ABSTRACT
Background: The coronavirus disease (SARS-COV-2) is an infectious disease caused by a coronavirus (Covid-19), which was first detected in clusters of pneumonia-like diseases in Wuhan City of china on December 31st, 2019. WHO already declared a global pandemic in April 2020 when this infection spread to more than 230 countries. Overall, 20-30 % of cases in the United States have required hospitalisation, resulting in a substantial burden on health care workers and the U.SHealth care system and other world economies including developed and developing countries like India. The Indian national expert group on vaccine administration for covid-19 (NEGVAC) will guide all aspects of covid-19 vaccine planning in India. In response to alleviate the severity of Covid-19 infection spread, our scientists have developed one vaccine with AstraZeneca collaboration, as Covishield and another Covaxin from serum institute. The aim is a prospective study on the effectiveness of the Covid-19 vaccine among health care providers. Aim(s): The study aims to describe the role of the vaccine in health care providers exposed to sars-cov-2 infection during the post-vaccination period of 6 months duration. The objective is to Primary To evaluate the efficacy of the Covid-19 vaccine among health care providers. Secondary - evaluation of the effectiveness of Covid-19 vaccine among different age groups of health care providers, detected Covid-19 positive by RT-PCR Test before vaccination. Evaluation of the effectiveness of covid-19 vaccine among a subgroup of Health care providers in which RT-PCR tests were found negative before vaccination. Material(s) and Method(s): This project was completed after covid-19 vaccines among exposed health care providers with and without prior history of covid-19 infection and followed up for a post-vaccination period of 6 months to assess the incidences of Covid-19 cases. The covid-19 vaccine intelligence network(CO-WIN) systems digital platform will be utilised to track the enlisted health care and frontline workers for vaccination and administration of vaccine on a real time basis. Result(s): The total number of RT-PCR confirmed cases among participants was 126(11%) out of 1140;which comprises of;in fully vaccinated, partially vaccinated and non-vaccinated participitants were 39(5.5%), 77(19.25%) and 10(26.31%) respectively. Conclusion(s): The covishield vaccine provides significant protection against the covid-19 infection, hence rapid vaccination along with other social measures likes hand sanitization, use of mask and social distancing are the most important weapons of humanity to fight this horrible disease named covid-19 Infection. Copyright © Necati Ozpinar. All rights reserved.
ABSTRACT
Introduction: The most common COVID-19 associated glomerular diseases are COVID associated nephropathy (COVAN) and Thrombotic Microangiopathy (TMA). Other less common glomerular diseases associated with COVID reported are antineutrophil cytoplasmic antibody (ANCA) vasculitis, anti-glomerular basement membrane (Anti GBM) antibody disease, podocytopathies, and IgA nephropathy. We report a case of TMA due to COVID-19 infection. Case Description: A 67-year-old woman with asthma was admitted for COVID related respiratory failure and was noted to have acute kidney injury with anemia and thrombocytopenia. She was hypertensive and urine analysis was notable for hematuria and proteinuria. ANA, ANCA, Anti GBM, Coombs, ADAMTS13, disseminated intravascular coagulation panel, serum immune fixation and free light chains, cryoglobulins, and infectious work up were unrevealing. Complement C3 and C4 were low, lactate dehydrogenase and bilirubin were high, haptoglobin was undetectable, and schistocytes were seen on peripheral smear which raised concern for thrombotic microangiopathy. Renal function deteriorated rapidly with ensuing anuria prompting initiation of dialysis. Kidney biopsy confirmed acute thrombotic microangiopathy. She was started on plasma exchange (PLEX) for COVID related thrombotic microangiopathy and she started producing urine with rapid improvement in creatinine (Cr) after two treatments. Cr was down to 3.11mg/dL from a peak of 7.45 mg/dL after PLEX and normalized at discharge. The patient is currently being monitored with renal panel and complete blood picture every three months, as an outpatient. Discussion: COVID is known to cause TMA that is presumed to be secondary to endothelial dysfunction and complement activation. There are no standard guidelines for treatment. Terminal complement blockade was not used in our patient. Our case demonstrates the efficacy of PLEX in the treatment of COVID related TMA. Early recognition and treatment is crucial and may reduce morbidity and mortality.
ABSTRACT
Introduction: Collapsing glomerulopathy (cFSGS) is most commonly seen in association with Human Immunodeficiency Virus infection (HIVAN) and can also occur in association with viral and non viral infections, autoimmune diseases, malignancy and drug exposure. Patients typically present with rapidly worsening renal function and nephrotic syndrome. We report a case of cFSGS due to Hemophagocytic lymphohistiocytosis (HLH) Case Description: A 41-year-old man with acute myeloid leukemia and allogenic hematopoetic stem cell transplant with graft versus host disease on Ruxolitinib, was admitted for hypervolemia, respiratory failure, rapidly rising creatinine and nephrotic range proteinuria. He was noted to have anemia, thrombocytopenia, high LDH, low haptoglobin and abnormal liver function tests. He underwent renal biopsy that showed collapse of capillary loops and podocyte hyperplasia on light microscopy with marked foot process effacement on electron microscopy. Extensive work up was pursued to identify the etiology of cFSGS. Infectious work up including HIV, hepatitis B and C, parvo virus B19, BK virus, CMV, EBV, HSV, Human herpes virus 6, SARS-COV-2, Mycobacteria, fungal, and parasitic organisms was negative. He had marked elevation of ferritin at 35,000ng/ml and triglycerides at 1,529 mg/dL in the setting of severe pancytopenia and fever raising concern for HLH. He underwent bone marrow biopsy that showed hemophagocytosis of nucleated cells supporting diagnosis of HLH. Soluble interleukin 2 receptor levels (sCD25) were normal consistent with the use of Ruxolitinib. Despite receiving Anakinra, Rituximab, and Dexamathasone for HLH he deteriorated clinically and was transitioned to comfort care Discussion: cFSGS has been associated lupus, IgA nephropathy, diabetic nephropathy, thrombotic microangiopathy/acute glomerular ischemia, bisphosphonate therapy, HLH, and infections like HIV, Parvo virus B19, pulmonary tuberculosis, CMV and more recently SARS-COV-2. Treatment of cFSGS is directed towards the underlying cause. cFSGS complicating HLH is rare. Excessive immune activation with release of pro inflammatory cytokines targeting the podocytes is hypothesized to cause cFSGS in HLH. Renal prognosis appears to be poor despite therapy and most patients remain dialysis dependent. HLH has been reported post stem cell transplant and should be considered in the differential diagnosis of cFSGS.