ABSTRACT
The purpose of this correlational, cross-sectional design study was to examine the relationships between COVID-19-related stress, quality of life (QOL), and intrinsic religiosity of university students during the pandemic. Data were collected using the Psychological General Well-being Index, Impact of Events Scale-Revised, and Duke University Religiosity Index and analyzed using Pearson's r, bivariate analysis, and hierarchical regression analysis. For the sample of 422 participants, COVID-19-related stress was negatively associated with QOL, while religiosity was positively associated with participants' QOL. Religiosity, however, did not moderate the relationship between stress and QOL. Institutions of higher education should consider providing additional mental health support and self-care initiatives to improve student stress responses. Understanding the effects of religiosity on student stress responses and QOL would allow faculty and institutions to prioritize holistic care, including spiritual care in conjunction with religiosity. © 2023 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.
ABSTRACT
Background: Ensovibep is a multi-specific DARPin (designed ankyrin repeat protein) therapeutic in clinical development for treatment of COVID-19. In Part A (Phase 2) of the EMPATHY study, ensovibep treatment demonstrated greater viral load decline versus placebo (Pbo), and a relative risk reduction for hospitalization, ER visits and death. We report the sustained clinical recovery data from Phase 2 of EMPATHY. Method(s): Patients (pts) were eligible for EMPATHY (NCT04828161) when presenting >=2 mild-to-moderate COVID19 symptoms (onset within 7 days) and a positive SARS-CoV-2 rapid antigen test on day of dosing. 407 pts were randomised (1:1:1:1) to ensovibep (600, 225 or 75mg) or Pbo as single, IV infusion. The FDA COVID-19 symptom questionnaire was used (daily to Day 15, and on Days 22, 29) to assess time to sustained clinical recovery (secondary endpoint). Result(s): Ensovibep treatment was associated with a shorter time to sustained clinical recovery versus Pbo (Fig 1). The median time to sustained recovery were 23 days, 15 days, 14 days, and 29 days in 600mg, 225mg, 75mg, placebo arms, respectively. The cumulative proportion of patients with sustained clinical recovery by Day 15 were 44%, 54%, 55% and 36% in 600mg, 225mg, 75mg, and placebo arms, respectively. Conclusion(s): Ensovibep administration was associated with earlier sustained clinical recovery versus placebo.
ABSTRACT
Background Primary cardiac lymphoma (PCL) is an extranodal lymphoma involving only the heart and/or pericardium. PCL accounts for 2% of primary cardiac tumors and 0.5% of extranodal lymphomas. Its diagnosis is usually delayed due to rarity and non-specific findings. Case A 77-year-old man with Alzheimer dementia, atrial fibrillation on apixaban, and COVID-19 illness 3-weeks prior, who presented to the hospital with diffuse abdominal discomfort, fatigue, anorexia, and hypoactivity. Patient was tachycardic and normotensive with pronounced jugular venous distention, non-collapsing with respiration. ECG revealed sinus tachycardia, first degree atrioventricular (AV) block and chronic LBBB. Cardiac troponins were mildly elevated without significant delta. An abdominopelvic CT revealed an incidental, large pericardial effusion (PE). Bedside echocardiogram confirmed a large hemodynamically significant PE as well as a mass-like echogenicity encasing and infiltrating the pericardium and myocardium at the basal aspect of the right ventricle free wall. Decision-making In view of recent COVID-19 infection, he was started on indomethacin and colchicine for suspected viral or neoplastic pericarditis. Pericardiocentesis drained 900ml of amber to serosanguineous fluid with quick hemodynamic improvement. Fluid analysis was non-diagnostic for neoplasia. Subsequently, he developed symptomatic bradycardia with an intermittent complete AV block with junctional escape rhythm, transitioning to a second-degree AV block after removal of beta-blocker. Awaiting permanent pacemaker implant, he developed ventricular fibrillation with sudden cardiac death that required prolonged unsuccessful ACLS. Autopsy revealed an extensive infiltrative tumor, predominantly right-sided, consistent with primary cardiac B-cell lymphoma. Conclusion PCL should be part of the working diagnosis in patients presenting with a pericardial effusive process in combination with a right sided myocardial mass. Early cardiac MRI/PET scan or biopsy should be considered when the diagnosis is not certain. Prompt diagnosis could allow for treatment that potentially prolongs survival.Copyright © 2023 American College of Cardiology Foundation
ABSTRACT
Background. Ensovibep is a multi-specific DARPin (designed ankyrin repeat protein) antiviral in clinical development for treatment of COVID-19. In the Phase 2 EMPATHY study, ensovibep demonstrated greater viral load decline versus placebo. Here we report (1) the efficacy of ensovibep in patients with and without anti-SARS-CoV-2 antibodies at baseline and (2) SARS-CoV-2 mutation emergence data with treatment. Methods. Eligible ambulatory patients with >=2 COVID-19 symptoms (onset within 7 days) and positive SARS-CoV-2 rapid antigen test on day of dosing, were randomized (1:1:1:1) to ensovibep (600, 225 or 75 mg) or placebo as single, IV infusion. Chemiluminescent immunoassays were used for antibody detection (SARS-CoV-2 S1/S2 IgG and SARS-CoV-2 IgM). A pre-specified subgroup analysis was performed based on baseline anti-SARS-CoV-2 antibody status. Analysis of changes in viral genome from baseline to post baseline was performed to evaluate treatment-emergent mutations. Results. Of the patients analyzed, 48.5% had anti-SARS-CoV-2 antibodies at baseline. Baseline log10 SARS-CoV-2 viral load (mean +/-SD) was similar across groups [ensovibep (all doses) 6.5 +/-1.5, placebo 6.2 +/-1.5];> 90% were infected with the Delta (B.1.617.2) variant. SARS-CoV-2 viral load reduction up to Day 8 showed similar effects in favor of ensovibep compared with placebo regardless of the presence of anti-SARS-CoV-2 antibodies (Figure 1). Patients in ensovibep 75 mg, 600 mg, and placebo groups had comparable incidences of emergent mutations, with a higher incidence in the 225 mg group. Based on analysis of 70% of the expected viral sequencing data, two mutations in the key binding residues of ensovibep were observed (Y489H and F486L) in a total of three patients treated with ensovibep. These patients either cleared virus by Day 8 or mutations were transient (occurred at a single time point but not later in the course of infection). (Figure Presented) Conclusion. Ensovibep effectively reduces SARS-CoV-2 viral load regardless of the presence of anti-SARS-CoV-2 antibodies at baseline. Furthermore, there were no emerging mutations of concern, indicating that a single dose administration of ensovibep is associated with minimal selective pressure.
ABSTRACT
Background: Covid-19 is associated with an increased risk of pulmonary embolism (PE) therefore, should the cut off d-dimer value be adjusted for these patients? Material(s) and Method(s): Retrospective and observational study to understand if there is a d-dimer cut-off that could guide clinics to perform a thoracic computed tomography angiography (CTA) in patients with covid-19. The population was covid-19 patients admitted to covid-19 dedicated wards of a University Hospital Centre for one year. Result(s) and Conclusion(s): 725 (52%) patients with covid-19 had a d-dimer value dosed during the first 5 days of the disease. Those, 63 (9%) did a CTA with a diagnosis of 16 (25%) PE. Gender was equally represented, median age was 70 years (ID=3.49) and the majority (94%) survived. Thirteen (81%) patients with PE had a d-dimer value above 2500 ng/mL (OR=9.244, 95% CI 2.248-9.837), with 7 (54%) with values over 10000 ng/mL, but in 3 (9%) it was under 1500 ng/mL. Seventy-three (63%) of patients with a d-dimer over 1500 ng/mL did not had a thoracic CTA performed. In our population PE was not a frequent outcome. The results are influenced by the low number of thoracic CTA performed because, even tough the cut-off d-dimer value used at our hospital to perform a thoracic CTA to exclude PE is 1500 ng/mL, most patients with that d-dimer value did not take the exam and so PE could not be excluded. Although in most PE cases the d-dimer value was above 2500 ng/mL, the results of our study cannot verify if that is a better cut-off value.
ABSTRACT
BACKGROUND: Respiratory failure in severe coronavirus disease 2019 (COVID-19) is associated with a severe inflammatory response. Acetylcholine (ACh) reduces systemic inflammation in experimental bacterial and viral infections. Pyridostigmine increases the half-life of endogenous ACh, potentially reducing systemic inflammation. We aimed to determine if pyridostigmine decreases a composite outcome of invasive mechanical ventilation (IMV) and death in adult patients with severe COVID-19. METHODS: We performed a double-blinded, placebo-controlled, phase 2/3 randomized controlled trial of oral pyridostigmine (60 mg/day) or placebo as add-on therapy in adult patients admitted due to confirmed severe COVID-19 not requiring IMV at enrollment. The primary outcome was a composite of IMV or death by day 28. Secondary outcomes included reduction of inflammatory markers and circulating cytokines, and 90-day mortality. Adverse events (AEs) related to study treatment were documented and described. RESULTS: We recruited 188 participants (94 per group); 112 (59.6%) were men; the median (IQR) age was 52 (44-64) years. The study was terminated early due to a significant reduction in the primary outcome in the treatment arm and increased difficulty with recruitment. The primary outcome occurred in 22 (23.4%) participants in the placebo group vs. 11 (11.7%) in the pyridostigmine group (hazard ratio, 0.47, 95% confidence interval 0.24-0.9; P = 0.03). This effect was driven by a reduction in mortality (19 vs. 8 deaths, respectively). CONCLUSION: Our data indicate that adding pyridostigmine to standard care reduces mortality among patients hospitalized for severe COVID-19.
Subject(s)
COVID-19 Drug Treatment , Adult , Male , Humans , Middle Aged , Female , Pyridostigmine Bromide/therapeutic use , SARS-CoV-2 , Respiration, Artificial , Inflammation , Treatment OutcomeABSTRACT
Background: Cardiac sequelae after recovery from COVID-19 infection has not been well-established. Recent studies have used cardiac magnetic resonance (CMR) imaging to assess myocardial involvement or ongoing myocarditis in patients with prior COVID-19 infection. Objectives: The primary objective of this study was to identify the CMR imaging findings in adult COVID-19 recovered patients. Methods: This was a single-center retrospective observational cohort study of adult COVID-19 recovered patients who underwent cardiac magnetic resonance imaging. Patient demographics, CMR findings, blood marker results, and treatment received were obtained. Results: Of the 77 included patients, 42 (54.55%) were male, and the median age was 45 years. Only 6 patients had completely normal scans, making the prevalence of an abnormal CMR 92.21% (95% CI 83.5%–96.5%). All those with an abnormality demonstrated late gadolinium enhancement (LGE), and of these, 64 (90%) had preserved left ventricular ejection fraction (LVEF). Thirty-four patients (44%) had evidence of myocardial edema. Among patients with myocardial edema and LGE, the median numbers of involved segments were 4 (range 1–16) and 7 (range 1–15), respectively. Myocardial edema was most frequently found in the mid inferolateral segment (53%), followed by the basal inferior septum, basal anterior septum, and basal inferolateral segments (each with 41%). Meanwhile, late gadolinium enhancements were most commonly located in the basal inferior septum (75%), mid inferior septum (80%), and basal anterior septum (73%). Conclusion: Cardiac involvement, particularly edema and late gadolinium enhancement, affecting multiple myocardial segments were observed in a considerable number of patients recovered from COVID-19. Funding Acknowledgement: Type of funding sources: None.
ABSTRACT
COVID-19 is an emerging infectious disease that has specific characteristics that interfere with the care of patients with osteoporosis. This article discusses the interfaces between osteological issues and COVID-19. A prevalent fracture very modestly increases the risk of death from COVID-19 but in hospitalized patients, the prevalence of vertebral fracture can be considered another aspect of polymorbidity increasing the likelihood of an adverse course of infection. Vitamin D deficiency correlates with worse outcomes in COVID-19, and sufficient vitamin D saturation is very likely protective in relation to COVID-19. Containment measures at the peak of the pandemic may result in muscle loss and increased risk of falls in the elderly. Densitometry and majority of laboratory tests can be easily delayed in patients with osteoporosis. This also applies to parenteral administration of bisphosphonates, whereas continuation of oral bisphosphonate therapy can be ensured by electronic prescription. Teriparatide should not be discontinued for more than 2–3 months, and the interval between denosumab administrations should not exceed 7 months.
ABSTRACT
Background: Several international guidelines have highlighted the importance of ensuring the energy and protein intake of people with COVID- 19, but little is known about the nutritional risks for patients in critical conditions. There is still controversy if the modified Nutric score (mNUTRIC) is associated with higher mortality in patients with COVID-19 in the intensive care unit (ICU). Therefore, this study aims to investigate the applicability of the mNUTRIC score to assess nutritional risks and mortality in these critically ill patients with COVID-19 to improve prognosis and clinical results. Methods: This is a retrospective, observational study carried out in three ICU specially equipped for COVID-19 at the Hospital Clinica San Francisco, Guayaquil, Ecuador. Critically ill COVID-19 patients admitted in these ICUs between March and May 2020 were the study population. The exclusion criteria were those under 18 years of age or with a length of stay in the ICU of less than 24 hours. The nutritional risk of each patient was assessed upon admission to the ICU using the mNUTRIC score, and a score ≥of 5 indicates a high nutritional risk. Mortality was calculated according to the results of the patients after 30 days of ICU hospitalization. The results were presented by descriptive statistical analysis. Results: A total of 97 COVID-19 patients were admitted to the ICU with a median age of 64 years, 68 men (70%). Based on the mNutric score at ICU admission, a low nutritional risk (< 4 points) was observed in 65% of critically ill patients with COVID-19, while a high nutritional risk (≥5 points) was observed in 34%. The ICU mortality at 30 days was significantly higher in the high nutritional risk group than the survivors (40% vs. 15%) Also this group was associated with more days in mechanical ventilation (median 11 days) and more days in ICU w(mean 13 days). Furthermore, it was observed that the patients who survived the ICU had a much higher nutritional risk than those who did not survive (84% vs 59%). Conclusion: A large percentage of critically ill COVID-19 patients were at low nutritional risk, as evidenced by the mNUTRIC score. However, patients at high nutritional risk at ICU admission showed significantly higher ICU mortality at 30 days than those who survived. Therefore, the mNUTRIC score may be an appropriate tool for assessing nutritional risk and prognosis for critically ill COVID-19 patients.
ABSTRACT
This review study is important to elucidate the effects of the virus on the central nervous system, allowing greater knowledge about the effect of the virus and how some neurological disorders develop after contamination by Covid-19. Although much research is being done on the current pandemic, there is still much to be studied to ensure the health of the population. Some symptoms of this virus can be confused with other diseases, but their identification is made only by laboratory means. The present study can contribute to research and assist in the process of disseminating knowledge to identify possible pathologies associated with the disease. This work can be deepened, contributing with new research and knowledge about this topic.