Calibration of Prediction Models of In-hospital Mortality in SARS-CoV-2 Patients Depends also on Data Quality.

How to cite this article: Finsterer J, Scorza FA. Calibration of Prediction Models of In-hospital Mortality in SARS-CoV-2 Patients Depends also on Data Quality. Indian J Crit Care Med 2024;28(2):181-182.

First-Ever Ischemic Stroke In Covid-19: How Is It Different? - A Stroke Registry-Based Study From South India.

BACKGROUND AND AIMS: Stroke associated with COVID-19 has been characterised in several multicentre retrospective studies and meta-analyses. However, they did not distinguish first-ever ischemic strokes (F-AIS). Therefore, we aimed to study the incidence, clinical characteristics, and outcomes of a cohort of F-AIS associated with COVID-19 during the first wave of the pandemic and compare this cohort with those of F-AIS without COVID-19, COVID-19 without stroke. We also sought to compare the stroke admissions and mechanisms during the pandemic and immediate prepandemic periods.

Zinc deficiency as a possible risk factor for increased susceptibility and severe progression of Corona Virus Disease 19.

The importance of Zn for human health becomes obvious during Zn deficiency. Even mild insufficiencies of Zn cause alterations in haematopoiesis and immune functions, resulting in a proinflammatory phenotype and a disturbed redox metabolism. Although immune system malfunction has the most obvious effect, the functions of several tissue cell types are disturbed if Zn supply is limiting. Adhesion molecules and tight junction proteins decrease, while cell death increases, generating barrier dysfunction and possibly organ failure. Taken together, Zn deficiency both weakens the resistance of the human body towards pathogens and at the same time increases the danger of an overactive immune response that may cause tissue damage. The case numbers of Corona Virus Disease 19 (COVID-19) are still increasing, which is causing enormous problems for health systems and economies. There is an urgent need to reduce both the number of severe cases and the resulting deaths. While therapeutic options are still under investigation, and first vaccines have been approved, cost-effective ways to reduce the likelihood of or even prevent infection, and the transition from mild symptoms to more serious detrimental disease, are highly desirable. Nutritional supplementation might be an effective option to achieve these aims. In this review, we discuss known Zn deficiency effects in the context of an infection with Severe Acute Respiratory Syndrome-Coronavirus-2 and its currently known pathogenic mechanisms and elaborate on how severe pre-existing Zn deficiency may pre-dispose patients to a severe progression of COVID-19. First published clinical data on the association of Zn homoeostasis with COVID-19 and registered studies in progress are listed.

The impact of clinical pharmacist implemented education on the incidence of prescribing errors in COVID-19 patients.

Background: Clinical pharmacists have a vital role during COVID-19 pandemic in mitigating medication errors, particularly prescribing errors in hospitals. That is owing to the fact that prescribing errors during the COVID-19 pandemic has increased. Aim: This study aimed to evaluate the impact of the clinical pharmacist on the rate of prescribing errors on COVID-19 patients in a governmental hospital. Methods: The study was a pre-post study conducted from March 2020 till September 2020. It included the pre-education phase P0; a retrospective phase where all the prescriptions for COVID-19 patients were revised by the clinical pharmacy team and prescription errors were extracted. Followed by a one-month period; the clinical pharmacy team prepared educational materials in the form of posters and flyers covering all prescribing errors detected to be delivered to physicians. Then, the post-education phase P1; all prescriptions were monitored by the clinical pharmacy team to assess the rate and types of prescribing errors and the data extracted was compared to that from pre-education phase. Results: The number of prescribing errors in P0 phase was 1054 while it was only 148 in P1 Phase. The clinical pharmacy team implemented education phase helped to significantly reduce the prescribing errors from 14.7/1000 patient-days in the P0 phase to 2.56/1000 patient-days in the P1 phase (p-value <0.001). Conclusion: The clinical pharmacist significantly reduced the rate of prescribing errors in patients with COVID-19 which emphasizes the great role of clinical pharmacists' interventions in the optimization of prescribing in these stressful conditions.

[Research progress on application of laboratory indicators detection of COVID-19].

The outbreak of corona virus disease-19 (corona virus disease-19, COVID-19) caused a huge human disaster from the end of 2019 which is caused by SARS-CoV-2. It will cause damage to multiple organs function in the disease occurrence and development, viral nucleic acid, antibody and serological biochemical immune indicators are mainly indicators of clinical laboratory. The results of these indicators can reflect the organs function of patients and further guide clinical treatment. In this paper, the detection and clinical application of COVID-19 laboratory indicators are reviewed.

Implications of Corona Virus Disease-19 pandemic on cytopathology laboratory-Challenges and solutions in resource-limited settings.

Background: Corona Virus Disease-19 (COVID-19) disease which is still showing peaks and plateau with emerging new mutational viral variants has led to the modification of working of hospitals and medical institutes. Cytopathology laboratories geared up with the changing situation to cope up with not only the COVID-19 patients but also patients of other diseases, particularly oncology patients. It was also important to adopt changes in the cytopathology residency program so as to cope up with the changing scenario. Aim: The present study was conducted to study the various measures adopted and the changes made in the cytopathology laboratory during COVID-19 infection in a resource-limited setting while catering to a large population of COVID-19-positive patients in the north Himalayan region of India. It was also intended to study the methods adopted for effective cytopathology residency training during corona times. Setting and Design: The study was conducted from March 2020 to December 2021 in the cytopathology lab, and all the samples were analyzed and compared with the samples received in pre-corona times from March 2018 to December 2019. The different methods adopted during corona times for effective cytopathology residency training were also analyzed. Results: The total number of samples received in the cytopathology laboratory in pre-corona times from March 2018 to December 2019 were 6822, and samples received from March 2020 to December 2021 were 6567 with decrease of 1.9% of cases. There was increase in 17.4% for the samples of the respiratory tract received in the lab with an increase in cases of infections including aspergillosis, mucormycosis, and tuberculosis. There was 10.3% increase in cytological diagnosis of malignant cases during corona times. Use of 90% alcohol for fixation rather than air drying of smears, avoiding of pneumatic tubes, judicious use of personal protective equipment (PPE) kits along with access to the digital cytology slide database were included in the changes made in the lab. Conclusions: There was a marginal decrease in cytopathological diagnosis during COVID-19 with substantial increase in the malignancy rate of 10.3% in cytological diagnosis of different organs. Diagnosis of mucormycosis, aspergillosis, and tuberculosis infections of respiratory tract cytology increased during this period. Judicious use of limited available resources led not only to smooth functioning of the cytopathology lab but also prevented any infection in the working health personals. Newer online resources were explored and modified for continuous training of the cytopathology residents. Emotional support with effective communication was the key to alleviate any psychological stress among all health professionals in the cytopathology laboratory.

COVID-19 Can Unveil Brugada: A Rare Case.

Brugada syndrome (BRS) is a channelopathy with three characteristic electrocardiogram patterns and an increased risk of sudden cardiac death (SCD), in the absence of gross structural heart disease. Fever is shown to precipitate ventricular arrhythmias in patients with BRS. Here, we report a rare case of Brugada pattern in a patient with Coronavirus Disease 2019 (COVID-19) without fever. A baseline ECG should be considered for patients with COVID-19, even in the absence of fever. COVID-19 by itself may be a factor that can induce Brugada pattern ECGs.

Microbiological profile of multidrug resistant bacteria before and during COVID-19 in CHU Mohammed VI.

Background and Objectives: A new type of corona virus has caused Corona virus disease-19 and, subsequently, a global pandemic. All individuals are prone to the disease, so drastic measures were taken to prevent its spread. This study aimed to evaluate the impact of COVID-19 on the progression of the antimicrobial resistance rate by comparing two periods: before and during COVID-19. Materials and Methods: We used a cross-sectional design to investigate the Antimicrobial Resistance (AMR) rate before (03/2019 to 03/2020) and during COVID-19 (03/2020 to 03/2021) in a University Hospital in Marrakech. The data were analyzed using SPSS Version 25.0. Results: Among the 7106 specimens, there was a significant increase in the multidrug-resistant bacterial from 27.38% to 35.87% during COVID-19 (p<0.001), particularly in blood culture, cerebrospinal fluid, catheter, and pus. However, there was a non-significant change in puncture fluid, expectoration, protected distal sampling, joint fluid, stool culture, and genital sampling. A decrease in Multidrug-resistant bacteria (MDRB) was observed only in cytobacteriological urine tests (p<0.05). According to species, there was an increase in extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus. Conclusion: In our study, it is particularly noticeable that the MDRB has increased. These results highlight the importance that the pandemic has not been able to slow the progression.

ANFIS for prediction of epidemic peak and infected cases for COVID-19 in India.

Corona Virus Disease 2019 (COVID-19) is a continuing extensive incident globally affecting several million people's health and sometimes leading to death. The outbreak prediction and making cautious steps is the only way to prevent the spread of COVID-19. This paper presents an Adaptive Neuro-fuzzy Inference System (ANFIS)-based machine learning technique to predict the possible outbreak in India. The proposed ANFIS-based prediction system tracks the growth of epidemic based on the previous data sets fetched from cloud computing. The proposed ANFIS technique predicts the epidemic peak and COVID-19 infected cases through the cloud data sets. The ANFIS is chosen for this study as it has both numerical and linguistic knowledge, and also has ability to classify data and identify patterns. The proposed technique not only predicts the outbreak but also tracks the disease and suggests a measurable policy to manage the COVID-19 epidemic. The obtained prediction shows that the proposed technique very effectively tracks the growth of the COVID-19 epidemic. The result shows the growth of infection rate decreases at end of 2020 and also has delay epidemic peak by 40-60 days. The prediction result using the proposed ANFIS technique shows a low Mean Square Error (MSE) of 1.184 × 10-3 with an accuracy of 86%. The study provides important information for public health providers and the government to control the COVID-19 epidemic.

Relation between Guillain-Barré syndrome and Covid-19: Case-Series.

Approximately two-thirds of the Guillain-Barré syndrome (GBS) cases are preceded by upper respiratory tract infection or enteritis. There has been previous documentation of a clear association between Covid-19 and GBS. Covid-19 can affect the nervous tissue either through direct damage or through triggering a host immune response with subsequent development of autoimmune diseases such as GBS. Covid-19 can affect the host`s immune system through the activation and interaction of the T-and B-lymphocytes with subsequent production of antibodies that cross-react with the gangliosides. Depending on the nature of the neuronal autoimmune destruction, the affected individual may have either a demyelinating or axonal subtype of GBS. These subtypes differ not only in symptoms but also in the likelihood of recovery. This report presents two cases of GBS that developed after the respiratory symptoms of Covid-19. Their neurological features indicated demyelination, axonal damage, irritation of spinal nerve roots, and impaired sensory and motor transmission with additional facial nerve palsy in the second-studied case. This case report highlights the relationship between GBS and Covid-19 infection.

What Has Changed in Patients Aged 65 and over Diagnosed with Breast Cancer during the COVID-19 Pandemic: A Single-Center Experience.

Introduction: The COVID-19 pandemic has a worldwide negative impact on healthcare systems. This study aims to determine how the diagnosis, clinicopathological features, and treatment approaches of patients with breast cancer (BC) diagnosed at ≥65 years old were affected during the pandemic. This survey has shown that patients, especially the elderly, had to postpone their BC health problems or delay their routine controls due to the risk of COVID-19 transmission, high mortality rates due to comorbidity, and restrictions. Materials and Methods: The medical records of 153 patients with BC diagnosed at ≥65 years old before (January-December 2019; group A, n = 61) and during (March 2020-May 2021; group B, n = 92) the COVID-19 pandemic were retrospectively analyzed. In addition, clinicopathological features of patients, including age, admission form, clinical stage, tumor (T) size-grade-histology-subtype, lymph node involvement, surgery type, and treatment protocols, were evaluated. Results: Patients mostly applied for screening purposes were included in group A and patients who frequently applied for diagnostic purposes due to their existing BC or other complaints were included in group B (p = 0.009). Group B patients had a higher clinical stage (p = 0.026) and had commonly larger (p = 0.020) and high-grade (p = 0.001) Ts. Thus, mastectomy and neoadjuvant systemic therapy were more commonly performed in group B (p = 0.041 and p = 0.005). Conclusion: The survey showed significant changes in BC diagnosis and treatment protocols for patients diagnosed at ≥65 years old during the COVID-19 pandemic. Postponing screening and delaying treatment leads to more advanced BC stages in elderly patients.

Anxiety, Perceived Stress and Coping Strategies among the Nepalese Nurses Working around the World During a Corona Virus Disease -19 Outbreak.

BACKGROUND: Nurses are the frontline health professional of healthcare delivery system prone to have psychosocial problems. This study aimed to explore anxiety, stress and coping strategies among the Nepalese Nurses working around the World during a corona virus disease -19 Outbreak. METHODS: A web based cross sectional study was conducted for a period of three month among 240 nurses from Nepal and working abroad. They were invited to participate via various web based networks. Anxiety Self rating scale, perceived stress Scale and coping strategies were used for data collection. Chisquare, spearman rho and Manwhitnney was used for data analysis. RESULTS: More than half 58.8% were <30 years of age,mean age was 31±7.29 ,range was 20-56 years.Only17.5%were having Mild to Extreme Anxiety and, 62.5% Nepalese nurses were having stress. Regarding coping strategies mean score is higher in positive reframing followed by acceptance.There was significant association between stress and demographic variables marital status and country.Nepalese Nurses working in Nepal were having more anxiety and stress mean score than Nepalese nurses working abroad. CONCLUSIONS: Nepalese nurses working in Nepal were having more anxiety and stress mean score than Nepalese nurses working in abroad. Mean score of coping strategies was higher in avoidant coping (Maladaptive coping) in nurses working in Nepal whereas mean score is higher in Approach coping (Adaptive coping) in Nepalese nurses working abroad.

Clinical Profile and Outcome of Corona Virus Disease-19 Infection in Pregnant Women.

BACKGROUND: The corona virus disease 19 pandemic has affected the whole world with pregnant ladies being more vulnerable population. This study aimed to evaluate characteristics of corona virus disease 19 infection in pregnancy and neonates and whether close proximity to the mother increases the incidence of corona virus disease infection in neonates.. METHODS: This is a hospital based prospective cross sectional observational study done among pregnant women presenting to Paropakar maternity and womens hospital from 1st September 2020 to 31st march 2021 with confirmed corona virus disease 19 infection. RESULTS: The total 160 cases were included in study. Most of the women (33.8%) were of 20- 25 years of age, 55 % were multigravida and 77.6 % were full term. Around 74 % of cases were symptomatic with predominant symptoms being cough, fever and sore throat present in 33.1 %, 18% and 14% respectively. Out of 125 deliveries 71 % of cases underwent cesarean section of which fetal distress was most common indication. Six newborns were positive for corona virus disease 19 infection within 48 hours of life. Mortality was seen in four mothers and three neonates. CONCLUSIONS: The clinical presentation of corona virus disease infection in pregnant ladies is similar to general population. There is no increased risk of vertical transmission to the baby.

Lifestyle Behaviours among General Population During Lockdown Period during Corona Virus Disease-19 Pandemic.

BACKGROUND: Healthy lifestyle behaviours have been consistently associated with reduced non-communicable disease related morbidity, mortality and wellbeing. Unhealthy behaviours are major contributors to the global burden of disease. The main aim of this study is to access lifestyle behaviours in adults during the corona virus disease-19 pandemic. METHODS: Cross sectional study was conducted among general population residing in Nepal. Online questionnaire was developed using Google Forms. Questionnaire comprised of three validated tools regarding the following lifestyle behaviours: Physical activity, Nutrition, Sleep. The collected data was analysed using SPSS version 20. To test the differences between changes in dietary and physical activity behaviours in relation to changes in body weight a Chi-square test was used. RESULTS: During Covid -19 lockdown, 124(42%) participants performed moderate level of physical activity. Of those participated, 127(43.1%) and 44(14.9%) reported an increase and decrease of weight, respectively. Among 110(37.3%) who reported snacking in lockdown led to weight gain in 68(61.8%). Availability of more time for meal preparation (24.1%) and feelings of boredom (17.4%) were the main reasons for changing dietary habits. The subjective sleep quality of participants was as follows: very good-40.3%; fairly good-45.4 %; fairly bad-11.2%; very bad 3.1%. There was significant positive correlation between sleep quality and sleep duration (R=0.261; P<0.001), sleep latency (R=0.362; P<0.001), sleeping medications (R=0.174; P<0.003) and daytime dysfunction (R=0.308; P<0.001). CONCLUSIONS: Life style behaviours were affected during lockdown period. Higher amounts of food intake and snaking were increased. Physical activity was at a moderate level, increased sedentary behaviour was reported by most participants during lockdown. However, sleep quality was not negatively affected.

The Combined Use of Neuropsychiatric and Neuropsychological Assessment Tools to Make a Differential Dementia Diagnosis in the Presence of "Long-Haul" COVID-19.

The longer term neurocognitive/neuropsychiatric consequences of moderate/severe COVID-19 infection have not been explored. The case herein illustrates a complex web of differential diagnosis. The onset, clinical trajectory, treatment course/response, serial neuroimaging findings, and neuropsychological test data were taken into account when assessing a patient presenting 8 months post-COVID-19 (with premorbid attention-deficit hyperactivity disorder, diabetes mellitus, mood difficulties, and a positive family history of vascular dementia). Her acute COVID-19 infection was complicated by altered mental status associated with encephalopathy and bacterial pneumonia. After recovery from COVID-19, the patient continues to experience persisting cognitive and emotive difficulties despite an ongoing psychopharmacotherapy regimen (16 + years), psychotherapy (15 + sessions), and speech-language pathology SLP; 2 × week/for 12 weeks). The purpose of her most recent and comprehensive neuropsychological evaluation was to determine the presence/absence of neurocognitive disorder. The patient is a 62-year-old Caucasian woman. Cognitive screening was completed 3 months post-acute COVID-19 as part of an SLP evaluation, and a full neuropsychological evaluation was conducted 8 months post-COVID-19 recovery on an outpatient basis (in person). The patient had serial neuroimaging. Initial neurological evaluation during acute COVID-19 included unremarkable brain computed tomography (CT)/magnetic resonance imaging. However, follow-up CT (without contrast) revealed, in part, "asymmetric perisylvian atrophy on the left." Full neuropsychological evaluation at 8 months post-COVID-19 recovery revealed a dysexecutive syndrome characterized by language dysfunction and affective theory-of-mind deficit, consistent with dementia. There is need for careful use of differential diagnosis in COVID-19 patients with multiple risk factors that make them more susceptible to long-term neurological complications post-COVID-19. Differential diagnosis should involve multidisciplinary assessment (e.g., neuropsychology, SLP, neurology, and psychiatry).

Myasthenia gravis with ocular symptoms following a ChAdOx1 nCoV-19 vaccination: A case report.

Purpose: We report on the case of a 35-year-old man who developed myasthenia gravis with ocular symptoms following a ChAdOx1 nCoV-19 vaccine injection. Observations: A 35-year-old man complained of binocular diplopia one month following ChAdOx1 nCoV-19 vaccination. He had weak infraduction of the left eye. Upper and lower extremity strength was normal on presentation. A serum antiacetylcholine receptor antibody titer was elevated at 1.60 nmol/L. His diplopia improved temporarily following the application of an ice pack for 2 min. Conclusions and importance: This case report describes a rare occurrence of myasthenia gravis with ocular symptoms as a potential complication of ChAdOx1 nCoV-19 vaccination.

Lockdown-induced Urban Aerosol Change over Changchun, China During COVID-19 Outbreak with Polarization LiDAR.

Depending on various government policies, COVID-19 (Corona Virus Disease-19) lockdowns have had diverse impacts on global aerosol concentrations. In 2022, Changchun, a provincial capital city in Northeast China, suffered a severe COVID-19 outbreak and implemented a very strict lockdown that lasted for nearly two months. Using ground-based polarization Light Detection and Ranging (LiDAR), we detected real-time aerosol profile parameters (EC, extinction coefficient; DR, depolarization ratio; AOD, aerosol optical depth), as well as air-quality and meteorological indexes from 1 March to 30 April in 2021 and 2022 to quantify the effects of lockdown on aerosol concentrations. The period in 2022 was divided into three stages: pre-lockdown (1-10 March), strict lockdown (11 March to 10 April), and partial lockdown (11-30 April). The results showed that, during the strict lockdown period, compared with the pre-lockdown period, there were substantial reductions in aerosol parameters (EC and AOD), and this was consistent with the concentrations of the atmospheric pollutants PM2.5 (particulate matter with an aerodynamic diameter ≤ 2.5 µm) and PM10 (particulate matter with an aerodynamic diameter ≤ 10 µm), and the O3 concentration increased by 8.3%. During the strict lockdown, the values of EC within 0-1 km and AOD decreased by 16.0% and 11.2%, respectively, as compared to the corresponding period in 2021. Lockdown reduced the conventional and organized emissions of air pollutants, and it clearly delayed the time of seasonal emissions from agricultural burning; however, it did not decrease the number of farmland fire points. Considering meteorological factors and eliminating the influence of wind-blown dust events, the results showed that reductions from conventional organized emission sources during the strict lockdown contributed to a 30% air-quality improvement and a 22% reduction in near-surface extinction (0-2 km). Aerosols produced by urban epidemic prevention and disinfection can also be identified using the EC. Regarding seasonal sources of agricultural straw burning, the concentrated burning induced by the epidemic led to the occurrence of heavy pollution from increased amounts of atmospheric aerosols, with a contribution rate of 62%. These results indicate that there is great potential to further improve air quality in the local area, and suggest that the comprehensive use of straw accompanied by reasonable planned burning is the best way to achieve this.

Continuous positive airway pressure in the treatment of COVID-19 patients with respiratory failure. A report of six cases with excellent outcome.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently considered a significant threat to global health and global economy. This new rapidly spreading virus causes enormous stress to healthcare systems as large number of patients present with respiratory failure, needing intubation and mechanical ventilation. While the industry is racing to meet the rising demand for ventilators, all the alternative respiratory support modalities are employed to save lives in hospitals around the globe. We hereby report 6 patients who were diagnosed with SARS-CoV-2 and treated with continuous positive airway pressure in a negative pressure isolated room in a tertiary center in western Greece. The rapid progression of mild flu-like symptoms to respiratory failure in all patients was controlled with the use of continuous positive airway pressure making this strategy a reasonable alternative to respiratory failure due to SARS-CoV-2 as it may avert intubation and mechanical ventilation.

Higher Levels of C-Reactive Protein and Ferritin in Patients with Overweight and Obesity and SARS-CoV-2-Related Pneumonia.

INTRODUCTION: Overweight and obesity are associated with a more severe COronaVirus Disease 19 (COVID-19). Adipose tissue-related chronic inflammation could be a promoter for the occurrence of the cytokine storm that predicts aggravation of COVID-19. The primary aim was to investigate if this increased risk for more severe COVID-19 was associated with a higher inflammatory response. METHODS: We enrolled patients <75 years old hospitalized in a medical COVID-19 ward with SARS-CoV-2-related pneumonia. Patients were classified according to BMI as normal weight, overweight, and obesity. Laboratory parameters were measured at admission and every second day during the hospital stay. RESULTS: Ninety patients (64.4% males; median age 61 years) were enrolled. Invasive mechanical ventilation (IMV) was needed in 9% of the patients with normal weight, in 32.4% of the patients with overweight, and in 12.9% of the patients with obesity (p = 0.045). Maximal C-reactive protein (CRP) level during hospital stay was 92 (48-122) mg/L in patients with normal weight, 140 (82-265) mg/L in patients with overweight, and 117 (67-160) mg/L in patients with obesity (p = 0.037). Maximal ferritin values were 564 (403-1,379) µg/L in patients with a normal weight, 1,253 (754-2,532) µg/L in patients with overweight, and 828 (279-1,582) µg/L in patients with obesity (p = 0.015). CONCLUSION: Patients with overweight and obesity required more IMV and had higher peaks of CRP and ferritin than patients with normal weight during COVID-19.

A vision of immuno-oncology: the Siena think tank of the Italian network for tumor biotherapy (NIBIT) foundation.

BACKGROUND: The yearly Think Tank Meeting of the Italian Network for Tumor Biotherapy (NIBIT) Foundation, brings together in Siena, Tuscany (Italy), experts in immuno-oncology to review the learnings from current immunotherapy treatments, and to propose new pre-clinical and clinical investigations in selected research areas. MAIN: While immunotherapies in non-small cell lung cancer and melanoma led to practice changing therapies, the same therapies had only modest benefit for patients with other malignancies, such as mesothelioma and glioblastoma. One way to improve on current immunotherapies is to alter the sequence of each combination agent. Matching the immunotherapy to the host's immune response may thus improve the activity of the current treatments. A second approach is to combine current immunotherapies with novel agents targeting complementary mechanisms. Identifying the appropriate novel agents may require different approaches than the traditional laboratory-based discovery work. For example, artificial intelligence-based research may help focusing the search for innovative and most promising combination partners. CONCLUSION: Novel immunotherapies are needed in cancer patients with resistance to or relapse after current immunotherapeutic drugs. Such new treatments may include targeted agents or monoclonal antibodies to overcome the immune-suppressive tumor microenvironment. The mode of combining the novel treatments, including vaccines, needs to be matched to the patient's immune status for achieving the maximum benefit. In this scenario, specific attention should be also paid nowadays to the immune intersection between COVID-19 and cancer.