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1.
Canadian Journal of Cardiology ; 38(10 Supplement 2):S114-S115, 2022.
Article in English | EMBASE | ID: covidwho-2177602

ABSTRACT

Background: Important healthcare differences exist between the US and Canada. The goal of this investigation is to compare clinical characteristics, treatment strategies and clinical outcomes of STEMI patients with COVID-19 infection treated in the US versus Canada. Methods and Results: The North American COVID-19 Myocardial Infarction (NACMI) registry is a prospective, investigator-initiated study enrolling STEMI patients with documented COVID infection in the US and Canada. The primary end-point is in-hospital mortality. The secondary end-points include stroke, reinfarction and a composite of death, stroke or reinfarction. Of the 767 STEMI-COVID patients, 67 (9%) were from Canada and 669 (91%) from the US. Patients enrolled in Canada were more likely to present with chest pain (79% vs. 54%, p< 0.001), otherwise patients across both countries had comparable presenting demographics (Table 1). The proportion of patients not undergoing coronary angiography was significantly lower in Canada compared with the US (9% vs. 19%, p=0.039);of those who underwent angiography, no significant differences in reperfusion modalities were noted. Compared with the US, patients in Canada had a significantly lower unadjusted risk for in-hospital mortality (15% vs. 29%, p=0.016) and the risk for the composite of death, stroke or re-infarction (15% vs. 31%, p=0.006). Vaccination status was available in Canada 26 / 67 patients (unvaccinated 13, vaccinated 13) and US 328/ 669 patients (unvaccinated 282, vaccinated 46);a strong association between vaccination and adverse clinical composite is noted in both countries (Canada: 3/13, 23% (unvaccinated) vs. 0/13, 0% (vaccinated), p=0.22;and, US: 75/282, 27% (unvaccinated) vs. 6/46, 13% (vaccinated), p=0.048). Conclusion(s): Among patients with STEMI and COVID-19 infection those treated in Canada had higher proportions undergoing angiography and a lower risk of death, stroke or reinfarction. Regardless of geography, vaccination was associated with significantly lower risk of mortality in both countries. [Formula presented] Copyright © 2022

2.
Sultan Qaboos Univ Med J ; 22(4): 578-582, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2111239

ABSTRACT

Prioritisation of individual patients for thoracic surgeries gained importance during the current COVID-19 pandemic to ensure optimal utilisation of resources. We report a 76-year-old-male patient who presented to a tertiary care hospital in Muscat, Oman, 2020, with bilateral pulmonary metastasis. The patient underwent an urgent pulmonary metastasectomy with successful anaesthesia management in an elderly patient despite him testing positive for COVID-19 twice via real-time reverse transcription-polymerase chain reaction. At the 3-month follow-up some pulmonary abnormalities persisted but the patient was recovering well. This report discusses the rationale to perform surgery in this case and highlights the precautions taken for reducing aerosol generation during the various stages of anaesthesia.


Subject(s)
Anesthetics , COVID-19 , Metastasectomy , Humans , Male , Aged , SARS-CoV-2 , Pandemics
3.
EClinicalMedicine ; 46: 101359, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1828410

ABSTRACT

Background: There is an enormous knowledge gap on management strategies, clinical outcomes, and follow-up after kidney transplantation (KT) in recipients that have recovered from coronavirus disease (COVID-19). Methods: We conducted a multi-center, retrospective analysis in 23 Indian transplant centres between June 26, 2020 to December 1, 2021 on KT recipients who recovered after COVID-19 infections. We analyzed clinical and biopsy-confirmed acute rejection (AR) incidence and used cox-proportional modeling to estimate multivariate-adjusted hazard ratios (HR) for predictors of AR. We also performed competing risk analysis. Additional outcome measures included graft loss, all-cause mortality, waiting time from a positive real-time polymerase test (RT-PCR) to KT, laboratory parameters, and quality of life in follow-up. Findings: Among 372 KT which included 38(10·21%) ABO-incompatible, 12(3·22%) sensitized, 64(17·20%) coexisting donors with COVID-19 history and 20 (5·37%) recipients with residual radiographic abnormalities, the incidence of AR was 34 (9·1%) with 1(0·26%) death censored graft loss, and 4(1·07%) all-cause mortality over a median (interquartile range) follow-up of 241 (106-350) days. In our cox hazard proportional analysis, absence of oxygen requirement during COVID-19 compared to oxygen need [HR = 0·14(0·03-0·59); p-value = 0·0071], and use of thymoglobulin use compared to other induction strategies [HR = 0·17(0·03-0.95); p-value = 0·044] had a lower risk for AR. Degree of Human leukocyte antigen (HLA) DR mismatch had the highest risk of AR [HR = 10.2(1·74-65·83); p-value = 0·011]. With competing risk analysis, with death as a competing event, HLA DR mismatch, and oxygen requirement continued to be associated with AR. Age, gender, obesity, inflammatory markers, dialysis vintage, steroid use, sensitization and ABO-incompatibility have not been associated with a higher risk of AR. The median duration between COVID-19 real time polymerase test negativity to transplant was 88(40-145) days (overall), and ranged from 88(40-137), 65(42-120), 110(49-190), and 127(64-161) days in World Health Organization ordinal scale ≤ 3, 4, 5, and 6-7, respectively. There was no difference in quality of life, tacrolimus levels, blood counts, and mean serum creatinine assessed in patients with a past COVID-19 infection independent of severity. Interpretation: Our findings support that the outcomes of KT after COVID-19 recovery are excellent with absence of COVID-19 sequelae during follow-up. Additionally, there does not seem to be a need for changes in the induction/immunosuppression regimen based on the severity of COVID-19. Funding: Sanofi.

4.
Transplantation ; 105(7): 1423-1432, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1704612

ABSTRACT

BACKGROUND: There is limited current knowledge on feasibility and safety of kidney transplantation in coronavirus disease-19 (COVID-19) survivors. METHODS: We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR)-confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020, to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment, and outcomes. Patients with a previous diagnosis of COVID-19 were accepted after documenting 2 negative severe acute respiratory syndrome coronavirus 2 PCR tests, normal chest imaging with complete resolution of symptom for at least 28 d and significant social distancing for 14 d before surgery. RESULTS: Clinical severity in patients ranged from asymptomatic (n = 17, 22.7%), mild (n = 36.48%), moderate (n = 15.20%), and severe (n = 7.9.3%) disease. Median duration between PCR positive to transplant was 60 d (overall) and increased significantly from asymptomatic, mild, moderate, and severe disease (49, 57, 83, 94 d, P 0.019), respectively. All recipients and donors were asymptomatic with normal creatinine after surgery at a median (interquartile range) follow-up of 81 (56-117) d without any complications relating to surgery or COVID-19. Patient and graft survival was 100%, and acute rejection was reported in 6.6%. CONCLUSIONS: Prospective kidney transplant recipients post-COVID-19 can be considered for transplantation after comprehensive donor and recipient screening before surgery using a combination of clinical, radiologic, and laboratory criteria, careful pretransplant evaluation, and individualized risk-benefit analysis. Further large-scale prospective studies with longer follow-up will better clarify our initial findings. To date, this remains the first and the largest study of kidney transplantation in COVID-19 survivors.


Subject(s)
COVID-19/complications , Kidney Failure, Chronic/surgery , Kidney Transplantation , Adult , Aged , COVID-19/diagnosis , Donor Selection/methods , Female , Follow-Up Studies , Humans , India , Kidney Failure, Chronic/complications , Male , Middle Aged , Patient Selection , Retrospective Studies , Survivors , Treatment Outcome
5.
Transplant Proc ; 54(6): 1429-1433, 2022.
Article in English | MEDLINE | ID: covidwho-1487993

ABSTRACT

BACKGROUND: The effect of coronavirus disease 2019 (COVID-19) on a developing nation is sparsely reported and, more importantly, the discrepancies in public and private sectors are underexplored. METHODS: We retrospectively investigated the data on the effect of COVID-19 on renal transplantation between 2019 and 2020 in a nationwide analysis from 8 public and 10 private sector hospitals of India. RESULTS: On comparing the yearly data, the number of living-related transplants and deceased donor transplants declined by 48% (2610 vs 1370) and 49% (194 vs 99), respectively. The outpatient numbers and in-center admissions decreased by 40.4% (616,741 vs 367,962) and 30.8 % (73,190 vs 49,918). respectively. There was no increase in the number of renal or graft biopsies in the COVID-19 era. The number of waitlisted patients on hemodialysis was higher in public (304,898 vs 338,343) when compared with private (163,096 vs 150,292) in the last 2 years. Similarly, the number of waitlisted patients on peritoneal dialysis (4655 vs 3526) was higher in the public sector compared with private sector (932 vs 745). The decline in living transplants during the pandemic was higher in public sectors (58%) compared with the private (49%). However, the decline in deceased donation was higher in private (57.9%) relative to public (50.6%). CONCLUSIONS: COVID-19 has adversely affected the transplantation activities across the Indian transplantation centers, with a disproportionately higher impact on waitlisted patients in public sector programs. A sound prioritization of health care resources is mandated to safeguard the most deprived and high-risk waitlisted patients during the pandemic.


Subject(s)
COVID-19 , Nephrology , COVID-19/epidemiology , Humans , India/epidemiology , Public Sector , Retrospective Studies
6.
Exp Clin Transplant ; 19(10): 1023-1031, 2021 10.
Article in English | MEDLINE | ID: covidwho-1404032

ABSTRACT

OBJECTIVES: There is scarcity of data on reoccurrence of SARS-CoV-2 infections in kidney transplant recipients. MATERIALS AND METHODS: We conducted a retrospective multicenter cohort study and identified 13 kidney transplant recipients (10 living and 3 deceased donors) with recurrent COVID-19, and here we report demographics, immunosuppression regimens, clinical profiles, treatments, and outcomes. RESULTS: COVID-19 second infection rate was 0.9% (13/1350) in kidney transplant recipients with a median age of 46 years; median time interval from transplant to first episode of COVID-19 diagnosis was 9.2 months (interquartile range, 2.2-46.5 months). The most common comorbidities were hypertension (84%) and diabetes (23%). Fever was significantly less common with recurrent COVID-19. COVID-19 severity ranged from asymptomatic (23%), mild (31%), and moderate (46%) during the first infection and asymptomatic (8%), mild (46%), and severe (46%) in the second infection. All 6 kidney transplant recipients with severe second infections died. The median interval between the 2 episodes based upon reverse transcriptase polymerase chain reaction COVID-19-positive tests was 135 days (interquartile range, 71-274 days) without symptoms. Statistically significant risk factors for mortality were dyspnea (P = .04), disease severity (P = .004), allograft dysfunction (P < .05), higher levels of neutrophil-to-lymphocyte ratio (P = .05), and intensive care unit/ventilator requirement (P = .004). Although our limited resources did not allow for molecular diagnostics and typing, we suggest that these second episodes were reinfections with SARS-CoV-2. CONCLUSIONS: To our knowledge, this is the largest study of kidney transplant recipients with reoccurring SARS-CoV-2 infection, and we observed 46% mortality.


Subject(s)
COVID-19 , Kidney Transplantation , COVID-19 Testing , Child, Preschool , Cohort Studies , Humans , Infant , Kidney Transplantation/adverse effects , Retrospective Studies , SARS-CoV-2 , Transplant Recipients
7.
Journal of Clinical and Diagnostic Research ; 15(8):OR01*-OR04, 2021.
Article in English | EMBASE | ID: covidwho-1362739

ABSTRACT

Corona Virus Disease 2019 (COVID-19) infection can have myriad presentations ranging from non specific constitutional symptoms to respiratory failure and extrapulmonary manifestations. As COVID-19 is viewed predominantly as an illness of the respiratory tract, extrapulmonary manifestations are often overlooked. The case series is of seven COVID-19 diagnosed patients who presented with diarrhoea, without respiratory symptoms. Clinico-demographic characteristics, hospital course and outcome of these patients are described here. Median age of the patients was 42 years. There were four males and three females. Three patients had diabetes mellitus and one had hypertension, one had hypothyroidism and one had non-Hodgkin’s lymphoma along with tuberculosis. Five patients had fever while all had diarrhoea as the predominant presenting complaint. Median duration of symptoms was four days before admission. Laboratory abnormalities included anaemia (n=5;57.1%), lymphopenia (n=3;42.9%) and elevated inflammatory markers i.e., ferritin and C reactive protein (n=2;28.6%). Most patients did not require any specific treatment other than supportive care. All patients were successfully discharged after a median hospital stay of 10 days. Isolated diarrhoea without respiratory symptoms can be presenting complaint of COVID-19 and should be considered by clinicians in current pandemic scenario.

8.
Transplantation ; 105(4): 851-860, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-991012

ABSTRACT

BACKGROUND: There is a scarcity of data on the consequences of coronavirus disease-19 (COVID-19) infections in kidney transplant recipients (KTRs) from emerging countries. METHODS: Here, we present a cohort study of 13 transplant centers in India including 250 KTR (226 living and 24 deceased donors) with polymerase chain reaction-confirmed COVID-19 positivity from March 23, 2020, until September 15, 2020. We detailed demographics, immunosuppression regimen, clinical profile, treatment, and outcomes. RESULTS: Median age of transplant recipients was 43 years, and recipients presented at a median of 3.5 years after transplant. Most common comorbidities (94%) included arterial hypertension (84%) and diabetes (32%); presenting symptoms at the time of COVID-19 included fever (88%), cough (72%), and sputum production (52%). Clinical severity ranged from asymptomatic (6%), mild (60%), and moderate (20%) to severe (14%). Strategies to modify immunosuppressants included discontinuation of antimetabolites without changes in calcineurin inhibitors and steroids (60%). Risk factors for mortality included older age; dyspnea; severe disease; obesity; allograft dysfunction before COVID-19 infection; acute kidney injury; higher levels of inflammatory markers including C-reactive protein, interleukin-6 level, and procalcitonin; chest X-ray abnormality, and intensive care unit/ventilator requirements. Overall patient mortality was 11.6% (29 of 250), 14.5% (29 of 200) in hospitalized patients, 47% (25 of 53) in intensive care unit patients, and 96.7% (29 of 30) in patients requiring ventilation. KTRs with mild COVID-19 symptoms (n = 50) were managed as outpatients to optimize the utilization of scarce resources during the COVID-19 pandemic. CONCLUSIONS: Mortality rates in COVID-19-positive KTR appear to be higher than those in nonimmunosuppressed patients, and high mortality was noted among those requiring intensive care and those on ventilator.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Kidney Transplantation/adverse effects , SARS-CoV-2 , Adult , Aged , Antiviral Agents/therapeutic use , Cohort Studies , Female , Humans , Immunosuppression Therapy/adverse effects , Immunosuppression Therapy/methods , India/epidemiology , Kidney Transplantation/mortality , Male , Middle Aged , Multivariate Analysis , Pandemics , Proportional Hazards Models , Retrospective Studies , Transplant Recipients , Treatment Outcome , Young Adult , COVID-19 Drug Treatment
9.
Am J Transplant ; 20(11): 3206-3209, 2020 11.
Article in English | MEDLINE | ID: covidwho-591954

ABSTRACT

As the coronavirus disease 2019 (COVID-19) pandemic spread across the globe, transplant programs suffered a setback. We report the first experience of COVID-19 infection within 1 month of living donor kidney transplant (LDKT). We describe 2 LDKT recipients who were detected positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at day 19 and day 7 posttransplant. They had minimal symptoms at diagnosis and did not develop any respiratory complications or allograft dysfunction. Immunosuppression was de-escalated; however, nasopharyngeal swab real-time reverse transcription polymerase chain reaction (rRT-PCR) remained positive for SARS-CoV-2 for a prolonged time. Younger age, absence of other comorbidities, and lower dose of anti-thymocyte globulin (ATG) used as induction possibly contributed to good outcome in our recent LDKT recipients compared with earlier published cases of recent deceased donor kidney transplant recipients with COVID-19.


Subject(s)
COVID-19/epidemiology , Graft Rejection/prevention & control , Immunosuppression Therapy/methods , Kidney Failure, Chronic/surgery , Kidney Transplantation/methods , Pandemics , Transplant Recipients , Adult , Comorbidity , Humans , Kidney Failure, Chronic/epidemiology , Male , Middle Aged
10.
Public Health ; 185: 91-92, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-437215

ABSTRACT

OBJECTIVES: The incidence of emerging coronavirus disease 2019 (COVID-19) disease is variable across the different parts of the world. Apart from travel patterns, other factors determining this difference may include host immune response. The aim of this study was to assess the effect of tuberculosis (TB) endemicity and Bacille Calmette-Guerin (BCG) coverage on COVID-19. STUDY DESIGN: This was a cross-sectional study. METHODS: We reviewed available data regarding TB incidence, BCG coverage (as per the World Health Organization), and COVID-19 incidence of 174 countries. We divided the countries into four cohorts depending on annual TB incidence and BCG coverage. RESULTS: Countries with high TB incidence had lower COVID-19 than countries with low TB incidence. Similarly, countries with high BCG coverage had lower incidence of COVID-19, suggesting some protective mechanisms in TB-endemic areas. However, the ecological differences and different testing strategies between countries could not be accounted for in this analysis. CONCLUSION: Higher TB incidence and BCG coverage were found to be associated with lesser incidence of COVID-19. This outcome paves the way for further research into pathogenesis and immune response in COVID-19.


Subject(s)
BCG Vaccine/administration & dosage , Coronavirus Infections/epidemiology , Global Health/statistics & numerical data , Pneumonia, Viral/epidemiology , Tuberculosis/epidemiology , Vaccination Coverage/statistics & numerical data , COVID-19 , Cross-Sectional Studies , Humans , Incidence , Pandemics
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