ABSTRACT
Background: Covid-19 disease initially started as respiratory illness but later was found to involve almost all organ systems. Earlier the focus of the research was more on preventing transmission of the disease and mortality but with time focus has shifted to addressing the impact of the disease on quality of life and managing the Long Covid Syndrome. Aim(s): To study symptom profile in Post-Covid patients and risk factors associated with Long Covid Syndrome. Material(s) and Method(s): This observational, single-centre prospective study was conducted on Covid-19 patients who presented to postcovid clinic, during the months of July 2021 to December 2021, at Chest Diseases Hospital, Srinagar. Patients who had microbiologically confirmed Covid-19 Disease were included in the study. Patients were evaluated for Long Covid symptoms. Hospital stay, disease severity and co-morbidities of the patients were also taken into account. Result(s): In total of 720 patients, 388 were females and 332 were males. 622 patients had post-Covid symptoms, out of which 516 patients had received hospital care and 106 were treated on outpatient basis. Fatigue, shortness of breath, cough, headache and sleep disturbances were the most common complaints in patients who presented to our post-Covid clinic. It was also observed that female sex, prolonged hospital stay and older age were associated with Long Covid symptoms. Patient with severe disease were also at higher risk of having Long Covid symptoms. Conclusion(s): In our study, we concluded that Long Covid symptoms can be disabling for patients and have huge impact on quality of life of patients. Further studies are needed to understand the pathophysiology of Long Covid Syndrome and explore therapeutic options for the same.
ABSTRACT
Introduction: Coronavirus disease 2019 (COVID-19) is a novel coronavirus that was frequently isolated from Wuhan, China in patients with respiratory tract infections. The most prevalent symptoms are fever and respiratory tract involvement. In this paper, seizures, an uncommon manifestation of the condition, is described. Case Discussion: A previously healthy 34-year-old female was taken to the emergency room with a widespread tonic-clonic seizure. Five days prior to admission, the patient complained of fever, cough, headache, widespread weakness, and myalgias. She experienced two episodes of convulsions around one hour ago. The MRI of the brain was normal, whereas the CT of the chest indicated localised ground-glass opacities. Using real-time PCR, the respiratory material was positive for COVID-19. The patient's symptoms improved after using anticonvulsive and antiviral drugs. Conclusion(s): To our knowledge, this is one of the rare case studies reporting a link between frequent seizures and COVID-19. Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
Background: During the COVID-19 pandemic, off-label medication prescribing and utilizing herbal products and multiple vitamins in the treatment, prevention, and symptom management of COVID-19 was an urgently needed practice to halt the SARS-CoV-2 infection crisis and progression. Objective(s): This study aimed to determine the correlation between medications used during the pandemic and SARS-CoV-2 infection post-recovery symptoms. Method(s): A cross-sectional questionnaire-based study was conducted on recovered COVID-19 patients. There were 20 multiple-choice questions, including patient demographics, treatment, and post-recovery symptoms. Chi-square and Fisher's exact tests were used to investigate significant relationships. In addition, Binary logistic regression was performed to determine confounders. Data were analyzed using SPSS version 22. Result(s): Medications and supplements varied in their therapeutic effects on SARS-CoV-2 post-recovery symptoms. Patients who took vitamin D and calcium experienced increased symptom frequency, and patients taking ACE inhibitors experienced more headaches and coughs. Furthermore, patients receiving azithromycin were asymptomatic after recovery. Patients who took H2 antagonists reported persistent headaches and muscle pain. Conclusion(s): Patients infected with SARS-CoV-2 have responded differently to medications, multivitamins, and herbal supplements. Patients reported resolution of some symptoms and persistence of others post-recovery. Therefore, expert opinion should be considered in COVID-19 management until randomized controlled trials answer many questions and determine medications' safety and efficacy in prevention, treatment strategies, and symptoms of SARS-CoV-2 infection post-recovery. Copyright © 2022 Naseef et al.
ABSTRACT
Background. Nirmatrelvir with ritonavir (nirmatrelvir/r) is an oral antiviral COVID-19 treatment. We report its efficacy to shorten time to sustained alleviation and resolution of COVID-19 signs/symptoms in nonhospitalized adults with COVID-19 at high risk of severe disease as of primary completion data cut (11 Dec 2021). Methods. In this phase 2/3 double-blind study, eligible adults with confirmed SARS-CoV-2 and <= 5 days (d) of symptoms were randomized 1:1 to nirmatrelvir/r 300 mg/100 mg or placebo (PBO) every 12 hrs for 5 d. Pts logged presence and severity (on 3- or 4-point scales) of prespecified COVID-19 signs/symptoms daily Day 1 (predose) through 28. Times to sustained alleviation and resolution of all targeted signs/ symptoms were assessed, summarized with Kaplan-Meier curves, and compared by treatment by log-rank test. Individual signs/symptoms were compared with descriptive analyses. Results. From Jul-Dec 2021, 2246 pts enrolled;2085 pts (nirmatrelvir/r, n=1039;PBO, n=1046) met criteria for the mITT1 population (<= 5 d of symptom onset, did not/not expected to receive an mAb). More pts achieved sustained alleviation or sustained resolution with nirmatrelvir/r. Shorter median times to sustained alleviation/ resolution were observed with nirmatrelvir/r (13/16 d) vs PBO (15/19 d;Fig 1 & 2). Also, a shorter median time to sustained alleviation was seen in pts treated <= 3 d of symptoms with nirmatrelvir/r (12 d) vs PBO (15 d). The most common symptoms were cough, muscle/body aches, and headache in both groups. The median time to sustained alleviation of cough and headache was 2 d less with nirmatrelvir/r vs PBO. The median time to sustained resolution of muscle aches and shortness of breath was 3 d and 4 d less with nirmatrelvir/r. The proportion of pts with severe signs/symptoms in the nirmatrelvir/r vs PBO group was significantly higher at baseline, but significantly lower after treatment, showing nirmatrelvir/r significantly reduced symptom severity through Day 28 (Fig 3). Pts who were seronegative vs seropositive or had high vs low viral load at baseline achieved faster times to sustained alleviation with nirmatrelvir/r vs PBO. Conclusion. Nirmatrelvir/r treatment reduced duration and severity of COVID-19 symptoms vs PBO in pts at high risk of progressing to severe disease. NCT04960202.
ABSTRACT
Background. Case and contact investigation is a mitigation strategy to understand transmission of diseases. The goal of this study is to assess COVID-19 transmission in schools that employ contact tracing. Methods. Five middle and high schools provided a list of ongoing student and staff cases and their school contacts for the 2021-22 school year. Cases were eligible for interview if they had a known positive test or were a 'presumed positive' by a practitioner. Contacts were eligible if they were identified as a close contact to a case within their school. Contacts who later became a case were eligible for a separate case interview. Trained interviewers contacted eligible individuals to offer COVID-19 resources and determine interests in participating in the study. Interested cases and contacts underwent a semi-structured interview with standardized questions. Results. From 5/2021-4/2022, 360 cases (45% during Omicron surge) and their 412 contacts were identified (Fig 1).Among the 111 cases interviewed, 75% were students, half were in grades 6-8 (Fig 2). 61% of the cases were vaccinated with their primary series. 92% were symptomatic and fatigue, cough, and headaches were the most common symptoms. Transmission from school occurred in 29% (Fig 3) and most commonly occurred in the classroom. Among the 68 contacts interviewed, 96% were students. The two most reported activities contacts participated in were band (n=9) and sports (n=22), 10 from playing basketball. Three contacts reported exposure to COVID-19 within the household and five contacts reported exposure outside the home or school. Conclusion. Case and contact investigation can be a valuable tool to assess COVID-19 transmission in schools. Almost one-third of cases reported school exposures, a greater school transmission rate than previous reported likely do to the increased transmissibility of Omicron. Assessing transmission events with this strategy alone may be limited by its reliance on self-reports. Case investigations can help schools identify potential areas to improve in limiting school-based COVID-19 transmission.
ABSTRACT
Background:- The highly contagious zoonotic coronavirus (SARS-COV-2) spread to most parts of the world and created a public health emergency in almost 200 countries. Many sources of information and suggestions were developed to guide the public about its transmission and prevent infection. The pathogen responsible for the infection is acute respiratory syndrome coronavirus-2 (SARSCoV-2). The World Health Organization (WHO) made a collaborative effort to tackle the situation and declared it a global pandemic on March 12, 2020. The regularly updated COVID-19 dashboard reported 40, 49, 10, 528 confirmed cases and 57, 83, 776 deaths globally by this deadly virus by February 12, 2022 (World Health Organization, 2022). In India, COVID-19's first case was reported in Trissur, Kerala, on January 27. A 20-year lady had a history of traveling to China (Andrews MA et al., 2020). Rapid migration of people from the global perspective and between the cities increased the spread of transmission all over the major cities of India. Evidenced-based strategies like social distancing and personal and respiratory hygiene with sustained public cooperation in different countries were mandated to prevent the spread of diseases. The WHO has also issued recommendations for the prevention and control of infection among the general population and healthcare facilities, including hand cleanliness, face masks, social distancing, avoidance of crowds, self-isolation, and immediate medical attention for the person with symptoms of fever, cough, and headache (WHO, 2020). Method(s): - An online or web literature review or articles related to Covid-19 and knowledge, attitude, practices, and compliance were conducted through PubMed/Google scholar and BMJ and NIH databases published between Jan 2019 to Jan 2022. Result(s): - The present review revealed that students' knowledge levels varied from appropriate to high. A positive attitude and acceptable preventive behavior among college students toward Covid-19 were demonstrated. Education level, nationality, habitat, psychological factors, risk perception, health literacy, and early disease awareness were positively associated with knowledge, attitude, and preventive behavior. Those who received most of the information from the World Health Organization, government sources, social media, and TV news channels had good knowledge, positive attitude, and adherence to acceptable preventive behavior. The students with false beliefs and misinformation depicted common knowledge and negative attitude towards COVID-19. Conclusion(s): - There is a need to convey relevant and updated information through different media access by the student community. Myths and tackling misinformation are substantial as the correct information correlates with increased knowledge, a positive attitude, and more adherence to COVID preventive measures. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
Introduction: A patient with progressive rhino-orbito-cerebral mucormycosis (ROCM) despite maximal therapy survived 2 months after complete discontinuation of treatment. A 35-year-old man with poorly controlled diabetes presented to outside hospital with severe headaches, cough, and hyperglycemia. He was found to be COVID-19 positive and in severe diabetic ketoacidosis. He received neither corticosteroids nor monoclonal antibodies for COVID-19. Empiric therapy with intravenous (IV) antibiotics, antivirals, and antifungals was initiated. Endoscopic sinus debridement revealed fungal invasion;pathology confirmed mucormycosis. Subsequent imaging showed disease progression with intracranial extension despite maximal treatment. The patient elected to stop all treatment and was discharged with home hospice. He continued only metformin and did not make a concerted effort toward glycemic control. After 2 months he presented to Loma Linda Hospital with right eye symptoms;imaging showed persistent disease. IV antibiotics and antifungals were initiated. After endoscopic evaluation and debridement, tissue pathology showed residual mucormycosis. The patient was discharged home after 16 days with a 6-week course of meropenem and lifelong posaconazole. Method(s): A PubMed search for English-language case reports and series from 2000 to present was performed using search terms mucormycosis, survive, rhino-orbitocerebral, rhino-cerebral, and cerebral. Result(s): No reports of long-term survival after discontinuation of therapy were identified. Conclusion(s): This case illustrates a rare situation in which a patient whose ROCM progressed despite maximal therapy survived for over 2 months after halting treatment. ROCM mortality is as high as 85%. Outcomes are improved with surgical and antifungal therapy, and there are many reports of survival with ongoing treatment. However, there appear to be no documented cases of survival with active disease after termination of therapy. This patient's unsuccessful management and 2-month treatment hiatus make his long-term survival surprising.
ABSTRACT
Background and Aim: Cardiac involvement is seen in the majority of cases with multisystem inflammatory syndrome in children (MIS-C). Various rhythm and conduction disturbances, as well as repolarization abnormalities, have been described by more than 50% of the patients, while there are few cases with complete heart block or with asystole. Method(s): Case report Results: 8-year old girl presented with a 5-day history of fever, cough, headache, and abdominal pain. Because of the critical con-dition, with respiratory insufficiency and heart failure symptoms, the child was intubated and started on inotropic support. ECG showed complete AV-block with a ventricular rate of 75/min and with ST-T changes;echocardiography revealed dilated left ventricle with reduced contractility, CT-scan of the lungs showed bilateral pneumonia, the inflammatory markers were elevated, in combination with high troponin levels, and positive SARS-CoV2-IgG antibodies. The diagnosis MIS-C was made and treatment with immunoglobulins, antibiotics, corticosteroids, and anticoagulants was initiated. During the next 2 days, the cardiac function deteriorated further, and while still on mechanical ventilation and inotropic support, extreme bradycardia with a ventricular rate of 35/min was regis-tered, and the patient was indicated for temporary emergency pac-ing. Upon induction of anesthesia, the child became asystolic, requiring extensive resuscitation. After circulation recovery, the ECG showed nodal tachycardia with a heart rate of 140-170/min. A temporary transvenous pacemaker (PM) was inserted, and the patient was started on intravenous amiodarone which resulted in a slower ventricular rate of 70/min. 3 days later sinus rhythm was restored, with first-degree AV-block, which allowed removal of the PM 5 days after its insertion. Left ventricular dimensions were normalized and contractility remained low-normal (EF 56%). During the 6-month follow-up, the ECG and the Holter-monitoring showed sinus rhythm with first-degree AV-block. Magnetic resonance imaging (MRI) on day 15 of the hospital stay demonstrated scattered areas of myocarditis and ischemia predominantly in the left ventricle, as well as thickening of the basal septum. Six months later the MRI changes were reduced but still persistent. Conclusion(s): MIS-C can present with serious and life-threatening rhythm and conduction disturbances in children;this is why extensive cardiac monitoring is obligatory by all patients.
ABSTRACT
SESSION TITLE: Signs and Symptoms of Chest Disease Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Vaping products have been rapidly gaining popularity, with studies showing increasing use, even among school-going children and adolescents. E-cigarette or Vaping Associated Lung Injury (EVALI) is defined as respiratory failure within 90 days of e-cigarette use with pulmonary infiltrates on imaging, in the absence of infectious or alternative causes of respiratory failure.[1] Vitamin E acetate, a thickening agent in THC containing e-cigarettes, is thought to be the main causative agent of EVALI and has been found in the bronchoalveolar lavage samples in almost all cases of EVALI.[2] However, diagnosing EVALI in this era of COVID -19 is a challenge due to striking similarities in clinical symptoms and imaging findings. CASE PRESENTATION: A 32-year-old male with anxiety and polysubstance abuse, presented with headache, cough, low-grade fevers and chills of 1 week. In the ED, he was febrile to 102 F and hypoxic to 89% on room air and was started on 3 liters of oxygen. Labs showed leukocytosis and elevated inflammatory markers. Urine toxicology was positive for THC. Chest X-ray showed bilateral interstitial opacities. CT angio of the chest showed bilateral ground glass opacities. Despite 2 negative PCR tests, suspicion for COVID was high and the patient was initially started on dexamethasone and other supplements, along with antibiotic coverage for a possible bacterial etiology. Despite this, respiratory symptoms and hypoxia continued to worsen. Infectious work up including blood, sputum cultures with AFB staining, urine streptococcus and legionella tested negative. The patient however now revealed the regular use of THC containing vape and procuring the THC oil from a new street vendor. This prompted us to suspect vaping induced chemical pneumonitis. He was restarted on steroid therapy with methylprednisolone and within 1 week, had symptomatic improvement and resolution of hypoxia. The patient was eventually discharged on prednisone taper over 7-10 days. DISCUSSION: Our patient was initially treated for COVID pneumonia despite repeated negative PCR tests, as findings were suggestive of SARS-COV-2 infection. Fortunately, the patient eventually revealed about regular use of THC-oil vapes, making us consider a diagnosis of vaping induced chemical pneumonitis. The mainstay of treatment is steroid therapy and cessation of e-cigarette use. The severity of the pandemic has led to a low threshold for suspecting COVID, causing increased anchoring and availability bias, and potentially under-diagnosing conditions like EVALI which resemble COVID infection.[3] CONCLUSIONS: While it is important to have a low threshold for suspecting COVID-19, considering other mimics of COVID is prudent for providing treatment in an appropriate and timely manner. Detailed inquiry of e-cigarette use, particularly THC-oil containing vapes, duration of use and source of procurement, goes a long way in diagnosing of EVALI. Reference #1: EVALI and the Pulmonary Toxicity of Electronic Cigarettes: A Review Lydia Winnicka, MD and Mangalore Amith Shenoy, MD PMCID: PMC7351931 PMID: 32246394 Reference #2: Clinical presentation, treatment, and short-term outcomes of lung injury associated with e-cigarettes or vaping: a prospective observational cohort study Denitza P Blagev 1, Dixie Harris 2, Angela C Dunn 3, David W Guidry 2, Colin K Grissom 4, Michael J Lanspa 5 PMID: 31711629 DOI: 10.1016/S0140-6736(19)32679-0 Reference #3: EVALI: A Mimicker of COVID-19 Mitchell M. Pitlick, MD,a Daenielle K. Lang, MD,a Anne M. Meehan, MBBCh, PhD,b and Christopher P. McCoy, MDb, PMCID: PMC8006188 PMID: 33817560 DISCLOSURES: No relevant relationships by Kaushik Darbha No relevant relationships by Rashmikant Doshi No relevant relationships by Ishan Sahu No relevant relationships by sara samad
ABSTRACT
SESSION TITLE: COVID-19 Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Biological disease modifying anti-rheumatic drugs (bDMARDs) are commonly used to treat interstitial lung disease (ILD) in patients with connective tissue disease (CTD). These patients often develop concurrent COVID-19 disease and existing data is scarce to guide treatment. We describe a case with a rare anti-Pl-7 Anti-Synthetase Syndrome (ASS) receiving Rituximab treatment for ILD who developed acute respiratory distress syndrome (ARDS) secondary to COVID-19 disease. CASE PRESENTATION: A 58-year-old female presented with worsening shortness of breath, loss of taste and smell, cough and headaches for 1 week. She had pre-existing severe chronic ILD secondary to ASS on Rituximab therapy. She tested positive on SARS-CoV-2 PCR testing, CT chest showed bilateral lung honeycombing, reticulations, traction bronchiectasis along with ground glass opacities consistent with active inflammatory interstitial process superimposed on ILD. She was diagnosed with COVID-19 pneumonia. She was initially started on high-dose Dexamethasone, Remdesivir and supplemental oxygen via high flow nasal cannula and supportive care for ARDS, however level of care was escalated due to worsening respiratory distress. Rituximab was discontinued due to active COVID-19 infection, the decision was made to start Baricitinib at 4 mg daily. She received treatment for 14 days, that led to a significant improvement in her respiratory status. DISCUSSION: ASS is a rare autoimmune condition involving multiple organs, with ILD being the major cause of morbidity. bDMARDS, especially Rituximab, have shown promising results in management of severe and refractory ILD in ASS. However, the role of bDMARDs as protective or risk factor for developing severe COVID-19 disease in these patients is unclear. ARDS in COVID-19 disease involves a vigorous inflammatory response and cytokine production leading to diffuse alveolar damage. Literature supports that use of corticosteroids, IL-1 and IL-6 receptor blockers and Janus Kinase (JAK) inhibitors for severe COVID-19 pneumonia is associated with decreased morbidity. Baricitinib is a JAK1 and JAK2 with anti-cytokine and anti-viral properties and has been associated with reduction in morbidity and mortality in patients with COVID-19 as demonstrated in our case. Generally, use of bDMARDs does not contribute to worse outcomes in COVID-19 disease in patients receiving these agents for rheumatological conditions. However, use of Rituximab and high dose glucocorticoids have been associated with worse outcomes, while Baricitinib may have a protective effect. Therefore, holding Rituximab in those with active COVID-19 infection is recommended. CONCLUSIONS: Management of COVID-19 in patients with CTD is a challenge due to the novel nature of the disease and scarcity of available data. The association of use of bDMARDs in rheumatological disease with outcomes in SARS-CoV-2 infection is yet to be elucidated. Reference #1: Barbosa AN, Silvinato A, Bacha H, Floriano I, Tanni S, Bernardo W. Use of disease-modifying drugs (tocilizumab, tofacitinib, and baricitinib-a biological or synthetic target specific) in patients hospitalized with COVID-19. Rev Assoc Med Bras (1992). 2022;68(1):3-8. Reference #2: Santos CS, Férnandez XC, Moriano Morales C, Álvarez ED, Álvarez Castro C, López Robles A, Pérez Sandoval T. Biological agents for rheumatic diseases in the outbreak of COVID-19: friend or foe? RMD Open. 2021 Jan;7(1):e001439. doi: 10.1136/rmdopen-2020-001439. PMID: 33455920;PMCID: PMC7813407. Reference #3: Galarza-Delgado DÁ, Serna-Peña G, Compeán-Villegas JE, Cardenas-de la Garza JA, Pineda-Sic RA, Colunga-Pedraza IJ, Vega-Morales D, Pérez-Barbosa L, Skinner-Taylor CM, Flores-Alvarado DE. Characteristics and evolution of 38 patients with rheumatic diseases and COVID-19 under DMARD therapy. Clin Rheumatol. 2021 Mar;40(3):1197-1199. doi: 10.1007/s10067-020-05510-9. Epub 2020 Nov 24. PMID: 33231774;PM
ABSTRACT
SESSION TITLE: Critical Care in Chest Infections Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: EVALI is an acute lung injury that occurs due to the use of e-cigarettes or vaporizer products that usually contain THC or nicotine. There was an outbreak of EVALI in 2019. This is a diagnosis of exclusion with foamy macrophages with pneumocyte vacuolization being the best diagnostic clues. (1) Vitamin E acetate laced products seem to be the causing factor. CASE PRESENTATION: A 34-year-old female presented to the emergency department due to increasing shortness of breath, fever, pleuritic chest pain, cough, and headaches for the last 9 days. Two days prior she presented to urgent care where she was given an albuterol inhaler and azithromycin. At arrival, the patient was found to have tachycardia with a rate of 120-130, afebrile, SpO2 at 96% on room air, BP at 100/59. Her initial workup was grossly normal except for an elevated WBC and elevated D-Dimer. Chest X-ray revealed opacities in the lower lungs consistent with pneumonia. CTA of the chest revealed patchy pulmonary opacities consistent with COVID pneumonia. She took three separate SARS-CoV-2 PCR tests which all came back negative. The patient underwent a large workup which included infectious disease, pulmonology, and cardiology consults. She was treated with broad-spectrum antibiotics for the presumed diagnosis of pneumonia but her condition quickly deteriorated, eventually requiring 6L of O2 via nasal cannula. Screening for a large array of bacteria, fungus, and viruses all resulted negative. Upon further discussion with the patient, she admitted to smoking a THC vaporizer every night for the last seven months and that she had recently purchased a new fluid for her THC vaporizer through the internet. Bronchoscopy was also acquired but did not show any specific findings, including being negative for eosinophils. Discontinuation of antibiotics and initiation of IV steroids treatment provided rapid improvement of the patient's condition. Based on her history of THC vaping, the clinical presentation of fever, hypoxia, her chest x-ray, and chest CT showing extensive lung infiltrates, infections were ruled out and the most likely diagnosis of EVALI was made which responded well to steroids. DISCUSSION: COVID and EVALI initially can present similarly as respiratory problems, fever, and the need for oxygen. It is important to gather history on the patient as a vaping history is needed to suspect EVALI as imaging can show a wide range from ground-glass opacities to acute hypersensitivity pneumonitis. (2) CONCLUSIONS: There are some distinguishing features of EVALI from COVID one being in EVALI there is a large increase in the white count and lastly the response to steroids is the key (2). Steroids are the primary care for someone with EVALI with most patients recovering in 1-3 days with the use of steroids. (2) Reference #1: Bierwirth, A., Orellana, G., Milazzo, E. and Hamdan, A., 2020. TETRAHYDROCANNABINOL VAPING-ASSOCIATED LUNG INJURY (EVALI): A US EPIDEMIC?. Chestnet Journal. Reference #2: MacMurdo, M., Lin, C., Saeedan, M., Doxtader, E., Mukhopadhyay, S., Arrossi, V., Reynolds, J., Ghosh, S. and Choi, H., 2020. e-Cigarette or Vaping Product Use-Associated Lung Injury. Chestnet Journal. DISCLOSURES: No relevant relationships by Narden Gorgy No relevant relationships by Matheus Moreira Sanches Peraci No relevant relationships by George Walbridge No relevant relationships by John Zakhary
ABSTRACT
BACKGROUND: COVID-19 vaccines have lessened the effects of the ongoing pandemic. Those vaccinated are less likely to be hospitalized than unvaccinated and, if hospitalized, have better outcomes. The literature is less developed on the effect of vaccination on disease burden and symptomatology in outpatient settings. We compared the symptom severity from SARS-CoV-2 infection among unvaccinated with those vaccinated within 6 months. We hypothesized that vaccinated individuals will have less symptom burden than unvaccinated. METHODS: We compared the proportion of COVID-19 symptoms at baseline from participants enrolled in the COVID-OUT trial, an outpatient treatment trial of SARS-CoV-2 infection. Adults aged 30-85 with a body mass index >= 25kg/m2 were eligible within 3 days of a positive COVID-19 test;symptoms not required but must be <7 days if present. 413 patients were enrolled through September 12, 2021. Of those, only 124 unvaccinated and 68 vaccinated within 6 months of enrollment provided baseline symptom data. We compared unvaccinated with those vaccinated using Fisher's Exact tests. We computed a total symptom score for each participant reflecting symptom severity and total number of symptoms, assigning numeric values to each grade of symptom severity (mild, moderate, severe), with more points given for higher severity. Treating the total symptom score as continuous, we fit a linear regression model to assess the association between total symptom score and vaccination status. RESULTS: A larger proportion of unvaccinated versus vaccinated reported chills/shivering (19% vs. 6%;p=0.01), diarrhea in the last 24 h (19% vs. 3%;p<0.01), feeling hot or feverish (30% vs. 6%;p<0.01), body aches (55% vs. 26%;p<0.01), and nausea (19% vs. 6%;p=0.02). A larger proportion of vaccinated versus unvaccinated had a stuffy/runny nose (56% vs. 35%;p<0.01). There was no significant difference in cough, headache, loss of smell or taste, fatigue, shortness of breath, difficulty breathing, sore throat, or vomiting between groups. The mean total symptom score for unvaccinated participants was 13.6 (95% CI: (12.4, 14.8)), significantly larger than the vaccinated average score of 11.2 (95% CI: (9.5, 12.8)) (p = 0.02). CONCLUSIONS: There appears to be an association between vaccination and symptom type and severity from COVID-19. Unvaccinated individuals reported more systemic symptoms (fever, chills, and diarrhea);Vaccinated reported more mucosal symptoms (runny nose). This difference could be due to differing IgG and IgA responses to vaccination and decline over time. Although vaccination was associated with a significantly lower total symptom score than those unvaccinated, the small difference may not track with functional outcomes such as return to work.
ABSTRACT
Objective: To present a case of a longitudinal myelitis (LM) in the setting of SARS-CoV-2 infection. Background: While there is an established link between viral infections and new-onset demyelinating diseases [1, 2], data on the association between SARS-CoV-2 and myelitidies is lacking. Design/Methods: Consent obtained from patient. Results: A 53-year-old man presented with epigastric pain and urinary retention following ten days of fever, chills, headache, and cough. On presentation, he tested positive for SARS-CoV-2, prompting admission, then subsequently developed bilateral lower extremity weakness and numbness. MRI revealed T2 cord hyperintensity from C7 caudally to the conus. CSF revealed elevated total protein (67), WBC (16), IgG (11.1), and myelin-based protein (9). Testing for other demyelinating, infectious, and inflammatory conditions was negative. He had modest improvement in sensation following intravenous methylprednisolone and plasma exchange although remains paraplegic. Conclusions: This unique case of a longitudinal myelitis in the setting of SARS-CoV-2 infection adds to previously reported cases of acute disseminated encephalomyelitis, meningoencephalitis, and optic neuritis as neurological manifestations of SARS-CoV-2 infections [2].
ABSTRACT
Objectives: To evaluate the impact of SARS-CoV-2 on psoriasis in children during and after SARS CoV- 2 infection. Method: We performed a retrospective study on children hospitalised with COVID-19 infection and diagnosed previously with severe psoriasis. Results: Case 1: A 16-year old boy, diagnosed with plaque psoriasis at the age of 10, was hospitalised 10 days for COVID-19 (confirmed by PCR) with fever, cough, headache. Before admission to the hospital for COVID-19 infection psoriasis was treated with phototherapy. During hospitalisation psoriasis remained the same and no Long-COVID was noted. Case 2: A 17-year-old boy diagnosed with plaque psoriasis at the age of 13 was hospitalised 12 days for COVID-19 (confirmed by PCR) with fever, cough, headache. Before admission to the hospital for COVID-19 infection psoriasis was treated with MTX. During hospitalisation psoriasis remained the same and no Long-COVID was noted. Case 3: A 16-year-old girl, diagnosed with plaque psoriasis at the age of 12, was hospitalised 12 days for COVID-19 (confirmed by PCR) with fever, cough, headache. Before admission to the hospital for COVID-19 infection psoriasis was treated with MTX. During hospitalisation psoriasis remained the same and no Long-COVID was noted. Discussion: No impact of SARS Cov2 infection was noted on evolution of children diagnosed and treated previously for severe psoriasis.
ABSTRACT
Background: Remdesivir (REM) is authorized to cure COVID-19 pneumonia with low oxygen supplementation. We evaluated the effect of combination of REM and usual treatment with enoxaparin and dexamethasone on clinical outcome. Methods: A prospective open study with REM (200 mg first day and then 100 mg /day for four days) was performed in a medical unit with critical sector in the period of half november 2021 and half January 2022 . All COVID-19 patients requiring supplemental low O2 therapy were treated with enoxaparin (4000 unit/day for almost patients) and dexamethasone (6 mg);three patients were treated even with baricitinib for rapid pulmonary deterioration. The primary endpoint was the final outcome with discharge from Hospital. Results: 33 COVID-19 patients were enrolled, 20 men, mean age 66 y (range 41-87);14 patients with a complete vaccinal schedule;therapy was started 1-2 days after entering the hospital. The lenght of hospitalization was 7.5 days with a range of 7-25;mortality in two patients (one not vaccinated), need of intensive care in 10 patients with favorouble evolution (3 with oral intubation and seven with non invasive ventilation support);at the end, 31 patients were discharged or at home or at sub acute unit. We did not observe major side effects, cough, headache, moderate increase of transaminases Conclusions: REM treatment, associated with heparin, dexamethasone and oxigen supplement, especially if started early, is safety and associated with reduced length of hospitalization and reduction mortality.
ABSTRACT
COVID-19, which is considered a global pandemic, is constantly being renewed. Acute motor axonal neuropathy (AMAN) is a rare, axonal variant of Guillain-Barré syndrome (GBS). This article presents a 69-year-old female patient diagnosed with AMAN due to a COVID-19 infection. Sixty-nine-year-old female patient who started myalgia, headache, cough 14 days ago, and was added diarrhea, fever, loss of smell and taste. Nasopharyngeal SARS-CoV-2 polymerase chain reaction (PCR) was found to be positive. Ten days later, numbness and weakness developed in the distal extremities. As a result of the patient's neurological examination, acute motor axonal neuropathy (AMAN) was diagnosed.
ABSTRACT
Background. We sought to describe the range of Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in children. Methods. Patients < 18 years of age who had a positive nasopharyngeal polymerase chain reaction (PCR) for SARS-CoV-2 at a single health system in central Pennsylvania from 3/19/2020-12/31/2020 were identified. Using a random number generator, 150 additional patients < 18 years of age who had a negative PCR test were also identified. Asymptomatic patients and those without clinical data in the electronic medical record were excluded from analysis. Demographic characteristics, symptoms present at the time of testing, and outcomes were compared between PCR-positive and negative patients. Odds ratios were calculated using univariable and multivariable logistic regression models to patients with positive vs. negative PCR tests. Results. We included 544 patients in analysis, 412 (76%) of which had a positive SARS-CoV-2 PCR. PCR-positive patients were statistically more likely to have a known contact, no comorbidities, and to present with cough, cold-like symptoms, headache, or loss of taste and smell. All patients who presented with loss of taste and smell were PCR positive at time of presentation. Positive patients were statistically less likely to present with fever or emesis than negative patients. Multivariable regression identified increased age, cough, cold symptoms, headache, and non-white race as predictive of PCR positivity. Patients who tested positive were statistically less likely to be admitted to the hospital and less likely to require respiratory support than negative patients. Conclusion. Loss of taste and smell is a specific, though uncommon, indicator of SARS-CoV-2 infection in the pediatric population. Headache, cough, and cold-like symptoms are also suggestive of SARS-CoV-2 infection, while fever and gastrointestinal symptoms appear less common. This data suggests that screening questions developed for adults may be less applicable in children. Future research, including more dedicated and prospective studies, is warranted to identify patients in whom a positive SARS-CoV-2 test is sufficiently likely to warrant isolation and testing.
ABSTRACT
Introduction: There are a limited number of studies about COVID-19 during delivery and postpartum. Case Presentation: A 38-years-old G3p2 woman at 35 weeks and 4 days of gestation was referred with the chief complaints of dyspnea, cough, headache, and fever. Pharyngeal swab polymerase chain reaction (PCR) was negative for COVID-19;however, in chest Computed Tomography (CT) angiography, ground glass was observed in the basal lobe of the left lung. The infant was born via cesarean section with a gestational age of 36 weeks and an Apgar score of 8/9. No infant document was found about COVID-19 and other infections in several days after delivery. The patient died eight days after the onset of symptoms due to cardiovascular collapse. Discussion: we reported the first postpartum maternal death with COVID-19 and a healthy baby with no evidence of COVID-19 and a gestational age of 36 weeks. Conclusion: Physicians should be aware that pregnant women with symptoms of respiratory infection and pulse negative PCR test should be followed for infection with COVID-19. This infection may lead to maternal death.
ABSTRACT
Objective: Paediatric neurologists are concerned about the risk of COVID-19 in children with demyelinating disorders receiving immunomodulatory treatment. To investigate this, we collected data via the UK Childhood Neuro-Inflammatory Disorders (UK-CNID) network of the British Paediatric Neurology Association (BPNA). Methods: Survey of paediatric neurologists managing unvaccinated UK children (<18 years) with a demyelinating disorder (multiple sclerosis [MS];neuromyelitis optica spectrum disorder [NMOSD] and myelin oligodendrocyte glycoprotein antibody disease [MOGAD]) on immunomodulatory therapy with SARS-CoV-2 infection confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR) of nasopharyngeal swabs between March and December 2020. Results: Of 151 UK children (MS 98, MOGAD 37, NMOSD 16) with a median age of 9 years (range 6-18y), with a demyelinating disorder, nine (6.0%) had a positive PCR for SARS-CoV-2. Five had MS and four MOGAD. Four were from south Asian or south-east Asian, four were White and one was mixed White and south Asian. Seven children had COVID-19 symptoms;two were asymptomatic. Two required a brief hospital admission for typical COVID-19 respiratory symptoms and the remaining five had mild symptoms including fever, rash, cough and headache. One with MOGAD, treated with azathioprine, developed transverse myelitis 12 days after COVID-19 onset. She recovered fully with a course of corticosteroids. MS patients were on following disease modifying therapies;dimethylfumarate (n=2), fingolimod (n=1);natalizumab (n=1) and ocrelizumab (n=1). MOGAD cases were on the following immune therapy: combination of oral prednisolone and intravenous immunoglobulin (n=2), prednisolone steroids (n=1) and azathioprine (n=1). Conclusions: In contrast to adult patients, who often have underlying co-morbidities and advanced neurological disabilities, we have identified that children treated for demyelinating disorders appear to have a milder COVID-19 course. Whilst the number of children treated for demyelinating disorders that developed COVID-19 is low, the overall mild course described may provide reassurance to neurologists, patients and family members.
ABSTRACT
Introduction Aplastic anemia is a syndrome of bone marrow failure characterized bone marrow hypoplasia. Immunosuppressive therapy is one modality of its management. We report a case in which use of this modality was hindered by lack of data showing the effects of its use during the novel COVID- 19 infection. Case presentation A 20-year-old man with a newly diagnosed pancytopenia presented with fever, cough, headaches, and exertional dyspnea. When his vital signs were obtained, he was afebrile but his blood pressure, heart rate and oxygen saturation were within normal range. Physical exam was unremarkable. Laboratory tests showed that the white blood cell count was 1.42 K/mL, hemoglobin level was 9.7 g/dl, and platelet count was 13 K/mL. He was tested for COVID-19 infection and was found to be positive. A peripheral blood smear showed pancytopenia. A bone marrow biopsy showed hypocellular marrow with trilineage hypoplasia. Flow cytometry showed no significant trilineage abnormalities. Vitamin 12 and folate levels were within normal range. Testing for antinuclear antibodies, rheumatoid factor, HIV, hepatitis C, and hepatitis B were negative. Ultrasound of the abdomen showed no enlargement of the spleen. The PNH FLAER test was done twice and was inconclusive possibly due to hemolysis or severe pancytopenia. The patient was diagnosed with aplastic anemia, but the cause was unclear. Anti-thymocyte globulin, cyclosporine, and steroids were considered for treating the aplastic anemia, but there was concern about their unknown effect on his active COVID-19 infection. Immunosuppressive therapy was decided to be held until he was cured from his COVID-19 infection, and he was discharged after his blood cell indices improved. Discussion Being an infection caused by a novel virus, COVID 19 can cause a therapeutic dilemma when no data are available about the effects of certain therapies on the infection. In our patient, immunosuppressive therapy was needed to treat the aplastic anemia but there was no published literature on the effect of this treatment on the course of the infection. This should become less of an issue with time as data surrounding COVID-19 infection and its effects on other diseases and treatment modalities grow.