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1.
Chest ; 162(4):A1102, 2022.
Article in English | EMBASE | ID: covidwho-2060769

ABSTRACT

SESSION TITLE: Issues After COVID-19 Vaccination Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: More reports are indicating a temporal association between Bell's palsy and the mRNA vaccine for coronavirus disease 2019 (COVID-19). Therefore, collecting vaccine history is becoming important in post-marketing surveillance to monitor the safety of vaccines in real-world settings. We report the case of concomitant occurrence of Bell's palsy and glossopharyngeal neuralgia leading to severe symptomatic hyponatremia in a previously healthy patient. CASE PRESENTATION: A 60 year-old-female without significant medical history presented to the hospital with odynophagia, and generalized weakness for two weeks. She decreased her oral intake due to stabbing pain in the back of her throat triggered by swallowing. She reported hyperacusis and frequent shooting pain in the left cheek managed with non-steroidal anti-inflammatory drugs. The symptoms occurred several days after the first dose of the mRNA vaccine for COVID-19. She denied previous COVID-19 infection and herpes zoster. Examination revealed dry mucosa, left facial muscle weakness, inability to raise the left eyebrow or lift the labial commissure, effacement of the nasolabial fold, and left-sided frontal wrinkles. Laboratory investigation revealed sodium of 110. Computerized Tomography of the brain revealed negative findings for intracranial abnormalities. Severe symptomatic hyponatremia was managed with hypertonic saline. The neurologist made the diagnosis of Bell's palsy and glossopharyngeal trigeminal neuralgia leading to poor oral intake. We initiated acyclovir, prednisone, and gabapentin. The patient recovered from hyponatremia and experienced improvement of neurological symptoms with initiated medications. DISCUSSION: High morbidity and mortality of patients with COVID-19 accelerated the development and production of the vaccines. During the pandemic, mRNA COVID-19 vaccines reduced asymptomatic and prevented severe symptomatic COVID-19 infection and its complications. Although the benefits and protective effects of the COVID-19 vaccines outweighed the risks associated with them, we have reports of associations between vaccines and certain disorders such as Bell's palsy. Glossopharyngeal neuralgia is defined as sudden severe brief pain in the distribution of the glossopharyngeal nerve. It can be described as transient stabbing pain experienced in the ear, tonsillar fossa, and base of the tongue. Unusual presentation is fear to eat as this can be a precipitating cause of the pain. It overlaps with trigeminal neuralgia and can create a diagnostic dilemma. CONCLUSIONS: In summary, it is unknown what causal relationship exists between the mRNA COVID-19 vaccine and neurological diseases such as Bell's palsy and glossopharyngeal neuralgia. Glossopharyngeal neuralgia is frequently overlooked as a diagnosis. This is a unique case of concomitant glossopharyngeal neuralgia and Bell's palsy that is coincidental with a history of COVID-19 vaccine. Reference #1: El Sahly HM, Baden LR, Essink B, et al. Efficacy of the mRNA-1273 SARS-CoV-2 Vaccine at Completion of Blinded Phase. New England Journal of Medicine. 2021;385(19):1774-1785. doi:10.1056/NEJMoa2113017 Reference #2: Singh PM, Kaur M, Trikha A. An uncommonly common: Is glossopharyngeal neuralgia. Ann Indian Acad Neurol. 2013;16(1):1-8. doi:10.4103/0972-2327.107662 Reference #3: Cellina M, D'Arrigo A, Floridi C, Oliva G, Carrafiello G. Left Bell's palsy following the first dose of mRNA-1273 SARS-CoV-2 vaccine: A case report. Clin Imaging. 2022;82:1-4. doi:10.1016/j.clinimag.2021.10.010 DISCLOSURES: No relevant relationships by Nemanja Draguljevic No relevant relationships by Katherine Hodgin No relevant relationships by Kristina Menchaca No relevant relationships by Catherine Ostos Perez

2.
Middle East Journal of Digestive Diseases ; 14(3):346-348, 2022.
Article in English | EMBASE | ID: covidwho-2044377

ABSTRACT

Esophagitis dissecans superficialis (EDS) is an uncommon disease characterized by esophageal mucosal sloughing. EDS is a benign condition that usually resolves without residual pathology. Medication, chemical irritants, hot drinks, and autoimmune diseases have all been associated with EDS. Here a 60-year-old lady with post-COVID-19 EDS is presented. Her chief complaint was dysphagia and odynophagia for 2 weeks duration. EDS diagnosis was based on endoscopic findings and biopsy. Her problem was improved by a high dose of pantoprazole.

3.
Annals of the Rheumatic Diseases ; 81:1701, 2022.
Article in English | EMBASE | ID: covidwho-2009142

ABSTRACT

Background: High levels of tumor necrosis factor (TNF), a key proinfamma-tory cytokine, is associated with SARS-CoV-2 infection. In rheumatoid arthritis patients with SARS-CoV-2 infection, anti TNF therapy reduces not only TNF but other cytokines responsible for high morbidity and mortality. The severe systemic infammation in COVID-19 causes respiratory symptoms, fever, fatigue, neurological and gastrointestinal manifestations. Objectives: We followed the evolution of SARS-CoV-2 infection in rheumatoid arthritis patients who received anti TNF blockers. Methods: Our study included 95 rheumatoid arthritis patients who were diagnosed with SARS CoV-2 infection through a positive RT-PCR-SARS-CoV2 test. 21 patients were men and 74 were women. Mean age was 58 ±11,5. 24 patients received monotheraphy with anti TNF blockers (Adalimumab/Infiximab), 48 received TNF blockers in combination with Methotrexate (10 mg per week) and 23 received TNF blockers in combination with Lefunomide (20 mg per day). We followed serum ferritin, C reactive protein and D-dimer in all patients. 59 patients were vaccinated with two doses of Pfzer-BioNtech (64.1 %). The study group was analyzed from 30th December 2021 to 1st of January 2022. From 95 patients, 35 (36,8%) were hospitalized and 60 received ambulatory care. Results: Our patients with COVID-19 presented with asimptomatic forms, forms with mild symptoms and complicated forms that required hospitaliza-tion. No patients had died. Milder forms were associated with the use of TNF blockers and Methotrexate and patients with monotherapy-TNF blockers. They presented with mild symptoms (fever, arthralgia, odynophagia, dysgeu-sia/ageusia, anosmia). Hospitalization rate in patients who received mono-theraphy with TNF blockers was 29,1%, 31,2% in patients who received TNF blockers and Methotrexate and 56,5% in patients with TNF blockers and Lefunomide (69,3%). Factors associated with higher odds of hospitalization included older age (p=0,001), active disease (p=0,02), obesity (p=0,005), pulmonary chronic disease (p=0,02), diabetes (p=0,001) and concomitent dose of Lefunomide (p=0,0006). Female sex was associated with milder forms of the disease. Patients with high levels of D-dimer had a higher odd of hospital-ization (p<0,001). Strong positive correlation was observed between elevated D-dimers and hospitalization odds. Conclusion: TNF blockers in monotheraphy or associated with Methotrexate were correlated with lower odds of hospitalization and milder forms of COVID-19. No signifcant difference of hospitalization odd was observed between vaccinated and unvaccinated patients.

4.
Annals of the Rheumatic Diseases ; 81:1690-1691, 2022.
Article in English | EMBASE | ID: covidwho-2009073

ABSTRACT

Background: COVID19 may present different degrees of severity. It is generally thought that viral infections in patients with rheumatic infammatory diseases (R-IMID) or receiving immunosuppressive treatment tend to present more severe disease. However, data comparing the severity of the disease between R-IMID and the general population are scarce. Objectives: To assess the predisposing factors, clinical-analytical features and severity of COVID-19 infection in R-IMID compare to patients without R-IMID. Methods: Case-control study in a single University Hospital. We included all consecutive patients with a diagnosis of a R-IMID and a positive test for COVID-19 up to March 31st, 2021. A total of 274 controls were selected for each case, and matched by sex, age (± 5 years), and without previous diagnosis of R-IMID or use of immunosuppresive therapy. Confrmed infection was defned if the patient had a positive nasopharyngeal swab for SARS-CoV-2. COVID-19 case severity was divided into mild, moderate, severe and critical according to the United States National Institute of Health (NIH) COVID-19 guidelines (1). Mild/moderate COVID19 was compared with critical. Results: We included 274 patients (185 women/89 men), mean age 59.1 18 years. More frequent R-IMID were: Rheumatoid arthritis (RA) (n=87, 31.8%), Axial spondylarthritis/Psoriatic arthritis (SpA/PsA) (n=90, 32.8%), Polymyalgia Rheumatica (PMR) (n=22, 8%) and Systemic Lupus Erythematosus (SLE) (n=22, 8%) We also included 274 age and matched controls. Main characteristics of patients with R-IMID and controls are shown in Table 1. Concerning comorbidities, hypertension and dyslipidemia were more frequent in patients with R-IMID (p< 0.05). COVID-19 symptoms' distribution is shown in Figure 1. Cough and dyspnoea were more frequent and headache, odynophagia and diarrhea were less frequent in the R-IMID group. The only analytical difference was D-Dimer that was signifcantly higher in patients with R-IMID. Although most of the cases were mild, critical cases and deaths were more frequent in R-IMID (p <0.05). Conclusion: Most of the patients present a mild COVID-19. However, a more severe syndrome was observed in R-IMID.

5.
Enfermedades Infecciosas y Microbiologia ; 41(3):97-101, 2021.
Article in Spanish | EMBASE | ID: covidwho-1965436

ABSTRACT

sars-cov-2 infections appear to affect children less frequently and severely than adults. Children are frequently asymptomatic or have less severe symptoms and, therefore, less tested. objective. To determine prevalence and epidemiological characterization of sars-cov-2 in children from Chaco, Argentina. material and method. Descriptive, observational study. Once authorized by the Ethics Committee, the Chaco Epidemiology Computerized Database was reviewed, laboratory confirmed pediatric patients with sars-cov-2 infection of both sexes were included, aged between 30 days of life and under 13 years and 11 months of age, from March to September 2020. results. 320 pediatric patients (170 men and 150 women) were admitted. The ages between one and 13 years;average of seven years. The provenance mostly from Resistencia. Regarding morbidities, 86.8% did not present any type and 13.1% did. The most frequent comorbidity was asthma. Regarding the signs and symptoms of presentation: 285 (89%) presented signs-symptoms and 35 (10.9%) asymptomatic. The most frequent signs and symptoms were: fever 106 (37.1%);cough 61 (21.4%);odynophagia 47 (16.4%). conclusions. In the studied population, a higher prevalence of symptomatic was found;being fever and cough, the most prevalent symptoms, however they cannot be considered characteristic of sars-cov-2 in children, requiring further studies.

6.
Journal of Clinical Periodontology ; 49:84, 2022.
Article in English | EMBASE | ID: covidwho-1956753

ABSTRACT

The aim is to determine oral manifestations in patients with COVID-19 disease and in the postcovid period. Methods: A special survey (questionnaire) was made in 424 people who had COVID-19 confirmed by RT-PCR, ELISA for specific IgM and IgG antibodies and Chest CT scan (168 people). 123 people had complaints and clinical symptoms in the oral cavity 2-6 months after the illness and they came to the University dental clinic. Laboratory tests have been performed (clinical blood test, blood immunogram, virus and fungal identification). Results: Survey results showed that 16,0% participants had asymptomatic COVID-19, 23,6% - mild and 48,1% moderate disease. 12,3% with severe COVID-19 were treated in a hospital with oxygen support. In the first 2 weeks 44,3% indicated xerostomia, dysgeusia (21,7%), muscle pain during chewing (11,3%), pain during swallowing (30,2%), burning and painful tongue (1,9%), tongue swelling (30,2%), catharal stomatitis (16,0%), gingival bleeding (22,6%), painful ulcers (aphthae) (8,5%) and signs of candidiasis - white plaque in the tongue (12,3%). After illness (3-6 months), patients indicated dry mouth (12,3%), progressing of gingivitis (20,7%) and periodontitis (11,3%). In patients who applied to the clinic we identified such diagnoses: desquamative glossitis - 16 cases, glossodynia (11), herpes labialis and recurrent herpetic gingivostomatitis (27), hairy leukoplakia (1), recurrent aphthous stomatitis (22), aphthosis Sutton (4), necrotising ulcerative gingivitis (13), oral candidiasis (14), erythema multiforme (8), Stevens-Johnson syndrome (2), oral squamous cell papillomas on the gingiva (4) and the lower lip (1). According to laboratory studies, virus reactivation (HSV, VZV, EBV, CMV, Papilloma viruces) was noted in 52 patients (42,3%), immunodeficiency in 96 people (78,0%), immunoregulation disorders (allergic and autoimmune reactions) in 24 people (19,5%). Conclusions: Lack of oral hygiene, hyposalivation, vascular compromise, stress, immunodeficiency and reactivation of persistent viral and fungal infections in patients with COVID-19 disease are risk factors for progression of periodontal and oral mucosal diseases.

7.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927840

ABSTRACT

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is well described as an etiology to severe acute respiratory distress syndrome (ARDS). However, rare immunologic and allergic manifestations may also occur from this infection. We report a novel case of angioedema occurring in the setting of COVID-19 infection in a fully vaccinated patient. Case Report: A 61-yearold COVID-19 vaccinated female with hypertension presented to the emergency department with tongue and lip swelling, odynophagia, dysphonia, and difficulty breathing. She denied personal or family history of allergies, anaphylaxis, or angioedema. Her home medications included Aspirin, methadone, Seroquel, and Klonopin, with no recent changes reported. Physical exam was notable for significant lip and tongue edema, audible dysphonia, and bilateral end-inspiratory wheezing. She was hypoxemic and placed on nasal cannula. Laboratory findings revealed lymphopenia, elevated inflammatory proteins, including C-reactive protein (57), Lactate dehydrogenase (LDH) (238), and D-dimer (11.52). Functional C1 esterase inhibitor levels (>91) were normal. Nasal PCR swab returned positive for SARS-CoV-2. Ear, nose, and throat specialist was consulted given concern for angioedema, and flexible nasolaryngoscopy was performed revealing uvular, epiglottic, and bilateral arytenoid edema concerning for impending airway compromise. The patient was initiated on intravenous methylprednisolone, epinephrine, antihistamines, tranexamic acid and admitted to the medical intensive care unit (ICU). She was monitored closely in the ICU with subsequent improvement of the angioedema and resolution of the hypoxemia. She was discharged with an oral steroid regimen and scheduled for a follow-up appointment with an allergist. Discussion: There exists only a handful of case reports describing angioedema in patients with COVID-19 infection. In those reports, patients also had normal C1 esterase inhibitor levels and no personal or family history of inherited angioedema. Interestingly, our patient was vaccinated six months prior to her presentation. The association between SARS-CoV-2 and angiotensinconverting enzyme 2 (ACE-2), the primary receptor for viral entry into the epithelial cells of the lungs, could be a potential explanation for the occurrence of angioedema. ACE-2 plays a pivotal role in inhibiting a potent ligand of bradykinin receptor 1, Arginine bradykinin. It has been postulated that SARS-CoV-2 downregulation of ACE-2 leads to elevated angiotensin II levels and subsequent activation of the bradykinin pathway. Excessive bradykinin production generates high levels of nitric oxide and prostaglandins, resulting in vasodilation, increased vascular permeability, and angioedema. This case highlights the importance of recognizing atypical and rare presentations of COVID-19 infection, especially angioedema, given its sudden onset and life-threatening complications.

8.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925586

ABSTRACT

Objective: NA Background: Here we report a patient with COVID-19 associated inflammatory myopathy, presenting with facial, bulbar and proximal limb weakness. A 58-year-old woman presented with cough, dyspnea, and myalgia. Vital signs and her physical exam was unremarkable. Initial PCR testing for SARS-CoV-2 was negative and the patient was discharged home. She returned three weeks later with more severe dyspnea, cough, dysarthria, dysphagia, odynophagia and severe generalized weakness with inability to ambulate. She had no sensory symptoms or bowel or bladder dysfunction. Physical examination was significant for tachycardia and oxygen saturation of 88% on room air. She had bilateral ptosis, facial weakness, hypernasal dysarthria and profound symmetric proximal limb weakness. Reflexes were symmetrically diminished. Repeated SARS-CoV-2 PCR was positive. MRI of the entire neuroaxis showed no central or peripheral nervous system involvement, but demonstrated diffuse muscle edema and enhancement, with a region of myonecrosis Motor nerve conduction studies were unremarkable, needle electromyography revealed sparse fibrillation potentials;On admission, CK was elevated to 700 U/L. Anti-Sjögren's-syndrome-related antigen and anti-small ubiquitinlike modifier-1 activating enzyme antibodies were both strongly positive and Ku antibody was weakly positive. Muscle biopsy showed perivascular inflammatory infiltration with endomysial extension, regenerating fibers and upregulation of HLA Class ABC expression on non-necrotic fibers. Our presumptive diagnosis was COVID-19 associated myositis and a five-day course of 1000 mg intravenous methylprednisolone was administered. Over two weeks, her CK levels normalized and she recovered the ability to raise her arms and legs from the bed and showed slow improvement in bulbar function. Design/Methods: NA Results: Viral infection is a well-known cause of myositis. The severe immune activation known to occur in COVID-19 patients likely plays a major pathophysiologic role. The finding of multiple serologic autoimmune antibodies is intriguing suggesting an epiphenomenon rather than activation or unmasking of a specific immune response directed to the muscles. Conclusions: NA.

9.
Thalassemia Reports ; 12(2):30-33, 2022.
Article in English | EMBASE | ID: covidwho-1917754

ABSTRACT

Transfusion-dependent thalassemia patients undergo transfusion immunomodulating effects, which result in a general immune response depression and, consequently, an increase in the frequency of infectious episodes and neoplastic events due to a reduction in phagocytic function. Altered natural killer functions and IL-2-mediated lymphocytic response, defects in antigen presentation due to monocyte–macrophage cells, and decreases in bone marrow precursors and HLA II+ cells all play key roles in immunodepression in thalassemia major. SARS-CoV-2 infection presents marked lymphopenia, occurring in 96.1% of severe cases. COVID-19-related lymphopenia is due to various mechanisms, which lead to an increase in lymphocytic apoptosis. Post-COVID-19 lymphocytic quantitative and functional disorders may compromise immune response and promote the onset of infections via opportunistic pathogens. Herein, we report a case of a thalassemia major patient who developed severe post-COVID-19 lymphocytopenia, which may have facilitated the onset of a severe Klebsiella Pneumoniae infection.

10.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-337458

ABSTRACT

Background. The disease caused by the new coronavirus SARS-CoV-2, COVID-19, which appeared in early 2020 in Mexico, was the second leading cause of mortality in the country that year and has generated an increasing demand for medical care. By January 2022, 4.13 million cases and 300 thousand direct deaths have been documented. Objective: To describe the main symptoms of people with a positive test for SARS-CoV-2 treated at the Mexican Institute of Social Security (IMSS) by sex, age group, and IMSS delegation. Methods. 4.5 million epidemiological reports were registered in the IMSS epidemiological surveillance system between February 2020 and November 2021. They were analyzed, reporting for those with either a positive PCR or rapid test, the prevalence of symptoms by sex, groups of age, and IMSS delegation. Results. Among the population treated at the IMSS, six symptoms are observed as the most prevalent in general, as well as by sex, age groups, and state of residence: cefalea, fever, cough, myalgia, odynophagia, and arthralgias. Conclusions. A better understanding of the clinical picture with which confirmed cases of COVID-19 present contributes to reporting timely diagnoses, considering the particularities by sex, age, and place of residence.

11.
Open Access Macedonian Journal of Medical Sciences ; 10:330-334, 2022.
Article in English | EMBASE | ID: covidwho-1855901

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has been declared a global health emergency. Reports of thousands of cases with morbidity and mortality continue to increase every day. The clinical course of patients with comorbidities influences the prognosis and progression of the COVID-19 disease. Hypertension is the most common comorbidity of COVID-19 patients with long hospitalizations. AIM: This study aimed to determine the clinical differences between COVID-19 patients comorbid and non-comorbid. METHODS: The study was conducted retrospectively through samples of medical records of inpatients for the period June 1, 2021–August 31, 2021. The samples were divided into comorbid and non-comorbid groups;each totaling 130 medical records. The sample of the comorbid group was selected by simple random;while the non-comorbid group with the matching process. Data were analyzed using t-test and Wilcoxon. RESULTS: The most common comorbid is hypertension with clinical manifestations of cough, fever, headache, runny nose, painful swallowing, anosmia, shortness of breath, nausea, vomiting, and diarrhea. The average length of stay for patients with comorbidities was 21 days and without comorbidities 14 days. The test results showed that there were clinical differences between patients with comorbid and non-comorbid patients with p = 0.0000 (p > 0.05) and there was a difference in length of stay with p = 0.001 (p > 0.05). CONCLUSION: The clinical difference between COVID-19 patients comorbid and non-comorbid lies in the symptoms of headache with a longer duration of treatment, which is 22 days. More intensive treatment and care is needed for COVID-19 patients with comorbid hypertension.

12.
Open Forum Infectious Diseases ; 8(SUPPL 1):S687-S688, 2021.
Article in English | EMBASE | ID: covidwho-1746317

ABSTRACT

Background. SARS CoV2 infection produces clinical manifestations of different severity. The pediatric population represents less than 10% of cases, with a mortality of less than 1%. The severity of the condition and mortality are mainly associated with comorbidities. There is controversy about the correlation between the viral load of SARS CoV2 in respiratory samples and the evolution and severity of the clinical picture. The CT (cycle threshold) in the detection of the SARS CoV 2 genome in respiratory samples can be used as an indirect indicator of the viral load in the analyzed samples. Goals. to determine the correlation between the SARS CoV 2 CT values in the detection of the viral genome with the severity of the clinical picture. Describe the clinical, epidemiological, and laboratory characteristics of patients with PCR-confirmed SARS CoV2 infection in respiratory samples. Methods. A retrospective, observational and analytical study that included patients under 15 years of age with confirmed SARS CoV2 infection by PCR of respiratory samples treated at the Hospital Isidoro Iriarte in the city of Quilmes between March 1 2020 and April 30, 2021. Results. 485 patients (n) were included. The distribution by severity of the clinical picture was mild (84%, n = 408), moderate (12%, n = 59) and severe (4%, n = 18). Comorbidities were more frequent among patients with moderate and severe symptoms. Viral load was associated with severity of clinical manifestations. Patients with moderate and severe COVID19 required hospital admission more frequently for a longer time, the use of supplemental oxygen and antibiotics were more frequent in patients with moderate and severe symptoms. Symptoms of lower respiratory tract infection such as cough and respiratory distress were more frequent in patients with moderate and severe symptoms. No patient required admission to the ICU or mechanical ventilation. No patient died. Conclusion. In this study, patients with moderate and severe COVID19 infection had a higher viral load in respiratory samples, a higher frequency of comorbidities, a higher frequency of hospitalization and a longer hospital stay. Lower respiratory symptoms were associated with moderate and severe symptoms, while odynophagia, vomiting, and diarrhea were associated with mild clinical symptoms.

13.
Viruses ; 14(3)2022 03 06.
Article in English | MEDLINE | ID: covidwho-1732246

ABSTRACT

Omicron is the most mutated SARS-CoV-2 variant-a factor that can affect transmissibility, disease severity, and immune evasiveness. Its genomic surveillance is important in cities with millions of inhabitants and an economic center, such as Mexico City. Results. From 16 November to 31 December 2021, we observed an increase of 88% in Omicron prevalence in Mexico City. We explored the R346K substitution, prevalent in 42% of Omicron variants, known to be associated with immune escape by monoclonal antibodies. In a phylogenetic analysis, we found several independent exchanges between Mexico and the world, and there was an event followed by local transmission that gave rise to most of the Omicron diversity in Mexico City. A haplotype analysis revealed that there was no association between haplotype and vaccination status. Among the 66% of patients who have been vaccinated, no reported comorbidities were associated with Omicron; the presence of odynophagia and the absence of dysgeusia were significant predictor symptoms for Omicron, and the RT-qPCR Ct values were lower for Omicron. Conclusions. Genomic surveillance is key to detecting the emergence and spread of SARS-CoV-2 variants in a timely manner, even weeks before the onset of an infection wave, and can inform public health decisions and detect the spread of any mutation that may affect therapeutic efficacy.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/epidemiology , Cities/epidemiology , Genomics , Humans , Mexico/epidemiology , Phylogeny , SARS-CoV-2/genetics
14.
Gastroenterology ; 160(6):S-160, 2021.
Article in English | EMBASE | ID: covidwho-1597728

ABSTRACT

Background/Aims: Digestive symptoms are common in patients with COVID-19. Neverthe-less, the evidence available so far is based on retrospective and observational studies. This prospective multicenter cohort study aimed to describe the frequency, intensity, evolution, and impact of digestive symptoms and complications, during hospitalization and after dis-charge, of patients with COVID-19. Methods: Patients hospitalized due to COVID-19 (posi-tive PCR for SARS-CoV-2) from May to August 2020, were prospectively recruited in 31 centers. Follow-up included the period between admission and 15 days after discharge. Results: 829 patients (mean age 56.7±17.9 years;42% of females) were enrolled in this study. Of these, 7.2% were active smokers and the mean BMI was 29.1±5.7. Proton pump inhibitors were used by 21.5% (n=178). The most prevalent symptoms on admission were diarrhea (39.4%), nausea (27.4%), and abdominal pain (20.7%). Anorexia, a non-specific symptom, was present in 49.8% of hospitalized patients. At discharge and 15 days after discharge, most symptoms resolved, returning to the baseline prevalence of patients (<5%). Digestive complications during admission were infrequent, except for liver injury defined as hypertransaminasemia which was present in 267 patients (32.3%). The mean length of hospital stay was 8 days (5-12) and 13.6% needed ICU admission. Death happened in 5.2%of patients. On multivariate analysis, diarrhea on admission was associated with a shorter hospital stay (<10 days) ORa 0.508 (0.350-0.739) p=0.000. During hospitalization, diarrhea, constipation, and abdominal bloating were associated with shorter hospital stay ORa 0.531 (0.298-0.946) p=0.032, ORa 0.384 (0.167-0.885) p=0.025, ORa 0.163 (0.057-0.466) p= 0.00, respectively.Odynophagia and dysphagia during hospitalization were associated with a higher need for ICU admission, ORa 6.518 (2.255-18.835) p=0.001 and ORa 4.035 (1.453-11.204) p=0.007, respectively. Liver injury during hospitalization was associated with a higher hospital stay (>10 days) ORa 1.442 (1.019-2.041) p=0.039. In the linear regression analysis, the set of GI symptoms and complications, along with age, comorbidity, and respiratory symptoms, were able to predict 43% (R2 0.43) of the observed variability in the speed of ICU admission;in this case, digestive symptoms slowed it down (more days until ICU admission). Conclusions: Gastrointestinal manifestations of COVID-19 are common in hospitalized patients, while complications are infrequent. Gastrointestinal symptoms seemed to predict a shorter hospital stay and slower speed of ICU admission. These tend to resolve to their baseline prevalence 15 days after discharge, while elevated transaminases were associated with a longer hospital stay. Odynophagia and dysphagia during hospitaliza-tion were associated with an increased need for ICU admission.

15.
Gastroenterology ; 160(6):S-191, 2021.
Article in English | EMBASE | ID: covidwho-1597396

ABSTRACT

ntroduction: Since the COVID 19 infection has been declared a pandemic by the World Health Organization, the spectrum of symptoms have been described, however, the presence of digestive symptoms as part of the probable sequelae of the disease has not been well studied. Objective: To determine the variables present during the active stage period of the COVID 19 infection and their association with symptoms of dyspepsia during the recovery period. Material and methods: An online survey was conducted to patients recovered from COVID 19 infection during the months of May and June 2020, evaluating the demographic variables of age, sex and comorbidities, the presence of COVID 19 infection symptoms during the disease active stage and digestive symptoms during recovery. Using SPSS version 22, univar-iate and multivariate logistic regression analysis was performed to determine the variables associated with the presence of dyspeptic symptoms such as early satiety, epigastric pain and postprandial fullness during recovery from the disease (4 weeks after the infection resolved). Results: A total of 315 patients recovered from COVID 19 infection were evaluated, mainly 59.6% from Baja California, 12.2% from Sonora, 7.8% CDMX, 6% Sinaloa, 3% Veracruz with an average age of 35.7 ±11.5 years of age, 65.4% female, with obesity comorbidities in 19.6% of cases, high blood pressure in 10.9%, asthma in 7.1% and diabetes mellitus in 2.2%. The most frequent symptoms reported of the disease were headache 79.5 %, myalgias 64.1%, diarrhea 60.9%, anosmia 62.2%, fever 57.1%, ageusia 58.7%, odynophagia 56.1%, arthralgias 54.7%, anorexia 52.6%, cough 49.7%, chest pain 39.4%, dyspnea 28.5%. Dyspep-sia in the recovery period was reported with pain in 18.6%, postprandial fullness 34.3%and early satiety in 52.2%. It was found that the variables independently associated with the presence of postprandial fullness during recovery from the disease are male (OR 0.544,IC 0.309-0.958, P = 0.035), anorexia (OR 3.07, IC 1.73-5.45, P <.001) and diarrhea (OR 1.87. IC 1.04-3.34, P = 0.034). The variable associated with the presence of satiety during recovery from the disease is the presence of anorexia (OR 6.65, CI 3.75-11.79, P <0.001). The presence of epigastric pain after COVID 19 infection is associated with diarrhea (OR 3.32, IC 1.42-7.79, P = 0.006), arthralgia (OR 3.15, IC 3.15-1.16-8.55, P = 0.026), treatment with azithromycin ( OR 2.29, IC 1.13-4.64, P = 0.021), chlorine dioxide treatment (OR 11.35, IC 2.69-47.9, P = 0.001).Conclusions: The presence of dyspepsia after infection by COVID 19 is frequent, some of the associated variables are similar to those reported in other cases of post-infectious dyspep-sia, the use of medications has an important relationship with the presence of epigastric pain.

16.
Gut ; 70(SUPPL 4):A136, 2021.
Article in English | EMBASE | ID: covidwho-1554179

ABSTRACT

Introduction Waiting times for endoscopy are rising rapidly following the COVID-19 pandemic. In addition, cancers may be missed as patients are placed on routine waiting lists but not monitored. Some hospitals use the Edinburgh Dysphagia Score to assess and prioritise patients for investigation. This offers a sensitivity of 98.4% and specificity of 9.3% to detect malignancy in patients presenting with dysphagia.4 However, it is not designed for detecting gastric cancer. We aimed to create a more accurate screening questionnaire as an aid to triaging referrals. Methods Patients were recruited as part of the Saliva to Predict rIsk of disease using Transcriptomics and epigenetics (SPIT) study. Patients were recruited from 2 week-wait suspected upper gastrointestinal cancer pathway referrals at 20 hospitals in the United Kingdom. The cohort was further enriched with patients found to have oesophageal adenocarcinoma on emergency hospital admission. They completed over 200 questions about a wide variety of symptoms and risk factors. After data cleaning, 800 patients were available for evaluation. Of these, 80 had upper GI cancer. A machine learning model was developed to identify those at highest risk of having upper GI cancer using a 'cost-based' approach which maximises the chance of detecting cancer. Information gain was followed by correlated feature selection and a multivariable logistic regression curve was created with scores from 0 (cancer very unlikely) to 100 (cancer very likely). The training dataset used 80% of the data and the model was tested with the other 20%. Results 20 features were found to be important and reproducible. They included age, sex, dysphagia, odynophagia, early satiety, weight loss, duration of chest pain and regurgitation, frequency of acid taste in the mouth, a previous history of smoking, cancer or psychological disorders, current anxiety level and frequency of vegetable intake. The area under the receiver operator curve to detect cancer was 0.83. 50% of cancers scored greater than 85 whereas 50% of normals scored less than 25. At a cut-off score of 10, sensitivity was 98.7% with specificity 26.8% to detect cancer (figure). Conclusions We have created a simple, reproducible risk score to identify patients at high and low risk of upper GI cancer. It performs better than previous scores but now needs testing in the real world. It might be usable to both upgrade routine patients to urgent endoscopy and remove patients at very low risk from waiting lists, thereby helping to prioritise patients with a greater clinical need and reducing the endoscopic backlog.

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Ear Nose Throat J ; : 1455613211012114, 2021 May 11.
Article in English | MEDLINE | ID: covidwho-1223689

ABSTRACT

OBJECTIVE: As a result of the COVID-19 pandemic that occurred in the last year, it has been revealed that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) does not only cause viral respiratory tract infection but can also affect many organs in the short or long term. In our study, we aimed to reveal that COVID-19 infection affects the endocrine system and triggers subacute thyroiditis (SAT) in the acute period. MATERIAL AND METHOD: In our retrospective study, the ear-nose-throat examination, internal diseases consultation (investigation of COVID-19 symptoms and polymerase chain reaction [PCR] test), routine blood tests, T3, T4, thyroid-stimulating hormone, antithyroglobulin (anti-TG), antithyroid peroxidase (anti-TPO), thyroid scintigraphy, and thyroid ultrasonography results of 5 patients who applied to the otorhinolaryngology clinic due to complaints of neck pain and odynophagia between April 2020 and February 2021 were examined. FINDINGS: All 5 patients were female patients (30.4 years) with odynophagia and pain in the front lower region of the neck. These patients had no previous history of thyroiditis. COVID-19 PCR tests of the patients diagnosed with SAT were positive, and there were no typical COVID-19 signs and symptoms except odynophagia and neck pain. RESULT: It comes in view that SARS-COV-2 affects thyroid functions and causes SAT and the main symptoms in patients are pain in the neck and odynophagia.

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