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1.
Archives of Disease in Childhood ; 107(Supplement 2):A342, 2022.
Article in English | EMBASE | ID: covidwho-2064040

ABSTRACT

Aims Imposition of restrictions during COVID-19 pandemic adversely affected access and quality of pediatric consultations leading to increased parental anxiety. During pandemic AIIMS Patna initiated telemedicine-based COVID-19 Children's Helpline 'COViTel' in eastern part of India. The aim of the study was to assess the impact of telehealth services on parents' level of anxiety regarding COVID-19 illness in their children using a newly developed Parental Anxiety Score related to Child health (PASC). Methods A prospective cohort study was conducted on 75 parents seeking teleconsultation on 'COViTel' for children either diagnosed with COVID-19 or having direct contact with a COVID-19 positive case. As there was no existing scoring system to assess parental anxiety related with COVID-19 illness, a 6-item PASC (figure 1) was developed to assess parents anxiety level before and 3 days after pediatric teleconsultation. Ethical clearance was granted by institute ethics committee. Results Demographic details are provided in table 1. Parents had moderate level of anxiety (PASC 8) with highest score on item 6 at the time of registration (table 2). Parental anxiety had significantly reduced (PASC 4.2) after teleconsultation (mean difference= 3.787, 95% CI 2.899-4.674, P<0.01) with maximum reduction on item 2 (mean difference= 1.147 95% CI 0.93-1.36, P<0.01) on paired t-test. Conclusion This is first kind of study proving effectiveness of teleconsultation in mitigating parental anxiety related to COVID-19using a novel PASC score.

2.
Kidney International Reports ; 7(9):S508-S509, 2022.
Article in English | EMBASE | ID: covidwho-2041721

ABSTRACT

Introduction: Because of the limited donor pool, transplants are being done across the blood group and even HLA incompatibility barriers. But this comes at the cost of increased immunosuppression and the side effects. Effect of this intensified immunosuppression on the incidence of post transplant infections and the type of infection has not been studied extensively. Methods: We retrospectively analysed the incidence of infection in ABO incompatible transplants (ABOi) and compared it with propensity matched cohort of ABO compatible transplants(ABOc) over the same timeframe i.e. 2011 to April 2019. using hospital eHIS record system. Patients were matched with 1:2 ratio (ABOi: ABOc) for age (<60yr, >60yrs),sex, number of previous transplants, pretransplant infections, history of prior immunosuppression, diabetic status, NODAT, and induction agent used. Desensitization protocol for ABO incompatible transplant includes rituximab with double filtration plasmapheresis, plasmapharesis or immunoadsorption to target anti blood group titre of 8. Patient with high immunological risk (e.g.second transplant, HLA incompatible) receive ATG induction while others receive basiliximab induction. Valganciclovir prophylaxis was given only in patients with ATG induction. Results: [Formula presented] [Formula presented] During the study period 89 patients underwent ABOi transplants which were compared with 178 ABOc transplants. (Table1)Mean follow up duration was 50.45months (SD 26.8) in ABOi group and 49.47months (SD28.7) in ABOc group. 17% patients lost to follow up with their last follow up being more than 2 years before. Incidence of overall infections was similar in both the groups (59% (43/89) Vs 44.3% (79/178);p=0.6). (Table2) Incidence of urinary tract infections(UTI)was significantly more in ABOi group vs ABOc group.(23.5% (21/89) vs 11.79% (21/178);p=0.019). Cytomegalovirus infections (CMV) were significantly more in ABOi group 12.3% (11/89) as compared to ABOc group 5% (9/187) (p=0.04). All the patients with CMV infection were CMV IgG positive pretransplant except 2, one from ABOc group who was CMV IgG negative and another from ABOi group who’s pretransplant CMV serology was unavailable. There was no significant difference in incidence of fungal infection, pneumocystis infection, diarrheal infections (other than CMV),pneumonia (other than CMV, PCP, fungal), Herpes, BKV infection. Incidence of post-transplant tuberculosis (3.3% (3/89) Vs 2.8% (5/178);p=1.0) and SARS COV2 infections (12.3% (11/89) vs 9% (16/178);p=0.39 was similar in both the groups. Patient survival was similar in both the groups i.e.95.5% but death censored graft loss was significantly more in ABOi group 0.9% (8/89) as compared ABOc group 0.3% (5/178) p=0.03. Reason of graft loss in all the patients was immunological and not infection. Infection was cause for death in three ABOi patients and four ABOc patients. Conclusions: Overall incidence of infections in ABOi transplants was similar to Abo compatible transplant. Incidence of UTIs and CMV infections were significantly higher in ABOi group. No conflict of interest

3.
European Journal of Molecular and Clinical Medicine ; 9(4):3496-3510, 2022.
Article in English | EMBASE | ID: covidwho-2040949

ABSTRACT

Introduction: Congenital talipes equinovarus (CTEV) is the most common congenital foot disorder, commonly known as congenital clubfoot. Ponseti method of manipulation and serial plaster casting is the gold standard treatment for idiopathic congenital clubfoot. The purpose of this study is to analyse the efficacy of correction of Congenital Talipes Equinovarus deformity (CTEV) using ponseti method. Materials and Methods: This analysis was carried out at the Jhalawar Medical College Hospital's Orthopaedics Department, including 30 children with idiopathic CTEV of age less than 2 years, among which 13 unilateral and 17 bilateral CTEV, total 47 feet, willing for treatment. Patients were followed up weekly for corrective casting till tenotomy and corrective cast was applied for three weeks after final correction or percutaneous tendo-achilles tenotomy. Results: Assessment of results using Pirani severity scoring6,7 at the end of treatment and on regular follow-ups. The most common age group was 0-1 months with 24(80%) cases.Among 30 cases,there were 22 males(73.30%) & 8 females(26.70%). 17 cases were bilateral(56.67%) and 13 cases(43.33%) were unilateral. Post casting treatment, percutaneous tenotomy was done in 14 cases (46.67%) in which 12 cases(54%) were male and 2 cases(16%) were female. No patient has undergone extensive surgery like postero-medial soft tissue release or bony procedures to correct the deformity. Only two recurrence were recorded which was due to non compliance due to occurrence of pandemic COVID-19 Lockdown. They were treated with manipulation and pop cast followed D-B splint. Conclusion: Ponseti method is an excellent conservative method of treatment of Congenital Talipes Equino varus. Treatment must start at the earliest possible for better outcome. Long term follow up till 4 years age would be better to assess the relapse rate.

4.
Artificial Intelligence, Machine Learning, and Mental Health in Pandemics: A Computational Approach ; : 343-363, 2022.
Article in English | Scopus | ID: covidwho-2035578

ABSTRACT

The Electronic Health Record (EHR) systems provide health information about patients. Data security, integrity, and management of EHR are crucial problems. Records can be modified and altered by different stockholders as the different users may be using them in more than one form. We provide a new approach, methodology, and system for calculating dyslexia symptoms in this research with a machine learning algorithm and secure dyslexia data storage using blockchain technology. The major role of our paper is to test a primary-age group student against dyslexia, a student detected in such early years of his life for such a disability then he or she can be easily cured for the disabilities and can spend the rest of his life normally. For this, we will be using various machine learning algorithms. Dyslexic patterns and a large amount of data can be shared for future clinical research, statistical analysis, and quality assurance because the framework is language-independent and built on Blockchain and a decentralized big data repository. This paper presents the design, execution, and test results, demonstrating the dyslexia health management system's high potential for worldwide deployment using blockchain technology. © 2022 Elsevier Inc. All rights reserved.

5.
Journal of Cystic Fibrosis ; 21:S65, 2022.
Article in English | EMBASE | ID: covidwho-1996771

ABSTRACT

Objectives: People with CF (PwCF) are at increased risk of respiratory infections and chronic inflammation.We sought to determine whether the inflammatory response is different in nasal epithelium of PwCF compared to healthy volunteers (HV). Since Interferons can increase ACE2 expression, a protein required for SARS-CoV-2 entry,we focused our analysis on the the focusing on the interferon-response signature. Methods: We reanalysed nasal curettage sample bulk RNA-seq signatures of pilot and validation datasets for which the study methods and demographics of the recruited cohort have already been reported. For this analysis, we performed in-silico deconvolution of bulk RNA-seq data using publicly available single-cell RNA-seq data from nasal epitheliumas a reference to determine the abundance of the specific cell types in each sample. Results: Hierarchical clustering of the pilot and validation cohorts revealed 3 clusters. Analysis of the larger validation cohort revealed that Cluster A included HV (11 out of 11 subjects) and both homozygous (7 out of 13 subjects) and heterozygous (3 out of 10 subjects) PwCF. Subject cluster A was characterised by increased expression of genes related to secretory and ciliated epithelial cells, whereas Clusters B and C contained both homozygous and heterozygous PwCF only and were characterised by genes restricted to neutrophils and involved in immune responses. We then compared samples from cluster A that contained samples from HV (n = 11), PwCF homozygous (n = 7) and heterozygous (n = 3) for F508del. This analysis identified 379 genes upregulated in HV and 146 genes upregulated in PwCF homozygous for F508del and only 44 and 6 genes upregulated in HV and PwCF heterozygous for F508del, respectively (FDR q < 0.05). ACE2, TMPRS2 or other interferon-response genes were not deferentially expressed in either comparison of cluster A. Conclusion: PwCF do not have higher expression of interferon-response genes in nasal epithelial cells

6.
JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY ; 34(2):176-179, 2022.
Article in English | Web of Science | ID: covidwho-1939217

ABSTRACT

Background: Most studies of COVID vaccination focused on cell-mediated immunity and serum IgG antibodies, overlooking the role of anti-Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) neutralizing IgA antibodies in preventing viral infection. SARS-CoV-2 vaccine generates variable Anti-Spike IgG responses following one or two vaccine doses in almost all individuals for protection. Aim: The study aimed to quantify and estimate the Anti-Spike SARS-CoV-2 IgG antibody response after the second dose of the Covishield vaccine in healthcare workers (HCWs) over the time frame of one, three, and six months. Material and Methods: 30 HCWs who had received both doses of the Covishield vaccine were selected and divided into three groups based on the time elapsed after the second dose of vaccine for serological analysis. Post-vaccination antibody responses were measured using the SARS-CoV-2 IgG Quantitative assay (detection threshold: & GE;50 AU/ml) using chemiluminescent microparticle immunoassay (CMIA). Data were analyzed using the Kolmogorov-Smirnov test, Kruskal-Walli's test, and Mann-Whitney U test. Result: Vaccination leads to measurable anti-spike IgG antibodies in HCWs. Only 1 individual was seronegative. The highest antibody titer was reported after one month of the second dose (3615.3 AU/ml). The lowest antibody titer (491.5 AU/ml) was seen after six months of the second dose of Covishield is statistically significant. Conclusion: Anti-Spike SARS-CoV-2 IgG antibody determination is necessary for an immune response after vaccination. This titer decreases with time consequently as the duration after the second dose of the Covishield vaccine increases. This helps assess the requirement of a booster dose for effective immunity against coronavirus.

7.
Alcoholism: Clinical and Experimental Research ; 46:285A-286A, 2022.
Article in English | EMBASE | ID: covidwho-1937883

ABSTRACT

Purpose of the study: Rural areas in the United States have been disproportionately burdened with high rates of substance use, mental health challenges and suicide behaviors. Factors such as a lack of mental health services, decreased accessibility to public health resources, and social isolation contribute to these disparities. The current study explore risk factors to suicide related admissions, using emergency room discharge data from Maryland. Methods: The current study used data from the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) from the State of Maryland. Logistic regression was used to assess the association between opioid use disorder, alcohol use disorder, cannabis use disorder, major depressive disorder, and the outcome variable, of suicide ideation emergency department discharge based on International Classification of Disease, 10th edition (ICD-10). We controlled for income based on zip code of residence, race, age, and gender. Results: Previous major depressive disorder diagnosis (OR = 79.30;95%CI 51.91-121.15), alcohol use disorder (OR = 6.87;95% CI 4.97-9.51), opioid use disorder (OR = 5.39;95% CI 3.63- 7.99), and cannabis use disorder (OR = 2.67;95% CI 1.37-5.18) were all positively associated with suicidal ideation discharge status. Conclusion: The study highlights the strong link between substance use disorder, depression and suicidal ideation admission, indicating the need for prevention and intervention, particularly among those in rural areas burden. As health disparities between rural and urban areas further widened during the COVID-19 pandemic, there is an urgent need to address these issues.

8.
Topics in Antiviral Medicine ; 30(1 SUPPL):250, 2022.
Article in English | EMBASE | ID: covidwho-1880476

ABSTRACT

Background: Tocilizumab is an IgG1 class humanized monoclonal antibody targeting IL-6 receptor (IL-6R). IL-6 is a key cytokine involved in cytokine storm of severe COVID-19. Tocilizumab down-regulates IL-6 preventing fatal and permanent damage to vital organs, significantly preventing COVID-19 related mortality and morbidity. Therefore, this study aimed to compare the efficacy and safety of Tocilizumab (biosimilar) developed by Hetero Biopharma Ltd, India vs reference medicinal product (RMP)-Tocilizumab manufactured by Roche in cytokine storm of severe COVID-19 pneumonia. Methods: This multicenter, randomized, double-blind, active-controlled study enrolled patients aged 18 to 65 years, with laboratory-confirmed, hospitalized, severe COVID-19 disease with elevated inflammatory markers not on mechanical ventilation. Patients were randomized (3:1 ratio) to receive either Test-Tocilizumab (Test) 8 mg/kg or RMP-Tocilizumab 8mg/kg, maximum 800mg, administered once on day 1. The primary endpoint was the cumulative proportion of patients requiring mechanical ventilation by Day 14. Secondary endpoints included 28 day mortality rate, proportion of patients with a 2-point decrease in WHO ordinal scale, time to clinical failure (death or required mechanical ventilation or withdrawn), change in inflammatory markers (CRP, IL-6, Ferritin and D-dimer) and duration of hospital stay in days. Safety endpoints included the incidence of adverse events;the proportion of patients discontinued the study due to adverse events and the incidence of any post-treatment bacterial and/or fungal infection. Results: Out of 211 patients screened, 172 patients were randomized (131 to Test and 41 to RMP) to receive Tocilizumab 8mg/kg. Patients were similar in both groups at baseline in terms of age, gender, weight etc. Fourteen (10.69%) patients in Test and 5 (12.20%) patients in RMP progressed to mechanical ventilation by Day 14 (p=0.7789). Overall, 9 (7.83%) patients died in Test vs 5 (13.16%) in RMP during 28 days follow up (p=0.3382). Clinical improvement was seen 62.60% and 77.10% vs 53.66% and 73.17% in Test vs RMP at day 14 and 28 respectively. The time to clinical failure was 6 vs 5 days and time to clinical improvement was 11 vs 11.5 days. Hospitalization duration was 12.9 versus 13.8 days in the Test and RMP. ARDS, Insomnia and Pain were most commonly reported adverse events. Conclusion: Tocilizumab biosimilar is comparable with RMP-Tocilizumab in preventing mechanical ventilation in severe COVID19 pneumonia patients.

9.
Journal of Clinical and Diagnostic Research ; 16(5):VC01-VC04, 2022.
Article in English | EMBASE | ID: covidwho-1856269

ABSTRACT

Introduction: Although isolation and quarantine are important measures to curb the exponential growth of the prevailing Coronavirus disease 2019 (COVID-19) pandemic, but at same time this can impose psychological issues among the affected population and also to their family members. Aims: To evaluate the mental health problems, their severity and associated factors in quarantined population during the COVID-19 pandemic. Materials and Methods: This cross-sectional study was conducted among 207 quarantined subjects at different quarantine centres of Ajmer, associated with JLN Medical College, Ajmer, from August 2020 to October 2020,after getting approval from ethics committee of the centre. All the consenting quarantined subjects who were of age 18 years and above, irrespective of their gender were enrolled in the study. For the assessment of psychiatric morbidity, participants were screened using Mini-International Neuropsychiatric Interview (MINI) 6.0.0. Finally, the relevant psychiatric assessment tools like Hamilton Rating Scale for Depression (HAM-D),Hamilton Anxiety Rating Scale (HAM-A) and Yale-Brown Obsessive Compulsive Scale were applied to assess the severity of the disorders. Pearson correlation analysis was used to evaluate the relationship among various clinical variables.The level of significance was considered at p-value lt;0.05. Results: Majority 85 (41%) subjects belonged to the age group 31-40 years of age. Around 116 (77.3%) participants were male. Around 51 (24.6%) presented moderate depression and 25 (12%) presented with severe depression. Also 182 (87.9%) presented with moderate anxiety. The study showed a statistically significant association between depression/anxiety and substance abuse, insomnia, co-morbidities, suicidal ideation/attempts. Conclusion: The findings of the present study concluded that a significant proportion of the quarantined population suffered from psychological issues. So, the psychological impact of a mandatory quarantine should be weighed more thoughtful and in an evidence based manner.

10.
Blood ; 138(SUPPL 1):3826, 2021.
Article in English | EMBASE | ID: covidwho-1770242

ABSTRACT

Introduction: Axicabtagene ciloleucel (axi-cel) is an autologous anti-CD19 Chimeric Antigen Receptor (CAR) T-cell therapy that induces durable responses in patients with relapsed or refractory large B-cell lymphoma. At a median of 27.1 months follow-up on the ZUMA-1 trial, median overall survival (OS) was 25.8 months with 39% progression free survival (PFS) at 2 years post-infusion (Locke, Lancet Onc 2019). We previously reported outcomes of axi-cel patients treated with standard of care therapy at a median follow up of 12.9 months, including 42% who did not meet eligibility criteria for ZUMA-1 based on co-morbidities (Nastoupil, JCO 2020). Here we report results from this cohort at a median follow up of 32.4 months, as well as late outcomes of interest including cytopenias, infections and secondary malignancies. Methods and Results: The US Lymphoma CAR-T Consortium comprised of 17 US academic centers who contributed data independent of the manufacturer. Two hundred and ninety-eight patients underwent leukapheresis with intent to manufacture standard of care axi-cel as of September 30, 2018. In infused patients (n=275), OS and PFS were calculated from date of infusion. After median follow-up of 32.4 months (95% CI 31.1 - 34.3), median OS was not reached (95% CI 25.6 - not evaluable) (Figure 1A) with 1-, 2- and 3-year OS of 68.5% (95% CI 62.6-73.7), 56.4% (95% CI 50.1-62.2) and 52.2% (95% CI 45.7-58.2%), respectively. Median PFS was 9 months (95% CI 5.9-19.6) (Figure 1B);1-, 2- and 3-year PFS was 47.4% (95% CI 41.4-53.2), 41.6% (95% CI 35.6-47.5) and 37.3% (95% CI 31.3-43.2), respectively. Twenty-seven PFS events occurred at or after 1 year post infusion;19 events were progressive lymphoma, with the latest relapse observed 28 months after axi-cel infusion. Eight patients died while in remission from their lymphoma: 4 from secondary malignancy, 3 from infection, and 1 from unknown causes. Results of multivariable modeling were similar to our prior analysis: factors associated with both a shorter PFS and shorter OS included male sex, elevated pre-lymphodepletion LDH, and poor ECOG status. Complete blood count and B- and T-cell recovery data were collected at 1 and 2-years post-infusion, excluding patients who had relapsed or been treated for secondary malignancy at time of collection (Table 1). Rates of neutropenia (absolute neutrophil count ≤1000) at 1- and 2- years were 9.2% (10/109) and 11.2% (9/80) and rates of CD4 count ≤200/ul were 62% (23/37) and 27% (7/26). Recovery of B cells was seen in 54% (15/28) and 57% (13/23) at 1-and 2-years post infusion. Infections were reported in 31.2% (34/109) patients between 6- and 12-months post infusion, and 17% (18/109) were severe, requiring either hospitalization and/or IV antibiotics. Twenty-one patients (24%, 21/89) had an infection between 1- and 2- years, 11% of which were severe. Twenty percent (10/49) of patients between 2- and 3-years had an infection and 4 (8%) were severe. Neutropenia, low CD4 counts, and IgG levels were not associated with infection, though patients with infection between 6-12 months were more likely to have received IVIG (p<0.001). No patient in this cohort died of COVID-19. Twenty-two of 275 (8%) patients were diagnosed with subsequent malignancy after axi-cel treatment: 14/275 (5%) patients were diagnosed with myeloid malignancies (MDS (n=12), AML (n=1), CMML (n=1));other malignancies included squamous cell carcinoma of skin (n=3);sarcoma (n=1);endometrial (n=1);lung (n=1);mesothelioma (n=1) and AITL (n=1). Patients with myeloid malignancy had a median age of 62 at axi-cel apheresis (IQR 56-67), 64% were male and median lines of prior therapy was 4 (IQR 3-6), including 36% with a prior autologous stem cell transplant. Eleven patients were in remission from lymphoma at myeloid malignancy diagnosis, while 3 were diagnosed after progression and interval therapy. Conclusion: This multi-center retrospective study showed similar long-term results to the ZUMA-1 trial, despite including patients who did not meet ZUMA-1 eligibility criteria ba ed on comorbidities. Sixteen percent of PFS events were seen after 1 year, largely due to disease progression. Late infection was common but was not explained by persistent neutropenia or low CD4 counts. Subsequent malignancy, including MDS, occurred in 8% of patients and require further study to better identify patients at risk. (Figure Presented).

11.
Journal of the American College of Cardiology ; 79(9):663, 2022.
Article in English | EMBASE | ID: covidwho-1768624

ABSTRACT

Background: Left Atrial Appendage Occlusion (LAAO) with the Watchman device is considered an elective procedure, and thus often deferred during outbreak peaks associated with the COVID-19 pandemic. Patients with bleeding issues on anticoagulation may require additional hospitalization for bleeding episodes or suffering increased risk of stroke by postponing occlusion while anticoagulation is discontinued. We chose to develop a protocol for screening, same day discharge, and follow up of selected LAAO patients and continuing to provide quality clinical outcomes while accounting for decreased bed and staff capacity due to the pandemic. Methods: Utilizing Knowledge to Action (KTA) nursing framework, a protocol was developed and reviewed with key stakeholders. Criteria for Same Day Discharge (SDD) includes: support at home, stable vitals and access site hemostasis prior to DC, agreeable to SDD, tolerant of oral intake, ability to urinate and safely ambulate prior to DC. Exclusion for SDD includes: Liver disease, Plt count <70,000, ESRD or CKD IV or any site or procedure complications. With Perclose usage patients must have 3 hours of bedrest, with manual pressure closure must have bedrest for 6 hours and purse string suture removed. This is followed by a next day phone call to ensure the patient is taking appropriate medicines and have no medical issues. Results: 38 out of 113 patients were screened as SDD candidates from January 2021-October 2021. Average patient age was 76, 31% female, with average CHA2DS2-VASc of 5. One patient required overnight hospitalization due to underlying asthma and need for nebulizer. One patient presented to an outpatient ED on a weekend with chest pain and underwent heart catheterization due to elevated troponin and did not require intervention. There were no access site complications. No patients contracted SARS-Cov-2 within 6 weeks post procedurally, compared with 2 of the overnight stays during the same period (75 patients). Conclusion: SDD in a carefully selected patient population is a feasible and safe strategy for LAAO patients. These patients had a clinically significant, though underpowered decrease in incidence of COVID-19 diagnosis within 6 weeks post implant.

12.
Studies in Computational Intelligence ; 1007:269-280, 2022.
Article in English | Scopus | ID: covidwho-1767462

ABSTRACT

A pandemic like COVID-19 has conveyed the necessity of maintaining social distancing between two or more human beings. However, it is not possible for police or government officials to be omnipresent and regulate gatherings all around. This paper presents a model for maintaining social distancing norms using Unmanned Aerial Vehicles (UAV) which helps in aerial surveillance and detecting humans using Hierarchical Extreme Learning Machine(HELM), estimating their geolocations, and calculating the distance between two immediate beings and alerting them in case they are in close proximity with another body using on-board systems and algorithms. The human being is alerted through a prerecorded audio clip played through a speaker present on the UAV to maintain necessary distance. Furthermore, the use-case is expanded for surveillance and crowd control measures by alerting the local authorities in case of a mass gathering in a region. This approach minimizes the deployment of personnel for ensuring and monitoring social distancing and helps regulate crowd gatherings using cyber-physical systems. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

13.
Electronic Journal of General Medicine ; 19(3):7, 2022.
Article in English | Web of Science | ID: covidwho-1761631

ABSTRACT

Background: Globally, micronutrient use has increased over the last few decades for disease prevention and holistic health. This article has analyzed the worldwide search trends of micronutrients in the Google Trends (GT) platform to understand the significance and correlation of search trends, comparing the search interests across countries and recognizing the factors involved. Methods: Specific search terms were used to identify the search trends of micronutrients in the GT platform. Statistical analysis was done to evaluate the outcomes of significance and correlation of search terms from 2004 to 2021 by using statistical softwares. Results: There was a rise in searches for micronutrients vitamin D, vitamin C, zinc, & iron from 2004 to June 2021 with a steep increase during 2020 correlating with the COVID-19 pandemic. A stable search has been reported in iron searches. Significance and correlation of vitamin D, vitamin C, zinc, & iron over the years and search interest popularity score of countries for micronutrient searches have been described. Conclusions: The GT tool can be a necessary tool for healthcare communities and government sectors to understand people's interests, necessities and respond to their concerns accordingly, thus helping us promote population-centric awareness and achieve better evidence-based outcomes.

14.
Global Finance Journal ; 51:22, 2022.
Article in English | Web of Science | ID: covidwho-1747982

ABSTRACT

In 2020, ESG funds that invest in companies that score higher on environmental, social, and governance measures witnessed an increase in investment compared to 2019. Understanding the causal relationship and spillover between these two types of indexes may help investors determine if clean energy indexes follow the same trend as conventional indexes or the reverse. Additionally, investors would benefit from understanding this causation in both the pre- and post-Covid-19 eras. We conceive this study to plug this gap and advance the knowledge in this critical area. We study the causality and spillover between NASDAQ clean energy indexes, and their corresponding alternatives namely, NASDAQ Composite Index and NASDAQ Global Select Market Composite using the daily data and from 1 st January 2011 to 29 th June 2021. We apply the Granger-Causality test and the spillover models approach by Diebold and Yilmaz (2012) and Barunik and Krehlik (2018) to determine any medium-run, or long-run causality, and spillover between the indexes under reference, respectively. Our results suggest us to observe that both sustainable and green indexes exhibit bi-directional causality where both sets of indexes impact each other in the long-run. Additionally, after the emergence of the COVID-19 pandemic, the connectivity between the two sets of indices rose significantly. Our findings also suggest that the investors will not lose on risk-adjusted returns if they chose to go green. With the investors' ability to shift towards green investment without losing on financial returns, it shall become even easier for businesses to steer their operations.

15.
Open Forum Infectious Diseases ; 8(SUPPL 1):S363-S364, 2021.
Article in English | EMBASE | ID: covidwho-1746472

ABSTRACT

Background. Our group performed an in-silico screen to identify FDA approved drugs that inhibit SARS-C0V-2 main protease (Mpro), followed by in vitro viral replication assays, and in vivo pharmacokinetic studies in mice. These studies identified atovaquone as a promising candidate for inhibiting viral replication. Methods. Enrolled patients were randomized in a 2:1 fashion to atovaquone 1500 mg twice daily versus matched placebo. Patients received standard of care treatment including remdesivir, dexamethasone, or convalescent plasma as deemed necessary by the treating team. Patients agreed to allow collection of saliva at baseline and twice a day while hospitalized or up to 10 days. Saliva was collected and RNA extracted for viral load (VL) measurement by Real-time PCR. Our primary outcome was to examine the between group differences in log transformed VL(copies/mL) using generalized linear mixed-effect models of repeated measures from all samples. Additional analysis of Atovquone plasma concentrations were examined and correlated with viral load and body mass index (BMI). Results. Of the 61 patients enrolled;41 were received atovaquone and 19 placebo. Overall the population was predominately male Hispanic with a mean age of 51 years. The two groups were balanced (Table 1) with regard to age, gender, race, co-morbidities, days from onset of symptoms, baseline oxygen requirements, and receipt of COVID-19 specific standard of care treatment. A higher proportion with diabetes was noted in the Atovaquone arm. The log10 VL was 5.25 copies/mL vs. 4.79 copies/mL at baseline in the atovaquone vs. placebo group. Although there was a decrease in VL over time, there was no differences between the atovaquone plus standard of care arm versus the standard of care arm (Figure 1). Additional analysis of atovaquone plasma concentration demonstrated a wide variation in atovaquone levels, inverse association between atovaquone levels and BMI (rho -0.44, p=0.03), and Day 5 concentrations and VL (rho -0.54, p=0.005). Conclusion. Although atovaquone showed promising in vitro antiviral properties for COVID-19, in this pilot study we did not detect a change in VL in patients who received atovaquone compared to placebo, possibly due to failure of patients achieve adequate drug levels.

16.
Am J Blood Res ; 11(6):580-591, 2021.
Article in English | PubMed | ID: covidwho-1661366

ABSTRACT

BACKGROUND: The "cytokine storm" (CS) in COVID-19 leads to the worst stage of illness which can be controlled only with timely intervention. There is an urgent need to identify laboratory markers of disease progression for optimum allocation of resources in developing countries like India. METHODS: A cross-sectional study was conducted on 100 COVID-19 positive patients over two months. The cases were sub-classified based on disease severity into mild to moderate (n=61), severe (n=26) and very severe (n=13) and into survivors (n=85) and non-survivors (n=15) based on survivor status. These patients were tested for hematological parameters (total blood lymphocyte counts, NLR, PLR, platelet indices etc.), coagulation markers (D-dimer, fibrin degradation products (FDP), fibrinogen etc.) and biochemical markers (LDH, ferritin, IL-6, procalcitonin, hs-CRP). RESULTS: Statistically significant differences were observed in hematological variables (ANC, NLR and ESR), coagulation parameters (D-dimer, FDP, fibrinogen and thrombin time) and biochemical markers (LDH, ferritin, IL-6, procalcitonin and hs-CRP) with regard to subcategories based of disease severity as well as survivor status. There was strong correlation between NLR, D-dimer, IL-6, procalcitonin and ferritin. IL-6 emerged as the single best marker of disease severity (AUC: 0.997, P=0.00), however procalcitonin, LDH, D-dimer, FDP and NLR could also predict severe disease with a good sensitivity and specificity. CONCLUSION: To conclude, study demonstrates a plethora of biomarkers which could be utilized to accurately identify the hyperinflammation and tissue damage reminiscent of cytokine storm in COVID-19 patients so that timely, safe, and effective therapies can be administered to prevent progression and potentially reduce mortality.

17.
Blood ; 138:2321, 2021.
Article in English | EMBASE | ID: covidwho-1582311

ABSTRACT

Background Based on early evidence of a high rate of coronavirus mortality in patients with acute myeloid leukaemia (AML) undergoing intensive chemotherapy (IC), the national health service (NHS) in the United Kingdom temporarily made venetoclax available as an alternative therapy, with the aim of reducing both mortality and healthcare resource use. From late April 2020, venetoclax was available to patients aged >16y with NPM1 mutation without FLT3 internal tandem duplication (ITD), patients aged >50y with NPM1, IDH1 or IDH2 mutations (regardless of FLT3 status) and patients aged >60y without favourable-risk cytogenetics. Venetoclax could be given with either azacitidine or low-dose cytarabine (LDAC), with the latter recommended mainly for patients with NPM1 mutation. We report a health-system-wide real world data collection for toxicity and patient outcomes across 65 NHS Hospitals. Methods Each patient was registered on a central NHS database. Clinicians certified that their patient met the above criteria, had not received previous AML treatment, and was fit for induction chemotherapy. Anonymised data were retrospectively collected by treating physicians. Venetoclax dose, duration and toxicity information was requested for the first 4 cycles of therapy. Response definitions were as per European Leukaemia Network (ELN) guidelines. A total of 870 patients have been registered on the scheme, with outcomes reported here for those with follow-up information at a data cut on 1st August 2021. Results There were 301 patients, median age 72y (range 34 - 90) with 62% male. The majority (81%) had an ECOG performance status of 0-1. AML was secondary to a previous haematological disorder in 33%, therapy-related in 10% and de novo in the remaining 57%. MRC cytogenetic risk was intermediate in 70% and adverse in 27%. NPM1 mutations were detected in 28% and FLT3-ITD in 12%. Next-generation sequencing results were available in 86% of patients, which detected mutations in IDH1 or IDH2 in 28%, ASXL1 in 20%, RUNX1 in 17% and TP53 in 12%. The ELN risk was favourable for 23%, intermediate for 30% and adverse for 44%. A majority received venetoclax in combination with azacitidine (85%), with the remaining 15% receiving LDAC. The LDAC cohort was enriched for de novo AML (76% vs 54%) and NPM1-mutated disease (56% vs 23%). Most patients (81%) followed the recommended initial schedule of venetoclax 100mg daily for 28 days in combination with posaconazole or voriconazole. Patients spent a median 14 days in hospital in cycle 1, then a median of 0 days for cycles 2-4. In cycles 1, 2, 3 and 4, the median number of days for recovery of neutrophils to >0.5x10 9/L was 33, 25, 24 and 14 respectively, and the median number of days to recovery of platelets to >50x10 9/L was 22, 3, 0 (no drop below 50) and 0. The composite complete remission (CR) / CR with incomplete haematological recovery (CRi) rate was 70%. MRD data is being collected. The best response was morphological leukaemia free state (MLFS) in 2%, partial remission in 7% and refractory disease in 11%. CR/CRi was higher in de novo (78%) compared to secondary AML (57%, p=0.02);NPM1 mutated (78% vs 67%, p=0.02) and IDH1/IDH2 mutated disease (85% vs 62%, p=0.02). ELN favourable risk patients had the highest CR/CRi rate (85%, intermediate 71%, adverse 60%, p=0.01). Median follow-up was 8.2 months (95%CI 7.8 - 9.0) with median overall survival (OS) 12.8 months (95%CI 10.9 - not reached). Mortality at day 30 was 5.7% and day 60 was 8.4%. 12-month overall survival was 51%, increasing to 71% in those who achieved CR/CRi. Survival was poorer in secondary (HR 1.9, p <0.01) and therapy-related AML (HR 2.1, p=0.02), better in NPM1 mutated (HR 0.6, p=0.02) and IDH mutated (HR 0.5, p=0.02) disease and poorer with TP53 mutation (HR 2.0, p=0.01). Overall survival did not differ for patients treated with LDAC compared to azacitidine (HR 1.1, p=0.7). Conclusion This large real-world study demonstrates CR/CRi and survival rates comparable to those reported in prospective clinical trials. Importantly, during t e COVID-19 pandemic, the adoption of venetoclax regimens permitted the great majority of treatment to be delivered as an outpatient with significant resource saving at a time of critically constrained inpatient resources. The data support prospective comparisons of venetoclax-based regimens to IC in fit adults with AML particularly in older patients with de novo AML, NPM1-mutated and IDH-mutated disease. [Formula presented] Disclosures: Belsham: Celgene: Other: meeting attendance;Abbvie: Other: meeting attendance. Khan: Abbvie: Honoraria;Astellas: Honoraria;Takeda: Honoraria;Jazz: Honoraria;Gilead: Honoraria;Novartis: Honoraria. Khwaja: Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Astellas: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Abbvie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Latif: Kite: Consultancy, Honoraria, Speakers Bureau;Jazz: Consultancy, Honoraria;Daiichi Sankyo: Consultancy, Honoraria;Novartis: Consultancy, Honoraria;Amgen: Consultancy, Honoraria;Abbvie: Consultancy, Honoraria;Astellas: Consultancy, Honoraria, Speakers Bureau;Takeda UK: Speakers Bureau. Loke: Pfizer: Honoraria;Amgen: Honoraria;Janssen: Honoraria;Novartis: Other: Travel;Daichi Sankyo: Other: Travel. Murthy: Abbvie: Other: support to attend educational conferences. Smith: ARIAD: Honoraria;Pfizer: Speakers Bureau;Daiichi Sankyo: Speakers Bureau. Whitmill: Daiichi-sankyo: Other: travel fees;EHA in stockholm: Other: conference support. Craddock: Novartis Pharmaceuticals: Other: Advisory Board;Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding. Dillon: Shattuck Labs: Membership on an entity's Board of Directors or advisory committees;Jazz: Other: Education events;Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: educational events;Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Session chair (paid to institution), Speakers Bureau;Menarini: Membership on an entity's Board of Directors or advisory committees;Astellas: Consultancy, Other: Educational Events, Speakers Bureau;Amgen: Other: Research support (paid to institution);Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Research Support, Educational Events.

18.
Blood ; 138:1254, 2021.
Article in English | EMBASE | ID: covidwho-1582298

ABSTRACT

Background Early data suggest that patients undergoing salvage chemotherapy for relapsed or refractory (R/R) acute myeloid leukaemia (AML) have poor outcomes if infected with SARS-CoV-2, and nosocomial transmission has been a major problem worldwide. Gilteritinib is effective in R/R FLT3 mutated AML, is significantly less immunosuppressive and does not require hospital admission, however at the start of the pandemic this was not yet approved for routine use in all countries. In the United Kingdom, the National Health Service (NHS) made gilteritinib available as an emergency measure from late April 2020 to patients aged >16y with R/R FLT3 mutated AML, with the aim of reducing both mortality and healthcare resource use. We report a health-system-wide real world data collection for toxicity and patient outcomes across 27 NHS Hospitals. Methods Each patient was registered on a central NHS database, with clinicians certifying that their patient met the above criteria. Anonymised data were retrospectively collected by treating physicians. Gilteritinib dose, duration and toxicity information was requested for the first 4 cycles of therapy. Response definitions were as per European Leukaemia Network (ELN) guidelines. A total of 81 patients have been registered on the scheme, with outcomes reported here for those with follow-up information at a data cut on 1st August 2021. Results Fifty patients were included with a median age of 59y (range 19 - 77) and 50% male. The majority (83%) had an ECOG performance status of 0-1. AML was secondary to a previous haematological disorder in 12%, therapy-related in 4% and de novo in the remaining 84%. The disease was refractory to the last therapy in 38%. Most patients had previously received 1 (65%) or 2 (33%) lines of therapy, including intensive chemotherapy in a majority (86%). A FLT3 inhibitor had previously been administered to 45% and 35% were post allogeneic transplant. The FLT3 mutation was an internal tandem duplication (ITD) in 80% and tyrosine kinase domain (TKD) mutation in 22%. NPM1 mutations were detected in 34%. Next-generation sequencing results were available for 94% of patients, with mutations in IDH1 or IDH2 in 12.5%, ASXL1 in 2%, RUNX1 in 21% and no TP53 mutations. Patients spent a median 3.5 days in hospital in cycle 1, 0 days in cycles 2 and 3 and 1 day in cycle 4. In cycles 1, 2, 3 and 4, the median number of days of grade 4 neutropenia was 18, 7, 7.5, and 6.5 respectively, and the grade 4 thrombocytopenia was 2, 7, 0.5 and 0.5. The composite complete remission (CR) / CR with incomplete haematological recovery (CRi) rate was 27%. MRD data is being collected. The best response was morphological leukaemia free state (MLFS) in 4%, partial remission (PR) in 25% and refractory disease in 38%. The rate of combined CR/CRi did not differ in those with previous exposure to FLT3 inhibitors (23% vs 32%, p=0.6) or with past allogeneic transplant (29% vs 27%, p=0.3). There were no CR/CRi in patients with adverse cytogenetic risk. Median follow-up was 10.5 months (95%CI 7.3 - 12.3) with median overall survival (OS) 6.7 months (95%CI 4.5 - not reached). Mortality at day 30 was 0% and day 60 was 14%. 12-month overall survival was 38%. Patients who achieved a CR/CRi had a 12-month OS of 83%, and for PR this was 35%. Survival did not differ in those with previous FLT3 inhibitor exposure (HR 1.0, p>0.9) or allogeneic transplant (HR 0.63, p=0.3). Seven patients (14%) so far have been bridged with gilteritinib to allogeneic transplant. Conclusion Our data demonstrate that gilteritinib is well tolerated and clinically active in adults with relapsed FLT3 mutated AML. Importantly, during the COVID-19 pandemic, its availability has permitted the great majority of treatment to be delivered as an outpatient with significant resource saving at a time of critically constrained inpatient resources. Patients who achieve CR/CRi have good short-term outcomes and are able to proceed to a potentially curative allogeneic stem cell transplant. [Formula presented] Disclosures: Belsham: Celgene: Other: meeting attendance;Abbvie: Other: meeting attendance. Byrne: Incyte: Honoraria. Khan: Abbvie: Honoraria;Astellas: Honoraria;Takeda: Honoraria;Jazz: Honoraria;Gilead: Honoraria;Novartis: Honoraria. Khwaja: Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Astellas: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Abbvie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Latif: Kite: Consultancy, Honoraria, Speakers Bureau;Jazz: Consultancy, Honoraria;Daiichi Sankyo: Consultancy, Honoraria;Novartis: Consultancy, Honoraria;Amgen: Consultancy, Honoraria;Abbvie: Consultancy, Honoraria;Astellas: Consultancy, Honoraria, Speakers Bureau;Takeda UK: Speakers Bureau. Loke: Amgen: Honoraria;Daichi Sankyo: Other: Travel Support;Janssen: Honoraria;Novartis: Other: Travel Support;Pfizer: Honoraria. Munisamy: Jazz Pharmaceuticals: Speakers Bureau;Roche: Speakers Bureau. Murthy: Abbvie: Other: support to attend educational conferences. Smith: Daiichi Sankyo: Speakers Bureau;Pfizer: Speakers Bureau;ARIAD: Honoraria. Craddock: Novartis Pharmaceuticals: Other: Advisory Board;Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding. Dillon: Amgen: Other: Research support (paid to institution);Astellas: Consultancy, Other: Educational Events, Speakers Bureau;Menarini: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Session chair (paid to institution), Speakers Bureau;Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: educational events;Jazz: Other: Education events;Shattuck Labs: Membership on an entity's Board of Directors or advisory committees;Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Research Support, Educational Events.

19.
International Journal of Research in Pharmaceutical Sciences ; 12(4):2548-2556, 2021.
Article in English | EMBASE | ID: covidwho-1554033

ABSTRACT

The outbreak of the SARS CoV2 ’Coronavirus pandemic’ is believed to have originated in Wuhan in 2019 as a zoonotic spread from bats to humans. It is a highly communicable infection-causing rapid human to human transmission of the virus by virtue of its infectious and pleomorphic nature. The virus has affected millions of people worldwide, with numbers still rising with each passing day. Depleting oxygen saturation levels is amongst the prime concerns in the majority of infected patients. Nasal prongs, face masks, mechanical ventilation and extracorporeal membrane (ECMO) are the commonly used modes of oxygen delivery in such patients. These methods though mostly successful, at times fail to restore the depleting oxygen levels to normal. Hyperbaric oxygen therapy (HBOT) involves the administration of 100% O2 in a special chamber whose pressure is maintained at a level greater than 1 ATP. The main purpose for raising the pressure within the chamber is that as the atmospheric pressure increases, the saturation levels of oxygen in the blood also increase, which eventually result in increased overall tissue oxygenation. This article provides a systematic and wholesome review on the basic principle of hyperbaric oxygen therapy, its effects on the body at a microscopic and macroscopic level, its various uses and its suitability as an adjuvant for the treatment of select COVID-19 infected patients.

20.
Annals of Indian Psychiatry ; 5(2):153-157, 2021.
Article in English | Web of Science | ID: covidwho-1538641

ABSTRACT

Background: The coronavirus disease-19 (COVID-19) pandemic in India has put health-care workers (HCWs) under intense pressure and has led to immense psychological stress due to factors including a high risk of infection, inadequate protection from contamination, overwork, cutting-off with families, and exhaustion. The unprecedented stressful conditions are causing mental health problems such as stress, anxiety, depression, disturbed sleep, irritability, fear, and panic. The present study was carried out to investigate the mental health problems among HCWs working in close proximity with COVID-19 patients in quarantine centers and to explore the relevant influencing factors for the development of psychological interventions for them. Subject and Methods: HCWs working in COVID-19 quarantine centers in Ajmer were interviewed for exploring mental health problems in a cross-sectional study carried out at JLN Medical College, Ajmer, India. Depressive symptoms, anxiety, and stress among HCWs were assessed using the Depression Anxiety Stress Scale and Perceived Stress Scale (PSS). Relevant data were analyzed, and comparisons between different groups were performed using the two independent sample t-tests. All statistical analyses were performed using the SPSS software version 22.0 for Windows. Results: 53.57% (n = 30) of participants were suffering from depressive symptoms, 64.28% (n = 36) were suffering from anxiety symptoms, and 78.6% (n = 47) were suffering from stress. HCWs living in joint families were more affected by depression (P = 0.02). Both anxiety and stress were more commonly reported by HCWs of age <30, females, nurses and those living in joint families, but difference was statistically insignificant. Conclusion: The present study demonstrated that a considerable number of HCWs were suffering from mental health problems such as depression, anxiety, and stress. It is important to have periodic mental health assessment of HCWs dealing with COVID-19 patients.

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