Mantle Cell Lymphoma: A Single Centre Experience from a Tertiary Care Centre in North India

Introduction: Mantle cell lymphoma (MCL) is an aggressive lymphoma with an incidence of 2.4-6% among all non-Hodgkin's lymphoma. Though with the addition of rituximab to standard chemotherapy backbone with autologous stem cell transplant (ASCT) consolidation and novel small molecule inhibitors, the outcome of MCL has improved, however, not many patients undergo ASCT due to financial constraints. Aims & Objectives: To study the clinical profile of all patients of MCL over a period of 6 years and assess their outcome. Material(s) and Method(s): This study was a retrospective cohort study which included all patients diagnosed with mantle cell lymphoma, between January 2016 to January 2022, conducted in the Department of Haematology, Sanjay Gandhi Institute of Medical Sciences, Lucknow, India. A total of 53 cases were included in the study. SPSS-23 was used for the data analysis. Result(s): The median age was 59 years (ranging from 39-81 years), with a male to female ratio of 5.3:1. The ECOG performance status was of 0-2 was seen in 85.2%. The median haemoglobin, leukocyte count and platelet count at presentation was 10.6 g/dL, 7400/mm3 and 1,52,000/mm3 respectively. Of the 53 patients, 48% presenting with B symptoms. The median Lactate dehydrogenase levels were 521 (ranging from 220-1230). 72% patients presented with stage IV disease and MIPI score was high, intermediate and low risk in 43.4%, 32.1% and 24.5% low risk. 48% patients received RCHOP/RDHAP regimen, 36% received RCHOP and 16% received R-Benda. 5 patients underwent ASCT. 13 patients relapsed, 1 was refractory and 1 died post-transplant due to Covid sepsis. The third patient, who had relapsed, received R Benda, was found to have multiple myeloma 1 year after therapy, and succumbed to sepsis. 63% were put on Rituximab maintenance. Conclusion(s): MCL is a rare, aggressive B cell lymphoma with a lesser incidence in Indian population compared to the world. While aggressive chemotherapy with monoclonal antibody has improved the response rate of patients with nodal MCL, wait and watch strategy remains the backbone of management of leukaemic NNMCL.

Shaheen Bagh: Muslim women contesting and theorizing citizenship and belonging during COVID-19

This paper documents an important slice of global South COVID-19 history, of primarily Muslim women's protests against the Indian Government and Legislature for taking away their constitutional rights as citizens. The Shaheen Bagh mobilization has already become an important disruption in contemporary Indian history stirring public intellectuals to probe the question: "who is a citizen of India?" in their scholarship and public-community work. By virtue of the disruption the event has caused in the enactment of the citizenship law, including other biometric directives, CAA-NRC-NPR, it has ceased to be regarded a minority or marginalized occurrence. This paper examines the writings of 4 prominent academics, public scholars, and thinkers (Romila Thapar, N. Ram, Gautam Bhatia, Gautam Patel) examining citizenship in contemporary India. In order to juxtapose expert musings on citizenship with embodied voices from the protest ground, I am critically reading two volumes with multiple essays, one edited (Seema Mustafa) and the other co-written by civically-engaged journalists (Ziya Us Salam and Uzma Ausaf) and members of the Shaheen Bagh protests. As an Indian-non-Muslim, I understand scholarship regarding Shaheen Bagh as an essential part of contemporary history, insofar as secularism is a worthy intercultural political philosophy to uphold at this temporal juncture of hate, intolerance and minority- baiting globally.

Response to COVID-19 Vaccination Post-CAR T Therapy in Patients with Non-Hodgkin Lymphoma and Multiple Myeloma

Background:COVID-19 adversely affects individuals with cancer. Several studies have found that seroconversion rates among patients with hematologic malignancies are suboptimal when compared to patients without cancer. Among patients with hematologic malignancies, seroconversion rates also appear to be influenced by recent treatment and the type of treatment they have received. Patients with non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) are immunocompromised due to impaired humoral and cellular immunity in addition to prescribed immunosuppressive therapy. Chimeric antigen receptor T-cell (CAR T) therapy is now widely used for NHL and MM, but little is known about seroconversion rates after COVID-19 vaccination among these populations. Current national guidelines recommend COVID-19 vaccination to be offered to CAR T recipients as early as three months thereafter. We retrospectively evaluated SARS-CoV-2 spike-binding IgG antibody levels following COVID-19 vaccination among NHL and MM CAR T therapy recipients. Methods:This retrospective study was conducted at three Mayo Clinic sites on NHL and MM patients that received CAR T infusions from Sept 2016 to June 2021. Baseline characteristics were ascertained from medical records. All NHL and MM patients who had received CAR T at any point and were alive at the time that the COVID-19 vaccine first became available were eligible for inclusion for antibody response evaluation. For antibody response to vaccination, antibody spike values > 0.80 U/mL were considered positive. Results: Out of 104 CAR T infusions, 73 patients are alive at the time of this submission. We have had 7 patients with known COVID-19 pre-CAR T and all 7 are currently alive (5 have antibody titers and 2 have not been tested yet). Nineteen patients developed known COVID infection post-CAR T (13 alive and 6 deceased). The mortality of COVID post-CAR T in our sample was 31.5%. Furthermore, of the 13 patients that survived COVID-19, they received CAR T an average of 416 days prior to COVID-19 infection (median = 337, range = 54 - 1406);the 6 patients who died from COVID-19 had received CAR T an average of 250 days prior to COVID-19 infection (median = 164, range = 7 - 846). All 6 deceased patients did not receive COVID-19 vaccination pre-CAR T. Out of 17 CAR T patients tested for antibody spike titers post COVID-19 vaccination, 76.4% were able to mount an antibody response. More patients with MM had a higher titer response to the vaccine (>250 U/mL) compared to the NHL counterparts (0.80-249 U/mL). All patients that received the vaccine, regardless of antibody response, were alive at the time of this submission. Conclusions:The majority of CAR T recipients with NHL and MM are able to mount an antibody response following COVID-19 vaccination in our relatively small sample. The frequency of seroconversion among CAR T recipients seems to be similar to patients with hematologic malignancy who had received a hematopoietic cell transplant reported elsewhere. These findings are limited by our small sample size and may be influenced by the timing of vaccination relative to CAR T. Furthermore, almost half of our patients received IVIG post CAR T which could potentially cause false positive antibody results as pooled immunoglobulin preparations may contain COVID-19 antibodies from vaccinated healthy donors. To better understand the characteristics of the immunologic response against SARS-CoV-2 in patients post-CAR T, larger multicenter studies exploring both humoral and cellular immunity will be needed. JEWN, MI and JM are co-first authors and PV, HM and AR are co-senior authors. [Formula presented] Disclosures: Munoz: Physicians' Education Resource: Honoraria;Seattle Genetics: Honoraria;Bayer: Research Funding;Gilead/Kite Pharma: Research Funding;Celgene: Research Funding;Merck: Research Funding;Portola: Research Funding;Incyte: Research Funding;Genentech: Research Funding;Pharmacyclics: Research Funding;Seattle Genetics: Research Funding;Janssen: Research Funding;Millennium: Research Funding;Gilea /Kite Pharma, Kyowa, Bayer, Pharmacyclics/Janssen, Seattle Genetics, Acrotech/Aurobindo, Beigene, Verastem, AstraZeneca, Celgene/BMS, Genentech/Roche.: Speakers Bureau;Pharmacyclics/Abbvie, Bayer, Gilead/Kite Pharma, Pfizer, Janssen, Juno/Celgene, BMS, Kyowa, Alexion, Beigene, Fosunkite, Innovent, Seattle Genetics, Debiopharm, Karyopharm, Genmab, ADC Therapeutics, Epizyme, Beigene, Servier: Consultancy;Targeted Oncology: Honoraria;OncView: Honoraria;Kyowa: Honoraria. Bergsagel: Oncopeptides: Consultancy, Honoraria;Novartis: Consultancy, Honoraria, Patents & Royalties: human CRBN mouse;Pfizer: Consultancy, Honoraria;Celgene: Consultancy, Honoraria;Janssen: Consultancy, Honoraria;Genetech: Consultancy, Honoraria;GSK: Consultancy, Honoraria. Wang: Incyte: Membership on an entity's Board of Directors or advisory committees, Research Funding;LOXO Oncology: Membership on an entity's Board of Directors or advisory committees, Research Funding;Genentech: Research Funding;InnoCare: Research Funding;Novartis: Research Funding;MorphoSys: Research Funding;Eli Lilly: Membership on an entity's Board of Directors or advisory committees;TG Therapeutics: Membership on an entity's Board of Directors or advisory committees. Fonseca: Juno: Consultancy;Kite: Consultancy;Aduro: Consultancy;OncoTracker: Consultancy, Membership on an entity's Board of Directors or advisory committees;GSK: Consultancy;AbbVie: Consultancy;Patent: Prognosticaton of myeloma via FISH: Patents & Royalties;Caris Life Sciences: Membership on an entity's Board of Directors or advisory committees;Scientific Advisory Board: Adaptive Biotechnologies: Membership on an entity's Board of Directors or advisory committees;BMS: Consultancy;Amgen: Consultancy;Sanofi: Consultancy;Merck: Consultancy;Mayo Clinic in Arizona: Current Employment;Celgene: Consultancy;Takeda: Consultancy;Bayer: Consultancy;Janssen: Consultancy;Novartis: Consultancy;Pharmacyclics: Consultancy. Palmer: Sierra Oncology: Consultancy, Research Funding;CTI BioPharma: Consultancy, Research Funding;Protagonist: Consultancy, Research Funding;Incyte: Research Funding;PharmaEssentia: Research Funding. Dingli: Novartis: Research Funding;GSK: Consultancy;Apellis: Consultancy;Alexion: Consultancy;Sanofi: Consultancy;Janssen: Consultancy. Kapoor: Sanofi: Research Funding;AbbVie: Research Funding;Takeda: Research Funding;Karyopharm: Consultancy;Cellectar: Consultancy;BeiGene: Consultancy;Pharmacyclics: Consultancy;Sanofi: Consultancy;Amgen: Research Funding;Ichnos Sciences: Research Funding;Regeneron Pharmaceuticals: Research Funding;Glaxo SmithKline: Research Funding;Karyopharm: Research Funding. Kumar: Roche-Genentech: Consultancy, Research Funding;Oncopeptides: Consultancy;Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;BMS: Consultancy, Research Funding;Beigene: Consultancy;Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding;Novartis: Research Funding;Adaptive: Membership on an entity's Board of Directors or advisory committees, Research Funding;Astra-Zeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Tenebio: Research Funding;Merck: Research Funding;Carsgen: Research Funding;KITE: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Amgen: Consultancy, Research Funding;Bluebird Bio: Consultancy;Antengene: Consultancy, Honoraria;Sanofi: Research Funding. Paludo: Karyopharm: Research Funding. Bennani: Kymera: Other: Advisory Board;Vividion: Other: Advisory Board;Kyowa Kirin: Other: Advisory Board;Daichii Sankyo Inc: Other: Advisory Board;Purdue Pharma: Other: Advisory Board;Verastem: Other: Advisory Board. Ansell: Bristol Myers Squibb, ADC Therapeutics, Seattle Genetics, Regeneron, Affimed, AI Therapeutics, Pfizer, Trillium and Takeda: Research Funding. Lin: Kite, a Gilead Company: Consultancy, Research Funding;Merck: Research Funding;Gamida Cell: Consultancy;Takeda: Research Funding;Juno: Consultancy;Bluebird Bio: Consultancy, Research Funding;Celgene: Consultancy, Research Funding;Novartis: Consultancy;Janssen: Consultancy, Research Funding;Sorrento: Consultancy;Legend: Consultancy;Vineti: Consultancy. Murthy: CRISPR Therapeutics: Research Funding.

APPROACH TO ACUTE HYPOXIC RESPIRATORY FAILURE IN A PATIENT WITH COPD AND UNDERLYING HISTORY OF HEREDITARY HEMORRHAGIC TELENGIECTASIA WITH PULOMARY AV MALFORMATIONS

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Hereditary Hemorrhagic Telangiectasia is a multisystem disease which results in AV Malformations and telangiectasia. It has autosomal dominant inheritance and prevalence of 1 in 5000 to 1 in 10,000. 1 Patients with Pulmonary AVMs can present with hypoxia, more post exercise and in sedentary position with improvement on standing. Patients presenting with hypoxia with history of HHT should undergo thorough evaluation including radiological imaging and echocardiography to rule out recurrence of AVMs and sequelae such as pulmonary hypertension or pulmonary arterial hypertension, respectively. CASE PRESENTATION: We present a case of 66 y/o male with Past medical history of HHT with AVM s/p repair presented with complaints of dyspnea with cough and sputum production. In ER patient was hypoxic with SPO2 88% on room air. Patient had coarse rhonchi, scattered wheeze and telangiectasia on the nose and hands. Routine labs were normal. Legionella antigen, SARS antigen, COVID PCR were negative. Chest x-ray revealed peri hilar and basilar reticular opacities. CT of chest with contrast revealed prior right lower lobe AVM repair with almost complete resolution and signs of severe COPD with emphysema. Transthoracic echocardiogram ruled out pulmonary artery hypertension. Patient was treated for COPD exacerbation with albuterol/ ipratropium nebulization, steroids, oxygen support and azithromycin. DISCUSSION: HHT is a familial genetic disease with autosomal dominant mutations of endoglin gene on chromosome 9q33-q34 or ALK-1 gene on chromosome 12q13.2 50% of all HHT patients develop pulmonary AV malformations. Clinical finding includes hypoxic respiratory failure. Pulmonary AVMs lead to right to left shunt formation impairing effective gas exchange leading to hypoxia, interestingly these patients can participate in high intensity physical activity despite of being severely hypoxic, this has been attributed to hemodynamic compensatory responses. 3 This shunt can lead to paradoxical emboli causing strokes and brain abscess. Management of Pulmonary AVMs includes trans catheter coil vaso-occlusion of the artery. Recanalization of treated pulmonary AVMs and development or growth of untreated pulmonary AVMs has been known, warranting long term follow up. Pulmonary AVMs itself is a life threating condition, its course can be further complicated by chronic lung disease like COPD. These patients can present with dyspnea not explained by right to left shunting, it is attributed more to underlying lung conditions, in our patient's case, COPD. CONCLUSIONS: While HHT is not known to cause COPD, it can lead to worsening of COPD by causing Pulmonary hypertension due to high output cardiac failure or pulmonary artery hypertension. Therefore, in patients with history of HHT presenting with hypoxia, it is crucial to have detailed evaluation for recurrence of AV malformations or new onset pulmonary hypertension. REFERENCE #1: Mary E. Meek, M.D., James C. Meek, D.O., Michael V. Beheshti, M.D. Management of Pulmonary AV Malformations [Google Scholar, PubMed] REFERENCE #2: C. Sabba, M. Gallitelli, G. Pasculli, P. Supressa, F. Resta and E. Tafaro. HHT: A rare disease with a broad spectrum of clinical aspects [PubMed] REFERENCE #3: Dupius-Girod S., Cottin V, Shovlin C. The lung in hereditary hemorrhagic telangiectasia [Google Scholar] DISCLOSURES: No relevant relationships by Khushdeep Chahal, source=Web Response No relevant relationships by priyanka kapoor, source=Web Response

TIVA for ECMO and VAD

In recent decades, the use of temporary and permanent use of mechanical assist devices is on the rise for patients with end-stage cardiac failure. These support strategies hold inherently different risks in the face of noncardiac critical illness and require multidisciplinary treatment strategies. The main issues with all mechanical devices whether extracorporeal membrane oxygenation (ECMO) or ventricular assist device (VAD), are related to thrombosis, anticoagulation, infection, avoiding hypertension and thus use of intravenous drugs, which requires intense monitoring, to circumvent further renal, ischemic or neurological injury and prevent complication.

Ecmo in covid-19-the diffidence has to be overcome by the intensivists and administrators in 2021

In this phase of a shifting geopolitical order with the risk of China and increasing economic inequalities across the globe, there is confusion in understanding the economic recession.The pandemic has revealed one of the weakest links in the health system, that is, the institutional neglect of public district hospitals.We are now hopefully seeing a declining trend in the second wave of the pandemic in India.This is the most appropriate time to identify and plug the existing gaps on our health systems.We must act now to shore up our resources in all technologies to combat the COVID-19 virus with all forms of precaution at the local level and expertise of advanced technologies like mechanic ventilatory support to the failing lungs and heart in the form of extracorporeal membrane oxygenation (ECMO).The latter can be the foun- dation for a functioning and effective health in the inten- sive care unit (ICU) system.Guidelines and expertise from across the borders globally is the need of the hour.After the COVID pandemic dies down, it is the district hospitals and their infrastructure which should be strengthened by way of upgrading public health systems.

A Phase II Study of Isatuximab (SAR650984) (NSC-795145) for Patients with Previously Treated AL Amyloidosis (SWOG S1702;NCT#03499808)

Background: Isatuximab (SAR650984) is an IgG1k monoclonal antibody that binds with high affinity to CD38 expressed on plasma cells in AL amyloidosis. It has been shown to be efficacious and well tolerated in relapsed and refractory multiple myeloma as a single agent and in combination. Here we report on the preliminary results of a prospective multi-center, phase II study of isatuximab in previously treated patients with AL amyloidosis (NCT03499808). Methods: Eligibility included age ≥ 18 years, relapsed or refractory systemic AL amyloidosis, ≥ 1 prior line of therapy, measurable disease (defined as a positive monoclonal serum immunofixation electrophoresis (IFE) or urine IFE, a serum free light chain ratio outside of the normal range (0.25-1.65), and a difference in the involved versus the uninvolved serum free light chain of ≥ 4.5 mg/dL), at least one organ involved, not refractory to daratumumab, ECOG performance status 0-2, creatinine clearance ≥25 mL/min as measured by 24-hour urine collection or as estimated by Cockcroft and Gault formula, and NT-proBNP ≤8500 pg/mL. Patients received isatuximab intravenously 20 mg/kg weekly during the first 28 day cycle and every other week during cycles 2 through 24 for a maximum of 24 cycles. The primary objective was hematologic response with secondary objectives of organ response, safety, progression free survival, and overall survival. Results: At data cut-off (July 24, 2020), 43 patients were registered from March 2018 to September 2019 at 14 institutions. Thirty six patients were eligible with 35 patients receiving at least one dose of isatuximab. Of the eligible patients, the median age was 70 (range 40-81). Prior therapies included proteasome inhibitors in 32 patients (89%), high dose therapy followed by autologous stem cell transplant in 17 patients (47%), immunomodulatory therapy in 9 patients (25%), and anti-CD38 monoclonal antibody therapy in 2 patients (6%). Single organ system involvement was seen in 19 patients (53%), ≥ 2 organ systems in 17 patients (47%), 16 patients (44%) had renal involvement, and 24 (67%) had cardiac involvement. For those with cardiac involvement, 7 patients (29%) had cardiac biomarker stage II and 9 patients (38%) had stage III disease using the Revised Mayo Staging (Kumar S et al., J Clin Oncol, 2012). A total of 17 patients remain on therapy. The median duration on treatment for eligible patients is currently 11.8 months (current range, 0.3-22.1). Of the 19 patients who discontinued treatment, the most common reasons included adverse events in 5 patients (26%), disease progression in 4 patients (21%), sub-optimal response in 2 patients (11%), and concerns related to COVID-19 in 2 patients (11%). The current median follow up is 16.3 months. The most common drug-related AEs were infusion related reactions in 18 patients (50%) with the majority (16/18) being grade I or II, anemia in 9 patients (25%) with the majority (8/9) being grade I, and lymphopenia in 8 patients (22%). Patient characteristics and preliminary safety data were previously presented at the International Symposium on Amyloidosis. The overall hematologic response rate was 77%. Hematological complete response (CR) was observed in 1 of 35 evaluable (completing at least 1 dose) patients (3%), very-good-partial response (VGPR) in 19 patients (54%), and partial response (PR) in 7 patients (20%). Conclusions: Isatuximab demonstrates encouraging efficacy in previously treated patients with AL amyloidosis. The administration of isatuximab in these patients is associated with a good safety profile similar to other monoclonal antibodies against CD38. The data will be updated at the meeting. Disclosures: Sanchorawala: Prothena: Research Funding;Caelum: Research Funding;Oncopeptide: Research Funding;Janssen: Research Funding;Regeneron: Other: advisory board;Caleum: Other: advisory board;Proclara: Other: advisory board;Abbvie: Other: advisory board;UpToDate: Patents & Royalties;Takeda: Research Funding;Celgene: Research Funding. Kapoor: Sanofi: Consultancy, Resea ch Funding;Celgene: Honoraria;Cellectar: Consultancy;Janssen: Research Funding;Amgen: Research Funding;GlaxoSmithKline: Research Funding;Takeda: Honoraria, Research Funding. Neparidze: GlaxoSmithKline: Research Funding;Janssen: Research Funding;Sanofi: Membership on an entity's Board of Directors or advisory committees, Other: Advisory board;Eidos Therapeutics: Membership on an entity's Board of Directors or advisory committees, Other: Diagnostic committee member. Sarosiek: Spectrum: Research Funding. Durie: Amgen, Celgene, Johnson & Johnson, and Takeda: Consultancy. Usmani: Incyte: Research Funding;Takeda: Consultancy, Honoraria, Other: Speaking Fees, Research Funding;Sanofi: Consultancy, Honoraria, Research Funding;Janssen: Consultancy, Honoraria, Other: Speaking Fees, Research Funding;SkylineDX: Consultancy, Research Funding;Merck: Consultancy, Research Funding;Array Biopharma: Research Funding;Pharmacyclics: Research Funding;Celgene: Other;Seattle Genetics: Consultancy, Research Funding;GSK: Consultancy, Research Funding;BMS, Celgene: Consultancy, Honoraria, Other: Speaking Fees, Research Funding;Amgen: Consultancy, Honoraria, Other: Speaking Fees, Research Funding;Abbvie: Consultancy. Orlowski: Laboratory research funding from BioTheryX, and clinical research funding from CARsgen Therapeutics, Celgene, Exelixis, Janssen Biotech, Sanofi-Aventis, Takeda Pharmaceuticals North America, Inc.: Research Funding;STATinMED Research: Consultancy;Founder of Asylia Therapeutics, Inc., with associated patents and an equity interest, though this technology does not bear on the current submission.: Current equity holder in private company, Patents & Royalties;Sanofi-Aventis, Servier, Takeda Pharmaceuticals North America, Inc.: Honoraria, Membership on an entity's Board of Directors or advisory committees;Amgen, Inc., AstraZeneca, BMS, Celgene, EcoR1 Capital LLC, Forma Therapeutics, Genzyme, GSK Biologicals, Ionis Pharmaceuticals, Inc., Janssen Biotech, Juno Therapeutics, Kite Pharma, Legend Biotech USA, Molecular Partners, Regeneron Pharmaceuticals, Inc.,: Honoraria, Membership on an entity's Board of Directors or advisory committees. OffLabel Disclosure: Isatuximab is FDA approved for relapsed refractory myeloma in combination with pomalidomide and dexamethasone. Isatuximab is not FDA approved for AL amyloidosis.

Initial experiences in the use of portable chest radiography as a tool to guide clinical management of COVID-19 positive patients in resource limited settings

Introduction: Radiological diagnosis of COVID-19 has shifted from the use of routine chest X-rays (CXRs) early on during the pandemic to high-resolution computed tomography (HRCT) of the chest to accurately describe the pattern of COVID involvement of the lungs. The morphological patterns seen at HRCT are increasingly being tapped into by a clinician in the management of this uncharted territory, for example, HRCT lung findings are categorized into three distinct phenotypes by an intensivist for guiding advanced ventilatory management of COVID patients. However, in resource-limited settings, HRCT places a heavy burden on the radiology departments and poses an enormous challenge to infection control in the CT suite. Our study aims to describe CXR patterns of COVID-19 acquired by portable radiography units and correlate them to symptom onset and progression in an attempt to enroll it as a reliable tool to assist clinical management including intensive unit care and ventilatory support. Methodology: Our study was a retrospective observational study of portable CXR findings in all patients diagnosed as COVID-19 positive by reverse transcription-polymerase chain reaction at a tertiary medical center from April to May 2020. Results: A total of fifty patients were included in the study, and the presence or absence of CXR findings in the presence or absence of clinical symptoms was analyzed. Our study showed that 24 (48%) patients had baseline features of lung involvement on CXR. Patients who presented with fever or breathlessness were found to be highly likely to show changes on the CXR. The most commonly noted changes were ground-glass opacities in 31 (63%) of patients with a bilateral, peripheral pattern of involvement seen in the lower zones of the lungs. Conclusion: While the higher sensitivity of the HRCT is of great clinical value, the portable CXR offers a feasible alternative to screen, follow clinical progress, and assist management of COVID-19 patients and should be considered as a means to reduce radiological service demands and reduce the risk of cross-infection.

Recent advances in orthodontics

Orthodontic science has progressed tremendously in the last two decades, from traditional stainless wires and brackets to sophisticated contemporary materials, types of brackets and bonding agents, anchorage devices and the use of nanotechnology. The development has extended to all domains of diagnosis, treatment planning, treatment alternatives, storage of data, patient education and marketing. This chapter comprehensively lists all spheres of advancements, highlighting the advantages and limitations of each of the enumerated processes. Digitization in orthodontics has completely revolutionized diagnosis, employing three-dimensional (3D) analysis by intraoral scans, 3D-Cone Beam Computed Tomography (3D-CBCT) radiographs and stereophotogrammetry, for greater accuracy and possibility of virtual setting. In addition, aligner technology has also seen a boom using this virtual data for computer aided design(CAD) and creation of appliances by 3D printing. Varied softwares have found their way into orthodontic office for analysis, superimpositions and predictions, thus allowing the patients to make informed decisions. Few softwares also allow remote patient monitoring, tele-orthodontics, patient education and reminder applications. Social media has become a powerful tool for product awareness, discussions with patients, orthodontic teaching, though the accuracy of information is questionable. Acceleration of orthodontic treatment has been targeted with various surgical (micro-osteoperforation, corticotomy, Wilckodontics etc.), non-surgical (vibration, lasers etc.) and biological (prostaglandins etc.) agents. This chapter also touches upon upcoming areas like machine learning, artificial intelligence and big data in orthodontics which can aid in evidence-based practice from large clinical repositories in cost effective ways. Current COVID-19 times brings forth the importance of virtual patient data and minimal patient contact, thus emphasizing the role of modified orthodontic triage, a significant mention of which has been made in the current chapter. © 2021 by Nova Science Publishers, Inc.

Message sharing and verification behaviour on social media during the COVID-19 pandemic: a study in the context of India and the USA

Purpose: Technology has eased access to information. During the ongoing COVID-19 pandemic, ease of access and transmission of information via social media has led to ambiguity, misinformation and uncertainty. This research studies the aforementioned behaviours of information sharing and verification related to COVID-19, in the context of social media. Design/methodology/approach: Two studies have been carried out. Study 1, with Indian social media users, is a two-factor between-subjects experimental design that investigated the effect of message polarity (positive versus negative) and message type (news versus rumour) on the dissemination and verification behaviour of COVID-19-related messages. The study also investigated the mediation of perceived message importance and health anxiety. Study 2 is a replica study conducted with US users. Findings: The study finding revealed significantly higher message sharing for news than rumour. Further, for the Indian users, message with positive polarity led to higher message sharing and message with negative polarity led to higher verification behaviour. On the contrary, for the US users, message with negative polarity led to higher message sharing and message with positive polarity led to higher verification behaviour. Finally, the study revealed message importance mediates the relationship of message type and message sharing behaviour for Indian and US users;however, health anxiety mediation was significant only for Indian users. Practical implications: The findings offer important implications related to information regulation during a health crisis. Unverified information sharing is harmful during a pandemic. The study sheds light on this behaviour such that stakeholders get insights and better manage the information being disseminated. Originality/value: The study investigates the behaviour of sharing and verification of social media messages between users containing health information (news and rumour) related to the ongoing COVID-19 pandemic. Peer review: The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-07-2020-0282. © 2021, Emerald Publishing Limited.

Perceived vulnerability to COVID-19, dispositional optimism and intention to adopt preventive health behaviour: an experiment with anti-smoking advertising

Purpose: High dispositional optimism is often associated with people engaging in behaviour that has adverse effects on their health such as smoking. This study aims to investigate people’s intention to adopt preventive health behaviour by observing the effectiveness of anti-smoking ads during the ongoing coronavirus (COVID-19) pandemic. Design/methodology/approach: Two studies have been carried out, first with a UK sample and second with the US sample. The studies examined the effectiveness of anti-smoking ad (appeal: high fear vs low fear), smoking behaviour elicited perception of vulnerability to COVID-19 and dispositional optimism on lowering people’s urge to smoke. Findings: The study findings revealed a high fear appeal ad is more effective in lowering people’s urge to smoke. However, this association is significantly mediated by perception of vulnerability to COVID-19. Further, high dispositional optimism was found to moderate the effect of the anti-smoking ad on the perception of vulnerability to COVID-19, although a comparatively smaller effect was observed for the UK sample. Finally, high dispositional optimism significantly moderated the mediation of vulnerability to COVID-19 on lower urge to smoke only for the US sample. Originality/value: The study highlights a need for a greater collaborative effort by the public, government, firms in the business of nicotine replacement solutions, socially responsible cigarette and tobacco manufacturing firms and health agencies that may lead to increased preventive health behaviour during the ongoing pandemic. © 2021, Emerald Publishing Limited.

India transitions: Culture and society during contemporary viral times

The following sections are included: • CONTEXT OF THE STUDY • CONTEMPORARY HISTORICAL TRANSITION IN THREE ACTS: CAN THE REAL CITIZENS PLEASE STAND UP? • THE COVID-19 VIRAL PHASE • TRANSFORMATIVE POTENTIAL OF VOICE, SOUND, AND LISTENING WITHIN CRITICAL MEDIA STUDIES • CONTEXTUALIZING SOUND TRADITIONS OF RUDAALIS, BAULS, AND QAWWALS: ENGAGING MODERNITY AND POST-COLONIALISM • THE RUDAALI’S RHYTHMIC CRY: FROM LOCAL PRACTICE TO GLOBAL SOUND • SYNCRETIC SOUND OF THE QAWWALS: FROM SINGING AT THE DARGAH (SHRINE OF A HOLY PERSON IN HINDUISM AND ISLAM) TO GLOBAL MUSIC • EMBODIED ANALYSIS • ROLE OF MEDIA, VOICE, AND FREE SPEECH • REFERENCES. © 2020 Institute of Indian Studies, HUFS.

Cardiac Echocardiography in COVID-19 Infection

The novel COVID-19 disease mainly affects respiratory organs;however, involvement of cardiovascular system is also not uncommon. Cardiac involvement can manifest as myocarditis, heart failure, myocardial infarction, pulmonary embolism, or arrhythmias in COVID-19 patients. This novel Coronavirus enters into the cells of the human body by binding to ACE-2 receptors which are predominantly present on pneumocytes and cardiomyocytes. The damage to myocardium is manifested by the increase in cardiac enzymes such as troponin-I, CK-MB, and NT pro-BNP. Although echocardiogram is an important tool in the cardiac evaluation of COVID-19 patients, its indiscriminate use is discouraged, owing to the risk of transmission to echocardiography service providers, as well as possible risk of contaminating echocardiography equipment. In this article, we discuss the different mechanisms and cardiac manifestations of COVID-19. We also review the current guidelines for echocardiography evaluation of COVID-19 patients as well as current recommendations on safety of echocardiography personnel and equipment against contamination. We also include our experience of two cases in which COVID-19 affliction of heart was strongly suspected, and echocardiography clinched the diagnosis.

COVID-19 ECMO Myths Busted

Literature has proven that COVID-19 patients develop pneumonia. Prognosis of this is poor in case of COVID-19 patients developing the following: low lymphocyte count (< 16%) which gets lower with active COVID-19 infection, sedentary lifestyle, obesity, and uncontrolled diabetes mellitus with no exercise. A lot of dilemmas and myths in this nascent COVID-19 pandemic period exist regarding the use of ECMO. Perplexities such as do we treat the COVID-19 patients on ECMO, as a pulmonary ARDS pneumonia, and/or do we need high PEEP or moderate PEEP, during ECMO for this ARDS;are some common COVID-19 ECMO myths which this short review aims to cover in a question-answer format.