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1.
Biol Methods Protoc ; 7(1), 2022.
Article in English | PubMed Central | ID: covidwho-2160925

ABSTRACT

COVID-19 infections have imposed immense pressure on the healthcare system of most countries. While the initial studies have identified better therapeutic and diagnostic approaches, the disease severity is still assessed by close monitoring of symptoms by healthcare professionals due to the lack of biomarkers for disease stratification. In this study, we have probed the immune and molecular profiles of COVID-19 patients at 48-h intervals after hospitalization to identify early markers, if any, of disease progression and severity. Our study reveals that the molecular profiles of patients likely to enter the host-immune response-mediated moderate or severe disease progression are distinct even in the early phase of infection when severe symptoms are not yet apparent. Our data from 37 patients suggest that at hospitalization, interleukins (IL6) (>300 pg/ml) and IL8 levels (>200 pg/ml) identify cytokine-dependent disease progression. Monitoring their levels will facilitate timely intervention using available immunomodulators or precision medicines in those likely to progress due to cytokine storm and help improve outcomes. Additionally, it will also help identify cytokine-independent progressive patients, not likely to benefit from immunomodulators or precision drugs.

2.
Fertility and Sterility ; 118(4 Supplement):e228, 2022.
Article in English | EMBASE | ID: covidwho-2095346

ABSTRACT

Objective: We sought to evaluate the impact of non-cavity-distorting intramural myomas on pregnancy outcomes in an ideal study group: patients undergoing frozen embryo transfer (FET) of a single euploid blastocyst. Material(s) and Method(s): This is an interval analysis of a prospective cohort study at a single large university-affiliated institution from January 2018 to April 2022. There was a hiatus in recruitment from March 2020 to February 2022 due to the COVID-19 pandemic. All patients underwent an autologous natural or programmed FET with endometrial preparation and luteal support per a standardized protocol. Prior to transfer, patients were divided based on the presence (Group A) or absence (Group B) of non-cavity-distorting myomas. All ultrasounds (US) were performed by physicians. If myomas were detected, their number, size, location (FIGO classification system), and distance from the uterine cavity were recorded. The primary outcome was clinical intrauterine pregnancy (IUP). The secondary outcomes were positive human chorionic gonadotropin (hCG) test, biochemical pregnancy, missed abortion, and ongoing pregnancy and live birth rates. A Fisher's exact test was done to compare proportions. A p-value of <0.05 was deemed statistically significant. Result(s): Of the 122 enrolled patients, 19 (15.6%) had a non-cavity-distorting intramural myoma (Group A), while 103 (84.4%) did not have a myoma (Group B). No patients had a cavity-distorting myoma. The patients who had myomas tended to be older with a higher BMI, but otherwise had similar baseline characteristics including gravidity, parity, endometrial thickness, peak estradiol level, and AMH. There was no significant difference in the proportion of patients who achieved a clinical IUP in Group A (52.6%) and Group B (63.1%, p=0.45). There was also no difference in the secondary outcomes (Table 1). Conclusion(s): This prospective observational study has not demonstrated a significant impact of non-cavity-distorting intramural myomas on FET outcomes, although this study is ongoing and will continue to recruit patients. Impact Statement: Non-cavity-distorting myomas do not appear to affect positive hCG, biochemical, clinical IUP rate, miscarriage, or ongoing pregnancy or live birth rates in an ideal study population of single euploid FET transfer cycles. Copyright © 2022

3.
Fertility and Sterility ; 118(4 Supplement):e30, 2022.
Article in English | EMBASE | ID: covidwho-2086204

ABSTRACT

Objective: We aimed (1) to quantify the impact of COVID-19 on the number of oocyte cryopreservation cycles performed, and (2) to characterize the demographics of fertility preservation patients both before and during the pandemic. Material(s) and Method(s): We performed a retrospective analysis of patients who underwent social oocyte cryopreservation at a large university-affiliated REI practice. Cycles were divided into two 22-month study periods: pre-pandemic (May 2018-February 2020) and post-pandemic (March 2020-December 2021). Oocyte cryopreservation cycles for medical indications (e.g., cancer diagnosis) were excluded. A Student's t-test was used to compare parametric variables between the two groups, while a Wilcoxon Rank-Sum was used for non-parametric variables. A Chi-squared test was used to compare the proportion of oocyte cryopreservation cycles to total ovarian stimulation cycles during each study period. A p-value of <0.05 was considered statistically significant. Result(s): During the pandemic, there was a decrease in total ovarian stimulation cycles (n=6,343) compared to the pre-pandemic period (n=6,653). In contrast, there was an 18.9% increase in the number of oocyte cryopreservation cycles seen in the post-pandemic group versus the pre-pandemic group (n=1,165 and n=980, respectively). Overall, there was a difference in the proportion of oocyte cryopreservation cycles performed at our institution pre-pandemic and post-pandemic (14.7 vs. 18.3%, p < 0.001). In addition, the age of post-pandemic oocyte cryopreservation patients decreased (36.2 vs. 35.7 yr, p = 0.004). There was no significant difference found in the BMI, AMH, and number of cryopreserved oocytes per cycle between the two patient groups. Conclusion(s): Although total ovarian stimulation cases declined following the pandemic, the number of social oocyte cryopreservation cycles increased proportionally. This suggests a shift in patients who present to REI clinics for proactive reproductive planning versus infertility care. More studies are needed to elucidate if this is due to a trend toward delayed childbearing, increase in ART, and/or the pandemic. Impact Statement: Following the COVID-19 pandemic, there was a proportional increase in social oocyte cryopreservation cycles. [Formula presented] Copyright © 2022

4.
Journal of Clinical and Diagnostic Research ; 16(9):DC12-DC17, 2022.
Article in English | EMBASE | ID: covidwho-2067199

ABSTRACT

Introduction: Bharat Biotech International Ltd in partnership with National Institute of Virology (NIV), has developed an indigenous whole virion inactivated Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) viral vaccine BBV-152 (Covaxin), formulated with Toll Like Receptors 7/8 agonist Imidazoquinoline (IMDG) molecule adsorbed to alum (Algel). Variety of factors other than environmental ones can affect vaccines efficiency outside the strict setting of clinical trials, like how the vaccine is stored or transported, and even how patients are vaccinated. In addition, the intrinsic capacity of the recipient to respond to a vaccine which is determined by sex, genetic factors, age, psychological stress, nutrition and other diseases are also likely to have an impact. Aim(s): To determine the safety, reactogenicity and immunogenicity of the inactivated whole virus vaccine (Covaxin) amongst hospital-based population groups. Material(s) and Method(s): The prospective analytical study was conducted in the Department of Microbiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India, from January 2021 to March 2021.The study primarily included Healthcare Workers (HCWs) employed at SMS Medical college and attached hospitals. In-vitro quantitative IgG antibodies against SARS-CoV-2 spike Receptor Binding Domain (RBD) were measured using Chemiluminescence Immunoassay (CLIA) based Advia centaur SARS-CoV-2 IgG, manufactured by Siemens Pvt Ltd, Munich, Germany, as per manufacture's instructions. Result(s): Out of total 223 individuals, 61.88 % (138/223) showed neutralising antibody titre of >1 index value by CLIA, rest 38.12% (85/223) were non reactive i.e., titre <1 index value, after four weeks of receiving first dose of Covaxin. After 2 to 4 weeks of receiving second dose 84.30% (188/223) showed neutralising antibody titre of >1 index value by CLIA, rest 15.70% (35/223) were non reactive i.e., titre <1 index value. After receiving first dose, 100% (223/223) of the participants developed localised pain and bodyache 33.63% (75/223). None of the participants showed any anaphylactic reaction or any emergency condition just after vaccination. Conclusion(s): Covaxin is a well-tolerated vaccine, and induces good humoral response against SARS-CoV-2 with a significant rise in the neutralising antibody titres. Copyright © 2022 Journal of Clinical and Diagnostic Research. All rights reserved.

5.
European Journal of Molecular and Clinical Medicine ; 9(3):4988-5003, 2022.
Article in English | EMBASE | ID: covidwho-1857603

ABSTRACT

Background: SARS CoV-2 infection took the whole world by storm in the final month of 2019.Different measures have been taken to reduce its spread by timely and accurate detection of COVID 19(coronavirus disease 2019) infection in suspected patients and theircontacts. Aim: This study was conducted to assess commercially available five Rt pcr (reverse transcriptase polymerase chain reaction) kits from different manufacturers available in our center for diagnostic testing ofSARS CoV-2 infection .94 oropharyngeal clinical samples, previously confirmed as 64 positive and 30 negative for SARS CoV-2 were extracted and amplified separately by each of the five Rt pcr kitsand the results compared. Results:The performance of different kits was in was satisfactory and above 90 percent in agreement with the standard kit for samples (n=47) with low Ct values (Ct values<30) . There was a significant variation in performance among the five kits while testing high Ct values (Ct value >30) samples (n=17).Significant variation in Ct values of E gene ,RdRp gene and N gene was observed in the Rt pcr kits results . Conclusion: We conclude that it is necessary to assess the diagnostic performance of different Rt pcr kits for COVID 19 clinical samples from time to time to study the variation in Ct values, sensitivity of different gene targets of SARS CoV2 virus, with proper co -ordination with other laboratories , for development of reliable COVID 19 diagnostic centers at every level.

6.
Journal of Ayurveda and Integrative Medicine ; 13(1), 2022.
Article in English | CAB Abstracts | ID: covidwho-1838939

ABSTRACT

Background Influenza-like Illness (ILI) refers to a wide range of viral infections with an important cause of morbidity and mortality worldwide. The global incidence of ILI is estimated at 5-10% in adults and 20-30% in children. In India influenza accounts for 20-42% of monthly acute medical illness hospitalizations during the peak rainy season. AYUSH-64, a poly-herbal drug, is in practice for 40 years for various clinical conditions like fevers, microfilaremia, and inflammatory conditions. Objective A pilot study was conducted to evaluate the safety and efficacy of Ayurvedic formulation, AYUSH-64 in clinically diagnosed ILI for accelerating the recovery. Material and Methods A prospective, open-label, nonrandomized, single group, single-center pilot clinical study with pre-test and post-test design was conducted at Raja Ramdeo Anandilal Podar Central Ayurveda Research Institute for Cancer, Mumbai, an institute of Central Council for Research in Ayurvedic Sciences (CCRAS) between June 2018 and July 2019. A total of 38 participants of clinically diagnosed ILI (18-65 years) were studied with an one-week intervention of 'AYUSH 64' in a dose of 3 gm/day and three weeks post-treatment observation period. Assessment of parameters viz. improvement in the symptoms of ILI, frequency of usage of acetaminophen, antihistaminic and cough syrup, hematology, liver function and kidney function tests along with incidence of secondary complications, and time to return to a normal routine was done. Results One-week intervention of AYUSH 64 helped to recover from ILI symptoms with reduced frequency of usage of acetaminophen and antihistaminic. The intervention was safe on hematology and biochemical parameters. No serious adverse effects were observed during the study. Conclusion AYUSH 64 along-with standard care in ILI is safe and efficacious and this may be used in other viral infections with pyrexia as add-on to standard care for early recovery and better outcome.

7.
International Journal of Pharmaceutical and Clinical Research ; 14(2):257-264, 2022.
Article in English | EMBASE | ID: covidwho-1777064

ABSTRACT

Background: Corona virus disease 2019 is a highly infectious disease which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2. SARS-CoV-2 is transmitted from person to person mainly by respiratory droplets and aerosols as well as by direct or indirect contact. Aims and objective: To compare different RNA extraction methods for detection of SARSCov-2 RNA from nasopharyngeal and oropharyngeal swabs using three different methods which are based on different techniques. Material and methods: This analytical observational study was conducted in the department of Microbiology, Sawai Man Singh Medical College Jaipur, Rajasthan from December 2020 to January 2021. We selected 200 confirmed positive (extracted by Easy Mag automated system) (remnant) samples showing a wide range of different Ct values and 20 confirmed negative samples stored in Viral Transport Media VTM for this study. In order to compare quality of three extractions methods, all samples were aliquoted separately for each extraction technique. (1) Extraction by manual method (spin column base): was done by as per manufacturer’s instructions. (2) Extraction by QIA cube HT (vaccum column base): was done by as per manufacturer’s instructions. (3) Extraction by Perkins Elmer chemagic 360: (magnetic beads based). Result: A panel consisting of 200 Covid-19 positive and 20 Covid-19 negative samples were extracted by three methods (i.e. Manual column based, automated column-based and automated magnetic beads-based method). The extracted material/elutes were put for realtime RT-PCR assay for the detection of SARS CoV-2 RNA. There was no major difference seen in individual samples’ ct values between three extraction system. CONCLUSION: In conclusion, we recommended all three RNA extraction methods (i.e. magnetic beads & silica column-based) are interchangeable in a diagnostic workflow for the SARS CoV-2 by RTPCR and can be taken into account for SARS CoV-2 detection in possible future shortage of one kit or times of crisis in such pandemic time.

8.
Open Forum Infectious Diseases ; 8(SUPPL 1):S371, 2021.
Article in English | EMBASE | ID: covidwho-1746458

ABSTRACT

Background. Tocilizumab (TCZ) and remdesivir (RDV) have both shown benefit for patients with SARS-CoV-2. However, there have been no head to head studies comparing the efficacy of the two therapies. The purpose of this study is to compare clinical outcomes of patients who have received corticosteroids (CS) along with TCZ or RDV. Methods. This is an IRB approved retrospective observational study completed in a three hospital health system in New Jersey. Patients were included if age was ≥ 18, admitted with SARS-CoV2 infection requiring oxygen. Patients were stratified into two treatment arms;CS + TCZ and CS + RDV. The primary objective was to compare all-cause inpatient mortality (ACIM) based on oxygenation status;nasal cannula (NC), high-flow nasal cannula (HFNC), and invasive mechanical intubation (IMV). Secondary objectives was a snapshot analysis with a focus on clinical improvement (CI) defined as improvement in clinical ordinal scale by 2 or more at end of stay. Additional endpoint included progression to IMV after therapy initiation. Results. There were total of 1053 patients included (123 in the CS+TCZ arm, 930 in the CS+RDV arm). Oxygen requirements were as follows: In the CS+TCZ arm (NC n=57, HFNC n=26, IMV n=40), and the RD+CS arm (NC n=669, HFN n=159, and IMV n=102). Results from the primary endpoints can be found in Table 1. No statistically significant differences were observed between the two treatment arms. For the secondary objective there were 214 patients included (70 in the CS+TCZ arm and 105 in the CS+RDV arm). For patients receiving NC, no difference seen in CI between two treatment arms (81.4% CS+RDV vs. 81.5% CS+TCZ). In HFNC group more patients in the CS+TCZ group observed CI compared to CS+RDV (68.8% vs. 40%). Less patients requiring HFNC progressed to IMV in CS+TCZ group (25%) compared to CS+RDV (40%). Conclusion. No statistical difference in ACIM was detected between the two treatment arms regardless of baseline oxygenation requirements. There was a trend towards lower ACIM for IMV patients in the CS+TCZ arm compared to the CS+RDV arm. More patients experienced CI in CS+TCZ group compared to CS+RDV in HFNC group. Less HFNC patients also required new IMV in the CS+TCZ arm. Larger studies need to be performed to evaluate a true statistical difference between the two treatment arms.

9.
Journal of Clinical and Diagnostic Research ; 15(9):DC11-DC15, 2021.
Article in English | Web of Science | ID: covidwho-1700969

ABSTRACT

Introduction: The emergence of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic has been troublesome particularly for developing countries that lack infrastructure and capacities to produce the kits locally. Simplification of the method can increase diagnostic efficiency which can benefit patients and help in infection control, consequently saving time and lives. Aim: To evaluate the diagnostic value of four methods (that omit extraction step) for detection of SARS-CoV-2 against the traditional extraction method. Materials and Methods: This was a cross-sectional analysis for evaluating diagnostic accuracy of four methods for detection of SARS-CoV-2 by real-time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR), conducted in the Department of Microbiology, SMS Medical College, Jaipur, Rajasthan, India, in October 2020. Ninety four SARS-CoV-2 RT-PCR positive samples and 20 negative samples were taken for this study. Automated extraction system was used for Ribonucleic Acid (RNA) extraction and four different approaches were compared to the traditional extraction method for detection of SARS-CoV-2 by RT-PCR. Data was entered and analysed using Statistical Package for the Social Sciences (SPSS) statistical software version 24.0. Results: The automated RNA extraction method was compared to the method of direct addition of samples with (Heat processed Direct Viral transport medium Sample (HDVS)) and without heating (Direct Viral transport medium Sample (DVS)), directs addition of diluted (1:5) sample with (Heat processed diluted VTM sample (HdVS)) and without heating (Diluted VTM sample (dVS)) as well as after addition of Proteinse K (PK) to the diluted samples that came either negative/invalid. Out of four methods, the HdVS method gave the best results, considering extraction with Perkin Elmer as standard, this method showed sensitivity of 96.74%, specificity of 100%. Conclusion: In current pandemic, molecular testing is critically challenged by the limited supplies of reagents of nucleic acid extraction alternative method like diluting and heating of Viral Transport Media (VTM) samples and using them directly as elutes serve as an easy, fast and inexpensive alternative.

10.
Open Public Health Journal ; 14(1):462-468, 2021.
Article in English | Scopus | ID: covidwho-1551389

ABSTRACT

Background: In the context of newly emerging diseases, global health security has gained importance in recent years. The pandemic COVID-19 has reemphasized the significance. Despite increased attention to enhance health security, the existing capacities were not optimally prepared to respond to public health threats posed by emerging infectious diseases. Objective: The objective of the study was to develop a simple tool that can help monitor and build up the critical capacity to prevent, detect, respond and help identify the gaps in the preparedness of the health system. Methods: The cross-sectional study was conducted from January 2018 – December 2018 amongst the district level health functionaries like the disease surveillance, laboratory, and the animal health focal points in the selected districts across the three South Indian states. Results: The responses received from the participants of the study were scored and categorized by domains into a biosecurity index, which was easily adaptable to all districts and easy to implement by a district official or state health officer for the initial assessment. Data acquired from this tool could be analysed to build and inform readiness and response plans for preventing and controlling health emergencies. Conclusion: The biosecurity index developed for the Indian districts was an appropriate instrument for epidemic preparedness assessment. © 2021 Vyas et al.

11.
Journal of Clinical and Diagnostic Research ; 15(8):DC20-DC24, 2021.
Article in English | EMBASE | ID: covidwho-1395290

ABSTRACT

Introduction: Coronavirus Disease 2019 (COVID-19) has been haunting the world since December 2019 and has grown to pandemic proportions from March 2020. Even after a full year of research and study, the most effective way to control the spread of this infection is early diagnosis and isolation of the cases. Real-time Reverse Transcription Polymerase Chain Reaction (RT-PCR) is considered the standard test all over the world for the diagnosis of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection. All the sample collection guidelines have recommended stringent maintenance of the cold chain for the sample transport. However, it is not possible for the resource constrained developing countries with inadequate infrastructure to comply with these guidelines all the time. Aim: To determine necessity of these stringent transport criteria and the effect of temperature on the clinical sensitivity of a RT-PCR assay for diagnosis of SARS-CoV-2 infection. Materials and Methods: In this prospective experimental study conducted in November 2020, 49 positive samples were kept at ambient room temperature and were tested everyday with RT-PCR for the detection of SARS-CoV-2 Ribonucleic Acid (RNA). The samples were also kept under refrigeration at the 4°C and were also tested by RT-PCR and the results were compared with their respective counterparts kept at room temperature till nine days. Python Jupiter notebook SciPy and Anaconda software was used for statistical analysis. Results: It was observed that the positivity of the RT-PCR results were not deteriorated till five days and there was no significant deterioration even after nine days of samples being stored at room temperature suggesting that even if the viral RNA itself is not stable outside strict temperature control but small fragment or target genetic sequences are enough for detection of virus by RT-PCR. Conclusion: It is possible to keep samples at this ambient temperature for five days without any loss of positivity in RT-PCR.

12.
Electronic Journal of E-Learning ; 19(3):147-158, 2021.
Article in English | Web of Science | ID: covidwho-1370057

ABSTRACT

There is a convergence unfolding between two formerly unique and separate areas of teaching research methodology: distance education and problem-based learning (PBL) environments. Much has been published on each field independently, however, in the modern-era of online, distance, and hybrid educational programs there is a need for more case and experiential-based learning activities which can effectively measure stated learning objectives. Trends in education have led to the development of various methods to instruct courses and conduct research online. Teaching research methodology and pedagogy have evolved to include video capture, remote conferencing, and other real-time communications techniques allowing faculty and students to collaborate across great distances. Meanwhile, PBL environments have been used extensively in teaching medicine, clinical practice, law, business/management, and many other disciplines to improve student learning. This has been further accelerated during the COVID-19 pandemic through the use of technologies like Zoom, WebEx, GoToMeeting, Google Hangout Meet, etc. and the availability of PBL-ready environments in breakout rooms and asynchronous simulated projects. Student preference data from 2020 are reported as part of this study. One example of this merger between online delivery and PBLs was the development of a PBL statistical process control (PBL-SPC) module. A cross-functional academic team was created across both a college of business and college of education in which a PBL-SPC module was developed based on a real-life situation in which students immerse themselves in a potato chip factory environment. The motivation for the PBL-SPC was that this is a challenging topic to cover which students often find difficult to relate to and/or boring. Three different scenarios were developed and students, as individuals or in teams, must traverse the simulated factory to assess the situation. Learning outcomes are measured by the course instructors and the PBL environment is being used by faculty around the world. Additionally, the PBL-SPC module has now been scaled to other applications such as six-sigma simulated project training during the COVID-19 pandemic. Pedagogical methods should be interactive, stimulate learning, improve the learning outcomes / critical thinking, and enhance student experience. This paper proposes that merging the effective and tech-friendly pedagogical methods of PBL-SPC, with the right modalities and model of online delivery, can help achieve these aforesaid goals. Even more, it can deliver a great opportunity to educators and institutions worldwide for advancing the reach of education.

13.
Journal of Neurological Surgery Part B: Skull Base ; 82(SUPPL 2), 2021.
Article in English | EMBASE | ID: covidwho-1254098

ABSTRACT

Introduction: In the wake of both the unprecedented nationwide ban on elective surgery during the COVID-19 pandemicand the increased mortality of otolaryngologists and neurosurgeons during this same time period, concern regarding thetiming and safety of neurosurgical intervention for sellar-based pathology has been raised within both the neurosurgical andotolaryngology communities. Methods: A retrospective chart review was performed on all patients who underwent operative intervention for sellar-basedpathology from March 12 to July 1 for both 2019 and 2020. Dates were chosen to align with the Virginia State ofEmergency on March 12 and the multiphase reopening of the public which lasted until July 1. Primary endpoints studied forcomparison included case volume, median time to surgery, and COVID-related mortality. Results: In total, a 26.6% decrease in overall surgical case volume occurred in comparison to the previous year. Astatistically significant decrease in frequency of endonasal surgery was seen from 20 in 2019 to 6 in 2020 ( p = 0.04). Whilemedian time to surgery for pituitary adenomas was unchanged from the previous year (26 days), this data does not takeinto account six patients who electively postponed treatment due to fear of receiving medical care during the pandemic.Among 2,795 COVID-19 patients treated in our institution, only one patient had a pituitary tumor. Here, treatment wasdelayed by 81 days. For emergent cases, such as pituitary apoplexy, surgeons increased utilization of the microscope as ameans to reduce the number of personnel exposed. Finally, our practice had no COVID-related mortality for patientsundergoing sellar-based surgery. Conclusion: The COVID-19 pandemic did not delay time to treatment for emergent presentations of vision loss or pituitaryapoplexy. In these instances, our department followed strict institutional policy regarding use of proper PPE, as well asminimization of hospital personnel exposure. On an outpatient basis, the pandemic did cause a noticeable delay in time totreatment;however, patients' outcomes were unaffected. Close patient monitoring was achieved via utilization oftelemedicine to trend hormone levels and assess development of related symptoms. Finally, decreases in overall casevolume are likely due to ongoing cultural avoidance of seeking medical care, while deferment of endonasal surgery may beattributed to a concern for greater mortality for endonasal procedures.

14.
Open Forum Infectious Diseases ; 7(SUPPL 1):S341, 2020.
Article in English | EMBASE | ID: covidwho-1185911

ABSTRACT

Background: Tocilizumab (TCZ) is a monoclonal antibody against the interleuikin- 6 receptor which is potentially beneficial in COVID-19 induced cytokine release syndrome (CRS). However, there are limited studies showing anti-inflammatory effect and clinical benefit of TCZ in COVID-19 patients. This retrospective study examines treatment responses of criteria based TCZ therapy for SARS-CoV-2 respiratory infection for ICU vs. non-ICU patients. Methods: We established institutional criteria to identify patients at risk of CRS from COVID-19. Patients were included if they received at least 1 dose of TCZ and were admitted for at least 72 hours. Primary endpoint was to assess clinical improvement (CI) at the end of admission. CI was defined by extubation, downgrade from ICU, discharged or improvement in Clinical Ordinal Scale by 2. Secondary endpoint of the study was to assess inpatient mortality (IM) and risk factors associated with IM. Subgroup analysis included impact of early (< 96 hours) vs late (≥ 96 hours) TCZ therapy on IM. Results: Between March 25 to May 6, 2020, 170 patients met criteria and received TCZ. There were 83 non-ICU patients and 87 in the ICU. Forty five patients needed invasive mechanical ventilation (IMV). ICU patients tended to be obese, receive 2 doses of TCZ and have longer length of stay. Overall CI was seen in 71% of patients. CI was higher in non-ICU vs ICU patients (85.5% vs 57.5%, P=0.002). Overall IM was 18.8%;however, IM was lower in non-ICU vs ICU patients (8.4% vs 28.7%, P=0.0014). IM was higher in patients on IMV vs. non-IMV (30% vs 15.4%, P=0.03). Risk factors of ICU admission, BMI ≥ 30 kg/m2 and AKI were associated with higher risk of IM. Many IM patients were made comfort care. No differences were observed in early vs late TCZ therapy on inpatient mortality, but there was a trend toward lower mortality with early TCZ. COS Review of Tocilizumab Patients Conclusion: TCZ is an effective treatment option in patients with SARS-CoV-2 patients at risk of CRS. Patients receiving TCZ in non-ICU setting had a better response to treatment compared to ICU patients. Obesity and AKI were associated with higher risk of mortality, but there was no statistical difference in early vs late therapy. Further studies with control group and larger sample size are warranted.

15.
Indian Journal of Pharmaceutical Education and Research ; 54(4):835-842, 2020.
Article in English | EMBASE | ID: covidwho-1030353

ABSTRACT

India, which is called the “world of pharmacy” for being a top supplier of medicines in several countries, can depend on other countries for Active Pharmaceutical Ingredients (API) and other raw materials. Although India is one of the major suppliers of high-quality medicines in several countries, the Indian pharmaceutical industry is highly dependent on China and other countries in terms of raw materials (including the production of essential medicines such as Crocin). These raw materials are called Active Pharmaceutical Ingredients (API), also known as loose drugs. Indian pharmaceutical manufacturers import medicines from China and other countries/regions to account for about 70% of total medicine demand. This article sheds light on the important question of how India depends on other countries to obtain API and other raw materials. Also, the effect of COVID-19 pandemic on the supply chain of bulk drugs, which indirectly affects the pharmaceutical manufacturers. The article concludes that this is the right time for India to remove the dependencies for bulk drugs on china and other countries and start producing their own API in the country itself. COVID-19 situation provides India an opportunity to become a preferred alternate hub for manufacturing APIs and intermediates.

16.
International Journal of Pharmaceutical Research ; 12:1712-1726, 2020.
Article in English | Scopus | ID: covidwho-832672

ABSTRACT

The novel Coronavirus disease-19, caused by Severe Acute Respiratory Syndrome Coronavirus-2, is the most contagious disease of recent years and declared as pandemic by World Health Organization, which rapidly spreads from one person to another mainly by intimate and proximate contact. Although it belongs to same corona virus’s family those caused Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) in past decades, it has high transmission and infection rate but a low mortality rate as compared to these past diseases. National Institutes of Health has mentioned that SARS-CoV-2 can easily survive for three hours in droplets to a maximum of three days on different surfaces. Worldwide many pharmaceutical and biotechnological companies are conducting clinical trials in search of vaccine and possible therapeutics for the treatment of the disease but currently personal hygiene, frequent hand wash, breaking the chain of infection by social distancing and sanitization are only solutions of COVID-19. Of course, boosting immunity with the help of home-based remedies and traditional system of medicines along with yoga and meditation is the holistic way of getting rid of the COVID-19. Present article reviews the SARS-CoV-19 structure, types, genetic characteristics, symptoms, epidemiology, world statistics, its transmission, prevention, treatment and immunity boosting for the prevention of the disease. © 2020, Advanced Scientific Research. All rights reserved.

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