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PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-297073


Wastewater-based epidemiology is an emerging tool to monitor COVID-19 infection levels by measuring the concentration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater. There remains a need to improve wastewater RNA extraction methods' sensitivity, speed, and reduce reliance on often expensive commercial reagents to make wastewater-based epidemiology more accessible. We present a kit-free wastewater RNA extraction method, titled "Sewage, Salt, Silica and SARS-CoV-2" (4S), that employs the abundant and affordable reagents sodium chloride (NaCl), ethanol and silica RNA capture matrices to recover 6-fold more SARS-CoV-2 RNA from wastewater than an existing ultrafiltration-based method. The 4S method concurrently recovered pepper mild mottle virus (PMMoV) and human 18S ribosomal subunit rRNA, both suitable as fecal concentration controls. The SARS-CoV-2 RNA concentrations measured in three sewersheds corresponded to the relative prevalence of COVID-19 infection determined via clinical testing. Lastly, controlled experiments indicate that the 4S method prevented RNA degradation during storage of wastewater samples, was compatible with heat pasteurization, and could be performed in approximately 3 hours. Overall, the 4S method is promising for effective, economical, and accessible wastewater-based epidemiology for SARS-CoV-2, providing another tool to fight the global pandemic. SYNOPSIS: The 4S method for measuring SARS-CoV-2 in wastewater is promising for effective, economical, and accessible wastewater-based epidemiology. Abstract art:

American Journal of Gastroenterology ; 116(SUPPL):S1091, 2021.
Article in English | EMBASE | ID: covidwho-1534814


Introduction: It is established that COVID-19 predisposes patients to arterial and venous thrombotic disease,1 though the exact mechanism is unknown. Cases of PE and DVT are well described, while arterial and multi-vessel thromboses are rare.2 We report COVID-19 associated hepatic artery thrombosis (HAT) and portal and superior mesenteric vein (PV;SMV) thrombosis, both resulting in compromised liver function. Case Description/Methods: A 47-year-old man with a history of remote orthotopic liver transplantation (OLT) for HBV cirrhosis presented to the ED with two days of RUQ pain and vomiting. Physical exam revealed tenderness to palpation in the RUQ. Labs were normal, including liver synthetic function. COVID-19 nasopharyngeal swab was positive. CT of the abdomen and pelvis with IV contrast revealed complete acute thrombosis of the aortohepatic conduit near its origin, new from imaging six months prior. He received remdesivir and methylprednisolone and was discharged on a DOAC. A 57-year-old man with a history of Lynch syndrome and decompensated alcoholic cirrhosis presented to the ED with 3 days of LUQ pain, melena, coffee ground emesis and subjective fever. Physical exam and vital signs were normal. Labs showed Hgb 5.4 and WBC 15.2. COVID-19 nasopharyngeal swab was positive. CT of the abdomen and pelvis with IV contrast revealed extensive PV and SMV thrombosis. The patient was treated with pRBC, PPI, octreotide, and empiric antibiotics. He was given IV heparin and bridged to warfarin. Discussion: Thrombosis is a serious complication of COVID-19 infection. While there are known macrovascular thrombotic events associated with COVID-19, there are no reports of HAT, and one reported case of PV and SMV thrombosis. It is important to evaluate for thromboses in patients with cirrhosis or prior OLT and COVID-19 due to elevated thrombotic risk. Thromboses in these patients can compromise blood supply and further worsen liver function.