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1.
Romanian Journal of Neurology/ Revista Romana de Neurologie ; 21(2):172-178, 2022.
Article in English | EMBASE | ID: covidwho-1957675

ABSTRACT

Objective. Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological symptoms. To compare the clinical features, imaging and treatments in patients with and without COVID 19. To compare the mortality and in-hospital stay among patients with and without COVID 19 and negative patients. Materials and methods. In this retrospective, single-center study, we included all the patients who attended the department of neurology with neurologic symptoms with confirmed COVID-19 and long COVID-19 from June 2020 to January 2021. Data on clinical signs, diagnosis, laboratory findings were collected and analyzed from the records for positive patients and compared with neurologic patients without COVID-19 admitted in the same period. Statistical analysis: The mean values between study groups were compared using an independent sample t-test and Mann Whitney u test. Categorical outcomes were compared using the Chi square test. Data was analyzed using coGuide soft-ware. Results. Headache was the common neurologic manifestation present in COVID positive patients compared to COVID negative patients (39.13%). There was no statistically significant difference between the two groups in baseline parame-ters. Laboratory parameters like CRP, Serum Ferritin, LDH, D-dimer, ESR, and IL-6 showed a significant increase in COVID positive patients (P <0.05). In-hospital mortality was more in COVID positive patients than COVID negative patients (P <0.011). Conclusion. The study showed varied neurologic symptoms in COVID patients, with headache as the common symptom. Hospital stay, morbidity, mortality, and inflammatory parameters were more in COVID positive patients compared to COVID negative patients.

2.
Indian Journal of Forensic Medicine and Toxicology ; 16(2):326-333, 2022.
Article in English | EMBASE | ID: covidwho-1957671

ABSTRACT

Coronavirus disease 2019 discovered in December 2019, Wuhan, China. It was transmitted globally producing the present COVID-19 pandemic. Concerns have been raised about the potential impact of COVID-19 on male reproductive organs and male fertility as the number of infections in the male community has increased. The objectives of current study are studying the relationship between the plasma levels of testosterone and the markers of immune reaction with the severity and mortality in a sample of COVID-19 patients. A cross section study included NO= 103 male patients affected by SARS-CoV-2 pneumonia, diagnosed by PCR and chest CT scan, (≥ 18 years old), and recovered in the respiratory intensive care unit (RICU). Several biochemical risk factors were determined Free Testosterone, sex hormone binding globulin (SHBG) were measured by Enzyme-Linked Immunosorbent Assay(ELISA), D-dimer, Ferritin, CRP, Urea, Creatinine were measured by automated method by using Abbott Architect c4000 and Complete Blood Count(CBC). The results show that the serum free testosterone and SHBG levels a significant lower in non-survivor patients than survivor patients with COVID-19. While the other biomarkers (D-dimer, Ferritin, Urea, Creatinine) were significant higher in non-survivor patients than survivor patients. The CRP, WBC and lymphocyte showed that no significant between the both group of patients. In conclusion the study showed that lower free testosterone and SHBG levels enable significant role in increasing risk of COVID-19 mortality amongst adult male patients.

3.
Indian Journal of Pharmaceutical Sciences ; 84(3):617-630, 2022.
Article in English | EMBASE | ID: covidwho-1957666

ABSTRACT

Drug repositioning may be a promising way to find potential therapies against coronavirus disease 2019. Although chloroquine and hydroxychloroquine showed controversial results against the coronavirus disease 2019 disease, the potential common and diverging mechanisms of action are not reported and need to be dissected for better understanding them. An integrated strategy was proposed to systematically decipher the common and diverging aspects of mechanism of chloroquine and hydroxychloroquine against coronavirus disease 2019-disease network based on network pharmacology and in silico molecular docking. Potential targets of the two drugs and coronavirus disease 2019 related genes were collected from online public databases. Target function enrichment analysis, tissue enrichment maps and molecular docking analysis were carried out to facilitate the systematic understanding of common and diverging mechanisms of the two drugs. Our results showed that 51 chloroquine targets and 47 hydroxychloroquine targets were associated with coronavirus disease 2019. The core targets include tumor necrosis factor, glyceraldehyde 3-phosphate dehydrogenase, lymphocyte-specific protein-tyrosine kinase, beta-2 microglobulin, nuclear receptor coactivator 1, peroxisome proliferator-activated receptor gamma and glutathione disulfide reductase. Both chloroquine and hydroxychloroquine had good binding affinity towards tumor necrosis factor (affinity=-8.6 and -8.4 kcal/mol, respectively) and glyceraldehyde 3-phosphate dehydrogenase (-7.5 and -7.5 kcal/mol). Chloroquine and hydroxychloroquine both had good affinity with angiotensin-converting enzyme 2, 3-chymotrypsin-like protease and transmembrane serine protease 2. However, hydroxychloroquine manifested better binding affinity with the three proteins comparing with that of chloroquine. Chloroquine and hydroxychloroquine could have potential to inhibit over-activated immunity and inflammation. The potential tissue-specific regulation of the two drugs against severe acute respiratory syndrome coronavirus 2 infection may related with the lung, liver, brain, placenta, kidney, blood, eye, etc. In conclusion, our data systematically demonstrated chloroquine and hydroxychloroquine may have potential regulatory effects on coronavirus disease 2019 disease network, which may affect multiple organs, protein targets and pathways. Routine measurements of the chloroquine and hydroxychloroquine blood concentrations and tailored therapy regimen may be essential. But, further rigorous and high quality randomized controlled clinical trials are warranted to validate the antiviral effects of chloroquine and hydroxychloroquine against severe acute respiratory syndrome coronavirus 2. Our proposed strategy could facilitate the drug repurposing efforts for coronavirus disease 2019 treatment.

4.
Vestnik Urologii ; 10(2):72-77, 2022.
Article in Russian | EMBASE | ID: covidwho-1957627

ABSTRACT

Introduction. SARS-CoV-2 causes several negative processes in the body and complicates the course of chronic somatic diseases, causing dysfunction and having a negative effect on many organs and systems of the body, including organs of the reproductive system. Objective. To study morphological changes in testicles of patients who have undergone a new coronavirus infection. Materials and methods. Objects of morphological research were testicular tissues obtained by intraoperative biopsy under intravenous anesthesia served. Material sampling was carried out in 12 patients aged 25–29 years with idiopathic infertility who underwent COVID-19. Patients showed ultrasound signs of fibrosis in the testicles, which were absent before infection with SARS-CoV-2. The biopsy was performed 12 months after COVID-19. Results. In all observations, changes were observed that are characteristic of the inflammatory process, nonbacterial autoimmune genesis. Histio-lymphocytic infiltration of testicular tissue with destruction of single tubules and parenchyma atrophy, combined with varying degrees of sclerosis, was verified. Conclusion. In testicular biopsy specimens from patients who have undergone COVID-19, an autoimmune inflammatory process is recorded, manifested by lymphocytic infiltration of testicular tissue, which was combined with varying degrees of sclerosis.

5.
Iranian Journal of Microbiology ; 14(3):300-304, 2022.
Article in English | EMBASE | ID: covidwho-1957624

ABSTRACT

Background and Objectives: Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is commonly detected in pneumonia patients who travel from the Middle East regions. Besides MERS-CoV, many other pathogenic agents cause pneumonia. Detection of such organisms must be done swiftly, especially in case of the negative MERS-CoV samples. The aim of this study was to identify the pathogenic agents that might account for bacterial pneumonia, from Hajj and Umrah pneumonia cases. Materials and Methods: We conducted a cross-sectional study, 38 pneumonia clinical samples from suffering of Hajj and Umrah in 2017 with negative MERS-CoV were selected. The laboratory testing was done at National Reference Laboratory in Jakarta and performed by multiplex real-time PCR using a FTD respiratory pathogens. Results: Haemophilus influenzae (26.4%) was the most frequent bacteria detected. Other causative agents of bacterial pneumonia identified were Moraxella catarrhalis (20.8%), Klebsiella pneumoniae (13.2%), Streptococcus pneumoniae (9.4%), and Staphylococcus aureus (5.7%). From 38 samples showed that 25 (65.79%) samples were positive with bacteria, in-cluding five samples with coinfection. The coinfection were combinations among S. aureus and S. pneumoniae (1/20), S. pneumoniae and K. pneumoniae (1/20), S. pneumoniae and M. catarrhalis (2/20), S. pneumoniae and H. influenzae (2/20), K. pneumoniae and H. influenzae (5/20), and M. catarrhalis and H. influenzae (5/20). Conclusion: Haemophilus influenzae is the most recurrent bacteria to be identified in samples of pneumonia of hajj and umrah cases.

6.
Avicenna Journal of Medical Biotechnology ; 14(3):233-238, 2022.
Article in English | EMBASE | ID: covidwho-1957621

ABSTRACT

Background: Evidence on seroconversion profile of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients is limited. We mainly aimed to evaluate seroconversion and persistence of virus-specific antibodies in patients infected by coronavirus disease 2019 (COVID-19). Methods: This prospective study was conducted on 118 patients with COVID-19 presen-tations admitted to three hospitals in Iran and recovered from the disease, during April and May 2020. Presence of COVID-19 was confirmed by Polymerase Chain Reaction (PCR) testing on nasopharyngeal swabs. Serum samples were collected at different time points, including 0-5, 6-15, 16-25, 26-35, and 36-95 days of clinical symptom onset. For measurement of SARS-CoV-2-specific IgG and IgM antibody titers, Iran's Food and Drug Administration-approved SARS-CoV-2 ELISA kits were used. Results: Serologic assay revealed that 37.3% of patients (n=44) were positive for IgM at 0-5 days interval after clinical symptom onset. This rate was 60.2% (n=71) for IgG. There were increasing IgM and IgG seroconversion rates during first 25 days of clinical symptom onset, but seropositivity started to decrease thereafter, which was more evi-dent for IgM (17.9%) than IgG (58.9%) at the 36-95 days post symptoms appearance. In other words, it was found that 83.6% of IgM-positive and 32.9% of IgG-positive patients in the first month of clinical symptom onset became seronegative in the third month of clinical symptom onset. Conclusion: The findings demonstrated that antibody responses to SARS-CoV-2 infection were developed in recovered COVID-19 patients;however, some of them were seronegative three months after onset of relevant symptoms. Furthermore, the stability of anti-SARS-CoV-2 antibodies could also correct our expectations from COVID-19 vaccination responses.

7.
Medical Immunology (Russia) ; 24(2):389-394, 2022.
Article in Russian | EMBASE | ID: covidwho-1957613

ABSTRACT

Coronary artery disease (CAD) is widely considered a chronic inflammatory disorder, and dysfunction of epicardial adipose tissue could be an important source of the inflammation. Amino-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) is a known marker of cardiovascular disorders of cardiac origin. Recent studies show that inflammatory stimuli may influence its secretion. Our purpose was to evaluate NT-proBNP serum concentration in relation to immune cell ratios in epicardial adipose tissue (EAT), and cytokine levels in the patients with stable CAD. Patients with stable CAD and heart failure classified into classes II-III, according to the New York Heart Association (NYHA) scale, scheduled for the coronary artery bypass graft (CABG) surgery, were recruited into the study (n = 10;59.5 (53.0-65.0) y. o.;50% males). The EAT and subcutaneous adipose tissue (SAT) specimens were harvested in the course of CABG surgery. Immunostaining with anti-CD68, anti-CD45, anti-IL-1β and anti-TNFα monoclonal antibodies was performed to evaluate cell composition by differential counts per ten fields (400 magnification). Fasting venous blood was obtained from patients before CABG. Blood was centrifuged at 1500g, aliquots were collected and stored frozen at -40 °С until final analysis. Concentrations of NT-proBNP, IL-1β, IL-6, IL-10, TNFα were determined in serum samples by enzyme-linked immunosorbent assay (ELISA). We have found increased production of IL-1β and TNFα cytokines in EAT compared to SAT. Concentrations of NT-proBNP exceeded 125 pg/ml in 4 patients, and correlations between the CD68+ macrophage counts in both EAT and SAT samples (rs = 0.762;p = 0.010 and rs = 0.835;p = 0.003, respectively). NT-proBNP levels showed positive relations with CD45+ leukocyte counts (rs = 0.799;p = 0.006), and with IL-1β+ cell numbers (rs = 0.705;p = 0.023) in EAT samples only. As for the serum biomarkers, NT-proBNP levels showed negative correlation with fasting glucose levels (rs = -0.684;p = 0.029), and positive correlation with serum IL-6 concentrations (rs = 0.891;p = 0.001). Increased serum concentrations of NT-proBNP in CAD patients correlate with accumulation of macrophages in EAT, which is associated with increased production of IL-1β in EAT and correlates with some metabolic parameters.

8.
NeuroQuantology ; 20(8):207-212, 2022.
Article in English | EMBASE | ID: covidwho-1957606

ABSTRACT

Minister of Health Regulation No. 18 of 2021 concerning Amendments to the Regulation of the Minister of Health Number 10 of 2020 concerning the Implementation of Vaccination in the Context of Combating Covid-19 in which it regulates the implementation of vaccinations both from the target, financing, service flow, and so on. Molowagu Public Health Center is one of the health centers with low vaccination coverage, with 16.9% of people receiving the first dose of vaccine and 6.92% of the second dose. The purpose of this study was to analyze the factors that influence the status of the Covid-19 vaccination in the Molowagu Health Center Work Area, Tojo Una Una Regency. The research method is quantitative with an analytical observational approach using a cross sectional research design. The research was carried out in February-March 2022 in the working area of the Molowagu Health Center, Tojo Una-una Regency. The sample of this research is 153 respondents. Collecting data using a questionnaire. Collecting data using a questionnaire. Data analysis using chi-square and multiple logistic regression. The results showed that there was an effect of knowledge on vaccination status (p = 0.001), there was no effect of accessibility on vaccination status (p = 0.894), there was an influence of supporting factors on vaccination status (p = 0.005) and there was no influence of driving factors on vaccination status. (p = 0.055) To the Health Office of Tojo Una una Regency further improve health status, so that it can benefit the community by increasing body resistance and improving the environment through health education about the covid-19 vaccine).

9.
NeuroQuantology ; 20(6):7390-7410, 2022.
Article in English | EMBASE | ID: covidwho-1957603

ABSTRACT

Background: Gestational Diabetes is considered to be a serious health problem among pregnant women in Egypt. The seriousness, dramatically increasing and incidence of this disease make its management more essential and need more attention. Applying Tele-nursing in healthcare is increasingly prioritized to reduce maternal mortality, morbidity and improve newborns’ survival. Aim of the study: was to evaluate the effect of Tele-nursing guidelines on health lifestyle and self-efficacy among women with gestational diabetes during COVID-19 pandemic. Research design: Quazi experimental design was adopted to carry out this study. Setting: The study was conducted at family planning and antenatal care unit in outpatient clinic, at Zagazig University Hospital. Subjects: Purposive sample of 5o pregnant women with gestational diabetes. Tools of data collection: Four tools were used for data collection. Tool I: A structured interviewing questionnaire, Tool II: Health Promotion Lifestyle Profile scale (HPLP), Tool III: Self-efficacy scale in gestational diabetes and Tool IV: An educational nursing guidelines booklet for pregnant women with gestational diabetes. Results: There was a statically significant difference regarding mean score of all domains of the health promotion lifestyle profile throughout the intervention phase (p<0.001).Also;a statistically significant relation (p<0.05) was found between post self-efficacy score and post-knowledge score through post-intervention phase, Conclusion: it was concluded that;there was a highly statistical significant improvement among the studied women regarding total knowledge, health promotion life style and self-efficacy about GDM at pre and post intervention. In addition;there was a positive correlation coefficient (r =0.336), with statistically significant p (0.017) between self-efficacy and health promotion lifestyle throughout study phases Recommendations: Tele-nursing should be programmed, implemented and applied as a part of health plan with the routine nursing care in antenatal unites.

10.
Journal of Clinical Urology ; 15(1):24, 2022.
Article in English | EMBASE | ID: covidwho-1957025

ABSTRACT

Objective: Men appear at greater risk of poor clinical outcomes and death from Covid-19. This suggests that serum testosterone could be a mediator. The aim of this retrospective study was to evaluate the association between serum total testosterone (TT), other prognostic indicators, and mortality in men with COVID-19. Methods: 110 men consecutively admitted to a district general hospital (with COVID-19 related symptoms) tested for SARS-CoV-2, 85 were positive and 27 of these men died. Serum TT was compared (rank-sum test) between men negative and positive for SARS-CoV-2. Factors associated with mortality in the latter group were analysed. Results: No significant difference was found (p=0.12, rank-sum test) in serum TT between men positive and negative for SARS-CoV-2. Serum TT was lower (p=0.0011, rank-sum test) in men with COVID-19 who died (median TT 2.0nmol/L) compared with survivors (median TT 5.0nmol/L). Mortality (logistic regression) was associated with age and serum TT (odds ratio: 0.77, 95% confidence intervals (CI): 0.64, 0.91). Survival (Cox regression) was inversely associated with serum TT (continuous variable, hazard ratio (HR): 0.85 (95% CI: 0.74, 0.98), stratified by median, TT ≥ 3.9nmol/L (reference, TT < 3.9nmol/L), HR:0.24, (95% CI: 0.089, 0.63). Conclusions: Serum TT was inversely associated with mortality in men with COVID-19 and requires measurement at admission and whilst managing long COVID. Future research should establish whether low serum TT, possibly associated with negative acute phase response, contributes to a poorer prognosis and a role for testosterone therapy.

11.
Sexually Transmitted Infections ; 98:A53, 2022.
Article in English | EMBASE | ID: covidwho-1956926

ABSTRACT

The covid-19 pandemic restricted face-to-face contact with patients and encouraged new ways of working. Patients needing test-of-cure (TOC) for gonorrhoea (GC) and mycoplasma genitalium (MG) could no longer attend clinics. Staff offered alternatives, advising patients to order tests from our on-line service (usually if they were already registered) or providing patient with a 'blue bag': test kit and prepaid envelope to send to the laboratory from home. Methods Reviewed all patients diagnosed with GC or MG August 2020-January 2021 and compared TOC rates depending on method used Results 164 patients diagnosed with MG or GC, attending iCasH Cambs for treatment TOC achieved for 77% of all patients, GC 80% (106/136), MG 75% (21/28), it was 88% for patients with a documented follow-up plan in the records. Discussion Return rates were similar to the previous year and well above national average. Home sampling for TOC is an effective and acceptable method for patients. TOC kits provided by the clinic allowed testing for infections such as MG and avoided the need for a new patient to register on the on-line testing platform. Return rates were slightly higher using the 'blue bag' system than the on-line platform (87% vs 82%). While the difference was not statistically significant, providing samples for TOC in clinic might be preferable for some patients. (Table Presented).

12.
Sexually Transmitted Infections ; 98:A40, 2022.
Article in English | EMBASE | ID: covidwho-1956913

ABSTRACT

Introduction Obtaining samples of Neisseria gonorrhoeae for antibiotic sensitivity testing is important for purposes of antimicrobial stewardship. While urethral and cervical gonorrhoea culture samples are usually taken by a healthcare professional, the Covid-19 pandemic necessitated a reduction in direct patient contact. In our service, patients with confirmed gonorrhoea who did not otherwise require examination were asked to take their own urethral or vaginal culture swabs. Methods GUMCAD coding was used to identify cases of cervical or male urethral Neisseria gonorrhoeae infection diagnosed on nucleic acid amplification testing, where the gonococcal culture result and the identity of the swab-taker (patient/healthcare professional) were recorded in the notes. 50 cases were selected in 2019, and 50 in 2020, after the onset of the Covid-19 pandemic. Proportions of patients taking their own swabs were calculated for the two periods. Culture positivity rates were compared between self-taken and healthcare professional-taken swabs. Results During the pandemic, use of self-taken culture samples increased ten-fold. Although positivity for Neisseria gonorrhoeae was lower for self-taken swabs, 38% of male self-taken urethral samples tested positive for gonorrhoea, and the organism was successfully cultured from a self-taken vaginal swab on one occasion. Discussion Although self-taken gonorrhoea cultures were less likely to grow Neisseria gonorrhoeae than those taken by healthcare professionals, they proved a useful tool in gathering sensitivity data in a time of restricted patient contact. The lower positivity rate of self-taken cultures may be partially attributable to their use in patients with fewer symptoms, and hence a lower bacterial load. (Table Presented).

13.
Sexually Transmitted Infections ; 98:A24, 2022.
Article in English | EMBASE | ID: covidwho-1956901

ABSTRACT

Introduction Self-sampled specimens to test for blood borne viruses can involve either mini tube testing (MTT) or dried blood spot testing (DBST).[1] In the UK, remote testing for STIs has increased in recent years, a trend enhanced by the COVID-19 pandemic. Whilst information is already available on these different testing technologies, little is known about the patient experience of home blood-sampling. We present a pilot service evaluation to explore the patient experience of DBST and MTT. Methods DBST kits (including tests for HIV, syphilis, Hepatitis B and C) were sent to 30 patients. People were included in this service evaluation if they were MSM who had a) requested an online MTT kit from our clinic website within the preceding 6 months, b) subsequently returned a blood sample which was inadequate for analysis and c) not yet attended the department for a venous sample. Sample return rates and results were analysed, and patients were also invited to complete a short telephone survey. Discussion Our sample return rate was 67%. This is higher than the reported average from UKHSA for MTT (57%).[2] Nineteen patients completed the survey discussing their experience of both MTT and DBST. We identified significant issues faced by patients when carrying out remote MTT which included logistical difficulties when collecting blood samples, pain and distress. Comparatively, our evaluation demonstrated that DBST was less labour-intensive and therefore the preferred test for 100% of our respondents. Conclusion DBST proves to be a promising and acceptable candidate for future delivery of blood borne virus home sampling.

14.
Sexually Transmitted Infections ; 98:A7, 2022.
Article in English | EMBASE | ID: covidwho-1956893

ABSTRACT

Introduction We examine changes in sexual behaviour, STI & HIV testing and testing need among MSM in the UK preand post-COVID-19 restrictions. Methods An online survey of 1,309 MSM recruited via social media and Grindr over three weeks in November/December 2021. Questions on sexual behaviour and service use had an approximate three-month lookback period corresponding to a period of no/limited COVID-19 restrictions. Unmet testing need was defined as reporting any new and/or multiple condomless anal sex (CAS) partners without a recent STI/HIV test. MSM recruited through Grindr who were UK-resident, cisgender, aged ≥16 years who reported sex with men in the last year (N=430) were compared to those from a related 2017 survey (N=1914) using multivariable regression to adjust for demographic differences between the samples. Results Compared to the 2017 survey, sexual risk behaviour was higher in the 2021 survey: ≥1 recent new sex partner (71.5% vs. 81.5%, respectively, aOR=1.80);≥2 recent CAS partners (30.1% vs. 48.8%, aOR=2.23). Reporting recent testing for STIs/HIV was also higher in late 2021 (37.3% vs. 42.6%, aOR=1.34;and 48.7% vs. 45.1%, aOR=1.27, respectively). However, there was no significant change in the proportion with unmet need for STIs (41.4% vs. 44.2%) and HIV (34.8% vs. 39.3%). Discussion These large, community surveys of MSM in the UK suggest greater sexual risk behaviour post-restrictions in 2021 compared to 2017. However, while we found no evidence of reduced service accessibility following the removal of most restrictions, there remains considerable unmet STI/HIV testing need among UK MSM. (Table Presented).

15.
British Journal of Dermatology ; 186(6):e257, 2022.
Article in English | EMBASE | ID: covidwho-1956712

ABSTRACT

A 27-year-old man presented to Accident and Emergency with an itchy rash over the thighs and buttocks. This followed 2 days of fever, headache and malaise. His past medical history was unremarkable and there was no regular medication use. He was unvaccinated. There was no history of previous erythema multiforme (EM) or herpes simplex virus (HSV) infection. He was febrile but otherwise haemodynamically stable. Clinically, over the thighs and buttocks there was a symmetrical rash consisting of striking urticated targetoid lesions. Some had a dusky centre and had coalesced over the thighs. There was no mucosal involvement. A SARS-CoV-2 polymerase chain reaction test was positive. Mycoplasma serology and swabs for HSV were negative. Other bloods were unremarkable. A skin biopsy from affected skin showed spongiosis and a mild dermal lymphocytic infiltrate. There was an absence of necrotic keratinocytes. He was treated with 5 days of prednisolone (30 mg) and potent topical steroids. There was complete clinical resolution of the rash in a week. In the published literature there are a small number of EM-like eruptions in the context of COVID-19 infection. Similar to our patient, skin biopsies often show features not typical of EM, including spongiosis and a lymphocytic perivascular and interstitial infiltrate (Torrelo A, Andina D, Santonja C et al. Erythema multiforme-like lesions in children and COVID-19.

16.
British Journal of Dermatology ; 186(6):e253, 2022.
Article in English | EMBASE | ID: covidwho-1956703

ABSTRACT

We present the case of a severe cutaneous reaction following COVID-19 vaccination. A 60-year-old white woman presented to our service with an extensive painful, pruritic rash affecting her bilateral lower limbs. This was on a background of psoriasis, psoriatic arthritis and notably inoculation against COVID-19 with the Johnson & Johnson vaccine hours prior to onset. There was no history of new medications, illicit drug use or infections. On examination, extensive palpable purpura was noted circumferentially at both lower limbs from the knee distally. Tense bullae were described at her bilateral ankles. She was apyrexial. Her cardiopulmonary and gastrointestinal examinations were normal. A punch biopsy taken from her right lower limb demonstrated findings consistent with leucocytoclastic vasculitis (LCV). Direct immunofluorescence demonstrated IgA deposits within the vasculature. IgA LCV secondary to COVID-19 vaccination was proposed on the basis of histological and clinical findings. Treatment consisted of oral steroids, oral antibiotics for secondary infection and wound dressings. Opioid analgesia and nitrous oxide were implemented for severe pain associated with dressing changes. As her urinary protein creatinine ratio was in excess of 100 mg dL-1 and microscopic haematuria was noted on urine microscopy, she was referred to nephrology. We note case reports of patients diagnosed with LCV up to 2 weeks following COVID-19 vaccination (Cavalli G, Colafrancesco, De Luca G et al. Cutaneous vasculitis following COVID- 19 vaccination. Lancet Rheumatol 2021;3: E743-4). In this case, onset of symptoms occurred within hours. While this presentation may have been coincidental, the relationship between immune complex vasculitis, COVID-19 infection (Iraji F, Galehdari H, Siadat AH, Bokaei Jazi S. Cutaneous leukocytoclastic vasculitis secondary to COVID-19 infection: a case report. Clin Case Rep 2020;9: 830-4) and vaccination (Cavalli et al.) has been reported in the literature and represents the most likely diagnosis.

17.
British Journal of Dermatology ; 186(6):e258, 2022.
Article in English | EMBASE | ID: covidwho-1956701

ABSTRACT

A 21-year-old woman presented with a 5-month history of swollen, painful, purple discolouration of her toes and fingers, which began 6 weeks after COVID-19 infection. This was refractory to ibuprofen and clobetasol 0.05% w/w ointment. She reported no other associated symptoms. On examination she had erythematous mottling of the tips of the toes and nail folds of the right foot and sausage-shaped deformities of the left second and fourth toes, consistent with dactylitis. Her blood work-up for COVID toes revealed a raised serum angiotensin- converting enzyme (ACE) level (64 U L-1) with no other abnormalities. Her chest X-ray was unremarkable. Plain radiographs of the feet showed soft tissue swelling and lacelike bony appearances with discrete areas of lucency, particularly affecting the middle phalanx of the left second toe. This pattern has been described in sarcoid arthropathy. Magnetic resonance imaging of the left foot demonstrated features of inflammatory arthropathy, including subarticular bone marrow oedema, periarticular soft tissue oedema and flexor tendon tenosynovitis. The findings were consistent with COVID toes;however, some features of the dactylitis extended beyond the expected presentation of a vascular manifestation of COVID-19. She displayed overlap features seen in sarcoid-related pathologies, including raised ACE levels and a lace-like bony appearance. We believe this to be a sarcoid-like immune reaction to COVID-19 presenting with COVID toes and dactylitis. A sarcoid-like immune reaction to COVID-19 with granulomatous skin lesions rather than dactylitis has been reported. Viral infections are a documented trigger for sarcoid- like immune reactions. This case suggests that COVID-19 can trigger sarcoid-like immune reactions, albeit with a more discrete presentation.

18.
British Journal of Dermatology ; 186(6):e248, 2022.
Article in English | EMBASE | ID: covidwho-1956696

ABSTRACT

A 21-year-old woman was admitted with a 3-day history of severe vulval ulceration, oedema and pain. On examination she had large deep necrotic-appearing kissing ulcers on the right and left inner labia minora, with overlying grey eschar and significant surrounding inflammation. The pain was described as agonizing, requiring opioid analgesia and catheterization for micturition. Three weeks prior, she had tested positive for SARS-CoV-2, having had mild symptoms, but her PCR was negative on admission. She had not been sexually active for several months due to dyspareunia. She was initially started on co-amoxiclav and acyclovir due to a raised C-reactive protein of 94, and white cell count of 11. Investigations were negative for Epstein-Barr virus (EBV), HIV and mycoplasma. Bacterial and viral skin swabs were negative. Biopsies were taken under general anaesthesia. Histology revealed ulceration and granulation tissue only. Bacterial and atypical mycobacterial cultures were negative. She was discharged when the ulcers had stabilized and pain was controlled. Follow-up 2 weeks later revealed full healing of the ulceration. Therefore, this is a case of reactive nonsexually acquired acute genital ulceration (AGU), also known as Lipsh€utz ulceration (Sadoghi B, Stary G, Wolf P et al. Ulcus vulvae acutum Lipsch€utz: a systematic literature review and a diagnostic and therapeutic algorithm. J Eur Acad Dermatol Venereol 2020;34 1432-9), which is likely to have developed secondary to COVID -19 in this patient. This rare form of vulval ulceration has been previously linked to infections including EBV, cytomegalovirus and mycoplasma. There have been three case reports of AGU linked to COVID -19 (Krapf JM, Casey RK, Goldstein AT. Reactive non-sexually related acute genital ulcers associated with COVID-19. BMJ Case Rep 2021;14: e242653). This is a rare and dramatic presentation that needs to be recognized by the dermatologist to aid timely diagnosis and treatment.

19.
British Journal of Dermatology ; 186(6):e252, 2022.
Article in English | EMBASE | ID: covidwho-1956690

ABSTRACT

A 44-year-old man of Pakistani origin presented to emergency 6 days following his first dose of the AstraZeneca (AZ) SARSCoV- 2 vaccine. He developed flu-like symptoms followed by erythematous pruritic rash. Physical examination showed a maculopapular rash associated with purpura and targetoid lesions affecting his distal extremities, trunk and mucous membranes. He also had crusting and ulceration of his oral and genital mucosal areas. He had no other significant past medical history. A biopsy was taken from his right arm and sent for urgent histology and direct immunofluorescence. Histology revealed parakeratotic scale with interface dermatitis comprising basal layer vacuolation and lymphocyte exocytosis. The epidermis showed prominent dyskeratotic keratinocytes scattered throughout the epidermis. The papillary dermis showed a mild perivascular lymphocytic infiltrate including eosinophils and melanophages. Other investigations showed leucocytosis (12 × 109 L-1), high eosinophils (0.9 × 109 L-1), raised liver enzymes with alkaline phosphatase 159 U L-1 and alanine aminotransferase 172 U L-1. A full infection screen, including herpes simplex virus, SARS-CoV-2 and atypical viral infection, was negative. Immunology was also reported as negative. Based on the findings, a diagnosis of erythema multiforme (EM) secondary to AZ vaccine was made. He was treated with topical steroids and emollients, leading to resolution of his skin and mucosal areas in 4-6 weeks. Recently, there have been a few reported cases of EM in patients with COVID-19 (Jimenez-Cauhe J, Ortega-Quijano D, Carretero- Barrio I et al. Erythema multiforme-like eruption in patients with COVID-19 infection: clinical and histological findings. Clin Exp Dermatol 2020;45: 892-5) and two patients who have had the Pfizer-BioNTech vaccine [Kim M, Kim J, Kim M et al. Generalized erythema multiforme-like skin rash following the first dose of COVID-19 vaccine (Pfizer-BioNTech). J Eur Acad Dermatol Venereol 2021], but the information is limited. Our case emphasizes the need for further studies into the cutaneous adverse effects related to COVID-19vaccines.

20.
BJOG: An International Journal of Obstetrics and Gynaecology ; 129:206-207, 2022.
Article in English | EMBASE | ID: covidwho-1956670

ABSTRACT

Objective: To improve training for all obstetrics and gynaecology trainees in Northern Ireland (NI) through access to an agreed simulation programme. Design: Laparoscopic simulation leads were identified in all training units within NI. A regional laparoscopic simulation programme was designed and reviewed by all units to ensure a regional approach was maintained. Laparoscopic boxes were provided to all units alongside a curriculum document to follow. Method: Laparoscopic simulation leads were identified in all training units. A detailed curriculum was developed which ranged from basic to intermediate and advanced laparoscopic skills. All units were provided with laparoscopic simulation boxes to use throughout the 10 week programme. The teaching sessions were held on alternate Friday afternoons over a 20 week period as part of the regional CME programme within NI. This was part of the restoration of gynaecological surgical training in response to the challenges raised by COVID-19. Each week began with a lecture (delivered virtually) was given on the following topics;Theatre set up and equipment Ergonomics in laparoscopy Laparoscopic instruments and electrosurgery Pelvic anatomy Laparoscopic entry techniques Laparoscopic adnexal surgery Laparoscopic hysterectomy Laparoscopic urogynaecology Specimen retrieval Laparoscopic complications Each lecture was then followed by time spent using the laparoscopic simulation boxes under direct consultant supervision. A laparoscopic skills log book was designed to log all procedures performed by trainees including space for consultant feedback. A post course questionnaire was completed by trainees. Conclusion: COVID-19 has significantly impacted training and this programme has addressed concerns voiced by trainees and has made access to simulation training available to all trainees throughout NI. With consultant supervision and the use of an agreed curriculum and log book this has been a welcomed introduction with limited time spent in a live theatre environment. As this was held in each individual unit throughout NI all COVID regulations were met and good quality teaching in the trainees current training unit. This not only simulated laparoscopic skills but also the consultant supervision and feedback they would have experienced in theatre.

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