Assessing Unique Risk Factors for COVID-19 Complications Among Cancer Patients: A Multi-ethnic Cohort Study.

A myriad of organ-specific complications have been observed with COVID-19. While racial/ethnic minorities have been disproportionately burdened by this disease, our understanding of the unique risk factors for complications among a diverse population of cancer patients remains limited. This is a multi-institutional, multi-ethnic cohort study evaluating COVID-19 complications among cancer patients. Patients with an invasive cancer diagnosis and confirmed SARS-CoV-2 infection were identified from March to November 2020. Demographic and clinical data were obtained and a multivariate logistic regression was employed to evaluate the impact of demographic and clinical factors on COVID-19 complications. The study endpoints were evaluated independently and included any complication, sepsis, pulmonary complications and cardiac complications. A total of 303 patients were evaluated, of whom 48% were male, 79% had solid tumors, and 42% were Hispanic/Latinx (Hispanic). Malignant hematologic cancers were associated with a higher risk of sepsis (OR 3.93 (95% CI 1.58-9.81)). Male patients had a higher risk of sepsis (OR 4.42 (95% CI 1.63-11.96)) and cardiac complications (OR 2.02 (95% CI 1.05-3.89)). Hispanic patients had a higher odds of any complication (OR 2.31 (95% CI 1.18-4.51)) and other race was associated with a higher odds of cardiac complications (OR 2.41 (95% CI 1.01-5.73)). Clinically, fever, cough, and ≥2 co-morbidities were independently significantly associated with any complication. This analysis evaluated covariates that can significantly predict a myriad of complications among a multi-ethnic cohort of cancer patients. The conclusions drawn from this analysis elucidate a mechanistic understanding of differential illness severity from COVID-19.

COVID-19 severity and cardiovascular outcomes in SARS-CoV-2-infected patients with cancer and cardiovascular disease.

Background: Data regarding outcomes among patients with cancer and co-morbid cardiovascular disease (CVD)/cardiovascular risk factors (CVRF) after SARS-CoV-2 infection are limited. Objectives: To compare Coronavirus disease 2019 (COVID-19) related complications among cancer patients with and without co-morbid CVD/CVRF. Methods: Retrospective cohort study of patients with cancer and laboratory-confirmed SARS-CoV-2, reported to the COVID-19 and Cancer Consortium (CCC19) registry from 03/17/2020 to 12/31/2021. CVD/CVRF was defined as established CVD or no established CVD, male ≥ 55 or female ≥ 60 years, and one additional CVRF. The primary endpoint was an ordinal COVID-19 severity outcome including need for hospitalization, supplemental oxygen, intensive care unit (ICU), mechanical ventilation, ICU or mechanical ventilation plus vasopressors, and death. Secondary endpoints included incident adverse CV events. Ordinal logistic regression models estimated associations of CVD/CVRF with COVID-19 severity. Effect modification by recent cancer therapy was evaluated. Results: Among 10,876 SARS-CoV-2 infected patients with cancer (median age 65 [IQR 54-74] years, 53% female, 52% White), 6253 patients (57%) had co-morbid CVD/CVRF. Co-morbid CVD/CVRF was associated with higher COVID-19 severity (adjusted OR: 1.25 [95% CI 1.11-1.40]). Adverse CV events were significantly higher in patients with CVD/CVRF (all p<0.001). CVD/CVRF was associated with worse COVID-19 severity in patients who had not received recent cancer therapy, but not in those undergoing active cancer therapy (OR 1.51 [95% CI 1.31-1.74] vs. OR 1.04 [95% CI 0.90-1.20], pinteraction <0.001). Conclusions: Co-morbid CVD/CVRF is associated with higher COVID-19 severity among patients with cancer, particularly those not receiving active cancer therapy. While infrequent, COVID-19 related CV complications were higher in patients with comorbid CVD/CVRF. (COVID-19 and Cancer Consortium Registry [CCC19]; NCT04354701).

A Model to Detect Face Mask Using Deep Learning

Coronavirus pandemic started spreading in 2019 and is still spreading until now in 2021 all over the world. Due to this the healthcare sectors are going on crisis all over the world. One basic protective measure that we can implement in our daily life is wearing a face mask. Wearing a mask properly can control the spread of this virus to a great extent. Various regions have made wearing face mask mandatory to prevent spread of this virus. In this paper we have proposed a deep learning-based model to detect face mask using python, OpenCV, TensorFlow and it can be used in our health care sectors. © 2022 IEEE.

Cancer, more than a "COVID-19 co-morbidity".

Patients with cancer represent a particularly vulnerable population at risk of adverse outcomes related to COVID-19. Collectively, the initial studies, including patients with and without cancer, confirmed that patients with cancer had a higher risk of complications and death related to COVID-19. Subsequent studies on patients with COVID-19 and cancer investigated patient and disease-related factors associated with COVID-19 severity and morality. Multiple interconnected factors include demographics, comorbidities, cancer-associated variables, treatment side effects, and other parameters. However, there is a lack of clarity on the contributions of any one factor. In this commentary, we deconvolute the data of specific risk factors associated with worse outcomes due to COVID-19 in cancer patients and focus on understanding the recommended guidelines to mitigate COVID-19 risk in this vulnerable population. In the first section, we highlight the key parameters, including age and race, cancer status, type of malignancy, cancer therapy, smoking status and comorbidities that impact outcomes for cancer patients with COVID-19. Next, we discuss efforts made at the patient, health system, and population levels to mitigate the effects of the ongoing outbreak for patients with cancer, including (1) screening, barrier and isolation strategies (2), Masking/PPE (3), vaccination, and (4) systemic therapies (e.g., evusheld) to prevent disease onset in patients. In the last section, we discuss optimal treatment strategies for COVID-19, including additional therapies for patients with COVID-19 and cancer. Overall, this commentary focuses on articles with high yield and impact on understanding the evolving evidence of risk factors and management guidelines in detail. We also emphasize the ongoing collaboration between clinicians, researchers, health system administrators and policymakers and how its role will be important in optimizing care delivery strategies for patients with cancer. Creative patient-centered solutions will be critical in the coming years, post the pandemic.

Clinical Characteristics, Racial Inequities, and Outcomes in Patients with Breast Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Cohort Study (preprint)

Title: Clinical Characteristics, Racial Inequities, and Outcomes in Patients with Breast Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Cohort Study Background: Limited information is available for patients with breast cancer (BC) and coronavirus disease 2019 (COVID-19), especially among underrepresented racial/ethnic populations. Methods: This is a COVID-19 and Cancer Consortium (CCC19) registry-based retrospective cohort study of females with active or history of BC and laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection diagnosed between March 2020 and June 2021 in the US. Primary outcome was COVID-19 severity measured on a five-level ordinal scale, including none of the following complications, hospitalization, intensive care unit admission, mechanical ventilation, and all-cause mortality. Multivariable ordinal logistic regression model identified characteristics associated with COVID-19 severity. Results: 1,383 female patient records with BC and COVID-19 were included in the analysis, the median age was 61 years, and median follow-up was 90 days. Multivariable analysis revealed higher odds of COVID-19 severity for older age (aOR per decade, 1.48 [95% CI, 1.32 - 1.67]); Black patients (aOR 1.74; 95 CI 1.24-2.45), Asian Americans and Pacific Islander patients (aOR 3.40; 95 CI 1.70 - 6.79) and Other (aOR 2.97; 95 CI 1.71-5.17) racial/ethnic groups; worse ECOG performance status (ECOG PS [≥]2: aOR, 7.78 [95% CI, 4.83 - 12.5]); pre-existing cardiovascular (aOR, 2.26 [95% CI, 1.63 - 3.15])/pulmonary comorbidities (aOR, 1.65 [95% CI, 1.20 - 2.29]); diabetes mellitus (aOR, 2.25 [95% CI, 1.66 - 3.04]); and active and progressing cancer (aOR, 12.5 [95% CI, 6.89 - 22.6]). Hispanic ethnicity, timing and type of anti-cancer therapy modalities were not significantly associated with worse COVID-19 outcomes. The total all-cause mortality and hospitalization rate for the entire cohort was 9% and 37%, respectively however, it varied according to the BC disease status. Conclusions: Using one of the largest registries on cancer and COVID-19, we identified patient and BC related factors associated with worse COVID-19 outcomes. After adjusting for baseline characteristics, underrepresented racial/ethnic patients experienced worse outcomes compared to Non-Hispanic White patients. Funding: This study was partly supported by National Cancer Institute grant number P30 CA068485 to Tianyi Sun, Sanjay Mishra, Benjamin French, Jeremy L. Warner; P30-CA046592 to Christopher R. Friese; P30 CA023100 for Rana R McKay; P30-CA054174 for Pankil K. Shah and Dimpy P. Shah; and the American Cancer Society and Hope Foundation for Cancer Research (MRSG-16-152-01 -CCE) and P30-CA054174 for Dimpy P. Shah. REDCap is developed and supported by Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH). The funding sources had no role in the writing of the manuscript or the decision to submit it for publication. Clinical trial number: CCC19 registry is registered on ClinicalTrials.gov, NCT04354701.

Carbon footprint of FFP2 protective facial masks against SARS-CoV-2 used in the food sector: effect of materials and dry sanitisation

Purpose: International outbreak of the SARS-CoV-2 infection has fostered the Italian government to impose the FFP2 protective facial masks in closed environments, including bar, restaurants and, more in general, in the food sector. Protective facial masks are rocketing, both in mass and in costs, in the food sector imposing efforts in fostering reuse strategies and in the achievement of sustainable development goals. The scope of the present paper is to depict possible strategies in manufacturing and reuse strategies that can reduce the carbon footprint (CF) of such devices. Design/methodology/approach: To implement circular economy strategies in the protective facial masks supply chain, it was considered significant to move towards a study of the environmental impact of such devices, and therefore a CF study has been performed on an FFP2 facial mask used in the food sector. Different materials besides the mostly used polypropylene (PP) (polyethylene (PE), polycarbonate (PC), poly (lactic acid) (PLA), cotton, polyurethane (PUR), polystyrene (PS) and nylon 6,6) and different sanitisation alternatives as reuse strategies (both laboratory and homemade static oven, ultraviolet germicidal irradiation) readily implemented have been modelled to calculate the CF of a single use of an FFP2 mask. Findings: The production of textiles in PP, followed by disposal was the main contributor to CF of the single-use FFP2 mask, followed by packaging and transportations. PP and PE were the least impacting, PC, cotton and Nylon 6-6 of the same weight results the worst. PLA has an impact greater than PP and PE obtained from crude oil, followed by PUR and PS. Static laboratory oven obtained an 80.4% reduction of CF with respect to single use PP-made FFP2 mask, whereas homemade oven obtained a similar 82.2% reduction;UV cabinet is the best option, showing an 89.9% reduction. Research limitations/implications: The key strategies to reduce the environmental impacts of the masks (research for new materials and reuse with sanitisation) should ensure both the retention of filtering capacities and the sanitary sterility of the reused ones. Future developments should include evaluations of textile recycling impacts, using new materials and the evaluation of the life cycle costs of the reused masks. Practical implications: This paper intends to provide to stakeholders (producers, consumers and policy makers) the tools to choose the best option for producing and reuse environmentally friendly protective facial masks to be used in the food sector, by using both different materials and easily implemented reuse strategies. Social implications: The reduction of the CF of protective facial masks in the food sector surely will have relevant positive effects on climate change contributing to reach the goals of reducing CO2 emissions. The food sector may promote sustainable practices and attract a niche piece of clients particularly sensible to such themes. Originality/value: The paper has two major novelties. The first one is the assessment of the CF of a single use of an FFP2 mask made with different materials of the non-woven filtering layers;as the major contribution to the CF of FFP2 masks is related to the non-woven textiles manufacturing, the authors test some other different materials, including PLA. The second is the assessment of the CF of one single use of a sanitised FFP2 mask, using different sanitation technologies as those allowed in bars or restaurants. © 2022, Pasquale Giungato, Bianca Moramarco, Roberto Leonardo Rana and Caterina Tricase.

Breakthrough SARS-CoV-2 infections among patients with cancer following two and three doses of COVID-19 mRNA vaccines: a retrospective observational study from the COVID-19 and Cancer Consortium.

Background: Breakthrough SARS-CoV-2 infections following vaccination against COVID-19 are of international concern. Patients with cancer have been observed to have worse outcomes associated with COVID-19 during the pandemic. We sought to evaluate the clinical characteristics and outcomes of patients with cancer who developed breakthrough SARS-CoV-2 infections after 2 or 3 doses of mRNA vaccines. Methods: We evaluated the clinical characteristics of patients with cancer who developed breakthrough infections using data from the multi-institutional COVID-19 and Cancer Consortium (CCC19; NCT04354701). Analysis was restricted to patients with laboratory-confirmed SARS-CoV-2 diagnosed in 2021 or 2022, to allow for a contemporary unvaccinated control population; potential differences were evaluated using a multivariable logistic regression model after inverse probability of treatment weighting to adjust for potential baseline confounding variables. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported. The primary endpoint was 30-day mortality, with key secondary endpoints of hospitalization and ICU and/or mechanical ventilation (ICU/MV). Findings: The analysis included 2486 patients, of which 564 and 385 had received 2 or 3 doses of an mRNA vaccine prior to infection, respectively. Hematologic malignancies and recent receipt of systemic anti-neoplastic therapy were more frequent among vaccinated patients. Vaccination was associated with improved outcomes: in the primary analysis, 2 doses (aOR: 0.62, 95% CI: 0.44-0.88) and 3 doses (aOR: 0.20, 95% CI: 0.11-0.36) were associated with decreased 30-day mortality. There were similar findings for the key secondary endpoints of ICU/MV (aOR: 0.60, 95% CI: 0.45-0.82 and 0.37, 95% CI: 0.24-0.58) and hospitalization (aOR: 0.60, 95% CI: 0.48-0.75 and 0.35, 95% CI: 0.26-0.46) for 2 and 3 doses, respectively. Importantly, Black patients had higher rates of hospitalization (aOR: 1.47, 95% CI: 1.12-1.92), and Hispanic patients presented with higher rates of ICU/MV (aOR: 1.61, 95% CI: 1.06-2.44). Interpretation: Vaccination against COVID-19, especially with additional doses, is a fundamental strategy in the prevention of adverse outcomes including death, among patients with cancer. Funding: This study was partly supported by grants from the National Cancer Institute grant number P30 CA068485 to C-YH, YS, SM, JLW; T32-CA236621 and P30-CA046592 to C.R.F; CTSA 2UL1TR001425-05A1 to TMW-D; ACS/FHI Real-World Data Impact Award, P50 MD017341-01, R21 CA242044-01A1, Susan G. Komen Leadership Grant Hunt to MKA. REDCap is developed and supported by Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH).

Improving the Domain Adaptation of Retrieval Augmented Generation (RAG) Models for Open Domain Question Answering

Retrieval Augment Generation (RAG) is a recent advancement in Open-Domain Question Answering (ODQA). RAG has only been trained and explored with a Wikipedia-based external knowledge base and is not optimized for use in other specialized domains such as healthcare and news. In this paper, we evaluate the impact of joint training of the retriever and generator components of RAG for the task of domain adaptation in ODQA. We propose RAG-end2end, an extension to RAG that can adapt to a domain-specific knowledge base by updating all components of the external knowledge base during training. In addition, we introduce an auxiliary training signal to inject more domain-specific knowledge. This auxiliary signal forces RAG-end2end to reconstruct a given sentence by accessing the relevant information from the external knowledge base. Our novel contribution is that, unlike RAG, RAG-end2end does joint training of the retriever and generator for the end QA task and domain adaptation. We evaluate our approach with datasets from three domains: COVID-19, News, and Conversations, and achieve sig-nificant performance improvements compared to the original RAG model. Our work has been open-sourced through the HuggingFace Transformers library, attesting to our work's credibility and technical consistency. © 2023 Association for Computational Linguistics. Distributed under a CC-BY 4.0 license.

Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19.

Importance: Cytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation. Objective: To determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer. Design, Setting, and Participants: This registry-based retrospective cohort study included 12 046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings. Exposures: Immunosuppression due to therapy; systemic anticancer therapy (IO or non-IO). Main Outcomes and Measures: The primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm. Results: The median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR], 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79). Conclusions and Relevance: This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm. Trial Registration: ClinicalTrials.gov Identifier: NCT04354701.

Gastrointestinal manifestations in children with COVID-19 infection: Retrospective tertiary center experience.

Objective: The majority of pediatric severe acute respiratory syndrome coronavirus 2 (COVID-19) cases demonstrate asymptomatic, mild or moderate disease. The main symptoms in children with COVID-19 are respiratory symptoms but some patients develop gastrointestinal symptoms and liver injury. We aim to review gastrointestinal symptoms and liver injury in children with confirmed COVID-19 infection. Method: This is a retrospective case note review of children with positive COVID-19 nasal Polymerase Chain Reaction aged 0-18 years admitted to a tertiary pediatric hospital from March 1st till June 1st 2020. Results: 180 children were identified. Mean age was 5 years (Range: 0.01-17), the majority of patients were school aged (30%). Patients were mainly from East Asia 81 (45%) and Arabs 67 (37%). Gastrointestinal symptoms were encountered in 48 (27%) patients and 8 (4%) patients had only Gastrointestinal symptoms with no associated fever or respiratory symptoms. Liver injury was seen in 57 (32%) patients. Patients with fever and cough were more likely to have gastrointestinal symptoms (P = <0.001 and 0.004 respectively). Fever was more likely to be associated with liver injury (P = 0.021). Children with abdominal pain were more likely to have elevated C-Reactive Protein (P = 0.037). Patients with diarrhea and vomiting were more likely to have elevated procalcitonin (P = 0.034 and 0.002 respectively). Children with Gastrointestinal symptoms were not more likely to be admitted to Pediatric Intensive Care Unit (P = 0.57). Conclusion: COVID-19 infection in children can display gastrointestinal symptoms at initial presentation. Additionally, gastrointestinal symptoms can be the only symptoms patients display. We demonstrated that children with gastrointestinal symptoms and liver injury can develop more severe COVID-19 disease and are more likely to have fever, cough, and raised inflammatory markers. Identifying children with gastrointestinal manifestations needs to be part of the initial screening assessment of children.What is known?• Pediatric COVID-19 cases mostly demonstrate asymptomatic, mild or moderate disease.• The symptoms in children are mainly respiratory but some display gastrointestinal symptoms.• Children with COVID-19 display increased gastrointestinal symptoms when compared to adults.What is new?• Children with COVID-19 displaying gastrointestinal symptoms are more likely to have fever, cough and elevated inflammatory markers.• Children with liver injury are more likely to develop fever.• Children with gastrointestinal involvement in COVID-19 are more likely to demonstrate more severe disease but are not more likely to be admitted to PICU.

CoviFL: Edge-Assisted Federated Learning for Remote COVID-19 Detection in an AIoMT Framework

Detection of COVID-19 has been a global challenge due to the lack of proper resources across all regions. Recently, research has been conducted for non-invasive testing of COVID-19 using an individual's cough audio as input to deep learning models. However, these methods do not pay sufficient attention to resource and infrastructure constraints for real-life practical deployment and the lack of focus on maintaining user data privacy makes these solutions unsuitable for large-scale use. We propose a resource-efficient CoviFL framework using an AIoMT approach for remote COVID-19 detection while maintaining user data privacy. Federated learning has been used to decentralize the CoviFL CNN model training and test the COVID-19 status of users with an accuracy of 93.01 % on portable AIoMT edge devices. Experiments on real-world datasets suggest that the proposed CoviFL solution is promising for large-scale deployment even in resource and infrastructure-constrained environments making it suitable for remote COVID-19 detection. © 2022 IEEE.

Changing Dimensions of Customers Behaviour for A Life Insurance Product Amid COVID-19 Pandemic

COVID-19 pandemic can be considered as an economic and health crisis of uncertain magnitude and duration. Frequent lockdowns, salary cuts, and losses of jobs and lives have spurred changes in human behaviour. Today customers are experiencing a transformation in their perceptions towards a life insurance product. The common attitude to treat life insurance as an optional investment instrument has been shifted towards a mandatory risk protection instrument. Thus the demand for a life insurance product is increasing by leaps and bounds and undoubtedly competition among insurance providers at the same time. This article seeks to examine the features that should form part of a life insurance product to attract customers in Indiaduring the COVID-19 pandemic. Data for the study were collected for 159 respondents from October 2020 to December 2020 from Delhi and NCR region. The data were analyzed using Principal Component Analysisafter walking through a maze of articles relating to normal times and crisis times. There is testable evidence to show a paradigm shift in the outlook of customers regarding a life insurance product. Thus, the article also paves the path for future research in the direction of customers behaviour for a life insurance product.

The impact of blockchain technology adoption on tourism industry: a systematic literature review

The current COVID-19 pandemic has led to the acceleration of the digitization process and to a shifting to Industry 4.0. Blockchain (BC) is one of the technologies that has been introduced worldwide in recent years. It has been beneficial for the tourism industry, in addition to many other sectors. This article investigates the advantages and disadvantages of BC adoption in the tourism industry, as well as the possible solutions to overcome the challenges. This paper conducts a systematic literature review (SLR) that consists of the operations for detecting, selecting, categorizing, and analyzing relevant articles on a specified subject. It is evident from the results that the majority of the academic works illustrate the benefits of BC implementation and explain its potential by providing diverse models of BC-based systems. However, since BC is a young technology, numerous challenges have appeared on the path to its full adoption in the tourism industry. Possible solutions are the achievement of a collaborative approach among the stakeholders, the deepening of academic research in the field, testing more models of BC-based systems, and the establishment of relevant policies. Consequently, the implications for the theory, practice, policy, and research of this work are significant.

Highlights of Traditional Ayurveda Medicine for Covid-19 in India

Introduction: Novel corona virus or the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) a new public health crisis spreading continuously. The virus originating in bats and was transmitted to humans through yet unknown intermediary animals in Wuhan, china in December 2019. The disease is transmitted by inhalation or contact with infected droplets and the incubation period ranges from 2 to 14 days. Traditional Indian Medicines has lot to offer in the management of COVID-19. It was reported that traditional remedies may alleviate the symptoms of COVID-19. The Approach of Ayurveda on strengthening host defence may be useful as effective, safer, accessible and affordable prophylaxis of COVID- 19. Objective: The objective of this study to review protocol ofAyurveda and provide information for prevention and treatment ofCOVID-19. Methods: The national guideline summarised which provide the best management for COVID-19. We extracted the case definition and clinical classifications of COVID-19 in along with relevant treatment. Results: We present the most recent case definition, clinical classifications, and relevant treatments of COVID-19 in accordance with the recommendations in the Indian guidelines. COVID-19 has been categorized in four specific situation based on the severity of clinical condition. Several Ayurvedaformulation are recommended for COVID-19 cases according to their clinical classification. Conclusion: To control the COVID-19 outbreak, countries must ensure the adherence of their citizens to local public health measures. Medical professionals should diagnose and treat patients according to up-to-date guidelines. This review provide preventive strategy by increasing the immunity of the body to fight covid-19.However till today social distancing is considered as most effective way to stop the spread of COVID-19. © 2022 University of Stockholm. All rights reserved.

Demographics, Outcomes, and Risk Factors for Patients with Sarcoma and COVID-19: A CCC19-Registry Based Retrospective Cohort Study.

BACKGROUND: Patients with sarcoma often require individualized treatment strategies and are likely to receive aggressive immunosuppressive therapies, which may place them at higher risk for severe COVID-19. We aimed to describe demographics, risk factors, and outcomes for patients with sarcoma and COVID-19. METHODS: We performed a retrospective cohort study of patients with sarcoma and COVID-19 reported to the COVID-19 and Cancer Consortium (CCC19) registry (NCT04354701) from 17 March 2020 to 30 September 2021. Demographics, sarcoma histologic type, treatments, and COVID-19 outcomes were analyzed. RESULTS: of 281 patients, 49% (n = 139) were hospitalized, 33% (n = 93) received supplemental oxygen, 11% (n = 31) were admitted to the ICU, and 6% (n = 16) received mechanical ventilation. A total of 23 (8%) died within 30 days of COVID-19 diagnosis and 44 (16%) died overall at the time of analysis. When evaluated by sarcoma subtype, patients with bone sarcoma and COVID-19 had a higher mortality rate than patients from a matched SEER cohort (13.5% vs 4.4%). Older age, poor performance status, recent systemic anti-cancer therapy, and lung metastases all contributed to higher COVID-19 severity. CONCLUSIONS: Patients with sarcoma have high rates of severe COVID-19 and those with bone sarcoma may have the greatest risk of death.

The impact of gender differences on pulmonary diseases and their clinical implications

Male and female patients are usually considered clinically equivalent from a diagnostic and treatment point of view, and no relevance is given to the differences in morphometry and physiology of the respiratory system between the two sexes. This is a major limitation in the understanding of the pathology and effective management of multiple respiratory ailments. The present review analyses the available literature on the major respiratory diseases from a gender-difference perspective. We performed our research using the PubMed Advanced Browser. The research for each clinical condition was conducted by using the key words "gender" OR "sex." For example, considering asthma, the search criteria were "asthma" AND "gender" OR "sex." All the respiratory diseases considered in this review are deeply influenced by the sex of the patient in diverse ways. For example, in women, estrogens could play a protective role in some conditions, like IPF, while in others they are associated with increased risk of disease development, as in some types of severe asthma. Psychological symptoms are more frequent in women with obstructive conditions such as OSAS, COPD, and asthma. Despite the available evidence, current therapeutic strategies largely ignore these differences, and data on gender-weighted interventions are still scarce. Sex differences are common in respiratory diseases. They have largely been ignored in clinical approaches towards these diseases. Evidence has been generated in the last few decades in favor of gender-based diagnostic and therapeutic strategies.

THE IMPACT OF DIGITAL NAVIGATION PATHWAYS ON NO-SHOW RATES FOR PATIENTS UNDERGOING COLONOSCOPY: A QUALITY IMPROVEMENT STUDY

Background: High no-show rates for colonoscopy have been previously associated with poor clinical outcomes, decreased operational efficiency, and diminished utilization of resources. Studies have suggested that addressing barriers like poor health literacy, logistical challenges, and psycho-emotional issues could reduce no-show rates for colonoscopies. Recently, digital navigation tools designed to eliminate such barriers are an emerging trend with promising results leading to better outcomes for patients undergoing colonoscopy. Objective: The goal of this study was to examine the feasibility of an automated, text message-based digital navigation program and determine the impact on no-show rates for patients undergoing colonoscopies. Methods: Rx.Health developed a Digital Navigation Pathway (DNP) that consisted of bowel-prep instructions, appointment reminders, driving instructions, microlearning videos, and educational messaging. Providers at the Gastroenterology (GI) clinic of NYC Health + Hospitals/Lincoln Medical Center prescribed this pathway through RxUniverse, a digital medicine unification platform, to the patients' smartphones. The sample included patients scheduled for colonoscopy between October 2019 to March 2020 (pre-intervention) and October 2020 to March 2021 (post-intervention). Through a year over year analysis, the mean no-show rates and the number of scheduled colonoscopies at the GI clinic were compared between the pre-intervention and post-intervention groups. Furthermore, as a part of the pre/post program implementation analysis, the colonoscopy utilization patterns at the GI clinic were compared. Results: There were 567 colonoscopies scheduled during the pre-intervention period and 381 scheduled colonoscopies in the post-intervention period. The average no-show rate in the pre-intervention group was 27.81 percent compared to 4.46 percent (p<0.00001)* in the post-intervention group, which translated into an 83.9 percent reduction in no-show rates at the GI clinic. Furthermore, this resulted in 23.7 colonoscopies saved per 100 scheduled colonoscopies in the post-intervention group. Conclusion: Patients that were enrolled in the digital navigation program were more likely to show up to their scheduled colonoscopy appointment compared to patients in the preintervention group. Given the pre-/post implementation study design and COVID-19 pandemic that occurred during the intervention period, future cluster randomized controlled trials should be conducted to examine if there is an association between digital navigation programs and no-show rates for patients undergoing colonoscopies. (Figure Presented) Figure 1. Colonoscopy Bowel Preparation Digital Navigation Pathway (Figure Presented) Figure 2. The Effect of DNPs on No-Show Rates during the Pre- and Post-intervention Period (p < 0.00001) *

Herbal Drugs as Immune Booster Against Viral Infections

The immune system involves both active and passive immunization. The antibodies are developed against the antigens during active immunization and are permanently stored. But, in the case of passive immunization, the antibodies are exposed to the same antigens in every person who is already infected. In order to enhance the immune systems i.e. innate and adaptive immune responses, herbal plants are used as an immune booster. Some of the herbal plants have been proven clinically to enhance immunity that includes Morniga oleifera (Drumstick), Azadirachta indica (Neem), Ocimum sanctum (Tulsi), Withania somnifera (Aswagandha), Zingiber officinale (Ginger), Allium sativum (Garlic), Curcuma longa (Turmeric), Emblica officinalis (Amla) etc. Compared to synthetic drugs, herbal drugs have fewer side effects and stimulate the immune system to defend against various foreign pathogens. Even though herbal medicines are usually considered as safe and effective therapy, it is clinically proven that if a drug is effective, it would have some side effects. But, sometimes, the antioxidant property of herbal medicines is helpful in reducing the toxicities produced by any toxic substances or any drugs. This review aims to encourage the study of various herbal constituents and their role in the treatment of different types of viral infections.

Patients Recently Treated for B-lymphoid Malignancies Show Increased Risk of Severe COVID-19.

Patients with B-lymphoid malignancies have been consistently identified as a population at high risk of severe COVID-19. Whether this is exclusively due to cancer-related deficits in humoral and cellular immunity, or whether risk of severe COVID-19 is increased by anticancer therapy, is uncertain. Using data derived from the COVID-19 and Cancer Consortium (CCC19), we show that patients treated for B-lymphoid malignancies have an increased risk of severe COVID-19 compared with control populations of patients with non-B-lymphoid malignancies. Among patients with B-lymphoid malignancies, those who received anticancer therapy within 12 months of COVID-19 diagnosis experienced increased COVID-19 severity compared with patients with non-recently treated B-lymphoid malignancies, after adjustment for cancer status and several other prognostic factors. Our findings suggest that patients recently treated for a B-lymphoid malignancy are at uniquely high risk for severe COVID-19. SIGNIFICANCE: Our study suggests that recent therapy for a B-lymphoid malignancy is an independent risk factor for COVID-19 severity. These findings provide rationale to develop mitigation strategies targeted at the uniquely high-risk population of patients with recently treated B-lymphoid malignancies. This article is highlighted in the In This Issue feature, p. 171.