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1.
Osteopathic Family Physician ; 13(4):19-23, 2021.
Article in English | EMBASE | ID: covidwho-1822743

ABSTRACT

Upper respiratory tract infections (URI) are prevalent in the United States. URIs can also be debilitating and costly. The most common etiology for an URI is viral, and there are currently no antiviral medications for the common cold. Therefore, cost-effective preventative measures are essential in the prevention of URIs. This literature review intends to compare the few studies evaluating the effectiveness of saltwater gargle for preventing URIs. The goals of this review include commenting on the potential for a saltwater gargle in preventing URIs, shortcomings of the few studies performed and recommendations for further research in evaluating saltwater gargle as an effective prevention method. This review looks explicitly at three studies evaluating the effectiveness of saltwater gargling and the prevention of URIs. Conclusions derived from this review include both physiological and clinical evidence of the potential for saltwater gargling in URI prevention. The first two studies demonstrate patient-derived evidence for saltwater gargling, potentially providing a decreased risk of URI when used preventatively. The third study demonstrates the potential for polymerase chain reaction (PCR) in evaluating the effectiveness of saltwater gargling in reducing the duration of illness. Additionally, in the wake of the COVID-19 pandemic, cost-effective treatment options targeting viral URIs, such as SARS-CoV-2, warrant further evaluation and discussion.

2.
Antibiotics ; 11(4), 2022.
Article in English | EMBASE | ID: covidwho-1822410

ABSTRACT

The containment measures following COVID-19 pandemic drastically reduced airway infections, but they also limited the access of patients to healthcare services. We aimed to assess the antibiotic prescription patterns in the Italian paediatric primary care setting before and after the containment measures implementation. For this retrospective analysis, we used a population database, Pedianet, collecting data of patients aged 0–14 years enrolled with family paediatricians (FP) from March 2019 to March 2021. Antibiotic prescriptions were classified according to WHO AWaRe classification. An interrupted time series evaluating the impact of the containment measures implementation on the monthly antibiotic index, on the access to watch index, and on the amoxicillin to co-amoxiclav index stratified by diagnosis was performed. Overall, 121,304 antibiotic prescriptions were retrieved from 134 FP, for a total of 162,260 children. From March 2020, the antibiotic index dropped by more than 80% for respiratory infections. The Access to Watch trend did not change after the containment measures, reflecting the propensity to prescribe more broad-spectrum antibiotics for respiratory infections even during the pandemic. Similarly, co-amoxiclav was prescribed more often than amoxicillin alone for all the diagnoses, with a significant variation in the trend slope for upper respiratory tract infections prescriptions.

3.
Archivos Venezolanos de Farmacologia y Terapeutica ; 41(1):8-12, 2022.
Article in Spanish | EMBASE | ID: covidwho-1818550

ABSTRACT

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus that was first identified in December 2019 in the city of Wuhan, Hubei province in the People’s Republic of China, the virus is transmitted from one person to another in the respiratory secretions that are dispersed when the infected person coughs, speaks or sneezes. With 10.93 deaths per million people from coronavirus as of April 6, 2020, Ecuador has one of the highest mortality rates from COVID-19 in Latin America, with only 7.46 Polymerase Chain Reaction tests. (RT-PCR) per 10,000 people. Pediatric cases were rare in the first days of the COVID-19 outbreak, but with the appearance of family aggregation, they began to appear, registering the first cases on March 27th. The pediatric group is always susceptible to upper respiratory tract infections because their immune system is developing. This report describes the epi-demiological situation of pediatric patients in Ecuador, where it was shown that adolescents aged 15 to 18 years were more susceptible to contracting COVID-19 and the group with the highest mortality was from 0 to 9 years old, it was also shown that of the total diagnostic tests performed, 63.6% were RT-PCR tests and 36.3% were rapid tests.

4.
Egyptian Journal of Radiology and Nuclear Medicine ; 53(1), 2022.
Article in English | EMBASE | ID: covidwho-1817311

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was declared a pandemic by the World Health Organization on 11 March 2020 has been reported in most countries around the world since its origins in Wuhan, China. As of September 2021, there have been over 229 million cases of COVID-19 reported worldwide, with over 4.7 million COVID-19–associated deaths. Body: The devastating second wave of the COVID-19 pandemic in India has seen a rise in various extrapulmonary manifestations. One of key components in the pathogenesis of COVID-19 is downregulation of ACE-2, which is expressed on many organs and counterbalances the pro-inflammatory effects of ACE/angiotensin-II axis. This leads to influx of inflammatory cells into alveoli, increased vascular permeability and activation of prothrombotic mediators. Imaging findings such as ground glass opacities, interlobular septal thickening, vascular dilatation and pulmonary thrombosis correlate well with the pathogenesis. Conclusion: We hypothesize that the systemic complications of COVID-19 are caused by either direct viral invasion or effect of cytokine storm leading to inflammation and thrombosis or a combination of both. Gaining insights into pathobiology of SARS-CoV-2 will help understanding the various multisystemic manifestations of COVID-19. To date, only a few articles have been published that comprehensively describe the pathophysiology of COVID-19 along with its various multisystemic imaging manifestations.

5.
Front Public Health ; 10: 843850, 2022.
Article in English | MEDLINE | ID: covidwho-1785447

ABSTRACT

A great number of patients with Coronavirus Disease 2019 (COVID-19) experience olfactory dysfunction, typically of a short duration and with a high incidence rate, during the early stages of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This kind of olfactory dysfunction appears more likely in young people and women. This study presents a review of the clinical features and pathogenic mechanism of the olfactory dysfunction related to SARS-CoV-2 infection, aiming to provide a clinical reference for the diagnosis, differential diagnosis, treatment, and prevention of olfactory dysfunction in COVID-19 patients.


Subject(s)
COVID-19 , Olfaction Disorders , Adolescent , Female , Humans , Olfaction Disorders/etiology , SARS-CoV-2 , Smell
6.
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.

7.
Leukemia and Lymphoma ; 62(SUPPL 1):S40-S42, 2021.
Article in English | EMBASE | ID: covidwho-1747051

ABSTRACT

Introduction: TG-1701 is a selective, covalent BTK inhibitor administered once daily (QD). Both the 'U2' combination (anti-CD20 mAb ublituximab+the PI3Kd-CK1e inhibitor umbralisib) and BTK inhibitors are highly efficacious in treatment- naïve (TN) and relapsed/refractory (R/R) CLL, each having previously demonstrated superiority over standard chemoimmunotherapy. Here, we report results for patients treated with TG-1701 alone or in combination with U2 from an ongoing Phase 1 study, with a focus on patients with CLL. Methods: Patients with R/R CLL and B-cell non-Hodgkin lymphoma were enrolled in an ongoing Phase 1 study initially evaluating dose escalation (DE) of oral TG-1701 QD continuously administered in 28-day cycles (100, 200, 300, and 400 mg). After characterizing the safety profile of TG-1701 monotherapy, we implemented a parallel DE arm of TG-1701+U2. Select dose levels of TG-1701 monotherapy were also expanded. All patients were treated until disease progression, unacceptable toxicity, or investigator/patient decision to withdraw. Safety was evaluated in all treated patients, and efficacy was evaluated in all treated patients with CLL who had at least 1 post-baseline assessment. Results: As of 30 April 2021, 125 patients were treated with TG-1701, 49 of whom had CLL. Enrollment was: 25 patients in the monotherapy DE arm (6 with CLL), 61 in the 200-mg disease-specific cohorts (20 CLL [5 TN], 21 mantle cell lymphoma [MCL, 4 TN], 20 Waldenström's macroglobulinemia [WM, 8 TN]), 20 in the 300-mg CLL cohort (4 TN), and 19 in the 1701+U2 DE arm (3 with CLL). Patients with MCL or WM in the 200-mg disease-specific cohorts were excluded from this analysis. The median # of prior therapies among CLL patients was 1 (range, 0-5) and all patients were BTKi-naïve. TG-1701 was well-tolerated and the maximum tolerated dose for monotherapy was not reached up to 400mg (near 100% saturation of the BTK at all dose levels studied). In the DE arms, the most common all-causality treatment-emergent adverse events (TEAE) were constipation (32%), increased ALT (28%), bruising (28%), and upper respiratory tract infection (28% of patients) with TG-1701 monotherapy;diarrhea (53%) and bruising (42%) with TG-1701+U2. Grade 3/4 AEs were limited. In the CLL-specific cohorts, the most common TEAE was increased ALT/AST (all grades, 17.5%;grade 3, 2.5%;grade ≥4, none), followed by diarrhea (all grades, 12.5%;grade ≥3, none), and COVID-19 (all grades, 12.5%;grade 3-4, none;grade 5, 7.5%). There were no cases of atrial fibrillation, major bleeding, or ventricular tachyarrhythmia in the CLL cohorts at a median follow-up of 10.5 months. TEAEs leading to TG-1701 dose reduction occurred in 7.5% of patients. TEAEs leading to treatment discontinuation occurred in 7.5% of patients (all COVID-19). At the data cut-off, 48 patients with CLL were evaluable for response, including nine in DE. ORR was 95.6% for TG-1701 monotherapy (all PR/PR-L) and 100% for TG-1701+U2 (all PR). The median duration of response has not been reached in either cohort. The best change from baseline in tumor burden in patients with CLL is presented in Figure 1, and treatment exposure and response duration data are presented in Figure 2 below. In patients with anemia and thrombocytopenia at baseline, sustained improvement in hematologic variables was observed in the 200- and 300-mg cohorts. Lymphocytosis was observed in 70% of the monotherapy patients, with a resolution to normal or <50% of baseline in 57.1%. Consistent response rates were observed across all subgroups, including age and high-risk genomic features, such as del17p/TP53, unmutated immunoglobulin heavy-chain variable-region (IGHV), and complex karyotype (defined as three or more cytogenetic abnormalities). Time to event data will be reported at the time of presentation. Conclusions: TG-1701 exhibits an encouraging safety and efficacy profile in patients with CLL, with promising activity and a manageable tolerability profile as monotherapy and in combination with U2 (Figure 1). Future registration trials ar being planned in CLL with TG-1701. Recruitment to this study (NCT03671590) continues.

8.
Open Forum Infectious Diseases ; 8(SUPPL 1):S176, 2021.
Article in English | EMBASE | ID: covidwho-1746736

ABSTRACT

Background. The majority of human antimicrobial utilization occurs in the outpatient setting. Despite being mainly viral in etiology, upper respiratory tract infections (URIs) were the most common indication for outpatient antimicrobial prescriptions at our institution. Methods. Through our electronic health record (EHR), we were able to determine our rate of antibiotic prescriptions for inappropriate URI diagnosis at our primary care practice sites. We selected staff volunteers from each our primary care practice sites to serve as stewardship champions. They were given training in stewardship best practices, and an URI stewardship toolkit which included viral URI prescription pad, EHR order panel, and patient education signage. They were tasked with providing education and feedback to their practice sites. We meet with them on a monthly basis to disseminate prescribing data and education. They also provided feedback from practice sites to the stewardship committee. Results. Our decentralized model was put in place in November 2020. In the 6 months prior to the intervention, the average prescribing rate was 29.1%. In the 6 months after the intervention, the average prescribing rate decreased by 15% to 24.8%. During the intervention phase, there was an increase in number of non-COVID URIs diagnosed at our primary care sites. Temporal Trend in Inappropriate Antibiotics Prescribing Rates for Viral URIs Preand Post- Intervention Inappropriate antibiotic prescribing rate for viral upper respiratory tract infections from May 2020 until May 2021. Intervention started in December 2021 (arrow). Preintervention average was 29.1%. Post-intervention age was 24.8% which is a 15% decline in prescribing rate. Viral Upper Respiratory Infections Visits The total number of visits for presumed viral upper respiratory infections to primary care sites from May 2020 until May 2021. The majority of COVID-19 precautions in the area expired at the end of March 2021. Conclusion. We have been able to lower our inappropriate prescriptions for URIs utilizing a decentralized model of stewardship champions. This result was especially notable as the intervention phase corresponded with the end of COVID-19 precautions and an increase in non-COVID URIs diagnosed. The advantage of this approach includes an advocate embedded at each practice site who is familiar with the opportunities and challenges of the site, and a two-way flow of information from practice sites to the stewardship committee. This model provided additional benefit during the COVID-19 pandemic as the ability of centralized staff to travel to off campus clinic sites was curtailed.

9.
Open Forum Infectious Diseases ; 8(SUPPL 1):S574, 2021.
Article in English | EMBASE | ID: covidwho-1746342

ABSTRACT

Background. Antimicrobial resistance is increasing at an alarming rate. Patient education is a critical component of stewardship and many patients access resources online. TikTok is a video-sharing social media platform with 700 million monthly users and contains videos that discuss health information. The objective of this study was to evaluate antibiotic-themed TikTok videos for their validity and reliability. Methods. In March 2021, a search on TikTok using the term "antibiotics" was performed and the top 300 consecutive videos were identified. Data collected included: number of likes, associated disease state, medications, educational aim, mention of COVID-19, and if performed by a healthcare professional (HCP). Non-English videos were excluded. The DISCERN score was used to evaluate all videos for reliability. Results. The first 300 consecutive videos were assessed using the DISCERN score. Of the 300 videos, most (n=224) were not created by HCPs (non-HCPs). The number of "likes" per video ranged from 1 like to 2 million likes with a mean of 34,949 ± 143,482. Videos produced by HCPs were significantly more valid and reliable (mean DISCERN score of 1.65 vs 1.17, p < .00001) than non-HCPs. They were found to be more relevant (p< .00001), have clearer aims (p< .00001), and were more balanced/unbiased (p=.00188). Videos created by HCPs were more likely to have an educational focus (p< .0001). There was no difference between groups in clarity of sources utilized or risk/benefits discussed of each treatment. Across all videos, the most common disease states mentioned were urinary tract infection, skin and soft tissue infection, and upper respiratory tract infection. Natural products, penicillins, and sulfa antibiotics were the most commonly discussed medications. Conclusion. Videos created by HCPs were significantly more valid and reliable than those created by non-HCPs. The videos created by HCPs were also more likely to have clear aims and be more relevant. However, the majority of the videos evaluated were created by non-HCPs. It may be beneficial for HCPs to provide TikTok videos that are valid and reliable for patient education.

10.
Open Forum Infectious Diseases ; 8(SUPPL 1):S801-S802, 2021.
Article in English | EMBASE | ID: covidwho-1746284

ABSTRACT

Background. As part of our outpatient Antimicrobial Stewardship Program, we do surveillance of diagnoses and antibiotic use for common upper respiratory tract infections such as acute upper respiratory tract infection, acute bronchitis, sinusitis, and pharyngitis. We sought to evaluate the impact of the Covid-19 pandemic on the incidence rate of upper respiratory tract infection diagnoses per clinic visit during October 2020 to March 2021 season compared to the three prior respiratory seasons. We also sought to reflect of impact of increase in televisits and overlapping symptoms of COVID 19 and upper respiratory tract infections. Methods. Our cohort study extending from October 2017 to March 2021. We collected number of diagnoses of upper respiratory infections and number of unique clinic visits during four consecutive respiratory seasons at our primary care sites via electronic health records. Results. During the recent October 2020 to March 2021 respiratory season which coincided with the second NYC Covid-19 wave, we had 11569 unique clinic visits and 39 diagnoses of an upper respiratory tract infection - incident rate of 1.29. In the three prior respiratory seasons combined, we had 40939 unique clinic visits and 833 diagnoses of an upper respiratory tract infection - incident rate of 1.49. The incident rates showed a dramatic decline using the test based method and the chi square-statistic p< 0.0001 with an incident rate ratio using a poisson exact method of 6.0359. Statistical comparisons of the current season to each prior individual season yielded similar results. The percentage of Tele-visits during the current season was 19% compared to 0% in the 3 prior seasons. Conclusion. During the first respiratory season from October 2020 to March 2021 in midst of the Covid-19 pandemic which also coincided with the second Covid-19 wave in New York, we saw a statistically significant decrease in incidence of common upper respiratory tract infection diagnoses per clinic visit compared to the three prior respiratory seasons. Overlapping signs and symptoms of upper respiratory tract infections and Covid-19 with the added percentage in Tele-visits did not cause an increase in incidence rates of upper respiratory tract infection diagnoses. Covid-19 related mitigation efforts may have played a role.

11.
Open Forum Infectious Diseases ; 8(SUPPL 1):S266-S267, 2021.
Article in English | EMBASE | ID: covidwho-1746671

ABSTRACT

Background. Over 32 million cases of COVID-19 have been reported in the US. Outcomes range from mild upper respiratory infection to hospitalization, acute respiratory failure, and death. We assessed risk factors associated with severe disease, defined as hospitalization within 21 days of diagnosis or death, using US electronic health records (EHR). Methods. Patients in the Optum de-identified COVID-19 EHR database who were diagnosed with COVID-19 in 2020 were included in the analysis. Regularized multivariable logistic regression was used to identify risk factors for severe disease. Covariates included demographics, comorbidities, history of influenza vaccination, and calendar time. Results. Of the 193,454 eligible patients, 36,043 (18.6%) were hospitalized within 21 days of COVID-19 diagnosis, and 6,397 (3.3%) died. Calendar time followed an inverse J-shaped relationship where severe disease rates rapidly declined in the first 25 weeks of the pandemic. BMI followed an asymmetric V-shaped relationship with highest rates of disease severity observed at the extremes. In the multivariable model, older age had the strongest association with disease severity (odds ratios and 95% confidence intervals of significant associations in Figure). Other risk factors were male sex, uninsured status, underweight and obese BMI, higher Charlson Comorbidity Index, and individual comorbidities including hypertension. Asthma and overweight BMI were not associated with disease severity. Blacks, Hispanics, and Asians experienced higher odds of disease severity compared to Whites. Conclusion. Odds of hospitalization or death have decreased since the start of the pandemic, with the steepest decline observed up to mid-August, possibly reflecting changes in both testing and treatment. Older age is the most important predictor of severe COVID-19. Obese and underweight, but not overweight, BMI were associated with increased odds of disease severity when compared to normal weight. Hypertension, despite not being included in many guidelines for vaccine prioritization, is a significant risk factor. Pronounced health disparities remain across race and ethnicity after accounting for comorbidities, with minorities experiencing higher disease severity.

12.
Open Forum Infectious Diseases ; 8(SUPPL 1):S354, 2021.
Article in English | EMBASE | ID: covidwho-1746493

ABSTRACT

Background. Targeted reduction of SARS-CoV-2 viral load in the nose may mitigate the severity of lower tract respiratory disease as well as reduce hospitalization and mortality rates. Nasal Photodisinfection has been deployed for 10 years in Canadian hospitals reducing post-surgical infections. The objective of thiswork was to demonstrate effectiveness of APDT in early stage COVID-19 and asymptomatic carriers. Methods. A cohort of 40 COVID-19 positive patients were treated with nasal photodisinfection (Steriwave) at a private clinic. All patients were previously identified by PCR as SARS-CoV-2 positive and admitted into the treatment cohort. BD rapid antigen nares testing was used before and after Photodisinfection treatment. Of the 40 patients, 13 were female and 27 were male. Age range was 9- 56 years of age. Treatment involved 3-4 applications of photosensitizer and 16-24 minutes per patient of treatment time. Patients were followed up within 24 hours, 48 hours as well as day 5 and 6 and day 10/11. Patients filled out a COVID-19 score card. Results. Results demonstrated APDT was capable of significant and rapid viral load reduction in COVID-19 carriers. 100% of patients were converted from positive rapid antigen test to negative. 60% of patients reported fever resolution within 24 hours. Fever resolution occurred in 100% of patients within 48hours. Moreover, results demonstrated accelerated resolution of COVID-19 symptoms and significantly improved mental health benefits from reduction of COVID-19 related stress and anxiety. None of the patients experienced severe symptoms and no patients were hospitalized. Safety outcomes demonstrated no patient safety issues with only minor transient side effects (rhinorrhea, sneezing) observed. Moreover, the treatment procedure was pain-free and well tolerated by all patients. Conclusion. Photodisinfection-based nasal decolonization anti-viral efficacy was demonstrated with improved outcomes for all patients treated in this case series. Significant rapid viral load reduction was confirmed by rapid antigen tests in all patients. More clinical studies are warranted in support of Photodisinfection based therapy for upper respiratory infections such as COVID-19.

13.
J Clin Virol Plus ; 1(4): 100048, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1734704

ABSTRACT

BACKGROUND: The clinical epidemiology of hospitalized COVID-19 patients has never been described before in Lebanon. Moreover, the hospital admission and PCR positivity rates have not been assessed and compared yet. OBJECTIVES: To describe the characteristics and outcomes of hospitalized patients with coronavirus induced disease 2019 (COVID-19) in Lebanon and identify risk factors for severe disease or death. STUDY DESIGN: This is a retrospective mono-center cohort study in which we used patients' files to extract and analyse data on demographic and clinical characteristics, as well as mortality. Moreover, we tracked the pandemic by recording the daily total and ICU inpatient census and the PCR positivity rate for admitted and outpatients. RESULTS: Although the total admission rate increased from September to April, the ICU census switched this trend in December to stabilize at an average of around 10 patients/day until April. The case fatality rate was 19% for the 902 hospitalized patients, of which the majority (80%) had severe COVID-19. The severity odds ratio is significantly decreased in immunosuppressed cases (OR, 0.18; CI, 0.05-0.67; p=0.011). Additionally, the odds of COVID-19 related death are significantly greater if consolidations are found in the chest computed tomography (CT) scan (OR, 12; CI, 2.63-55.08; p=0.0013). CONCLUSION: Consolidations in the lungs significantly increase the COVID-19 death risk. Risk factors identification is important to improve patients' management and vaccination strategies. In addition, hospital statistics are good indicators of a pandemic's track.

14.
Annals of Allergy, Asthma and Immunology ; 127(5):S66, 2021.
Article in English | EMBASE | ID: covidwho-1734157

ABSTRACT

Introduction: The risk of toxic epidermal necrosis (TEN) depends on both drug and host factors, such as autoimmune disease. We present a case of TEN in a patient with recently diagnosed macrophage activation syndrome (MAS). Case Description: A 23-year-old previously healthy woman was admitted multiple times over 4 weeks for spiking fevers, cervical lymphadenopathy, and macular rash. Her symptoms began one week after her second SARS-CoV-2 mRNA vaccine and did not respond to outpatient treatment with azithromycin and steroids for presumed upper respiratory infection. Extensive infectious evaluation was unrevealing. She had elevated liver enzymes, cytopenias, lymphadenopathy, and splenomegaly. Lymph node and bone marrow biopsies were unrevealing. Further evaluation demonstrated elevated triglycerides, ferritin, and soluble IL-2 receptor. Natural killer cell function was normal. IL-18 was markedly elevated (181,803 pg/mL) supporting the diagnosis of adult-onset Still’s disease with MAS. Dexamethasone and anakinra were initiated on day 29 of illness with prophylactic atovaquone and pantoprazole. Her symptoms and labs improved until day 57 of illness when she developed a diffuse, painful, blistering maculopapular rash consistent with TEN. Potential culprit drugs were held (pantoprazole, atovaquone, and cephalosporins) and she received a short course of IVIG and cyclosporine in addition to anakinra and steroids. She required prolonged hospitalization for wound care and rehabilitation. She has recovered well and remains on prednisone and canakinumab. Discussion: The widespread innate immune activation from MAS, possibly triggered by preceding vaccination, may have augmented her risk of developing TEN. Treatment was therefore directed towards ongoing MAS in addition to TEN. [Formula presented]

15.
Developmental Medicine and Child Neurology ; 64(SUPPL 1):17, 2022.
Article in English | EMBASE | ID: covidwho-1723124

ABSTRACT

Acute encephalopathy with biphasic seizures and delayed diffusion changes (AESD) is an extremely rare syndrome outside Asia. AESD is diagnosed based on clinic-radiological correlation. Influenza or human herpesvirus 6 infection have been most commonly isolated in previously healthy children with AESD and there is possible correlation with genetic abnormalities such as mutations in the SCN1A gene. We report a 2 year old previously fit and well white female who presented febrile status epilepticus at day 3 of an upper respiratory tract infection with subsequent prolonged left facial palsy and left hemiparesis. Brain MRI on day 4 showed swelling and diffusion restriction of the right hippocampus, without any other focal abnormality or signs of ischaemia. On day 6 she presented clusters of focal left sided seizures, non-responding to treatment Levetiracetam and sodium valproate add on. Repeated brain MRI on 7 showed prolonged and diffuse diffusion restriction over the whole right hemisphere, which along with the characteristic clinical presentation led to the diagnosis of AESD. She received high dose IV steroids with taper over 6 weeks starting on day 9. The seizures stopped on day 10 but motor function recovery was slow. CSF analysis showed no signs of infection. Nasopharyngeal swab was positive for Bocavirus and she had positive antibodies for SARS-COV-2 with negative PCR. Genetic investigations were requested and are pending. This case illustrates the importance of repeated brain imaging in abrupt onset refractory seizures with abnormal neurological examination which can lead to early diagnosis and treatment. More studies are needed to investigate the correlation between SARs-COV-2 or Bocavirus and AESD.

16.
Zeitschrift fur Gastroenterologie ; 60(1):e30, 2022.
Article in English | EMBASE | ID: covidwho-1721710

ABSTRACT

Background Chronic liver disease (CLD) patients, including those with ALD, are particularly susceptible to infections. Thus, respiratory infections such as seasonal flue or COVID 19 may be speculated to be a major threat to these patients. However, despite general recommendations for seasonal flu vaccinations systematic evaluations of the efficacy of such vaccinations are widely lacking. In the current pandemic, substantial evidence on the efficacy on vaccination against upper airway respiratory infection is essential to improve the outcome of patients with Alcoholic liver disease. Methods Evaluating a large cohort of patients with alcoholic liver disease form the USA with a total of 4667 patients, we investigated the efficacy of vaccination of patients with ALD. As quality of hepatological treatment may have significantly changed and improved over the past several decades the analysis was limited to the years 2000 to 2020. Results During the last decade vaccinations against several seasonal influenza A variants (H1N1 (p = 0.000), H3N2 (p = 0.000)), influenza B virus (p = 0.000), Massachusetts-2-2010-liver variant (p = 0.000), and B-Wisconsin-1-2010 (p = 0.006) variant all demonstrated a highly significant survival benefit for these patients. Discussion and Conclusion Vaccination against ongoing or seasonal viral upper airway infections improves survival of patients with ALD and should therefore be recommended and carried out consistently.

17.
Journal of Investigative Medicine ; 70(2):557-558, 2022.
Article in French | EMBASE | ID: covidwho-1698858

ABSTRACT

Case Report Hemophagocytic Lymphohistiocytosis (HLH) is an hyperinflammatory state due to hyperactivation of macrophages and T-cells which rarely affects adults. It can be familial or sporadic. Triggers are infections, auto-immune diseases, malignancies, and immune checkpoint inhibitors. HLH diagnostic criteria are fever, splenomegaly, bicytopenia, hypertriglyceridemia, hemophagocytosis, low/absent NK-cellactivity, elevated ferritin, and high-soluble interleukin-2-receptor (IL-2R). Five out of eight criteria are required for diagnosis. A 54-year-old female was noted to have leukopenia during a routine visit with her family physician. Follow up labs revealed worsening leukopenia, anemia and a normal platelet count. She received Amoxicillin/Clavulanic acid for a presumed upper respiratory infection and developed nausea, diarrhea and decreased appetite. She was referred to Hematology Oncology for leukopenia. During workup she developed fatigue, night sweats and high fevers. Workup revealed WBC 2400 mcL, microcytic anemia, transaminitis with lactate dehydrogenase of 1725 U/L and ferritin of >15000 ng/ mL . Peripheral blood smear showed leukopenia without immature cells or blasts and mild microcytic erythrocytes. Further tests detected CXCL-9 of 125050 pg/mL, D-dimer of >5000 ng/mL and interleukin-2-receptor of 20604 pg/ mL. EBV, CMV, HSV, HHV-6, parvovirus, bartonella, leishmaniasis, bacteria and COVID-19 were negative. Computed tomography of the chest, abdomen and pelvis did not reveal lymphadenopathy. Brain imaging showed no abnormalities. Cerebrospinal fluid cytology was unremarkable. Bone marrow biopsy (BMBX) showed prominent histiocytic phagocytosis of erythroid precursors and platelets. HLH-94 treatment protocol including weekly steroid and etoposide initiated. Patient's fever, night sweats and leukopenia resolved during hospitalization, with subsequent down trending of ferritin to 103 ng/ml, CXCL-2 to 2663 pg/mL and interleukin-2-receptor to 2,265 pg/mL. Repeat BMBX revealed significant improvement. HLH is a rare life-threatening diagnosis. This patient with nonspecific symptoms was diagnosed with HLH (fever, bicytopenia, elevated ferritin, high-soluble IL-2R and hemophagocytic lymphohistiocytosis on BMBX). Several HLH gene mutations were tested including PRF1, UNC13D, STXBP2, although none was mutated. No infectious, rheumatologic or oncologic triggers were detected. Early diagnosis and treatment are critical. Without treatment, survival is measured in months due to multiorgan failure. This syndrome rarely presents in the absence of triggers which may cause delay in diagnosis and successful treatment. 5-year overall survival with HLH 94 protocol is 54% as opposed to 0% prior to the advent of this protocol. Etoposide and steroids are the mainstay of HLH-94. Cyclosporine can be added in the maintenance phase and hematopoietic stem cell transplant is reserved for familial or relapsed HLH.

18.
Asian Journal of Pharmaceutical and Clinical Research ; 14(2):135-137, 2022.
Article in English | EMBASE | ID: covidwho-1689627

ABSTRACT

Objectives: COVID-19 outbreak is a major pandemic affecting many people worldwide, including India. The main clinical features of this disease are cough, fever, and myalgia, and in some cases, breathing difficulty. There are many non-specific symptoms also. Loss of smell (Anosmia) is one of the non-specific clinical features in many patients. The main objective of this study is to diagnose COVID-19 disease in patients presenting with loss of smell, which helps in early isolation of the patient and prevents the spread of infection to others before the diagnosis of COVID-19 is confirmed by RTPCR, which may take 2–3 days. Another objective of this study is to know the factors that influence recovery from anosmia. Methods: Data was collected from 105 patients who attended Outpatient Department/COVID Ward in GITAM Institute of Medical Sciences and Research, Rushikonda, Visakhapatnam, from April 2020 to August 2020. The follow-up study for factors influencing the recovery of anosmia was performed in 100 patients who tested positive for COVID-19 disease with loss of smell as a presenting feature. Results: Male, to female ratio of patients with upper respiratory infection and loss of smell was 64:36. Out of 105 patients, 27 were tested positive for COVID19. Thus, the prevalence of anosmia in COVID 19 patients was 28.35%. In the follow-up study, out of 100 patients, 34 patients showed complete recovery in 2 weeks, and 42 patients showed partial recovery in 2 weeks and complete recovery in 4 weeks, and 24 patients showed only partial or no recovery within 1 month from the onset of anosmia. Conclusions: The presence of anosmia can be considered as a non-specific clinical feature in COVID-19, and early identification and isolation of the patient will help in decreasing the spread of disease to other people before the COVID-19 diagnosis is confirmed. It also suggests that recovery from loss of smell is better in middle-aged and female patients. The recovery has been delayed in patients with comorbidities and older people.

19.
Blood ; 138:2640, 2021.
Article in English | EMBASE | ID: covidwho-1623627

ABSTRACT

Background: Continuous Bruton's tyrosine kinase (BTK) inhibition represents an effective and easily administered oral therapy for patients with CLL;however, it is not curative, can have serious side effects, and is expensive. Novel combinations may provide deep remissions allowing fixed duration therapy. The second generation BTK inhibitor acalabrutinib (ACALA) has demonstrated an improved safety profile compared to ibrutinib. Importantly, unlike ibrutinib, ACALA does not inhibit anti-CD20 monoclonal antibody dependent cellular phagocytosis (VanDerMeid et al, Cancer Immuno Res 2018). Using standard doses, rituximab (RTX) rapidly exhausts the finite innate immune system cytotoxic capacity (Pinney, et al Blood 2020) and also causes loss of cell membrane CD20 from CLL cells by trogocytosis. Previous studies have shown that high frequency low dose (HFLD) IV RTX (20mg/m 2 three times per week) was effective and limited loss of CD20 (Zent, et al Am J Hematol, 2014). Subcutaneous (SQ) RTX is FDA approved in CLL, has similar efficacy and pharmacokinetics, and can be self-administered. This phase II study tested the efficacy and tolerability of the combination of ACALA and HFLD RTX as initial treatment for patients with treatment-naïve CLL. Methods: Eligible patients were treated with 50mg RTX on day 1 and 3 of each week for six 28-day cycles. The first dose was administered IV over 2 hours. If tolerated, subsequent doses were SQ and could be self-administered at home by trained patients. ACALA 100mg BID therapy was initiated on cycle 1 day 8 for a minimum of 12 cycles. Treatment response was assessed during cycles 12 and 24. Patients achieving an iwCLL complete response (CR) with undetectable minimal residual disease (uMRD) by 6-color flow cytometry (£ 1:10 -4)at either time point could stop therapy. The primary objective was to determine the rate of iwCLL CR with a secondary endpoint of rate of uMRD. Results: 37 patients have been treated with a median follow-up of 14 months. Baseline demographics were male/female (22/15) and median age 67 years (range 40-78). High-risk genetic features included TP53 mutation (21.6%), del17p (13.5%), del 11q (16.2%), unmutated IGHV (62.2%), NOTCH1 mutation (21.6%) and SF3B1 mutation (10.8%). Grade 3/4 AEs occurring in ≥5% of patients were infections (13.5%), neutropenia (8.1%) and anemia (8.1%). No patients discontinued therapy due to AEs and there were no deaths on treatment. The most common (≥20%) AEs (all grades and all causality) were infusion-related reactions (62.1%), infections (56.8%) (upper respiratory infections in 29.7% of patients, urinary tract infections in 18.9%, COVID-19 pneumonia in 8.1%), fatigue (51.3%), anemia (51.3%), headache (43.2%), rash or other skin changes (32.4%), thrombocytopenia (29.7%), bruising (27.0%), and diarrhea (21.6%). Injection site reactions (8.1%) from SQ RTX were grade 1. Three patients contracted COVID-19 while on study during times of high community transmission prior to the availability of vaccines. Two required hospitalization, one contracted the virus following cycle 1 requiring a delay in RTX, and all patients remained on ACALA while COVID-19 positive. 27 patients have completed 12 cycles and been evaluated for response. All patients responded with 1 MRD+ CR, 20 partial responses (PR), and 6 PR with sustained lymphocytosis. 10 of these patients have completed 24 cycles and had a sustained PR. One patient with del17p and TP53 mutation had progressive disease after 25 cycles of therapy. All other patients remain on treatment per protocol. Conclusion: HFLD RTX and ACALA is a tolerable, effective and convenient therapy that could be the basis for regimens incorporating other novel agents. It is notable that three patients have contracted COVID-19 during the trial;however, none required intubation, and all remained on ACALA during their infection. This at-home combination markedly decreased patient infection risk during the COVID-19 pandemic. This regimen has the potential to enable RTX to be administered at facilities with limited medica IV infusion capacity which could be very useful in rural and economically disadvantaged areas. While all patients have responded to therapy, no patients to date have achieved an uMRD CR, suggesting that additional agents are required to allow for time-limited treatment. Disclosures: Baran: AstraZeneca/Acerta: Research Funding. Friedberg: Novartis: Other: DSMC;Acerta: Other: DSMC;Bayer: Other: DSMC. Reagan: Kite, a Gilead Company: Consultancy;Genentech: Research Funding;Seagen: Research Funding;Curis: Consultancy. Casulo: Verastem: Research Funding;Genentech: Research Funding;BMS: Research Funding;Gilead: Research Funding. Zent: TG Therapeutics: Research Funding;Acerta/AstraZeneca: Research Funding. Barr: Morphosys: Consultancy;Janssen: Consultancy;Bristol Meyers Squibb: Consultancy;AstraZeneca: Consultancy;Genentech: Consultancy;TG Therapeutics: Consultancy;Beigene: Consultancy;Seattle Genetics: Consultancy;Abbvie/Pharmacyclics: Consultancy;Gilead: Consultancy.

20.
Cogent Medicine ; 8, 2021.
Article in English | EMBASE | ID: covidwho-1617064

ABSTRACT

Introduction: Respiratory tract diseases are a major cause of morbidity and mortality in children. This study aimed to compare respiratory illness rates and aetiology requiring hospitalization in 2019 (pre-COVID lockdown in Ireland) and 2020 (during COVID lockdown in Ireland). Methodology: Data from medical admissions were retrospectively collected from the emergency department admissions record of a Tertiary Paediatric Hospital in Dublin, Ireland. This study focused on September, October and November in 2019 and 2020. The documented reason for admission in each case was noted;these were transcribed and grouped into categories. Reasons for admission under the category of respiratory included: bronchiolitis, lower respiratory tract infection, upper respiratory tract infection, wheeze, stridor and exacerbation of asthma. Rates of admission in this category were compared from 2019 versus 2020. Rates of investigative nasopharyngeal swabs for these admissions were documented, as well as the resultant viruses isolated. The results were compared across 2019 and 2020. Results: 1040 admission were included in the study. Of these, 620 were in 2019 and 420 in 2020. This alone shows a decrease of 32% in the admissions rate to Temple Street Children's hospital during COVID-19 restrictions. Of the 620 admissions across September, October and November 2019, 265 were attributed to respiratory illnesses (42.77%). In the same time period of 2020, only 67 admissions were attributed to respiratory causes (15.95%). This shows a dramatic decrease in the number of paediatric respiratory illnesses requiring hospital admission. There was a decrease in the number of respiratory panel nasopharyngeal swabs taken in 2020 compared to 2019, although 89% of respiratory admissions were swabbed for Sars-CoV-2 in 2020. Respiratory syncytial virus accounted for 54.60% of respiratory admissions swabbed in 2019 versus a 0% isolation rate in 2020. The table below further outlines virology differences between 2019 and 2020. (table) Conclusion: SARS-CoV-2 pandemic related social restrictions dramatically interfered with the seasonality of childhood respiratory illnesses. This was reflected in the unexpected reduction in the number of hospitalizations in the paediatric population during this period. There is also an obvious stark contrast in the viruses isolated in children presenting with respiratory illnesses in 2019 and 2020. This study raises serious questions and concerns regarding paediatric immunity to respiratory illnesses and begs the question: will we experience a more severe respiratory season in 2021?

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