Factors Associated With Persistence of Dyspnea and Change in Health-Related Quality of Life in Patients With COVID-19 After Discharge.

Introduction Coronavirus disease 2019 (COVID-19) is a deadly virus affecting multiple organ systems, predominantly the respiratory system. Dyspnea along with the deterioration of health-related quality of life (HRQoL) is common in COVID-19 patients discharged from a dedicated Coronavirus disease (COVID) hospital. Very few studies in India used HRQoL for the assessment of COVID-19 patients after discharge. Our article aims to assess the factors associated with the persistence of dyspnea and HRQoL in discharged patients of COVID-19. Methods A total of 48 patients were included in this prospective observational study. Ethical approval from Institutional Ethics Committee was obtained before the enrolment of patients. Patients having dyspnea at exertion and during discharge were selected for this study. Modified Medical Research Council (mMRC) scale and modified Borg scale were used for assessing dyspnea on activity, and Saint George's Respiratory Questionnaire (SGRQ) was used to assess HRQoL. Data were collected on the day of discharge (D0) and after 60 days (D60) post-discharge. The significance of changes in parameters from D0 to D60 was evaluated by paired t-test. Results The mean mMRC, modified Borg, and SGRQ scores at D0 were 2.38±0.98, 3.15±2.12, and 45.36±27.32, respectively, which were improved to 0.94±0.86, 0.94±1.27, and 19.22±18.96 at D60. Age showed significant positive correlations with initial modified Borg (r=0.292, p=0.044) and SGRQ (r=0.332, p=0.021) scores. Body mass index showed significant positive correlations with initial mMRC (r=0.352, p=0.014) and SGRQ (r=0.419, p=0.003) scores. Conclusion Our study showed that on discharge, many COVID patients have impaired HRQoL. Many of them also have dyspnea on exertion. With the early institution of standard pulmonary rehabilitation protocol, symptoms and HRQoL improves rapidly in a month. Different influencing factors were identified. Long-term follow-up with a bigger sample size is needed to formulate a management strategy for these patients.

Recent Emergence of Bovine Coronavirus Variants with Mutations in the Hemagglutinin-Esterase Receptor Binding Domain in U.S. Cattle.

Bovine coronavirus (BCoV) has spilled over to many species, including humans, where the host range variant coronavirus OC43 is endemic. The balance of the opposing activities of the surface spike (S) and hemagglutinin-esterase (HE) glycoproteins controls BCoV avidity, which is critical for interspecies transmission and host adaptation. Here, 78 genomes were sequenced directly from clinical samples collected between 2013 and 2022 from cattle in 12 states, primarily in the Midwestern U.S. Relatively little genetic diversity was observed, with genomes having >98% nucleotide identity. Eleven isolates collected between 2020 and 2022 from four states (Nebraska, Colorado, California, and Wisconsin) contained a 12 nucleotide insertion in the receptor-binding domain (RBD) of the HE gene similar to one recently reported in China, and a single genome from Nebraska collected in 2020 contained a novel 12 nucleotide deletion in the HE gene RBD. Isogenic HE proteins containing either the insertion or deletion in the HE RBD maintained esterase activity and could bind bovine submaxillary mucin, a substrate enriched in the receptor 9-O-acetylated-sialic acid, despite modeling that predicted structural changes in the HE R3 loop critical for receptor binding. The emergence of BCoV with structural variants in the RBD raises the possibility of further interspecies transmission.

Invasive Fungal Infection in COVID-19-Recovered Patient Detected on 18F-FDG-Labeled Leukocytes PET/CT Scan.

ABSTRACT: Occurrence of invasive fungal infections has gained significant attention during recent times in patients with COVID-19. Patients with severe form of COVID-19, such as those treated in the intensive care unit with prolonged steroid use, are particularly vulnerable to secondary bacterial and fungal infections. Disseminated systemic mycosis is a life-threatening condition, especially in immunocompromised patients. Here, we report a case of a recovered severe COVID-19 patient, who presented with persistent fever. 18F-FDG-labeled leukocyte scan revealed focal accumulation of radiotracer in the small intestine and right lung lower lobe. Subsequently, performed biopsy revealed mucormycosis.