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1.
Curr Opin Ophthalmol ; 33(1): 28-34, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1494046

ABSTRACT

PURPOSE OF REVIEW: Endophthamitis following intraocular surgery is rare using current antiseptic techniques, such as single application of 5% povidone-iodine to the ocular surface and adjuvant topical or intracameral antibiotics. Challenges remain, however, including increased multidrug-resistant bacterial endophthalmitis, increased fungal endophthalmitis, and the low but nonzero endophthalmitis rate attributable to the typical bacteria that colonize the ocular surface. RECENT FINDINGS: Povidone-iodine has a wide spectrum of activity, including activity against novel pathogens, such as SARS-CoV-2. Povidone-iodine alternatives, such as hypochlorous acid can have significantly less efficacy in vitro against endophthalmitis isolates. Repetitive application of dilute povidone-iodine has an excellent safety profile and strong evidence base for efficacy. SUMMARY: Povidone-iodine is widely available, inexpensive, and commonly used by ophthalmologists. The repetitive application of dilute povidone-iodine is a well studied, well tolerated, and efficacious way to transiently sterilize the ocular surface during intraocular surgery. Additional benefits include activity against multidrug-resistant bacteria, fungi, and lack of inducible resistance.


Subject(s)
Anti-Infective Agents, Local , COVID-19 , Endophthalmitis , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents, Local/therapeutic use , Endophthalmitis/prevention & control , Humans , Postoperative Complications/drug therapy , Povidone-Iodine , SARS-CoV-2
2.
Exp Clin Transplant ; 19(7): 744-748, 2021 07.
Article in English | MEDLINE | ID: covidwho-1323413

ABSTRACT

Acute respiratory distress syndrome remains the main cause of death among people with COVID-19. Although many immunomodulatory and antiviral drug therapies have been tested, the only effective therapy against severe COVID-19 pneumonia among the general population is a regimen of high-dose corticosteroids for cases of severe associated inflammation. In solid-organ transplant recipients with long-term immunosuppression, data on disease presentation and evolution are scarce, and the benefit of high-dose corticosteroids remains uncertain for cases of severe COVID-19 pneumonia. Here, we report 2 cases of COVID-19-related acute respiratory distress syndrome that occurred in lung transplant recipients in March and April 2020, respectively. Both cases of acute respiratory distress syndrome occurred in patients with long-term azithromycin treatment prescribed to prevent chronic allograft dysfunction. Acute respiratory distress syndrome was associated with severe inflammation and was cured after early administration of high-dose corticosteroids in both cases, with progressive and complete resolution of lung lesions evidenced on thoracic computed tomography scan. Our findings support the benefit of early high-dose corticosteroids in COVID-19-related acute respiratory distress syndrome with hyperinflammation in patients with long-term immunosuppression such as lung transplant recipients.


Subject(s)
COVID-19/drug therapy , Lung Transplantation , Methylprednisolone/therapeutic use , Postoperative Complications/drug therapy , Respiratory Distress Syndrome/drug therapy , COVID-19/complications , Female , Humans , Male , Middle Aged , Postoperative Complications/virology , Remission Induction , Respiratory Distress Syndrome/virology
3.
J Mycol Med ; 31(2): 101125, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1164245

ABSTRACT

Mucormycosis is an invasive fungal infection (IFI) due to several species of saprophytic fungi, occurring in patients with underlying co-morbidities (including organ transplantation). During the ongoing Coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of bacterial and fungal co-infections occurring in COVID-19 patients, including COVID-19 associated pulmonary aspergillosis (CAPA). We describe a case of mucormycosis occurring after COVID-19, in an individual who received a recent heart transplant for severe heart failure. Two months after heart transplant, our patient developed upper respiratory and systemic symptoms and was diagnosed with COVID-19. He was managed with convalescent plasma therapy and supportive care. Approximately three months after COVID-19 diagnosis, he developed cutaneous mucormycosis at an old intravascular device site. He underwent extensive surgical interventions, combined with broad-spectrum antifungal therapy. Despite the aggressive therapeutic measures, he died after a prolonged hospital stay. In this case report, we also review the prior well-reported cases of mucormycosis occurring in COVID-19 patients and discuss potential mechanisms by which COVID-19 may predispose to IFIs. Similar to CAPA, mucormycosis with COVID-19 may need to be evaluated as an emerging disease association. Clinicians should be vigilant to evaluate for invasive fungal infections such as mucormycosis in patients with COVID-19 infection.


Subject(s)
COVID-19/complications , Heart Transplantation , Invasive Fungal Infections/complications , Mucormycosis/complications , Postoperative Complications/etiology , Rhizopus/isolation & purification , Aged , Anti-Infective Agents/therapeutic use , Bacteremia/complications , Bacteremia/drug therapy , Bacteremia/microbiology , COVID-19/therapy , Catheter-Related Infections/drug therapy , Catheter-Related Infections/etiology , Coinfection/drug therapy , Coinfection/microbiology , Combined Modality Therapy , Contraindications, Drug , Debridement , Dermatomycoses/drug therapy , Dermatomycoses/etiology , Disease Susceptibility , Fatal Outcome , Heart Failure/surgery , Humans , Hydroxychloroquine/therapeutic use , Immunization, Passive , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Intra-Aortic Balloon Pumping/instrumentation , Invasive Fungal Infections/drug therapy , Male , Mucormycosis/drug therapy , Mucormycosis/microbiology , Negative-Pressure Wound Therapy , Opportunistic Infections/complications , Opportunistic Infections/drug therapy , Opportunistic Infections/microbiology , Postoperative Complications/drug therapy , Postoperative Complications/microbiology , Postoperative Complications/virology , Surgical Wound Infection/complications , Surgical Wound Infection/drug therapy , Surgical Wound Infection/microbiology , Surgical Wound Infection/surgery
5.
Clin J Gastroenterol ; 14(3): 842-845, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1118282

ABSTRACT

The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in 2019; thereafter, the COVID-19 outbreak became a health emergency of international concern. The impact of COVID-19 on liver-transplant recipients is unclear. Thus, it is currently unknown whether liver-transplant recipients are at a higher risk of developing complications related to COVID-19. Here, we report the case of liver-transplant recipients who were infected with SARS-CoV-2. A 20-year-old man who had undergone living-donor liver transplantation from his father at 5 years of age because of congenital biliary atresia was referred to our hospital for SARS-CoV-2 infection. Chest computed tomography did not show any abnormalities; however, laboratory results revealed liver dysfunction. He received tacrolimus as maintenance therapy that was continued at the same dose. He has not developed severe pulmonary disease and was discharged after 10 days of hospitalization. Limited data are available on post-transplant patients with COVID-19, and this case of a young patient without metabolic comorbidities did not show any association of severe COVID-19 under tacrolimus treatment. The progression of COVID-19 in liver-transplant recipients is complex, and COVID-19 risk should be evaluated in each patient until the establishment of optimal guidelines.


Subject(s)
COVID-19/diagnosis , Immunosuppressive Agents/therapeutic use , Liver Transplantation/adverse effects , Postoperative Complications/drug therapy , SARS-CoV-2/isolation & purification , Tacrolimus/therapeutic use , Adult , COVID-19 Testing , Humans , Immunocompromised Host , Living Donors , Male , Postoperative Complications/diagnosis , Postoperative Complications/etiology , SARS-CoV-2/immunology , Transplant Recipients , Treatment Outcome , Young Adult
6.
BMC Infect Dis ; 20(1): 849, 2020 Nov 16.
Article in English | MEDLINE | ID: covidwho-1067190

ABSTRACT

BACKGROUND: Mycobacterium houstonense is rapidly growing mycobacteria (RGM) that belongs to M. fortuitum group. So far, there have been few associated reports of human diseases induced by M. houstonense worldwide. CASE PRESENTATION: We present a delayed-onset postoperative endophthalmitis caused by M. houstonense after glaucoma drainage implant (GDI) surgery. The ocular infection lasted for 2 months without appropriate treatment that developed into endophthalmitis and the patient underwent an emergency enucleation. CONCLUSION: Implant erosion and a delay in diagnosis of ocular infection could lead to irreversible damage as observed in our case. Ophthalmologists should be alert for ocular RGM infection, and prompt laboratory diagnosis with initiation of effective multidrug therapy might prevent loss of vision.


Subject(s)
Endophthalmitis/diagnosis , Endophthalmitis/etiology , Glaucoma Drainage Implants/adverse effects , Mycobacteriaceae/genetics , Postoperative Complications/diagnosis , Amikacin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Drug Therapy, Combination , Endophthalmitis/drug therapy , Endophthalmitis/surgery , Eye Enucleation , Follow-Up Studies , Humans , Levofloxacin/therapeutic use , Male , Middle Aged , Mycobacteriaceae/isolation & purification , Postoperative Complications/drug therapy , Postoperative Complications/microbiology , Postoperative Complications/surgery , RNA, Ribosomal, 16S/genetics , RNA, Ribosomal, 23S/genetics , Treatment Outcome
7.
Kidney Int ; 98(6): 1559-1567, 2020 12.
Article in English | MEDLINE | ID: covidwho-1023699

ABSTRACT

We investigated the prevalence and clinical outcomes of COVID-19 in recipients of kidney transplants in the Bronx, New York, one of the epicenters of the pandemic. Between March 16 and June 2, 2020, 132 kidney transplant recipients tested positive by SARS-CoV-2 RT-PCR. From May 3 to July 29, 2020, 912 kidney transplant recipients were screened for SARS-CoV-2 IgG antibodies during routine clinic visits, of which 16.6% tested positive. Fifty-five of the 152 patients had previously tested positive by RT-PCR, while the remaining 97 did not have significant symptoms and had not been previously tested by RT-PCR. The prevalence of SARS-CoV-2 infection was 23.4% in the 975 patients tested by either RT-PCR or SARS-CoV-2 IgG. Older patients and patients with higher serum creatinine levels were more likely diagnosed by RT-PCR compared to SARS-CoV-2 IgG. Sixty-nine RT-PCR positive patients were screened for SARS-CoV-2 IgG antibodies at a median of 44 days post-diagnosis (Inter Quartile Range 31-58) and 80% were positive. Overall mortality was 20.5% but significantly higher (37.8%) in the patients who required hospitalization. Twenty-three percent of the hospitalized patients required kidney replacement therapy and 6.3% lost their allografts. In multivariable analysis, older age, receipt of deceased-donor transplantation, lack of influenza vaccination in the previous year and higher serum interleukine-6 levels were associated with mortality. Thus, 42% of patients with a kidney transplant and with COVID-19 were diagnosed on antibody testing without significant clinical symptoms; 80% of patients with positive RT-PCR developed SARS-CoV-2 IgG and mortality was high among patients requiring hospitalization.


Subject(s)
COVID-19/immunology , Kidney Transplantation , Postoperative Complications/virology , SARS-CoV-2/isolation & purification , Aged , Biomarkers/blood , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/mortality , COVID-19 Nucleic Acid Testing/statistics & numerical data , COVID-19 Serological Testing/statistics & numerical data , Cohort Studies , Female , Humans , Immunoglobulin G/blood , Male , Middle Aged , New York/epidemiology , Pandemics , Postoperative Complications/diagnosis , Postoperative Complications/drug therapy , Postoperative Complications/mortality , SARS-CoV-2/immunology , Seroepidemiologic Studies
9.
Am Heart J ; 232: 84-93, 2021 02.
Article in English | MEDLINE | ID: covidwho-893407

ABSTRACT

BACKGROUND: Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response after Percutaneous Coronary Intervention (TAILOR-PCI) is the largest cardiovascular genotype-based randomized pragmatic trial (NCT#01742117) to evaluate the role of genotype-guided selection of oral P2Y12 inhibitor therapy in improving ischemic outcomes after PCI. The trial has been extended from the original 12- to 24-month follow-up, using study coordinator-initiated telephone visits. TAILOR-PCI Digital Study tests the feasibility of extending the trial follow-up in a subset of patients for up to 24 months using state-of-the-art digital solutions. The rationale, design, and approach of extended digital study of patients recruited into a large, international, multi-center clinical trial has not been previously described. METHODS: A total of 930 patients from U.S. and Canadian sites previously enrolled in the 5,302 patient TAILOR-PCI trial within 23 months of randomization are invited by mail to the Digital Study website (http://tailorpci.eurekaplatform.org) and by up to 2 recruiting telephone calls. Eureka, a direct-to-participant digital research platform, is used to consent and collect prospective data on patients for the digital study. Patients are asked to answer health-related surveys at fixed intervals using the Eureka mobile app and or desktop platform. The likelihood of patients enrolled in a randomized clinical trial transitioning to a registry using digital technology, the reasons for nonparticipation and engagement rates are evaluated. To capture hospitalizations, patients may optionally enable geofencing, a process that allows background location tracking and triggering of surveys if a hospital visit greater than 4 hours is detected. In addition, patients answer digital hospitalization surveys every month. Hospitalization data received from the Digital Study will be compared to data collected from study coordinator telephone visits during the same time frame. CONCLUSIONS: The TAILOR-PCI Digital Study evaluates the feasibility of transitioning a large multicenter randomized clinical trial to a digital registry. The study could provide evidence for the ability of digital technology to follow clinical trial patients and to ascertain trial-related events thus also building the foundation for conducting digital clinical trials. Such a digital approach may be especially pertinent in the era of COVID-19.


Subject(s)
Internet-Based Intervention , Multicenter Studies as Topic , Patient Generated Health Data , Randomized Controlled Trials as Topic , Registries , COVID-19/epidemiology , Clopidogrel/therapeutic use , Continuity of Patient Care , Feasibility Studies , Follow-Up Studies , Genotype , Geographic Information Systems , Health Surveys/methods , Humans , Ischemia/drug therapy , Mobile Applications , Patient Compliance , Patient Participation , Percutaneous Coronary Intervention , Postoperative Complications/drug therapy , Pragmatic Clinical Trials as Topic , Purinergic P2Y Receptor Antagonists/therapeutic use , Research Design , SARS-CoV-2 , Telephone
10.
Am J Otolaryngol ; 41(5): 102604, 2020.
Article in English | MEDLINE | ID: covidwho-628588

ABSTRACT

OBJECTIVES: The role of topical anti-infectives in acute exacerbations of chronic rhinosinusitis is controversial. Povidone-iodine is an anti-bacterial and anti-viral that is affordable and available over-the-counter and may demonstrate advantages over mupirocin as a sinus irrigation therapy. The objective was to compare povidone-iodine or mupirocin versus saline sinus irrigations for sinusitis exacerbations in post-surgery subjects as well as to assess tolerability of povidone-iodine sinus irrigations. MATERIALS AND METHODS: This was a prospective single-blinded (clinician only) randomized controlled trial. Subjects were post-surgery with acute exacerbations of chronic rhinosinusitis and gram-positive bacteria on culture. They received povidone-iodine, mupirocin, or saline sinus irrigations, twice daily for 30 days. Outcomes were post-treatment culture negativity (primary) and Sinonasal Outcome Test-20 and Lund-Kennedy endoscopic score change (secondary). RESULTS: Of the 62 subjects analyzed, post-treatment culture negativity rate was higher in the MUP (14/20, 70%) group compared to the PI (9/21, 43%) and SAL (9/19, 47%) groups, although this was not significant (p = 0.29). Povidone-iodine sinus irrigations at the 1% concentration were very well-tolerated, similar to saline irrigations. There were no significant differences in Sinonasal Outcome Test-20 score (povidone-iodine -0.3 [-0.6, 0.05] vs. mupirocin -0.3 [-0.7, 0.05] vs. saline -0.4 [-0.8, 0.05]; p = 0.86) or Lund-Kennedy endoscopic score (povidone-iodine -3.5 [-7, -0.5] vs. mupirocin -2 [-4, 2] vs. saline -3 [-5, 0]; p = 0.45) change. No serious adverse effects were reported. CONCLUSIONS: In patients who have had prior sinus surgery with acute exacerbations of CRS and gram-positive bacteria on culture, mupirocin sinus irrigations achieved a better post-treatment culture "control" rate compared to saline and povidone-iodine. In addition, 1% povidone-iodine solution was well-tolerated as a sinus irrigation and may represent a feasible method for temporarily disinfecting the sinonasal cavity of bacteria and viruses such as COVID-19.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Mupirocin/therapeutic use , Postoperative Complications/drug therapy , Povidone-Iodine/therapeutic use , Rhinitis/drug therapy , Sinusitis/drug therapy , Adult , Anti-Infective Agents, Local , Chronic Disease , Female , Humans , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Prospective Studies , Rhinitis/diagnosis , Rhinitis/etiology , Saline Solution , Single-Blind Method , Sinusitis/diagnosis , Sinusitis/etiology , Therapeutic Irrigation
11.
Clin Transplant ; 34(11): e14072, 2020 11.
Article in English | MEDLINE | ID: covidwho-733252

ABSTRACT

A potential benefit of immunomodulatory agents such as tocilizumab (TCZ) has been reported in patients with coronavirus disease 2019 (COVID-19) and severe pulmonary involvement. However, this therapy has been scarcely studied in kidney transplant (KT) recipients. Herein, we describe the clinical course and outcome of 10 KT patients with severe COVID-19 that were treated with TCZ. Mean age of the study group was 54 ± 10 years (70% females), and 30% of the cases were within 6 months from transplant. Mycophenolate mofetil was discontinued in all cases upon admission, whereas baseline steroids were maintained and tacrolimus dose was reduced. Initial treatment included hydroxychloroquine, antibiotics, and prophylactic anticoagulation. Before treatment with TCZ, 3 patients were receiving high-flow oxygen, 4 patients low-flow oxygen and 1 case non-invasive ventilation. All patients received a single dose of intravenous TCZ within a mean time of 7 ± 4 days since admission. During a median follow-up of 16 days (IQR: 10-29), 7 patients (70%) gradually improved and were finally discharged while three cases (30%) did not exhibited clinical improvement and ultimately died. In conclusion, although treatment with TCZ could be associated with improved clinical outcomes in a subset of KT recipients with COVID-19, further studies are warranted before drawing firm conclusions.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/drug therapy , Immunologic Factors/therapeutic use , Kidney Transplantation , Postoperative Complications/drug therapy , Adult , Aged , COVID-19/etiology , Female , Follow-Up Studies , Hospitalization , Humans , Male , Middle Aged , Retrospective Studies , Severity of Illness Index , Treatment Outcome
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