ABSTRACT
Objective: The pandemic caused by SARS-CoV-2 virus continues to have a profound effect worldwide. However, COVID-19 induced oral facial manifestations have not been fully described. We conducted a prospective study to demonstrate feasibility of anti-SARS-CoV-2 IgG and inflammatory cytokine detection in saliva. Our primary objective was to determine whether COVID-19 PCR positive patients with xerostomia or loss of taste had altered serum or saliva cytokine levels compared to COVID-19 PCR positive patients without those oral symptoms. Our secondary objective was to determine the correlation between serum and saliva COVID-19 antibody levels. Materials and methods: For cytokine analysis, saliva and serum were obtained from 17 participants with PCR-confirmed COVID-19 infection at three sequential time points, yielding 48 saliva samples and 19 paired saliva-serum samples from 14 of the 17 patients. For COVID-19 antibody analyses, an additional 27 paired saliva-serum samples from 22 patients were purchased. Results: The saliva antibody assay had 88.64% sensitivity [95% Confidence Interval (CI) 75.44%, 96.21%] to detect SARS-CoV-2 IgG antibodies compared to serum antibody. Among the inflammatory cytokines assessed - IL-6, TNF-α, IFN-γ, IL-10, IL-12p70, IL-1ß, IL-8, IL-13, IL-2, IL-5, IL-7 and IL-17A, xerostomia correlated with lower levels of saliva IL-2 and TNF-α, and elevated levels of serum IL-12p70 and IL-10 (p < 0.05). Loss of taste was observed in patients with elevated serum IL-8 (p < 0.05). Conclusions: Further studies are needed to construct a robust saliva-based COVID-19 assay to assess antibody and inflammatory cytokine response, which has potential utility as a non-invasive monitoring modality during COVID-19 convalescence.
ABSTRACT
Objective: Studies have shown that gingival crevices may be a significant route for SARS-CoV-2 entry. However, the role of oral health in the acquisition and severity of COVID-19 is not known. Design: A retrospective analysis was performed using electronic health record data from a large urban academic medical center between 12/1/2019 and 8/24/2020. A total of 387 COVID-19 positive cases were identified and matched 1:1 by age, sex, and race to 387 controls without COVID-19 diagnoses. Demographics, number of missing teeth and alveolar crestal height were determined from radiographs and medical/dental charts. In a subgroup of 107 cases and controls, we also examined the rate of change in alveolar crestal height. A conditional logistic regression model was utilized to assess association between alveolar crestal height and missing teeth with COVID-19 status and with hospitalization status among COVID-19 cases. Results: Increased alveolar bone loss, OR = 4.302 (2.510 - 7.376), fewer missing teeth, OR = 0.897 (0.835-0.965) and lack of smoking history distinguished COVID-19 cases from controls. After adjusting for time between examinations, cases with COVID-19 had greater alveolar bone loss compared to controls (0.641 ± 0.613 mm vs 0.260 ± 0.631 mm, p < 0.01.) Among cases with COVID-19, increased number of missing teeth OR = 2.1871 (1.146- 4.174) was significantly associated with hospitalization. Conclusions: Alveolar bone loss and missing teeth are positively associated with the acquisition and severity of COVID-19 disease, respectively.
ABSTRACT
Background: SARS-CoV2 can infect enterocytes, and plasma cells and lymphocytes infiltrate the GI tract. In HIV, increased intestinal permeability and the ensuing microbial translocation are thought to contribute to systemic inflammation. We hypothesize that severe COVID-19 is associated with increased intestinal permeability, leading to microbial translocation and systemic inflammation. Methods: Serum/plasma samples were obtained from participants enrolled in a longitudinal COVID-19 study. Participants had Mild (outpatient), Moderate (inpatient but not requiring Intensive Care Unit (ICU) level care or mechanical ventilation), or Severe (inpatient requiring ICU level care and mechanical ventilation or ECMO) COVID-19. Intestinal fatty acid binding protein (iFABP), lipopolysaccharide binding protein (LBP), and soluble CD14 (sCD14) were measured by ELISA. Student's t-tests were used for between group comparisons, and paired t-tests were used for within group comparisons. Results: Participants with Moderate and Severe COVID-19 presentations were older compared to the Mild group (p<0.001) (Mild: 42.2 years (range: 20-63 years), Moderate: 64.2 years (range: 33-97 years);Severe: 61.9 years (range: 32-86 years)). The Severe group had a greater proportion of men (69% vs 36%) than women and a greater proportion of black/African Americans (27% vs 6%) than whites versus the Mild group. iFABP, LBP, and sCD14 levels were significantly higher in participants with Moderate or Severe disease compared to Mild disease (Table 1), with no significant differences between Moderate and Severe groups. Among the 65 participants with samples from two timepoints (mean separation of 24.3+/-22.4 days), sCD14, iFABP, and LBP did not change significantly. Conclusion: Levels of biomarkers of enterocyte turnover (iFABP), microbial translocation (LBP), and lipopolysaccharide-induced monocyte activation (sCD14) were increased in patients with Moderate and Severe COVID-19 compared to Mild COVID-19. Whether interventions that improve gut health will attenuate the cytokine storm that precipitates Severe COVID-19 needs further study.
ABSTRACT
Purpose: COVID-19 has impacted many facets of medical care. Elective surgical procedures were put on hold to prevent the spread of the virus, reduce exposure risk of staff, and potentially repurpose ORs for critical care areas. Interventional radiology (IR) suites were largely kept open for all procedures (emergent or elective) with changes focused on workflow, PPE, and room sanitation between procedures. Previous single-hospital study showed a large reduction in IR procedure volume over a span of 4-weeks. Here, we explore the effect of COVID-19 on procedure volume in a multi-hospital analysis over the course of months. Materials and Methods: Case load in 3 URMC-affiliated hospitals during a 4-months period before and after the COVID-19 pandemic were analyzed. Procedure types and context (inpatient, outpatient, or emergency) were recorded for all procedures. CT-guided procedures, angiograms, and venograms were grouped together. Procedure volume was calculated as a percentage of all procedures, and differences per month were compared between pre-COVID and COVID months using two-tailed t-test with significance set at P< 0.05. Results: A total of 7159 procedures were performed over the eight-month period (November 2019–June 2020). There was a significant reduction in procedures per month after the onset of the COVID pandemic from 1005 to 838 (P = 0.023). When analyzing volume of individual procedures, there was a significant reduction in volume of common procedures, such as Mediport discontinuations (P = 0.035) and ultrasound-guided percutaneous biopsies (P = 0.027). There was an increase in volume of procedures shared with other specialties, such as angiograms (P = 0.045) and paracenteses (P = 0.005). More complex procedures, such as TIPS or tumor ablations did not reflect a significant change in volume. There was a significant decrease in volume of emergency room procedures (P = 0.011) and a significant increase in volume of inpatient procedures (P = 0.016);changes in outpatient procedures were not significant. Conclusions: Across 3 hospitals in the URMC network, there was an overall reduction in monthly procedure volume after the onset of the COVID-19 pandemic. As expected, common elective procedures experienced a decrease in volume during the COVID-19 months. However, IR continues to demonstrate its value during the COVID-19 pandemic as a minimally invasive specialty, seeing an overall increases in inpatient volume and procedures commonly shared with other specialties.