Severe Autoimmune Hemolytic Anemia in a Young Child with Active Covid-19 Infection

INTRODUCTION: Autoimmune hematological complications related to COVID-19 are rare. There are only 5 pediatric case reports of autoimmune hemolytic anemia (AIHA) among 14 million pediatric COVID-19 cases in USA. Four were older (13-17 years), two had underlying autoimmune/hematologic conditions. Immunologic analysis varied, with cold, warm & mixed hemolytic anemias described. We present a previously healthy child with COVID-19 associated severe AIHA with peripheral reticulocytopenia. DESCRIPTION: A 3-year-old male presented with lethargy, fever, tachycardia and jaundice 10 days after COVID-19 diagnosis. Pertinent labs include hemoglobin (Hgb) 3.8 g/dL, Hct 9.9%, bilirubin 3.6 mg/dL, platelets 321,000/muL, RBC count 1.2 M/muL, WBC 35,600/muL, MCV 82.5fL. Reticulocyte count (RC) was only 2.8%. Peripheral blood smear showed anisocytosis, poikilocytosis, nucleated RBCs and left shifted granulocytosis. Bone marrow biopsy revealed erythroid hyperplasia without underlying malignancy;myeloid:erythroid ratio of 0.3:1. The outside hospital reported cold C3 agglutination following 4degreeC incubation, while our laboratory identified spontaneous agglutination at room temperature (warm agglutination). IV fluids, O2, and methylprednisolone (4 mg/kg/day) were started and two packed RBC transfusions (total 30 ml/kg) given for symptomatic anemia with Hgb < 4 g/dL. LDH peaked at 2255 U/L on Day 3. Reticulocyte count was low (2.8%-3.8%) Days 1-3, increased to 6.5% on Day 4 and peaked at >30.0% on Day 7. He was changed to oral prednisone 2 mg/kg/day on Day 12 and discharged on Day 13 with Hgb 7.0 g/dL and RC 29.9%. Most recent Hgb is 13.0 g/dL and RC 2.6%. DISCUSSION: COVID-19 associated AIHA is rare, and previously reported mostly in older children. Our patient was previously healthy, and demonstrated a strong bone marrow response with erythroid hyperplasia. Peripheral reticulocytosis was delayed, and correlated with initiation of systemic steroid therapy. Our patient had both cold and warm agglutination supporting extensive autoimmune destruction of early red cell lineage. These findings support immune activation during acute COVID-19 infection and COVID-19 as a trigger for AIHA. Patients developing AIHA may need to be tested for COVID-19 and carefully monitored for complications.

A perspective on Master of Public Health (MPH) Graduates in India: Current role and way head

The public health sector of any country deals on the forefront and utilizes the multidisciplinary approach. In India the Masters of Public Health graduates are trained in unstandardized manner and lack a regulatory body. The gap created in serving the unserved can easily be fulfilled by utilization of this workforce in systematic manner, The emerging competition in the field, undervalued sector in terms of monitory benefits, poor demand and limited training institutions for MPH graduates along with the contribution of MPH during COVID 19 pandemic has been emphasized in the article. The perception of those working in the field has been highlighted with the way ahead of MPH program in India.

CRISPR-Cas: A continuously evolving technology

The discovery of the CRISPR/Cas microbial adaptive immune system and its ongoing development as a genome editing tool represents the work of many scientists around the world.The time line of CRISPR/Cas system shows that this technology is improving continuously to remove the demerits of preceding one with the aim of development of highly efficient, specific with low off target effect and ultimately transgene free technology in light of ethical and environmental issues related with transgenic technology.Initially, CRISPR/Cas9 was developed as method of choice as it provides targeted mutagenesis under in vivo condition and all the homeoalleles of a gene can be targeted in same plant, especially in case of polyploid species efficiently which is difficult through other existing technology.No residual or foreign gene insertion is required and modification is permanent.Now, CRISPR/Cpfl has been developed as more potent, efficient and simpler than CRISPR/Cas9.Different forms of Cas enzymes provide new avenues for regulation of genomic component.In view of the present devastating COVID-19 disaster the scientists used this novel technology for detection of virus in humans at an early stage of infection thus saving human lives.The evolution of CRlSPR'Cas technology, their advantages, apprehensions and solution, experimental design and updates of this technology is discussed in the present review. © 2021 Indian Council of Agricultural Research. All rights reserved.

Parameter Estimation and Early Dynamics of COVID-19 Disease

In this article, we have considered nine countries where the epidemic shows steady state or has a rising trend and used the traditional SEIR model to estimate the parameter for COVID-19 disease. These parameters are contact rate, removal rate, basic reproduction number, initial doubling time, point of inflection, and epidemic rate. In another part of the work, we have considered five countries where the epidemic trend has not settled and used exponential smoothing technique to forecast the infected cases. The study reports a magnifiable concern for reducing the transmission rate in order to combat the disease. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Coronavirus disease-19 (COVID-19) pandemic impact on Obstetrics and Gynecology residents' case logs

Objective The COVID-19 Pandemic has drastically affected healthcare systems worldwide. Precautionary measures taken by healthcare systems involved decreasing nonurgent clinical loads so as to optimize hospital resources. This decrease is expected to affect training and residency programs, as difficulties meeting surgical program requirements may be encountered. This brief report analyzes the impact of COVID-19 on surgical case logs of fourth- and sixth-year obstetrics and gynecology (OBGYN) residents at Singhealth. Design Retrospective review of case logs. Methods This is an audit of the case logs of fourth- and sixth-year residents from the ACGME-I Case Log System. Cases were collected at the end of the academic years of 2019 and 2020, which close at the end of June. Data of the total obstetric, benign gynecological and gynecological-oncology resident case logs from 2017 to 2020 were collected for trending. Results There was a 14.29% decrease in mean number of cases logged by the fourth-years between 2019 and 2020, compared to a 6.84% increase for the sixth-years. There was a significant decrease between benign gynecological and obstetric cases for the fourth-year residents (P = 0.001). The year-to-year trends for obstetric, benign gynecology and gynecological-oncology cases of fourthand sixth-year residents remain grossly unchanged from 2017 to 2020. Conclusions Despite the re-prioritization of hospital resources and the changes in case log numbers, residents are able to meet the surgical training requirements stipulated by the ACGME-I, suggesting that, in spite of COVID- 19, surgical training and education are not compromised.

Knowledge, attitudes and expectations of perinatal care during the COVID-19 pandemic

There is limited evidence regarding the transmission of SARS-CoV-2 from mother to infant, as well as the optimal management of infected women and infant during pregnancy, labor and early postnatal period. The knowledge, concerns and expectations of women with regards to care during the COVID-19 pandemic is currently unclear. This study aimed to investigate the knowledge and expectations of pregnant women on perinatal and neonatal care during the COVID-19 pandemic in Singapore. A cross-sectional survey was administered via a secure online platform to pregnant women attending antenatal clinics between August-September 2020. Participants aged > 21 years who were pregnant and had no history of confirmed COVID-19 were included in the study. The survey consisted of 10 questions to evaluate the knowledge and expectations of these women on the perinatal and neonatal care during this pandemic. 313 pregnant women completed the survey during the study period. The mean age of the participants was 30 years (SD 4;range 22-43 years). The median gestational age of women at survey participation was 25 weeks (range 4-40 weeks). The participants were predominantly multiparous (54%) and 98% had completed secondary level education. Majority were cognizant of the spread of COVID- 19 by respiratory secretions and contact (90%), and the importance of hand hygiene and face-masking (94%). Up to 72% agreed or strongly agreed that in-utero transmission of SARS-CoV-2 to the fetus was possible. Most were unsure of the optimal mode of delivery (77%) and only 22% believed that breastfeeding was safe in a mother with active COVID-19. There was no significant association between the sociodemographic factors evaluated and maternal agreement with the possibility of in-utero SARS-CoV-2 transmission and the risk associated with vaginal delivery in women with COVID-19. Although 46% of participants were concerned about the increased risk of contracting COVID-19 during routine clinic appointments at the hospital, only 37% were agreeable with teleconferencing their appointments. More than half (56%) of the participants reported that their postnatal confinement plans were affected by the pandemic. Majority of participants were aware of modes of transmission and the prevention strategies of SARS-CoV-2. However, there were significant gaps identified in their knowledge related to the risk of in-utero transmission and safety of breastfeeding, and significant variability to the agreement with alterations to the perinatal care. We recommend provision of evidence-based information early to expectant mothers by the healthcare professionals, to reduce misinformation and anxiety related to the current pandemic.

Good and not so good of learning using digital platforms: Experience sharing from PG students

Gone are the days when learning was confined inside four walls. With advent of technology, education sector has also advanced and a lot of educational platforms have been introduced for online learning also known as digital or e-learning. Though this concept is more famous in West, but during these times of Covid these platforms have reached and covered the gaps which conventional way of teaching couldn’t and people have come to know about the bright side of digital learning as well. Digital learning has replaced the classroom learning. It was in the trends but due to Covid 19 it has completely disrupted the learning pedagogy and also has been savior for the learners across the globe. The present discussion is about the digital learning and issues faced by learners. The feedback was conducted by the learners of post graduate courses and content analysis has been performed. © 2021 Karadeniz Technical University. All rights reserved.

SARS patients: Use of convalescent plasma therapy in rural area

Aims & Objectives: Aim and Objective- In order to evaluate the efficacy of convalescent plasma therapy in the treatment of patients with severe acute respiratory syndrome (SARS), Patients/Materials & Methods: Patients- 38 patients. Material and method- After the assessment of the donor, 200600 mL plasma can be collected with apheresis devices. Donor eligibility, Predonation evaluation of donors, Donor recruitment, Collection of convalescent plasma at apheresis centers. Results: Results 37 SARS patients were given convalescent plasma at K.D MEDICAL COLLEGE MATHURA UP, between 09 SEPTEMBER and 13 OCTOBER 2020. Good outcome was defined as patient responded to plasma therapy in 24 to 48 h after infusion. Poor outcome was defined as no response or death after 48 h of infusion. Discussion & Conclusion: Conclusion- CP seems to be a safe and probably effective treatment for critically ill patients with COVID19. It could also be used for prophylactic purposes but the safety and effectiveness of this approach should be tested in randomized prospective clinical trials.

PIN172 Emerging New Treatment Patterns Given New Therapies in Advanced RCC Treatment in the US

Objectives: Scant research exists on evolving real world treatment patterns given new immuno-oncology (IO) combination regimens added to the National Comprehensive Cancer Network (NCCN) guidelines for advanced renal cell carcinoma (aRCC). This study describes real-world (RW) treatment patterns in a large US claims database toward understanding new standards of care in aRCC treatment. Methods: Using Optum Clinformatics Claims data, patients ≥18 with ≥ 2 RCC diagnoses 30-days apart, who subsequently start first-line (1L) aRCC treatment (study index date) during April 2018 to March 2019 were all followed-for 9 months. Patients had ≥2 secondary malignancy codes in the 12 months prior/30 days post-index date and 9-months of continuous enrollment pre- and post-index. Results: Study identified 415 1L aRCC patients. The most common 1L regimen was monotherapy tyrosine kinase inhibitors (mono TKIs) representing 43.13% (N=179). Combination IO (combo IO), monotherapy IO (mono IO), IO + TKI, and Other, represented 28.43% (N=118), 25.30% (N=105), 0.96% (N=4) and 3.13% (N=13) respectively. Combo IO patients were younger, mean age 66.58, compared to mono TKI and mono IO patients, mean age 70.15 (p=0.003) and 72.72 (p<0.001), respectively. Mean days of continuous therapy for mono TKI patients was 152.17, compared to combo IO 171.64 (p=0.034) and mono IO 173.22 (p=0.028). Mono TKI users went on to second-line treatment more often, 41% vs combo IO 12.38% (p=0.0005) and vs mono IO 33.05% (p=0.158). Conclusions: RW claims data provide insight into how physicians and patients adapt to new treatment guidelines. The prevalence of 1L IO monotherapy was an interesting finding given it is not indicated for first line treatment. Ongoing monitoring of real-world treatment patterns of new and evolving regimens, as well as oral versus injectable preferences, will be especially important in the face of the COVID-19 pandemic as we track the impact of health services interruptions.

Pandemic Considerations on Essential Oral Health Care.

The coronavirus disease 2019 (COVID-19) pandemic revealed a lack of consensus on the concept of essential oral health care. We propose a definition of essential oral health care that includes urgent and basic oral health care to initiate a broader debate and stakeholder alignment. We argue that oral health care must be part of essential health care provided by any health system. Essential oral health care covers the most prevalent oral health problems through an agreed-on set of safe, quality, and cost-effective interventions at the individual and community level to promote and protect oral health, as well as prevent and treat common oral diseases, including appropriate rehabilitative services, thereby maintaining health, productivity, and quality of life. By default, essential oral health care does not include the full spectrum of possible interventions that contemporary dentistry can provide. On the basis of this definition, we conceptualize a layered model of essential oral health care that integrates urgent and basic oral health care, as well as advanced/specialist oral health care. Finally, we present 3 key reflections on the essentiality of oral health care. First, oral health care must be an integral component of a health care system's essential services, and by implication, oral health care personnel are part of the essential health care workforce. Second, not all dental care is essential oral health care, and not all essential care is also urgent, particularly under the specific risk conditions of the pandemic. Third, there is a need for criteria, evidence, and consensus-building processes to define which dental interventions are to be included in which category of essential oral health care. All stakeholders, including the research, academic, and clinical communities, as well as professional organizations and civil society, need to tackle this aspect in a concerted effort. Such consensus will be crucial for dentistry in view of the Sustainable Development Goal's push for universal health coverage, which must cover essential oral health care.