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1.
Journal of Commercial Biotechnology ; JOUR:57-66, 27(2).
Article in English | EMBASE | ID: covidwho-2090781

ABSTRACT

The COVID-19 pandemic has led to new challenges for teachers and students in different countries. International scholars and researchers provide insight into the success of blended learning approaches that foster social and emotional connectedness, affective learning processes, feedback loops, cultural understanding and dialogue. This article will explore how a blended teaching strategy was developed during the COVID-19 pandemic that brings together web-based teaching with face-to-face interaction in order to support the resilience of students from different countries. Online teaching is used primarily for course materials and exams, but increasingly it is being used for other educational activities including helping people to recover from mental illness or disaster. Copyright © 2022 ThinkBiotech LLC. All rights reserved.

2.
2021 IEEE 20TH INTERNATIONAL CONFERENCE ON TRUST, SECURITY AND PRIVACY IN COMPUTING AND COMMUNICATIONS (TRUSTCOM 2021) ; : 122-129, 2021.
Article in English | Web of Science | ID: covidwho-1937855

ABSTRACT

With more devices being inter- or intra-connected, Internet of Things (IoT) has gradually been adopted in many disciplines, such as healthcare industry, coined as Internet of Medical Things (IoMT). The purpose of IoMT is to facilitate the efficiency and effectiveness of medical operations, i.e., remotely monitoring the status of patients. In such healthcare environments, smartphones have become an important device to communicate with others and update the information of patients, resulting in a special type of IoMT called Medical Smartphone Networks (MSNs). To reinforce the distributed architecture, trust management schemes are often implemented to defend against insider attacks. However, how to maintain the robustness of trust management in heavy traffic networks still remains a challenge, i.e., COVID-19 incident would cause excessive traffic for healthcare organizations and increase the difficulty of validating trustworthiness among MSN nodes. In this work, we focus on this issue and propose a blockchain-enabled adaptive traffic sampling method to help enhance the robustness of trust management under high traffic environments. The use of blockchain technology aims to build a verified database of malicious traffic among all nodes. The evaluation in a real healthcare environment demonstrates the viability and effectiveness of our approach.

3.
PubMed; 2022.
Preprint in English | PubMed | ID: ppcovidwho-333882

ABSTRACT

BACKGROUND: CoronaVac (®) is an inactivated SARS-CoV-2 vaccine approved by the World Health Organization. Previous studies reported increased levels of neutralizing antibodies and specific T cells two- and four-weeks after two doses of CoronaVac (®) , but the levels of neutralizing antibodies are reduced at six to eight months after two doses. Here we report the effect of a booster dose of CoronaVac (®) on the anti-SARS-CoV-2 immune response generated against variants of concern (VOC) Delta and Omicron in adults participating in a phase 3 clinical trial in Chile. METHODS: Volunteers immunized with two doses of CoronaVac (®) in a four-week interval received a booster dose of the same vaccine between twenty-four and thirty weeks after the 2nd dose. Four weeks after the booster dose, neutralizing antibodies and T cell responses were measured. Neutralization capacities and T cell activation against VOC Delta and Omicron were detected at four weeks after the booster dose. FINDINGS: We observed a significant increase in neutralizing antibodies at four weeks after the booster dose. We also observed an increase in CD4 (+) T cells numbers over time, reaching a peak at four weeks after the booster dose. Furthermore, neutralizing antibodies and SARS-CoV-2 specific T cells induced by the booster showed activity against VOC Delta and Omicron. INTERPRETATION: Our results show that a booster dose of CoronaVac (®) increases the anti-SARS-CoV-2 humoral and cellular immune responses in adults. Immunity induced by a booster dose of CoronaVac (®) is active against VOC, suggesting an effective protection.

4.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-333766

ABSTRACT

BACKGROUND: The ongoing COVID-19 pandemic has had a significant impact worldwide, with an incommensurable social and economic burden. The rapid development of safe and protective vaccines against this disease is a global priority. CoronaVac is a vaccine prototype based on inactivated SARS-CoV-2, which has shown promising safety and immunogenicity profiles in pre-clinical studies and phase 1/2 trials in China. To this day, four phase 3 clinical trials are ongoing with CoronaVac in Brazil, Indonesia, Turkey, and Chile. This article reports the safety and immunogenicity results obtained in a subgroup of participants aged 18 years and older enrolled in the phase 3 Clinical Trial held in Chile. METHODS: This is a multicenter phase 3 clinical trial. Healthcare workers aged 18 years and older were randomly assigned to receive two doses of CoronaVac or placebo separated by two weeks (0-14). We report preliminary safety results obtained for a subset of 434 participants, and antibody and cell-mediated immunity results obtained in a subset of participants assigned to the immunogenicity arm. The primary and secondary aims of the study include the evaluation of safety parameters and immunogenicity against SARS-CoV-2 after immunization, respectively. This trial is registered at clinicaltrials.gov ( NCT04651790 ). FINDINGS: The recruitment of participants occurred between November 27 (th) , 2020, until January 9 (th) , 2021. 434 participants were enrolled, 397 were 18-59 years old, and 37 were ≥60 years old. Of these, 270 were immunized with CoronaVac, and the remaining 164 participants were inoculated with the corresponding placebo. The primary adverse reaction was pain at the injection site, with a higher incidence in the vaccine arm (55.6%) than in the placebo arm (40.0%). Moreover, the incidence of pain at the injection site in the 18-59 years old group was 58.4% as compared to 32.0% in the ≥60 years old group. The seroconversion rate for specific anti-S1-RBD IgG was 47.8% for the 18-59 years old group 14 days post immunization (p.i.) and 95.6% 28 and 42 days p.i. For the ≥60 years old group, the seroconversion rate was 18.1%, 100%, and 87.5% at 14, 28, and 42 days p.i., respectively. Importantly, we observed a 95.7% seroconversion rate in neutralizing antibodies for the 18-59 years old group 28 and 42 days p.i. The ≥60 years old group exhibited seroconversion rates of 90.0% and 100% at 28 and 42 days p.i. Interestingly, we did not observe a significant seroconversion rate of anti-N-SARS-CoV-2 IgG for the 18-59 years old group. For the participants ≥60 years old, a modest rate of seroconversion at 42 days p.i. was observed (37.5%). We observed a significant induction of a T cell response characterized by the secretion of IFN-γ upon stimulation with Mega Pools of peptides derived from SARS-CoV-2 proteins. No significant differences between the two age groups were observed for cell-mediated immunity. INTERPRETATION: Immunization with CoronaVac in a 0-14 schedule in adults of 18 years and older in the Chilean population is safe and induces specific IgG production against the S1-RBD with neutralizing capacity, as well as the activation of T cells secreting IFN-γ, upon recognition of SARS-CoV-2 antigens. FUNDING: Ministry of Health of the Chilean Government;Confederation of Production and Commerce, Chile;Consortium of Universities for Vaccines and Therapies against COVID-19, Chile;Millennium Institute on Immunology and Immunotherapy.

5.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-333724

ABSTRACT

Novel mRNA vaccines for SARS-CoV2 have been authorized for emergency use and are currently being administered to millions of individuals worldwide. Despite their efficacy in clinical trials, there is limited data on vaccine-induced immune responses in individuals with a prior SARS-CoV2 infection compared to SARS-CoV2 naive subjects. Moreover, how mRNA vaccines impact the development of antibodies as well as memory B cells in COVID-19 experienced versus COVID-19 naive subjects remains poorly understood. In this study, we evaluated antibody responses and antigen-specific memory B cell responses over time in 33 SARS-CoV2 naive and 11 SARS-CoV2 recovered subjects. mRNA vaccination induced significant antibody and memory B cell responses against full-length SARS-CoV2 spike protein and the spike receptor binding domain (RBD). SARS-CoV2 naive individuals benefitted from both doses of mRNA vaccine with additional increases in antibodies and memory B cells following booster immunization. In contrast, SARS-CoV2 recovered individuals had a significant immune response after the first dose with no increase in circulating antibodies or antigen-specific memory B cells after the second dose. Moreover, the magnitude of the memory B cell response induced by vaccination was lower in older individuals, revealing an age-dependence to mRNA vaccine-induced B cell memory. Side effects also tended to associate with post-boost antibody levels, but not with post-boost memory B cells, suggesting that side effect severity may be a surrogate of short-term antibody responses. The frequency of pre-vaccine antigen-specific memory B cells in SARS-CoV2 recovered individuals strongly correlated with post-vaccine antibody levels, supporting a key role for memory B cells in humoral recall responses to SARS-CoV2. This observation may have relevance for future booster vaccines and for responses to viral variants that partially escape pre-existing antibodies and require new humoral responses to be generated from memory B cells. Finally, post-boost antibody levels were not correlated with post-boost memory responses in SARS-CoV2 naive individuals, indicating that short-term antibody levels and memory B cells are complementary immunological endpoints that should be examined in tandem when evaluating vaccine response. Together, our data provide evidence of both serological response and immunological memory following mRNA vaccination that is distinct based on prior SARS-CoV2 exposure. These findings may inform vaccine distribution in a resource-limited setting. Abstract figure:

6.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-333522

ABSTRACT

Although critical illness has been associated with SARS-CoV-2-induced hyperinflammation, the immune correlates of severe COVID-19 remain unclear. Here, we comprehensively analyzed peripheral blood immune perturbations in 42 SARS-CoV-2 infected and recovered individuals. We identified broad changes in neutrophils, NK cells, and monocytes during severe COVID-19, suggesting excessive mobilization of innate lineages. We found marked activation within T and B cells, highly oligoclonal B cell populations, profound plasmablast expansion, and SARS-CoV-2-specific antibodies in many, but not all, severe COVID-19 cases. Despite this heterogeneity, we found selective clustering of severe COVID-19 cases through unbiased analysis of the aggregated immunological phenotypes. Our findings demonstrate broad immune perturbations spanning both innate and adaptive leukocytes that distinguish dysregulated host responses in severe SARS-CoV-2 infection and warrant therapeutic investigation. ONE SENTENCE SUMMARY: Broad immune perturbations in severe COVID-19.

7.
Concurrency and Computation: Practice and Experience ; 2022.
Article in English | Scopus | ID: covidwho-1750342

ABSTRACT

With the outbreak of Covid-19, both people's health and the world economy are facing great challenges. Contact tracing scheme based on Bluetooth of smartphones has been regarded as a viable way to mitigate the spread of Covid-19. The existing schemes mainly belong to the centralized or the decentralized structure, both of which have their own limitations. It is infeasible for the existing schemes to balance the different demands of governments and users for user privacy and tracing efficiency at different periods of the epidemic. In this paper, we propose a hybrid contact tracing scheme named MLCT (multi-level contact tracing scheme) which is mainly based on short group signature. MLCT provides multiple privacy levels by applying anonymous credential technology and secret sharing technology to desensitize user identity privacy and encounter privacy. Comparing to the previous schemes, MLCT fully considers the different demands of the government, patients, and close contacts for user privacy and tracing efficiency in the different stages of Covid-19. The experimental results show viability in terms of the required resource from both server and mobile phone perspectives. And the security analysis demonstrates that MLCT can achieve the five targets security goals. It is expected that MLCT can contribute to the design and development of contact tracing schemes. © 2022 John Wiley & Sons, Ltd.

9.
Blood ; 138:1757, 2021.
Article in English | EMBASE | ID: covidwho-1582174

ABSTRACT

Background: The two FDA approved mRNA-based SARS-CoV2 vaccines have shown >90% efficacy at preventing COVID and eliciting protective immunity in nearly all healthy individuals. However, the extent of vaccine induced antibody and T cell immunity in immunocompromised patients is not well known. Our study objective is to determine if patients with hematologic malignancies treated with B-cell targeting chimeric antigen receptor (CAR) T cell therapies can mount antibody and T cell immune responses to SARS-CoV2 vaccines. A prospective single-center study to evaluate the SARS-CoV2 immune responses in immunocompromised individuals (COVAX Study) was initiated at University of Pennsylvania following the IRB guidelines. The study enrolled 8 healthy adults,12 patients are in remission after treatment (average of 40.6 months) with CART cells targeting either CD19 or CD19+CD22 and received both doses of SARS-CoV2 vaccine. Methods and Results: Serology to SARS-CoV2 spike-receptor binding domain (RBD) IgG, RBD-IgA, RBD-IgM and spike-specific T cell responses were measured prior to vaccination and serially up to 28 days after booster vaccination. RBD-IgG and RBD-IgA were detected in 8/8 and 7/8 healthy subjects compared to 5/12 and 2/12 CART patients, respectively (Figure A). In the CART cohort, several patients who demonstrated an induction of RBD-IgG (57.2/uL +/- 20.2) compared to those who were RBD-IgG-negative (9/uL +/- 10.1, ANOVA with multiple comparisons test p=0.017) have higher level of circulating B cells. No association was found with time since CART infusion, age, disease type, or vaccine manufacturer. All 8 healthy subjects demonstrated induction of SARS-Cov2 spike-specific CD4 + T cell immunity compared to 7 out of 11 CART patients (Figure B). RBD-IgG responses were not correlated with CD4 + T cell activation (Pearson correlation, R=0.21, p=0.53). Indeed, 3 CART patients demonstrated robust CD4 + T cell activation despite absence of antibody induction. Overall, 8/12 CART patients demonstrated induction of either or both humoral and T cell immune responses. Conclusions: We show that immune responses to SARS-CoV2 mRNA vaccines are induced in majority of patients who have been treated with CART therapies targeting B-cell lineage antigens. Induction of vaccine-specific antibody was strongly associated with the level of circulating B cells. However, in CART cohort patients despite severe humoral immune deficiency, strong CD4 + T cell responses were observed suggestive of a sufficient protective immunity. [Formula presented] Disclosures: Frey: Novartis: Research Funding;Sana Biotechnology: Consultancy;Kite Pharma: Consultancy;Syndax Pharmaceuticals: Consultancy. Garfall: Amgen: Honoraria;CRISPR Therapeutics: Research Funding;GlaxoSmithKline: Honoraria;Janssen: Honoraria, Research Funding;Novartis: Research Funding;Tmunity: Research Funding. Porter: American Society for Transplantation and Cellular Therapy: Honoraria;Genentech: Current equity holder in publicly-traded company, Ended employment in the past 24 months;ASH: Membership on an entity's Board of Directors or advisory committees;DeCart: Membership on an entity's Board of Directors or advisory committees;Incyte: Membership on an entity's Board of Directors or advisory committees;Janssen: Membership on an entity's Board of Directors or advisory committees;Kite/Gilead: Membership on an entity's Board of Directors or advisory committees;National Marrow Donor Program: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees, Patents & Royalties, Research Funding;Tmunity: Patents & Royalties;Wiley and Sons Publishing: Honoraria. June: AC Immune, DeCART, BluesphereBio, Carisma, Cellares, Celldex, Cabaletta, Poseida, Verismo, Ziopharm: Consultancy;Tmunity, DeCART, BluesphereBio, Carisma, Cellares, Celldex, Cabaletta, Poseida, Verismo, Ziopharm: Current equity holder in publicly-traded company;Novartis: Patents & Royalties.

10.
Chinese Journal of Disease Control and Prevention ; 25(4):405-410, 2021.
Article in Chinese | Scopus | ID: covidwho-1566854

ABSTRACT

Objective To explore the lag effect of daily average temperature on the incidence of coronavirus disease 2019 (COVID-19) in Hunan Province and to provide scientific evidences for effective prevention of COVID-19.  Methods  The meteorological factors, the air quality factors and the data conincidence of COVID-19 reported in Hunan Province during January 21, 2020 to March 2, 2020 were collected. Spearman correlation and distributed lag non-linear model analysis were performed.  Results  A total of 1 018 COVID-19 cases were reported in Hunan Province. The distribution lag non-linear model results showed that the influence of daily average temperature on the incidence of COVID-19 presented a nonlinear relationship. The cumulative relative incidence risk of COVID-19 decreased with the increase of daily average temperature, and the lowest temperature risk of the patients was 0 ℃. Both cold temperature and hot temperature increased incidence risk of COVID-19. It was indicated that the hot effects were immediate, however, the cold effects with obvious lag effect persisted up to 12 days. The highest relative risk of COVID-19 incidence was associated with lag 8-day daily average temperature of -5 ℃(RR=2.20, 95% CI=1.16-4.19). The influence of high temperature(10 ℃) was more significant than that of low temperature(6 ℃).  Conclusion  The daily average temperature, especially cold or hot temperature, was an important influencing factor of the incidence of COVID-19 in Hunan Province, which had lag influence on the incidence of COVID-19. We suggested that some related preventive measures should be adopted to protect vulnerable population and severe patients to reduce the incidence risk. © 2021, Publication Centre of Anhui Medical University. All rights reserved.

11.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-293569

ABSTRACT

SARS-CoV-2 mRNA vaccines have shown remarkable efficacy, especially in preventing severe illness and hospitalization. However, the emergence of several variants of concern and reports of declining antibody levels have raised uncertainty about the durability of immune memory following vaccination. In this study, we longitudinally profiled both antibody and cellular immune responses in SARS-CoV-2 naive and recovered individuals from pre-vaccine baseline to 6 months post-mRNA vaccination. Antibody and neutralizing titers decayed from peak levels but remained detectable in all subjects at 6 months post-vaccination. Functional memory B cell responses, including those specific for the receptor binding domain (RBD) of the Alpha (B.1.1.7), Beta (B.1.351), and Delta (B.1.617.2) variants, were also efficiently generated by mRNA vaccination and continued to increase in frequency between 3 and 6 months post-vaccination. Notably, most memory B cells induced by mRNA vaccines were capable of cross-binding variants of concern, and B cell receptor sequencing revealed significantly more hypermutation in these RBD variant-binding clones compared to clones that exclusively bound wild-type RBD. Moreover, the percent of variant cross-binding memory B cells was higher in vaccinees than individuals who recovered from mild COVID-19. mRNA vaccination also generated antigen-specific CD8+ T cells and durable memory CD4+ T cells in most individuals, with early CD4+ T cell responses correlating with humoral immunity at later timepoints. These findings demonstrate robust, multi-component humoral and cellular immune memory to SARS-CoV-2 and current variants of concern for at least 6 months after mRNA vaccination. Finally, we observed that boosting of pre-existing immunity with mRNA vaccination in SARS-CoV-2 recovered individuals primarily increased antibody responses in the short-term without significantly altering antibody decay rates or long-term B and T cell memory. Together, this study provides insights into the generation and evolution of vaccine-induced immunity to SARS-CoV-2, including variants of concern, and has implications for future booster strategies. Graphical abstract:

12.
American Journal of Respiratory and Critical Care Medicine ; 203(9):1, 2021.
Article in English | Web of Science | ID: covidwho-1407319
13.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277253

ABSTRACT

Introduction: Coronavirus Disease 2019 (COVID-19) testing has grown exponentially in the United States since the dawn of the pandemic, with the vast majority of samples being obtained via nasopharyngeal swab. Although convenient and widely used, the test itself carries potential adverse effects, particularly those at high risk of bleeding. We present a patient who developed several arrays of complications after being tested for COVID-19 using the nasal swab sampling technique. Case Presentation: An 80-yo female presented from home with a complaint of hematuria. Her past medical history includes rheumatic heart disease status post repair on warfarin, atrial fibrillation and stroke. Vital signs were normal. She had benign head and neck exam, clear lung sounds, an irregular heart rhythm and a normal abdominal exam. Labs were at baseline with hemoglobin of 10.4. Chest x-ray and CT abdomen were unremarkable. She received a PCR nasopharyngeal swab in the emergency room and subsequently developed profuse epistaxis. Initial nasal packing and Afrin sprays failed to control the bleeding and she required emergent intubation for airway protection. She also needed vasopressors due to hypotension. Repeat hemoglobin was 7.5 and lactic acid was 10.4. Bleeding eventually stopped after continuous nasal packing, transfusional support and IV vitamin K. In the following days, she developed fever, leukocytosis and lung infiltrates. She received empiric antibiotic coverage, although no growth from cultures. Endoscopy findings were consistent with ischemic colitis. Later, she stabilized hemodynamically but was unable to be liberated from the ventilator. She was discharge to a long-term care facility after 43 days of stay. Discussion: Nasopharyngeal swabs are the mainstay of testing for COVID-19, however, little has been discussed regarding its procedural risks. Common adverse effects include headaches, nasal pain, ear discomfort and rhinorrhea. Recent studies have suggested that the incidence of epistaxis can be as high as 10% after the test. Alternatively, multiple research centers, including Yale and University of Illinois have released promising data on saliva-based testing. Their evidence supported high sensitivity comparable to the nasopharyngeal method with simpler and safer nature. Also, the saliva-based testing can be done at home, which is believed to reduce healthcare cost and lower the risk of cross infection. This case vividly demonstrates that even the most common procedure can result in devastating outcomes. As such, health care providers should be cognizant of these complications and consider alternative testing method when possible.

14.
IEEE Internet of Things Journal ; 2021.
Article in English | Scopus | ID: covidwho-1238339

ABSTRACT

Driven by an increasing number of connected medical devices, Internet of Medical Things (IoMT), as an application of Internet of Things (IoT) in healthcare, is developed to help collect, analyze and transmit medical data. During the outbreak of pandemic like COVID-19, IoMT can be useful to monitor the status of patients and detect main symptoms remotely, by using various smart sensors. However, due to the lack of emotional care in current IoMT, it is still a challenge to reach an efficient medical process. Especially under COVID-19, there is a need to monitor emotion status among particular people like elderly. In this work, we propose an emotion-aware healthcare monitoring system in IoMT, based on brainwaves. With the fast development of EEG (electroencephalography) sensors in current headsets and some devices, brainwave-based emotion detection becomes feasible. The IoMT devices are used to capture the brainwaves of a patient in a scenario of smart home. Also, our system involves the analysis of touch behavior as the second layer to enhance the brainwave-based emotion recognition. In the user study with 60 participants, the results indicate the viability and effectiveness of our approach in detecting emotion like comfortable and uncomfortable, which can complement existing emotion-aware healthcare applications and mechanisms. IEEE

15.
Chest ; 158(4):A366, 2020.
Article in English | EMBASE | ID: covidwho-866532

ABSTRACT

SESSION TITLE: Fellows Chest Infections Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Since December 2019, the coronavirus disease 2019 (COVID-19) outbreak has resulted in widespread transmission and death. Understanding how this viral pneumonia causes acute lung injury is evolving, but it typically manifests as peripheral bilateral ground glass on chest imaging. We report a unique case of a COVID-19 patient who presented with a new isolated left pleural effusion that is likely a sequela of the infection. CASE PRESENTATION: A 25-year-old female with no co-morbidities was seen in ED at another hospital for flu-like symptoms and found to have COVID-19. At that time, her chest radiograph showed hazy opacities overlying left greater than right lung lobes consistent with multifocal pneumonia. She was discharged home on doxycycline. Patient felt better following discharge but then presented to our hospital four weeks later with left sided pleuritic chest pain of two weeks duration. She denied any fever, cough, recent travel, or sick contacts. Vital signs were: T 99.4 F, HR 97, BP 109/76, RR 20, and 96 % O2 saturation on room air. Physical exam was significant for decreased air entry at left lung base. A comprehensive metabolic panel, complete blood count, troponins, BNP, and LDH were within normal limits. However, D-dimer was elevated. Both chest radiograph and CT chest angiogram showed a new moderate left pleural effusion, but in addition CT showed ground glass opacities in the left upper and right lower lung lobes noted on the CT. Patient was started on empiric antibiotics. Her symptoms improved after 700 cc of serous pleural fluid was drained via a pigtail catheter. Pleural fluid analysis showed an overtly exudative fluid with protein ratio of 0.74 and LDH ratio of 3.08 with fluid LDH of 719. Other pertinent fluid analysis revealed: pH 7.5, WBC 9744 with 60% neutrophils, with no organisms on gram stain or culture. Fluid cytology showed numerous acute and chronic inflammatory cells and few macrophages admixed with degenerated cells. Patient underwent repeat COVID-19 testing via the nasal swab and pleural fluid PCR, which were both negative. DISCUSSION: Pleural effusions can be related to diseases of the lungs and heart or to a systemic disease. To treat pleural effusions, it is important to determine the etiology. In this case, given the patient’s history of COVID-19 infection and exclusion of all other causes, the exudative predominantly neutrophilic pleural effusion most likely reflected a parapneumonic effusion. CONCLUSIONS: COVID-19 can present with non-specific imaging findings;however, to our knowledge, an isolated pleural effusion has not been reported in patients with COVID-19. Reference #1: McIntosh K, Hirsch Martin, Bloom A. Coronavirus disease 2019 (COVID-19): Clinical features and diagnosis. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate;2020. www.uptodate.com. Accessed May 31, 2020. Reference #2: Hani C et al. COVID-19 pneumonia: A review of typical CT findings and differential diagnosis. Diagn Interv Imaging. 2020;101(5): 263-268. doi: 10.1016/j.diii.2020.03.014 Reference #3: Bernheim A et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology. 2020;295(3): 685-691. doi:10.1148/radiol.2020200463 DISCLOSURES: No relevant relationships by Sharath Bellary, source=Web Response No relevant relationships by Sudipa Chowdhury, source=Web Response No relevant relationships by William Meng, source=Web Response No relevant relationships by Richard Miller, source=Web Response No relevant relationships by SUMITANAND MISHRA, source=Web Response No relevant relationships by Rutwik Patel, source=Web Response No relevant relationships by Hari Sharma, source=Web Response

16.
Chest ; 158(4):A364-A365, 2020.
Article in English | EMBASE | ID: covidwho-860880

ABSTRACT

SESSION TITLE: Fellows Chest Infections Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: From Raja Ampat, Indonesia to the Red Sea of Indian Ocean, marine corals have attracted myriad of divers and hobbyists around the world with their rainbow-like colors, assorted shapes and unique symbiotic roles. However, certain species contain some of the deadliest toxins known to human that can subject handlers to health problems and even life-threatening conditions. We report a case of Palythoa coral exposure induced respiratory failure. CASE PRESENTATION: A 44-year-old man with childhood asthma presented to the emergency room with sudden onset of shortness of breath. His symptoms started one hour prior to his arrival and included chills, dyspnea, chest tightness, pleuritic pain and nausea. Further questioning revealed that our patient was cleaning some Palythoa sp. corals out from his saltwater aquarium two hours before he fell sick. He ran a piece of coral over hot water to kill it. It emitted a strong foul odor immediately afterwards. He had never attempted such cleaning process before. He was not wearing any protective equipment but denied using any cleaning chemicals. There was no other pertinent history. Initial vital signs included heart rate of 117, respiratory rate of 28 bpm, blood pressure 123/59, and oxygen saturation of 97% on 75%, 40 liters/min High-Flow Nasal Canula. He was in mild distress. Auscultation revealed decreased bilateral air entry, faint wheezing and mild apical rales. Cardiac, abdominal and neurological exams were otherwise benign. ABG showed pH of 7.42, PaCO2 41, PaO2 52 and HCO3 26. Chest CT revealed diffuse centrilobular ground-glass opacities in an upper-lobe-predominant distribution. Lab studies were significant for lactic acid of 3.4, troponin of 0.44 and BNP at 666 pg/ml. CRP was 293 mg/L and procalcitonin of 15. WBC was 27.3 with 85% neutrophils without eosinophilia. Complete septic workups including atypical pneumonia pathogens, HIV and COVID-19 were negative. Patient’s symptoms subsequently improved with nebulized albuterol treatments, IV steroids and supplemental oxygen. He remained on regular floor with intent for discharge in the following days. DISCUSSION: Palytoxin (PTX), originally described in a Hawaiian legend, is an extremely poisonous substance synthesized by certain species of corals and dinoflagellates. Its lethal power stems from the ability of inactivating the sodium/potassium ATPase pump, thereby destroying cellular ion gradient. Ensuing cardiac, respiratory, renal and hematologic dysfunctions have been observed. Fewer than 300 cases were ever reported worldwide. Most were due to ingestion of contaminated fish, though dermal and inhalational exposure, such as our patient, have been documented. CONCLUSIONS: It thus becomes necessary to take PTX poisoning into consideration, whenever compatible history is provided. While in vitro and in vivo animal studies have been conducted, there is no known antidote. Management is usually supportive. Reference #1: Hamade AK, Deglin SE, McLaughlin JB, et al. Suspected Palytoxin Inhalation Exposures Associated with Zoanthid Corals in Aquarium Shops and Homes - Alaska, 2012-2014. MMWR Morb Mortal Wkly Rep 2015;64:852. Reference #2: Ramos V, Vasconcelos V. Palytoxin and analogs: biological and ecological effects. Mar Drugs. 2010;8(7):2021-2037. Published 2010 Jun 30. doi:10.3390/md8072021 Reference #3: Thakur LK, Jha KK. Palytoxin-induced acute respiratory failure. Respir Med Case Rep. 2016;20:4-6. Published 2016 Oct 21. doi:10.1016/j.rmcr.2016.10.014 DISCLOSURES: No relevant relationships by Mourad Ismail, source=Web Response No relevant relationships by TAWFIQ KARADSHEH, source=Web Response No relevant relationships by William Meng, source=Web Response No relevant relationships by Richard Miller, source=Web Response No relevant relationships by Roberto Solis, source=Web Response No relevant relationships by Yasmeen Sultana, source=Web Response no disclosure on file for Qizhi Wang

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