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Introduction/Objective Numerous SARS-CoV-2 variants/lineages have been identified based on genome sequencing. As of June 15, 2022 almost 11,399,573 whole genome sequences have been deposited in the GISAID-database. Severity and spread of COVID19 is based on their efficiency of infection and to multiply in host. That largely depend upon the structural mutation in spike, ORF and N proteins etc. That happens due to translation of genomic mutations during polypeptide synthesis. Also, the mutations are region/country specific. Specific mutation and combination of mutation causes the emergence of new strains. However, the strains can migrate from one region to other through travelers. The main objective of the current study is profiling of mutations in the genome of SARSCoV2 using Next- Generation-Sequencing (NGS) in international travelers and phylogenetic analysis of the sequences to find out different clades of SARSCoV2. Methods/Case Report A total of 557 SARSCoV2 genomes were sequenced on S4-sequencing flow-cell on NovaSeq 6000. For NGS of SARS-CoV-2 genome, Illumina, COVIDSeq kits and the protocols will be used strictly as recommended by the manufacturer. After NGS the analysis was done followed by FASTA sequences retrieval, mutations recording and phylogeny. Results (if a Case Study enter NA) This study reports 11 clades (19A, B, 20A, B, C, D, 20E;EU1, 20G, 20H;Beta V2, 20I: Alpha V1, 21D;and Eta) for the first time in international travelers. To best of our knowledge, this is the first report of the COVIDSeq approach for detection of mutation in SARSCoV2 genomic clades. The study revealed some dominants mutations was (Orf1a: P2018Q, K1053R, E176V, Orf1b: A520V, T2165A, S: D1127G, D614G, L18F etc. in other genes). Conclusion Profiling of common mutations among travelers could fill some gaps about the existence of SARS-CoV-2 variants information. However, further studies are needed to consolidate these findings before to be utilized for development of a potential therapeutic strategy.
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Rationale: SARS-CoV-2 has been identified as a highly infective and contagious viral infection. The SARS-CoV-2 pandemic has been spread worldwide and affected more than 210 countries. Globally, the fast spread of novel SARS-CoV-2 variants has been mostly attributed to international travel. Patient concerns: We are reporting the genomic evidence of SARS-CoV-2 Eta VOI among two international travelers. Both travelers were males from Nigeria aged 24 and 34 years and both were asymptomatic. Diagnosis: The nasopharyngeal swab samples were in both travelers positive by real-time RT-PCR followed by COVIDSeq-NGS. Interventions: Paracetamol 3 times daily for 5 days. Outcomes: Patient recovered completely within 10 days and discharged after 14 days of quarantine duration. Lessons: This report highlights genomic variation of SARS-CoV-2 among the travelers. For managing the present health crisis, molecular identification of viral variants present in different geographical locations will be very helpful.
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PERSPECTIVE FROM A UK DISTRICT GENERAL HOSPITAL Background: Patients with cancer undergoing systemic chemotherapy have been postulated to be at increased risk of mortality from COVID- 19. Given this proposed risk, NICE issued COVID-19 rapid guidelines for safe delivery of systemic chemotherapy in March 2020. Based on this guidance local and regional guidelines were established. Aims: The primary objective of this audit was to assess the impact of COVID-19 on patients undergoing systemic chemotherapy and their outcomes at Queen's Hospital Burton. Methods: 115 patients undergoing active chemotherapy were identified using local records of chemotherapy administration. Retrospective data collection and analysis of these patients was undertaken from March 2020 to December 2020. Results: Patients with a diagnosis of Myeloma (36%) who had a stable disease (42%) had treatment either delayed or suspended during the first wave. Bisphosphonate treatment in 12 out of 14 patients was stopped who already completed the anti-myeloma treatment. Similarly for lymphoma patients, maintenance immunotherapy with Rituximab (6) and Obinutuzumab (3) were suspended or stopped in all cases. Other patients with aggressive Lymphomas, CML, High risk MDS/AML and those with advanced CLL either continued with their treatment or new therapy was started as clinically appropriate. In total, 31 patients had chemotherapy delayed or stopped completely. Only 2 patients on maintenance Rituximab had disease progression. COVID-19 was detected in 9 patients and sadly 4 patients passed away with COVID-19 related complications. Among these were 2 patients on Ruxolitinib, one on VMP lite and 1 on Zometa without chemotherapy at the time. Following the first wave of COVID-19, of the 31 patients 29 were re-commenced on chemotherapy. No patients on high dose chemotherapy had an increase in morbidity and mortality. Summary/Conclusion: The impact of COVID-19 and systemic anticancer therapies is poorly described and based on limited small cohort studies. A few of these studies concluded that cancer patients are not only at risk to contract the virus but also at risk of developing more severe complications as compared with the general population. The UK CORONAVIRUS CANCER MONITORING PROJECT (UKCCMP), serving as a public health surveillance registry, concluded that cytotoxic chemotherapy within 4 weeks before confirmed COVID-19 is not a significant contributor to more severe disease, or a predictor of death from COVID-19, compared with cancer patients who have not received chemotherapy in that period. Again, this analysis was based on small data sets. Our audit also confirms the findings of UKCCMP and shows no significant increased risk in mortality in patients both on active chemotherapy and where chemotherapy was temporarily stopped. The overall risks and benefits of continuing or holding chemotherapy need to be discussed in details with patients. Withholding anti-cancer therapies may well present a greater individual risk of morbidity and mortality than COVID-19. Further studies are required to assess the impact of COVID- 19 on morbidity and mortality, to better inform these discussions. Whilst these factors become clearer, additional measures within our practice have aimed to ensure safe patient care in this new environment. These included telephonic and video consultations, home delivery of oral chemotherapy and blood monitoring at local GP surgeries to avoid hospital exposures.
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Content: Introduction: Telemedicine clinics have historically been unpopular due to a range of clinical barriers. In March 2020 WHO declared COVID-19 as a global pandemic. This was a paradigm shift in the world of clinical medicine and initiated a rapid transition into virtual clinics as a strategy to minimise face to face (FtF) visits and limit viral spread. At Queen's Hospital Burton, Haematology patients are among the most vulnerable given the immunosuppressive effects of their conditions and treatments. Our outpatient work involves assessment of patients receiving chemotherapy which can be associated with fatal complications. It was felt that telephone consultations may be suboptimal for these assessments, and with the unclear duration of the pandemic, there has been an initiative to recruit more patients to video clinics. The Attend Anywhere' (AA) video consultation system was implemented in June. This drastically reduced the need for FtF visits to reduce infection risks. Objective: The primary objective of this audit was to evaluate the uptake of AA over time. We also used the data to assess whether particular patient groups were more likely to engage in video consultations. A concurrent survey was organised in order to assess patient satisfaction with AA. Method: A quantitative analysis of data from a consultant-led clinic was obtained from June to December 2020. The clinic letters were examined for patient demographics and to assess the type of consultation undertaken. A separate mixed-method survey of 29 patients was conducted as a part of our audit. Results: The results revealed a trend towards video consultations over telephone consultations during the period of time analysed, although the volume of patients undertaking telephone consultations remained higher overall. Despite the proportion of AA consultations being higher in the lower age groups, it remained popular in older age groups. The patient survey showed a high rate of patient satisfaction. A lot of the patients considered AA to be an excellent alternative to FtF and cited other significant benefits in saving time, reducing effort and minimising risk. Video consultations also felt more personal than over the phone and patients felt all their concerns were addressed with high standards of patient care. Conclusion: The audit showed that AA consultations are popular with patients in all demographics. They are felt to be safer than telephone consultations. As many appointments are still conducted via telephone, there is further work to be done to encourage more patients onto AA. A number of barriers to AA were noted. There were initially difficulties with staff accessing the software. There were a number of cases where patients either had no computer access, or struggled with the software. Improving communication and information booklets helped to overcome this. The older ages may have had higher representation if they had easier access to a computer, or if the software had been more straightforward. It is felt that a dedicated mobile application may provide a more user friendly system for patients. Whilst the added value of physical examination is missing in AA consultations, especially in new clinic patients, this has been a novel solution to challenges the pandemic has brought. It has helped to ensure continuity and safety in patient care.