Correlation between vitamin D and anosmia in post acute Covid syndrome clinic

Introduction: Anosmia has emerged as a clinical feature of Covid-19. It is estimated over half of patients with Covid19 report anosmia. It is primarily transient, but can persist over a month in around 20% of cases. There is a hypothetical interaction between hypovitaminosis D and diminished smell. A deficiency may lead to neurologic decline in cranial nerves, including the olfactory nerve. Few studies investigating this are available. Loss of smell is a common occurrence through adulthood, with many physiologic and anatomic contributing factors. Limited data is available addressing anosmia post Covid-19. Aim(s): To assess the correlation between vitamin D (VD) and anosmia, in patients referred to post acute COVID syndrome (PACS) clinic, and to assess the variation of data across age groups. Method(s): A "Sniffin' Sticks" test was undertaken for all patients referred to the PACS clinic. This was correlated with a recent serum VD level. Result(s): 143 patients presented to the PACS clinic over a 10 month period. 84% were under 65 years. 60% of these patients who developed anosmia were found to have VD insufficiency. A similar proportion of patients with hyposmia, and patients with normal smell were found to be VD insufficient (36% vs 34.7%). Within the older cohort, none of the patients with anosmia were deficient in VD, and 7.7% of patients with smell dysfunction had insufficiency. Conclusion(s): There is an association between anosmia and VD deficiency in patients under 65 years of age seen at PACS clinic. This did not reflect in the cohort with hyposmia. In the older age group, the majority of patients had normal VD levels, which may indicate other contributing factors towards the decrease in smell.

Disseminated Strongyloiodes Infection after Corticosteroid Use

INTRODUCTION: While there are endemic foci of Strongyloides in the southeastern United States, strongyloidiasis in the US is most commonly found in immigrants and military veterans who have lived in endemic regions. We report a case of reactivated disseminated strongyloidiasis in a critically ill COVID-19 patient. DESCRIPTION: A 46 year old undomiciled man with a medical history of hypertension was found down by a friend and brought to the hospital for evaluation of altered mental status. The patient immigrated from Mexico in 1991 and lived in Florida for several years working as a gardener. On presentation he complained of headaches, with tremors and tongue fasciculations noted on physical exam. He underwent treatment for alcohol withdrawal. His hospital course was complicated by COVID-19 pneumonia requiring intubation, and a subarachnoid hemorrhage that did not require acute neurosurgical intervention. Several days after completion of remdesivir and dexamethasone treatment for COVID-19, the patient's absolute eosinophil count increased from 20/ uL on admission to 340/uL with a peak at 1500/uL. The patient was found to have Strongyloides and ESBL Klebsiella in a bronchoalveolar lavage after a bedside bronchoscopy. Ivermectin 200ug/kg/day and meropenem 2g every 8 hours were started. The patient remained persistently comatose despite being off sedation and a relatively benign brain MRI that demonstrated resolving subarachnoid hemorrhages. Strongyloides were confirmed in the CSF nine days after initial discovery in the BAL. Albendazole 400mg BID was added to the regimen and meropenem was continued for possible culture negative bacterial meningitis in the setting of disseminated strongyloidiasis. HIV and HTLV-1 serology was negative. The patient remained in the ICU with poor neurological status and ongoing goals of care discussions with the family. DISCUSSION: Strongyloides hyperinfection is an uncommon complication with a high mortality rate, with meningeal involvement often described post-mortem. Prophylactic anti-parasitic agents can be considered for patients identified as high risk for chronic strongyloidiasis who are about to undergo corticosteroid treatments, including COVID-19 associated regimens.

Sleep changes in parents with children with type 1 diabetes (T1D) during the COVID-19 pandemic

Introduction: Parents of children with T1D experience sleep difficulties. During the COVID-19 pandemic, families experienced new stressors and routines which may have further impacted sleep and T1D management. Objectives: We compared parental sleep across three time-points (1 prior to and 2 during the pandemic). Methods: Parents (n=123, 93% mothers) of youth with T1D (Mage =6.5±1.7 yrs, Mduration=2.7±.7 yrs) in a behavioral RCT completed surveys at: RCT completion, June/July 2020, and February/March 2021. Parents completed the Pittsburgh Sleep Quality Index (PSQI) with T1D-related sleep questions and 2 sleep items from a COVID-19 experiences survey. We compared sleep difficulties pre-pandemic to 2020 and 2021 data using χ2 tests. Results: Many parents (61%) endorsed clinically significant poor sleep in 2021 compared to pre-pandemic (46%) or earlier in the pandemic in 2020 (45%). Similarly, diabetes-specific sleep disruptions (i.e., difficulty sleeping due to child's healthcare needs, due to stress related to child's health) initially decreased in the early pandemic then significantly increased later in the pandemic (Figure). Parents endorsing moderate-to-extreme difficulty sleeping overall also significantly increased throughout the pandemic from 29% in 2020 to 43% in 2021, p=.012. Conclusions: Parents of children with T1D experienced changes in sleep during the pandemic. While some aspects of sleep appeared to improve initially, diabetes-specific sleep disruptions have increased as the pandemic has progressed. Sleep difficulties in parents of children with T1D may have been delayed or may have compounded as people adjusted or as pandemic restrictions loosened. As parental sleep impacts psychosocial wellbeing and T1D management, it warrants clinical attention especially in the context of stressors such as the COVID-19 pandemic.

Pharmacologic profiling reveals lapatinib as a novel antiviral against SARS-CoV-2 in vitro.

The emergence of SARS-CoV-2 virus has resulted in a worldwide pandemic, but effective antiviral therapies are not widely available. To improve treatment options, we conducted a high-throughput screen to uncover compounds that block SARS-CoV-2 infection. A minimally pathogenic human betacoronavirus (OC43) was used to infect physiologically-relevant human pulmonary fibroblasts (MRC5) to facilitate rapid antiviral discovery in a preclinical model. Comprehensive profiling was conducted on more than 600 compounds, with each compound arrayed across 10 dose points. Our screening revealed several FDA-approved agents that can attenuate both OC43 and SARS-CoV-2 viral replication, including lapatinib, doramapimod, and 17-AAG. Importantly, lapatinib inhibited SARS-CoV-2 RNA replication by over 50,000-fold. Further, both lapatinib and doramapimod could be combined with remdesivir to improve antiviral activity in cells. These findings reveal novel therapeutic avenues that could limit SARS-CoV-2 infection.

Resilience in real time: Parents of youth with type 1 diabetes (T1D) summer 2020 psychosocial experiences

Objective: The COVID-19 pandemic disproportionately impacts parents, people with health risks like diabetes, and those with fewer financial resources. Minorities face particularly negative outcomes of the pandemic, and racial tensions after George Floyd's murder may have worsened effects. We examined group differences by race/ethnicity and socio-economic status (SES) in depressive symptoms and protective factors in parents of children with T1D in summer 2020. Methods: Participants were n=100 parents (98% mothers) of youth with T1D (60% female, M age=6.7±1.6 yrs, M T1D duration = 2.9±.5 yrs), who completed a behavioral RCT ≥6 months prior. In July/July 2020, parents selfreported on awareness of how to obtain housing/financial/food resources (Protective Factor Survey Concrete Support [PFS-CS] subscale) and depressive symptoms (Center for Epidemiological Studies -Depression [CESD]). Race/ethnicity (66% non-Hispanic white, 12% non-Hispanic Black, 11% Hispanic, 11% other) and health insurance (33% public, 67% private) were reported at RCT enrollment. We ran ANOVAs and Pearson correlations to compare CES-D and PFS-CS by demographic groups. Results: PFS-CS scores differed significantly by race/ethnicity and insurance status, both p<.01. Hispanic (M=1.6±0.5) and non-Hispanic Black (M=1.6±0.6) parents had higher CS than non-Hispanic white parents (M = 1.3±0.3). Those with public insurance (M = 1.6±0.5) had higher CS than those with private insurance (M = 1.3±0.3). Higher CS correlated with lower CES-D, r = -.26, p = .05. CES-D did not differ across groups. Conclusion: Racially/ethnically diverse and lower SES parents of children with T1D reported more knowledge about how to access useful resources. This may have buffered against elevated mood symptoms during cooccurring major societal and public health stressors in 2020. Highlighting sources of support and resilience may be a useful strategy in strength-based interventions for parents of children with T1D.

PriSeT: Efficient de novo primer discovery

Motivation: DNA metabarcoding is commonly used to infer the species composition of environmental samples, whereby a short, homologous DNA sequence is amplified and sequenced from all members of the community. Samples can comprise hundreds of organisms that can be closely or very distantly related. DNA metabarcoding combines polymerase chain reaction (PCR) and next-generation sequencing (NGS), and sequences are taxonomically identified based on their match to a reference database. Ideally, each species of interest would have a unique DNA barcode. This short, variable sequence needs to be flanked by conserved regions that can be used as primer-binding sites. PCR primer pairs would amplify a variable barcode in a broad evolutionary range of taxa. To date, no tools exist that computationally search and analyze the effectiveness of new primer pairs for large unaligned sequence data sets. More specifically we solve the following problem: Given a set of reference sequences R = {R1, R2,.., Rm}, find a primer set P that allows for a high taxonomic coverage. This goal can be achieved by filtering for frequent primers and ranking by coverage or variation, i.e. the number of unique barcodes for further analysis. Here we present the software PriSeT, an offline primer-discovery tool that is capable of processing large libraries and is robust against mislabeled or low-quality references. It avoids the construction of a multisequence alignment of R. Instead, PriSeT uses encodings of frequent k-mers that allow bit-parallel processing and other optimizations. Results: We first evaluated PriSeT on references (mostly 18S rRNA genes) from 19 clades covering eukaryotic organisms that are typical for freshwater plankton samples. PriSeT recovered several published primer sets as well as additional, more chemically suitable primer sets. For these new sets, we compared frequency, taxonomic coverage, and amplicon variation with published primer sets. For 11 clades we found de novo primer pairs that cover more taxa than the published ones, and for six clades de novo primers resulted in greater sequence (i.e., DNA barcode) variation. We also applied PriSeT to SARS-CoV-2 genomes and computed 114 new primer pairs with the additional constraint that the sequences have no co-occurrences in closely related taxa. These primer sets would be suitable for empirical testing. Availability: https://github.com/mariehoffmann/PriSeT Contact: marie.hoffmann@fu-berlin.de © 2021 ACM.