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Introduction: Colorectal Cancer (CRC) is on the rise, prompting the need for earlier screening in the United States (U.S.) population. The American Cancer Society now recommends screening for CRC in patients with average risk at the age of 45. Further complicating this picture, the COVID-19 pandemic has disrupted the routine screening process for CRC, which we hypothesize has impacted the stage at which CRC is detected. We sought to determine the extent to which the COVID-19 pandemic has affected colorectal cancer diagnosis trends at a large urban community hospital. Method(s): We performed a retrospective analysis of patients, comparing two time periods: pre-pandemic (1/1/2019-1/31/2020) and during COVID pandemic (2/1/2020-9/29/21). Data was extracted from the electronic medical record (EMR) to compile a database of patients diagnosed with CRC during these time periods. Patients included in this study had a new diagnosis of colorectal cancer and either followed with colorectal specialists at the hospital or had undergone tissue biopsy analysis by the Department of Pathology. The primary outcome was determining the stage at which CRC was detected and the modality utilized for CRC screening in that patient. Additional variables collected were as follows: age, pathological findings (grade, presence of tumor mutations, or microsatellite instability), gender, race, and insurance. Result(s): Data was collected from a total of 380 patients, which included 190 patients diagnosed with CRC within the timeframe defined as pre-pandemic and 190 diagnosed with CRC within the timeframe defined as during the pandemic. CRC diagnosis was analyzed in terms of TNM stage at time of diagnosis (Stages 0 through IV). Stage III and IV were grouped together and categorized as a late-stage diagnosis, whereas Stages 0, I, and II were grouped together and categorized as an early-stage diagnosis. Late-stage diagnosis was found in 34.7% (66/190) of patients in the pre-pandemic group. In comparison, late-stage diagnosis was found in 46.3% (88/190) of patients in the during pandemic group. Conclusion(s): Our results suggest that the COVID-19 pandemic did produce delays in care and work-up for CRC. We believe this is why CRC stage at the time of initial diagnosis was later for patients diagnosed during the pandemic than for patients diagnosed prior to the pandemic. In the future, we hope to evaluate if the impact of COVID-19 is reflected in tumor grade and genetic mutations at the time of diagnosis, and determine race and gender disparities.
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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.
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Background: Patients with systemic lupus erythematosus (SLE) are at an increased risk of infection relative to the general population. We aimed to describe the frequency and risk factors for serious infections in patients with moderate-to-severe SLE treated with rituximab, belimumab, and standard of care therapies in a large national observational cohort. Method(s): The British Isles Lupus Assessment Group Biologics Register (BILAG-BR) is a UK-based prospective register of patients with SLE. Patients were recruited by their treating physician as part of their scheduled care from 64 centres across the UK by use of a standardised case report form. Inclusion criteria for the BILAG-BR included age older than 5 years, ability to provide informed consent, a diagnosis of SLE, and starting a new biological therapy within the last 12 months or a new standard of care drug within the last month. The primary outcome for this study was the rate of serious infections within the first 12 months of therapy. Serious infections were defined as those requiring intravenous antibiotic treatment, hospital admission, or resulting in morbidity or death. Infection and mortality data were collected from study centres and further mortality data were collected from the UK Office for National Statistics. The relationship between serious infection and drug type was analysed using a multiple-failure Cox proportional hazards model. Finding(s): Between July 1, 2010, and Feb 23, 2021, 1383 individuals were recruited to the BILAG-BR. 335 patients were excluded from this analysis. The remaining 1048 participants contributed 1002.7 person-years of follow-up and included 746 (71%) participants on rituximab, 119 (11%) participants on belimumab, and 183 (17%) participants on standard of care. The median age of the cohort was 39 years (IQR 30-50), 942 (90%) of 1048 patients were women and 106 (10%) were men. Of the patients with available ethnicity data, 514 (56%) of 911 were White, 169 (19%) were Asian, 161 (18%) were Black, and 67 (7%) were of multiple-mixed or other ethnic backgrounds. 118 serious infections occurred in 76 individuals during the 12-month study period, which included 92 serious infections in 58 individuals on rituximab, eight serious infections in five individuals receiving belimumab, and 18 serious infections in 13 individuals on standard of care. The overall crude incidence rate of serious infection was 117.7 (95% CI 98.3-141.0) per 1000 person-years. Compared with standard of care, the serious infection risk was similar in the rituximab (adjusted hazard ratio [HR] 1.68 [0.60-4.68]) and belimumab groups (1.01 [0.21-4.80]). Across the whole cohort in multivariate analysis, serious infection risk was associated with prednisolone dose (>10 mg;2.38 [95%CI 1.47-3.84]), hypogammaglobulinaemia (<6 g/L;2.16 [1.38-3.37]), and multimorbidity (1.45 [1.17-1.80]). Additional concomitant immunosuppressive use appeared to be associated with a reduced risk (0.60 [0.41-0.90]). We found no significant safety signals regarding atypical infections. Six infection-related deaths occurred at a median of 121 days (IQR 60-151) days from cohort entry. Interpretation(s): In patients with moderate-to-severe SLE, rituximab, belimumab, and standard immunosuppressive therapy have similar serious infection risks. Key risk factors for serious infections included multimorbidity, hypogammaglobulinaemia, and increased glucocorticoid doses. When considering the risk of serious infection, we propose that immunosupppressives, rituximab, and belimumab should be prioritised as mainstay therapies to optimise SLE management and support proactive minimisation of glucocorticoid use. Funding(s): None.Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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Epidemic handling is one of the foremost tasks for any country globally as it affects the population directly, creating a situation of chaos and disruption in humanity in every way possible. In the current world, where we find a new virus or bacteria daily in different parts of the world, it is very difficult for the medical industry and researchers worldwide to combat these situations as quickly as needed. However, with the emergence of AI and machine learning in the past 15-20 years, it is a blessing for these industries. It gives them a way to combat these deadly situations more quickly and effectively. COVID-19 is a highly communicable virus and affects the respiratory system to reach fatality and has created panic due to its worldwide spread recently. This study postulates how COVID-19 has spread across the globe, and its impact on various factors like economy, health, and employment, and how the studies have been carried out after the outbreak has been reported. We also present a bibliometric and systematic analysis of how much contribution from various segments has come to understand and handle this pandemic and how the researches have taken place in what direction. The study concludes by identifying the gaps in those research directions and finding the same future scope. © 2023 American Institute of Physics Inc.. All rights reserved.
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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.
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Several techniques, including mathematical models, have been explored since the onset of COVID-19 transmission to evaluate the end outcome and implement drastic measures for this illness. Using the currently infected, noninfected, exposed, susceptible, and recovered cases in the Indian community, we created a mathematical model to describe the transmission of COVID-19. In particular, we used the semianalytical Adomian decomposition method without considering any discretization to perform the first-order differential equations related to COVID-19 cases. According to our early findings, rigorous initial isolation for 22-25days would reduce the number of exposed and newly infected people. As a result of the downstream effect, the number of suspected and recovered persons would remain stable, assuming that social distance is properly recognized. In a larger sense, the parameters established by our mathematical model may aid in the refinement of future pandemic tactics. © 2022 Elsevier Inc. All rights reserved.
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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.
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Background: The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), infected by a new strain of human coronavirus, has engulfed the whole globe with its vicious potential to eradicate humankind. The pandemic has emerged from the Wuhan provinces of China with high transmissibility. Researchers are rushing to discover vaccines and drugs for the disease, which is not known yet. In this study, we have focused on the in-silico screening of phytochemicals occurring naturally in plant extracts that could possibly interact with receptor binding motif (RBM) of spike protein and thereby inhibit virus-cell interaction. Materials and Methods: In this study, we have taken 100 phytochemicals that have been studied in various viral interactions and have shown antiviral properties. Initially, these compounds were analyzed on the basis of their physicochemical and pharmacokinetic properties, biological activities, possible target interactions, similar compounds in humans, and gene regulations using bioinformatic tools, namely Swiss-ADME, PASS (prediction of activity spectra for substances), SwissTargetPrediction, similar ensemble approach (SEA) search server, DIEGP-pred, respectively and were filtered out on the basis of immunobiological activities and expression of genes involved in cytokine storm regulation and immunostimulation. Further, they were docked with the receptor-binding domain (RBD) of spike protein in the SARS-CoV-2 using SwissDock and analyzed by UCSF Chimera.
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Background/Aims The COVID-19 pandemic led to an overnight shift in healthcare delivery and rapid uptake of digital technology. Such approaches risk digital exclusion for people without access to or not confident in their use of technology. We sought to examine digital access and e-health literacy in people with inflammatory conditions. Methods People (n=2,024) were identified from their electronic health record and invited to participate in a survey, using SMS and postal approaches. Data were collected on age, gender, self-reported arthritis diagnosis (RA, PsA, AS, SLE and other), access to an internet-enabled device and frequency of internet access, health literacy (single-item literacy screener) and self-perceived e-health literacy (eHEALs). Ethical approval was obtained (Ref 21/PR/0867). Results 639 people completed the survey, of whom 287 (44.9%) completed it online. Mean (sd) age was 64.5 (13.1) years and 384 (64.7%) were female. 98.3% were white. Approximately 20% of people did not have access to an internet enabled device (Table). 93 (15.3%) of patients reported never accessing the internet, this proportion was higher in people with RA. Approximately 19% had low health literacy. In those reporting internet use, eHealth literacy was moderate. The most Conclusion Low health literacy, lack of digital access and low reported internet use was common, especially in people with RA, leading to high use of telephone advice and rheumatology appointments. Digital roll-out needs to take account of people requiring extra support to enable them to access care or risks excluding many patients with inflammatory conditions.
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Background/Aims Concerns about the risk of COVID-19 infection led to guidelines advocating shielding for many people with inflammatory conditions. We aimed to assess the impact of the pandemic on the self-reported physical and mental health of people with inflammatory conditions. Methods 2024 patients with inflammatory conditions (RA, PsA, AS, SLE and other) were randomly selected from electronic health records. Survey invites were sent (August 2021 to coincide with relaxation of COVID restrictions) using a combination of SMS and postal approaches. Data collected included demographics, COVID infection and shielding status, physical (MSK-HQ) and mental health (PHQ8 and GAD7) and global impact on physical or mental health (4 options: none-severe). Ethical approval was obtained (REC Ref 21/PR/0867). Results 639 people completed the survey, of whom 287 (44.9%) completed online. Mean (sd) age was 64.5 (13.1) years and 384 (64.7%) were female. The majority of people had RA although 57 (9%) reported more than one inflammatory condition. 349 (57.9%) of people were advised to shield. Rates of COVID infection were relatively low across the groups (Table 1). 254 (41.2%) reported moderate or severe impact of the pandemic on physical health, which impacted least in people with RA. 244 (39.4%) reported moderate or severe impact of the pandemic on mental health with 175 (28.7%) reporting moderate depression (PHQ8>10) and 138 (22.6%) moderate anxiety (GAD-7≥10). Conclusion Reported COVID infections were low in our cohort. The pandemic had significant effects on physical and mental health, which appeared less in people with RA than other inflammatory conditions.
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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.
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INTRODUCTION: The diagnosis of methemoglobinemia is infrequently thought of in cases of hypoxia, given its rarity. The most common inciting factor is an exposure to oxidizing agents, such as various antibiotics (sulfonamides, trimethoprim, and dapsone), local anesthetics, nitrites, and aniline dyes. This is a case of methemoglobinemia in a patient who was initially treated for COVID 19 with outpatient vitamin infusions. DESCRIPTION: A 76-year-old man was brought to the emergency department after collapsing at home. He was treated for COVID-19 the week prior with ivermectin and vitamin infusions, however developed high fevers, up to 102 F, with worsening cough and fatigue. On arrival his oxygen saturation was 50%, which improved with non-rebreather. Chest CT revealed multifocal ground glass opacities, consistent with COVID pneumonia. Shortly after admission, a rapid response was initiated as the patient was becoming more hypoxic with worsening altered mental status. Pulse oximetry revealed oxygen saturation of 60%;the patient was quickly intubated and transferred to the intensive care unit - oxygen saturation continued to read 70% despite a FiO2 100%. An arterial blood gas appeared brown in color and revealed a normal paO2 and pCO2. The patient was found to have a methemoglobin level of 21%. The patient underwent exchange transfusion of 7 units, with subsequent resolution of his hypoxia. DISCUSSION: Methemoglobinemia is a life threatening disorder, and diagnosis is dependent on a high degree of clinical suspicion. Patients typically present with shortness of breath, fatigue, cyanosis, and can ultimately develop loss of consciousness. An arterial blood gas, with its classic chocolate-brown appearance, a normal Po2, and CO-oximetry panel confirms diagnosis. Methemoglobinemia is routinely treated with methylene blue and, in severe cases, requires red cell exchange. There are reports that have shown benefits of high-dose vitamin C for safe and effective treatment of methemoglobinemia in centers with no access to methylene blue, through its anti-oxidant effect. Interestingly, this patient developed this condition after being treated for COVID 19 with vitamin infusions. This case highlights the importance of careful history taking, as certain medications can have unknown and fatal side effects.
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The spread of COVID-19 contagion has to lead the world on a pause, because of its alarming rate. The only immediate solution was to practice social distancing and enforce lockdown. COVID-19 has declared an international emergency because it has been labeled pandemic, and different countries are still developing their vaccine. As far as now various countries with various governments have undertaken active plans and emergency measures to protect the public. The government and various health organizations are in charge of the survey. In fear of being affected, people tend to avoid hospital visits and circumvent the COVID-19 test. As of now, many Web applications are developed to avoid social interaction and community gathering. The COVID-19 test booking Web app provides the user to choose what, when, and where to take the COVID-19 test, it also helps the government health officials to maintain a safe database. This ensures the increase of COVID-19 test being taken and provides the individual proper safety and assurance. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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COVID-19 patients have lower immunosuppressive CD4+ T and CD8+ T cells and henceforth patients in intensive care units (ICU) need mechanical ventilation, henceforward they stay in hospitals. These patients have been exposed to advances in fungal co-infections. COVID-19 patients progress towards mucormycosis a black fungal infection that is deadly leading to loss of sight and hearing and eventually death. This article discusses the clinical manifestations, risk factors and emphases on virulence traits and management of black fungus.
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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.
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Background: In locally advanced gastroesophageal and gastric cancers, which constitute the majority of the presentation, the postoperative 5 year survival rate remains only 30-40%. It is in these patients that perioperative chemotherapy has helped improve radical resection rates control preoperative micrometastases and improve survival. Since 2017,FLOT based chemotherapy has largely replaced ECF/ECX in this setting. We did a retrospective analysis on our patients treated with FLOT regimen during the COVID-19 pandemic to assess its efficacy, tolerance and pathological response (TRG). Methods: Patients with resectable gastric and GOJ cancers who presented to us from August 2019 – March 2020 and treated with FLOT based perioperative chemotherapy were analyzed with SPSS (version 26, IBM, Armonk, NY). Pathologic assessment of tumour regression was done by Mandard's TRG scoring. A total of 36 patients were analysed, out of which 91% were males, median age 68 years,cT3/T4 86%, cN1/2 72.2%,GOJ 77.8%,Gastric 22%,Grade 2/3 94%.Total of 80.6% patients completed all 4 cycles of neoadjuvant FLOT and 88.9% patients underwent surgery(all R0).Median interval between last dose of chemo and surgery was 7 weeks.A total of 52.8% patients completed all 4 cycles of adjuvant FLOT. Treatment was delayed due to COVID-19 in 11%. Results: Median followup was 16.3 mths.1 year DFS was 66.3% and OS was 91.4%.Pathological CR(TRG 1) was seen in 2.8% patients.3 patients died due to postop complications. Most common grd-3 toxicities were oral mucositis(6%), diarrhea (6%),neutropenia(8.3%).5FU cardiotoxicity noted in 5.6%. [Formula presented] Conclusions: In our subset of patients,treatment delivery,surgery rates and toxicity profile were comparable to the seminal FLOT4 trial.Our histological responses are lower with pathCR in only 2.8% (vs 16%)patients,with most having TRG 3.The survival rates are better but a longer followup is required. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.