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1.
CEUR Workshop Proceedings ; 3395:314-319, 2022.
Article in English | Scopus | ID: covidwho-20240287

ABSTRACT

This paper describes my work for the Information Retrieval from Microblogs during Disasters.This track is divided into two sub-tasks. Task 1 is to build an effective classifier for 3-class classification on tweets with respect to the stance reflected towards COVID-19 vaccines.Task 2 is to devise an effective classifier for 4-class classification on tweets that can detect tweets that report someone experiencing COVID-19 symptoms.This paper proposes a classification method based on MLP classifier model.The evaluation shows the performance of our approach, which achieved 0.304 on F-Score in Task 1 and 0.239 on F-Score in Task 2. © 2022 Copyright for this paper by its authors.

2.
4th International Conference on Advances in Computing, Communication Control and Networking, ICAC3N 2022 ; : 770-777, 2022.
Article in English | Scopus | ID: covidwho-2303838

ABSTRACT

This paper presents a new methodology and a comparative study using past stock market data that can help businesses take investing or divesting decisions in critical situations in the future. These may be like the COVID-19 pandemic, where market volatility is extremely high, thus creating an urgent need for better decision support systems to minimise loss and ensure better profits. The results of the study are based on the comparison of different configurations of ARIMAX, Prophet, LSTM and Bidirectional LSTM Models trained on historical NSE data. By understanding the correlation and variations in the data processing and model training parameters, we have successfully proposed a LSTM neural network model training and optimising method which could successfully help businesses take both long and short term profitable decisions before and after big financial and market crises with a respective accuracy of 98.60 percent and 96.97 percent. © 2022 IEEE.

3.
Indian Journal of Occupational and Environmental Medicine ; 26(1):39, 2022.
Article in English | EMBASE | ID: covidwho-2273561

ABSTRACT

Introduction: Stress and the ability to cope with stress can influence the health and performance of laboratory technicians. This is especially true in the current circumstances of a global pandemic which has placed a tremendous amount of stress on healthcare professionals, including laboratory technicians. However, there is little to no research in India about the relationship between stress and coping abilities and its influence on health and work performance. Objective(s): To assess the self-reported stress levels, perceived coping effectiveness, coping techniques & health behaviours of lab technicians. Material(s) and Method(s): A cross-sectional observational study was done using a structured questionnaire among 152 lab technicians working in a lab chain across 3 states in Western India. Result(s): The responses indicated that the lab technicians had less than ideal stress levels. 80.3% reported moderate-to-very high stress levels;51.3% slept less than 8 hours of sleep per night;53.3 to 61.2% did not exercise regularly;30.9% consumed less than 2 servings of fruits and vegetables per day;and 9.2% were classified as binge drinkers. When confronted with workplace stress, 34.1% reported that they consumed more food than usual (28.3% reported that they consumed more junk food), 48.1% reported a loss of appetite and eating less food than usual, 45.4% reported losing sleep. Lab technicians in the "high stress and poor coping" group reported a statistically significant higher number of days feeling worried, tense or anxious, sad or depressed. The attitudes of lab technicians to preventive health in the COVID-19 pandemic (especially considering the increased risk of co-morbidities during the COVID-19 pandemic) were also less than ideal: 83.6% did not undergo a preventive health check-up package in the past year, 55.9% had not visited a doctor for a general physical exam in the past year. Conclusion(s): Given the amount of stress and work that has been placed on the diagnostic industry over the past 2 years, it is imperative that we understand the stress levels, coping adequacy and health behaviours of lab technicians who form the backbone of the industry. As the results of this pilot study show, there is an immediate need to implement worksite health promotion programmes focusing on stress reduction, stress management and the development of healthy coping skills.

4.
Indian Journal of Hematology and Blood Transfusion ; 38(Supplement 1):S8, 2022.
Article in English | EMBASE | ID: covidwho-2175131

ABSTRACT

Introduction: Autologous stem cell transplant (ASCT) remains the backbone therapeutic modality with the highest progression-free survival (PFS) and overall survival (OS) benefit even in the era of the novel agents in newly diagnosed multiple myeloma (NDMM). The survival post-transplant can be prolonged using maintenance therapies. The regimen with maximum benefit is still debated, with bortezomib showing PFS benefit even in the high-risk myeloma. Aims & Objectives: This randomized phase II trial is aimed at studying the efficacy (as measured by overall survival (OS), progression- free survival (PFS)), and safety of post-ASCT different maintenance regimens in patients with NDMM. Material(s) and Method(s): Multicentric open-label interventional study with randomized allocation, parallel assignment, with intention-totreat analysis. Recruitment was prospective starting 01 Jan 2017, including all NDMM patients eligible for the study. Remission status was evaluated at D100 and every 6 months for 2y post-ASCT, including MRD analysis by multicolor flow cytometry (MFC) and PET/CT. The four arms included (Arm-A) bortezomib alone (V), (Arm-B) bortezomib in combination with cyclophosphamide and dexamethasone (VCD), (Arm-C) bortezomib in combination with lenalidomide (VR), and (Arm-D) Lenalidomide starting D100 till 2y post-ASCT. Adverse events with CTACE grade<2 were defined as non-serious and the rest as serious. JMP ver. 13 was used for statistical analysis and p<0.05 was considered significant. Kaplan Meier statistics was used for survival analysis. Result(s): A total of 123 patients have enrolled of which 92 patients completed the study protocol and the rest 31 patients were excluded because of protocol deviation due to the COVID pandemic. The median age of the study population was 54.5y (35-76y) with a male preponderance (67%). There was no statistically significant difference between the four arms on the log-rank test in the OS (p-0.99), clinical PFS (p-0.65), biochemical PFS (p-0.6), or MFC-based PFS (p-0.83). There was a statistically significant difference between the four arms on the log-rank test (p-0.0185) on PET/CT-based PFS (PFS being in a descending order VCD>V>VR>R regimen). The all-cause mortality of the study participants was 19.57% (n-18) and the difference in deaths among the various groups was not statistically significant (p-0.85). The tolerability, serious and non-serious adverse were significantly higher amongst Arm D patients. Conclusion(s): We conclude that there was no difference in OS between the different regimens. Patients on Lenalidomide-only therapy had significantly inferior Imaging-PFS.

5.
Indian Journal of Hematology and Blood Transfusion ; 38(Supplement 1):S78-S79, 2022.
Article in English | EMBASE | ID: covidwho-2175095

ABSTRACT

Introduction: Hemophagocytic Lymphohistiocytosis (HLH) is an aberrant hyperinflammatory immune response syndrome that can lead to a potentially fatal cytokine storm. Malignancy-associated HLH (Mal-HLH) is rare and can complicate the preexisting illness, leading to fatal outcomes. We present 3 cases with Mal-HLH, their diverse clinical presentation and outcomes following treatment with HLH 2004 protocol. Aims & Objectives: To observe the response, outcomes and complications of Mal-HLH following treatment with HLH 2004 protocol while simultaneously treating the underlying cause. Material(s) and Method(s): In April 2022, three cases presented with persistent fever and pancytopenia. Case 1 had Myelodysplastic syndrome Excess Blasts -1, RIPSS -high risk on Azacitidine and Venetoclax therapy with disease remission and presence of EBV viremia. Case 2 had Acute myeloid leukemia FLT3-TKD, NPM1 mutated,46XX, ELN- intermediate risk post-induction chemotherapy in morphological remission but with Minimal residual disease (MRD) positive. Case 3 had of T cell histiocyte-rich large B cell lymphoma stage 4, IPI- high risk with disease relapse post autologous stem cell transplant (AutoHCT) and on salvage chemotherapy. Extensive infective workup was negative, and fever was unresponsive to antimicrobials. HLH was suspected and patients were evaluated as per 1994 HLH diagnostic criteria followed by primary disease status evaluation. Treatment and assessment of the outcomes was done on the lines of the HLH 2004 protocol. Result(s): Patient characteristics and parameters with outcomes are shown in table 1. At 2 weeks, case 1 and case 2 showed a partial response short of a clinical response while case 3 showed a complete clinical response. At 8 weeks, case 1 had flare of HLH activity and case 2 endured a RhinocerebroorbitalMucormycosis, both succumbed to complications of the above, while case 3 had complete resolution of HLH. At 11 weeks, case 3 contracted a COVID 19 infection followed by HLH reactivation at 14 weeks and is currently under treatment for the same. Conclusion(s): Mal-HLH can have varied precipitating causes other than the underlying disease itself leading to fatal outcomes despite adequate treatment. Hence, a high index of clinical suspicion, timely evaluation and aggressive treatment of the underlying cause is prudent. (Figure Presented).

7.
NeuroQuantology ; 20(8):3642-3648, 2022.
Article in English | EMBASE | ID: covidwho-2006540

ABSTRACT

Mucormycosis is a rare and devastating disease caused by a ubiquitous fungus that belongs to the class Zygomycetes and order Mucorales.It is an opportunistic fungal infection which is most commonly seen in immunocompromised patients.The pandemic coronavirus disease 2019 (COVID-19) continues to be a significant problem worldwide.SARS-COV-2 is a cytokine storm syndrome that causes severe immunosuppression that might compromise the host response and increase the risk to develop opportunistic infections. There are several cases which have shown occurrence of Mucormycosis in patients who have a history of COVID-19. Therefore this review will highlight about the fungal infection Mucormycosis and its relation with COVID 19 disease.

8.
Gastroenterology ; 162(7):S-959, 2022.
Article in English | EMBASE | ID: covidwho-1967384

ABSTRACT

Introduction: Immunosuppressed individuals are at higher risk for COVID-19 and resulting complications, yet robust data in patients with Inflammatory Bowel Disease (IBD) are lacking. We evaluated the risk of COVID-19-related hospitalization and severe sequelae in a large, population-based U.S. cohort of patients with IBD. Methods: We conducted a retrospective cohort study utilizing insurance claims data from two large U.S. health plans (Anthem and Humana). Cohort follow-up began on 1 March 2020, the beginning of the COVID-19 pandemic in the US. We included IBD patients identified by two diagnosis codes for Crohn's disease (CD) or ulcerative colitis (UC) or one diagnosis code plus a treatment code for an IBD-specific medication in the six months prior to cohort entry. Use of IBD medications was ascertained in the 90 days prior to cohort entry. Study outcomes included COVID-19 hospitalization, mechanical ventilation, and inpatient death. Patients were followed until outcome of interest, death, disenrollment, or end of the study period. We described the occurrence of COVID-19 outcomes according to IBD treatment status ascertained prior to cohort entry. Results: The study population included 102,989 patients (48,728 CD, 47,592 UC) with a mean age of 53 years;55% were female. Overall, 412 (0.4%) patients were hospitalized for COVID-19. Individuals treated with systemic corticosteroids were more likely to be hospitalized than those treated with any other non-steroid medication (0.6% vs 0.3%, p=<.0001). Among patients not treated with corticosteroids, patients receiving anti-TNF were less likely to be hospitalized than those treated with other medication classes (0.2% vs 0.5%, p=<.0001) or no medications (0.5%, p=<.0001). Older age was associated with increased incidence of hospitalization for COVID-19. Overall, 71 patients (0.07%) required mechanical ventilation and 52 (0.05%) died at the hospital due to COVID-19 or resulting complications. The proportion of patients requiring mechanical ventilation or dying was higher amongst users of corticosteroids versus those treated with any other non-steroid medication (1.9% vs 0.05%, p=<.0001 and 0.1% vs 0.04%, p=0.0015) respectively). Associations between corticosteroid use all outcomes were similar across age groups. Conclusion: Among patients with IBD, those treated with systemic corticosteroids had more frequent hospitalization, mechanical ventilation, and death from COVID-19 as compared to patients on other treatments or no treatment at all. Anti-TNF therapy was associated with a decreased occurrence of hospitalization. This finding reinforces previous guidance to taper and/or discontinue corticosteroids to reduce the risk of infections, including COVID-19. Use of steroid-sparing maintenance treatments such as anti-TNF agents appears to be safe.

9.
Journal of Clinical and Diagnostic Research ; 16(4):LC37-LC42, 2022.
Article in English | EMBASE | ID: covidwho-1791828

ABSTRACT

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has imposed an unprecedented burden on our healthcare system. Serological testing for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) antibodies serves as an useful marker for determining an infection by the virus in the recent past and the immune response. The immune response, including the humoral response to the infection is one of them and the knowledge in this area is still evolving. Virus specific antibodies are expected to help in eliminating the virus and to provide protective immunity against reinfection. Aim: To serially monitor the total antibody response to SARSCoV-2 in order to gain better insight into the duration of antibody persistence. Materials and Methods: This prospective observational study was conducted in 66 Healthcare Workers (HCW) with a history of Reverse Transcription- Polymerase Chain Reaction (RT-PCR) proven COVID-19 infection. The study was conducted between May 2020 to April 2021 at the Suburban diagnostics Central Processing Laboratory, Mumbai, Maharashtra, India. Serum samples were serially examined for the presence of total antibodies against the Nucleocapsid (N) protein of SARS-CoV-2 upto 180 days postinfection. A further follow-up examination was done at 360 days. A qualitative Electrochemiluminescence Immunoassay (ECLIA) assay was used for assessment of the antibody response. The chi-square or Fisher-exact test was used to compare categorical variables and the Mann-Whitney U test, Kruskal Wallis test and student t-test were used to compare continuous variables across groups. For assessing relationship between variables, the Pearson test or linear regression were used as appropriate. Results: Out of 66 healthcare workers, 32 were male (48.5%) and 34 were females (51.5%) with the median age of 29.5 years. Out of 66 cases, 62 (94%) cases developed antibodies against SARS-CoV-2 at different time intervals, 48 cases during the 14-30 day interval, 10 cases during the 31-60 day interval, three cases during the 61-90 day interval and one case during the 90-120 days interval. Thirty one out of 35 (88%) cases that could be followed-up at 360 days showed persistence of antibodies. No patient reported symptoms which would warrant a repeat RT-PCR test. Conclusion: This study showed that the antibody response to SARS-CoV-2 virus was sustained for 12 months postinfection in most cases. The absence of fresh infection in these cases during the study period suggests that the antibodies might protect against reinfection with the virus. So, it may be safe to defer vaccination in postinfection cases by 6-9 months thereby saving precious resources.

10.
Asia Pacific Journal of Innovation in Hospitality and Tourism ; 10(1):81-94, 2021.
Article in English | CAB Abstracts | ID: covidwho-1573346

ABSTRACT

The Movement Control Order (MCO) and travel restrictions to contain the COVID-19 pandemic have taken a toll on Malaysian tourism and hospitality businesses. Notably, the tourism business's disruption is likely to continue for many months to come or beyond, causing unrest to the Malaysian economic sustainability. This study aims to comprehend the current tourism business trends, the impacts, and the needs arising from the COVID-19 pandemic. Consequently, this study gauges the tourism industry's resilience and readiness amid the Malaysian government fiscal policies and Central Bank financial support. The pandemic's impact has been immediate, as respondents for this study reported a decrease in their tourism sales and revenue. Most respondents reacted positively to the government's support. However, they are still uncertain of the industry's future outlook. This study recommends that the Malaysian government provide industry players with additional and tailor-made financial measures to support the tourism industry efficiently.

11.
Dubai Med. J. ; : 6, 2021.
Article in English | Web of Science | ID: covidwho-1448075

ABSTRACT

Background: COVID-19 patients are at increased risk of coagulopathy. This coagulopathy may be due to a severe pro-inflammatory state (cytokine storm) and/or by viral sepsis. This can sometimes lead to consumption coagulopathy and decreased platelet count, leading to increased risk of bleeding and may manifest like hematomas in atypical locations. These bleeding manifestations may be spontaneous or can be induced by even minor trauma. Cases: It is a single-center retrospective analysis. Four patients with a confirmed diagnosis of COVID-19 depicting increased risk of bleeding manifestations were included. Patients in our study were managed as per guidelines recommended by the Ministry of Health and Family Welfare Directorate General of Health Services, Government of India. Results: All patients were male. The mean age was 56 +/- 18.64 years. One patient was managed conservatively with discontinuation of anticoagulants, volume resuscitation, and transfusion of blood products. Drainage with incision was done for 2 patients. One was managed with pigtail drainage. Conclusion: The effect of anticoagulants given in therapy and their varied presentations are discussed in this article. The article concludes that we need vigilant observation to identify this complication in the early period, resulting in successful management.

12.
Lecture Notes on Data Engineering and Communications Technologies ; 70:313-324, 2021.
Article in English | Scopus | ID: covidwho-1366336

ABSTRACT

COVID-19, an uninvited visitor, is working its way through raising a major global health issue. Public health officials suggest little or no human involvement to prevent the virus from spreading any further. This situation caused a lockdown by several nations. Such uncommon times have set the nations a daunting task of finding a balance between reopening the economy and avoiding a second wave of infections. No sectors have been left unaffected by the virus’s harsh effects. During these times, it proved difficult to meet the demand for essential commodities on time. The current supply chain management strategy failed to meet the demand. In this paper, an informal network of the ‘Decentralized Supply Chain Management’ is proposed which aims to overcome the current problems in the supply chain management. The architecture consists of four versatile layers in which data processing, automation, real-time data visibility, monitoring and quality assurance are integrated. © 2021, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

13.
Med J Armed Forces India ; 77: S398-S403, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1333642

ABSTRACT

BACKGROUND: The issue of vertical transmission of SARS-CoV-2 infection to the foetus has not yet been resolved. Its main reason is lack of a bigger study to analyse this question. The evidence of the affection of the foetus during antenatal or intrapartum period is limited to some anecdotal reports. To look for the possibility of vertical transmission of Severe Acute Respiratory Syndrome - Corona Virus-2 (SARS-CoV-2) infection to the foetus, this prospective pilot study was conducted at a tertiary health care COVID-19 designated centre of Armed Forces. METHODS: This study was conducted during 01 June 2020 and 15 October 2020 and included 54 covid-positive pregnant mothers. During delivery, amniotic fluid and cord blood samples were collected in a sterile manner. Amniotic fluid samples were not collected during vaginal deliveries as chances of contamination was very high. These samples were tested for the presence of SARS-CoV-2 gene by Reverse Transcriptasee Polymerase Chain Reaction (RT-PCR) test, and the results were analysed. Newborns were allowed to room in with mother, and they underwent throat and nasal swab RT-PCR testing of covid within 24-48 h of delivery. RESULTS: A total of 1520 pregnant mothers underwent RT-PCR test during the study period. Total positivity rate among our pregnant women was 2.8%. Out of 54 covid-positive women during the study period, amniotic fluid RT-PCR tests were carried out for 43 women, and cord blood was tested for 45 women. CONCLUSION: RT-PCR test of amniotic fluid, cord blood and nasal and throat swab of all newborns delivered by SARS-CoV-2-positive pregnant women were negative. Based on our study, the possibility of intrauterine vertical transmission of SARS-CoV-2 infection appears to be unlikely.

14.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277100

ABSTRACT

Rationale: Interruptions in usual care and changes in health management behaviors due to COVID-19 pandemic is of particular concern for patients with predisposing, chronic comorbidities, such as respiratory illness. We present an interim analysis of the Understanding Community Considerations, Opinions, Values, Impacts, and Decisions in COVID-19 (UC-COVID) Study, focusing on how people with asthma view their own health and changes to their health behaviors and access to healthcare during the COVID-19 pandemic. Methods: Data were collected from a web-based national survey aimed at understanding the effects of the COVID-19 pandemic, with responses collected between May 8 and September 30, 2020. We analyzed responses of 314 respondents (18 years or older) who reported a diagnosis of asthma. Descriptive analyses were completed to characterize how this population has perceived the impact of the pandemic on their health and access to care. Results: Of the 314 respondents with asthma, the mean age was 50 years (SD±15), with 78% female, 11% Hispanic/Latinx ethnicity, and 16% non-White race. This population was 61% employed and 98.7% had some form of insurance. In the past 12 months, 42% of respondents reported an asthma exacerbation. Respondents reported a median of 5 poor mental health days [IQR 0-10] and 1 poor physical health days [IQR 0-5] in the preceding 30 days. Exercise habits changed in 60% and 86% attributed this change to the COVID-19 pandemic. Of the 21 current smokers, 76% changed their smoking habits and 81% attributed the change to COVID-19. In this population, 88% had a primary healthcare provider and 79% had seen this provider in the past year. Since March 1, 2020, 61% of respondents reported having to cancel, reschedule or change a healthcare appointment for themselves due to pandemic-related reasons. In this same time period, 57% delayed care for a health issue for which they felt they should see a provider but delayed a visit due to COVID-19. In 20% of these cases, the health issue was reported as moderately or extremely serious. Of those 57% who delayed care, 7% reported something bad happening as a result of the delay. Conclusions: In this sample, there was noteworthy rate of health habit change directly attributed to the COVID-19 pandemic. The majority of respondents delayed care due to COVID-19 and some reported negative outcomes from this delay. For those with asthma, a delay in addressing an attack or episode can be particularly dangerous during a respiratory pandemic.

15.
Bjog-an International Journal of Obstetrics and Gynaecology ; 128:25-26, 2021.
Article in English | Web of Science | ID: covidwho-1271342
16.
Bjog-an International Journal of Obstetrics and Gynaecology ; 128:125-126, 2021.
Article in English | Web of Science | ID: covidwho-1250332
17.
Epidemiologic Methods ; 9(s1), 2020.
Article in English | Scopus | ID: covidwho-1040072

ABSTRACT

Meteorological factors and climatic variability have an immense influence on the transmission of infectious diseases and significantly impact human health. Present study quantifies the delayed effect of atmospheric temperature on the risk of hospitalization due to the Coronavirus disease 2019 (COVID-19) with adjusting the effects of other environmental factors in Mumbai, India. The daily reported data of the number of hospitalized COVID-19 positive cases and the environmental factors at Mumbai, Maharashtra, India were collected and analyzed to quantify the main and the delayed effects. Exploratory data analysis and Distributed Linear and Non-linear lag Model (DLNM) with Generalized Additive Model (GAM) specification have applied to analyze the data. The study identified the Diurnal Temperature Range (DTR) delayed effect on the risk of hospitalization changed over the lag period of 0-14 days with increasing Relative Risk (RR) at the low DTR and decreasing RR at the higher DTR values. The extreme DTR suggests a high risk of hospitalization at earlier lags (i.e., 0-5 days). DTR's cumulative effect was significant at higher 0-10 lag days (p-value <0.05). Exposure to the low and moderate DTR suggests a high risk of hospitalization with more than six days of lag. The RR for daily average humidity with 95% C.I was 0.996 (0.967, 1.027). The risk of hospitalization due to COVID-19 showed an increasing nature (p-value <0.05) with the increase in air pollution and average wind speed (WSAvg) at lag 0. Also, the risk of hospitalization changed through different lag periods of DTR. The analysis confirms the higher amount of delayed effect due to low DTR compared with moderate and high DTR. The study suggests that both the climatic variations and air quality have significant impact on the transmission of the global pandemic COVID-19. © 2020 Walter de Gruyter GmbH, Berlin/Boston.

18.
Journal of the American Society of Nephrology ; 31:278-279, 2020.
Article in English | EMBASE | ID: covidwho-984635

ABSTRACT

Background: There is limited information on the presentation and risk factors for poor outcome in kidney transplant recipients with COVID-19. Methods: We reviewed data of admitted kidney transplant recipients at 12 system hospitals with COVID-19 between March 1, 2020, and April 30th, 2020. We analyzed risk factors for mortality. Results: 31 patients were identified, 30 were admitted. Median age was 58 (IQR 53- 68), 61% male, 32% Caucasian, 29% African American, 29% multiracial and 6% Asian. Median time from transplant to COVID-19 testing was 1178 days (IQR 252-2897). The most common symptom was cough, followed by fever, shortness of breath and fatigue. Chest X-ray/CT revealed multifocal patchy opacities. Ten patients required mechanical ventilation. Laboratory markers can be seen in the table. Acute kidney injury occurred in 39% of patients. The majority of patients were on triple immunosuppression (94% on tacrolimus, 90% on mycophenolate, and 74% on prednisone). During the hospital course 87% had the antimetabolite stopped while 35% had CNI stopped. Treatments utilized included hydroxychloroquine (93%), azithromycin (50%), convalescent plasma (14%), IL-6 inhibitor (10%) and 1 received remdesivir. At a median follow up of 19 days (IQR 8 - 26) 10 patients died. Risk of death was greater if the patient was admitted to a nontransplant hospital (80% vs 23%, p=0.027), lymphopenic at presentation (47% vs 8%, p=0.013 or had O2 saturation less than 94% upon admission (100% vs 57%, p=0.03). During hospitalization mortality was also higher in patients with higher peak serum creatinine (3.2 mg/dl vs 1.5 mg/dl, p=0.013), or if requiring intubated (70% vs 14%, p<0.001). Increase in inflammatory markers including peak D-dimer, peak CRP, ferritin and procalcitonin were also predictive of mortality. Conclusions: Kidney transplant recipients with COVID-19 should be monitored closely in a transplant center. Mortality is high, particularly in patients presenting with lymphopenia and hypoxemia.

19.
Journal of the American Society of Nephrology ; 31:285, 2020.
Article in English | EMBASE | ID: covidwho-984634

ABSTRACT

Background: Recent publications report great variations in the clinical course and mortality of COVID-19 in solid organ transplant (SOT) recipients. It is unclear whether these differences are related to study methods, treatment choices, or variables associated with patient populations. Methods: We reviewed and summarized 9 published articles of COVID-19 in solid organ transplant recipients. We contrasted difference between study design and compared outcomes. Results: All studies included kidney transplant recipients while study 6 and 8 included non-renal SOT. Four come from the United States. Results can be seen in the attached table. Most studies had a median age in the 50's, with hypertension and diabetes being common comorbidities. Tacrolimus, mycophenolate analogs and prednisone was the most common immunosuppression regimen. Presenting symptoms were usually fever, cough, dyspnea, and diarrhea. Immunosuppression was either reduced or discontinued in all studies. The majority of patients received hydroxychloroquine. Azithromycin, remdesevir, leronlimab, lopinavir/ritonavir, darunavir, oseltamivir, and tocilizumab were also used. Mortality ranged from 0% to 30%. All studies described hospitalized patients. A third of reports also included outpatients. The median follow up was approximately 3 weeks for most studies (range of 7 to 29 days). All but one series with reported patient deaths under 20% either did not include or had follow-up periods of less than 10 days. Conclusions: Presentation of COVID-19 and immunosuppression strategies are similar among transplant centers. Differing outcomes may be related to small number of cases, potentially varying acuities of illness and follow up periods. Given that cytokine storm occurs late in the course of COVID-19, it is plausible that mortality may increase in studies with short follow up. When excluding short or missing follow up, mortality appears to be between 20-30%, which suggests that transplant recipients have a higher mortality than their non-immunocompromised peers.

20.
Journal of the American Society of Nephrology ; 31:31, 2020.
Article in English | EMBASE | ID: covidwho-984591

ABSTRACT

Background: COVID-19 shows increased disease burden in patients with diabetic kidney disease (DKD). SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) for host cell entry, so ACE2 levels may influence SARS-CoV-2 susceptibility. We investigated how pre-existing conditions and drug treatments alter receptor expression in kidney cells (Figure 1). Methods: Single cell RNA profiling of 7 healthy living donor kidneys, 44 DKD, 3 BK virus nephropathy (BKVN) and a urine COVID19 patient with acute kidney injury (COV-AKI) revealed ACE2 expression primarily in proximal tubular epithelial cells (PTEC). Results: ACE2 mRNA expression levels were higher in proximal tubule epithelial cells (PTEC) in DKD versus LD, but unaltered by exposures to renin angiotensin aldosterone system inhibitors. Bayesian integrative analysis of public -omics datasets identified molecular network modules induced in ACE2 positive versus negative PTEC in DKD and BKVN (hb.flatironinstitute.org/COVID-kidney), that were linked to viral entry, immune activation, endomembrane reorganization, and RNA processing. Similar programs were seen in COV-AKI ACE2-positive PTEC, and overlapped with programs in SARS-CoV-2 infected cells. Conclusions: A consistent ACE2-coregulated expression program in PTEC may interact with SARS-CoV-2 infection processes. These networks can seed further research into developing therapeutic strategies and assessing risk in patients with COVID-19. (Figure Presented).

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