Impact of microfiber pollution on aquatic biota: A critical analysis of effects and preventive measures.

The widespread use of Personal protective equipments (PPEs) by the healthcare professionals and public due to Corona Virus Disease (COVID-19) pandemic has become a new source for MFs pollution. Mismanaged plastic wastes and random dispose of used surgical face mask end up in large aquatic bodies via small waterways and waste water treatment plants (WWTPs). Microplastics/Microfibres (MPs/MFs) have recently been reported in a variety of aquatic and terrestrial ecosystems, including water, deep sea sediments, air and soil. Natural components like UV radiation and temperature play a major role in weathering of surgical masks. High loads of MPs/MFs emitted into the aquatic environment are easily consumed by organism's habitat in such ecosystem by disrupting the food chain and causing chronic health problems in the organisms including humans. The aim of this review article is to shed light on these issues and compile the most recent information available regarding the deterioration of surgical face masks in the environment as well as other contaminants and their presence in various environments, particularly with regard to methods that make use of exposure models, biomarkers of exposure, and their limitations. Along with this, the study focuses on identifying gaps in current understanding and highlighting prospective research directions. The literature on surgical face mask pollution and its effects on the biological and physiological systems of various organisms and ecosystems is critically analysed in this review. It also raises awareness of how to properly dispose of used surgical face masks and other PPEs.

Safety and Tolerability of Tixagevimab/Cilgavimab for Pre-Exposure Prophylaxis of COVID-19 in Kidney Transplant Recipients

Background: Kidney transplant recipients (KTR) remain at risk for severe COVID-19 because of emerging SARS-CoV-2 variants and impaired antibody response to COVID-19 vaccines. There is an urgent need for effective vaccination and pre-exposure prophylaxis. In December 2021, the FDA issued an emergency use authorization of tixagevimab/ cilgavimab for pre-exposure prophylaxis of COVID-19 in moderately-severely immunocompromised individuals. In PROVENT, tixagevimab/cilgavimab resulted in 83% relative risk reduction in incidence of symptomatic COVID-19, but only 3% of subjects received immunosuppressive medications and <1% had immunosuppressive disease. We report safety and tolerability of tixagevimab/cilgavimab in KTR at our center. Method(s): 40 doses initially allocated to KTR. We designed an online questionnaire to assess therapy tolerability. 28/38 KTR who received therapy responded. Result(s): Patient characteristics of 38 KTR who received tixagevimab/cilgavimab are listed (Table 1a). Negative Anti-S antibody documented in 54.1% patients, with 17(85%) testing negative after three vaccines. 28 KTR completed the survey and authorized use of their deidentified data. Most patients, 81.5%, reported tolerating tixagevimab/cilgavimab "Very Well" (Table 1b). The most common symptom was fatigue, moderate in 25% and mild in 29%. Other symptoms were less frequent, <15%. Conclusion(s): Tixagevimab/cilgavimab was generally "very well" tolerated. Additional data substantiating safety and tolerability of tixagevimab/cilgavimab over a longer observation period and with more study participants should help increase confidence in a pre-exposure prophylaxis strategy and offer a safety net for kidney transplant recipients and others at risk for severe COVID-19.

Outcomes in Kidney Transplant Recipients With COVID-19 Illness in the Era of Vaccines

Background: Kidney transplant recipients (KTRs) are risk for severe complications from COVID-19 illness due to immunosuppression. Predating COVID-19 vaccines our center reported AKI in 39% & death in 13% of KTRs. Here we describe the impact of COVID-19 on allograft & patient outcomes in KTRs with & without COVID-19 vaccination. We also compare outcomes in KTRs with & without response (SARS-CoV2 spike/anti-S antibody) to COVID-19 vaccine. Method(s): This is a retrospective cohort analysis of 142 KTRs identified with COVID-19 illness between 7/1/21 and 2/10/22. We collected data on patient demographics, COVID19 vaccine doses, anti-S levels & clinical outcomes including graft dysfunction, hospitalization, ICU admission & death. Result(s): Of 142 KTRs in our cohort, 113 (80%) were fully vaccinated (+/-booster) and 29 (20%) were un or partially vaccinated. 60 of 113 vaccinated KTRs were tested for anti-S levels between COVID19 vaccination & illness: 68% tested positive and 32% negative for anti-S Ab. Allograft dysfunction & hospitalization were less frequent in fully vaccinated vs unvaccinated KTRs (Fig.1). There was no difference between the two in terms of ICU admission and death (22 vs 18%, p=0.7). Among vaccinated KTRs, there was a trend towards less graft dysfunction in positive vs. negative anti-S (15% vs. 33% p=0.15). No differences were observed between anti-S levels and hospitalization (23% vs 26% p=0.7), ICU admission (11 vs 60% p=0.07) and death (11 vs 20% p=0.65). Conclusion(s): In our cohort, kidney allograft dysfunction and hospitalization was less common vaccinated vs unvaccinated KTRs with COVID-19. Additionally, there is a trend towards lower graft dysfunction in those with positive anti-S Ab. No significant differences were observed in death and ICU admissions with vaccination or positive anti-S. Vaccination to COVID-19 and maintaining positive anti-S Ab (with boosters or monoclonal Ab) are important in preventing graft dysfunction and hospitalization following COVID-19.

Post COVID-19 Sequelae in Kidney Transplant Recipients (KTR): A Single Center Report

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, on KTR remains unknown. We aimed to determine the impact of COVID-19 illness on kidney graft function including graft loss and characterize Long COVID (LC) symptoms in KTR. Method(s): Clinical data were extracted from an established registry of KTR diagnosed with COVID-19 between February 2020 to April 2022. A LC symptom questionnaire was developed and distributed. KTR that self-reported COVID-19 associated symptoms >=2 months were considered to have Long COVID (LC). Result(s): Of the 121 post COVID-19 KTR, 15 (12%) developed graft dysfunction defined as an increase in serum creatinine >0.3 mg/dL. Characteristics of KTR stratified as with and without graft dysfunction are shown in Table 1. Urine albumin/creatinine ratio was higher in the group with dysfunction and 2 (1.6%) KTR lost their allografts as well. Four (18%) reported LC symptoms and the frequency of LC symptoms among the first 22 questionnaire respondents are shown in Figure 1. Conclusion(s): Both allograft injury and LC symptoms are frequent among KTR. Identification of risk factors for long-term complications post COVID-19 and development of mechanism-based interventions may mitigate post COVID-19 sequalae in KTR.

COVID-19 management in New York City kidney transplant recipients: Before and after the apex

Background: Kidney graft recipients receiving immunosuppressive therapy may be at heightened risk for Covid-19 and adverse outcomes. We aimed to study how practice patterns and outcomes changed before and after the peak incidence of cases in New York City. Methods: We reviewed 68 consecutive adult kidney graft recipients from our center diagnosed with SARS-CoV-2 from March 13, 2020 to May 25, 2020. We compared outcomes of those treated from March 13 until the apex of infections on April 14 (Phase 1), and those treated from April 15th to May 25, 2020 (Phase 2). Results: Characteristics of both Phase 1 and Phase 2 patients are described in Table 1. Inflammatory markers were lower in the second phase as was patient mortality. Changes in management strategies between the two phases are highlighted in Figure 2. Graft loss occurred in 4 patients (6%) and there were 5 deaths (7%). Conclusions: Data from our study suggest that management strategies of immunosuppressed patients changed over the course of the Covid-19 Pandemic in New York City, including less use of hydroxychloroquine, and increased use of novel agents such as remdesivir. Additional data are needed to better understand if the decrease in patient mortality during the second phase is attributable to better management or lower inflammatory response in the setting of Covid-19 illness.