Development of Spondyloarthritis after COVID-19 in HLAB27-Positive Monozygotic Twins: Case Reports with Single Cell Transcriptome Profiling

A subset of spondyloarthritis (SpA) called ‘reactive arthritis' is triggered by causal pathogens, usually bacteria related to venereal disease or gastrointestinal infection. During the outbreak of coronavirus disease 2019 (COVID-19), there have been case reports about SpA after COVID-19, but the causality is still elusive. We described cases of 23-year-old monozygotic twins both diagnosed with SpA after COVID-19. The probable linkage between SpA and COVID-19 was elaborated with our cases as well as literature reviews. Of note, shared genetic traits by monozygotic twins, particularly HLA-B27 positivity, might have contributed to their susceptibility to COVID-19-induced SpA. Moreover, single-cell transcriptome analysis revealed that the transcriptomic profile of peripheral compartment of SpA after COVID-19 was distinctive from that of typical radiographic axial SpA as shown by differential expression of ribosomal protein S26 (RPS26) and small nucleolar RNA host gene 5 (SNHG5) in nearly all subsets of peripheral blood mononuclear cells. Copyright © The Korean College of Rheumatology.

Successful treatment of post–COVID-19 acute disseminated encephalomyelitis with urgent immunotherapy and neurointensive management: a case report

Background: Acute disseminated encephalomyelitis (ADEM)-like white matter disease, a rare complication of coronavirus disease 2019 (COVID-19), is a potentially life-threatening neurological disorder. The objective of this study was to report the successful treatment of post–COVID-19 ADEM with urgent immunotherapy and neurointensive management. Case Report: A 53-year-old female patient was referred to our hospital with a 2-day history of progressive mental deterioration and was diagnosed with ADEM after COVID-19. The patient's symptoms worsened despite the administration of high-dose steroids, and targeted temperature management was employed to manage brain edema. Additionally, the neurointensivist decided to use intravenous immunoglobulin early for intractable post–COVID-19 ADEM. Her mental status and neuroimaging findings showed rapid im-provement at about 3 months after admission. Conclusion: This case highlights that if the patient's symptoms worsen despite high-dose steroid administration in the acute stage, early use of intravenous immunoglobulin is expected to have a positive effect on the prognosis of patients with post–COVID-19 ADEM. © 2022 The Korean Neurocritical Care Society.

RATES OF COVID-19 INFECTION IN A FERTILITY TREATMENT POPULATION

OBJECTIVE: To assess rates of COVID-19 positivity in a fertility treatment population who continued to seek care throughout the pandemic. MATERIALS AND METHODS: A retrospective chart review of all patients actively pursuing fertility treatment and had a positive COVID-19 test between March 2020 and February 2021 at a University-affiliated IVF center was performed. Testing was performed on medication start date, and regularly throughout the treatment cycles, approximately once a week. Social distancing, mask use, and temperature and symptomatic screening was implemented early in the process. Rates of infection were calculated by dividing COVID-19 positive patients (whether symptomatic or asymptomatic) by total number of patients in care. This was then multiplied by 100,000, in order to compare our rates to the rate of cases in the state. Information on the general population's COVID-19 positivity rate was obtained from the State Department of Health. RESULTS: Rates of infection in our treatment population varied from 55 in August of 2020 to a high of 2333 per 100,000 in April of 2020. Rates of infection in the general population ranged from 167 per 100,000 to a high of 1367 in Nov of 2020. Our rates of infection did see a trend that was consistent with the curve of infections seen in the general population in the state (Table 1). CONCLUSIONS: Rates of infection were consistently at or below the state's rate per month for much of the 12-month period of study. The exceptions to this included April 2020, where we suspect that patients undergoing treatment were more likely than the general population to receive testing due to the center's testing policies compared to the lack of tests for the general population. Indeed, throughout the studied period, the patients receiving fertility treatment were much more likely than the general population to receive a test, as they were undergoing testing while asymptomatic. Additionally, the rate in February of 2021 was higher than that of the general population. IMPACT STATEMENT: The Covid-19 pandemic was unprecedented in the history of gynecologic endocrinology and infertility, and impacted the ability of patients to access fertility care worldwide. Our findings reveal that with proper mitigation techniques, infertility treatment can be safely delivered even in the face of a pandemic without radically increasing the risk of infection. (Table Presented).

FIRST TRIMESTER OUTCOMES OF PATIENTS SEEKING INFERTILITY CARE AFTER COVID-19 INFECTION

OBJECTIVE: To assess if COVID-19 infection differentially impacts first trimester outcomes in patients seeking infertility care at one large fertility practice. MATERIALS AND METHODS: A retrospective chart review of all female patients actively pursuing fertility care in a single fertility center with positive COVID-19 test results from March 2020 to February of 2021 was performed. Positive COVID-19 test results included PCR tests performed in our clinic and symptomatic patients who informed us of their outside positive test results by phone during their treatment with our clinic. This was compared to a control group of all comers in our clinic in 2020. Information was gathered on infertility treatment type, and pregnancy outcomes. Chemical pregnancy rate (CPR) is documented as a positive pregnancy test and ongoing pregnancy was documented as a positive fetal heart beat between 7-8 weeks of gestation and discharge to routine OBGYN care. Fishers exact test was used to calculate p value, statistically significant associations were considered to exist when the p value ≤0.05. RESULTS: A total of 178 cases of COVID-19 were documented in patients between April 2020 and February 2021. After COVID-19 infection (Covid+) sixty-two pregnancies were documented, with sustained implantation in fifty-three (85%) patients. In the subgroup of Covid+ patients that underwent subsequent fertility treatment the CPR was 30.1% with IUI, and 70.1% with IVF and single frozen embryo transfer. This is in comparison to our control population CPR of 14.1 % with IUI (p=0.002) and 68% (p=0.78) with IVF with single embryo transfer (Table 1). Clinical pregnancy loss rate was recorded and shown in Table 1. CONCLUSIONS: In an infertile population, a recent history of COVID-19 diagnosis did not negatively impact pregnancy outcome as measured against a control population. One of the limitations of this study was the relatively small sample size, which may have conflated our data on COVID-19 patients who underwent IUI, whose higher rate of pregnancy is unlikely to be clinically significant. IMPACT STATEMENT: Patients who have had COVID-19 and then proceeded with infertility treatment were no more likely than our control population to have first trimester complications in one fertility clinic. The findings from this study should provide reassurance that attempts at pregnancy do not need to be delayed after recovery from a COVID-19 diagnosis.

Supporting the Contact Tracing Process with WiFi Location Data: Opportunities and Challenges

Contact tracers assist in containing the spread of highly infectious diseases such as COVID-19 by engaging community members who receive a positive test result in order to identify close contacts. Many contact tracers rely on community member's recall for those identifications, and face limitations such as unreliable memory. To investigate how technology can alleviate this challenge, we developed a visualization tool using de-identified location data sensed from campus WiFi and provided it to contact tracers during mock contact tracing calls. While the visualization allowed contact tracers to find and address inconsistencies due to gaps in community member's memory, it also introduced inconsistencies such as false-positive and false-negative reports due to imperfect data, and information sharing hesitancy. We suggest design implications for technologies that can better highlight and inform contact tracers of potential areas of inconsistencies, and further present discussion on using imperfect data in decision making. © 2022 ACM.

ASSOCIATION BETWEEN EPIRETINAL MEMBRANE, EPIRETINAL PROLIFERATION, AND PROGNOSIS OF FULL-THICKNESS MACULAR HOLE CLOSURE

Purpose: To demonstrate the effects of epiretinal membrane (ERM) and epiretinal proliferation on surgical outcomes for full-thickness macular hole. Methods: Nested case-control study with propensity score matching. Patients operated on for full-thickness macular hole between January 2011 and March 2020 were enrolled. The primary outcome was failure of the macular hole closure, and the secondary outcome was unfavorable hole closure (V or l type closure) at 6 months after the surgery. Results: Five hundred and thirty-four eyes of 534 patients met the inclusion criteria. After 1:1 propensity score matching (127 pairs), patients demonstrating ERM were more likely to have a failure of hole closure (adjusted odds ratio, 2.71;95% confidence interval, 1.19-6.14) and unfavorable hole closure (adjusted odds ratio, 2.07;95% confidence interval, 1.16-3.71). Epiretinal membrane spanning the hole margin (hole marginal ERM) greatly increased the likelihood of unfavorable hole closure (adjusted odds ratio, 2.13;95% confidence interval, 1.12-4.07). Patients with hole marginal-ERM + epiretinal proliferation were more likely to have a failure of hole closure (38.4%) compared with those with no ERM (11.8%). Conclusion: Patients with ERM had a higher risk for adverse surgical outcomes for full-thickness macular hole closure. The location of the ERM relative to the macular hole and the presence of epiretinal proliferation might affect the surgical outcomes for full-thickness macular hole closure.

Smilax guianensis Vitman extract prevents LPS-induced inflammation by inhibiting the NF-κB pathway in RAW 264.7 cells

Nutraceutical treatments can reduce inflammation and prevent the development of inflammatory diseases. In this study, the anti-inflammatory effects of Smilax guianensis Vitman extract (SGE) were examined. SGE suppressed lipopolysaccharide (LPS)-mediated nitrite production in RAW 264.7 cells. SGE also prevented the LPS-induced expression of inducible nitric oxide synthase (iNOS) but not cyclooxygenase (COX)-2. Western blot analysis showed that SGE attenuated LPS-induced phosphorylation of IκB kinase, inhibitor of kappa B (IκB), and p65. Additionally, SGE inhibited LPS-induced IκB degradation in RAW 264.7 cells. Western blot analysis of the cytosolic and nuclear fractions, as well as immunofluorescence assay results, revealed that SGE suppressed LPS-induced p65 nuclear translocation in RAW 264.7 cells. Moreover, SGE reduced LPS-induced interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α) mRNA expression and IL-1β and IL-6 protein expression in RAW 264.7 cells. Collectively, these results indicate that SGE suppresses the NF-κB signaling pathway and thereby inhibits the production of NO, IL-1β, and IL-6.