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1.
Baylor University Medical Center Proceedings ; JOUR
Article in English | Scopus | ID: covidwho-2087528

ABSTRACT

Guillain-Barré Syndrome (GBS) is an immune-mediated polyneuropathy, most often occurring within weeks of an infection. Cases of COVID-19–related GBS have been reported, and the typical presentation is a progressive ascending paralysis. We describe a case of a 40-year-old with recent symptomatic COVID-19 who presented with atypical GBS findings, hand weakness that progressed to tetraplegia within 24 hours. He had hyperreflexia on his initial exam and did not meet diagnostic criteria for GBS. Inconsistent neurological findings with spontaneous improvement of symptoms, unremarkable initial evaluation including lumbar puncture, and anxiety further complicated the diagnosis. On day 6, he was intubated for diaphragmatic paralysis, and repeat lumbar puncture showed albumin-cytologic dissociation. Intravenous immunoglobulin followed by plasmapheresis improved strength and allowed for extubation. This case highlights the difficulty of recognizing heterogenic GBS presentations. © Copyright © 2022 Baylor University Medical Center.

2.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003371

ABSTRACT

Background: Pediatric admissions in Canada have demonstrated increasing complexity, acuity and subspeciality usage. However, subspecialists are concentrated in urban tertiary centres, forcing rural pediatric patients to travel long distances. Moreover, tertiary centres are in overcapacity while regional sites underutilize pediatric beds. Therefore, our team developed an innovative Telehealth-facilitated Rounding and Consultation Model for Kids (TRaC-K). TRaC-K is currently being piloted between a tertiary pediatric hospital (Alberta Children's Hospital), and a single regional hospital (Medicine Hat Regional Hospital) in the Canadian province of Alberta. To sustain, improve and scale-up the TRaC-K model, it is essential to understand the experiences of those using the model. Hence, the purpose of this study was to understand tertiary and regional site clinician experiences with providing inpatient clinical care using the TRaC-K model. Methods: This qualitative study was conducted after 3 months of piloting the TRaC-K model. Clinicians with the experience of using TRaC-K at tertiary and regional hospitals were recruited to participate in focus groups. These focus groups were conducted virtually to elicit their perspectives, experiences, and suggestions regarding the model. NVivo 12 was used to conduct inductive thematic analysis. The Donabedian model, a conceptual model commonly used for examining health services and evaluating quality of health care based on structure, process and outcomes was used as the framework to thematically analyze the qualitative data. Preliminary findings of this study are reported here. Results: In total, 15 clinicians participated in 6 focus groups across the two sites. Participants included physicians, nurses and allied health professionals. In terms of structure, clinicians identified that various members were involved in TRaC-K. The model aided in connecting multidisciplinary care teams from both hospitals as well as families, promoting inclusive participation. The telehealth monitor was easy to maneuver with good audio and visual quality. However, technology improvements included integrating TRaC-K with other platforms such as Zoom and providing captions. Regarding process, the onset of the COVID-19 pandemic and shift towards virtual health increased the applicability and uptake of the program. The clinicians suggested operational improvements such as off- hours availability, role clarifications, and more clearly defined goals. Despite suggested improvements, the program was easy to use and had beneficial outcomes such as collaborative decision making between the sites which increased confidence in inter-hospital transfer. Clinicians expressed that the program had the potential to be expanded into other patient populations and sites. Conclusion: These findings indicate that the users of the TRaC-K model felt that it was feasible and reported positive perceptions and experiences using TRaC-K. The findings from this study would help develop similar models to provide pediatric inpatient clinical care to rural children in other parts of the world.

3.
Biocell ; 46(10):2201-2208, 2022.
Article in English | Web of Science | ID: covidwho-1918326

ABSTRACT

Mesenchymal stem cells (MSCs) are multipotent cells usually isolated from bone marrow, endometrium, adipose tissues, skin, and dental pulp. MSCs played a crucial role in regenerative therapy and have been introduced as an interdisciplinary field between cell biology and material science. Recently, MSCs have been widely explored for their application in regenerative medicine and COVID-19 treatment. Different approaches to evaluate the future of biomaterials and stem cell properties have been developed. However, misconceptions and ethical issues still exist, such as MSCs being non-angiogenic, anti-apoptotic, and immunoregulatory competencies. Embryonic stem cells isolation primarily requires the consent of donors and can include the killing of fertilized eggs. These issues generate questions related to ethical and moral issues. However, MSCs have gained considerable attention for tissue regeneration owing to their differentiation ability with immunomodulatory effects. They are capable of secreting a broad range of biomolecules such as proteins, nucleic acids, exosomes, microRNAs, and membrane vesicles, collectively known as secretomes. Secretomes are released in response to the surrounding microenvironment. In this article, we briefly address topics related to the therapeutic potential of MSCs as an advanced approach in the field of regenerative medicine and various perspectives.

4.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-296990

ABSTRACT

Determinants of protective immunity against SARS-CoV-2 infection require the development of well-standardized, reproducible antibody assays to be utilized in concert with clinical trials to establish correlates of risk and protection. This need has led to the appearance of a variety of neutralization assays used by different laboratories and companies. Using plasma samples from COVID-19 convalescent individuals with mild-to-moderate disease from a localized outbreak in a single region of the western US, we compared three platforms for SARS-CoV-2 neutralization: assay with live SARS-CoV-2, pseudovirus assay utilizing lentiviral (LV) and vesicular stomatitis virus (VSV) packaging, and a surrogate ELISA test. Vero, Vero E6, HEK293T cells expressing human angiotensin converting enzyme 2 (hACE2), and TZM-bl cells expressing hACE2 and transmembrane serine protease 2 (TMPRSS2) were evaluated. Live-virus and LV-pseudovirus assay with HEK293T cells showed similar geometric mean titers (GMTs) ranging 141-178, but VSV-pseudovirus assay yielded significantly higher GMT (310 95%CI 211-454;p < 0.001). Fifty percent neutralizing dilution (ND50) titers from live-virus and all pseudovirus assay readouts were highly correlated (Pearson r = 0.81-0.89). ND50 titers positively correlated with plasma concentration of IgG against SARS-CoV-2 spike and receptor binding domain (RBD) ( r = 0.63-0.89), but moderately correlated with nucleoprotein IgG ( r = 0.46-0.73). There was a moderate positive correlation between age and spike (Spearman's rho=0.37, p=0.02), RBD (rho=0.39, p=0.013) and nucleoprotein IgG (rho=0.45, p=0.003). ND80 showed stronger correlation with age than ND50 (ND80 rho=0.51 (p=0.001), ND50 rho=0.28 (p=0.075)). Our data demonstrate high concordance between cell-based assays with live and pseudotyped virions.

5.
Topics in Antiviral Medicine ; 29(1):87, 2021.
Article in English | EMBASE | ID: covidwho-1250335

ABSTRACT

Background: SARS-CoV-2 has claimed over a million lives and remains a global threat. Understanding immune responses to infection and developing validated laboratory assays to measure them is critical to the rapid development, assessment and implementation of effective interventions. Our development of a validated pseudovirus neutralization assay and characterization of neutralizing antibody (nAb) profiles in a diverse post-SARS-CoV-2 cohort can inform preventative and therapeutic efforts, including vaccine and monoclonal antibody development and deployment. Methods:This analysis comprises an observational cohort of n=330 adults in the US (n=168) and Peru (n=162), convalescing from SARS-CoV-2 infection and stratified by age, asymptomatic or symptomatic infection, and hospitalization. NAb titers are measured in serum by SARS-CoV-2.D614G Spike-pseudotyped virus infection of 293T/ACE2 cells. Multiple linear regression is applied to define associations between nAb titers and demographic variables, disease severity and duration, and co-morbidities within and across US and Peruvian cohorts over time. Results: The mean age is 48 years;49% were assigned female sex at birth, 51% male;54% are Latinx;50% identified as Other race, 34% White, 11% Black, 4%Asian. The mean days from SARS-CoV-2 diagnosis to enrollment was 52. NAb titers were higher in participants with a history of severe illness (p<0.001) and peaked 28-42 days post-diagnosis. ID50 (ID80) nAb titers >20 were detected at enrollment in 66% (46%) of asymptomatic, 86% (74%) of symptomatic and 95% (92%) of hospitalized individuals. Median ID50 (ID80) titers at enrollment among asymptomatic, symptomatic and hospitalized individuals were 107 (10), 482 (59) and 1,953 (366), respectively. Two months post-enrollment, median ID50 (ID80) titers among asymptomatic, symptomatic and hospitalized individuals declined to 30 (10), 130 (16) and 564 (103), respectively. Diabetes (p=0.011), age >55yo (p<0.001), male sex (p=0.003) and BMI ≥30 (p=0.021) were associated with higher ID80 titers. Hypertension was associated with lower ID50 titers (p=0.005). Conclusion: NAb titers after SARS-CoV-2 infection correlate with illness severity and underlying co-morbidities, and peak approximately one month postdiagnosis. Large, diverse, well-characterized cohorts of convalescent individuals facilitate development of standardized laboratory methods and reagents to measure immune responses and provide standardized values to benchmark SARS-CoV-2 vaccine-elicited responses.

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