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Background: The usefulness of leukocyte cell population data (CPD) is currently being investigated. In COVID-19 pandemic several reports showed the clinical importance of hematological parameters. Our study aimed to assess CPDs in Sars CoV-2 patients as new disease markers. Method(s): From February to April 2020 (1st wave) 540 and from September to December 2020 (2nd wave) 2821 patients respectively were enrolled. SARS CoV-2 infection diagnosis was carried out by Multiplex rRT-PCR from nasopharyngeal swabs. CPDs were detected by XN 2000 hematology analyzer (Sysmex Corporation). A comparison between two disease waves was performed. Additionally, C-reactive protein (CRP) and lactate dehydrogenase (LDH) were assayed. Result(s): CPDs were classified into: cell complextity, DNA/RNA content and abnormal sized cells. We detected parameters increased from the reference population for all cell types for both 1st and 2nd wave (p<0.05). However, in the 2nd vs 1st wave 5 CPDs vs 9 CPDs were found. In addition we observed higher CPD values of the 1st compared to 2nd wave: (NE-SFL) (p<0.001), (LY-Y) (p<0.0001), (LY-Z) (p<0.0001), (MO-X) (p<0.0001), (MO-Y) (p<0.0001). These findings were confirmed by the higher concentrations of CRP and LDH in the 1st vs 2nd wave: 17.3 mg/L (8.5-59.3) vs 6.3 mg/L (2.3-17.6) (p<0.001) and 241.5 IU/L (201-345) vs 195 IU/L (174-228) (p< 0.001) (median, interquartile range) respectively. Conclusion(s): CPDs showed increased cell activation in 1st wave patients confirmed by clinical and biochemical data, associated with worse clinical conditions. Results highlighted the CPDs as disease characterization markers or useful for a risk model.Copyright © 2023 Sciendo. All rights reserved.
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Background Fulminant myocarditis can cause biventricular dysfunction with a mortality rate over 40%. We report a case with severe biventricular failure due to fulminant myocarditis that was successfully supported by left and right ventricular assist devices. Case A 65-year-old woman presented with chest pain, abdominal pain and diarrhea. She was hypotensive and labs revealed elevated troponin-T of 13.5 ng/mL and lactate of 4.3 mmol/L. She was positive for COVID by antigen testing. She was started on multiple vasopressor infusions and admitted to the intensive care unit. Echocardiogram revealed a severely reduced left ventricular ejection fraction of 15% and severe global hypokinesis. The following day, she developed a wide complex tachycardia that was refractory to amiodarone, lidocaine and multiple defibrillation attempts. She was transferred emergently to the cardiac cath lab where coronary angiography revealed an isolated 70% stenosis of the distal left circumflex artery. A Swan-Ganz catheter was placed that yielded a cardiac index by Fick of 1.2 L/min/m2, systemic vascular resistance of 1270 dynesseccm-5 and mixed venous oxygen saturation of 35%. Decision was made to emergently insert an Impella CP device. That evening, she developed complete heart block and transvenous pacing wire was inserted. Due to frequent suction alarms, decision was made to insert ProtekDuo device, which resulted in hemodynamic stabilization. A temporary coronary sinus pacing lead for atrial capture was inserted to improve atrioventricular synchrony. After several days of monitoring, repeat echocardiogram showed complete recovery of biventricular function and Impella CP and ProtekDuo devices were removed. Decision-making The decision of early implantation of ProtekDuo device was made to provide adequate blood flow to the left ventricular assist device for hemodynamic support. In addition, increased atrioventricular synchrony via insertion of temporary coronary sinus pacing wire improved cardiac output. Conclusion Fulminant myocarditis involving biventricular dysfunction can be supported by the use of simultaneous left and right ventricular assist devices.Copyright © 2023 American College of Cardiology Foundation
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IntroductionThe usefulness of leukocyte cell population data (CPD) derived from optical signals of new hematology analyzers is currenctly being investigated. In Covid-19 pandemic several reports showed the clinical importance of functional and quantitative blood parameters. Our study aimed to assess CPDs in positive Sars Cov-2 patients as potential disease markers.MethodsFrom February to April 2020 (1st wave), 540 patients (490 negative and 50 SARS CoV-2 positive) were enrolled in this retrospective study, as well as 2821 patients from September to December 2020 (2nd wave) (2762 negative and 59 SARS CoV-2 positive). SARS CoV-2 infection diagnosis was carried out by Multiplex rRT-PCR from nasopharyngeal swabs and clinical information collected in cardiology emergency department (ED). CPDs were detected by XN 2000 hematology analyzer (Sysmex Corporation) considering a single determination on whole blood. Comparisons between disease waves and SARS CoV-2 negative and positive patients were performed. Additionally, C-reactive protein (CRP) and lactate dehydrogenase (LDH) were assayed. Statistical analysis using the univariate and multivariate general linear regressions were made.ResultsLeukocyte CPDs were classified into: cell complextity (NE, LY, MO X-axis), DNA/RNA content (NE, LY, MO Y-axis) and abnormal sized cells (NE, LY, MO Z-axis). We detected cytometric parameters increased from the reference population for all cell types for both 1st and 2nd wave (p<= 0.03). However, smaller quantitative alterations were found in the 2nd vs 1st wave: 5 CPDs vs 9 CPDs. In addition we found higher CPD values of the 1st compared to 2nd wave: (NESFL) (p=00004), (LY-Y) (p<=0.0001), (LY-Z) (p<=0.0001), (MO-X) (p<=0.0001), (MO-Y) (p<=0.0001). These findings were confirmed by the higher concentrations of CRP and LDH in the 1st vs 2nd wave: 17.3mgdL (8.5-59.3) vs 6.3 mg/dL (2.3-17.6) (p=0.0003) and 241.5 U/L (201-345) vs 195 U/L (174-228) (p=0.0005) (median, interquartile range) respectively.Conclusions Leukocyte CPDs showed increased cell activation in patients of 1st wave confirmed by biochemical data, correlated with worse clinical conditions of hospitalized patients. Our results highlighted the CPDs as disease characterization markers or useful for a predictive risk model.
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Introduction: Following acute coronavirus 2019 (COVID-19) disease, at least 10% of patients report some form of residual limitation, most commonly dyspnea and fatigue. These COVID-19 “long haulers” experience symptoms that are largely unexplained by pulmonary function testing (PFT), echocardiogram and chest computed tomography (CT). Using invasive cardiopulmonary exercise testing, this pilot study characterized exercise limitation in 5 patients with persistent symptoms 1 year following mild COVID-19 illness. Methods: Following written informed consent, data were obtained in accordance with an IRBapproved protocol entailing placement of radial and pulmonary arterial catheters for pressure monitoring and blood sampling prior to and during maximum upright incremental exercise. Rest and exercise pulmonary hemodynamics, ventilation and gas exchange were recorded. Aerobic exercise capacity was estimated by peak O2 consumption (VO2 ). Results: All patients had normal biventricular and valvular function on resting echocardiogram, no evident parenchymal lung disease on CT, and normal PFTs. Resting mean pulmonary arterial pressure was ≤20 mmHg for all patients with pulmonary vascular resistance <3 Woods units. At maximum exercise, all patients exhibited normal respiratory, cardiac output (% predicted), and total pulmonary vascular resistance responses, but demonstrated clearly depressed aerobic capacity (peak VO2 <80% predicted). Reduced peak VO2 was associated with impaired systemic O2 extraction as indicated by an arterial-venous O2 content difference (adjusted for hemoglobin) of <80% (Figure 1). Conclusion: This case series provides preliminary evidence that reduced peak aerobic capacity among long haulers is primarily attributable to a peripheral (i.e., impaired systemic O2 extraction), rather than central cardiopulmonary, limitation. These results suggest that systemic microcirculatory dysfunction contributes to exercise limitation.
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Background: Intersecting priority populations are disproportionately affected by HCV and COVID-19;including people who use drugs, those with mental health issues, and those who are homeless/street-involved. COVID-19 vaccine clinics present an opportunity for co-localization of HCV testing by leveraging resources and infrastructure that promote COVID-19 vaccination among these populations. Methods: HHCV Ab point-of-care testing (POCT) was offered at two COVID-19 vaccination sites: the Centre for Addiction and Mental Health (CAMH) in Toronto, ON and the Ontario Addiction Treatment Centre (OATC) in North Bay, ON. Vaccine recipients (VRs) were staff, community members, or patients (CAMH);or patients and household members (OATC). HCV outreach workers approached VRs for testing, which was promoted by clinic staff. At OATC, VRs received a $5 coffee card incentive to undergo testing. At both sites, Ab POCT was done by fingerprick (OraQuick) during or after a 15-minute post-vaccine observation period. Results were provided after 5 minutes based on prior data showing this approach detects all viremic individuals (VIRCAN 5-Minute Rule). Dried blood spot (DBS) samples were collected by fingerprick for HCV RNA testing following Ab+ results. Results: CAMH - 2759 individuals received vaccine over 12 days (mean 230/day, range 102-350). 621 (23%) underwent Ab POCT (mean 52/day, range 16-106). The mean age was 46 yrs (range 12-87) and 307 (49%) were male. Staff constituted 55% of tested VRs with a positivity rate of 0% compared to 2.2% in patients/community members. Of 6 Ab+ individuals, 5 DBS samples were collected and 2 were RNA+. One Ab+ individual was counseled by phone to follow up for RNA testing due to a late Ab+ result (20'). OATC - 150 individuals received vaccine over 9 days (mean 17/day, range 11-33). 27 (18%) were recruited for Ab POCT (mean 3/day, range 0-10). The mean age was 37 yrs (range 25-56) and 14 (52%) were male. Seven individuals were known to be Ab+ and DBS samples were collected from each, of which 4 were RNA+. The remaining 20 individuals were all Ab- by POCT. Outreach and linkage to care is ongoing at both sites. Conclusion: Co-localization of HCV testing with COVID-19 vaccination enables reaching and re-engaging populations with a tenuous link to the healthcare system. HCV Ab POCT with the VIRCAN 5-Minute Rule followed by DBS sample collection is a quick, low-barrier approach that enables high throughput and ensures complete diagnosis of HCV.