Antibody response to COVID-19 vaccines used in India: An observational cohort study among healthcare workers

Background: COVID-19 pandemic witnessed rapid development and use of several vaccines. In India, a country-wide immunization was initiated in January 2021. COVISHIELD, the chimpanzee adenoviral vectored vaccine with full length SARS-COV-2 spike insert and COVAXIN, the whole virus, inactivated vaccine, were used. Objective(s): The present study was aimed at assessment and comparison of antibody response to COVISHIELD and COVAXIN. Material(s) and Method(s): Blood samples were collected pre-vaccination, 1 month post-1/post-2 doses and 6 months post-dose-2, from healthcare workers receiving COVISHIELD and COVAXIN vaccines. The samples were tested for IgG-anti-SARS-CoV-2 (ELISA) and neutralizing antibodies (Nab, PRNT50). Result(s): In pre-vaccination-antibody negative COVISHIELD recipients (pre-negatives, n = 120), % Nab seroconversion increased from 55.1% post-dose-1 to 95.6% post-dose-2, that were independent of age/gender/BMI. Presence of co-morbidities reduced Nab titers (p = 0.004). In pre-positives (n = 67), Nab titers increased to 40.7 fold from 75 (IQR 29-129) before vaccination to 3050 (IQR 1282-3998, p<0.001) post-first-dose, but declined to 1740 (IQR 911-3116, p = 0.037) post-2nd-dose. Nab response in pre-positives was independent of age/gender/BMI/co-morbidities. Post-dose-2 seroconversion (50%, p<0.001) and Nab titers (6.75, 2.5-24.8, p<0.001) in COVAXIN recipients were lower than COVISHIELD. Diminished Nab titers were observed at 6 months post-dose-2 for both vaccines. Conclusion(s): This first-time, systematic, real-world assessment revealed generation of higher neutralizing antibody titers by COVISHIELD. Relation of dose interval and decline in Nab titers post- 2nd-dose in pre-positives need further assessment. Diminished Nab titers at 6 months emphasize early booster.

Added value of the measles-rubella supplementary immunization activity in reaching unvaccinated and under-vaccinated children, a cross-sectional study in five Indian districts, 2018-20.

INTRODUCTION: Supplementary immunization activities (SIAs) aim to interrupt measles transmission by reaching susceptible children, including children who have not received the recommended two routine doses of MCV before the SIA. However, both strategies may miss the same children if vaccine doses are highly correlated. How well SIAs reach children missed by routine immunization is a key metric in assessing the added value of SIAs. METHODS: Children aged 9 months to younger than 5 years were enrolled in cross-sectional household serosurveys conducted in five districts in India following the 2017-2019 measles-rubella (MR) SIA. History of measles containing vaccine (MCV) through routine services or SIA was obtained from documents and verbal recall. Receipt of a first or second MCV dose during the SIA was categorized as "added value" of the SIA in reaching un- and under-vaccinated children. RESULTS: A total of 1,675 children were enrolled in these post-SIA surveys. The percentage of children receiving a 1st or 2nd dose through the SIA ranged from 12.8% in Thiruvananthapuram District to 48.6% in Dibrugarh District. Although the number of zero-dose children prior to the SIA was small in most sites, the proportion reached by the SIA ranged from 45.8% in Thiruvananthapuram District to 94.9% in Dibrugarh District. Fewer than 7% of children remained measles zero-dose after the MR SIA (range: 1.1-6.4%) compared to up to 28% before the SIA (range: 7.3-28.1%). DISCUSSION: We demonstrated the MR SIA provided considerable added value in terms of measles vaccination coverage, although there was variability across districts due to differences in routine and SIA coverage, and which children were reached by the SIA. Metrics evaluating the added value of an SIA can help to inform the design of vaccination strategies to better reach zero-dose or undervaccinated children.

UNDERSTANDING THE PALLIATIVE CARE INFORMATION CIRCULATING ON TWITTER DURING THE CORONAVIRUS PANDEMIC

Palliative care is a growing medical specialty. While its value has become particularly evident during the pandemic, it faces various challenges including misconceptions among the general public, a lack of awareness of its benefits, and limited/sporadic access and coverage by Medicare. Given the increasing number of people sharing their health information and seeking healthcare information on social media where misinformation is widely spread, this study examined types of information on palliative care circulated on Twitter. A total of 26,495 English Tweets were collected 01/01/2020 – 12/30/2021 using the keywords "Palliative” and "Covid” or "Corona”. We manually developed a framework for coding/classifying the first 6,000 Tweets. Of those, 5,308 were unrelated Tweets (e.g., advertising palliative care seminars/conferences). Among the remaining Tweets, persistent myths were observed (e.g., palliative care is only for dying people) and were labeled accordingly. In addition, while some people mentioned negative impact of the pandemic on palliative care (e.g., shortage of beds), others found value in palliative care and reported positive changes due to the pandemic (e.g., telehealth in palliative care). Consequently, the following categories were defined for Tweets: i) Recognized benefits (203 Tweets);ii) Positive impact of the pandemic on palliative care (120 Tweets);iii) Negative impact of the pandemic on palliative care (333 Tweets);iv) Myth (63 Tweets). We will use these manually classified Tweets to train machine-learning algorithms to automatically classify the remaining tweets, aiming to obtain a comprehensive understanding of palliative care information circulating on Twitter and seek ways to promote palliative care use.

Phase 1 clinical trial for intravenous administration of mesenchymal stem cells derived from umbilical cord and placenta in patients with moderate COVID-19 virus pneumonia: results of stage 1 of the study

Objective: Mesenchymal stem cells can serve as a therapeutic option for COVID-19. Their immunomodula-tory and anti-inflammatory properties can regulate the exaggerated inflammatory response and promote recovery of lung damage. Method: Phase-1, single-centre open-label, prospective clinical trial was conducted to evaluate the safety and efficacy of intravenous administration of mesenchymal stem cells derived from umbilical cord and placenta in moderate COVID-19. The study was done in 2 stages with total 20 patients. Herein, the results of stage 1 including first 10 patients receiving 100 million cells on day 1 and 4 with a follow up of 6 months have been discussed. Results: No adverse events were recorded immediately after the administration of MSCs or on follow up. There was no deterioration observed in clinical, laboratory and radiological parameters. All symptoms of the study group resolved within 10 days. Levels of inflammatory biomarkers such as NLR, CRP, IL6, ferritin and D-dimer improved in all patients after intervention along with improved oxygenation demonstrated by improvement in the SpO2/FiO2 ratio and PaO2/FiO2 ratio. None of the patients progressed to severe stage. 9 out of 10 patients were discharged within 9 days of their admission. Improvements were noted in chest x-ray and chest CT scan scores at day 7 in most patients. No post-covid fibrosis was observed on chest CT 28 days after intervention and Chest X ray after 6 months of the intervention. Conclusion: Administration of 100 million mesenchymal stem cells in combina-tion with standard treatment was found to be safe and resulted in prevention of the cytokine storm, halting of the disease progression and acceleration of recovery in moderate COVID-19. This clinical trial has been registered with the Clinical Trial Registry-India (CTRI) as CTRI/2020/08/027043. http://www.ctri.nic.in/Clinicaltrials/pmaindet2. php?trialid=43175.

Nationwide CoViD-19 lockdown impact on air quality in India

This paper presents the comparative results of surface and satellite measurements made during the Phase 1 (25 March to 14 April), Phase 2 (15 April to 3 May) and Phase 3 (3 May to 17 May) of Covid-19 imposed lockdown periods of 2020 and those of the same locations and periods during 2019 over India. These comparative analyses are performed for Indian states and Tier 1 megacities where economic activities have been severely affected with the nationwide lockdown. The focus is on changes in the surface concentration of sulfur dioxide (SO2), carbon monoxide (CO), PM2.5 and PM10, Ozone (O-3), Nitrogen dioxide (NO2) and retrieved columnar NO2 from TROPOMI and Aerosol Optical Depth (AOD) from MODIS satellite. Surface concentrations of PM2.5 were reduced by 30.59%, 31.64% and 37.06%, PM10 by 40.64%, 44.95% and 46.58%, SO2 by 16.73%, 12.13% and 6.71%, columnar NO2 by 46.34%, 45.82% and 39.58% and CO by 45.08%, 41.51% and 60.45% during lockdown periods of Phase 1, Phase 2 and Phase 3 respectively as compared to those of 2019 periods over India. During 1st phase of lockdown, model simulated PM2.5 shows overestimations to those of observed PM2.5 mass concentrations. The model underestimates the PM2.5 to those of without reduction before lockdown and 1st phase of lockdown periods. The reduction in emissions of PM2.5, PM10, CO and columnar NO2 are discussed with the surface transportation mobility maps during the study periods. Reduction in the emissions based on the observed reduction in the surface mobility data, the model showed excellent skills in capturing the observed PM2.5 concentrations. Nevertheless, during the 1st & 3rd phases of lockdown periods AOD reduced by 5 to 40%. Surface O-3 was increased by 1.52% and 5.91% during 1st and 3rd Phases of lockdown periods respectively, while decreased by-8.29% during 2nd Phase of lockdown period.

Journey of Natural Killer Cells and their Role in Liver Diseases

Natural Killer (NK) cells are the key lymphocyte subset of the natural immune system that arbitrates antiviral and anticancer responses. In the human body NK cells inhabit in the bone marrow, lymph nodes, tonsils, skin, liver, gut, and lungs. This bibliographic study covers the origins and evolution of these cells. This review of NK cells includes synopsis of their well-known and evolving themes including their development, functions of cytokine production, anticancer cytotoxicity, clearing of viral infections and exhaustion. Within the liver, NK cells are enhanced in lymphocytes and possess distinctive phenotypic characters and useful properties, which contain tumour cytotoxicity and explicit cytokine profiles. NK cells, while providing innate immunity in the liver, play important roles in providing protection versus pathogens and tumours utilising their cytotoxicity and cytokine production. Accruing substantiation from the last few decades proposes that NK cells perform a vital role in regulating viral hepatitis and liver tumours. In addition, they contribute to the pathogenesis of liver damage including its inflammation. Understanding the description of hepatic NK cell functions has aided us in better understanding the pathogenesis of diseases of the liver and consequently divulging novel therapeutic goals for treating these illnesses.

Enhancing the Online Engineering Education during COVID-19 Period: A Blended Approach of Online Tools

An unplanned shift into educational sector, from physical education to virtual, online education has been caused by the COVID-19 pandemic. Within no time, the passionate educators and learners sought the support of e-Learning where teaching is being done through remote, digital platforms. In this paper, an approach pursued by us has been presented that was used for delivering the enhanced online engineering education to our students in the period of COVID-19 pandemic. Through use of technologies such as GoTo Webinar tool, Udemy online learning platform and the LearniCo student mobile application, the approach has achieved a soothed quality education delivery The approach has demonstrated a touch of personalized and on-demand learning with improved engagement of the online attendees. This approach has generated promising statistics about the learning inclination, understanding levels and adaption rate percentage by the online attendees including their reviews and feedbacks. The motivating statistics of the students embracing to this approach has been the proof of its impact. © 2022, Rajarambapu Institute Of Technology. All rights reserved.

Covid-19-associated fungal osteomyelitis of jaws and sinuses: An experience-driven management protocol.

Invasive fungal co-infections with COVID-19 are currently being reported at an alarming rate. Our study explores the importance of early identification of the disease, probable etiopathogenesis, clinical and radiological features and a treatment protocol for COVID-19 Associated Fungal Osteomyelitis of Jaws and Sinuses (CAFOJS). A one-year prospective study from June 2020 to May 2021 was conducted among CAFOJS diagnosed patients at a tertiary care center in South India. Demographic details, COVID-19 infection and treatment history, time taken for initiation of symptoms after COVID-19 diagnosis, medical history and clinical features were recorded. All patients were managed with a standard diagnostic and intervention protocol which included pre-operative and post-operative administration of Inj. Amphotericin B 50 mg (liposomal), early aggressive surgical debridement and tab. Posaconazole GR 300 mg OD for 90 days after discharge. Thirty-nine (78%) patients were diagnosed with CAFOJS out of 50 osteomyelitis patients. 35 patients (90%) were diabetic and 21 patients (54%) were known to receive steroids during the COVID-19 treatment. Sole existence of Mucorales spp. was seen in 30 patients (77%), Aspergillus fumigatus in 2 patients (5%), Curvularia spp. in 2 patients (5%). Concomitant existence of Mucorales and Aspergillus fumigatus was reported in two patients (5%) and Candida albicans in three patients (8%). Patients underwent treatment with standard protocol and no recurrence noted. CAFOJS is a clinical entity with aggressive presentation and warrants early diagnosis and treatment. LAY SUMMARY: Invasive fungal infections of head and neck region cause necrosis of bones affected by it, especially maxilla. Early diagnosis and treatment are advocated in such infections due to its aggressive clinical presentation compared to similar infections before COVID-19 pandemic.

Depression and Anxiety in Persons with Von Willebrand Disease

[Formula presented] Background: Depression and anxiety are associated with poor health-related quality of life (HRQoL), lower functioning and decreased treatment adherence. In 2019, 7% adults in the US had moderate/severe symptoms of depression, while <5% had anxiety. Impacts of depression and anxiety in persons with von Willebrand disease (VWD) are unclear and less studied. Objective: We assessed sociodemographic and clinical characteristics associated with depression and anxiety in a geographically diverse cohort of individuals with VWD obtaining care at seven US Hemophilia Treatment Centers (HTCs). Methods: The study enrolled and collected data on individuals age ≥12 with VWD Type 1 (VWF:Ag/RCo: ≤30%), low VWF(VWF:Ag/RCo: 30-50%), Type 2, and type 3 between September 2018-June 2021. Participants completed a survey at enrollment to collect sociodemographic and clinical characteristics, self-reported pain, joint problems and HRQoL measured by the EQ-5D-3L. A quarterly survey administered one year post-enrollment collected similar data. The patient health questionnaire (PHQ-8) and the generalized anxiety disorder (GAD-7) were administered with the last follow-up survey after August 2019. Chart reviews ed VWD type information. The association of sociodemographic and clinical characteristics with depression or anxiety was assessed using Chi-square tests for categorical variables, as well as logistic regression models with stepwise selection. Results: We analyzed data from 77 participants who completed both baseline and last follow-up surveys. Mean age was 34.2 (standard deviation (SD)=18.8) years, 74.0% were adults ≥18 years, 79.2% were female, 60.8% had Type 1/low VWF, and 3.9% had Type 3 VWD. Mean age at VWD diagnosis was 13.9 (SD=13.2) years. Overall reported depression rate was 63.4%, and 58.3% for anxiety (values ≥10 on either PHQ-8 or GAD-7). Proportion of those with depression (75% vs. 62%) or anxiety (58% vs. 58%) prior to and during the COVID-19 pandemic were not significantly different. Persons with low VWF had higher rates of depression (86.7%) or anxiety (69.2%) as compared to those with type 1 VWD (55.3% for depression, 52.8% for anxiety) or types 2 and 3 (62.5%, 60.9%, p=0.10, not significant (NS) for depression and p=0.56, NS for anxiety, respectively). Females reported a higher rate of anxiety (61.4%) than males (46.7%, p=0.30, NS). When compared to individuals who rated their general health as the same or better than 3-months ago, those who rated their health as worse had significantly higher rates of depression (92.3% vs. 57.8%, p=0.02) and anxiety (83.3% vs. 53.3%, p=0.05). Participants with chronic pain reported a significantly higher depression rate (81.6% vs. 36.8%, p=0.0003). Those who reported having joint problems also reported depression at a significantly higher rate (82.4% vs. 48.8%, p=0.002) or anxiety (74.1% vs. 46.3%, p=0.02) than those without joint problems. Logistic regression analyses demonstrated that among adults or parents of pediatric patients, being single or not with a partner was the most important variable associated with depression (odds ratio (OR)=7.0, confidence interval (CI): 1.7-29.0), followed by having joint problems (OR=6.3, CI=2.0-20.1). The most important variable associated with anxiety was being a youth aged 12-18 years old (OR=6.7, CI=1.6-26.9), followed by being single or not with a partner (OR=10.8, CI=2.5-47.5), or having worse health compared to 3-months prior (OR=12.3, CI=1.3-116.2). Mean covariates adjusted EQ index scores were lower among persons with depression (0.75±standard error (SE) 0.03 vs. 0.83±0.04, p=0.06 NS) or anxiety (0.75±0.03 vs. 0.82±0.04, p=0.7 NS) than among those without depression or anxiety. As compared to individuals without depression or anxiety, mean covariates adjusted EQ VAS was significantly lower in persons with depression (68.7±3.1 vs. 77.6±4.2, p=0.03), but not among those with anxiety (69.3±3.7 vs. 71.3±4.3, p=0.66 NS). Conclusions: Our study revealed higher rates of major depression and anxiety in thi VWD sample than the general US population. Depression had a significant negative impact on HRQoL. Mental health screening is imperative for persons with VWD, especially those with low VWF, chronic pain or joint problems. Special attention should be paid to women and youth. This study underscores the need for a multidisciplinary approach in the comprehensive care of patients seen at HTCs. Disclosures: Roberts: Genentech, Novo Nordisk, Octapharma, Pfizer, Sanofi, Takeda, uniQure: Consultancy;Takeda;Speakers Bureau: Novo Nordisk, Octapharma, Sanofi, Takeda.: Research Funding. Kulkarni: Genentech: Honoraria, Membership on an entity's Board of Directors or advisory committees;CSL Behring: Honoraria, Membership on an entity's Board of Directors or advisory committees;Shire/Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees;Novo Nordisk: Honoraria, Membership on an entity's Board of Directors or advisory committees;Bayer: Honoraria, Membership on an entity's Board of Directors or advisory committees;Sanofi Genzyme: Honoraria, Membership on an entity's Board of Directors or advisory committees;Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees;Octapharma: Honoraria, Membership on an entity's Board of Directors or advisory committees. Sidonio: Bayer: Consultancy;Catalyst: Consultancy;Genentech: Consultancy, Research Funding;Novo Nordisk: Consultancy;Guardian Therapeutics: Consultancy;Octapharma: Consultancy, Research Funding;Biomarin: Consultancy;Pfizer: Consultancy;Takeda: Consultancy, Research Funding. Carpenter: Genentech: Honoraria;Novo Nordisk: Honoraria;Kedrion Pharmaceuticals: Honoraria;Hemophilia and Thrombosis Research Society: Membership on an entity's Board of Directors or advisory committees. Konkle: Pfizer, Sangamo, Sanofi, Sigilon, Spark, Takeda and Uniqure: Research Funding;BioMarin, Pfizer and Sigilon: Consultancy. Wu: Baxalta US Inc., Bannockburn, IL (a Takeda Company), CSL Behring L.L.C., Octapharma USA, Inc., Genentech Inc.: Research Funding. Curtis: Pfizer, Bayer, and Novo Nordisk: Consultancy;University of Southern California: Consultancy. Nichol: Pfizer, Genentech Inc., Baxalta US Inc., Bannockburn, IL (a Takeda Company), Octapharma, CSL Behring, Global Blood Therapeutics, and Novo Nordisk: Research Funding.

Performance analysis of k-nearest neighbor classification algorithms for bank loan sectors

An attempt has been made to develop an algorithm for banks to check the credibility of borrowers to avoid nonperformance assets. People move towards different banks for loan purpose to fulfil their financial needs. Approaching bank for loan is increasing day by day mainly for child marriage, education, agriculture, business, home loan etc. Some people take the loan and they won't pay back in time or some will move out of the country without any intimation, so that bank will go in loss. Even now in covid-19 pandemic many industries were closed but they need to give salary to the employees, need to pay rent and electricity bills too for that they will approach bank for loan. For all these cases bank first need to analyse their Credit Information Bureau India Limited score and check whether they had done loan repayments in appropriate time or not. In the present work the effectiveness of K nearest neighbor algorithm were analysed. This research were carried out using python. The accuracy of this classifier is analysed using following metrics such as Jaccard index, F1-score and LogLoss. This helps to find the potential of the customer which is much higher than the data mining classification algorithm and thus it helps in sanctioning loans. © 2021 The authors and IOS Press.

Knowledge, attitude, and practices among police force toward covid-19 pandemic during Lockdown in Pune, India - An Online cross-sectional survey

Background: COVID-19 has affected millions of people and more than thirty thousand deaths. Social distancing and lockdown are important measures for prevention. Police personnel are losing their lives due to COVID-19 while doing their duty in this lockdown time. Aim: The study aims to assess knowledge, attitude, and practices (KAP) of police force toward COVID-19. To assess correlation of knowledge with their practices and attitude. Materials and Methods: A cross-sectional, self-administered, anonymous survey questionnaire was administered to 8706 police personnel and data collected over a time period from April 11 to 16, 2020. We used t-test and multivariable binary logistic regression analysis to identify the association between KAP and demographic variables. Results: In all 8706 police personnel participated in the study. The median age of participants was 35 years (interquartile range: 19-59), 6787 (77.9%) were male, 6675 (76.6%) were of constable grade. Seven thousand three hundred thirty-two (83.7%) of participants recorded accurate (high) knowledge, and 6790 (78%) reported following preventive practices. Female participants were more likely to follow preventive measures despite low knowledge as compared to their male counterparts (P < 0.0001). Female gender, age more than 35 years, and lower rank were associated with low knowledge and fear of contracting the disease. Multivariable binary logistic regression analysis showed that low knowledge is significantly associated with fear of getting disease odds ratio 1.29;95% confidence interval (1.15-1.46). Conclusion: In a cohort of police personnel, overall knowledge about COVID-19 is high. Female participants are found to be practicing appropriate preventive measures and they have faced stigmatizing behavior from society. The study provides important information on the need for developing health awareness programs to improve COVID-19 KAP. © 2021 Medical Journal of Dr. D.Y. Patil Vidyapeeth.

The prognostic significance of neutrophil-lymphocyte ratio (NLR) in patients with COVID-19

INTRODUCTION: Neutrophil lymphocyte ratio (NLR) is elevated in response to stressful stimuli and has been shown to be associated with poor prognosis in both benign & malignant disorders. Literature regarding NLR as a prognostic marker in COVID19 are limited. Our study was aimed to investigate the relationship between NLR & survival outcomes in patients hospitalized with Coronavirus disease 2019 (COVID19). METHODS: Ours was a single center, retrospective observational study, which included 472 nasopharyngeal swab SARS-CoV-2 RT-PCR positive patients. NLR was derived from the admission complete blood count & was divided into 5 sub-groups as (0-0.99, 1-2.99, 3-9.99, 10-19.99, >20). Demographics, comorbid conditions, and outcomes such as need for mechanical ventilation, length of stay and inpatient mortality were assessed. Statistics were performed using STATA. Significance was assigned at p<0.05. RESULTS: The mean age was 71.16 years in NLR >10 group as compared to 60.3 years in patients with normal NLR 1-2.99. Male patients were found to have much higher NLR than females (65.12% vs 34.88% in NLR 10-19.99, 64.86% vs 35.14% in NLR>20;p-value: 0.05). Among comorbidities, COPD patients were found to have higher NLR (18.92% of NLR>20 vs 10.71% of NLR 1-2.99;p-value:0.02). Rate of endotracheal intubation and need for mechanical ventilation was significantly higher with increasing NLR (0% vs 7% vs 14% vs 17% vs 32%;p-value: 0.03). Inpatient mortality was significantly higher in patients who had NLR>20 (70.27% of NLR>20 vs 16.07% of NLR 1-3 p-value <0.0001). On multivariate regression, patients with NLR>20 had 4 times higher odds of mortality;however, the p-value was not significant (4.07±2.78 p-value: 0.175). CONCLUSIONS: Increasing NLR in COVID19 patients is associated with increased ICU admission, intubation & inpatient mortality. Further studies are warranted to establish NLR, which is readily available & inexpensive, as a potential prognostic indicator in COIVD19 patients.

The prognostic significance of absolute lymphocyte count in patients with COVID-19

INTRODUCTION: The host immune responses try to confront Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with all the potential cells and cytokines. Eventually, natural killer cells and T cells become exhausted, decreasing their counts, leading to lymphopenia. This study aims to assess the clinical utility of the absolute lymphocyte count (ALC) at admission in predicting outcome in patients with COVID-19. METHODS: Ours was a single-center, retrospective observational study, which included 463 nasopharyngeal swabs SARS-CoV-2 RT-PCR positive patients. Absolute lymphocyte count was retrieved from the admission complete blood count & was divided into 3 sub-groups (<500, <1000, and >1000 cells/μL). Demographics, comorbid conditions, and outcomes such as the need for mechanical ventilation, length of stay, and inpatient mortality were assessed. Statistics were performed using STATA. Significance was assigned at p<0.05. RESULTS: 13.82% of patients had ALC count<500, 44.71% had <1000 and 41.25% had more than 1000. Mean age in ALC group<500 was higher (71±1 years vs 65± 1.1 years in ALC group <1000 and 59.9+/-1.3 in ALC group >1000). Profound lymphopenia (<500 cells/μL) was more common in males compared to females (71.88 % vs 28% p value 0.01). ALC count <500, was associated with higher rate of non-invasive (45.31% vs 26.56% for ALC <1000, p-value: 0.01) as well as invasive ventilation (26.5% with ALC <500 vs 19% with ALC <1000 vs 10.4% with ALC with >1000;p-value: 0.01). Inpatient mortality was significantly higher in cohort with ALC <500 (51.56% with ALC <500 vs 33.3% with ALC <1000 vs 24.08% with ALC >1000;p-value 0.05). On multivariate regression, ALC was not a independent predictor of mortality (ALC<500, OR: 1.56±0.75, p-value: 0.44). CONCLUSIONS: Lymphopenia at admission in COVID19 patients is associated with an increased need for non-invasive & invasive ventilation & inpatient mortality. Currently, clinical trials assessing GM-CSF as a possible therapeutic option is underway.

Can age alone be used as a guide for decision-making in COVID-19 patients? a retrospective study

INTRODUCTION: Coronavirus disease 2019 (COVID- 19) caused by the SARS-CoV-2 virus has emerged as one of the greatest challenges to humanity in recent history. Older people have shown to have poor outcomes in recent studies. Our study looks at the characters and outcomes in patients of different age groups admitted to our center. METHODS: Our study is a single-center, retrospective, observational study of 471 COVID-19 patients (confirmed with a positive nasopharyngeal swab for SARS-CoV2 RT PCR) admitted to our hospital. Patients were divided into 3 groups based on Age (0-45 years, 46-65 years, and >65 years). Demographic characteristics and in-hospital outcomes were compared between these groups. STATA was used to perform statistics. Statistical significance was assigned at p=<0.05. RESULTS: 471 patients were included in the study of which 79 (16.77%), 159 (33.76%), and 233 (49.47%) belonged to the age group of 0-45 years (Group A), 46- 65 years (Group B) and >65 years (Group C) respectively. On comparison of pre-existing comorbidities, patients in group B and group C had a higher incidence of baseline comorbidities (Diabetes, Hypertension, Heart failure, COPD rates were 33.96% vs 43.1%, 55.35% vs 81.12%, 9.01% vs 20.59%, 2.5% vs 11.21% respectively). On comparing in-hospital outcomes, the mean time to mechanical ventilation from admission was 3.25 (±1.31) days, 2.42 (±0.68) days and 2.75 (±0.53) days for group A, B and C respectively. 74 (15.71%) patients required intubation during hospitalization of which 7.5%, 32.5%, and 60% belonged to groups A, B, and C respectively. The overall mortality rate among intubated patients was 90.54% among which 8.15%, 31.08%, and 60.81% belonged to groups A, B, and C respectively. The inhospital mortality rate was 32.48% of which 3.27%, 17.65%, and 79.08% belonged to groups A, B, and C respectively. In-hospital mortality rate for group A, B and C were 6.33%, 16.98% and 51.93% respectively (p <0.0001). However, on multivariate regression analysis, age was not an independent predictor of in-hospital mortality for any age group. CONCLUSIONS: Patients >65 years of age have higher co-morbidities and worse in-hospital outcomes. However, age is not an independent predictor of mortality and each patient should be evaluated individually while making an important treatment decision.

The prognostic significance of lymphocyte-to-crp ratio (Lcr) in patients with COVID-19

INTRODUCTION: Systemic inflammation elicited by a cytokine storm is considered a hallmark of coronavirus disease 2019 (COVID-19). This study aims to assess the clinical utility of the lymphocyte-to-C-reactive protein (CRP) ratio (LCR), typically used for gastric & colorectal cancer prognostication. METHODS: Ours was a single center, retrospective observational study, which included 321 nasopharyngeal swab SARS-CoV-2 RT-PCR positive patients. LCR was derived from the admission complete blood count & was divided into 2 sub-groups (<99.99 vs >100). Demographics, comorbid conditions, and outcomes such as need for mechanical ventilation, length of stay and inpatient mortality were assessed. Statistics were performed using STATA. Significance was assigned at p<0.05. RESULTS: LCR <99.99 group had more elderly patients as compared to LCR >100 group (67.74% vs 54.01% of patients >60 years of age). Male patients were found to have lower LCR than females (60.75% vs 39.25% with LCR <99.99;p-value: 0.03). Among comorbidities, patients with history of cancer were found to have higher LCR (7.53% of LCR <99.99 vs 13.24% of LCR >100;p-value:0.03). Lower LCR was associated with higher rate of non-invasive (36.56% with LCR <99.99 vs 19.12% with LCR >100;p-value: 0.01) as well as invasive ventilation (17.74% with LCR <99.99 vs 11.76 with LCR >100;p-value: 0.01). Inpatient mortality was significantly higher in patients who had LCR <99.99 (39.25% with LCR <99.99 vs 22.63% with LCR >100;p-value <0.03). On multivariate regression, patients with LCR <99.99 had 2 times higher odds of mortality;however, this finding did not reach statistical significance. (2.27± 0.81 p-value: 0.15). CONCLUSIONS: Decreasing LCR in COVID19 patients is associated with increased need for non-invasive & invasive ventilation & inpatient mortality. Further studies are warranted to establish LCR, which is readily available & inexpensive, as a potential prognostic indicator in COIVD19 patients.

Outcomes of novel coronavirus disease in patients with diabetes mellitus: A retrospective analysis

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a multisystem infection caused by SARS-CoV-2 Virus. Recent studies have demonstrated poor outcomes in patients with diabetes mellitus (DM). We sought to assess the in-hospital outcomes of COVID19 patients with DM at our centre. METHODS: Ours was a single centre, retrospective, observational study of 470 COVID-19 patients admitted to our hospital. We divided these patients into 2 groups;those with DM and those without. We compared demographic characteristics, comorbid conditions, and in-hospital outcomes between the two groups. Statistics were performed using STATA. Statistical significance was assigned at p<0.05. RESULTS: Out of the 470 patients included in the study, 35.53% of patients had DM. Mean age of patients with and without DM was 68.35years±1.08 vs 61.71±1.05years respectively. 8.72% of patients were on pharmacological therapy. The diabetic cohort had a higher prevalence of hypertension, heart failure compared to the non-diabetic cohort (88.02 vs49.5% p-value:0.004, 22.9% vs 9.31% p-value: 0.04). Other comorbidities such as OSA, CKD, COPD, Asthma were comparable between both groups. The DM group had a higher level of inflammatory markers during the course of hospitalisation (D-dimer 3802.68± 1499 vs 3448.13 ±1139, CRP: 12.60±0.76 vs 11.85±0.60, ESR: 73.66±10.41 vs 58.04±7.10). The DM group had a significantly higher need for mechanical ventilation (18.56% vs 13.29%, p<0.03), and subsequent in-hospital mortality (43.35% vs 25.74% p<0.05). On multivariate regression, diabetics had 2.64 higher odds of in-hospital mortality, however, the p-value was not significant (Write ODDS Ratio and Confidence interval p-value: 0.116). CONCLUSIONS: Overall inpatient mortality was higher in patients with DM, likely driven by an increased need for mechanical ventilation. Our study positively adds to the existing literature that DM is a significant risk factor for higher morbidity and mortality in COVID-19 patients.