BACKGROUND: Remdesivir has proved its antiviral efcacy on COVID-19 virus in-vitro, but its role in infected patients is still obscure. OBJECTIVE:To evaluate the efcacy and safety of Remdesivir in COVID-19 patients with signicant pulmonary involvement. STUDYDESIGN AND METHOD:We conducted a single center, two-arm, prospective, open-label, phase II study from June 2020 to December 2020 on COVID-19 patients (≥18 years), admitted at Jagjivan Ram Railway Hospital, Mumbai. The primary outcome was to evaluate the all-cause mortality up to 28 days in COVID-19 patients; secondary outcome was to assess the length of hospital stay (LOHS) and duration of respiratory supports, using PASS v11.0 software (19). RESULTS:Overallmortality status at 28 dayswas notsignicant(62 (31.2%)in the remdesivir group vs 65 (32.5%)in the control group), and themean LOHS was less in remdesivir arm which was statistically signicant in the female subgroup although the remdesivir group had delay in hospital admission from the onset of the symptoms and statistically higher index IL6 values. Duration of invasive mechanical ventilation showed signicant statistical difference among the study groups(4.7±1.18 daysin control vs 2.8±1.88 daysin remdesivir), and across both the genders. Hypertension and diabetesmellitusfoundtobe themost commoncomorbiditiesinCOVID-19.Nosafetyconcernswere reportedinRemdesivirgroup. CONCLUSION: Remdesivir was well tolerated without any adverse events, but did not show any signicant effect on COVID-19 survival rate, however it decreases the length of hospital stay and duration of invasive ventilator support. More studies are needed to understand the effects of Remdesivir in larger populations.

Abstract Background In cardiac resynchronization therapy, left ventricular (LV) lead placement at the desired position may be difficult due to abnormal coronary sinus (CS) and lateral vein anatomy. We present a case with difficult anatomy in which we used ‘an indigenous snare’ made from hardware used for coronary angioplasty procedures, which is available in any cardiac catheterization laboratory. Case summary A 52-year-old man presented with dyspnoea due to chronic heart failure was evaluated for cardiac resynchronization therapy. The LV lead was difficult to advance into the only target lateral branch of the CS due to a combination of angulation and proximal stenosis. Balloon dilation was tried first, but we failed to track the LV lead. We formed a venovenous loop, advancing the coronary guidewire 0.014″ into the posterolateral vein; subsequently into the middle cardiac vein via a collateral. The wire was advanced into the CS and then to superior vena cava. The guidewire then snared through the same left subclavian vein and exteriorized by using indigenous snare. Over this loop, the LV lead of the cardiac resynchronization therapy with defibrillator device was implanted successfully. Discussion We have used the snare technique, with the use of a snare prepared from a coronary guidewire. Use of such an indigenous snare has not been described before in the literature. The hardware used in this case is routinely used for coronary angioplasty procedures in all catheterization labs. The importance of our case is that no special hardware like dedicated snare was required to negotiate the LV lead at its desired location.

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