Early Experience With COVID-19 and Solid Organ Transplantation at a US High-volume Transplant Center.

BACKGROUND: The novel coronavirus severe acute respiratory syndrome coronavirus 2 [coronavirus disease 2019 (COVID-19)] poses unique challenges for immunosuppressed patients. Solid organ transplant (SOT) recipients comprise a large proportion of this group, yet there is limited knowledge about the presentation, clinical course, and immunosuppression management of this novel infection among heart, lung, liver, pancreas, and kidney transplant recipients. METHODS: We present 21 SOT recipients diagnosed with COVID-19 between January 1, 2020 and April 22, 2020 at a US high-volume transplant center. Diagnostic workup, clinical course, immunosuppression/antiviral management, and immediate outcomes are described. RESULTS: Twenty-one (15.9%) of 132 symptomatic patients tested were positive. Mean age at diagnosis was 54.8 ± 10.9 y. Median time from transplant was 5.58 y (interquartile range 2.25, 7.33). Median follow-up was 18 d (interquartile range 13, 30). Fourteen patients required inpatient management, with 7 (50%) placed in the intensive care unit (ICU). All transplant types were represented. Nearly 43% exhibited GI symptoms. Over half (56.2%) presented with elevated serum creatinine suggestive of acute kidney injury. The majority of patients (5/7) with concomitant infections at baseline required the ICU. Eighty percent received hydroxychloroquine ± azithromycin. Ten received toclizumab and/or ribavirin; 1 received remdesivir. Antimetabolites ± calcineurin inhibitors were held or reduced. Over half of hospitalized patients (8/14) were discharged home. Only 1 mortality (4.8%) to date, in a critically ill heart/kidney patient who had been in the ICU before diagnosis. CONCLUSIONS: COVID-19 positive SOT at our institution had favorable short-term outcomes. Those with concomitant infections had more severe illness. More data will be available to evaluate long-term outcomes and disease impact on graft function.

Synthesis of ligands containing N-oxide donor atoms and their assembly into metallosupramolecular structures.

A series of ligands that contain both N-donor and N-oxide donor atoms have been synthesised and ligands L5, L6, L7 and L8 contain, 4, 6, 5, and 6 donor atoms respectively. The smallest ligand L5 forms a mononuclear complex with Cu2+ ([Cu(L5)(ClO4)2(MeCN)]) whereas L6 and L7 form dinuclear double helicates with Ni2+ and Cu2+ respectively ([Ni2(L6)2]4+ and [Cu2(L7)2]4+). L8 forms a tetranuclear cyclic helicate upon reaction with Co2+ ([Co4(L8)4]8+) and in all cases the complexes are characterised by single-crystal X-ray diffraction and ESI-MS. The N-oxide units imparts flexibility in the ligand strand and where the unoxidised ligand strand forms a cyclic helicate, the incorporation of an N-oxide unit allows the formation of the dinuclear double helicate.

The immediate effect of soleus trigger point pressure release on restricted ankle joint dorsiflexion: A pilot randomised controlled trial.

OBJECTIVES: The primary aim of this study was to investigate the immediate effect on restricted active ankle joint dorsiflexion range of motion (ROM), after a single intervention of trigger point (TrP) pressure release on latent soleus myofascial trigger points (MTrPs). The secondary aim was to assess aspects of the methodological design quality, identify limitations and propose areas for improvement in future research. DESIGN: A pilot randomised control trial. PARTICIPANTS: Twenty healthy volunteers (5 men and 15 women; mean age 21.7±2.1 years) with a restricted active ankle joint dorsiflexion. INTERVENTION: Participants underwent a screening process to establish both a restriction in active ankle dorsiflexion and the presence of active and latent MTrPs in the soleus muscle. Participants were then randomly allocated to an intervention group (TrP pressure release) or control group (no therapy). RESULTS: The results showed a statistically significant (p=0.03) increase of ankle ROM in the intervention compared to the control group. CONCLUSION: This study identified an immediate significant improvement in ankle ROM after a single intervention of TrP pressure release on latent soleus MTrPS. These findings are clinically relevant, although the treatment effect on ankle ROM is smaller than a clinical significant ROM (5°). Suggestions for methodological improvements may inform future MTrP research and ultimately benefit clinical practice in this under investigated area.