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Background: Multiple studies have shown an association between immune status and SARS CoV-2 disease severity, however data on specific immunosuppressive medications is not fully described. Immunocompromised individuals are at increased risk of mortality and morbidity therefore, vaccination against COVID-19 is essential. Research also suggests that elevated IgG levels post-vaccination correlate with host viral neutralization. We present data indicating that induction and maintenance immunosuppression therapy affects responsiveness to SARS CoV-2 vaccination among kidney transplant recipients. Method(s): 48 kidney transplant patients at our institution were retrospectively analyzed after receiving two doses of the SARS CoV-2 mRNA type vaccine between January and March 2021. Kidney transplantation occurred between 1983 and 2020. SARS-CoV-2 spike antigen-specific IgG levels were measured after 30-days to evaluate immunological responsiveness to the vaccine. Result(s): 35% of study subjects showed detectable peak COVID IgG serum levels 30 days after the second vaccine dose while 65% showed no response. Of the nonresponders, (62%) were predominantly heavily immunocompromised;on either high dose Mycophenolate (at least 720 mg twice daily) in addition to standard Calcineurin inhibitor/Sirolimus +\- Prednisone), or had received high dose Thymoglobulin (6 mg/kg or more) within a year of vaccination. This contrasts to published reports of over 95% immunological responsiveness or viral neutralization after the second vaccination dose among immunocompetent patients. Conclusion(s): Induction therapy with Anti-Thymocyte globulin and maintenance immunosuppression with Mycophenolate serve as the cornerstone of transplantation management. However, their utilization impacts B cell proliferation which is hypothesized to reduce antibody production and the effectiveness of the SARS-CoV-2 vaccine in transplant patients. This finding supports the need for a third or possibly fourth booster dose to achieve a sustained and effective response in combination with ongoing immunological surveillance post-vaccination among transplant patients.
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This article has been withdrawn: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been withdrawn as part of the withdrawal of the Proceedings of the International Conference on Emerging Trends in Materials Science, Technology and Engineering (ICMSTE2K21). Subsequent to acceptance of these Proceedings papers by the responsible Guest Editors, Dr S. Sakthivel, Dr S. Karthikeyan and Dr I. A. Palani, several serious concerns arose regarding the integrity and veracity of the conference organisation and peer-review process. After a thorough investigation, the peer-review process was confirmed to fall beneath the high standards expected by Materials Today: Proceedings. The veracity of the conference also remains subject to serious doubt and therefore the entire Proceedings has been withdrawn in order to correct the scholarly record.
ABSTRACT
Purpose: The COVID-19 pandemic portends significant morbidity and mortality in immunocompromised individuals. Vaccination against COVID-19 among immunocompromised population is an essential step to minimize deadly complications. Numerous studies have shown an association between immune status, disease severity, and suboptimal responsiveness to vaccination. Additionally, data suggests that elevated IgG levels correlated with host viral neutralization. We herein present data indicating that induction and maintenance immunosuppression therapy affects responsiveness to vaccination among kidney transplant recipients. Method(s): The study data was retrospectively analyzed for 48 kidney transplant patients who received mRNA type COVID-19 vaccine at our institution. Majority of patients received vaccination between January and March 2021;two doses in total. The 30 days post-vaccination SARS-CoV-2 spike antigen-specific IgG levels were measured to assess immunological response to vaccine. Result(s): The included patients underwent kidney transplantation between 1983 and 2020. Among these patients, 35% showed detectable peak COVID IgG serum levels 30 days after the 2nd vaccine dose. A total of 31 patients (65%) did not show any response;majority of these non-responders (62%) were heavily immunocompromised, either on high dose Mycophenolate (at least 720 mg twice daily) in addition to standard Calcineurin inhibitor/Sirolimus+/-Prednisone), or had received high dose Thymoglobulin (6 mg/kg or more) within a year of vaccination. Among immunocompetent patients, over 95% immunological responsiveness or viral neutralization after the second vaccination dose has been reported. Conclusion(s): Anti-thymocyte globulin as induction immunosuppression and antimetabolites like Mycophenolate as maintenance immunosuppression serve as the cornerstone of transplantation management. However, their utilization impacts B cell proliferation, thereby reducing antibody production and the effectiveness of the SARS-CoV-2 vaccine in transplant patients. The ability of these immunosuppressive medications to suppress responsiveness to the SARS CoV-2 vaccine supports the need for 1) regular immunological surveillance post-vaccination among transplant patients, and 2) the need for a third or possibly fourth booster dose to achieve a sustained and effective response.
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Purpose: Vaccination against SARS-CoV-2 is essential. Complicating this effort are reports of a suboptimal response to the SARS-CoV-2 spike protein in patients on immunosuppressive medications and possible thrombotic microangiopathy (TMA) in renal transplant patients who receive the mRNA type vaccines. Method(s): 48 year old male with end stage renal disease who received a living unrelated transplant in 2015. Pre-operative creatinine was 10.42 mg/dL and decreased to 2.48 mg/dL within a week. Patient received Basiliximab induction and maintained on tacrolimus and mycophenolate (MMF). One month post-transplant patient was diagnosed with TMA. Tacrolimus was stopped and patient was switched to Sirolimus and continued on MMF. Patient was followed closely by transplant nephrology for the next 5 years with a baseline creatinine of 1.9 mg/dL, protein to creatinine ratio below 0.5 mg/mg and well controlled diabetes. No DSA Class I or II detected on regular testing. Patient was compliant with all prescribed medications. On January 25 2021 patient received Pfizer Vaccine. Second Pfizer vaccine administered on February 18 2021. A week later creatinine was noted to be 3.44 mg/dL. Repeat creatinine of 4.27 mg/dL. Biopsy revealed diffuse lymphocytic interstitial inflammation, peritubular capillaritis, and C4D negative. Findings consistent with chronic TMA. DSA testing revealed Class II DSA:DQ2 (SI-5933), Allosure 1.2 %. BK < 500 and CMV undetected. Patient received therapeutic plasma exchange, IV Ig infusion and steroids while on MMF and sirolimus. His creatinine decreased to 2.9 mg/dL on discharge. Over the next 6 months graft function deteriorated. He is now CKD stage 5 and under evaluation for a second transplant. Result(s): There are case reports of COVID-19 vaccine administration and transplant graft dysfunction. A possible mechanism involves the mRNA lipid nanoparticleencapsulated platform producing such a robust CD4 and CD8 T-cell response that pro-inflammatory cytokines are activated or that immune complex associated glomerular disease occurs resulting in the development of TMA in susceptible patients. Conclusion(s): A possible link between SARS CoV-2 vaccination and kidney transplant TMA warrants the implementation of close surveillance of vaccinated transplant patients, particularly susceptible individuals. More research is needed to determine if this link exists.
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Purpose: COVID-19 infection involves entry of SARS-CoV-2 virus into cells via interaction between its spike protein and angiotensin converting enzyme resulting in an NF-kappabeta mediated inflammatory response. A cytokine storm may cause organ dysfunction. Cardiac manifestations without pulmonary symptoms is uncommon but has been described in the literature during an acute infection. We report a rare case of a potential late cardiac complication months after an acute COVID-19 infection. Method(s): A 62-year-old male with hypertension and end stage renal disease on hemodialysis three times a week presented with fever, arthralgia and myalgia. He denied chest pain or respiratory symptoms. Patient tested positive for COVID-19 and received conservative management only. Over the next nine months he reported persistent fatigue and new onset of shortness of breath. He continued to be very compliant with dialysis. On presentation to the hospital, all laboratory investigations, including BUN (27mg/dL) were within normal limits. Chest X- ray revealed cardiomegaly. Echocardiogram showed a large circumferential pericardial effusion without tamponade. Pericardiocentesis was accomplished with removal of 1700 ml of bloody fluid. Cell count, LDH, protein and glucose was normal. Fungal, aerobic, and anaerobic cultures of the pericardial fluid was negative. No malignant cells were detected. Patient had gradual resolution of his symptoms. Serial echocardiograms at 1, 3 and 5 months revealed a persistent small pericardial effusion. Result(s): Cardiac manifestations of SARS-CoV-2 includes myocarditis, pericarditis and pericardial effusions. In case reports, the presence of the cardiac inflammatory state occurred simultaneously with an acute COVID-19 infection. In our case the COVID-19 infection occurred over nine months earlier yet remains a plausible explanation for his hemorrhagic pericardial effusion due to the absence of other identified causes. Further, COVID-19 molecular PCR testing of pericardial testing remains low yield due to its specific development for nasopharyngeal swab sampling. Conclusion(s): Cardiac manifestations of SARS-CoV-2 infection typically occur at the time of diagnosis. A late cardiac complication of COVID-19 may include pericardial inflammation with effusion. Further data and testing needs to be developed to confirm the diagnosis and guide therapy.
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Funding Acknowledgements Type of funding sources: None. Background World is facing Coronavirus disease (COVID-19) pandemic since December 2019. [1, 2]. COVID-19 has significantly decreased the influx of patients presenting with cardiovascular diseases at hospitals. The aim of this study was to determine the difficulties faced by patients in visiting the cardiac outpatient department during COVID-19 era and to assess the awareness regarding telemedicine and wiliness to adopt if offered in future. Methods This cross sectional study was carried out on patients presenting to the outpatient department in a National Institute of Cardiovascular Diseases. Data was collected after verbal consent from patients. The collected data was entered using IBM SPSS version 21, mean ± SD was calculated for continuous variables and frequency and percentages were calculated for the categorical variables. Results A total of 404 patients were interviewed, 42% female and 58% male with 77.5% from urban areas and 22.5% from rural areas. A total of 32.1% patients presented with shortness of breath, 28.8% with chest pain and 19% with palpitations. Regarding cardiovascular diagnosis 69.5% had ischemic heart disease, 38.3% had hypertension, 29.3% suffered from heart failure and 10.3% had valvular heart disease. A total of 26.7% visited the emergency room during the pandemic, 81.9% were compliant with medication and only 66% were compliant with a healthy lifestyle. A total of 52.8% patients found it difficult to attend the out patients department due to limited appointments, 24% due to limited mobility due to lockdown, 18.2% due to financial issues, 14.2% due to fear of acquiring infection from the hospital. Regarding telemedicine, 11.2% of the patients were aware of it and only 4.5% had previously used it, with 41.3% patients willing to opt for telemedicine in future. Regarding barriers to usage of telemedicine, a total of 40.7% of patients had no access to internet, 32.7% did not have a smart device and 11.6% were afraid of being diagnosed incorrectly. Conclusion It was found that distancing measures, lockdowns and restricted mobility of the masses has made it difficult for patients to visit the clinics which has led to patients visiting the emergency room. Telemedicine awareness was found to be limited, however many patients were willing to adopt provided their limitations can be overcame. Figure. Difficulty faced during OPD visit Figure. Barriers to Tele-medicine
ABSTRACT
Vaccination against SARS-CoV-2 is essential. Complicating this effort are reports of a suboptimal response to the SARS-CoV-2 spike protein in patients on immunosuppressive medications and possible thrombotic microangiopathy (TMA) in renal transplant patients. 48-year-old male who received a living unrelated transplant in 2015. Pre-operative creatinine was 10.42 mg/dL and decreased to 2.48 mg/dL within a week. Patient received Basiliximab induction and maintained on tacrolimus and mycophenolate (MMF). One month post-transplant patient was diagnosed with TMA. Tacrolimus was stopped and patient was switched to Sirolimus and continued on MMF. Patient was followed closely by transplant nephrology for the next 5 years with a baseline creatinine of 1.9 mg/dL, protein to creatinine ratio below 0.5 mg/mg and well controlled diabetes. No DSA Class I or II detected on regular testing. Patient was compliant with all prescribed medications. On January 25 2021 patient received Pfizer Vaccine. Second Pfizer vaccine administered on February 18 2021. A week later creatinine was noted to be 3.44 mg/dL. Repeat creatinine of 4.27 mg/dL. Biopsy revealed diffuse lymphocytic interstitial inflammation, peritubular capillaritis, and C4D negative. Findings consistent with chronic TMA. DSA testing revealed Class II DSA:DQ2 (SI- 5933), Allosure 1.2 %. BK < 500 and CMV undetected. Patient received therapeutic plasma exchange, IV Ig infusion and steroids while on MMF and sirolimus. His creatinine decreased to 2.9 mg/dL on discharge. Over the next 6 months graft function deteriorated. He is now CKD stage 5 and under evaluation for a second transplant. There are case reports of COVID-19 vaccine administration and transplant graft dysfunction. A possible mechanism involves the mRNA lipid nanoparticle-encapsulated platform producing such a robust CD4 and CD8 T-cell response that pro-inflammatory cytokines are activated or that immune complex associated glomerular disease occurs resulting in the development of TMA in susceptible patients. A possible link between SARS CoV-2 vaccination and kidney transplant TMA warrants the implementation of close surveillance of vaccinated transplant patients, particularly susceptible individuals. More research is needed to determine if this link exists.
ABSTRACT
COVID-19 infection involves entry of SARS-CoV-2 virus into cells via interaction between its spike protein and angiotensin converting enzyme resulting in an NF-kB mediated inflammatory response. Cardiac manifestations without pulmonary symptoms is uncommon but has been described in the literature during an acute infection. We report a rare case of a potential late cardiac complication months after an acute COVID-19 infection. 62-year-old male with hypertension and end stage renal disease on hemodialysis three times a week. Patient presented with fever, arthralgia and myalgia. He denied chest pain or respiratory symptoms. Patient tested positive for COVID-19 and received only treatment of symptoms. Over the next nine months he reported persistent fatigue and new onset of shortness of breath. He continued dialysis without interruption. His symptoms progressed resulting in hospital admission. All laboratory investigations, including BUN (27mg/dL), were within normal limits. Chest Xray revealed cardiomegaly. Echocardiogram showed a large pericardial effusion without tamponade. Pericardiocentesis was accomplished with removal of 1700 ml of bloody fluid. Cell count, LDH, protein and glucose was normal. Fungal, viral, aerobic and anaerobic cultures of the pericardial fluid was negative. No malignant cells detected. Serial echocardiograms at 1, 3 and 5 months revealed a persistent small pericardial effusion. Cardiac manifestations of SARS-CoV-2 includes myocarditis, pericarditis and pericardial effusions. In case reports, the presence of the cardiac inflammatory state occurred simultaneously with an acute COVID-19 infection. In our case the COVID-19 infection occurred over nine months earlier yet remains a plausible explanation for his hemorrhagic pericardial effusion due to the absence of other identified causes. Further, COVID-19 molecular PCR testing of pericardial testing remains low yield due to its specific development for nasopharyngeal swab sampling. Cardiac manifestations of SARS-CoV-2 infection typically occur at the time of diagnosis. A late cardiac complication of COVID-19 may include pericardial inflammation with effusion. Further data and testing needs to be developed to confirm the diagnosis and guide therapy.
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The coinfection with novel coronavirus disease (COVID-19) and cytomegalovirus (CMV) among disease donor kidney transplant (DDKT) recipients is rarely reported, to date. We present a case series of 3 DDKT recipients coinfected with COVID-19 and CMV. A 37 year-old male with DDKT secondary to membranous glomerulonephritis, presented with pneumonia, acute kidney injury (AKI), positive COVID-19 and CMV. Patient was admitted to ICU due to worsening respiratory status and Ganciclovir-resistant CMV pneumonitis, for which high dose Ganciclovir was given. After 10 days in ICU, respiratory status, oxygen requirement, and CMV titers improved, and patient was subsequently discharged. A 49 year-old female with DDKT secondary to diabetes, presented with pneumonia, AKI, positive COVID-19 and CMV. Despite initial standard treatment, patient remained hypoxic and subsequently intubated. After a prolonged and complicated 35 days ICU course, patient was eventually extubated and is currently stable. A 49 year-old male with DDKT secondary to diabetes, presented with fever, abdominal pain, AKI, positive COVID-19 and CMV, without any respiratory compromise. Patient was started on Ganciclovir and continued on immunosuppression. Over the course of next few days, patient's symptoms improved and was discharged. (Figure) Among DDKT recipients, the coinfection of COVID-19 and CMV is rare and very challenging in the setting of their immunosuppressed status. Interestingly, our stated 3 cases of coinfection and AKI were relatively young and presented within a year of transplant, and were successfully recovered. The COVID-19 and CMV coinfection can lead to variable disease severity among DDKT recipients and can be treated with combined antiviral and immunosuppressive regimen. A high index of suspicion for coinfection is warranted in immunocompromised patients with atypical or prolonged respiratory failure.
ABSTRACT
Background: World is facing Coronavirus disease (COVID-19) pandemic since December 2019. [1, 2]. COVID-19 has significantly decreased the influx of patients presenting with cardiovascular diseases at hospitals. The aim of this study was to determine the difficulties faced by patients in visiting the cardiac outpatient department during COVID-19 era and to assess the awareness regarding telemedicine and wiliness to adopt if offered in future. Methods: This cross sectional study was carried out on patients presenting to the outpatient department in a National Institute of Cardiovascular Diseases. Data was collected after verbal consent from patients. The collected data was entered using IBM SPSS version 21, mean ± SD was calculated for continuous variables and frequency and percentages were calculated for the categorical variables. Results: A total of 404 patients were interviewed, 42% female and 58% male with 77.5% from urban areas and 22.5% from rural areas. A total of 32.1% patients presented with shortness of breath, 28.8% with chest pain and 19% with palpitations. Regarding cardiovascular diagnosis 69.5% had ischemic heart disease, 38.3% had hypertension, 29.3% suffered from heart failure and 10.3% had valvular heart disease. A total of 26.7% visited the emergency room during the pandemic, 81.9% were compliant with medication and only 66% were compliant with a healthy lifestyle. A total of 52.8% patients found it difficult to attend the out patients department due to limited appointments, 24% due to limited mobility due to lockdown, 18.2% due to financial issues, 14.2% due to fear of acquiring infection from the hospital. Regarding telemedicine, 11.2% of the patients were aware of it and only 4.5% had previously used it, with 41.3% patients willing to opt for telemedicine in future. Regarding barriers to usage of telemedicine, a total of 40.7% of patients had no access to internet, 32.7% did not have a smart device and 11.6% were afraid of being diagnosed incorrectly. Conclusion: It was found that distancing measures, lockdowns and restricted mobility of the masses has made it difficult for patients to visit the clinics which has led to patients visiting the emergency room. Telemedicine awareness was found to be limited, however many patients were willing to adopt provided their limitations can be overcame. (Figure Presented).
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Objective: The purpose of the survey was to gather information from students on their learning preferences prior to the COVID-19 outbreak, barriers to online education during the pandemic, and the mental and psychological effects of COVID-19 on students. Method: Applying Google Forms, a cross-sectional pharmacy student-targeted online questionnaire designed to develop. In order to ensure that only pharmacy students responded, an introductory opening inquiry of the program name used to select out non-pharmacy students. Following that, these few demographic questions are asked to the participant's present institution and program year in which the participants currently in. Results: A total 260 pharmacy students received the survey, out of total 186 replies were received from professional pharmacy students, resulting in a response rate of around 71.5%. Almost half of the students (94%) chose traditional face-to-face training, while 32.8% preferred a combination of online and face-to-face instruction, and only 16.7% liked online instruction alone. The difficulties to online education during the COVID-19 pandemic outbreak show that, Issues with in-person communication (23.7%), pandemic-related anxiety and stress (22%), time management (19.9%), experience in online education (16.7%). The majority of respondents (87%) intended to incorporate online knowledge gained during the COVID-19 pandemic outbreak into their teaching/learning techniques. During the COVID-19 epidemic, we discovered that practically all students were plagued by symptoms of sadness, anxiety, tension, and poor sleep quality, with the majority suffering from significant depression (31.2 %). Conclusion: This study concludes that most of the students are in favor of incorporation and applications of online learning experiences in teaching/learning practices garnered during pandemic. Furthermore, the majority of students had changed their behavior as a result of coronavirus, while nearly half of those polled experiencing an increase in anxiety and tension.
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Purpose: A critical question facing transplant programs is if, when and how to safely accept living kidney donors (LKD) who have a history and recovered from COVID-19 Infection. The purpose of the study is to understand current practices related to accepting living donors for donation who have recovered from COVID-19. Methods: We surveyed US transplant programs from September 3, 2020 through November 3, 2020 by e-mail and postings to professional society list-serves. Center level as well individual opinion based responses were analyzed. Results: A total of 174 US respondents from 115 unique centers responded, representing 59% of US Living Donor Programs and 72.4% of 2019 and 71.9% of 2020 LKD volume (as of October 31, 2020). Respondent Roles included Nephrologist (53.4%);Surgeon (19.5%);Infectious Disease (11.5%);Coordinator (9.8%). Overall during the survey period, 48.6% of responding centers had received inquiries from such LKDs, while 44.3% were currently evaluating such donors. A total of 98 donors were reported to be in the evaluation phase, while 27.8% centers had approved a total of 42 such donors to proceed with donation. Conclusions: Selection practices and criteria for LKD who have recovered from COVID-19 are variable. Ongoing research and consensus building are needed to guide optimal practices to ensure the safety of accepting such donors.
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The novel human coronavirus disease (COVID-19) is the major pandemic throughout the globe and its occurrence is due to the presence of severe acute respiratory syndrome coronavirus (SARS-CoV2). That began from Wuhan, Hubei province of China in late 2019 and afterward drastically spread worldwide. It effects around 213 countries and territories around the globe and have reported a total of 8,128,490 confirmed cases of COVID-19. As an unprecedented global pandemic it sweeps the planet and affects each and every human being either physically, mentally or economically. The most common symptoms of COVID-19 are pyrexia, tiredness, and dry cough but in some cases it is asymptomatic. It can be diagnosed by a health care provider based on symptoms and confirmed through laboratory tests. Till date there is not even a single drug or vaccine that can be used for the effective treatment for this disease. The international community is to introduce a global synchronized strength to prevent the outbreak that needs a strong public health response, high level political commitment and sufficient funding. The aim of this review article is to summarise the recent state of awareness, epidemiology and social impact on surrounding due to outbreak of COVID-19 pandemic.