Kidney Transplantation Utilizing SARS-CoV-2 Rt-PCR Positive Donor Kidneys with Immediate Post Exposure Casirivimab / Imdevimab Followed by Thymoglobulin Induction

Purpose: At the beginning of the pandemic, kidneys from SARS-CoV-2 (COVID) RT-PCR positive donors were not utilized for transplantation, due to the risk of viral transmission. With the advent of the COVID vaccines, and improved monoclonal antibody therapy we transplanted organs from COVID positive donors irrespective of disease severity. Method(s): We performed six kidney transplants from COVID RT-PCR positive donors. Potential donors were screened for the date of the first positive COVID RTPCR. Only donors whose test had been positive at least 10 days prior to donation on a nasopharyngeal swab or bronchoalveolar lavage were accepted. A cycle threshold (ct)of >= 35 cycles was used as a cut off for accepting kidneys, when results were available prior to donation. Disease severity was not considered in donor evaluation. Recipient selection was performed based on willingness to give informed consent for the use of such kidneys, prior vaccination with at least 2 doses of the COVID vaccine and negative RT-PCRs in the month prior to transplantation. Result(s): We successfully transplanted 6 recipients from 5 donors. While one of the kidneys was recovered locally, the remainder were imported as non mandatory nationally shared organs. Four donors suffered from ARDS secondary to COVID pneumonia. Two donors were on ECMO at the time of donation. Two of the 5 donors were DCD recoveries with warm ischemic times times of 22 and 28 minutes. Co-infections in the donors included Candida glabrata, Enterococcus faecalis, and Burkholderia Cepacia for which appropriate prophylaxis was used in the recipients. All donors had positive nasopharyngeal RT-PCRs. Three had positive bronchioloalveolar lavage RT-PCRs. One donor was RT-PCR negative at the time of donation. Three recipients were sensitized with a PRA of 48%, 96%and 100%. The mean cold ischemic time was 25 hours. The mean KDPI was 51%. The delayed graft function rate was 33%. There was no primary nonfunction, rejection, death or graft loss after median follow-up of 87 (30-250days). The mean recipient GFR was 43ml/min. Dual kidney transplants were performed in two recipients. None of the recipients developed a COVID infection. 5/6 recipients received monoclonal antibodies (casirivimab and imdevimab) immediately after reperfusion. One patient did not receive casirivimab and imdevimab as it was not yet available in our region. All 6 patients received Thymoglobulin induction. Conclusion(s): With careful selection of immunized recipients, clinical assessment of transmission risk, and the preemptive use of monoclonal antibodies post exposure , SARS-Cov-2 positive donor kidneys can be safely utilized for single or dual kidney transplantation, without an increased risk of viral transmission, rejection or graft loss.

Medical care disruptions during the first six months of the COVID-19 pandemic: the experience of older breast cancer survivors.

PURPOSE: Older cancer survivors required medical care during the COVID-19 pandemic, but there are limited data on medical care in this age group. METHODS: We evaluated care disruptions in a longitudinal cohort of non-metastatic breast cancer survivors aged 60-98 from five US regions (n = 321). Survivors completed a web-based or telephone survey from May 27, 2020 to September 11, 2020. Care disruptions included interruptions in seeing or speaking to doctors, receiving medical treatment or supportive therapies, or filling prescriptions since the pandemic began. Logistic regression models evaluated associations between care disruptions and education, medical, psychosocial, and COVID-19-related factors. Multivariate models included age, county COVID-19 death rates, comorbidity, and post-diagnosis time. RESULTS: There was a high response rate (n = 262, 81.6%). Survivors were 32.2 months post-diagnosis (SD 17.5, range 4-73). Nearly half (48%) reported a medical disruption. The unadjusted odds of care disruptions were higher with each year of education (OR 1.22, 95% CI 1.08-1.37, p = < 0.001) and increased depression by CES-D score (OR 1.04, CI 1.003-1.08, p = 0.033) while increased tangible support decreased the odds of disruptions (OR 0.99, 95% CI 0.97-0.99, p = 0.012). There was a trend between disruptions and comorbidities (unadjusted OR 1.13 per comorbidity, 95% CI 0.99-1.29, p = 0.07). Adjusting for covariates, higher education years (OR1.23, 95% CI 1.09-1.39, p = 0.001) and tangible social support (OR 0.98 95% CI 0.97-1.00, p = 0.006) remained significantly associated with having care disruptions. CONCLUSION: Older breast cancer survivors reported high rates of medical care disruptions during the COVID-19 pandemic and psychosocial factors were associated with care disruptions. CLINICALTRIALS. GOV IDENTIFIER: NCT03451383.

SARS-CoV-2/COVID-19 and its transmission, prevention, treatment and control - an update. (Special Issue: Coronaviruses and COVID-19- Past, Present, and Future.)

Coronavirus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Virus-2 (SARS-CoV-2), pandemic has caused huge panic, havoc and global threats worldwide. The origin of this virus has been linked to animals, intermediate host is still to be identified, and studies are being carried out that how it got transmitted to humans and acquired rapid human-to-human transmission. Within a short time period of only 05 months, SARS-CoV-2 has spread to 213 countries, and till 28th May, 2020, nearly 5.8 million confirmed cases have been reported while taking lives of 0.36 million persons. Seeing the current situation of rapid increase in COVID-19 cases daily in many countries, this seems to be the deadliest pandemic after the 1918 Spanish Flu. There is currently no specific effective treatment for COVID-19 and also in absence of vaccine the radical cure of the disease is far away. Researchers are pacing high to design and develop effective vaccines, drugs and therapeutics to counter COVID-19, however such efforts, clinical trials, necessary approvals and then to reach the level of bulk production of many millions of doses may still take much time. Prevention and control of COVID-19 outbreaks requires an evidence-based, multi-factorial and effective mitigation strategy to be adopted. The current review discusses on the research advancements, challenges and opportunities in COVID 19 management with a focus on its transmission, prevention, treatment and control.

Importance of bats in wildlife: not just carriers of pandemic SARS-CoV-2 and other viruses. (Special Issue: Coronaviruses and COVID-19- Past, Present, and Future.)

Bats are the only flying mammals that carry multiple pathogens, such as the SARS-CoV-2. As a consequent of fear of the zoonotic origin of SARS-CoV-2, there is an adverse reaction in multiple countries against these animals. Bats contribute with arthropod control and pollination, among other positive roles of these animals.

Performance Comparison of Machine Learning Algorithms for Prediction of Students' Social Engagement

The various techniques and algorithms of ML DL are becoming popular for prediction with different level of accuracy. This paper includes performance comparison of few machine learning algorithms in the reference of student social engagement during covid-19 pandemic period. In this study, the comparison of Naïve Bayes, J48 tree, REPTree and Random forest algorithm is carried on structured dataset of 1200+ instance. In this paper, study proposes scrutinizes commonly used social app platform. Further, it compares them with the various ML approach. The objective of this study is to foreseeing the correlation between student social engagement for one the most popular social engagement platform during covid-19 pandemic. This paper focusses on accuracy, F-measure and time to summarize comparison result. The findings of the study and dynamic analysis indicate ML/Deep learning algorithm can lead better accuracy and other factor for preprocessed student social engagement dataset. The finding can predict engagement of students for most popular social media platform with performance comparison of ML algorithm. © 2021 IEEE.

Conducting an rct in the COVID-19 pandemic: Targeting vulnerability to seasonal and acute weather changes to keep australians with cardiovascular disease out of hospital-the res

Objective: Australia is experiencing ever more frequent/provocative weather and environmental challenges, including more extreme heatwaves and catastrophic bushfires. Concurrently, the annual challenge of wintry conditions to a population adapted to warmer conditions persists. Remarkably, however, there are no proven interventions to reduce seasonal challenges to the cardiovascular health of vulnerable individuals. In a world-first, the REsilience to Seasonal ILlness and Increased Emergency admissioNs CarE (RESILIENCE) Trial will test the hypothesis that an individually tailored, intervention program will reduce the risk of re-hospitalisation and mortality in vulnerable individuals. Design and method: 300 adult patients admitted to the Austin Hospital in Melbourne, Australia with heart disease and multimorbidity will be recruited and randomised (1:1) to standard care (SC) or the RESILIENCE program (RP) over 12-months. Applying a COVID-19 adapted protocol, the RP group will have their bio-behavioural profile and home environment assessed post-discharge, to determine their vulnerability to seasonal events. An individualised case-management program, including a virtual clinic review with a dedicated RP cardiac nurse and physician, will be applied to promote seasonal resilience. The primary end-point is all-cause days alive out of hospital (DAOH) during 12-month follow-up. Results: With study recruitment delayed due to COVID-19 restrictions, virtual screening of medical in-patients has confirmed the need and potential for the RP. Of 630 potential participants identified over a 6 week period, 196 patients (31%) met eligibility criteria-85 women and 79 men, mean (±SD) age 79 ± 11 years. Non-eligibility was largely due to non-chronic form of heart disease (34%), no comorbidity (23 %), and inability to give informed consent (15%). Conclusions: Preliminary data suggest that once commenced, we will rapidly recruit the requisite number of trial participants and depending on the results, we will be able to determine the cost-effectiveness of the RP to reduce seasonallyinduced admissions and mortality.

Medical Care Disruptions During the First Six-Months of the COVID19 Pandemic: The Experience of Older Breast Cancer Survivors.

PurposeOlder cancer survivors required medical care during the COVID-19 pandemic despite infection risks, but there are limited data on medical care in this age group. METHODS: We evaluated care disruptions in a longitudinal cohort of non-metastatic breast cancer survivors ages 60-98 from five US regions (n=321). Survivors completed a web-based or telephone survey from May 27, 2020 to September 11, 2020. Care disruptions included self-reported interruptions in ability to see doctors, receive treatment or supportive therapies, or fill prescriptions. Logistic regression models evaluated bivariate and multivariate associations between care disruptions and education, medical, psychosocial and COVID-19-related factors. Multivariate models included age, county COVID-19 rates, comorbidity and post-diagnosis time. RESULTS: There was a high response rate (n=262, 81.6%). Survivors were 32.2 months post-diagnosis (SD 17.5, range 4-73). Nearly half (48%) reported a medical disruption. The unadjusted odds of care disruptions were significantly higher with more education (OR 1.23 per one-year increase, 95% CI 1.09-1.39, p =0.001) and greater depression (OR 1.04 per one-point increase in CES-D score, CI 1.003-1.08, p=0.033); tangible support decreased the odds of disruptions (OR 0.99, 95% CI 0.97-0.99 per one-point increase, p=0.012). There was a trend for associations between disruptions and comorbidity (unadjusted OR 1.13 per 1 added comorbidity, 95% CI 0.99-1.29, p=0.07). Adjusting for covariates, only higher education (p=0.001) and tangible social support (p=0.006) remained significantly associated with having care disruptions. CONCLUSIONS: Older breast cancer survivors reported high rates of medical care disruptions during the COVID-19 pandemic and psychosocial factors were associated with care disruptions.

SArS-Cov-2 / COviD-19: Salient facts and strategies to combat ongoing pandemic

Severe acute respiratory syndrome coronavirus – 2 (SARS-CoV-2), an emerging novel coronavirus causing coronavirus disease 2019 (COVID-19) pandemic, has now rapidly spread to more than 215 countries and has killed nearly 0.75 million people out of more than 20 million confirmed cases as of 10th August, 2020. Apart from affecting respiratory system, the virus has shown multiple manifestations with neurological affections and damaging kidneys. SARS-CoV-2 transmission mainly occurs through close contact of COVID-19 affected person, however air-borne route is also now considered as dominant route of virus spread. The virus has been implicated to have originated from animals. Apart from bats, pangolins and others being investigates to play role in transmitting SARS-CoV-2 as intermediate hosts, the recent reports of this virus infection in other animals (cats, dogs, tigers, lions, mink) suggest one health approach implementation along with adopting appropriate mitigation strategies. Researchers are pacing to develop effective vaccines and drugs, few reached to clinical trials also, however these may take time to reach the mass population, and so till then adopting appropriate prevention and control is the best option to avoid SARS-CoV-2 infection. This article presents an overview on this pandemic virus and the disease it causes, with few recent concepts and advances.