Background: The “second wave” of the COVID-19 pandemic hit India from early April 2021 to June 2021. We describe the clinical features, treatment trends, and baseline laboratory parameters of a cohort of patients with SARS-CoV-2 infection and their association with the outcome. Methods: This was a retrospective cohort study. Multivariate logistic regression models were fitted to identify clinical and biochemical predictors of developing hypoxia, deterioration during the hospital stay, and death. Results: A total of 2080 patients were included. The case fatality rate was 19.5%. Among the survivors, the median duration of hospital stay was 8 (5–11) days. Out of 853 (42.3%%) of patients who had COVID-19 acute respiratory distress syndrome at presentation, 340 (39.9%) died. Patients aged >45 years had higher odds of death as compared to the 18–44 years age group. Vaccination reduced the odds of death by 40% (odds ratio [OR] [95% confidence interval [CI]]: 0.6 [0.4–0.9], P = 0.032). Patients with hyper inflammation at baseline as suggested by leukocytosis (OR [95% CI]: 2.1 [1.5–3.1], P < 0.001), raised d-dimer >500 mg/dL (OR [95% CI]: 3.2 [2.2–4.7], P < 0.001), and raised C-reactive peptide >0.5 mg/L (OR [95% CI]: 3.7 [2.2–13], P = 0.037) had higher odds of death. Patients who were admitted in the 2 nd week had lower odds and those admitted in the 3 rd week had higher odds of death. Conclusion: This study shows that vaccination status and early admission during the inflammatory phase can change the course of illness of these patients. Improving vaccination rates and early admission of patients with moderate and severe COVID-19 can improve the outcomes.
Background: Neoadjuvant chemotherapy response rates in locally advanced breast cancer (LABC) vary significantly among Indian patients, and the factors affecting pathological complete response (pCR) rate are not clear in this population. Objectives: This study was aimed at identifying the various clinicopathological features associated with achieving pCR and its effect on disease-free survival (DFS) and overall survival (OS) among Indian women diagnosed with LABC. Materials and Methods: Women diagnosed with LABC between 2013 and 2019 and who received neoadjuvant chemotherapy followed by surgery and radiotherapy were ambispectively analyzed for clinicopathological responses and survival outcomes. Factors associated with pCR and the role of pCR as a prognostic factor for survival outcomes were examined. Results: After neoadjuvant chemotherapy, pCR was achieved in 99 (23.3%) patients, with the highest rates noted in patients with triple-negative breast cancer (TNBC) and human epidermal growth factor receptor 2 (HER2)-positive tumors. Compared to hormone receptor-positive tumors with HER2-negative status, all other tumor groups had significantly higher odds of achieving pCR after neoadjuvant chemotherapy (TNBC: adjusted odds ratio [aOR], 4.58 [95% CI, 2.20–9.53]; hormone receptor- and HER2+: aOR, 3.93 [95% CI, 1.66–9.27]; hormone receptor + and HER2+: aOR, 2.78 [95% CI, 1.20–6.44]). Hormone receptor status and attainment of a pCR after neoadjuvant chemotherapy were associated with better DFS and OS outcomes particularly in patients with HER2-positive and TNBC tumors. Conclusions: Patients who attain a pCR following neoadjuvant chemotherapy have improved survival outcomes; pCR rates vary by hormone and HER2 receptor status. Therapeutic approaches such as anti-HER2 and platinum-based regimens may be considered for achieving better pCR rates. The use of biomarkers for the identification of individuals with breast cancer who will not benefit from neoadjuvant chemotherapy should be considered along with early cancer detection strategies.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.