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Background: Dual anti-platelet therapy is cornerstone in the management of patients with acute coronary syndrome (ACS). The most commonly prescribed combination is aspirin (A) and clopidogrel (C). However, both drugs have the problem of drug resistance (5-40% and 30%, respectively), resulting into vascular events. Prasugrel (P), the newer antiplatelet agent is supposedly better because of different pharmacokinetic profile. However, it is not approved for use in patients with ACS not undergoing intervention. Aim: The present study was aimed at evaluating the effects of P and C on recurrent angina, MI, and stroke within 30 days in patients with ACS managed conservatively, with similar background therapy. Methods: This study was done on 63patients presenting with ACS, diagnosed on the basis of clinical history, ECG findings and cardiac enzymes changes, managed conservatively. The patients were randomized in a1:1 fashion in two groups. The group 1 patients received P (60 mg loading followed by 10 mg P.O. daily, dose was reduced to 30 mg loading and 5 mg maintenance dose in patients aged > 75 years and weight < 60 kgs) and the group 2 patients received C (300mg loading followed by 75 mg P.O. daily). Patient in both the groups received aspirin (325 mg loading followed by 75 mg P.O. daily), atorvastatin (40 mg P.O. daily), weight adjusted enoxaparin and antianginal therapy as appropriate. There were no significant demographic differences between patients in the two groups. Result: The study showed that patients on P responded better, irrespective of age, sex, presence or absence of diabetes, dyslipidemia, ECG changes, and troponin positivity. There was a relative risk reduction of 35.61% (relative risk (RR), 0.64; 95% confidence interval (CI), 0.44-1.01; P=0.05) in the incidence of composite of primary end points in the group receiving prasugrel. No major or minor bleeding episodes were seen in any patient. Although our study is under powered, it creates space for a larger study with prasugrel to find out the true significance of our observation. Conclusions: The present study concluded that prasugrel significantly reduces the incidence of composite of refractory ischemia, MI and CV death and non-significantly reduced refractory ischemia, MI and CV death in patients of ACS managed conservatively.

Several studies have shown that subjects with a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection had significantly higher antibody titers than previously uninfected vaccinees after vaccination with mRNA vaccine. Yet no information is available for other vaccines. In the current observational cohort study, 105 health care workers who had received Covishield an Adeno associated viral vector-based DNA vaccine were enrolled at Sarojini Nadu Medical College Agra, India. The study included 40 (23 men and 17 women) subjects with a previous history of SARS-CoV-2 infection and 65 participants (39 men and 26 women) who were not infected previously. Both the groups received the adenovirus vector vaccine ChAdOx1-S recombinant vaccines (Covishield, Astra Zeneca). The levels of SARS-CoV-2-anti-spike-IgG-antibodies titer were measured using Electrochemiluminescence immunoassay on Roche platform as arbitrary units per milliliter (AU/ml). After 28 days of the second dose, subjects with no previous SARSCoV-2 infection showed a significantly lower level of circulating anti-spike-IgG-antibody titers compared to previously infected participants. After the second dose, we also observed a significant increase in SARS-CoV-2 infection in subjects with no prior history of SARS-CoV-2 infection compared to subjects with a previous history of natural infection. The most important observation of the study is a low percentage of infection in previously infected subjects. The finding of the study also indicates the presence of robust humoral memory response in previously infected patients.

ObjectivesConvalescent plasma (CP) as a passive source of neutralizing antibodies and immunomodulators is a century-old therapeutic option used for the management of viral diseases. We investigated its effectiveness for the treatment of COVID-19.DesignOpen-label, parallel-arm, phase II, multicentre, randomized controlled trial.SettingThirty-nine public and private hospitals across India.ParticipantsHospitalized, moderately ill confirmed COVID-19 patients (PaO2/FiO2: 200-300 or respiratory rate > 24/min and SpO2 ≤ 93% on room air).InterventionParticipants were randomized to either control (best standard of care (BSC)) or intervention (CP + BSC) arm. Two doses of 200 mL CP was transfused 24 hours apart in the intervention arm.Main Outcome MeasureComposite of progression to severe disease (PaO2/FiO2< 100) or all-cause mortality at 28 days post-enrolment.ResultsBetween 22ndApril to 14thJuly 2020, 464 participants were enrolled; 235 and 229 in intervention and control arm, respectively. Composite primary outcome was achieved in 44 (18.7%) participants in the intervention arm and 41 (17.9%) in the control arm [aOR: 1.09; 95% CI: 0.67, 1.77]. Mortality was documented in 34 (13.6%) and 31 (14.6%) participants in intervention and control arm, respectively [aOR) 1.06 95% CI: −0.61 to 1.83].InterpretationCP was not associated with reduction in mortality or progression to severe COVID-19. This trial has high generalizability and approximates real-life setting of CP therapy in settings with limited laboratory capacity. A priori measurement of neutralizing antibody titres in donors and participants may further clarify the role of CP in management of COVID-19.Trial registrationThe trial was registered with Clinical Trial Registry of India (CTRI); CTRI/2020/04/024775.