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Background: Despite the transformative potential of chimeric antigen receptor T (CAR-T) therapy, more tools to assist with identifying patients with increased likelihood of benefitting from this therapy will be helpful, particularly given the logistical complexity and socio-economic demands for CAR-T relative to other therapies. Health care resource restriction during the COVID-19 pandemic highlights the need for these tools. We present a simple survival score that uses 3 readily available clinical labs: platelet (plt), absolute lymphocyte count (ALC), and Lactate dehydrogenase (LDH), to predict the risk of dying within 6 months of CAR-T therapy in patients with aggressive lymphoma. Method(s): We conducted a retrospective chart review of patients with aggressive non-Hodgkin lymphoma (NHL) who received FDA-approved CAR-T between Jan 2018 to Jan 2022 at Mayo Clinic Rochester.(Table Presented)Results: Among a total of 110 pts who received CAR-T, 27 (25%) pts died within the first 6 months post CAR-T infusion (OS <= 6 months). Disease progression was the main cause of death (18/25, 72%), followed by infection (4/25, 16%), CAR-T related (HLH/MAS, 2/25, 8%), second primary malignancy (1/25, 4%) and unknown (2/25, 8%).Baseline demographics were comparable between the OS>6months and <=6months groups (Table 1). Patients' ECOG, Karnofsky performance status and 11 labs at the time of evaluation for CAR-T therapy (initial eligibility assessment, prior to leukapheresis) were compared between those who died from any cause within 6 months of CAR-T infusion and those who did not. Hemoglobin, plt, ALC, absolute monocyte count, CRP, ferritin, and LDH were selected as clinically and/or statistically significant variables for multivariate testing. Multivariate regression with boot-strap testing identified plt, ALC, and LDH as the most predictive variables with 80.9+/-11.7% accuracy for predicting death within 6 months of CAR-T infusion. Patients were scored 0-3 using these 3 labs, with 1 point assigned for plt <= 100 X109/L, ALC <= 0.4 X109/L, or LDH > 222 U/L (upper limit of normal). OS by this survival score is shown in Figure 1.(Figure Presented)Discussion: Due to the curative potential of CAR-T, patients with broader characteristics than those treated on registration studies have been treated in standard of care practice. While an estimated 5%-10% risk of CAR-T associated deaths in the first 3 months is seen across all patients in clinical trials, predictors for early death after CAR-T in real-world patient populations can provide additional context for pts and providers when selecting treatment. This survival score is important proof of concept that a simple model using readily accessible clinical labs at the time of CAR-T evaluation could provide additional context to help with additional clinical decision-making. Multicenter prospective studies will help define and validate the definitive survival scoring system.Copyright © 2023 American Society for Transplantation and Cellular Therapy
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Clinical Information Patient Initials or Identifier Number: JS Relevant Clinical History and Physical Exam: A 55-year old woman was brought to emergency department complaining of sudden onset squeezing chest pain radiating to her arm and jaw and associated with giddiness. She had flu like illness a day prior to her presentation associated with malaise, arthralgia and dry cough. She had history of hypertension. Physical examination revealed dual heart sounds and clear lung fields to auscultation. Relevant Test Results Prior to Catheterization: Electrocardiogram (ECG) showed normal sinus rhythm and the cardiac enzymes were elevated;high sensitivity troponin-I, 23000 ng/L (range0-10 ng/L). RNA PCR was positive for SARS-CoV-2 (COVID-19). D-Dimer was 303microgram/L (normal <500). Transthoracic echocardiogram showed severe hypokinesis of the mid inferolateral wall with left ventricular ejection fraction (LVEF) 52%. Chest X-ray showed no focal consolidation. [Formula presented] [Formula presented] Relevant Catheterization Findings: Invasive coronary angiogram showed tortuous coronary arteries with abrupt narrowing of mid- distal Ramus Intermiedius and discrete lesion of mid PDA. SCAD (spontaneous Coronary dissection) of Ramus Intermedius and mid PDA (posterior descending artery) was suspected, and patient was treated conservatively. Repeat coronary angiography, few months later showed complete resolution of SCAD with normal appearance of affected vessels. [Formula presented] [Formula presented] [Formula presented] Interventional Management Procedural Step: After obtaining an informed consent right Radial access was achieved with 6F Terumo sheath using over the wire technique. 1% lignocaine was used as local anaesthetic. 5F JL 3.5 (Judkin's) and JR 4 catheters were used to engage left main stem (LMS) and right coronary artery (RCA) and selective coronary angiography was performed. No percutaneous coronary intervention was performed. After the procedure hemoband (TR band) was applied to access site. Patient remained hemodyanamically stable throughout the procedure. [Formula presented] [Formula presented] [Formula presented] Conclusion(s): SCAD is a potential cause of type II myocardial infarction in patients with COVID-19, but more studies are needed to establish causality. Infection-related SCAD may occur at any time during index events and could be difficult to diagnose. Conservative management seems like a safe strategy.Copyright © 2023
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This paper has been designed to understand the effect of COVID-19 on the Indian banking industry. The spread of COVID-19 has dismantled the functioning of all the sectors of the economy. The financial sector is one of the most prioritised sectors and banks are the most important component of the financial system of the country. This report compares the pre and post COVID period to arrive at a fair conclusion about most affected instruments of banks. The policies and measures taken by the Central Bank and the Union to combat the tragedy have been listed for accurate results. The report also highlights several suggestions which are necessary to implement to revive the banking output.
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Introduction: Infertility is a clinically common disease, occurring in approximately 10% of women of childbearing age. There is a paucity of studies investigating hematological parameters among infertile women and the association of anemia with infertility. Aims & Objectives: To estimate the prevalence of anemia and the haematological profile among women undergoing infertility treatment. Material(s) and Method(s): This is a cross-sectional single centre descriptive study from Western India. Patients visiting artificial reproductive (ART) centre aged between 18-50 years and were cohabitating with husband for at least six months during the study period (Jan 2021 to Sep 2022) were screened for inclusion. Patients with chronic kidney disease, chronic liver disease, malignancy, on chemotherapy for any malignancy, taking drugs interfering with Iron/ Vitamin B12/Folic acid metabolism and diabetes mellitus were excluded from the study. All included patients were subjected to CBC using 7-part coulter and those with any haematological abnormality were further assessed by haematologist for establishing firm diagnosis. Those patients who didn't give consent for detailed evaluation or those who were lost to follow up because of COVID were excluded from the study. Data was analysed using JMP ver 16.0.0. Result(s): Study population included 108 patients with a mean age of 28.30 +/- 4.14y. Eighty percent of the study population were home makers. Average annual family income was 7.55 +/- 1.47 lakhs per year. The mean duration of infertility being 5.95 +/- 3.52 years with most of them having primary infertility (81%). RBC characteristics of study population being, Hb- 12.12 +/- 1.07 g/dL, MCV- 81.57 +/- 7.12fL, PCV-36.72 +/- 2.88%, RBCs-4.52 +/- 0.45million/ lL, MCH-26.99 +/- 2.86 pg, MCHC-33.02 +/- 1.11 g/L, and RDW- 14.96 +/- 2.17. Other hematological profiles of the infertility patients revealed a total leukocyte count of 7439 +/- 1897/muL, Platelets- 2.53 +/- 0.90/lL. Of all the patients 43% had anemia at presentation to the infertility clinic. Among those who had anemia 52% had microcytic hypochromic whereas 46% had normocytic normochromic with 2% having macrocytic anemia. Among those with microcytic hypochromic anaemia, the mean Mentzer index was 15.53 +/- 2.40. Irrespective of anemia status, 30% of patients had microcytosis. Most of the patients with microcytic hypochromic anemia had Iron deficiency with one two patients having BTT. The prevalent anemia was not higher than the background prevalence. None of the patients had any leukocyte or platelet disorders. Conclusion(s): There is no predominant haematological association with female infertility.
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Aim: Amid COVID pressures, standards of surgical practices need constant reviewing to maintain patient safety and streamline care pathways. Newly published BOAST (British Orthopaedic Association Standards for Trauma and Orthopaedics) guidelines for paediatric supracondylar fractures became a benchmark against which a restructured DGH trauma unit's performance can be appraised. Method: Theatre records were analysed between April-2020 and September-2020. Data were collected to reveal time to theatre, operative techniques, documentations of ulnar nerve protection, complications, follow-up plans, time to first post-op radiograph and to wire removal. Results: 90% of patients underwent operations within 24-48 hour. Although there was no incidence of iatrogenic nerve injury, documentation of ulnar nerve protection was not identified in 45% of crossed wire fixations. Wire size was not mentioned in 14%. 33% did not have first follow-up with radiograph within 4-10 days, and 43% of patients did not have the wires removed till 4 weeks post op. Conclusion: This re-audit highlights the need to improve in documentation for ulnar nerve protection and to identify the delays in follow-up appointments. Although BOAST no longer recommends a fixed timeframe for follow-up plan, first radiograph within 4-10 days and wire removal within 4 weeks are still reasonable locally.
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Herpes zoster Ophthalmicus accounts for a minority of all patients with zoster infections. It leads to varied clinical presentations, but total unilateral ophthalmoplegia has rarely been reported in the literature. We hereby present a 50-year-old male patient presenting with the above combination for aiding the clinical diagnosis by dermatologists and ophthalmologists. Early initiation of treatment leads to a near total recovery of ophthalmoplegia in the majority of treated patients.
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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.
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COVID-19 has been shown to spread rapidly among Healthcare Workers (HCWs) and there is an urgent need to find and implement various mitigation strategies for these individuals. In this study, we summarize the epidemiological characteristics of the COVID-19 outbreak among HCWs in a tertiary care hospital and compare various parameters and preventive measures taken by infected and uninfected subjects. A retrospective questionnaire and record-based analysis was carried out to evaluate the epidemiological and clinical parameters of the participants. Preventive strategies such as masking, hand hygiene and use of prophylactic agents were compared for infected and uninfected subjects. Appropriate statistical tests were applied wherever required. The average age of participants in the COVID-19 positive group was 35.9 years and 52.1% of the positive HCWs were symptomatic. Three of these subjects needed hospitalization and one required admission to an intensive care unit. The study found a protective role of full course of prophylactic hydroxychloroquine in treated subjects versus untreated controls (p = 0.021) and benefit of N95 masks over others (p<0.001). Our results did not show any added protection with the use of other strategies (prophylactic vitamin C, D, zinc, betadine gargles, or other home remedies). We observed outbreak control with increased awareness, near universal testing, PPE provision, sanitation drive and promoting social distancing among HCWs. This study highlights the role of hydroxychloroquine prophylaxis, use of N95 mask and effect of early interventions in outbreak mitigation.