REMDESIVIR-ASSOCIATED ASYMPTOMATIC BRADYCARDIA IN AN ICU PATIENT ON DEXAMETHASONE FOR COVID-19

SESSION TITLE: Cardiovascular Complications in Patients with COVID-19 SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Even though COVID-19 is the largest pandemic of the twenty-first century, little is known about the disease or its management. Remdesivir has demonstrated some activity against severe ARDS associated with COVID-19. There is a dearth of data on the adverse effects of Remdesivir. We report a case of a COVID-19 patient who developed bradycardia following the administration of Remdesivir. CASE PRESENTATION: A 64-year-old man, who tested positive for COVID-19, presented with shortness of breath (SOB) for a week. SOB was accompanied by a cough with tan-colored sputum. Past medical history included hypertension and benign prostatic hyperplasia. Physical examination showed regular rate and rhythm of the heart and diffusely decreased breath sounds. His blood pressure was 104/60 mmHg and his heart rate was 80 bpm. Oxygen saturation was 58% at room air. Significant lab results showed elevated CRP: 17.13 mg/dl, D-Dimer: 10.16 ug/mL FEU, Lactic acid: 2.5 mg/dl, Creatinine: 1.8 mg/dl, BUN: 60 mg/dl, and AST: 46 U/L. Chest x-ray showed bilateral patchy interstitial airspace opacities. Calculated Well's score of 3 indicated a moderate risk for pulmonary embolism. CT scan showed moderate bilateral diffuse areas of ground-glass lung consolidation concerning diffuse atypical infection. The patient was admitted to the ICU and started on CPAP with PEEP of 12 and FiO2 of 100%. The management included dexamethasone 6 mg oral for 10 days, Remdesivir for 5 days, and Tocilizumab given elevated CRP level. The patient was found to develop asymptomatic bradycardia with a heart rate as low as 40 bpm. An EKG obtained demonstrated sinus bradycardia without any heart block. Echocardiography showed mildly dilated right ventricle & mild aortic regurgitation. Bradycardia resolved after the last dose of Remdesivir. DISCUSSION: Remdesivir is frequently used in severe COVID-19 infections. The commonly reported adverse events affect the gastrointestinal and renal systems. The reported cardiovascular adverse events include hypotension, atrial fibrillation, and cardiac arrest. However, bradycardia is becoming increasingly encountered. Although corticosteroids are known to cause bradycardia, the patient we managed developed bradycardia following remdesivir therapy. The baseline EKG was normal and the history was non-contributory. Given the asymptomatic nature of the finding, cardiac monitoring alone sufficed. The heart rate picked up following the last dose of remdesivir further suggesting its causative role. CONCLUSIONS: Bradycardia is becoming more common with Remdesivir use. If the patient is not exhibiting any symptoms, cardiac monitoring alone should suffice;bradycardia is expected to resolve when the drug is stopped. Reference #1: Elsawah HK, Elsokary MA, Abdallah MS, ElShafie AH. Efficacy and safety of remdesivir in hospitalized Covid-19 patients: Systematic review and meta-analysis including network meta-analysis. Rev Med Virol. 2021;31(4):e2187. Reference #2: Taqi M, Gillani SFUHS, Tariq M, Raza ZA, Haider MZ. Current updates on clinical management of COVID-19 infectees: a narrative review. Rev Assoc Med Bras (1992). 2021 Aug;67(8):1198-1203. doi: 10.1590/1806-9282.20210582. PMID: 34669870. DISCLOSURES: No relevant relationships by AISHA ADIGUN No relevant relationships by Mobeen Haider No relevant relationships by Yousra Khalid No relevant relationships by Muhammad Hasib Khalil No relevant relationships by Aleena Naeem No relevant relationships by Zarlakhta Zamani

CSF and BLOOD ANALYSES in PARTICIPANTS with POST-COVID-19 NEUROPSYCHIATRIC SYMPTOMS

Background: The pathogenesis of neuropsychiatric symptoms persisting months after acute SARS-CoV-2 infection is poorly understood. We examined clinical and laboratory parameters in participants with post-acute COVID-19 neuropsychiatric symptom to assess for systemic and nervous system immune perturbations. Methods: Participants with a history of laboratory confirmed COVID-19 and ongoing neurologic symptoms were enrolled in an observational study that collected medical history;detailed post-COVID symptom survey;and paired cerebrospinal fluid (CSF) and blood. In addition to standard clinical labs, neopterin and anti-SARS-CoV-2 antibodies (anti-spike, RBD, and nucleocapsid) were measured by ELISA. Non-parametric tests were used to compare CSF and blood findings between the post-COVID participants and pre-COVID-19 era healthy controls. Results: Post-COVID participants (n=27) and controls (n=21) were similar in age (median 51 and 46 years), but there was a greater proportion of females (67% vs 24%;p=0.004) and white participants in the post-COVID cohort (63% vs 24%;p=0.04). The post-COVID study visit was a median of 264 days (IQR 59-332) after acute COVID-19 symptom onset. 35% were hospitalized during their acute illness;12% required intensive care. 33% had previously been treated with medications for mental health conditions. The most frequent neuropsychiatric symptoms were cognitive impairment (67%), mood symptoms (67%), headache (56%), and neuropathy (41%). Blood c-reactive protein, T cell count, and T cell subset frequency (CD4% and CD8%) were similar between groups, while D-dimer was higher in the post-COVID cohort (median 0.48 vs 0.27 mg/L;p = 0.019) (Figure). CSF WBC, protein, neopterin, and CSF/blood albumin ratio were similar between the groups;the frequency of CSF lymphocytes was lower in the post-COVID cohort (p = 0.05) (Figure 1). Antibodies against at least one SARS-CoV-2 antigen were detected in 7/10 CSF and 8/9 blood samples in the post-COVID CSF (antibody reactivity range 1.5 to 55-fold greater than to control antigens). Conclusion: In this small cohort of post-COVID participants with neurologic symptoms, we found limited differences in CSF and blood markers when compared to pre-pandemic healthy controls. Deeper immunophenotyping in a larger number of participants may provide greater insight into subtle differences. The presence of anti-SARS-CoV-2 antibodies in CSF months after acute infection warrants further investigation.

Unpacking Misinformation Amid the COVID-19 Pandemic: A Mixed Methods Study

Misinformation knows no bounds, but its impacts are particularly prominent in low-income countries, such as Pakistan, where social media usage is widespread, and health and media literacy levels are too low to navigate pitfalls when consuming COVID-19-related misinformation. This mixed methods study deploys a researcher- administered survey (N = 380) and semistructured interviews (N = 30) to assess how exposure to social media affects people's perceptions of the COVID-19 pandemic in Pakistan against the backdrop of sociocultural nuances and an "infodemic" of COVID-19 misinformation. In addition, we show that the triad of social media usage, COVID-19 misinformation, and sociocultural aspects affect sociodemographic groups differentially. Nearly 80% of the total respondents were social media users. The survey results indicate that belief in COVID-19-related misinformation was higher among low-income and poorly educated respondents in comparison to respondents from relatively high-income and educated backgrounds, whereas the interviewees were increasingly susceptible to political-, scientific-, and religious-sounding misinformation about COVID-19.

Post effects associated with SARS-CoV-2 vaccination among health care workers in Pakistan

The coronavirus disease 2019 (COVID-19) pandemic has witnessed the rapid development of vaccines produced simultaneously form various countries. However, these vaccines were shrouded by a set of myths ranging from serious effects to change of human deoxyribonucleic acid (DNA). Pakistan was one of the countries to start vaccination early and the front-line workers were first to be vaccinated. We undertook to study the vaccinated health care workers for the post effects of vaccines they received. The methodology adopted was through a structured questionnaire comprising 12 questions covering almost all the possible post effects. This was circulated among health care workers of Pak-Emirates Military hospital and Army Medical College/National University of Medical Sciences, Rawalpindi, Pakistan. Fever was the most frequently encountered post effect, followed closely by pain at site of injection, headache and fatigue. There was a strong association between age and post effects of vaccination. No life threatening or serious side effects were experienced by health care workers indicating that benefits of vaccine outweigh its adverse effects especially with emergence of new variants. No participant required hospitalization following immunization. Therefore, vaccination against severe acute respiratory syndrome corona virus (SARS-CoV-2) should be carried out on priority basis in order to avoid severe COVID-19 infection. © 2022, Intelektual Pustaka Media Utama. All rights reserved.

Assessment of pregnant females' anxiety and health concerns during COVID-19 pandemic

Objective: To determine level of anxiety in pregnant females during covid-19 using CAS scale and to determine pregnant women's maternal and fetal health concerns during COVID-19. Study Design: Descriptive Cross sectional study Place and Duration of Study: This study was conducted at the Outpatient department of Obstetrics and Gynaecology Isra University Hospital Hyderabad from January 2021 to March 2021 for a period of 03 months. Materials and Methods: A convenience sampling technique was used to collect data from 180 pregnant women who had no previous psychiatric, missed abortion, or ectopic pregnancy history. A standardized CAS scale was used to assess each participant's level of anxiety about COVID-19, followed by a self-structured questionnaire to assess women's concerns about foetal and maternal health in the context of COVID-19. Frequency was calculated for all variables. Results: The bulk of our patients were over 35 years old and multigravida, according to our results. Corona related anxiety was found in 63.8% of patients, and it had an impact (58%) on their lives, both in terms of their health (41.3%) and the health of their unborn child (53.8%). Conclusion: Anxiety was shown to be present in majority of pregnant females with most of them being worried about the health of their unborn child. © 2021 Medical Forum Monthly. All rights reserved.

Social Value Orientations and Public Confidence in Institutions: A Young Democracy Under the Imprint of COVID-19

Social value orientations (SVOs) of a society determine peoples' behaviour and are critical for young democracies in crises. This paper draws on the Maldives Values in Crisis survey, conducted during the first wave of COVID-19 pandemic. SVOs assessed using the Schwartz Personal Values Questionnaire shows that Maldivian society weigh slightly towards prosocial. Urban-rural, age, and gender determine the SVOs on the dimension of Openness to change versus Conservation white age and gender determine the SVOs on Self-enhancement versus Self-transcendence dimension. Confidence in the public institutions were moderate and not associated with the SVOs. The moderate level of SVOs and confidence in institutions reflects the democratic landscape of the country. Although prosocial SVOs are favourable for implementing containment measures of the pandemic, without a strong value orientation towards conservation and self-transcendence, and confidence in the institutions, the country faces the risk of non-compliance to measures and escalation of the crisis.

An association between exposure to Middle East Respiratory Syndrome (MERS) and mortality rate of Coronavirus Disease 2019 (COVID-19).

OBJECTIVE: Our objective was to find an association between exposure of a population to Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and mortality rate due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) across different countries worldwide. MATERIALS AND METHODS: To find the relationship between exposure to MERS-CoV and mortality rate due to SARS-CoV-2, we collected and analyzed data of three possible factors that may have resulted in an exposure of a population to MERS-CoV: (1) the number of Middle East Respiratory Syndrome (MERS) cases reported among 16 countries since 2012; (2) data of MERS-CoV seroprevalence in camels across 23 countries, as working with camels increase risk of exposure to MERS-CoV; (3) data of travel history of people from 51 countries to Saudi Arabia was collected on the assumption that travel to a country where MERS is endemic, such as, Saudi Arabia, could also lead to exposure to MERS-CoV. RESULTS: We found a significantly lower number of Coronavirus disease 2019 (COVID-19) deaths per million (deaths/M) of a population in countries that are likely to be exposed to MERS-CoV than otherwise (t-stat=3.686, p<0.01). In addition, the number of COVID-19 deaths/M of a population was significantly lower in countries that reported a higher seroprevalence of MERS-CoV in camels than otherwise (t-stat=4.5077, p<0.01). Regression analysis showed that increased travelling history to Saudi Arabia is likely to be associated with a lower mortality rate due to COVID-19. CONCLUSIONS: This study provides empirical evidence that a population that was at an increased risk of exposure to MERS-CoV had a significantly lower mortality rate due to SARS-CoV-2, which might be due to cross-protective immunity against SARS-CoV-2 in that population because of an earlier exposure to MERS-CoV.

Saudi Heart Rhythm Society Task Force on Management of Potential Arrhythmogenicity Associated with Pharmacotherapy for COVID-19.

Evidence of cardiovascular complications associated with the COVID-19 global pandemic continues to evolve. These include direct and indirect myocardial injury with subsequent acute myocardial ischemia, and cardiac arrhythmia. Some results from a limited number of trials of antiviral medications, along with chloroquine/hydroxychloroquine and azithromycin, have been beneficial. However, these pharmacotherapies may cause drug-induced QT prolongation leading to ventricular arrhythmias and sudden cardiac death. Mitigation of the potential risk in these susceptible patients may prove exceptionally challenging. The Saudi Heart Rhythm Society established a task force to perform a review of this subject based on has recently published reports, and studies and recommendations from major medical organizations. The objective of this review is to identify high-risk patients, and to set clear guidelines for management of patients receiving these pharmacotherapies.