Covid-19 Bivalent Booster Effectiveness in People with and without Immune Dysfunction

Background: Data on the effectiveness of the bivalent booster vaccine against COVID-19 breakthrough infection and severe outcomes is limited. Method(s): Using patient-level data from 54 sites in the U.S. National COVID Cohort Collaborative (N3C), we estimated bivalent booster effectiveness against breakthrough infection and outcomes between 09/01/2022 (bivalent vaccine approval date) to 12/15/2022 (most recent data release of N3C) among patients completed 2+ doses of mRNA vaccine. Bivalent booster effectiveness was evaluated among all patients and patients with and without immunosuppressed/compromised conditions (ISC;HIV infection, solid organ/ bone marrow transplant, autoimmune diseases, and cancer). We used logistic regression models to compare the odds of breakthrough infection (COVID-19 diagnosis after the last dose of vaccine) and outcomes (hospitalization, ventilation/ECMO use, or death <=28 days after infection) in the bivalent boosted vs. non-bivalent boosted groups. Models controlled for demographics, comorbidities, geographic region, prior SARS-CoV-2 infection, months since the last dose of non-bivalent vaccine, and prior non-bivalent booster. Result(s): By 12/15/2022, 2,414,904 patients had received 2+ doses of mRNA vaccination, 75,873 of them had received a bivalent booster vaccine, and 24,046 of them had a breakthrough infection. At baseline, the median age was 52 (IQR 36-67) years, 40% male, 63% white, 10% Black, 12% Latinx, 3.5% Asian American/Pacific Islander, and 14% were patients with ISC. Patients received a bivalent booster were more likely to be female and had comorbidities. Bivalent booster was significantly associated with reduced odds of breakthrough infection and hospitalization (Figure). The adjusted odds ratios comparing bivalent vs. non-bivalent group were 0.28 (95% CI 0.25, 0.32) for all patients and 0.33 (95% CI: 0.26, 0.41) for patients with ISC. Compared to the nonbivalent group, the bivalent group had a lower incidence of COVID-19-related hospitalization (151 vs. 41 per 100,000 persons), invasive ventilation/ECMO use (7.5 vs. 1.3 per 100,000 persons), or death (11 vs. 1.3 per 100,000 persons) in all patients during the study period;the incidence of severe outcomes after bivalent boosting was similar among patients with and without ISC. Conclusion(s): A bivalent booster vaccine was highly effective against COVID-19 breakthrough infection and severe outcomes among patients received 2+ doses of mRNA vaccine and offered similar protection in patients with and without ISC. (Figure Presented).

The Impact Of COVID-19 Lockdown on Parents Handling Children with Disability in Chennai, India

Introduction: Millions around the globe were directly or indirectly affected by COVID-19 pandemic. The COVID-19 epidemic has harmed the lives of children with special needs in many ways, whether directly or in-directly. Few studies have evaluated the Impact of covid-19 lockdown among children with disability. Howev-er, the Impact of COVID on parents dealing with special children was scarcely studied in detail. Investigating parental stress, worries, and morbidity during the lockdown is particularly important for assisting these parents during further outbreaks. The aim is to assess the Impact of covid-19 lockdown among parents handling disabled children, parenting stress, their concerns, and morbidity during the COVID-19 lockdown. Materials And Method: The study was done among the parents of disabled children attending special schools in Chennai, using a cross-sectional study design. Parents with any recent trauma, mental disorders, or major diseases and undergoing treatment for themselves were excluded. After obtaining ethics approval, a semi-structured questionnaire was used to assess the Impact of the covid-19 lockdown. Collected data were ana-lyzed using SPSS v.21. Results: The study includes 305 parents, predominantly mothers (58%) and the mean age was 38.9+8.2 years. We observed that the COVID-19 lockdown impacted 149 parents (48.9%). The significant predictors for the Impact of COVID-19 lockdown were being a single parent [AOR-2.91(95%CI-1.05-8.08)] and having a part-time job [AOR-0.36(95%CI-0.14-0.93)]. Conclusion: The COVID-19 outbreak and lockdown significantly impacted the parents of disabled children. It is high time we give importance to these parents of children with special needs during this pandemic to help them during similar occasions in the future. © 2023, MedSci Publications. All rights reserved.

Diazoxide in the Treatment of Asymptomatic Refractory Hypoglycemia in End Stage Renal Disease

Introduction: Diabetic patients with end-stage renal disease (ESRD) treated with insulin or any other diabetic agent show high variations in their glucose metabolism, lower insulin clearance level, and uncertain accuracy of glycemic control measurements. Therefore, these patients are at a greater risk of developing hypoglycemia. Diazoxide use in the treatment of spontaneous and refractory hypoglycemia in this population has not been well documented. We report a case of a young diabetic male that has been successfully treated with diazoxide for his asymptomatic refractory hypoglycemic episodes. Case Description: A young man with type 2 diabetes mellitus complicated by diabetic nephropathy, on hemodialysis for ESRD, presented with shortness of breath due to COVID pneumonia. After resolution of his infection, he was noted to have recurrent asymptomatic hypoglycemic episodes, although he has been off his diabetes medications for the past few years due to worsening of his kidney function. His oral intake was adequate and there was no concern for malnutrition, or any substance use. From the testing performed, we were able to exclude exogenous insulin or insulin secretagogues use and the presence of insulin antibodies. Insulin and noninsulin (insulin-like growth factor) mediated mechanisms were also ruled out. Since he was having recurrent and refractory asymptomatic hypoglycemic episodes and to minimize the need for supplemental dextrose containing fluids, he was started on diazoxide at 3 mg/kg/day. Knowing the risk of fluid retention with diazoxide, this patient on hemodialysis tolerated it well. Diazoxide helped reduce his episodes of hypoglycemia and he was then safely discharged on it. Discussion(s): In ESRD, hypoglycemia can be explained by the impaired contribution of the kidneys to gluconeogenesis and glucose release, as well as the higher insulin levels caused by insulin resistance and decrease in insulin clearance. When his hypoglycemia persisted even after the resolution of his infection, further testing and work-up was done and other causes of hypoglycemia were ruled out. Generally, diazoxide is used as a treatment to manage the symptoms of hypoglycemia in congenital hyperinsulinism, insulinomas and post bariatric surgery cases of hyperinsulinemic hypoglycemia. However, it has not been the optimal treatment when it comes to treating hypoglycemia in ESRD patients because of its side effects;specifically, fluid retention, and electrolyte imbalances. In our case, the patient was treated with diazoxide as a last resort, despite its known side effects and the limited documentation of its use in ESRD patients. Actually, a few other case reports, have also shown promising results with the use of diazoxide for that purpose with no or minimal side effects. However, there are not enough studies that have shown the benefits or risks of long-term treatment of diazoxide in ESRD patients, an area of growing interest.Copyright © 2023

COVID-19 detection on chest x-ray image using yolo based architecture

The whole world has been facing the problem of novel Coronavirus (COVID-19) since 2020. Over 88 million cases are confirmed and around 5 lacks deaths are accounted. Using the Lung-Computed Tomography (CT) Lesion Segmentation dataset, deep learning techniques may be used to quickly identify COVID-19 and the exact region that is infected. Based on CT, it is easy to identify the problem and the infected area, then assisting treatment of COVID-19. In the literature survey, research study has considered many research papers worked done work on identification of COVID-19 using chest/lungs X-ray image, and with that identified what are the deep learning-based models or methodology they have used for detecting COVID-19 result. To overcome their result, Authors have proposed a latest methodology of deep learning with the YOLO variant 7x to get optimum result of COVID -19 detection from lungs X-ray image. To identify COVID-19, Authors have applied proposed methodology on publically avail X-ray image-based dataset of COVID-19, proposed methodology has achieved good performance to detect COVID infection from lungs. © 2023 IEEE.

In-silico Discovery of Fungal Metabolites Bergenin, Quercitrin and Dihy-droartemisinin as Potential Inhibitors against Main Protease of SARS-CoV-2

Background: Emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has given rise to COVID-19 pandemic, which has become a wreaking havoc worldwide. Therefore, there is an urgent need to find out novel drugs to combat SARS-CoV-2 in-fection. In this backdrop, the present study aimed to assess potent bioactive compounds from different fungi as potential inhibitors of SARS-CoV-2 main protease (Mpro) using an in-silico analysis. Method(s): High-Resolution Liquid Chromatography Mass Spectrometry analysis (HR-LCMS) was used for the bioactive profiling of ethanolic crude extract of Dictyophora indusiata, Geastrum tri-plex and Cyathus stercoreus. Of which, only bergenin (D. indusiata), quercitrin (G. triplex) and di-hydroartemisinin (C. stercoreus) were selected based on their medicinal uses, binding score and the active site covered. The 6LU7, a protein crystallographic structure of SARS-CoV-2 Mpro, was docked with bergenin, quercitrin and dihydroartemisinin using Autodock 4.2. Result(s): A total of 118 bioactive compounds were analyzed from the crude extract of used fungi and identified using HR LC/MS analysis. The binding energies obtained were-7.86,-10.29 and-7.20 kcal/mol, respectively, after docking analysis. Bergenin, quercitrin and dihydroartemisinin formed hydrogen bond, electrostatic interactions and hydrophobic interactions with foremost active site amino acids THR190, GLU166, GLN189, GLY143, HIS163, HIS164, CYS145 and PHE140. Conclusion(s): Present investigation suggests that these three compounds may be used as alternative inhibitors against SARS-CoV-2 Mpro. However, further research is necessary to assess in vitro potential of these compounds. To the best of our knowledge, the present investigation reported these three bioactive compounds of fungal origin for the first time.Copyright © 2021 Bentham Science Publishers.

Machine learning- based lung disease diagnosis from CT images using Gabor features in Littlewood Paley empirical wavelet transform (LPEWT) and LLE

The term 'lung disease' covers a wide range of conditions that affect the lungs, including asthma, COPD, infections like the flu, pneumonia, tuberculosis, lung cancer, COVID, and numerous other breathing issues. Respiratory failure may result from several respiratory disorders. Recently, various methods have been proposed for lung disease detection, but they are not much more efficient. The proposed model has been tested on the COVID dataset. In this work, Littlewood-Paley Empirical Wavelet Transform (LPEWT) based technique is used to decompose images into their sub-bands. Using locally linear embedding (LLE), linear discriminative analysis (LDA), and principal component analysis (PCA), robust features are identified for lung disease detection after texture-based relevant Gabor features are extracted from images. LLE's outcomes inspire the development of new techniques. The Entropy, ROC, and Student's t-value methods provide ranks for robust features. Finally, LS-SVM is fed with t-value-based ranked features for classification using Morlet wavelet, Mexican-hat wavelet, and radial basis function. This model, which incorporated tenfold cross-validation, exhibited improved classification accuracy of 95.48%, specificity of 95.37%, sensitivity of 95.43%, and an F1 score of.95. The proposed diagnosis method can be a fast disease detection tool for imaging specialists using medical images.Copyright © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Automated diagnosis of COVID stages using texture-based Gabor features in variational mode decomposition from CT images

COVID-19 is a deadly and fast-spreading disease that makes early death by affecting human organs, primarily the lungs. The detection of COVID in the early stages is crucial as it may help restrict the spread of the progress. The traditional and trending tools are manual, time-inefficient, and less accurate. Hence, an automated diagnosis of COVID is needed to detect COVID in the early stages. Recently, several methods for exploiting computed tomography (CT) scan pictures to detect COVID have been developed;however, none are effective in detecting COVID at the preliminary phase. We propose a method based on two-dimensional variational mode decomposition in this work. This proposed approach decomposes pre-processed CT scan pictures into sub-bands. The texture-based Gabor filter bank extracts the relevant features, and the student's t-value is used to recognize robust traits. After that, linear discriminative analysis (LDA) reduces the dimensionality of features and provides ranks for robust features. Only the first 14 LDA features are qualified for classification. Finally, the least square- support vector machine (SVM) (radial basis function) classifier distinguishes between COVID and non-COVID CT lung images. The results of the trial showed that our model outperformed cutting-edge methods for COVID classification. Using tenfold cross-validation, this model achieved an improved classification accuracy of 93.96%, a specificity of 95.59%, and an F1 score of 93%. To validate our proposed methodology, we conducted different relative experiments with deep learning and traditional machine learning-based models like random forest, K-nearest neighbor, SVM, convolutional neural network, and recurrent neural network. The proposed model is ready to help radiologists identify diseases daily. © 2023 Wiley Periodicals LLC.

Nanotechnology and stem cell therapy for combating COVID-19

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.

The influence of the first coronavirus wave on the two-week-wait head and neck cancer referrals to a London hospital

The coronavirus Covid-19 has sent reverberations in all aspects of healthcare, where its spread in 2019 has impacted multiple National Health Services, including the head and neck cancer clinics. Early diagnosis combined with the appropriate treatment plays an unquestionable significant role in the survival rates and prognosis for head and neck cancer patients. King's College Hospital sits in the heart of south-east London, serving a population of 700,000;however also acts as a tertiary care centre receiving referrals for a multitude of specialties from across the South of England. A retrospective review was conducted of 365 cases referred for suspected head and neck cancer to the Oral and Maxillofacial Surgery and Oral Medicine two-week-wait clinic at King's College Hospital during the first coronavirus wave (1st of March 2020 to 31st of September 2020) and the same time period in 2019. A total of 233 suspected head and neck cancer referrals were made via the Pan London referral pathway during the first wave in 2020, compared to 132 referrals made in 2019. A total of 3.4% (n = 8) of the patients referred during the first wave were diagnosed with a subtype of head and neck cancer, compared with 9.8%(n = 13) in 2019. Of these referrals, the proportion of patients not seen within the required 14-day period only slightly increased from 3.03% (n = 4) in 2019 to 3.86% (n = 9) in 2020. There was a significant impact from the government-enforced lockdown where reduced face-to-face examinations impacted the quantity of referrals and their diagnosis via the two-week-wait pathway. This study allows reflection of the impact of the first coronavirus wave on the two-week-wait head and neck cancer referrals and gives valuable insight for service implementation and staff reallocation in the event of future periods of waves to prevent overburdening of services.Copyright © 2021

Realtime Risk Monitoring System using Convolutional Neural Network for COVID19 Pandemic

The COVID19 pandemic has significantly changed the lifestyle of billions of people across the globe. It has greatly affected almost all sectors of business, industry and public life. As per the WHO's guidelines, wearing a face mask has become the new compulsory and precautionary measures for everyone. Currently, all the public and private service providers will expect their stakeholders to wear face mask in an appropriate way to avail any services. Therefore, detection of face mask at public places is a crucial task to help the society to overcome current pandemic. This paper presents a unique approach to not only detect face mask but also calculate the risk of getting infected by COVID-19 using machine learning algorithms. The proposed model detects the various faces present in an input video, identifies if it has a mask present or not. If the mask is not detected, the model calculates the risk of human being getting infected based on their age. Finally, the model generates the output and provides analysis based on the real time data it has processed. As a real-time surveillance system, the model can also classify a face when a person is moving in the live video. The proposed method attained a highest accuracy of 99.57 % against standard datasets under study. The authors experimented and explored various Convolutional Neural Network models like DenseNet, MobileNet_V2, Inception_V3 and YOLO_V4 find the best model, detecting the presence of masks accurately without causing over-fitting. © 2022 IEEE.

Complex organisational factors influence multidisciplinary care for patients with hip fractures: a qualitative study of barriers and facilitators to service delivery.

BACKGROUND: Hip fractures are devastating injuries, with high health and social care costs. Despite national standards and guidelines, substantial variation persists in hospital delivery of hip fracture care and patient outcomes. This qualitative study aimed to identify organisational processes that can be targeted to reduce variation in service provision and improve patient care. METHODS: Interviews were conducted with 40 staff delivering hip fracture care in four UK hospitals. Twenty-three anonymised British Orthopaedic Association reports addressing under-performing hip fracture services were analysed. Following Thematic Analysis of both data sources, themes were transposed onto domains both along and across the hip fracture care pathway. RESULTS: Effective pre-operative care required early alert of patient admission and the availability of staff in emergency departments to undertake assessments, investigations and administer analgesia. Coordinated decision-making between medical and surgical teams regarding surgery was key, with strategies to ensure flexible but efficient trauma lists. Orthogeriatric services were central to effective service delivery, with collaborative working and supervision of junior doctors, specialist nurses and therapists. Information sharing via multidisciplinary meetings was facilitated by joined up information and technology systems. Service provision was improved by embedding hip fracture pathway documents in induction and training and ensuring their consistent use by the whole team. Hospital executive leadership was important in prioritising hip fracture care and advocating service improvement. Nominated specialty leads, who jointly owned the pathway and met regularly, actively steered services and regularly monitored performance, investigating lapses and consistently feeding back to the multidisciplinary team. CONCLUSION: Findings highlight the importance of representation from all teams and departments involved in the multidisciplinary care pathway, to deliver integrated hip fracture care. Complex, potentially modifiable, barriers and facilitators to care delivery were identified, informing recommendations to improve effective hip fracture care delivery, and assist hospital services when re-designing and implementing service improvements.

Hafnia, a case of translocated septicemia

Case Report: Hafnia alvei, a member of the Enterococcus family, is a gram-negative anaerobe native to the gastrointestinal tract. While very rarely pathogenic, it has historically been associated with gastroenteritis, meningitis, bacteremia, pneumonia, and nosocomial wound infections. Here we report a non-fatal case of Hafnia-septicemia following recent ERCP for Choledocholithiasis. Case Report: 73-year-old Caucasian male with Chronic obstructive pulmonary disease, chronic kidney disease Stage 5, diabetes mellitus and hypertension who presented to the Emergency Department (ED) with a chief complaint of chills and fevers as well as worsening dry hacking cough and intermittent shortness of breath. Of note, patient had presented to the ED the previous day with abdominal pain and nausea after undergoing ERCP for Choledocholithiasis from day prior. Computed tomography (CT) imaging from 1st ED visit showed no acute signs of pancreatitis, however patient was noted to have bibasilar opacities. Lipase was normal at 39. Other lab work was significant for leukocytosis to 11 000. Patient's abdominal pain and nausea resolved while in the ED, he also denied shortness of breath and was breathing comfortably on room air. He was discharged from the ED with 7-day course of Azithromycin for community acquired pneumonia. On return visit next day, patient reported new onset shortness of breath and fevers. Physical exam was remarkable for hypoxia requiring 2 liters nasal cannula, and tachycardia to 104. Patient tested negative for Covid -19. Patient admitted for acute hypoxic respiratory failure and sepsis secondary to presumed bacterial pneumonia. Patient was started on IV Vancomycin and Cefepime and required oxygen support for hypoxia. He showed marked improvement by day two of hospitalization and was weaned off oxygen. Admission Blood cultures were positive for gram negative rods after 24 hours and subsequently grew Hafnia that was pan sensitive except to Ampicillin + Sulbactam. Repeat blood cultureswere negative 24 hours later. Patient was deemed medically stable on day 3 of admission and discharged on PO Levofloxacin for 10-day course for Hafnia septicemia and pneumonia. Discussion(s): When considering the etiology of septicemia especially in the context of a recent gastrointestinal procedure, translocation of anaerobic bacteria should be on the differential. Hafnia alvei is a rare pathologic cause of septicemia with only a handful of reported cases upon literature review. Copyright © 2023 Southern Society for Clinical Investigation.

Susceptible Factors, Awareness and Health Care Management of Covid-19 Patients Discharged from A Tertiary Hospital in the Pune District

INTRODUCTION: Coronavirus disease (COVID-19), an infectious disease caused by a new coronavirus called SARS-CoV-02, causes mild to moderate respiratory illness, and patients with benign disease conditions recover without requiring special treatment. The best way to prevent and slow down transmission is to be well-informed about the COVID-19 virus, the disease, its causes, and how it spreads;hence a qualitative research tool using focus group discussion was carried out with the following objective. To determine various symptoms, awareness, course of the disease, and health care impact on COVID-19 cases seeking health care. METHODOLOGY: A cross-sectional qualitative study was conducted at a tertiaryhospital attached to a medical college in April 2020. Information about the discharge of patients with a number equal to or more than 12 patient groups and their ward numbers was obtained from the office of the hospital's CEO. The collective proportion of content analysis of all the groups interacted, Word cloud, text mining, and ATLAS-TI software were used for analysis. RESULT(S): The investigator interacted with the groups until saturation in reply was achieved. The average age group was 41 years. 91% of patients ranged from middle-aged adults. There were 62% male and 38 % female patients. The patients could recollect and guess the likely source of infection. A specific inquiry was made to remind them to obtain the answers. Those aware of the confirmed case, either in the family, relatives, workplace, neighbours, or mass testing of patients in their chawl, could guess the reason for their positivity. CONCLUSION(S): Health experts should remove the fear among the patient during such pandemic situations after the patients enter isolation. The patients experienced stigma from the society they lived in. Copyright © 2023 Authors. All rights reserved.

Patient Satisfaction Over Changing Dental Treatment Trends During COVID-19 Pandemic-A Cross-Sectional Study

Introduction: Patient satisfaction in health care describes the degree to which patients' needs 'meet their expectations and provide an acceptable standard of care'. Therefore, their opinion should be incorporated to understand factors affecting patients' satisfaction with the health-care setting. The recent COVID-19 pandemic has posed a significant challenge for the field of dentistry owing to its working characteristics. It is difficult for dentists to provide optimum satisfaction to patients receiving dental care with such changes proposed. A study aiming to evaluate the patient's satisfaction receiving treatment in the Department of Dentistry during the pandemic was planned. Materials and Methods: A cross-sectional observational study from September to November 2020 was conducted. A self-administered printed questionnaire drafted in English/Gujarati was provided to 225 patients on completion of their dental treatment. Thirteen close-ended questions were included in determining the patient's satisfaction. Descriptive statistical analysis was used to describe the parameters of the questionnaire. The Chi-square test was used to find a significant association between parameters, and P < 0.05 was considered statistically significant. Results: About 74.3% of the participants were satisfied with dentist-patient communication. Positive response (80%) by patients where they were able to get an appointment as per their suitability and were informed in advance by the department if there were any changes. One hundred and sixty-eight (84%) patients responded that the waiting area was hygienic. One hundred and thirty-seven (68.5%) patients assured that their arrival was intimated to the respective dentist by supporting staff and that they were taken into an operatory for treatment within 10 min of arrival. Participants said that they were informed about the delay from their allotted appointment schedule with reasons;hence, better compliance (79%) was obtained from them. Conclusions: This cross-sectional study indicated that with proper communication, a positive response by participants over satisfaction was obtained even due to changing treatment patterns due to pandemic.

Role of Tocilizumab in Patients with Moderate-to-Severe Covid-19 Pneumonia

Objectives: Cytokine release syndrome (CRS) is believed to be responsible for death in COVID-19. Tocilizumab is an interleukin (IL)-6 receptor antagonist, IL-6 being identified as a major component of the CRS cascade. The objective of the study was to determine if tocilizumab can prevent mortality and morbidity in moderate-to-severe COVID-19 pneumonia. Method(s): Patients admitted to the ICU between the time period of June 2020-August 2020 were included in this retrospective and cohort study conducted at GCS medical college, hospital and research center. Patients had to be more than 18 years of age and were required to have a positive reverse transcription polymerase chain reaction report for COVID-19. After applying the inclusion/exclusion criteria, 119 patients were considered for final analysis. Tocilizumab was administered as a single dose of 8 mg/kg in 22 patients. Rest of the patients received standard of care regime. The primary outcome was either discharge or death of the patients and the requirement of invasive mechanical ventilation during their hospital stay. The secondary outcome was the length of hospital stay. Appropriate demographic, clinical, and laboratory data were documented. Statistical analysis was done with appropriate clinical tests with significance set at p<0.05. Result(s): Tocilizumab significantly reduced deaths in patients as well as the need for mechanical ventilation with NNT=3 and 5, respectively. The same held true even when the data were adjusted for age, gender, and number of comorbidities. Number of comorbidities had a negative association with mortality and need for mechanical ventilation irrespective of administration of tocilizumab as evidenced by multivariable logistic regression. There was no effect of tocilizumab in shortening the hospital stay in patients. Conclusion(s): Tocilizumab seems to be a promising agent for the treatment of moderate to severe COVID-19 pneumonia and similar agents hold promise for any similar future emerging infections. Copyright © 2022 The Authors.

A Booster Dose of Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine Induced C7-C8 Radiculitis Leading to Hand Dysfunction: A Case Report

Case Diagnosis: A 71-year-old female developed C7-C8 radiculitis with left hand weakness 4 days after receiving her booster dose of SARS-CoV-2 vaccine. Case Description or Program Description: Patient with a significant past medical history of cervical fusion and bilateral carpal tunnel releases over 20 years ago presented to outpatient office because of decreased hand grip strength 4 days after receiving her booster dose of Pfizer-BioNTech SARS-CoV-2 vaccine. Her left hand weakness was spontaneous in onset, making her unable to flex her index finger and type. No pain or paresthesia. No trauma, swelling, color or temperature change in her left hand. Nerve conduction study and electromyography performed 19 days after the onset of her symptoms revealed acute greater than chronic changes mainly in distal muscles innervated by C7-C8 nerve roots, compatible with left C7-8 radiculopathy. MRI findings were chronic and compatible with her history of cervical fusion. Her clinical presentation was thought to be an inflammatory rather than mechanical etiology associated with the booster. Patient was referred to outpatient occupational therapy to help her restore hand function. Setting(s): Outpatient office of acute rehabilitation hospital Assessment/Results: Patient underwent occupational therapy and reported mild improvement in hand strength and function after 3 months of therapy. Discussion (relevance): The clinical course of this patient suggested an association between her symptoms and the booster dose of SARS-Cov-2 vaccine. It is possible that some component of the booster might have triggered an immune response and cross-reacted to the peripheral nerve system, leading to acute neuritis and the weakness of her hand. Conclusion(s): Neurologic complications after SARSCov- 2 vaccination is usually mild and self-limiting. We present a rare case of acute radiculitis that was associated with SARS-Cov-2 vaccination with residual impairment in function. Although the causality cannot be confirmed due to the lack of a biological marker, this case may help guide further research into a potential pathogenic mechanism.