CONVALESCENT PLASMA THERAPY FOR COVID-19 PATIENTS: REGULATORY GUIDANCE ON COLLECTION, TESTING, PROCESSING, STORAGE, DISTRIBUTION, AND CLINICAL TRIALS

Convalescent plasma can be transfused to patients suffering from the same infection or for preparing immunoglobulin concentrates. Plasma obtained from recovered patients can be a valuable alternative during the COVID-19 pandemic for supporting its treatment within a randomized or case-control clinical trials or observational studies of plasma transfusion and for preparing plasma-derived biological products. WHO Blood Regulators Network highlighted that a systematic approach for collecting convalescent plasma from patients recovered from COVID-19 could provide a useful intervention. Structured clinical trials can be used to assess safety and effectiveness of convalescent plasma. The convalescent plasma therapy is still in the experimental stage and is currently not included in the interim clinical guidelines of WHO. However, an emergency investigational new drug application (eIND) process has been induced to ensure the availability of COVID-19 convalescent plasma to the patients with severe or life-threatening COVID-19 conditions. USFDA is regularly amending its guidance as new results, and best practices are emerging. The write-up provides an overview of convalescent plasma, from a regulatory considerations viewpoint, systematic workflow protocol, and a cross-section of clinical trials underway

Hypereosinophilia presented as thromboembolic event: a rare manifestation

Eosinophilia refers to peripheral blood absolute eosinophil count above the ULN, normal range of AEC is 0.05-0.5× 109/l (1-6%). Hyper eosinophilia refers to AEC above 1.5×109/l. Hypereosinophilia can affect multiple organs and can cause cardiomyopathy, gastroenteritis, cutaneous lesions, pneumonitis, and neuritis. In addition, some patients develop thromboembolic complications. We are presenting a case who presented to us with thromboembolic complication later diagnosed as hypereosinophilia with Bone marrow showing myeloid associated eosinophilia (Primary eosinophilia)

Scrub typhus in North India: clinical spectrum, laboratory parameters and treatment outcome in tertiary care teaching hospital

Background: Scrub typhus is an acute febrile illness causing serious complications leading to significant mortality especially if there is delay in diagnosis and treatment. It is caused by Orentia tsutsugamushi a gram negative bacterium and transmitted by the bite of the trombiculid mite (chigger). This study was undertaken to document the clinical manifestations, laboratory parameters and treatment outcomes of scrub typhus cases.Methods: This retrospective study was done in a tertiary care teaching hospital which included 40 confirmed cases of scrub typhus. The diagnosis was confirmed by positive IgM ELISA. Clinical spectrum and manifestations, laboratory parameters and course in hospital with outcomes were evaluated. Factors associated with complications and mortality were analyzed.Results: The mean age of the patients was 40 ±15 yrs with almost equal proportion of males and females (47.5 vs 52.5%). The most common presenting symptoms were Fever (100%), shortness of breath (40%), altered sensorium (22.5%), nausea/vomiting (10%), and diarrhea (7.5%). Mean duration of fever before presentation to hospital was 11.1±4.9 days. Eschar was seen in 15% of patients. Common laboratory abnormalities documented was thrombocytopenia (85%), elevated transaminases (57%) leukocytosis (45%), and leucopenia (15%). About 37.5% of patients developed multiple organ dysfunction syndrome (MODS) with case fatality rate was 10%. Acute renal failure, acute hepatitis, need of ventilator support and CNS dysfunction was higher among patient with MODS.Conclusions: Scrub typhus patients can have a wide range of manifestation ranging from mild illness to serious and life threatening complications like acute respiratory distress syndrome, acute renal failure, and acute hepatitis and CNS dysfunction. High index of suspicion with early recognition and treatment is key for good outcome. Use of empirical doxycycline may be lifesaving

Scrub Typhus with Multiple Cranial Nerve Palsy: A Rare Case Presentation

Scrub typhus, a rickettsial disease endemic in several parts of India, usually presents with acute symptoms. It is causedby small intracellular Gram-negative bacteria belonging to the Rickettsiaceae family. Optic neuritis and lateral rectus palsymay be associated with a range of autoimmune disorders, infectious diseases and raised intracranial tension. In this case,we report optic neuritis and lateral rectus palsy induced by Orientia tsutsugamushi. We report a case of a 23-year-old womanpresenting with complaints of high-grade fever, vomiting and generalized swelling since 5 days. During this febrile period,on 4/10/2021, she complained of difficulty in vision and double vision. She was found to be positive for scrub typhus on5/10/2021. Optic neuritis was diagnosed on the basis of ophthalmologic examination and magnetic resonance imaging (MRI)brain. Investigation was done to rule out autoimmune disorders (vasculitis and connective tissue diseases). Rickettsial opticneuritis was confirmed by detection of specific antibodies in serum and the negativity of other serologic tests. Fever, eschar,history of tick exposure and supportive diagnostic tests usually lead to the diagnosis. This case aims to raise awarenessamong the healthcare providers for this type of association. Scrub typhus should be included in the differential diagnosiswhen a patient presents with fever with or without eschar and isolated or multiple cranial nerve palsy

Comparative evaluation of valethamate bromide and hyoscine butyl bromide on cervical dilatation in water buffaloes after detorsion

After detorsion, incomplete cervical dilatation is major cause of dystocia. The present study aimed to investigate the comparative efficacy of valethamate bromide and hyoscine butyl bromide on cervical dilation after detorsion and their effect on haematological and biochemical parameters of torsion detorted water buffaloes. A total of 18 buffaloes were selected for study which were divided into three groups of six animals each. After detorsion by Sharma’s Modified Schaffer’s method, animals with grade I and grade II cervix were selected for the study. Group I (control group) buffaloes were administered with dexamethasone (40 mg, I/M), cloprostenol (500 μg, I/M) and mifex (450 mL, slow I/V) after successful detorsion. Along with these drugs, in group II and group III, valethamate bromide (100 mg, I/M) and hyoscine butyl bromide (160 mg, I/M) were administered, respectively. The cervical dilation rate (CDR) of each group was calculated and compared. Blood samples were collected three times: before detorsion, after treatment and at parturition. Group III (2.17±0.07 cm/h) had significantly higher CDR followed by group II (1.39±0.21 cm/h), and control group (0.47±0.19 cm/h). Serum calcium levels were also elevated after treatment. Both drug combinations were found safe haematologically and biochemically

Low voltage ride through capability for resilient electrical distribution system integrated with renewable energy resources

It is evident that renewable energy sources (RES), will soon be considered as primary energy source in electrical networks. However, the increased penetration of RES along with the variable charging profile of electric vehicles in the distribution grid will pose serious technical challenges such as network instability, protection malfunctioning, aggravated line, and low- and high-voltage ride through capabilities. Moreover, the frequent occurrence of natural disasters has posed different dimensional problems for distribution system engineers. Hence, owing to the immediate demand for resilient electrical systems, many researchers have presented planning and operating techniques for resiliency enhancement. Consequently, application of low-voltage ride through (LVRT) during grid transformation in small clusters has significant role. However, the implementation of LVRT in operational methods during the transformation of an electric grid after a natural disaster has a lean share in the literature. Moreover, the applicability of grid code during microgrid formation due to extreme events also drives the planning and operational methodology. Therefore, this article first substantiates the importance of grid codes and IEEE standards for the interconnection of RES plants into a grid. Additionally, the paper presents a succinct summary on various control strategies to overcome the challenges of fault ride through capability, reactive power support, and anti-islanding in integrated wind and solar plants. Thenceforth, the importance of LVRT visibility in resiliency enhancement validated by simulating the urban electrical grid using the DIgSILENT PowerFactory Software

Role of umbilical artery Doppler velocimetry in predicting the adverse perinatal outcomes in hypertensive disorder of pregnancy

Background: Early detection of fetoplacental compromise with Umbilical Artery Doppler indices and to know the predictive value of each indices in predicting perinatal outcome and interventional strategies in these patients.Methods: The present prospective study was conducted on 200 women with hypertensive disorder of pregnancy. Umbilical artery doppler evaluation done in all the patients at (28-32) weeks, (33-36) weeks and (37-40) weeks of gestation and more frequently in those patients having deranged Doppler. Patients divided into two groups women with abnormal Umbilical artery indices (group B) and normal indices (group A). Perinatal outcome of both the groups were compared, analyzed statistically using Chi-square test. Multiple pregnancy, chronic hypertension, fetal congenital anomalies, systemic disease and those lost to follow up till delivery were excluded from study.Results: A total of 200 pregnant women with hypertensive disorder, 64% were primgravida. Abnormal umbilical artery indices seen in 36%. Adverse outcome was seen in 88.88% patients of group B. Statistically significantly higher rate of caeserian section, induction of labour, Preterm delivery, fetal growth restriction, NICU admission, NICU stay >48hrs were seen in group B. In all indices Umbilical artery PI had highest Sensitivity (84.21%), positive predictive value (88.88%) and accuracy (90%).Conclusions: Umbilical artery PI is the most reliable to predict adverse perinatal outcomes and help in appropriate timing of intervention to improve perinatal outcome

CURRENT UPDATES ON COVID-19 VACCINES

Background: COVID-19 caused the world to shut down and made us to critically look out at our advanced healthcare systems that are well prepared for heart diseases, cancers, organ transplantation but not for attack of a tiny virus. WHO and other authorized bodies are continuously issuing advisory on preventive measurements, tracking the outbreak and distributing vital medical kits. Scientific community and vaccine experts have developed and started to distribute safe and effective immunization worldwide. Objective: The paper outlines several developed and developing immunization vehicles for the management of COVID -19 that will hit global market in year 2021. Method: Non clinical and clinical data are collected from authentic sources of World Health Organization portal and press release provided by COVID-19 vaccine developers. Result: Different platforms including mRNA, DNA, Viral vectors, Synthetic peptides etc. have been conversed that are globally involved for elimination of SARS-CoV-2, a causative virus of COVID-19. Conclusion: Numerous academic institutions and companies of worldwide have developed and evaluated their inoculums after extremely compressed clinical trial agendas. Worldwide eminent developers such as Pfizer and BioNTech, Moderna, AstraZenaca and Bharat Biotech are ready with their esteemed products for the management of pandemic COVID-19. They explored pharmaceutical technologies reliant on genetics, nanoengineering and biotechnology for successful development of these anti SARS-CoV-2 inoculums. Taking account on conditions of more vulnerable community including immunocompromised, geriatrics and comorbidities patients the safety and efficacy of vaccine are yet to be monitored.