Fulminant varicella infection complicated by disseminated intravascular coagulation following influenza-A case report

Objectives: Varicella is common infectious disease mainly in childhood, usually is a mild, self-limited illness and complications are usually rare. The incubation period for this disease is generally 14- 16 days but may vary from 7 to 21 days. Varicella in the adults with comorbidities or immunosuppressed children may be severe and prolonged with complications. Method(s): A case report of a 6-year-old girl hospitalized for new-onset manifestations of disseminated vesicular exanthema, the manifestations of which occurred mainly on the chest, back, capillitium, oral cavity, and genital area. The child was suffering from abdominal, knee and lumbosacral pain at that time. The patient's history revealed that 10 days prior to the cutaneous manifestations, she had influenza with bronchopneumonia requiring oxygen therapy, steroids and antibiotics. Result(s): The condition progressed within 48 h, complicated by the development of multi-organ failure, coagulopathy with the development of disseminated intravascular coagulopathy over the course of antiviral, antibiotic and antifungal therapy. Laboratory parameters included high elevation of C-reactive protein, il-6, leukocytosis, neutrophilia and highly elevated liver enzymes. Varicella infection was confirmed by detection of herpes zoster virus - polymerase chain reaction (PCR) from vesicles. The patient received intravenous immunoglobulin therapy at a dose of 2 g/L and fresh frozen plasma, thrombocyte concentrate. The girl was intubated with analogization. Laboratory parameters subsequently revealed high anti CoV-2 positivity, high CoV-2 IgG positivity and negative CoV-2 IgM. The patient's condition did not preclude the course of multisystem inflammatory syndrome in children (MIS-C) corticosteroids were added to the treatment at a dose of 1 mg/kg weight. Patient's condition stabilized after 1 month. Discussion(s): Our case report presents an example of fulminant complicated life-threatening course of varicella. Even in common respiratory infections, we must think about the risk and consequences of coinfections and post-infectious complications such as in our case especially influenza and COVID-19.

- Mass gatherings and vaccines usefulness.

Introduction: Mass gatherings (MGs) are usually pre-planned large events that are known to amplify the risk of infectious disease (1). Although, the risk and pattern of diseases at mass gatherings vary depending on the features of the event such as crowding, shared accommodation, possibilities of the participants to prolonged exposure and close contact with infectious individuals, type of activities, and also the characteristics of the participants including their age & immunity to infectious agents, many of these can be prevented by appropriate vaccinations (2, 3). The aim of this article is to present a summary of the risk of vaccine-preventable diseases in MGs. Method(s): The method used to develop this article weas based on a litterature review. A summaryzing process of the documented risk of vaccine-preventable diseases in MGs was conducted to extract the most useful knowledge on this topic. It explored also available evidence on the effectiveness of vaccination policies for reducing disease transmission associated with these events and also the outstanding questions that need to be addressed for future consideration of some new and promising vaccines. Pubmed- Medline, Scopus, web of science and google Scholar were used to search over the published litterature. Result(s): The current Hajj vaccination policy includes mandatory vaccination for all pilgrims against meningococcal disease. This is in addition to mandatory vaccination against yellow fever, polio and Sarscov2 for pilgrims coming from endemic region. The Saudi Ministry of Health also strongly recommends seasonal influenza vaccination for all pilgrims, particularly those at high risk of infection complications. Data on the vaccination requirements for other mass gathering events such as Kumbh Mela and other religious, sports and entertainment events are still clearly lacking. Travelers to the FIFA 2022, Qatar, were advised to remain up-to-date with routine vaccines. Apart from the hajj settings, no data are available on the possible impact of the current vaccination policy on the control of infectious disease transmission in mass gatherings. The available data demonstrate that the current vaccination policy and health requirement for hajj is effectively contributing towards controlling the transmission of infectious diseases associated with Hajj pilgrimage (37), however evidence on effectiveness is clearly lacking. Moreover, there is no vaccination policy as part of health requirements for attendance in Kumbh Melain India. Conclusion(s): While taking into account local immunization policies of countries of origin and countries of travel, for diseases with known effective prequalified vaccines, WHO recommends that travelers at risk of developing complications, or at increased risk of acquiring and spreading infection such as those attending mass events, should consider vaccination as a preventive measure. Such policies are effective when these are driven by evidence and its effectiveness are measured through large scale studies. Mots cles: Mass Gatherings, Vaccines, Vaccination, Prevention Declaration de liens d'interets: Les auteurs n'ont pas precise leurs eventuels liens d'interets.Copyright © 2023

Experiences of Covid19 Disease and Vaccination in Hungarian Myositis Patients: Anti-Jo-1 Is a Risk Factor for Hospitalization

Background. Pandemic caused by severe acute respiratory syndrome coronavirus 2 (COVID19) raises a smash barrier for clinicians and patients since 2 years. Limited information is available on disease course after COVID19 infection or vaccination in patients with idiopathic inflammatory myopathies (IIM). Objective(s): The primary goals of the current research were to assess frequency and outcome of COVID19 disease and to determine the vaccination rate and effect in our IIM cohort. Secondary objectives were to search for risk factors of infection, predictive factors of hospitalization and to assess incidence of pots-vaccination adverse events and breakthrough infections. Methods. We identified the confirmed COVID19 positive patients and assessed disease course and outcome on 01/06/2021 in our cohort then patients were prospectively followed. Incidence and complications of infection and vaccination were determined by questionnaires and using the database. Anti-SARS-CoV-2 spike protein electrochemiluminescent immunoassay has been used to assess seroconversion. Disease activity was determined by physician global activity. Results. A total of 176 patients were screened and 101 participated in the study. By 01/06/2021, the COVID infection rate was 34.7%, which was significantly higher than the national prevalence at that time (8.2%). A third of these infections occurred asymptomatically or mild, but 20% of the infected patients were hospitalized, one patient died. Longer disease duration (8.67 vs. 17.87 years;p=0.003) and higher incidence of anti-Jo-1 antibody (57% vs. 10%;p=0.018) were significantly associated with hospitalization. All patients became seropositive after COVID19 infection regardless of immunosuppressive therapy or symptoms severity, meanwhile 72.3% of patients became seropositive after vaccination. Different vaccines induced various titer of antibody against the spike protein. Significantly higher antibody titers was detected after Pfizer-BioNTech (177.1 U / ml vs. 81.1 U / ml;p=0.001) and numerically lower ones after AstraZeneca (45.05 U/ml vs. 126.93 U/ml p=0.054) vaccination compared to others. Patients receiving steroid therapy had significantly decreased post-vaccination antibody response compared to those without steroid treatment (94.03 U/ml vs. 165.6 U/ ml;p=0.008). We did not found short term vaccine related major adverse events. Long term data by 15/02/2022 revealed more infections (42.57%), where anti-Jo1 positivity still showed significant association with hospitalization (50% vs. 9%;p=0.0103). Breakthrough infection was detected in 9,25 % of the vaccinated patients, which was significantly more often after Astra Zeneca vaccination (40 % vs. 7%, p=0.017). All the fatal (n=3) COVID infections occurred in patients with seronegativity to anti-spike protein regardless vaccination. We identified 7,4 % post vaccination disease relapse needing therapy changes and 24,7% new autoantibody positivity. Conclusions. Based on our results, myositis may be associated with an increased risk of COVID19 disease. Independent risk factor for hospitalization for unvaccinated people is anti-Jo1 positivity. Anti-SARS-CoV2 vaccines are safe, tolerable, could prevent complicated infections and strongly recommended for IIM population. Further investigation is required to assess clinical significance of post-vaccination disease flare.

Mucormycosis following COVID-19: clinical case and literature review.

Mucormycosis is one of the most aggressive invasive mycoses. The mortality rate of patients with mucormycosis, depending on clinical form and background disease, varies from 30% to 100%. This article provides the first description of mucormycosis in Russia after infection caused by SARS-CoV-2, as well as a review of literature reports on mucormycosis in patients with COVID-19 (as of September 2021).Copyright © 2021, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.

Odontogenic Osteomyelitis in Healthy Individualscomplications in the Sars-Cov-2 Pandemic

Introduction: Osteomyelitis is an infection of the bone that usually affects immunocompromised individuals with multiple comorbidities. Maxilla and the mandible are at risk because of close contact with primarily contaminated spaces of the oral cavity and maxillary sinus that can harbor subclinical infection and a thin mucosal layer that adheres to the periosteum. Recently, odontogenic osteomyelitis has become rare due to better oral hygiene, stomatological care, and the widespread use of antibiotics. During the pandemic of the SARS-CoV-2 virus, the availability of medical care was limited, and the number of complicated infections rose. Case report: We present two cases of odontogenic osteomyelitis of the mandible in healthy individuals that were complicated with relapses and SARS CoV-2 coinfection. The first patient was a 30-year-old otherwise healthy female who developed localized osteomyelitis after extraction of the tooth 38. She was asymptomatic but tested positive for SARS-CoV-2. The second patient was a COVID-19-positive 29-year-old male with no previous illnesses, whose odontogenic abscess and neck edema compromised the airway, requiring urgent tracheotomy. After two weeks he developed a relapse of the infection and osteomyelitis of mandibular ramus with the formation of sequestrum. Coinfection with SARS CoV-2 virus could aggravate osteomyelitis by causing immune dysfunction and depletion of CD-4 and CD-8 lymphocytes. The osteomyelitic site is hypoperfused because of tissue edema and the inability of intraosseal spaces to expand. Endothelial le-sions and increased coagulation in COVID infection could contribute to hypoperfusion and the spread of the infection. Currently, it is impossible to claim that SARS CoV-2 infection aggravated the clinical status of our patients, but further studies are needed about the impact of SARS CoV-2 infection on other organs and illnesses, especially in mild and asymptomatic cases.

National Study on the Risks of Covid-19 for Paediatric Renal Transplant Recipients

From the start of the COVID-19 pandemic evidence emerged that children were less affected by SARS-CoV- 2 PCR DNA COVID-19 positive infections with increasing evidence showing immunosuppressed children were less at risk compared to immunosuppressed adults. The aim of our study was to investigate how COVID-19 infections affected paediatric renal transplant recipients in the UK. Methods Questionnaires regarding patient demographics renal transplant information COVID-19 infection data and care of patients during the COVID-19 pandemic were sent out to all 13 UK paediatric nephrology centres. Results 54 patients (69% male;50% Black Asian and minority ethnic [BAME];57% living donors) aged 4-19 (median 11) years and between 2 months - 15 years (median 3 years 1 month) post-transplantation from nine centres tested positive for SARS-CoV-2 PCR DNA. Four centres had no positive patients. 48% presented with the classical COVID-19 symptoms (37% fever 11% continuous cough and 4% loss of sense of taste or smell);atypical presentations included diarrhoea (13%) and headache (8%). 37% of patients were asymptomatic. 28% were hospitalised (median stay 2 days) which included asymptomatic patients admitted for other reasons. Of those admitted one patient required oxygen;however, no patients required ventilation or intensive care admission. One child had a rejection episode as a complication of the infection and one adolescent had ongoing cardiorespiratory symptoms for six months. There was evidence of AKI with renal transplant dysfunction in 31% of patients, with increase in mean baseline plasma creatinine from 80.6mmol/l to 171.7mmol/l but no patients required CVVH or dialysis. Conclusion 9% of the UK paediatric renal transplantation population have had documented SARS-CoV-2 PCR DNA infections with 28% required hospitalisation. There was increased prevalence of AKI particularly after the first wave of the COVID-19 pandemic possibly due to different variants, although there is no specific virological data to support this.

The updated SIOG COVID-19 working group recommendations on COVID-19 vaccination among older adults with cancer

Background: Older patients with cancer remain at high risk for negative outcomes from COVID-19 infection, particularly those who have multimorbidities and on immunosuppressive therapy. These patients have been excluded or underrepresented in pivotal COVID-19 vaccine clinical trials and there are ongoing concerns that they may not acquire the same level of protection from the available vaccines as the immunocompetent adults. Moreover, the level of protection wanes over time making them more susceptible to emerging COVID-19 novel variants of concern. Despite the implementation of global vaccination campaigns which have successfully reduced COVID-related hospitalisations and deaths in many parts of the world, there remains many unresolved issues and challenges to address as the pandemic ensues. With aging, concerns for age-related dysregulation and immune dysfunctions called immunosenescence may lead to potentially lower immunogenicity to vaccines. Despite receiving the primary vaccination, real-world evidence showed that both patients aged > 65 years and those with cancer have a higher risk of developing breakthrough COVID-19 infections and related complications. Subsequent booster doses are found to be effective at improving immune response, particularly against the novel variants, and the vulnerable population should be given the priority in booster campaigns. Method(s): Since the beginning of the pandemic in 2020, The International Society of Geriatric Oncology set up a COVID-19 Working Group comprised of multidisciplinary specialists by developing recommendations, advocacy, and action plans based on expert opinion and evidence related to older adults with cancer. Result(s): The table below summarises the updated recommendations from the SIOG COVID-19 Working Group. Conclusion(s): The SIOG COVID-19 Working Group supports ongoing public health interventions, continued mass immunisations, and booster campaigns targeting the most vulnerable members of the society, including older adults with cancer (Table Presented).

Clinical, echocardiographic and electrocardiographic manifestations of COVID-19 multisystem inflammatory syndrome in children in the Dominican Republic

Background. The COVID-19 pandemic has spread globally and millions of infections have occurred. As cases mount, atypical manifestations of COVID-19 and post-infectious complications such as multisystem inflammatory syndrome in children (MIS-C) become more likely. MIS-C is a life threatening post-infectious complication of COVID-19. There is a paucity of data of MIS-C in the Dominican Republic (DR). We seek to understand the clinical manifestations of MISC-C in the DR. Methods. This is a retrospective review of cases admitted to a pediatric hospital in the Dominican Republic from March 2020 to December 2021. Patients with clinical findings and a diagnosis of MIS-C were included. Echocardiographic (Echo) and electrocardiographic (ECG) changes were reviewed. Results. A total of 16 patients were included in our study, of which 68.75 were male. Ages were 12.5% < 1 years old, 12.5% between 1-4, 62.5% 5-12 and 12.5% over 12. Fever and rash were the most common clinical findings (Figure 1), while 69% had a new abnormality on echo and 50% had new ECG abnormalities. Echocardiographic findings are listed in Figure 2. Clinical findings in patients admitted with MIS-C Echo findings ECG findings Conclusion. The clinical manifestation of MIS-C are primarily fever, conjunctivitis, rash and hypotension. Because these findings can be non-specific, a high level of suspicion is needed. With over two thirds of patients with MIS-C showing echocardiographic changes and more than 50% showing ECG changes, these two tests can add significant diagnostic value in the right clinical setting. Clinicians should consider early echocardiography and ECG in patients with possible or suspected MIS-C.

Recognizing and Addressing Infections in Patients With Diabetes

Individuals with diabetes are at a heightened risk for development of infections, including skin/soft tissue infections, urinary tract infections, and lower respiratory tract infections, as well as more complex and rare infections. Research has established that among those with diabetes, especially those with poorly controlled disease, there is a greater risk for the development of infections and related complications due to a complex interplay between various factors, which can be classified as systemic and local host factors and/or specific pathogens. Findings have revealed that infections in those with diabetes are often correlated with increased rates of hospitalization, durations of stay, and complications. Pharmacists are well poised to educate patients about the augmented risk for infection. They can also provide patients with pertinent information regarding measures to reduce or prevent these infections, including clinical guidelines that recommend eligible individuals with diabetes obtain pneumonia, influenza, and COVID-19 vaccines. Pharmacists can also emphasize the importance of adherence to therapy and nutritional plans and the impact of tight glycemic control to lessen their risks. Copyright © gettyimages.com / JobsonHealthcare.

COVID-19 IN LUNG TRANSPLANT RECIPIENTS: A SINGLE CENTER EXPERIENCE

SESSION TITLE: Lung Transplantation: New Issues in 2022 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Immunosuppressed patients are more susceptible to severe infection due to COVID-19. Management of lung transplant recipients is especially difficult due to constant exposure of the graft to the environment, leading to increased risk of rejection and requiring higher levels of maintenance immunosuppressive regimens. Mortality rates for lung transplant recipients with COVID-19 infection have ranged from 15% to 40% in published case series. We report our centers experience in managing lung transplant recipients with COVID-19 infections in a moderate-volume lung transplant center in Grand Rapids, Michigan. METHODS: This is a single center review of all lung transplant recipients with a COVID-19 diagnosis from March 2020 to December 2021. Recipients’ demographics and baseline characteristic, as well as their management, post infectious complications, and mortality data, were reviewed. RESULTS: In 2019, our center performed 48 lung transplants. During the study period, 42 of the 219 (19%) lung transplant recipients followed at our center had COVID-19 infections diagnosed by nasal or nasopharyngeal PCR testing. Twenty-four (57%) were male, mean age of 60.5 (range 25-77). Thirty-six (86%) patients had bilateral lung transplants. The diagnosis leading to their transplantation were COPD (N=18, 43%), idiopathic pulmonary fibrosis (N=12, 29%), cystic fibrosis (N=5, 12%), other pulmonary fibrosis (N=3, 7%), alpha-1 antitrypsin deficiency (N=2, 5%), Sarcoidosis (N=1, 2%), and ARDS (N=1, 2%). Almost all patients were on standard three drug immunosuppressive regimens which included a steroid, calcineurin inhibitor, and nucleotide-blocking agent, at the time of diagnosis. Mean time from transplant to diagnosis of COVID-19 was 34.6 months (range 1 to 104 months). Fifteen (36%) of the patients were unvaccinated. Once diagnosed, patients were advised to monitor their home spirometry and vitals at least daily. They were evaluated weekly via telemedicine by a physician or advanced practice provider. They received the following treatments: monoclonal antibody (N=31, 74%), increased steroids (N=5, 12%), remdesivir (N=2, 5%), Tocilizumab (N=1, 2%). Eleven (26.2%) patients required hospitalization, 4 (10%) required ICU admission and intubation. Mean length of stay was 7.5 days (median of 3 days). Three (7%) patients required oxygen at discharge. Of the 42 infected patients, 3 (7.1%) died on day 3, 16 and 326 days from the date of infection. CONCLUSIONS: Our center reports a lower mortality rate than previously published data in lung transplant recipients infected with COVID-19. We attribute this to availability of the vaccine, early detection and treatment, as well as close monitoring of the patients. CLINICAL IMPLICATIONS: Though COVID-19 infection can have devastating complications in lung transplant recipients, vaccinations and monoclonal antibody treatment reduce morbidity and mortality in this population. DISCLOSURES: No relevant relationships by Phillip Camp research relationship with United Therapeutics Please note: 2016- ongoing by Reda Girgis, value=Grant/Research research relationship with Pfizer Please note: 2014-2020 by Reda Girgis, value=Grant/Research Speaker/Speaker's Bureau relationship with Boehringher Ingelheim Please note: 2016-ongoing by Reda Girgis, value=Honoraria Speaker/Speaker's Bureau relationship with Genentech Please note: 2016-ongoing by Reda Girgis, value=Honoraria no disclosure on file for Ryan Hadley;No relevant relationships by Sheila Krishnan No relevant relationships by Edward Murphy No relevant relationships by Gayathri Sathiyamoorthy

ACCELERATED GRANULOMATOUS LYMPHOCYTIC INTERSTITIAL LUNG DISEASE DUE TO COVID-19 IN A PATIENT WITH COMMON VARIABLE IMMUNODEFICIENCY PRESENTING WITH RECURRENT PNEUMOTHORACES

SESSION TITLE: Post-COVID-19 Infection Complications SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Patients with COVID-19 usually recover completely in the acute setting but it has been demonstrated post-infectious complications include continued dyspnea, myalgias, and other long-term complications which are not fully known yet. A case published in the British Medical Journal by Nunna demonstrated the development of a large spontaneous pneumothorax in a middle-aged patient after his Covid-19 infection [1]. Here, we present a 60-year-old female with a history of common variable immunodeficiency (CVID) and hypothyroidism presenting with recurrent pneumothoraxes as a late complication of COVID-19. CASE PRESENTATION: A 60-year-old female with a history of CVID and COVID-19 pneumonia complicated by chronic hypoxic respiratory failure and a right sided loculated hydropneumothorax diagnosed in December of 2020, on 3 to 5 liters of home oxygen, presents to the emergency department due to dyspnea and left-sided pleuritic chest pain in July of 2021. On presentation, the patient was tachypneic, had labored breathing and was requiring 7 liters of oxygen to saturate adequately. Repeat imaging of the chest showed a large tension pneumothorax on the left side with near complete collapse of the lung and tracheal deviation to the right [figure 1]. At that time, a chest tube was placed to re-expand the lung. After 5 days of treatment, repeat imaging showed marked improvement, with the pneumothorax decreasing significantly [figure 2]. Pulmonary function testing in the outpatient setting showed a moderate restrictive lung defect with sever decrease in diffusion capacity. The patient continued to have dyspnea so, the decision was made for the patient to undergo an open lung biopsy. The pathology report showed noncaseating granulomas with focal interstitial fibrosis and lymphocytic infiltrates consistent with granulomatous lymphocytic interstitial lung disease (GLILD), which is a complication of CVID [figure 3]. Roughly 1 in 5 patients with CVID develop histopathological findings consistent with GLILD[2]. We believe these changes were accelerated due to her COVID-19 infection. DISCUSSION: This case habits the importance of continued consideration for long-term complications of COVID-19, especially in patients who are immunocompromised. Reports of diffuse alveolar injury caused by the virus can result in emphysematous changes ultimately leading to alveolar rupture such as in this patient [3]. Although pneumothorax is an uncommon late complication, it should be on the differential diagnosis for COVID-19 patients with sudden respiratory decompensation. As a life-threatening event, it requires prompt recognition and treatment. CONCLUSIONS: Patients who have CVID complicated by GLILD accelerated by COVID-19, are more prone to life-threatening tension pneumothoraxes and they should be encouraged to seek lung transplantation as this could be the only way to stop the formation of these pneumothoraxes. Reference #1: Nunna, K., & Braun, A. B. (2021). Development of a large spontaneous pneumothorax after recovery from mild COVID-19 infection. BMJ Case Reports, 14(1), e238863. Reference #2: Granulomatous and Lymphocytic Interstitial Lung Disease (GLILD): A Spectrum of Pulmonary Histopathological Lesions in Common Variable Immunodeficiency (CVID) - Histological and Immunohistochemical Analysis of 16 cases. (n.d.). Reference #3: Gradica, F. (2020). Spontaneous Pneumothorax in Covid-19 Pneumonia. Case report. Clinical Orthopaedics and Trauma Care, 2(1), 01–03. https://doi.org/10.31579/2694-0248/010 DISCLOSURES: No relevant relationships by Elizabeth Bankstahl No relevant relationships by Talal Bazzi No relevant relationships by Mujtaba Cherri No relevant relationships by Khairya Fatouh

Systematic Investigations of Neurological, Cardiac and Dental Problems in Patients with Infectious and other Problems, Hospitalization &Types of nutrition in the Special Care Unit With Drug Delivery in Patients

This systematic review of scientific sources (190 articles) shows that the simultaneous presence of cardio-metabolic, dental, as well as neurologic diseases is common in people who are hospitalized due to COVID-19 infection, and cardiovascular complications occur frequently. Many people with COVID-19 have few or no symptoms. However, COVID-19 can make the blood "sticky," blocking both small (capillaries) and large blood vessels, which may cause 1 heart attacks, strokes, or blood clots in the legs or lungs. People with diabetes, high blood pressure, or pre-existing heart problems are at higher risk of developing such complications if they get COVID-19. A total of 190 studies reported relevant information. Further studies were conducted in China and the United States of America. The results show that high blood pressure, diabetes and heart disease are very common in hospitalized patients with COVID-19 and are associated with an increased risk of mortality. More than a third of patients with COVID-19 had a history of high blood pressure, 23.4% of them mentioned a previous heart or blood vessel problem, 30.4% had diabetes, and 14.6% were obese.

Study the prevalence of different neurological disorders among patients with hospitalized Covid-19

The aim of this study was to estimate the prevalence of different neurological disorders among patients with hospitalized Covid-19 The study included the collection of accurate information from 350 patients infected with Covid-19 virus in Tikrit city hospitals and who are over 25 years old and of both sexes for the period from the beginning of February 2021 to the end of May 2021.. The study included real detection of all associated diseases such as diabetes and hypertension. heart attack and arteriosclerosis, as well as identifying all types of neurological diseases that affect society and whose prevalence will be determined in the current study.. The study also included knowledge of the clinical cases of the injured in proportion to their health status, such as imperceptible injuries and simple, medium and difficult injuries.. all that It has previously been studied in infected persons whose infection was confirmed in laboratories approved by the Iraqi Ministry of Health and within the international protocols for diagnosing the Covid-19 virus. The study showed that, new neurologic disorder occurred in 12.86% of studied patients, Stroke present in 6.29%, Ischemic heart disease in 2% of patients. The study showed that 47.14% of covid-19 cases were asymptomatic, 18% were with mild infection, 12.86% with severe infection and 6.86% were with critical infection (P<0.001). The study demonstrated that, 67.9% covid-19 infected patients improved after two weeks of infection, 24.6% had complication of infection while unfortunately, 7.5% died due to complications of Covid-19 infection. 18.

Outcomes of Liver Transplantation from Deceased Donors with Coronavirus-Disease 2019 and Late Complications of Infection

Background: The transplant patients should be considered a main high-risk population during the COVID-19 outbreak due to the use of immunosuppressive regimens and comorbidities. Objective: This study aimed to evaluate the possibility of COVID-19 transmission by liver transplantation from a donor with a late complication of COVID-19 to the recipients. Methods: This descriptive study was conducted on all the recipients of liver transplantation who had an acute liver failure or were the models for the End-Stage Liver Disease (MELD) higher than 20. Results: In general, 36 liver transplantation was performed during the study period. Out of these patients, only 14 cases (deceased donors) had hemorrhagic cerebrovascular accidents, and other donors died of trauma (n=7) and anoxia (n=15). All patients showed negative results for polymerase chain reaction (PCR) (two negative 24 h PCR), whereas their high-resolution computed tomography (HRCT) test revealed that they had previously lung involvement with COVID-19 as the late complication of the disease. Conclusion: This study supports the safety of continuing donation and transplant process during the outbreak even the transplant donor be infected previously with the COVID-19, which is reinforced by other similar pieces of evidence.

Single centre, real-world retrospective analysis of the use of azacitadine and venetoclax as firstline treatment in patients with AML in the COVID era

To manage the complexities of treating acute myeloid leukaemia (AML) during the COVID pandemic, NICE have recommended the use of venetoclax and azacitadine as first-line treatment in patients with in patients would otherwise be eligible for standard intensive induction chemotherapy, with the hope that this will reduce inpatient stay, and reduce the risk of neutropenia . This combination has been shown to have favourable outcomes in high-risk patients which is defined as;the elderly, those with unfavourable cytogenetics and secondary AML. Here were discuss the 11 patients diagnosed with AML in the two-year period between 1 January 2020 and 31 December 2021 at Northwick Park Hospital, London, that were eligible to initiate azacitadine and venetoclax as first-line therapy, and evaluate how these new treatment recommendations have affected patient outcomes. One patient was removed due to insufficient written records, leaving a total of 10 patients;seven male, and three female with an average age of 78.2 years, at the time of diagnosis. All but one had secondary AML. Fifty per cent of cases were secondary to MDS, two secondary to CML, one to polycythaemia and one with CML/MDS overlap. Four (36%) received only one cycle of treatment. Ninety per cent of patients had treatment complications, with seven (70%) having cytopenia, three (30%) having cardiovascular complications and nine (90%) having infection related complications. Other serious complications included, transient ischaemic attack and pyoderma gangrenosum. Each patient had an average of 2.3 admissions with one patient having six hospital admissions since initiating treatment. The average length of hospital admission is 11.65 days per visit. Prolonged and frequent hospital admissions during critical times of the pandemic, counteract the intention of wanting to use these oral treatment agents to minimise their exposure to infections. Six (60%) obtained complete morphological remission after the first cycle of treatment. The maximum number of cycles received is 15 and counting. Three (30%) of patients only tolerated one cycle of treatment due to prolonged neutropenia, and/or infective complications. Although all patient developed neutropenia during, and after the completion of the first cycle of treatment, the 40% that are still alive, did not develop concurrent thrombocytopenia after cycle 1 of treatment. Sixty per cent of the patients have died since initiating treatment, making an average of 19.95 weeks from the initiation of treatment to death. Fifty per cent of these patients died from sepsis related causes. The remainder, had unclearly documented cause of death. While being mindful of the small sample size, these realworld data show that although most patients will achieve a good response to the combination of azacytidine and venetoclax after the first cycle, cytopenias, and in particular neutropenia, remains a difficult challenge to tackle leading to recurrent and prolonged hospital admissions, treatment delays and discontinuation of therapy. Although this treatment combination remains a safer option during the pandemic compared to intensive chemotherapy, the data compel us to reflect on the intentions of treatment, and encourage us to have more transparent conversations with patients about the likelihood of recurrent hospital admissions at a time where hospitals are deemed more dangerous than self-isolating, and the possibility of contracting an infection stronger than their body's ability to cope.

Absence of cardiac involvement in children with uncomplicated SARS-CoV-2 infection

Introduction: The pandemic of SARS-CoV-2 is a major health issue, and involvement of the cardiovascular system is common amongst adult with acute coronavirus disease 2019 (COVID-19). Since the beginning of the epidemic, children seem relatively spared with a low morbidity and mortality. However, multisystem inflammatory syndrome in children (MIS-C) is a rare but severe complication following SARS-CoV-2 infection. Cardiovascular involvement is reported in about 80% of MIS-C cases, with elevated cardiac enzymes, left ventricular dysfunction, shock, coronary artery dilatation, mitral regurgitation and arrhythmias. Although MIS-C seems to be a post-infectious complication, its pathogenesis has not yet been clearly elucidated. It is unknown whether children with uncomplicated SARS-CoV-2 infection can develop subclinical cardiac implication and coronary artery dilatation. Methods: Children with an acute infection of SARS-CoV-2 confirmed by positive RT-PCR test on nasopharyngeal swab between March and May 2020, who didn't meet MIS-C diagnostic criteria, were proposed an outpatient cardiology appointment. Electrocardiogram and echocardiography were performed in all participants. Results: 35 children (17 female) aged 2 months to 16 years (mean: 9.2 years) were enrolled after informed consent. Cardiology assessment took place 66 days (range 44 to 100 days) after the test. Shortening fraction of the left ventricle was normal in all subjects (mean shortening fraction 35.25%, range 30-43%). Coronary arteries were normal without dilatation in all 35 children. Moreover, there was no valvar abnormalities and no pericardial effusion. ECGs were normal without conduction abnormalities. Conclusions:Wedidn't observe any subclinical cardiac involvement in our cohort of pediatric patients with uncomplicated SARSCoV-2 infection. Cardiac dysfunction and coronary artery dilatations reported in MIS-C, but never or rarely reported in acute pediatric COVID-19 cases corroborate the hypothesis of a postinfectious syndrome. Further researches are necessary to better understand the underlying mechanisms of cardiovascular involvement after SARS-CoV-2 infection.

THE GREAT AORTIC VALVE DESTROYER: A CASE OF NEISSERIA GONORRHEA INFECTIVE ENDOCARDITIS

Background: With the advent of antibiotics to eradicate common sexually transmitted infections (STIs), such as those due to Neisseria gonorrhea, we do not often see their most severe complications. Disseminated gonococcal infection (DGI) occurs in 0.5-3% of all infections, with infective endocarditis (IE) being a complication in 1-2% of patients with DGI. Case: A 30-year-old male with no past medical history, presented for 2 weeks of progressively worsening midline pleuritic chest pain, fevers, chills, malaise and dyspnea. TTE on admission noted severe aortic regurgitation and mild to moderate mitral regurgitation. Follow-up TEE noted destruction of the aortic valve with evidence of para-aortic abscess and a small dissection of the aortic root. Empiric intravenous antibiotic coverage was subsequently initiated. These findings, coupled with 2 blood cultures positive for N. gonorrhea, led to the patient's transfer to our institution for surgical evaluation. Decision-making: There have been about 50 reported cases of N. gonorrhea infective endocarditis since 1949. Treatment of the offending pathogen is made difficult by the infected typically being asymptomatic, which is why the mortality rate remains at about 20%. In our case, the patient was treated empirically for chlamydial co-infection and maintained on IV ceftriaxone until 6 weeks post-operatively. Due to the patient's symptoms and degree of valvular destruction, urgent surgical aortic valve replacement (AVR) was undertaken. The 2015 European Society of Cardiology guidelines for IE management recommend either bioprosthetic or mechanical AVR. A mechanical valve was chosen based on 2020 data indicating that there may be an association between bioprosthesis and higher IE risk. Conclusion: Despite our current ability to eradicate STIs with oral antibiotics, complicated infections like IE are still seen. This is pervasive amongst the sexually active in our underserved populations, augmented by decreased healthcare contact due to the COVID-19 pandemic. Therefore, continued consideration of this diagnosis in patients like ours, as well as a multidisciplinary approach inclusive of surgical evaluation, is imperative.