The Impact Of Years Since Transplant On The Clinical Course After SARS-CoV-2 Infection In Heart Transplant Recipients

Introduction: The risk of Severe Acute Respiratory Syndrome - Coronavirus-2 (SARS-CoV-2) infection and mortality is higher in heart transplant (HT) recipients compared to immunocompetent individuals. The impact of years since transplant on clinical course risk is unknown. We evaluated the differences in clinical phenotypes and outcomes according to years since transplant in HT recipients with active SARS-CoV-2 infection. Method(s): Consecutive HT recipients from our National Transplant Centre with confirmed SARS-CoV-2 between April 2020 and March 2022 were enrolled in this retrospective observational study. Patients were stratified into 2 groups: <5 years after HT (Group A) and >/= 5 years after HT (Group B). Result(s): A total of 63 HT recipients were enrolled [median age 56 (41,66) years, 32% female] with 33% of patients (n=21) assigned to Group A, and 67% (n=42) to Group B. In Group B patients, the prevalence of diabetes mellitus and cardiac allograft vasculopathy was significantly higher compared to those in Group A. Meanwhile, Group A patients were more likely to have a history of neutropenia prior to SARS-CoV-2 infection and were more frequently taking maintenance steroids and antimetabolite immunosuppressants (Table 1). Those recipients less than 5 years since HT were also significantly more likely than those >5 years out to develop the infection despite a 3rd dose of COVID vaccine (60% vs 31%, p 0.03).During the active infection, Group A recipients more frequently developed neutropenia (73% vs 27%, p 0.01), and trended towards higher rates of hospitalizations (57% vs 32%, p 0.06). Notably, none of the patients in Group A required mechanical ventilation compared to just under 10 % (n=4) of those in Group B. Further, no Group A patients died during the active infection hospitalization compared to 14% (n=6) of those in Group B. Conclusion(s): In HT recipients, years since transplant is a simple, clinically useful parameter stratifying outcomes after SARS-CoV-2 infection. While patients with less than 5 years since transplant are more likely to develop infection despite booster vaccination and require hospitalization, greater number of years since transplant was associated with more severe consequences during hospitalization.Copyright © 2022

Low Covid-19 Related Mortality Among Lung Transplant Recipients at a Single Center

The omicron variant era led to a dramatic increase in COVID-19 infection in lung transplant recipients (LTR). We previously described our experience with COVID-19 in LTR during the wild type and delta variant eras. Here we provide an update on short and intermediate term outcomes of COVID-19 infections in LTR. This is a single-center retrospective study of all LTR at the University of California San Diego with COVID-19 infections between June 2020 and September 2022. Patient demographic data, immunosuppression regimen, and hospital course were recorded. Subsequent spirometry, imaging, biopsy results and interventions were also obtained (Table 1). 72 LTR with PCR-confirmed COVID-19 infection were included. 45 (62.5%) were male, 39 (54.2%) were Caucasian, and 56 (77.8%) had double-LT. 56 (73.6%) had symptomatic infections, 27 (37.5%) required hospitalization, including 7 (9.7%) requiring ICU admission and 1 (1.4%) requiring extracorporeal membrane oxygenation. The median drop in FEV1 and FVC at 3 months was 2.4% and 2.5%, respectively. Post-infection ACR and death were seen in 3 (4.2%) patients. Of the 3 deaths, 2 were due to COVID-19 infection in LTRs with stage 3 chronic lung allograft dysfunction (CLAD). The remaining death was related to failure to thrive and occurred months after COVID infection. The omicron era of COVID-19 led to a nearly 5-fold increase in COVID-19 infections among LTR. Despite the higher prevalence of COVID-19 infection, the mortality in our cohort remained low compared to other published reports of COVID-19 infection in LTR. Compared to our prior analysis which included only wild type and delta variant eras, the rates of mortality and ACR both decreased from 11.8% to 4.2%. This improvement in post COVID-19 outcomes may be attributable to monoclonal antibody therapy, increased vaccination, pre exposure prophylaxis and changes in viral virulence. Larger studies are needed to assess the impact of the various COVID-19 variants on LTRs. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Sotrovimab in Heart Transplant Recipients with Covid-19 in the Omicron Era: A National Transplant Center Experience

Early use of anti-SARS-CoV-2 monoclonal antibodies has shown to be a safe option to reduce hospitalization and death in solid organ transplant recipients with COVID-19. Real world data regarding sotrovimab in heart transplant (HT) recipients is scarce. We aim to describe our experience in terms of safety and outcomes in this group. Consecutive HT recipients from our center with confirmed SARS-CoV-2 Omicron variant who received intravenous sotrovimab infusion between January and April 2022 were enrolled in this observational study. Clinical data was recorded including the first 24 hours post infusion, as well as 1-month and 3-month follow-ups. A total of 29 HT recipients with SARS-CoV-2 infection who received sotrovimab were enrolled [median age 53 (IQR 36, 62), 52% female]. Baseline characteristics are shown in Table 1. The median time since symptom onset was 2 (1,3) days, and 86% of patients had previously received ≥3 doses of COVID-19 vaccine. No acute infusion-related reactions were reported. A total of five patients were admitted (17%), 3 of them with COVID-19 pneumonitis, receiving high-dose steroids. Bacterial superinfection was reported in 4 patients. Neither invasive mechanical ventilation nor ICU care were required, and no in-hospital deaths were recorded. Hospitalized patients had more comorbidities [diabetes (40 vs 13%, p 0.13), hyperlipidemia (80 vs 29%, p 0.03), advanced chronic kidney disease (100 vs 38%, p 0.01), leucopenia (40 vs 4%, p 0.02), and anemia (100 vs 46%, 0.03)], compared to non-hospitalized patients. Over a median follow-up of 111 (86, 131) days, there were 2 cases of COVID-19 reinfection and 6 non-COVID-19-related readmissions. No episodes of acute rejection, new onset graft dysfunction or death were registered. In our series, the early use of sotrovimab in HT recipients with COVID-19 was safe. No COVID-19-related deaths were recorded, hospitalization rate was low and more frequent in patients with prior chronic comorbidities. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Detection of SARS-CoV-2 by RT-LAMP assay in Human COVID-19 patients

Background: The novel COVID-19 outbreak has infected human population all around the world. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) diagnosis in a rapid manner remains challenging for health care professionals. Currently, RT-qPCR technique is extensively practiced in SARS-CoV-2 diagnosis and is considered as gold standard. The constraints of RT-qPCR, high cost and need for trained technician, longer detection time, highlighted the need for alternate healthcare diagnostic approaches. They follow the WHO assured standard and offer the health-care sector optimism. One of them is the Loop Mediated isothermal amplification system (LAMP). There is no need for costly equipment like thermal cycler since LAMP assay is performed at a fixed temperature. It can also be implemented as a point of care testing device. RT-LAMP is one of the extensively used isothermal amplification system in pathogen diagnostics.Aims: The current study aims to validate and standardize RT-LAMP assay for rapid diagnosis of SARS-CoV-2 in both lab and field conditions. The reactions can be carried out using a heating vessel including the use of a water bath and end-point detection by colorimetry. A rising middle ground of tiny, more portable technology, that provides most of the capability at less cost and time.Methods and Results: 20 Samples were taken from COVID-19 positive patients. RNA extraction from COVID-19 samples was followed up by one-step reverse transcription and loop-mediated isothermal amplification (LAMP). LAMP primers were designed to amplify the conserved regions of SARS-COV-2 specific genes. The target regions for primer design were selected after genome-wide sequence alignment of SARS-CoV-2 strains isolated in various regions of the world i.e., Europe, Africa, Asia, and North America. RT-LAMP assays were performed at the specific incubation temperature (60°C) for 50 minutes. Assay was optimized as per consumable compatibility, COVID template integrity, primer concentration, template concentration, primer ratio, testing time etc. Sensitivity and specificity of the assay was elucidated. Finally, different end-point analysis i.e., Agarose Gel Electrophoresis and Colorimetry have been used to interpret the results.Conclusion: RT-LAMP assay has shown to be a quick and accurate diagnostic method that can be put to use for SARS-CoV-2 detection in laboratories and Point-of- Care settings. © 2022 IEEE.

Management of Transplant Graft and Role of Immunosuppression in the Outcome of Covid-19 Infection in Solid Organ Transplant Recipients

Background. COVID-19 disease became a global health care crisis and was declared pandemic by WHO in March 2020. Little is known how the immunosuppressive medications impact the mortality rate in Solid Organ Transplant (SOT) recipients. There is also minimal data regarding the incidence of transplanted graft failure or rejection that could be attributed to the COVID-19 infection itself or its complications and management. Our study aims to investigate the management of COVID-19 infection, outcome of the infection, transplant failure and rejection rates in SOT recipients. Methods. We conducted a retrospective cohort study of all consecutive SOT recipients who were admitted to our transplant center from March 2020 to April 2021 with COVID-19 infection. Data was collected from the electronic medical records after receiving Institutional Review Board approval. Results. A total of 135 patients met the inclusion criteria. After the diagnosis of COVID -19 infection, 31% recipients had decrease in the dose of immunosuppressive medications (change group) and 69% had no changes in the dose (no change group). Out of the 73 Kidney Transplant recipients 33% were in the change group compared to 14% of liver, 25% of heart and 27% of lung transplant recipients. Of the total 42 recipients in the change group, 28.6% required Intensive Care Unit (ICU) level care significantly higher compared to 7.5% in the no change group (p-value < 0.005). Mechanical ventilation was required in 14.3% of the patients in the change group and 6.5% in the no change group (p-value < 0.5). Out of the total, 85.7% patients in the change group survived compared to 94.6% in the no change group (p-value < 0.1). Overall, the transplant rejection rate was higher in the change group compared to the no change group (p-value < 0.5). Conclusion. Our study showed a significantly higher ICU admission rate and mortality in SOT recipients who had their immune suppression reduced at the time of COVID-19 diagnosis. The same group also had a higher risk of rejection of transplanted graft. More studies with larger sample size needs to be done to further understand the management of immunosuppressive drugs in the SOT recipients with COIVD-19 infection.

COVID-19 in Solid Organ Transplant Recipients: A Single Transplant Center Experience

Background. COVID-19 disease became a global health care crisis and was declared pandemic by WHO in March 2020. Some studies have indicated that Solid Organ Transplant (SOT) patients may have increased morbidity and mortality while others showed no difference. Our study aims to investigate patients' characteristics, disease course, management of COVID-19 and outcomes in our SOT patient population. Methods. We conducted a retrospective cohort study of all consecutive SOT recipients who were admitted to our transplant center from March 2020 to April 2021 with COVID-19 infection. Data was collected from the electronic medical records after receiving Institutional Review Board approval. (Table Presented) Results. A total of 135 patients met inclusion criteria. Average age at the time of COVID-19 diagnosis was 56.38+/-12.93 years. Majority of the patients (54%) were kidney transplant recipients. Out of the total, 28% of the patients required supplemental oxygen and 14% required intensive care unit (ICU) care. A total of 12 patients (9%) required intubation and mechanical ventilation. 21% of the patients were treated with Remdesivir and 30% met criteria for the use of corticosteroids. Unfortunately, 11 patients (8%) of the patients died from COVID-19 infection and its complications. Of those 11 patients 5 were treated with Remdesivir and 10 were treated Corticosteroids. None of the patients met the criteria for ECMO (Extra Corporeal Membrane Oxygenation). Conclusion. Our study showed a higher mortality rate in SOT patients compared to general population. Treatment with Remdesivir and Corticosteroids improved the overall mortality rate but had no benefit in patients with critical illness requiring ICU level care. COVID vaccination significantly improved the outcome, and the major limitation of the study was COVID vaccination information was not included since the study was initiated prior to introduction of vaccines. More studies with larger sample size and vaccine data need to be conducted to accurately determine the outcome of COVID-19 infection in this patient population.

Lung Transplantation for COVID-19-Associated Lung Injury (CALI): An International Registry

Background. SARS-CoV-2 can result in a range of infections from asymptomatic disease to progressive COVID-19 and death. In some pts with CALI, lung transplantation (LTx) may be lifesaving. Up to 10% of LTx in the US is currently for pts with CALI. Understanding the characteristics and outcomes of these pts is critical. Methods. A open-access electronic registry was established to collect deidentified data from pts who have undergone LTx for CALI from centers globally. The study was IRB approved at Northwestern with a wavier for consent (no PHI is collected sites could submit data about pre-Tx, peri-Tx and post-Tx course). Follow-up for 1-yr post-LTx was collected. Results. To date, 89 pts with complete day 30 post-LTx data have been entered into the registry. Pt demographics and pre-Tx status are shown in Table 1. 3 pts required oxygen prior to COVID-19. Most sites required neg PCR tests prior to listing (11 (12.4%) required no - PCRs, 11 (12.4%) required 1 and 61 (68.5%) required 2). LTx occurred 137 days post-infection and none developed COVID-19 in the first 30 d;4 were given monoclonal antibodies post-tx. Post-tx ICU LOS averaged 24.5 d with total post-tx hospitalization of 37.6 d (See Table 2). Most experienced infectious and noninfectious morbidity. Most (47.8%) required an additional 30 days of rehab. 2 pts died within 30 days due to sepsis and anoxia. 5 died between day 30 and 90 and an additional 12 died between day 90 and 365. Conclusion. The contribution of cases to this international registry is ongoing. While outcomes of LTx for CALI are generally good, patients experience prolonged post-transplant hospitalization, rehabilitation and significant morbidity and infections are common. (Table Presented).

Does expanded access to primary prophylaxis with G-CSF decrease the burden of febrile neutropenia?

Category: Management/measurement of side-effects of treatment (acute or late), including patient-reported outcome measures (PROMs) Purpose: Guidelines recommend primary prophylaxis (PP) with haematopoietic colony stimulating factors (CSFs) in chemotherapy with a >=20% risk of febrile neutropenia (FN). During the COVID-19 pandemic, guidelines temporarily supported routine use of G-CSF as PP for intermediate risk regimens. Our retrospective real-world data compares hospital admissions for FN during a period of expanded access (June to December 2020) against baseline use (June to December 2019) in a district general UK hospital. Methods and materials: The process measure was the proportion of patients prescribed PP with G-CSF when initiating a new intermediate/low-risk regimen/month. The outcome measure was the monthly rate of hospital admissions for FN in intermediate/low-risk regimens. Statistical process control (SPC) charts and chi-square tests were used for analysis. Result(s): Use of G-CSF as PP showed statistically significant special cause variation on SPC p-charts consistent with policy change. Median PP prescription rate in June to December 2019 was 0.9% (interquartile range (IQR) 0-2.6%) and June to December 2020 was 34.8% (IQR 29%-43%). Monthly G-CSF prescriptions for all indications was a median of 3% (2019) versus 70% (2020). However, the trends in admissions for FN were stable on SPC p-charts with a median monthly event rate of 0.63% in 2019 and 0.66% in 2020. Summary statistics showed 12 events/698 unique patients in 2019 (1.72%) and ten events/618 patients in 2020 (1.62%), (p=0.8). Conclusion(s): Despite significantly increased use of PP with G-CSF for intermediate/low-risk chemotherapy, the burden of hospitalisations for FN remained unchanged and was lower than expected. Copyright © 2022

Financial Issues Faced by the Industrial Labours during Covid-19 in District Faisalabad

COVID-19 was traced on 17th November 2019 in China the first case was reported on 31st December 2019 in the China city of Wuhan province of Hubei. The COVID-19 pandemic is a worldwide pandemic virus which is severely affected on acute respiratory system in human beings. The pandemic has raised several issues in Pakistan but the major issue faced the socio-economic issues. The outbreak disease of COVID-19 has severely affected Pakistan's economy. On a large scale Industries were closed and labour was unemployed. The major victim of the COVID-19 outbreak is micro small and medium size industries. Many employed of the industries administrator and labourers are unemployed. COVID-19 has created negative impacts on the livelihood of the Pakistani population. Many employed labourers lost their job. The purpose of the study finds the economic issues of industrial labour in the period of COVID-19 in the District of Faisalabad Punjab. The data was collected from different industrial labourers in District Faisalabad. 150 respondents were selected from the different industries of Faisalabad. The research planned to analyze the study of socio-economic impacts of covid-19 on industries' labour in District Faisalabad. Three industries were selected from these industries area Sheikupura Road and canal road Faisalabad. The areas of industries are Masood textile mills Chenab textile and Rafhan maize mill Faisalabad. Then 50 respondents were selected from each area through a purposive sampling technique. Data was gathered through interviewing schedule. Data were analyzed by using statistical techniques. The majority of my respondents were male and these are the head of the family that age is under 25-30 and 35-35. The data include 22.7% of respondents having 1-2 rooms 42.7% of respondents having 2-4 rooms 24% of respondents having 4 to 6 4ooms and 10.7% of respondents having above six rooms. This indicates that 83.3% of respondents lost their jobs during COVID-19 and 16.7% of respondents did not lose their job and continued their work as before during COVID-19. Copyright © 2022, Anka Publishers. All rights reserved.

Study of early warning efficiency of different laboratory markers in predicting progression of disease in COVID-19.

Introduction: COVID 19 pandemic has given rise to several challenges to clinicians and one of the keys in this is to predict the set of patients who progress from mild disease to moderate and severe. Apart from the symptomatology and signs, there are several lab parameters varying from biochemical, hematological to radiological parameters which help us in stratifying the stage of disease and also in deciding on which set of patients need close and vigilant monitoring. This would help us in better stratification of disease and utilize the available infrastructure and resources in an optimum way for better management of the disease. Aim: To analyze the early warning efficiency of laboratory parameters individually or in combination in predicting the progress of disease in patients from mild to moderate/severe disease. Materials and Methods: This was taken up as a retrospective study with 100 cases and 100 controls. The demographic details, inflammatory markers, biochemical markers and hematological markers were analyzed. Test of significance was employed to compare categorical variables while student t-test was employed to test the difference in the mean value such as age between case and control (Mann-Whitney U-test in parameters not having normal distribution). Receiver operating characteristic (ROC) curve was constructed for these parameters using cases and controls and area under the curve (AUC) were estimated which was used as an indicator of sensitivity and specificity of the parameter in their early warning efficiency. The critical values for each of the parameters either individually or in combination was estimated as well. Results: Among the parameters C reactive protein (CRP), d-dimers and eosinopenia have the best early warning efficiency. The area under the ROCs curve for neutrophil lymphocyte ratio (NLR), CRP. Ferritin, lactate dehydrogenase, Eosinopenia was 0.609, 0.947, 0.614, 0.554, 0.617 respectively at triage. However, a combination of eosinopenia with CRP (AUC-0.732) or NLR with CRP (AUC-0.728) have a good sensitivity and specificity in predicting the outcome regarding the progression of the disease. Conclusions: Among the parameters, CRP, d-dimers, Eosinopenia and NLR have the best early warning efficiency. However, a combination of Eosinopenia and CRP at triage should also serve as a red flag sign in patients apart from the well-known NLR and IL6 values.

Résumé Introduction: La pandémie covide 19 a relevé plusieurs défis aux cliniciens et l'une des clés dans ce domaine est de prédire l'ensemble des patients qui passent d'une maladie légère à modérée et sévère. Outre la symptomatologie et les signes, plusieurs paramètres de laboratoire variant des paramètres biochimiques, hématologiques à radiologiques qui nous aident à stratifier le stade de la maladie et également à décider quel ensemble de patients nécessite une surveillance étroite et vigilante. Cela nous aiderait à mieux stratification des maladies et à utiliser l'infrastructure et les ressources disponibles de manière optimale pour une meilleure prise en charge de la maladie. Objectif: Analyser l'efficacité d'alerte précoce des paramètres de laboratoire individuellement ou en combinaison pour prédire les progrès des maladies chez les patients d'une maladie légère à modérée / sévère. Matériaux et méthodes: Ceci a été considéré comme une étude rétrospective avec 100 cas et 100 contrôles. Les détails démographiques, les marqueurs inflammatoires, les marqueurs biochimiques et les marqueurs hématologiques ont été analysés. Le test de signification a été utilisé pour comparer les variables catégorielles tandis que le test T des étudiants a été utilisé pour tester la différence de valeur moyenne telle que l'âge entre le cas et le contrôle (test U Mann - Whitney dans les paramètres n'ayant pas de distribution normale). La courbe des caractéristiques de fonctionnement du récepteur (ROC) a été construite pour ces paramètres en utilisant les cas et les contrôles et la zone sous la courbe (AUC) ont été estimés qui ont été utilisés comme indicateur de sensibilité et de spécificité du paramètre dans leur efficacité d'alerte précoce. Les valeurs critiques pour chacun des paramètres individuellement ou en combinaison ont également été estimées. Résultats: Parmi les paramètres C Protein réactif (CRP), les D - dimères et l'éosinopénie ont la meilleure efficacité d'alerte précoce. La zone sous la courbe ROCS pour le rapport lymphocyte des neutrophiles (NLR), CRP. La ferritine, la lactate déshydrogénase, l'éosinopénie était de 0,609, 0,947, 0,614, 0,554, 0,617 respectivement au triage. Cependant, une combinaison d'éosinopénie avec CRP (AUC - 0,732) ou NLR avec CRP (AUC - 0,728) a une bonne sensibilité et spécificité pour prédire le résultat concernant la progression de la maladie. Conclusions: Parmi les paramètres, le CRP, les D - dimères, l'éosinopénie et le NLR ont la meilleure efficacité d'alerte précoce. Cependant, une combinaison d'éosinopénie et de CRP au triage devrait également servir de signe du drapeau rouge chez les patients en dehors des valeurs NLR et IL6 bien connues. Mots-clés: C Protéine réactive, efficacité d'alerte précoce, éosinopénie, progression de la maladie dans Covid ­ 19.

Lung Transplantation for COVID-19: An International Registry

Purpose: SARS-CoV-2 can result in a range of infections from asymptomatic disease to progressive COVID-19 and death. In some patients with COVID-19 Lung Disease (C19LD), lung transplantation (LTx) may be lifesaving. Up to 10% of LTx in the US is currently for patients with C19LD. Understanding the characteristics and outcomes of these patients is critical. Method(s): A open-access electronic registry was established to collect de-identified data from pts who have undergone LTx for C19LD from centers globally. The study was IRB approved at Northwestern with a wavier for consent (no PHI is collected sites could submit data about pre-Tx, peri-Tx and post-Tx course). Follow-up for 1-yr post-LTx was collected. Result(s): To date, 23 patients with complete day 30 post-LTx data have been entered into the registry. Patient demographics and pre-Tx status are shown in Table 1. 3 patients required oxygen prior to COVID-19 infection. All sites required neg PCR tests prior to listing (22 (95.7%) require 2 neg PCRs). LTx occurred 150 days post-infection and none developed COVID-19 in the first 30 days. Post-Tx ICU LOS averaged 18.6 days with total post-tx hospitalization of 36.3 days (See Table 2). Most LTx experienced infectious and non-infectious morbidity. Most (47.8%) required an additional 36.8 days of rehab. 1 patient died within 30 days due to sepsis. Conclusion(s): The contribution of cases to this international registry is ongoing. While outcomes of LTx for C19LD are generally good, patients experience prolonged post-transplant hospitalization, rehabilitation and significant morbidity.

Implications of Pre-Transplant (tx) COVID-19 on SOT or HCT: A Multicenter Study

Purpose: Describe outcomes of patients (pt) with pre-tx COVID-19. Method(s): Multicenter study of SOT/HCT candidates who had a positive (pos) SARS-CoV-2 PCR pre-tx. Result(s): Pre-tx: Of 208 pt, median age was 56 (range 3-76). 87.8% were SOT candidates (40.5% kidney, 40.5% liver, 9.8% lung, 6.9% heart, 2.3% pancreas) and 13.9% were HCT candidates (54.2% allo, 45.8% auto). Pt underwent a median of 2 tests (range 1 - 14). In 41% of pt, > 1 neg PCR was required by the tx center before reactivation. Neg PCR was documented in 67.4% of pt at a median of 41 days (18-68) after pos PCR. Waitlist mortality was 11.0%;deaths were due to COVID-19 in 60% (12/20). Post-tx (all pt): 78 pt underwent tx at a median of 65.5 days (range 17-324) from COVID-19;71/78 have completed 4-weeks of follow-up. 24/78 (30.7%) pt were still PCR pos at time of tx (details below). 54/78 (69.2%) pt underwent routine PCR testing post-tx;62% were tested regularly for 8 weeks. Only 1 pt, who remained asymptomatic, developed recurrent pos PCR on surveillance testing 18 days post-tx. 1 pt had graft loss. There were no deaths at 4 weeks post-tx. Pt transplanted without a negative PCR: 24 pt with COVID-19 did not have neg PCR at time of tx: 9 (37.5%) kidney, 9 (37.5%) liver, 2 (8.3%) SLK, 1 (4.2%) lung, 1 heart (4.2%), 2 auto-HSCT (8.3%), 2 allo-HSCT (8.3%). Of 24 pt who were reactivated at a median of 21 days (range 8 - 38) from COVID-19 diagnosis, 7 underwent tx emergently (5 liver, 1 lung, 1 heart). 20/24 completed 4-weeks of follow-up;all were alive. PCR Cycle thresholds (Ct) increased over time, suggesting a reduction in SARS-CoV-2 viral loads with time elapsed since COVID-19 diagnosis. Conclusion(s): Short-term outcomes of transplantation in SOT/HCT candidates with prior COVID-19 were promising in this small cohort, even with a positive PCR going into transplant. Whether documentation of a negative PCR should be required for all tx candidates with a history of COVID-19 prior to transplantation should be investigated further, particularly among lung tx candidates. For certain tx candidates with COVID-19, relying time-based strategy instead of a test-based strategy may be safe.

Platelet Indices and Platelet to Lymphocyte Ratio (PLR) as Markers for Predicting COVID-19 Infection Severity

Background Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (or coronavirus disease 2019;COVID-19) has caused a large number of infections across the globe. Numerous markers are being used to predict the severity of infection. This study was undertaken to assess the utility of platelet count, mean platelet volume (MPV), platelet distribution width (PDW), and platelet lymphocyte ratio (PLR) as markers of severity and mortality among patients with COVID-19 infection. Methodology This is a retrospective study conducted in a tertiary care center in India from April 2021 to June 2021. Patients admitted with COVID-19 infection were included in the study. Based on the severity, patients were categorized into the mild and severe (moderate severity included) groups. Platelet count, MPV, PDW, and PLR done at admission were studied and correlated with the disease severity and mortality. Statistics The independent t-test was used to compare the variables. The receiver operating characteristic (ROC) curve was done to identify the cut-off value. Statistical analysis was performed using SPSS 18 software (SPSS Inc. Released 2009. PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc). Results One hundred patients admitted with COVID-19 infection were studied. 51 patients had a mild and 49 had a severe infection. The mean PLR was 141.40 among patients with mild illness and 252.6 with severe infection (P<0.001). The mean PLR among survivors was 104.4 (SD-23.56) and among nonsurvivors was 302.78 (SD-34.5) (P<0.001). There was no statistically significant difference between the two groups with respect to platelet count, MPV, and PDW. Conclusion PLR was found to be a reliable marker of severity and mortality among patients with COVID-19 illness.

Immunologic Monitoring of a Breakthrough Infection in a Heart and Kidney Transplant Recipient

Introduction Solid organ transplant recipients (SOTR) have lower SARS-CoV-2 spike seroconversion than healthy subjects (HS) following vaccination. A breakthrough (BT) infection is defined as the detection of SARS-CoV-2 in a respiratory specimen after a person is ≥14 days after completing the recommended doses for a vaccine. We report a case of SARS-CoV-2 BT infection in a SOTR who was immunologically followed longitudinally following vaccination. Case Report A 44-year-old man with a history of non-ischemic cardiomyopathy (NICM) and end stage renal disease had undergone heart and kidney transplantation in December 2017 with thymoglobulin induction. His NICM was secondary to radiation for non-Hodgkin's lymphoma treated with autologous bone marrow transplant in 2001. Maintenance immunosuppression consisted of sirolimus 2mg daily, tacrolimus 2mg twice daily (BID), and prednisone 5mg daily at his 1st Moderna vaccine in April 2021. In anticipation of surgery, sirolimus was stopped and mycophenolate mofetil (MMF) 500mg BID was started. He was on this regimen at the time of his 2nd Moderna vaccine. Sirolimus was restarted in July and increased to 1mg daily while continuing MMF 500mg BID, tacrolimus, and prednisone. At the end of July, the patient was exposed to several family members with COVID-19. He tested positive 89 days after his 2nd Moderna vaccine (cycle threshold of 33.5). He was asymptomatic at the time, but later developed fever, myalgias, headache, and loss of taste and smell and was treated with casirivimab and imdevimab monoclonal antibody (mAb) infusion. We assessed the patient's immunologic response 14 days post 2nd Moderna vaccination and at BT infection prior to mAb infusion and compared this to HS. The patient developed SARS-CoV-2 spike-specific CD4+ T cells at 14 days post 2nd mRNA vaccine at a frequency below the average frequency for HS. At BT infection, the patient did not have SARS-CoV-2 spike-specific CD4+ T cells, partly due to virus induced lymphopenia. The patient did not develop spike-specific CD8+ T cells, spike IgG or neutralizing antibodies at 14 days post 2nd Moderna vaccination or at BT infection. Summary The patient developed SARS-CoV-2-specific CD4+ T cells following vaccination. His uneventful recovery may be secondary to these SARS-CoV-2 specific CD4+ T cells post vaccination as well as receiving mAb therapy 8 days post infection.

NASOPHARYNGEAL SPECIMEN COLLECTION FROM SUSPECTED COVID-19 CASES, MAKING THE PROCEDURE SAFE

Objective: To comparison was made between standard (control group) nasopharyngeal sample collection technique for RT-PCR and modified technique and the outcome was compared in terms of the proportion of positive results of Rt-PCR tests. Study Design: Double blinded randomized clinical trial. Place and Duration of Study: Pakistan Naval Ship Shifa Hospital Karachi Pakistan, from June and July 2020. Methodology: This study was a newly developed modified technique for nasopharyngeal sampling for RT-PCR tests of COVID-19 suspects. Target population included all patients who developed COVID-19 related symptoms and/or also had history of recent travel or closed contact with Covid-19 patients. Total 1500 nasopharyngeal PCR tests were done by a team of trained technicians. Systemetic probability sampling technique was utilized. Subjects were divided into two groups by using even and odd serial numbers. Proportion of positive test results were compared between two groups by using chi square test. Results: Results were collected for 3000 nasopharyngeal swab sample for RT-PCR testing. Mean age was 31.68 ± 11.89 years. In study group with modified technique, 470 tests were found positive for a total of 1500 samples while only 297 out of 1500 samples were detected positive in control group with standard technique. Chi square test applied to assess the difference between this proportion and it proved that the difference was highly statistically significant (p-value <0.00). Conclusion: we interpret that modified samples collection technique is relatively safe for sample collector of Covid-19 PCR which has got potential benefits to get more genuine results of these samples. © 2021, Army Medical College. All rights reserved.

Analysis of Synchronous and Asynchronous Approaches in Students' Online Learning Satisfaction during Covid-19 Pandemic

The Covid-19 Pandemic forced the global closure of numerous activities along with education and shifted traditional education to an online version via two e-learning platforms, i.e., synchronous and asynchronous. This transition was unplanned for all educational institutions, due to which teachers and students had to face several teaching/learning challenges. Thereby a quantitative study was designed to investigate the learning satisfaction of students in both synchronous and asynchronous learning environments from public universities of Karachi, Pakistan. The participants of the study were selected through simple random sampling, and 108 students from different universities filled the complete questionnaires. The data were analyzed through various statistical tests, i.e., (mean, standard deviation and Pearson correlation, and T-test. The Findings identified that students showed significantly higher satisfaction in the synchronous learning environment. Thereby, the study mainly suggests that the learning process should be facilitated by synchronous e-learning mode by providing adequate institutional support to optimize their learning satisfaction by raising their digital competence. Besides, teachers should employ activity-based teaching Strategies for keeping students involved in the learning process. © 2021 IEEE.