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Background: Neutralizing antibodies cocktail (casirivimab and imdevimab) has received emergency use authorization recommendation by Food and Drug Administration (FDA) and WHO for mild-to-moderate COVID-19 infection in specific high-risk groups. Antibodies cocktail has shown promising results in preventing progression to severe disease, but the real-world experience is still evolving. Herein, we present a retrospective analysis of 22 patients who were administered the antibodies cocktail between August 2021 and March 2022 at our tertiary care center. Methods: We conducted an observational retrospective analysis of clinicoradiological, inflammatory parameters, progression of the disease, and outcome among 22 mild and moderate COVID-19 patients treated with antibodies cocktail. Results: The mean age was 67.7 years (SD ± 18.3) and comprised of 13 males (59%), while 9 were females (40.9%). Nine (40.9%) patients were fully vaccinated with two doses, nine (40.9%) were partially vaccinated with one dose while four patients (18.2%) were unvaccinated, and the rest were unvaccinated. Diabetes and hypertension were the commonest comorbidities; hematological and solid organ malignancies were other comorbidities. Eight patients had radiological opacities consistent with COVID-19 pneumonia and had shown significant regression in four patients after the therapy. None of our patients required supplemental oxygen or progressed to severe acute respiratory distress syndrome. All patients were discharged in a stable condition within 6 days of the therapy. Conclusions: The neutralizing antibodies cocktail has shown encouraging results in our analysis in preventing progression to severe disease in patients with high-risk conditions.
ABSTRACT
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.
ABSTRACT
Background: India is the epicenter of diabetes mellitus (DM). The relationship between COVID and DM in age/gender-matched non-diabetics has not been studied yet. The role of DM in predicting the disease severity and outcome in COVID patients might provide new insight for effective management. Methods: We conducted a prospective comparative study at a COVID care center from 25th April-31st May 2021. Among 357 severe-COVID patients screened, all consecutive diabetes (n-113) and age/gender-matched non-diabetes (n-113) patients were recruited. All diabetics and non-diabetics at admission were subjected to high resolution computed tomography (HRCT) chest and inflammatory markers (C-reactive protein (CRP), D-dimer, ferritin, interleukin-6 (IL-6), lactate dehydrogenase (LDH), Neutrophil-Lymphocyte Ratio (NLR)) before starting anti- COVID therapy. Statistical analysis was done using JMP 15·0 ver·3·0·0. Results: The prevalence of DM among the screened population (n-357) was 38·37%. The mean age of the study population was 61y with male preponderance (57%). There was no statistical difference in the HRCT-score or inflammatory markers in the two groups except for higher NLR (p-0·0283) in diabetics. Diabetics had significantly inferior overall survival (OS) (p-0·0251) with a 15d-OS of diabetics vs. non-diabetics being 58·87%, 72·67%, and 30d-OS of diabetics vs. non-diabetics being 46·76%, 64·61%, respectively. The duration of the hospital stay was not statistically different in the two groups (p-0·2). Conclusion: The mortality is significantly higher in severe-COVID patients with DM when compared to age/gender-matched non-diabetics. There was no significant difference in most inflammatory markers/CT at admission between the two groups.
ABSTRACT
Background: Majority of COVID 19 patients that are hospitalized are with respiratory illness including pneumonia and ARDS.The acute manifestations of COVID 19 has been well documented however long-term sequelae from acute COVID 19 remain speculative. Chronic lung disease including IPF is a risk factor for poorer prognosis in COVID 19 infection. Case Study: A 52-year-old male patient presented to emergency department with history of dyspnea on and off for past 6 months increased over last two days, cough with expectoration for past 2 months. Eight months back he was treated for COVID 19 pneumonia with dexamethasone and maximal oxygen requirement of 2L via nasal cannula. CT chest showed diffuse GGO's in bilateral upper and lower lobes with CT severity score of 20/25. Patient was discharged with no oxygen requirement with saturation of 96% on room air. On arrival to the hospital, patient was tachypneic and in type 1 respiratory failure, requiring 10L of oxygen. CT chest showed honeycombing with consolidation and traction bronchiectasis. Discussion: Advanced fibrosis and poor lung function are associated with severe disease and poorer prognosis in COVID 19 infection. CD 209L receptors has been implied in the pathogenesis of progressive ILD in COVID 19 infection. Conclusion: Early detection of potential cases of post- COVID 19 pulmonary fibrosis may give a chance to prevent or at least modify such disabling complication.
ABSTRACT
The introduction of vaccines has inspired hope in the battle against SARS-CoV-2. However, the emergence of viral variants, in the absence of potent antivirals, has left the world struggling with the uncertain nature of this disease. Antibodies currently represent the strongest correlate of immunity against SARS-CoV-2, thus we profiled the earliest humoral signatures in a large cohort of acutely ill (survivors and nonsurvivors) and mild or asymptomatic individuals with COVID-19. Although a SARS-CoV-2-specific immune response evolved rapidly in survivors of COVID-19, nonsurvivors exhibited blunted and delayed humoral immune evolution, particularly with respect to S2-specific antibodies. Given the conservation of S2 across 0-coronaviruses, we found that the early development of SARS-CoV-2-specific immunity occurred in tandem with preexisting common I3-coronavirus OC43 humoral immunity in survivors, which was also selectively expanded in individuals that develop a paucisymptomatic infection. These data point to the importance of cross-coronavirus immunity as a correlate of protection against COVID-19.
ABSTRACT
The COVID-19 infection has been causing significant burden on the health infrastructure of almost every country and the COVID-related mortalities and morbidities translate into a significant impact on the societal perspective. Adequate precautions are mandatory for the healthcare workers managing patients at healthcare facilities like use of personal protective equipment (PPE) while handling patients. The clinical examination forms an important tool in the evaluation of any patient. For the last few years, the clinical skills of the clinicians have been on the decline noticed by the medical fraternity. The clinicians have become increasingly reliant on investigation reports and imaging technologies to diagnose and manage the patient. The situation of COVID-19 and management of these patients in COVID care hospitals and centers have further diminished the role of clinical skills with the added difficulties of wearing the full component of PPE during the patient evaluation and care. Patients are isolated as per the protocol, and doctors are forced to avail the telemedicine facilities and depend on the objective data provided by the junior doctors or paramedics. The pondering question is, have we reached a new tipping point in the utility of clinical diagnosis, making it further alienated in the future? We will have to wait and see if the clinical skill utility change caused by this pandemic would have a lasting effect.