The Clinical Impact of Casirivimab-Imdevimab Monoclonal Antibody Therapy (CIMAT) in COVID-19 patients: A real-world insight from India

Background. Various clinical studies from developed countries support the use of Casirivimab-Imdevimab Monoclonal Antibody Therapy (CIMAT) to treat outpatients with mild to moderate coronavirus disease-19 (COVID-19). However, the real-world clinical data from India, owing to the portrayed benefits, are limited. Moreover, the choice of CIMAT depends upon the willingness of the patient or his bystanders for this therapy. The study aimed to assess the impact of Casirivimab-Imdevimab Monoclonal Antibody Therapy (CIMAT) for mild to moderate COVID-19 in India. Methods. A single-center, retrospective comparative study was conducted to evaluate the impact of the CIMAT in symptomatic adult COVID-19 patients admitted to a secondary care hospital in South India, categorized as mild or moderate, and who are at high risk for progression to severe COVID-19. The data for the study were retrieved from the Electronic Health Records (EHR) of the hospital from April 2021 to March 2022, a period of 12 months. The primary outcome of the study was the length of hospitalization, and the secondary outcomes were mechanical ventilation postinfusion, readmissions after discharge, and mortality rate. Outcomes in the CIMAT cohort were compared to those of a control group of patients admitted with a diagnosis of SARS-CoV-2 during the same period who were qualified for CIMAT but were unwilling to administer it. Results. This study included 474 patients, 48 in the CIMAT cohort and 426 in the control group. In the CIMAT cohort, the median age was 65 years (IQR: 50-73);56.2% were >=65 years old;54.3% were males. Patients on CIMAT compared to the control group had a lower length of hospitalization(median: 4 [IQR 1-8]), lesser requisite for mechanical ventilation (4.3% vs 20.8%, p < 0.001) and less frequent readmissions within 10 days post-discharge (6.5% vs 9.3%, p < 0.001). Mortality was more among the control group, i.e., 22 (5.1%), and only one patient in the CIMAT cohort died during hospitalization (p = 0.23). The majority of the patients in the CIMAT cohort (41[89.1%]) were symptom-free within seven days of antibody cocktail administration. Conclusion. Patients treated with CIMAT for COVID-19 were more clinically benefitted than those treated without the antibody cocktail.

The Experiences of Healthcare Workers during the Second Wave of COVID-19 Crisis in the South Indian State of Kerala

Background. The COVID-19 pandemic has presented an unprecedented crisis and challenge for healthcare professionals globally. This study aims to explore the challenges faced by healthcare professionals during the second wave of COVID-19 in the south Indian state of Kerala. Methods. An online cross-sectional survey was designed and disseminated through social media and professional organizations to collect the relevant information from the healthcare workers. The questionnaire composed of demographics, and of questions about the employment, work role, and access to personal protective equipment. Results. Of the 423 responses received, 268 (63.3%) were nurses, followed by pharmacists (7.4%), doctors (14.6%), and allied healthcare professionals (4.4%). Nearly half i.e., 198 (46.8%) of the total responders, expressed concern about workrelated risks to themselves and their families. The primary concerns expressed by the participants include higher workload, psychological distress, shortage of quality personal protective equipment (PPE), lack of incentives, and social stigmatization. Just over a third of respondents (35%) perceived that care provided in their workplace was significantly worse than before the pandemic. Conclusion. The study offers lessons for hospitals in middle-income and lowincome countries to ensure a safe working environment for front-line healthcare workers in their fight against COVID-19. This implies the need to support with adequate safety kits, protocols, and support for both physical and mental health of the healthcare professionals.

Development of a Steroid Stewardship Bundle to tackle the Glucocorticoid-Induced Hyperglycemia in COVID-19 patients: Results of SUPER Diabetes Study

Background. Glucocorticoid therapy in COVID-19 patients poses a greater risk of hyperglycemia, leading to an unexpected detrimental effect on treatment outcomes. The Steroid Use in Patients Exhibiting Risk (SUPER) to Diabetes -SUPER Diabetesstudy aimed to implement a steroid stewardship bundle to encounter the incidence of Glucocorticoid-Induced Hyperglycemia (GCIH) in COVID-19 patients and to evaluate the effectiveness of the Steroid Stewardship Program. Methods. This interventional study included 600 COVID-19 confirmed patients admitted between April 2021and March 2022 in a secondary care hospital in India (stewardship cohort). A six-item Steroid Appropriate Index (SAI) assessed the need for steroid therapy using the parameters like the severity of disease, the onset of symptoms, weight of the patient, CT Thorax score, the preferred route of administration, and the comorbid disorders. This created a steroid stewardship bundle with the following parameters: (1) appropriate selection of the corticosteroid;(2) repeat blood sugar monitoring every 8 hours until discharge from hospital;(3) appropriate duration of therapy (4) proper de-escalation of dose/intravenous to oral switch. The patients were followed until discharge/death to track the incidence of hyperglycemia. The analysis of the effectiveness of SAI and the stewardship bundle was done by comparing this with the clinical outcomes among 300 COVID-19 confirmed patients admitted before implementing the scale (retrospective cohort). Results. The majority of the patients included in the stewardship cohort were males (367;61.1%), and the mean age was 47.3 +/- 17.1 years. The incidence of newonset of hyperglycemia or a worsened glycemic profile, i.e., Glucocorticoid-Induced Hyperglycemia (GCIH), was more among the retrospective cohort when compared with the stewardship cohort (32.1% vs 6.3%), p < 0.001). The study also revealed that history of diabetes (p < 0.001), age (p =0.002), number of medicines used for treatment (p< 0.001), and the frequency of monitoring of diabetes (p< 0.001) are significantly associated with GCIH. Conclusion. Implementing the steroid stewardship bundle significantly improved the appropriate selection and use of corticosteroids, decreasing the incidence of associated adverse events.

The Practice of Face Masking Among Young Adults in South India: An Online Cross-Sectional Survey During Second Wave of COVID-19

Objectives: COVID-19 pandemic urges the need for respiratory protective equipment like face masks as a public health measure to control the spread of infection. This study aimed to investigate the trends followed in the practice of mask-wearing by the South Indian population amid the second wave of COVID-19 outbreak in 2021. Methods: A web-based, online cross-sectional survey was conducted among the young adult population in India in late April 2021. An eight-item questionnaire was designed to assess the social perceptions and attitudes regarding wearing a face mask as a part of universal safety precautions. The social perceptions towards wearing masks were categorized as excellent, good average and poor on a scale (Social Perception Scale -SPS) scored out of 8. The details collected using a predesigned google form are statistically analyzed using the Chi-square test with a p-value of < 0.05 is considered statistically significant. Results: Among the 1283 participants who completed the questionnaire, 57% wore cloth masks followed by 26% wearing N95 masks and 12% wearing surgical masks. Even though the age of the study population varied from 19 – 76 years and with a male preponderance of 56.3% (n = 723), students and recent graduates participated largely in the study (71.8%, n = 922). A mean SPS score of 5.67±1.07 (out of 8) indicates that the social perception of the study population is good. A statistically significant association is observed between the SPS score and the age (p = 0.003), type of mask used (p < 0.001), and economic background of the study population (p <0.001). Breathing difficulty, communication problems, additional cost incurred and dermatologic issues were commonly reported barriers against mask-wearing. Conclusions: Adjunctive public health measures such as mask-wearing are crucial in curbing the COVID-19 transmission. By shaping an appropriate public attitude, policymakers can ensure compliance towards mask-wearing.

POSC324 Clinical Pharmacist Intervention to Improve the Administration of Injectable Antiviral Agents By Nurses in the Treatment of COVID-19 Infection

Objectives: To Analyse the impact of clinical pharmacist intervention on the administration of injectable anti-viral agents by nurses in the treatment of COVID-19 infection. Methods: A One-group pre-test, post-test experimental study was conducted during the month of May 2021 among the staff nurses of a secondary care hospital using a pre-structured and pre-validated questionnaire. The questionnaire was organized into 3 domains i.e, Knowledge, Attitude, and Practice (KAP) regarding injectable anti-viral agents including Remdesivir were evaluated. Demographic details, as well as the related information, were also collected. Paired-t-test and Chi-square tests were employed to evaluate the statistical significance of the study variables. Results: A total of 56 nurses were included in the study, among which the majority (59.7%) were diploma holders and the rest of them were degree holders in nursing. On analyzing the years of experience of study samples, it was found that the majority had 1-4 years experience (46.3%) followed by 4-8 years (28.6%) and the least percentage had experience for more than 12 years. The pre-test vs post-test values of the staff nurses shows a significant improvement in Knowledge (6.7vs.10.5, p<0.001), Attitude (6.7vs 8.9, p=0.003), and Practice domain (7.1604 vs 8.3, p<0.001). No statistically significant association was observed between knowledge and practice of the nurses with the baseline variables like level of education or years of experience (P=0.07). Conclusions: Clinical Pharmacist initiated continuing education programs for the nurses related to the administration practices of anti-viral agents like Remdesivir is very much crucial in assuring the proper clinical care to critically ill COVID-19 patients.

POSC15 Addressing Glucocorticoid-Induced Hyperglycemia in COVID -19 Patients: The Expanding Role of Steroid Stewardship

Objectives: To characterize the incidence of Glucocorticoid-Induced Hyperglycemia (GCIH) in COVID -19 patients and to evaluate the effectiveness of a Steroid Stewardship Program in countering this effect. Methods: This prospective, interventional study included 100 COVID-19 confirmed patients admitted between March 12 – May 12, 2021 who are categorized into B & C as per the guidelines of the Directorate of Health Services, Kerala, India. A five-item Steroid Appropriate Index (SAI) was prepared based on the onset of symptoms, weight of the patient, CT Thorax severity score, the preferred route of administration, and the underlying diseases for choosing the appropriate doing of the preferred corticosteroid. The demographic profile of these patients was collected and they were followed up till discharge/death to track the incidence of worsening of hyperglycemia or new onset of diabetes. The effectiveness of SAI was analyzed by comparing the data of treatment and clinical outcome among 100 COVID-19 confirmed patients admitted before and after implementation of the scale. Results: The majority of the patients were males (57) and the mean age was 45.7± 16.6 years. The incidence of new-onset of hyperglycemia i.e., GCIH was more among the retrospective cohort when compared with the SAI cohort (7% vs 26%, p< 0.001). The study also revealed that history of diabetes (p<0.001), age (p=0.002), number of medicines used for treatment (p<0.001) are significantly associated with glucocorticoid-induced hyperglycemia. Conclusions: The appropriate selection of corticosteroids based on real-world scenarios can decrease the incidence of adverse events associated. Implementation of steroid appropriate index and proper monitoring can be an aid for the same.

POSC1 The Influence of Diabetic History in the Prognosis of Hospitalized COVID-19 Patients: A Prospective Observational Study

Objectives: To evaluate the association between a known history of diabetes mellitus (DM) and its clinical outcomes in hospitalized COVID-19 diabetic patients. Methods: This prospective cohort study categorized COVID-19 positive patients admitted to a secondary care hospital in South India into DM patients and Non-DM patients. Data regarding the past medical and medication history was collected on the day of admission and the patients were regularly followed up till discharge or death. The outcome measures including duration of hospital stay, mortality, need for ICU care/mechanical ventilation were compared between the two groups. Data is extracted and statistically analyzed using Pearson correlation. Results: Out of a total of 118 patients observed, 53 patients were diabetic and 65 were non-diabetic. Out of the 53 hyperglycemic patients, 39 patients were on metformin therapy while 15 patients were on insulin before admission due to COVID-19. A higher mortality rate was observed in the DM group when compared with the Non-DM group [26.4% (14) vs 9.23% (6)]. An increased random blood glucose levels at the time of admission had a positive correlation with mortality (p = 0.003). While insulin administration prior to admission had negative correlation with mortality [R value is -0.282 (p = 0.02)], increased insulin requirement during hospitalization is associated with poor outcomes [R value is 0.327 (p = 0.002)]. Conclusions: People with diabetes when infected with COVID-19 are at a greater risk of morbidity and mortality. The study highlights the need for rational management of hyperglycemia in COVID patients with a history of diabetes mellitus.

POSA21 An In-Hospital Study to Trace the Risk Factors Associated with Adverse Drug Reactions during the Second Wave of COVID-19 in a Secondary Care Hospital in India

Objectives: To characterize the adverse drug reactions (ADRs) and the risk factors associated with COVID -19 treatment in a secondary care hospital in South India. Methods: A prospective observational study was carried out on 327 patients admitted between April 1 and May 15, 2021, using an in-person surveillance system. The demographic characters of all the patients including the time of admission, comorbid diseases, length of stay, history of drug allergies, and the number of medications used during hospitalization were collected. After identification of an adverse drug event, the causality, suspicious drugs, and prognosis of ADRs were also recorded. Descriptive statistics and multivariate logistic regressions were carried out to analyze the risk factors of ADRs. Results: Out of the 327 patients, 194 (59.3%) were men and the mean age was 45.7± 16.6 years. 122 ADRs were reported among 87 patients with an incidence rate of 26.6%. Most of the reactions were associated with dexamethasone (31.9%), remdesivir (18%), and favipiravir (14.7%) with dexamethasone-induced hyperglycemia being most prominent. The majority of the suspected ADR cases were categorized as probable (61.8%) according to the WHO-UMC causality assessment. When compared with the No ADRs group, the length of stay (p=0.004), history of drug allergies (p<0.001), number of drugs used in treatment (p<0.001) were significantly higher in the ADRs group. Multivariable analysis revealed that length of stay (OR: 2.03;95% CI 1.02–3.98;P = 0.04), comorbidities (OR: 2.08;95% CI 1.05–4.18;P = 0.04), number of drugs used for treatment (OR: 3.17;95% CI 1.60–6.27;P = 0.001) and were independent risk factor for ADRs in the patients. Conclusions: Active surveillance measures are important in case of all drugs used for COVID treatment to keep the living guidelines the most live one.

An Active Surveillance Study to Trace the Risk Factors Associated with Adverse Drug Reactions in COVID-19 Treatment: An International Journal of Medical Toxicology and Drug Experience

Background/Introduction: Second wave of COVID-19 in India has been drastic in terms of the number of people affected directly and indirectly. Objective/Aim: To characterize the adverse drug reactions (ADRs) and its the risk factors in COVID -19 treatment in a secondary care hospital in South India. Methods: A prospective observational study was carried out on 327 patients admitted between April 1 and May 15, 2021 using an active in person surveillance system. The demographic characters of all the patients including the time of admission, comorbid diseases, length of stay, history of drug allergies and the number of medications used during hospitalization were collected. After identification of an adverse drug event, the causality, suspicious drugs and prognosis of ADRs were also recorded. Descriptive statistics and multivariate logistic regressions were carried out to analyze the risk factors of ADRs. Results: Out of the 327 patients, 194 (59.3%) were men and the mean age was 45.7 ± 16.6 years. 122 ADRs were reported among 87 patients with an incidence rate of 26.6%. Most of the reactions were associated with dexamethasone (31.9%), remdesivir (18%) and favipiravir (14.7%) with dexamethasone induced hyperglycemia being most prominent. Majority of the suspected ADR cases were categorized to probable (61.8%) according to WHO-UMC causality assessment. When compared with the No ADRs group, the length of stay (p = 0.004), history of drug allergies (p < 0.001), number of drugs used in treatment (p < 0.001) were significantly higher in the ADRs group. Multivariable analysis revealed that length of stay (OR 2.03;95% CI 1.02-3.98;P = 0.04), comorbidities (OR 2.08;95% CI 1.05-4.18;P = 0.04), number of drugs used for treatment (OR 3.17;95% CI 1.60-6.27;P = 0.001) and were independent risk factor for ADRs in the patients. Conclusion: Active surveillance measures are important in case of all drugs used for COVID treatment so as to keep the living guidelines the most live one.

Steroid Stewardship as a Tool to Tackle Glucocorticoid Induced Hyperglycemia in COVID-19 Patients: An International Journal of Medical Toxicology and Drug Experience

Background/Introduction: Hyperglycemia has been identified as an independent predictor of mortality in hospitalized patients with COVID-19. Administration of systemic corticosteroids can worsen the incidence of hyperglycemia in COVID-19 patients. Objective/Aim: To characterize the incidence of Glucocorticoid Induced Hyperglycemia (GCIH) in COVID -19 patients and to evaluate the effectiveness of a Steroid Stewardship Program in countering this effect. Methods: This prospective, interventional study included 100 COVID-19 confirmed patients admitted between March 12-May 12, 2021 who are categorized into B&C as per the guidelines of directorate of health services, Kerala, India. A five-item Steroid Appropriate Index (SAI) was prepared based on the onset of symptoms, weight of the patient, CT Thorax severity score, preferred route of administration and the underlying diseases for choosing the appropriate doing of the preferred corticosteroid. Demographic profile of these patients was collected and they were followed up till discharge/death to track the incidence of worsening of hyperglycemia or new onset of diabetes. The effectiveness of SAI was analyzed by comparing the data of treatment and clinical outcome among 100 COVID-19 confirmed patients admitted before and after implementation of the scale. Results: Majority of the patients were males (57) and the mean age was 45.7 ± 16.6 years. The incidence of new onset of hyperglycemia i.e., GCIH was more among the retrospective cohort when compared with the SAI cohort (7% vs 26%, p < 0.001). The study also revealed that past history of diabetes (p < 0.001), age (p = 0.002), number of medicines used for treatment (p<0.001) are significantly associated with glucocorticoid induced hyperglycemia. Conclusion: The appropriate selection of corticosteroids based of the real-world scenarios can decrease the incidence of adverse events associated. Implementation of steroid appropriate index and proper monitoring can be an aid for the same.

PNS198 Arogya Setu Mobile Application for COVID-19 Self-Assessment, Education and Participatory Disease Surveillance: Perception Among Medical and Technology University Students

Objectives: Technology plays a tremendous role in the active surveillance and communication in COVID-19 containment. We estimate the perceptions of medical and technology university students from India towards the use of Arogya Setu mobile application developed by the Ministry of Health and Family Welfare, Government of India. Methods: An online cross-sectional survey, using a quick snowball sampling was conducted among total of 445 professional students randomly selected from Indian state of Kerala, including 234 and 211 from medical and technology universities respectively. The study was conducted during the month of May 2020, by disseminating the questionnaire in the social media platforms. Results: Among the study participants, majority (411;92.3%) belong to an age category less than 25 years and with a male preponderance of 54.6% (43). Out of the 97.9% (436) students who were aware of the Arogya Setu app, only a very few number (46;10.3%) downloaded the app. While most of the participants choose television news, social media and print news (23.6%, 45.1%, and 12.2% respectively) for COVID-19 related information, hardly any had opted Arogya Setu. Data privacy (231;51.9%) and low quality use interface (62;13.9%) were reported as the main reasons for ignoring the use of the app. It was found that 288 (64.7%) students had taken a self-assessment test with majority from medical background (174;39.1%). No significant association was observed with the use of Arogya Setu across age, sex or place of living. In contrast, place of living was significantly associated with the source of information regarding COVID-19 (p =0.007). Conclusions: Participatory surveillance applications like Arogya Setu are crucial in providing insights of infection distribution data to control the community transmission of COVID-19. An appropriate user interface, engaging content and proper awareness regarding the application may boost the use among the students as well as professionals.

PIN102 IMPACT of National Lockdown on Gaming Behavior and Internet Usage of College Students: An Insight from India

Objectives: The uncertainty created by the national lockdown due to COVID-19 has created a stress among the vulnerable college going young students across the world. The study aimed to assess the changing trends in gaming behavior and internet usage among the college students during the lockdown period. Methods: An online cross sectional study was conducting by disseminating a google forms based questionnaire through social media networks and E-mail. Descriptive statistics and Odds ratio is calculated to identify the relationship between variables of interest. Results: Out of the total of 574 participants involved in the study, with a male preponderance of 57.1%, majority (n=366;63.7%) reported an increase in gaming hours during lockdown. Among internet users, the time was allotted sequentially as for Social media networking (n=423;73.6%), watching Netflix (n=325;56%), games (n=244;42.5%). In binary logistic regression analysis, hours of gaming per day (odds ratio [OR] 1.63 [1.21–2.16]), increase in gaming due to stress (OR 4.76 [1.07–20.78]), and belief that gaming helps managing stress (OR 4.23 [1.62–10.03]), were associated with gaming behavior and internet use during lockdown period. Conclusions: Increase in gaming behavior during the lockdown attributed towards increasing stress and as a belief to manage stress. This highlights the need of other coping mechanisms to combat stress.

PIN70 Knowledge Towards Universal Safety Precautions Among Healthcare Population in India during Initial Phase of COVID-19: A Web Based Survey

Objectives: The first case of COVID–19 in India surfaced in the state of Kerala on January 31 2020. Hence, an early exploration of knowledge and perceptions of medical students and professionals, regarding transmission and universal safety precautions during the early phase of the disease is aimed in the study. Methods: A web-based, online cross-sectional survey was conducted among the healthcare population in India during late February 2020. A questionnaire was designed to assess the knowledge regarding clinical and epidemiological characters of COVID-19 along with the universal safety precautions. A virtual snowball sampling using predesigned google forms were disseminated through social media networks. Descriptive statistics along with Chi-square test were performed with a p-value of < 0.05 was considered as statistically significant. Results: Among the 983 participants who provided their consent of willingness and completed the questionnaire, 63% represented pharmacy profession followed by 14% from nursing discipline. Even though the age of study population varied from 18 – 79 years and with a female preponderance of 54.1% (n = 532), students as a whole participated largely in the study (68.1%, n = 670). A mean knowledge score of 3.21±1.14 (out of 6) indicated inadequate knowledge among the study population. The study revealed that there is no statistically significant difference in knowledge score based on age, place of living and medical discipline, but a significant association was observed between knowledge level and gender (p = 0.004). Conclusions: The knowledge regarding universal safety precautions and transmission of a disease is vital in preventing the community spread, while an inadequate and improper knowledge among medical population can amplify the spread. Online classes and training programs should be initiated at the university levels as well as a part of CME curriculum for up gradation of early knowledge regarding COVID-19.

Knowledge pertaining to COVID19 among medical population of Indian state of Kerala: An online cross-sectional survey

The coronavirus disease 2019, the first case of India surfaced in Kerala. Hence, an exploration of knowledge of medical professionals regarding transmission and steps adopted for prevention and spread of disease was assessed via a cross-sectional study, designed and disseminated through media. The study revealed no significant difference in knowledge score based on district, age and medical discipline. However, majority of the participants lacked basic knowledge and opted social media to update knowledge, which pinpoints towards the need for online training courses in newer disaeses.