Rare Rupture of Small 4.3 cm Abdominal Aortic Aneurysm.

Abdominal aortic aneurysm (AAA) is a common medical condition with the feared, and often fatal, complication of rupture. The risk of rupture has been well documented to correlate with aneurysm size. It is exceedingly rare for an AAA less than 5 cm to rupture. This case report demonstrates an asymptomatic 4.3 cm AAA that ruptured while admitted to the hospital with COVID-19 pneumonia. The patient was successfully managed with an endovascular aortoiliac stent graft. Although rare, in patients with small AAA, rupture must remain in the differential diagnosis in the setting of acute onset abdominal or back pain. Furthermore, when quickly recognized, these patients can be safely managed with an endovascular approach.

Relationships between stress appraisals and intolerance of uncertainty with psychological health during early COVID-19 in the USA.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has caused increased psychological distress and decreased quality of life (QoL), but limited research has evaluated cognitive appraisals of COVID-19. This study aimed to examine the role of three stress appraisals of the COVID-19 pandemic - threat appraisal, harm/loss appraisal, and challenge appraisal - and the interaction between these appraisals and intolerance of uncertainty (IU) on psychological distress and QoL. DESIGN: This was a cross-sectional survey study using Amazon's Mechanical Turk. METHODS: A sample of 327 adults living in the U.S. completed a series of questionnaires investigating IU, appraisal of the pandemic, psychological distress, and QoL in May 2020 during the first wave of the COVID-19 pandemic. RESULTS: Controlling for demographic variables, IU and harm/loss appraisal positively related to psychological distress and negatively related to QoL. Challenge appraisals negatively related to distress and positively related to QoL. Moderation analyses revealed that higher levels of IU led to stronger positive relationships between threat appraisal and psychological distress. CONCLUSIONS: Cognitive appraisals of COVID-19 are associated with psychological health, though the relationship between threat appraisal and psychological distress are strongest for those with difficulty tolerating uncertainty. Theoretical and practical implications are discussed.

Assessing the predictors of adaptive and maladaptive Covid-19 preventive behaviours: an application of protection motivation theory.

Despite the high death toll of the COVID-19 pandemic, reported rates of adherence to adaptive preventive health behaviours during the early wave of the pandemic were suboptimal for reducing the risk of disease spread. Additionally, some have adopted practices with the intention of preventing infection that have harmful consequences. Protection Motivation Theory (PMT), consisting of perceived vulnerability, severity, response efficacy, and self-efficacy, has been used to predict intentions to engage in behaviours in past pandemics, and can be extended to the COVID-19 outbreak. Three hundred and thirty-three American adults completed a survey in May 2020 through Amazon's Mechanical Turk. Ten behaviours recommended by the CDC and WHO and two 'maladaptive' behaviours presented in the media were selected for investigation. Binary logistic regressions were conducted to assess the impacts of demographic variables and PMT constructs on behaviour frequency. Perceived severity and vulnerability were not significant predictors of behaviour frequency. Behaviour specific response efficacy and self-efficacy were significant predictors of 11/12 (odds ratios: 2.70-6.22) and 10/12 (odds ratios: 2.59-4.64) behaviours, respectively. Age, gender, education, political ideology, perceived severity, and perceived vulnerability were generally unimportant predictors. Beliefs about the effectiveness of the behaviour and one's ability to carry out that behaviour consistently seem to be more important in predicting how often someone engages in that behaviour than the perceived dangerousness of COVID-19 and one's believed susceptibility to infection. These results suggest that interventions trying to modulate the likelihood of engaging in preventive behaviours should focus on the effectiveness of these behaviours in reducing risk of spread and the individual's ability to engage in these behaviours frequently rather than the dangerousness of the COVID-19 pandemic and the individual's risk of becoming infected.

Approach and Avoidance Coping Dynamics during the COVID-19 Pandemic.

Approach-avoidance conflicts were one of the earliest applications of catastrophe theory. Empirical studies evaluating the cusp catastrophe model for approach-avoidance dynamics have only started to appear recently, however. The present study reviews the extant research and expands the concept to approach and avoidance coping styles. Research participants were 333 adults from the general population recruited through Amazon Mechanical Turk. They completed measures of psychological symptoms, quality of life (QOL), approach and avoidance coping styles, and COVID-related stress. Cusp models for symptoms (R2 = .84) and QOL (R2 = .89) illustrated approach and avoidance functioning as bifurcation gradients for both psychological symptoms and QOL. Both models provided more accurate representations of the data than the linear alternatives (R2 = .54 and .24 respectively), thus providing further support for the cusp dynamics. The cusp catastrophe model has extensive applicability to approach-avoidance behaviors. There was greater variability (hysteresis) in outcomes for people who used fewer coping strategies of either the approach or avoidance types.

The Rise and Fall of SARS-CoV-2 Variants and Ongoing Diversification of Omicron.

In late December of 2019, high-throughput sequencing technologies enabled rapid identification of SARS-CoV-2 as the etiological agent of COVID-19, and global sequencing efforts are now a critical tool for monitoring the ongoing spread and evolution of this virus. Here, we provide a short retrospective analysis of SARS-CoV-2 variants by analyzing a subset (n = 97,437) of all publicly available SARS-CoV-2 genomes (n = ~11.9 million) that were randomly selected but equally distributed over the course of the pandemic. We plot the appearance of new variants of concern (VOCs) over time and show that the mutation rates in Omicron (BA.1) and Omicron sub-lineages (BA.2-BA.5) are significantly elevated compared to previously identified SARS-CoV-2 variants. Mutations in Omicron are primarily restricted to the spike and nucleocapsid proteins, while 24 other viral proteins-including those involved in SARS-CoV-2 replication-are generally conserved. Collectively, this suggests that the genetic distinction of Omicron primarily arose from selective pressures on the spike, and that the fidelity of replication of this variant has not been altered.

Comparison of intra-ovarian platelet rich plasma versus autologous bone marrow derived stem cell instillation in women with diminished ovarian reserve for ovarian rejuvenation

Study question To compare role of intra-ovarian platelet rich plasma (PRP) versus marrow derived stem cell (SC) instillation for improvement in ovarian reserve (AFC, AMH and FSH) Summary answer Both PRP and SC therapy improves the ovarian reserve however, response to PRP is superior to SC post intervention What is known already With increasing incidence of females with diminished ovarian reserve (DOR), posing a serious challenge in terms of limited treatment options for these couples. Clinicians are trying to find effective strategies besides oocyte donation or adoption Of late, novel ovarian rejuvenation approaches has been investigated which are currently available for research purposes only. Multiple studies are evaluating effect of intra-ovarian PRP or autologous SC instillation, the results are encouraging as they are showing improvement in ovarian reserve thus bringing a paradigm shift in treatment options. None of the published studies so far have compared PRP versus SC in DOR population. Study design, size, duration A prospective comparative study was conducted at Division of Reproductive Medicine of a tertiary care institute. 72 infertile females (20-39 years) with poor ovarian reserve (AMH <1.2 ng /ml;AFC<5) were enrolled in the study between January 2020 to December 2021. The two comparative groups underwent either intra-ovarian PRP instillation (n = 42) or autologous SC transplantation (n = 30). Participants/materials, setting, methods After the two groups were matched (PRP vs SC) for baseline characteristics (Age, AMH, AFC, FSH, Estradiol), 30 subjects in each group were compared for change in serum FSH/AMH/Estradiol levels, AFC, right and left ovarian volume at 1st month and 3rd month post intervention from the baseline. This was also compared between the two groups using Student t-test. The cost and procedural pain measured using Visual analog scale (VAS) were also compared between the groups. Main results and the role of chance After matching for baseline characteristics, significant ∼ 1.8/2 and ∼1.5/1.6 fold increase in AFC at 1st/3rd month post intervention (p<0.001) was observed after PRP instillation and SC transplantation respectively. This significant improvement was observed more in PRP group than SC group at 3rd month post intervention (7.07 vs 5.60, p=0.02), while no significant difference existed at 1st month of follow up. However, there was no significant improvement in serum FSH, AMH and Estradiol levels (p0.05) from the baseline at 1st and 3rd month post intervention in both the groups. Similarly, there was no significant difference between the two groups in serum FSH level (7.98 IU/ml vs 9.62 IU/ml, p=0.062;8.26 IU/ml vs 9.50 IU/ml, p=0.15), AMH level (1.62 ng/ml vs 1.02 ng/ml, p=0.27;1.35 ng/ml vs 0.95 ng/ml, p=0.24), Estradiol level (49.12 pg/ml vs 56.48 pg/ml p=0.443;54.7 pg/ml vs 61.12 pg/ml, p=0.44), right ovarian volume (3.13 cm3 vs 2.49 cm3, p=0.06;3.37 cm3 vs 2.74 cm3,p=0.063) and left ovarian volume (2.98 cm3 vs 2.47 cm3, p=0.102;2.87 cm3 vs 2.34 cm3,p=0.103) at 1st and 3rd month post intervention respectively. PRP was more cost-effective and associated with less pain (32.5 mm vs 28.13 mm, p=0.02), and better patient compliance. Limitations, reasons for caution This was a comparative study and the participants were not randomized but were matched for the baseline characteristics. Also due to impact of Covid-19 causing intermittent pause in nonessential facilities like IVF services, a smaller sample size could be enrolled and also clinical outcomes could not be evaluated Wider implications of the findings This study, although comparative, for the first time highlights the beneficial role of PRP over SC, thus can establish superiority of PRP as minimally invasive, economical, patient friendly and a recommended therapy for ovarian rejuvenation and folliculogenesis, providing the DOR females an opportunity to produce their own offspring Trial registration number CTRI/2020/01/022726

Comparison of intraovarian instillation of platelet-rich plasma versus stem-cells for ovarian rejuvenation

Objective: To compare the role of intra-ovarian Platelet-Rich Plasma (PRP) versus marrow derived Stem-Cells (SC) instillation for improvement in ovarian-reserve (AFC,AMH, FSH). Design: A prospective comparative study. Method: 72 infertile females (20-39 years) with poor ovarian reserve (AMH <1.2 ng/ml;AFC < 5) (POSEIDON criterion) were enrolled for study between January 2020 -December 2021. The two comparative groups underwent either intra-ovarian PRP instillation (n = 42) or autologous SC transplantation (n = 30). After the two groups were matched (PRP vs. SC) for baseline characteristics (Age, AMH, AFC, FSH, Estradiol), 30 subjects in each group were compared for change in serum FSH/AMH/Estradiol levels and AFC at 1st month and 3rd month post intervention from the baseline. This was also compared between the two groups using Student t-test. The cost and procedural pain measured using Visual analog scale (VAS) were also compared. Results: After matching for baseline characteristics, significant ∼ 1.8/2 and ∼1.5/1.6fold increase in AFC at 1st/3rd month post intervention (p < 0.001) was observed after PRP instillation and SC transplantation respectively. However, PRP group fared better than SC group at 3rd month post intervention (7.07 vs. 5.60, p = 0.02), while no significant difference existed amongst the two at 1st month of follow up. Levels of Serum FSH, AMH and Estradiol (p > 0.05) did not differ significantly from the baseline at 1st and 3rd month post intervention in both the groups. Similarly, there was no significant difference between the two groups in serum FSH level (7.98 IU/ml vs. 9.62 IU/ml, p = 0.062;8.26 IU/ml vs. 9.50 IU/ml, p = 0.15), AMH level (1.62 ng/ml vs. 1.02 ng/ ml, p = 0.27;1.35 ng/ml vs. 0.95 ng/ml, p = 0.24), Estradiol level (49.12 pg/ml vs. 56.48 pg/ml p = 0.443;54.7 pg/ml vs. 61.12 pg/ml, p = 0.44) at 1st and 3rd month post intervention respectively. PRP is comparatively more cost effective and is associated with lesser pain (32.5 mm vs. 28.13 mm, p = 0.02) then SC group thus showing better compliance and acceptability. Conclusion: Both PRP and SC therapies improves the ovarian reserve markers however, response to PRP is superior to SC. Also, further to note that PRP is minimally invasive and has better compliance and acceptability. The main limitation of this study is small sample size and due to Covid pandemic inability to perform the IVF cycles to show improvement in clinical pregnancies and live births. Therefore, a large randomized trial is required to validate these results.

IgG Antibody Response to the Pfizer BNT162b2 SARS-CoV-2 Vaccine in Healthcare Workers with Healthy Weight, Overweight, and Obesity.

Obesity is a significant factor for increased morbidity and mortality upon infection with SARS-CoV-2. Because of the higher potential for negative outcomes following infection of individuals with obesity, the impact of body mass index (BMI) on vaccine immunogenicity and efficacy is an important public health concern. Few studies have measured the magnitude and durability of the vaccine-specific response in relation to BMI. We measured the receptor binding domain (RBD)-specific serum IgG and surrogate neutralizing titers in a cohort of 126 vaccinated individuals with no clinical history or serological evidence of previous SARS-CoV-2 infection 50 and 200 days following vaccination. BMI had no significant impact on RBD-specific IgG titers and surrogate neutralizing titers 50 days following immunization, and leptin levels had no correlation with the response to immunization. Two hundred days following immunization, antibody titers in all groups had declined by approximately 90%. The responses were also similar between male and female participants and did not significantly vary across age groups. These results indicate that the magnitude and durability of the antibody response to mRNA-based vaccines are unaffected by BMI in this cohort.

An uncommon case of metastatic myxofibrosarcoma presenting with elbow and hip masses.

Myxofibrosarcoma frequently recurs locally but rarely metastasizes. Herein, we describe an elderly woman who had myxofibrosarcoma of the right elbow that went untreated during the COVID-19 pandemic. She subsequently presented with two large tumors ulcerating through the skin of her right elbow and left hip.

In-Hospital Mortality Disparities Among American Indian and Alaska Native, Black, and White Patients With COVID-19.

Importance: American Indian and Alaska Native populations have some of the highest COVID-19 hospitalization and mortality rates in the US, with those in Mississippi being disparately affected. Higher COVID-19 mortality rates among Indigenous populations are often attributed to a higher comorbidity burden, although examinations of these associations are scarce, and none were believed to have included individuals hospitalized in Mississippi. Objective: To evaluate whether racial mortality differences among adults hospitalized with COVID-19 are associated with differential comorbidity experiences. Design, Setting, and Participants: The described cross-sectional study used retrospective hospital discharge data from the Mississippi Inpatient Outpatient Data System. All adult (aged ≥18 years) Mississippians of a known racial identity and who had been hospitalized with COVID-19 from March 1 to December 31, 2020, in any of the state's 103 nonfederal hospitals were included. Data were abstracted on June 17, 2021. Exposure: Racial identity. Main Outcomes and Measures: In-hospital mortality as indicated by discharge status. Results: A total of 18 731 adults hospitalized with a COVID-19 diagnosis and known racial identity were included (median age, 66 [IQR, 53-76] years; 10 109 [54.0%] female; 225 [1.2%] American Indian and Alaska Native; 9191 [49.1%] Black; and 9121 [48.7%] White). Pooling across comorbidity risk groups, odds of in-hospital mortality among Black patients were 75% lower than among American Indian and Alaska Native patients (odds ratio [OR], 0.25 [95% CI, 0.18-0.34]); odds of in-hospital death among White patients were 77% lower (OR, 0.23 [95% CI, 0.16-0.31]). Within comorbidity risk group analyses, Indigenous patients with the lowest risk (Elixhauser Comorbidity Index score ≤0) had an adjusted probability of in-hospital death of 0.10 compared with 0.03 for Black patients (OR, 0.29 [95% CI, 0.10-0.82]) and 0.04 for White patients (OR, 0.37 [95% CI, 0.13-1.07]). Probability of in-hospital death at the highest comorbidity risk levels (Elixhauser Comorbidity Index score ≥16) was 0.69 for American Indian and Alaska Native patients compared with 0.28 for Black patients (OR, 0.16 [95% CI, 0.08-0.32]) and 0.25 for White patients (OR, 0.14 [95% CI, 0.07-0.27]). Conclusions and Relevance: This cross-sectional study of US adults hospitalized with COVID-19 found that American Indian and Alaska Native patients had lower comorbidity risk scores than those observed among Black or White patients. Despite empirical associations between reduced comorbidity risk scores and reduced odds of inpatient mortality, American Indian and Alaska Native patients were significantly more likely to die in the hospital of COVID-19 than Black or White patients at every level of comorbidity risk. Alternative factors that may contribute to high mortality rates among Indigenous populations must be investigated.

Pathophysiological Response to SARS-CoV-2 Infection Detected by Infrared Spectroscopy Enables Rapid and Robust Saliva Screening for COVID-19.

Fourier transform infrared (FTIR) spectroscopy provides a (bio)chemical snapshot of the sample, and was recently used in proof-of-concept cohort studies for COVID-19 saliva screening. However, the biological basis of the proposed technology has not been established. To investigate underlying pathophysiology, we conducted controlled infection experiments on Vero E6 cells in vitro and K18-hACE2 mice in vivo. Potentially infectious culture supernatant or mouse oral lavage samples were treated with ethanol or 75% (v/v) Trizol for attenuated total reflectance (ATR)-FTIR spectroscopy and proteomics, or RT-PCR, respectively. Controlled infection with UV-inactivated SARS-CoV-2 elicited strong biochemical changes in culture supernatant/oral lavage despite a lack of viral replication, determined by RT-PCR or a cell culture infectious dose 50% assay. Nevertheless, SARS-CoV-2 infection induced additional FTIR signals over UV-inactivated SARS-CoV-2 infection in both cell and mouse models, which correspond to aggregated proteins and RNA. Proteomics of mouse oral lavage revealed increased secretion of kallikreins and immune modulatory proteins. Next, we collected saliva from a cohort of human participants (n = 104) and developed a predictive model for COVID-19 using partial least squares discriminant analysis. While high sensitivity of 93.48% was achieved through leave-one-out cross-validation, COVID-19 patients testing negative on follow-up on the day of saliva sampling using RT-PCR was poorly predicted in this model. Importantly, COVID-19 vaccination did not lead to the misclassification of COVID-19 negatives. Finally, meta-analysis revealed that SARS-CoV-2 induced increases in the amide II band in all arms of this study and in recently published cohort studies, indicative of altered ß-sheet structures in secreted proteins. In conclusion, this study reveals a consistent secretory pathophysiological response to SARS-CoV-2, as well as a simple, robust method for COVID-19 saliva screening using ATR-FTIR.

Immune Thrombocytopenia Post Covishield Vaccination

Introduction: Immune thrombocytopenia (ITP) after COVID-19vaccination is being increasingly reported worldwide.Aims &Objectives: We present five cases of ITP following theAstraZeneca Covishield vaccination.Materials &Methods: We retrospectively collected data on patientspresenting with immune thrombocytopenia post-Covishield vaccination at the Department of Hematology, AIIMS, New Delhi.Result: 5 patients diagnosed with ITP followingAstraZeneca Covishieldvaccination were included. Themedian age at diagnosis in our cohortwas44 years (21-67 years). Of the 5 patients, 2 are female and 3 aremale. Allof them received the Astrazeneca Covishield vaccine. Most of thepatients presented with petechiae and wet purpura with the onset ofsymptoms between 7-20 days (median 15 days) post-vaccination. All ofthese patients had severe thrombocytopenia at presentationwith amedianplatelet count of 7 × 109/l (range 1-14 × 109/l). Anti PF4 antibodytesting was done in two patients which were negative.Therapy details include IVIG (3), steroids (4), eltrombopag (2),azathioprine (1), and platelet transfusions (2). Of these, two patientshad no response to first-line therapies. One patient did not respond toIVIG, steroids, azathioprine, and subsequently developed anintracranial bleed. He was managed with platelet transfusions, IVIG,steroids, and eltrombopag. His platelet counts have stabilized at50 × 109/l and he did not have further bleeding manifestations. Atthe last follow-up, 80% (n = 4) of our patients have achieved aresponse.Conclusions: Immune thrombocytopenia is being increasingly recognized post-COVID vaccination. All our patients had severethrombocytopenia requiring therapy. The question of whether thesecases are actually primary ITP coinciding with the administration ofthe vaccine or ITP secondary to vaccination remains unanswered.Additional surveillance is needed to determine the true incidence ofCOVID-19 vaccine-induced ITP.

COVID-19 Inpatient Mortality Disparities Among American Indian Adults in Mississippi's Safety Net Hospital.

BACKGROUND: Long-standing health disparities experienced by American Indians (AIs) are associated with increased all-cause mortality rates and shortened life expectancies when compared to other races and ethnicities. Nationally, these disparities have persisted with the COVID-19 pandemic as AIs are more likely than all other races to be infected, hospitalized, or die from SARS-CoV-2. The Mississippi Band of Choctaw Indians, the only federally recognized American Indian tribe in the state, has been one of the hardest hit in the nation. METHODS: Using de-identified data from the University of Mississippi Medical Center's COVID-19 Research Registry, a retrospective cohort study was conducted to assess COVID-19 inpatient mortality outcomes among adults (≥ age 18) admitted at the state's safety net hospital in 2020. RESULTS: Exactly 41% (n = 25) of American Indian adults admitted with a deemed diagnosis of COVID-19 died while in hospital, in comparison to 19% (n = 153) of blacks and 23% (n = 65) of whites. Racial disparities persisted even when controlling for those risk factors the CDC reported put adults at greatest risk of severe outcomes from the disease. The adjusted probability of inpatient mortality among American Indians was 46% (p < 0.00) in comparison to 19% among blacks and 20% among whites. CONCLUSION: Although comorbidities were commonly observed among COVID-19 + American Indian inpatients, only one was associated with inpatient mortality. This challenges commonly cited theories attributing disparate COVID-19 mortality experiences among indigenous populations to disparate comorbidity experiences. Expanded studies are needed to further investigate these associations.

SLAMP: A Rapid Fluorometric RT-LAMP Assay for Sensitive and Specific Detection of SARS-CoV-2 from Human Saliva (preprint)

Rapid testing methods can identify outbreaks and trigger preventive strategies for slowing the spread of SARS-CoV-2, the virus that causes COVID-19. The gold-standard detection method for SARS-CoV-2 is reverse transcription quantitative polymerase chain reaction (RT-qPCR) performed on samples collected using a nasopharyngeal (NP) swab. While NP RT-qPCR provides high sensitivity, it requires trained personnel to administer and suffers from lengthy time-to-result. Recently, the testing community has turned to rapid saliva-based screening methods including saliva-to-RT-qPCR and/or saliva-to-RT-LAMP (reverse transcription loop-mediated isothermal amplification) to identify infected individuals regardless of symptomatic presentation. Here, we report a simple and rapid RT-LAMP fluorometric assay performed directly on heat-inactivated saliva, without the addition of buffers or proteinase K treatments we call saliva LAMP (SLAMP). Over the course of two days, a total of 243 individuals were tested using NP RT-qPCR, saliva-based qPCR, and saliva-based RT-LAMP. Of the 243 NP RT-qPCR tests, 65 were positive, 178 were negative, and SLAMP demonstrated a 91% sensitivity and 98% specificity. SLAMP sensitivity becomes 95% when samples negative in saliva tests while positive in NP RT-qPCR are excluded from evaluation, potentially indicating significant differences in viral titer between collection sites on the body. SLAMP is performed in triplicates and takes 45 min to run in the laboratory, requiring less technician time and instrument run time than NP RT-qPCR. These results demonstrate that saliva-based RT-LAMP can enable frequent and rapid screening of large numbers of people to identify pre-symptomatic and asymptomatic individuals thereby controlling outbreaks.

Addition of eltrombopag to immunosuppressive therapy (ATG, cyclosporine) in acquired aplastic anemia: A tertiary care center experience

Aims & Objectives: To assess the responses of Acquired Aplastic Anaemia patients who have received Eltrombopag in addition to Immunosuppressive therapy (ATG → Cyclosporine A) at our tertiary care center. Patients/Materials & Methods: We retrospectively analysed the responses of Acquired Aplastic Anaemia patients who have received Eltrombopag, Antithymocyte globulin, and Cyclosporine A from Jan 2019 to March 2020. Results: Thirty-eight patients were included in our study. The median age is 27.6 years (7-68). Male to Female ratio 1.2:1. 6 patients were less than 13 years of age and, 31 patients were between>13 years to<60 years and 1 patient was>60 years. PNH clone was positive in 6 patients(15%). Majority of our patients were Severe Aplastic Anemia (76.3%), and Non Severe Aplastic Anemia (10.5%), Very Severe Aplastic Anaemia(13.1%).All of our patients received Cyclosporine and Danazol before ATG. The median duration from diagnosis to treatment is 12.2 months(1-60 months). Except for one who received Rabbit ATG, everyone received Equine ATG. Eltrombopag was given at a dose of 75 mg in 13.15% (5) and 150 mg in 86.85% (33). Complete Response, Partial Response, No response were seen in 15.8%,57.8%,26.5% respectively. 3 patients expired within three months of treatment, 3 more patients expired by 6 months(1, COVID-19). Discussion & Conclusion: Overall Response rates of 75% in an Indian cohort of acquired aplastic anemia patients treated with ATG and Cyclosporine plus Eltrombopag is comparable to that reported in studies from US and Europe. Median duration of disease prior to ATG based IST was 1 year in our cohort of AA patients.Addition of eltrombopag to ATG and Cyclosporine was able to overcome the delayed initiation of IST in AA patients.Treatment was well tolerated in our patients.