ABSTRACT
The World Health Organization declared coronavirus infectious disease-2019 (COVID-19) linked to the severe acute respiratory syndrome (SARS-CoV-2), a global pandemic in March 2020. The pandemic outbreak has led to the most unprecedented and catastrophic loss of human life in the recent history. As of January 2021, there were more than 100 million cases of COVID-19 and more than two million deaths worldwide. Compared to the general population, patients with cancer are at a higher risk of poor outcomes from COVID-19. In large cohort studies, mortality from COVID-19 in patients with cancer can be as high as 40%. In addition to clinical variables (older age, male sex, and co-morbidities) that are associated with mortality in general population, cancer patients are uniquely vulnerable to severe COVID-19 due to immunosuppression from cancer and its therapy, and disruption of routine clinical care. Among patients with cancer, the lung cancer population is at a higher risk of poor outcomes and mortality from COVID-19 for several reasons. For instance, lung is the main target organ in COVID-19 that can lead to respiratory failure, patients with lung cancer have baseline poor lung function from chronic obstructive pulmonary disorder and smoking. In addition, some of the lung cancer treatment side-effects like pneumonitis, may obscure the diagnosis of COVID-19. In this article, we systematically review the most impactful cohort studies published to date in patients with cancer and COVID-19. We describe the rates of mortality in patients with cancer and COVID-19 with a special focus on the lung cancer population. We also summarize the factors associated with poor outcomes and mortality in patients with lung cancer and COVID-19.Copyright © The Author(s) 2021.
ABSTRACT
This research aims to check the chargeability of sodium hypochlorite and the efficacy evaluation of an air-assisted electrostatic disinfection device. Five different inanimate surfaces i.e., wood, glass, stainless steel, plastic and fabric were considered to examine the performance in terms of efficacy, survival time, off-target losses, spray coverage and the volume of disinfectant consumed. A significant charge-to-mass level of 2.43 mC/kg was achieved for sodium hypochlorite at an applied voltage of 2.0 kV, a liquid flowrate of 253 ml/min and applied air pressure of 4.0 bar. The experimental results found that 1000 mg/L of sodium hypochlorite concentration effectively eliminated Pseudomonas aeruginosa, Clostridium perfringens and Bacteriophage MS2 colonies. © 2023 Elsevier B.V.
ABSTRACT
Introduction: The associations between ABO system of blood and COVID-19 infection in various studies provide reason to think true associations may be in reality between blood type and incidence of COVID-19 and death due to COVID-19. Objectives: To estimate frequency of COVID-19 illness in different ABO blood systems and also to find linkage between the ABO system of blood and degree of COVID-19 illness. Methods: A prospective cohort study was conducted on all COVID-19 patients (Patients were grouped A positive and A negative blood groups into 1st group and other blood types such as B, AB, and O, irrespective of their Rh status, into 2nd group) admitted at Tertiary Care Hospital of Ahmedabad City, Gujarat, India during the four months of study duration. Results: COVID-19 infection was found in 380 (63.3%) male. Mean age was 56.46 ±15.35 years in which 26.8% patients were in age group of 60 to 70 years. Among total 600 patients, 35% of patients were having B positive type of blood followed by O positive type of blood (25%). There were 25% of patients having overall co-morbidity like diabetes. And 8% of B positive patient having co-morbidity and amongst the, 1.2% patients were admitted to Intensive Care Unit. Case fatality rate was 7.5%. Among B positive blood group patients, 37.8% deaths occurred. Conclusion: Patients having blood group O may have lower chances of ICU admission as compared to other blood groups. © 2022 IJPH.
ABSTRACT
After the initial occurrence in Wuhan, Hubei Province, China, at the end of the year 2019, Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, has wreaked havoc on livelihoods and health worldwide. By the end of June 2021, more than 3 million deaths and a total of more than 179 million positive cases have been registered, and the numbers are steadily climbing (https://covid19.who.int/). The principal life-threatening manifestations of COVID-19 illness are caused by the dysregulated immune system and inflammatory response triggered by a surge of cytokines known as cytokine storm. This makes the lower respiratory tract more susceptible to infection resulting in acute lung injury/acute respiratory distress syndrome intermittently resulting in the death of the patient. The range of medicinal therapy available to treat COVID-19 is continuously expanding and includes both the Food and Drug Administration (FDA)-approved drugs as well as medications approved for emergency use by the FDA. The world has greeted extremely encouraging and long-awaited COVID-19 vaccination. A total of 2,624,733,776 vaccine doses have been globally administered (https://covid19.who.int/) by June 23, 2021. Even though prevention therapy in form of vaccinations is currently accessible to some, logistics and limited supplies will make it months before the entire world gets vaccinated. Even after more than one and a half years of this global threat, there are no specific therapeutics to treat this viral infection with only a few repurposed drugs authorized to treat COVID-19. Hence, multiple treatment strategies to reduce the severity of COVID-19 impact on patients must be explored. © 2023 Elsevier Inc. All rights reserved.
ABSTRACT
Background: In the current pandemic of COVID-19, hydroxychloroquine (HCQ) is recom-mended as an experimental drug for prophylaxis and treatment of the illness. Although it is a safe drug, it can rarely produce a severe drug reaction 'drug rash with eosinophilia and systemic symptoms syndrome (DRESS)', and to differentiate it from systemic viral infections is challenging. Case Presentation: A 45-year old male nurse working in a COVID-19 ward consumed HCQ weekly for two weeks for prevention of SARS-COV-2 illness. He presented with fever, pruritic maculopapular palmar rash, cervical lymphadenopathy for 12 hours and was quarantined as a suspected COVID-19 case. His laboratory tests revealed lymphopenia, eosinophilia, atypical lymphocytes, raised liver en-zymes along with IgM negative, IgG positive rapid antibody test of SARS-COV-2. However, his throat swabs for SARS-COV-2 by real-time PCR were negative on day 1 and 7. He was finally diagnosed as definite DRESS based on the RegiSCAR score of six. He responded to levocetirizine 5 mg OD and oral prednisolone 60 mg daily tapered over 7 days. Conclusion(s): DRESS due to HCQ is 'probable', 'of moderate severity', and 'not preventable' adverse effect mimicking SARS-COV-2 illness.Copyright © 2021 Bentham Science Publishers.
ABSTRACT
Introduction Objectives of this retrospective study were to describe clinical presentations and mortality outcome of hospitalised patients with COVID-19 omicron variant within two acute district general hospitals and to evaluate demographic factors associated with these presentations and mortality. Methods Data was obtained over a month in 2021-22 from a retrospective survey of all patients hospitalised and detected to have SARS-COV-2 omicron variant infection. The trust serves a diverse multi-ethnic inner-city population. Data included socio-demographic details, vaccination status, admitting specialty and mortality outcome. Patients were sub-divided into three groups;Group 1 were admitted with 'true' COVID pneumonitis;Group 2 were found to have 'incidental' COVID on admission screening;Group 3 were negative for COVID on admission but developed COVID >7days after admission. Results Of 553 patients, only 24.1%[133/553] were in Group 1;322[58.2%] in Group 2;98[17.7%] in Group 3. Patients with Group 1 and Group 3 were significantly older than those in Group 2 (p<0.001). 30% patients from BAME ethnicity had COVID pneumonitis compared to 19% from white ethnicity[p=0.002]. 20% patients were admitted within non-medical specialties i.e. surgical specialties, paediatrics and obstetrics. Of 36 requiring critical care, only 21 were in Group 1;20/21[95%] of these were unvaccinated;7/21 who died were all unvaccinated[100%]. This study showed that common COVID presentations included delirium, falls (and fractures), seizures, COPD, and antenatal problems. 13.7%[76/553] patients died;only 21 were in Group 1[27.6%]. Only 26 deaths were directly attributable to COVID;4.7%[26/553] of all patients. Discussion This large multi-ethnic study has described clinical presentations and mortality of hospitalised patients with omicron. It has determined socio-demographic factors associated with these presentations including ethnicity and vaccination rates. The study useful information for future COVID studies examining outcomes and presentations of omicron and future COVID variants.
ABSTRACT
Introduction: A significant reduction of acute rejection rates was observed after using Mycophenolate mofetil (MMF) in renal transplant recipients (RTR). However, side-effects like hematological and gastrointestinal intolerance often occur when MMF is used in routine doses.MMF dose reduction is required during its side-effects or co-existing infection in RTR.The outcome of MMF dose modulation in RTR is not well established. COVID-19 pandemic has given an opportunity to study the effect of MMF dose modulation on graft function as large number of RTR who had Covid19 received MMF dose reduction or discontinuation. This study's objective was to determine whether MMF dose reduction or discontinuation was associated with the effect on allograft function after renal transplantation. We included all RTR who had an infection with SARS-CoV2 and received MMF dose reduction or discontinuation Methods: We prospectively collected data of Renal transplant recipients developing covid 19 infection during the first and second covid waves. Management including decision on admission, immunosuppression modulation, antibiotics were done based on clinician's discretion subject to logistics and the prevailing guidelines by the ISOT. All patients were followed up for minimum 15 months for graft dysfunction, biopsy rate, biopsy proven acute rejection ( BPAR). The effect of immunosuppression modulation - MMF cessation (Group A) Vs MMF reduction/no manipulation (Group B) and its bearing on the incidence of rejection and was compared. Additional factors such as follow - up sub therapeutic CNI levels, development of DSA ( when done ), steroid increment were studied regression model. Kaplan - meier survival curves for 24 months drawn. Result(s): Among 251 renal transplant patients with SARS-CoV2 infection, 38 patients died during Index admission. 45 patients has not completed for 15 months.168 patients completed 15 month follow - up. Among them, anti-metabolite were reduced in 115 ( 68.5%), stopped in 42 (25%), not manipulated in 5 ( 3%) and 6 patients were not on anti-metabolites and hence excluded from present analysis. Of the 162 patients, MMF had been stopped for 2 weeks or until presumed clinical recovery in 42 patients ( Group A) and the rest in 120 patients ( Group B). Mean age was 41.18 ( +/- 12.8) and 75.6 % had mild COVID. Median duration of follow-up was 18 months ( 14q1-22q3 months). Total Readmission rate was 66 ( 40.7%) (Group A 21( 50%) Vs Group B 45 ( 37.5 %). Graft Biopsy was done in 16% of patients. 9.3 % patients had acute rejection ( 11.9% Vs 8.3%, p 0.05). Among those who had rejection, ABMR was seen in 2, ACR in 3, CABMR in 5 and combined rejection in 1. Conclusion(s): MMF dose modulation to tackle an infectious episode may be associated with graft dysfunction and rejection on follow-up and close follow up is needed in any patient in whom MMF dose in manipulated No conflict of interestCopyright © 2023
ABSTRACT
Background: With the ongoing SARS-CoV-2 pandemic there is concern for development of Long COVID in patients with immune-mediated diseases treated with immunosuppressive agents. We aimed to determine the incidence of Long COVID among Inflammatory Bowel Disease (IBD) patients and to identify associated risk factors. Our study also aimed at studying the differences in risk of Long COVID among different IBD medication exposures. Method(s): We conducted a retrospective cohort study utilizing a nationwide cohort of patients with IBD in the Veteran Affairs Healthcare System (VAHS). Patients diagnosed with SARS-COV-2 between March 10th, 2020, and January 24th, 2021, were included. All charts were reviewed to determine recent IBD hospitalization, hospitalization for SARS-CoV-2 infection, and stability of IBD control pre and post infection. COVID-19 hospitalizations were also reviewed for intensive care unit requirement (ICU). COVID-19 treatments including remdesivir, monoclonal antibody infusions, and corticosteroids were also ascertained. Primary outcome was development of Long COVID. Cox regression analysis was used to identify variables associated with Long COVID. Result(s): A total of 677 patients with SARS-CoV-2 infection were included, of which 49 (7.3%) were diagnosed with Long COVID (Table 1). No significant differences in IBD medication class between patients with and without Long COVID diagnoses were noted. In multivariable regression analysis, COVID-19 hospitalization (HR 3.56, 95% CI 1.80-7.09, p<0.001), ICU requirement (HR 2.20, 95% CI 1.18-4.08, p=0.01), and COPD (HR 2.41, 95% CI 1.03-5.64, p=0.04) were significantly associated with Long COVID (Table 2). Adjusted survival curves showed that relative to patients who were not hospitalized, patients hospitalized in the ICU had an 8.61-fold increased hazard of Long COVID (HR 8.61, 95% CI 3.98-18.65, p<0.001) (Figure 1). Conclusion(s): Hospitalization and ICU care for COVID-19, as well as pre-existing COPD, were associated with increased risk of developing Long COVID, suggesting that severity of infection with a vulnerable substrate are key drivers of risk. Medications used in the treatment of IBD did not impact the risk of Long COVID. These findings should help reassure and inform IBD patients about the risk of Long COVID.
ABSTRACT
Background: Neutrophil serine proteases (NSPs) are involved in the pathogenesis of COVID19 and are increased in severe and fatal infection. We investigated whether treatment with Brensocatib, an inhibitor of dipeptidyl peptidase-1, an enzyme responsible for the activation of NSPs, would improve outcomes in hospitalized patients with COVID19. Method(s): In a randomized, double-blind, placebo-controlled trial, 406 hospitalized patients with COVID19 with at least one risk factor for severe disease were randomized 1:1 to once-daily Brensocatib 25mg (n=192) or placebo (n=214) for 28 days. Primary outcome was the 7-point World Health Organisation Clinical Status scale at day 29. Secondary outcomes included time to clinical improvement, national early warning score, new oxygen and ventilation use, neutrophil elastase activity in blood and mortality. Finding(s): Brensocatib treatment was associated with worse clinical status at day 29 (adjusted odds ratio 0 72, 95%CI 0 57-0 92) compared to placebo. The adjusted hazard ratio (aHR) for time to clinical improvement was 0 87 (95%CI 0 76-1 00) and time to hospital discharge was 0 98 (95%CI 0 84-1 13). During the 28-day follow-up period, 23 (11%) and 29 (15%) patients died in the placebo and Brensocatib treated groups respectively). Oxygen and new ventilation use were greater in the Brensocatib treated patients. Neutrophil elastase activity in blood was significantly reduced in the Brensocatib group from baseline to day 29. Prespecified subgroup analyses of the primary outcome supported the primary results.
ABSTRACT
The negative impact of COVID on the respiratory system is well characterized in a general population. The increased complexity of COVID in lung transplant recipients (LTRs) and assessment of injury severity is less defined. We compared allograft injury as measured by donor derived cell-free DNA (dd-cfDNA) in LTRs with post-transplant COVID. We hypothesized more severe COVID infection would be associated with higher lung injury, as evidenced by higher dd-cfDNA. All LTRs positive for COVID with peri-infection dd-cfDNA (%, AlloSure, CareDx) from Memorial Hermann Hospital (MHH) and University of Texas Health Science Center San Antonio (UTHSC-SA) were evaluated. LTRs were stratified on hospitalized vs not hospitalized for COVID. Time between dd-cfDNA result and COVID infection was calculated and graphed. LTRs with concurrent immune events (acute cellular rejection or antibody mediated rejection) were excluded. Twenty-eight LTRs had post-COVID dd-cfDNA results available (MHH 18, UTHSC-SA 10). Peri-COVID infection dd-cfDNA trends are shown in Figure 1. Seventeen (61%) were hospitalized and 39% (n=11) were not. Median max dd-cfDNA in hospitalized LTRs was 1.10% (IQR 0.82, 2.40) drawn at median 50 days (IQR 35, 151) post-COVID. Median max dd-cfDNA in not hospitalized LTRs was 0.94% (IQR 0.45, 1.80) drawn at median 81 days (IQR 43, 235). As dd-cfDNA levels were not drawn at the same times post-COVID between hospitalized and not hospitalized patients, differences cannot be directly compared. However, there are clear elevations in median dd-cfDNA among COVID hospitalized LTRs indicating a higher degree of allograft injury in those patients. Both the dd-cfDNA elevation preceding date of COVID positivity and the following decay between hospitalized and not hospitalized LTRs could be important prognostically. Investigation into effect of COVID treatment on dd-cfDNA, time to return to dd-cfDNA baseline levels, and resolution of pulmonary function are warranted. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
COVID-19 vaccine has emerged as the most powerful weapon against the spread of the coronavirus. Therefore, the management of the vaccine inventory is undoubtedly the most influential and important task for the global distribution of the vaccine. This paper is an attempt to model the vaccine inventory system having time-varying holding costs and partially backlogged shortages. The concept of fuzzy set and cloud pentagonal fuzzy number has been incorporated to make the models more realistic and applicable. Models are solved and validated through numerical examples and graphical representation. Further, sensitivity analysis has been done to identify the most sensitive parameters of all. Finally, managerial insights and conclusions have been drawn to make the vaccine inventory system more robust. © 2023 World Scientific Publishing Company.
ABSTRACT
Creating a comprehensive didactic curriculum for breast imaging fellows can be a demanding undertaking, especially considering that most breast practices are understaffed because of the COVID-19 pandemic and amid rising clinical volumes. This leaves little time for didactic education. In this article, we present our approach to creating a collaborative weekly multidisciplinary didactic lecture series involving multiple institutions, using the Society of Breast Imaging's suggested fellowship curriculum as the foundation. We discuss the advantages for both trainees and faculty, including fostering camaraderie, networking, and engagement among breast imaging fellows. Faculty have the opportunity for professional development by leveraging their clinical expertise through selecting didactic topics in their niche. This creates a pathway for speaking faculty to be recognized as regional and national experts.
ABSTRACT
In the COVID-19 pandemic, to minimize aerosol-generating procedures, cardiac magnetic resonance imaging (CMR) was utilized at our institution as an alternative to transesophageal echocardiography (TEE) for diagnosing infective endocarditis (IE). This retrospective study evaluated the clinical utility of CMR for detecting IE among 14 patients growing typical microorganisms on blood cultures or meeting modified Duke Criteria. Seven cases were treated for IE. In 2 cases, CMR results were notable for possible leaflet vegetations and were clinically meaningful in guiding antibiotic therapy, obtaining further imaging, and/or pursuing surgical intervention. In 2 cases, vegetations were missed on CMR but detected on TEE. In 3 cases, CMR was non-diagnostic, but patients were treated empirically. There was no difference in antibiotic duration or outcomes over 1 year. CMR demonstrated mixed results in diagnosing valvular vegetations and guiding clinical decision-making. Further prospective controlled trials of CMR Vs TEE are warranted. © 2022 Elsevier Inc.
ABSTRACT
Background: Even with the massive increase in financial investments in pharmaceutical research over the last decade, the number of new drugs approved has plummeted. As a result, finding new uses for approved pharmaceuticals has become a prominent alternative approach for the pharmaceutical industry. Objective: Drug repurposing or repositioning is a game-changing development in the field of drug research that entails discovering additional uses for previously approved drugs. Methods: In comparison to traditional drug discovery methods, drug repositioning enhances the preclini-cal steps of creating innovative medications by reducing the cost and time of the process. Drug reposition-ing depends heavily on available drug-disease data, so the fast development of available data as well as developed computing skills has resulted in the boosting of various new drug repositioning methods. The main goal of this article is to describe these different methods and approaches for drug repurposing. Results: The article describes the basic concept of drug repurposing, its significance in discovering new medications for various disorders, drug repurposing approaches such as computational and experimental approaches, and previous as well as recent applications of drug repurposing in diseases such as cancer, COVID-19, and orphan diseases. Conclusion: The review also addresses obstacles in drug development using drug repurposing strategies, such as a lack of financing and regulatory concerns and concludes with outlining recommendations for overcoming these challenges. © 2023 Bentham Science Publishers.
ABSTRACT
Cellular and humoral responses are required for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) eradication. Antigen-presenting cells load SARS-CoV-2 peptides on human leukocyte antigen (HLA) with different avidities and present to T- and B-cells for imposing humoral and cellular responses. Due to immunosuppression, renal transplant recipient (RTR) patients are speculated to poorly form the antibody against the SARS-CoV-2. Therefore, determining the association of specific HLA alleles with anti-SARS-CoV-2 spike protein antibody formation will be helpful in managing the RTR having specific HLA alleles from SARS-CoV-2 infection and vaccination. Material(s) and Method(s): In this study, anti-SARS-CoV-2 spike protein antibody in 161 RTRs was determined by the chemiluminescent microparticle immunoassay methods, and HLA alleles were determined by the polymerase chain reaction-single-strand oligonucleotide methods and analyzed to study the HLA allele association with anti-SARS-CoV-2 spike protein-specific humoral response and severity of COVID-19 symptoms in recently SARS-CoV-2-infected RTRs. Result(s): The anti-SARS-CoV-2 spike protein specific antibody seroconversion rate in RTRs was 90.06% with a median titer of 751.80 AU/ml. The HLA class I alleles, A*11 in 22.1%, A*24 in 21.37%, A*33 in 20.68%, HLA B*15 in 11%, B*07 in 8.27%, HLA-C*30 in 20.93%, C*70 in 23.25% and HLA Class II alleles, DRB1*07 in 18.62%, DRB1*04 in 13.8%, HLA-DRB1*10 in 14.48%, HLA-DQA1*50 in 32.55% of RTRs were associated with the seroconversion. The mean SARS-CoV-2 clearance time was 18.25 +/- 8.14 days. Conclusion(s): RTRs with SARS-CoV-2 infection developed a robust seroconversion rate of 90.0% and different alleles of HLA-B, DRB1, and DQA1 were significantly associated with the seroconversion. Copyright © 2022 Indian Journal of Transplantation.