The pathogenesis of COVID-19: Hypercoagulation and D-dimer in thrombotic complications

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) caused a new coronavirus disease (COVID-19), which is highly contagious and its pathogenesis has not been fully elucidated. In COVID-19, the inflammation and blood coagulation systems are excessively activated. SARS-CoV-2 damages endothelial cells and pneumocytes, which leads to disruption of hemostasis in SARS. Thromboembolism is the main cause of mortality in patients with COVID-19. Clots, including pulmonary embolism (PE) and deep vein thrombosis (DVT), ranging from minor to fatal complications of the SARS-CoV-2 infection are known. Individuals with pre-existing diseases are more susceptible to the development of blood clots and poor outcomes. High levels of circulating cytokines and D-dimer (DD) are influential biomarkers of poor outcomes in COVID-19. The latter occurs as a result of hyperfibrinolysis and hypercoagulation. Plasmin is a key player in fibrinolysis and is involved in the cleavage of many viral envelope proteins, including SARS-CoV. Due to this function penetration of viruses into the host cell occurs. In addition, plasmin is involved in the pathophysiology of acute respiratory distress syndrome (ARDS) in SARS and promotes the secretion of cytokines, such as IL-6 and TNF, from activated macrophages. The focus of existing treatment to alleviate fibrinolysis in patients with COVID-19 is the use of systemic fibrinolytic therapy given thrombotic pathology in severe forms of COVID-19 which may lead to death. However, fibrinolytic therapy may be harmful in the advanced stages of COVID-19, when the status of disseminated intravascular coagulation (DIC) changes from suppressed fibrinolysis to its enhancement during the progression of the disease. This narrative review aims to elucidate the pathogenesis of COVID-19, which will further help in precise diagnosis and treatment. Take-home message: The COVID-19 virus disrupts haemostasis and thromboembolism by over activating the inflammation and blood coagulation systems. High levels of cytokines and D-dimer are indicators of pre-existing diseases and blood clots. Systemic fibrinolytic treatment can reduce severe fibrinolysis in COVID-19, which is caused by plasmin. In the late stages of DIC, when fibrinolysis increases, it may be dangerous. To improve therapy and results, understanding COVID-19 pathogenicity is critical. © 2023 by the authors.

Development of real-time RT-PCR systems for detection and quantitation of bovine enteric viral pathogens

The enteric viruses in animals are responsible for severe and devastating losses to the livestock owners with a profound negative impact on animal, health, welfare, and productivity. These viruses are usually transmitted via the feco-oral route and primarily infect the digestive tract of the humans, bovines and different mammals as well as birds. Some of the important enteric viruses in ruminants are: Rotavirus A (RVA), Peste des petits virus (PPRV), Norovirus (NV), Bovine corona virus (BoCV) and Bluetongue virus (BTV). In the present study, sensitive, specific and reliable TaqMan probe-based RT-qPCRs were developed and standardized for the rapid detection and quantification of enteric viruses from fecal samples. The assays result in efficient amplification of the RVA, BTV and BoCV RNA with a limit of detection (LoD) of 5, 5 and 4 copies, respectively, which is 1000 times more sensitive than the traditional gel-based RT-PCR. The reproducibility of each assay was satisfactory, thus allowing for a sensitive and accurate measurement of the viral RNA load in clinical samples. In conclusion, real time PCR developed for these viruses are highly specific and sensitive technique for the detection of diarrheic viral pathogens of cattle and buffalo. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Evolution of SARS-CoV-2 variants: A rapid literature scan

Emerging Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-Cov-2) variants continue to be a threat to tackling the pandemic and a challenge to scientists as they continue to find solutions to the evolving complexities of the pandemic. This rapid literature scan aims to synthesize evidence related to the existence of the new variants, their epidemiology, and data related to vaccine efficacy. Previous variants, such as Alpha, Beta, Gamma, Delta, and Omicron were identified as “Variants of Concern” (VOCs), whereas Lambda and Mu were classified as “Variants of Interest” (VOIs). The risk of hospitalization largely differs among all these variants and the research landscape is still evolving. According to the collective evidence, Gamma variant had the highest hospitalization risk (adjusted hazard ratio, aHR 3.20, 95% CI: 2.40 to 4.26) followed by Beta (aHR 2.85, 95% CI: 1.56 to 5.23), Delta (aHR 2.28, 95% CI: 1.56 to 3.34), Alpha (aHR 1.64, 95% CI: 1.29 to 2.07), and Omicron (aHR 0.92, 95% CI: 0.56 to 1.52) as compared to the original Wuhan strain. It was also found that vaccination decreased the risk of hospitalization following infections with more virulent strains, such as Alpha, Beta, Gamma, and Delta. The risk of hospitalization was the lowest following Omicron infection among vaccinated individuals. Deltacron, a new hybrid strain (AY.4/BA.1) is believed to result from the previous co-circulation of SARS-CoV-2 Delta and Omicron during November 2021-February 2022. This hybrid virus may have been formed in the body of a person who was exposed to both viruses at the same time. Existing evidence suggested no change in epidemiology and severity of infections resulting from this hybrid strain. The COVID-19 pandemic continues to be insidious and treacherous in every form and variant. Vaccination offers a pragmatic solution to fight against the pandemic and in reducing the risk of hospitalizations. Further research and epidemiological surveillance will be needed to determine the evolving complexities of the variants and the pandemic, especially as the pandemic changes its course towards endemicity. The development of efficacious therapeutic interventions and increased vaccine uptake could reduce the morbidity and mortality associated with the SARS-CoV-2 variants. Take-home message: The SARS-CoV-2 virus and its variants are going to appear as the part of typical evolution cycle. This review emphasizes the need for performing continuous genomic surveillance at all levels (local, national, and global) to monitor variant trajectories and outcomes. © 2022 by the authors.

Association of Chest CT Score During Acute COVID-19 Illness with Subsequent Lung Function Loss Among Lung Transplant Patients

Purpose: Limited data exists on CT chest abnormalities during acute Coronavirus disease 2019 (COVID-19) infection and associated post-illness loss of lung function among lung transplant (LT) patients. Method(s): The institutional database was interrogated for any LT patient diagnosed with COVID-19 during a one-year period (March 2020 to Feb 2021;n=54). 44 patients with acute COVID-19 were alive at 3-month follow up (COVID-survivors: 81.5%). Of the survivors, 34 had a CT chest during the first two weeks of acute illness. A validated CT score was used to quantify the parenchymal abnormalities due to COVID-19. Each lung was divided into 10 separate regions which were scored 0-2 based on the severity and extent of parenchymal opacification (maximum score per lung=20). To avoid confounding from underlying lung disease, only the allograph was assessed in single LT. The average score of both lungs was calculated in bilateral LT. The primary outcome measure was sustained decline of FEV1 or FVC >10% from pre-infection spirometry. Result(s): Abnormal CT score and lung opacities on CT chest were nearly ubiquitous during acute COVID-19 illness (>0;36/37, 97.3%, median score with IDR: 7.25, 4.625-10.125). The lower lobes (LL) were more affected by COVID-19 than the upper and middle lobes (UML) (median CT score in LL: 4, 2.75-6 vs 3.5, 1.25-5 in UML). A >10% decline in FEV1 or FVC was common after COVID-19 pneumonia (38.2%). The overall CT score correlated with amount of lung function loss (r=0.36, p=0.03) although the association was modest and limited to regions reflecting the UML. On ROC curve, CT score was modestly predictive of lung function decline (Fig 1). CT score from UML had the highest area under the curve (78.2%, 61.1-95.4%;p=0.006) with a score of 4.5 being the best cut-off (sensitivity 71%, specificity 85% for post-COVID lung function loss >10%). An UML CT score >4.5 was strongly associated with respiratory failure during acute illness (69% vs 24%;OR: 7.2, 1.5-33.8;p=0.01) and lung function decline >10% (77% vs 19%;OR: 14.2, 2.6-76.7;p=0.001). Conclusion(s): The CT score during acute COVID-19 infection provides prognostic information regarding loss of lung function among LT patients who survive COVID-19. Parenchymal abnormalities in the UML best predict subsequent lung function loss.

DOES COVID-19 INCREASE THE RISK OF DEVELOPING CYSTIC LUNG DISEASE?

SESSION TITLE: Late Breaking Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: (1) Assess the characteristics of COVID-19 patients who developed pulmonary cysts, bullae, blebs, and pneumatoceles. (2) Investigate outcomes of patients who developed cystic lung disease from COVID-19. METHODS: A literature search using Pubmed, Cochrane, and Embase was performed for case reports from 2020 to 2022 describing COVID-19 patients who developed lung cysts, bullae, blebs and pneumatoceles. The following data were extracted: patient demographics, presence of underlying lung disease, history of smoking, maximum oxygen requirements during acute illness, imaging findings, complications, and patient mortality. RESULTS: 65 publications (11 case series and 54 case reports) with a total sample size of 76 patients were analyzed. The mean age of patients was 52.2 ± 15.8 years. A majority of the cases were males (n=67, 88.2%). Twelve (15.8%) cases had an underlying lung disease, such as COPD or asthma, and 16 (21.1%) cases had a history of smoking tobacco. We categorized severity of illness based on the levels of oxygen requirement defined as: (1) mild - 0 to 2 liters of oxygen, (2) moderate - greater than 2 liters of oxygen to face mask/venturi mask and (3) severe - high flow nasal cannula, non-invasive ventilation, or mechanical ventilation. The majority of patients (n=40, 52.6%) had severe illness while 7 (9.2%) and 17 (22.4%) presented with mild and moderate disease, respectively. Of the 25 (32.9%) patients who required invasive mechanical ventilation, duration of ventilator days was provided for 14 patients, with a median of 40 days (interquartile range=54). Twenty-one (27.6%) patients were found to have cysts on imaging, 26 (34.2%) were found to have bullae, 3 (3.9%) were found to have blebs, 15 (19.7%) were found to have pneumatoceles, and 11 (14.5%) were found to have more than one of the aforementioned findings. A total of 53 (69.7%) patients developed pneumothorax and 12 (15.8%) developed pneumomediastinum. Seventeen (22.4%) patients were on the mechanical ventilator while pulmonary complications occurred. Additionally, 41 (53.9%) required chest tube placement, 16 (21.1%) required surgical intervention including open thoracotomy or video assisted thoracoscopy. A total of 47 (61.8%) cases reported either resolution of symptoms and complications, or improved imaging findings following interventions. The rate of inpatient mortality was 11.8%. CONCLUSIONS: Patients with severe COVID-19 may have a higher risk for developing cystic lung disease, hence, increasing the risk for complications such as pneumothorax and pneumomediastinum. CLINICAL IMPLICATIONS: Patients who had severe COVID-19 may benefit from closer follow up and serial imaging for early detection of cystic lung disease. DISCLOSURES: No relevant relationships by Kavita Batra No relevant relationships by Rajany Dy No relevant relationships by Christina Fanous No relevant relationships by Wilbur Ji No relevant relationships by Max Nguyen No relevant relationships by Omar Sanyurah

Prevalence and predictors of burnout syndrome among schoolteachers during the COVID-19 pandemic in Italy: A cross-sectional survey

Introduction: During the COVID-19 pandemic, teleworking affected the mental well-being of nearly all strata of the population. Teachers, who were employed to teach online courses during lockdown have been psychologically distressed. The primary aim of the current study was to estimate the prevalence and differences in the Burnout Syndrome (BOS) symptomatology in the light of gender, work position, teaching role, and subject taught. As a secondary aim, differences in perceived wellbeing were estimated through the contribution of individual factors. Methods: An online cross-sectional survey was conducted from February-May 2021 to recruit a total of 361 teachers from all Italian regions. The Work-Life Balance scale, the Maslach Burnout Inventory, and an ad-hoc questionnaire with items on perceived physical well-being and perceived impact and difficulty in remote work were utilized. Predictors associated with burnout and its subscales were examined using linear regression analyses. Results: Burnout, measured as the co-existence of high emotional exhaustion (EE), high depersonalization (DP), and low personal accomplishment (PA) was revealed in 16.9% of teachers, while high EE, high DP, and low PA were respectively measured in 35.2%, 13.2% and 35.2% of the sample. Variables, such as gender, work position, teaching role, and subject taught were all significant for group differences in perceived well-being or BOS dimensions among teachers. Discussion: Our findings suggest that the implementation of occupational health programs and workplace health promotion programs for improving the mental well-being of teachers. In particular, a higher caution must be needed for implementing critical institutional changes, such as the wide and rapid adoption of telecommuting. Take-home message: Italian schoolteachers engaged in teleworking are exposed to a high risk of stress and burnout during the COVID-19 emergency. Implementing occupational health surveillance programs and workplace health promotions programs are needed to protect and improve teachers’ mental well-being. © 2022 by the authors.

Role of resilience in psychological adjustment and satisfaction with life among undergraduate students in Turkey: A cross-sectional study

Introduction: Cultivation of resilience is shown to reduce mental health problems and improve well-being. The effect of resilience on psychological adjustment problems and satisfaction with life is however not adequately discussed. This study investigated the predictive effect of resilience in psychological adjustment and satisfaction with life among undergraduate students during the second wave of the COVID-19 pandemic in Turkey. Methods: In this cross-sectional study, a convenience sampling method was utilized to recruit undergraduate students from a public educational institution in Turkey. Psychometric valid tools, such as the Brief Resilience Scale (BRS), Brief Psychological Adjustment-6 (BASE-6) and Satisfaction with Life Scale (SWLS) were used to measure the primary outcomes of the study. Data were analyzed using the independent samples t-test, one-way ANOVA, Pearson correlation, and hierarchical multiple regression. Results: Of total 224 undergraduates participated in this study, nearly 74% were males and the mean age of the sample was 21.03±1.66 years. More than half of the participants had average socioeconomic status (53.57%) followed by above-average (40.18%) and below-average (6.25%). The results indicated that males and individuals who had low socioeconomic status reported greater psychological maladjustment problems. Furthermore, the resilience negatively predicted the psychological maladjustment (β =-0.31, p<0.01) and positively predicted satisfaction with life (β = 0.17, p< 0.05) after controlling for age, gender, and perceived socioeconomic status. Discussion: These results shed light on the relationship of resilience with psychological outcomes in terms of satisfaction with life and psychological adjustment during the COVID-19 pandemic. The findings of this study point to the potential role of resilience in improving satisfaction with life and psychological adjustment among undergraduate students in Turkey. Additionally, efforts by practitioners and policymakers should be made in developing resilience-building interventions to foster post-traumatic growth among students. Take-home message: The current findings will serve as preliminary evidence to develop innovative preventative intervention programs aiming at reducing psychological adjustment problems and promoting satisfaction with life among undergraduate students in Turkey. © 2022 by the authors.

Recurrent lymphangioleiomyomatosis in a lung allograft with COVID-19: autopsy case report and literature review

Lymphangioleiomyomatosis (LAM) is a rare neoplastic disease of the lung with a characteristic feature of diffuse cystic changes in bilateral lungs. Lung transplantation is considered to be one of the effective treatments in end stage disease. Patients with LAM who underwent lung transplant tend to have more favorable outcome compared to other end stage lung diseases. We report a case of a female patient who was diagnosed with LAM and received bilateral lung transplantation at 45 years of age. Subsequent allograft biopsies were significant for mild acute cellular rejection (Grade A2), for which the immunosuppressive regimen was adjusted accordingly. At 7 years post-transplant, she presented with shortness of breath, cough, and fatigue, and diagnosed with a viral infection. Her chest imaging was unremarkable. However, a transbronchial biopsy was performed to rule out rejection and revealed foci of spindle cells proliferation, with positive HMB-45 and smooth muscle actin immunohistochemical studies, confirming the diagnosis of recurrent LAM. After she was discharged, she was re-admitted 1 week later with severe COVID-19. Her clinical course was complicated by acute respiratory distress syndrome, respiratory failure, and gastrointestinal hemorrhage. The patient passed away on day 36 of hospital stay. Autopsy was requested and confirmed the pathology of recurrent LAM and diffuse alveolar damage from COVID-19.

Impact of COVID-19 on Healthcare Labor Market in the United States: Lower Paid Workers Experienced Higher Vulnerability and Slower Recovery

The resilience of the healthcare industry, often considered recession-proof, is being tested by the COVID-19 induced reductions in physical mobility and restrictions on elective and non-emergent medical procedures. We assess early COVID-19 effects on the dynamics of decline and recovery in healthcare labor markets in the United States. Descriptive analyses with monthly cross-sectional data on unemployment rates, employment, labor market entry/exit, and weekly work hours among healthcare workers in each healthcare industry and occupation, using the Current Population Survey from July 2019-2020 were performed. We found that unemployment rates increased dramatically for all healthcare industries, with the strongest early impacts on dentists' offices (41.3%), outpatient centers (10.5%), physician offices (9.5%), and home health (7.8%). Lower paid workers such as technologists/technicians (10.5%) and healthcare aides (12.6%) were hit hardest and faced persistently high unemployment, while nurses (4%), physicians/surgeons (1.4%), and pharmacists (0.7%) were spared major disruptions. Unique economic vulnerabilities faced by low-income healthcare workers may need to be addressed to avoid serious disruptions from future events similar to COVID-19.

COVID-19 and social isolation endangering psychological health of older adults: Implications for telepsychiatry

Coronavirus disease-19 (COVID-19) has created a public health emergency and had claimed 911,877 lives at the time of writing this manuscript (September 12, 2020). While everybody is at the risk of acquiring infection following the exposure to SARS-CoV-2, older adults are significantly more likely to experience severe illness, life-threatening complications, hospitalizations, and deaths. As the pandemic evolved, social distancing or shielding efforts as primary prevention were instituted to protect the physical health status of the vulnerable population, with no or limited consideration to the psychological health of the older population. Social isolation and loneliness are the long-standing public health concerns among older adults, which appear to be exacerbating amidst the COVID-19 pandemic. Given the pre-existing risk of late-life psychiatric disorders among older individuals, it is critical to determine challenges posed by COVID-19 and associated social distancing protocols as it relates to the psychosocial well-being of the aging population. Such information is imperative to design targeted interventions to fulfill the unmet needs of the older population. Therefore, this review endeavors to identify the healthcare and emotional needs of the aging population during the COVID-19 pandemic in the context of psychological health and social capital. Additionally, this review also identifies the barriers in the uptake of telepsychiatry and highlights the need for promoting remote counseling services among older people to promote their psychosocial well-being.