The Effect of Novel D3 Compounds on Saliva Samples from COVID-19 Patients: A Lab Study (preprint)

Background: Saliva is one of the diagnostic tools available for dental fields due to its comfortable and noninvasive nature and greater patient acceptance of all ages, especially elderly individuals, children and cancer patients, when compared to the gold standard (swabs). As cancer incidence has been increasing worldwide, the discomfort, soreness, ulcerations and dryness a patient may suffer would divert our strategy toward novel ways for increasing patient acceptance of diagnostic tools and therapy, i.e., using saliva for such purposes. Many studies have shown the antimicrobial effects of vitamin D, one of which is its antiviral effects and role in the immune system. The aimof this study was to explore the antiviral effects of vitamin D on saliva samples collected from COVID-19-positive patients and to compare saliva and swab results to aid in the development of new policies to better serve these patients. Methods: Inclusion criteria were as follows: saliva and swab samples collected from adult patients with a positive test for COVID-19 at the KFSH-RC in Jeddah: Department of ER, Family Medicine and Inpatients. The exclusion criteria for patients were immunocompromised and pregnant, children and those younger than 18 years of age. D3 was made at different concentrations (100 IU, 300 IU, 800 IU and 1,200 IU) and was added to the first samples in the laboratory (n=20); the rest of the swab specimens were compared to the saliva samples via RT‒PCR (total n=257). Results: Of these, 236 participants (94.8%) had positive saliva sample test results, 7 (2.8%) had errors, and 6 (2.4%) had negative saliva sample test results. Of the 236 positive tests, 235 (99.6%) had acycle threshold (Ct values) indicating strong positive reactions, and only one value (Ct=28.86) was weak. Conclusion: Among the 236 positive test results, 235 (99.6%) exhibited robust positive reactions, indicating a substantial positive sample size. Consequently, saliva might be considered a dependable alternative testing tool when obtaining swab samples from patients is inconvenient or challenging.

Perforated Stress Ulcer of the Duodenum: a Case of an Unexpected Diagnosis in a COVID-19 Patient Following Dilatation and Curettage Procedure.

Background: Stress ulcers in the upper gastrointestinal tract can arise from pathologies related to erosive or inflammatory insults in critically ill patients. The relationship between stressful bodily events and the ischemia and perforation of stress ulcers is poorly understood. Objective: We present a case of perforated stress ulcer following an abortion that was treated by dilatation and curettage (D&C) and complicated by a coronavirus disease 2019 (COVID-19) infection. Case presentation: A 40-year-old lady presented to the emergency room complaining of diffuse abdominal pain, she was recently diagnosed with an incomplete abortion and managed via a D&C procedure in an external hospital. A computed tomography (CT) scan was done at our center for the abdomen and pelvis, showing extensive pneumoperitoneum, which brought the radiologist's attention to suspect a small bowel perforation presumably accompanying a uterine perforation secondary to the D&C. There were no obvious signs of pelvic small bowel perforation in the initial CT images. The perforated duodenal stress ulcer was diagnosed the next day by a new CT scan following oral contrast ingestion and managed surgically by repair and omental patch, and no other bowel perforations were found upon surgical exploration. After the surgery, the patient was diagnosed with COVID-19, and her clinical status deteriorated gradually during the following week, and she passed away from a cardiac arrest. Conclusion: It is unclear whether septic abortion or COVID-19 has resulted in stress ulcer perforation in our patient. This case report highlights the importance of raising early suspicion in the diagnosis of stress ulcer perforation in critically ill patients to reduce the risk of morbidity and mortality.

Case Reports on Black Fungus of the Gastrointestinal Tract: A New Complication in COVID-19 Patients.

Gastrointestinal mucormycosis is a rare disease with a significant mortality rate, even when promptly diagnosed and treated. An unusual complication was observed in India during the second wave of coronavirus disease 2019 (COVID-19). Two incidences of gastric mucormycosis were found. A 53-year-old male patient with a history of COVID-19 one month earlier came into the intensive care unit. After admission, the patient developed hematemesis, which was initially treated with blood transfusions and digital subtraction angiography embolization. Esophagogastroduodenoscopy (EGD) revealed a large ulcer with a clot in the stomach. During an exploratory laparotomy, the proximal stomach was necrotic. Histopathological examination confirmed mucormycosis. The patient was started on antifungals, but despite rigorous therapy, the patient died on the tenth postoperative day. Another patient, an 82-year-old male with a history of COVID-19, arrived with hematemesis two weeks earlier and was treated conservatively. EGD revealed a large white-based ulcer with abundant slough along the larger curvature of the body. Mucormycosis was verified by biopsy. He was treated with amphotericin B and isavuconazole. He was discharged after two weeks in a stable condition. Despite quick detection and aggressive treatment, the prognosis is poor. In the second case, prompt diagnosis and treatment saved the patient's life.

Oral Ulcers as A Manifestation Of COVID-19 Infection: A Cross-Sectional Study in Egypt (preprint)

Objectives This study aimed to examine the prevalence of oral ulcers in COVID-19 patients within the Egyptian population, while considering potential risk factors, assessing pain intensity, and exploring the implications for early detection and treatment.Materials and Methods A questionnaire was developed consisting of 16 questions that included both open-ended and close-ended formats. The survey gathered information on the patient’s demographic characteristics, medical background, oral hygiene practices, associated symptoms, and treatments received.Results Of 363 participants with COVID-19, oral ulcers were found in 34.1% of cases, predominantly affecting the tongue (25.8%), gums (11.3%), and inner oral mucous membrane (9.7%). Ulcer development was significantly associated with corticosteroid therapy, abdominal pain, shortness of breath, nasal congestion, and diarrhea (p < 0.05). However, there were no significant associations with age, gender, brushing habits, or co-morbidities. Pain intensity increased, as assessed on the pain scale, by 2.08 with abdominal pain and by 0.06 with age, while it decreased with good brushing habits by 2.1 and with patients in the ICU by 4.4.Conclusions The survey findings revealed that tongue ulcers were the most commonly observed oral manifestation among COVID-19-infected individuals in Egypt. The occurrence of ulcers was associated with factors such as corticosteroid therapy, abdominal pain, nasal congestion, and diarrhea. The severity of pain experienced was influenced by abdominal pain and age.Clinical Relevance Recognizing the clinical importance of oral ulcers in COVID-19 aids in the identification of the tangible discomfort experienced by patients and the potential implications associated with these ulcers as an indicative sign of COVID-19 infection.

Oral cavity manifestations in COVID-19 patients: A cross-sectional study (preprint)

Objective To determine the prevalence of oral manifestations in symptomatic patients in the ambulatory setting with suspected COVID-19. Methods This cross-sectional study evaluated oral manifestations in adults (aged ≥ 18 years) with suspected and confirmed SARS-CoV-2 infection. Chi-square and Fisher’s exact tests were used to compare data between the groups (RT-PCR-positive and RT-PCR-negative patients). Results One hundred and thirty-sixparticipants were included. Mostwere female (n = 79; 58.1%), mean age of 39.53 (± 14.17) years. Of these, 54 (39.7%) had a positive RT-PCR test, and 82 (60.3%) had negative RT-PCR results. Oral manifestations were observed in 40 participants (74.1%)in the RT-PCR-positive group and in 67 participants (81.7%) in the RT-PCR-negative group. The most common oral manifestations were xerostomia (n = 85; 62.5%) and dysgeusia/ageusia (n = 57; 41.9%). Different rates of gingivitis (n = 12; 22.2% vs n = 5; 6.1%) and halitosis (n = 7; 13.0% vs n = 1; 1.2%) were observed between the RT-PCR-positive and negative groups, respectively. Mouth ulcers, glossitis, tongue coating, and petechiae were reported in both groups, without significant differences. Conclusions A high prevalence of oral manifestations was observed in symptomatic patients with suspected or confirmed COVID-19. Clinical Relevance This study highlights the importance of routine oral examinations by dentists as part of the multidisciplinary care of COVID-19 patients.

Abnormal thrombosis and neutrophil activation increase hospital-acquired sacral pressure injuries and morbidity in COVID-19 patients.

Hospitalized patients have an increased risk of developing hospital-acquired sacral pressure injury (HASPI). However, it is unknown whether SARS-CoV-2 infection affects HASPI development. To explore the role of SARS-CoV-2 infection in HASPI development, we conducted a single institution, multi-hospital, retrospective study of all patients hospitalized for ≥5 days from March 1, 2020 to December 31, 2020. Patient demographics, hospitalization information, ulcer characteristics, and 30-day-related morbidity were collected for all patients with HASPIs, and intact skin was collected from HASPI borders in a patient subset. We determined the incidence, disease course, and short-term morbidity of HASPIs in COVID-19(+) patients, and characterized the skin histopathology and tissue gene signatures associated with HASPIs in COVID-19 disease. COVID-19(+) patients had a 63% increased HASPI incidence rate, HASPIs of more severe ulcer stage (OR 2.0, p<0.001), and HASPIs more likely to require debridement (OR 3.1, p=0.04) compared to COVID-19(-) patients. Furthermore, COVID-19(+) patients with HASPIs had 2.2x increased odds of a more severe hospitalization course compared to COVID-19(+) patients without HASPIs. HASPI skin histology from COVID-19(+) patients predominantly showed thrombotic vasculopathy, with the number of thrombosed vessels being significantly greater than HASPIs from COVID-19(-) patients. Transcriptional signatures of a COVID-19(+) sample subset were enriched for innate immune responses, thrombosis, and neutrophil activation genes. Overall, our results suggest that immunologic dysregulation secondary to SARS-CoV-2 infection, including neutrophil dysfunction and abnormal thrombosis, may play a pathogenic role in development of HASPIs in patients with severe COVID-19.

Acute vulvar ulcer as a possible adverse event of gene-based COVID-19 vaccines: A review of 14 cases.

AIM: To evaluate whether an acute vulvar ulcer that developed after the COVID-19 vaccine administration is an adverse effect of the vaccine. METHODS: This is a descriptive study of two cases that we observed in addition to cases that have been reported in the literature. We searched for case reports in the PubMed. The consistency of clinical manifestations among cases and the association between ulceration and vaccination were assessed. RESULTS: Fourteen female patients were identified, including 12 patients from 8 literatures published in 2021 and 2022 and 2 patients from our cases. Of the 14 patients, 11 had received the BNT162b2 vaccine, 2 had received the ChAdOx1 nCoV-19 vaccine, and one had received the mRNA-1273 vaccine. The patient's ages were 16.9 ± 5.0 (mean ± SD) years. Postvaccination, the disease progressed in the following sequence (time interval from vaccination): fever and other systemic inflammatory reactions (0.9 ± 0.4 days), development of vulvar ulcers (2.4 ± 1.2 days), and resolution of the ulcer (16.9 ± 7.4 days). The ulcers eventually healed in all cases, except one where the prognosis was not noted. For two-dose vaccine recipients, more patients developed the ulcer after the full vaccination (the second or third doses) compared with after the first dose: n = 10 and n = 2, respectively. CONCLUSION: The acute vulvar ulcer was closely associated with COVID-19 vaccination in terms of temporality and vaccine doses, supporting the notion that a vulvar ulcer is an adverse event of the COVID-19 vaccines.

Lipschütz acute vulvar ulcer related to COVID-19 vaccination: First case report in South America.

Lipschütz ulcer is a non-sexually transmitted genital lesion of unknown etiology, which presents as a painful vulvar ulcer. Lipschütz ulcers have been described in most continents. This is the first case reported in Peru and South America. We present the case of a 33-year-old female patient with a Lipschütz ulcer after being vaccinated with the second dose of the AstraZeneca COVID-19 vaccine. She reported having had only one sexual partner in her lifetime. Laboratory results were negative for herpes simplex 2, Cytomegalovirus, Toxoplasma gondii, Epstein-Barr virus, and syphilis. The patient received symptomatic treatment. Ten days after the onset, the patient was significantly better during follow-up. This case report displays a potential adverse effect of the AstraZeneca COVID-19 vaccine as a Lipschütz ulcer triggered by the host humoral immune response. However, further research is needed to establish the causal relationship between these two.

La úlcera de Lipschütz es una lesión genital no transmitidas por vía sexual de etiología desconocida, se presenta como una úlcera vulvar muy dolorosa. Las úlceras de Lipschütz se han descrito en la mayoría de los continentes. Este es el primer caso que se reporta en Perú y Sudamérica. En este reporte de caso se presentauna paciente de 33 años con una úlcera de Lipschütz luego de haber sido vacunada con la segunda dosis de la vacuna AstraZeneca COVID-19. Refirió haber tenido una sola pareja sexual a lo largo de su vida. Los resultados de laboratorio fueron negativos para herpes simplex 2, Citomegalovirus, Toxoplasma gondii, virus de Epstein-Barr y sífilis. La paciente recibió tratamiento sintomático. Diez días después, durante el seguimiento, la paciente estaba significativamente mejor. Este reporte de caso expone un potencial efecto adverso de la vacuna AstraZeneca COVID-19, en forma de úlcera de Lipschütz, desencadenado por la respuesta inmune humoral del huésped. Sin embargo, es necesario realizar más investigación para establecer la relación causal entre ambos.

SARS-CoV-2-Infected Pregnant Woman Requiring 38 Days of Extracorporeal Membrane Oxygenation Experiences Rectal Ulcer Bleeding: A Case Report.

Pregnancy has been shown to be associated with an adverse clinical course and symptomatic patients with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Extracorporeal membrane oxygenation (ECMO) is rarely used in pregnant or postpartum women with severe coronavirus disease 2019 (COVID-19). Here, we report the rare case of a pregnant woman diagnosed with SARS-CoV-2 infection placed on ECMO postpartum who subsequently received treatment for active rectal ulcer bleeding. Despite being placed on ECMO for 38 days and receiving a massive transfusion of 95 packs of red blood cells, she recovered and was discharged on hospital day 112. ECMO can be used in most patients with severe COVID-19, including pregnant patients, although potential coagulopathy complications must be considered.

Pattern of Consumption of Dietary and Herbal Supplements by Individuals with Non-communicable Diseases During Covid-19 Pandemic in Nigeria (preprint)

Cognizance of the implication of Covid-19 pandemic on health and well-being resulted in an upsurge is use of several dietary and herbal supplements (DHS) for the prevention and/or prophylaxis against the new disease.  Objectives: To evaluate the pattern of DHS consumption among Nigerians with Non-communicable Diseases (NCD) for the prevention and treatment of COVID-19.  Design: Cross-sectional questionnaire survey. Setting: Adolescents, and adults residing in Nigeria.  Participants:Participants with NCD (n = 165) from a larger study (n=645) were recruited from different geo-political zones and various ethnic groups.  Primary and Secondary Outcomes: Prevalence and determinants for the use of different DHS for the prevention and treatment of COVID-19 in Nigeria, and sources of information for DHS use.  Results: Hypertension was the most prevalent NCD (63.6%) in the study and both breast cancer and anxiety disorder were the least (0.6%). A minimum (75.2%) of the respondents had less than 8 hours of sleep daily and almost all did not smoke cigarette at all. The proportion of male and female hypertensives who believed that dietary supplements are necessary during infectious disease outbreak such as Covid-19 was moderately high (55.2%), higher among asthmatics (65.0%), diabetes (58/105, 68.4%), those with kidney disease (100.0%), ulcer (83.3%) and liver disease. Almost all the respondents with hypertension (101/105, 96.2%), asthma (19/20, 95.0%), diabetes (19/19, 100.0%) and kidney disease (6/6, 100.0%), consumed supplements more during Covid-19 pandemic in Nigeria. The proportion of those who consumed supplements more during the pandemic in Nigeria was higher among male hypertensives (57/101, 56.4%) than among the female (44/101, 43.6%), though the difference was not significant (χ²=2.93, P-value=0.09). Vitamin C was the commonest vitamin taken by respondents with ulcer (83.3%), kidney disease (83.3%), diabetes (57.9%), asthma (50.0%), hypertension (48.6%) and the two respondents with breast cancer (1, 100.0%) and anxiety disorder (1, 100.0%) respectively. Calcium and zinc were the commonest minerals taken by respondents with ulcer (50.0%, 16.7%), diabetes (10.5%, 5.3%), asthma (30.0%, 10.0%) and hypertension (13.3%, 11.4%) respectively. High proportions (83.3%, 80.0%) of those with kidney disease and with asthma consumed DHS to maintain good health. Health workers were the dominant source of information for most on the use of supplements during Covid-19 pandemic in Nigeria.  Conclusions: The findings showed widespread use of DHS for the prevention and treatment of COVID-19 among persons with NCD. The use of DHS in this study was mainly guided by health workers with a marginal role of social media and Mass media. These findings call for a more robust consolidative tactic towards DHS to ensure its proper and safe use.

Etiological Surveillance of Genital Ulcer Syndrome in South Africa: 2019 to 2020.

BACKGROUND: Herpes simplex virus (HSV) has been the leading cause of genital ulcer syndrome (GUS) in South Africa for more than a decade, and acyclovir therapy is incorporated into syndromic management guidelines. We conducted surveillance at 3 sentinel sites to define the common sexually transmitted etiologies of GUS and to determine whether current syndromic management is appropriate. Secondary objectives of surveillance were to determine the seroprevalence of coinfections (HIV, syphilis, HSV-2) in persons presenting with GUS. METHODS: Consecutive, consenting adult men and women presenting with visible genital ulceration were enrolled between January 1, 2019, and December 31, 2020. Genital ulcer swab and blood specimens were collected and transported to a central sexually transmitted infection reference laboratory in Johannesburg. RESULTS: Among 190 participants with GUS, HSV-2 was the most frequently detected ulcer pathogen (49.0%; 95% confidence interval [CI], 41.9%-56.1%). The relative prevalence of the second most common ulcer-derived pathogen, Treponema pallidum, was 26.3% (95% CI, 20.5%-33.1%), with 90% of primary syphilis cases having a positive rapid plasma reagin (RPR) titer. Male sex was independently associated with primary syphilis compared with herpetic ulcers, after adjusting for the effect of casual sex partners and other exposures (adjusted odds ratio, 3.53; 95% CI, 1.35-9.21; P = 0.010). The overall HIV prevalence among participants was 41.3% (78 of 189; 95% CI, 34.2%-48.6%). CONCLUSIONS: Herpes simplex virus 2 remains the predominant cause of GUS, justifying the continued use of acyclovir in syndromic guidelines. Adequate supplies of benzathine penicillin G for syphilis treatment are essential at primary health care level, in addition to the provision of syphilis and HIV risk reduction services.

Vulvar Aphthous Ulcers in an Adolescent After Coronavirus Disease 2019 (COVID-19) Vaccination.

BACKGROUND: Nonsexually acquired genital ulcers have been described among girls who are prepubertal after various viral illnesses due to mucosal inflammation from an immunologic response. Until recently, nonsexually acquired genital ulcers have only been associated with viral infections. CASE: We present a case of an adolescent girl developing nonsexually acquired genital ulcers after both her first and second coronavirus disease 2019 (COVID-19) vaccine doses. Her course followed an expected timeline for severity and resolution of ulcers. CONCLUSIONS: Aphthous ulcers may arise from inflammatory effects of COVID-19 vaccination. Clinical monitoring after COVID-19 vaccination from all formulations should include assessment for nonsexually acquired genital ulcers if vaginal pain is reported.

Sudden winter iloprost withdrawal in scleroderma patients during COVID-19 pandemic.

INTRODUCTION: Intravenous iloprost is currently recommended in the treatment of Raynaud's phenomenon (RP) refractory to oral therapy and of digital ulcers (DUs) related to systemic sclerosis (SSc). In real-life practice there is a huge heterogeneity about the Iloprost regimens used. METHODS: A survey was carried out on SSc patients that interrupted Iloprost infusion to compare acral vascular symptoms just before Iloprost withdrawal and just after the missed infusion. Severity, and frequency of RP, new DUs onset or aggravation of those pre-existing were reported. Last available capillaroscopic images were also evaluated. RESULTS: The analysis includes 50 patients. After iloprost withdrawal, 11 patients reported a RP worsening because of enhanced intensity (p = 0.007). Only 8 patients of them also complained of an increased frequency (p = 0.07). None of the patients experienced digital ulcers for the first-time during quarantine. Among the 27 patients with a history of digital ulcers, 9 reported worsening and 7 recurrence of DUs. Overall, 17 patients (34.0 %) complained of a worsening of SSc vascular acral manifestations, namely RP or DUs. Reduced capillary density was associated with RP worsening, in particular, each unit increase of capillary density corresponds to an average 44 % decrease in the odds of RP worsening (OR 0.56, CI 95 % 0.36-0.97, p = 0.037). As for RP worsening, the aggravation of DU was associated with a lower capillary density. CONCLUSIONS: Low capillary density can predict a worsening of both RP and DUs in controlled quarantine conditions within a month after iloprost discontinuation in SSc patients.

Concurrent coronavirus disease 2019 and primary syphilis in a young man: A rare case report.

INTRODUCTION: The global rise of syphilis infections and the ongoing coronavirus disease 2019 (COVID-19) pandemic are causes for concern. We herein report a rare case of concurrent primary syphilis and COVID-19. CASE REPORT: A 29-year-old man was admitted with a diagnosis of COVID-19. Although COVID-19 pneumonia appeared during ciclesonide and favipiravir treatment, his symptoms improved without developing severe hypoxemia. A small, red ulcer on the left-side of his glans penis was noted and left inguinal lymph node swellings were detected on computed tomography (CT). He reported that his last engagement in sexual intercourse had been 3 months previously, and that his partner had subsequently been diagnosed with syphilis. Although both serum Treponema pallidum (TP) antibody and rapid plasma reagin (RPR) quantitative tests were negative on the day of admission, we clinically diagnosed a suspected case of primary syphilis and started treatment with amoxicillin (1500 mg/day). We subsequently learned that the TP antibody and RPR quantitative tests had been positive 4 days before starting syphilis treatment. Amoxicillin treatment was continued for 61 days, and the ulcer gradually improved. One year later, the RPR quantitative test was negative, and CT revealed a reduction in size of the inguinal lymph nodes and no residual signs of COVID-19 pneumonia. CONCLUSION: The prevalence of syphilis has been increasing even during the COVID-19 pandemic, and the incidence of concurrent syphilis and COVID-19 might be higher than is recognized. Asking patients with COVID-19 about high-risk sexual behavior and genital lesions could help with early diagnosis of syphilis.