderate-to-severe level anxiety, depression, and stress significantly declined to 6.5% ( p = 0.031), 9% ( p = 0.01), and 19% ( p < 0.001) compared with 39.5, 40.5, and 30.5% during the pandemic onset. On further analysis, HCWs with affected family members had higher levels of stress ( p = 0.002). The rest of the parameters did not have significant impact on mental health outcomes. Conclusion With public education, awareness, and vaccination strategies, the second follow-up survey conducted after vaccine implementation demonstrated a significant number of HCWs in the radiation oncology community, exhibiting a decline in the incidence of anxiety, depression, and stress levels compared with the initial wave of the pandemic.

Retrospective Analysis of Clinical Laboratory Parameters, Therapeutics and Outcome in Patients Infected with SARS-CoV2.

SARS-CoV-2 is the third coronavirus to have caused severe disease in humans in the last two decades, with approximately 5% of all patients and 20% of hospitalized patients experiencing severe symptoms, necessitating intensive care. The occurrence of Cytokine Storm has been implicated in the immune-pathogenesis of severe COVID-19. This is associated with cardiac injury, precipitated by cytokine mediated imbalance of coagulation and fibrinolysis, in the lung alveoli. In the absence of proven therapeutic agents, combinations of anti-viral drugs, immune-modulators and other adjunctive therapies have been tried in different clinical settings. A total of 128 confirmed cases of severe COVID-19 admitted to BLK-MAX Super Speciality Hospital between 16th of June to 31st of July, 2020 were included in this study. The correlation of age, gender, first value (on admission) of serum IL-6 and D-dimer, and impact of Tocilizumab and Remdesivir therapy on clinical outcome (28-day mortality), was evaluated in confirmed cases of severe COVID-19. The mortality rate was highest in the age group above 70 years. The incidence of death was significantly higher in males above 50 years, when age and gender were considered together. IL-6 and D-dimer levels >70 pg/mL and > 0.5µg FEU/mL respectively, were associated with poor outcome. 85.3% of patients treated with Remdesivir showed clinical improvement. When Tocilizumab and Remdisivir were administered together, 44.0% of patients survived while 56% expired. 79.7% of patients survived while 20.3% expired when neither Tocilizumab nor Remdesivir was administered.

EFFECT OF HIGH- VS LOW-DOSE OF DEXAMETHASONE ON INCIDENCE OF HOSPITAL-ACQUIRED INFECTIONS IN ACUTE HYPOXEMIC RESPIRATORY FAILURE IN SARS COV-2 PNEUMONIA

SESSION TITLE: Critical Care Management of COVID-19 SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: To compare the incidence of hospital acquired infections (HAI) in patients treated with systemic corticosteroids (dexamethasone or equivalent alternative corticosteroid) with high (> 10 mg/day) vs low (6 mg/day) dose for COVID-19 related acute hypoxemic failure METHODS: Observational cohort study of COVID-19 patients from July 25 and Oct 1, 2021 at a tertiary care hospital. 227 hospitalized patients were positive for COVID-19. 168 patients were included in the analysis. Corticosteroid type and dose was analyzed. Comparison of high vs low dose cohorts was done. Primary outcome measure was incidence of HAI in each group. Bloodstream Infections (BSI), Hospital Acquired Pneumonia (HAP) and Urinary Tract Infections (UTI) were included. Secondary measures were number of patients requiring intubation, length of ICU stay and inpatient mortality. Descriptive statistics were used to compare variables between cohorts including body mass index (BMI), severity of illness (SOFA and modified SOFA scores) and glucose control RESULTS: Of 168 patients: 68 (40%) received high dose (> 10 mg dexamethasone) & 100 patients (60%) received low dose (6 mg dexamethasone) corticosteroids. High vs Low dose: Demographics: Age (57 vs. 64 years;p 0.21), sex (51% vs. 57% female;p 0.77) & chronic comorbidities including BMI (29.2 vs 33.1;p 0.45). Severity of illness scores at day of corticosteroid use were similar (SOFA 4.7 vs 4.1;p 0.71 & mSOFA 2.6 vs 2.3;p 0.07) despite difference in rates of patients that required intubation (56% vs 18%;p<0.001). 45% of intubated died in high dose compared to 18% in low dose group. Overall mortality was 29.4% vs 11%;p 0.011. Glucose control (insulin > 50 u/day) was worse in high dose group (35% vs 14%;p<0.01). Baricitinib or tocilizumab used in 60% vs 44% of intubated;p0.62). HAI data: BSI- High dose 18/68 (26.5 %) vs low dose group 13/10 (13%);p 0.07. UTI-High dose 4/68 (6%) vs low dose group 5/100 (5%);p 1.00. HAP-High dose 27/68 (39.7%) vs low dose group 11/100 (11%);p <0.001. High dose group HAP > 1 organism: 15/27 (MSSA 44%, Aspergillus 18%, MRSA 18%, Streptococcus 26%, Pseudomonas 18%, rest were Enterobacter, H Influenzae, Acinetobacter, Serratia, E coli, Klebsiella, Providencia and Citrobacter species at 3% each). Low dose group HAP > 1 organism: 2/11 (Streptococcus 36%, MSSA 27%, H Influenzae 18%, rest were pseudomonas, E coli, stenotrophomonas and acinetobacter species) CONCLUSIONS: In hospitalized COVID-19 patients with acute respiratory failure, high dose dexamethasone use was associated with significantly higher HAP rates compared to low dose dexamethasone. Moreover the high dose group had higher BSI, worse glucose control, higher intubations and deaths in the intubated cohort despite similar severity of illness in either group CLINICAL IMPLICATIONS: High dose dexamethasone may increase susceptibility to HAIs and negatively impact outcomes in COVID-19 associated hypoxemic failure DISCLOSURES: No relevant relationships by Beenish Bhutta No relevant relationships by Rosalyn Chi No relevant relationships by Jason Graf No relevant relationships by mohsin iqbal No relevant relationships by Rajat Kapoor No relevant relationships by Rachel Kruer No relevant relationships by Connor Parker No relevant relationships by Omar Rahman No relevant relationships by James Skinner

Examine the Indian Tweets to Determine Society Emphasis on Novel Corona-Viruses (COVID-19)

The recent emerging coronavirus as novel corona virus (2019‐nCoV) formed viral pneumonia based emergency not only in Wuhan but also Europe, Iran, North Korea, India, and many more countries. WHO has already declared this situation as pandemic of corona virus. The world has around twenty-four lakhs cases in the whole world with around one and half lakhs deaths as on 20 April 2020. The corona virus is the family member of Nidovirales, which occur in human body from animal-human interaction. Here, we deliver the basics of corona virus and illustrate the social impact of this emergency. The review will aid the knowledge of CoV with their family and understand the person for healthy life. Here we study the Indian Tweets to determine the people’s emphasis on emerged Novel Coronaviruses (COVID-19), also compute the comparative tweets as concern of corona virus especially for Indian capital region for last six months January to June 2020 and January to March 2021 and find out the tactics of tweets for peoples concern about it. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

A Prospective, Descriptive Study on Awake Self-prone in Hospitalized COVID-19 Patients A Multidisciplinary Approach

Purpose/Aims Healthcare workers internationally continue to look for innovative ways to improve patient outcomes and optimize resource utilization during the coronavirus disease 2019 (COVID-19) pandemic. Proning awake, nonintubated patients has been suggested as a potential intervention in critical care. The aim of this study is to provide a multidisciplinary approach to safely perform awake self-prone positioning in the acute care setting. Design This is a prospective, descriptive study. Method Patients with COVID-19 were screened and enrolled within 48 hours of a positive test. After approval from the primary team, patients were provided education materials by a multidisciplinary team on the self-prone intervention. Visual cues were placed in the room. Patients were requested to maintain a diary of hours of prone positioning. Patients' baseline characteristics, admission vitals, daily oxygen requirements, and level of care were collected. Results Of 203 patients screened, 31 were enrolled. No pressure-related injury or catheter (intravenous or urinary) displacement was identified. Eighty-one percent of patients spent less than 8 hours a day in prone positioning. Among patients enrolled, none required invasive ventilation or died. Conclusions Awake self-proning can be performed safely in patients given a diagnosis of COVID-19 in the acute care setting with a multidisciplinary team.

Cytokine storm in severe COVID-19: Does remdesivir/ tocilizumab improve clinical outcome?

Objective: To study correlation of age, gender, serum IL-6 & D-dimer value (on admission), and impact of Tocilizumab (immunomodulator)/ Remdesivir (antiviral) therapy on clinical outcome (28-day mortality), in severe COVID-19. Methodology: Confirmed cases of severe COVID-19 (ICMR/ WHO criteria), admitted in the COVID-ICU were included. Venous plasma samples were collected within 6 hours of admission on day 1 for measurement of IL-6 and Ddimer and analyzed within 2 hours. Demographic characteristics, laboratory tests and therapeutic interventions were recorded. Results: The incidence of death was significantly higher in males above fifty years. The mortality rate correlated with increasing values of IL-6 (highest at levels >70 pg/mL. D-dimer values above 0.5μg FEU/mL were associated with increased risk of poor outcome. 85.3% of patients treated with Remdesivir showed clinical improvement. When Tocilizumab and Remdisivir were administered together, 44.0% of patients survived while 56% expired. Conclusion: Men above fifty years were most vulnerable to a poor outcome. Higher levels of IL-6 and D-dimer correlated with increased mortality. Both these biomarkers may be estimated on admission, and serially thereafter, to guide clinicians in recognizing patients with severe COVID-19 early in the disease course, and monitor prognosis. Remdesivir improved clinical outcome. The mortality rate was higher when Remdesivir and Tocilizumab were administered together.

ClassRoute: An English to Punjabi Educational Video Translation Pipeline for Supporting Punjabi Mother-Tongue Education

Information Communication Technology (ICT) permeates almost every aspect of our daily lives and has become one of the most important priorities for formal and informal education. However, many people particularly those in least developed countries, are unable to reap the benefits due to lack of access to ICT but also due to lack of access to quality educational material. Additionally, in Punjab India, due to a shortage of resources and lack of infrastructure, the education system suffers from massive gaps including high student to teacher ratios, shortage of qualified teachers, and poor teacher training programs. This all has also been further exacerbated due to the COVID19 Pandemic as schools shut down globally and all teaching/learning activities moved online where possible or were canceled otherwise. In an effort to help relieve some of the burden on the Punjabi education system, and motivated by the proven efficiency of mother-tongue based education as well as the importance of visual-based learning, this paper introduces a pipeline for translating English educational videos into Punjabi equivalents which seeks to go beyond simple translation and in future iterations take into consideration the cultural needs of the learners in order to better connect them with the topics being taught. This pipeline is among a series of under construction pipelines aimed at translating English educational videos into other languages, dubbed as ClassRoute.

Predictive Values of Haematological Parameters, Neutrophil Lymphocyte Ratio and Derived Neutrophil Lymphocyte Ratio on Disease Severity in COVID 19 Patients

Introduction: COVID-19 caused by SARS-CoV-2is a highly contagious disease. It is a complex systemic disease primarily involving therespiratory system. Patients usually have mild to moderate illness andpresent with flu like symptoms. However, a small group of patientsmay progress or present in a critical condition necessitating intensivecare. Early identification of risk factors associated with critical illnessmay aid in providing timely supportive care and access to theintensive care unit (ICU) when required.Aims &Objectives: To compare the CBC findings, NeutrophilLymphocyte Ratio (NLR), derived neutrophil lymphocyte ratio (dNLR), Platelet Lymphocyte Ratio (PLR) and Lymphocyte MonocyteRatio (LMR) in mild and severe categories of COVID 19 patients.Materials &Methods: Cases diagnosed as COVID 19 and admittedin the wards and ICU of GTB Hospital, Delhi were included. Sampleswere collected from 27 cases. The cases were divided in severe andmild categories. Blood was collected in EDTA vial and CBC wasdone using Automated Hematology Analyser. Data were entered inSPSS 26 and statistical analysis was done using same software.Result: NLR, dNLR values and TLC were found to be significantlyhigher (P< 0.05) in severe COVID-19 patients compared to mildCOVID-19 patients. Differences in platelet count, PLR and LMRvalues were not significant between the two groups. Using ROCcurve, a cut off value of 10,950 for TLC, 6.19 for NLR and 4.13 fordNLR were determined. Using these values TLC was found to be93.3% sensitive, 91.7% specific;NLR was found to be 73.3% sensitive, 72.7% specific;dNLR was found to be 80% sensitive, 81.8%specific in recognizing severe COVID 19 infections.Conclusions: NLR, d-NLR, PLR &LMR are readily accessiblebiomarker, which can be calculated based on a complete blood count.In our study, TLC, NLR and dNLR were found to be useful indetecting severe COVID 19 infections. TLC was the most sensitiveand specific marker in detecting severe COVID 19 patients followedby dNLR. NLR was less valuable than dNLR.

Covid-19 Infection in Hematological Malignancies: Registry Data from India

Background: The impact of COVID-19 pandemic has been highly heterogeneous across the globe and different regions within the country. The differences in the outcome of these patients is related to their demographic profile, genetics, socio-economic conditions, and government health policies. Prior to the COVID-19 pandemic, the Healthcare Access and Quality (HAQ) Index for hematological malignancies (HAQ index <30) in a low-middle socio-demographic index(SDI) country like India was less than the mean HAQ index for all other diseases (HAQ index 41) with a significant regional disparity.(1)Several national and international registries from high socio-demographic Index (SDI) countries have reported worse short-term outcomes of coronavirus disease (COVID-19) in patients with hematologic as compared to other solid cancers. The outcomes of COVID-19 in patients with hematologic malignancies from a low-middle SDI country are yet unknown. The COVID-19 Hematologic Cancer registry of India reports these outcomes from India. Methods: Ten tertiary referral hospitals across India reported the demographic, clinical, laboratory, treatment, and outcomes of COVID-19 infection in patients with hematological malignancies. The registry was retrospective from March 21, 2020, and prospective from November 1, 2020, till March 20, 2021. Risk factors associated with severity and mortality were evaluated using the penalised logistic regression and Cox proportional hazards model. Findings: Data from 565 patients was included in this study. Among these, 429 (76%) patients were hospitalized, 186 (33%) patients had moderate/severe COVID-19.There were 116 (20.5%) non-survivors at a mean follow up of 147 (95% CI : 142-153) days. Age >60 years (HR 2·55, 1·23 - 5·27), diagnosis of acute myeloid leukemia (HR 2·85, 1·58 - 5·13), interruption or alteration of anticancer therapy (HR 2·78, 1·65 - 4·68), and post hematopoietic cell transplant status (HR 3·68, 1·82 - 7·45) predicted mortality. In contrast, increasing age [20-40 years (OR 2·54, 1·32 - 4·90), 41-60 years (OR 3·51, 1·84 - 6·71), >60 years (OR 6·04, 3·01 - 12·10), comorbidities such as diabetes mellitus (OR 1·89, 1·18 - 3·04), hypertension (OR 1·94, 1·17 - 3·19), diagnosis of AML (OR 3·70, 2·06 - 6·67), indolent non-hodgkin lymphoma (OR 3·20, 1·68 - 6·09), multiple myeloma (OR 2·88, 1·64 - 5·05), malignancy not being in remission (OR 1·71, 1·12 - 2·60)were significantly associated with severe COVID-19 on univariate analysis. Of these, only increasing age [20-40 years (OR 2·60 (1·31 - 5·15), 40-60 years (OR 3·44, 1.60 - 7·41), more than 60 years (OR 5·70, 2·43 - 13·35)], AML (OR 2·73, 1·45 - 5·12), and malignancy not being in remission (OR 1·85, 1·18 - 2·89) were significantly associated with severe COVID-19 on multivariable analysis Conclusion: The overall mortality from COVID-19 infection of the entire cohort was 20.5%;the mortality was 46.2% in patients who had moderate to severe disease COVID-19 illness. Similar to previous studies, age, diagnosis of acute myeloid leukemia and a post stem cell transplant status was associated with mortality. In addition, interruption or de-escalation of anticancer therapy during Covid-19 infection was identified as an important factor associated with higher mortality on follow up in the current study. References 1. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. Lancet (London, England)2018;391(10136): 2236-71.Lee AJX, Purshouse K. COVID-19 and cancer registries: learning from the first peak of the SARS-CoV-2 pandemic. Br J Cancer 2021;124(11): 1777-84. [Formula presented] Disclosures: No relevant conflicts of interest to declare.

Clinical and Postoperative Outcomes of Cancer Surgeries during the COVID-19 Pandemic: A Comparative Study with its Pre-COVID Surgical Audit at Five Major Tertiary Care Hospitals' Cancer Departments in India

Introduction There has been an exponential rise in number of coronavirus disease 2019 (COVID-19)-positive infections since March 23, 2020. However, cancer management cannot take a backseat. Objective The aim of this study was to identify any difference in the complication and mortality rates for the cancer patients operated during the ongoing COVID-19 pandemic. Materials and Methods This was a retrospective study of a prospectively maintained database of five centers situated in different parts of India. Variables such as demographics, intraoperative, and postoperative complications were compared between COVID-19 (group A-March 23, 2020-May 22, 2020) and pre-COVID time period (group B-January 1 to January 31, 2020). Results One-hundred sixty-eight cancer surgeries were performed in group B as compared with 148 patients who underwent oncosurgeries in group A. Sixty-two percent lesser cancer surgeries were performed in the COVID-19 period as compared with the specific pre-COVID-19 period. There was no significant difference in age group, gender, comorbidities, and type of cancer surgeries. Except for the duration of surgery, all other intraoperative parameters like blood loss and intraoperative parameters were similar in both the groups. Minimally invasive procedures were significantly lesser in group A. Postoperative parameters including period of intensive care unit stay, rate of infection, need for the change of antibiotics, and culture growth were similar for both the groups. While minor complication like Clavien-Dindo classification type 2 was significantly higher for group A, all other complication rates were similar in the groups. Also, postoperatively no COVID-19-related symptoms were encountered in the study group. A subset analysis was done among the study groups between those tested preoperatively for COVID-19 versus those untested showed no difference in intraoperative and postoperative parameters. No health-care worker was infected from the patient during the time period of this study. Conclusion Our study shows that there is no significant difference in the incidence of postoperative morbidity and mortality rates in surgeries performed during COVID-19 pandemic as compared with non-COVID-19 time period.

Communication aids in intensive care during unprecedented times

The ongoing COVID-19 pandemic has placed immense duress on the NHS with intensive care units (ICUs) at maximum capacity. Social distancing, virtual communication with relatives, and personal protective equipment have reduced the quality of communication between staff and patients causing an increase in family member distress and dissatisfaction. This project aimed to assist with communication between staff and patients through the use of an infographic explaining equipment in ICU at a district general hospital. Methods An infographic poster was created describing common ICU equipment and its uses. Pre-and post-intervention surveys were sent to both ICU staff and recently discharged patients and families. Staff confidence in explaining and patient/relative satisfaction in understanding ICU equipment were analysed before (staff n = 26, patient/relatives n = 29) and after (staff n = 20, patient/relative n = 10) infographic implementation. Scoring was carried out on a scale of 0-5, where 0 represented either complete dissatisfaction, or a complete lack of confidence, and 5 being either very satisfied or very confident. Results A positive shift and a decrease in score variation was seen in patient/relative satisfaction from a median of 4 (range: 1-5) pre-intervention to 5 (range: 4-5) post-intervention. Staff confidence also saw a positive increase from 4 (range: 2-5) to 5 (range: 2-5) pre-and post-intervention respectively. Discussion Clear and effective communication in ICU is imperative to reduce the predictable fear and anxiety a patient or family member might experience in such an intimidating and unfamiliar environment. Recently, animations have found a role in explaining various cardiovascular procedures, highlighting the potential for depicting medical information in a user-friendly manner [1, 2]. This infographic offers a simple and clear method of aiding ICU communication without having to increase the demands of or retrain staff. The effectiveness of this measure could see implicated uses throughout clinical areas as a renewable and effective communication aid and has the potential to be implemented as either an information leaflet supplement or ward-based poster.

Transportation cost optimization model for the petroleum industry

The petroleum industry faced a two-pronged crisis in the past year, one of supply glut due to OPEC-Russia price war and second of lower demand due to COVID'19. During such supply chain disruptions, cost-effective strategies are a savior for any industry from bankruptcy. The logistic is one of the fertile areas to reduce the bottom line in the cost-intensive petroleum industries. In the present paper, we propose the multi-product, multi-modal transportation cost optimization model for the petroleum industry's downstream supply chain. The MILP model is proposed and solved on AMPL software with the MINOS solver. The comparison of the optimized solution with real practice is also proposed, and the reasons for choosing sub-optimal solutions by the managers are also enlisted. The relationship between the absolute and per-unit transportation cost with the demand and pipeline capacity is identified through different experiments and sensitivity analyses. We found that absolute and per-unit transportation cost decreases with an increase in pipeline capacity and increases with an increase in depot demand. We also proposed the decision support systems prototype for the managerial implementation of our model. © IEOM Society International.

Tele-oncology in cancer care during COVID-19 pandemic-expanding role in the developing world

COVID-19 pandemic has challenged the entire health care system to a great extent and led to the development and utilization of alternative approaches. Tele-oncology holds great potential to deliver cancer care. With the use of tele-oncology, physical distancing can be maintained. This will help the cancer patients as well as the oncologist and other supporting staff from getting exposed to the virus. However, there are many challenges for starting tele-oncology especially in resource limited settings. We hereby discuss tele-oncology its applications, methods available, tools, set up and infrastructure, benefits of tele-oncology and various patient, physician and resource-related factors in detail, especially in the setting of low- A nd middle-income countries.

Persistent Antibody Responses to SARS-CoV-2 Infection in Cancer Patients: A Single-Center Retrospective Observational Study

Introduction There is limited literature available regarding the prevalence and durability of immune response to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/coronavirus disease 2019 (COVID-19) in cancer patients. Objective The aim of this study was to analyze the seroconversion rate in cancer patients recovered from SARS-CoV-2 infection. Materials and Methods We retrospectively analyzed antibody levels and seroconversion rates in serum samples from 135 cancer patients who had recovered from SARS-CoV-2 infection. Chemiluminescent immunoassay using Roche Cobas e801 analyzer (Roche Diagnostics, Rotkreuz, Switzerland) was performed to identify Pan Ig antibody against nucleocapsid antigen. Reports of first, third, and sixth month were analyzed. Seroconversion was also compared with health-care workers (HCW) of our institute who had recovered from COVID-19 infection. Results Seroconversion rate in cancer patients was 81.2% at 1 month, 95% at 3 months, and 94.6% at 6 months post reverse transcriptase-polymerase chain reaction positivity. There was no difference in seroconversion rate among different age groups, gender, comorbidities, severity of COVID-19 symptoms, cancer disease status, and treatment with chemotherapy. Seroconversion rate in cancer patients is comparable to HCW (90.4 vs. 96%, p = 0.82) and is durable. Conclusion Humoral response to COVID-19 infection in cancer patients is comparable to general population and sustained. Such responses suggest that cancer patients are likely to benefit from COVID-19 vaccination.

The impact of oral health status on covid-19 severity, recovery period and c-reactive protein values

Background: The mouth cavity can serve as source for respiratory viruses, putting patients at risk of superinfection. Poor oral hygiene has been linked to hyper-inflammation in several studies. COVID-19 severity has also been connected to increased inflammatory responses. As a result, we hypothesised in this study that greater COVID-19 severity could be connected to poor dental health. This was accomplished by evaluating dental health, COVID-19 symptom severity, C-reactive protein (CRP) levels, and recovery time. Methods and Materials: After meeting the study's exclusion criteria, 419 patients with confirmed positive polymerase chain reaction (PCR) tests were enrolled in the study. The questionnaire was divided into two components, the first of which assessed oral health and the second of which assessed COVID-19 severity. An oral health score was used to assess the impact of dental health on COVID-19 severity. As a secondary outcome, the impact of dental health on CRP and recovery time was assessed. The questionnaire was used to obtain data on CRP levels and COVID-19 PCR testing, which were then verified by consulting medical records. Results: There was a significant inverse connection between oral health and COVID-19 severity (p0.001, r = -0.512). Furthermore, there was a strong inverse association between oral health and recovery period and CRP values (p 0.001, -0.449 and p 0.001, -0.190, respectively), indicating that poor dental health was linked to higher CRP levels and a longer recovery period. Conclusion: Our findings suggest that oral health may have a role in the severity of COVID-19. The study design, however, limits the correlation. To explore this relationship, a larger study endeavour is required.