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1.
Clin Infect Dis ; 2022 Mar 10.
Article in English | MEDLINE | ID: covidwho-1852989

ABSTRACT

BACKGROUND: COVID-19 testing policies for symptomatic children attending U.S. schools or daycare vary, and whether isolated symptoms should prompt testing is unclear. We evaluated children presenting for SARS-CoV-2 testing to determine if the likelihood of having a positive SARS-CoV-2 test differed between participants with one versus ≥2 symptoms, and to examine the predictive capability of isolated symptoms. METHODS: Participants ≤ 18 years presenting for clinical SARS-CoV-2 molecular testing in six sites in urban/suburban/rural Georgia (July-October, 2021; delta variant predominant) were queried about individual symptoms. Participants were classified into three groups: asymptomatic, one symptom only, or ≥2 symptoms. SARS-CoV-2 test results and clinical characteristics of the three groups were compared. Sensitivity, specificity, and positive/negative predictive values (PPV/NPV) for isolated symptoms were calculated by fitting a saturated Poisson model. RESULTS: Of 602 participants, 21.8% tested positive and 48.7% had a known or suspected close contact. Children reporting one symptom (n=82; OR=6.00, 95% CI: 2.70-13.33) and children reporting ≥2 symptoms (n=365; OR=5.25: 2.66-10.38) were significantly more likely to have a positive COVID-19 test than asymptomatic children (n=155), but they were not significantly different from each other (OR=0.88: 0.52-1.49). Sensitivity/PPV were highest for isolated fever (33%/57%), cough (25%/32%), and sore throat (21%/45%); headache had low sensitivity (8%) but higher PPV (33%). Sensitivity/PPV of isolated congestion/rhinorrhea were 8%/9%. CONCLUSIONS: With high delta variant prevalence, children with isolated symptoms were as likely as those with multiple symptoms to test positive for COVID-19. Isolated fever, cough, sore throat, or headache, but not congestion/rhinorrhea, offered highest predictive value.

2.
Inflamm Bowel Dis ; 2022 Apr 09.
Article in English | MEDLINE | ID: covidwho-1784355

ABSTRACT

Despite all efforts, about one-third of IBD patients are still not vaccinated. Although there is an emphasis on the booster dose, there is still a large population that has received no vaccination. Younger, healthy smokers with CD and on anti-TNF agents residing in the South and Midwest are less likely to get vaccinated. Targeted efforts should be made at this subset of IBD patients to increase vaccination rates.

3.
Cureus ; 14(2): e22160, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1753937

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) has created a global pandemic. As we try to understand the virus, we are learning that it can affect many organ systems. Most commonly coronavirus disease 2019 (COVID-19) virus affects the respiratory tract and the lungs impairing oxygen transport to the systemic circulation. Its effect on the cardiovascular system can be equally as devastating. Patients can develop pericarditis, myocarditis, and pericardial effusion that can at times lead to tamponade. Here we present an unusual case of a patient with COVID-19 pneumonia who presented with pericardial effusion along with enlarged mediastinal lymph nodes.

4.
Int J Environ Res Public Health ; 18(19)2021 Sep 27.
Article in English | MEDLINE | ID: covidwho-1438624

ABSTRACT

Coronavirus disease (COVID-19) spreads from one person to another rapidly. A recently discovered coronavirus causes it. COVID-19 has proven to be challenging to detect and cure at an early stage all over the world. Patients showing symptoms of COVID-19 are resulting in hospitals becoming overcrowded, which is becoming a significant challenge. Deep learning's contribution to big data medical research has been enormously beneficial, offering new avenues and possibilities for illness diagnosis techniques. To counteract the COVID-19 outbreak, researchers must create a classifier distinguishing between positive and negative corona-positive X-ray pictures. In this paper, the Apache Spark system has been utilized as an extensive data framework and applied a Deep Transfer Learning (DTL) method using Convolutional Neural Network (CNN) three architectures -InceptionV3, ResNet50, and VGG19-on COVID-19 chest X-ray images. The three models are evaluated in two classes, COVID-19 and normal X-ray images, with 100 percent accuracy. But in COVID/Normal/pneumonia, detection accuracy was 97 percent for the inceptionV3 model, 98.55 percent for the ResNet50 Model, and 98.55 percent for the VGG19 model, respectively.


Subject(s)
COVID-19 , Deep Learning , Big Data , Humans , SARS-CoV-2 , X-Rays
6.
Gastroenterology ; 161(3): 827-836, 2021 09.
Article in English | MEDLINE | ID: covidwho-1243319

ABSTRACT

BACKGROUND & AIMS: Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly expanded; however, clinical trials excluded patients taking immunosuppressive medications such as those with inflammatory bowel disease (IBD). Therefore, we explored real-world effectiveness of coronavirus disease 2019 (COVID-19) vaccination on subsequent infection in patients with IBD with diverse exposure to immunosuppressive medications. METHODS: This was a retrospective cohort study of patients in the Veterans Health Administration with IBD diagnosed before December 18, 2020, the start date of the Veterans Health Administration patient vaccination program. IBD medication exposures included mesalamine, thiopurines, anti-tumor necrosis factor biologic agents, vedolizumab, ustekinumab, tofacitinib, methotrexate, and corticosteroid use. We used inverse probability weighting and Cox's regression with vaccination status as a time-updating exposure and computed vaccine effectiveness from incidence rates. RESULTS: The cohort comprised 14,697 patients, 7321 of whom received at least 1 vaccine dose (45.2% Pfizer, 54.8% Moderna). The cohort had median age 68 years, 92.2% were men, 80.4% were White, and 61.8% had ulcerative colitis. In follow-up data through April 20, 2021, unvaccinated individuals had the highest raw proportion of SARS-CoV-2 infection (197 [1.34%] vs 7 [0.11%] fully vaccinated). Full vaccination status, but not partial vaccination status, was associated with a 69% reduced hazard of infection relative to an unvaccinated status (hazard ratio, 0.31, 95% confidence interval, 0.17-0.56; P < .001), corresponding to an 80.4% effectiveness. CONCLUSIONS: Full vaccination (> 7 days after the second dose) against SARS-CoV-2 infection has an ∼80.4% effectiveness in a broad IBD cohort with diverse exposure to immunosuppressive medications. These results may serve to increase patient and provider willingness to pursue vaccination in these settings.


Subject(s)
COVID-19 Vaccines , COVID-19 , Immunosuppressive Agents , Inflammatory Bowel Diseases , SARS-CoV-2 , Aged , COVID-19/complications , COVID-19/immunology , COVID-19/therapy , COVID-19 Vaccines/adverse effects , Female , Humans , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/immunology , Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/drug therapy , Inflammatory Bowel Diseases/immunology , Male , Retrospective Studies , SARS-CoV-2/drug effects , SARS-CoV-2/immunology , Treatment Outcome , Vaccination , Veterans
7.
Cureus ; 13(3): e14209, 2021 Mar 31.
Article in English | MEDLINE | ID: covidwho-1200343

ABSTRACT

Multiple neurological complications, including Guillain-Barre syndrome (GBS), have been reported in association with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak. GBS has well-known associations with viruses such as influenza, human immunodeficiency virus, Zika, severe acute respiratory syndrome, Middle East respiratory syndrome, Epstein-Barr virus, and cytomegalovirus. Till date, there have been around 50 distinct published cases of GBS occurring concurrently or shortly after SARS-CoV-2 infection. This report describes the case of a 53-year-old male who presented with bilateral extremity paresthesias two weeks after a positive SARS-CoV-2 test. His symptoms were originally thought to be due to underlying diabetic peripheral neuropathy, but as they progressed, he was eventually diagnosed with SARS-CoV-2-associated GBS. Though GBS may not be a common sequelae of SARS-CoV-2 infection, the prevalence of diabetes mellitus-associated peripheral neuropathy is high enough to warrant awareness and prompt recognition of neurological symptoms that deviate from the baseline in individuals with recent, confirmed SARS-CoV-2 infection.

8.
Gastroenterology ; 160(5): 1904, 2021 04.
Article in English | MEDLINE | ID: covidwho-1189302
9.
Gut ; 70(9): 1657-1664, 2021 09.
Article in English | MEDLINE | ID: covidwho-1147197

ABSTRACT

OBJECTIVE: Our aim was to explore the risk of infection with all classes of inflammatory bowel disease (IBD) medications and the impact of these medications on the disease course in a nationwide cohort of patients with IBD. DESIGN: This was a retrospective national cohort study of patients with IBD in the Veterans Affairs Healthcare System. We categorised IBD medication use immediately prior to the COVID-19 pandemic and used survival analysis methods to study associations with SARS-CoV-2 infection, as well as a combined secondary outcome of COVID-19 hospitalisation or COVID-19-related mortality. RESULTS: The analytical cohort of 30 911 patients was primarily male (90.9%), white (78.6%) and with ulcerative colitis (58.8%). Over a median follow-up of 10.7 months, 649 patients (2.1%) were diagnosed with SARS-CoV-2 infection and 149 (0.5%) met the combined secondary outcome. In adjusted models, vedolizumab (VDZ) use was significantly associated with infection relative to mesalazine alone (HR 1.70, 95% CI 1.16 to 2.48, p=0.006). Patients on no IBD medications had increased risk of the combined secondary outcome relative to mesalazine alone (sub-HR 1.64, 95% CI 1.12 to 2.42, p=0.01), however, no other IBD medication categories were significantly associated with this outcome, relative to mesalazine alone (each p>0.05). Corticosteroid use was independently associated with both SARS-CoV-2 infection (HR 1.60, 95% CI 1.23 to 2.09, p=0.001) and the combined secondary outcome (sub-HR 1.90, 95% CI 1.14 to 3.17, p=0.01). CONCLUSION: VDZ and corticosteroid were associated with an increased risk of SARS-CoV-2 infection. Except for corticosteroids no medications including mesalazine were associated with an increased risk of severe COVID-19.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Inflammatory Bowel Diseases/complications , Adult , Aged , Cohort Studies , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Assessment , Risk Factors , United States , United States Department of Veterans Affairs
10.
Am J Gastroenterol ; 116(4): 808-810, 2021 04.
Article in English | MEDLINE | ID: covidwho-881531

ABSTRACT

INTRODUCTION: The clinic course of SARS-CoV-2 among patients with inflammatory bowel disease (IBD) has been extensively studied. However, there is a paucity of data on whether patients with IBD have an increased risk of developing SARS-CoV-2 with compared with patients without IBD. METHODS: We conducted a nationwide retrospective cohort study in the US Veterans' Affairs healthcare system from January 1, 2020, to June 30, 2020. We matched each patient with IBD with 2 patients without IBD on age, sex, race, location, and comorbidities. The outcome of interest was development of SARS-CoV-2. RESULTS: Among 38,378 patients with IBD and 67,433 patients without IBD, 87 (0.23%) and 132 (0.20%) patients developed incident SARS-CoV-2 infection, respectively (P = 0.29). DISCUSSION: Patients with IBD are not at a significantly increased risk of developing SARS-CoV-2 infection when compared with patients without IBD.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Inflammatory Bowel Diseases/complications , Aged , Cohort Studies , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Assessment , Risk Factors , United States , United States Department of Veterans Affairs
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