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In addition to the classical functions of the musculoskeletal system and calcium homeostasis, the function of vitamin D as an immune modulator is well established. The vitamin D receptors and enzymes that metabolize vitamin D are ubiquitously expressed in most cells in the body, including T and B lymphocytes, antigen-presenting cells, monocytes, macrophages and natural killer cells that trigger immune and antimicrobial responses. Many in vitro and in vivo studies revealed that vitamin D promotes tolerogenic immunological action and immune modulation. Vitamin D adequacy positively influences the expression and release of antimicrobial peptides, such as cathelicidin, defensin, and anti-inflammatory cytokines, and reduces the expression of proinflammatory cytokines. Evidence suggestss that vitamin D's protective immunogenic actions reduce the risk, complications, and death from COVID-19. On the contrary, vitamin D deficiency worsened the clinical outcomes of viral respiratory diseases and the COVID-19-related cytokine storm, acute respiratory distress syndrome, and death. The study revealed the need for more preclinical studies and focused on well-designed clinical trials with adequate sizes to understand the role of vitamin D on the pathophysiology of immune disorders and mechanisms of subduing microbial infections, including COVID-19.Copyright © 2023 Bentham Science Publishers.
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Coronavirus-induced disease-19 (COVID-19), caused by SARS-CoV-2, is still a major global health challenge. Human endogenous retroviruses (HERVs) represent retroviral elements that were integrated into the ancestral human genome. HERVs are important in embryonic development as well as in the manifestation of diseases, including cancer, inflammation, and viral infections. Here, we analyze the expression of several HERVs in SARS-CoV-2-infected cells and observe increased activity of HERV-E, HERV-V, HERV-FRD, HERV-MER34, HERV-W, and HERV-K-HML2. In contrast, the HERV-R envelope is downregulated in cell-based models and PBMCs of COVID-19 patients. Overexpression of HERV-R inhibits SARS-CoV-2 replication, suggesting its antiviral activity. Further analyses demonstrate the role of the extracellular signal-regulated kinase (ERK) in regulating HERV-R antiviral activity. Lastly, our data indicate that the crosstalk between ERK and p38 MAPK controls the synthesis of the HERV-R envelope protein, which in turn modulates SARS-CoV-2 replication. These findings suggest the role of the HERV-R envelope as a prosurvival host factor against SARS-CoV-2 and illustrate a possible advantage of integration and evolutionary maintenance of retroviral elements in the human genome.Copyright © 2023 The Authors.
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The clinical picture of COVID-19 ranges from asymptomatic to mild, moderate or severe disease sometimes leading to death. Differences in the interaction between SARS-CoV-2 Spike (S) protein and angiotensin converting enzyme 2 (ACE2) protein may lead to differences in disease severity. We studied whether ACE2 polymorphisms are associated with disease severity and outcome. We recruited 114 patients between July 2020 - March 2022 confirmed positive by RTPCR for COVID-19 with different degrees of severity (21 mild, 29 moderate, 34 severe, 30 death) and 30 controls (10 non-vaccinated+ 20 vaccinated) who were RT-PCR negative inspite of high-risk contact. Next-gen sequencing was done on MiSeq (Illumina) using amplicon-based targeted sequencing approach using a custom-designed panel to sequence all the exons of ACE2 gene. SPSS ver.26 was used for analysis. The following ACE2 variants were identified on the Local Run Manager (LRM) software from Illumina: (i) rs2285666 (c.439+4G>A) splice region variant, in controls (60%) and Patients (45.8%), (ii) rs4646140 (c.802+24G>A) intronic variant in 4/114 patients and 1/30 controls, (iii) rs41303171 ( c.2158A>G) missense variant in 2/114 patients, (iv) rs536749578 (c.2114+9T>C) intron variant, (v) rs763994205 (c.868A>C) missense variant and (vi) rs7595907 (c.656G>A) missense variant in 1/114 patient each only. rs2285666 was observed in equal frequency ( 60%) in vaccinated and non-vaccinated controls. rs2285666 was observed amongst different severity groups: Mild (80.95%), Moderate (37.93%), Severe (44.11%), and Death (56.67%) revealing association with disease severity, probably having a protective effect. However, these results need to be confirmed on larger sample sizes.
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Acquired hemophilia (AH) is a potentially life-threatening hemorrhagic disorder. We report the second confirmed case of COVID-19-associated AH in a 45-year-old female which, unfortunately, expired as her treatment failed. She presented to the emergency department with abnormal bleeding and spontaneous hemoptysis about ten days after a removal surgery of her epiglottis tumor. Aggregation tests, such as partial thromboplastin time (PTT), are recommended in patients with COVID-19 infection that have bleeding episodes.Copyright © 2022 The Author(s);Published by Society of Diabetic Nephropathy Prevention.
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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus disease (COVID-19) pandemic is the largest infectious crisis in the present century. It has been reported that COVID-19 infection may trigger autoimmune diseases. Herein, we report a 68-year-old male that was diagnosed with thrombotic thrombocytopenic purpura (TTP) following COVID-19 infection. To our knowledge, this is the fourth case of COVID-19-associated TTP. More attention is required regarding the possibility of developing TTP in COVID-19 patients, especially with the presence of decreased consciousness and low levels of hemoglobin and platelet. © 2023 The Author(s).
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The objective of this study is to examine the main constraints experienced in the online mode of education during this pandemic at higher education level in Pakistan. The COVID-19 pandemic credibly transformed the method of learning and teaching from face to face to online. In unexpected sudden septicity, universities in Pakistan have started online education without proper instructional provision and relevant experience. For this purpose, the data is collected from 750 students and teachers across all over the regions in Pakistan. The study has used partial least square structural equation modeling (PLS-SEM). The findings show that technological bottlenecks, institutional preparedness, and digital divide are significant challenges. The differences in perceptions of rural and urban areas are also very important referring to several policies implications, implementing information communication technology (ICT), friendly curriculums, enhancing online accessibility and infrastructure development. This study contributes to help universities for developing effective e-learning policies for students in the situation of COVID-19.
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Learning Objectives: Covering the domains of knowledge, skills and attitudes, residents were expected to analyze structural violence and health gaps, demonstrate inclusive and trauma-informed care, recognize implicit bias, use strategies to reduce it, and critically assess the EM health equity literature. Introduction/Background: Since the 2003 Unequal Treatment report showed that health gaps are not due to access or income, racial injustice and COVID-19 have laid bare worse inequities. In 2021, the ACGME EM Milestones addressed recognition of health gaps and personal bias, however there is no guidance on how to do this. ED patients require an unbiased evaluation to ensure rapid and accurate diagnosis and treatment, but implicit bias reigns with high cognitive load. Thus, we describe a deliberate and formal diversity, inclusion and racial equity (DIRE) curriculum. Educational Objectives: Residents were expected to analyze structural violence and health gaps, demonstrate inclusive and trauma-informed care, recognize implicit bias, use strategies to reduce it, and critically assess the EM health equity literature. Curricular Design: An ED survey confirmed the need for this curriculum. Since July 2020, the course has been available to all ED staff but is mandatory for residents. The free online platform, Canvas, was chosen for ease of access and use, and for resource sharing, discussion facilitation, and quiz scoring. Biweekly articles, online videos, a journal club and quarterly book clubs led to health equity discourse. Residents took part in simulated cases involving diverse patients. A workshop reviewed strategies to reduce implicit bias. Residents were assessed with quizzes, reflective writing and direct observation. Based on feedback, sessions are now held monthly with more media resources, live seminars, and diverse content. Impact/Effectiveness: As of July 2021, residents have had positive feedback, 100% completion rates, and high knowledge retention. Structural violence must be included in resident didactics. Simulated cases provide an avenue to assess interpersonal communication skills for residents to develop tools to partner with patients. This model may serve as a blueprint for those seeking to improve DIRE knowledge, skills and attitudes.
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SESSION TITLE: COVID-19 Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Pneumomediastinum is the presence of air or other gas in the mediastinum which can be due to trauma related to mechanical ventilation or spontaneous in preexisting lung diseases. Here, we present the case of Covid-19 pneumonia, who developed pneumomediastinum without any trauma or other risk factors. CASE PRESENTATION: A 56-year-old male COVID unvaccinated with a history of essential hypertension presented to the ED with shortness of breath and worsening cough for one week. He was living with his father, who was admitted to the ICU and receiving treatment for COVID pneumonia. The patient appeared to be in respiratory distress. His initial vital signs were temperature of 99.6 F, respiratory rate of 26 breaths per minute, blood pressure 125/71 mm Hg, heart rate 109 beats per minute with a regular rhythm, and oxygen saturation of 50% while he was breathing ambient air. Pulmonary examination revealed use of respiratory accessory muscle and widespread bilateral coarse rhonchi on auscultation. The rest of the physical examination was within normal limits. RT- PCR COVID -19 test was positive. The blood gas analysis reported respiratory alkalosis. Inflammatory markers were elevated: erythrocyte sedimentation rate (35.2 mg/L), C-Reactive Protein (17.70 mg/dL), Ferritin (1108.1 ng/mL), Lactate Dehydrogenase (813 U/L), Lactate (2.4 mg/dL), D-Dimer (35.20 mg/L) and Troponin High Sensitivity-236.6 ng/L. His CBC, electrolytes, and kidney function were normal. Chest X-ray showed Pneumomediastinum with dense basilar predominant consolidation. CT Angio Chest with contrast reported Pneumomediastinum likely from the left central airway source and bilateral dense ground glass consolidation. An echocardiogram showed an ejection fraction of 60-65%, no valvular abnormalities. He was placed on vapotherm(Oxygen 40L/min) with 100% FiO2. He was given Dexamethasone 6mg for ten days, Remdesivir, Barcitinib, and a 7-day course of Azithromycin and Ceftriaxone for community-acquired pneumonia. He was advised to practice prone positioning for 12 hours or more per day. Pulmonology, Infectious Disease, and Cardiology were consulted. Gradually, his oxygen requirement was weaned down and Pneumomediastinum resolved on serial chest x rays. He was discharged on home oxygen in a clinically stable condition. DISCUSSION: Pneumomediastinum in viral pneumonia is rare. The exact mechanism is unknown. Covid-19 pneumonia causes diffuse alveolar wall damage, which might cause air leakage into the mediastinum. The development of pneumomediastinum is an ominous sign in these patients. Fortunately, our patient did not worsen and was weaned off high flow oxygenation requirement. CONCLUSIONS: Few isolated reported cases of pneumomediastinum in a COVID-19 patient have been associated with life-threatening complications. It should be used as a prognostic marker, and close monitoring of these patients is advisable. Reference #1: Damous, S.H.B., dos Santos Junior, J.P., Pezzano, Á.V.A. et al. Pneumomediastinum complicating COVID-19: a case series. Eur J Med Res 26, 114 (2021) DISCLOSURES: No relevant relationships by Saad Ansari No relevant relationships by Akshit Chitkara No relevant relationships by Sudeshna Ghosh No relevant relationships by Femina Patel
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Objective: To assess the role of virtual ward in COVID-19 Pandemic in a developing country and to describe our experience with first 100 patients admitted in virtual ward. Methodology: This retrospective study is chart review of first 100 patients who presented consecutively to our service in virtual ward. The data were captured from the electronic medical record system, which was secure and password protected. We used Microsoft excel for data analysis. Results: Out of 100 patients, there were 63 males and 37 females and with age range of 50 – 60 years. Majority had no comorbidities while 20% had diabetes, another 24% with cardiac disease and 4% with pulmonary disease. Off all patients, 90% were discharged from the service and 10% were admitted to the hospital. One person died during the stay in service. Feedback on the quality of service showed majority patients were satisfied with the service with the score of 4.8 on the scale of 1 to 5. Conclusion: In pandemic era, there is increasing need for safer and coordinated care through virtual ward. It increases the level of patient's satisfaction and lowers the inpatient burden for the hospital.
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Background: Blood glucose level is an important risk factor for the prognosis of infection and critically ill patients. Stress-induced hyperglycemia is well-known as an adaptive response and expected during times of infection. However, this is believed to be a transient response that resolves upon the improvement of the infection. Aim: The aim of this study is to evaluate the blood glucose levels in a cohort of COVID-19 patients to determine their hyperglycemic status before and after the recovery regardless of their diabetic status. Methodology: This is a multicenter, retrospective, observational study. A detailed case history including investigations and laboratory findings was taken from the recovered COVID-19 patients. Data of their random blood sugar levels before and after COVID-19 recovery were collected and compared to check for their hyperglycemic status after the recovery. Data were then tabulated in the spreadsheet and statistical analysis was done. Results: In our study, we compared the hyperglycemic status after the recovery. About 22.1% had hyperglycemia post-COVID. During COVID, the prevalence of hyperglycemia in patients was 23% with or without a previous history of diabetes. Altogether, there was a significant increase in Blood Glucose levels post-COVID (2-month follow-up) period. A significant P (P = 0.0001) was found in the statistical analysis. Conclusion: Clinicians must recognize that some patients may require monitoring the glycemic status and intensification of the antihyperglycemics for several weeks to months after infection devoid of their diabetic status. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Acquired hemophilia (AH) is a potentially life-threatening hemorrhagic disorder. We report the second confirmed case of COVID-19-associated AH in a 45-year-old female which, unfortunately, expired as her treatment failed. She presented to the emergency department with abnormal bleeding and spontaneous hemoptysis about ten days after a removal surgery of her epiglottis tumor. Aggregation tests, such as partial thromboplastin time (PTT), are recommended in patients with COVID-19 infection that have bleeding episodes. © 2022 The Author(s);Published by Society of Diabetic Nephropathy Prevention.
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The COVID-19 pandemic has badly affected the human health and exerted a negative impact on national and global economies. The understanding, observations and responses of the general public during COVID pandemic may help in discussion about healthiness risk and encourage acquiescence with standard guiding principles. Therefore, the study was aimed to measure the Knowledge, Attitude and Practice (KAP) of an individual regarding the COVID-19. However, the present learning was in the setting of a web based cross sectional study conducted to evaluate the KAP among the general public via the dissemination of online Performa. In this context, a questionnaire was designed that was comprised into various scoring divisions to calculate the KAP. The KAP response was achieved from 842 persons and of this strength, 344 were male and 498 responses were attained from females. The Percentages and the frequencies were reported and calculated for each of the response and the chi-square test was applied to find the association (considering pvalue >0.05 as significant). The questionnaire was executed to the age of 22 years and above. On the basis of revealed knowledge (K1-7), the result of K3 and K7 were found highly significant (p-0.001), whilst the K4 response was significant (P≥0.05). The rest Ks were reported non-significant. Likewise, attitude (A1-5) was reported with high percentage in females and overall it was revealed highly significant (p- 0.002) in A5 response. In general, attitudes among genders were found comparatively encouraging and meaningful. Moreover, practices (P1-4) regarding COVID-19 showed week response to the sub divisions of P1-4 but, P2 and P3 were showed highly significant i.e. p-0.00 in both cases. Hence, majority of the general public presented good response against KAP regarding the COVID-19 pandemic. Additionally, incorporation of good practices and knowledge in life can enhance and maintain the population health. In this respect, the policymakers of government organizations have performed well in pointing the grass root populations having no education and un-aware workers via health promotional activities. © 2022
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This study examines both the short- and long-run impact of public debt on the economic growth of Uttar Pradesh during the post-reform period of 30 years by employing the vector error correction model. The empirical analysis revealed that the increase in public debt-to-gross state domestic product ratio and interest payments burden would have an adverse impact on the long-run economic growth of UP, while having no significant impact on the short-run growth. It is also notable that the effective interest rate has negatively correlated with the gross capital formation in UP, and the latter has shown significant positive long-run association with the economic growth. In order to attract investments and economic growth, the state Government of UP should continue a countercyclical fiscal stance that would help in adhering to fiscal sustainability rules by smoothing out the repercussions of the COVID-19 pandemic. © 2022 Economic and Political Weekly. All rights reserved.
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Background: COVID-19 is due to severe acute respiratory syndrome coronavirus 2 (SARSCoV2) and was declared a global pandemic by World Health Organization. Various biochemical parameters and serial High Resolution Computed Tomography (HRCT) chest were used to evaluate the severity of the disease. Aim & Objectives: The study was done to assess the association between biochemical parameters and serial HRCT chest. Material and Methods: It was a retrospective observational study at a tertiary hospital in Central India. Patients >/= 18 years old admitted from 01 July 2020 to 31 December 2020 with laboratory-confirmed COVID-19 cases were included in the study. The laboratory parameters included lymphopenia, neutrophil-lymphocyte ratio (NLR), C- Reactive protein (CRP), Lactate Dehydrogenase (LDH), Ferritin, D- Dimer. Only Serial HRCT chest patients were included in the study. Results: In the study total of 44 patients (29 Males/15 Females) were taken. Serial HRCT chest severity and biochemical markers severity were assessed, and the results were obtained. It was found that there is a definite correlation between biochemical markers severity and HRCT chest severity. Conclusion: Since there was a definitive relationship between the severity of biochemical markers and the severity of HRCT chest, biochemical profile can be utilized to determine severity in the absence of HRCT chest.
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Background: With the emergence and spread of coronavirus disease 2019 (COVID-19) globally, health care systems have faced the biggest challenge in recent decades. Objectives: The present study aimed to identify risk factors associated with oropharyngeal candidiasis (OPC) in COVID-19 patients. Methods: The total number of confirmed COVID-19 patients was 218 (105 cases with OPC and 113 controls without OPC). The questionnaire used in this study consisted of demographic data, treatment strategy, clinical and laboratory data, and underlying diseases collected from the onset of clinical OPC until the end of hospitalization. Results: Pseudomembranous candidiasis (77/105, 73.3%) was the most prevalent form of OPC in case patients. The majority of the cases (58.1%) and controls (58.4%) were males. Increasing age (P = 0.03) and hospitalization length (P = 0.016) were significantly associated with OPC in COVID-19 patients. Diabetes (P = 0.003), solid tumor (P = 0.019), and hypertension (P = 0.000) were the most common underlying conditions. The use of dentures (P = 0.003) and poor oral hygiene (P = 0.000) were related to OPC in the case group. Therapy with chloroquine (P = 0.012), IVIG (P = 0.001), diuretics (P = 0.000), and corticosteroid pulse therapy (P = 0.000) were significantly associated with developing OPC in case patients. Conclusions: Old age, hospitalization length, poor oral hygiene, corticosteroids use, diabetes, solid tumor, and hypertension may predispose COVID-19 patients to develop OPC. © 2021, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
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Severe SARS-CoV-2 infection is complicated by dysregulation of the blood coagulation system and high rates of thrombosis, but virus-intrinsic mechanisms underlying this phenomenon are poorly understood. Increased intracellular calcium concentrations promote externalization of phosphatidylserine (PS), the membrane anionic phospholipid required for assembly and activation of the tenase and prothrombinase complexes to drive blood coagulation. TMEM16F is a ubiquitous phospholipid scramblase that mediates externalization of PS in a calcium-dependent manner. As SARS-CoV-2 ORF3a encodes a presumed cation channel with the ability to transport calcium, we hypothesized that ORF3a expression by infected host cells perturbs the cellular calcium rheostat, driving TMEM16F-dependent externalization of PS and enhancing procoagulant activity. Using a doxycycline-inducible system, synchronized expression of ORF3a in A549 pulmonary epithelial cells resulted in a time-dependent augmentation of tissue factor (TF) procoagulant activity exceeding 9-fold by 48 hours (p < 0.0001), with no change in TF cell-surface expression. This enhancement was dependent upon PS as determined by inhibition with the PS-binding protein lactadherin. Over 2-fold enhancement of prothrombinase activity (p < 0.0001) was also observed by 48 hours. ORF3a increased intracellular calcium levels by 18-fold at 48 hours (p < 0.0001), as determined by the intracellular calcium indicator fluo-4. After 16 hours of ORF3a expression, more than 60% of cells had externalized PS (p < 0.001) without increased cell death, as quantified by flow cytometry following annexin V binding. Immunofluorescence microscopy staining for ORF3a, annexin V, and nuclei confirmed ORF3a expression within internal and cell surface membranes and increased PS externalization. PS externalization was insensitive to the pan-caspase inhibitor z-VAD-FMK, and there was no evidence of apoptotic activation as determined by caspase-3 cleavage. By contrast, ORF3a expression did not augment coagulation in cells deficient in the calcium-dependent phospholipid scramblase TMEM16F. Similarly, ORF3a-enhanced TF procoagulant activity (p < 0.01) and prothrombinase activity (p<0.05) was completely abrogated using TMEM16 inhibitors, including the uricosuric agent benzbromarone that has been registered for human use in over 20 countries. Live SARS-CoV-2 infection of A549-ACE2 cells increased cell surface factor Xa generation at MOI 0.1 (p < 0.01) but not MOI 0.01 or following heat inactivation of the virus, and RNA sequencing confirmed ORF3a induction without increased F3 expression. RNA sequencing of human SARS-CoV-2 infected lung autopsy and control tissue (n= 53) confirmed these findings in vivo. Immunofluorescence staining for ORF3a and KRT8/18 and CD31 in SARS-CoV-2 infected human lung autopsy specimens demonstrated ORF3a expression in pulmonary epithelium and endothelial cells, highlighting the potential pathologic relevance of this mechanism. Here we demonstrate that expression of the SARS-CoV-2 accessory protein ORF3a increases the intracellular calcium concentration and TMEM16F-dependent PS scrambling to augment procoagulant activity of the tenase and prothrombinase complexes. Our studies of human cells and tissues infected with SARS-CoV-2 support the pathologic relevance of this mechanism. We highlight the therapeutic potential to target the ORF3a-TMEM16F axis as with benzbromarone to mitigate dysregulation of coagulation and thrombosis during severe SARS-CoV-2 infection. Disclosures: Schwartz: Miromatrix Inc: Membership on an entity's Board of Directors or advisory committees;Alnylam Inc.: Consultancy, Speakers Bureau. Schulman: CSL Behring: Consultancy, Research Funding.
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Emergency Department (ED) visits result from urgent conditions and instances caused by disease, disaster, accidents, or injury and require immediate medical attention. Today, emergency dental services are becoming an integral and crucial facet of properly functioning healthcare systems. Dental emergency visits are a risky undertaking when the COVID-19 epidemic is decimating global health systems. Emergencies in dental care are possibly life-threatening occurrences and demand instant attention to curb infection, severe pain, and tissue bleeding. Examples of these conditions include trauma affecting different facial bones, bacterial infection on soft tissues or cellulitis, and uncontrolled bleeding. Today, given the implications of the COVID-19 pandemic, all providers need to use their professional judgment to determine the need for emergency or urgent care for a patient. Consequently, this systematic review of literature reviews the implications of the COVID-19 epidemic on the use of dental services in different care facilities across the nation.
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Introduction: Traditionally intravenous immunoglobulin (IVIG) has been used for immunodeficiency disorders. It has been also used in certain autoimmune and infectious diseases. IVIG has several immunomodulatory and anti-inflammatory effects. Here, we are reporting a case where IVIG was used for BK viremia in a patient with COVID-19 pneumonia who showed dramatic recovery of COVID-19 symptoms and laboratory parameters. Case Description: Our patient is a 55-year-old African American male who received simultaneous pancreas and kidney transplant in April 2019 with induction immunosuppression with thymoglobulin and was on chronic immunosuppression with Tacrolimus and Mycophenolic mofetil. His Post-transplant course was complicated by BK viremia and presumed BK nephropathy after 2 months. His immunosuppression was gradually tapered off but his viremia was persistent despite being off Mycophenolate and low target goal of Tacrolimus. Patient partially responded to high dose IVIG so we decided to continue monthly high dose IVIG with daily Leflunomide. Later in April 2021, patient was admitted with COVID-19 symptoms with normal oxygen saturation at room air. His clinical condition worsened over the following 4-5 days in the form of hypoxic respiratory failure requiring high flow oxygen supplements and Acute Kidney injury (AKI) with nephrotic range proteinuria and gradual rising inflammatory markers. Patient was about to be transferred to the Intensive Care Unit as his clinical condition was worsening and refractory to the traditional treatment with steroid and antibiotics. On day 10 he received his monthly due dose of IVIG therapy (0.5 gm/kg of body weight for 4 consecutive days). His COVID symptoms started to improve from day 2 of the treatment. His inflammatory markers were dramatically down trended over the next 3-4 days post IVIG. He was discharged home with oxygen therapy (3L/min) by the day 5 post treatment with IVIG with recovering AKI. Discussion: Few international studies have reported that initiation of high dose IVIG as adjuvant treatment for COVID-19 disease in selected patients may result in early clinical and laboratory recovery. The studies are limited due to the small sample size and patient selection criteria. Although our patient exhibited dramatic recovery, randomized clinical trial needs to be done to explore more about effect on COVID-19 pneumonia and COVID-19 associated AKI.
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IntroductionSince the publication of the ARUBA trial, interventional management of cerebral arteriovenous malformations has become an area of debate. Treatment practices may have changed based on data from this recent trial which suggested that the risk of AVM treatment is greater than medical management in unruptured AVMs. To assess the ‘real world’ experience with interventional AVM outcomes, we compared outcomes of ARUBA eligible patients from the NVQI-QOD registry database to the ARUBA trial results.MethodsIn an IRB approved study, the NVQI-QOD AVM registry database was queried for treated patients between 2017 to present with the following inclusion criteria: age > 18 years, baseline mRS> 1, unruptured AVMs. 174/364 patients were ARUBA eligible and were included in the analysis. Patients were divided into embolization alone, microsurgery with or without embolization, and gamma knife radiation therapy with or without embolization. Primary outcomes of ischemic/hemorrhagic stroke or death were analyzed with a mean follow up time of 5.8 months (range 1 to 128 months).ResultsA total of 14 (8.0%) of patients that underwent any type of intervention suffered stroke or mortality. The risk of stroke or death was 6.8% (5 of 74) for microsurgery, 5.4% (2 of 37) for gamma knife, and 10.9% (7 of 64) for embolization alone. Annual stroke or death rates for all treatments were 7.5% (13 of 174) at one year and 0.57% (1 of 174) at 2 years.ConclusionARUBA eligible patients from the NVQI-QOD registry demonstrate a significantly lower risk of stroke or death with intervention of 8.0% (N=174) compared to the 30.7% (N=114) ARUBA trial interventional risk, and is nearly equivalent to the ARUBA trial medical management risk of 10.1% (N=109) over 33 months.DisclosuresN. Moore: 1;C;SNIS Joe Niekro Research Grant. R. Abdalla: None. T. Patterson: None. Y. Moazeni: None. P. Rasmussen: 2;C;Blockade Medical, Covidien/Medtronic, Stryker Neurovascular, Perflow Medical. 4;C;Perflow Medical. G. Toth: None. M. Bain: 2;C;Stryker Neurovascular. S. Ansari: None. S. Hussain: 2;C;Pulsar Inc.