2-Deoxy-D-Glucose: A Repurposed Drug for COVID-19 Treatment

Coronaviruses is a broad group of viruses that has the potential to cause mild or severe respiratory infections. Currently, there is no specific treatment for the treatment of COVID-19. The symptomatic treatment is generally given on case-to-case basis along with basic life supportive measures for management of COVID-19. There is an acute urgency of evaluating the pre-existing drugs to develop a convincing treatment for COVID-19 or at least to reduce its severity. 2-DG being inhibitor of both glycolysis and glycosylation appears as a promising therapeutic option. In the present chapter, the rationale of repurposing of 2-DG as a potential treatment option for the management of COVID-19 has been discussed. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023.

Impact of COVID-19 Lockdown on Ambient Air Quality in the Southwest Coastal Urban Regions of India

The rapid growth of urban areas and population as well as associated development over recent decades have been a major factor controlling ambient air quality of the urban environment in Kerala (India). Being located at the southwestern fringe of the Indian peninsula, Kerala is one of the regions that has been significantly influenced by the activities in the Indian Ocean. The present study focuses on the effect of the COVID-19 lockdown (in 2021) on ambient air quality in the selected coastal metropolitan areas of Kerala. Although previous research studies reported improvement in ambient air quality in Kerala during the lockdown period, this study demonstrates the potential of onshore transport of air pollutants in controlling the air quality of coastal urban regions during the lockdown period. Data from the ambient air quality monitoring stations of the Kerala State Pollution Control Board in the urban areas of Thiruvananthapuram (TM), Kollam (KL), Kozhikode (KZ), and Kannur (KN) are used for the analysis. Temporal variation in the concentration of air pollutants during the pre-lockdown (PRLD), lockdown (LD), and post-lockdown (PTLD) periods (i.e., 1 March to 31 July) of 2021 is examined to assess the effect of lockdown measures on the National Air Quality Index (AQI). Results indicate a significant decline in the levels of air pollutants and subsequent improvement in air quality in the coastal urban areas. All the effect of lockdown measures has been evident in the AQI, an increase in the concentration of different pollutants including CO, SO2, and NH3 during the LD period suggests contributions from multiple sources including onshore transport due to marine traffic and transboundary transport. © 2023, The Author(s) under exclusive licence to Institute of Earth Environment, Chinese Academy Sciences.

Corporate response to macroeconomic shocks

COVID-19 has bought its fair share of troubles to the world when it came unannounced in late December 2019. Nobody was spared, and the corporate sectors bore the brunt of it along with the common man. Globally, almost all industries were affected by the pandemic due to lockdowns and restrictions which further intensified the problems of the corporate sectors. Many sectors faced shocks from both the demand side and the supply side. Unemployment, instabilities in the financial markets, and uncertainties prevailing in almost all sectors of the economy were predominant throughout the world. This chapter is an attempt to see how the demand shocks and supply shocks impacted the different industries and what measures were taken up by the governments and the corporate sectors to wade through this period of uncertainty and ambiguity. © 2023, IGI Global.

Internet of Things in Smart and Intelligent Healthcare Systems

Independent and convenient healthy living is the prime goal of everyone. Unfortunately, there are limitations to this idea due to various factors such as age, illness, and pandemics. Through health-monitoring systems, people can easily and safely monitor their vital health parameters. Modern technologies have enabled people to live a healthy and independent life. Internet of things (IoT)-based health-monitoring systems have evolved to enable healthcare providers and patients to connect and coordinate with each other, allowing patients to monitor their vital health conditions and make informed decisions. IoT technology combined with various other technologies such as blockchain, cloud computing, artificial intelligence, and so on is gradually increasing the grip of smart systems on several other tasks in the healthcare sector. Modern smart healthcare systems are becoming more prevalent due to the emergence of smart home technologies. The healthcare module of the smart home automation system will allow people to receive better care even at home, minimizing the loneliness that often accompanies hospital visits. Also, such systems have facilitated remote healthcare governance with utmost accuracy. Also, in light of COVID-19, the need for such systems is becoming higher. The reality is that such systems are taking the load off medical personnel and providing a safer contact-free environment. Also, when it comes to clerical and administrative tasks, IoT-based smart systems have proved their mettle over the years. Even though such technology is in a stage of rapid growth, the reach is still minimal due to certain challenges that persist when it comes to the implementation side. The future is expected to be controlled by such modular technologies, and thus, extensive research both from the side of academia and industry is expected to revolutionize the technology even more soon. © 2023 selection and editorial matter, Durgesh Srivastava, Neha Sharma, Deepak Sinwar, Jabar H. Yousif, and Hari Prabhat Gupta;individual chapters, the contributors.

Treatment of COVID-19 ARDS with a tabletop NIV device in a Respiratory Intermediate Care Unit

Background: Non-invasive ventilation (NIV) has been tried in COVID-19 ARDS (CARDS), and its role is being increasingly recognised. If proven, it could be a game-changer in resource limited settings. We report our experience with administration of respiratory support using a tabletop NIV device in a respiratory intermediate care unit (RIMCU). Methodology: We retrospectively studied a cohort of hospitalised COVID-19 patients, who received protocolised management with positive airway pressure using a tabletop NIV device in the RIMCU as a step-up rescue therapy for deterioration despite low flow oxygen support. Treatment was commenced with continuous positive airway pressure (CPAP) mode up to a pressure of 10 cm H2O and if required inspiratory pressures were added with the bilevel positive airway pressure (BPAP) mode. Success was defined as weaning from NIV and stepping down to the ward. Failure was defined as escalation to the intensive care unit (ICU) or need for intubation or death. Result(s): In all, 246 patients were treated in the RIMCU during the study period. Of these, 168 received respiratory support via tabletop NIV device as a step-up rescue therapy. Their mean age was 54 years, and 83% were males. Diabetes Mellitus (78%) and hypertension (44%) were the commonest comorbidities. Treatment was successful with tabletop NIV in 77%;of this, 41% was on CPAP alone and 36% after receiving increased inspiratory pressures on BPAP mode. Conclusion(s): Respiratory support using a tabletop NIV device is an effective, and economical treatment for CARDS. Further studies are required to assess the appropriate time of initiation for maximal benefit and judicious resource utilisation.

YUDH: Multi-utility Tool to Reassure Serenity in the COVID-19 Pandemic

COVID-19, the virus that has affected current living standards, has undergone mutation, and the second wave has caused a much more devastating situation in India. In such a scenario, the alert of a third wave by the authorities has alarmingly increased concern in the nation. After being declared as an international emergency, the development of its vaccine has been conducted by different countries. India among other countries is also pursuing to develop much more efficient variants of the vaccine. The situation still persists to be hostile and maintaining the current precaution measures and maximizing the distribution of the vaccines is the only solution in hand. A necessity arises for a user-friendly app to reduce social interaction while assisting in medical support. In this paper, we have proposed an android application named YUDH, which focuses on the overall service that an individual requires from booking test centers, vaccine slot notification to home sanitization. The user can book COVID-19 testing centers and can arrange sanitization service after recovery with the provision of place, date, and time. In addition to booking test centers, swab testing at the doorstep is also available. The user also gets regular notifications on COVID vaccine slot availability in accordance with CoWIN portal and users' preferences. This deployment is aimed at the safety of the user and their privacy safeguard. The application also assists the government to maintain a database more efficiently. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Cytokine Storm, Immunomodulators and Mucormycosis in COVID-19: Bench To Bed Side

The world is undergoing its biggest health crisis named coronavirus disease, which is associated with increased proinflammatory cytokine storm, which ultimately leads to various medical complications including acute respiratory distress syndrome. The treatment protocol was always controversial due to the excessive use of corticosteroids in aggressive pneumonia and associated hyperinflammatory conditions.The excessive use, misuse, and rampant use of steroids may lead to various coinfection like mucormycosis which is referred to as black fungus that manifests within the skin and also affects the lungs and brain which may be more fatal. It is necessary to have early diagnosis and management to tackle the severity of post covid coinfection. Copyright © RJPT All right reserved.

Determinants for Mode of Delivery in COVID-19 Pregnancy: A Single-center Retrospective Observational Study

Introduction: With the rise in COVID-19 cases round the world, we have the problem of COVID-19 positive pregnancies at hand. Various case series and reports around the world have shown a high incidence of cesarian deliveries in these patients. We have attempted to study the factors predicting an increase in cesarean section (CS) rates in COVID-19 positive pregnancies admitted to our institution. Methods: Retrospective analysis of all deliveries of COVID-19 affected pregnancies in a tertiary care center in north Kerala from 15 April 2020 to 31 October 2020. There were 253 deliveries during this period with 183 cases of cesarean and 70 vaginal deliveries. The data were entered in Microsoft Excel and analyzed with appropriate statistical software. Results: There was 71.42% cesarean section rate in women below 35 years of age compared to 100% in those above 35 years. The rate was higher among nullipara (77.77%) compared to 67.32% among multipara. There was also a positive correlation between cesarean with obesity [prepregnancy body mass index (BMI) more than 30]. There were 70.22% term cesareans compared to 89.28% in preterm. Induction of labor also seemed to increase rate of cesarean. Fetal growth restriction (88.88%) contributed more to cesarean rates unlike those without (71.06%) preterm rupture of membranes (PROM) and meconium staining of amniotic fluid (MSAF) was also seen to increase the possibility of cesarean. Cardiotocogram abnormalities (13.83%) were another important contributing factor. A total of 100% of patients with abnormal cardiotocogram (CTG) underwent cesarean section when compared to only 67.88% in those with normal CTG. In patients delivered while still positive, the incidence of cesarean section was 77.63%, while this reduced to 63.04% in those whom delivery was delayed till seronegativity achieved. A total of 75.95% cases were done in the morning. There were 19.67% cases of fetal distress which added to the cesarean numbers. Conclusions: We found increased maternal age, obesity, nulliparity, fetal growth restriction, PROM, MSAF as factors which contributed to increased cesarean section rates in COVID-19 positive pregnancies. Hence these pregnancies need careful monitoring. © The Author(s).

Energy Audit in an Urban Indian Residential Community-A Case Study

This paper presents an energy audit study conducted for an urban residential community in Mumbai. The consumers are categorized using a k-means clustering algorithm based on their electricity consumption. The energy-efficient appliance selection is undertaken by a benchmarking study based on the appliance energy labeling and star rating initiated by the Bureau of Energy Efficiency(BEE) in India. The study establishes the techno-economic feasibility of energy savings in Indian urban households with an average payback period of 3.3 years. The energy-saving opportunities are selected based on each cluster's capital cost and payback period. Sensitivity analysis of electricity tariff of a region on payback period is undertaken. The covid impact analysis on the residential energy consumption is conducted by comparing energy consumption before and after the covid. The benefits are replicable in most Indian households, especially the urban residential consumers with high consumption in regions with high electricity tariffs. © 2022 IEEE.

Effectiveness of self-instructional module on level of knowledge on reduction of social anxiety among first year nursing students in Covid-19 Pandemic

Background of the study: All over the globe anxiety was present among young adolescence. They are fear of infection and away from real education and fewer confidants to manage Covid pandemic situation.Objectives: Study investigated to assess the pre and posttest level of knowledge on social anxiety among First year nursing students in Covid-19 pandemic.Material and Methods: Experimental study done to assess the effectiveness of level of knowledge on reduction of social anxiety among first year nursing students in Covid-19 Pandemic among 100 Basic BSc 1st year nursing students. Self-prepared questionnaire selected as a tool for pre and post intervention which was validated by the expert .Ethical permission taken before conduction of study .samples chosen as per inclusion criteria of the study. Samples were explained well the purpose of the study .Pre taken with help of questionnaire and after seven days post taken and data analyzed as per objectives of the study.(Level of knowledge score was good8-29 ,average 4-7and poor 0-3 )Results: In this study pretest knowledge score was 16%, 72% and 12% as poor, average and good knowledge .post-test knowledge score was 0 %, 16% and 84% as poor, average and good knowledge. Pretest test SD1.565 and posttest SD 1.1.69 which was extremely significant.(p<0.ooo1)Conclusion: Finding of the study shows that self-instructional module was effective to increase the level of knowledge among the 1st year Basic B.Sc. student in covid-19 Pandemic.

YUDH: Multi-utility Tool to Reassure Serenity in the COVID-19 Pandemic

COVID-19, the virus that has affected current living standards, has undergone mutation, and the second wave has caused a much more devastating situation in India. In such a scenario, the alert of a third wave by the authorities has alarmingly increased concern in the nation. After being declared as an international emergency, the development of its vaccine has been conducted by different countries. India among other countries is also pursuing to develop much more efficient variants of the vaccine. The situation still persists to be hostile and maintaining the current precaution measures and maximizing the distribution of the vaccines is the only solution in hand. A necessity arises for a user-friendly app to reduce social interaction while assisting in medical support. In this paper, we have proposed an android application named YUDH, which focuses on the overall service that an individual requires from booking test centers, vaccine slot notification to home sanitization. The user can book COVID-19 testing centers and can arrange sanitization service after recovery with the provision of place, date, and time. In addition to booking test centers, swab testing at the doorstep is also available. The user also gets regular notifications on COVID vaccine slot availability in accordance with CoWIN portal and users’ preferences. This deployment is aimed at the safety of the user and their privacy safeguard. The application also assists the government to maintain a database more efficiently. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Spectrum of opportunistic fungal lung co-infections in COVID-19: What the radiologist needs to know Espectro de coinfecciones pulmonares fúngicas oportunistas en COVID-19: lo que el radiólogo debe saber

Fungal lung co-infections associated with COVID-19 may occur in severely ill patients or those with underlying co-morbidities, and immunosuppression. The most common invasive fungal infections are caused by aspergillosis, mucormycosis, pneumocystis, cryptococcus, and candida. Radiologists integrate the clinical disease features with the CT pattern-based approach and play a crucial role in identifying these co-infections in COVID-19 to assist clinicians to make a confident diagnosis, initiate treatment and prevent complications.

Spectrum of opportunistic fungal lung co-infections in COVID-19: What the radiologist needs to know.

Fungal lung co-infections associated with COVID-19 may occur in severely ill patients or those with underlying co-morbidities, and immunosuppression. The most common invasive fungal infections are caused by aspergillosis, mucormycosis, pneumocystis, cryptococcus, and candida. Radiologists integrate the clinical disease features with the CT pattern-based approach and play a crucial role in identifying these co-infections in COVID-19 to assist clinicians to make a confident diagnosis, initiate treatment and prevent complications.

VACCINE-INDUCED THROMBOCYTOPENIA AND THROMBOSIS: SAILING CLOSE TO THE WIND IN A PANDEMIC

SESSION TITLE: Issues After COVID-19 Vaccination Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Ever since the global introduction of adenovirus-vector COVID-19 vaccines, cases of cerebral venous sinus thrombosis and thrombocytopenia after immunization has been reported, posing a challenge to global effects on vaccine implementation. CASE PRESENTATION: A previously healthy 33 year old male presented to emergency room with altered mental status after a left sided seizure episode at home. Patient had a 1week history of occipital headache after receiving Ad26.COV2·S Johnson and Johnson vaccine 2 weeks prior. MRI showed superior sagittal sinus thrombosis and right high frontal hemorrhage 8.6x4.7x4.9 cm. CT angiography confirmed nearly occlusive thrombosis of superior sagittal sinus with extension to right transverse sinus. Noted to have a hemoglobin of 15, platelet count of 74000, PT/INR 16/1.2 and PTT of 28. Started on intravenous heparin and intubated for GCS of 4. Heparin was stopped due to supra therapeutic PTT of 200 overnight, drop in platelet count to 55 and hemoglobin to 13. Repeat ct head done for change in neurological exam of dilated right pupil, showed frontoparietal hemorrhage 9.3 cmx4.1 cm and 7 mm midline shift. Heparin was reversed with protamine and transfused 1 unit platelets prior to emergent decompressive craniectomy and thrombectomy. Heparin induced platelet antibody and SRA came back positive confirming vaccine induced thrombocytopenia and thrombosis. Treatment was initiated with argatroban and IVIG. Platelet count improved with no further propagation of thrombus. Patient underwent feeding tube and tracheostomy placement after 10 days due to prolonged ventilator weaning period and poor mental status. Patient's neurological status continued to improve significantly over subsequent months in acute rehabilitation facility with only residual left sided hemiparesis. Patient was successfully decannulated and anticoagulation switched to apixaban DISCUSSION: Possible pathophysiology is thought to be due to a trigger in spike protein production after biodistribution of adenovirus vaccine and a subsequent autoimmune response resulting in thrombosis. Similar to HIT, platelet consumption leads to thrombocytopenia and the continued platelet and monocyte activation increases thrombin generation, resulting in thrombosis. CDC advices to maintain a high suspicion of cases with symptoms that may indicate an underlying thrombotic event along with simultaneous thrombocytopenia. Heparin use is discouraged, unless HIT testing is negative. The International Society on Thrombosis and Hemostasis (ISTH), recommend considering non-heparin anticoagulants and high-dose intravenous immunoglobulin (IVIG). While platelet transfusions are avoided, rapid progression with rising ICP may necessitate transfusion to enable neurosurgical intervention CONCLUSIONS: Management of complications including seizures and elevated intracranial pressure (ICP) is essential to reduce morbidity and mortality risk. Reference #1: Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med 2021;384:2092–101. Reference #2: Muir KL, Kallam A, Koepsell SA, Gundabolu K. Thrombotic thrombocytopenia after Ad26.COV2.S vaccination. N Engl J Med 2021;384:1964–5 Reference #3: Pavord S, Scully M, Hunt BJ, et al. Clinical Features of Vaccine-Induced Immune Thrombocytopenia and Thrombosis. N Engl J Med 2021;385:1680–9 DISCLOSURES: No relevant relationships by Axel Duval No relevant relationships by Nadish Garg No relevant relationships by ARCHANA SREEKANTAN NAIR

POSITIVE END-EXPIRATORY PRESSURE (PEEP) INDEX: A NOVEL, BETTER DISCRIMINATION MARKER THAN PAO2/FIO2 FOR RESCUE MEASURES IN COVID-RELATED ARDS

SESSION TITLE: ECMO and ARDS in COVID-19 Infections SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: COVID-related acute respiratory distress syndrome (ARDS) is associated with significant morbidity and mortality. PaO2/Fio2 (PFR) is a prognostic and severity marker for ARDS. Other markers have been posited for ARDS. PEEP Index (PIx) [PEEP/PFR] or [(PEEP*Fio2)/PaO2] could serve as a new discriminatory marker to assess rescue therapies such as proning or ECMO referral. METHODS: Retrospective cohort study of all intubated COVID-19 patients with ARDS hospitalized at our institution between February 5th – May 11th, 2020. ARDS were calculated within first 24 hours of worst PaO2/FIO2 and their associated PEEP with bilateral infiltrates on Chest X-ray manually confirmed within 24hours of intubation fulfilling 2012 Berlin criteria. Outcomes of interest were all-cause in-hospital mortality, need for pronation and paralysis use. Binomial logistic regression with ROC curve were performed for univariate association for outcomes of interest. Cox proportional hazard regression modeling was performed and adjusted for potential confounders. PFR was transformed into a denominator of itself to reflect a direct proportional relationship. RESULTS: Data was analyzed from 113 hospitalized COVID-19 patients with identified ARDS. Mean age was 56.4 (STD 14.4);24% (27/113) were female. Median BMI was 30.3 [IQR 48.5,65.5]. Mean Tidal Volume (Vt) was 430 (STD 54). 64% (72/113) were compliant with low Vt (=<6mL/kg based on IBW). Median PFR 125 [IQR 99,192]. Mortality was 66% (74/113). 44% (50/113) were proned. 62% (70/113) required paralysis. PEEP Index outperformed PFR for discrimination for proning use: AUC 0.73 [95%CI 0.63,0.82], p< 0.005;vs AUC 0.674 [95%CI 0.58,0.77], p= 0.02. PEEP Index performed mildy better than PFR for discrimination of requiring paralytic use in ARDS with AUC 0.68 [95% 0.57,0.78], p< 0.05;vs AUC 0.62 [95%CI 0.51,0.73], p<0.05. APACHE2 score showed poor discrimination for both proning and paralytic use (AUC= 0.46 [95%CI 0.35,0.56];p=0.43 and respectively, AUC=0.45 [95%CI 0.34,0.56];p=0.36). After adjusting for confounders, PEEP Index nor PFR didn’t for predict for mortality (p>0.05);however, our sample was not powered. CONCLUSIONS: PEEP Index (PIx) is a novel tool that can serve as a better discriminatory function to evaluate patients with ARDS in the ICU who will require proning in comparison to traditional used PFR. CLINICAL IMPLICATIONS: PEEP Index (PIx) can serve as an easy alternative calculation to Oxygenation Index (OI) [(FiO2 x PAW) / PaO2] to identify patients that would benefit from early proning and other rescue therapies. Further studies are required to compare and validate PIx and OI prospectively as well as benefit cut-off points between proning and ECMO. DISCLOSURES: No relevant relationships by Perminder Gulani No relevant relationships by Manuel Hache Marliere no disclosure on file for Adarsh Katamreddy;No relevant relationships by Hyomin Lim No relevant relationships by Marzio Napolitano No relevant relationships by Leonidas Palaiodimos No relevant relationships by Anika Sasidharan Nair No relevant relationships by Jee Young You

An empirical study on the effect of repeated online/offline transitions on student satisfaction

The disruption due to COVID has been two-fold due the uncertainty of the pandemic. Once the first wave had subsided the academic activities resumed in offline mode. But due to the rise of the second wave of COVID the classes had to be again shifted to online mode. Such drastic changes in the teaching-learning process will definitely have an impact on the student satisfaction. Hence an empirical study was carried out to understand the mindset of the students and how these transitions have distracted the teaching-learning process from a student point of view. Student satisfaction analysis was conducted with the major scales namely ‘Faculty support’, ‘Peer support’, ‘Student learning’ and ‘Assessment’. Each of these scales were further divided into subscales and the influence of each of these subscales on ‘Student Satisfaction’ is also discussed in detail. Analysis is carried out through stepwise regression analysis, analysis of variance and correlation. Apart from these a brief analysis on the impact of parent support on the student’s learning process is also compiled for better understanding. The results and conclusions from this analysis give us an understanding of how the teachers could better understand the teaching-learning process and adapt themselves accordingly for better results. © 2022, Rajarambapu Institute Of Technology. All rights reserved.

Environmental Transmission of Human Pathogens Associated with SARS-CoV-2 and the Effect on Soil and Aquatic Ecosystem: A Biological Way of Management

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious virus which has caused the Coronavirus disease – 2019 (COVID-19) outbreak in 2019, and, in a very short time, it has infected people all over the world. In fact, WHO declared it as pandemic in March 2020. The adaptation of SARS-CoV-2 was found to be originated from interaction between several hosts, which makes it a potential zoonotic agent. Regarding the survival of virus on the environment, it is important to assess the period of infectivity, which differs among different surfaces. This chapter highlights the viability of virus on different contaminated surfaces, also focusing on metagenomic interactions. To investigate the potential directions for the evolution of this pandemic in the future, SARS-CoV-2 requires a reliable tool to access crucial details regarding the adaptation and evolution of the virus in the environment. Bioinformatic tools play an important role in identifying the similarity and variations in the Open Reading Frames (ORFs) of the viral genomes to elucidate the phytogenic relationships. In this regard, this chapter discusses about recent advances in bioinformatic tools to track the evolution of SARS-CoV-2 in the soil and aquatic ecosystem. New technologies are coming into existence with a new aspect of solving some social problems. Hence, in this work a reliable in silico tool for metagenomic analysis of SARS-CoV-2 variants in the environment has been discussed. Overall, this study tries to shed further light on aspect that could help to understand different types of robotics and techniques used for soil and aquatic system, with the main aim of accessing to relevant details on SARS-CoV-2 in the environment. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

HALT - Targeted Therapy with or without Dose-Intensified Radiotherapy in Oligo-Progressive Disease in Oncogene Addicted Lung Tumours

Introduction: Following initial response to TKI, advanced NSCLC patients with actionable mutations ultimately develop treatment resistance. In a proportion of patients (15-40%), initial, limited progression (≤5 lesions) is observed, termed oligoprogressive disease (OPD). SBRT offers hypofractionated, targeted radiotherapy treatment hypothesised to prolong clinical benefit from TKI prior to widespread disease development. With limited evidence to date, and poor clinical/biological selection criteria, the potential benefit offered by SBRT to ablate OPD sites prior to change in systemic therapy is an important question to address. Methods: HALT is a randomised, multi-centre, phase II/III international trial with seamless transition to phase III incorporated. Eligible patients (stage IV NSCLC, actionable mutation, TKI response prior to OPD) are randomised 2:1 to SBRT/continued TKI or continued TKI alone. Eligibility is confirmed by a virtual MDT (vMDT) comprising trial clinicians and radiologists (confirmation of OPD, SBRT suitability). Follow-up assessments are aligned with routine care at 3-monthly intervals until change in systemic therapy is clinically indicated, with imaging and toxicity assessment at each visit. Results: Recruitment commenced November 2017 with 25 centres (17 UK;8 non-UK) open to date. Following the COVID-19 pandemic, recruitment is recovering with 129 registered and 74 randomised patients. Over the last 4 years, little evidence has emerged to confirm any potential benefit of SBRT in this patient group and the impact on patient toxicity remains unknown. Therefore, with persisting questions around clinical equipoise, HALT remains highly relevant. With an 18-month extension and a recent amendment to the HALT inclusion criteria (≤5 OPD lesions, ≤7cm and OPD assessments by PET-avidity), the target of 110 randomised patients remains achievable. Conclusions: As the first randomised trial assessing SBRT benefit in this mutation-positive NSCLC patient population, HALT will provide valuable treatment efficacy and safety information, informing subsequent trial design and contribute to the development of international guidelines for the identification and clinical management of oligoprogression in mutation positive lung cancer. Keywords: Stereotactic body radiotherapy, NSCLC, Phase II

Analysis of COVID-19 Detection Algorithms Based on Convolutional Neural Network Models Using Chest X-ray Images

COVID-19, a disease caused by corona virus is a worldwide pandemic which put millions into death. Not only on lives of people but also it has affected all countries in terms of development and wealth. The main challenge is to detect COVID-19 effectively with high accuracy. A fast classification algorithm can help the health professionals in many ways. This work focuses on the implementation analysis of various Convolutional Neural Network (CNN) which are pre-trained in detecting the disease from chest X-ray images with highest accuracy. Transfer learning is utilized, and fine tuning is performed to get a reliable classification of the image data. For the pre-trained CNN model Mobilenet-V2, highest accuracy of 94.298% and precision of 89.76% obtained. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.