INTRODUCTION:This study aimed to evaluate the role of prophylactic norfloxacin in preventing bacterial infections and its effect on transplant-free survival (TFS) in patients with acute-on-chronic liver failure (ACLF) identified by the Asian Pacific Association for the Study of the Liver criteria.METHODS:Patients with ACLF included in the study were randomly assigned to receive oral norfloxacin 400 mg or matched placebo once daily for 30 days. The incidence of bacterial infections at days 30 and 90 was the primary outcome, whereas TFS at days 30 and 90 was the secondary outcome.RESULTS:A total of 143 patients were included (72 in the norfloxacin and 71 in the placebo groups). Baseline demographics, biochemical variables, and severity scores were similar between the 2 groups. On Kaplan-Meier analysis, the incidence of bacterial infections at day 30 was 18.1% (95% confidence interval [CI], 10–28.9) and 33.8% (95% CI, 23–46) (P = 0.03); and the incidence of bacterial infections at day 90 was 46% (95% CI, 34–58) and 62% (95% CI, 49.67–73.23) in the norfloxacin and placebo groups, respectively (P = 0.02). On Kaplan-Meier analysis, TFS at day 30 was 77.8% (95% CI, 66.43–86.73) and 64.8% (95% CI, 52.54–75.75) in the norfloxacin and placebo groups, respectively (P = 0.084). Similarly, TFS at day 90 was 58.3% (95% CI, 46.11–69.84) and 43.7% (95% CI, 31.91–55.95), respectively (P = 0.058). Thirty percent of infections were caused by multidrug-resistant organisms. More patients developed concomitant candiduria in the norfloxacin group (25%) than in the placebo group (2.63%).DISCUSSION:Primary norfloxacin prophylaxis effectively prevents bacterial infections in patients with ACLF.

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This single-center prospective observational study was conducted to assess the safety and immunogenicity of combination vaccines AstraZeneca’s ChAdOx1-nCov-19 (Covishield in India) and inactivated whole virion BBV152 (Covaxin). A total of 330 unvaccinated healthy volunteers were screened for SARS-COV2 seropositivity. RT PCR tests were conducted for seronegative volunteers (n =44). They were randomly assigned to four groups and given either same or mixed vaccines at an interval of 4 weeks between the two doses. Mix and match of vaccines did not evoke any adverse events. Combination of vaccines elicited similar immune responses in 4 groups. They were further studied dividing into homologous and heterologous vaccine groups. In Conclusion, Combination vaccines are safe and immunogenic and heterologous vaccines elicit better immunogenic response.

Background and objectives During Corona Virus Disease-19 (COVID-19) pandemic, it has been estimated that approximately 10% of health care professionals (HCPs) have been diagnosed contacting  COVID-19. Aerosol-generating procedures have led to change in safety practices among HCPs. We thus evaluated the efficacy of the endoscopic safety measures among HCPs posted in the endoscopy unit. Methods In this retrospective analysis, all endoscopic procedures performed over a period of 4 months, from 1 April to 31 July 2020 were included. We noted indications and number of COVID-positive procedures as well as comprehensive screening of HCPs posted in our endoscopy unit. The aim of the study was to evaluate the incidence and outcome of COVID-19 among HCPs. Results Three thousand four hundred and sixty procedures were included in the analysis. Indications were divided as urgent ( n = 190, 5.49%), semi-urgent ( n = 553, 16%) and non-urgent group ( n = 2717, 78.52%). Thirty-four procedures (0.98%) were done on diagnosed COVID-19 patients. The most common indications were gastrointestinal bleed ( n = 12/34, 35.30%) followed by biliary sepsis ( n = 9/34, 26.5%). Among the HCPs, the incidence of symptomatic COVID-19 was 6.58% ( n = 5/76). All HCPs recovered with excellent outcomes. A comprehensive screening showed 7.90% ( n = 6/76) HCPs having Immunoglobulin G (IgG) antibody in their sera. Conclusion Addition of safety measures in endoscopy leads to low risk of transmission among HCPs.

Despite effective vaccination programs, waning immunity in the vaccinated populations and the emergence of variants of concern posed a risk of breakthrough infections. A booster dose was demonstrated to provide substantially increased protection against symptomatic disease and hospitalization. We aimed to evaluate immune memory and the efficacy of reducing the rate of SARS-CoV-2 infection post heterologous booster with CORBEVAX after primary vaccination with two doses of COVISHIELD. SARS-CoV-2 S1/S2 spike IgG and RBD-specific antibody responses were elicited with both booster vaccines, with a greater response in individuals receiving heterologous booster. T and B memory responses were increased with booster dose, whereas B memory needed a longer duration to develop in individuals who received a homologous booster (90 days) in comparison to a heterologous booster (30 days). RBD-specific B memory and antibody-secreting (non-memory) B lymphocytes were enhanced with both boosters; however, the duration of response was longer with the heterologous booster compared to the homologous, indicating greater protection with the heterologous booster. The rate of infection 14 days after administration of the heterologous booster was comparatively lower than that of the homologous booster, with the symptoms being much less or asymptomatic.

Coronavirus disease (COVID-19) continues to be a major health concern leading to substantial mortality and morbidity across the world. Vaccination is effective in reducing the severity and associated mortality. Data pertaining to the duration of immunity, antibody waning and the optimal timing of booster dose administration is limited. In this cross-sectional study, we assessed the antibody levels in healthcare workers who were fully vaccinated after obtaining Institutional ethics committee approval and informed consent. Whole blood was collected and enumeration of S1/S2 neutralizing antibody levels was carried out using LIAISON SARS-COV-2 S1/S2 IgG assay. A total of 1636 individuals who were vaccinated with Covaxin or Covishield were included. Of these, 52% were males with a median age of 29 years. Diabetes and Hypertension was noted in 2.32% (38/1636) and 2.87% (47/1636) of the individuals. Spike neutralizing antibodies were below the detectable range (<15 AU/ml) in 6.0% (98/1636) of the individuals. Decline in neutralizing antibody was seen in 30% of the individuals above 40 years of age with comorbidities (diabetes and hypertension) after 6 months. These individuals may be prioritized for a booster dose at 6 months.

Introduction Vaccination has shown to be protective against severe coronavirus disease 2019 by various studies. However, the vaccine efficacy was demonstrated to be less against the emerging variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Both vaccine- and infection-induced immunity against SARS-CoV-2 may prevent reinfection and severity. Our study aims to assess and compare the humoral response in heterogeneous population based on infection and vaccination status along with hybrid immunity. Methods A retrospective, observational study of 2,545 adults was conducted. The study groups comprised of group I (n = 309) naive with a single dose of vaccination, group II (n = 357) infected and unvaccinated, group III (n = 590) completely vaccinated with two doses of vaccine, group IV (n = 70) booster dose, group V (n = 602) with hybrid immunity (pre-vaccination infection), and group VI (n = 617) with breakthrough infection (post-vaccination infection). Data pertaining to demographic details, clinical presentations, reverse transcription-polymerase chain reaction, anti-SARS-CoV-2 total antibodies immunoglobulin G (IgG), neutralizing antibodies by anti SARS-CoV-2 sVNT (surrogate virus neutralization test), S1/S2IgG, S-RBD (receptor-binding domain), and ChAdOx1-nCov-19 (Covishield) vaccination were retrieved from electronic health records. Results The mean levels of neutralizing antibodies of group V were S1/S2, RBD (10.5/14.3 times), and sVNT (84.44%) and group VI had S1/S2, RBD (11.4/11.8 times), and sVNT (78.07%) when compared to group III. We also observed a statistically significant higher immune response in group V and VI than group I and II. A higher percentage (18.2%) of group II individuals had severe disease when compared to group V and VI (6.5/10.8%). Conclusion A single dose of ChAdOx1 vaccine gives robust antibody responses in previously infected individuals and may confer long-term hybrid immunity following booster vaccination.

This single-center prospective observational study was conducted to assess the safety and immunogenicity of combination vaccines AstraZeneca’s ChAdOx1-nCov-19 (Covishield in India) and inactivated whole virion BBV152 (Covaxin). A total of 330 unvaccinated healthy volunteers were screened for SARS-COV2 seropositivity. RT PCR tests were conducted for seronegative volunteers (n =44). They were randomly assigned to four groups and given either same or mixed vaccines at an interval of 4 weeks between the two doses. Mix and match of vaccines did not evoke any adverse events. Combination of vaccines elicited similar immune responses in 4 groups. In Conclusion, Combination vaccines are safe and immunogenic.