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The coronavirus disease 2019 (COVID-19) is induced by the SARS-CoV-2 virus, which caused the global pandemic, infecting approximately 608.328.548 confirmed cases and bringing about 6.501.469 deaths worldwide, as WHO stated in September 2022. The disease is more deadly due to the lack of specific drug molecules or a treatment plan. Therefore, the development of potent pharmacological compounds is urgently required to combat COVID-19. Due to their biological actions, snake venoms constitute a source of potentially beneficial medicinal compounds. Vipera ammodytes ammodytes (VA) is a viper species whose venom has been shown to have anti-proliferative, antimetastatic, anti-cancer, and anti-microbial activities. This in silico study was conducted to evaluate the efficacy of selected VA venom proteins (Adamalysin II, Ammodytoxin A, Ammodytin L, L-amino acid oxidase) against molecular targets;Main protease (3CLpro) and Angiotensin-Converting Enzyme 2 (ACE2) by molecular docking study. Molecular docking investigations were performed by using AutoDock Vina software. All compounds displayed negative binding energy values to 3CLpro and ACE2, suggesting that their interactions with the active sites were favourable. L-amino acid oxidase had the highest binding affinity with both 3CLpro and ACE2. This study revealed for the first time that VA venom proteins are functional inhibitors of 3CLpro and ACE2 activities, and the components of VA venom can be considered potential SARS-CoV-2 inhibitors. However, more studies are needed to validate these compounds in vitro and in vivo. [ FROM AUTHOR] Copyright of Journal of the Institute of Science & Technology / Fen Bilimleri Estitüsü Dergisi is the property of Igdir University, Institute of Science & Technology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Background: Hymenoptera venom immunotherapy (VIT) is a safe and effective treatment for Hymenoptera venom allergy (HVA). Unexpected events, such as venom extracts shortage or COVID-19 pandemic, can impact HVA management, and a change in VIT supplier may became necessary. We aimed to evaluate the safety of switching VIT manufacturer without any dose adjustments. Method(s): A retrospective study of patients treated with VIT between 2013 and 2021, in the maintenance phase and without any previous systemic reactions was performed. All the patients switched to another manufacturer while keeping the same venom without any dose modification. All venom extracts were aqueous preparations. Demographic and clinical data were also analyzed. Result(s): A total of 40 patients were included (31 male, median age 44 years old);76% lived in a rural environment, 58% had apiaries <3km from home or work, and 18% were medicated with beta-blockers and/or angiotensin converting enzyme inhibitors. Most patients (68%) were treated with bee venom and the remaining wasp venom. The median time between the beginning of the maintenance phase and the switch to a different VIT supplier was 18 months [1-52 months]. A total of 42 changes between 4 suppliers were performed without any dose adjustments (39 Roxall to Leti;2 Stallergenes to Roxall;1 Inmunotek -> Roxall), with only local reaction reported. This healthy 50-year- old female patient treated with wasp VIT for 3-months in the maintenance phase, switched from Inmunotek to Roxall and presented a local reaction, similar to previous reactions with the former manufacturer. Two years later, she did not react when VIT was changed from Roxall to Leti. No systemic reactions occurred, and no one discontinued VIT. Conclusion(s): International recommendations regarding changing VIT supplier are scarce. Our results suggest that is safe to switch venom extracts from different manufacturers without the need for dose adjustment in patients on maintenance VIT without any previous systemic reactions.
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Background: Mastocytosis is a disorder characterized by an accumulation of mast cells in one or more organ systems and increased risk for severe anaphylaxis. Coronavirus disease 2019 (COVID-19) is associated with a relatively high rate of severe lung disease and mortality. During 2020, vaccines against COVID-19 were developed. The reported frequency of severe side effects appears to be low even in patients with severe allergies and mastocytosis. The aim of this study was to evaluate the safety of vaccines against COVID-19 in patients with mastocytosis. Method(s): Retrospective analysis of patients with a diagnosis of mastocytosis who have been vaccinated against COVID-19 in our department, from January to December 2021. Demographic data, history of anaphylactic reactions, COVID-19 vaccines used, premedication with antihistamines and hypersensitivity reactions were reviewed. Result(s): This study included 14 patients (64% (n = 9) were female, median age 51 +/- 18 years). Twelve (86%) patients had indolent systemic mastocytosis and two (14%) had cutaneous mastocytosis. Four (29%) patients had a history of idiopathic anaphylaxis, three (21%) reported anaphylaxis to hymenoptera venoms and one (7%) anaphylaxis to NSAID. The median basal serum tryptase level was 38.9 ng/ml, with a range from 12.7 to 91 ng/ml. Thirteen (93%) patients received an mRNA vaccine, and one adenoviral vector vaccine (7%), 2 doses each (28 administrations in total). None of the patients received premedication with antihistamines before the vaccination. None of the patients presented hypersensitivity reactions after the vaccine against COVID-19. Conclusion(s): As reported in recent studies, vaccination against COVID-19 in adult patients with mastocytosis is safe. Some authors recommend premedication in patients with mastocytosis at high risk for anaphylaxis. In our study, none of the patients received premedication and no hypersensitivity reactions were observed. More studies are needed, but in our sample, as observed for other vaccines, the vaccine against COVID-19 in patients with mastocytosis was safe.
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Background: One of the most disadvantageous group of people in Covid 19 pandemic are those with chronic diseases who have been unable to reach medical services they should have. The aim of our study was to investigate if our patients receiving either subcutaneous allergen immunotherapy (SCIT) or biologicals had been effected in terms of compliance to their treatment. Method(s): All of our patients that were being followed in our outpatient clinic receiving a regular treatment -either SCIT or a biological agent -before January 2020 were included in the study. The study group consisted of a total of 223 adult patients of whom 128 were on SCIT and 95 on a biological agent. We applied a conversation based survey to each patient by means of a phone call or during an office visit to identify any disruption in their treatment. We also screened our patient files to collect demographic data and data related to the diagnosis and duration of therapy. Patients were also asked if they had past Covid -19 infection or not. Result(s): Out of 128 patients receiving SCIT for an aeroallergen or venom,124 patients (median age 38 (min-max 18-66)) could have the survey completed. Eighty one patients (63.3%) reported that they couldn't continue their treatment while 43 (37.6%) patients could. The most common reasons of noncompliance were the reluctance of patients to go to the hospital with the fear of getting Covid 19 infection (n = 36 ;44.4%) and the difficulties in supplying the allergen immunotherapy product (n = 15;18.5%). Fourteen patients (17.3%) left the treatment as they were already close to the end of the scheduled treatment duration. Ninety one patients (median age 53 (min-max 19-75)) out of 95 who were on a biological treatment-either omalizumab or mepolizumab-had completed the survey. Only nine patients (9.9%) left the treatment while 82 patients (90.1%) did not. The most common reason for noncompliance was similarly the reluctance to go to the hospital in 4 (4.4%) of the patients . Twenty one of the SCIT patients (16.9%) and 22 patients (24.2%) receiving biologicals had documented Covid 19 infection. Conclusion(s): Covid 19 pandemic had a negative effect on our patients'compliance to their treatment. This effect was apparently higher in the patients receiving SCIT who should have their shots only in an allergy clinic under close supervision while patients on biologicals may receive their treatments in other healthcare centers.
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Background: SARS-Cov- 2 is a new respiratory virus that causes COVID-19 disease. It is a new infectious agent and knowledge is still very limited, particularly its interaction with allergic disease. The aim of this study was to assess the effect of allergic disease on the risk of hospitalization for COVID-19. Method(s): A total of 7542 SARS-CoV- 2 infections were diagnosed from 1 March to 31 December 2020 at the Centro Hospitalar Universitario de Sao Joao. A total of 1727 (22.9%) patients were hospitalized (31% in intensive care) and 5815 were followed up by an outpatient clinic. Of this group, 3479 (65%) answered a telephone questionnaire, 3 to 6 months after acute infection, about sociodemographic, clinical, behavioral and psychological characteristics. They were also asked about a previous diagnosis of allergic disease. Individuals aged < 18 years and those with asymptomatic infection were excluded. Result(s): A sample of 2702 participants was analyzed, 33.5% reported allergic disease prior to the diagnosis of COVID-19: 215 (8%) asthma, 517 (19.2%) rhinitis, 138 (5.1%) drug allergy, 36 (1.3%) food allergy, 22 (0.8%) atopic dermatitis and 2 (0.1%) hymenoptera venom allergy. The proportion of participants with asthma is not statistically different across age groups, but when grouping other allergic diseases other than asthma, a reduction was observed with age (21.5% of 18-29 years old vs. 4.9 % with >=80 years, p > 0.001). Allergic disease was significantly more prevalent in women (asthma 9.8% vs. 5.2%;other allergies: 17.9% vs. 12.7%, p < 0.001). In a univariate analysis, the risk of hospitalization of patient with COVID-19 was significantly lower in those with allergic disease (OR = 0.7;95% CI: 0.55-0.92), but for asthma the effect was not significant. Gender was an interaction factor in this association, so in a separate multivariate model for women and men and adjusted for the other significant risk factors -age, obesity and comorbidities -the effect on risk reduction remained only in the men (adjusted OR = 0.6;95% CI:0.33-1.07). Conclusion(s): In this study, allergic disease, excluding asthma, was associated with a decrease in the severity of COVID-19, especially in men. However, further studies, namely prospective studies, are needed to better characterize this effect and the underlying mechanisms.
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Background: The development of vaccines against coronavirus disease 2019 (COVID-19) and the report of associated allergic reactions has led to growing concern about their safety, especially in populations at risk for anaphylaxis such as patients with systemic mastocytosis. Method(s): We conducted a retrospective descriptive analysis of patients with systemic mastocytosis referred to our Allergy and Clinical Immunology Department, between June 2021 and February 2022, for COVID-19 vaccination. Patients were divided into two groups according to their risk of allergic reaction: low/moderate-risk (no history of severe allergic reaction, with or without a history of allergic disease) and high-risk (history of any severe allergic reaction). All patients were premedicated with 60 mg of oral prednisolone 24 hours and 1 hour prior inoculation, and with an oral antihistamine 1 hour before vaccine administration. Low/moderate-risk patients were monitored for 30 minutes after vaccine inoculation. High-risk patients got a peripheral venous access and remained under medical surveillance for 60 minutes. Result(s): A total of 45 patients were included in the analysis: 62.2% females, with a mean age of 48.8 years (range: 22-85). All patients had indolent systemic mastocytosis subtype, with a median tryptase level of 15.6 ng/mL (range: 4.3-185 ng/mL);11 (24.4%) were in the high-risk group (8 with history of anaphylaxis to hymenoptera venom and 3 with prior drug anaphylaxis). Low/moderate-risk and high-risk groups had similar median levels of serum tryptase (15.5 vs. 16.6 ng/ mL, p = 0.932). All patients received BNT162b2 mRNA COVID-19 vaccine and a total of 118 doses were administered (24.6% in the high risk group). No adverse events, including allergic reactions, after vaccine inoculation were recorded during the surveillance period. Conclusion(s): To our knowledge, this is the largest series reporting safety of a mRNA COVID-19 vaccine in patients with systemic mastocytosis. Our data reinforce the fact that even patients with increased risk for allergic reactions can be safely vaccinated against COVID-19, and that earlier concerns should be abandoned so a widespread immunization can be achieved.
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The new corona virus illness (COVID-19) swept around the world, quickly creating a serious international disaster. For the treatment and prevention of COVID-19, apitherapy appears to be a viable source of pharmacological and nutraceutical medicines. Honey, pollen, propolis, royal jelly, beeswax, and bee venom, for example, have been demonstrated to have significant antiviral action against infections that cause severe respiratory syndromes, including those produced by human corona viruses. Furthermore, many of these natural products are involved in the induction of antibody production, maturation of immune cells, and stimulation of innate and adaptive immunological responses and many of them are involved in the induction of antibody production, maturation of immune cells, and stimulation of innate and adaptive immunological responses.
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Because of the catastrophic consequences of COVID-19 on the world population, there should be novel interventions to handle ongoing infections and daily death cases. The aim of the current study is to examine the effectiveness of HBV (Honeybee venom) proteins on spike protein RBD by in silico tools. The sequences of 5 HBV proteins were used for homology modeling by Phyre 2. The generated protein models were employed for protein-protein docking against Omicron Spike glycoprotein receptor binding domain (RBD) (PDB ID# 7T9L) through HDock and ClusPro platforms followed by prediction of binding affinity using PRODIGY web portal and PDBsum for revealing interaction details. It was found that all of the examined HBV proteins exhibited strong docking scores and binding affinity profiles toward RBD. The findings of the present study indicate the possible HBV as preventive as well as treatment options against Omicron SARS-CoV-2. © 2022, Palladin Institute of Biochemistry of the NASU. All rights reserved.
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Targeted therapeutics for SARS-CoV-2 virus caused COVID-19 are in urgent need. Chansu has been reported to have broad-spectrum antiviral effects and widely used in Southeast Asian countries. This study aims to assess the efficacy of Chansu injection in treating patients with severe COVID-19. A randomized preliminary clinical trial was conducted and eligible patients were allocated to receive general treatment plus Chansu injection or only general treatment as control for 7 days. The primary outcomes of the oxygenation index PaO2/FiO2 and ROX, secondary outcomes of white blood cell count, respiratory support step-down time (RSST), safety indicators, etc were monitored. After 7 days of treatment, the oxygenation index was improved in 95.2% patients in the treatment group compared with 68.4% in the control group. The PaO2/FiO2 and ROX indices in the treatment group (mean, 226.27+/-67.35 and 14.01+/-3.99 respectively) were significantly higher than the control group (mean, 143.23+/-51.29 and 9.64+/-5.54 respectively). The RSST was 1 day shorter in the treatment group. Multivariate regression analysis suggested that Chansu injection contributed the most to the outcome of PaO2/FiO2. No obvious adverse effects were observed. The preliminary data showed that Chansu injection had apparent efficacy in improving the respiratory function of patients with severe COVID-19.Copyright © 2021 The Authors
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This study aims to fully exploit the natural compound; bee venom (BV) as a substance that can kill and inhibit the growth of microbes and viruses. For this target, BV was loaded onto a safe, natural, and economically inexpensive polymer, which is chitosan (Ch) in its nano-size form using the ionic gelation method and chemical crosslinking agent (sodium tripolyphosphate; TPP). The findings illustrated that chitosan nanoparticles (ChNPs) were prepared thru this method exhibited spherical shape and average hydrodynamic size of 202â¯nm with a polydispersity index (PDIâ¯=â¯0.44). However, the size was increased to 221â¯nm and PDI (0.37) when chitosan nanoparticles were loaded with BV (ChNC). In addition, the particles of BV appeared as a core and chitosan nanoparticles as a shell implying the successful preparation of nanocomposite (ChNC) that based on the. Encapsulation of BV into ChNPs with significantly small size distribution and good stability that protect these formed nanocomposites from agglomeration. The cytopathic effect (CPE) inhibition assay was used to identify potential antivirals for Middle East respiratory syndrome coronavirus (MERS-CoV). The response of the dose study was designed to influence the range of effectiveness for the chosen antiviral, i.e., the 50â¯% inhibitory concentration (IC50), as well as the range of cytotoxicity (CC50). However, our results indicated that crude BV had mild anti-MERS-COV with SIâ¯=â¯4.6, followed by ChNPs that exhibited moderate anti-MERS-COV with SIâ¯=â¯8.6. Meanwhile. The nanocomposite of ChNC displayed a promising anti-MERS-COV with SIâ¯=â¯12.1. Additionally, the synthesized nanocomposite (ChNC) had greater antimicrobial activity against both Gram-positive and Gram-negative bacteria when compared with ChNPs, BV or the utilized model drug.
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Introduction/Background: Primary bone marrow oedema syndrome is an elusive and less well-defined entity. Whether Rheumatologists should consider it as a stand alone diagnosis, is debatable. It possibly would be best described as an MRI feature which could be a finding in a number of diseases which would include the initial phases of Osteonecrosis of the bone, Rheumatoid Arthritis, Spondyloarthritis, Enthesitis related, Post traumatic, OA, Infections and Cancers. The treatment options become constricted due to the paucity of evidence. Rheumatologists need to consider this as an area of unmet need with development of consensus classification criteria and treatment approaches. Description/Method: 27-year-old male, Height 174 cms Weight 90 Kgs BMI 29 Kg/m2, became symptomatic in Jan 2022 with complains of pain in the both hip joints & groin regions, pain became excruciating and he became bed-bound, with early morning stiffness lasting approximately 45 mins. Had received steroids for COVID infection in August 2020. Investigations Hb 13.5gm/dl TLC 7000/mm3 Platelet 400 x 103/mm3 Sr Bil 0.8mg/dl AST 16 IU/L. ALT 24 IU/L Sr Creatininine 1.1mg/dl Blood Sugar Levels, Fasting 89 mg/dl Post Prandial 102 mg/dl ESR 10mm in 1st hour by Wintrobes method CRP Quantitative 29.38mg/L HLA B27 by PCR Negative, RF Negative, ACCP Negative Serum, IgG, Beta2 Glycoprotein 1.44 SGU Serum, IgM, Beta2 Glycoprotein 3.44 SGU Serum, IgG, Cardiolipin antibody 8.4 GPL Serum, IgG, Cardiolipin antibody 17.45 GPL Lupus anticoagulant by DRVVT Negative Sr Cholesterol 211mg/dl HDL 29 mg/dl LDL 156mg/dl TGs 130 mg/dl MRI Hips & SI joints Transient bone marrow oedema/osteopenia of bilateral hip. PET CT Increased metabolic activity in both hip joints Bone Scan (99mTcMDP) Increased vascularity in perfusion phase, increased accumulation in soft tissue in blood pool phase and increased uptake in bilateral Hip joints in skeletal phase scan, suggestive of CRPS Type-I. Management Was initially managed with Tab Etoricoxib 90mg BD, also started on Tab Sulphaslazine and Tab Methotrexate. However, when he had no symptomatic relief he was administered Inj Infliximab on 12 May 2022 and a second dose on 9 June 2022. He had excellent pain relief after the 1st dose, however after 10 days of the administration, he again began experiencing pain especially after walking. He also had pain in the knees on this occasion. He was also administered Inj Zoledronic 4mg on 23 May 2022. He is at present not requiring any NSAIDs over the last 1 month. Discussion/Results: The patient having presented with excruciating and debilitating pain was worked up and evaluation revealed features of bone marrow oedema on MRI which was corroborated with bone scan and PET CT imaging. The acute phase reactant CRP was also significantly elevated. The patient also gave history of early morning stiffness lasting approximately 45 mins. Hence an underlying Inflammatory process such as Spondyloarthritis(Peripheral) with enthesitis was considered. The confounding factors were the pain which worsened on mobilization, HLA B27 negative status, Rheumatoid Factor and ACCP negative status and past history of having received IV Corticosteroids for COVID infection in August 2020. In view of the debilitating pain and aworking diagnosis of Spondyloarthritis, hewas started onNSAIDs alongwith rest, initially, followed by conventional synthetic disease modifying agents in Rheumatic disease followed by biologic synthetic diseasemodifying agent - Inj Infliximab. The thought process was to avoid prolonged NSAID use to prevent the associated side effects. However, since Avascular Necrosis of the Femoral head is a very likely possibility, the patient is planned to be kept under close follow up. Key learning points/Conclusion: Collaborative efforts between the Departments of Nuclear Medicine, Radiology, Orthopaedics and Rheumatology are crucial in the early detection and approach to cases of Bone Marrow oedema. Avascular necrosis of head of Femur is a far more common entity and must be kept in ind even when a diagnosis of Bone Marrow oedema syndrome is being entertained. Diagnosis of Bone Marrow oedema syndrome must be entertained only as a diagnosis of exclusion. Continued follow up and regular imaging must be pursued rigorously in patients diagnosed with Bone Marrow oedema syndromes. There is a requirement to document acute phase reactants such as CRP and ESR in patients diagnosed with Avascular necrosis of bone as this data could help us differentiate AVN from Primary Bone marrow oedema in the early stages.
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We present a patient with multiple bee stings who developed lung and liver injuries and subsequently tested positive for coronavirus disease 2019 (COVID-19). A 65-year-old male patient presented to the emergency department after being stung by more than 100 honeybees. His physical examination revealed pustular lesions distributed across his chest, arms, back, legs, and head, marking the sting zones. While the patient had no history of liver disease, initial laboratory test results showed elevated liver enzyme levels. A chest computer tomography scan was ordered, revealing bilateral ground-glass opacities suggesting COVID-19. His condition worsened over the course of the following day, and when he was admitted to the intensive care unit (ICU), his SpO2 decreased to 83% despite oxygen support with a mask. The second polymerase chain reaction test taken in the ICU was positive for COVID-19 infection. After stung with multiple bees, the patient developed acute liver injury and suffered from concomitant COVID-19-related respiratory insufficency, and he was treated accordingly. Starting on the 5th day, the patient's liver markers began to improve, and on the 13th day, he was discharged with normal vital signs and liver enzyme values. There seem to be varying outcomes across different studies with regard to the relationship between bee stings and COVID-19. Further research is needed to explore the possibility of this complementary treatment with bee venom in the prevention of severe acute respiratory syndrome coronavirus-2 infection.
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Introduction: Acquired hemophilia A (AHA) is a rare hemorrhagic disease in nonhemophiliacs (1 case/106 persons per year) due to autoantibodies/inhibitors against factor VIII. The disease occurs more often in the elderly, it is usually idiopathic and it causes sudden skin and mucosal bleeding. The aim of this study was to describe a case of AHA, diagnosed during hospitalization for COVID-19. Method(s): A female patient, 87 years old was hospitalized for COVID-19. She had no personal or family history of spontaneous bleeding and was not under anticoagulant therapy. Routine coagulation parameters, mixing test-aPTT and activity of coagulation factors were performed in ACL-TOP 750 (IL). Result(s): The first bleeding episode happened two months ago when the patient underwent coronary angiography and started bleeding mainly at the catheterization point (left radial artery). Three hospitalizations followed due to extensive ecchymoses and recurrent bleeding episodes at multiple sites of venipuncture, treated with hemostatic suturing and transfusions. The patient was subsequently admitted to our hospital due to COVID-19 infection and anemia. She presented with an isolated prolongation of activated partial thromboplastin time (aPTT) (>60) since the day of her first admission. In our hospital, a mixing-test of aPTT was performed: aPTTmix-direct = 40 [Rosner-Index = 11.45% (< 12% = correction)] aPTTmix-after two hours of incubation at 37degreeC = 62.5 [(Rosner-Index = 36.45% (>15% = no correction)] Therefore, the probable presence of a coagulation factor inhibitor was indicated. No lupus anticoagulant was detected (DRVVT-TR = 0.9). A reduced activity of FVIII = 1.9% (m.p.= 50-150%) was found and she was immediately treated with prednisolone, with positive clinical response, cessation of bleeding episodes and normalization of Hct and aPTT. Conclusion(s): AHA is the most common type of acquired hemophilia. An isolated prolongation of aPTT is usually due to anticoagulants mainly heparin. If not, it may indicate a clotting-factor deficiency or the presence of an inhibitor, that is either specific (e.g. antibody to factor VIII/AHA) or nonspecific (e.g. lupus anticoagulant). The mixing-test aPTT should be routinely used in these cases to detect AHA, a rare disease usually underdiagnosed that can be fatal without early recognition and appropriate management.
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Viruses infect all types of organisms, causing viral diseases, which are very common in humans. Since viruses use the metabolic pathways of their host cells to replicate, they are difficult to eradicate without affecting the cells. The most effective measures against viral infections are vaccinations and antiviral drugs, which selectively inhibit the viral replication cycle. Both methods have disadvantages, which requires the development of new approaches to the treatment of viral diseases. In the study of animal venoms, it was found that, in addition to toxicity, venoms exhibit other types of biological activity, including an antiviral one, the first mention of which dates back to middle of the last century, but detailed studies of their antiviral activity have been conducted over the past 15 years. The COVID-19 pandemic has reinforced these studies and several compounds with antiviral activity have been identified in venoms. Some of them are very active and can be considered as the basis for antiviral drugs. This review discusses recent antiviral studies, the found compounds with high antiviral activity, and the possible mechanisms of their action. The prospects for using the animal venom components to create antiviral drugs, and the expected problems and possible solutions are also considered.
Subject(s)
COVID-19 Drug Treatment , Virus Diseases , Animals , Antiviral Agents/pharmacology , Antiviral Agents/therapeutic use , Humans , Pandemics , Virus Diseases/drug therapyABSTRACT
The care of patients suffering from allergological disorders is a clinical priority of the Karlsruhe Dermatology Clinic. Previously, the diagnostic focus was on detection of type-IV-sensitisation. However, due to increasing demand, the diagnosis of hymenoptera venom allergies has become a much more prominent issue. The direct impact of recent events on the allergological activity in the Karlsruhe Dermatology Clinic, was, with regard to the clarification on a potential allergy to a Covid 19 vaccine, recently becoming even more noticeable. Copyright © 2022 Georg Thieme Verlag. All rights reserved.
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Introduction: Thrombophilia is a co-morbidity in the general population with a prevalence of 5%. However, it is not known whether it affects severity of COVID-19. It may be possible that undiagnosed thrombophilia exaggerates an already prothrombotic state in COVID- 19 patients and hence, results in severe disease. Aims & Objectives: To study the association of underlying thrombophilia with severity of COVID-19 in post COVID patients after a minimum of 6 weeks of recovery. Material(s) and Method(s): Eighty RT-PCR confirmed adult covid patients (40 severe,40 non-severe) post 6 weeks of recovery were included. The venous blood in EDTA and citrate vials was tested for complete blood counts and coagulation parameters such as Prothrombin time, activated partial prothrombin time, Lupus anticoagulant by dRVVT, Antithrombin-III, Protein C and S). Result(s): 6/40 patients had Protein C deficiency in severe category and none in non severe. 7/40 patients had Protein S deficiency in severe category and 1 patient was deficiant in non-severe group. Conclusion(s): Thrombophilia was detected significantly in patients with severe COVID even after 6 weeks of recovery, indicating that undetected underlying thrombophilia could be a factor affecting disease severity. The common abnormalities detected were Protein C & S deficiency. This is a novel finding which needs to be explored further with extensive thrombophilia profiles. The influence of underlying thrombophilia in patients who succumbed to the disease is not known and cannot be known retrospectively. However, the extrapolation of this study suggests that thrombophilia may be an important influence on severity and mortality. (Table Presented).
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Background: Thrombosis is a frequent and severe complication in COVID-19 patients admitted to the intensive care unit (ICU). Lupus anticoagulant (LA) is a strong acquired risk factor for thrombosis in various diseases and is frequently observed in COVID-19 patients. Whether LA is associated with thrombosis in patients with severe COVID-19 is currently unclear. Aim(s): To investigate if LA is associated with thrombosis in critically ill COVID-19 patients. Method(s): The presence of LA and other antiphospholipid antibodies was assessed in COVID-19 patients admitted to the ICU. Informed consent was obtained by an opt-out approach and the study was approved by the local medical ethical committee. LA was determined with dilute Russell's Viper Venom Time (dRVVT) and LA-sensitive Activated Partial Thromboplastin Time (aPTT) reagents. Statistical analysis to study the association of LA and other antiphospholipid antibodies with thrombosis occurrence was performed using logistic regression. Result(s): Out of 169 COVID-19 patients, 116 (69%) tested positive for at least one antiphospholipid antibody upon admission to the ICU. Forty (24%) patients tested positive for LA;of whom 29 (17%) tested positive with a dRVVT, 19 (11%) tested positive with an LA-sensitive aPTT and eight (5%) tested positive on both tests. Fifty-eight (34%) patients developed thrombosis after ICU admission. The odds ratio (OR) for thrombosis in patients with LA based on a dRVVT was 2.4 (95%-CI: 1.1-5.4), which increased to 5.1 (95%-CI: 1.7-15.4) in patients on or below the median age of this study population (64 years). LA-positivity based on a dRVVT or LA-sensitive aPTT was only associated with thrombosis in patients younger than 65 years (OR: 4.2, 95%-CI: 1.5-11.7). Conclusion(s): LA on admission is strongly associated with thrombosis in critically ill COVID-19 patients, especially in patients <65 years of age.
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Background: Argatroban is a direct thrombin inhibitor licenced in the UK and USA for treatment of Heparin Induced Thrombocytopenia and has been utilised as alternative anticoagulation for critically ill COVID-19 patients. Interferences in specialised haemostasis assays may be clinically important when bridging anticoagulant regimens or investigating thrombotic and bleeding complications common in critically ill patients. Aim(s): * Assess effect of Argatroban on specialised haemostasis assays * Assess effectiveness of DOAC-Remove (DR) in removing Argatroban interference Methods: Argatroban calibration plasma, spanning concentrations of 0 mug/ml-2.08 mug/ml, was tested for Antithrombin (IIa activator), Factors IX, and XI, and dilute Russel's viper venom time (dRVVT) to assess Argatroban interference. Samples were treated with DOAC-Remove and re-run for these assays. A p value of <0.05 was used to assess significance using paired t-tests Results: * Antithrombin results were significantly and linearly increased by increasing Argatroban concentrations (R -0.99). * Factor IX and XI concentrations were significantly decreased by increasing Argatroban concentrations from 83.4 IU/dl at 0 mug/ml to 3.79 IU/ dL at 2.07 mug/ml Argatroban * dRVVT screen results were significantly increased by increasing Argatroban concentrations (DRVVT ratio 1.07 (no Argatroban) to 3.79 at 2.07 ng/ml Argatroban) * Pre-treatment of samples with DOAC-Remove completely removes Argatroban interference to baseline. Conclusion(s): Argatroban has significant effects on specialist haemostasis assays. Antithrombin overestimation was observed when IIa activator is used, a Xa activator should be considered in such patients. dRVVT screen ratios were significantly increased, which could lead to false positive Lupus anticoagulant results. Factors IX and XI results were significantly decreased. Similar results have been published for direct oral anticoagulants with the need for pre-analytical screening, where anticoagulant status is unknown, becoming more important. For Argatroban, dilute thrombin time can be used as a pre-analytical screening tool. (Table Presented).
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Background: Hypercoagulability has been established in COVID-19 and has been linked to thrombotic risk. The existence of an antiphospholipid (aPL) syndrome in COVID-19 remains controversial. Aim(s): Determine if markers of aPL syndrome are elevated in COVID-19 and associated with hypercoagulability and in-hospital clinical events. Method(s): Blood, urine, clinical data, and outcomes were analyzed in patients hospitalized with COVID-19 (n = 100) enrolled in the IRB approved TARGET-COVID study and in healthy subjects (n = 131). aPL syndrome was assessed using using lupus anticoagulant assays (dRVVT and Hex LA, Precision BioLogic Inc.);aPL antibody (APA) profiling (IgA,IgM,IgG) against aB2GP1, anticardiolipin (aCL), and anti-phosphotidyl serine (aPS) assays (Corgenix). Hypercoagulability, and coagulation markers (D-Dimer, Factor-V, VIII, XII, and Prekalikrein) were assessed using thromboelastography (TEG-6s), ELISA, and standard coagulation assays, respectively. Result(s): Mean age was 59 +/- 19 years;predominately African American (65%), with a high prevalence of hypertension (74%), obesity (53%), and diabetes (45%). LA positivity was observed in 2%;and 32%, 23%, and 9% by aB2GP1, aCL, and aPS antibody testing, respectively (Figure 1). Hypercoagulability defined by platelet-fibrin clot strength (MA >= 68 mm) was observed in 62% of the total group and was not associated with LA or APA positivity. Patients had lower FV, FXII, PK activity vs. healthy subjects (p < 0.05 for all). D-dimer was higher in patients with aPL's vs. negative patients (p = 0.03) but was not associated with thrombotic events (21% vs. 16%). Patients with positive aPS antibodies had higher mortality than aPS negative, and aCL positive, and aB2GP1 positive patients (44% vs. 18%, 10%, 7%;p< 0.05) respectively. Conclusion(s): Based on LA assay, aPL syndrome is infrequent in COVID-19. However, there is a high prevalence of aPL antibodies that correlate with D-dimer with the greatest prevalence observed for aB2GP1. aPS positivity correlated with mortality and deserves further investigation as a biomarker of poor outcomes. (Figure Presented).
ABSTRACT
We have been experiencing more allergic reactions to vaccines during the recent pandemic. Severe allergic reactions to vaccines are rare and difficult to predict. It might be defined as an idiosyncratic reaction caused by an immunologic mechanism. Regarding the World Allergy Organization (WAO) recommendation, immunologic reactions to drugs are categorized based upon the timing of the appearance of symptoms. This system defines two general types of reactions: immediate and delayed. Recently COVID vaccines are broadly applied worldwide. The CDC has provided the following differentiation: (1) contraindication: persons with a known (diagnosed) allergy to PEG, polysorbate, or another component of a COVID-19 vaccine or who have experienced a severe allergic reaction (e.g., anaphylaxis) after a previous COVID-19 vaccine dose have a contraindication to vaccination;(2) precaution: persons with an immediate allergic reaction to other (non-COVID-19) vaccines or injectable therapies OR a non-severe immediate allergic reaction (onset < 4 hours) after a previous dose of COVID-19 vaccine fall into this category. May proceed with COVID-19 vaccine: (1) persons with a history of food, pet, insect, venom, environmental, oral medication (including the oral equivalent of an injectable medication) or latex allergies;or (2) a family history of allergies. Other reactions like vaccineinduced immune thrombotic thrombocytopenia (VITT) or thrombosis-thrombocytopenia syndrome (TTS) have been reported with adenoviral vector covid-19 vaccines. Myocarditis/pericarditis and Guillain-Barre Syndrome are also reported with COVID vaccines. Results of safety monitoring from VAERS and V-safe after one month of vaccinations show that over 90% of reactions were nonserious. Anaphylaxis rates (4.5 per million doses) remain in the range of other vaccines. The female gender may be a risk factor for adverse reactions and anaphylaxis. To sum up, COVID vaccines are very safe, and severe allergic reactions are exceedingly rare.