Characteristics & outcomes of cancer patients with COVID-19: A multicentre retrospective study from India.

Background & objectives: High mortality has been observed in the cancer population affected with COVID-19 during this pandemic. We undertook this study to determine the characteristics and outcomes of cancer patients with COVID-19 and assessed the factors predicting outcome. Methods: Patients of all age groups with a proven history of malignancy and a recent diagnosis of SARS-CoV-2 infection based on nasal/nasopharyngeal reverse transcriptase (RT)-PCR tests were included. Demographic, clinical and laboratory variables were compared between survivors and non-survivors groups, with respect to observed mortality. Results: Between May 11 and August 10, 2020, 134 patients were included from the three centres and observed mortality was 17.1 per cent. The median age was 53 yr (interquartile range 39-61 yr) and thirty four patients (25%) were asymptomatic. Solid tumours accounted for 69.1 per cent and breast cancer was the most common tumour type (20%). One hundred and five patients (70.5%) had received chemotherapy within the past four weeks and 25 patients (19.3%) had neutropenia at presentation. On multivariate analysis, age [odds ratio (OR) 7.99 (95% confidence interval [CI] 1.18-54.00); P=0.033], haemoglobin [OR 6.28 (95% CI 1.07-37.04); P=0.042] neutrophil-lymphocyte ratio [OR 12.02 (95% CI 2.08-69.51); P=0.005] and baseline serum albumin [OR 18.52 (95% CI 2.80-122.27); P=0.002], were associated with higher mortality. Recent chemotherapy, haematological tumours type and baseline neutropenia did not affect the outcome. Interpretation & conclusions: Higher mortality in moderate and severe infections was associated with baseline organ dysfunction and elderly age. Significant proportion of patients were asymptomatic and might remain undetected.

Utilization of Robotics for Healthcare: A Scoping Review

Robotics is a disruptive technology that has already revolutionized patient healthcare globally. This technology is presently helping to perform various essential tasks such as conducting operations via numerous specializations and managing the entire operating room. Robot surgery is, in reality, available worldwide for knee substitution, correction of the hernia, and colon resection. Surgical robots entered the operating theatres far before entering other medicine-related robotics applications and now facilitate better outcomes for a whole range of healthcare products. In the COVID-19 pandemic, some robots were used in hospitals to deliver medicines, screen, perform odd jobs, and maintain hygienic conditions. This paper provides an overview about robotics and its various applications useful for healthcare. Significant enhancement, quality services, and advancements in healthcare services are also discussed. Here, we have identified the role of robotics in healthcare as a technology that dramatically changes the healthcare field. An artificial intelligence robot can duplicate creativity via algorithms, and its programming too plays a crucial role. Hospitals can now save time and money by removing the need for physical chores for different jobs. It is helpful for surgical training, exoskeletons, intelligent prostheses and bionics, robotic nurses, treatment, medicines, logistics, telepresence, and cleaning services. Robotics technologies such as gesture control, machine view, voice recognition, and touch sensor technology are also available. The future is bright with lower installation and maintenance costs.

Bendamustine in combination with pomalidomide and dexamethasone in relapsed/refractory multiple myeloma: A phase II trial.

Treatment of patients with resistant/refractory multiple myeloma (MM) is an unmet need. In this phase II study, we evaluated the role of bendamustine, pomalidomide and dexamethasone combination in this setting. Between February 2020 and December 2021, 28 patients were recruited. Patients received bendamustine 120 mg/m2 day 1, pomalidomide 3 mg days 1-21, and dexamethasone 40 mg days 1, 8, 11, 22, regimen given for a maximum of six cycles. The median (range) age of the patients was 54 (30-76) years and 15 (53.6%) were males. Patients had received a median (range) of three (two-six) prior lines and 85.7% were refractory to both lenalidomide and bortezomib. The primary end-point was the overall response rate (ORR) defined as ≥partial response after at least three cycles. Secondary objectives were toxicity, progression-free survival (PFS), time to progression and overall survival (OS). An intent-to-treat analysis was done. An ORR of 57.6% was achieved. Patients with extramedullary myeloma had a better response rate. At a median follow-up of 8.6 months, the median PFS and OS were 6.2 and 9.7 months respectively. Toxicity was manageable; mainly haematological (neutropenia, 46.4%; anaemia, 42.8%; and thrombocytopenia, 7.1%). Bendamustine, pomalidomide and dexamethasone could be a novel combination for the heavily pretreated, lenalidomide-refractory myeloma population.

Development and Validation of High-Performance Liquid Chromatography Method for the Quantification of Remdesivir in Intravenous Dosage Form.

Corona virus disease 2019 (COVID-19) has posed a mounting threat to public health with worldwide outbreak caused by a novel virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recently, remdesivir (RDV) has been approved by Food and Drug Administration (FDA) for treating COVID-19 patients ≥12 years old requiring hospitalization. To the best of our knowledge, a simple method to estimate RDV in the pharmaceutical formulations using high-performance liquid chromatography (HPLC) is still unexplored, highlighting the need for a precise analytical method for its quantification. The prime purpose of the current investigation was to develop and validate a well-grounded HPLC method for quantification of RDV in pharmaceutical formulations. The best chromatogram was obtained by means of an Inertsil ODS-3V column using a mobile phase of milli-Q water modified to pH 3.0 with o-phosphoric acid and acetonitrile (50:50, % v/v) at a flow rate of 1.2 mL/min and wavelength of detector set at 246 nm with retention time being achieved at 6.0 min. The method was validated following International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) Q2 (R1) guidelines for various parameters such as specificity and selectivity, system suitability, linearity, precision, accuracy, limits of detection and quantification, and robustness. The method developed for the quantification of RDV was found to be linear in the concentration range of 25-2,500 ng/mL with limit of detection and limit of quantification of 1.95 and 6.49 ng/mL, respectively. Assay value of 102% ± 1% was achieved for marketed injectable dosage form when estimated by the validated method. Therefore, in this study a simple, rapid, sensitive, selective, accurate, precise, and robust analytical method was developed and validated for the quantification of RDV using HPLC. The established method was successfully employed for quantification of RDV in marketed pharmaceutical formulation.

Intentional Azole Antifungals with Azacitidine-Venetoclax Based Combination in AML as an Outpatient Therapy: Experience from a Resource-Limited Setting in India

Introduction: Acute myeloid leukemia (AML) primarily warrants intensive induction therapy, followed by consolidation chemotherapy as a curative regimen. However, in elderly (>60 years) and unfit younger patients, less-intense regimens with targeted therapy have been effective. They have proven to be effective regimens for improving overall survival and remission rates while the world battles COVID-19. Patients and Methods: A retrospective study, where case files for all patients diagnosed with AML at a tertiary care center from 2016–2021 were reviewed. The study included patients who received a low-intensity regimen for remission induction, either in upfront or relapsed settings. The primary outcome was complete remission (CR) rates. Results: The median age of the study cohort (n=55) was 45 years (range: 17–75 years), with >60 years comprising 29%;44.4% had baseline ECOG performance status of >3, which declined to 16.6% after completion of four cycles. The most commonly encountered subtypes were M2 (42.5%) and AML-not otherwise specified (46.3%), according to FAB and WHO classifications, respectively. Azacitidine was employed in 52.7%, azacitidine and venetoclax (aza-ven) in 32.7%, and low-dose cytarabine in 14.5%. In the aza-ven cohort, patients received itraconazole (n=14/18, 77.7%) and voriconazole (n= 4/18, 22.2%) as azoles. The dose of venetoclax varied from 100 to 200 mg and no ramp-up was used. No patients developed TLS. Patients were initiated with remission induction in an outpatient setting. The complete remission rates (CR+CRi) in the aza-ven cohort were 16.6% and 27.7% in treatment-naive and relapsed/refractory settings, respectively. The time to neutrophil and platelet recovery in those achieving CR were 84 days (range: 28–140 days) and 28 days (range: 28–60 days), respectively. The incidence of febrile neutropenia and fungal infection (probable/possible/proven) were 16.6% and 16%, respectively. In the maintenance cohort, azacitidine was primarily used. Interestingly, MRD+ patients (3/10) attained MRD negativity after two cycles, accounting for 100% remission status (10/10). It bridged the gap, allowing three previously unfit patients to receive intensive chemotherapy and two to receive haploidentical transplants. Conclusion: This retrospective study highlights the importance of low-intensity therapy, especially during COVID-19. Aza-ven-azole is a safe and feasible remission induction regimen in patients who are ineligible for intensive induction.

Polymeric microneedles for transdermal delivery of nanoparticles: Frontiers of formulation, sterility and stability aspects

With the launch of few products in the market, transdermal drug delivery through microneedles (MNs) has evidenced a major leap. Interest in MNs is growing exponentially as it overcomes the limitations accompanying other delivery routes. Among the various types of MNs, polymeric microneedles (PMNs) seem to be more propitious because of the associated favourable innate properties. Nevertheless, struggle in loading capacity, unmanageable rate of drug release, and monotonic curative approach hampers the further development of PMNs. Recent emerging research has drawn inspiration from nanocarriers and in conjunction with PMNs have opened up new perspectives for the treatment of various diseases. In this review, we focus on recent progresses in the field of transdermal drug delivery using nano carriers in conjunction with PMNs for various therapeutic and diagnostic activities. Additionally, we describe the various factors impacting drug delivery, and challenges involved in sterilization and stability aspects associated with nanocarrier loaded PMNs, highlighting future research perspectives alongside.