Severe Covid-19 Infection Causing Severe Vasculopathy Resulting in Death in a Heart Transplant Recipient

Due to chronic immunosuppression and frequent comorbidities, severe infection with Covid-19 is common among heart transplant recipients. Heart transplant recipients with Covid-19 have a short-term mortality rate as high as 25% and hospitalization rates as high as 77%. These patients generally have a severe course of infection and present with right ventricular dysfunction, arrhythmias, and thromboembolic events. We present the case of a heart transplant recipient who presented with Covid-19 infection who, despite initial improvement, eventually passed from severe coronary vasculopathy. The incidence of vasculopathy six months post-transplant without coexisting infection is extremely uncommon. A 45-year-old male with end stage heart failure due to non ischemic cardiomyopathy underwent heart transplant in July 2021. Post-transplant, the patient was clinically stable with LVEF of 60-65%. In January 2022, the patient was admitted for cardiogenic shock with multi-organ failure and tested positive for Covid-19. His echo showed an LVEF of 20-25%. Inotrope therapy was initiated and an intra-aortic balloon pump was placed. Hemodialysis was begun due to oliguria and acute renal failure. RV biopsy indicated moderate acute T-cell mediated rejection and was treated appropriately. Prior to discharge following his six week hospitalization, pathology was negative for rejection and his LVEF increased to 50%. 3 weeks later, he was found unresponsive at home and pronounced dead by EMS. Autopsy determined that the cause of death was sudden cardiac death due to Covid-19. Autopsy Report: " The cause of death is sudden cardiac death secondary to a rapidly progressive graft vasculopathy with concomitant endothelitis and positive staining of endothelium for SARS-CoV-2 viral nucleoprotein, with consequent diffuse myocardial necrosis." The kidneys were enlarged with findings indicating Acute Tubular Necrosis. Our patient presented six months post-transplant with severe Covid-19 induced coronary vasculopathy which progressed to sudden cardiac death. This case demonstrates the importance of preventing Covid-19 infection among heart transplant recipients and the need to assess these patients for coronary vasculopathy prior to progression to sudden cardiac death. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Long-Term Impact of Covid-19 Infection Among Solid Organ Transplant Recipients

The short-term outcome of solid- organ transplant recipients infected with Covid-19 has been described extensively, but the long-term impact has yet to be described. The aim of this study is to describe the long- term impact of Covid-19 infection on heart, liver, and kidney transplant recipients. We retrospectively assessed whether transplant recipients who were diagnosed with Covid-19 have experienced decrease in their transplant function over time. All active patients who have undergone solid-organ transplant at UTMB Galveston who met inclusion criteria were retrospectively analyzed, including 120 liver transplant recipients (30 Covid-19 +, 90 Covid-19 -), 30 heart transplant recipients (10 Covid-19 +, 20 Covid-19 -), and 220 kidney transplant recipients (60 Covid-19 +, 160 Covid-19 -). Heart transplant function was assessed utilizing pre and post- infection LVEF. Kidney transplant function labs included GFR, Creatinine, and BUN. Liver transplant function labs were also analyzed and included ALT and AST. Pre- infection data was gathered and compared to data at at least 6 months post-infection and all subsequent data after 6 months. At an average of 1 year post-infection with Covid-19, a statistically significant decrease in ejection fraction was observed among heart transplant recipients when compared to their own pre-infection baseline EF (p=.05). Kidney transplant function showed no statistically significant change in GFR, BUN, or Cr 6 months to 3 years after Covid-19 infection. Liver transplant recipients infected with Covid-19 were determined to have statistically insignificant increases in ALT and AST (p=.09,.1). Mortality was unchanged in solid organ transplant recipients infected with Covid-19 versus those not infected. However, a trend was noted for increased mortality among infected versus not infected liver transplant recipients (p=.09). Heart transplant recipients infected with Covid-19 had statistically significant decreases in LVEF long-term, without effect on mortality. No change was observed among kidney transplant recipients. Among liver transplant recipients, there was a statistically insignificant increase in AST and ALT post-infection and increased mortality among infected patients. This study is one of the first to describe the long-term effects of Covid-19 infection on solid organ transplant recipients. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Update on Progress of the Mesenchymal Stromal Cell Trial in Refractory Lupus

BodyThere is a growing interest and use of cellular therapies in almost all fields of medicine. Mesenchymal stromal cells (MSCs) are pluripotent in their ability to differentiate in chondrocytes, adipocytes and osteoblasts. They more recently were reported to have significant immune activity, primarily by producing anti-inflammatory molecules. They can be derived from umbilical cords, adipose tissue and bone marrow primarily. Recent studies have tested their safety and efficacy in immune mediated diseases including graft versus host disease, inflammatory bowel disease and Type I diabetes among others. Reports of uncontrolled trials of MSCs in China suggest safety and efficacy of MSCs as treatment for refractory lupus. Based on encouraging results of a Phase I trial of 6 patients with lupus treated with MSCs, we initiated the first placebo- controlled trial of MSCs to treat lupus patients refractory to standard of care medications. There are nine participating centers across the US. The trial has two cohorts, one receiving low dose MSCs (one million cells/kg) and a high dose cohort of five million cells per kg, given as a one- time infusion. Patients then attend 10 follow-up visits over a year. Primary outcome is a decrease in the SRI of 4 at week 24. Inclusion criteria are patients with confirmed lupus refractory to 6 months of standard of care therapy defined by a SLEDAI of 6 or greater at screening. Exclusions were ongoing use of biologics, pregnancy, active infections, cancer, active CNS lupus or advanced renal disease. The first patient was screened in November of 2018. Patients are randomized with a 2/1 ratio of MSCs/placebo. Cohort 1 consisting of 41 patients was completed in May of 2021. We have infused 10 out of 40 patients in Cohort 2 to this point. Extensive studies of B cell, T cell, monocyte, dendritic cell and PMN number, function and phenotype are being performed. To this point there are no safety signals or concerns with DSMB reviews quarterly. There have been no SAEs attributed to the investigational product. Given the blind of the study, we cannot report on efficacy, though there are a number of participants who met the primary outcome of an SRI of 4 at 24 weeks. COVID had a profound impact on the study due to halting of enrollment for 5 months and a need for video visits due to institutional policies. A significant issue was protocol changes regarding disease activity measures in video visits. Other delays included a designed 12-week safety assessment upon completion of Cohort 1 prior to enrollment in Cohort 2 as well as a staggered start for the first six patients in Cohort 2 requiring a safety assessment by the DSMB chair at week 1 post infusion prior to the screening of the next patient. ConclusionsThere is no safety signal between the active treatment and placebo group in either Cohort to this date. Efficacy assessments await completion of the study as the two cohorts are combined for determination of efficacy. COVID has a profound impact on enrollment and management of the study. Results of the validity of assessment of different disease measures via video appointments is being assessed to inform future trials. We believe we will reach our enrollment goal and the study will answer the primary aim of whether MSCs are a potential therapeutic for patients with refractory lupus.

Review and thematic analysis of guiding principles for effective crisis communication using social media

Effective crisis communication on social media targets and tailor's crisis information to influence risk perception and ensures messages are accepted. The aim of the current research is to map the research available and summarize key findings of the guiding principles and strategies for social media-based risk and crisis communication during emerging infectious diseases. North American-focused literature assessing risk and crisis communication via social media during emerging infectious diseases between 2009 and 2021 was obtained and examined. From an analysis of 52 sources, we identified five descriptive themes related to the characteristics associated with the receiver of crisis messages, the source of crisis messages, and characteristics associated with increased message acceptance and uptake on social media platforms. The current review builds on prior reviews through the inclusion of additional qualitative studies incorporating public perspectives. The majority of included sources were quantitative U.S. studies focused on COVID-19. We found that social media attributes, features, and analytics can be used to enable interaction, promote amplification of crisis messages, and to better understand the information needs of various subpopulations. Additional research is needed to better understand how to effectively communicate via social media to subpopulations impacted by emerging infectious disease.

The Place of Tourism in Small-Town and Rural District Regeneration Before and During the Covid-19 Era

This case study reports a two-phase research project into tourism development in a rural district, Timaru, in the South Island of New Zealand. It addresses a lack of research into small town regeneration in New Zealand. The research is set within scholarly debates about small-town tourism-led regeneration, place promotion, and the impact on tourism of the COVID-19 pandemic. Using a qualitative social research methodology, the first phase of the research, pre-COVID-19, illustrates attempts to realise the potential of an underdeveloped visitor economy in Timaru. The challenges faced by tourism advocates are outlined, as are the halting attempts to advance their goals. The second research phase reports the dramatic impact of the COVID-19 pandemic and the way it stimulated a reimagining of tourism and its development in Timaru leading to new and more effective administrative arrangements and place promotion tactics, supported by extra-local funding. The case study concludes with a brief discussion of the research findings as they relate to the scholarly context of our work, emphasising particularly the influence the COVID-19 pandemic might have in the re-imagining of tourism and the practices of tourism development in rural places and communities.