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1.
Frontiers in Immunology ; 13:1056153, 2022.
Article in English | MEDLINE | ID: covidwho-2198898

ABSTRACT

Introduction: COVID-19 vaccination has been associated with rare but severe complications characterized by thrombosis and thrombocytopenia.

2.
Current Women's Health Reviews ; 19(1) (no pagination), 2023.
Article in English | EMBASE | ID: covidwho-2197803

ABSTRACT

Background: COVID-19 infection was declared pandemic infection on March 11, 2020 by the World Health Organisation. Pregnant women have a high propensity to acquire this infection due to their altered physiological and immunological function. Objective(s): To know the overall incidence of COVID positive obstetric patients and assess the pres-ence of any co-morbidity or obstetric complications as well as maternal and perinatal outcomes at our institute. Method(s): This retrospective observational study was conducted at the Saraswathi Institute of medical sciences (SIMS), Hapur Uttar Pradesh, India from April 2020 to December 2020. All Covid positive obstetric patients, antenatal and postnatal upto 6weeks postpartum were included from the hospital records. Their socio-demographic characters, period of gestation at the time of admission, pre-senting symptoms, any medical or obstetric complications as well as maternal and perinatal outcome were studied in the form of the severity of symptoms, ICU admissions, requirement of me-chanical ventilatory support and NICU admissions. Result(s): Total 95 obstetric patients were admitted, out of which 83 (87.36 %) were antenatal and 12 (12.63 %) were postnatal. Sixteen patients delivered at SIMS, out of which 9 (56.25 %) had cesarean delivery and 7 (43.75 %) had vaginal delivery and 9 had preterm deliveries (56.25 %). Among the 12 postnatal patients, 5 (41.66 %) undergone cesarean delivery and 7 (58.33 %) had vaginal delivery. Twenty (21.05 %) patients needed ICU admission and 3 (3.15 %) patients re-quired ventilatory support. There were 2 (2.10 %) maternal deaths and 2 (2.10 %) neonatal deaths. Conclusion(s): The course of COVID-19 obstetric patients was mild in majority of cases, however, increased rates of pregnancy complications and caesarean delivery was observed. Copyright © 2023 Bentham Science Publishers.

3.
Annals of Pediatric Surgery ; 19(1):5, 2023.
Article in English | ProQuest Central | ID: covidwho-2196577

ABSTRACT

BackgroundFew studies have evaluated the efficacy of short-term medical missions. This study was aimed to evaluate complication rates and determine the effects of protocol changes in a pediatric inguinal hernia campaign in Equatorial Guinea and analyze post-operative follow-up capacity.MethodsIn this prospective observational cohort study, we evaluated two patient cohorts (group A, 2017–2018;group B, 2019) treated during campaigns in Equatorial Guinea for congenital inguinal pathology (hernia, hydrocele, and cryptorchidism). Patients aged < 18 years treated in referral campaigns were included. Complications occurring up to 6 months post-operatively were evaluated. Two stages were defined: Stage 1, wherein, complication rate in group A was compared to that in a control group from a tertiary hospital in Spain (with a case–control ratio of 1:2, paired according to age, sex and diagnosis);stage 2, wherein, complication rates between groups A and B were compared. Group B received a single dose of prophylactic amoxicillin-clavulanic acid. Follow-up capacity was assessed through follow-up appointments.ResultsIn stage 1, complication and surgical site infection (SSI) rates were 21.3% and 7.4% in group A (n = 94), and 5.8% (p < 0.001) and 0.5% (p = 0.012) in the control group, respectively. Group A had 20.2% loss-to-follow-up. In group B (n = 62), 6-month postoperative follow-up could not be assessed owing to restrictions due to the COVID-19 pandemic, so only early complications were considered in stage 2, were complication and surgical site infection rates were 18.1% and 7.4% in group A and 11.3% (p = 0.350) and 1.6% (p = 0.150) in group B.ConclusionOur results showed higher than expected complication rates. Pre-operative prophylactic antibiotic could not show to reduce SSI. Further studies are needed to reduce complication rates in these campaigns. Patient loss-to-follow-up ratio warrants considering new strategies.

4.
Transfusion Medicine ; 32(6):443-444, 2022.
Article in English | EMBASE | ID: covidwho-2193287
5.
Colorectal Disease ; 23(Supplement 2):111, 2021.
Article in English | EMBASE | ID: covidwho-2192492

ABSTRACT

Aim: Despite Covid-19, hospitalsin the England, United Kingdom continued to assess and manage patients referred on two week-wait (2WW) suspected cancer referral pathways. Most index clinic assessments of such patients were conducted viatelephone. We retrospectively evaluated adistrict general hospital experience of managing patients on a 2WW suspected lower gastrointestinal tract (LGIT)cancer referral pathway, initially assessed via telephone Method: Data were obtained using a prospectively maintained database and electronic patient records. LGIT 2WW referrals between 01/06/2020to 31/10/2020 were included. Data were retrospectively collated and analysed using Excel (Microsoft Corporation, USA) Results: A total 757 patients (median age = 70, interquartile range = [59-79], female = 47.2%) were identified. The majority (n = 629,83.1%) were white Caucasian. All patients were initially assessed virtually and only 3 (0.4%) were re-assessed face-to- face for their index appointment. Sixteen (2.1%) missed at least one prior appointment. The most common presenting complaints included change in bowel habit, rectal bleeding, weight loss, anaemia and abdominal pain, and 415 (54.8%), 269 (35.5%) underwent endoscopy and imaging respectively as the first investigation. Forty four (5.8%) patients had malignant pathology with the majority (n = 37,84.1%) being colorectal in origin. Of those diagnosed with a primary colorectal malignancy 25 (67.6%) underwent surgical or endoscopic treatment, 3 (8.1%) were referred to chemoradiotherapy and 8 (21.6%) were referred for palliation. Conclusion(s): Patients referred on the 2WW LGIT pathway continued to be assessed and managed despite Covid-19. Index telephone clinic assessments are perhaps as effective a tool as face-to- face assessments, for patients referred on this pathway. This warrants further investigation.

6.
Colorectal Disease ; 23(Supplement 2):79, 2021.
Article in English | EMBASE | ID: covidwho-2192483

ABSTRACT

Aim: UK endoscopy services faced challenges prior to SARS-CoV- 2. During the first months of the pandemic, activity fell by 92%. Consequently, in June 2020, NHS England recommended Faecal immunochemical testing (FIT) for all symptomatic patients to rationalise endoscopy. This study sought to evaluate the real-world safety and effectiveness of this approach. Method(s): Patients referred with suspected colorectal cancer (CRC) on the two-week wait (2ww) pathway were asked to complete a FIT. Samples were analysed using the OC-Sensor. While a FIT > 100 mug Hb/g was used to prioritise investigation, all patients were subsequently investigated. FIT results were correlated with diagnostic studies. Result(s): Between January to December 2020, 48% of referred patients had a FIT. 26% was above the threshold of 10 mug Hb/g in and 8.6% above 100mug Hb/g. 347 patients also had a positive FIT but were not referred. The sensitivity, specificity, NPV, PPV, and likelihood ratio at a threshold of 10mug Hb/g were 78.6%(95%CI0.69-0.86%), 36.8%(95%CI0.34-0.39%), 7.1%(95%CI0.057-0.088%), 96.5% (95%CI 0.95-0.98%) and 1.24 respectively. At 100mug Hb/g, this was 37.8%(95%CI0.29-0.48%), 80.2%(95%CI0.78-0.82%), 10.5%(95%CI0.077-0.14%), 95.4%(95%CI0.94-0.96%) and 1.9 respectively. Conclusion(s): FIT shows promise in trials, but our data raises concerns about real-world performance. Only 48% of patients completed FIT before referral, and we are exploring why 347 FIT-positive patients were not referred. While results are broadly congruent with reported literature that suggested 10% of CRC are FIT negative, this is greater in our cohort at 25%. This raises concerns about the safety of discharging patients based on FIT alone. Modifying the FIT threshold may be required and improving safety-netting where FIT is known to be ineffective, such as patients with iron deficiency anaemia.

7.
Colorectal Disease ; 23(Supplement 2):92, 2021.
Article in English | EMBASE | ID: covidwho-2192476

ABSTRACT

Aim: Routine endoscopic services were significantly reduced in response to the COVID-19 pandemic. As a response, two-week- wait referral for patients with rectal bleeding suspicious of colorectal cancer, incorporated qFIT as a tool to identify patients that may require further investigation. This study aimed to analyse the accuracy and sensitivity of qFIT as a tool to identity malignant colorectal neoplasia. Correlations between qFIT, anatomical site of neoplasia and haemoglobin status (Hb) was similarly considered. Method(s): Participants were included if they had confirmed colorectal adenocarcinoma or adenoma detected via the two-week- wait referral system alongside a qFIT score. A qFIT score of >=10mg/g was interpreted as positive. Exclusion criteria included anal cancers, neuroendocrine cancers, small bowel tumours and participants without a qFIT level. Participants with polyps and confirmed rectal, sigmoid and/or colonic cancer were included. Haemoglobin level at diagnosis, colonoscopy report and histological outcomes were analysed. Result(s): 3664 patients were referred in on the two-week- wait pathway in 2020. Of these 372 (10%) were coded as having a gastrointestinal tumour or polyp cancer diagnosis. 119 (32%) of participants fulfilled the criteria to be amenable for review. Of these 10 (8.4%) participants only had a polyp, while 109 (91.6%) participants had colorectal adenocarincoma +/-polyps. A total of 12 (11%) participants with colorectal adenocarcinoma had a qFIT level of <=10mg/g, with 2 (16%) of these having concurrent anaemia. There was no demonstratable level of qFIT that correlated with right versus left sided colonic tumours. Conclusion(s): Symptomatic patients with a qFIT of >=10mg/g should undergo further investigation for malignant colorectal neoplasia. This study found that qFIT did not reliably predict the site of neoplasia. A qFIT of <=10mg/g was present in 11% of participants with colorectal adenocarcinomas and is therefore not a sensitive tool in excluding colorectal neoplasia.

8.
Acta Physiologica Conference: 5th Congress of Physiology and Integrative Biology and 89th Congress of French Physiological Society Lyon France ; 236(Supplement 726), 2022.
Article in English | EMBASE | ID: covidwho-2192375

ABSTRACT

Introduction: COVID-19 can alter many systems, including causing crucial hematological and biochemical changes in patients. COVID-19 survivors report persistent symptoms after discharge from hospital. No studies in Senegal are available on this stage of recovery. The aim of our study was to evaluate biological parameters in patients cured of COVID-19. Method(s): A descriptive cross-sectional study was conducted from April 1 to July 31, 2021. Patients cured of COVID-19 after infection confirmed by real-time PCR for SARS-CoV-2 were recruited. The time from hospital discharge to the start of our study ranged from 1 to 14 months. The study included a questionnaire and a clinical examination followed by blood and urine sampling. Result(s): Fifty patients cured of SARS-CoV2 were recruited with a sex ratio of 1.63. The mean age was 49.74 +/- 12.35 years. The majority of patients had presented a moderate symptomatic form (76%). Only ten patients (20%) were placed on oxygen therapy. The most common hematologic abnormalities were hyperlymphocytosis (52%), hyperbasophilia (48%), and neutropenia (42%). Anemia and leukopenia were found in 8% and 2% of patients respectively. The most frequent biochemical abnormalities were a decrease in HDL-cholesterol (40%), an increase in LDL-cholesterol (32%), a high atherogenicity index (36%) and an increase in d-dimer (3%). An increase in the proteinuria/creatinine ratio was observed in 24% of patients. Conclusion(s): Biological changes were observed in patients cured of COVID-19 due to viral infection and medical treatment. Knowledge of the biological profiles of COVID-19 would help advance infection control strategies.

9.
Pediatric Critical Care Medicine Conference: 11th Congress of the World Federation of Pediatric Intensive and Critical Care Societies, WFPICCS ; 23(11 Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2190815

ABSTRACT

BACKGROUND AND AIM: Coronavirus disease was thought to affect children less severely. However, a post viral immune mediated inflammatory process with an unclear pathogenesis has been reported also known as Paediatric Inflammatory Multisystem Syndrome (PIMS). Aim of this study is to describe the characteristics of a series of cases of PIMS hospitalized in a Pediatric Intensive Care Unit (PICU) in Athens, Greece. METHOD(S): Patients' files were reviewed from March 2020 until December 2021 to define PIMS cases as described by World Health Organization. RESULT(S): During the reviewed period, 25 cases of PIMS were admitted to our hospital. 8 were transferred in PICU and included in our study. Median age was 7.25 years. 6 patients were male. 1 had diabetes type I and 4 were obese. Presenting symptoms are shown in table 1. All patients showed increased levels of C-reactive protein, d-dimers, ferritin as well as anemia. 6 had lymphopenia, 4 hyponatremia and 3 hypoalbuminemia. All had negative PCR for Sars- Cov-2. 3 had respiratory failure and 1 required intubation. All showed elevated cardiac markers and 5 had reduced left ventricular ejection fraction that was eventually normalized. 3 were supported with inotropes and/or vasopressors and 1 with extracorporeal membrane oxygenation. Treatment was based on immunoglobulin (100%), glucocorticoids (100%) and/or biologic drugs (50% received interleukin [IL]-1 antagonists and 12% IL-6 receptor blockers). Mortality rate was 0%. CONCLUSION(S): Although PIMS following exposure to Sars-Cov-2 is a clinical syndrome with severe presentation, prognosis is good with appropriate and early treatment.

10.
Critical Care Medicine ; 51(1 Supplement):226, 2023.
Article in English | EMBASE | ID: covidwho-2190561

ABSTRACT

INTRODUCTION: Babesiosis, or Babesia microti in the blood, is a rare tickborne parasitic illness. It is endemic to the Northeast and upper Midwest regions of the United States, in warmer summer months, and is a reportable disease. Babesia is transmitted by the bite of an infected Ixodes scapularis nymph tick (black-legged or deer tick). Many people remain asymptomatic, while others experience life-threatening illness. even with low parasite index, such as the case described. Cases are rising in Pennsylvania overall since 2010, but since the start of COVID-19 pandemic, our small community hospital in rural Northeastern Pennsylvania (NEPA) has seen 12 cases. DESCRIPTION: A 63-year-old male presented with severe illness due to persistent Babesiosis parasitemia in a NEPA community hospital, with history of recent COVID-19 infection. He presented with fever, rigors, myalgias, diarrhea, and weakness. He reported history of tick bite two weeks prior to presentation. Initial exam was unremarkable. He was admitted to the hospital with hyponatremia, acute liver and kidney injury, anemia, thrombocytopenia, and elevated bilirubin. Babesia microti red blood cell (RBC) parasite index initially was 2%. He then became lethargic and hypotensive and parasite index escalated to 5% with worsening febrile illness, confusion, rapid atrial fibrillation, worsening acute kidney injury, and evidence of hemolysis and consumptive coagulopathy, despite standard-of-care antimicrobial regimen. He was fluid resuscitated and transferred to a higher level of care for urgent RBC exchange, which he obtained, and recovered after prolonged intensive care unit stay. DISCUSSION: Babesiosis can present indolently or acutely with flu-like and hemolytic illness. Those at higher risk of illness are elderly, and those with asplenia, baseline liver or kidney dysfunction, or immunocompromised status. Babesia cases are rising all over the country. Our single small hospital has seen 12 cases in the past 3 years. It is a possibility that the recent COVID-19 infection created a relative immunocompromised and pro-inflammatory state leading to susceptibility to the parasite. Illness can be life-threatening. Even with low parasitemia index, early RBC exchange should be considered if end organ dysfunction is present and clinical course is not improving.

11.
Critical Care Medicine ; 51(1 Supplement):175, 2023.
Article in English | EMBASE | ID: covidwho-2190520

ABSTRACT

INTRODUCTION: Lemierre's syndrome (LS) is characterized by fever, sore throat, neck swelling and tenderness, and septic thrombophlebitis of the jugular vein. It remains a fatal disease as serious complications commonly arise. DESCRIPTION: 20-year-old male patient with not known past medical history endorsed 1 week of sore throat, emesis, loose stools, weight loss as well as dyspnea associated with bilateral, non-pleuritic chest pain, night sweats, myalgias and subjective fever sensation. Patient was initially hypoxic, hypotensive, tachycardic, tachypneic and febrile, with scleral icterus, lymphadenopathy of neck and jaw bilaterally, enlarged tonsils, and diffuse abdominal tenderness. Laboratory results showed leukocytosis with neutrophile predominance, anemia, thrombocytopenia, elevated inflammatory markers. There was also pre-renal acute kidney injury, elevated alkaline phosphatase and hyperbilirubinemia. SARS-CoV-2 tests were negative. Initial computerized tomography (CT) of the chest showed extensive peripheral ground-glass nodules and rounded consolidations, with lower lobe predominance. Admission to medical ICU was warranted. Initial blood cultures showed no identification of speciation;Ceftriaxone was started with satisfactory response. However, patient developed worsening shortness of breath, orthopnea, rightsided neck pain and erythema. Repeat imaging showed new airspace opacities in both lungs with cavitation consistent with septic emboli, and thrombophlebitis of right jugular vein with no abscess. At that point, blood cultures grew Fusobacterium necrophorum and metronidazole was started. A four-week course was completed upon discharge with satisfactory response. DISCUSSION: Lemierre's syndrome remains as a rare but potentially fatal entity. Internal jugular vein (IJV) thrombophlebitis occurs through infection of the lateral pharyngeal space. Pulmonary metastases are common. Metronidazole comprises the foundation of the treatment given its tissue penetration and activity against all strains of Fusobacterium spp. Data regarding anticoagulation efficacy is limited. Clinicians should maintain high clinical suspicion, and a multidisciplinary approach with broad collaboration among specialties is imperative to aid early diagnosis and better clinical outcomes.

12.
Critical Care Medicine ; 51(1 Supplement):169, 2023.
Article in English | EMBASE | ID: covidwho-2190517

ABSTRACT

INTRODUCTION: Autoimmune hematological complications related to COVID-19 are rare. There are only 5 pediatric case reports of autoimmune hemolytic anemia (AIHA) among 14 million pediatric COVID-19 cases in USA. Four were older (13-17 years), two had underlying autoimmune/hematologic conditions. Immunologic analysis varied, with cold, warm & mixed hemolytic anemias described. We present a previously healthy child with COVID-19 associated severe AIHA with peripheral reticulocytopenia. DESCRIPTION: A 3-year-old male presented with lethargy, fever, tachycardia and jaundice 10 days after COVID-19 diagnosis. Pertinent labs include hemoglobin (Hgb) 3.8 g/dL, Hct 9.9%, bilirubin 3.6 mg/dL, platelets 321,000/muL, RBC count 1.2 M/muL, WBC 35,600/muL, MCV 82.5fL. Reticulocyte count (RC) was only 2.8%. Peripheral blood smear showed anisocytosis, poikilocytosis, nucleated RBCs and left shifted granulocytosis. Bone marrow biopsy revealed erythroid hyperplasia without underlying malignancy;myeloid:erythroid ratio of 0.3:1. The outside hospital reported cold C3 agglutination following 4degreeC incubation, while our laboratory identified spontaneous agglutination at room temperature (warm agglutination). IV fluids, O2, and methylprednisolone (4 mg/kg/day) were started and two packed RBC transfusions (total 30 ml/kg) given for symptomatic anemia with Hgb < 4 g/dL. LDH peaked at 2255 U/L on Day 3. Reticulocyte count was low (2.8%-3.8%) Days 1-3, increased to 6.5% on Day 4 and peaked at >30.0% on Day 7. He was changed to oral prednisone 2 mg/kg/day on Day 12 and discharged on Day 13 with Hgb 7.0 g/dL and RC 29.9%. Most recent Hgb is 13.0 g/dL and RC 2.6%. DISCUSSION: COVID-19 associated AIHA is rare, and previously reported mostly in older children. Our patient was previously healthy, and demonstrated a strong bone marrow response with erythroid hyperplasia. Peripheral reticulocytosis was delayed, and correlated with initiation of systemic steroid therapy. Our patient had both cold and warm agglutination supporting extensive autoimmune destruction of early red cell lineage. These findings support immune activation during acute COVID-19 infection and COVID-19 as a trigger for AIHA. Patients developing AIHA may need to be tested for COVID-19 and carefully monitored for complications.

13.
Critical Care Medicine ; 51(1 Supplement):166, 2023.
Article in English | EMBASE | ID: covidwho-2190515

ABSTRACT

INTRODUCTION: Chimeric antigen receptor T-cells (CAR-T) represent a promising immunotherapeutic approach in the treatment of refractory malignancies, but carry the risk of unique inflammatory toxicities including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). In moderate to severe cases, these toxicities necessitate intensive care unit (ICU) admission for aggressive support and management. DESCRIPTION: A 63-year-old male with a history of pulmonary embolism, prostate cancer with resection and relapsed/refractory IgG-kappa multiple myeloma (diagnosed 4 years earlier and status-post multiple chemotherapy regimens) was admitted for conditioning chemotherapy and CAR-T cell infusion. 1 day post-infusion on the ward, he developed CRS and ICANS, with fever and altered mental status, for which he received tocilizumab, dexamethasone, and anakinra, in addition to empiric antibiotics. He progressed with worsening hypotension and encephalopathy and was admitted to the ICU and required vasopressors, pulse-dose steroids, and siltuximab. A nasal swab was performed to rule out COVID-19, following which he developed persistent epistaxis, requiring packing and, after aspiration of blood, intubation for airway protection. Laboratory data showed anemia and thrombocytopenia, prolonged PT and aPTT, low fibrinogen, and elevated levels of ferritin of 44,124 mg/ mL, D-Dimer of 1.35 mug/mL, interleukin-6 of 8,595 pg/ mL, interleukin-10 of 1,042 pg/mL, tumor necrosis factor- alpha of 103 pg/mL, and interferon-gamma above 244 pg/mL. The patient received numerous red cell and platelet transfusions, aminocaproic acid, cryoprecipitate, and additional packing and thrombin application by ENT before his epistaxis was controlled. Ultimately, he was weaned from vasopressors, extubated after two weeks and transferred out of the ICU, discharged to rehabilitation, and later home. DISCUSSION: Severe CRS can be associated with hemophagocytic lymphohistiocytosis and disseminated intravascular coagulation (DIC), which can lead to lifethreatening bleeding as demonstrated in our patient. Effective and timely treatment of bleeding associated with DIC and severe CRS can be life-saving. It behooves the intensivist to recognize the toxicities of CAR-T as therapeutic applications broaden in the coming years.

14.
Critical Care Medicine ; 51(1 Supplement):163, 2023.
Article in English | EMBASE | ID: covidwho-2190512

ABSTRACT

INTRODUCTION: Serum albumin (ALB) is inversely associated with COVID-19 severity through an unclear mechanism. We addressed this gap using machine learning to identify traits exhibiting explanatory variance (EV%) in mortality risk within 12h of admission versus near end of hospitalization in the context of hypoalbuminemia. METHOD(S): Data were extracted under IRB exemption from medical records of COVID-19 patients at least 18 years old in the ICU with at least two ALB measures from March 2020 through September 2021. ALB, COVID-19 inflammation and injury traits were characterized across hospitalization. Hypoalbuminemia present on admission (POA) was defined as ALB < 3.2 g/dL. Traits associated with mortality were controlled for age, sex, COVID-19 directed treatment and the four COVID surges. Bootstrap Forest (BF) evaluated EV% of traits in mortality. Continuous data were compared using KruskalWallis. Discrete data were compared with chi-squared test. RESULT(S): Among 878 patients, 631 (72%) vs. 247 (28%) POA respectively with ALB < 3.2g/dL vs. >3.2g/ dL. Median age 68(57,77) years distributed across 64% males with 75% Whites, 10% Blacks and 15% other races exhibiting hypertension (53%), coagulopathy (28%), chronic pulmonary disease (22%) and heart failure (22%). Excess comorbidity associated with hypoalbuminemia included obesity (48% vs. 38%, p=.004), anemias (42% vs. 28%, p<.0001), and diabetes (39% vs. 32%, p=.03). Respective hypoalbuminemia near end of hospitalization increased to 97% (p<.0001) and 84% (p<.0001) with hospital mortality of 51% vs. 31% (p=<.0001). Associated ALB declines were 0.5(0.1, 1.0) vs. 1.0 (0.6, 1.0) g/dL. BF modeling (RSquared=0.69) identified POA traits EV% including CRP (21%), AST/SGOT (11%), proBNP (9%), WBC (9%), and ferritin (9%) among others. BF modeling (RSquared=0.84) identified near end visit traits EV% including WBC (31%), CRP (13%), platelet (12%), and ANC (11%) among others. CONCLUSION(S): The EV% of CRP at presentation corroborates an inverse relationship with ALB suggesting acute phase signaling may evoke hypoalbuminemia. Specifically, increased endothelial permeability allowing ALB extravasation as evidenced by proBNP EV%. Secondary etiology may derive from inhibited albumin synthesis secondary to liver injury as suggested by AST/SGOT at presentation and visit end.

15.
Open Forum Infectious Diseases ; 9(Supplement 2):S664-S665, 2022.
Article in English | EMBASE | ID: covidwho-2189867

ABSTRACT

Background. Epetraborole (EBO) - an orally available bacterial leucyl transfer RNA synthetase inhibitor with potent activity against nontuberculous mycobacteria - is under clinical development for treatment of MAC lung disease. We conducted a Phase 1b dose-ranging study of EBO tablets in healthy adult volunteers, to inform dose selection in the treatment of MAC lung disease. Methods. In this double-blind, placebo-controlled trial, EBO or placebo tablets were administered (n=8/cohort, 3:1 randomization) at dosages of 250-1000 mg q24h or 500 mg or 1000 mg q48h for up to 28 days. Standard Ph1 clinical and laboratory evaluations and treatment-emergent adverse events (TEAEs) were assessed. Based on prior human studies using significantly higher EBO daily doses, gastrointestinal (GI) events and anemia were predetermined AEs of special interest (AESIs). Plasma concentrations of EBO were measured by validated LC-MS/MS methods. Plasma PK parameters were determined using non-compartmental methods. Results. A total of 43 subjects were enrolled;the 1000 mg q24h cohort was terminated early due to local COVID restrictions. Overall, 80.6% EBO subjects and 83.3% placebo subjects experienced >=1 TEAE, none of which was serious or severe (Table). Most TEAEs were mild in severity (90%), and the remainder were moderate (10%). No TEAE leading to withdrawal from study was reported. The most frequent types of TEAEs were GI events (48.4% EBO, 41.7% placebo subjects), the most common being mild nausea. Two subjects had premature discontinuation of EBO due to a TEAE (asymptomatic liver enzyme elevations in a 250 mg q24h subject and mild nausea in a 1000 mg q48h subject). One 1000mg q24h subject had a TEAE of anemia. No clinically significant findings or TEAEs were observed for physical examinations, ECGs, or urine laboratory tests. Plasma Cmax and AUC0- of EBO increased in a linear, dose-proportional manner across cohorts. Tmax was observed at ~1 h post dose;mean t1/2 ranged from 7.63 to 11.1 h. Conclusion. * Oral EBO administered for 28-day dosing was generally well tolerated at the predicted therapeutic dose (500mg q24h) * Predictable PK characteristics facilitate its use in MAC lung disease * Further evaluation in a Phase 2/3 treatment-refractory MAC lung disease study is planned.

16.
European Heart Journal, Supplement ; 24(Supplement K):K139, 2022.
Article in English | EMBASE | ID: covidwho-2188669

ABSTRACT

Background: There is still much controversy concerning the impact of gender on mortality during ST-segment elevation myocardial infarction (STEMI). The COVID-19 pandemic deeply affected the clinical history of these patients, both in terms of presentation time and management. The aim of our study was to evaluate the impact of female gender on acute and mid-term mortality in STEMI patients hospitalized during the pandemic period. Material(s) and Method(s): Our study focuses on STEMI patients hospitalized during the darkest period of the pandemic.We retrospectively analyzed consecutive STEMI patients hospitalized from 15 March 2020 to 15 March 2021 in our Hub centre in Milan, Lombardy. All clinical, demographic, and procedural characteristics were collected in a dedicated database. Patient follow-up was carried out through clinical visits, telephone calls and remote monitoring through the "Lombardia Regional Registry". Result(s): From a total of 283 patients, women represented 26.8% of the population, with a mean age of 72 - 11.2 years vs. 64.7 - 12.6 years in men. Anterior STEMI was the most represented with a mildly reduced ejection fraction (EF 48.3 - 11.8%) similar between genders. Coronary angiography showed more extensive disease in man, while women presented with a higher Killip class at admission and a more pronounced anemic status. In-hospital and 1-year mortality of the whole cohort were 11.4% and 7.5%, respectively, with no significant differences between genders (14.5% women vs. 10.6% men, p = ns;9.2% women vs. 7% man, p = ns). EF resulted in being the only independent predictor of mortality in the short-term and at 1-year follow up in both genders. In the acute phase, the only other independent predictor of mortality was COVID-19 infection, secondary to the higher rate of respiratory omplications, without any difference in terms of major adverse cardiac events. The impact of COVID-19 infection on mortality was completely lost at 1-year follow up. Conclusion(s): Our study has shown that female gender in STEMI patients does not represent an independent predictor of mortality both in the short- and in the midterm follow up. Concomitant COVID-19 infection significantly influenced in-hospital mortality due to the higher rate of respiratory complications in both genders. The impact of COVID-19 on mortality was completely lost at follow-up, where age and a reduced EF remained the only independent predictors, regardless of gender.

17.
Acta Clinica Belgica ; 77(Supplement 2):50, 2022.
Article in English | EMBASE | ID: covidwho-2187672

ABSTRACT

Background: Cushing syndrome associated with neuro-endocrine carcinoma of prostate is a rare and difficult diagnosis cause of paraneoplastic syndrome. This is partly due to the rarity of neuroendocrine prostate cancer (less than 1% of prostate cancers) and that the extra-pulmonary location of neuroendocrine tumours is less known. This can lead to a delay in diagnosis. Case presentation: A 58-year-old man was admitted for sudden muscle weakness in the context of an infection with Sars-cov2. The systematic history did not highlight any other complaint. His physical examination revealed swollen legs with godet sign and symmetrical proximal strength deficit. The rest of the clinical examination was unremarkable. The patient is known for a total radical prostatectomy in the context of a neuro-endocrine carcinoma with small cells of the prostate with multiple metastasis. His chronic treatment consisted of alizapride, metoclopramide and lormetazepam. Initial blood testing revealed an anemia with lymphopenia and eosinopenia, hypokaliemia (2.3 mmol/l), hypo-proteinemia, high level of LDH. CRP and creatinine were within standards. In the light of his muscle weakness, severe hypokaliemia refractory to IV KCl high dose and oncological history, a cushing syndrome was suspected. Which was confirmed with cortisoluria (31,272.1 nmol/24 h) and a high level of serum ACTH (582 pg/ml). An ACTH adenoma was reasonably excluded by a pituitary-MRI. With all of these elements, we conclude at a paraneoplasic cushing syndrome arising of a recidivism of his prostatic neuro-endocrine carcinoma. Discussion(s): In a neoplasic contexte with none pituitary adenoma, the ACTH-dependent cushing syndrome is due to an ectopic secretion of ACTH (rarely CRH) in a context of paraneoplasic syndrome. Patients with suggestive signs or symptoms should alert us as complications of cushing syndrome are fatal by an increased cardiovascular risk, a prothrombophilic state, suicidal ideation and immunosupression. In our patient's case, the clinic was poor because of the rapidity with which the pathology sets in, and the blood test was the most evocative. It can also be the point of call for the fortuitous discovery of a neoplasia of the neuro-endocrine or carcinoid type. We rely on cortisoluria or the short dexamethasone test and the ACTH to suspect the diagnosis. If there is any doubt about the neoplastic origin or in the absence of a history, an octreotide scan can be performed to locate the ectopic secretion of ACTH. Cancer treatment remains the main therapy. With regard to the actual treatment of the cushing syndrome, there is debate. We can inhibit steroid production (ketoconazole, metyrapone, etomidate, ...) or make bilateral adrenalectomy (surgery, mitotane). Conclusion(s): The paraneoplastic cushing syndrome may be difficult in early state with just some aspecific abnomalies at the blood testing. In our case, the patient initially had only hypokalemia associated with proximal muscle weakness. We must keep in mind that Cushing's syndrome is a fatal disease. Increased cardiovascular risk, hypertension and prothrombotic state are the major causes of death associated with cushing syndrome. Hypoproteinemia leading to a decrease in immune defences leads to severe infections and even septic shock.

18.
Pediatric Hematology Oncology Journal ; 2023.
Article in English | ScienceDirect | ID: covidwho-2182286

ABSTRACT

Background Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is the cause of COVID-19 but almost 50% of infected people with the virus are asymptomatic (Sakurai et al., 2020 Aug 27) [1]. After the introduction of the COVID-19 vaccine, as per early reports from observational studies, there is a significant reduction in symptomatic infection among vaccinated individuals (Thompson et al., 2021 Apr 2) [2]. The possibility of viral transmission through blood products is unconfirmed yet (Sakurai et al., 2020 Aug 27) [1]. Case report We report a successful stem cell transplant case in a patient with Sickle cell anemia from an asymptomatic COVID-19-positive donor who underwent stem cell collection under general anesthesia. No complications were encountered during and after the procedure. The marrow was infused safely with good immune reconstitution in the recipient. Conclusion This report revealed that an asymptomatic PCR-positive person might be an acceptable HSCT donor due to existing milder variants of COVID-19.

19.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63(Supplement 2):S167-S168, 2022.
Article in English | EMBASE | ID: covidwho-2179921

ABSTRACT

Background: Scurvy is a rare deficiency of vitamin C characterized by hematologic, musculoskeletal, and neuropsychiatric symptoms [1-2]. Children with autism spectrum disorder (ASD) are particularly vulnerable to this nutritional deficiency due to selective eating [2]. While there are reports of scurvy in patients with ASD, these are limited to a pediatrics population [3]. We present the case of an adult patient with presumptive diagnosis of ASD who presented with severe symptoms of scurvy secondary to highly restrictive eating habits that were exacerbated during the coronavirus disease 2019 (COVID-19) pandemic. Case Presentation: Patient is a 26-year-old male with unspecified depressive disorder and attention-deficit/hyperactivity disorder (ADHD) admitted with lower extremity weakness, perifollicular petechiae, and anemia concerning for scurvy. Psychiatry was consulted to evaluate for a contributing psychiatric condition after he reported eating exclusively "pizza bagels" for the preceding eight months. There were no signs or symptoms of acute depression, psychosis, or mania and no prior history of psychosis, intellectual impairment, or substance use. However, he met DSM-5 criteria for avoidant-restrictive food intake disorder (ARFID), and there was high suspicion of ASD. His presentation was not consistent with other eating disorders such as anorexia nervosa. Low blood ascorbic acid level was confirmed, and vitamin C was repleted, resulting in significant symptomatic improvement. He was discharged to a skilled nursing facility with recommendations for outpatient neuropsychiatric follow up. Discussion(s): The adult psychiatric literature on scurvy is focused on patients with psychotic disorders, classic eating disorders, or substance use disorders - known risk factors for vitamin C deficiency [1,4]. There is minimal literature on scurvy in adults with ARFID. However, pediatric cases have described scurvy as an initial presentation of ASD co-occurring with ARFID [3], the suspected diagnoses in this patient. Social isolation during the COVID-19 pandemic likely exacerbated this patient's restrictive eating, making him more prone to severe malnutrition [2]. Conclusion(s): This report highlights the importance of keeping a broad differential that includes neurodevelopmental disorders when evaluating adults with avoidant or restrictive eating patterns. Though uncommon, scurvy may present in vulnerable populations such as those with psychiatric illness, particularly under the strains of the COVID-19 pandemic. References: 1. Wright AD, Stevens E, Ali M, Carroll DW, Brown TM. The neuropsychiatry of scurvy. Psychosomatics. 2014;55(2):179-185. 2. Seifer CM, Glaser A, Gesiotto Q, Waknin R, Oller KL. Petechiae, Purpura, and a Pandemic: A Recipe for Scurvy. Cureus. 2020;12(10):e10960. 3. Sharp WG, Berry RC, Burrell L, Scahill L, McElhanon BO. Scurvy as a Sequela of Avoidant-Restrictive Food Intake Disorder in Autism: A Systematic Review. J Dev Behav Pediatr. 2020;41(5):397-405. 4. Nousari Y, Wu BC, Tausk F. From the Caravels to the Wards: Scurvy and Schizophrenia. J Acad Consult Liaison Psychiatry. 2021;62(6):665-666. Copyright © 2022

20.
Hematology, Transfusion and Cell Therapy ; 44(Supplement 2):S672-S673, 2022.
Article in English | EMBASE | ID: covidwho-2179235

ABSTRACT

Introducao: Portadores oncohematologicos sao suscetiveis a infeccoes graves e potencialmente fatais devido a imunossupressao relacionada as doencas de base e seus tratamentos. Em Marco de 2020, a OMS declarou a COVID-19 uma pandemia e pouco se sabia do comportamento da infeccao nesses pacientes. Objetivos: Avaliar caracteristicas de pacientes adultos oncohematologicos hospitalizados por COVID-19;identificar variaveis na admissao preditoras de obito;e comparar os pacientes durante as duas primeiras ondas e a terceira onda da pandemia. Materiais e Metodos: Estudo observacional, retrospectivo, multicentrico, que incluiu pacientes acima de 18 anos com neoplasias hematologicas hospitalizados por COVID-19. Foram avaliadas variaveis demograficas, relacionadas a doenca de base e a infeccao, medicacoes, admissao em UTI e necessidade de ventilacao mecanica. Os grupos de sobreviventes e nao sobreviventes foram comparados utilizando o teste X2 ou o teste de Fisher para variaveis categoricas e o teste de Mann-Whitney para variaveis numericas. Variaveis com p-valor<0,1 foram consideradas para analise multivariada atraves de regressao logistica. Os grupos da 1/2 onda e 3 onda foram comparados utilizando os mesmos testes. A analise estatistica foi realizada no software R versao 3.6.3. Resultados: Foram avaliados 126 pacientes, com uma idade mediana de 57 anos. 66 pacientes (52%) eram do sexo masculino e os linfomas foram o grupo de doenca mais frequente (41%). 57 pacientes (45%) faleceram na internacao. Na analise bivariada, variaveis associadas a obito foram doenca de base ativa, OS >= 2, dispneia, anemia, trombocitopenia, PCR, D-Dimero e TGO elevados, baixa sO2 e vidro fosco na TC de Torax. Na analise multivariada, hemoglobina baixa, PCR-t elevada e dispneia mantiveram relacao com obito na internacao. Dos 126 pacientes, apenas 18 (14%) foram admitidos na 3 onda. A letalidade nesse grupo foi de 33% versus 47% no grupo da 1/2 onda (p = 0,4). As principais diferencas entre os grupos foram que 97% dos pacientes da 3 onda receberam ao menos 1 dose de vacina, tiveram menos dispneia (22% x 49%;p = 0,04), maior sO2 (mediana 98% x 94%;p = 0,02), DDimero mais baixo (mediana 714 x 1563;p = 0,03), foram menos anticoagulados (0 x 21%;p = 0,04) e tiveram menos admissoes em UTI (11% x 38%;p = 0.03) e necessidade de ventilacao mecanica (11% x 37%;p = 0,03). Discussao: Nesse estudo, quase metade (45%) dos pacientes oncohematologicos hospitalizados por COVID-19 faleceu durante a internacao, evidenciando alta letalidade dos quadros moderados ou graves da infeccao. As variaveis na admissao associadas a maior mortalidade foram a hemoglobina, PCR-t e a presenca de dispneia. Apesar da alta infectividade da variante Omicron, responsavel pela 3 onda da pandemia, apenas 18 pacientes internaram nesse periodo. Quase todos (97%) haviam recebido ao menos 1 dose de vacina. Esses pacientes apresentaram quadros menos graves e menos complicacoes, necessidade de suporte ventilatorio invasivo e admissao em CTI, apontando para um provavel efeito benefico da vacina em reduzir a gravidade da infeccao. A letalidade nesse grupo foi menor que na 1/2 onda, porem sem significancia estatistica. Conclusao: Pacientes oncohematologicos hospitalizados por COVID-19 apresentam alta letalidade relacionada a infeccao, mas a comparacao entre as 2 primeiras e a 3 onda aponta para um efeito benefico da vacina na reducao da necessidade de internacao e da gravidade da infeccao nos pacientes que internam. Copyright © 2022

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