Effects of Body Mass Index on Presentation and Outcomes of COVID-19 among Heart Transplant and Left Ventricular Assist Device Patients: A Multi-Institutional Study.

The coronavirus disease 2019 (COVID-19) pandemic continues to pose a significant threat to patients receiving advanced heart failure therapies. The current study was undertaken to better understand the relationship between obesity and outcomes of SARS-CoV-2 infection in patients with a left ventricular assist device (LVAD) or heart transplant. We performed a retrospective review of patients with a heart transplant or LVAD who presented to one of the participating 11 institutions between April 1 and November 30, 2020. Patients were grouped by body mass index (BMI) into obese (BMI ≥ 30 k/m2) and nonobese cohorts (BMI < 30 kg/m2). Multivariable logistic regression models were used to estimate effects of obesity on outcomes of interest. Across all centers, 162 heart transplant and 81 LVAD patients were identified; 54 (33%) and 38 (47%) were obese, respectively. Obese patients tended to have more symptoms at presentation. No differences in rates of hospitalization or ICU admission were noted. Obese patients with LVADs were more likely to require mechanical ventilation (39% vs. 8%, p < 0.05). No differences in renal failure or secondary infection were noted. Mortality was similar among heart transplant patients (11% [obese] vs. 16% [nonobese], p = 0.628) and LVAD patients (12% vs. 15%, p = 1.0). BMI was not associated with increased adjusted odds of mortality, ICU admission, or mechanical ventilation (all p > 0.10). In summary, acute presentations of SARS-CoV-2 among heart transplant and LVAD recipients carry a significantly higher mortality than the general population, although BMI does not appear to impact this. Further studies on the longer-term effects of COVID-19 on this population are warranted.

Expand accessibility of monoclonal antibody in COVID-19 among different ethnicities and races

Background. Anti-SARS-CoV-2 monoclonal antibodies are administered to patients with mild-moderate COVID-19 who are at high risk of progression to severe disease. It has been shown that in addition to medical comorbidities, race or ethnicity may also place patients at high risk for progression to severe COVID-19 infection due to social disparities including limited access to care. The purpose of this study is to increase the accessibility of monoclonal antibody infusion to patients at high risk for severe outcomes of COVID-19, irrespective of race and ethnicity, by expanding outreach resources when availability of oral antiviral therapies was limited. Methods. We performed a single-center retrospective analysis of patients with mild-moderate COVID-19 infection receiving sotrovimab, amonoclonal antibody, between December 2021 and January 2022. A total of 93 SARS-CoV-2-positive patients meeting EUA criteria for eligibility were infused with sotrovimab in different settings such as emergency department, outpatient setting including infusion clinics and cancer centers, home health as well as patients hospitalized due to reasons other than COVID-19 at RUSH medical center, Chicago. For context, during omicron surge, initially home health was set up followed by introduction to infusion clinics. Primary care provider could refer patients to the infusions clinics or home health. Results. Out of 93 patients, 8 patients received mAb infusion in emergency department, 25 patients each in cancer center and infusion clinic, 17 patients in home health setting and 18 patients who were hospitalized due to reasons other than COVID-19. The median age of participants was 57 years and 61.2% were females. Overall, Hispanic patients received mAb less often than did non-Hispanic patients (33% vs 62%). Black, Asian and other racial groups received mAb 18.2%, 3.23%, 3.23% less often, respectively, than did White patients. Interestingly, in home health setting, Hispanic patients received infusion more often than non-Hispanic patients (12.9% vs 5.3%). Conclusion. Implementation of programs centered around needs of community such as increase accessibility to COVID-19 medications through home health or infusion clinics may help mitigate the racial and ethnic disparities in COVID-19 and thus, promote health equity.

The Association of Posterior Reversible Encephalopathy Syndrome with COVID-19: A Systematic Review

Objective: The increasing frequency of PRES during the COVID-19 pandemic, and a possible causal relationship between the two necessitates the review of available literature so that knowledge of practicing physicians is up to date in terms of the likely presentation and management of this clinical association. Background: The surge in COVID-19 cases is bringing with it an array of unique neurological manifestations. Clinicians report a possible association with Posterior Reversible Encephalopathy Syndrome (PRES). PRES is an otherwise rare disease that usually arises as part of greater complications such as hypertension and renal failure. Design/Methods: We conducted a systematic literature search on four databases namely PubMed/MEDLINE, Cochrane, Google Scholar, and ScienceDirect. A total of 34 articles describing 56 cases of PRES in COVID-19 were selected as a part of this review. Results: The mean age of the patients was 56.6 ± 15.3 years. The most common clinical presentation of PRES was altered mental status (53.6%) followed by seizures (46.4%) and visual disturbances (23.2%) while hypertension (28.6%) and diabetes mellitus (23.2%) were the most commonly reported predisposing comorbidities. 16.1% of the patients were treated for COVID19 with Tocilizumab, another predisposing factor for PRES. Symptomatic management was employed in most of the cases and 44 patients (78.5%) were reported to fully or partially recover. Conclusions: When COVID-19 is developed on a background of hypertension and diabetes, there is a possibility that all these factors play an additive role in the development of PRES. Therefore, neurologists and radiologists must consider PRES as a probable diagnosis when encountering COVID-19 patients with suggestive clinical and radiographic findings. The risk of using tocilizumab, a potential trigger of PRES, must be weighed against its potential benefit in mitigating the COVID-19 cytokine storm. Timely diagnosis and treatment report a good prognosis.

Covid-19 lockdown Impact on the Adult Pakistani Population

Background: COVID-19 pandemic started from Wuhan Hubei Area, China in December 2019 and by April 25th, 2020 had infected almost 2,858,000 people in 185 countries, resulting in more than 200,000 deaths. Pakistan first reported two cases was on 26th February, 2020. Aim: To illustrate the impact of lock down during Covid-19 on adult Pakistani population. Method: A cross sectional study was carried out from 1st June to 30th July, 2020. An online questionnaire was administered via social media and e-mailing channels, randomly dispersed to adult Pakistani population from 1st June 2020 until 30th July 2020. A self-prepared systematic questionnaire was utilized to record the responses of member. This survey included questions to check the impact of lockdown on Pakistani population behavior, health effect, income, daily routines and jobs status, demographic data, before and after lockdown (sleeping time, use of social networking and exercise time). Data analysis was performed using SPSS 24. Results: This data exhibit lockdown impacts the day-by-day schedules and habits of individuals. Periods of rest, eating propensities and internet users have found critical contrasts. The larger part of members acknowledged the urge influenced by lockdown in their schedules and propensities. Conclusion: Covid-19 lockdown has deistically affected all responses of life and people faced social isolation.

Multimodality Imaging for Cardiac Evaluation in Patients with COVID-19.

PURPOSE OF REVIEW: A growing number of cardiovascular manifestations resulting from the novel SARS-CoV-2 coronavirus (COVID-19) have been described since the beginning of this global pandemic. Acute myocardial injury is common in this population and is associated with higher rates of morbidity and mortality. The focus of this review centers on the recent applications of multimodality imaging in the diagnosis and management of COVID-19-related cardiovascular conditions. RECENT FINDINGS: In addition to standard cardiac imaging techniques such as transthoracic echocardiography, other modalities including computed tomography and cardiac magnetic resonance imaging have emerged as useful adjuncts in select patients with COVID-19 infection, particularly those with suspected ischemic and nonischemic myocardial injury. Data have also emerged suggesting lasting COVID-19 subclinical cardiac effects, which may have long-term prognostic implications. With the spectrum of COVID-19 cardiovascular manifestations observed thus far, it is important for clinicians to recognize the role, strengths, and limitations of multimodality imaging techniques in this patient population.