ABSTRACT
Background: COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to be a global health emergency. Although well-known for pulmonary injury, COVID-19 is a systemic process. Previous autopsy case series have speculated about, although not clearly defined, patterns of hepatic injury, with steatosis being reported in many patients. This retrospective study is the first case-control study investigating hepatic pathology in a large cohort of deceased COVID-19 patients. Design: Consented autopsy cases at two institutions, between 4/2020 and 2/2021, were retrospectively searched for documentation of COVID-19 as a contributing cause of death. A control group of 40 consecutive consented COVID-19(-) autopsy cases during the same period was identified. The autopsy report and electronic medical records were reviewed for clinical information. H&E-stained liver sections were examined for selected histologic features. Results: 54 COVID-19(+) (mean age 72, M:F=3.2:1) were included in the study. The 40 control cases had a mean age of 64 years and a M:F=1.4:1. The study group was significantly older (p=0.0095) but there was no significant difference in sex. The control group had a higher rate of chronic alcoholism and underlying malignancy, with no difference noted in BMI or other comorbidities. The study group was more likely to have received steroid (72.2% vs. 30%, p<0.0001) and anticoagulation therapy (75.9% vs. 47.5%, p=0.009). Histologically, the study group showed a higher incidence of clinically insignificant steatosis (≤5%), (33.3% vs 12.5%;P = 0.03). Presence of clinically relevant (>5%) steatosis or zonal distribution of steatosis was not significantly different between the groups. Mild nonspecific lobular inflammation and acidophil bodies were also more common in COVID-19 cases (51.9% vs 30.0%;P = 0.04). No significant difference was noted among other histologic features, including vascular changes (Table 1). Conclusions: Mild nonspecific lobular necroinflammatory activity is a common finding in deceased COVID-19 patients, suggestive of COVID-19 hepatitis. COVID-19 is unlikely a cause of clinically significant steatosis. However, patients with COVID-19 are more likely to have low levels of steatosis (≤5%) compared to controls. The high rate of steroid therapy in this population may be a possible source of this minor component of steatosis.
ABSTRACT
Background: Emerging reports suggest that continuation of clinical trials is feasible and safe even in hospitals admitting COVID-19 patients-given the appropriate safety procedures. However, to our knowledge no studies have yet addressed how to again engage patients in cancer research. C-CRES was developed to identify factors that may be affecting participation in cancer research during the COVID-19 pandemic. We aimed to examine patientspecific concerns around research participation. This information will help inform future strategies for mitigating the impact of COVID-19 on cancer research. Methods: Between 5-13 June 2020, we advertised an anonymous survey using our research group's Twitter account and tagged a variety of cancer patient organisations/charities. Patients aged 18 with a current cancer diagnosis were eligible to participate and asked about their diagnosis/treatment, experience in cancer research, and beliefs about future cancer research participation given the COVID-19 pandemic. We specifically asked about potential concerns relating to research engagement. Results: A total of 75 patients filled out our questionnaire, of whom 89% were UK-based. 65% of respondents were male and the majority was of a white background (89%). The median age category was 60-69 years. 47% of patients had prostate cancer, 15% breast, 12% bladder, and 9% kidney cancer-a reflection of the cancer types our research team focuses on. Interestingly, 49% of participants had never participated previously in research. We therefore set out to make comparisons of patient concerns with regards to research participation during the COVID-19 outbreak between those with and without research experience. Those who had never taken part in research before were more likely to have concerns about currently being on cancer treatment (p=0.02) and about the type of cancer they had been diagnosed with (p≤0.05), with regards to taking part in cancer research during the current COVID-19 outbreak. Conclusions:Those with no prior experience of taking part in cancer research may be more likely to have concerns related to their cancer type and current treatment, in terms of participation during COVID-19. Efforts should be made to reassure potential cancer research participants about safety of participating during the COVID-19 pandemic.
ABSTRACT
Background: With the increasing impact of Ebola virus disease (EVD) in sub-Saharan Africa, the global health community has recognized that EVD survivors are at high risk for uveitis, an ocular inflammatory condition that may lead to vision loss. These findings have immediate relevance, particularly as the ongoing COVID-19 pandemic has heightened our awareness of emerging infectious diseases (EIDs). Key Findings and Results: A range of infectious diseases including Ebola, Zika, and COVID-19 may show ophthalmic manifestations, which may be associated with ocular viral RNA presence.1 We previously cared for a U.S. health care worker and EVD survivor who developed a severe, sight-threatening panuveitis during EVD convalescence, which was associated with ocular Ebola virus persistence.2 Our evaluation of EVD survivors in Liberia led to the identification of uveitis in over 20% of EVD survivors, with vision impairment in 60% of eyes.3 The subsequent EVICT Study in Sierra Leone was performed to determine the prevalence of Ebola virus within the ocular fluid of patients needing cataract surgery. Our study results showed negative EBOV ocular fluid results by RT-PCR in 50 patients at a median of 18-34 following acute EVD. Patients who underwent cataract surgery showed vision restoration, improving from hand motions to 20/30 at three-months (P<0.001).4 Infrastructural support, training and rapid response teams are opportunities to prepare health systems for future EVD and EID outbreaks.1 Conclusions: Ebola and EIDs have demonstrated the importance of understanding ocular complications. Vision health systems preparedness will be particularly relevant as data emerges from the ongoing COVID-19 pandemic. References: 1. Bavinger JC, Shantha JG, Yeh S. Ebola, COVID-19, and emerging infectious disease: lessons learned and future preparedness. Curr Opin Ophthalmol 2020;315: 416-422. 2. Varkey JB, Shantha JG, Crozier I, et al. Persistence of Ebola virus in ocular fluid during convalescence. N Engl J Med 2015;372: 2423-2427. 3. Shantha JG, Crozier I, Hayek, et al Ophthalmic manifestations and causes of vision impairment in Ebola virus disease survivors in Monrovia, Liberia 2017;124: 170-177. 4. Shantha JG, Mattia JG, Goba A, et al. Ebola virus persistence in ocular tissues and fluids (EVICT) study: Reverse transcription-polymerase chain reaction and cataract surgery outcomes of Ebola survivors in Sierra Leone. EBioMedicine 2018;30: 217-224.