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1.
Current Opinion in Organ Transplantation ; 27(1):36-44, 2022.
Article in English | EMBASE | ID: covidwho-1821995

ABSTRACT

Purpose of review Heart failure incidence continues to rise despite a relatively static number of available donor hearts. Selecting an appropriate heart transplant candidate requires evaluation of numerous factors to balance patient benefit while maximizing the utility of scarce donor hearts. Recent research has provided new insights into refining recipient risk assessment, providing additional tools to further define and balance risk when considering heart transplantation. Recent findings Recent publications have developed models to assist in risk stratifying potential heart transplant recipients based on cardiac and noncardiac factors. These studies provide additional tools to assist clinicians in balancing individual risk and benefit of heart transplantation in the context of a limited donor organ supply. Summary The primary goal of heart transplantation is to improve survival and maximize quality of life. To meet this goal, a careful assessment of patient-specific risks is essential. The optimal approach to patient selection relies on integrating recent prognostication models with a multifactorial assessment of established clinical characteristics, comorbidities and psychosocial factors.

2.
Cell and Organ Transplantology ; 9(2):136-142, 2021.
Article in English | Scopus | ID: covidwho-1786543

ABSTRACT

The pathogenesis of acute respiratory distress syndrome (ARDS) includes neutrophilic alveolitis, alteration of alveolar epithelium and endothelium, formation of hyaline membranes and microvascular thrombosis, which results in an acute hypoxemic respiratory failure. ARDS results in major structural and cellular changes in organs and organ systems. It causes liver dysfunction in critical patients through paracrine action of cytokines and other pro-inflammatory mediators as well as hypoxemia, oxidative stress, toxins and hypoperfusion. Coronavirus disease 2019 (COVID-19)-associated ARDS affects liver through the development of systemic inflammatory response syndrome and hypoxia as well as cytokine storm. Liver injury manifests itself as increased plasma levels of hepatic transaminases and cholestatic liver enzymes. Stem cell therapy is one of the promising modern methods for treating ARDS-induced liver failure. Many studies showed the ability of multipotent mesenchymal stromal cells (MMSCs) to differentiate into functional hepatocyte-like cells, which were then successfully used for liver regeneration. MMSCs were proven to be able to prevent the apoptosis of hepatocytes, as well as have anti-fibrotic and anti-inflammatory activity which allows their successful use in the treatment of ARDS-induced liver injury. © 2021 The authors.

3.
World Journal of Gastroenterology ; 28(11):1102-1112, 2022.
Article in English | EMBASE | ID: covidwho-1780095

ABSTRACT

Coronavirus disease 2019 (COVID-19) is, at present, one of the most relevant global health problems. In the literature hepatic alterations have been described in COVID-19 patients, and they are mainly represented by worsening of underlying chronic liver disease leading to hepatic decompensation and liver failure with higher mortality. Several potential mechanisms used by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to cause liver damage have been hypothesized. COVID-19 primary liver injury is less common than secondary liver injury. Most of the available data demonstrate how liver damage in SARSCoV-2 infection is likely due to systemic inflammation, and it is less likely mediated by a cytopathic effect directed on liver cells. Moreover, liver alterations could be caused by hypoxic injury and drugs (antibiotics and non-steroidal anti-inflammatory drugs, remdesivir, tocilizumab, tofacitinib and dexamethasone). SARS-CoV-2 infection can induce multiple vascular district atherothrombosis by affecting simultaneously cerebral, coronary and peripheral vascular beds. Data in the literature highlight how the virus triggers an exaggerated immune response, which added to the cytopathic effect of the virus can induce endothelial damage and a prothrombotic dysregulation of hemostasis. This leads to a higher incidence of symptomatic and confirmed venous thrombosis and of pulmonary embolisms, especially in central, lobar or segmental pulmonary arteries, in COVID-19. There are currently fewer data for arterial thrombosis, while myocardial injury was identified in 7%-17% of patients hospitalized with SARS-CoV-2 infection and 22%-31% in the intensive care unit setting. Available data also revealed a higher occurrence of stroke and more serious forms of peripheral arterial disease in COVID-19 patients. Hemostasis dysregulation is observed during the COVID-19 course. Lower platelet count, mildly increased prothrombin time and increased D-dimer are typical laboratory features of patients with severe SARS-CoV-2 infection, described as “COVID-19 associated coagulopathy.” These alterations are correlated to poor outcomes. Moreover, patients with severe SARS-CoV-2 infection are characterized by high levels of von Willebrand factor with subsequent ADAMTS13 deficiency and impaired fibrinolysis. Platelet hyperreactivity, hypercoagulability and hypofibrinolysis during SARS-CoV-2 infection induce a pathological state named as “immuno-thromboinflammation.” Finally, liver dysfunction and coagulopathy are often observed at the same time in patients with COVID-19. The hypothesis that liver dysfunction could be mediated by microvascular thrombosis has been supported by postmortem findings and extensive vascular portal and sinusoidal thrombosis observation. Other evidence has shown a correlation between coagulation and liver damage in COVID-19, underlined by the transaminase association with coagulopathy, identified through laboratory markers such as prothrombin time, international normalized ratio, fibrinogen, D-dimer, fibrin/fibrinogen degradation products and platelet count. Other possible mechanisms like immunogenesis of COVID-19 damage or massive pericyte activation with consequent vessel wall fibrosis have been suggested.

4.
Journal of Clinical and Experimental Hepatology ; 12:S29, 2022.
Article in English | EMBASE | ID: covidwho-1778270

ABSTRACT

Background: During this covid pandemic hypoxia was one of the initial mode of screening diagnosis and follow-up. Hypoxia in liver cirrhosis patients is also not uncommon especially in late stages. Hypoxia can have varied causes either liver specific or systemic conditions. Aim: aim of our observational study was to find etiology, incidence, severity and hypoxia related mortality in patients with liver cirrhosis. Methods: we conducted an observational study over a period of two months a total of n=64 patients with liver cirrhosis with hypoxia were included in the study. Further follow up data was collected from their clinical work up. Mortality data was collected for their mean follow up periods from their inclusion in the study. Results: ACLF was found to be the most common cause of hypoxia in cirrhosis patients with n=24 (37.5%) with a mean spo2 of 86.4% Mortality in ACLF was 70.8%, second most common cause was covid pneumonitis n=17 (26.6%) with a mean spo2 of 82.6% and a mortality of 23.5%, Followed by sepsis n=10 (15.6%) with an average spo2 of 88% and mortality of 60%. Hepato-pulmonary syndrome was seen in n=8 (12.5%) average spo2 of 91% and mortality of 25% followed by hepatic and hydrothorax n=4 (6.25%) average spo2 of 92.5% with 25% mortality and one patient with porto- pulmonary syndrome with an spo2 of 93% no mortality. Conclusion: Novel corona virus induced hypoxia was second most common causes for hypoxia in the current pandemic era after ACLF. Though hypoxia in COVID pneumonitis was more severe than ACLF and sepsis but the mortality was higher in ACLF and sepsis subgroup. Prognosis and mortality in hypoxic cirrhosis depends on the etiology and does not directly corelate with the severity of spo2 directly.

5.
Embase; 2021.
Preprint in English | EMBASE | ID: ppcovidwho-331114

ABSTRACT

Coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to escalate worldwide and has become a pressing global health concern. This article comprehensively reviews the current knowledge on the impact of COVID-19 over pregnant women and neonates, as well as current recommendations for their management. We also analyse previous evidences from viral respiratory diseases such as SARS, Middle East respiratory syndrome, and influenza that may help to guide clinical practice during the current pandemic. We collected 23 case reports, case series, and case-control studies (18 from China) comprising 174 pregnant women with COVID-19. The majority of mothers showed a clinical presentation of the disease similar to that of non-infected adults. Preliminary evidences point towards a potentially increased risk of pregnancy adverse outcomes in women with COVID-19, with preterm delivery the most frequently observed (16.7%) followed by fetal distress (9.77%). The most commonly reported adverse neonatal outcomes included respiratory symptoms (7.95%) and low birth weight (6.81%). A few studies reported other maternal comorbidities that can influence these outcomes. Mothers with other comorbidities may be at higher risk of infection. Mother-tochild transmission of SARS-CoV-2 appears unlikely, with no study observing intrauterine transmission, and a few cases of neonatal infection reported a few hours after birth. Although the WHO and other health authorities have published interim recommendations for care and management of pregnant women and infants during COVID-19 pandemic, many questions remain open. Pregnant women should be considered in prevention and control efforts, including the development of drugs and vaccines against SARS-CoV-2. Further research is needed to confirm the exact impact of COVID-19 infection during pregnancy. To fully quantify this impact, we urgently need to integrate the current knowledge about viral characteristics, epidemiology, disease immunopathology, and potential therapeutic strategies with data from the clinical practice.

6.
Toxicol Rep ; 9: 541-548, 2022.
Article in English | MEDLINE | ID: covidwho-1768569

ABSTRACT

Paracetamol/Acetaminophen was widely used as a first-line antipyretic and analgesic for COVID-19 patients without giving any attention to the potential risk of related toxicities. A survey was conducted on 176 Egyptians using an online survey portal to assess their knowledge, and attitude regarding potential risk of paracetamol toxicities and whether COVID-19 pandemic affected their practices regarding safe use of paracetamol. The self-administered questionnaire was developed by the researchers and was validated by expert opinions. A pilot testing of the questionnaire was done. Alpha Cronbach test used to assess the internal consistency reliability of the survey revealed good reliability. Overall percent-score revealed that only 24.4% of participants had good knowledge about paracetamol and its related potential toxicities. 62.5% of participants considered paracetamol safer than other medications of the same indications. 42.6% of participants could advise others to use paracetamol without prescription. According to the participants' responses, physicians were less concerned to give instructions about possibility of overdosage. Our results also revealed that participants' administration of paracetamol without physician prescription was more during COVID-19. Practice of paracetamol administration more than the allowed number of tablets/day was significantly more evident during the pandemic. We concluded that the unsupervised use of paracetamol is an alarming sign that should be addressed as this could lead to a high rate of accidental paracetamol toxicity. A lesson learnt from COVID-19 pandemic is the need to implement behavior change measures to mitigate the risk of accidental paracetamol toxicity.

7.
Osteoporosis International ; 32(SUPPL 1):S97, 2022.
Article in English | EMBASE | ID: covidwho-1748520

ABSTRACT

Objective(s): SARC-F1 is recommended by the European Working Group on Sarcopenia in Older People (EWGSOP2) for sarcopenia case finding2. A number of other screening tools have been devised. We aim to present (i) SARC-F in the context of other screening measures for sarcopenia, (ii) their comparison to SARC-F in terms of the psychometric properties but also feasibility in different clinical scenarios. Material and methods: PubMed, EMBASE, Web of Science, and Cochrane Library were searched for the SARC-F original papers and conference s, and for the other screening measures for sarcopenia. The SARC-F national validation paper by Piotrowicz et al.3 will serve as an anchor for the discussion of the topic. Results: Eleven screening methods for sarcopenia case finding have been identified. We present their applicability in the various settings and different clinical conditions. This includes the COVID-19 pandemic and an emerging concept of acute sarcopenia due to SARSCoV- 2 infection. Conclusion(s): As compared with other sarcopenia screening tools, SARC-F is more versatile, as it can be self-administered, assessed during a telephone interview, or used in subjects of varying body-build, or body-build affected by pathologies such as heart failure, liver failure, hypoalbuminemia.

8.
Zeitschrift fur Gastroenterologie ; 60(1):e45, 2022.
Article in English | EMBASE | ID: covidwho-1721712

ABSTRACT

Infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the current coronavirus disease 2019 (COVID-19) pandemic. Despite a preferential respiratory tropism of SARS-CoV-2, multi-organ involvement has been described. SARS-CoV-2 entry into host cells is mediated by the entry factors angiotensin converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2). Recent studies suggest that SARS-CoV-2 causes direct hepatic impairment in COVID-19 patients. Interestingly, ACE2 and TMPRSS2 are also expressed in primary human hepatocytes (PHH). Despite this evidence, data on infection and factors modulating functional regulation of SARS-CoV-2 infection in PHHs are scarce. MicroRNAs (miRNAs) are a class of small non-coding RNAs that have been described to modulate various cellular processes and have been implicated as potential therapeutic target. We aimed to study the infection of PHHs with SARS-CoV-2 and to evaluate the potential of miRNAs for modulating viral infection. We could demonstrate that PHHs can be readily infected with SARS-CoV-2. Bioinformatics analyses revealed miR- 200c-3p, miR-429, let-7c-5p and miR-141-3p as candidate miRNAs targeting ACE2 and TMPRSS2. All miRNAs were able to reduce SARS-CoV-2 burden in PHH by supressing ACE2 and TMPRSS2. Our findings provide the first evidence of the applicability of miRNA molecules in reducing SARS-CoV-2 viral loads.

9.
Journal of Clinical Oncology ; 40(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1703534

ABSTRACT

Background: Combination of anti-VEGF compounds and immune checkpoint inhibitors is an approved therapy across multiple solid tumors, including advanced HCC. This phase Ib study (NCT03468426) is assessing BI 836880 (bispecific VEGF/Ang2 nanobody) + ezabenlimab (anti-PD-1 antibody) in pts with advanced solid tumors. The recommended phase 2 dose (RP2D) of BI 836880 720 mg + ezabenlimab 240 mg given IV every 3 weeks was determined in Part 1. In Part 2, RP2D was assessed in 7 expansion cohorts. We report data from cohorts in HCC after prior sorafenib/lenvatinib (cohort F) and untreated unresectable HCC (cohort G). Methods: Pts with locally advanced or metastatic HCC, Child-Pugh class A, not eligible for surgical or locoregional therapies were enrolled. Cohort F enrolled pts who had progressed on or after first-line treatment with sorafenib or lenvatinib or who had discontinued due to poor tolerability after ≥2 weeks of treatment. Cohort G enrolled pts who had received no prior systemic therapy for HCC. Treatment continued until disease progression, undue toxicity or consent withdrawal. Primary endpoint is objective response rate (ORR) by RECIST 1.1. Results: As of Aug 2021, 30/31 pts have been treated in cohorts F/G: 87/77% male;median age 65/64 yrs. Follow-up is ongoing in both cohorts. 9/19 pts in cohorts F/G remain on treatment;median (range) duration of treatment is 175 (42-532)/ 169 (42-336) days in cohorts F/G. All pts were evaluable for response in cohort F: confirmed ORR to date is 40% (1 complete response;11 partial responses [PRs]). Of 28 evaluable pts in cohort G, confirmed ORR to date is 21% (6 PRs). 12 (40%) pts in cohort F and 18 (64%) in cohort G have stable disease. In cohort F, AEs were reported in 28 (93%) pts, most frequently hypertension and proteinuria (each 30%). In cohort G, AEs occurred in 26 (84%) pts, most frequently ascites (26%) and thrombocytopenia (19%). 24 (80%) pts in cohort F and 15 (48%) in cohort G had treatmentrelated AEs (TRAEs). Most frequent TRAEs were proteinuria (27%), infusion-related reactions (IRRs) and hypertension (each 20%) in cohort F, and hypertension (13%), IRRs, hypothyroidism and diarrhea (each 10%) in cohort G. There were 3 pts with G5 AEs in cohort F (COVID-19 pneumonia [n = 1];low Glasgow coma score and dyspnea [n = 1];hepatic cirrhosis [n = 1]) and 1 G5 AE in cohort G (hepatic failure);none were considered related to treatment. AEs leading to discontinuation occurred in 2 pts in cohort F (G3 hepatic encephalopathy and G2 duodenal ulcer) and 3 in cohort G (G5 hepatic failure [n = 1];G2 acute kidney injury and G1 decreased appetite [n = 1];G2 diarrhea [n = 1]). Conclusions: BI 836880 + ezabenlimab had a manageable safety profile and showed promising activity in pts with untreated and second-line post-sorafenib/lenvatinib advanced HCC. Data continue to mature, particularly in cohort G. Cohort F has been expanded by a further 30 pts.

10.
Journal of Pediatric Intensive Care ; : 4, 2022.
Article in English | Web of Science | ID: covidwho-1684163

ABSTRACT

Therapeutic plasma exchange (TPE) can be applied as an effective therapeutic option in children with hematological, neurological, nephrological, and autoimmune/rheumatic disorders. We aimed to report our TPE experience in pediatric patients. In this article, we retrospectively reviewed the records of pediatric patients who underwent TPE between 2019 and 2021. A total of 128 TPE sessions were performed in 25 patients (13 males,12 females;mean age 59.6 +/- 11.7 [3-198] months). The TPE indications were sepsis with/without multiorgan dysfunction syndrome in five patients, acute liver failure, hemolytic uremic syndrome caused by Shiga toxin, and autoimmune hemolytic anemia in three patients, respectively, multiple sclerosis, autoimmune encephalitis, and multisystem inflammatory syndrome in children (MIS-C) in two patients each, and myasthenia gravis crisis, meningococcemia, hemolytic uremic syndrome caused by coronavirus disease 2019, hemophagocytic lymphohistiocytosis, autoimmune encephalitis, and metabolic disease (fatty acid oxidation defect, liver failure) in one patient each. Based on our findings, we proposed that the American Society for Apheresis criteria should be updated according to newly described clinical conditions such as MIS-C.

11.
Biomolecules ; 12(2)2022 01 28.
Article in English | MEDLINE | ID: covidwho-1667042

ABSTRACT

The complement system (CS) is part of the human immune system, consisting of more than 30 proteins that play a vital role in the protection against various pathogens and diseases, including viral diseases. Activated via three pathways, the classical pathway (CP), the lectin pathway (LP), and the alternative pathway (AP), the complement system leads to the formation of a membrane attack complex (MAC) that disrupts the membrane of target cells, leading to cell lysis and death. Due to the increasing number of reports on its role in viral diseases, which may have implications for research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), this review aims to highlight significant progress in understanding and defining the role of the complement system in four groups of diseases of viral etiology: (1) respiratory diseases; (2) acute liver failure (ALF); (3) disseminated intravascular coagulation (DIC); and (4) vector-borne diseases (VBDs). Some of these diseases already present a serious global health problem, while others are a matter of concern and require the collaboration of relevant national services and scientists with the World Health Organization (WHO) to avoid their spread.


Subject(s)
Complement System Proteins , Virus Diseases/etiology , Animals , Disseminated Intravascular Coagulation/immunology , Disseminated Intravascular Coagulation/virology , Humans , Liver Failure, Acute/immunology , Liver Failure, Acute/virology , Respiratory Tract Diseases/immunology , Respiratory Tract Diseases/virology , Vector Borne Diseases/immunology , Vector Borne Diseases/virology
12.
Cureus ; 13(12): e20455, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1579840

ABSTRACT

The coronavirus disease 2019 (COVID-19) has led to a global health crisis. Its clinical manifestations are well-documented, and severe complications among patients who survived the infection are being continuously reported. Several vaccines with well-established efficacies and excellent safety profiles have also been approved. To date, few side effects of vaccines have been reported. Drug-induced hepatotoxicity is an extremely rare side effect of these vaccines, with few reported instances. In this case report, we describe a patient who experienced hepatotoxicity after receiving the COVID-19 vaccine from Pfizer BioNTech.

13.
Acta Colombiana de Cuidado Intensivo ; 2021.
Article in Spanish | ScienceDirect | ID: covidwho-1588592

ABSTRACT

Resumen Reporte de un caso de infección por COVID 19, en un paciente que se presenta con síntomas gastrointestinales y respiratorios altos y bajos, terminando en falla respiratoria y necesidad de ventilación mecánica invasiva, presentando mejoría de su cuadro respiratorio y gastrointestinal, pero con limitaciones para la extubación por alteración del estado de conciencia a pesar del destete de sedo analgesia por más de 72 horas, en quien se encontró niveles elevados de amonio sin signos de falla hepática. La diarrea y el compromiso hepático son manifestaciones frecuentes en pacientes con COVID 19, que pueden llevar posiblemente a una disminución de los niveles de carnitina e hiperamonemia secundaria, convirtiéndose en un verdadero desafío para los clínicos. A case report of COVID 19 infection in a patient presenting with upper and lower gastrointestinal and respiratory symptoms, ending in respiratory failure and the need for invasive mechanical ventilation, presenting with improvement in his respiratory and gastrointestinal symptoms, but with limitations for extubation due to altered state of consciousness despite weaning from analgesia for more than 72 hours, in whom elevated levels of ammonia were found without signs of liver failure. Diarrhoea and liver involvement are frequent manifestations in patients with COVID 19, which can possibly lead to a decrease in carnitine levels and secondary hyperammonaemia, becoming a challenge for clinicians.

14.
Blood ; 138:974, 2021.
Article in English | EMBASE | ID: covidwho-1582308

ABSTRACT

Introduction Sickle cell disease is a genetic disease with acute and chronic complications. Pediatric mortality has decreased in recent decades with the introduction of systematic antibiotic therapy, preventive management of cerebral vasculopathy and therapeutic education of families. However, in the absence of cohort follow-up at birth, life expectancy, which is a different concept from age at death, cannot be assessed. In this retrospective, monocentric study, we describe causes and circumstances of death, acute chronic complications, long-term treatments and baseline biology of these patients. It seems important to analyze the risks of morbidity and mortality in order to decide on the necessary preventive measures. Material and method: Records of patients deceased between 2000 and 2020, from the national referral center (Henri Mondor Hospital), were retrospectively reviewed. The referral center follows 3500 patients. All deaths reported to the hospital, by families, other hospitals and health professionals were retrieved from computerized records. Deaths published by the INSEE (National Institute of Statistical and Economical study) from 2000 to December 2020 were accessible and compared with our databases to identify all our deceased patients. All patients with a medical record in our center were included for the study. Patients who had never visited our center were excluded. Results: During this period 226 patients including 128 women and 138 men are recorded. Genotypes for these patients were 204(76%) SS, 41 (15%) SC, 14(5%) Sβ°thalassemia and 7 (2%) Sβ+thalassemia. The median age at death was 41 years with an IQR [32-51]. 186 (70%) patients were hospitalized, 129 (70%) of whom were admitted to intensive care. 36 (13%) patients died at home, including 15 with opioid addiction and 5 patients with psychiatric pathology, and 4 patients on dialysis. This information was not available for 44 (16%) patients. The causes of death were vaso-occlusive complications with multivisceral failure in 44 cases, 42 sepsis, among which there were 11 renal failures, 9 of which were dialyzed. 5 patients died of COVID 19. Cerebral hemorrhage and neurological accident occurred in 22 cases, 4 of which were known to have macrovasculopathy. 25 patients died of a direct complication of renal failure, of which 17 were dialysed, 8 pre-dialysed and 3 transplanted. Acute liver failure in 16 cases, 10 precapillary pulmonary hypertension, 14 DHTR, 10 end-stage heart failure were noted. Two road accidents, 2 suicides, 1 dementia are repoted. For 51 cases, there was no information on the cause or circumstance of death. The causes of death according to genotype is on Table 1. Concerning the chronic complications, 94/266 (35%) patients had significant chronic organ damage. Sixteen patients had required renal or liver transplantation in their history. End-stage organ damage was frequent, 42 had end-stage renal failure, 21 had major liver failure, of which five were transplanted and 16 were awaiting transplantation. Twenty-one patients had known heart failure, 10 of which were associated with end-stage renal disease. Ten patients were followed for significant precapillary pulmonary hypertension. Transfusion difficulties due to a history of DHTR were found for 33 patients. Fourteen patients had an opioid addiction. Nine patients were pregnant and nine had received corticosteroids. Discussion: Causes of death have changed and chronic organ failure is the leading cause of death, especially in patients with kidney, liver and heart disease. This study does not calculate life expectancy, but there was an increase in age at death of about 1/4 of the patients who were between 51 and 81 years old.The management of sickle cell disease has progressed in recent years and new therapies are being proposed. Prevention of the development of these complications is one of the new challenges, especially for renal disease, which is associated with premature mortality. DHTR and cerebral hemorrhage, Covid-19 are new entities and DHTR was probably underdiagnosed in p evious publications. Pregnancy remains a period at risk, for which surveillance should be reinforced. The analysis is ongoing and correlations are currently being investigated between different parameters to find risk factors for mortality. [Formula presented] Disclosures: Habibi: Novartis: Consultancy, Honoraria;bluebird bio: Consultancy, Honoraria, Research Funding. Audard: Addmedica: Consultancy. Michel: Novartis: Consultancy;Amgen: Consultancy;Rigel: Honoraria;Alexion: Honoraria;UCB: Honoraria;Argenx: Honoraria. Galactéros: Addmedica: Membership on an entity's Board of Directors or advisory committees. Bartolucci: INNOVHEM: Other: Co-founder;Bluebird: Consultancy, Research Funding;F. Hoffmann-La Roche Ltd: Consultancy;GBT: Consultancy;Jazz Pharma: Other: Lecture fees;AGIOS: Consultancy;Hemanext: Consultancy;Emmaus: Consultancy;Fabre Foundation: Research Funding;Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Lecture fees, Steering committee, Research Funding;Addmedica: Consultancy, Other: Lecture fees, Research Funding.

15.
Blood ; 138:978, 2021.
Article in English | EMBASE | ID: covidwho-1582159

ABSTRACT

Background The COVID pandemic resulted in excess all-cause mortality in 2020 in the United States, especially among people who identify as Black and/or Latino. While many of these deaths were due to COVID-19 infection, others have been attributed to strain on the overburdened health care system and delays in patients seeking medical care due to the pandemic. We sought to examine the overall mortality in individuals with sickle cell disease (SCD) who received their care at our Sickle Cell Center in Bronx New York in 2020 and investigated whether the number and causes of death in 2020 differed from the previous 3 years. Methods: Death date was collected from electronic medical records (EMR) and death certificates. Clinical variables collected from EMR included age, gender, race, genotype, history of comorbidities, hydroxyurea use, and health care utilization in the 12 months prior to death date. To determine cause of death, two hematologists performed manual review of the EMR blinded from each other and deaths were categorized as due to: sudden death, cardiovascular causes, sepsis, stroke, acute organ failure (including multi organ failure syndrome), chronic organ failure, hemorrhage, and unknown when records of the death event were not available. A third hematologist served as a tie breaker in cases of disagreement. Patients were also categorized as having: 1) sepsis present or absent during the death event, 2) acute (new or newly worsened) renal or liver failure present or absent during the death event, and 3) COVID status at death (acute COVID, past COVID, no COVID, or unknown COVID status). Acute COVID infection was defined by a positive PCR swab during the hospitalization leading to death or in the prior two weeks. Past COVID infection was defined by a negative PCR swab during the hospitalization and a positive PCR swab and/or antibody test more than two weeks before the death event with documented resolution of symptoms. No COVID infection was defined by a negative PCR swab or antibody test documented in the EMR and no positive tests present or noted per patient report. Unknown COVID status was unknown if no testing was present in the EMR. To examine how 2020 decedents differed from decedents in the prior 3 years, we compared clinical variables using the Kruskal Wallis test for continuous variables and chi 2 tests for dichotomous variables. To examine differences between 2020 decedents between known COVID (acute or chronic) vs. no COVID, we repeated similar tests among the 2020 decedents only. Results: In the years 2017, 2018, 2019, and 2020, there were 9, 10, 8, and 22 patient deaths respectively. Compared with decedents in the prior 3 years, patients who died in 2020 were more likely to have acute liver failure during the hospitalization, were more likely to have history of stroke, and had more heme clinic visits in the prior 12 months. Otherwise, there was no difference in age, gender, genotype, hydroxyurea use, history of disease morbidity, hospital utilization in the prior 12 months, or sepsis before death (Table 1). Among the 22 who died in 2020, 3 had an acute COVID infection, five had past COVID, 8 had no COVID, and 6 had unknown COVID status. Among 2020 decedents, acute or past covid was associated with acute organ failure (p=0.02) and less hydroxyurea use (p=0.04). (Table 2). Conclusions: SCD deaths at our center more than doubled in 2020 compared to prior years, but fewer than half of the decedents had acute or prior COVID. Compared with prior years, 2020 decedents were more likely to have acute organ failure. This could be explained by COVID infection, delays in seeking care, or changes in care delivery during the COVID pandemic. This study emphasizes the need for further studies on the impact the pandemic had on the health of adults with SCD, as well as the need for prospective studies of patients with SCD who recover from COVID. [Formula presented] Disclosures: Curtis: GBT: Consultancy. Minniti: Forma: Consultancy;GBT: Consultancy;Novartis: Consultancy;Novo Nordisk: Consultancy;Chiesi: Consult ncy;F. Hoffmann-La Roche: Consultancy;Bluebird Bio: Other: Endpoint adjudicator;CSL Behring: Other: Endpoint adjudicator.

16.
J Clin Exp Hepatol ; 2021 Dec 08.
Article in English | MEDLINE | ID: covidwho-1562325

ABSTRACT

Patients with chronic liver disease (CLD) with or without cirrhosis remain at risk of developing hepatic decompensation when infected with viral or bacterial pathogens. The Advisory Committee on Immunization Practices (ACIP) currently recommends vaccination in CLD against hepatitis A virus (HAV), hepatitis B virus (HBV), influenza, pneumococcus, herpes zoster, tetanus, diphtheria, pertussis, and SARS-CoV-2. Inactivated vaccines are preferred over live attenuated ones, especially in transplant recipients where live vaccines are contraindicated. As the severity of the liver disease progresses, vaccine efficacy declines, and therefore, vaccines should be ideally administered early in the disease course for optimal immune response. Despite the strong recommendations, overall vaccination coverage in CLD remains poor; however, it is encouraging to note that in recent years coverage against influenza and pneumococcus has shown some improvement. Inadequate access to healthcare, lack of information on vaccine safety, poor financial reimbursement for healthcare providers, and vaccine misinformation are often responsible for low immunization rates. This review summarizes the impact of vaccine-preventable illness in those with CLD, updated vaccine guidelines, seroconversion rates in the vaccinated, and barriers faced by healthcare professionals in immunizing those with liver disease.

17.
Anaesth Rep ; 9(2): e12139, 2021.
Article in English | MEDLINE | ID: covidwho-1557808

ABSTRACT

COVID-19 infection immediately after liver transplantation presents a unique and challenging situation. In this report, we present the case of an 11-year-old girl who underwent emergency living donor liver transplantation for acute liver failure. After an uneventful intra-operative course, the patient was transferred to the intensive care unit. On the second postoperative day, the patient developed unexplained severe hypoxia. A polymerase chain reaction test was positive for SARS-CoV-2 virus and a hypercoagulable state was indicated by laboratory investigations. Despite therapies such as mechanical ventilation and therapeutic anticoagulation, further clinical deterioration occurred. On the seventh postoperative day, the patient's pupils were fully dilated bilaterally and unreactive to light, and brain death was later confirmed. This report highlights unique challenges pertaining to oxygenation, coagulation and immunosuppression after liver transplantation in a child with COVID-19. Hypoxia of unknown origin in the postoperative period should prompt consideration of COVID-19 as a possible cause.

18.
Digestive and Liver Disease ; 53:S109, 2021.
Article in English | EMBASE | ID: covidwho-1554122

ABSTRACT

Background and aim: Access to liver transplantation (LT) can beaffected by several barriers resulting in delayed referral and increased risk of mortality. Therefore, hub-and-spoke networks have been implemented in order to manage patients with liver disease. COVID-19 pandemic may have significantly changed this scenario, as most of medical resources have been allocated for the care of patients with SARS-CoV-2 infection. This study aimed to assess the influence of COVID-19 pandemic on referrals of patients with liver disease to a LT Center.Materials and methods: An integrated referral program was developed since 10.2017 at Multivisceral Transplant Unit, PadovaUniversity. All consecutive adult patients with liver disease referred for the first time using this program from 10.2017 to 12.2020 were prospectively collected. Clinical characteristics were analyzedoverall and according to era of referral (pre-COVID-19 era:10.2017-02.2020;COVID-19 era:03.2020-12.2020).Results: 231 patients with liver disease were referred over the study period (men 61%, mean ± SD age: 54±10 years). End-stage liver disease was the most common underlying condition (78.3%), followed by acute liver injury/acute liver failure (17.3%). During COVID-19 pandemic, the rate of referred patients showed a stable trend, if compared with the previous period (5.1 patients/monthvs. 6.1 patients/month), also when only in-patient referrals wereconsidered (pre-COVID-19 era vs.COVID-19 era: 2.9 vs. 3.2 patients/month). Considering 181 patients with cirrhosis, underlying etiology (p=0.22), severity of liver disease (MELD score: 21±7 vs. 20±8;p=0.44), and inpatient referrals (42% vs. 51%;p=0.34) did not differ between pre-COVID-19 and COVID-19 eras. There was a decreasing rate of ICU admission for cirrhosis-related complicationsduring COVID-19 pandemic (22% vs. 34%;p=0.3), with an increased in-hospital transplant-free mortality (41% vs. 30%;p=0.3).Conclusions: Conclusion: Our results did not show a significant decrease in the number of referrals and type of indications during the COVID-19 pandemic;however, the in-hospital transplant free mortality showed an increasing trend, which could be the consequence of a decreasing rate of ICU admissions. Taken together, thesefactors confirmed the importance of a referral network for the care of patients with liver disease, but also how the COVID-19 pandemic may influence the short-term outcome of patients with liver disease.

19.
Blood Purif ; 50(3): 290-297, 2021.
Article in English | MEDLINE | ID: covidwho-1533118

ABSTRACT

The principles and use of plasmapheresis are often little understood by intensivists. We propose to review the principles, the main indications, and the methods of using this technique.


Subject(s)
Critical Care/methods , Plasma Exchange/methods , Animals , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/therapy , COVID-19/therapy , Equipment Design , Guillain-Barre Syndrome/therapy , Humans , Liver Failure, Acute/therapy , Membranes, Artificial , Plasma Exchange/instrumentation , Purpura, Thrombotic Thrombocytopenic/therapy
20.
BMJ Open Gastroenterol ; 8(1)2021 11.
Article in English | MEDLINE | ID: covidwho-1528544

ABSTRACT

OBJECTIVE: In early 2019, a new coronavirus called SARS-CoV-2 emerged and changed the course of civilization. Our study aims to analyze the association between acute liver failure (ALF) and mortality in patients infected with COVID-19. A retrospective analysis of 864 COVID-19-infected patients admitted to Nassau University Medical Center in New York was performed. DESIGN: ALF is identified by acute liver injury (elevations in liver enzymes), hepatic encephalopathy and an international normalised ratio greater than or equal to 1.5. These parameters were analysed via daily blood work and clinical assessment. Multivariate logistic regression model predicting mortality and controlling for confounders such as age, coronary artery disease, intubation, hypertension, diabetes mellitus and acute kidney injury were used to determine the association of ALF with mortality. RESULTS: A total of 624 patients, out of the initial 864, met the inclusion criteria-having acute hepatitis and COVID-19 infection. Of those 624, 43 (6.9%) patients developed ALF during the course of their hospitalisation and their mortality rate was 74.4%. The majority of patients with ALF were male (60.6%). The logistic model predicting death and controlling for confounders shows COVID-19 patients with ALF had a nearly four-fold higher odds of death in comparison to those without ALF (p=0.0063). CONCLUSIONS: Findings from this study suggest that there is a significant association between mortality and the presence of ALF in patients infected with COVID-19. Further investigation into patients with COVID-19 and ALF can lead to enhanced treatment regimens and risk stratification tools, which can ultimately improve mortality rates during these arduous times.


Subject(s)
COVID-19 , Hepatitis , Liver Failure, Acute , Female , Humans , Liver Failure, Acute/epidemiology , Male , Retrospective Studies , SARS-CoV-2 , Safety-net Providers
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