A case of possible drug-induced liver injury due to COVID-19 vaccine.

The patient presented with nausea, appetite loss, and fatigue. She had received two doses of Pfizer/BioN-Tech BNT162b2 mRNA vaccine (COMIRNATY) for coronavirus disease 2019 (COVID-19). Acute liver injury was noted 14 days after the first dose of the vaccine. Re-exposure through the second dose worsened the liver injury. After liver biopsy on the third day of admission, methylprednisolone (1000 mg) was administered. Liver histology showed acute hepatitis with diffuse lobular inflammation/necrosis and lymphocyte-dominant infiltra-tion in the portal areas. The patient was diagnosed with drug-induced liver injury due to the COVID-19 vaccine based on the Digestive Disease Week Japan 2004 (DDW-J) scale, which assesses the temporal relationship, liver biopsy, and laboratory findings. With improvements in the blood test parameters, prednisolone was gradually tapered and stopped. One month later, no biochemical signs of relapse were noted. To our knowledge, this is the first report describing liver injury after the administration of the Pfizer COVID-19 vaccine in Japan.Copyright © 2022 The Japan Society of Hepatology.

Pulse Methylprednisolone Versus Dexamethasone in Covid-19: A Multicenter Cohort Study

INTRODUCTION: Although high-dose corticosteroids can hypothetically curb the cytokine storm effectively, the clinical benefit of pulse methylprednisolone in coronavirus disease 2019 (COVID-19) remains inconclusive. We compared pulse methylprednisolone therapy with dexamethasone as a COVID-19 treatment. METHOD(S): Using a Japanese multicenter database involving 350 acute care centers, we identified adults aged>=18 years admitted for COVID-19 and discharged between January 2020 and December 2021 who received pulse methylprednisolone (>=250 mg/day) or intravenous dexamethasone (>=6 mg/day) on the day of admission or the next day. One-to-one propensity score matching was performed with age, sex, comorbidities, disease severity, hospital size, and time of admission as covariates. The primary outcome was in-hospital mortality. Secondary outcomes were the length of hospital stay (LOS), insulin-requiring hyperglycemia, and fungal infection. RESULT(S): We included 1,202 (mean age, 62.4+/-16.3;male, 70.9%) and 7,669 (mean age, 61.6+/-16.3;male, 66.0%) patients in the pulse methylprednisolone and dexamethasone group, respectively. After propensity score matching (1,197 pairs), pulse methylprednisolone was associated with higher in-hospital mortality (12.0% vs 8.8%;p=0.011), longer LOS (13.0 [interquartile range: 9.0-22.0] vs 12.0 [8.0-18.0] days;p=0.002), and higher hyperglycemia incidence (16.3% vs 9.7%;p< 0.001), while fungal infection incidence (6.3% vs 4.6%;p=0.339) was not significantly different. In subgroup analysis, among patients who received mechanical ventilation (IMV) on the day of admission or the next day, in-hospital mortality was similar between the two groups (22.2% vs 20.5%;p=0.792). However, among patients without IMV, pulse methylprednisolone was associated with higher mortality (10.3% vs 7.0%;p=0.010). The sensitivity analysis involving patients who received >=1 g/day of methylprednisolone vs 6 mg/ day of dexamethasone showed consistent results. CONCLUSION(S): Compared to dexamethasone, pulse methylprednisolone may be associated with worse COVID-19 outcomes, especially in patients not on IMV. Providers should be aware of the potential consequences according to the type and dose of corticosteroid therapy and tailor the treatment for COVID-19.

A case of possible drug-induced liver injury due to COVID-19 vaccine

The patient presented with nausea, appetite loss, and fatigue. She had received two doses of Pfizer/BioN-Tech BNT162b2 mRNA vaccine (COMIRNATYR) for coronavirus disease 2019 (COVID-19). Acute liver injury was noted 14 days after the first dose of the vaccine. Re-exposure through the second dose worsened the liver injury. After liver biopsy on the third day of admission, methylprednisolone (1000 mg) was administered. Liver histology showed acute hepatitis with diffuse lobular inflammation/necrosis and lymphocyte-dominant infiltra-tion in the portal areas. The patient was diagnosed with drug-induced liver injury due to the COVID-19 vaccine based on the Digestive Disease Week Japan 2004 (DDW-J) scale, which assesses the temporal relationship, liver biopsy, and laboratory findings. With improvements in the blood test parameters, prednisolone was gradually tapered and stopped. One month later, no biochemical signs of relapse were noted. To our knowledge, this is the first report describing liver injury after the administration of the Pfizer COVID-19 vaccine in Japan. Copyright © 2022 The Japan Society of Hepatology.

TAKOTSUBO SYNDROME IN COVID-19 AND INFLUENZA INFECTIONS: A COMPARATIVE SYSTEMATIC REVIEW OF CLINICAL CHARACTERISTICS AND OUTCOMES

SESSION TITLE: Outcomes Across COVID-19 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Coronavirus disease 2019 (COVID-19) and influenza infections are associated with systemic inflammatory reactions that predispose to Takotsubo cardiomyopathy (TTS). Studies have investigated the epidemiology and clinical features of TTS in COVID-19 and influenza infection, however, there are limited data comparing TTS between patients with COVID-19 and influenza. METHODS: We searched PubMed/Medline, Web of Science, SCOPUS, EMBASE, and Google Scholar until November 1st, 2021, for case reports, case series, and observational cohort studies using these keywords: takotsubo syndrome/takotsubo cardiomyopathy, stress-induced cardiomyopathy, and broken heart syndrome combined with the terms COVID-19 and/or SARS-CoV-2, flu and/or influenza. All the published case reports included in the final analysis were in English and were categorized into patients with ‘COVID-19 + TTS’ and ‘Flu + TTS’. RESULTS: We identified 37 studies describing 64 patients with COVID-19+TTS and 10 case reports describing 10 patients with Flu + TTS. The mean age of patients in the COVID-19 + TTS was similar to the influenza group (69 years). Although women were more disproportionately affected by TTS in both groups, COVID-19 + TTS patients had a higher proportion of men than the Flu + TTS group (44% vs 30%) and previously reported incidence of TTS in men in the general population. Compared to patients with Flu + TTS, COVID-19 + TTS had a longer mean time from testing positive to developing TTS (7.3 days vs. 3.1 days), higher incidence rates of acute respiratory distress syndrome (77% vs. 40%), hypoxemic respiratory failure (86% vs. 60%), more likely to require invasive mechanical ventilation (63% vs. 40%) and higher in-hospital mortality rates (36%, n=23 vs 10%, n=1) CONCLUSIONS: Our systematic review highlights some important differences in the presentation and outcomes of TTS in patients with COVID-19 compared to seasonal influenza. Patients with COVID-19 + TTS had higher rates of respiratory complications and excess all-cause mortality compared to Flu + TTS. In contrast to the general population and patients infected with influenza, TTS tends to affect more men with COVID-19 infection. CLINICAL IMPLICATIONS: Hospitalized patients with COVID-19 who develop TTS appear to have a more severe disease course and poorer outcome compared to hospitalized patients with Flu+TTS. The study findings provide additional knowledge comparing complications between COVID-19 and influenza infections and may contribute to the continued efforts to manage the COVID-19 pandemic. DISCLOSURES: no disclosure on file for Temidayo Abe;No relevant relationships by Thomas Allingham No relevant relationships by Omovefe Edika No relevant relationships by Hammad Khalid No relevant relationships by Ifeoma Ogbuka No relevant relationships by Titilope Olanipekun No relevant relationships by Richard Snyder No relevant relationships by Abhinav Vedire No relevant relationships by Nicholas Wilson

IMPACT OF COVID-19 PANDEMIC ON SCHOLARLY PRODUCTIVITY IN AN ACADEMIC INTERNAL MEDICINE RESIDENCY PROGRAM

BACKGROUND: The ACGME requires internal medicine residents to engage in research during residency and present their findings in a scientific setting as one of the requirements for training completion. The ongoing COVID-19 pandemic has significantly impacted medical residency education globally, and there is limited data on the effect of the pandemic on scholarly productivity among internal medicine residents METHODS: We collected socio-demographic data of participants and responses on research activities during residency training before and during the pandemic. We assessed the perceived impact of the COVID-19 pandemic on scholarly productivity by asking the respondents to report if there has been an 'increase', 'decrease', or 'no change' in scholarly output comparing prepandemic and during the COVID-19 pandemic period. Respondents who reported decreased scholarly output were asked to provide reasons for the decline and suggest ways to improve scholarly productivity during pandemics. RESULTS: A total of 68 residents completed the survey which corresponds to a response rate of 85%. The mean age group was 30-34 years and 51% of the participant were females. Of the total number of respondents, 43% reported a decline in the number of publications during the COVID-19 pandemic compared to the pre-pandemic period. About 26% responded that the pandemic has had a negative impact on their level of participation in scientific conferences due to the cancellation of most in-person scientific conferences in compliance with social distancing and pandemic restrictions. More females reported a decline in scholarly productivity due to a combination of burnout from the pandemic and competing family commitments. CONCLUSIONS: In this survey, a significant proportion of residents of an academic internal medicine residency program reported a decline in research and scholarly productivity due to the COVID-19 pandemic. Burnout, loss of morale, and insufficient time due to competing domestic duties were the major contributory factors. Female residents were more affected due to burnout and challenges from having to strike a balance between their training and family duties. More research electives during training, more time to focus on mental health, dedicated faculty to mentor residents on research, and providing support for female residents to cope with domestic responsibilities may improve scholarly productivity during pandemics.

A RESIDENT-DRIVEN JOURNAL CLUB (JOURNAL CAFE) IMPROVED SCHOLARLY ACTIVITY IN AN ACADEMIC INTERNAL MEDICINE RESIDENCY PROGRAM DURING COVID-19 PANDEMIC

SETTING AND PARTICIPANTS: Residents of an Academic Medicine Resident Program (81 residents) - Morehouse School of Medicine, Atlanta, GA. DESCRIPTION: Journal clubs are an integral part of internal medicine residency education. Residents are mandated to participate in journal clubs to critically assess medical literature, epidemiology, and biostatistics as part of the accreditation requirements. However, studies show that the journal club activities have not been sufficient in improving scholarly productivity among residents often due to lack of specific goals and inability to sustain residents' interest and participation. At our institution, a resident-led research initiative called journal café (JC) was set up in the 2013/2014 academic year to increase the participation of residents in research and foster a culture of evidence-based clinical practice. Membership and participation in the journal café are voluntary. The JC runs independently of the mandatory residency journal club. JC members form different working groups based on shared research interests and meet on the last Friday of each month for 1 hour to discuss proposed research projects, critique scientific peer-reviewed publications, learn about research designs, epidemiology, and statistical analysis. EVALUATION: We evaluated the impact of the JC by conducting a survey of the internal medicine residents at our institution to compare research productivity between journal café members (29) and non-members (39). Research activities were categorized into two groups: 1. Published s and body of manuscripts in peer-reviewed scientific journals;2. Presentation of research work (oral or poster) at scientific meetings. The research publications and presentations were verified using research search engines. The majority of JC members were in post-graduate year 2. JC members were more likely to be interested in pursuing subspecialty fellowship training after residency (79% vs. 23%). The mean (SD) number of research publications among members of journal café was 7.3 (3.1) compared to 3.5 (2.6) among non-members. Likewise, JC members had a higher average number of research presentations at scientific conferences (6.6, SD 3.7 vs. 2.7, SD 2.1). On COVID19 related research, half of the respondents (n=35/68) reported conducting COVID-19 related research out of which 22 (63%) were JC members and 13 (37%) non-JC members. JC members were also more likely to publish COVID19 related research in peer-reviewed journals (68% vs 32%, n=19). DISCUSSION / REFLECTION / LESSONS LEARNED: A resident-led research initiative (Journal cafe) at an academic internal medicine residency program improves scholarly activity and boosts COVID-19 pandemic-related research productivity. The JC gives residents the opportunity to work together based on shared research interests which likely improved commitment and research productivity. Resident-led research clubs supported by the residency program may complement the traditional journal clubs and enhance residents' participation in research.

Time-series trend of pandemic sars-cov-2 variants visualized using batch-learning self-organizing map for oligonucleotide compositions

To confront the global threat of coronavirus disease 2019, a massive number of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome sequences have been decoded, with the results promptly released through the GISAID database. Based on variant types, eight clades have already been defined in GISAID, but the diversity can be far greater. Owing to the explosive increase in available sequences, it is important to develop new technologies that can easily grasp the whole picture of the big-sequence data and support efficient knowledge discovery. An ability to efficiently clarify the detailed time-series changes in genome-wide mutation patterns will enable us to promptly identify and characterize dangerous variants that rapidly increase their population frequency. Here, we collectively analyzed over 150,000 SARS-CoV-2 genomes to understand their overall features and time-dependent changes using a batch-learning self-organizing map (BLSOM) for oligonucleotide composition, which is an unsupervised machine learning method. BLSOM can separate clades defined by GISAID with high precision, and each clade is subdivided into clusters, which shows a differential increase/decrease pattern based on geographic region and time. This allowed us to identify prevalent strains in each region and to show the commonality and diversity of the prevalent strains. Comprehensive characterization of the oligonucleotide composition of SARS-CoV-2 and elucidation of time-series trends of the population frequency of variants can clarify the viral adaptation processes after invasion into the human population and the time-dependent trend of prevalent epidemic strains across various regions, such as continents. © 2021 The Author(s).

The toilet paper issue during the COVID-19 crisis

Using a new opinion dynamics using the polarity analysis of measured data of Twitter about "toilet paper" and "COVID-19", we analyzed the chain of fear that people feel for the rumor of lack of toilet paper and COVID-19 itself. We use opinion dynamics for the analysis of the fears, and we obtain the opinion distribution of the fear calculated using the opinion dynamics and the observed distribution. By comparing the two distribution, we found that the opinion distribution for the fear is consisted with the mixture of trust and distrust.

Depression in recovered African Americans with severe COVID-19 infection

Introduction The mental health impact of COVID-19 infection on its survivors have been reported. African Americans are disproportionately affected by COVID-19 and more likely to experience severe outcomes relative to other ethnicities. We evaluated the incidence and severity of depression among African American patients within 90 days of recovery from severe COVID-19 infection. Methods We identified African American patients with severe SARS-CoV-2 infection who received invasive mechanical ventilation at the intensive care unit (ICU) of Grady Memorial Hospital, Atlanta, Georgia between May 1, 2020, and June 30, 2020. The patient health questionnaire (PHQ-9), a nine-item questionnaire used to assess depression, and its severity was administered to the patients within 30 to 90 days of hospital discharge. Patients with a history of psychiatric disorders were excluded. We categorized patients into major depressive disorder (MDD) diagnosis or other depression based on their responses. To assess severity, all patients were categorized into none or minimal, mild, moderate, moderately severe, and severe based on a score range of 0-27 on the PHQ-9. We calculated the number of patients on treatment for depression as a percentage of the total eligible for treatment based on their PHQ-9 scores. Data analysis was performed using R version 3.6.3 (R Foundation). Results A total of 73 patients completed the questionnaire. The median age of the participants was 52.5 years [IQR 44-65 years] and 65% were males. 44% of the patients had a diagnosis of MDD. The incidence of MDD was higher among females (69%, n=18/26) compared to males (29%, n=14/47), patients aged 55-74 years (60%, n=18/30), > 75 years (66%, n=4/6) compared to younger patients and patients with multiple co-morbidities (45%, n=28/62) compared to patients with only one or no co-morbidity (36%, n=4/11). 27 patients in the study were eligible for treatment based on a PHQ-9 score of at least 14 (moderate and moderately severe depression). However, only 7 of them were receiving some form of depression treatment. The remaining 74% (n=20/27) had not been screened for depression since hospital discharge (Figure 1). ConclusionOur study showed that at least 4 out of 10 African Americans without prior psychiatric illness, hospitalized in the ICU for severe COVID-19 infection will develop MDD within 90 days of discharge. 74% of treatment eligible patients in our study had not been evaluated by a medical professional and were not on any form of treatment.

Pre-existing cardiovascular disease, acute kidney injury, and cardiovascular outcomes in hospitalized blacks with COVID-19 infection

BACKGROUND: The Corona Virus 19 (COVID-19) infection is associated with worse outcomes in blacks, although the mechanisms are unclear. We sought to determine the significance of black race, pre-existing cardiovascular disease (pCVD), and acute kidney injury (AKI) on cardiopulmonary outcomes and in-hospital mortality of COVID-19 patients. METHODS: We conducted a retrospective cohort study of blacks with/without pCVD and with/without in-hospital AKI, hospitalized within Grady Memorial Hospital in Georgia between February and July 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on qualitative polymerase-chain-reaction assay. The primary outcome was a composite of in-hospital cardiac events. RESULTS: Of the 293 patients hospitalized with COVID-19 in this study, 71 were excluded from the primary analysis (for race/ethnicity other than black non-Hispanic). Of the 222 hospitalized COVID-19 patients included in our analyses, 41.4% were female, 78.8% had pCVD, and 30.6% developed AKI during the admission. In multivariable analyses, pCVD (OR 4.7, 95% CI 1.5-14.8, P=0.008) and AKI (OR 2.7, 95% CI 1.3-5.5, P=0.006) were associated with increased odds of in-hospital cardiac events. AKI was associated with increased odds of in-hospital mortality (OR 8.9, 95% CI 3.3-23.9, P<0.0001). The presence of AKI was associated with increased odds of ICU stay, mechanical ventilation, and acute respiratory distress syndrome (ARDS). CONCLUSION: pCVD and AKI were associated with higher risk of in-hospital cardiac events, and AKI was associated with a higher risk of in-hospital mortality in blacks.

Therapeutic strategy for severe COVID-19 pneumonia from clinical experience

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019 in Wuhan, China, and has resulted in global pandemic. There is currently no effective therapeutic strategy for the management of mechanical ventilation or antiviral drugs for the treatment of this disease. As such, the development of a therapeutic strategy is urgently needed and should be established as soon as possible. In this case series, a therapeutic strategy was initially developed based on previous treatment methods used for the treatment of SARS and MERS in the absence of treatment options for COVID-19 due to a lack of information. During the search for a potential treatment, clinical findings were obtained from patients with severe COVID-19, and one therapeutic strategy was established. This therapeutic strategy was then applied to severe COVID-19 patients. In addition, we can require some interesting clinical features and characteristics of COVID-19 from blood analysis and physical findings. Here, we reported on the clinical features and characteristics of a therapeutic strategy for the treatment of severe COVID-19 pneumonia at our institution.