Persistence of Ad26.COV2.S-associated VITT and specific detection of VITT antibodies

Background: Some COVID-19 vaccinated individuals develop anti-platelet factor 4 (PF4) antibodies that cause thrombocytopenia and thrombosis;a rare syndrome referred to as vaccine-induced immune thrombotic thrombocytopenia (VITT). Currently, information on the characteristics and persistence of anti-PF4 antibodies that cause VITT after Ad26.COV2.S vaccination is limited, and available PF4-polyanion enzyme-linked immunosorbent assays (ELISAs) and functional diagnostic assays fail to differentiate Ad26.COV2.S and ChAdOx1 nCoV-19-associated VITT from similar clinical disorders, namely heparin-induced thrombocytopenia (HIT) and spontaneous HIT. Aim(s): Evaluate the persistence of anti-PF4 antibodies in Ad26. COV2.S-associated VITT and correlate findings with clinical and laboratory variables such as thrombosis and platelet counts. Develop/ investigate laboratory tools that differentiate VITT antibodies from HIT and spontaneous HIT. Method(s): Blood samples from VITT and HIT patient cohorts were tested in antigen-based and functional assays and correlated with clinical and laboratory features. Result(s): While Ad26.COV2.S-associated VITT patients were strongly positive in PF4-polyanion ELISAs;they were frequently negative in the serotonin release assay (4 of 8 tested patients were negative). In contrast, the PF4-dependent p-selectin expression assay (PEA) that uses PF4-treated platelets consistently diagnosed Ad26.COV2.S-associated VITT. Most Ad26.COV2.S-associated VITT antibodies persisted for >5 months in PF4-polyanion ELISAs, while the PEA became negative earlier. Two patients had otherwise unexplained mild persistent thrombocytopenia (140-150,000/ mul) six months after acute presentation. No recurrence of thrombosis was noted. Additionally, a novel un-complexed PF4 ELISA specifically differentiated VITT secondary to Ad26.COV2.S and ChAdOx1 nCoV-19 vaccination, from spontaneous HIT and HIT (Fig 1A-PF4/ polyanion ELISA;Fig 1B-Un-complexed PF4 ELISA;closed black circles-Ad26. COV2.S-associated VITT;closed red circle-ChAdOx1 nCoV-19-associated VITT;***p < 0.001;****p < 0.0001). Its specificity was further confirmed by testing commonly-encountered HIT-suspected patient samples that are PF4/polyanion ELISA-positive but negative in functional assays (1A-1B). Conclusion(s): Ad26.COV2.S-associated VITT antibodies are persistent, and the un-complexed PF4 ELISA appears to be both sensitive and specific for VITT diagnosis.

Celiac Disease Screening and Autoimmunity in the Era of the Covid-19 Pandemic

Celiac disease (CD) is a common immune-mediated disease of the gastrointestinal tract that results in small bowel damage from ingesting gluten in genetically susceptible patients. The SARS-CoV-2 (COVID-19) pandemic resulted in a nationwide healthcare lockdown, with the halting of elective medical procedures and tests. The potential consequence of the COVID-19 pandemic on the long-term risk of systemic and autoimmune disorders like CD is not yet clear. There is growing evidence that COVID-19 can cause a "cytokine storm" affecting epithelial cells like intestinal mucosal cells, which may increase the risk of celiac autoimmunity;defined as positive celiac serology like anti-tissue transglutaminase immunoglobulin A (TTG IgA). Many providers report observing an increased number of newly diagnosed autoimmune disorders such as the CD post-COVID-19 pandemic. It is not clear if this is a true increase in CD autoimmunity or due to overcompensation of diagnostic numbers after the lockdown. This study aims to evaluate the effect of the COVID-19 pandemic on the frequency of CD screening tests and the rate of celiac autoimmunity reflected by positive TTG IgA titers. Method(s): This retrospective cohort study used the Rochester Epidemiology Project (REP) electronic health records between January 2018 and December 2021. All subjects who underwent celiac serology screening testing (TTG IgA) during the study period were included. The REP 7-county core region includes Olmsted County and the following 6 counties: Wabasha, Waseca, Steele, Dodge, Freeborn, and Mower. We documented the total number of celiac serology screening (TTG IgA) tests ordered during the study period and compared the frequency of tests performed and the rate of positivity before and after COVID-19. We used January 2020 as a marker of the start of the COVID- 19 pandemic in the USA;referring to the first reported case by the CDC. All patients had active research authorization at the onset of the study before being included in the analysis. All data were stored and managed in compliance with the REP and Mayo Clinic IRB regulations. Result(s): A total of 15,443 (Mean=321.7, SD= 6.7, CI= 13.4) TTG IgA screening tests for CD were ordered from January 2018 till December 2021. As expected, the frequency of celiac screening tests ordered decreased sharply during the lockdown in early 2020 (March-May) (Mean= 202.7, SD=39.8, CI= 171.4)), but it picked rapidly by June 2020 with a 2.5% increase to the pre-pandemic testing frequency rate (Figure1). Despite this sharp decrease in celiac screening testing during the lockdown, the rate of celiac autoimmunity (positive TTG IgA) was higher during similar periods in pre and post-lock down years Figure1. Comparing the rate of positivity of celiac tests done during the months of March to May of the lockdown in 2020 (44/608;7.24%) to the same period during years 2018, 2019, and 2021, we found a statistical difference in the rate of positivity (p= 0.04, df= 3) figure2. There was no significant difference in the number of tests administered between pre-and post-COVID years (7625 vs. 7818, p = 0.09). Over the study period, the total number of positive screening tests was 655/15443 (4%). Using January 2020 as our cut-off, we compared the rate of screening test positivity pre and post COVID-19 to the total number of tests as demonstrated in figure1. Conclusion(s): Celiac screening and autoimmunity were stable over the study period, however, during the lockdown, the rate of celiac autoimmunity was significantly higher as compared to similar periods before and after the pandemic year. It is not clear if this is due to false-positive TTG IgA post-COVID, or true autoimmunity. We expect that follow-up studies with a longer follow-up period during and after the COVID-19 pandemic are needed to understand the true effect of COVID-19 on celiac autoimmunity. (Figure Presented).

Adipsic Hypernatremia With Neurologic Manifestations in a Patient With Severe COVID-19 Pneumonia.

This report describes a case of a 50-year-old man with hypertension who was admitted with a history of fever, chills, and shortness of breath and tested positive for COVID-19. Shortly after resolving his acute respiratory distress syndrome (ARDS), he developed adipsic hypernatremia with associated confusion, lethargy, and weakness. COVID-19 is a serious disease that mainly targets the respiratory system; however, we must not overlook its effects on other organ systems. When the etiology of hypernatremia is unclear, it requires extensive workup and monitoring, and the lack of rapid correction can cause serious and irreversible neurological damage.

Community knowledge, attitudes and behaviors in prevention of covid-19 transmission: A systematic review

The research objective was to determine the community's knowledge, attitudes, and behavior in preventing the transmission of COVID-19 with a systematic review approach. The research method used the protocol preferred reporting items for systematic review and meta-analysis (PRISMA). The research variables were sociodemographic, knowledge, attitudes, and behaviors to prevent COVID 19. The search process for articles was accessed on three electronic journal databases. The article inclusion criteria are quantitative research, primary data, and year of publication (January-July 2020), in English, open access;have gone through the peer review stage, and full-text articles. A descriptive analysis was carried out on each research variable. The results showed ten articles that fit the inclusion criteria, consisting of 100% sociodemographic variables, 90% knowledge, 90% attitude, and 80% behavior. The number of articles with significant research results on knowledge variables (covering aspects of disease recognition, modes of transmission, general symptoms, and methods of prevention) was 61.11% of articles. The number of significant articles on attitude variables (including self-isolation, use of masks, social distancing, COVID-19, and government) was 35.54%. The number of substantial articles on the variable of preventive behavior (including handwashing, social distancing, hand sanitizers, use of masks, and self-isolation) was 45%. © 2021, Universitas Ahmad Dahlan - Faculty of Publich Health. All rights reserved.