ABSTRACT
Purpose: In July 2021, the SARS-CoV-2 Delta variant emerged as the dominant strain in the North Texas area. We reviewed COVID-19 infections post-vaccination in Solid Organ Transplant Recipients (SOTRs) before and after the Delta variant became the dominant strain. Method(s): This was a retrospective review of SOTRs in the Baylor Scott and White Simmons Transplant Institute who received > 1 dose of COVID-19 vaccine between 01/01/21 to 11/04/21. Those with infections documented after 7/4/21 were included in the post-Delta (Post) group and those prior in the pre-Delta (Pre) group. Demographics, transplant, vaccine, and COVID-19 infection details were recorded. Student's t-tests, tests of proportions, and ANOVA were used to compare groups Results: Of the 11,328 SOTRs followed actively at the institute, 1,158 (19%) had documented vaccination before 7/4/21;2,584 (22.8%) had documented vaccination by 11/4/2021. A total of 48 patients (1.8% of vaccinated) had documented COVID-19 infections post-vaccination. Of these, 7 (0.6%) were included in the Pre group and 41 (1.6%) in Post group. The majority in both groups received the Pfizer vaccine (57% vs. 70.7%). The mean age, gender distribution and immunosuppression at presentation were similar between groups (Table). Those in the Post group were diagnosed significantly longer after their last dose of the vaccine (38.3 vs 140.7 days, p=0.00002). Rate of mortality (0% vs 7.3%, p=0.46), need for hospitalization (42% vs 53.7%, p=0.60), and hypoxemia (14% vs 34.1%, p=0.29) were lower in the Pre group, though these were not statistically significant. Conclusion(s): Despite the attenuated immunologic response to vaccination in SOTRs reported by other groups, the overall post-vaccination rate of infection in our transplant institute was low and remained low even in the post-Delta period. There was a higher rate of COVID-19 infection and a trend to more severe COVID-19 outcomes in the Post group. This may be due to waning immunity given the longer time from last vaccine dose or due to variant differences. Future directions include long-term effects of vaccination on COVID-19 risk and optimal vaccination schedules for SOTRs.
ABSTRACT
Background:Dexamethasone reduces the mortality in patients with severe COVID-19. We evaluated the decline in C-reactive protein (CRP) after the treatment with standard dose dexamethasone and its association with mortality and body mass index (BMI).Material and Methods&Results:This was a retrospective cohort of 678 patients with COVID-19 admitted to the public healthcare system of New York City between July 1st and December 31st, 2020 with laboratory-confirmed COVID-19, who received at least one dose of dexamethasone and had more than one measurement of CRP. Mortality was compared among groups stratified by BMI and CRP response. The reference group had BMI 25-34.9 kg/m2 and CRP response. Male sex, increasing age and CRP non-response were associated with higher in-hospital mortality. Patients with BMI 25-34.9 kg/m2 and CRP non-response (OR 2.71 [1.43-5.15];p=0.002) and BMI > 35 kg/m2 and CRP non-response (OR 2.64 [1.05-6.62];p=0.038) were associated with higher mortality.Conclusion:CRP non-response was associated with a higher likelihood for death after adjusting for other confounding factors. The CRP non-response rate was significantly higher in patients with severe obesity.
ABSTRACT
The effect of SARS-CoV-2 vaccination on de novo donor specific antibodies (dn DSA) in lung transplant recipients (LTRs) is unknown. We reviewed dn DSA results following SARS-CoV-2 vaccination in LTRs based on SARS-CoV-2 IgG response. LTRs were tested for SARS-COV-2 Multi-target IgG at 3 and 6 months post-vaccination. LTRs who received at least 1 dose of SARS-CoV-2 vaccine between 12/01/2020 to 07/01/2021 were included in this retrospective review. We compared patients based on anti-spike (S-IgG) results. We reviewed 55 LTR charts with S-IgG results. Only 24 (44%) developed S-IgG by 6 months after vaccination. Differences between S-IgG positive and negative groups are shown in the table. Those with positive S-IgG were further from transplant, had lower mycophenolate doses, more likely to have had COVID infection pre-vaccination, and had lower rates of hypogammaglobulinemia. Only 3 patients (5.5%) developed dn DSA after vaccination;all were S-IgG positive. One had history of antibody mediated rejection (AMR), while another was initially negative for dn DSA at 6 weeks post-vaccination, but turned positive at 7 months (low level Class II DSA). One patient who had prior DSA developed clinical rejection (AMR) with Class II dn DSA (DR7) and significant rise in prior DSA (DR53, DQ2) to >20,000 MFI at 6 months (negative at 3 months) post-vaccine in the setting of new viral infection. Another patient was excluded from this study as he died of AMR and dn Class II DSA (DQ8 > 10,000 MFI, DQ6, DR4 within 5 days of dose) 2 months after his first Pfizer/BioNTech dose, but before 3 month S-IgG testing. In our cohort, dn DSA after SARS-CoV-2 vaccination was uncommon but observed in patients who developed S-IgG response. The single AMR case occurred late and may be related to infection. In the excluded patient with acute AMR early after vaccine, correlation to S-IgG is unknown as the patient did not survive to 3 months. Further studies are needed to determine the impact of additional vaccine doses and long-term outcomes and immune responses. [ 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 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 . (Copyright applies to all s.)
ABSTRACT
Context: The pandemic of COVID-19, with its high rates of infectivity, unpredictable nature, and measures taken to deal with it such as extended periods of lockdown, has had an adverse impact on the psychological status of individuals affected by it directly or indirectly. To the best of our knowledge, this is the first report from India on the psychological status of COVID-19-positive individuals. Aim: The aim of the study was to assess the impact of COVID-19 pandemic on the psychological status of persons tested positive for COVID-19. Setting and Design: This was a case-control study in a tertiary care hospital setting at Mumbai. Materials and Methods: A total of 104 individuals detected to have positive COVID-19 status and admitted to the hospital from May 1, 2020 to May 30, 2020, were compared with 106 age- and gender-matched controls from the general population for the psychological impact of COVID-19 as measured by Perceived Stress Scale-10, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 Questionnaire, Insomnia Severity Index, and World Health Organization Well-Being Index-5. Statistical Analysis Used: Group comparisons on nominal variables were analyzed by Chi-square test. P < 0.05 was taken as statistically significant. Results: About 58.6% from COVID-19-positive group and 76.4% from control group reported moderate-to-high perceived stress. Moderate-to-severe depressive symptoms were reported in 6.7% versus 15%, moderate-to-severe anxiety symptoms in 1.9% versus 14.1%, clinical insomnia in 3.8% versus 14.1%, and poor quality of well-being in 22.1% versus 35.8%, in cases versus controls, respectively. Control group reported significantly higher levels of perceived stress (P = 0.020), depressive symptoms (P = 0.021), anxiety symptoms (P = 0.013), insomnia severity (P = 0.045), and poorer well-being index (P = 0.018) compared to COVID-19-positive group. Conclusions: Despite limitations, study findings, if replicated, highlight the urgent need for incorporating psychological screening and interventions into protocols for dealing with ongoing COVID-19 pandemic not only for infected individuals but also for the community as a whole.
ABSTRACT
Aim: In the ever-changing understanding of the ongoing COVID 19 pandemic, this study aims to present the spectrum of findings in chest radiographs conducted in serologically proven symptomatic patients of COVID 19 in a tertiary care hospital in Mumbai, India. Methods: The study was a retrospective analysis of 449 chest radiographs(CXRs) obtained from serologically proven symptomatic 312 COVID patients in a tertiary care institute at Mumbai, India. CXRs were conducted as per a hospital approved protocol. The x-rays were analysed by three radiologists for presence of consolidation, ground glass opacities, interstitial opacities and distribution of findings. Results: Out of the total CXRs reviewed, 50.7% were abnormal with 91.7% of them showing the commonest pattern of finding as consolidation. The majority of findings were seen (71.1%) in patients above 50 yrs of age. 84 cases (26.9%) had a serial radiograph follow up mandated by their clinical status. Of these, 75% were abnormal. There were 46 fatal cases, out of which 22 patients (47.82%) underwent CXRs and 10 (21.73%) were followed up. All of these radiographs (100%) showed abnormal findings. Conclusions: Chest radiographs conducted in this retrospective analysis of patients with symptomatic COVID-19 infections showed that a little more than half of the patients with the infection had abnormal findings. The commonest pattern of involvement was a patchy peripheral consolidation with no predilection for any particular side. However, there was a significant basal predominance (85.5%). The progression of findings was seen in 75% of the CXRs with good correlation between clinical & radiological severity. The study shows that CXRs have an important diagnostic and prognostic role in the management of patients with the COVID-19 infection.
ABSTRACT
Background: Healthcare workers (HCWs) are particularly at a risk of acquiring COVID-19 infection. The pattern of disease and outcome in HCWs has not been studied adequately. This review was done to determine the prevalence of COVID-19 in HCWs and to find out the clinical profile and mortality of COVID-19 in HCWs. Materials and Methods: A systematic search of all published or in press studies from January 1, 2020, to July 15, 2020, with confirmed COVID-19 HCWs was done in PubMed, Scopus, and Google Scholar and in other key journals using terms such as "2019-nCoV," "novel coronavirus 2019," "COVID-19," "SARS-CoV-2," "Wuhan coronavirus," "health care worker," "health care professional," "physician," and "medical staff." Results: We analyzed 43 research articles, mostly cross-sectional studies with 20 studies from China, and included 13,725 COVID-19-positive HCWs. Proportion of COVID-19-positive HCWs (n = 8405) among all HCWs (n = 276,392) were 3.04% (95% confidence interval [CI]: 0.62-9.76), while the proportion of positive HCWs (n = 9458) among all COVID-19-positive patients (n = 230,626) were 4.1% (95% CI: 1.44-12.46). The mean age of HCWs was 42.78 +/- 6.82 years, 34.47% were males, and 51.04% were nurses. Most COVID-19-positive HCWs were asymptomatic (64.41%), while severe disease occurred in 4.08% with a mortality of 0.80% (47/5823). The incidence of severe disease and mortality among HCWs (n = 9458) and general population (n = 230,626) was extracted from nine studies, and it was seen that severe disease (1.7%) or mortality (0.04%) in HCWs was significantly less as compared to non-HCWs population (8.26% and 1.23%, respectively) (P < 0.001). Conclusion: There is a considerable risk of contracting COVID-19 infection among HCWs which re-emphasizes the strong need of personal protective measures. However, the incidence of severe disease and deaths is significantly low among HCWs, which may somewhat reduce apprehension and be morale boosting for HCWs all across the world.
ABSTRACT
Background: Health-care workers (HCWs) are at high risk of acquiring COVID-19. Hydroxychloroquine (HCQ) possesses in vitro antiviral activity and inhibits viral replication of coronavirus in cell cultures. The national task force for COVID-19 in India recommended the use of HCQ prophylaxis against severe acute respiratory syndrome coronavirus 2 infection in HCWs. Methodology: We conducted a retrospective cohort study in a mixed tertiary care facility to find the incidence and clinical profile of COVID-19 in HCWs between April 2020 and June 2020, who were advised preexposure prophylaxis with HCQ, at the start of the pandemic. Details of HCQ usage were collected using an online questionnaire form. The clinical profile, treatment, and outcome of COVID-19-positive HCWs were also studied. Results: We included 604 HCWs, of which 491 (81.2%) had taken adequate HCQ prophylaxis while 113 (18.7%) did not take adequate HCQ, 443 (73.3%) had high-risk COVID-19 exposure, and 32 HCWs (5.1% of the total) were COVID-19 positive. There were 10 COVID-19 cases (2.1%) among HCWs taking HCQ while 22 (19.4%) cases occurred in HCQ not compliant HCWs, with a relative risk of 0.1046 (95% confidence interval: 0.0510-0.2147, P< 0.0001), indicating a reduced risk of COVID-19 among HCWs taking HCQ prophylaxis. Among the noncompliant cases, 14 (43.7%) never took HCQ, 4 (12.5%) took HCQ but had poor compliance, and 4 (12.5%) stopped HCQ prematurely. Most (91.7%) COVID-19-positive HCWs were asymptomatic or had mild symptoms, moderate symptoms were seen in 3 (9.3%), and there were no severe cases or deaths. Conclusions: The use of HCQ as preexposure prophylaxis in HCWs was associated with reduced risk of COVID-19, suggesting its role as an effective chemoprophylactic agent.
ABSTRACT
Background: Thrombocytopenia (<150 x109/L) is often encountered during mechanical circulatory support. Coagulopathy in SARS-COV-2 illness (COVID-19) is increasingly recognized as a risk factor for more severe illness and higher mortality. Thrombocytopenia in COVID-19 patients requiring venovenous (VV) extracorporeal membrane oxygenation (ECMO) is challenging, and therefore identification of contributing factors may aid in management of these complex patients. Methods: A retrospective review was performed for consecutive adult patients on VV ECMO for COVID-19 respiratory failure at a single institution from March to July 2020. Patient data was obtained from our internal registry with IRB approval. Group comparisons of means were made using unadjusted t-tests and proportions were evaluated with a simple chi-square test. Results: The majority (85%) of COVID-19 patients on VV ECMO developed thrombocytopenia. Twelve of 27 patients (44%) exhibited larger drops in platelet counts following ECMO initiation (73% vs 52% fall to nadir) raising concern for heparin-induced thrombocytopenia (HIT). Nine of the 12 (75%) patients tested positive for anti-PF4 antibodies;however, none tested positive via serotonin release assay. Characteristics that affected the degree of platelet decline included the need for simultaneous continuous renal replacement therapy (CRRT) and treatment with an immunomodulating agent, convalescent plasma, or azithromycin. Discussion: Thrombocytopenia in COVID-19 patients on VV ECMO is likely multifactorial, but a more severe thrombocytopenia exists in a subset of patients. CRRT therapy and certain COVID-directed pharmacotherapy agents appear to be influential factors. Anti-PF4 antibody testing may be falsely positive and should be interpreted cautiously.