Managing patients with hematological malignancies during COVID-19 pandemic

The outbreak of the coronavirus disease 2019 (COVID‐19) has posed an unprecedented challenge to the health care communities across the globe. As of June 17th, 2020, a total of 8,339,829 confirmed COVID-19 cases with 448,420 deaths have been reported [2]. Different parts of the world are seeing different levels of COVID-19 activity with regards to the infection rate, susceptible population, and mortality rate. The COVID-19 pandemic is a rapidly evolving emergency and is a subject of regular debate and advanced research. Patients with hematological disorders and solid malignancies have special needs and oncologists are facing a compound challenge

Role of Immunomodulation of BCG Therapy on AML Remission

Bacillus Calmette-Guerin (BCG) has been studied in various cancers for its immune modulation. Although the mechanism is yet to be completely understood, we do have positive experiences in many oncological cases. Hereby, we present a case of an 82-year-old male with acute myeloid leukemia (AML) post allogeneic Stem Cell Transplants (AlloSCT) as a salvage therapy, now in remission, who presented with hematuria. Workup confirmed non-muscle invasive Bladder Cancer (NMIBC), for which he was treated with nine sessions of intravesical BCG therapy. During BCG treatment, the patient developed gradually increasing lymphocyte counts. Flowcytometry of a peripheral blood sample showed polyclonal cell lymphocytosis with CD8+ T-cell expansion. Although further work up his lymphocytosis to be polyclonal, it has persisted at follow-up for the last 4 years. Also, we did not find any evidence of leukemia recurrence at follow-up prompting us to associate the BCG use for this patient and it is role as immunomodulation to keep AML disease in remission

Cardiac drugs and outcome in COVID-19

We read with much interest the article “Are certain drugs associated with enhanced mortality in COVID -19” by Goldstein et al your esteemed Journal. Authors have discussed the theoretical basis of angiotensin receptor blockers, statins in worsening outcome of COVID – 19 patients.(1) We believe that this topic is rapidly evolving and requires further evidence and discussion for understanding the multiple factors which contribute to the pathogenesis and outcome. We have the following comments

Convalescent Plasma Therapy: A Passive Therapy for An Aggressive COVID-19

As of May 19, 2020, there are in total 4,986,200 laboratory-confirmed Coronavirus disease-2019 (COVID-19) cases. 2% (45,425) out of 2,657,390 active COVID-19 cases are critically ill and might be requiring intensive care support. Unfortunately, even after six months since its first detection, we still do not have any definitive treatment options for COVID-19 pneumonia. Recently, the use of human convalescent plasma is being considered as a potential option for the treatment of COVID-19

Review of clinical profile, risk factors, and outcome in patients with Tuberculosis and COVID -19

Coronavirus disease (COVID 19) has involved millions of people all over the world. Tuberculosis (TB) continues to affect millions of people every year with high mortality. There is limited literature on the occurrence of COVID 19 in patients with TB. We reviewed the available data on various clinical details, management, and outcome among patients with COVID-19 and TB. 8 studies reported a total of 80 patients with this coinfection. These patients were reported from ten different countries, with Italy reporting the largest number of cases. Migrant, males constituted a major proportion of cases. Most reported patients were symptomatic. Fever, dry cough, and dyspnea were the most commonly reported symptoms. Bilateral ground glass opacities were more common in COVID 19 infection and cavitary lesions were more common in patients with TB. Most reported TB patients had been found to have mycobacterium tuberculosis from sputum culture in the background of pulmonary TB. Most patients of TB were treated with multidrug regimen antitubercular therapy. In all 8 studies, COVID 19 was treated as per the local protocol. Mortality was reported in more than 10% of patients. Mortality was higher in elderly patients ( \u3e 70 years) and amongst patient with multiple medical comorbidities

Mechanisms of neurological injury in COVID-19

We read with much interest the article “Neurological Impact of Coronavirus Disease (COVID 19): Practical Considerations for the Neuroscience Community” by Werner et al. published in your esteemed Journal. Authors have described the various neurological details of COVID-19 in detail.1 We believe this topic is important and is continuously evolving. We have the following comments as an addition to the article

Cerebrovascular events in COVID-19 patients

Neurological manifestations in patients with COVID-19 are more frequently being reported. Cerebrovascular events have been reported in around 3% of patients. In this review we summarize the published literature on cerebrovascular events in patients with COVID-19 as available on the PubMed database. So far, 3 studies have reported cerebrovascular events. Cerebrovascular events were identified on screening patients with decreased consciousness or in the presence of focal neurological deficits. These events were common in elderly, critically ill patients and in patients with prior cardio-cerebrovascular comorbidities. The diagnosis of cerebrovascular events was confirmed with computed tomography of the brain in most studies reporting neurological events. Multiple pathological mechanisms have been postulated regarding the process of neurological and vascular injury among which cytokine storm is shown to correlate with mortality. Patients with severe illness are found to have a higher cardio- cerebrovascular comorbidity. With an increasing number of cases and future prospective studies, the exact mechanism by which these cerebrovascular events occur and attribute to the poor outcome will be better understood

SURVEILLANCE OF MORTALITY: FROM A TERTIARY CARE TEACHING HOSPITAL OF EASTERN INDIA IN PERSONS WITH AND WITHOUT DIABETES MELLITUS

Objective: There is abundant knowledge about the gravity of global load of diabetes mellitus (DM). There are conflicting reports on the cause of death from different parts of the world. In India, there are not enough studies to establish the cause of death in DM. To find out the mortality pattern in DM and non-DM (NDM) in a tertiary care teaching hospital in Eastern India.Methods: Retrospective analysis of in-hospital mortality in a tertiary care hospital in Eastern India, from January 2012 to December 2015.Results: There were a total of 1590 deaths of which 442 were having DM and 1148 did not have DM (NDM). Mean age of death for nondiabetics was 66.4 years (M:F = 67.5:65.3) and that for diabetics were 62.7 years (M:F = 63.5:60.04) which was not statistically significant (p=0.9) though diabetics died younger by 4 years. On analyzing the specific cause of death, coronary artery disease (CAD) was 14.71% in DM and 1.57% in NDM (p=0.0001). Chronic kidney disease (CKD) was 18.55% in DM and 1.92% in NDM (p=0.0001). Congestive heart failure was 7.27% in DM and 1.83% in NDM (p=0.0001). CVA was 13.57% in DM and 1.66% in NDM (p=0.0001). Infection was the most common cause of death (39.37%) in DM, but in NDM also this was quite high 34.41% (p=0.21). The death due to CVA in DM was more in hemorrhage as compared to ischemic (p=0.00001).Conclusion: We found causes of death in DM were an infection, CKD, CAD, CVA, and CHF in descending order in this part of the world. The diabetes patients had lesser hospital stay than nondiabetes patients (p=0.009)