Donor Arrangement Research Articles

It takes a village: A pilot cross-randomized trial to enhance pregnancy care and support in northern Ghana.

Maternal mortality remains a challenge in Ghana, where 263 women per 100 000 live births die during pregnancy or childbirth. Barriers to reaching the recommended antenatal care (ANC) include poor access to quality health care, cultural factors, and lack of support for pregnant women. We piloted two cross-randomized interventions: durbars, or local community meetings that incorporated education about ANC and supporting pregnant women, and an enhanced ANC model that added phone calls and a home visit to standard care. The study took place in 30 villages in the Upper East Region of Ghana between August 2021 and November 2022. We tracked 277 women during pregnancy, with 120 women randomly assigned to the enhanced ANC intervention and 142 women living in villages randomized to the durbar intervention. Women who were randomized to the enhanced ANC intervention were 13.2 percentage points (pp) (95% confidence interval (CI) = 0.1, 24.3) more likely to have average or above average knowledge of pregnancy danger signs, 22.1 pp (95% CI = 9.1, 36.5) more likely to have a birth plan, 28.2 pp (95% CI = 13.0, 42.4) more likely to prepare the plan with their partners, and 16.4 pp (95% CI = 0.9, 29.3) more likely to pay for delivery with funds set aside in birth plan. They were also 35 pp (95% CI = 16.1, 48.1) more likely to make blood donor arrangements than control women who made birth plans. We found no impact of the durbar intervention on study outcomes. Evidence from this pilot suggests that interventions that increase interactions between health providers and pregnant women outside of the health facility may substantially improve women's experience during pregnancy and maternal health outcomes. Providing structured ways for men to get engaged in ANC increased their involvement. Although we found no evidence the community meetings improved study outcomes, larger studies with repeated meetings and community-wide surveys are needed to make causal conclusions. American Economic Association RCT Registry: 10360; ISCRNT: ISRCTN95961119.

Photophysical properties of donor (D)-acceptor (A)-donor (D) diketopyrrolopyrrole (A) systems as donors for applications to organic electronic devices.

Fourteen substituted diketopyrrolopyrrole (DPP) molecules in a donor (D)-acceptor (DPP)-donor (D) arrangement were designed. We employed density functional theory, time-dependent DFT, DFT-MRCI and the ab initio wave function second-order algebraic diagrammatic construction (ADC(2)) methods to investigate theoretically these systems. The examined aromatic substituents have one, two, or three hetero- and non-hetero rings. We comprehensively investigated their optical, electronic, and charge transport properties to evaluate potential applications in organic electronic devices. We found that the donor substituents based on one, two, or three aromatic rings bonded to the DPP core can improve the efficiency of an organic solar cell by fine-tuning the highest occupied molecular orbital/lowest unoccupied molecular orbital levels to match acceptors in typical bulk heterojunctions acceptors. Several properties of interest for organic photovoltaic devices were computed. We show that the investigated molecules are promising for applications as donor materials when combined with typical acceptors in bulk heterojunctions because they have appreciable energy conversion efficiencies resulting from their low ionization potentials and high electron affinities. This scenario allows a more effective charge separation and reduces the recombination rates. A comprehensive charge transfer analysis shows that D-A (DDP)-D systems have significant intramolecular charge transfer, further confirming their promise as candidates for donor materials in solar cells. The significant photophysical properties of DPP derivatives, including the high fluorescence emission, also allow these materials to be used in organic light-emitting diodes.

Excited-State Dynamics in Segregated Donor-Acceptor Stacks Versus a Peri-Bisdonor-Acceptor System.

The investigation of impact of through-space/through-bond electronic interaction among chromophores on photoexcited-state properties has immense potential owing to the distinct emergent photophysical pathways. Herein, the photoexcited-state dynamics of homo-sorted π-stacked aggregates of a naphthalenemonoimide and perylene-based acceptor-donor (NI-Pe) system and a fork-shaped acceptor-bisdonor (NI-Pe2) system possessing integrally stacked peri-substituted donors was examined. Femtosecond transient absorption (fsTA) spectra of NI-Pe monomer recorded in chloroform displayed spectroscopic signatures of the singlet state of Pe; 1Pe*, the charge-separated state; NI-⋅-Pe+⋅, and the triplet state of Pe; 3Pe*. The examination of ultrafast excited-state processes of NI-Pe aggregate in chloroform revealed faster charge recombination ( =1.75 ns) than the corresponding monomer ( =2.46 ns) which was followed by observation of a broad structureless band attributed to an excimer-like state. The fork-shaped NI-Pe2 displayed characteristic spectroscopic features of the NI radical anion (λmax~450 nm) and perylene dimer radical cation (λmax~520 nm) upon photoexcitation in non-polar toluene solvent in the nanosecond transient absorption (nsTA) spectroscopy. The investigation highlights the significance of intrinsic close-stacked arrangement of donors in ensuring a long-lived photoinduced charge-separated state ( =1.35 μs) in non-polar solvents via delocalization of radical cation between the donors.

(Invited) Photochemistry of Metal-Assisted Electron Donor-Acceptor Assemblies

Here, we demonstrate a metal-ion assisted electron donor(D)-acceptor(A) arrangement. In this context, recently, we have reported that the zinc-ion assisted one-dimensional arrangement (A/D/A) of electron donor and acceptor (JACS 2020). Here, the present work studied on zinc-ion assisted circular arrangement, cyc-A/D-D-A/D-D.

The effect of histidine, histamine, and imidazole on electrochemical properties of Cu(II) complexes of Aβ peptides containing His-2 and His-3 motifs.

The N-truncation of amyloid beta (Aβ) peptides could lead to peptide sequences with the histidine residue at the second and third positions, creating His-2 and His-3 motifs, known as high-affinity Cu(II) binding sites. In such complexes, the Cu(II) ion is arrested in a rigid structure of a square-planar arrangement of nitrogen donors, which highly limits its susceptibility to Cu(II) reduction. Cu(II) reduction fuels the Cu(II)/Cu(I) redox cycle, which is engaged in the production of reactive oxygen species (ROS). Employing electrochemical techniques, cyclic voltammetry (CV) and differential pulse voltammetry (DPV), together with UV-vis spectroscopy, we showed that low-molecular-weight (LMW) substances, such as imidazole, histamine, and histidine, could enhance the redox activity of Cu(II) complexes of three models of N-truncated Aβ peptides, Aβ4-9, Aβ5-9, and Aβ12-16, identifying three main mechanisms. LMW compounds could effectively compete with Aβ peptides for Cu(II) ions, forming Cu(II)/LMW species, which are more prone to Cu(II) reduction. LMW substances could also shift the equilibrium between the Cu(II)/Aβ species towards the species with higher susceptibility to Cu(II) reduction. Finally, the presence of LMW molecules could promote Cu(I) reoxidation in ternary Cu(II)/Aβ/LMW systems. The obtained results raise further questions regarding the Cu(II) redox activity in Alzheimer's disease.

8-Oxoguanine Forms Quartets with a Large Central Cavity.

Oxidation of a guanine nucleotide in DNA yields an 8-oxoguanine nucleotide (oxoG) and is a mutagenic event in the genome. Due to different arrangements of hydrogen-bond donors and acceptors, oxoG can affect the secondary structure of nucleic acids. We have investigated base pairing preferences of oxoG in the core of a tetrahelical G-quadruplex structure, adopted by analogues of d(TG4T). Using spectroscopic methods, we have shown that G-quartets can be fully substituted with oxoG nucleobases to form an oxoG-quartet with a revamped hydrogen-bonding scheme. While an oxoG-quartet can be incorporated into the G-quadruplex core without distorting the phosphodiester backbone, larger dimensions of the central cavity change the cation localization and exchange properties.

The impact of Covid-19 on gamete shipping by Australian and New Zealand patients.

Cross-border surrogacy and egg donor arrangements are an increasingly common means to family building. Establishing patterns of use has always been difficult in relation to Australian patients. Accurate data is stymied by lack of documentation of international third-party reproductive care available to Australian authorities. When international travel bans came into effect, it is hypothesised that those planning to use cross-border reproductive care had to rely significantly more on local in vitro fertilisation (IVF) clinics for services such as sperm freezing, embryo creation and gamete release procedures. To quantify and characterise the impact of the Covid-19-related travel ban on international and interstate gamete shipping by Australian IVF clinics. Thirty-one Australian and New Zealand IVF clinics were invited to provide de-identified data on interstate and international gamete export applications from two 12month time periods pre- and during Covid-19-related international travel lockdowns. Seven IVF organisations provided data on: patient age; type of gametes exported; destination country/state; and date gamete release approved. Most gametes (78%) were shipped to another Australian IVF clinic and 22% internationally. Patient-initiated shipping domestically and internationally both showed significant increases when comparing pre- and post-Covid datasets. Of the 21 destination countries reported for international shipments, the US was the commonest (39%), followed by Ukraine (21%) and Canada (9%). The inability of involuntarily infertile patients to travel internationally, rather than halt cross-border reproductive care, has led to a significant increase in the uptake of gamete shipping. The high proportion of internationally shipped gametes going to the US and Ukraine is likely a reflection of the availability of surrogates and donors and more amenable legal frameworks.

The Impact of Covid-19 Travel Restrictions on Gamete Shipping from Australian IVF Clinics

Background: Cross-border surrogacy and egg donor arrangements are an increasingly common means to family building. Establishing patterns of use has always been difficult in relation to Australian patients. Accurate data is stymied by lack of documentation of international third-party reproductive care available to Australian authorities. Since Australia’s international travel ban came into effect, it is hypothesised that those planning to use cross-border reproductive care have had to rely significantly more on local IVF clinics for services such as sperm freezing, embryo creation and gamete release procedures. Establishing the increase in gamete shipping as a result of the ban on non-essential travel will improve understanding of the resource impact on Australian IVF laboratories. Such data can also assist policymakers assess the utility of state-based regulations relevant to CBRC. Aim: Quantify and characterise the impact of the Covid-19-related travel ban on Cross-Border Reproductive Care amongst patients of Australian IVF clinics. Method: All Australian IVF clinics were invited to provide de-identified data on interstate and international gamete export applications from two 12 month time periods pre and during Covid-19 related international travel lockdowns. Each dataset included: patient age; type of gametes exported; destination country or state; and date gamete release was approved. Results: Results showed a very significant increase in gamete shipping in the twelve months after Covid-19 travel restrictions were enforced. They illustrate the comparative prevalence of shipping to established and newer destinations during the periods March 2019–February 2020 and June 2020–May 2021. The volume of shipping to the commonest destinations is quantified. Conclusion: The inability of involuntarily infertile patients to travel internationally, rather than halt cross-border reproductive care, has led to a significant increase in update of gamete shipping. This is likely associated with increased utilization of Australian IVF clinics for embryo creation purposes. The high proportion of internationally-shipped gametes going to the US and Ukraine is likely a reflection of the availability of surrogates and donors and the legal frameworks.

Ternary Polymer Solar Cells with Low-Cost P3HT as the Second Donor by the Complementary Absorption Region from Long-Wavelength to Medium-Wavelength Regions Forming Cascaded HOMO and LUMO Energy Levels

In this work, ternary polymer solar cells (PSCs) were constructed with PTB7-Th as the host donor, O-IDTBR as the acceptor, and P3HT as the third component material. Two binary PSCs showed different advantages. The PTB7-Th-based binary PSCs showed the advantage of high VOC (1.03 V), while P3HT-based binary PSCs showed the advantage of a high fill factor (FF) (69.52%). P3HT can complement the medium-wavelength absorption spectra and allows efficient exciton dissociation due to the cascade’s lowest unoccupied molecular orbital and highest occupied molecular orbital level between P3HT, PTB7-Th, and O-IDTBR. Therefore, the optimized ternary PSCs combine the advantage of two binary PSCs. The optimized ternary PSCs showed higher JSC and FF than PTB7-Th-based binary PSCs and higher VOC than P3HT-based binary PSCs. P3HT can simultaneously enhance the arrangement of the blend donor to enhance crystallization, decrease roughness, and improve charge-carrier kinetic processes. In addition, the optimized ternary PSCs showed better thermal stability than PTB7-Th-based binary PSCs.

Synthetic Route to Conjugated Donor-Acceptor Polymer Brushes via Alternating Copolymerization of Bifunctional Monomers.

Alternating donor–acceptor conjugated polymers, widely investigated due to their applications in organic photovoltaics, are obtained mainly by cross-coupling reactions. Such a synthetic route exhibits limited efficiency and requires using, for example, toxic palladium catalysts. Furthermore, the coating process demands solubility of the macromolecules, provided by the introduction of alkyl side chains, which have an impact on the properties of the final material. Here, we present the synthetic route to ladder-like donor–acceptor polymer brushes using alternating copolymerization of modified styrene and maleic anhydride monomers, ensuring proper arrangement of the pendant donor and acceptor groups along the polymer chains grafted from a surface. As a proof of concept, macromolecules with pendant thiophene and benzothiadiazole groups were grafted by means of RAFT and metal-free ATRP polymerizations. Densely packed brushes with a thickness up to 200 nm were obtained in a single polymerization process, without the necessity of using metal-based catalysts or bulky substituents of the monomers. Oxidative polymerization using FeCl3 was then applied to form the conjugated chains in a double-stranded (ladder-like) architecture.

Comparative assessment of birth preparedness and complication readiness among women in rural and urban areas of Bangladesh

Background: Birth preparedness and complication readiness is an imperative intervention which has proven to reduce delays in care seeking behavior in case of obstetric emergencies. Although, many pregnant women and their families do not take the suggested steps to prepare for childbirth, despite of being known of them. Additionally, marked disparities often have been observed between rural and urban areas, with more maternal and neonatal deaths occurring in the rural areas owing to the unpreparedness. This study thus set out to assess and compare the knowledge, practice and factors associated with birth preparedness and complication readiness among women from rural and urban areas in Bangladesh. Methodology: A cross-sectional comparative study design have been undertaken among 250 rural and 240 urban women in the Department of Obstetrics and Gynecology, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh and Shaheed Sayed Nazrul Islam Medical College and Hospital, Kishoreganj, Dhaka over a period of 6 months from 1st October 2020 to 30th March 2021. All pregnant women who attended in the antenatal clinic of SSNIMCH and SSMCH for the first time during the study period was include in the study. Quantitative data was collected by the use of semi structured questionnaires adapted from the safe motherhood questionnaire, developed by maternal and neonatal Programme of Johns Hopkins Programme for International Education in Gynaecology and Obstetrics (JHPIEGO) an affiliate of John Hopkins University. Result: Birth preparedness and complication readiness was evident in 34.17% of the urban and 30.4% of the rural respondents. Urban women were statistically significantly more aware of the danger signs of pregnancy, labour and postpartum period (p<0.001). Selection of place of delivery, arrangement of transportation, emergency fund and blood donor was the most important actions taken as part of birth preparedness both in rural and urban respondents. Null birth preparedness was observed among 28.0% of the rural respondents compared to 2.50% of the urban respondents. The decision regarding the place of delivery was taken mostly by their husband both in urban and rural sub sets. Thus, this study findings showed low practice of BPACR both among urban and rural community while rural people showed more inaction than urban people. Bioresearch Commu. 8(2): 1100-1105, 2022 (July)

Selective Formation of Intramolecular Hydrogen-Bonding Palladium(II) Complexes with Nucleosides Using Unsymmetrical Tridentate Ligands.

Three palladium(II) complexes with amino-amidato-phenolato-type tridentate ligands were synthesized and characterized by 1H NMR spectroscopy and X-ray crystallography. The strategic arrangement of a hydrogen-bond donor and acceptor adjacent to the substitution site of the PdII complex allowed the selective coordination of nucleosides. Among two pyrimidine-nucleosides, cytidine and 5-methyluridine, cytidine was successfully coordinated to the PdII complex while 5-methyluridne was not. On the other hand, both purine-nucleosides, adenosine and guanosine, were coordinated to the PdII complex. As purines have several coordination sites, adenosine afforded three kinds of coordination isomers expected from the three different donors. However, guanosine afforded a sole product according to the ligand design such that the formation of double intramolecular hydrogen-bond strongly induced the specific coordination by N1-position of guanine moiety. Furthermore, the preference of the nucleosides was evaluated by scrambling reactions. It was found that the preference of guanosine is nearly twice as high as adenosine and cytidine, owing to the three-point interaction of a coordination bond and two hydrogen bonds. These results show that the combination of a coordination and hydrogen bonds, which is reminiscent of the Watson–Crick base pairing, is an effective tool for the precise recognition of nucleosides.

Evaluation of Pregnant Women's Awareness of Birth Preparedness. A Cross-Sectional Study

Aim: To evaluate pregnant women who are going to receive maternity care at the research area about birth preparation and catastrophe preparedness and warnings in the form of symbols throughout pregnancy, delivery, and postpartum Study design: A cross-sectional study Place and duration: This study was conducted at Muhammad Medical and Dental College Ratanabad Mirpurkhas Pakistan from March 2020 to March 2021. Methodology: After receiving permission, 153 pregnant women between the ages of 20 and 45 were recruited. Data was collected using a standardized questionnaire. Throughout all three stages, information was gathered on how well they understood the early symptoms: pregnancy, labor, and postpartum (2 days after birth). Results: A total of 63.34% of participants had never heard of BPCR. 7.1% made transportation preparations, 12 percent prepared blood donor arrangements, 27.23 percent arranged emergency funds, and 41.27 percent found a credentialed provider. 64.32% of women chose a health institution for the birth ahead of time, and 62.15% had four or more prenatal appointments. Vaginal bleeding (66.0%), placenta not delivered within 30 minutes of labor (61.2%), and vaginal bleeding (50.23%) were all stated as warning factors during pregnancy, delivery, and postpartum, respectively. Conclusion: During all three stages of pregnancy, there was a lack of awareness about BPCR and immediate warning signs. Increased prenatal visits present an incentive to educate mothers about BPCR and warnings in the form of symbols. There was a paucity of understanding regarding BPCR and warning signals in all three periods of pregnancy. Keywords: Antenatal care; Birth preparedness; Postpartum; Labor; Complication readiness; Complications of pregnancy

Red room temperature phosphorescence of lead halide based coordination polymer showing efficient angle-dependent polarized emission and photoelectric performance.

The development of organic-inorganic hybrid materials with long-lived room temperature phosphorescence (RTP) has attracted tremendous attention owing to their promising applications in the optoelectronic and anti-counterfeiting fields. In this work, by the selection of lead halide and electron-poor heteroaromatic molecule 1,10-phenanthroline (phen), a coordination polymer [Pb(phen)Cl2] has been synthesized under hydrothermal conditions. This complex shows an alternating arrangement of a long-range order of phen π-conjugated systems and lead halide inorganic chains as revealed by X-ray single-crystal structural analysis. This structural character and special chemical components endow this hybrid material with a rare example of red room temperature phosphorescence. Its electronic structure and electronic transition behavior were further examined by theoretical calculations. Meanwhile, the film of the complex features remarkable angle-dependent polarized emission and photoelectric performance.

Room-Temperature Phosphorescent Co-Crystal Showing Direct White Light and Photo-Electric Conversion.

The development of molecular crystalline materials with efficient room-temperature phosphorescence has been obtained much attention due to their fascinating photophysical properties and potential applications in the fields of data storage, bioimaging and photodynamic therapy. Herein, a new co-crystal complex [(DCPA) (AD)2] (DCPA = 9,10-di (4-carboxyphenyl)anthracene; AD = acridine) has been synthesized by a facile solvothermal process. Crystal structure analysis reveals that the co-crystal possesses orderly and alternant arrangement of DCPA donors and AD acceptors at molecular level. Fixed by strong hydrogen bonds, the DCPA molecule displays seriously twisty spatial conformation. Density functional theory (DFT) calculations show well separation of HOMO and LUMO for this co-crystal system, suggesting the efficient triplet excitons generation. Photoluminescence measurements show intensive cyan fluorescence (58.20 ns) and direct white phosphorescence (325 µs) emission at room-temperature. The transient current density–time curve reveals a typical switching electric response under the irradiation of simulated light, reveal that the [(DCPA) (AD)2] co-crystal has a high photoelectric response performance.

Cover Picture: Self‐Assembled Metal–Organic Framework Stabilized Organic Cocrystals for Biological Phototherapy (Angew. Chem. Int. Ed. 44/2021)

Lanterns on water resemble aqueous dispersible metal–organic framework (MOF) structures composed of an alternating arrangement of donor and acceptor molecules. This “lantern”-type network stabilizes the charge-transfer interactions. Under light irradiation, the “lanterns” light up, representing an enhanced photothermal effect, as reported by Chunying Duan, Gang Han et al. in their Communication on page 23569.

Chiral Thermally Activated Delayed Fluorescence Materials Based on R/S‐N2,N2′‐Diphenyl‐[1,1′‐binaphthalene]‐2,2′‐diamine Donor with Narrow Emission Spectra for Highly Efficient Circularly Polarized Electroluminescence

AbstractIn this study, two pairs of chiral thermally activated delayed fluorescence (TADF) materials enabling circularly polarized luminescence (CPL) named R/S‐p‐BAMCN (rod‐shape) and R/S‐o‐BAMCN (helix‐shape) are prepared based on a new pair of chiral donor (D*), R/S‐N2,N2′‐diphenyl‐[1,1′‐binaphthalene]‐2,2′‐diamine (R/S‐BAM), and two cyano (CN) acceptors. Due to the rigid molecular structure and special intramolecular arrangement, the chiral TADF materials show high photoluminescence quantum efficiency (up to 0.86) with narrow full‐width at half‐maximum (38 nm in cyclohexane, 51 nm in toluene) and photoluminescence dissymmetry factor (|gPL|) up to 5.3 × 10−3. Particularly, the circularly polarized OLEDs (CP‐OLEDs) with rod‐shaped R/S‐p‐BAMCN as the emitter show high device performances with the maximum external quantum efficiency nearing 28%. Meanwhile, the semi‐transparent CP‐OLEDs based on helix‐shaped R/S‐o‐BAMCN exhibit obvious circularly polarized electroluminescence (CPEL) properties with the electroluminescence |gEL| factors around 4.6 × 10−3. The strategy of rigid D*‐A‐D* structure with special arrangement of chiral donor provides a direct way to obtain efficient CP‐TADF materials with narrow emission spectra and promising CPL properties for better CPEL performance.

Donor-acceptor 2D covalent organic frameworks for efficient heterogeneous photocatalytic α-oxyamination

Covalent organic frameworks (COFs) have received widespread interest due to their high porosity, excellent crystallinity, tailorable structures, and broad application prospects. It has been demonstrated that proper combination and arrangement of electron donor and acceptor units in 2D conjugated COF lattice could promote efficient charge separation and electron transfer, and thus is beneficial for photocatalysis. In this article, three donor-acceptor (D-A) 2D COFs were prepared by Schiff base reaction of electron acceptor 4,4′,4″,4‴-(benzo[1,2-d:4,5-d′]bis(oxazole)-2,4,6,8-tetrayl)tetraaniline (BBO) with different electron donors: thieno[3,2-b]thiophene-2,5-dicarbaldehyde (TT), benzo[1,2-b:4,5-b′]dithiophene-2,6-dicarboxaldehyde (BDT) and terephthalaldehyde (Ph), respectively. These D-A 2D COFs exhibited prominent photocatalytic activity towards α-oxyamination of 1,3-dicarbonyl with 2,2,6,6-tetramethyl-1-piperdinyloxy (TEMPO) upon visible light irradiation. Among these D-ABBO-COFs, DTT-ABBO-COF exhibited the highest photocatalytic rates, which can be ascribed to the more negative highest occupied molecular orbital (HOMO) and narrower bandgap. The excellent stability, high activity and superior recyclability render DTT-ABBO-COF as a potential and environmentally friendly heterogeneous catalyst for α-oxyamination.

Management of Indian Haematology Patients during COVID19 Crisis

Introduction :- In current COVID19 situation, we have tried to formulate a practical approach for managing haematology patients, which we have been following for the last four months at our centre. Cancer can kill; COVID also can kill. The aim is to be alive till the end of pandemic - both patients and doctors. Some general points for consideration:Due to lockdown and general panic, the stocks in Blood Banks are in an all-time low. So transfusions and donor arrangements have to be dealt judiciously. [6,7]Telemedicine was encouraged to reduce hospital visits in all chronic follow up patients who are stable with safe blood counts. Our Haematology Management Protocol - COVID19 Acute Myeloid LeukaemiaFor Acute Promyelocytic Leukaemia cases it was the same as before.Acute Myeloid Leukaemia - NON-M3We admitted all these patients with one attendee for few hours in COVID suspect ward and did COVID19 test before starting treatment. We were worried about intense 7+3 induction regimen. Hypomethylating agent (Subcutaneous Azacitidine or five-day protocol Decitabine) + Venetoclax or Midostaurin was preferred than a 7+3 nightmare.For consolidation, we continued either hypomethylating agents or preferred 1.5gm cytarabine BD on Day 1,2,3. This protocol had a minimal blood product requirement and lessened the chance of febrile neutropenia. Acute Lymphoblastic LeukemiaWe did a 50% dose reduction of induction drugs and used minimal steroids In elderly patients, Vincristine + steroids were considered and few received 50% dose adjusted R-HYPER-CVAD / MACFor Consolidation we gave home-based Subcutaneous Cytarabine or switched to oral 6-MP/Methotrexate maintenance. We tried to keep WBC counts >2,000/microL in maintenance patients. Myelodysplastic SyndromesHigher-risk MDS (IPSS-R score of >3.5): We gave Hypomethylating agents (without reducing doses). We made Transfusion cut-off as Hb < 7gm and Platelet < 10,000/microL or clinical bleeding.Myelo- proliferative Neoplasms the protocol was the same like before. Myeloma [12]For Newly Diagnosed cases if <65 years -VRd x 4 cycles, followed by autograft & Lenalidomide maintenance protocol were continued.We converted Bortezomib to no more than weekly injections.We continued myeloma autograft with 140mg/m2 Melphalan. For Maintenance, we continued single-agent iMID. For Relapse - we tried weekly Carfilzomib with Pomalidomide. Hodgkin LymphomaWe gave ABVD every two weeks with Peg GCSF or mid-cycle home GCSF. This avoided severe neutropenia. We used liberal prophylactic antibiotics. In relapsed cases, Gemcitabine based or three-day admission DHAP salvage were given. We did dose adjusted BEAM autografts. Non- Hodgkin Lymphoma Indolent NHL:In asymptomatic patients, Wait & Watch policy with monthly monitoring was done. We gave R-CVP. Oral Ibrutinib home therapy for Marginal zone, Mantle cell, Small cell lymphoma, and Waldenstrom Macroglobulinemia. Relapsed /Refractory cases, we used Lenalidomide, Ibrutinib with or without Rituximab.High-grade Non-Hodgkin LymphomaIf fit - R-CHOP 14/21 was given with GCSF support. For Frail patients, we preferred R-CVP. Suspected CNS lymphoma, we gave R-CHOP with IT Methotrexate than HDMTx. In few patients, we considered Lenalidomide / Ibrutinib maintenance.Dose adjusted BEAM autografts were done. Bone marrow transplantWe did a detailed discussion about the pros and cons with patient and attendee. We admitted them in a separate block and got both tested for COVID19. The donor was made to stay as attendee for the patient. We shifted them inside transplant unit and observed for a week to rule out COIVD symptoms. For autograft , we did around 30% dose reduction but for allograft, no drug dose modification was done. Once engrafted, they were discharged early and kept on follow-up. From first lockdown to mid June 2020 , we completed twelve bone marrow transplants in our centre which included five AML haplo-identical transplants. ConclusionAs we wait for the situation to better, the normal functioning of hospitals may take some more time even months. These above are the methods we are following in our MIOT hospital at Chennai, India the city which has got around 30,000 COVID19 cases during submission. Our advice is where ever feasible, we should try to stick to time tested conventional protocols. The above protocols may be useful temporarily till the COVID crisis is over.DisclosuresNo relevant conflicts of interest to declare.

How We Did Bone Marrow Transplants amidst the COVID19 Pandemic

IntroductionCOVID19 is the most heard name for the last six months, and the situation seems to worsen now. This pandemic has created significant stress on the healthcare system. Most of the resources are being diverted to COVID care, and care of non-COVID patients is compromised. As haematologists dealing with frail immune-compromised patients, challenges we are facing are staff attrition, near-empty blood banks, less intensive care beds, the chance of our patients getting infected with COVID during the hospital stay, fear of donors being asymptomatic COVID carriers to mention a few. In this situation, we have tried to formulate a practical approach for doing bone marrow transplants, which we have been following for the last few months at our centre.Our Transplant ProtocolInitially we tried to postpone transplants. But as the COVID situation was becoming a chronic one, we formulated our ways to start transplants. Amidst lockdown, we successfully completed Autografts in myeloma and Lymphoma. We also started Allogeneic transplants including haplo-identical transplant for acute leukemia.In this hour of need, we had to strike a balance in transplant management. We tried to be practical in our decision-making skills at this hour of need. Being students of science, it was time to show practicality in ordering tests, therapy, and transfusions to the patient. Due to lockdown and general panic, the stocks in Blood Banks were at an all-time low. So transfusions and donor arrangements were be dealt judiciously.The hospital was divided into COVID and NON-COVID zones. All patients with fever and respiratory symptoms go directly to the COVID zone and get examined and tested by physicians with proper PPE as per WHO protocol.Even there are no symptoms of COVID like dry cough, fever, and throat pain, the patients entering NON-COVID also will be screened by a general physician at the single point of entry with proper protection and then patient with one attendee was allowed to come to transplant outpatient department. This helped us reduce risk to the medical professional and other patients waiting in a specialty department like ours.We had a detailed discussion about the pros and cons with patient and attendee. We admitted them in a separate block and got tested for COVID19 RTPCR. The patient had HRCT thorax to check for early radiological signs of COVID19. The blood parameters which serve as prognostic markers for COVID were checked alongside to double confirm false negativity of tests.The donor was made to stay as attendee for the patient. We shifted them inside transplant unit and observed for a week to rule out COVID symptoms. Radiological investigations were done before starting procedure. Minimal physical interaction was established and in Myeloma and Lymphoma autograft, we did around 20% dose reduction of conditioning regimen drugs. For allograft, no drug dose modification was done. The threshold for antibiotic stewardship was kept very low and high end antibiotics like Colistin / Fosfomycin were initiated early. We collected single donor platelets and kept stocks ready to avoid exposure to multiple random donors. The blood bank also was very careful in selecting donors after a thorough screening for symptoms of COVID19. Once engrafted, they were discharged early and kept on follow-up mostly by tele-consultation. The personal visits were kept to a minimum of once in four weeks. From first lockdown to date of submission, we completed nine bone marrow transplants at our centre which included three AML haplo-identical transplants.ConclusionPostponing transplant is not feasible in all situations, as few of our refractory diseases will ultimately relapse and transplant becomes the only live saving procedure. As we wait for the situation to better, the normal functioning of hospitals may take some more time.These above are the methods we are following in our MIOT hospital at Chennai, India the city which has got around 100,000 COVID19 cases during submission. Our advice is where ever feasible, we should try to stick to time tested conventional protocols. The above protocols may be useful temporarily till the COVID crisis is over.Reference 1.Willian J. Care of hematology patients in a COVID‐19 epidemic. British Journal of Hematology, 2020.2.Dholaria, Savani B.N. How do we plan hematopoietic cell transplant and cellular therapy with the looming COVID‐19 threat? British Journal of Haematology, 2020.https://doi.org/10.1111/bjh.16597DisclosuresNo relevant conflicts of interest to declare.