Analysis Of The Scope Of India's Virtual Court Hearings

With the increasing internet accessibility in India and the challenges posed by the Covid-19 pandemic, the practice of virtual court hearing has been accelerated in India. The virtual Court acts as an effective means to conduct Court proceedings, debarring geographical barriers and uplifting Courtroom functioning's productivity. Along with the practical applicability of virtual court hearings in India comes the glitches or challenges posed by the virtual hearing of matters. Nonetheless, the necessity of physical hearing of matters cannot be ignored. In pursuance of this, arguments in favor of reverting towards physical hearings after the pandemic situation ends are being posed before the Indian Judiciary, which negates the applicability of virtual courtrooms. Thereby, this article aims to analyze the applicability, necessity and efficacy of virtual court hearings and the challenges posed by Virtual Court hearings in India.Copyright © 2020 Ubiquity Press. All rights reserved.

Effective management of risk assessment of allergy to the SARS-CoV- 2 vaccine in Barcelona

Background: Public concern has risen regarding the risk of hypersensitivity reactions (HSR) due to vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) in the general allergic population, especially in those with a history of anaphylaxis. Moreover, the associated alarm that patients diagnosed with allergies to polyethylene glycol (PEG) could suffer from an allergic reaction to vaccines against SARS-CoV- 2 has become a limitation during the mass immunization campaign. Method(s): Objective: 1. To describe the management implemented between allergology and primary care physicians (PCP) in our territory during the first mass immunization campaign in order to safely reach the largest number of people immunized. 2. To only asses patients at risk of having an HSR to the components of the SARS-CoV- 2 vaccine according to the algorithm implemented in primary care centers. Method(s): A retrospective study was performed including patients referred to the allergist by PCP due to the potential risk of presenting HSR to SARS-COV- 2 vaccines between March and September 2021. An algorithm was created, to assess the potential risk of presenting HSR to SARS-COV- 2 vaccine in allergic population. Patients were visited firstly by PCP, who applied the algorithm proceeding with virtual consultation with the allergist if needed. Risk assessment performed by the allergist determined if vaccination could continue at their assigned place or if an allergological diagnosis approach was needed. The rate of virtual and physical consultations with the allergist as well as the results of skin test and drug provocation tests were recorded. Result(s): A total of 181 patients were assessed virtually. A total of 147 (81%) patients were immunized at their assigned vaccination point after virtual consultation without incidences. On the other hand, 19% of the patients were assessed by the allergist physically and only 12 (6.6%) patients underwent skin tests and drug provocation test with negative results and good tolerance to the vaccine in all cases. Conclusion(s): A careful allergological risk assessment protocol significantly reduced the number of patients who would have avoided vaccination due to a history of allergies or apparent HSR to the first doses of SARS-CoV- 2, demonstrating the low incidence of true allergy to SARS-COV- 2 vaccines in our territory.

The importance of a comprehensive study in allergic reactions

Background: Polyethylene glycol (PEG) is a condensed polymer of ethylene glycol used as excipient in over 1000 commonly medicines, as well as for industrial products or cosmetics (shampoo, toothpaste.) where it can act as thickener, solvent, softener or humectant. In relation to the recently developed COVID-19 vaccines and their excipients some questions have arisen in our consultations. Method(s): A 48-year- old woman came to our clinic with doubts about the administration of COVID-19 vaccine. 8 years ago, after rectal administration of a healing suppository for an anal fissure she immediately presented a dry cough and a generalized urticaria which subsided spontaneously without attend to the emergency department. 5 years ago, with the application of an hemorrhoid cream se presented an immediate reaction consisting of cough, difficulty breathing and generalized urticaria. The symptoms subsided spontaneously after 30-45 minutes. The patient reported previous tolerance to both drugs. She has avoided them ever since. All these medicines have in common PEG as an excipient. We performed several studies to find out if PEG was the culprit. Result(s): *Prick test with Casenlax (which contains 10 grams of PEG 4000): negative. *Oral provocation test with Casenlax: we started with the intake of 2.5 grams of Casenlax and after 5 minutes she started with oropharyngeal pruritus, dry cough, feeling of shortness of breath and desaturation (since 98% to 92-90%). The patient was monitored and administered intramuscular adrenaline (0.3 ml), methylprednisolone 60 mg and dexchlorpheniramine 5 mg. The symptoms were controlled after 15-30 minutes. *COVID-19 AstraZeneca vaccine was administered without incident. Conclusion(s): Given the high incidence of reactions to the excipients accompanying the drugs, this should be taken into account when taking the patient's medical history and in the subsequent pharmacological study.

Evaluation of bronchial hyperreactivity in patients after Covid-19 infection

Background: A typical patient complaint in patients with a history of Covid-19 infection is dyspnoea with or without exercise. One of the causes of shortness of breath could be bronchial obstruction due to bronchial hyperreactivity (BHR), a characteristic asthma prerequisite. Therefore, we tried to find out if one of the consequences of Covid-19 could be the development of BHR. The objective: of the study was to find out whether Covid-19 infection causes bronchial hyperreactivity. Materials: The study was conducted between 25.01.2021 and 07.10.2021, when the Covid-19 delta variant predominated. During this period, 447 bronchial challenge tests with methacholine (BCT) were performed in patients who complained of dyspnoea. The 96 patients studied had a history of Covid-19 infection. We also identified factors (gender, pneumonia, BMI, smoking, allergy, lung function parameters) that may be associated with positive BPT in patients with a history of Covid-19 infection. Result(s): The study revealed that 43% of patients with a history of Covid-19 had a positive BCT, but uninfected patients had a significantly higher number (56%) of positive BCT (p = 0.02). Factors associated with a positive BCT in patients with a history of Covid-19 infection included allergy (n = 78, p = 0.002) and FEV1/FVC ratio below 0.7 (n = 55, p = 0.04). Other factors were not associated with a positive BCT in patients with a history of Covid-19. Conclusion(s): The cause of dyspnoea in patients with a history of Covid-19 is not associated with bronchial hyperreactivity. Bronchial hyperresponsiveness in infected people is likely to be caused by an underlying allergy, which may be exacerbated by the disease.

COVID-19 vaccine provocation test outcome in high-risk allergic patients: A retrospective study from a tertiary hospital in Indonesia.

Background: High COVID-19 vaccine coverage is essential. Patients who are considered high risk for hypersensitivity reactions and have had an allergic reaction to the COVID-19 vaccine are usually referred to an allergist for assessment of vaccination. Administration of a vaccine graded challenge (also known as a provocation test) is an option that can be considered in this population. This primary objective of this study is to describe the outcome of the COVID-19 vaccine provocation test and to understand the predicting factors associated with hypersensitivity reaction after the provocation test as the secondary objective. Methods: Adult patients with a history of hypersensitivity reaction to the first COVID-19 vaccine and high-allergic patients who underwent COVID-19 vaccine provocation test up until May 2022 were included. A protocol using skin prick test (SPT), intradermal test (IDT), followed by graded challenge was developed for the determined vaccine used. Results: A total of 232 patients were included in the analysis. Twenty-eight had hypersensitivity to their first COVID-19 vaccine dose and 204 were high risk for allergic reaction. Hypersensitivity reactions occurred in 20 patients (8.6%, 95% CI: 5-12.2%), consisting of 4 reactions after SPT, 9 after IDT, 7 during or after titrated challenge. Half of the reactions were mild; however, 3 patients developed severe reactions. Patients with history of anaphylaxis were more likely to experience hypersensitivity reaction after provocation test (aRR = 2.79, 95% CI: 1.05-7.42). Conclusion: Provocation test in COVID-19 vaccination has a high success rate in patients with a history of hypersensitivity to the first COVID-19 vaccine and in high allergic patients. History of anaphylaxis is associated with hypersensitivity reaction after a COVID-19 vaccine provocation test.

Gestational Diabetes during the Pandemic: Screening Methods and Outcomes in First-time GDM

Objective: To study the impact of national recommendations on the method of screening used for GDM during the COVID-19 pandemic, and evaluate differences in maternal and fetal outcomes among women with first-time GDM (ftGDM). Design: A retrospective observational study in a single Tertiary London Hospital. During the pandemic, the RCOG recommended an amended GDM screening protocol to reduce hospital attendance and risk of virus transmission (fasting blood glucose level ≥5.3 and/or HbA1c ≥39 at 28 weeks of gestation). Our Trust did not adopt this due to concerns regarding its sensitivity. We adopt a 2-step approach to universal GDM screening using a 50g glucose challenge test, and refer those screening positive for a full oral glucose tolerance test. Method: Outcomes were reviewed for women with ftGDM delivering a singleton at ≥24 weeks gestation between 01/04/20 -28/ 5/21. Our primary aim was to determine the impact of the change in COVID-19 GDM screening policy, had it been implemented. Our secondary outcomes included GDM management method, maternal and perinatal complications. We excluded women with a booking HbA1c ≥42 (indicative of pre-diabetes) and those who had bariatric surgery. Demographic and outcome data were obtained from electronic databases. Results: 247 women were diagnosed with ftGDM using local screening methods. Only 23 of these women had a HbA1c ≥39 at time of diagnosis and a further 12 had FBG ≥5.3. There was no significant difference in age or ethnicity between the two groups. The locally diagnosed group had a statistically significantly lower booking BMI (P<0.001) and were less likely to require pharmacological management of GDM (P<0.001). There were no significant differences in rates of induction of labour, gestation at delivery, birth weight or any perinatal adverse outcome. However, the women in the Covid-19 GDM screening group were significantly more likely to be delivered by Emergency Caesarean Section (p = 0.03) and have gestational hypertensive disease (p = 0.025). Conclusions: If we had implemented RCOG HbA1c screening, we would have not diagnosed 207 women with GDM, 41% of whom required pharmacological treatment. It is not surprising that women with higher HbA1c values had higher rates of maternal complications, due to the well-established association between maternal hyperglycaemia and adverse obstetric outcomes. As such, it is imperative that more sensitive screening protocols such as the 50g screen are considered in any future pandemics, such that women with GDM can be identified and maternal hyperglycaemia treated to benefit in-utero fetal programming.

Simplifying the drug provocation test in non-immediate hypersensitivity reactions to amoxicillin in children: The experience of a tertiary care allergy unit.

BACKGROUND: Mild non-immediate reactions (NIR) to beta-lactams (ßLs) are the most common manifestation of adverse drug reactions in children, and the drug provocation test (DPT) remains the gold standard for diagnosis. However, there are still controversies about the protocol that should be used, especially regarding the administration of doses and the DPT length. OBJECTIVE: This study aimed to evaluate a pediatric population with a history of mild NIR to amoxicillin (AMX) or to amoxicillin-clavulanic acid (AMX/CL) who underwent a diagnostic workup including a DPT with the culprit drug, to understand if a graded DPT or, instead, a single full dose could be the most appropriate way of administration in clinical practice. METHODS: The data of children were retrospectively analyzed for a 5-year period, with demographic and clinical characteristics collected. We reported the allergy workup and the results of the DPT performed with the administration of incremental doses and a prolonged DPT at home for a total of 5 days. RESULTS: Three hundred fifty-four patients were included. Overall, 23/354 (6.5%) DPTs were positive: 11/23 patients showed a reaction after 2-8 h after the last dose on the 1st or 2nd day (1 reacted 30 min after the last dose), 1/23 reacted with urticaria 30 min after the first dose, 11/23 reacted at home on the 5th day of the DPT. CONCLUSION: This paper indirectly suggests that a single therapeutic dose administered on the 1st day of a DPT could be safe in the diagnostic workup of mild NIR to AMX/CL. Moreover, this could be less time-consuming as patients would spend less time in the hospital, also considering the public health restrictions imposed during the COVID-19 pandemic.

Colchicine-induced fixed drug eruption with first reported positive patch test

Case Report Background : Fixed drug eruption (FDE) is a rare delayed hypersensitivity reaction which is often misdiagnosed. Colchicine is a drug used for gout prophylaxis known to regulate multiple inflammatory pathways. Since 1996 only one case of colchicine-associated FDE has been reported. Case-presentation : A 58-year old man presented at the clinic with recurrent erythematous lesions on the right arm, hand, thighs, chest, and genitals which followed residual hyperpigmentation. First clinical presentation was in 2018 and upon subsequent episodes the lesions appeared on the same skin sites following a tendency to engage larger skin surface and new spots occurred. The patient reported on-demand treatment with colchicine, metamizole, paracetamol, diclofenac for gout arthritis, and acetylsalicylic acid/vitamine C, for Covid-19 prophylaxis. Epicutaneous patch tests with European standard series was performed on healthy skin, and patch testing with colchicine, paracetamol, diclofenac and metamizole was performed on lesional skin. Results were interpreted as positive for: nickel (++), peruvian balm (++), propolis (++), and colchicine (+). The patient did not report intake of food and drugs containing nickel, nor any consumption of honey and propolis-containing products. The patient's history, clinical presentation, and the positive colchicine patch test helped establish the diagnosis of colchicine-induced FDE. Conclusion : We report the second case of colchicine-induced FDE diagnosed for the first time by epicutaneous patch testing on lesional skin. Proper diagnosis might help evade further complications, and the need for oral challenge tests which could be associated with detrimental effects.

Cardio-COVID clinic-a one-center experience

Background: Persistent symptoms affect a relatively large portion of coronavirus disease (COVID) survivors. Hence, specific clinics had been established in order to better characterize and manage this emerging entity of Post-COVID, among them our Cardio-COVID Clinic, which is dedicated to the cardiovascular (CV) aspects of the phenomenon. Aim: To present the experience of our Cardio-COVID Clinic. Methods: Included in this report are 76 adult patients seen at the clinic between June 2020 and March 2021, who have recovered from a polymerase chain reaction (PCR)-confirmed COVID, and who were suspected by their referring physicians to experience ongoing cardiac sequelae. All participants underwent a structured assessment by a single cardiologist, which consisted of history taking, physical examination (PE), electrocardiogram (ECG), trans-thoracic echocardiogram (TTE), and further tests as deemed appropriate, including any combination of Holter, ischemic provocation test, cardiopulmonary exercise test (CPET), cardiac magnetic resonance (CMR), and cardiac computed tomography (CCT). Results: Initial visits occurred within a median of 131 days after diagnosis. Most participants (83%) were referred from our general Long-COVID Clinic. About half were males, and the mean age was 53 years. 18% of participants had prior CV conditions, and the majority (72%) had at least one CV risk factor, mostly dyslipidemia. Nearly all participants experienced a symptomatic acute illness, which was graded according to the National Institutes of Health (NIH) criteria as severe in 23% of the study cohort. As for Post-COVID, late symptoms were present in 97% of patients, the most common being dyspnea (57%). While PE was unremarkable in all but 3 patients who exhibited murmurs, ECG findings were revealed in 45%-mostly non-specific ST-T changes (31%) and conduction abnormalities (14%)-and TTE aberrations were discovered in 28%-including pericardial effusion (24%), reduced left ventricular ejection fraction (LVEF) (5%), grade 2 diastolic dysfunction (3%), moderate and up valvular dysfunction (1%), and systolic pulmonary hypertension (1%);right ventricular function was universally normal. Upon conclusion of the work-up, CV diagnoses were made in 8 (11%) patients-including myocarditis (4), myopericarditis (1), inappropriate sinus tachycardia (1), chronotropic incompetence (1), and an aberrant coronary (1). Of note, CPET and CMR had the highest diagnostic yield, in light of 57% positive results on each-followed by CCT, Holter, and provocation test. Interesting as well, among those with abnormal CMR findings, 40% had normal ECG's and TTE's. Also, none of the CV restraints on CPET translated to provocation test anomalies. Conclusion: CV symptoms of Post-COVID are highly prevalent, but signify actual CV disease only in a minority of patients. Further research is needed that will help identify predictors for CV morbidity and define optimal clinical pathways.