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1.
Indian Journal of Critical Care Medicine ; 26(9):1031-1035, 2022.
Article in English | Scopus | ID: covidwho-2030240

ABSTRACT

Background: Biomarkers have been extensively studied and used in the diagnosis and management of various diseases. The trend of biomarkers helps in prognosticating and managing critically ill patients. In resource-limited settings, the availability and feasibility of using these biomarkers are challenging. Our study aimed to see the trend of biomarkers and their effect on intensive care unit (ICU) mortality in coronavirus disease-2019 (COVID-19) patients. Methods: A retrospective observational study was done from 1 April 2020 to 30 September 2020. The primary objective was to evaluate the trend of biomarkers in patients with COVID-19 pneumonia and their effect on ICU mortality. The secondary objectives were the duration of mechanical ventilation and length of ICU stay. Results: A total of 380 patients were included. The mean age was 54.9 (SD = 11.1) and 67% were males. The mean age, acute physiology and chronic health evaluation II (APACHE II) score was 29.54 (5.8). Among the biomarkers, total count (TC), ferritin, and procalcitonin (PCT) were higher in non-survivors than in survivors in bivariate analysis. The final multivariable logistic regression model showed age, APACHE II score, length of ICU stay, neutrophil:lymphocyte (NL) ratio, and ferritin as covariates. Among these variables, ferritin was the only biomarker [odds ratio (OR): 1.80, 95% confidence interval (CI) 1.17–2.77] with the APACHE II score (OR: 1.15, 95% CI 1.01–1.30) found to be significant. Conclusion: Ferritin was the only significant biomarker with higher values in non-survivors than in survivors. The trend of biomarkers was not found to be useful in predicting outcome of the patients. © The Author(s). 2022.

2.
Annals of the Rheumatic Diseases ; 81:167, 2022.
Article in English | EMBASE | ID: covidwho-2009104

ABSTRACT

Background: To our knowledge, no published work has described precisely the severity and evolution of SARS-CoV-2 infection in patients with spondyloarthritis (SpA). Data on COVID-19 from cohorts of patients with immune-mediated infam-matory diseases concern small samples of SpA. Objectives: Our objective was to describe the severity and course of COVID-19 in a large cohort of patients with SpA, including axial SpA (axSpA) and psoriatic arthritis (PsA), and to identify factors associated with severe forms. Methods: Patients: individuals with Spondyloarthritis (SpA) from the French RMD COVID-19 cohort (observational, national, multicenter cohort) with a diagnosis of COVID-19 (clinical, PCR, CT or serology) were included. Data collected: demographics, type of SpA, comorbidities, treatments, severity of COVID-19. Severity of COVID-19 was graded according to care needed: mild = outpatient care;moderate = non-intensive hospital treatment;severe = intensive care unit admission or death;severe = moderate or severe. Statistical analyses: Logistic regression models were used to identify factors associated with these severe forms. All variables with p <0.20 in the univariate analysis were proposed in the multivariate model. Treatment variables (non-ste-roidal anti-infammatory drugs (NSAIDs), methotrexate (MTX), sulfasalazine (SLZ), TNF inhibitors (TNFi), IL-17 inhibitors (IL-17i) and IL-23p19/p40 inhibitors (IL-23p19/p40i)) were included in the models, even if p≥0.20. Results: Between March 2020 and April 2021, 626 SpAs reported COVID-19 with a mild course in 508 cases (81.1%), moderate in 93 cases (14.8%), and severe in 25 cases (3.9%), including 6 deaths. The cohort analyzed included 349 women (55.8%), mean age 49.3 ± 14.1 years, mean BMI 27.1 ± 5.4 with 403 axSpA (64.4%), 187 PsA (29.9%) and 36 other SpA, duration of disease 11.3 ± 9.8 years;352 (56.2%) had at least one comorbidity, of which obesity (23.6%), hypertension (15.5%), and smoking (10.4%) were the most frequent. Among them, 104 were treated with NSAIDs (16.6%), 186 with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) including 156 MTX, and 460 (73.5%) with biological DMARDs (379 TNFi, 57 IL-17i, 15 IL-23p19/p40i, 9 others). The following variables were associated with severe COVID-19 outcomes: age, body mass index, chronic obstructive lung disease, cardiovascular disease, diabetes, hypertension, interstitial lung disease, renal failure, and corticosteroids intake. The factors independently associated with severe COVID-19 outcomes were cor-ticosteroid intake (3.15 [CI95%: 1.46-6.76], p 0.004), and age (OR=1.06 [CI95%: 1.04-1.08], p <0.001] while anti-TNF (OR=0.26 [CI95%: 0.09-0.78], p=0.01]) was protective. NSAIDs intake (OR=0.97 [CI95%: 0.48-1.98]), SLZ (OR=7.9 [CI95%: 0.60-103]), or anti-IL17 (OR=0.37 [CI95%: 0.10-1.31]) was not associated with infection severity. Conclusion: The course of COVID-19 was mild for the majority of SpA patients (81.1%). Corticosteroid intake was associated with more severe COVID-19 outcomes, whereas TNFi were found to be protective.

3.
Journal of Surgical Research ; 2022.
Article in English | ScienceDirect | ID: covidwho-2004292

ABSTRACT

Background With the expected surge of adult patients with COVID-19, the Children’s Hospital Association recommended a tiered approach to divert children to pediatric centers. Our objective was understanding changes in interfacility transfer to Pediatric Trauma Centers (PTCs) during the first six months of the pandemic. Methods Children <18years injured between January 1, 2016 and September 30, 2020, who met National Trauma Databank inclusion criteria from 9 PTCs were included. An interrupted time series analysis was used to estimate expected number of transferred patients compared to observed volume. The “COVID” cohort was compared to a historical cohort (HA), using an average across 2016-2019. Site-based differences in transfer volume, demographics, injury characteristics, and hospital-based outcomes were compared between cohorts. Results 27,031/47,382 injured patients (57.05%) were transferred to a participating PTC during the study period. Of the COVID cohort, 65.4% (4620/7067) were transferred, compared to 55.7% (3281/5888) of the HA (p <0.001). There was a decrease in 15- to 17-year patients (10.43% COVID vs. 12.64% HA, p = 0.003). More patients in the COVID cohort had injury severity scores ≤15 (93.25% COVID vs. 87.63% HA, p <0.001). More patients were discharged home after transfer (31.80% COVID vs. 21.83% HA, p <0.001). Conclusions Transferred trauma patients to Level I PTC increased during the COVID-19 pandemic. The proportion of transferred patients discharged from Emergency Departments increased. Pediatric trauma transfers may be a surrogate for referring ED capacity and resources and a measure of pediatric trauma triage capability.

4.
Heart Lung and Circulation ; 31:S33, 2022.
Article in English | EMBASE | ID: covidwho-2004114

ABSTRACT

Background: Transoesophegeal echocardiogram (TOE) is the gold standard imaging modality to evaluate the left atrial appendage (LAA) prior to direct current cardioversion (DCCV) for atrial arrhythmia. TOE is an aerosol generating procedure, with the potential for transmission of COVID-19 infection. This study describes our experience of utilising cardiac computed tomography (CT) as an alternative imaging modality, to exclude LAA thrombus prior to DCCV in patients with atrial arrhythmias at Middlemore Hospital from 1st September 2020 until 30th September 2021 during the COVID-19 pandemic. Method: Patients with atrial arrhythmia requiring DCCV who underwent cardiac CT were identified from ANZACS-QI linked cardiac CT registry database. Patients without thrombus on cardiac CT proceeded to DCCV. Patients with slow flow or thrombus in the left atrium (LA) or LAA on CT were considered for TOE. Results: Eighty-five cardiac CT scans were performed in eighty patients (male 68.8%, mean age 59.3±14 years, body mass index 33.4±8). Sixty-seven patients (87%) had no LAA thrombus, and 65 patients proceeded safely to DCCV with no periprocedural stroke. Thirteen patients (16%) had slow flow or possible thrombus in the LA or LAA and one patient had definite thrombus. Six patients with slow flow or possible thrombus underwent TOE none had LA or LAA thrombus. Conclusion: In the majority of patients with atrial arrhythmia requiring DCCV, cardiac CT is a safe and useful alternative to TOE.

5.
British Journal of Anaesthesia ; 128(5):e332, 2022.
Article in English | EMBASE | ID: covidwho-1977069

ABSTRACT

Dental infection can cause reduced mouth opening which may make tracheal intubation after induction of general anaesthesia difficult. Although it is widely quoted in the literature that reduced mouth opening secondary to dental infection might not improve post-induction of anaesthesia,1 the evidence base for this is limited. The 4th National Audit Project in Anaesthesia highlighted that airway complications often resulted from poor assessment, inadequate planning of management, and a reluctance to use advanced airway techniques.2 An improved understanding and awareness of the effect of dental infection on mouth opening could help highlight potential airway difficulty, improving planning of airway management and the use of appropriate techniques to do this. We conducted a prospective observational study at the Royal Hallamshire Hospital, Sheffield. After study approvals (REC ref: 18/LO/1134, IRAS ID: 264468) were obtained, 11 patients presenting with dental infection requiring surgical management under general anaesthetic were recruited between December 2018 and January 2020. Maximal mouth opening was measured immediately before and after the induction of general anaesthesia using a TheraBite® ROM scale.3 The presence of a number of parameters associated with the severity of dental infection was also recorded. The mean pre-induction maximal mouth opening of the study participants was 18 mm (standard deviation [SD], 5.16 mm) whereas the mean post-induction maximal mouth opening was 22.3 (5.56) mm. Although the maximal mouth opening of 3 (17%) patients improved by more than 10 mm after induction of anaesthesia, the other 8 (73%) patient’s maximal mouth opening improved by less than 2 mm. Unfortunately, there was a large under-recruitment to the study in part owing to difficulties resulting from the COVID-19 pandemic. The study was therefore underpowered to perform further statistical analysis of the influence of induction of anaesthesia on a patient’s maximal mouth opening or to examine the influence of the presence of parameters associated with the severity of dental infection on maximal mouth opening. To our knowledge, this is the first study to look at the change in maximal mouth opening after induction of anaesthesia as a primary endpoint in patients with dental infection. Even in the context of the small sample size, the finding that 73% of the patients in the study had a less than 2 mm improvement in maximal mouth opening after induction is clinically highly relevant. A lack of improvement in reduced mouth opening has significant implications on airway management. This study clearly shows there is a reasonable prospect of this scenario in patients with dental infection and supports the practice of assuming mouth opening will not improve after induction of anaesthesia when planning airway management in these patients. References 1. Morosan M, Parbhoo A, Curry N. Continuing Education in Anaesthesia Critical Care & Pain 2012;12: 257–62 2. Cook TM, Woodall N, Frerk C. On behalf of the Fourth National Audit Project. Br J Anaesth 2011;106: 617–31 3. TheraBite® Range of Motion Scale. Available from: accessed date as: 5th November 2021

6.
INTERNATIONAL JOURNAL OF EARLY CHILDHOOD SPECIAL EDUCATION ; 14(4):498-503, 2022.
Article in English | Web of Science | ID: covidwho-1969767

ABSTRACT

The COVID-19 pandemic has brought significant changes over social economical and psychological dimensions of human life. After having dealt with the physical health, the post pandemic world will have to deal with its mental health. Fear and anxiety of the virus, physical distancing and safety had its impact on the world population. In Kerala 173 children committed suicide during the lockdown period (till October 30,2020) of which majority are girls. The study was conducted in the Kondazhy Panchayath in the Thrissur district of Kerala. The study was based on primary and secondary data. Primary data was collected using questionnaire and personal interview method of data collection while secondary collected from government officials. The paper highlights the need of emotional regulation, interaction with peers and proper guidance for children. It also studied about how peer interaction and involvement of experts influence lives of children. The study finds that quality of life of girls in institution is better than that of homes due to safer feeling and expert's services in agency. Study suggested that in order to accomplish the new circumstances, an understanding of impact of the pandemic on not just girl children, but the whole human race and the trends should be investigated thoroughly. Appropriate and effective measures are to be taken to reduce the socio-environmental impact of the pandemic on children.

7.
Clin Gastroenterol Hepatol ; 2022 Jul 16.
Article in English | MEDLINE | ID: covidwho-1936142

ABSTRACT

BACKGROUND & AIMS: Liver transplant recipients (LTRs) show a decreased immune response after 2 severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) vaccinations compared with healthy controls (HCs). Here, we investigated the immunogenicity of additional vaccinations. METHODS: In this prospective study, humoral (anti-SARS-CoV-2 receptor-binding domain [anti-S RBD]) and cellular (interferon-gamma release assay) immune responses were determined after mRNA-based SARS-CoV-2 vaccination in 106 LTRs after a third vaccination and in 36 LTRs after a fourth vaccination. Patients with anti-S RBD antibody levels >0.8 arbitrary unit (AU)/mL after vaccination were defined as responders. RESULTS: After 3 vaccinations, 92% (97/106) of LTRs compared with 100% (28/28) of HCs were responders. However, the antibody titer of LTRs was lower compared with HCs (1891.0 vs 21,857.0 AU/mL; P < .001). Between a second and third vaccination (n = 75), the median antibody level increased 67-fold in LTRs. In patients seronegative after 2 vaccinations, a third dose induced seroconversion in 76% (19/25), whereas all HCs were already seropositive after 2 vaccinations. A spike-specific T-cell response was detected in 72% (28/39) after a third vaccination compared with 32% (11/34) after a second vaccination. Independent risk factors for a low antibody response (anti-S RBD <100 AU/mL) were first vaccination within the first year after liver transplant (odds ratio [OR], 8.00; P = .023), estimated glomular filtration rate <45 mL/min (OR, 4.72; P = .006), and low lymphocyte counts (OR, 5.02; P = .008). A fourth vaccination induced a 9-fold increase in the median antibody level and seroconversion in 60% (3/5) of previous non-responders. CONCLUSIONS: A third and fourth SARS-CoV-2 vaccination effectively increases the humoral and cellular immune response of LTRs, but to a lesser extent than in HCs. A fourth vaccination should be generally considered in LTRs.

8.
Acs Es&T Water ; : 12, 2022.
Article in English | Web of Science | ID: covidwho-1927044

ABSTRACT

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in wastewater has been used to track community infections of coronavirus disease-2019 (COVID-19), providing critical information for public health interventions. Since levels in wastewater are dependent upon human inputs, we hypothesize that tracking infections can be improved by normalizing wastewater concentrations against indicators of human waste [Pepper Mild Mottle Virus (PMMoV), beta-2 Microglobulin (B2M), and fecal coliform]. In this study, we analyzed SARS-CoV-2 and indicators of human waste in wastewater from two sewersheds of different scales: a University campus and a wastewater treatment plant. Wastewater data were combined with complementary COVID-19 case tracking to evaluate the efficiency of wastewater surveillance for forecasting new COVID-19 cases and, for the larger scale, hospitalizations. Results show that the normalization of SARS-CoV-2 levels by PMMoV and B2M resulted in improved correlations with COVID-19 cases for campus data using volcano second generation (V2G)-qPCR chemistry (r(s) = 0.69 without normalization, r(s) = 0.73 with normalization). Mixed results were obtained for normalization by PMMoV for samples collected at the community scale. Overall benefits from normalizing with measures of human waste depend upon qPCR chemistry and improves with smaller sewershed scale. We recommend further studies that evaluate the efficacy of additional normalization targets.

9.
Pain Physician ; 25(3): 239-250, 2022 05.
Article in English | MEDLINE | ID: covidwho-1871336

ABSTRACT

BACKGROUND: Among the multiple causes of low back and lower extremity pain, sacroiliac joint pain has shown to be prevalent in 10% to 25% of patients with persistent axial low back pain without disc herniation, discogenic pain, or radiculitis. Over the years, multiple Current Procedural Terminology (CPT) codes have evolved with the inclusion of intraarticular injections, nerve blocks, and radiofrequency neurotomy, in addition to percutaneous sacroiliac joint fusions. Previous assessments of utilization patterns of sacroiliac joint interventions only included sacroiliac joint intraarticular injections, since the data was not available prior to the introduction of new codes. A recent assessment revealed an increase of 11.3%, and an annual increase of 1.2% per 100,000 Medicare population from 2009 to 2018, showing a decline in growth patterns. During the past 2 years, the COVID-19 pandemic has also had significant effects on the utilization patterns of sacroiliac joint interventions. STUDY DESIGN: The impact of the COVID-19 pandemic and analysis of growth patterns of sacroiliac joint interventions (intraarticular injections, nerve blocks, radiofrequency neurotomy, arthrodesis and fusion) was evaluated from 2010 to 2019 and 2010 to 2020, with a comparative analysis from 2019 to 2020 to assess the impact of the COVID-19 pandemic. OBJECTIVES: To update utilization patterns of sacroiliac joint interventions with assessment of the impact of the COVID-19 pandemic. METHODS: The Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master dataset was utilized in the present analysis. RESULTS: The results of this evaluation demonstrated a significant impact of the COVID-19 pandemic with a 19.2% decrease of utilization of sacroiliac joint intraarticular injections from 2019 to 2020. There was a 23.3% increase in sacroiliac joint arthrodesis and a 5.3% decrease for sacroiliac joint fusions with small numbers from 2019 to 2020. However, data was not available for sacroiliac joint nerve blocks and sacroiliac joint radiofrequency neurotomy as these codes were incorporated in 2020. Overall, from 2010 to 2019, sacroiliac joint intraarticular injections showed an annual increase of 0.9% per 100,000 Medicare population. Sacroiliac joint arthrodesis and fusion showed an annual increase from 2010 to 2020 per 100,000 Medicare population of 29% for arthrodesis and 13.3% for fusion. LIMITATIONS: Limitations of this study include a lack of inclusion of Medicare Advantage patients constituting approximately 30% to 40% of the overall Medicare population. As with all claims-based data analyses, this study is retrospective and thus potentially limited by bias. Finally, patients who are non-Medicare are not part of the dataset. CONCLUSIONS: The study shows the impact of the COVID-19 pandemic with a significant decrease of intraarticular injections of 19.2% from 2019 to 2020 per 100,000 Medicare population. These decreases of intraarticular injections are accompanied by a 5.3% decrease of fusion, but a 23.3% increase of arthrodesis from 2019 to 2020 per 100,000 Medicare population. Overall, the results showed an annual increase of 0.9% per 100,000 Medicare population for intraarticular injections, a 35.4% annual increase for sacroiliac joint arthrodesis and an increase of 15.5% for sacroiliac joint fusion from 2010 to 2019.


Subject(s)
COVID-19 , Chronic Pain , Aged , Chronic Pain/epidemiology , Humans , Injections, Intra-Articular , Medicare , Pain Management/methods , Pandemics , Retrospective Studies , Sacroiliac Joint/surgery , United States
10.
A A Pract ; 15(2): e01406, 2021 Feb 23.
Article in English | MEDLINE | ID: covidwho-1869126

ABSTRACT

The Internet is a source of professional self-education for medical students and residents. Unfortunately, much of the content discovered through search engines is of insufficient quality for professional education. The Anesthesia Toolbox (AT) was developed to provide online peer-reviewed educational resources for anesthesiology trainees and faculty. Since 2014, AT has developed 24 curricula, 822 content items, and 3238 quiz questions. As of March 2020, 64 anesthesiology residency programs in the United States subscribed to the AT (41% of total). Since the onset of the pandemic in March, AT has added 25 programs (28% increase) and gained 1156 users (26% increase).


Subject(s)
Anesthesia , Anesthesiology , Computer-Assisted Instruction , Internship and Residency , Anesthesiology/education , Humans , Surveys and Questionnaires , United States
11.
Annals of Behavioral Medicine ; 56(SUPP 1):S262-S262, 2022.
Article in English | Web of Science | ID: covidwho-1849354
12.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-333674

ABSTRACT

The ongoing pandemic of Coronavirus disease 2019 (COVID-19) continues to exert a significant burden on health care systems worldwide. With limited treatments available, vaccination remains an effective strategy to counter transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent discussions concerning vaccination strategies have focused on identifying vaccine platforms, number of doses, route of administration, and time to reach peak immunity against SARS-CoV-2. Here, we generated a single dose, fast-acting vesicular stomatitis virus-based vaccine derived from the licensed Ebola virus (EBOV) vaccine rVSV-ZEBOV, expressing the SARS-CoV-2 spike protein and the EBOV glycoprotein (VSV-SARS2-EBOV). Rhesus macaques vaccinated intramuscularly (IM) with a single dose of VSV-SARS2-EBOV were protected within 10 days and did not show signs of COVID-19 pneumonia. In contrast, intranasal (IN) vaccination resulted in limited immunogenicity and enhanced COVID-19 pneumonia compared to control animals. While IM and IN vaccination both induced neutralizing antibody titers, only IM vaccination resulted in a significant cellular immune response. RNA sequencing data bolstered these results by revealing robust activation of the innate and adaptive immune transcriptional signatures in the lungs of IM-vaccinated animals only. Overall, the data demonstrates that VSV-SARS2-EBOV is a potent single-dose COVID-19 vaccine candidate that offers rapid protection based on the protective efficacy observed in our study. ONE SENTENCE SUMMARY: VSV vaccine protects NHPs from COVID-19 in 10 days.

13.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-333550

ABSTRACT

SARS-CoV-2 emerged in late 2019 and resulted in the ongoing COVID-19 pandemic. Several animal models have been rapidly developed that recapitulate the asymptomatic to moderate disease spectrum. Now, there is a direct need for additional small animal models to study the pathogenesis of severe COVID-19 and for fast-tracked medical countermeasure development. Here, we show that transgenic mice expressing the human SARS-CoV-2 receptor (angiotensin-converting enzyme 2 [hACE2]) under a cytokeratin 18 promoter (K18) are susceptible to SARS-CoV-2 and that infection resulted in a dose-dependent lethal disease course. After inoculation with either 10 4 TCID 50 or 10 5 TCID 50 , the SARS-CoV-2 infection resulted in rapid weight loss in both groups and uniform lethality in the 10 5 TCID 50 group. High levels of viral RNA shedding were observed from the upper and lower respiratory tract and intermittent shedding was observed from the intestinal tract. Inoculation with SARS-CoV-2 resulted in upper and lower respiratory tract infection with high infectious virus titers in nasal turbinates, trachea and lungs. The observed interstitial pneumonia and pulmonary pathology, with SARS-CoV-2 replication evident in pneumocytes, were similar to that reported in severe cases of COVID-19. SARS-CoV-2 infection resulted in macrophage and lymphocyte infiltration in the lungs and upregulation of Th1 and proinflammatory cytokines/chemokines. Extrapulmonary replication of SARS-CoV-2 was observed in the cerebral cortex and hippocampus of several animals at 7 DPI but not at 3 DPI. The rapid inflammatory response and observed pathology bears resemblance to COVID-19. Taken together, this suggests that this mouse model can be useful for studies of pathogenesis and medical countermeasure development. AUTHORS SUMMARY: The disease manifestation of COVID-19 in humans range from asymptomatic to severe. While several mild to moderate disease models have been developed, there is still a need for animal models that recapitulate the severe and fatal progression observed in a subset of patients. Here, we show that humanized transgenic mice developed dose-dependent disease when inoculated with SARS-CoV-2, the etiological agent of COVID-19. The mice developed upper and lower respiratory tract infection, with virus replication also in the brain after day 3 post inoculation. The pathological and immunological diseases manifestation observed in these mice bears resemblance to human COVID-19, suggesting increased usefulness of this model for elucidating COVID-19 pathogenesis further and testing of countermeasures, both of which are urgently needed.

14.
Microbiology Spectrum ; 10(1):13, 2022.
Article in English | Web of Science | ID: covidwho-1790201

ABSTRACT

The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an unprecedented event requiring frequent adaptation to changing clinical circumstances. Convalescent immune plasma (CIP) is a promising treatment that can be mobilized rapidly in a pandemic setting. We tested whether administration of SARS-CoV-2 CIP at hospital admission could reduce the rate of ICU transfer or 28-day mortality or alter levels of specific antibody responses before and after CIP infusion. In a single-arm phase II study, patients >18 years-old with respiratory symptoms with confirmed COVID-19 infection who were admitted to a non-ICU bed were administered two units of CIP within 72 h of admission. Levels of SARS-CoV-2 detected by PCR in the respiratory tract and circulating anti-SARS-CoV-2 antibody titers were sequentially measured before and after CIP transfusion. Twenty-nine patients were transfused high titer CIP and 48 contemporaneous comparable controls were identified. All classes of antibodies to the three SARS-CoV-2 target proteins were significantly increased at days 7 and 14 post-transfusion compared with baseline (P < 0.01). Anti-nucleocapsid IgA levels were reduced at day 28, suggesting that the initial rise may have been due to the contribution of CIP. The groups were well-balanced, without statistically significant differences in demographics or co-morbidities or use of remdesivir or dexamethasone. In participants transfused with CIP, the rate of ICU transfer was 13.8% compared to 27.1% for controls with a hazard ratio 0.506 (95% CI 0.165-1354), and 28-day mortality was 6.9% compared to 10.4% for controls, hazard ratio 0.640 (95% CI 0.124-3.298). IMPORTANCE Transfusion of high-titer CIP to non-critically ill patients early after admission with COVID-19 respiratory disease was associated with significantly increased anti-SARSCoV-2 specific antibodies (compared to baseline) and a non-significant reduction in Ku transfer and death (compared to controls). This prospective phase II trial provides a suggestion that the antiviral effects of CIP from early in the COVID-19 pandemic may delay progression to critical illness and death in specific patient populations. This study informs the optimal timing and potential population of use for CIP in COVID-19, particularly in settings without access to other interventions, or in planning for future coronavirus pandemics.

15.
Eur J Immunol ; 52(8): 1297-1307, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1782587

ABSTRACT

COVID-19, caused by SARS-CoV-2, has emerged as a global pandemic. While immune responses of the adaptive immune system have been in the focus of research, the role of NK cells in COVID-19 remains less well understood. Here, we characterized NK cell-mediated SARS-CoV-2 antibody-dependent cellular cytotoxicity (ADCC) against SARS-CoV-2 spike-1 (S1) and nucleocapsid (NC) protein. Serum samples from SARS-CoV-2 resolvers induced significant CD107a-expression by NK cells in response to S1 and NC, while serum samples from SARS-CoV-2-negative individuals did not. Furthermore, serum samples from individuals that received the BNT162b2 vaccine induced strong CD107a expression by NK cells that increased with the second vaccination and was significantly higher than observed in infected individuals. As expected, vaccine-induced responses were only directed against S1 and not against NC protein. S1-specific CD107a responses by NK cells were significantly correlated to NK cell-mediated killing of S1-expressing cells. Interestingly, screening of serum samples collected prior to the COVID-19 pandemic identified two individuals with cross-reactive antibodies against SARS-CoV-2 S1, which also induced degranulation of NK cells. Taken together, these data demonstrate that antibodies induced by SARS-CoV-2 infection and anti-SARS-CoV-2 vaccines can trigger significant NK cell-mediated ADCC activity, and identify some cross-reactive ADCC-activity against SARS-CoV-2 by endemic coronavirus-specific antibodies.


Subject(s)
COVID-19 , SARS-CoV-2 , Antibodies, Viral/metabolism , Antibody-Dependent Cell Cytotoxicity , BNT162 Vaccine , Humans , Killer Cells, Natural , Pandemics
16.
J Pediatr Surg ; 57(7): 1370-1376, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1783583

ABSTRACT

BACKGROUND: Firearm sales in the United States (U.S.) markedly increased during the COVID-19 pandemic. Our objective was to determine if firearm injuries in children were associated with stay-at-home orders (SHO) during the COVID-19 pandemic. We hypothesized there would be an increase in pediatric firearm injuries during SHO. METHODS: This was a multi institutional, retrospective study of institutional trauma registries. Patients <18 years with traumatic injuries meeting National Trauma Data Bank (NTDB) criteria were included. A "COVID" cohort, defined as time from initiation of state SHO through September 30, 2020 was compared to "Historical" controls from an averaged period of corresponding dates in 2016-2019. An interrupted time series analysis (ITSA) was utilized to evaluate the association of the U.S. declaration of a national state of emergency with pediatric firearm injuries. RESULTS: Nine Level I pediatric trauma centers were included, contributing 48,111 pediatric trauma patients, of which 1,090 patients (2.3%) suffered firearm injuries. There was a significant increase in the proportion of firearm injuries in the COVID cohort (COVID 3.04% vs. Historical 1.83%; p < 0.001). There was an increased cumulative burden of firearm injuries in 2020 compared to a historical average. ITSA showed an 87% increase in the observed rate of firearm injuries above expected after the declaration of a nationwide emergency (p < 0.001). CONCLUSION: The proportion of firearm injuries affecting children increased during the COVID-19 pandemic. The pandemic was associated with an increase in pediatric firearm injuries above expected rates based on historical patterns.


Subject(s)
COVID-19 , Firearms , Wounds, Gunshot , COVID-19/epidemiology , Child , Humans , Pandemics , Retrospective Studies , United States/epidemiology , Wounds, Gunshot/epidemiology
17.
BMC Public Health ; 22(1): 503, 2022 03 15.
Article in English | MEDLINE | ID: covidwho-1745467

ABSTRACT

BACKGROUND: The novel coronavirus pandemic (COVID-19) has had severe impacts on morbidity and mortality globally. METHODS: This study was set in rural central Kentucky and included participants recruited from public spaces. Fifteen qualitative interviews about personal experiences during the COVID-19 pandemic were conducted by phone from July 3 to July 24, 2020. Interviews were recorded, transcribed, and coded using a grounded theory approach. RESULTS: Participants who perceived COVID-19 to be a severe risk tended to have personal health concerns and therefore reported taking protective measures for themselves. A slightly smaller proportion of participants reported taking measures to protect others (particularly family). A minority of participants had an ambivalent attitude towards the risk and only took measures if required. COVID-19 vaccine acceptability was low with most participants expressing concerns regarding their need for a vaccine, safety of this vaccine, the value of personal rights, or future vaccine supply. CONCLUSIONS: Most participants perceived some risk of COVID-19 and took steps to prevent infections in themselves and others. Mandates for mask use in certain locations were additionally useful for those who had an ambivalent attitude towards the risk of illness. There was surprisingly little connection between perceiving COVID-19 risk and a desire for the COVID-19 vaccine. In this setting, vaccine acceptability was low, with vaccine concerns outweighing perceived potential benefits. In conclusion, because the risk was often constructed in terms of worries for themselves and others, the framing of health education materials for protective behaviors in these terms may be effective. Furthermore, future COVID-19 vaccine education should address vaccine knowledge and concerns, such as the need for a vaccine and its safety, and emphasize how a vaccination would reduce their chances of severe disease if they were to get sick.


Subject(s)
COVID-19 Vaccines , COVID-19 , COVID-19/prevention & control , Humans , Pandemics/prevention & control , Qualitative Research
18.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-330337

ABSTRACT

The SARS-CoV-2 beta coronavirus is the etiological driver of COVID-19 disease, which is primarily characterized by shortness of breath, persistent dry cough, and fever. Because they transport oxygen, red blood cells (RBCs) may play a role in the severity of hypoxemia in COVID-19 patients. The present study combines state-of-the-art metabolomics, proteomics, and lipidomics approaches to investigate the impact of COVID-19 on RBCs from 23 healthy subjects and 29 molecularly-diagnosed COVID-19 patients. RBCs from COVID-19 patients had increased levels of glycolytic intermediates, accompanied by oxidation and fragmentation of ankyrin, spectrin beta, and the N-terminal cytosolic domain of band 3 (AE1). Significantly altered lipid metabolism was also observed, especially short and medium chain saturated fatty acids, acyl-carnitines, and sphingolipids. Nonetheless, there were no alterations of clinical hematological parameters, such as RBC count, hematocrit, and mean corpuscular hemoglobin concentration, with only minor increases in mean corpuscular volume. Taken together, these results suggest a significant impact of SARS-CoV-2 infection on RBC structural membrane homeostasis at the protein and lipid levels. Increases in RBC glycolytic metabolites are consistent with a theoretically improved capacity of hemoglobin to off-load oxygen as a function of allosteric modulation by high-energy phosphate compounds, perhaps to counteract COVID-19-induced hypoxia. Conversely, because the N-terminus of AE1 stabilizes deoxyhemoglobin and finely tunes oxygen off-loading, RBCs from COVID-19 patients may be incapable of responding to environmental variations in hemoglobin oxygen saturation when traveling from the lungs to peripheral capillaries and, as such, may have a compromised capacity to transport and deliver oxygen.

19.
AERA Open ; 8, 2022.
Article in English | Scopus | ID: covidwho-1741903

ABSTRACT

While educators’ uses of social media for purposes such as professional learning and networking are now well-established, our understanding of how educational institutions use social media—including to engage key stakeholders during periods of crisis—is limited. In this study, we used a public data mining research approach to examine how K–12 school districts in the United States used Twitter as a communication tool during a critical period of the COVID-19 pandemic, March-April, 2020. Through a three-step grounded theory approach of 1,357 district tweets from 492 school districts, we found that districts worked to build community and share time-sensitive announcements in alignment with social media crisis communication recommendations. Announcements were more common during the early stages of the pandemic (and were engaged more collaboratively), with community-building posts more common later on. This study demonstrates how researchers can use publicly available (social media) data to understand districts’ communication priorities and strategies during and beyond periods of crisis. © The Author(s) 2022.

20.
10th International Conference on Advances in Computing and Communications, ICACC 2021 ; 2021.
Article in English | Scopus | ID: covidwho-1741182

ABSTRACT

It's been more than a year since the world is struggling with the COVID-19 pandemic. Mutation of the virus leads to a new wave of infection in a lot of countries. The virus has a very high spreading rate, so all the infected patients won't be able to treat in the hospitals and chances of it spreading among healthcare workers is also high. So we propose a system to monitor COVID-19 patients undergoing quarantine from their own homes during the pandemic, so as to save the hospital bed spaces for the patients with a critical health condition, who need immediate medical attention. The proposed system helps us to avoid overcrowding in hospitals and thereby avoiding the spreading of the virus from highly infected patients to the unaffected individuals. The methodology utilizes LSTM model which is a recurrent neural network (RNN) architecture used in the field of deep learning. © 2021 IEEE.

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