Internal Tremors and Vibration Symptoms Among People with Post-Acute Sequelae of SARS-CoV-2: A narrative review of patient reports (preprint)

To introduce the perspective of patients who have PASC with vibrations and tremors as a prominent component, we leveraged the efforts by Survivor Corps, a grassroots COVID-19 patient advocacy group, to gather information from people in their Facebook group suffering from vibrations and tremors. Survivor Corps collected 140 emails and 450 Facebook comments from members. From the emails, we identified 22 themes and 7 broader domains based on common coding techniques for qualitative data and the constant comparative method of qualitative data analysis. Facebook comments were analyzed using Word Clouds to visualize frequency of terms. The respondent emails reflected 7 domains that formed the basis of characterizing their experience with vibrations and tremors. These domains were: (1) symptom experience, description, and anatomic location; (2) initial symptom onset; (3) symptom timing; (4) symptom triggers or alleviators; (5) change from baseline health status; (6) experience with medical establishment; and (7) impact on lives and livelihood. There were 22 themes total, each corresponding to one of the broader domains. The Facebook comments Word Cloud revealed that the 10 most common words used in comments were: tremors (64), covid (55), pain (51), vibrations (43), months (36), burning (29), feet (24), hands (22), legs (21), back (20). Overall, these patient narratives described intense suffering, and there is still no diagnosis or treatment available.

Total and Stroke Related Imaging Utilization Patterns During the COVID-19 Pandemic (preprint)

During the COVID-19 pandemic, radiology practices are reporting a decrease in imaging volumes. We review total imaging volume, CTA head and neck volume, critical results rate, and stroke intervention rates before and during the COVID-19 pandemic. Total imaging volume as well as CTA head and neck imaging fell approximately 60% since the beginning of the pandemic. Critical results fell 60-70% for total imaging as well as for CTA head and neck. Compared to the same time frame a year prior, the number of stroke codes at the early impact of the pandemic had decreased approximately 50%. Proportional reductions in total imaging volume, stroke-related imaging, and associated critical result reports during the COVID-19 pandemic raise concern for missed stroke diagnoses in our population.

A single-cell RNA expression map of coronavirus receptors and associated factors in developing human embryos (preprint)

To predict if developing human embryos are permissive to coronaviruses, we analyzed publicly available single cell RNA-seq datasets of zygotes, 4-cell, 8-cell, morula, inner cell mass, epiblast, primitive endoderm and trophectoderm for the coronavirus receptors (ACE2, BSG, DPP4 and ANPEP), the Spike protein cleavage enzymes (TMPRSS2, CTSL). We also analyzed the presence of host genes involved in viral replication, the endosomal sorting complexes required for transport (ESCRT) and SARS-Cov-2 interactions. The results reveal that ACE2, BSG, DPP4 and ANPEP are expressed in the cells of the zygote, to blastocyst including the trophectodermal lineage. ACE2, TMPRSS, BSG and CTSL are co-transcribed in a proportion of epiblast cells and most cells of the trophectoderm. The embryonic and trophectodermal cells also express genes for proteins ESCRT, viral replication and those that interact with SARS-CoV-2. We identified 1985 genes in epiblast and 1452 genes in the trophectoderm that are enriched in the ACE2 and TMPRSS2 co-expressing cells; 216 genes of these are common in both the cell types. These genes are associated with lipid metabolism, lysosome, peroxisome and oxidative phosphorylation pathways. Together our results suggest that developing human embryos could be permissive to coronavirus entry by both canonical and non-canonical mechanisms and they also express the genes for proteins involved in viral endocytosis and replication. This knowledge will be useful for evidence-based patient management for IVF during the COVID-19 pandemic.