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1.
Australian Critical Care ; JOUR:S8-S8, 35.
Article in English | Web of Science | ID: covidwho-2101875
2.
West Indian Medical Journal ; JOUR:38, 70(Supplement 1).
Article in English | EMBASE | ID: covidwho-2083603

ABSTRACT

Objective: To identify factors associated with the need for supportive hospitalised care among children admitted for COVID-19. Design and Methods: A multicentre retrospective descriptive cohort of children <17 years , hospitalized with COVID- 19 in nine hospitals in Barbados, The Bahamas, and Jamaica from September 2020 to July 2021. The need for supportive therapy was explored by age, and among children with and without a range of comorbidities. Result(s): Among 238 hospitalized children, 56% were < 5 years of age. Comorbidities were present in 107 (45%), with proportionately more comorbidities among older children (> 5 years of age, p < 0.001). Comorbidities included asthma 21(9%), sickle cell disease 20 (8%), neurological 12 (5%) or cardiac 11 (5%) diseases, and diabetes 11 (5%). Multisystem Inflammatory Syndrome (MISC) was present among 32 (13%) children, and of these the largest proportion 12 (29%) were between 5 and 9 years of age (p = 0.04). All diabetic children had diabetic ketoacidosis (DKA), and 83% of neurology cases had seizures. Oxygen use was common among children with asthma (50%), obesity (75%) and MIS-C (40%). Blood products were required among children with MISC (40%), or with malignancy (50%). Almost three-quarters of children with MISC had additional complications, including liver dysfunction, acute kidney injury, and anaemia, and these children regularly required inotropes (22%), non-invasive ventilatory support (12%), or ICU admission (34%). Conclusion(s): Children with asthma, obesity, malignancy, diabetes and neurological disease require additional support with more ICU support needed in MISC cases. Care of vulnerable groups and early recognition and intervention for severe MISC should be prioritized.

3.
West Indian Medical Journal ; JOUR:21, 70(Supplement 1).
Article in English | EMBASE | ID: covidwho-2083602

ABSTRACT

Objective: The objectives are to determine the incidence of malnutrition and anemia and evaluate the association of nutritional status and COVID-19-related clinical outcomes in children hospitalized for COVID-19. Method(s): This multi-island inpatient survey presents data from nine hospitals in three Caribbean islands in children from birth to 17 years from September 2020 to July 2021. We explore statistical associations with inpatient characteristics and potential differences between malnourished and well-nourished children. Result(s): Among children hospitalized for COVID-19, 6.8% were stunted, 6.6% were underweight, 13.6% were overweight/ obese, and 30% had anemia. Anemia was associated with multi-system inflammatory syndrome (MIS-C) in children but not with malnutrition. The prevalence of underweight children exceeded the 4.4% prevalence in the general pediatric population in islands and there was a greater-than-expected prevalence of overweight children hospitalized with COVID-19. No clear associations were detected between malnutrition and indicator outcomes. There were two deaths in children with severe malnutrition, COVID and septicemia identified after the study window. Conclusion(s): Hospitalizations exceeded baseline population rates of undernutrition but no significant associations were detected possibly due to small numbers. T cell activity is associated with less disease severity in SARS-CoV-2 infection and the diverse repertoire of naive T lymphocytes in children may confer protection to undernourished children. The deaths in two children with severe malnutrition and sepsis may suggest a compound effect on immunity by nutrition severity and COVID-19 disease. Overweight children in this cohort may reflect an increased prevalence of overweight children in the general population that requires further evaluation and intervention.

4.
West Indian Medical Journal ; JOUR:20-21, 70(Supplement 1).
Article in English | EMBASE | ID: covidwho-2083601

ABSTRACT

Objective: There are few published reports concerning the impact of the COVID-19 pandemic on children in the Caribbean. The specific impacts of COVID-19 on Caribbean children aged 0-19 are examined. Method(s): Using standardized online questionnaire , primary data and published reports the burden of COVID-19 among children is evaluated. Result(s): Most islands have pediatric specialists, but few have designated pediatric hospitals. The higher number of cases among children is notable in islands with large populations such as Cuba, Jamaica, Trinidad, the Dominican Republic, and Haiti. The proportion of children among all cases in these islands range from 0.6%- 16.9% compared with a global case rate of 20.2%. As of August 2021, there were 33 cumulative deaths among children in Haiti, Jamaica, in Trinidad and Barbados. The case fatality rates (CFR) for 0-9-year-old and 10-19-year-old were 2.8 and 0.7 for Haiti, 0.1 and 0.2 for Jamaica, and 0 and 0.14 for Trinidad compared with and globally. Higher CFRs in Haiti may be related to the testing strategy, which may not identify all cases. However, low socioeconomic status and a poor healthcare system may have had an impact. Conclusion(s): Overall COVID-19 prevalence and mortality in children were consistent with global estimates. A standardized regional assessment and the multidimensional impact of the COVID-19 pandemic among children warrants further examination in light of limited resources and the potential lifelong impact of secondary effects.

5.
Motricidade ; 18(2), 2022.
Article in Portuguese | Scopus | ID: covidwho-1988397

ABSTRACT

The objective of the study was to create an assistance protocol for the public, specific for Physical Education (PE) professionals, in the context of COVID-19. The present study had a qualitative approach, delineated by documental and bibliographic analysis of the documents available on the websites of the Health Professional Councils. Thus, a protocol was elaborated consisting of two types of professional activity, of a general domain, which reinforces actions already presented by other studies, and of a specific domain, which presents new guidelines for PE professionals. Furthermore, this protocol classified the work of these professionals into three situations, namely: constant physical contact, transitory physical contact, and improbable physical contact. Up to the present moment, specifications of Personal Protective Equipment for PE professionals focused on clothing, client contact and exercise intensity have not been verified, except for the general work environment. Therefore, it is expected that the current study contributes to the health and safety of PE professionals in this pandemic context. © 2022 University of Beira Interior. All rights reserved.

6.
REVISTA AMBIENTE CONTABIL ; 14(2):380-408, 2022.
Article in English | Web of Science | ID: covidwho-1969941

ABSTRACT

Purpose: Considering the imposed social isolation measures to contain the spread of the SarsCov-2 virus, the cause of COVID-19 pandemic, the in-person classes started to be held remotely. Those measures had an impact on education, mainly because they had to be adopted quickly, with no time for preparation. In our current study, we investigate how remote teaching has been occurring in the undergraduate courses of Accounting and Actuarial Sciences at a Public Higher Education Institution (PHEI), in times of social distancing. Methodology: An e-survey was carried out with teachers and students, in order to obtain information on the subject. The collected data were processed using statistical techniques to generate the results. Results: It came across that the studied PHEI did not have resources such as a Flipped classroom, Digital Whiteboard or any other technological tools to support remote classes, since the remote teaching modality became a need during the COVID-19 pandemic. The PHEI launched, via public notices, programs for digital inclusion in order to acquire mobile data and equipment, such as computers/smartphones/tablets for students;however, only few of the students could have access to those resources. Contributions of the Study: Our research results contribute to the state-of-the-art regarding undergraduate courses, by investigating their evolution towards remote learning. Such contributions provide information and knowledge on this subject to the national scientific literature, and give support and guidance to other courses offered by public and/or private higher education institutions.

7.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927846

ABSTRACT

Introduction:Dupilumab is an anti-IL4R monoclonal antibody (mAb) with proven efficacy in severe eosinophilic asthma (SEA). We have previously identified that a suboptimal response to the eosinophil targeting anti-IL5/5R mAbs mepolizumab and benralizumab is seen in 27% and 14% of patients with SEA respectively1,2. The mechanism of this is not well-understood. It is unknown whether such patients respond in a clinically meaningful way following a switch to dupilumab. Methods:We performed a retrospective analysis of the clinical effectiveness of dupilumab (minimum 6 months treatment) in patients with SEA at our tertiary severe asthma centre who had failed to adequately respond to at least one of the anti-IL-5/5R mAbs. Change in the annualised exacerbation rate (AER), maintenance oral corticosteroids (mOCS) requirements, ACQ-6 and mAQLQ was recorded. Results:Thirty-two patients (mean age 41.2, 68.8% female, 71.9% atopic) were included in the analysis. 13/32(40.6%) had co-morbid nasal polyposis and 5/32(15.6%) had eczema. The baseline FeNO was 60ppb(IQR 39.6-87.5) and peak eosinophil count prior to any mAb was 0.6(IQR 0.5-0.9). 23/32(71.8%) were switched from benralizumab, of whom, 12/23(52.2%) had also failed to respond to at least one other anti-IL5 mAb previously. At six months, the daily median mOCS dose in those requiring mOCS at baseline (n=18) fell from 10mg(IQR 5-25mg) to 3mg(IQR 0-5mg), p≤0.001. 4/18(22%) were able to stop mOCS completely. Mean(SD) AER improved from 2.34(1.89) to 0.44(0.95), p≤0.001. There were also significant improvements in ACQ6 and mAQLQ that exceeded twice the MCID for both measures: mean (SD) ACQ6 improved from 3.04(1.26) to 1.82(1.28), p≤0.001;mAQLQ improved from 3.90(SD 1.40) to 5.36(SD 1.05), p≤0.001. Due to the COVID-19 pandemic, FEV1 data was only available for 8 patients. However, there was nonetheless a significant rise in FEV1 (%predicted) from 55.6% (9.78) to 68.5%(16.9), p=0.011. One patient discontinued dupilumab during the follow-up period. Conclusion: A minority of individuals with SEA have a suboptimal response to eosinophil targeted therapy with an anti-IL5/5R mAb. In these patients, we report significant clinical improvements following initiation with dupilumab suggesting an important role for the IL-4/-13 pathway in these patients. Further research is required to understand whether these patients represent a distinct subphenotype of T2-high asthma.

8.
Atithya: A Journal of Hospitality ; 7(2):39-43, 2021.
Article in English | CAB Abstracts | ID: covidwho-1918884

ABSTRACT

In any industry, recruitment, training and effective onboarding of a new staff is considered to be a challenging task. In the backwash of the coronavirus pandemic, however, the industry is now found in completely new landscape. The old followed practices for recruiting and training are no longer effective enough. There is complete new set of requirements established by the COVID-19. Post the outbreak of pandemic, hospitality industry has witnessed a drastic change. Sudden lockdown and prolonged closure of the hotels has made the employees of the industry suffer a lot. From a busy working day to a day without any work has been a very unpleasant transition for everyone. However, post unlock hotels have started their operations slowly following all the new normal implemented post COVID-19. Imagine, a crisis to forces hospitality industry to change their way of operations almost overnight. Notwithstanding initial fears and anxiety, industry has realized that these changes in operations could be treated as a blueprint for upcoming years. This is what the industry leaders are finding across the globe as they respond to the COVID-19. Housekeeping being a core department responsible for maintaining the upkeep of the hotel, is no longer responsible for just the cleaning jobs. The role has changed 360 degrees and the department has truly become a backbone of the hotels. In the difficult times of pandemic, staffs have reskilled and upskilled themselves to deal with this situation and create safe and hygienic environment for both staff and guest. Lot of training programs have been implemented vigorously before the reopening of hotels, making their staff ready to take up the new challenges. These training programs have helped the staff members keep their morals high and welcome guests with new energy and hope.

9.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880212
10.
Hematology, Transfusion and Cell Therapy ; 43:S339, 2021.
Article in Portuguese | EMBASE | ID: covidwho-1859643

ABSTRACT

Objetivos: Desenvolvimento e implementação de reforço do processo de captação ativa de doadores de sangue, a fim de suprir as demandas do Hospital Cristo Redentor (HCR), especializado no atendimento às vítimas de trauma na cidade de Porto Alegre/RS, tendo início em setembro de 2020. Material e métodos: Elaboração e implementação de um fluxo de abordagem humanizada, educativa e transparente dos usuários e familiares para captação/ sensibilização quanto à importância da doação de sangue. O fluxo tem início na entrada do paciente no hospital, adotando estratégia mais abrangente com todos os familiares dos pacientes internados. A solicitação de doadores varia conforme o tipo de cirurgia a ser realizado. As abordagens ocorrem com os pacientes ambulatoriais que internam para realizar cirurgias eletivas, durante a consulta médica e de enfermagem e na marcação cirúrgica. Os pacientes internados vindos da emergência têm seus familiares abordados pela equipe do Serviço Social, de forma a esclarecer as dúvidas referentes à doação e entendimento da importância quanto à necessidade de manter os estoques de hemocomponentes para atender as demandas da hemoterapia. Resultados: A partir da implementação do fluxograma de captação/sensibilização de doadores ocorreu aumento do número de doações direcionadas ao HCR recebidas no Banco de Sangue do Hospital Nossa Senhora da Conceição, que abastece a demanda de estoques de hemocomponentes do serviço. A Agência Transfusional do HCR realiza em média 250 transfusões mensais (período da pandemia), dessas 174 são de Concentrado de Hemácias (CH). O cálculo do percentual de doadores reposição é realizado de acordo com a equação: número de doadores aptos/número total de transfusões de CH. O percentual de reposição foi de 54% (1° semestre 2020) para 111% (2° semestre 2020) e 140% (1° semestre 2021). Discussão: Considerando a drástica diminuição de doações de sangue durante o período da pandemia de COVID-19 e a necessidade de manter um estoque adequado para atendimento de vítimas de trauma, foi necessário o desenvolvimento de estratégias que possibilitassem um incremento do número de doações, a fim de suprir as demandas da Agência Transfusional do HCR. Após a implementação de uma abordagem mais ativa sobre a importância da doação de sangue, observamos uma maior mobilização de amigos e familiares de pacientes internados e consequentemente aumento no número de doações para o HCR, mesmo em nome de pacientes que não necessitaram efetivamente de transfusão. Conclusão: O trabalho de captação de doadores é uma tarefa contínua e integrada que requer participação de todos profissionais da saúde. Diante das adversidades enfrentadas na pandemia, diminuição da capacidade de atendimento de doadores no Banco de Sangue, doações com horário marcado e o isolamento social foi necessário criar métodos para continuar atendendo a demanda de transfusões. O esclarecimento quanto à segurança da doação e da importância da mesma para familiares dos pacientes foi fundamental para o engajamento no processo de captação de doadores. Esse esforço resultou em um salto na média de doadores de reposição de 54% no primeiro semestre de 2020 para 140% no primeiro semestre de 2021. Um aumento considerável no número de doadores de sangue mesmo em um período complicado por tantas restrições.

11.
International Journal of Sensor Networks ; 38(4):273-281, 2022.
Article in English | Web of Science | ID: covidwho-1855053

ABSTRACT

The COVID-19 pandemic has led many serving environments to seek solutions to control people's access and avoid crowding in order to contain its spread, and to ensure the health and safety of users. Given the various current solutions, this paper presents a monitoring system that shows, in real-time, via web, the status of people in closed environments. It uses internet of things (IoT) techniques for data interconnections and electronic components - NodeMCU board and proximity sensors - to monitor the entrance and exit of people in an enclosed environment, providing the statistics through an IoT platform (application) that can be installed in a mobile device (smartphone). This study highlights a low-budget system, shows the implementation of IoT platforms in the development of prototypes and the tests carried out in the academic service office.

13.
Journal of Virology ; 96(3):16, 2022.
Article in English | Web of Science | ID: covidwho-1755903

ABSTRACT

Susceptibility to severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) and the outcome of coronavirus disease 2019 (COVID-19) have been linked to underlying health conditions and the age of affected individuals. Here, we assessed the effect of age on SARS-CoV-2 infection using a ferret model. For this, young (6-monthold) and aged (18- to 39-month-old) ferrets were inoculated intranasally with various doses of SARS-CoV-2. By using infectious virus shedding in respiratory secretions and seroconversion, we estimated that the infectious dose of SARS-CoV-2 in aged animals is similar to 32 PFU per animal, while in young animals it was estimated to be similar to 100 PFU. We showed that viral replication in the upper respiratory tract and shedding in respiratory secretions is enhanced in aged ferrets compared to young animals. Similar to observations in humans, this was associated with higher transcription levels of two key viral entry factors, ACE2 and TMPRSS2, in the upper respiratory tract of aged ferrets. IMPORTANCE In humans, ACE2 and TMPRSS2 are expressed in various cells and tissues, and differential expression has been described in young and old people, with a higher level of expressing cells being detected in the nasal brushing of older people than young individuals. We described the same pattern occurring in ferrets, and we demonstrated that age affects susceptibility of ferrets to SARS-CoV-2. Aged animals were more likely to get infected when exposed to lower infectious dose of the virus than young animals, and the viral replication in the upper respiratory tract and shedding are enhanced in aged ferrets. Together, these results suggest that the higher infectivity and enhanced ability of SARS-CoV-2 to replicate in aged individuals is associated, at least in part, with transcription levels of ACE2 and TMPRSS2 at the sites of virus entry. The young and aged ferret model developed here may represent a great platform to assess age-related differences in SARS-CoV-2 infection dynamics and replication.

14.
Developmental Medicine and Child Neurology ; 64(SUPPL 1):24, 2022.
Article in English | EMBASE | ID: covidwho-1723130

ABSTRACT

Objective: To present paediatric cases of unusual neuroinflammatory conditions encountered during the COVID-19 pandemic in Trinidad & Tobago. Methods: Retrospective study design. Inpatient paediatric patients (aged 0-16 years) hospitalized for neurological complaints from June 2020 - August 2021 at EWMSC. Outcome measures were age at presentation, sex, ethnicity, diagnosis, radiological findings, blood/CSF findings, COVID-19 PCR and antibodies testing, treatment, outcomes and other systems involved. Results: Twenty (20) patients (aged 4-months-old to 15-years-old) had documented neurological involvement. 50% had a diagnosis of ADEM/ADS/AHNE;45% had a diagnosis of either CNS vasculitis (n=3), autoimmune encephalitis (n=3) or GBS (n=3);5% had a diagnosis of acute COVID-19 encephalitis. 70% were of African descent. The youngest age group (0-4 years) (n=11) constituted more males (82%) whereas the eldest age group (10-15 years) (n=3) were all females. Neuroimaging findings were corpus callosal lesions;deep white matter T2 hyperintensities;cerebellar involvement;area postrema and brainstem/C-spine involvement;microhaemorrhages and necrotizing/haemorrhagic lesions (peripheral/central). 70% of patients were either SARS-CoV-2 PCR or COVID-19 antibodies positive. Other systems were involved in 40% to 62.5% (n=5) had cardiac involvement (myocarditis, coronary arteries dilatation, valve regurgitation) and 37.5% (n=3) had pancreatic involvement (autoimmune pancreatitis, type 1 diabetes mellitus). Treatment modalities for CNS manifestations (n=17) were clinically based - 24% (n=4) 3rd line treatment, 29% (n=5) 2nd line treatment, 41% (n=7) 1st line treatment and 6% (n=1) requiring no treatment. All 3 patients with a diagnosis of GBS responded appropriately to IVIG. Developmental outcomes were worst in patients with a diagnosis of autoimmune encephalitis. Conclusion: We have had an explosion of neuro-inflammatory cases since the COVID-19 pandemic began. The range of neuroradiological diagnoses and other systemic involvement (including criteria for PIMS) are interesting, alluding to a neuroinflammatory mechanism. Effects on long-term sequelae and developmental outcomes are concerning in some cases, however, still unknown at this stage.

15.
Embase;
Preprint in English | EMBASE | ID: ppcovidwho-326815

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19) in humans, has a broad host range, and is able to infect domestic and wild animal species. Notably, white-tailed deer (WTD, Odocoileus virginianus), the most widely distributed cervid species in the Americas, were shown to be highly susceptible to SARS-CoV-2 in challenge studies and reported natural infection rates approaching 40% in free-ranging WTD in the U.S. Thus, understanding the infection and transmission dynamics of SARSCoV-2 in WTD is critical to prevent future zoonotic transmission to humans and for implementation of effective disease control measures. Here, we demonstrated that following intranasal inoculation with SARS-CoV-2, WTD fawns shed infectious virus up to day 5 post-inoculation (pi), with high viral loads shed in nasal and oral secretions. This resulted in efficient deer-to-deer transmission on day 3 pi. Consistent a with lack of infectious SARS-CoV-2 shedding after day 5 pi, no transmission was observed to contact animals added on days 6 and 9 pi. We have also investigated the tropism and sites of SARS-CoV-2 replication in adult WTD. Infectious virus was recovered from respiratory-, lymphoid-, and central nervous system tissues, indicating broad tissue tropism and multiple sites of virus replication. The study provides important insights on the infection and transmission dynamics of SARS-CoV-2 in WTD, a wild animal species that is highly susceptible to infection and with the potential to become a reservoir for the virus in the field.

16.
Brazilian Journal of International Law ; 18(2):35-54, 2021.
Article in Portuguese | Scopus | ID: covidwho-1551761

ABSTRACT

The COVID-19 pandemic has deeply challenged all national states in their ability to formulate public policies efficiently and timely. Among them include the aim of guaranteeing access to medicines, personal protection equipment (EPI) and medical products in general, national or imported. Foreign trade policies give support to urgent sanitary and economic domestic policies and require articulation with the international sphere. This article assesses the relationship between international trade regulation under the GATT/OMC system and the responses provided by member states related to the import, export and trade on medical products. It aimed at analyzing the relevance and efficiency of the WTO in its institutional functions, and the practices of its technical committees TBT and SPS to guarantee transparency and provide opportunity for regulatory cooperation among member-countries. In order to test the hypothesis, we provide a case study on the Brazilian trade policies and trade-related administrative measures from the executive power and regulatory bodies related to the COVID-19, and notified to the WTO in the period from March to July 2020. Data collected were analyzed in light of the agreements and the institutional structure of the trading multilateral system and the literature on International Economic Law. The study demonstrates that the interaction between regulation and practices developed in the multilateral system with the Brazilian domestic institutional structures may have positively influenced effective foreign trade policies and administrative trade-related measures taken during the health crisis, in the period under analysis. © 2021 Centro Universitario de Brasilia. All rights reserved.

17.
Chest ; 160(4):443A-443A, 2021.
Article in English | Web of Science | ID: covidwho-1530764
18.
Archives of Disease in Childhood ; 106(SUPPL 1):A35, 2021.
Article in English | EMBASE | ID: covidwho-1495034

ABSTRACT

Background Neuromyelitis Optica Spectrum Disorder (NMOSD) is an inflammatory demyelinating disease of the central nervous system (CNS) primarily affecting the optic nerves and spinal cord, but also involving other regions of the CNS including the area postrema, periaqueductal gray matter, and hypothalamus. There are limited cases describing the development of NMOSD post SARSCOV- 2. Objectives We present a case of seronegative NMOSD meeting the diagnostic criteria with coronary artery involvement and the probable association of Paediatric Multisystem Inflammatory Syndrome (PIMS)/SARS-COV-2. Methods A 13-year-old female of Chinese descent met the diagnostic criteria for sero-negative NMOSD: . Optic neuritis (presented initially with decreased vision right eye, progressed to complete blindness involving both eyes;optic discs swelling bilaterally) + enhancing focus in left parieto-occipital region . Area postrema syndrome (intractable vomiting) + enhancing lesion in the left aspect of the dorsal medulla . Acute brainstem syndrome (autonomic dysfunction, respiratory distress with new-onset squint) + enhancing foci in medulla . Symptomatic cerebral syndrome (left arm weakness, headache, behaviour change) + several enhancing foci within the cerebral hemisphere and sulcal thickening/oedema enhancement in the right fronto-temporal lobe She presented initially with headache and behaviour change x8 days;weakness left arm x6 days;loss of vision right eye x6 days;facial numbness x6 days;vomiting x2 days but no preceding viral illness/vaccine. She was initially managed as ADEM/ADS with steroids (imaging at this time revealed cerebral lesions). However, a protracted illness persisted with intractable nausea/vomiting, and development of new symptoms (squint, autonomic dysfunction, respiratory distress). Repeat imaging showed new involvement of the dorsal and ventral medulla. IVIG and rituximab treatment were then commenced. Results CSF pleocytosis (22 white cells) and elevated protein concentration (131mg/dL) were present. Anti-MOG and Aquaporin-4 antibodies testing post steroids were negative. ESR increased to 82 mm/hr and ANA titre was mildly elevated during her illness. ENA, dsDNA titres normal. COVID-19 IgM antibody level rose to 0.921. Infectious screen negative (Hepatitis studies, HIV, HSV, ASOT). Neoplastic workup negative (Antineuronal antibodies, CEA, CA-125, AFP, Blood film). MRI pelvis was normal. Anticardiolipin and lupus anticoagulant antibodies negative. Interestingly, ECHO done post steroids, IVIG and during rituximab treatment showed moderately dilated left middle coronary artery and severely dilated left anterior descending artery. Her neurological function has improved post IVIG and rituximab. Conclusions Due to the evidence of inflammation and neurological and cardiac dysfunction, we question whether this could be a post SARS-COV-2 related presentation of PIMS. This is our 3rd case in Trinidad & Tobago linking coronary artery and neurological involvement in the same patients possibly in relation to SARS-COV-2. The other cases: 1) 20-month-old with corpus callosal lesions and right coronary artery ectasia post-treatment 2) 2-year 7-months-old with long segment of cord enlargement with heterogenous appearance from C1 to C6 and dilated coronary arteries/mild mitral regurgitation/pericardial effusion.

19.
Chest ; 160(4):A486, 2021.
Article in English | EMBASE | ID: covidwho-1458141

ABSTRACT

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: There have been increasing reports of a rare hyperinflammatory syndrome seen in children following Coronavirus disease 2019 (COVID-19) with shared features of Kawasaki's Disease (KD). More recently, cases involving adolescents and young adults are emerging [1]. We present a case of severe multi-system inflammatory syndrome with myocarditis in a young adult. CASE PRESENTATION: A 20-year-old male with beta-thalassemia trait and a family history of Sjogren disease presented for screening after contact with a friend who tested positive for COVID-19. PCR testing confirmed COVID-19. He was asymptomatic at that time and was advised to quarantine at home.Five weeks later, he presented with a high-grade fever of 104 F, myalgias, difficulty breathing, chest pain, palpitations, hematuria, and hematochezia. Vital signs showed tachycardia (127 bpm) and hypotension (90/53 mmHg). Chest X-ray showed no infiltrates. Electrocardiogram (EKG) showed no ST abnormalities. Nasopharyngeal PCR was negative for COVID-19. Labs showed elevated C-reactive protein (CRP), creatinine phosphokinase (CPK), and lactate (8.0 mmol/L). Troponin T was elevated to 1.5 ng/L, and high sensitivity troponin was 12759 ng/L. Sequential Organ Failure Assessment (SOFA) score was 9. He was admitted to the intensive care unit (ICU) for cardiogenic vs distributive shock. Echocardiogram revealed new-onset reduced ejection fraction (EF) at 20%, with no wall motion abnormalities. He was anuric with rhabdomyolysis and acute tubular necrosis. He was treated with hemodialysis, intravenous N-acetylcysteine protocol, inotropic support, three doses of intravenous immunoglobulins (IVIG), corticosteroids, and aspirin. Serial blood cultures were negative. He had a high serum titer of COVID-19 antibody. Patient slowly improved following IVIG treatment and supportive care, with decreasing SOFA score. He was weaned off pressors and dialysis. Repeat echocardiogram showed recovered EF at 45%, and inflammatory markers improved to normal. After a 3-week hospital course, patient was near baseline with post-ICU deconditioning. DISCUSSION: Multisystem Inflammatory Syndrome in Adults (MIS-A) is a rare post-infectious sequela of COVID-19 with shared features of KD. Proposed mechanisms include direct hypoxic, ischemic injury, and post-viral immune-mediated vasculitis. Patients usually have limited respiratory involvement, evidence of recent COVID-19, and high antibody titers, which supports a post-infectious, immune-mediated etiology. Myocarditis is more common compared with Kawasaki disease, and both can have coronary artery aneurysms. Limited data from case series show good outcomes with IVIG, corticosteroids, and aspirin [2]. CONCLUSIONS: MIS is a rare extrapulmonary complication of COVID-19 with a wide spectrum of presentation. Initially described in children, more cases are emerging in young adults. A multidisciplinary approach is essential in severe cases. REFERENCE #1: Hékimian G, Kerneis M, Zeitouni M, et al. Coronavirus Disease 2019 Acute Myocarditis and Multisystem Inflammatory Syndrome in Adult Intensive and Cardiac Care Units. Chest. 2021;159(2):657-662. doi:10.1016 REFERENCE #2: Godfred-Cato S, Bryant B, Leung J, Oster ME, Conklin L, et al. California MIS-C Response Team. COVID-19-Associated Multisystem Inflammatory Syndrome in Childre, March-July 2020. MMWR Morb Mortal Wkly Rep. 2020 Aug 14;69(32):1074-1080. doi: 10.15585 DISCLOSURES: No relevant relationships by Mateus Fernandes, source=Web Response No relevant relationships by Ifediba Nwachukwu, source=Web Response

20.
Chest ; 160(4):A443, 2021.
Article in English | EMBASE | ID: covidwho-1457762

ABSTRACT

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: The spectrum of autoimmune phenomena associated with Coronavirus disease 2019 (COVID-19) continues to expand. Guillain-Barré Syndrome (GBS) manifesting as a post-infectious sequela of COVID-19 has been increasingly reported [1]. Rare cases of autoimmune hemolytic anemia (AIHA) associated with COVID-19 are also emerging [2]. Our case describes a novel presentation of GBS and hemolysis in a patient with COVID-19. CASE PRESENTATION: A 62-year-old male with a past medical history of hypertension initially presented with 5 days of low-grade fever and cough. He denied dyspnea and was not hypoxic. Nasopharyngeal PCR confirmed COVID-19. He received bamlanivimab and etesevimab infusion and was discharged from the emergency room. He returned 6 days later with new-onset unsteady gait and weakness of the lower extremities. He had 1+ reflexes in the patellar and ankle bilaterally and 3+ in both triceps and biceps. This worsened into flaccid paralysis of bilateral lower extremities by admission day 2. Labs showed a drop in hemoglobin (Hgb) from 14.7 mg/dL to 10.9 mg/dL, haptoglobin <1.0 mg/dL, lactate dehydrogenase (LDH) 742 U/L, mean corpuscular volume (MCV) 90 fL, and indirect bilirubin 1.9 mg/dL.Magnetic resonance imaging (MRI) of the brain and spine were performed, with no significant findings. Lumbar puncture was consistent with albuminocytologic dissociation, with a white cell count of 2 /mcL, and protein 78 mg/dL. CSF PCR panel was negative. Patient fulfilled Brighton criteria level 2 for GBS and was treated with 3 doses of intravenous immunoglobulin (IVIG). Following IVIG, patient weakness resolved and reflexes improved to normal. Repeat labs showed decreased LDH, normal bilirubin, improved Hgb, and negative Direct Coombs test. The patient was discharged with a GBS disability score of 0, and he continued to be symptom-free 3 weeks later. DISCUSSION: There have been increasing reports of GBS in patients with COVID-19 [1]. Most cases are treated with IVIG (77-92%) or plasmapheresis (8-11%), with about 35% of patients having residual deficits (GBS disability score >2) at time of discharge [1, 3]. AIHA has also been associated with COVID-19, with mixed warm and cold agglutin formation [2]. A negative CSF PCR panel with high protein suggests that novel antibodies may mediate myelin damage, which may also target other components such as fibrinogen in α/β chains. Immunoglobulin fragment alteration resulting in molecular mimicry may also occur following antigen-antibody complex formation directed against the virus [1]. CONCLUSIONS: GBS and AIHA are rare but important complications in patients with COVID-19. The spectrum of autoimmune phenomena associated with COVID-19 continues to expand. This case highlights the need for the differential to include autoimmune disease in patients with extrapulmonary manifestations of COVID-19. Further studies are needed to determine if causal relationships are present. REFERENCE #1: Sheikh AB, Chourasia PK, Javed N, et al. Association of Guillain-Barre syndrome with COVID-19 infection: An updated systematic review. 2021 Apr 18. J Neuroimmunol. 2021;355:577577. doi:10.1016/j.jneuroim.2021.577577 REFERENCE #2: Lazarian G, Quinquenel A, Bellal M, et al. Autoimmune haemolytic anaemia associated with COVID-19 infection. Br J Haematol. 2020;190(1):29-31. doi:10.1111/bjh.16794 REFERENCE #3: Hasan I, Saif-Ur-Rahman KM, Hayat S, et al. Guillain-Barré syndrome associated with SARS-CoV-2 infection: A systematic review and individual participant data meta-analysis. J Peripher Nerv Syst. 2020 Dec;25(4):335-343. doi: 10.1111/jns.12419. DISCLOSURES: No relevant relationships by Mateus Fernandes, source=Web Response No relevant relationships by Ifediba Nwachukwu, source=Web Response

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