ABSTRACT
Introduction: De novo and relapsed glomerulonephritis (GN), including membranous nephropathy (MN), have been reported after COVID-19 mRNA-vaccination. We report a case of MN that relapsed following COVID-19 vaccination after 26 years of remission. Case Description: A 78-year-old man presented with nephrotic syndrome (UPC 8.0). His history was notable for primary MN diagnosed by kidney biopsy in 1994. He was treated with prednisone and ACE inhibitor with full resolution of proteinuria. He received COVID-19 vaccine (mRNA-1273, Moderna) March 3 and April 1, 2021. Between the two doses, he had onset of leg swelling. This was attributed to amlodipine, which was discontinued by his PCP. After the second dose of vaccine, edema progressed to anasarca. Urine protein was 5.73g/day. Two months later, the UPC was 8.0, serum creatinine 0.86 mg/dL, and serum albumin 2.7mg/dL. Anti-PLA2R was positive (24RU/mL, ref. >19RU/mL). Renal biopsy showed recurrent MN, EM stage 3-4, PLA2R1 positive. Due to regional surge of COVID-19 Omicron variant, immunosuppression was held to administer EvuSheld for COVID-19 prophylaxis. Proteinuria improved initially without intervention (UPC 2.7) but increased again (UPC 4.7) a month later. Rituximab was initiated three months after biopsy resulting in undetectable anti-PLA2R 1 week after treatment, with reduction in UPC to 3.7 and improvement of anasarca 2 weeks after treatment. Discussion(s): Onset or relapse of GN after vaccination historically has rarely been reported. There are numerous reports of de novo or relapsed GN after COVID-19 infection, and increasing reports of GN after COVID-19 vaccination with mRNA and traditional vaccine platforms. The pathogenesis of GN in this setting has not been established. Nonspecific immune activation and specific COVID-19-related immune reaction have been postulated. MN related to COVID-19 vaccination, although rarely reported, has been treated with standard immunosuppression with favorable results. Management of MN and other forms of GN will evolve with greater understanding of disease course in the setting of COVID-19 infection and vaccination. Patients with a history of GN, including MN, should be counseled about the possibility of relapse with COVID-19 infection or vaccination, even if their original disease was remote.
ABSTRACT
The recent global pandemic of Corona Virus Disease-19 has impacted all aspects of society, producing a growing demand for a powerful virus inactivation method. To assess a potential and mechanism of human coronavirus inactivation using atmospheric pressure plasma (APP) technology, replication of a human coronavirus (HCoV-229E) after He + H2O APP plume exposure was evaluated using rhesus monkey kidney epithelial cells. The HCoV-229E titers were reduced by 3 log(10)TCID(50) after the APP exposure for 30 s, showing a strong virus-inactivation efficacy of the APP. It was experimentally verified that the APP produced the liquid-phase reactive oxygen and nitrogen species (RONS) at high rates [e.g. (OH)-O-center dot: similar to 1.7 nmol s(-1), H2O2 (including H2O2 precursors): similar to 9.2 nmol s(-1), NO2 (-) (including NO2 (-) precursors): similar to 3.3 nmol s(-1)]. However, an administration of H2O2 with NO2 (-) failed to inactivate the virus and only Mn type superoxide dismutase among several RONS scavengers for (OH)-O-center dot, HO2 (center dot)/O-2 O-center dot-, 1(2), and (NO)-N-center dot/(NO2)-N-center dot was significantly effective for the recovery of the APP-induced decrease in the viral titers. This suggests O-2 (center dot-)-related chemical reaction in a network of interconnected reactions induced by the APP exposure is very important for the APP-induced virus inactivation. These results provide new insight into a more efficient inactivation method of human coronavirus using APPs.
ABSTRACT
BACKGROUND: Acute type A aortic dissection (ATAAD) is a surgical emergency with an operative mortality of up to 30%, a rate that has not changed meaningfully in more than 2 decades. A growing body of research has highlighted several comorbidities and presenting factors in which delay or permanent deferral of surgery may be considered;however, modern comprehensive summative reviews are lacking. The urgency and timing of this review are underscored by significant challenges in resource use posed by the coronavirus disease 2019 (COVID-19) pandemic. This review provides an update on the current understanding of risk assessment, surgical candidacy, and operative timing in patients with ATAAD. METHODS: A literature search was conducted through PubMed and Embase databases to identify relevant studies relating to risk assessment in ATAAD. Articles were selected by group consensus on the basis of quality and relevance. RESULTS: Several patient factors have been identified that increase risk in ATAAD repair. In particular, frailty, advanced age, previous cardiac surgery, and use of novel anticoagulant medications have been studied. The understanding of malperfusion syndromes has also expanded significantly, including recommendations for surgical delay. Finally, approaches to triage have been significantly influenced by resource limitations related to the ongoing COVID-19 pandemic. Although medical management remains a reasonable option in carefully selected patients at prohibitive risk for open surgery, endovascular therapies for treatment of ATAAD are rapidly evolving. CONCLUSIONS: Early surgical repair remains the preferred treatment for most patients with ATAAD. However, improvements in risk stratification should guide appropriate delay or permanent deferral of surgery in select individuals.