Active COVID-19 Infection Research Articles

Stroke in Patients with Active COVID-19 Infection: Case Series in a Single Center

Stroke in Patients with Active COVID-19 Infection: Case Series in a Single Center

Physiological And Biomechanical Responses To Endurance Training With An Active Covid-19 Infection: A Case Study

Physiological And Biomechanical Responses To Endurance Training With An Active Covid-19 Infection: A Case Study

MDS-Type Morphologic Abnormalities of Peripheral Blood Granulocytes in Symptomatic COVID-19 Patients.

Background: Hematological abnormalities in COVID-19 infection included quantitative and qualitative changes and should be further characterized. Evaluation for myelodysplastic syndromes (MDS) is usually prompted by abnormal hematologic findings and the presence of dysplastic morphologies. Viral infections are considered to be the cause of dysplastic morphologies and should be considered by morphologists. There are few reports of dysplastic abnormal morphologies in patients with COVID-19 infection. However, such correlations still have to be clarified. Materials and Methods: In the present study, we examined the granulocyte lineage morphological abnormalities in symptomatic RT-PCR-confirmed COVID patients. Peripheral blood samples were collected from 82 patients with symptomatic COVID-19. Blood smears were prepared according to the standard Wright-Giemsa staining procedure. The morphological examination was carried out by two laboratory experts. Results: Blood smear examination revealed common myelodysplastic syndrome (MDS) type abnormalities including but not limited to pseudo-pelger nuclear lobulation (4.8%), hypogranulation (7.3%), Howell-Jolly-like bodies or detached nuclear segments (6.0%) and elongated and thin nuclear filaments (6.0%). One case of abnormal immature granulocyte and ring form nucleus is also evident. Conclusion: Our results accounted for the possibility of active COVID-19 infection in all subjects with granulocyte dysplasia. These results are of practical importance for patients suspected of having myelodysplastic syndromes or disease processes associated with myeloid malignancies.

Validity of A new Weaning Index of Discontinuation From Mechanical Ventilation in Intensive Care Unit

Abstract Background Failure to wean from mechanical ventilation (MV) is a frequent problem in the intensive care unit (ICU) setting. Herein, we investigate a new WI measured at the initial spontaneous breathing trial (SBT) in order to predict successful liberation from MV in mechanically ventilated ICU cases. Patients and methods This prospective cross-sectional study consisted of two phases; Phase I was designed to create a new WI from the criteria of 60 mechanically ventilated patients, while Phase II aimed to assess the accuracy of that index in another 40 patients. Patients aged older than 18 years who were receiving controlled-mode MV from day 3 to day 14 and planned to be weaned off MV were included in our study. Contrarily, patients with prior history of poor tolerance to SBT, weaning failure were excluded. Additionally, we also excluded patients with neurological or neuromuscular disorders, tracheostomy, pregnancy, or an active COVID-19 infection. Results The incidence of failed weaning was 33.3% in phase I, and 35% in phase II. Pulmonary causes were the most common indication in both groups. Multivariate regression analysis was done for phase I variables, and the following equation was created; (((Cough strength* 0.743) - 1.927) *0.05 + ((PaCO2 (mmHg)* - 0.126) + 6.786) *0.08 + ((mean airway pressure (CmH2O) * -1.304) + 14.119) *0.193 + ((PaO2/FIO2 * 0.268) - 58.555) *0.328 + ((rapid shallow breathing index * -0.485) + 24.406) *0.353). Using a cut-off value of > 0.69 and applying this index in phase II, it showed a mean value of -1.43 and 4.67 in the failure and success groups, respectively (p < 0.001). This new WI with cutoff value (> 0.69) had 88.5% sensitivity, 57.1% specificity, and a 77.5% accuracy to predict the success of weaning from MV. Conclusion We developed a new WI with good sensitivity and moderate specificity for predicting successful weaning from MV in ICU patients. Its use should be encouraged in the ICU setting, especially by less experienced ICU physicians.

Association between gut microbiota dysbiosis and poor functional outcomes in acute ischemic stroke patients with COVID-19 infection.

Acute ischemic stroke (AIS) patients with active COVID-19 infection often have more severe symptoms and worse recovery. COVID-19 infection can cause gut microbiota dysbiosis, which is also a risk factor for poor outcomes in AIS patients. However, the association between gut microbiota and functional outcomes among AIS patients with COVID-19 infection has not been fully clarified yet. In this study, we performed 16S rRNA gene sequencing to characterize the gut microbial community among AIS patients with acute COVID-19 infection, AIS patients with post-acute COVID-19 infection, and AIS patients without COVID-19 infection. We found that AIS patients with acute COVID-19 experienced poorer recovery and significant gut dysbiosis, characterized by higher levels of Enterobacteriaceae and lower levels of Ruminococcaceae and Lachnospiraceae. Furthermore, a shorter time window (less than 28 days) between COVID-19 infection and stroke was identified as a risk factor for poor functional outcomes in AIS patients with COVID-19, and the enrichment of Enterobacteriaceae was indicated as a mediator in the relationship between infection time window and poor stroke outcomes. Our findings highlight the importance of early intervention after COVID-19 infection, especially by regulating the gut microbiota, which plays a role in the prognosis of AIS patients with COVID-19 infection.IMPORTANCEThe gut microbiota plays an important role in the association between respiratory system and cerebrovascular system through the gut-lung axis and gut-brain axis. However, the specific connection between gut bacteria and the functional outcomes of acute ischemic stroke (AIS) patients with COVID-19 is not fully understood yet. In our study, we observed a significant decrease in bacterial diversity and shifts in the abundance of key bacterial families in AIS patients with acute COVID-19 infection. Furthermore, we identified that the time window was a critical influence factor for stroke outcomes, and the enrichment of Enterobacteriaceae acted as a mediator in the relationship between the infection time window and poor stroke outcomes. Our research provides a new perspective on the complex interplay among AIS, COVID-19 infection, and gut microbiota dysbiosis. Moreover, recognizing Enterobacteriaceae as a potential mediator of poor stroke prognosis offers a novel avenue for future exploration and therapeutic interventions.

Incidence, management and prognosis of new-onset sarcoidosis post COVID-19 infection.

SARS-CoV-2 infection has been linked to hyperinflammation in multiple organs with a potential mechanistic link with resulting autoimmunity. There have been reports of many inflammatory complications following COVID-19, including sarcoidosis. A literature review on new-onset sarcoidosis following COVID-19 is lacking. We evaluated potential associations between COVID-19 and development of new-onset sarcoidosis. Articles discussing biopsy-proven sarcoidosis after confirmed COVID-19 infection, published 1956 until April 2023, were included. All article types were deemed eligible except opinion and review articles. A pooled total of 15 patients with new-onset diagnosis of sarcoidosis after COVID-19 infection were included, 45.5% female, mean age 46.1 years (standard deviation 14.7) at onset of sarcoidosis. Patients were from: Europe (n=11); North America (n=2); South America (n=1); Asia (n=1). The mean time between COVID-19 infection and diagnosis of sarcoidosis was 56.3 days, although this ranged from 10 to 140 days. Organ systems predominantly affected by sarcoidosis were: pulmonary (n=11); cutaneous (n=3); cardiac (n=2); ocular (n=1); systemic (n=1) (with overlapping features in certain patients). Sarcoidosis was treated as follows: glucocorticoids (n=8); azathioprine (n=1); cardiac re-synchronisation therapy (n=1); heart transplant (n=1). All patients were reported to have survived, with one requiring intensive care admission. Our result suggests there is a potential link between COVID-19 and new-onset sarcoidosis. The potential mechanism for this is through cytokine mediated immune modulation in COVID-19 infection. Obtaining a tissue sample remains key in confirming the diagnosis of sarcoidosis and this may be delayed during active COVID-19 infection.

Accuracy of Smartwatch Pulse Oximetry Measurements in Hospitalized Patients With Coronavirus Disease 2019

ObjectiveTo assess the ability of two commercially available smartwatches to accurately detect clinically significant hypoxia in patients hospitalized with COVID-19. Patients and MethodsA prospective multi-center validation study was performed from 1st November 2021 to 31st August 2022 assessing the Apple Watch Series 7 and Withings ScanWatch inbuilt pulse oximetry, against simultaneous ward-based oximetry as the reference standard. Patients hospitalized with active COVID-19 infection not requiring intensive care admission were recruited. Results750 smartwatch pulse oximetry measurements and 400 ward oximetry readings were successfully obtained from 200 patients (male 54%, age 66 ± 18 years). For detection of clinically significant hypoxia the Apple Watch had a sensitivity and specificity of 34.8% and 97.5% respectively, with a positive predictive value (PPV) of 78.1% and negative predictive value (NPV) of 85.6%. The Withings ScanWatch had a sensitivity and specificity of 68.5% and 80.8% respectively with a PPV of 44.7% and NPV of 91.9%. Overall accuracy was 84.9% for the Apple Watch and 78.5% for the Withings ScanWatch. Spearman rank correlation coefficients demonstrated moderate correlation to ward-based PPG (Apple: rs = 0.61; Withings: rs = 0.51, both p < 0.01). ConclusionWhile smartwatches are able to provide SpO2 readings, their overall accuracy may not be sufficient to replace standard PPG technology in detecting hypoxia in COVID-19 patients.

Perioperative Analysis of Patients Undergoing Liver Transplantation at the Hospital de Clínicas da Unicamp in the Context of SARS-Cov-2 Pandemic

Introduction: SARS-CoV-2 began in 2020 and caused important changes in the number of transplants performed in hospitals and in the protocols for admitting candidates to perform the procedure. The Brazilian Association of Organ Transplantation (ABTO) recommends not performing transplants from donors with active COVID-19 infection, positive test results or with Severe Acute Respiratory Syndrome. The hepatic repercussions related to COVID-19 are presented in some reports in the medical literature. Liver changes resulting from other corona viruses such as SARS-CoV and MERS-CoV are well documented. The Hospital de Clínicas of the State University of Campinas is a tertiary center that performs solid organ transplants. Objectives: To carry out a perioperative, retrospective, descriptive analysis of liver transplants in the context of the SARS-CoV-2 pandemic carried out at the Hospital das Clínicas of the State University of Campinas from March 2020 to July 2021. Materials and Methods: Retrospective, descriptive, longitudinal cohort study based on the review of medical records of patients undergoing liver transplantation in the context of the SARS-CoV-2 pandemic from March 2020 to July 2021 at the clinical hospital of the State University of Campinas. Results:Retrospective analysis was performed on 57 patients in the period. Only 1 patient needed to be excluded because he was under 18 years old. Of the 56 patients, 52 underwent RT-PCR laboratory testing and chest tomography (CT). Of these 52 patients, only 2 tested positive, one pre-transplant (TX) and one post-operatively (post-op). Regarding chest CT scans, none of them showed typical changes for COVID pre-TX, in the post-op 4 patients presented typical chest CT scans. The average age was 55.86 years. The mortality rate was 38% and no deaths were attributed to COVID 19. The average MELD-Na scale was 20.94. Conclusion: The present study carried out at the Hospital de Clínicas da Unicamp analyzed the clinical, laboratory and radiological association to better elucidate the variables determined by COVID-19 in its diagnosis and in-hospital management. It is concluded that the SARS-CoV-2 pandemic had an impact on the routine of liver transplantation worldwide and on the service in which the study was carried out.

Differences in newborn status between those born from mothers with active covid-19 infection and those born from mothers who underwent covid-19 infection in first trimester of pregnancy - Pilot study

Differences in newborn status between those born from mothers with active covid-19 infection and those born from mothers who underwent covid-19 infection in first trimester of pregnancy - Pilot study

Effect of COVID-19 on peripheral and central hearing abilities

BackgroundCOVID-19 has caused various implications on physical and mental health of human beings. It included several symptoms involving the auditory vestibular system. This study aims to investigate the impact of active COVID-19 infection on central and peripheral auditory pathways.MethodTwo groups of subjects were involved in the research: Group I consisted of 45 individuals with no history of COVID-19, while Group II included 41 individuals who were diagnosed with COVID-19 through RT-PCR testing.The audiological battery used in this study included Pure tone audiometry, Digit in Noise test, Dichotic CV test, and Pitch pattern test, all of which were administered online. Testing was conducted in two phases for both groups. Phase 1 testing took place within the first 7 days of a positive RT-PCR result, while Phase 2 testing occurred within a week of a negative RT-PCR test. Additionally, participants completed a questionnaire to provide information on general health conditions and their otological symptoms.ResultsThe results from Phase 1 testing revealed that Group II exhibited statistically lower scores in all the audiological tests compared to Group I (control group). However, during Phase 2 testing, this significant difference was no longer observed between both groups.ConclusionBased on the findings, it can be inferred that the audiological pathway was compromised during the active infection stage of COVID-19. Therefore, this study highlights changes in performance concerning tests that assess the central auditory system during the infection period.Trial registrationSH/IRB/RP/24. Registered 12 January 2021.

Pattern of pulmonary function tests in subjects recovered from COVID 19 infection

Introduction and Aim: The pulmonary sequelae of COVID-19 have not been extensively studied in the Indian population. This study was taken up with the aim to assess the pulmonary function tests (PFT) in subjects recovered from COVID-19. Material and Methods: In this observational cross-sectional study PFT was assessed in 50 adults in the age group of 18-60years. Rapid Antigen Testing was performed to rule out active COVID-19 infection. Subjects with acute or chronic respiratory illnesses that could affect lung functions were excluded. Results: We performed PFT on 50 subjects, with a mean age and BMI of 36.09 years and 25.17 kg/m2. Fatigue and/or breathlessness were the most common complaints present post-recovery. A normal PFT was found in 22 participants and 28 showed a restrictive pattern. Based on the severity of the disease they had experienced the study population was classified into three groups mild, moderate or severe COVID. The three groups were found to be comparable in their demographic parameters, the PFT parameters were significantly different between the groups with significantly lower values seen in subjects who recovered from severe COVID. Conclusions: Restrictive pattern on PFT was the common abnormality found in patients recovered from COVID-19. This finding emphasises the need for long-term follow-up and establishment of a plan of assessment and management in patients recovered from COVID-19.

COVID-19-Associated Neurological Complications in Children.

Neurological manifestations of Severe Acute Respiratory Syndrome coronavirus-2 have been well documented in adults during and after infection with the virus as well as after vaccination. The incidence of severe neurological symptoms among children is very low. This study aimed to analyze the varied neurological manifestations after COVID-19 infection among children and give a report on a single-center experience with these severe neurological symptoms. Case records of patients less than 18 years admitted between July 2021 to December 2022 with neurological manifestations and COVID-19 infection or with elevated COVID-19 antibodies after exclusion of other etiological diagnosis were analyzed. There were 10 cases in the age range of 1-15 years. All the cases had elevated COVID-19 antibodies with history of contact 2-3 weeks prior except one who was positive for COVID-19 infection. Two cases presented with acute ascending paralysis suggestive of Guillain-Barre syndrome. Four cases presented with features of encephalopathy with clinical presentation fulfilling the criteria of Multisystem inflammatory syndrome in children. One case presented with fever and focal seizures with MRI showing sagittal sinus thrombosis, and one presented with fever and altered sensorium with MRI showing leukoencephalopathy. One child had cerebral mucormycosis without any evidence of immunosuppression. There was one child with features of encephalopathy with active COVID-19 infection. The varied presentation highlights the central and peripheral nervous system involvement by the virus in the pediatric population. It also emphasizes the need to investigate for COVID-19 in children presenting with these complaints during the pandemic.

Pregnancy outcomes of COVID&amp;ndash;19 positive pregnant mothers at a tertiary care centre in Colombo &amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;

Background and Objective The COVID–19 pandemic affected almost all aspects of health. It appeared to increase morbidity and mortality among pregnant women in Sri Lanka, during the 3rd wave. The aim of this study was to determine maternal and neonatal outcomes in mothers with active COVID-19 infection. Method A cross-sectional descriptive study was conducted over a period of 3 months during the 3rd wave of the COVID-19 pandemic on 59 mothers who were either admitted to the maternity isolation ward with active infectio or were positive for COVID-19 at any point during gestation and came for delivery to the professorial unit obstetric ward. Socio demographic details, vaccination status against COVID-19 and details regarding management were collected using an interviewer administered questionnaire and analysed using the Statistical Package for the Social Sciences (SPSS – 23) software. Results A majority of 33, 55.9% experienced mild symptomatic disease, 25, 42.4% were asymptomatic and one developed pneumonia. Disease severity showed no statistically significant association to the trimester of contracting COVID-19, vaccination status, mode and timing of delivery or intrapartum and postpartum complications. A significant percentage (18%) delivered preterm where 77.8% of them had active disease. Low birth weight was reported in 22.7% of the newborns. Majority (71.7%) of the study sample underwent lower segment caesarean section where most (80.7%) had active disease at delivery. All newborns tested for COVID-19 status were negative. Conclusion An increased percentage of preterm delivery and low birth weight was observed with no statistically significant associations with trimester of contracting COVID-19 or vaccination status.

Effect of High Serum Ferritin on Extent of Involvement of COVID-19 Associated Mucormycosis.

Coronavirus disease 2019 attributed to severe acute respiratory syndrome has been implicated with life threatening opportunistic infections like mucormycosis. COVID-19 is a hyperferritinemic syndrome and emerging data project the role of iron in the susceptibility and pathogenesis of mucormycosis but whether high ferritin is an indicator of severity of mucormycosis is debated. The study aimed to determine the relationship between serum ferritin levels and the extent of involvement of COVID-19 associated mucormycosis. A hospital based observational study was conducted with a sample size of 70. All biopsy confirmed cases of COVID-19 associated mucormycosis were included. Retrospective data from hospital records prepared at the time of patient admission were retrieved. The imaging data was used to determine the extent of disease involvement and serum ferritin values were analysed. During the study period 40 patients had mild extent mucormycosis and 30 had severe extent. A statistically significant difference was seen in levels of serum ferritin between mild extent mucormycosis and severe extent involvement (p < 0.01). COVID-19 associated Mucormycosis patients tend to have higher serum ferritin values especially in severe extent disease and with active COVID-19 infection along with diabetes mellitus as a potent aggravating factor.

Optimizing Surgical Management of Acute Invasive Fungal Sinusitis.

Early surgical debridement is vital for favorable outcomes in acute invasive fungal sinusitis (AIFS). Our study aimed to propose guidelines with tailored, conservative surgical procedures based on areas of involvement and evaluate their usefulness in avoiding repeated debridement. This retrospective observational study was conducted on 150 AIFS patients operated on with the proposed surgical guidelines from May to June 2021 at a tertiary care hospital. Data including demography, comorbidities, surgical procedures, revision surgery, and outcome were collected and analyzed. All 150 patients underwent bilateral endoscopic sinonasal debridement. Among them, 108 patients (72%) had current or recent coronavirus disease (COVID) infection. Ninety-two patients (61.3%) required additional procedures based on disease extent. Twenty patients (15.4%) required revision debridement because of progressive or recurrent disease. Mean age of this group was 46.15 (standard deviation ±11.2) years with a strong male predominance (9:1). Seventeen had diabetes mellitus, 12 suffered from active COVID-19 infection and six had received corticosteroids. None of the 31 patients who had recovered from COVID-19 or had no comorbidities required revision surgery. Age, gender, and comorbidities were not significant predictors for revision surgery. Fourteen patients (70%) underwent second surgery within one month of primary surgery. Predominant disease locations were alveolus and palate (55% each), and in 80% the site was uninvolved at primary surgery. The most common revision procedure was inferior partial maxillectomy (60%). At follow-up, all were asymptomatic with no evidence of disease. The proposed surgical guidelines for AIFS allow for adequate surgical debridement with preservation of optimum functional status. Low revision surgery rates and good outcomes with minimal morbidity validate its usefulness.

Incidence of Venous Thromboembolism in Pediatric Cancer Patients with COVID-19: MD Anderson Cancer Center Experience

Background: Patients with COVID-19 are at increased risk of venous thromboembolism (VTE) due to a hypercoagulable state. Multisystem inflammatory syndrome in children (MIS-C) is a unique entity in the pediatric population affected by COVID-19 which also increases the risk of VTE. This has been described in the literature and guidelines have been established across different institutions regarding anticoagulation prophylaxis. It is well known that cancer increases the risk of VTE greater than four-fold to that of the general population and, for patients receiving active chemotherapy, the risk is up to 6.5 times greater. Studies have shown that adults patients with active cancer and COVID-19 infection had increased risk of mortality due to VTE associated complications. Contrary to that, some reports have shown that incidence of VTE does not appear to be increased in adults with cancer compared to non-cancer patients. Hence, the data is yet scarce as well as conflictive. Anecdotally, we observed a decreased number of cases of VTE associated with COVID-19 infection in our pediatric cancer patients. There are limited studies that evaluate COVID-19 infection with VTE incidents and complications in this population. In this study, we report a retrospective analysis of pediatric cancer patients at our center during a span of three years to determine the incidence of COVID-19 infection with VTE and related complications. Objectives: Primary objective: Investigate the incidence of VTE in pediatric cancer patients with COVID-19 infection. Secondary objectives: Investigate COVID-19 associated complications, comorbidities in pediatric cancer patients. Methods: This is a single center retrospective cohort study. Data was extracted from COVID-19 database established at MD Anderson Cancer Center since the start of the pandemic. Patients 0 to 18 years of age affected by COVID-19 infection who were seen at MD Anderson Cancer Center from March 2020 to March 2023 were included. VTE inclusion criteria was development of thrombosis event from 14 days prior up to three months after COVID-19 infection. All cancer types were included. ICD 10 codes for diagnosis of COVID-19 infection and VTE were used to search for patients meeting the above criteria. Foundry database software was used to analyze the data and validation was done by the software checks by two independent reviewers and accordingly modified our search terms. Results: Three cohorts ( figure 1) were identified; patients with COVID-19 infection with or without VTE (Group 1), patients with VTE with or without COVID-19 infection (Group 2), and patients with both COVID-19 infection and VTE (Group 3). From group 1 (pediatric cancer with COVID infection with and without VTE), a total of 235 cancer patients ranging between 0 to 18 years of age were found affected by COVID-19 infection (Mean = 11.1 years, median = 12 years). The majority of patients were Caucasians (57.4%). Fifty percent of patients were male. From group 2 (pediatric cancer patients with VTE with or without COVID-19 infection), 272 patients were identified who had developed VTE of which 55.5% were males, and 54% were Caucasians with similar age distribution (mean = 13.1 years, median =15 years). In our study population, we identified three patients with VTE events who had COVID-19 infection (group 3, see table 1). Conclusion: The incidence of VTE in pediatric cancer patients affected by COVID-19 infection was lower compared to COVID-19 negative pediatric cancer patients. Our findings suggest that COVID-19 infection does not appear to be an additional risk factor for the development of VTE in pediatric cancer patients. Further studies are currently ongoing to investigate co-morbidities and COVID-associated complications other than VTE.

Factor V Inhibitor in COVID-19 an Unusual Presentation

Introduction : A huge variety of haematological manifestations and derangements have been frequently published with COVID-19 infections, however Factor V deficiency and COVID-19 infection has not been documented. We are reporting a case of acquired Factor V deficiency due to inhibitor caused by COVID 19 infection . Factor V deficiency is a rare bleeding disorder having either inherited or acquired forms. Acquired factor V deficiency (AFVD) can present at any age, with the manifestations ranging from abnormal deranged PT/PTT to serious bleeding and quite often challenging to diagnose. The risk factors for development of inhibitors include surgical procedures, Hepatitis, antibiotic, Urinary tract infections, blood transfusions, haemodialysis, malignancies like multiple myeloma, amyloidosis and autoimmune disorders. Around 30% of cases of AFVI are found to be idiopathic. Studies suggest that there is a temporal Connection between SARS-CoV-2 infection and the development of coagulopathy. This could be possible since COVID -19 infection is well associated with autoimmune coagulation abnormalities such as lupus anticoagulant, antiphospholipid antibodies, and venous thromboembolism. The precise mechanisms behind the relationship between Covid19 infection and development of Factor V deficiency is not fully understood. SARS-CoV-2 infection induces a proinflammatory state causing endothelial damage, platelet activation and hyperviscosity. We suggest that the factor V inhibitor was formed in the setting of immune dysregulation from the underlying COVID-19 as coagulation profile was normal before admission to hospital. Result and method: A 62 year old gentleman with background of dyslipidemia and IBS was admitted to the hospital with asymptomatic COVID pneumonia. The patient was started on Lopinavir-Ritonivir 500mg BID and enoxaparin 40mg OD. Upon routine testing patient was found to have a deranged coagulation profile (PT: 41.9sec/APTT: 104.7sec/INR: 3.5/Fibrinogen: 3.04gm/L/ D-dimer: &amp;lt;0.30mg/L FEU). Daily results kept showing a steady rise of coagulation parameters (PT: 46.5sec/APTT: 122.0sec/INR: 3.9) however the patient was asymptomatic. Results demonstrated severe factor V deficiency (&amp;lt;5.7%) with mildly reduced Factor VII (53.8%) and a mildly elevated factor VIII (195.4%). PT and APTT mixing studies showed no correction of the prolonged clotting times before and after 2 hours incubation, hence the failure of correction suggested the presence of an inhibitor for which Bethesda test for Inhibitor's titer and autoimmune screening were sent. Considering the Factor V inhibitor deficiency with background of active COVID-19 infection and to prevent bleeding complications, the patient was started on Inhibitor eradication therapy with Dexamethasone 20 mg, and Immune globulin intravenous 45 gm. Inhibitor titers came back positive for an inhibitor level of 9 BU/ml. Autoimmune screen for ANA and anti-B2 glycoprotein came back negative. Malignancy was ruled out. Throughout the hospital stay , we did not encounter any bleeding manisfestions or drop in haemoglobin. Since the patient had a previous record of normal coagulation profile in 2019, a diagnosis of COVID-19 infection-related Factor V deficiency with inhibitor was made. After a four-days course of inhibitors eradication, PT INR and aPTT started coming down with no significant complications, the patient was discharged on oral prednisolone and vitamin K. Follow up in the clinic after 3 weeks showed complete normalization of coagulation profile. Conclusion: A wide range of haematological manifestation have been reported with COVID-19 infection, but the association of Factor V deficiency due to inhibitors and COVID-19 infection have not been reported in the literature earlier. Treatment will be focusing on treating the primary cause and eradication of the inhibitors.

Clinical outcomes of cardiac devices in heart failure patients hospitalized with COVID-19: insights from the united states national inpatient database

Abstract Background COVID-19 has caused global impact especially in patients with cardiac devices(CD). Moreover, since the onset of the COVID-19 pandemic, physicians have suspended nonurgent procedures. Scarce date is available with respect to CD implantations in patients with active COVID-19. Purpose We aimed to investigate the impact of COVID-19 on implantation rates and clinical outcomes in heart failure (HF) patients hospitalized for COVID-19. Methods Data from National Inpatient Sample database from 2020 was used to identify hospitalizations for COVID in HF patients. Clinical outcomes of CD implantations were compared using univariate and multivariate logistic regression analysis. Results From March-December 2020, a total of 20,426 CD were performed in HF patients in the United States, of which 0.9 % were among those with active COVID-19 infection. Patients with COVID were younger, more hispanic and black population, and had a higher prevalence of comordities such as ventricular fibrillation and complete heart block when compared to patients without COVID. CD implantation in patients with COVID had significantly increased in-hospital mortality, longer lengths of stay, higher hospitalization costs, and outcomes such as incidence of acute stroke, thromboembolism, and sepsis. Device related complications and the need for revisions were comparable in the two cohorts. After adjustment for baseline characteristics, COVID cohort had increased odds of in-hospital mortality. Conclusion Patients with active COVID-19 infection who underwent device implantation had increased in-hospital mortality, longer lengths of stay and higher hospitalization costs with comparable outcomes of device complications.Figure 1Figure 2

Prior COVID-19 infection is associated with persistent and higher thrombus burden in acute coronary syndromes

Abstract Background/Introduction The COVID-19 pandemic challenged global healthcare systems by causing a multi-organ syndrome with a high mortality rate. COVID-19 infection is associated with a profound inflammatory response and hypercoagulability in the acute phase, however little is known on the persistence of endothelial dysfunction and hypercoagulability beyond this phase and its impact on acute coronary syndrome (ACS). Purpose The purpose of this study was to investigate the effects of COVID-19 infection on the presentation and outcomes of coronary artery disease in patients with ACS. Methods A single centre prospective observational study was conducted from 10th of June 2020 to 6th of May 2021. Patients aged 18 or over presenting with ACS were included. Participants were excluded if they had active COVID-19 infection or if they did not undergo coronary angiography on admission. Study participants were tested one presentation for SARS-CoV-2 nucleoprotein (N) antibody and SARS-CoV-2 spike protein receptor binding domain (RBD) antibody to determine whether the participants had prior COVID-19 infection, COVID-19 vaccination, or neither at the time of their presentation. Data was collected on their baseline demographics, angiographic findings, and treatments. Patients were followed up via telephone call and electronic case record review to assess outcomes at one year. The primary end-point was all-cause mortality. Pre-specified secondary endpoints were cerebral infarction, repeat myocardial infarction or unplanned revascularisation and death (MACE) at one year, coronary artery ectasia, presence of thrombus, and thrombectomy requirement. Results 280 patients were approached for the study. 5 refused participation, 8 were lost to follow-up, 2 did not undergo coronary angiography, and 98 had uninterpretable/insufficient blood samples for antibody analysis. The remaining study population had 167 patients (median age 64 [43-85], 69.5% male). 22 (13.1%) had prior infection, 76 (45.5%) were antibody negative and 69 (41.3%) had a post COVID-19 immunisation response. 31.7% had diabetes mellitus, and 49.7% were smokers. There was no difference in the primary endpoint between the groups. Patients with prior COVID-19 infection were more likely to have coronary ectasia/aneurysm compared to vaccinated and antibody negative patients (57.1% vs 27.5% and 30.3%, respectively p = 0.034). They were also more likely to have thrombosis (61.9% vs 33.3% and 52.6%, p = 0.019), and undergo thrombectomy (19.0% vs 4.3% and 3.9%, p=0.027). Conclusions and Relevance Our findings suggest that COVID-19 infection may lead to persistent endothelial dysfunction and hypercoagulability, portending increased severity of coronary artery ectasia and coronary thrombosis even after recovery from the initial infection.

Abstract 15792: COVID-19 and Pericoronary Fat Attenuation Index; Is There a Link?

Introduction: Pericoronary fat attenuation index (pFAI) is a marker of coronary inflammation, a key step in atherosclerotic plaque formation. COVID-19 infection has also been shown to be associated with significant systemic inflammation. The aim of this study is to assess the impact of active COVID-19 infection on pFAI. Methods: Cases consisted of patients with acute or subacute COVID-19 infection who underwent clinically indicated coronary computed tomography angiography (CCTA) and were matched 1:3 on clinical and cardiovascular risk factors to controls having no prior or active COVID-19 infection. pFAI was measured for all 3 major epicardial coronary vessels (LAD, LCx and RCA). Per-vessel and per-patient analysis were done. SARS-COV-2 variant was determined as the predominant variant at the time of diagnosis. Results: We included 102 cases matched to 386 controls (64 ± 12 years, 42% men). Mean pFAI in overall cohort was higher in COVID-19 cases vs controls on both per patient (mean: -75.16 vs -77.15, p=0.024; LAD: -75.98 vs -78.65, p=0.004, LCx: -72.56 vs -74.38, p=0.047) (Figure 1a) and per-vessel (-75.17 vs -77.13, p=0.0001) analyses. Results of subgroup analysis of patients with no CAD and patients with CAD-RADS 0 showed a similar trend (Figure 1b-1c) . In univariable linear regression, there was a positive association between COVID-19 and pFAI for mean per patient (beta coefficient=1.90, 95% CI: 0.26 - 3.53, p=0.02) and per-vessel (beta coefficient=1.96, 95% CI: 0.85 - 3.07, p=0.00) analyses. The association remained significant after adjusting for age, sex, and cardiovascular risk factors. Conclusions: There is a weak but statistically significant association between COVID-19 infection and elevated pFAI.