A Study to Assess the Level of Anxiety among COVID-19 Recovered Patient in Community Area

A new strain of the coronavirus, SARS-CoV-2, was identified as the cause by the Chinese authorities and the World Health Organization (WHO). At the time, it was referred to as a coronavirus disease 2019 and is now commonly referred to as COVID-19. Gamil Ghaleb Alrubaiee and associates 2020) coronaviruses are a family of enveloped RNA viruses that get their name from the outer edge of their envelope proteins that look like crowns ('corona' in Latin). The purpose of this study was to determine how anxious COVID-19 recovered patients in a specific community area were. A quantitative strategy with a descriptive study design for the research. Purposive sampling is used to collect 50 samples from COVID-19 recovered patients for this study. The average anxiety score among COVID-19 recovered patients was 26.76, with a standard deviation of 5.76 and a minimum anxiety score of 13.0 and a maximum anxiety score of 40.0. In patients who had recovered from COVID-19, the analysis showed that none of the demographic variables had a statistically significant relationship with the level of anxiety. ASEAN Journal of Psychiatry, Vol. 24 (1) January, 2023;1-8.

A Repeated-Measures Study of Relational Turbulence and Transition Processing Communication During the Summer of COVID-19 (Summer 2020)

Drawing upon relational turbulence theory and the experiencing life transitions model, this study examined communication and relationship qualities as married couples experienced work-family changes during the COVID-19 pandemic. Sixty-four American married, different-sex partners affected by job-related changes due to COVID-19 reported their relationship qualities and their own and their spouse's engagement in transition processing communication weekly for 10 weeks. Hypotheses addressed associations between relationship qualities and communication experiences both averaged across the 10 weeks and indexed by within-week deviations from those averages, controlling for the previous week's reports. Husbands' and wives' own attempts—and also their perceptions of their spouse's attempts—to increase interaction, promote connection, promote feeling situated, and increase confidence were associated with decreased relationship uncertainty and improved interdependence. Husbands' self-reported relationship qualities demonstrated the strongest associations with averaged reports of relationship-focused communication, whereas wives' relational qualities were more strongly associated with week-to-week fluctuations in relationship-focused communication. © The Author(s) 2023.

COVID VACCINE ASSOCIATED GLOMERULAR DISEASES- A CASE SERIES

Introduction: Vaccination is a known trigger for the development of de-novo or flare of glomerular diseases. Here we present a case series of fourteen patients with COVID vaccine- associated glomerular diseases (CVAGD). Methods: Patients with new onset proteinuria, hematuria or renal failure after SARS- CoV2 vaccine were included in the study. Demographic and clinical details were collected and laboratory investigations including serum creatinine, albumin, urine microscopy and urine spot protein creatinine ratio were done. Renal biopsy specimens were subjected to light microscopy and immunofluorescence examination. Results: We cared for 14 patients with CVAGD. Of them, eight patients were males. The mean age was 25.7 years. Three patients had relapse of their previous disease while eleven patients had no previously detected renal diseases. Eleven patients had received COVISHIELD and three had received COVAXIN. All patients presented after the first vaccine dose. At presentation, seven patients had nephrotic syndrome, two patients had rapidly progressive renal failure and five patients had nephritic syndrome. The mean duration of symptom onset after vaccination was 18 days. Renal biopsy revealed IgA nephropathy in 3 patients, endocapillary proliferative glomerulonephritis in 2 patients, minimal change disease in 5 patients, pauci- immune glomerulonephritis (ANCA associated vasculitis) in one patient, lupus nephritis ISN/RPS class 3 in one and focal segmental glomerulosclerosis in two patients. There was no history of COVID infection in any of our patients. Three patients had renal failure at presentation but none required renal replacement therapy. The patients with MCD and FSGS were treated with steroids, patients with ANCA vasculitis and lupus nephritis were managed with the appropriate Cyclophosphamide and steroid regimens while the others were managed conservatively with anti-proteinuric medications. On follow up, five patients (One IgAN, three MCD, one endocapillary proliferative GN) achieved complete remission of proteinuria and resolution of renal failure, while the remaining eight patients achieved partial remission. One patient with MCD had a relapse of proteinuria 3 weeks after achieving partial remission, he responded well to steroid therapy. All 14 patients remain on close follow up. Conclusions: Although causality cannot be definitively established, there is a definite temporal association between the presentation of glomerular diseases and COVID vaccination, in the absence of other inciting factors. Hence, new-onset or relapse of glomerular diseases presenting post vaccination, although rare, should be observed as a possible adverse event. Intriguing questions such as how to proceed with the vaccination schedule in patients with CVAGD and would changing the vaccine type reduce the risk of relapse remain unanswered. No conflict of interest

RHEUMATOID ARTHRITIS DISEASE ACTIVITY ASSESSED by PATIENT-REPORTED OUTCOMES and FLOW CYTOMETRY before and after AN ADDITIONAL DOSE of COVID-19 VACCINE

Background: The Centers for Disease Control and Prevention recommends an additional dose (AddDose) of COVID-19 vaccine for moderately/severely immunosuppressed individuals following an initial vaccine series. The American College of Rheumatology suggests that patients interrupt use (hold) certain DMARDs around the time of COVID-19 vaccination to improve immunogenicity. Whether holding DMARDs around an AddDose of COVID-19 vaccine affects RA disease activity or affects frequencies of lymphocyte populations that may be associated with RA disease activity remains unknown. Objectives: To test whether RA disease activity and frequencies of lymphocyte populations change pre-vs. post-AddDose of COVID-19 vaccine, overall and stratifed by holding vs. continuation of DMARDs around the AddDose. Methods: Prospective observational cohort study of patients with RA who had completed an initial COVID-19 vaccine series (2 doses of mRNA vaccine or 1 dose of adenovirus vector vaccine). Subjects enrolled July-November 2021, prior to receiving an AddDose. Subjects held or continued DMARDs around the AddDose based on discussion with their rheumatologist and/or personal decision-making. RA disease activity was assessed weekly using the validated patient-reported RA Disease Activity Index-5 (RADAI-5) from enrollment through 4 weeks post-AddDose. We compared mean RADAI-5 pre-vs. post-AddDose using generalized estimating equations to account for correlated data among individual subjects. We aimed to enroll 60 subjects to achieve 91% power to detect a 15% non-inferiority margin in mean RADAI-5 post-vs. pre-AddDose. A subset of subjects with seropositive RA provided blood for fow cytometry at enrollment and week 4 post-AddDose. Frequencies of lymphocyte populations (T peripheral helper [Tph] cells, T follicular helper [Tfh] cells, age-associated B cells [ABC], and plasmablasts) were compared pre-vs. post-AddDose using Wilcoxon paired tests with Bonferroni correction. Results: Among 71 subjects, mean age was 62 (SD 12) years, 85% were female, and 87% had seropositive RA. Methotrexate (42%) and TNF inhibitors (38%) were the most common DMARDs;21% were taking prednisone. One subject reported COVID-19 infection prior to the AddDose. The mean RADAI-5 was 3.20 (SD 0.23) pre-AddDose compared to 3.25 (SD 0.23) after (difference of 1.6%, p=0.51). Figure 1 displays mean RADAI-5 in 35 (49%) subjects that held at least 1 DMARD and 36 (51%) subjects that continued all DMARDs around the AddDose. Mean change in RADAI-5 between pre-vs. post-AddDose did not signifcantly differ based on whether subjects held vs. continued DMARDs (p for interaction = 0.16). Frequencies of Tph, Tfh, ABC, and plasmablast populations did not signifcantly differ between the pre-and post-AddDose timepoints in subjects that held at least 1 DMARD (n=16) or subjects that continued all DMARD (n=11) (Figure 1). Conclusion: RA disease activity, measured weekly with a validated patient-reported outcome, is stable around the time of an AddDose of COVID-19 vaccine. Lymphocyte subsets of interest in RA were also similar before and after the AddDose, supporting the observation of stable patient-reported RA disease activity. Holding DMARDs was not associated with greater RA disease activity following the AddDose.

The Effects of the COVID-19 Pandemic on Penetrating Neurotrauma at a Level 1 Trauma Center

INTRODUCTION: The COVID-19 pandemic forced the implementation of social distancing guidelines to minimize spread of the coronavirus. However, it is not yet understood what effects these precautions had on the rates of penetrating neurotrauma. METHODS: We retrospectively analyzed neurotrauma data from our institutional trauma registry from distinct periods defined as pre-COVID-19 (March 2019-September 2019) and COVID-19 (March 2020-September 2020). Demographics, injury characteristics, mechanisms of trauma, and past medical history (including psychiatric diagnosis) were collected. Data were analyzed for between-group differences and presented as odds ratios. RESULTS: We observed a significant rise in the number of neurotrauma cases in 2020 (558 vs. 630, OR 1.129 [1.0071, 1.2657]). There was a decrease in the proportion of male victims (71.3% vs. 68.6%, p = 0.03). There were significant differences noted in the mechanism of injury between groups. Patients in 2020 were less likely to present with falls (42.3% vs. 34.3%, OR 0.7119 [0.5627, 0.9005]) and more likely to present with GSW (4.48% vs. 7.78%, OR 1.7981 [1.0951, 2.9523]). Of the patients with penetrating cranial injuries, the most common motive was assault (56.7% vs. 60.0%), followed by self-inflicted (13.3% vs. 20.0%) and accidental (20.0% vs. 18.3%) with a significant difference between years (p = 0.0043). The presence of comorbid psychiatric illness or substance abuse did not confer an increased odds of presenting with penetrating injuries. No significant differences were noted in mean arrival or discharge GCS or injury severity as measured by ISS. However we did observe significant increases in patients presenting with bilaterally reactive pupils (48.3% vs 59.3%, p = 0.0025), patients discharged home (27.6% vs 37.3%, p = 0.0002), and survival at 6 months (41.4% vs. 54.2%, p = 0.0188). CONCLUSION: We observed a higher rate of penetrating neurotrauma while social distancing measures were in place. It is unclear if the psychosocial effects of quarantine and social distancing had a causative relationship with the increased rates of assault and self-inflicted penetrating injuries.

POS-801 COVID ASSOCIATED MUCORMYCOSIS IN KIDNEY TRANSPLANT RECIPIENTS- A CASE SERIES

Introduction: Mucormycosis is a life-threatening angio-invasive infection caused by fungi of the order Mucorales. In India, the second wave of the COVID pandemic, primarily driven by the delta variant, led to a surge in cases of mucormycosis. The majority of these cases occurred following recovery from COVID, and resulted in increased morbidity and mortality. Here we present a series of five kidney transplant recipients (KTR’s) who presented with COVID-related mucormycosis. Methods: This is a single-centre, prospective, observational study that included all KTRs who presented to Madras Medical College with COVID-related mucormycosis between May 2021 and August 2021. Relevant clinical details and laboratory data were collected, therapeutic interventions were recorded, and outcomes of hospitalization were noted. Results: Five patients developed COVID-related mucormycosis during the study period. Their clinical details and hospital course are summarized in Table 1. Only one patient had received COVID vaccination (2 doses of covishield). All patients had underlying post-transplant diabetes mellitus, with severe hyperglycemia at admission. They all received intravenous dexamethasone for COVID pneumonia. Mucormycosis developed 10-21 days after recovery from COVID in four patients;one patient developed both infections concurrently. All patients received liposomal Amphotericin B, with four patients also undergoing functional endoscopic sinus surgery (FESS). Acute graft dysfunction occurred in all five patients;three had complete renal recovery, one had partial renal recovery, and one patient died during hospitalisation. [Formula presented] Conclusions: All five KTR’s in our series who developed COVID-related mucormycosis had acute graft dysfunction. They all had multiple risk factors that included elements of hyperglycemia, sepsis and nephrotoxic drugs (amphotericin B). Four of our five patients recovered, with only one case succumbing to the infection No conflict of interest

Clinical characteristics and outcome of novel coronavirus disease in kidney transplant recipients: A single-center prospective observational study

Background: Organ transplant recipients are at increased risk of infections which may result in acute graft dysfunction and death. Coronavirus disease (COVID-19) is the ongoing global infectious challenge and little is known about the impact of this novel virus in kidney transplant recipients. We here describe the clinical presentations, laboratory profile, and outcomes of 42 such patients, from a large tertiary care center in south India. Materials and Methods: This prospective, observational study included all renal transplant recipients with confirmed COVID-19 by reverse transcription polymerase chain reaction from the start of the outbreak till August, 2020. Clinical features at presentation, laboratory and radiological data, and outcomes were analyzed. Results: Forty-two patients were included in the analysis. As many as, 86.7% patients of our cohort had symptoms at presentation, with the most common symptoms being fever (52.5%), breathlessness (50%), and cough (40.5%). Significant need for respiratory support was noted in individuals with longer duration posttransplant (P < 0.03). Acute worsening of allograft function was observed in 22 (52.4%) patients. Fourteen (65%) of them had acute on chronic graft dysfunction and acute graft dysfunction was noted in 8 (35%) patients. Six patients (14.5%) died due to the disease and none of the parameters were found to be an independent predictor of mortality in regression analytic models including acute graft dysfunction (P = 0.49) or acute on chronic graft dysfunction (P = 0.07). There was no correlation between disease severity and baseline immunosuppressive agents whether tacrolimus or cyclosporine (P = 0.57) and mycophenolate mofetil or azathioprine (P = 0.91). Conclusions: Our largest cohort of patients from India showed higher incidence of acute graft dysfunction and significant mortality in patients with COVID-19.