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American Journal of Gastroenterology ; 117(10 Supplement 2):S1198-S1199, 2022.
Article in English | EMBASE | ID: covidwho-2326134


Introduction: Pancreatitis is a very common gastrointestinal disease that results in hospital admission. Early detection and treatment leads to better outcomes. This is the first reported case of pancreatitis secondary to elevated tacrolimus in a patient with prior renal transplantation after receiving Paxlovid for a COVID-19 infection. Case Description/Methods: A 57-year-old male with past medical history of 4 renal transplants secondary to posterior urethral valves who presented to the emergency room with acute onset epigastric pain for 24 hours. He was on tacrolimus 5 mg every 48 hours monotherapy for his immunosuppression. 10 days prior to his presentation he had developed chills and anxiety. He tested positive for COVID-19 at that time on a home rapid test. His symptoms had not significantly improved and given his immunosuppressed state he was given Paxlovid (Nirmatrelvir/ritonavir). He took 2 days of Paxlovid, however after his second day of treatment he developed severe epigastric pain requiring him to go to the emergency room. On admission his labs were notable for a lipase of 150 U/L (ULN 63 U/L). He underwent a CT scan was notable for an enlarged pancreatic head and neck with peripancreatic fat stranding (Figure). He also had a right upper quadrant ultrasound without any cholelithiasis and only trace sludge noted. His creatinine was noted to be 1.81 mg/dl which was above his baseline of 1.2 mg/dl. His tacrolimus trough level resulted at a level 45.6 ng/ml and later peaked at 82.2 ng/ml. His liver enzymes were normal. He was treated as acute pancreatitis with hydration and his tacrolimus was held with overall clinical improvement. Discussion(s): Tacrolimus is one of the most common medications used in solid organ transplantation. It is a calcineurin inhibitor that inhibits both T-lymphocyte signal transduction and IL-2 transcription. It is metabolized by the protein CYP3A and levels are monitored closely. Paxlovid is currently prescribed as an antiviral therapy for COVID-19 infection. The ritonavir compound in Paxlovid is potent inhibitor of CYP3A. Currently the guidelines do not recommend Paxlvoid as a therapeutic in patients taking tacrolimus as there is concern about increased drug levels. There have been several case reports of pancreatitis in setting of tacrolimus. This case report helps to demonstrate the need for close monitoring of therapeutics levels, especially in medications with high risk of drug to drug interaction to help prevent serious side effects such as tacrolimus induced pancreatitis.

Building Research and Information ; 51(1):39-55, 2023.
Article in English | Scopus | ID: covidwho-2242971
Asian Journal of Business Ethics ; 2023.
Article in English | Web of Science | ID: covidwho-2235367


In order to gain greater insight into the nature of corporate social responsibility (CSR) during a time of crisis, the study examines the commitment of firms to continue to engage in CSR activity despite financial pressures to divert their slack resources elsewhere. The setting of the study is CSR activity during the perhaps unprecedented global crisis associated with the COVID-19 pandemic. Based on a qualitative research method approach, both a variety of media sources and the relevant academic literature are reviewed in order to identify examples of CSR activity related specifically to COVID-19. The examples are then categorized and situated according to Professor Archie Carroll's well-known CSR Pyramid framework describing the economic, legal, ethical, and philanthropic domains of CSR. As such, this study is the first to extend the rich literature stream utilizing Carroll's CSR Pyramid within the unique context of a global pandemic.

Asian Journal of Business Ethics ; : 1-24, 2023.
Article in English | PubMed Central | ID: covidwho-2175238
Modern Pathology ; 35(SUPPL 2):1353, 2022.
Article in English | EMBASE | ID: covidwho-1857908
Journal of Urology ; 206(SUPPL 3):e576-e577, 2021.
Article in English | EMBASE | ID: covidwho-1483628
Library Journal ; 146(6):8-8, 2021.
Article in English | Web of Science | ID: covidwho-1323705
Journal of Agriculture Food Systems and Community Development ; 10(2):11-27, 2021.
Article in English | Web of Science | ID: covidwho-1244312
Transplant Proc ; 52(9): 2688-2692, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-899633


BACKGROUND: Cytokine release storm (CRS) is a potentially fatal, hyperinflammatory condition common to both coronavirus disease 2019 (COVID-19) and reactive hemophagocytic lymphohistiocytosis (rHLH). We present our experience with the use of a diagnostic score, developed for rHLH, in a kidney transplant recipient hospitalized with COVID-19. METHODS: We applied the H-Score to risk-stratify our patient to help predict his hospital course. This study was exempt from requiring specific Institutional Review Board approval, but met all the criteria required by our institution for this type of study and report including consent from the patient. RESULTS: The calculated H-Score for our patient fell below the diagnostic cut-off value for rHLH. Because rHLH is characterized by CRS, we expected him to have a milder hospital course with COVID-19. Correlating with his below cut-off H-score, the patient had a more benign than expected hospital course. CONCLUSIONS: Because this is only a single case, we plan to retrospectively review a series of patients to validate our initial experience-that a low H-Score may correlate with a milder hospital course in kidney transplant patients with COVID-19.

Coronavirus Infections/immunology , Coronavirus Infections/therapy , Immunocompromised Host , Pneumonia, Viral/immunology , Pneumonia, Viral/therapy , Severity of Illness Index , Betacoronavirus , COVID-19 , Cytokine Release Syndrome/diagnosis , Cytokine Release Syndrome/etiology , Humans , Kidney Transplantation , Male , Middle Aged , Pandemics , Prognosis , Retrospective Studies , SARS-CoV-2