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Purpose: The purpose of this study is to reveal the readiness of the employees in the banking sector in the Republic of North Macedonia to adapt to the reor-ganisation of working hours while at the same time using the safest payment methods in conditions when the world is trying to deal with the crisis caused by the COVID-19 virus. Need for the study: The world is rapidly moving towards increasing digitalisation, which is part of all spheres of human life. The outbreak of the COVID-19 virus pandemic has accelerated these processes by requiring people to adapt to the new conditions. The countries that have worked rapidly to digitise the sys-tem, while massively using non-cash payments, have adapted more easily to their regular daily tasks. The Republic of North Macedonia, as a developing country, is trying to take a step forward by introducing the innovations used by developed countries, taking into account the available assets and human resources. Methodology: A method for qualitative forecasting, Delphi, is used in three rounds, and the gained insights serve as inputs in the creation of two analytic hierarchy process (AHP) models. Findings: From the extensive analysis we performed, we found that the lack of digitalisation and process automation made it difficult for employees to adapt to the method of working from home, and on the other hand, they had a much easier time adapting to the use of alternative distribution channels. Practical implications: Our findings are useful for the country, regulatory bod-ies and the bank's management in developing strategies and plans for working from home or reorganisation of working hours, to be more acceptable to employees, emphasising the benefits for both employees and employers. Also, researchers and management practitioners in developing countries interested in this area can follow our combined Delphi-AHP approach in conducting similar research. © 2022 by Violeta Cvetkoska, Gokulananda Patel and Milanka Dimovska.
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The COVID-19 pandemic has generated a world-wide consciousness that the present way of lifestyle does not work. There are many areas need the revolutionary changes and it has become obvious, one among is educational sector. In India, educational institutes/universities remain closed since the mid of March-2020, because of the fast spread of COVID-19. Emergency lockdown has a preventive measure upended the life of students, parents and teachers. To combat this inevitable crisis educational sectors started conducting the online classes. The sudden changeover in teaching/learning method has raised new challenges and opportunities. In this study, a survey based-investigation has been carried out to analyse the efficacy of online teaching and learning method compared to traditional teaching method. A questionnaire-based survey is prepared to collect the data from different degree students, faculties and parents with general publics. A total of 874 responses gathered from people of different background participated in the survey. The analysis of collected responses confirm that the traditional chalk and talk methodology is often better than online sessions. Results and analysis indicated that lack of facilities, infrastructure, technical tools and the internet access are the major drawback for conducting online sessions. The suggestions and recommendations are provided to improve the current online teaching methods to outreach many students and improve quality teaching/learning experience. The precautions to be taken by the universities to avoid rapid spread of COVID-19 cases are high lightened, if colleges/universities opens before vaccination.
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Background: Vaccine hesitancy has been recognized as a public health issue which needs to be addressed urgently. With reopening of school unvaccinated children might become major carriers of COVID-19. An assessment of the determinants of vaccine hesitancy will aid in the acceleration of vaccine administration among children. Objective: This study aims to explore parental COVID-19 vaccine hesitancy in Surat and determine factors associated with it. Methodology: This is a cross sectional study in Surat among 250 participants selected from Rural and Urban field practice area by Systematic Random Sampling. Data collection was done by data collectors in an interview during the month of January and February, 2022. Univariate analysis was done, followed by Chi square test to establish associations. Predictors were determined by Binomial Logistic Regression. Results: Mean age of population was 31.3 + 10.7 years. Vaccine Hesitancy was recorded in 154 (61.6%) participants. Urban address (p=0.013), Full Vaccination status of parents (<0.001) and Perceived Benefits of vaccine to the child (p=0.001) were significant predictors of Vaccine Hesitancy. Conclusion: High proportion of Vaccine hesitancy was found in this study. Interventions can be planned on the basis of factors affecting Vaccine Hesitancy. © The Authors retain the copyrights of this article.
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Study question To compare role of intra-ovarian platelet rich plasma (PRP) versus marrow derived stem cell (SC) instillation for improvement in ovarian reserve (AFC, AMH and FSH) Summary answer Both PRP and SC therapy improves the ovarian reserve however, response to PRP is superior to SC post intervention What is known already With increasing incidence of females with diminished ovarian reserve (DOR), posing a serious challenge in terms of limited treatment options for these couples. Clinicians are trying to find effective strategies besides oocyte donation or adoption Of late, novel ovarian rejuvenation approaches has been investigated which are currently available for research purposes only. Multiple studies are evaluating effect of intra-ovarian PRP or autologous SC instillation, the results are encouraging as they are showing improvement in ovarian reserve thus bringing a paradigm shift in treatment options. None of the published studies so far have compared PRP versus SC in DOR population. Study design, size, duration A prospective comparative study was conducted at Division of Reproductive Medicine of a tertiary care institute. 72 infertile females (20-39 years) with poor ovarian reserve (AMH <1.2 ng /ml;AFC<5) were enrolled in the study between January 2020 to December 2021. The two comparative groups underwent either intra-ovarian PRP instillation (n = 42) or autologous SC transplantation (n = 30). Participants/materials, setting, methods After the two groups were matched (PRP vs SC) for baseline characteristics (Age, AMH, AFC, FSH, Estradiol), 30 subjects in each group were compared for change in serum FSH/AMH/Estradiol levels, AFC, right and left ovarian volume at 1st month and 3rd month post intervention from the baseline. This was also compared between the two groups using Student t-test. The cost and procedural pain measured using Visual analog scale (VAS) were also compared between the groups. Main results and the role of chance After matching for baseline characteristics, significant ∼ 1.8/2 and ∼1.5/1.6 fold increase in AFC at 1st/3rd month post intervention (p<0.001) was observed after PRP instillation and SC transplantation respectively. This significant improvement was observed more in PRP group than SC group at 3rd month post intervention (7.07 vs 5.60, p=0.02), while no significant difference existed at 1st month of follow up. However, there was no significant improvement in serum FSH, AMH and Estradiol levels (p0.05) from the baseline at 1st and 3rd month post intervention in both the groups. Similarly, there was no significant difference between the two groups in serum FSH level (7.98 IU/ml vs 9.62 IU/ml, p=0.062;8.26 IU/ml vs 9.50 IU/ml, p=0.15), AMH level (1.62 ng/ml vs 1.02 ng/ml, p=0.27;1.35 ng/ml vs 0.95 ng/ml, p=0.24), Estradiol level (49.12 pg/ml vs 56.48 pg/ml p=0.443;54.7 pg/ml vs 61.12 pg/ml, p=0.44), right ovarian volume (3.13 cm3 vs 2.49 cm3, p=0.06;3.37 cm3 vs 2.74 cm3,p=0.063) and left ovarian volume (2.98 cm3 vs 2.47 cm3, p=0.102;2.87 cm3 vs 2.34 cm3,p=0.103) at 1st and 3rd month post intervention respectively. PRP was more cost-effective and associated with less pain (32.5 mm vs 28.13 mm, p=0.02), and better patient compliance. Limitations, reasons for caution This was a comparative study and the participants were not randomized but were matched for the baseline characteristics. Also due to impact of Covid-19 causing intermittent pause in nonessential facilities like IVF services, a smaller sample size could be enrolled and also clinical outcomes could not be evaluated Wider implications of the findings This study, although comparative, for the first time highlights the beneficial role of PRP over SC, thus can establish superiority of PRP as minimally invasive, economical, patient friendly and a recommended therapy for ovarian rejuvenation and folliculogenesis, providing the DOR females an opportunity to produce their own offspring Trial registration number CTRI/2020/01/022726
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Study question Does adding gonadotropin-releasing hormone agonist (GnRHa) to hCG trigger increases the number of high-grade embryos in GnRH antagonist protocol in fresh non-donor IVF? Summary answer Final oocyte maturation triggered by dual trigger increases the number of MII oocytes thus transferring good-quality embryos and cryopreserving surplus embryos compared to hCG trigger. What is known already hCG has been conventionally used as a ‘faux’ LH surge to bring about final oocyte maturation due to structural similarity between the two. GnRH agonist, on the other hand, induces a more physiological gonadotropin surge for follicular maturation, but is associated with luteal phase deficiency. Recent studies have shown that combining GnRHa with hCG trigger improves oocyte maturation and embryo quality with the added benefit of a luteal phase support, thereby improving IVF outcomes in terms of both embryological and reproductive outcomes. Study design, size, duration A single-center, open labelled, randomized controlled trial including 100 normal responder patients between 21-38 years undergoing IVF using GnRH antagonist protocol between January 2020 to August 2021. The study excluded patients with the presence of other variables of adverse outcomes like diminished ovarian reserve (AFC < 5 or AMH < 1.2 ng/ml), endocrine disorders, thin endometrium (<6mm), previous history of uterine surgeries, and high responders. Participants/materials, setting, methods 100 patients undergoing fresh IVF cycle using GnRH antagonist protocol were randomized after informed consent to receive either dual trigger (Leuprolide acetate 1 mg + rhCG 250 mcg, n = 50) or single hCG trigger (rhCG 250 mcg, n = 50). Oocyte retrieval was done 35-37 hours after trigger followed by IVF/ICSI, as indicated. Oocyte and embryo grading was done using Istanbul consensus. Analysis was done by ITT. Outcomes were analyzed using Independent t-test and Chi-square test. Main results and the role of chance The baseline characteristics were comparable in both arms. the number of MII oocytes retrieved (7.82 versus 5.92, p = 0.003) and the number of day-3 grade-1 embryos (4.24 versus 1.8, p < 0.001) were higher in the dual trigger group, whereas fertilization rates between the two groups (91.82% versus 88.51%, p=NS) were comparable. Consequently, the number of embryos cryopreserved (2.68 versus 0.94, p < 0.001) were significantly higher in the dual trigger group. However, the implantation rate between the two groups (21% versus 19.6%, p = 0.770) was comparable. The serum LH levels 12 hours post trigger were measured in both the arms and as expected, high serum LH values were documented in the dual trigger group (46.23 mIU/ml vs 0.93 mIU/ml, p < 0.0001). Limitations, reasons for caution Due to the impact of the Covid-19 pandemic causing an intermittent pause in IVF services at our center, a smaller sample size of 100 patients could be enrolled in the study, and reproductive outcomes in terms of live births and cumulative live births could not be assessed Wider implications of the findings This study, though small, has contributed to some evidence of redesigning the dual trigger in all antagonist cycles, with the exception of high responders and PCOS patients. The addition of GnRHa to hCG trigger has led to the possibility of cryopreserving surplus embryos thereby increasing the cumulative live births. Trial registration number CTRI/2020/08/027030
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1.7 billion Learners were affected globally with educational institutions closures during the COVID-19 outbreak. India has the world's second-largest school system, after China. Shutting schools to maintain social distancing during the COVID-19 crisis was the most logical solution to avoid community transmission in the initial response to COVID-19, given uncertainty over transmission rates among school-aged children and the potential impact of the virus. All education institutions in India were temporarily closed in March 2020. Since the pandemic, education has changed is never going to be the same in the terms of the educational pedagogies. This study focused on the need assessment of spiral curriculum in teacher education due to COVID-19. In the study, a three-point scale for the questionnaire was used to collect educators. A total of 45 teacher instructors responded to the questionnaire that was exploring the opinions of the teacher-instructors about the practical work of the spiral curriculum and collecting suggestions for intensifying the practical work of the trainees. The findings suggest that there was learning loss during the covid19 pandemic due to less classroom interaction, collaboration and peer support and technical difficulties. Further, there was aa digital literacy and technical difficulties that made learning practical work not so possible. The learning outcome proves a need of spiral curriculum in teaching for the learners to gain he skills that was intended in the B. Ed course.
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Objective: To compare the role of intra-ovarian Platelet-Rich Plasma (PRP) versus marrow derived Stem-Cells (SC) instillation for improvement in ovarian-reserve (AFC,AMH, FSH). Design: A prospective comparative study. Method: 72 infertile females (20-39 years) with poor ovarian reserve (AMH <1.2 ng/ml;AFC < 5) (POSEIDON criterion) were enrolled for study between January 2020 -December 2021. The two comparative groups underwent either intra-ovarian PRP instillation (n = 42) or autologous SC transplantation (n = 30). After the two groups were matched (PRP vs. SC) for baseline characteristics (Age, AMH, AFC, FSH, Estradiol), 30 subjects in each group were compared for change in serum FSH/AMH/Estradiol levels and AFC at 1st month and 3rd month post intervention from the baseline. This was also compared between the two groups using Student t-test. The cost and procedural pain measured using Visual analog scale (VAS) were also compared. Results: After matching for baseline characteristics, significant ∼ 1.8/2 and ∼1.5/1.6fold increase in AFC at 1st/3rd month post intervention (p < 0.001) was observed after PRP instillation and SC transplantation respectively. However, PRP group fared better than SC group at 3rd month post intervention (7.07 vs. 5.60, p = 0.02), while no significant difference existed amongst the two at 1st month of follow up. Levels of Serum FSH, AMH and Estradiol (p > 0.05) did not differ significantly from the baseline at 1st and 3rd month post intervention in both the groups. Similarly, there was no significant difference between the two groups in serum FSH level (7.98 IU/ml vs. 9.62 IU/ml, p = 0.062;8.26 IU/ml vs. 9.50 IU/ml, p = 0.15), AMH level (1.62 ng/ml vs. 1.02 ng/ ml, p = 0.27;1.35 ng/ml vs. 0.95 ng/ml, p = 0.24), Estradiol level (49.12 pg/ml vs. 56.48 pg/ml p = 0.443;54.7 pg/ml vs. 61.12 pg/ml, p = 0.44) at 1st and 3rd month post intervention respectively. PRP is comparatively more cost effective and is associated with lesser pain (32.5 mm vs. 28.13 mm, p = 0.02) then SC group thus showing better compliance and acceptability. Conclusion: Both PRP and SC therapies improves the ovarian reserve markers however, response to PRP is superior to SC. Also, further to note that PRP is minimally invasive and has better compliance and acceptability. The main limitation of this study is small sample size and due to Covid pandemic inability to perform the IVF cycles to show improvement in clinical pregnancies and live births. Therefore, a large randomized trial is required to validate these results.
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Introduction: Many women undergoing simple mastectomy have an overnight hospital stay. Offering a day case procedure for simple mastectomy has the potential to improve outcomes in terms of patient safety, feasibility, and reduction in associated costs. We aimed to study the proportion of day case mastectomies over a 2-year period and assessed relative readmission and complication rates alongside patient reported outcome measures (PROMs). Following this, we wanted to analyse whether a day case procedure should be routinely offered. Method: A retrospective audit was conducted on all patients undergoing a simple mastectomy. Data were collected from patient and pathology records. PROMs were obtained via telephone conversation using the validated BREAST-Q survey. Patient demographics, reason for mastectomy and readmission for complications were all assessed. Results: Out of the 202 patients analysed, over 75%had an overnight stay. The most common complications for both groups of patients were readmission due to infection and haematoma evacuation, with similar rates across the two (p=0.26, p=0.69). Data from PROMs also suggested that patients had similar outcome and satisfaction levels (p=0.27). Conclusions: The result from this study shows that it is safe as well as acceptable to patients to offer simple mastectomies as a day case procedure. This has become more important since COVID-19 reduced inpatient theatre capacity, and it is anticipated that these outcomes will allow a routine day case mastectomy pathway to be established even when normal operations recommence as encouraged by the association of day case surgery.
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Background: Data from the first wave of COVID-19 infection demonstrated that a history of cancer and SACT was associated with poorer outcomes. Our study compares outcomes for cancer patients matched to non-cancer patients between the two waves in order to explore further how cancer and its treatment may impact COVID-19 mortality. Methods: Data was collected for patients with positive PCR and history of cancer between 1 Mar to 20 May 2020 and 1 Dec to 8 Feb 2021 for wave 1 and 2, respectively. A contemporaneous cohort of patients without cancer were age- and sex-matched for comparison. Results: The total number of patients presenting with COVID-19 was higher in wave two (1135 vs 626). 207 of these patients had cancer, and were matched to 452 patients without cancer from both waves. There was a significantly improved chance of mortality in wave 2 (HR 0.41, p < 0.0001). When adjusting for age, sex and co-morbidities, cancer was an independent risk factor for mortality amongst patients hospitalised with COVID-19 in wave 1 (HR 1.62, p = 0.02), but not in wave 2. There was a trend towards improved survival for hospitalised patients in wave 2 receiving COVID-19 specific treatment including dexamethasone, remdesivir, tocilizumab (HR 0.75, p = 0.086). For the combined cancer cohort, SACT was an independent predictor of mortality, as was metastatic disease. [Formula presented] Conclusions: The mortality for both cancer and non-cancer patients improved between waves of the pandemic. Advances in detection, prevention and treatment may account for this. Cancer was no longer a risk factor for mortality in the second wave, however SACT and metastatic cancer remained risk factors for mortality within the cancer cohort. This emphasises the need for ongoing protection of patients with advanced cancer and those on SACT, including through their prioritisation for COVID-19 vaccination globally. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: H. Shaw: Financial Interests, Personal, Invited Speaker, Advisory/Consultancy: Novartis;Financial Interests, Personal, Invited Speaker, Advisory/Consultancy: BMS;Financial Interests, Personal, Invited Speaker, Advisory/Consultancy: MSD;Financial Interests, Personal, Invited Speaker, Advisory/Consultancy: Immunocore;Financial Interests, Personal, Invited Speaker, Advisory/Consultancy: Idera;Financial Interests, Personal, Invited Speaker, Advisory/Consultancy: Iovance;Financial Interests, Personal, Invited Speaker, Advisory/Consultancy: Sanofi Genzyme/Regeneron;Financial Interests, Personal, Invited Speaker, Advisory/Consultancy: Macrogenics;Financi Interests, Personal, Invited Speaker, Advisory/Consultancy: Roche. R. Roylance: Financial Interests, Personal, Other, Personal Fees: Novartis;Financial Interests, Personal, Other, Personal Fees & None-financial support: Daiichi Sankyo;Financial Interests, Personal, Other, Personal Fees: Eli-Lilly;Financial Interests, Personal, Other, Personal Fees: Pfizer;Financial Interests, Personal, Other, Personal Fees & None-financial support: G1 Therapeutics;Non-Financial Interests, Personal, Other, None-financial support: Roche;Non-Financial Interests, Personal, Other, None-financial support: AstraZeneca. All other authors have declared no conflicts of interest.
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Background: Early reports from registry studies demonstrated high vulnerability of cancer patients from COVID-19, with case-fatality rates (CFR) >30% at the onset of the pandemic. With advances in disease management and increased testing capacity, the lethality of COVID-19 in cancer patients may have improved over time. Methods: The OnCovid registry lists European cancer patients consecutively diagnosed with COVID-19 in 35 centres from Jan 2020 to Feb 2021. We analysed clinical characteristics and outcomes stratified in 5 trimesters (Jan-Mar, Apr-Jun, Jul-Sep, Oct-Dec 2020 and Jan-Feb 2021) and studied predictors of mortality across 2 semesters (Jan-Jun 2020 and Jul 2020-Feb 2021). Results: At data cut-off, the 2634 eligible patients demonstrated significant time-dependant improvement in 14-days CFR with trimestral estimates of 29.8%, 20.3%, 12.5%, 17.2% and 14.5% (p<0.0001). Compared to the 2nd semester, patients diagnosed in the Jan-Jun 2020 time period were ≥65 (60.3% vs 56.1%, p=0.031) had ≥2 comorbidities (48.8% vs 42.4%, p=0.001) and non-advanced tumours (46.4% vs 56.1%, p<0.001). COVID-19 was more likely to be complicated in Jan-Jun 2020 (45.4% vs 33.9%, p<0.001), requiring hospitalization (59.8% vs 42.1%, p<0.001) and anti-COVID-19 therapy (61.7% vs 49.7%, p<0.001). The 14-days CFR for the 1st and 2nd semester was 25.6% vs 16.2% (p<0.0001), respectively. After adjusting for gender, age, comorbidities, tumour features, COVID-19 and anti-cancer therapy and COVID-19 complications, patients diagnosed in the 1st semester had an increased risk of death at 14 days (HR 1.68 [95%CI: 1.35-2.09]), but not at 3 months (HR 1.10 [95%CI: 0.94-1.29]) compared to those from the 2nd semester. Conclusions: We report a time-dependent improvement in the mortality from COVID-19 in European cancer patients. This may be explained by expanding testing capacity, improved healthcare resources and dynamic changes in community transmission over time. These findings are informative for clinical practice and policy making in the context of an unresolved pandemic. Clinical trial identification: NCT04393974. Legal entity responsible for the study: Imperial College London. Funding: Has not received any funding. Disclosure: D.J. Pinato: Financial Interests, Personal, Speaker’s Bureau: ViiV Healthcare;Financial Interests, Personal, Speaker’s Bureau: Bayer;Financial Interests, Personal, Advisory Board: EISAI;Financial Interests, Personal, Advisory Board: Roche;Financial Interests, Personal, Advisory Board: AstraZeneca. All other authors have declared no conflicts of interest.
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Background: COVID-19 has financially burdened Government's healthcare system as well as households with COVID-19 patients. Present study aims to value the out-of-pocket expenditure and health-related quality of life (HRQOL) using EQ-5D-5L among COVID-19 patients who sought treatment in COVID-19 center of a tertiary hospital in Vadodara, Gujarat.
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The SARS-CoV-2 virus emerged as a major cause of the COVID-19 pandemic in December 2019. Many attempts have been made to block the viral infection by targeting various processes like its entry, uncoating, replication, activating T cells response, and rising antibody titer. Also, many drugs are repurposed like remdesivir, dexamethasone, tocilizumab, hydroxychloroquine based on their established therapeutic efficacy against other viruses in the past. Natural products (NP) consist of a promising candidate and are needed to evaluate those molecules with molecular docking for preliminary screening and in vitro studies. Therefore, in the present study, a total of 12 active constituents from natural products like Ashwagandha, Tinospora cordifolia, Tea, Neem and lemon balm were docked, using the Autodock tool, onto the crystal structure of SARS CoV-2 main protease (PDB ID-5R80), to study their capability to act as main protease (Mpro) COVID-19 inhibitors. All NPs derivatives displayed good binding energies (Delta G) ranging from -8.8 to -5.2 kcal/mol, but berberine, epicatechin, and rosmarinic acid were found most potent, among others. Therefore, good binding energy, drug-likeness, and efficient pharmacokinetics suggest the potential of NPs derivatives as SARS-CoV-2 main protease (Mpro) inhibitors. However, further research is necessary to investigate the ability of these compounds as COVID-19 inhibitors. (C) 2021 ACG Publication. All right reserved.
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Introduction and Objectives Descriptions of clinical characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19), their clinical course and short-term in- A nd outpatient outcomes in deprived urban populations in the United Kingdom is still relatively sparse. We describe the epidemiology, clinical course, experience of non-invasive ventilation and intensive care, mortality and short-term sequalae of patients admitted to two large District General Hospitals across a large East London NHS Trust during the first wave of the pandemic. Methods A retrospective analysis was carried out on a cohort of 1,946 patients admitted to two hospital sites during the first UK wave of the pandemic, including descriptive statistics and survival analysis. A more detailed analysis was undertaken of a subset of patients admitted across three Respiratory Units in the trust. Results Overall survival and rates of transfer to critical care are comparable to data from other urban centers. Increasing age, male sex and Asian ethnicity were associated with worse outcomes. Increasing severity of chest X-ray abnormalities trended with mortality. Radiological changes persisted in over 50% of cases at early follow up (6 weeks). Ongoing symptoms including hair loss, memory impairment, breathlessness, cough and fatigue were reported in 67% of survivors, with 42% of patients unable to return to work due to ongoing symptoms. At 12-week follow up, 5 patients out of 109 followed up required treatment for pneumonitis with 2 requiring re-admission. Associated complications such as MI, PE and CVA were seen in less than 2% overall postdischarge. Conclusions Whilst clinical features, course of illness and inhospital outcomes are broadly in line with published literature, our initial follow up data suggest there are ongoing sequalae of COVID-19 including, persistent symptoms and radiological abnormalities. These data highlight the ongoing need for localized pathways to provide physical, emotional and psychological support these patients. There are also potential economic ramifications from these patients' delayed return to work. Further data, including longer term follow up data, are necessary to improve our understanding of this novel pathogen and associated disease.
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Background: Nucleic Acid Amplification Tests (NAATs) of nasopharyngeal specimens (NPS) have become standard for diagnosis of SARS-COV2. IDSA guidelines suggest repeat testing after 24-48 h when initially negative and clinical suspicion persists. We characterized patients from whom initial NPS were NAAT-negative, but repeats were NAAT-positive, in order to identify which patients might benefit from repeat NAAT for SARS-CoV-2, and the appropriate interval. Methods: We conducted an IRB-approved retrospective review of laboratory and electronic medical record data for all patients evaluated for SARS-CoV-2 infection at the Mount Sinai Health System, whose initial NAATs were done between March 16 - March 30, 2020, and who were retested within one month. NAATs were performed on NPS in viral transport medium using the Roche Diagnostics cobas® 6800 SARS-CoV-2 Test. Baseline patient characteristics, clinical and radiographic findings were identified. Results: Of 235 patients eligible for inclusion, 172 (70.5%) were initially NAAT-negative, and 118 (68.6%) remained NAAT-negative over 1 month follow up. 54 (31.4%) converted to NAAT-positive over the next 1-month. Of patients who became NAAT-positive, 31 (57.4%) were inpatients who converted results within a single admission;the average interval was 6d 7h between the NAAT-negative and NAAT-positive results, and the minimum interval was 10.5 h. Symptoms examined for correlation for conversion to NAAT-positive were: fever, cough, shortness of breath, and combined nausea/vomiting/diarrhea. Duration of symptoms reported at triage did not appear to affect time to conversion to NAAT-positive. No individual symptom was more likely to be associated with conversion to NAAT- positive. However, time to conversion to NAAT-positive was shorter for patients with multiple symptoms. In general, chest radiography (CXR) findings correlated with NAAT results;interval to NAAT-positive was shorter for patients with worsening CXR findings. Conclusion: Our data supports repeat testing in patients with multiple clinical symptoms suggestive of SARS CoV-2 infection and negative initial NP test results. Further studies are needed to determine the true clinical sensitivity and specificity of SARS-CoV-2 NAAT assays.
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Background: An unprecedented global effort in identifying potentially viable and emerging drugs for effective treatment of the novel coronavirus disease (2019) is being made. Of the most promising candidate therapies, convalescent plasma (CP), albeit controversial, is approved for emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA). The concept rests on passive immunity, achieved by administering plasma with high titers of neutralizing antibodies to reduce severity of SARS-CoV-2 infection and mortality. The aim of this paper is to assess the clinical improvement, patients' discharge status and all-cause mortality in convalescent plasma versus standard of care COVID-19 patient groups. Methods: Using PRISMA guidelines, a review was conducted from January, 2020, until October, 2020 employing keywords including "convalescent plasma", "clinical improvement, "mortality", "adverse events", "viral load", "dosing", and survival." Dichotomous data for all-cause mortality, patients' discharge status, and clinical improvement at day 14 of treatment were meta-analyzed applying the Mantel-Haenszel (M-H) random effects model using Review Manager 5.4. Results: A total of 627 (23.9%) patients in the CP group and 1997 (76.1%) patients in the control group were pooled. The studies were conducted in the United States, China, Netherlands, and Iran. The CP group had a lower association to all-cause mortality as compared to the control group [OR: 0.69;CI: 0.50 to 0.96;P=0.03]. Patients who received CP had higher probability of discharge during the study course [OR: 1.87;CI: 1.1 to 3.18;P=0.02]. Bias was expected in the analysis due to the stratified of study designs included. Conclusion: Convalescent plasma therapy may be an effective and vital tool with promising historical, current, and expected clinical trial evidence of metrics such as increased safety and reduction of all-cause mortality.
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Introduction and ObjectivesDescriptions of clinical characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19), their clinical course and short-term in- and outpatient outcomes in deprived urban populations in the United Kingdom is still relatively sparse. We describe the epidemiology, clinical course, experience of non-invasive ventilation and intensive care, mortality and short-term sequalae of patients admitted to two large District General Hospitals across a large East London NHS Trust during the first wave of the pandemic.MethodsA retrospective analysis was carried out on a cohort of 1,946 patients admitted to two hospital sites during the first UK wave of the pandemic, including descriptive statistics and survival analysis. A more detailed analysis was undertaken of a subset of patients admitted across three Respiratory Units in the trust.ResultsOverall survival and rates of transfer to critical care are comparable to data from other urban centers. Increasing age, male sex and Asian ethnicity were associated with worse outcomes. Increasing severity of chest X-ray abnormalities trended with mortality. Radiological changes persisted in over 50% of cases at early follow up (6 weeks). Ongoing symptoms including hair loss, memory impairment, breathlessness, cough and fatigue were reported in 67% of survivors, with 42% of patients unable to return to work due to ongoing symptoms. At 12-week follow up, 5 patients out of 109 followed up required treatment for pneumonitis with 2 requiring re-admission. Associated complications such as MI, PE and CVA were seen in less than 2% overall post-discharge.ConclusionsWhilst clinical features, course of illness and in-hospital outcomes are broadly in line with published literature, our initial follow up data suggest there are ongoing sequalae of COVID-19 including, persistent symptoms and radiological abnormalities. These data highlight the ongoing need for localized pathways to provide physical, emotional and psychological support these patients. There are also potential economic ramifications from these patients’ delayed return to work. Further data, including longer term follow up data, are necessary to improve our understanding of this novel pathogen and associated disease.