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2.
Circulation ; 144(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1635306

ABSTRACT

Introduction: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 can cause cardiovascular dysfunction. We aimed to determine if strain abnormalities persist in MISC patients 3-10 weeks post-discharge, and whether acute markers of clinical severity are associated with lower strain at subacute follow-up. Methods: We performed a retrospective cohort study of MIS-C patients admitted at a single center from 3/2020-3/2021. Demographic and clinical variables during hospitalization were obtained. Global longitudinal strain (GLS), 4-chamber longitudinal strain (4C-LS), mid-papillary circumferential strain (CS), and left atrial strain (LAS) at 3-10 week follow-up were compared to age matched controls (n=10). Bivariate analyses were performed using Spearman rank correlation and twosample t-test or Wilcoxon rank sum test. Results: Sixty MIS-C patients were identified (age 8.9 +/-4 years, 35/60 male, 39% Hispanic, 29% African American). Hypotension (65%), ICU admission (57%), and inotropic support (45%) were common;7% received mechanical ventilation. No deaths or need for ECMO were reported. Median length of stay (LOS) was 7 days. LVEF was <55% in 28% during hospitalization (median 57% [52-61]) and 6% at follow-up (median 65% [61-67]). Peak NT-proBNP (median 5321 pg/ml [IQR 1712, 17400]) and peak CRP (median 17 mg/dl [12, 22]) were significantly associated with hypotension, ICU admission, and total ICU days. Forty-five patients had available follow-up imaging for strain. CS (mean-26.0 vs-28.6;p=0.009) and LAS (mean-34.5 vs-51.2;p=0.001) were lower in MIS-C vs controls, but not GLS or 4C-LS. Lower CS (-24.2 +/-3.1 vs-26.7 +/-2.7;p=0.04) and lower 4C-LS (-19.1 +/-1.9 vs-21.2 +/-3.3;p=0.04) were associated with abnormal EF (<55%) during acute illness. CS was lower in those admitted to ICU (-25.1 +/-2.6 vs-27.5 +/-2.9;p=0.03). Peak CRP correlated with lower CS (r=-0.41, p=0.03) and GLS (r=-0.55, p=0.01) at follow-up. Conclusions: MIS-C patients show abnormal strain during subacute follow-up despite improvement in EF. Lower CS, GLS, and 4C-LS were associated with in-hospital markers of clinical severity. This data may allow for identification of at-risk MIS-C patients and help guide outpatient cardiology follow-up.

3.
O'Toole, A.; Hill, V.; Pybus, O. G.; Watts, A.; Bogoch, II, Khan, K.; Messina, J. P.; consortium, Covid- Genomics UK, Network for Genomic Surveillance in South, Africa, Brazil, U. K. Cadde Genomic Network, Tegally, H.; Lessells, R. R.; Giandhari, J.; Pillay, S.; Tumedi, K. A.; Nyepetsi, G.; Kebabonye, M.; Matsheka, M.; Mine, M.; Tokajian, S.; Hassan, H.; Salloum, T.; Merhi, G.; Koweyes, J.; Geoghegan, J. L.; de Ligt, J.; Ren, X.; Storey, M.; Freed, N. E.; Pattabiraman, C.; Prasad, P.; Desai, A. S.; Vasanthapuram, R.; Schulz, T. F.; Steinbruck, L.; Stadler, T.; Swiss Viollier Sequencing, Consortium, Parisi, A.; Bianco, A.; Garcia de Viedma, D.; Buenestado-Serrano, S.; Borges, V.; Isidro, J.; Duarte, S.; Gomes, J. P.; Zuckerman, N. S.; Mandelboim, M.; Mor, O.; Seemann, T.; Arnott, A.; Draper, J.; Gall, M.; Rawlinson, W.; Deveson, I.; Schlebusch, S.; McMahon, J.; Leong, L.; Lim, C. K.; Chironna, M.; Loconsole, D.; Bal, A.; Josset, L.; Holmes, E.; St George, K.; Lasek-Nesselquist, E.; Sikkema, R. S.; Oude Munnink, B.; Koopmans, M.; Brytting, M.; Sudha Rani, V.; Pavani, S.; Smura, T.; Heim, A.; Kurkela, S.; Umair, M.; Salman, M.; Bartolini, B.; Rueca, M.; Drosten, C.; Wolff, T.; Silander, O.; Eggink, D.; Reusken, C.; Vennema, H.; Park, A.; Carrington, C.; Sahadeo, N.; Carr, M.; Gonzalez, G.; Diego, Search Alliance San, National Virus Reference, Laboratory, Seq, Covid Spain, Danish Covid-19 Genome, Consortium, Communicable Diseases Genomic, Network, Dutch National, Sars-CoV-surveillance program, Division of Emerging Infectious, Diseases, de Oliveira, T.; Faria, N.; Rambaut, A.; Kraemer, M. U. G..
Wellcome Open Research ; 6:121, 2021.
Article in English | MEDLINE | ID: covidwho-1450989

ABSTRACT

Late in 2020, two genetically-distinct clusters of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with mutations of biological concern were reported, one in the United Kingdom and one in South Africa. Using a combination of data from routine surveillance, genomic sequencing and international travel we track the international dispersal of lineages B.1.1.7 and B.1.351 (variant 501Y-V2). We account for potential biases in genomic surveillance efforts by including passenger volumes from location of where the lineage was first reported, London and South Africa respectively. Using the software tool grinch (global report investigating novel coronavirus haplotypes), we track the international spread of lineages of concern with automated daily reports, Further, we have built a custom tracking website (cov-lineages.org/global_report.html) which hosts this daily report and will continue to include novel SARS-CoV-2 lineages of concern as they are detected.

4.
Irish Medical Journal ; 114(5), 2021.
Article in English | EMBASE | ID: covidwho-1326537

ABSTRACT

Presentation A 40-year-old healthcare worker (HCW) presented with cough, headache, sore throat, fatigue and myalgia seven months after primary infection with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Symptoms were milder and recovery was faster on the second episode. Diagnosis Reinfection with phylogenetically distinct SARS-CoV-2 was confirmed by whole-genome sequencing (WGS). Treatment Management involved symptomatic treatment and self-isolation. Discussion The incidence of SARS-CoV-2 reinfection is not well characterised. Infection control precautions may still be required in healthcare facilities, even in previously infected and possibly in vaccinated individuals while SARS-CoV-2 remains in circulation. Further research on the nature and duration of immunity is required to inform public health and infection control policy.

5.
Journal of the American Geriatrics Society ; 69(SUPPL 1):S16, 2021.
Article in English | EMBASE | ID: covidwho-1214814

ABSTRACT

Background: Terminal delirium (TD) occurs in up to 88% of patients at the end of life. Hyperactive TD requires an individualized management approach, which may include using a long-acting benzodiazepine. This medication can aggravate delirium;however, in the appropriate patient, with close interprofessional collaboration and if congruent with goals of care, it may provide net benefit. Case: An 85-year-old lady with dementia, macular degeneration, and failed spinal stenosis surgery requiring wheelchair use, presented from an assisted living facility with agitation and elopement attempt. She had multiple delirium episodes in the past year precipitated by separation from her husband and social isolation due to COVID-19. Infectious workup was negative. CT brain showed volume loss and severe chronic microangiopathic changes. During her hospitalization, she was screaming, restless, impulsive, combative, anxious, paranoid regarding her husband having extramarital affairs, and required restraints. Her behaviors made care provision very challenging. Trazodone and olanzapine were started and titrated, and home pregabalin and sertraline were continued. She still received frequent IM/IV antipsychotics as PO medications were not administered on a consistent schedule due to fluctuating emotional distress. Her family was routinely updated, and ultimately decided on a comfort care approach. Due to persistent agitation despite maximal doses of olanzapine, scheduled twice daily clonazepam was trialed given its long acting properties, in addition to morphine. There was finally a marked reduction in her emotional distress. She eventually passed peacefully. Discussion: Given the scarcity of evidence to guide the optimal management of TD, its treatment should be tailored to each patient. Beers Criteria recommends against benzodiazepines because of potential worsened delirium. However, if comfort is the treatment goal, TD patients with severe agitation refractory to behavioral approaches and multiple classes of medications including antipsychotics may be trialed on long acting benzodiazepines to achieve proportionate sedation and alleviate suffering. Our patient's distress was not ameliorated by multiple treatments over weeks, but she became comfortable after we scheduled clonazepam. Conclusion: Deviation from conventional geriatric treatment paradigms, including using long-acting benzodiazepines, might be required to treat hyperactive TD in a patient-centered manner.

6.
IEEE Internet Computing ; 24(5):45-53, 2020.
Article in English | Scopus | ID: covidwho-939655

ABSTRACT

The COVID19 Pandemic has highlighted our dependence on online services (from government, e-commerce/retail, and entertainment), often hosted over external cloud computing infrastructure. The users of these services interact with a web interface rather than the larger distributed service provisioning chain that can involve an interlinked group of providers. The data and identity of users are often provided to service provider who may share it (or have automatic sharing agreement) with backend services (such as advertising and analytics). We propose the development of compliance-aware cloud application engineering, which is able to improve transparency of personal data use-particularly with reference to the European GDPR regulation. Key compliance operations and the perceived implementation challenges for the realization of these operations in current cloud infrastructure are outlined. © 1997-2012 IEEE.

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