ABSTRACT
Cognitive impairment is a prominent symptom of the post-COVID syndrome (PCS). However, the correspondence between subjective cognitive complaints (SCC) and objective results is inconsistent. Here, we investigated this discrepancy. This longitudinal study included N = 42 individuals who reported SCC as PCS after mild infection at inclusion. Data collection comprised questionnaires and neuropsychological assessment at baseline and follow-up (FU). At FU - on average 15 months after acute COVID-19 - 88 % of patients reported persisting SCC. There was an approx. 40 % discrepancy between subjective report and test results at both visits. Patients with SCC and objective impairment indicated elevated fatigue and reduced quality of life compared to patients without SCC at FU. A growing number of patients is anticipated to request neuropsychological assessments even after mild infections.
ABSTRACT
Despite everyone's best intentions, RPP-produced research may still fall short of being responsive to the needs of practice partners. The COVID-19 pandemic arguably magnified the demand for research to help education leaders make informed decisions in unprecedented ways. Were RPPs able to be responsive to practice-side partners in their time of need? We draw upon data collected as part of the 2019, 2020, and 2021 National Network of Education Research-Practice Partnerships' (NNERPP) annual reports to explore this question. Our findings suggest an increase in design-based projects, in addition to increases in quick-turnaround research syntheses in order to accommodate partner needs. © The Author(s) 2022.
ABSTRACT
Objectives To study the incidence of new central precocious puberty (CPP) patients treated with GnRH agonist (GnRHa) in our Endocrinology clinic during Covid. Findings add to literature pertaining Covid pandemic effects on pediatric endocrine conditions, including CPP. Methods We performed a retrospective comparison of the incidence of newly diagnosed CPP with GnRHa treatment during the Covid pandemic (5/2020-4/2021) and pre-covid (5/2018-4/2019). CPP diagnosis was defined by a random LH >0.3 IU/L, a GnRH stimulated LH >5 IU/L, or a GnRH stimulated estradiol >40 pg/mL. Girls had onset of breast development at < 8 years-old, and boys had testicular size >4 ml at <9 years-old. We compared the number of new Endocrinology visits during the time periods. We evaluated time from diagnosis to GnRHa order, and time from GnRHa order to first day of treatment. We compared bone age (BA) and chronological age (CA), BA/CA and BA-CA between treatment windows. Results During pre-Covid year, 28 children (1 boy, 27 girls) were treated with GnRHa for CPP out of 2340 new Endocrinology visits (1.2% of patients seen). During Covid year, 64 children (7 boys, 57 girls) were treated out of 2261 new visits (2.8%). The incidence of new CPP cases on GnRHa during Covid has more than doubled compared to pre-Covid (p<0.01, Chi Square). There were no significant differences between the groups in age at diagnosis, time between diagnosis and treatment order, time between order and treatment, degree of BA advancement, or BMI (Tables 1-2). CPP incidence was consistent between 26-37 cases/year over the past 4 years prior to Covid. The number of cases per month did not correlate with the peaks of Covid cases (Figure). Conclusions CPP cases requiring GnRHa treatment significantly increased during the first year of Covid compared to pre-covid. There was no delay in presentation or treatment initiation during Covid based on bone age advancement. Preliminary data did not show a significant difference in rate of BA progression, time from diagnosis to onset of treatment, or changes in BMI during covid. Factors influencing a higher incidence of CPP during the pandemic are unclear, and likely multifactorial, including lifestyle changes and direct effects of the virus, potentially contributing to disruption of hormonal pathways. Controlled studies in larger cohorts are required to understand the pathogenic factors contributing to higher incidence of CPP during the pandemic.
ABSTRACT
Background: Response to COVID-19 vaccination is significantly impaired in kidney transplant recipients (KTR) even after three doses of an mRNA vaccine. Adaptive immunization strategies are urgently needed to ultimately protect these patients from COVID-19. Method(s): We determined the effect of an additional mRNA-1273 vaccine dose in 76 non-responder KTR with at least 3 previous vaccine doses. In 43 KTR with triple immunosuppressive therapy including a calcineurin inhibitor (CNI), mycophenolic acid (MPA), and corticosteroids (CS), MPA was withdrawn to investigate the effect of short-term MPA withdrawal on COVID-19 vaccine immunogenicity. Seroconversion was determined four weeks after vaccination. In addition, neutralization of the delta and omicron variants was determined using a live-virus assay. In patients with temporary MPA withdrawal, donor-specific antibodies (DSA) and donor-derived cell-free DNA (dd-cfDNA) were monitored before MPA withdrawal and at follow-up. Result(s): After vaccination, 24/69 (35%) KTR showed anti-spike S1 IgG antibodies above the predefined cut-off, excluding 7 breakthrough infections that occurred during follow-up. SARS-CoV-2 specific antibodies were significantly higher in patients where MPA was withdrawn (Figure 1A). Neutralization of the delta variant was significantly better compared to neutralization of the omicron variant (Figure 1B). Higher SARSCoV-2-specific antibodies were associated with better in-vitro neutralization of the delta and omicron variants (Figure 1C). In KTR with MPA withdrawal, no significant changes in S-creatinine, proteinuria or dd-cfDNA were observed. No acute rejection episode occurred during short-term follow-up. However, resurgence of pre-existing DSA was observed in 7 patients and the development of de novo DSA in one patient. Conclusion(s): MPA withdrawal seems reasonable to increase immunogenicity of SARS-CoV-2 vaccination. For safety reasons, this may only be offered to patients without current or previous DSA.
ABSTRACT
Background: Patient safety concerns that arose during COVID-19, related to blood shortages at a large oncological transfusion center, foregrounded the need for predictive modeling tools to optimize blood product inventory control. A maximum surgical blood ordering schedule (MSBOS), is a tool used to assist clinicians in predicting intraoperative blood usage based on retrospective historical data within an institution. Although MSBOS proves to be valuable, it is rudimentary in nature. Not only is data collection cumbersome but the data generated may not reflect current surgical practices and inter-patient variability may skew procedural averages. Predictive blood modeling is contingent generation of a digital health dashboard (DHB). DHB are electronically embedded in the electronic health record (EHR) to collect perioperative data. Coupling the generated informatics (patient demographics, diagnosis, laboratory results, procedural type, medications/supplements, surgeon) with machine learning allows for creation of patient centered predictive blood modeling algorithms and better inventory control. Methods: To characterize blood use across various procedures at our institution, we engaged information technology specialists to create a Web Intelligence report by integrating data from both an EHR and a lab information system (LIS) into a single repository. Information obtained illuminated a master procedure list, blood product usage patterns, and characterized patient demographics during January-March, 2020. Data is continuously extracted to create a perpetually updated MSBOS while secondarily functioning to cultivate data for future predictive machine learning algorithms. Results: Data analysis demonstrated 5598 procedures were performed during the first quarter of 2020. Procedures not transfused with packed red blood cells (pRBCs) totaled to 4,156 and 1,442 had a greater than or equal to 10% probability of requiring pRBCs. Our current practices reflected our overall cross-match to transfusion ratio ( C:T) was 5.4 to 1. Concerted collaboration, resulting in preparation of pre-surgical blood product orders according laboratory generated MSBOS schedule could decrease the C:T to 1.7 to 1. Additionally, high intraprocedural pRBCs variability was identified in current procedural subtypes. Conclusions: Traditionally generated MSBOS are functionally limited and may not be reflective of current surgical practices. Additionally, inter-patient variability may distort some procedural type guidance. Creating an integrated data report, eliminates some of the inherent limitations of traditional MSBOS. Moving forward, the cultivated data if coupled with machine learning has the potential to create transferable proprietary algorithms that proactively predict individual patient transfusion needs.
ABSTRACT
Background: Seroconversion rates following infection and vaccination are lower in dialysis patients compared to healthy controls. There is an urgent need for the characterization of humoral responses and success of a single-dose SARS-CoV-2 vaccination in previously infected dialysis patients. Methods: We performed a dual-center study with 43 dialysis patients after BNT162b2 vaccination and 25 dialysis patients after PCR-confirmed COVID-19. Single-dose vaccination was performed in 13 previously infected patients. Anti-S1 IgG, neutralizing antibodies, and antibodies against various SARS-CoV-2 epitopes were measured 6 weeks after the first vaccination or onset of COVID-19 and 3 weeks after single-dose vaccination. Results: Previously infected patients without vaccination showed a significantly higher neutralizing capacity than patients vaccinated twice (median (IQR) percent inhibition 88.0 (71.5-95.5) vs. 50.7 (26.4-81.0);P=0.018). After one single vaccine dose, infected individuals generated 15-to 34-fold higher levels of anti-S1 IgG than age-and dialysis vintage-matched patients after infection or two-time vaccination with a median (IQR) index of 274 (151-791) compared to 18 (8-41) and 8 (1-21) (for both P<0.001). With a median (IQR) percent inhibition of 97.6 (97.2-98.9), the neutralizing capacity of SARS-CoV-2 antibodies was significantly higher in previously infected patients compared to other groups (for both P<0.01). Bead-based analysis showed high antibody reactivity against various SARS-CoV-2 spike protein epitopes after single-dose vaccination in previously infected patients. Conclusions: Single-dose vaccination in previously infected dialysis patients induced a strong and broad antibody reactivity against various SARS-CoV-2 spike protein epitopes with high neutralizing capacity.