Modern views on the metabolism and biological effects of vitamin D

Vitamin D is a steroid hormone that plays a crucial role in maintaining normal bone condition and calcium homeostasis. In recent years, vitamin D has become a hot topic of endocrino-logical research, largely Due to the COVID-19 pandemic and the likely correlation between hypovitaminosis D and a high risk of chronic lung disease and associated mortality. Recent studies have shown that vitamin D exhibits a complex multistage metabolism and acts as a hormone on many extracellular targets. This review examines some new intriguing and as yet unclear aspects of vitamin D metabolism, such as new concepts of enzyme regulation, new pleiotropic effects of vitamin D receptor activation (VDR), and epigenetic effects. The mechanisms of vitamin D synthesis in the skin, its metabolism in the hepatic cytochrome P450 system, catabolism, metabolites and transport, gene control and epigenetic modulation are considered in Detail. In addition to the well-known role of vitamin D in calcium and bone metabolism, it has many pleiotropic extraskeletal effects, including potent effects on the immune system, cardiovascular system, adipose tissue and glucose/ lipid metabolism, muscle and more. Experimental studies have shown that VDRs are expressed by cancer cell lines. Recent studies have shown a link between low levels of vitamin D and almost all aspects of the metabolic syndrome, such as type 2 diabetes, fasting blood glucose, hypertension, dyslipidemia, obesity and insulin re-sistance. Several studies have focused on the role of vitamin D in adipose tissue biology. In particular, a negative correlation between vitamin D and leptin or resistin is shown, as well as an inverse correlation with adiponectin. Recent studies in vitamin D-deficient mice have shown impaired secretion of glucose-stimulated insulin by pancreatic islets. Vitamin D is thought to play a role in the pathogenesis and progression of cancer, and vitamin D analogues can slow cancer progression and metastasis. It is concluded that vitamin D is a molecule with several endocrine, paracrine and auto-crine effects on many tissues and organs, in addition to maintaining skeletal homeostasis. Research in this area, which aims to clarify the pleiotropy of many effects of vitamin D and its metabolites, continues. © 2022, Zaslavsky Publishing House. All rights reserved.

SARS-CoV-2: A Rapid Review Of The Transmission Risk From Vaccinated Populations

IntroductionSince the vaccine roll out, research has focused on vaccine safety and efficacy, with large clinical trials confirming that vaccines are generally effective against symptomatic COVID-19 infection. However, breakthrough infections can still occur, and the effectiveness of vaccines against transmission from infected vaccinated people to susceptible contacts is unclear.Health Technology Wales (HTW) collaborated with the Wales COVID-19 Evidence Centre to identify and examine evidence on the transmission risk of SARS-CoV-2 from vaccinated people to unvaccinated or vaccinated people.MethodsWe conducted a systematic literature search for evidence on vaccinated people exposed to SARS-CoV-2 in any setting. Outcome measures included transmission rate, cycle threshold (Ct) values and viral load. We identified a rapid review by the University of Calgary that was the main source of our outcome data. Nine studies published following the rapid review were also identified and included.ResultsIn total, 35 studies were included in this review: one randomized controlled trial (RCT), one post-hoc analysis of an RCT, 13 prospective cohort studies, 16 retrospective cohort studies and four case control studies.All studies reported a reduction in transmission of the B.1.1.7 (Alpha) variant from partial and fully vaccinated individuals. More recent evidence is uncertain on the effects of vaccination on transmission of the B.1.617.2 (Delta) variant. Overall, vaccine effectiveness in reducing transmission appears to increase with full vaccination, compared with partial vaccination. Most of the direct evidence is limited to transmission in household settings therefore, there is a gap in the evidence on risk of transmission in other settings. One UK study found protection against onward transmission waned within 3 months post second vaccination.ConclusionsEarly findings that focused on the alpha variant, showed a reduction in transmission from vaccinated people. There is limited evidence on the effectiveness of vaccination on transmission of the Delta variant, therefore alternative preventative measures to reduce transmission may still be required.

A rare cause of headache-cerebral sinus venous thrombosis after COVID-19 vaccination

Introduction: Cerebral sinus venous thrombosis (CSVT) is a rare complication of COVID-19 vaccination. There is an incidence of 0.55 per 100,000 person-months. We describe a case of CSVT post COVID-19 vaccine. Case description: A 58-year-old male presented to a district General hospital after being involved in an RTC with a 3 month history of left sided headache which had followed his first COVID-19 vaccine (AstraZeneca). No focal neurological deficits were elicited. Blood results were unremarkable. Radiological workup suggested left transverse and sigmoid sinus thrombosis with no other intracranial complications. The patient was admitted and managed with low molecular weight heparin with an uneventful recovery. Discussion(s): CSVT is a rare and sometimes fatal disease. An increased risk of CSVT after COVID-19 vaccination has been suggested. An underlying immunological mechanism is suspected with The involvement of platelet factor-4 (PF4) antibody. Headache is The most common presenting symptom with onset within one week of vaccination. Positive D-dimer, PF4 IgG assay and thrombocytopenia may also support The diagnosis. CSVT may progress to major complications including intracranial haemorrhage and even death. Prompt diagnosis and appropriate treatment prevents neuroSurgical intervention such as decompressive craniotomy and may improve neurological outcome. Conclusion(s): This case describes an important and rare finding of complications following COVID-19 vaccine. Consideration should be made in management for patients with a recent history of COVID 19 vaccination presenting with features of headache. A high level of clinical suspicion is needed to investigate and manage these patients appropriately with potential CSVT.

Kidney Disease and COVID-19 Outcomes in the Temporal Analysis of Pandemic Waves

Background: COVID-19 continues to spread worldwide with considerable morbidity and mortality. CKD is among the most prevalent diseases related to COVID-19 mortality. AKI is a common COVID-19 complication. Distinct pandemic waves were observed as a function of specific COVID-19 variants, public health policies and vaccination status. Studies reported changing patient characteristics and outcomes by different waves. However, changes in the effect of clinical risk factors as a function of each wave have not been well studied. Here, we examine the temporal effects of pre-existing CKD (also KDIGO A and G stages) on COVID-19 outcomes by waves. Method(s): We used estimated effective reproduction numbers with US data to define distinct waves. We designed a COVID-19 algorithm based on WHO guidelines, N3C COVID-19 V2.2 and local data characteristics as having >=1 positive SARSCov- 2 RT-PCR or antibody test, or >=3 diagnosis or problem codes if no relevant tests. Comorbidities and outcomes were captured electronically using published algorithms. We used logistic regression and survival analysis to identify predictors of COVID-19 outcomes for each wave. Result(s): Five national waves were identified and mapped to 4 distinct NYC waves observed at Columbia University Medical Center (CUMC). We identified 64246 COVID-19 cases at CUMC, 8% were severe, 18% were hospitalized. The risk of severe COVID-19 was associated with pre-existing CKD, heart disease, diabetes and hypertension in most waves;and lung disease, obesity and cancer in at least one wave. AKI occurred in 49% of severe cases and 35% of hospitalized ones. The risk of AKI was associated with heart failure, obesity, diabetes and cancer in most waves;and CKD, CAD, hypertension and stroke in one or two waves. The risk of AKI was not associated with pre-existing lung disease. A and G stages independently predicted severe COVID-19 and COVID-19 related AKI across all waves. Pre-existing albuminuria significantly predicted COVID-19 mortality independent of G-stage, diabetes, obesity, hypertension, cancer or cardiovascular disease throughout the entire pandemic. Conclusion(s): Pre-existing kidney disease was among the strongest and most consistent clinical predictors of poor COVID-19 outcomes regardless of the pandemic wave. Even in the pandemic late phase, patients with decreased kidney function or albuminuria were at a higher risk of severe COVID-19, AKI and death.

Effects of phenylpyridinone derivative on the replication of Porcine Deltacoronavirus

The purpose of this study was to investigate the antiviral effect of phenylpyridinone derivative JIB-04 on porcine deltacoronavirus (PDCoV), and explore the possible mechanism. Cell viability after treatment with different concentrations of JIB-04 was detected by CCK-8, and the 50% cytotoxic concentration (CC50) and 50% effective concentration (EC50) were calculated. TCID50 method was used to detect the effects of JIB-04 pretreatment and co-treatment on PDCoV replicationand the effect of JIB-04 treatment on virus attachment and penetration. Finally, qRT-PCR, TCID50 and Western blot methods were used to detect the effect of JIB-04 on virus replication at different times post infection. The results showed that JIB-04 did not affect the cell viability of LLC-PK cells at all tested concentrations, and CC50>640 micro mol.L-1, EC50=0.216 micro mol.L-1, and SI index is greater than 2 963. Compared with untreated virus infection group, JIB-04 treatment significantly reduced the virus titer (P < 0.001), but it had no effect on attachment or penetration of PDCoV. At 6 h post infection, compared with untreated virus infection group, virus titer in JIB-04 treatment group was significantly decreased (P < 0.01). At 12 and 24 h post infection, virus titer, genome copy number, and N protein expression level all significantly decreased (P < 0.01). JIB-04 has a low cytotoxicity and a high selective index, and can protect against PDCoV infection in vitro, making it a potential antiviral drug. JIB-04 can inhibit synthesis of viral RNA, protein and PDCoV replication.

Benchmarked molecular docking integrated molecular dynamics stability analysis for prediction of SARS-CoV-2 papain-like protease inhibition by olive secoiridoids.

Objectives: We performed a virtual screening of olive secoiridoids of the OliveNetTM library to predict SARS-CoV-2 PLpro inhibition. Benchmarked molecular docking protocol that evaluated the performance of two docking programs was applied to execute virtual screening. Molecular dynamics stability analysis of the top-ranked olive secoiridoid docked to PLpro was also carried out. Methods: Benchmarking virtual screening used two freely available docking programs, AutoDock Vina 1.1.2. and AutoDock 4.2.1. for molecular docking of olive secoiridoids to a single PLpro structure. Screening also included benchmark structures of known active and decoy molecules from the DEKOIS 2.0 library. Based on the predicted binding energies, the docking programs ranked the screened molecules. We applied the usual performance evaluation metrices to evaluate the docking programs using the predicted ranks. Molecular dynamics of the top-ranked olive secoiridoid bound to PLpro and computation of MM-GBSA energy using three iterations during the last 50 ps of the analysis of the dynamics in Desmond supported the stability prediction. Results and discussions: Predictiveness curves suggested that AutoDock Vina has a better predictive ability than AutoDock, although there was a moderate correlation between the active molecules rankings (Kendall's correlation of rank (τ) = 0.581). Interestingly, two same molecules, Demethyloleuropein aglycone, and Oleuroside enriched the top 1 % ranked olive secoiridoids predicted by both programs. Demethyloleuropein aglycone bound to PLpro obtained by docking in AutoDock Vina when analyzed for stability by molecular dynamics simulation for 50 ns displayed an RMSD, RMSF<2 Å, and MM-GBSA energy of -94.54 ± 6.05 kcal/mol indicating good stability. Molecular dynamics also revealed the interactions of Demethyloleuropein aglycone with binding sites 2 and 3 of PLpro, suggesting a potent inhibition. In addition, for 98 % of the simulation time, two phenolic hydroxy groups of Demethyloleuropein aglycone maintained two hydrogen bonds with Asp302 of PLpro, specifying the significance of the groups in receptor binding. Conclusion: AutoDock Vina retrieved the active molecules accurately and predicted Demethyloleuropein aglycone as the best inhibitor of PLpro. The Arabian diet consisting of olive products rich in secoiridoids benefits from the PLpro inhibition property and reduces the risk of viral infection.

Effects of yoga practice on physiological distress, fatigue and QOL in patients affected by breast cancer undergoing adjuvant radiotherapy.

Background and purpose: In this study we want to evaluate the efficacy of yoga practice on dysfunctional stress, inflammation and QOL in breast cancer patients undergoing adjuvant radiotherapy. Patients and methods: Patients with stage 0 to III breast cancer were recruited before starting radiotherapy (XRT) and were randomly assigned to yoga group (YG) two times a week during XRT or control group (CG). Self-report measures of QOL, fatigue and sleep quality, and blood samples were collected at day 1 of treatment, day 15, end of treatment and 1, 3 and 6 months later. Cortisol blood level, IL6, IL10, IL1RA, TNFα and lymphocyte-to-monocyte ratio were analyzed as measures of dysfunctional stress and inflammation. Results: Patients started XRT and yoga classes in October 2019. Due to COVID-19 pandemic we closed the enrollment in March 2020. We analysed 24 patients, 12 YG and 12 CG. The analysis of blood cortisol levels revealed an interaction (p = 0.04) between yoga practice and time, in particular YG had lower cortisol levels at the end of XRT respect to CG (p-adj = 0.02). The analysis of IL-1RA revealed an interaction effect (p = 0.04) suggesting differences between groups at some time points that post-hoc tests were not able to detect. Conclusions: To our knowledge, this is the first study to evaluate the effects of yoga in a cancer population studying inflammation markers, cortisol trend and QOL during and until 6 months after XRT. This study suggests that yoga practice is able to reduce stress and inflammation levels over time. Besides including a larger number of patients to increase the power, future studies should consider other inflammatory or pro inflammatory factors and long-term yoga program to gain more evidence on yoga practice benefits.

The human EF1a promoter does not provide expression of the transgene in mice.

In this work, we set out to create mice susceptible to the SARS-CoV-2 coronavirus. To ensure the ubiquitous expression of the human ACE2 gene we used the human EF1a promoter. Using pronuclear microinjection of the transgene construct, we obtained six founders with the insertion of the EF1a-hACE2 transgene, from which four independent mouse lines were established. Unfortunately, only one line had low levels of hACE2 expression in some organs. In addition, we did not detect the hACE2 protein in primary lung fibroblasts from any of the transgenic lines. Bisulfite sequencing analysis revealed that the EF1a promoter was hypermethylated in the genomes of transgenic animals. Extensive analysis of published works about transgenic animals indicated that EF1a transgenic constructs are frequently inactive. Thus, our case cautions against using the EF1a promoter to generate transgenic animals, as it is prone to epigenetic silencing.

Training Future Research Psychiatrists: Experience From the First Eight Match Classes of an NIMH-Funded Psychiatry Research Residency Track

Background: In 2014, UCSD initiated an NIMH-funded Research Residency Track (RRT) to increase the number and diversity of physician-scientists pursuing careers in Psychiatry research. This RRT’s novel curriculum prepares Residents for a successful academic career and its Summer Research Fellowship (URMSRF) connects under-represented minority (URM) MS1 medical students with Psychiatry research at a critical phase in career/identity development. This report describes results after 8 “Match” cycles, 4 graduating classes of Research Track Residents and 7 Summer URMSRF cycles. Methods: Outcome metrics for all trainees – Residents and URMSRF students – were used to assess program effectiveness. Results: 14 Residents have “matched” into this RRT (12 MD/PhD;2 MD;M:F=7:7): 7 have graduated, and 7 remain as PGY1-4. Two other MD/PhD Residents (M:F=1:1) joined “internally” as PGY2-3’s. Retention is 100%. Residents averaged >2 s and >2 peer-reviewed publications as lead- or co-author and >4 national honors/travel awards/competitive grants. Of the 7 graduates who “matched” into this RRT, 100% hold academic positions: 1 is a PGY5 Fellow and 6 have academic faculty appointments with stable research funding, 5 with NIH K- or VA Career Development Awards. Of 14 URMSRF students, 9 have graduated from medical school, 6 of whom pursued Psychiatry Residencies (2 in Psychiatry RRT’s) and 1 is a PGY5 Research Fellow. Conclusions: This RRT accomplishes NIMH goals of increasing the pipeline of diverse Psychiatric researchers. Comparison groups and program details will be discussed, as will five challenges: 1. Funding;2. URM recruitment;3. COVID-19;4. Maternity/paternity leave;5. success of “Internal” vs. “Matched” Residents. Supported By: MH101072 Keywords: Training, Education, Residency

Utility of exercise testing to assess athletes for post COVID-19 myocarditis.

Purpose: This study assessed a functional protocol to identify myocarditis or myocardial involvement in competitive athletes following SARS-CoV2 infection. Methods: We prospectively evaluated competitive athletes (n = 174) for myocarditis or myocardial involvement using the Multidisciplinary Inquiry of Athletes in Miami (MIAMI) protocol, a median of 18.5 (IQR 16-25) days following diagnosis of COVID-19 infection. The protocol included biomarker analysis, ECG, cardiopulmonary stress echocardiography testing with global longitudinal strain (GLS), and targeted cardiac MRI for athletes with abnormal findings. Patients were followed for median of 148 days. Results: We evaluated 52 females and 122 males, with median age 21 (IQR: 19, 22) years. Five (2.9%) had evidence of myocardial involvement, including definite or probable myocarditis (n = 2). Three of the 5 athletes with myocarditis or myocardial involvement had clinically significant abnormalities during stress testing including ventricular ectopy, wall motion abnormalities and/or elevated VE/VCO2, while the other two athletes had resting ECG abnormalities. VO2max, left ventricular ejection fraction and GLS were similar between those with or without myocardial involvement. No adverse events were reported in the 169 athletes cleared to exercise at a median follow-up of 148 (IQR108,211) days. Patients who were initially restricted from exercise had no adverse sequelae and were cleared to resume training between 3 and 12 months post diagnosis. Conclusions: Screening protocols that include exercise testing may enhance the sensitivity of detecting COVID-19 related myocardial involvement following recovery from SARS-CoV2 infection.

ADAPTATION OF FOREIGN EXPERIENCE IN ENSURING FOOD SECURITY TO RUSSIAN CONDITIONS

One of the most significant criteria characterizing the effectiveness of the country’s food security system is ensuring access of the entire population (including the poor) to the necessary amounts of food. To solve the problem of poverty and malnutrition, new approaches that involve strengthening government regulation, attracting resources from commercial companies, and increasing the efficiency of public socially-oriented organizations are needed. The article proposes a large-scale state program that provides support to the country’s poor, with the active participation of business structures and Russian food banks. The main directions of the state program are determined taking foreign experience in supporting the poor, as well as the specifics of the development of the Russian economy and social sphere into account. Particular attention is paid to the changes in the tax legislation of the Russian Federation, aimed at increasing the interest of private enterprises in the implementation of the program to support the low-income population. The proposed amendments are especially relevant in the face of the deteriorating economic situation caused by the COVID-19 pandemic. The developed set of measures complies with the provisions of the updated Food Security Doctrine of 2020 and can be an addition to the strategies being implemented to improve the efficiency of the food security system in the Russian Federation.Alternate : Одним из наиболее значимых критериев, характеризующих эффективность системы продовольственной безопасности страны, является обеспечение доступа всего населения (в том числе малоимущих) к необходимым объемам продуктов питания. Для решения проблем бедности и недоедания необходимы новые подходы, предусматривающие усиление государственного регулирования, привлечение ресурсов коммерческих компаний, а также повышение эффективности деятельности общественных социально ориентированных организаций. Ð’ статье предложено проведение широкомасштабной государственной программы, обеспечивающей поддержку малоимущего населения страны, при активном участии бизнес-структур и российских благотворительных продовольственных фондов. Основные направления государственной программы определены с учетом зарубежного опыта по поддержке малоимущих слоев населения, а также специфики развития российской экономики и социальной сферы. Особое внимание в статье уделено изменениям в налоговом законодательстве РФ, направленным на повышение заинтересованности частных предприятий в реализации программы поддержки малообеспеченного населения. Предлагаемые поправки особенно актуальны в условиях ухудшения экономической ситуации, обусловленной пандемией вируса COVID-19. Разработанный комплекс мер соответствует положениям обновленной Доктрины продовольственной безопасности 2020 г. и может стать дополнением к реализуемым стратегиям п ¾ повышению эффективности системы обеспечения продовольственной безопасности РФ.

Left ventricular global longitudinal strain imaging in identifying subclinical myocardial dysfunction among covid-19 survivors.

BACKGROUND: Covid-19 is multi-system viral infection caused by SARS-CoV-2 virus. Apart from having acute severe respiratory illness causing high mortality, the disease also has a variety of cardiovascular manifestations contributing to morbidity as well as mortality. Cardiac dysfunction and myocarditis are well established complications of Covid-19 as evident in multiple studies after the Covid-19 pandemic. However it is not sufficiently studied in Indian patients either by Echocardiography or by any other imaging modalities like cardiac magnetic resonance imaging (MRI). METHODOLOGY: In this study, we analysed the severity of Left ventricular(LV) dysfunction in Covid-19 survivors. A total of 100 consecutive patients of Covid-19 after one month of discharge who had no underlying cardiovascular diseases underwent echocardiography and global longitudinal strain (GLS) imaging. This study cohort included patients with mild 42 (42%),moderate 46(46%) and severe 12(12%) Covid-19 disease as defined by computerised tomography (CT) severity score. RESULT: We observed that total 36(36%) patients had reduced ejection fraction(EF) which included 11 patients having EF <40% and remaining 25(25%) having EF 40-50% (p<0.002). Also 22 (22%) patients had abnormal global longitudinal strain (GLS) values with normal ejection fraction which is suggestive of subclinical myocarditis. We observed LV dysfunction in 7(19.5%) patients who had severe Covid-19 while mild to moderate LV dysfunction observed in 29(80.5%) non critical patients. CONCLUSION: In conclusion our study demonstrates that myocardial dysfunction is common in covid-19 regardless of disease severity. 2D-echocardiography with GLS is likely to detect early LV dysfunction among these patients.

The MERS-CoV N Protein Regulates Host Cytokinesis and Protein Translation via Interaction With EF1A.

Middle East respiratory syndrome coronavirus (MERS-CoV), a pathogen causing severe respiratory disease in humans that emerged in June 2012, is a novel beta coronavirus similar to severe acute respiratory syndrome coronavirus (SARS-CoV). In this study, immunoprecipitation and proximity ligation assays revealed that the nucleocapsid (N) protein of MERS-CoV interacted with human translation elongation factor 1A (EF1A), an essential component of the translation system with important roles in protein translation, cytokinesis, and filamentous actin (F-actin) bundling. The C-terminal motif (residues 359-363) of the N protein was the crucial domain involved in this interaction. The interaction between the MERS-CoV N protein and EF1A resulted in cytokinesis inhibition due to the formation of inactive F-actin bundles, as observed in an in vitro actin polymerization assay and in MERS-CoV-infected cells. Furthermore, the translation of a CoV-like reporter mRNA carrying the MERS-CoV 5'UTR was significantly potentiated by the N protein, indicating that a similar process may contribute to EF1A-associated viral protein translation. This study highlights the crucial role of EF1A in MERS-CoV infection and provides new insights into the pathogenesis of coronavirus infections.

Understanding the role of left and right ventricular strain assessment in patients hospitalized with COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) can cause cardiac injury resulting in abnormal right or left ventricular function (RV/LV) with worse outcomes. We hypothesized that two-dimensional (2D) speckle-tracking assessment of LV global longitudinal strain (GLS) and RV free wall strain (FWS) by transthoracic echocardiography can assist as markers for subclinical cardiac injury predicting increased mortality. METHODS: We performed 2D strain analysis via proprietary software in 48 patients hospitalized with COVID-19. Clinical information, demographics, comorbidities, and lab values were collected via retrospective chart review. The primary outcome was in-hospital mortality based on an optimized abnormal LV GLS value via ROC analysis and RV FWS. RESULTS: The optimal LV GLS cutoff to predict death was -13.8%, with a sensitivity of 85% (95% CI 55-98%) and specificity of 54% (95% CI 36-71%). Abnormal LV GLS >-13.8% was associated with a higher risk of death [unadjusted hazard ratio 5.15 (95% CI 1.13-23.45), p = 0.034], which persisted after adjustment for clinical variables. Among patients with LV ejection fraction (LVEF) >50%, those with LV GLS > -13.8% had higher mortality compared to those with LV GLS <-13.8% (41% vs. 10%, p = 0.030). RV FWS value was higher in patients with LV GLS >-13.8% (-13.7 ±â€¯5.9 vs. -19.6 ±â€¯6.7, p = 0.003), but not associated with decreased survival. CONCLUSION: Abnormal LV strain with a cutoff of >-13.8% in patients with COVID-19 is associated with significantly higher risk of death. Despite normal LVEF, abnormal LV GLS predicted worse outcomes in patients hospitalized with COVID-19. There was no mortality difference based on RV strain.

Artificial Intelligence-Enabled POCUS in the COVID-19 ICU: A New Spin on Cardiac Ultrasound.

We present the novel use of a deep learning-derived technology trained on the skilled hand movements of cardiac sonographers that guides novice users to acquire high-quality bedside cardiac ultrasound images. We illustrate its use at the point of care through a series of patient encounters in the COVID-19 intensive care unit. (Level of Difficulty: Beginner.).

Cardiac Involvement in Patients Recovered From COVID-2019 Identified Using Magnetic Resonance Imaging.

Objectives: This study evaluated cardiac involvement in patients recovered from coronavirus disease-2019 (COVID-19) using cardiac magnetic resonance (CMR). Background: Myocardial injury caused by COVID-19 was previously reported in hospitalized patients. It is unknown if there is sustained cardiac involvement after patients' recovery from COVID-19. Methods: Twenty-six patients recovered from COVID-19 who reported cardiac symptoms and underwent CMR examinations were retrospectively included. CMR protocols consisted of conventional sequences (cine, T2-weighted imaging, and late gadolinium enhancement [LGE]) and quantitative mapping sequences (T1, T2, and extracellular volume [ECV] mapping). Edema ratio and LGE were assessed in post-COVID-19 patients. Cardiac function, native T1/T2, and ECV were quantitatively evaluated and compared with controls. Results: Fifteen patients (58%) had abnormal CMR findings on conventional CMR sequences: myocardial edema was found in 14 (54%) patients and LGE was found in 8 (31%) patients. Decreased right ventricle functional parameters including ejection fraction, cardiac index, and stroke volume/body surface area were found in patients with positive conventional CMR findings. Using quantitative mapping, global native T1, T2, and ECV were all found to be significantly elevated in patients with positive conventional CMR findings, compared with patients without positive findings and controls (median [interquartile range]: native T1 1,271 ms [1,243 to 1,298 ms] vs. 1,237 ms [1,216 to 1,262 ms] vs. 1,224 ms [1,217 to 1,245 ms]; mean ± SD: T2 42.7 ± 3.1 ms vs. 38.1 ms ± 2.4 vs. 39.1 ms ± 3.1; median [interquartile range]: 28.2% [24.8% to 36.2%] vs. 24.8% [23.1% to 25.4%] vs. 23.7% [22.2% to 25.2%]; p = 0.002; p < 0.001, and p = 0.002, respectively). Conclusions: Cardiac involvement was found in a proportion of patients recovered from COVID-19. CMR manifestation included myocardial edema, fibrosis, and impaired right ventricle function. Attention should be paid to the possible myocardial involvement in patients recovered from COVID-19 with cardiac symptoms.

SARS-CoV-2 Fulminant Myocarditis.

An 18-year-old male without prior medical history developed fulminant myocarditis concomitant to severe COVID-19 pneumonia, which was confirmed using serial cardiac magnetic resonance. This may have important diagnostic, monitoring, and pathogenic implications. (Level of Difficulty: Intermediate.).