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1.
Allergy, Asthma and Clinical Immunology ; 18(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1817263

ABSTRACT

Background: With increasing uptake of COVID-19 vaccines and media focus on adverse reactions, questions and anxiety surrounding vaccinations intensified. The potential relationship between patient anxiety and adverse reactions risks vaccine hesitancy and the possibility of increased COVID-19 infections. The need for allergy consultation for adverse reactions to COVID-19 vaccines is essential in ensuring completion of vaccination protocols, especially in patients identified as having adverse reactions from first vaccinations. Methods: Two patients with reactions to their first dose of the Pfizer- BioNTech COVID-19 vaccine were assessed for potential allergy. Symptoms included throat tightness, dyspnea, tingling, and dizziness immediately after vaccination. One of the patients required treatment with epinephrine with subsequent need for emergency room visit. A two-step approach was taken to assess these patients for a potential allergic cause and exclude anxiety-induced reactions. Patients were blinded and initially skin tested to saline, observed for 15 minutes, and then assessed prior to skin testing to polyethylene glycol (PEG) as a suspected IgE mediated allergic trigger in the Pfizer-BioNTech vaccine. Results: Both patients tested negative to saline. However, both experienced similar or worse symptoms as their initial reaction to Pfizer-BioNTech vaccination with dyspnea, pruritus, coughing, chest tightness, and dizziness during their allergy assessment. Notably, urticaria was absent. One of the patients then went on to receive skin testing to PEG and tested negative. Both patients later received their second vaccination without issue. Conclusions: Two patients experienced “allergic-type” reactions after their first COVID-19 vaccine, not felt to be IgE mediated. Testing to saline elicited similar allergic-type symptoms, likely due to anxiety presenting as pseudo allergic reactions. Benefits of allergy consult and blinded testing to saline facilitated completion of vaccination.

2.
Allergy, Asthma and Clinical Immunology ; 18(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1817262

ABSTRACT

Background: Individuals with myasthenia gravis (MG) are of particular importance with regards to COVID-19 vulnerability and vaccination precedence (1). However, evidence suggests COVID vaccines may contribute to exacerbations within these populations (2). It is important to consider pre existing conditions in MG patients who have expressed subsequent symptoms to COVID-19 vaccinations, even after negative allergic testing. Case Presentation: A 65 year old female with corticosteroid dependent MG was referred for allergy assessment to COVID vaccine components. The patient presented with lightheadedness, numbness/blisters in mouth, difficulty swallowing, chest pain, high pulse rate (96bpm), and low blood pressure (112/72) after receiving her first dose (D1) of the Pfizer vaccine. The patient tested negative to the main allergic components, polyethylene glycol (PEG) and polysorbate 80, but displayed symptoms of dizziness and respiratory distress after skin testing (ST). Physical examination was reassuringly normal, including vitals and respiratory examination. A vasovagal episode and anxiety was felt to be the cause of patients' reactions. The patient was encouraged to continue with her second vaccine dose (D2), and advised antihistamine usage the day before, day of, and day after for reassurance purposes. Further consultation with a neuromuscular specialist recommended corticosteroid augmentation 48 hours prior to one week post D2 to prevent MG exacerbation. The patient was advised to increase prednisone dosage (6mg to 8mg) two days prior to D2, and continue with 8mg for 1 week following. No adverse outcomes were reported following administration of D2. It was suspected the patient's D1 triggered her myasthenia, presenting with allergy-like symptoms. Conclusions: Negative allergic testing is insufficient to dismiss patients with preexisting MG. It is imperative to recognize underlying health conditions which may manifest adverse COVID-19 vaccine complications. In certain autoimmune conditions, such as MG, modest corticosteroid augmentation will prevent symptom presentation mimicking allergy from COVID vaccination.

3.
Allergy, Asthma and Clinical Immunology ; 18(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1817248

ABSTRACT

Background: Anaphylaxis is a systemic and life-threatening allergic reaction. Data are sparse regarding variations in anaphylaxis rates on a year-by-year basis. We aimed to assess changes in yearly rates of anaphylaxis in a pediatric Emergency Department (ED) in Montreal, Canada. Methods: Cases of anaphylaxis presenting to the Montreal Children's Hospital between April 2011 and May 2021 were recruited prospectively and retrospectively. Data were obtained via a standardized recruitment form. Descriptive analysis was used to assess the trend of anaphylaxis in relation to clinical triggers. Statistical significance was calculated using Pearson's chi-squared test. Results: Among 760,079 ED visits between April 2011 and May 2021, 2573 (34.95% of whom recruited prospectively) presented with anaphylaxis, The median age was 5.70 years (IQR: 2.20, 11.70), and 58.66% were males. The relative frequency of anaphylaxis cases with respect to ED visits doubled between 2011-2015, from 0.22 (95% CI, 0.19, 0.26) to 0.42% (95% CI, 0.38, 0.46). From 2015 to 2020 the rate was stable. Importantly, during the COVID-19 pandemic, beginning March 2020, the total absolute number of anaphylaxis and emergency cases declined, leading to a significant decrease in anaphylaxis cases by 24 cases per month(p < 0.05) and by 0.5% among ED visits (p < 0.05). Foods, (85.75%),drugs (2.81%) and venom (1.60%). Peanut (19.08%) and tree nuts (14.36%) were the major triggers of food-induced anaphylaxis. Most anaphylactic reactions were moderate (71.81%), defined as crampy abdominal pain, diarrhea, recurrent vomiting, hoarseness, “barky” cough, difficulty swallowing, dyspnea, moderate wheezing, and lightheadedness. Conclusions: The rate of anaphylaxis has plateaued over the last six years, representing increased awareness, modifications in food introduction strategies or lifestyle changes. The observed decrease in anaphylaxis during COVID-19 may reflect hesitancy in arrival for management in a hospital setting, given the similar decrease in ER visits.

4.
Clinical and Experimental Neuroimmunology ; 13(1):17-23, 2022.
Article in English | EMBASE | ID: covidwho-1816541

ABSTRACT

Neuromuscular manifestations of new coronavirus disease 2019 (COVID-19) infection are frequent, and include dizziness, headache, myopathy, and olfactory and gustatory disturbances. Patients with acute central nervous system disorders, such as delirium, impaired consciousness, stroke and convulsive seizures, have a high mortality rate. The encephalitis/encephalopathy that causes consciousness disturbance and seizures can be classified into three conditions, including direct infection with the SARS-CoV-2 virus, encephalopathy caused by central nervous system damage secondary to systemic hypercytokinemia (cytokine storm) and autoimmune-mediated encephalitis that occurs after infection. The sequelae, called post-acute COVID-19 syndrome or long COVID, include neuromuscular manifestations, such as anxiety, depression, sleep disturbance, muscle weakness, brain fog and cognitive impairment. It is desirable to establish diagnostic criteria and treatment for these symptoms. Vaccine-induced thrombotic thrombocytopenia, Guillain–Barré syndrome, bilateral facial paralysis, encephalitis and opsoclonus-myoclonus syndrome have been reported as adverse reactions after the COVID-19 vaccine, although these are rare.

5.
Oxford Medical Case Reports ; 2022(3):79-82, 2022.
Article in English | EMBASE | ID: covidwho-1816225

ABSTRACT

There is growing evidence that patients with severe systemic illness from coronavirus disease 2019 (COVID-19) are at risk for developing a variety of cardiac arrhythmias. Less is known about patients with milder symptoms. Here, we report on the case of a 62-year-old male, admitted to the hospital following an episode of syncope, who experienced multiple episodes of cardiac arrest due to asystole lasting up to 30 seconds. History revealed a recent asymptomatic COVID-19 infection, and recurrent episodes of prolonged asystole necessitated permanent pacemaker placement. To our knowledge, this is the first report of an asymptomatic COVID-19 patient experiencing prolonged asystole. Cardiac arrhythmias in asymptomatic or oligosymptomatic COVID-19 patients may be underestimated.

6.
Indian Journal of Otolaryngology and Head & Neck Surgery ; : 10, 2022.
Article in English | Web of Science | ID: covidwho-1800306

ABSTRACT

This study aimed to evaluate the various neuro-otological symptoms experienced by patients with COVID-19 disease. This is a retrospective study conducted from September 2020 to August 2021. Patients with positive RTPCR tests for COVID-19, aged between 18 and 60 years were included in the study. The patients were assessed for neuro-otological symptoms, the type, frequency, and character of these symptoms, their relation with age, gender and COVID-19 disease. Of the 286 patients, 64 (22.3%) had neuro-otological symptoms. The mean age of the patients was 36.3 +/- 8.1 years. The frequency of neuro-otological symptoms was higher in females than males and was more frequent in the age group of 18-30 years as compared with other age groups. Of these 64 patients, 29 had vertigo (10.1%), 21 (7.3%) tinnitus, 16 (5.5%) experienced hearing loss. Like many viral diseases, apart from its typical prodromal symptoms, COVID-19 can also cause symptoms like tinnitus, hearing loss, and vertigo.

7.
Respiratory Medicine Case Reports ; 37, 2022.
Article in English | EMBASE | ID: covidwho-1799736

ABSTRACT

There are no prospective studies or guidelines describing transition between selexipag and oral treprostinil. We present two different transition strategies from selexipag to oral treprostinil, one started inpatient and then completed at home, and one completely under outpatient settings. Neither patient experienced worsening prostacyclin-type adverse effects;both were rigorous in their attention to a 7–8 hour administration schedule for oral treprostinil, and both experienced objective clinical benefit at follow-up. Prospective studies are needed to help guide clinical decisions when patients remain intermediate risk after a trial of either drug.

8.
International Journal of Pharmaceutical and Clinical Research ; 14(2):249-256, 2022.
Article in English | EMBASE | ID: covidwho-1777158

ABSTRACT

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-also known as 2019 novel coronavirus or COVID-19-first emerged on December 31, 2019 in China, and has since rapidly spread to become a world-wide pandemic. Orthopaedic trauma services, have maintained a significant portion of their previous volume throughout the pandemic, specifically, hip fractures in the elderly population.Intertrochanteric fracture is one of the most common injuries among the elderly and is associated with a high mortality rate within 30 days after the injury event.Treatment of Intertrochanteric fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19infected patients and the maintenance of standards of care. PFNA2 provide stability, compression as well as rotational control of the fracture and allows early post operative mobilization, weight bearing and thereby early fracture union. This study aims to assess the functional outcome of intertrochanteric fracture treated by PFNA2 in COVID-19-positive patients. Objectives: To evaluate the functional outcome of intertrochanteric fracture treated by PFNA2 in COVID-19-positive patients: a retrospective study Methodology: This was a retrospective study of 30 patients,18 females and 12 males ≥55 years of age with intertrochanteric fracture and COVID-19 who underwent operative management with PFNA2. Clinical characteristics and early postoperative outcomes were reported. Results: A total of 30 patients, 21 patients (70%) had fever, cough, and fatigue at the time of presentation. 9 patients (30%) had sore throat and dyspnea, headache and dizziness (23%) (7 patients), abdominal pain and vomiting (16%) (5 patient), chest pain and nasal congestion (10%) (3 patient).18 patients (60%) had comorbidities. Postoperatively all 30 patients (100%) required non-invasive mechanical ventilation. All patients (100%) were given antibiotic therapy,18 patients underwent anti thromboembolic prophylaxis. 20 patients were treated with corticosteroids. Blood transfusion was done in 14 patients. Average HARRIS HIP SCORE was 83.6 at the end of six months graded as good outcome. The length of hospital stay in our study was 10 days (7-14 days). The complications in our study included bed sores, superficial and (which settled subsequently with Intravenous antibiotics and debridement respectively). Conclusions: Our study shows that intertrochanteric fracture patients who present with a mild to moderate COVID-19 symptoms who underwent Intertrochanteric fracture surgeries with PFNA2 had a good functional outcome with few post op complications.

9.
World Journal of Otorhinolaryngology - Head and Neck Surgery ; n/a(n/a), 2022.
Article in English | Wiley | ID: covidwho-1772856

ABSTRACT

Background Otologic and vestibular symptoms have been seen in patients confirmed to have COVID-19 disease. Further discussion of these symptoms may provide insight into short- and long-term management for these patients. Objective The aim of this review was to describe the otologic and vestibular symptoms that present in patients with COVID-19. The primary outcomes of this review were onset, duration and clinical outcomes of these symptoms. Sources of Evidence Pub Med, APAMed Central, Herdin, CINAHL, Scopus, Springer Link, ProQuest Coronavirus Research Database, and Google Scholar were searched for the articles to be included. Eligibility Criteria Studies included were those involving adult patients diagnosed with COVID-19 who experienced hearing loss, ear pain, ear discharge, otitis media, vertigo, or tinnitus. Studies were eligible for inclusion if there was a description of the otologic dysfunction, specifically onset, duration, or clinical outcomes. Results The majority of patients who experienced hearing loss (68%), tinnitus (88%), vertigo/dizziness (30%), ear pain (8%), and discharge (100%) did so within a month of experiencing the typical symptoms of COVID-19. A majority also experienced complete resolution of their symptoms within 2 weeks. Standard treatment for COVID-19 was usually provided but when specific diagnoses are made for these symptoms (e.g., sudden sensorineural hearing loss, otitis media, vestibular neuritis), they are treated in the same manner as one would for non-COVID-19 cases, in addition to the management for COVID-19. In certain cases, there may be a need for additional work-up to rule out other causes. Conclusions Otologic and vestibular symptoms were present in COVID-19 patients, majority as part of the systemic nature of the disease. The onset, duration, and course were consistent with the natural history of a systemic viral infection. COVID-19 should be considered in any patient with a new-onset hearing loss, tinnitus, or vertigo/dizziness, even in the absence of infectious or respiratory symptoms.

10.
Endocrine Practice ; 27(12 SUPPL):S34, 2021.
Article in English | EMBASE | ID: covidwho-1768067

ABSTRACT

Background: Subacute thyroiditis is being frequently seen after Covid infection as the cases of many other viral infections. Patients classically complain of symptoms of thyrotoxicosis mainly palpitations and sweating but with associated tenderness in neck with or without fever. Subacute thyroiditis has seldom been seen after viral vaccinations. We present a case series of subacute thyroiditis which presented after administration of the COVID-19 vaccine. Material(s) and Method(s): Case 1: A 28-year-old female without previous medical problems, presented to the clinic for sore throat, palpitations and dizziness . No recent history of any upper respiratory tract infection or pregnancy. The patient received her second dose of Pfizer/BioNTech mRNA vaccine for COVID-19 2 weeks earlier. Thyroid function testing was done and revealed TSH 0.001, fT4 3.29, fT3 6.8. Her TPO antibody, thyroglobulin antibodies and Trab were negative. Technetium-99m pertechnetate scan revealed diffuse thyroiditis. The patient was prescribed prednisone 20 mg daily. She reports rapid improvement of her symptoms and prednisone treatment was given for 3 weeks then stopped. Repeated tests showed normal TSH 10 days after stopping steroids. Case 2: A 49-year-old female with the history of V Leiden mutation and repetitive abortions presented to the clinics on May 25, 2021 for the complaint of unintentional weight loss of 6 kg in 20 days and palpitations, preceded by fever and neck pain at the end of April. The patient noted that she was vaccinated with her second dose of Sinopharm vaccine on the 6th of April 2021. Thyroid function test revealed a thyrotoxic profile TSH 0.005, fT4: 42, fT3 9,02. With negative thyroglobulin antibody, TRAb. CRP 60 , . Thyroid Ultrasound showed a diffuse heterogenous echtexture of the thyroid. A fever work up was done to rule out other infectious causes including Salmonella and Brucella, all were negative. The patient was prescribed prednisone 40 mg daily and propranolol 10 three times daily, gradually tapered over one months. Her Symptoms resolved and her follow up tests showed normal tsh and CRP Result(s): Discussion: Subacute thyroiditis is usually associated with upper respiratory tract infections including Covid -19 infection. This can be explained by T cells cross reacting between the virus and the thyroid cells. Moreover, De Quervain thyroiditis following viral vaccines has been reported influenza vaccines. Thyroiditis has not been described until now as a frequent side effect of Covid vaccine. So we presented the cases of a 28 and 49- year-old females who has presented with cases of subacute thyroiditis after receiving respectively the Pfizer mRNA vaccine and Sinopharm vaccine for COVID-19. Conclusion(s): Conclusion: Subacute thyroiditis after Covid-19 vaccine is rare but may be underreported. Further investigations are required to evaluate predisposing factors to De Quervain thyroiditis following Covid-19 vaccine.

11.
Leukemia and Lymphoma ; 62(SUPPL 1):S117-S118, 2021.
Article in English | EMBASE | ID: covidwho-1747039

ABSTRACT

Introduction: Bruton tyrosine kinase inhibitor (BTKi) therapy is remarkably effective in a number of B-cell malignancies;however, its continuous use is limited by adverse events (AE) leading to discontinuation. Zanubrutinib is a potent and selective BTKi with the potential to be a safe and effective therapy after intolerance to previous BTKi therapy. Here, we report preliminary results of a phase 2 study of zanubrutinib in patients with B-cell malignancies intolerant to ibrutinib and/or acalabrutinib based on a median follow-up of 6 months. Methods: Patients meeting protocol criteria for intolerance to ibrutinib, acalabrutinib, or both (without documented progressive disease on ibrutinib or acalabrutinib) were given zanubrutinib monotherapy (160mg twice daily or 320mg once daily at investigator's discretion). Recurrence of adverse events that led to intolerance to prior BTKi and additional safety measures were assessed based on the Common Terminology Criteria for AEs v5.0. Investigators determined responses using disease status at study entry as baseline and standard established disease response criteria. Results: As of 1 March 2021 (cutoff), 64 patients (n=48 chronic lymphocytic leukemia/small lymphocytic lymphoma, n=10 Waldenström macroglobulinemia, n=3 mantle cell lymphoma, n=3 marginal zone lymphoma) were enrolled, received ≥1 dose of zanubrutinib, and were analyzed for safety. The median age was 71 y (range, 49-91);the median duration of treatment was 5.9 months (range, 0.6-16.6). The median number of prior regimens was 2 (range, 1-12). Regarding prior BTKi, 55 patients had received ibrutinib monotherapy, eight had received ibrutinib combination therapy, and seven had received acalabrutinib monotherapy. The median number of ibrutinib- or acalabrutinib-intolerant adverse events per patient was 2 (range, 1-5). Most ibrutinib- (75%) and acalabrutinib-intolerant events (75%) did not recur with zanubrutinib (Table 1). A majority (90%) of the recurrent ibrutinib-intolerant events were less severe with zanubrutinib than with ibrutinib. Ibrutinib intolerance events present in >1 patient that did not recur on zanubrutinib were alanine aminotransferase increased, aspartate transaminase increased, neutropenia, and pain in extremity. The ibrutinib-intolerant events that recurred were diarrhea, dizziness, insomnia, nausea, constipation, myalgia, stomatitis, arthralgia, headache, muscle spasm, rash, atrial fibrillation, fatigue, hemorrhage, and hypertension. One-third of the recurrent acalabrutinibintolerant events were less severe with zanubrutinib than with acalabrutinib. The acalabrutinib-intolerant events that recurred were myalgia and arthralgia. Two events of arthralgia that induced acalabrutinib intolerance did not recur with zanubrutinib. No ibrutinib- or acalabrutinib-intolerant events recurred at a higher severity while patients were on zanubrutinib. At cutoff, 57 patients remained on treatment;one withdrew consent due to zanubrutinib-unrelated grade 3 syncope. Grade ≥3 adverse events were reported in 14 patients (21.9%), serious adverse events in five patients (7.8%;pain in jaw;COVID-19 pneumonia;anemia;febrile neutropenia and salmonella infection [occurred in the same patient]), adverse events requiring dose interruptions in 15 patients (23.4%), and adverse events leading to dose reduction in three patients (4.7%). Adverse events led to zanubrutinib discontinuation for three patients (4.7%). One death was reported (COVID-19 pneumonia). Among efficacy evaluable patients (n=48), the disease control rate was 89.6% and the overall response rate was 50.0%. Conclusions: In patients with B-cell malignancies intolerant to ibrutinib and/or acalabrutinib, zanubrutinib therapy was effective and controlled patient's disease or induced responses to therapy, and was well-tolerated;most adverse events that led to discontinuation of previous BTKi therapy did not recur while patients were on zanubrutinib.

12.
Open Forum Infectious Diseases ; 8(SUPPL 1):S394-S395, 2021.
Article in English | EMBASE | ID: covidwho-1746413

ABSTRACT

Background. On 14 December 2020, the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine was granted emergency use authorization in Singapore. Healthcare workers (HCW) were prioritized to receive the vaccine. We aim to investigate the side effects and risk factors for allergic reactions in our institution. Methods. All HCW vaccinations were recorded in an electronic centralized database. All reactions occurring within a 30-minute observation period post vaccination were recorded. Staff were required to report any vaccine-related medical consult including hospitalization occurring within 14 days after vaccination. Moderate/severe reactions were assessed by a medical team and determined if the reactions were probable allergic reactions with consultation with an Allergist. We extracted data from 8 Jan 2021 to 30 April 2021. Results. 5030 and 159 HCW completed 2 doses and 1 dose of the vaccine respectively. There were 1056 HCWs (20.3%) with self-reported pre-existing allergy. There were 114 (1.1%) reactions occurring without the 30-minute observation period, and 64 (56.1%) were related to first dose of vaccine. The most common side effect experienced was aches or pain on any part of the body (n=46, 40.4%) followed by fatigue and/or giddiness (n=45, 39.5%), palpitations and/or shortness of breath (n=22, 19.3%), systemic rash and/or angioedema (n=12, 10.5%) and nausea and/or vomiting (n=12, 10.5%). A total of 23 HCWs complained of systemic rash and/or angioedema that occurred anytime post vaccination. Fifteen HCWs (0.29% of the cohort) were considered to have probable allergic reaction to the vaccine. None of the reactions were classified as anaphylaxis or severe reactions, but 4 HCWs required short hospitalization stay for observation. HCWs with pre-existing allergy had 2.6 times the risk of having probable vaccine-related allergic reaction than HCWs without pre-existing allergy (RR 2.6, 95% CI 0.9 to 7.3, p=0.068) but this was not statistically significant. Conclusion. No anaphylaxis or severe reactions were observed in our institution. Acute side effects in our cohort were in line with published trial reports. We noted a raised relative risk of 2.6 of pre-existing allergy with probable vaccine-related allergic reaction but this was not statistically significant.

13.
Open Forum Infectious Diseases ; 8(SUPPL 1):S341, 2021.
Article in English | EMBASE | ID: covidwho-1744151

ABSTRACT

Background. Multi-system inflammatory syndrome in children (MIS-C) can present like Kawasaki disease (KD). After Centers for Disease Control and Prevention guidance was issued in May 2020, we implemented local management strategies emphasizing limited laboratory work up of non-toxic children with suspected MIS-C or KD. We then re-evaluated our management recommendations to ensure appropriate resource utilization for children with MIS-C and KD. Methods. We identified MIS-C and KD cases via convenience sampling of Pediatric Infectious Diseases records at Inova Fairfax Medical Center from May 1, 2020 to February 28, 2021. Manual chart review extracted clinical points of interest and descriptive statistics compared cohorts. Oral changes included edema, erythema, cracking, or strawberry tongue. Abdominal symptoms included pain, emesis, and diarrhea. Respiratory symptoms included shortness of breath, tachypnea, cough, and need for mechanical ventilation. Musculoskeletal symptoms included pain and edema. Neurological symptoms included headache, dizziness, altered mental status, and irritability. Results. We identified 8 KD cases and 29 concurrent MIS-C cases. MIS-C cases tended to be older and have presenting abdominal symptoms (median age 8 years old versus 2 years old, p < 0.01) and hypotension (20 versus 0, p < 0.01), otherwise there was no difference in the frequency of oral changes, rash, conjunctivitis, musculoskeletal symptoms, or neurological symptoms. 7 KD cases and 8 MIS-C cases did not require intensive care. Patients with MIS-C who did not need intensive care still had a lower initial absolute lymphocyte count (ALC) (median 1275/μL, p < 0.01), lower initial platelet count (median 217/μL, p = 0.05), and higher initial C-reactive protein (CRP) (median 18.3 mg/dL, p = 0.06) compared to KD cases;other results were not different between the two cohorts. Conclusion. We observed differences in the initial ALC, platelet count, and CRP between KD and MIS-C cases not requiring intensive care, whereas other labs such as ferritin, troponin, B-natriuretic peptide, and initial echocardiograms did not significantly differ between the two cohorts. Thus, our diagnostic management recommending limited laboratory evaluation for non-toxic patients with suspected KD or MIS-C is reasonable.

14.
Blood ; 138:2416, 2021.
Article in English | EMBASE | ID: covidwho-1736285

ABSTRACT

Background: First-line conventional chemoimmunotherapy in MCL can be improved. Promising results have been seen with Bruton tyrosine kinase inhibitors (BTKis) in combination with venetoclax (V) and an anti-CD20 monoclonal antibody in patients (pts) with relapsed/refractory or TN MCL. Acalabrutinib (A) is a next-generation, highly selective, covalent BTKi currently approved for relapsed/refractory MCL. We report initial safety and efficacy results of the ongoing, multicenter, open-label phase 1b study of A, V, and rituximab (R) (AVR) in TN MCL. Methods: TN MCL pts aged ≥18 y with ECOG PS ≤2 were eligible. Starting on cycle 1 day 1, A was administered at 100 mg BID until disease progression or discontinuation for other reasons. R was administered at 375 mg/m 2 on day 1 of each 28-day cycle for 6 cycles, followed by maintenance every other cycle for pts achieving complete response (CR) or partial response (PR), through cycle 24. Starting on cycle 2 day 1, V was administered via an initial 5-wk ramp-up schedule (20, 50, 100, 200, and 400 mg/d) to 400 mg/d, through cycle 25. Dose-limiting toxicity (DLT) was assessed from cycle 2 day 1 to cycle 3 day 28. Primary endpoint was AVR safety. Secondary endpoints were overall response rate (ORR), duration of response (DOR), and progression-free survival (PFS) per Lugano criteria. Positron-emission tomography (PET)/computed tomography (CT) scans were performed after 3 and 6 cycles and to confirm CR at any time. CT scans were performed after 3, 6, 9, and 12 cycles, and then every 6 cycles. Longitudinal minimal residual disease (MRD) was assessed using the clonoSEQ assay in peripheral blood at PR, CR, every 6 cycles post-CR, and treatment end. Results: 21 pts were enrolled (median age 66 y [range 51-85];ECOG PS ≤1 20 [95%];Ann Arbor stage IV disease 19 [90%];bulky disease >5 cm 7 [33%];intermediate- and high-risk simplified MCL International Prognostic Index scores 11 [52%] and 4 [19%], respectively;blastoid variant 1 [5%];and Ki-67 proliferation index ≥50% 3 [14%]). Fifteen (71%) pts had bone marrow (BM) involvement at baseline. As of March 19, 2021, median time on study was 16 mo (range 8-26.2). Median (range) number of cycles administered was 15 (7-27) for A, 13.5 (5-23) for 400 mg daily V, and 12 (6-15) for R. Seventeen (81%) pts remain on study treatment and 4 (19%) have discontinued (progressive disease: n=1;COVID-19 infection: n=3). No DLTs were observed;V 400 mg daily after ramp-up was the dose chosen for triple therapy. Most common any-grade AEs in ≥20% of pts were diarrhea (13 [62%]), headache (11 [52%]), fatigue (10 [48%]), neutropenia (6 [29%]), paresthesia (6 [29%]), cough (6 [29%]), dyspnea (6 [29%]), myalgia (5 [24%]), dizziness (5 [24%]), and hypoesthesia (5 [24%]). Grade 3/4 AEs in ≥2 pts were neutropenia (5 [24%]) and pneumonia (2 [10%]). Serious any-grade AEs in ≥2 pts were COVID-19 infection (4 [19%]) and pneumonia (2 [10%]). In the 4 pts with COVID-19 infection, the events led to triple-drug discontinuation and death in 3 pts and to dose holds of A and V and event resolution in 1 pt (all considered unrelated to study treatment). Diarrhea led to V dose reduction in 1 pt. AEs led to dose holds in 12 (57%) pts and were associated with A, V, and R in 52%, 48%, and 14%, respectively. Events of clinical interest are shown in Table 1. At the end of cycle 6, ORR was 100%, with CR/PR in 90%/10% by PET/CT alone (11 of the 13 CRs by PET/CT lacked BM confirmation);the CR/PR rate by Lugano criteria with BM confirmation was 38%/62% (Table 2). Median DOR was 19 mo (95% CI 17-not estimable [NE]) overall, and not reached when the 3 pts with COVID-19 deaths were censored. Median PFS and OS were not reached. The 1-y PFS and OS rates were 89% (95% CI 62-97) and 95% (95% CI 71-99), respectively. Treating the 3 COVID-19 deaths as censored, the 1-y PFS rate was 93.8% (95% CI 63.2-99.1). Median time to initial response and best response was 2.8 mo. Twelve of 16 (75%) pts with available MRD results at cycle 6 achieved MRD negativity (10 -6), including 6 pts with

15.
Turk Noroloji Dergisi ; 27:56-57, 2021.
Article in English | Scopus | ID: covidwho-1715954
16.
Current Medical Issues ; 20(1):32-36, 2022.
Article in English | EMBASE | ID: covidwho-1707979

ABSTRACT

Background: Vaccination against COVID-19 among people living with HIV (PLWH) infection is crucial. At present, evidence lacks to strategize vaccinating the hesitant PLWH. This study has estimated the proportion of PLWH vaccinated till October 2021, enumerated the various adverse events following vaccination, and identified the enabling and constraining factors associated with vaccination. Methods: A cross-sectional survey was conducted among PLWH by the snowball sampling in the Chittoor district of Andhra Pradesh, India. Data were analyzed using the descriptive statistics and qualitative analyses. Results: Two-hundred and forty-seven PLWH responded, out of which 52 (20.7%) were yet to be vaccinated. Seventy-five (30%) participants reported having adverse events, out of which five (7%) had pain at the injection site, and 72 (96%) had systemic reactions. Fever (n = 51, 68%), dizziness (n = 23, 31%), and joint pain (n = 23, 31%) were the major systemic reactions. Among the vaccinated, motivation by the health-care workers and village volunteers were the major enabling factors. On the contrary, uncertainty about the vaccine effects, negative feedback from the health-care workers, and lack of self-motivation were the important constraining factors in taking the vaccines. Conclusion: Some PLWH are still hesitant to take the vaccine. Evidence generation, coupled with community mobilization, is required to upthrust the vaccination campaign in achieving the herd immunity against COVID-19.

17.
Journal of Investigative Medicine ; 70(2):543-544, 2022.
Article in English | EMBASE | ID: covidwho-1707494

ABSTRACT

Case Report A 62-year-old male presented to our hospital with a few days of worsening dyspnea, associated with numbness in the left lower extremity, dizziness and transient brief chest pain that was described as a sharp intermittent pain. He denied any fever, chills, nausea, vomiting, diarrhea, headache, or recent ill contacts. The patient also denied any family history of blood or bone morrow disease. He had been released from incarceration 2 days prior to the presentation. Complete blood count revealed pancytopenia with hemoglobin of 6.8 g/dL, MCV of 112 fL, white blood cell count of 1.2 K/uL, and platelet count of 78 K/uL. The patient was transfused with packed red blood cells and then admitted to the inpatient medicine ward for further treatment and evaluation. Blood smear confirmed the pancytopenia with severe neutropenia, macrocytosis, and moderate thrombocytopenia. In addition, it showed erythrocytes with marked poikilocytosis including occasional schistocytes and teardrop cells. His lab investigations were notable for B12 level below 150 pg/mL (Normal range 211-911), fibrinogen of 144 mg/dL , haptoglobin less than 10 mg/dL, LDH of 1013 U/L. Other lab studies including troponin, ferritin, TIBC, serum iron, vitamin B1, PT/INR, PTT, SPEP, COVID-19, EBV, CMV, HIV, Hepatitis A, B, and C were all unrevealing. Abdominal ultrasound was significant for splenomegaly. CT head and chest xray were unremarkable. After starting treatment with cobalamin therapy, the patient has shown improvement in terms of cell counts, resolution of hemolysis. He also reported significant improvement in tingling and dizziness. All this confirms the diagnosis. Vitamin B12 deficiency manifestations can vary between asymptomatic, mild, and severe. In our case, the patient presented with pseudothrombotic microangiopathy and pancytopenia. Both are rare and serious manifestations of vitamin B12 deficiency. Physicians should be aware of cobalamin deficiency as one of the etiologies for pancytopenia and pseudothrombotic microangiopathy. Therefore, an early recognition and treatment is crucial. (Figure Presented).

18.
Kidney International Reports ; 7(2):S54, 2022.
Article in English | EMBASE | ID: covidwho-1705566

ABSTRACT

Introduction: Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a rare form of PGN that mimics immune-complex (IC) GN by light microscopy (LM), but shows monoclonal IgG deposits by immunofluorescence (IF). PGNMID often presents with membranoproliferative (MPGN) pattern or endocapillary hypercellularity. Focal crescents are not uncommon in PGNMID, but diffuse crescentic involvement is very rare. Methods: 78-year-old man with a history of hypertension and multiple cardiovascular comorbidities presented with weakness, dizziness, and anorexia, and was found to have severe hypertension and acute kidney injury with serum creatinine of 12 mg/dl (baseline 1 mg/dl). He was a chronic smoker and alcoholic. He reported productive cough with scanty whitish sputum, but denied hemoptysis. Urine analysis showed marked proteinuria, hematuria, and leukocyturia. Renal ultrasound revealed bilateral decrease corticomedullary differentiation without obstruction. Hemodialysis was initiated. Imaging showed bilateral upper lobe pneumonia with concerns for alveolar hemorrhages. Serology for complements, ANA, dsDNA, ANCA, Hepatitis B and C, Covid19 was negative. Kappa/lambda free light chain ratio was normal. SPEP, UPEP and immunofixation were negative for paraproteinemia. Renal biopsy showed diffuse crescentic and endocapillary PGN with MPGN features, and linear monoclonal IgG3-kappa immune deposits. Given the lack of clinical evidence of cryoglobulinemia and presence of immune-type electron dense deposits without organized substructures by EM, the findings were most consistent with PGNMID. However, the unusual biopsy presentation raised concerns for possible concurrent anti-GBM disease. Subsequently, Solu-Medrol was started followed by prednisone 1 mg/kg. He received 2 sessions of plasmapheresis before anti-GBM serology returned negative. Bone marrow biopsy revealed monoclonal B-cell lymphocytosis with CLL phenotype. Unfortunately, the patient developed Covid19 infection, and passed away before receiving further treatment. [Formula presented] Results: PGNMID is a rare form of renal involvement by monoclonal immunoglobulin deposition that mimics ICGN on renal biopsy. Nephrotic range proteinuria, hematuria and renal insufficiency are usual presentation. Cases of PGNMID classically show IgG3k, in a granular glomerular capillary wall, mesangial, and occasionally subepithelial distribution. By EM, these deposits appear granular typical of ICGN which lack organized substructure. The predominant LM patterns are MPGN and endocapillary hypercellularity. Less frequently focal crescents may be present, but diffuse crescentic involvement is especially rare (~5%). In our case, the diffuse cellular crescents and semilinear to linear GBM staining was unusual. Together with the clinical presentation, the findings prompted concerns for a concomitant Goodpasture syndrome, but anti-GBM antibody returned negative. The pathogenesis is still unclear, but some authors suggest infection as a possible trigger for crescentic transformation in PGNMID. The presence of crescents seem to confer a poorer prognosis and associated with progression to ESRD. Conclusions: Our case is a unique presentation of PGNMID in a patient who presented with clinical and pathologic features concerning for Goodpasture syndrome. PGNMID can rarely present with diffuse crescents and IF findings similar to anti-GBM nephritis in a patient with RPGN. No conflict of interest

19.
Journal of Investigative Medicine ; 70(2):603, 2022.
Article in English | EMBASE | ID: covidwho-1700739

ABSTRACT

Case Report A 17 year-old female with history of depression was transferred to the pediatric intensive care unit (PICU) from an emergency department (ED) for first time seizure and subsequent encephalopathy after five days of severe, diffuse abdominal pain and vomiting. The night prior to admission, she complained of lightheadedness and then had a witnessed generalized tonic-clonic seizure lasting 45 seconds. She initially returned to her baseline but then had three additional seizures requiring ED evaluation. She received intravenous doses of lorazepam and levetiracetam that aborted the clinical seizures. She remained encephalopathic and was orotracheally intubated for airway protection. Family denied known ingestions but reported she did vape nicotine. Urine drug screen was positive for benzodiazepines, consistent with seizure management. Cerebrospinal fluid analysis was unrevealing. Urinalysis showed moderate ketones and trace blood. Urine pregnancy test and nasopharyngeal SARS-CoV-2 polymerase chain reaction were negative. Head computerized tomography scan showed no intracranial pathology. On arrival to the PICU, the patient was afebrile, tachycardic, and hypertensive to 171/118 mmHg. She was somnolent on arrival but aroused to sternal rub without focal neurologic deficit. She presented with a Foley catheter that drained pinkorange urine. A nicardipine infusion was started given concern for the development of posterior reversible encephalopathy syndrome (PRES). Thyroid function tests were consistent with euthyroid sick syndrome. BioFire meningitis panel, plasma SARS-CoV-2 IgG, and toxicologic evaluation were all negative. Electrocardiogram showed sinus tachycardia. Magnetic resonance imaging of the brain revealed cortical and subcortical areas of diffusion restriction consistent with PRES. Ultimately, a random urine porphobilinogen and a 24-hour measurement of urine porphyrins collected on hospital day 1 were both markedly elevated. A diagnosis of Acute Intermittent Porphyria (AIP) was made. A gastrointestinal porphyria specialist was consulted and recommended monthly outpatient injections of givosiran upon hospital discharge. Discussion This case illustrates the importance of considering AIP in the differential diagnosis of new onset seizure or encephalopathy associated with hypertension, tachycardia, and abdominal pain in an adolescent. This case also adds to a small number of cases associating AIP with PRES. AIP is often viewed as an adult disease because it typically presents in the third or fourth decade of life. Timely recognition of AIP in the pediatric setting is critical to preventing delays in diagnosis, treatment, and patient education on triggers of acute attacks. AIP attacks are treated with dextrose and hemin infusions to reduce production of porphyrin precursors. Prophylactic treatment of AIP now includes givosiran, an interfering mRNA that reduces levels of intermediates in heme synthesis that are neurotoxic when elevated.

20.
Journal of Investigative Medicine ; 70(2):629, 2022.
Article in English | EMBASE | ID: covidwho-1700496

ABSTRACT

Case Report While the COVID-19 pandemic killing millions world-wide, definitive therapy is not yet available. However, vaccines were shown to effectively reduce COVID-19 related mortality. Side effects of COVID vaccination include thrombosis. Most of the vaccine-related thrombosis took place after the Oxford-AstraZeneca and Johnson & Johnson vaccines. Our case, however, developed thrombosis after receiving the Moderna mRNA vaccine. A 62 y/o female with hypertension and paroxysmal atrial fibrillation had retroperitoneal hematoma thought to be due to an aneurysm posterior to the pancreatic head and underwent embolization. Following this, she developed bilateral pulmonary embolism (PE) secondary to iliac vein thrombosis which was thought to be a direct result of compression from the hematoma. She was started on anticoagulation (rivaroxaban) at that time and monitored closely for possible bleeding. Unfortunately, she stopped rivaroxaban after one month due to financial reasons. A year later, the patient presented to the hospital with chest tightness for 3 days, one week after she took her 2nd dose of Moderna vaccine. 2 days later, she started having left-sided chest tightness and dizziness. She has no family history of clotting disorder, recent surgery, and has no known malignancy. On admission, she was hemodynamically stable with normal oxygen saturation in room air. Blood work showed normal platelet count and coagulation panel. CT angiogram of the chest showed PE in the right middle lobe segmental branch without right ventricular strain. She did not have troponin elevation or EKG changes. Apixaban was initiated through a financial assistance program on discharge. Although vaccine-related thrombosis remains at the top of the differential diagnosis for our patient, a history of prior thromboembolic event a year earlier and lack of adherence to anticoagulation may have enhanced this lady's resurgence of thrombosis. Having a high degree of suspicion following COVID vaccination is always important to make an early diagnosis and prevent serious consequences of thromboembolism. It is possible that the immune-modulatory effects of the mRNA vaccines can enhance the recurrence of thrombosis in persons with previous history of the condition.

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