Clinical Course Of COVID-19 Research Articles

Permanent and persistent atrial fibrillation are independent risk factors of mortality after severe COVID-19

Abstract Background New coronavirus disease (COVID-19), pandemic infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), had a deep global influence on morbidity and mortality profile. Comorbidities, especially cardiovascular diseases were identified to strongly modify the clinical course of COVID-19. However, the prognostic role of incident or prevalent atrial fibrillation has not been fully explained. Purpose The aim of this study was to evaluate the association between atrial fibrillation and outcomes following hospitalization in patients with severe COVID-19. Methods We analyzed 199 patients (72 female, median age 70 years) with severe COVID-19 hospitalized between November 2020 and February 2021, due to SARS-CoV-2 infection. Study cohort included 68 patients with a history of AF (34 patients with paroxysmal AF, 19 with permanent AF, 15 patients with persistent AF) and 51 patients presented with AF during hospitalization. Results Overall mortality during 90 days from the admission to hospital was 41% (n=82). Non-survivors were older, had significantly elevated inflammation markers (CRP, WBC, procalcitonin, IL-6), NT-proBNP and D-dimer on the first day of hospitalization, lower left ventricular ejection fraction and worse kidney function as compared to those who stayed alive during the follow-up. Among the hospitalized patients with COVID-19, a history of AF and the presence of AF during hospitalization contributed to higher mortality, p=0.001. The patients with permanent and persistent AF were at the greatest risk of death, p<0.001. In multivariate analysis, taking into account whether the patients had a history of AF, the subtypes of AF (paroxysmal, permanent, persistent) and whether the AF was present during hospitalization to identify the independent risk factors of death in the study period, we found that AF was related to worse prognosis and persistent or permanent form represented an independent predictor of mortality, p=0.035. Conclusions Different clinical presentations of AF have varying impact on survival in severe COVID-19. Mortality in hospitalized patients with severe COVID-19 was higher among patients with history of AF, especially with persistent and permanent type of AF, and with AF present during hospitalization.Figure.Survival depending on the type o.

Serum vitamin D levels and the severity and clinical course of COVID-19.

Low vitamin D levels are associated with different pulmonary diseases, such as chronic obstructive pulmonary disease, bronchial asthma, and obstructive sleep apnea. In this study, we aimed to assess the relation between vitamin D levels and COVID-19 severity. Positive COVID-19 patients were subjected to clinical examination, computed tomography of the chest, and laboratory investigations. Serum vitamin D level was measured and correlated with the severity and the clinical course of the disease. The study included 72 patients, classified into four groups according to the severity of the disease. There was a statistically significant difference between the four groups regarding age, lymphocyte count, serum vitamin D, C-reactive protein, and lactate dehydrogenase levels. Serum vitamin D levels can be correlated with COVID-19 severity and clinical course.

Arrhythmias in Children with Acute Respiratory Viral Infections: Prevalence and Causes

The article presents literature review about arrhythmias in children with acute respiratory viral infections (ARVI). The search was carried out in such databases as PubMed, CyberLeninka, RSCI, etc. ARVI is the most common infectious disease in children and adults, and it can have severe course and various complications. Arrhythmias can be frequently revealed in children with ARVI, and most of them are transient. Life-threatening cardiac rhythm and conduction disorders (CRCD) may occur more rarely, especially in severe cases. Knowledge and interest in the pathophysiology of viral infections have increased significantly, including CRCD risk factors in ARVI, thanks to the data obtained during the analysis of COVID-19 clinical course and outcome. This review summarizes and analyzes data on CRCD prevalence and arrhythmogenesis causes in ARVI.

High level of RNA HAS2-AS1 in the buffy coat of a patient blood sample is a more informative prognostic marker of COVID-19 clinical course compared to the level of hyaluronic acid in plasma

Numerous studies have confirmed the association of COVID-19 clinical course with the blood levels of hyaluronic acid and long non-coding RNA HAS2-AS1 as a positive regulator of hyaluronan synthase. We aimed to estimate both the level of hyaluronic acid in plasma and the level of RNA HAS2-AS1 in leukocytes (buffy coat) from the same blood sample at the time of patient admission to the hospital and to analyze the specificity of these indicators as biomarkers of COVID-19 severity. The study involved 78 patients with confirmed COVID-19 who underwent treatment between 2020 and 2021 at the Kyiv City Clinical Hospital N 4. The patients were divided into three groups based on the severity of the disease and classified as mild (n = 12), moderate (n = 36), and severe (n = 30). The level of hyaluronic acid in plasma was determined using the Hyaluronic Acid ELISA kit “Abcam” (USA). The buffy coat was isolated by centrifugation of the blood stabilized with EDTA-K and further aspiration of the leukocyte “cloud”. The expression level of HAS2-AS1 in buffy coat leukocytes was estimated using reverse transcription and real-time PCR. According to the obtained data, the level of hyaluronic acid in the plasma of patients with moderate and severe illness was 1.5 and 2.2 times higher compared to the mild illness group, respectively. Meanwhile, the level of RNA HAS2-AS1 in blood lymphocytes (buffy coat) of patient with moderate and severe illness was increased by 7.7 and 22.6 times compared to patients with mild illness. The results of our study demonstrate that, unlike the level of hyaluronic acid in plasma, the level of HAS2-AS1 in a buffy coat is a more reliable prognostic criterion for severe COVID-19 and allows distinguishing patients with varying clinical severity during hospitalization. Keywords: buffy coat, COVID-19, hyaluronic acid, leukocytes, plasma, RNA HAS2-AS1

Clinical and Genomic Perspective of SARS CoV-2 Infection in Liver Disease Patients: A Single-Centre Retrospective Study.

The limited literature on the clinical course of COVID-19 among patients with underlying liver disease (LD) is available from India. The present study aimed to evaluate the clinical and mutational profile of SARS-CoV-2 among LD cases. This was a retrospective study including admitted LD cases in whom SARS-CoV-2 RT-PCR testing was performed. Complete demographic and clinical details were retrieved from Hospital Information System. Detailed mutational analysis was performed by comparing LD COVID-19 positive study group, i.e. LD-CoV(+) with COVID-19 positive outpatients without any underlying LD as control, i.e. NLD-CoV(+). Out of 232 enrolled LD cases, 137 (59.1%) were LD-CoV(+). LD cases with existing co-morbidities were affected more (P = 0.002) and had 2.29 times (OR 2.29, CI 95%, 1.25-4.29) higher odds of succumbing to COVID-19 (P = 0.006). On multivariate regression analysis, ascites (P = 0.05), severe COVID-19 pneumonia (P = 0.046), and an increased levels of bilirubin (P = 0.005) and alkaline phosphatase (P = 0.003) were found to be associated with adverse outcome in LD-CoV(+).On mutational analysis, we found certain differences between LD- and NLD-CoV(+) infected with Delta [LD- and NLD-CoV (+ /D)] and Omicron [LD- and NLD-CoV(+/O)]. More mutations were shared between LD- and NLD-CoV(+/O) compared to LD- and NLD-CoV(+/D). There were differences in prevalence of indel mutations specific to LD-CoV ( +) for both Delta and Omicron. Moreover, we also reported an interesting genic bias between LD- and NLD-CoV( +) in harbouring deleterious/tolerated mutations. To conclude, LD cases with comorbidities were affected more and had higher odds of mortality due to COVID-19. The definite difference between LD- and NLD-CoV(+) groups with respect to frequency of harboured mutations and an inherent genic bias between them is of noteworthy importance.

Gut microbiota dysbiosis is associated with altered tryptophan metabolism and dysregulated inflammatory response in COVID-19

The clinical course of COVID-19 is variable and often unpredictable. To test the hypothesis that disease progression and inflammatory responses associate with alterations in the microbiome and metabolome, we analyzed metagenome, metabolome, cytokine, and transcriptome profiles of repeated samples from hospitalized COVID-19 patients and uninfected controls, and leveraged clinical information and post-hoc confounder analysis. Severe COVID-19 was associated with a depletion of beneficial intestinal microbes, whereas oropharyngeal microbiota disturbance was mainly linked to antibiotic use. COVID-19 severity was also associated with enhanced plasma concentrations of kynurenine and reduced levels of several other tryptophan metabolites, lysophosphatidylcholines, and secondary bile acids. Moreover, reduced concentrations of various tryptophan metabolites were associated with depletion of Faecalibacterium, and tryptophan decrease and kynurenine increase were linked to enhanced production of inflammatory cytokines. Collectively, our study identifies correlated microbiome and metabolome alterations as a potential contributor to inflammatory dysregulation in severe COVID-19.

Are COVID-19 Polymorphisms in ACE and ACE2 Prognosis Predictors?

Regardless of the containment of the SARS-CoV-2 pandemic, it remains paramount to comprehensively understand its underlying mechanisms to mitigate potential future health and economic impacts, comparable to those experienced throughout the course of the pandemic. The angiotensin-converting enzyme 2 (ACE2) provides anchorage for SARS-CoV-2 binding, thus implicating that ACE and ACE2 might contribute to the variability in infection severity. This study aimed to elucidate predisposing factors influencing the disease course among people infected by SARS-CoV-2, focusing on angiotensin-converting enzyme (ACE) and ACE2 polymorphisms. Notably, despite similar demographics and comorbidities, COVID-19 patients exhibit substantial differences in prognosis. Genetic polymorphisms in ACE and ACE2 have been implicated in disease progression, prompting our investigation into their role in COVID-19 evolution. Using next-generation sequencing (NGS), we analyzed ACE and ACE2 genes in a sample group comprising six subjects infected by SARS-CoV-2. Our findings revealed a correlation between specific polymorphisms and COVID-19 outcomes. Specifically, ACE and ACE2 intronic deletions were observed in all deceased patients, suggesting a potential association with mortality. These results highlight the significance of genetic factors in shaping the clinical course of COVID-19, emphasizing the importance of further research into the impact of genetic variations on COVID-19 severity.

A prediction model for secondary invasive fungal infection among severe SARS-CoV-2 positive patients in ICU.

The global COVID-19 pandemic has resulted in over seven million deaths, and IFI can further complicate the clinical course of COVID-19. Coinfection of COVID-19 and IFI (secondary IFI) pose significant threats not only to healthcare systems but also to patient lives. After the control measures for COVID-19 were lifted in China, we observed a substantial number of ICU patients developing COVID-19-associated IFI. This creates an urgent need for predictive assessment of COVID-19 patients in the ICU environment for early detection of suspected fungal infection cases. This study is a single-center, retrospective research endeavor. We conducted a case-control study on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive patients. The cases consisted of patients who developed any secondary IFI during their ICU stay at Jilin University China-Japan Union Hospital in Changchun, Jilin Province, China, from December 1st, 2022, to August 31st, 2023. The control group consisted of SARS-CoV-2 positive patients without secondary IFI. Descriptive and comparative analyses were performed, and a logistic regression prediction model for secondary IFI in COVID-19 patients was established. Additionally, we observed an increased incidence of COVID-19-associated pulmonary aspergillosis (CAPA) during this pandemic. Therefore, we conducted a univariate subgroup analysis on top of IFI, using non-CAPA patients as the control subgroup. From multivariate analysis, the prediction model identified 6 factors that are significantly associated with IFI, including the use of broad-spectrum antibiotics for more than 2 weeks (aOR=4.14, 95% CI 2.03-8.67), fever (aOR=2.3, 95%CI 1.16-4.55), elevated log IL-6 levels (aOR=1.22, 95% CI 1.04-1.43) and prone position ventilation (aOR=2.38, 95%CI 1.15-4.97) as independent risk factors for COVID-19 secondary IFI. High BMI (BMI ≥ 28 kg/m2) (aOR=0.85, 95% CI 0.75-0.94) and the use of COVID-19 immunoglobulin (aOR=0.45, 95% CI 0.2-0.97) were identified as independent protective factors against COVID-19 secondary IFI. The Receiver Operating Curve (ROC) area under the curve (AUC) of this model was 0.81, indicating good classification. We recommend paying special attention for the occurrence of secondary IFI in COVID-19 patients with low BMI (BMI < 28 kg/m2), elevated log IL-6 levels and fever. Additionally, during the treatment of COVID-19 patients, we emphasize the importance of minimizing the duration of broad-spectrum antibiotic use and highlight the potential of immunoglobulin application in reducing the incidence of IFI.

Developing Deep LSTMs With Later Temporal Attention for Predicting COVID-19 Severity, Clinical Outcome, and Antibody Level by Screening Serological Indicators Over Time.

The clinical course of COVID-19, as well as the immunological reaction, is notable for its extreme variability. Identifying the main associated factors might help understand the disease progression and physiological status of COVID-19 patients. The dynamic changes of the antibody against Spike protein are crucial for understanding the immune response. This work explores a temporal attention (TA) mechanism of deep learning to predict COVID-19 disease severity, clinical outcomes, and Spike antibody levels by screening serological indicators over time. We use feature selection techniques to filter feature subsets that are highly correlated with the target. The specific deep Long Short-Term Memory (LSTM) models are employed to capture the dynamic changes of disease severity, clinical outcome, and Spike antibody level. We also propose deep LSTMs with a TA mechanism to emphasize the later blood test records because later records often attract more attention from doctors. Risk factors highly correlated with COVID-19 are revealed. LSTM achieves the highest classification accuracy for disease severity prediction. Temporal Attention Long Short-Term Memory (TA-LSTM) achieves the best performance for clinical outcome prediction. For Spike antibody level prediction, LSTM achieves the best permanence. The experimental results demonstrate the effectiveness of the proposed models. The proposed models can provide a computer-aided medical diagnostics system by simply using time series of serological indicators.

Assessing the impact of long-term inhaled corticosteroid therapy on patients with COVID-19 and coexisting chronic lung disease: A multicenter retrospective cohort study

Background Patients with chronic lung disease (CLD), such as asthma or chronic obstructive pulmonary disease, were expected to have an increased risk of clinical manifestations and severity of COVID-19. However, these comorbidities have been reported less frequently than expected. Chronic treatment with inhaled corticosteroids (ICS) may impact the clinical course of COVID-19. The main objective of this study is to know the influence of chronic treatment with ICS on the prognosis of COVID-19 hospitalized patients with CLD. Methods A multicenter retrospective cohort study was designed, including patients hospitalized with COVID-19. Epidemiological and clinical data were collected at admission and at seven days, and clinical outcomes were collected. Patients with CLD with and without chronic treatment with ICS were compared. Results Two thousand five hundred ninety-eight patients were included, of which 1,171 patients had a diagnosis of asthma and 1,427 of COPD (53.37% and 41.41% with ICS, respectively). No differences were found in mortality, transfer to ICU, or development of moderate-severe ARDS. Patients with chronic ICS had a longer hospital stay in both asthma and COPD patients (9 vs. 8 days, p = 0.031 in asthma patients), (11 vs. 9 days, p = 0.018 in COPD patients); although they also had more comorbidity burden. Conclusions Patients with chronic inhaled corticosteroids had longer hospital stays and more chronic comorbidities, measured by the Charlson comorbidity index, but they did not have more severe disease at admission, evaluated with qSOFA and PSI scores. Chronic treatment with inhaled corticosteroids had no influence on the prognosis of patients with chronic lung disease and COVID-19.

COVID-19 infection in children, adolescents, and young adults with Down syndrome and hematologic malignancies.

Children, adolescents, and young adults (CAYAs) with Down syndrome (DS) and hematologic malignancies are particularly vulnerable to infections and related complications. There are limited data regarding COVID-19 infections in this group. We aimed to understand the clinical course of COVID-19 in this population. This observational study leverages the de-identified clinical and sociodemographic data captured by the Pediatric Oncology COVID-19 Case Report Registry (POCC) regarding CAYAs with cancer and COVID-19. We evaluated CAYAs (≤21years at COVID-19 infection) with hematologic malignancies and COVID-19 reported from April 1, 2020 to May 2, 2023, comparing those with and without DS. Using multivariable logistic regression, we examined rates of hospitalization, intensive care unit (ICU) admission, respiratory support, and changes in cancer-directed therapy. Among 1408 CAYAs with hematologic malignancies, 55 had DS (CAYA-DS). CAYA-DS had higher rates of hospitalization, ICU admission, and respiratory support (p<.001) than CAYAs without DS. Similarly, multivariable analyses found higher odds of hospitalization (odds ratio [OR]=2.8, 95% confidence interval [CI]: 1.5-5.1), ICU admission (OR=4.2, 95% CI: 1.9-9.1), and need for respiratory support (OR=4.2, 95% CI: 2.0-8.8) among CAYA-DS. Modifications to cancer-directed therapy were more common among CAYA-DS when related to neutropenia (p=.001), but not when unrelated to neutropenia (p=.88); CAYA-DS did not have higher odds of changes to cancer-directed therapy (OR=1.20, 95% CI: 0.7-2.1). We identify CAYA-DS with hematologic malignancies as a vulnerable subpopulation at greater risk for severe COVID-19 infection. This can inform conversations with patients and families regarding therapeutic and preventive measures, as well as the risks and benefits of modifying chemotherapy in the setting of COVID-19.

Permanent and Persistent Atrial Fibrillations Are Independent Risk Factors of Mortality after Severe COVID-19.

Background: The new coronavirus disease (COVID-19), a pandemic infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), had a deep global influence on morbidity and mortality profiles. Comorbidities, especially cardiovascular diseases, were identified to strongly modify the clinical course of COVID-19. However, the prognostic role of incident or prevalent atrial fibrillation has not been fully explained. The aim of this study was to evaluate the association between atrial fibrillation and outcomes following hospitalization in patients with severe COVID-19. Methods: We analyzed 199 patients (72 female, median age 70 years) with severe COVID-19 hospitalized between November 2020 and February 2021, due to SARS-CoV-2 infection. The study cohort included 68 patients with a history of AF (34 patients with paroxysmal AF, 19 with permanent AF, 15 patients with persistent AF), and 51 patients presented with AF during hospitalization. Results: Overall mortality during 90 days from the admission to hospital was 41% (n = 82). Non-survivors were older, had significantly elevated inflammation markers (CRP, WBC, procalcitonin, IL-6), NT-proBNP and D-dimer on the first day of hospitalization, lower left ventricular ejection fraction and worse kidney function, as compared to those who stayed alive during the follow-up. Among the hospitalized patients with COVID-19, a history of AF and the presence of AF during hospitalization contributed to higher mortality. Patients with permanent and persistent AF were at the highest risk of death. Different presentations of AF (any history of AF, the subtypes of AF-paroxysmal, permanent, persistent-and the presence of AF during hospitalization) were included in multivariate analysis, aiming to identify independent risk factors of death in the study period. We found that AF was related to worse prognosis, and persistent or permanent forms represented an independent predictor of mortality. Conclusions: Different clinical presentations of AF have varying impacts on survival in severe COVID-19. Mortality in hospitalized patients with severe COVID-19 was higher among patients with a history of AF, especially with persistent and permanent types of AF, and with AF present during hospitalization.

#743 Clinical outcomes of patients hospitalized with the diagnosis of COVID-19 infection and undergoing hemodialysis: a single center experience

Abstract Background and Aims The main purpose of this study is to determine the effect of dialysis on the prognosis (admission to intensive care unit, intubation requirement, length of hospitalization, mortality) of patients with COVID-19 receiving hemodialysis treatment in our clinics. Another aim of this study is to examine the effect of the need for hemodialysis on COVID-19 prognosis in order to contribute to the data of our country. Method Cross-sectional study of 104 patients with hemodialysis and were diagnosed COVID-19 were conducted. In this study, patients were divided into three groups: (i) those with chronic renal failure (CRF) and receiving routine hemodialysis; (ii) those with chronic kidney disease (CKD) but needing urgent hemodialysis; and (iii) those who did not have a known kidney disease but needed urgent hemodialysis because of acute kidney injury (AKI) . The study was performed in accordance with the Declaration of Helsinki. The local ethical committee approved the study design (date: 21.03.2022; reference number: 133/13). Results When we evaluated the demographic, clinical and laboratory factors in our study, it was found that the factors affecting mortality were lymphopenia, emergency HD treatment under the presence of CKD, an increase in AST more than 2 times, the need for mechanical ventilation and high d-dimer (Table 1). Conclusion This case demonstrates that AKI associated with cytokine storm and developing multi-organ dysfunction situation is directly linked to mortality, particularly in patients with severe clinical condition. When the biochemical data of the patients were analysed, it was discovered that AST increase, lymphopenia, and d-dimer rise were directly found associated with increase mortality. In light of these observations, the above-mentioned biochemical laboratory values of the patients can be closely monitored, as can the clinical course of COVID-19 and renal-related mortality.

COVID-19 and the flu: clinical and immunological features in children

In conditions of co-circulation of COVID-19 pathogens and other acute respiratory infections, the risk of simultaneous infection with SARS-CoV-2 and other pathogens, in particular influenza viruses, increases. Previously published data on the mutual influence of such combined infectious processes are very contradictory.Purpose. To determine the clinical and immunological features of the combined course of COVID-19 and influenza in children.Material and methods. Among 3,983 hospitalized children with COVID-19, 48 patients (1.2%) co-infected with influenza A and B viruses were identified by PCR. 31 children with a combination of COVID-19/Influenza were subjected to in-depth examination. The comparison group consisted of 30 children with SARS-CoV-2 monoinfection. In addition to standard physical, instrumental and laboratory studies, serum levels of IgM and IgG to SARS-CoV-2 S protein were determined in patients of the compared groups using ELISA.Results. In children with a combination of influenza and infection caused by both delta and omicron variants of SARS-CoV-2, acute bronchitis was more common, regardless of age, compared with patients with SARS-CoV-2 monoinfection. Co-infection with the influenza virus did not change the incidence of pneumonia in patients with omicron-SARS-CoV-2 infection, and in patients with delta-SARS-CoV-2 infection it decreased it. In co-infected children, the severity of intoxication syndrome and the level of D-dimer in the blood were higher. In addition, patients with a combination of COVID-19 and influenza showed lower concentrations of IgM and IgG to S-protein in comparison with patients with SARS-CoV-2 monoinfection.Conclusion. Co-infection with influenza viruses alters the clinical course of COVID-19, while the nature and vector of changes depend on the SARS-CoV-2 gene variant. A decrease in the severity of the humoral immune response to SARS-CoV-2 in co-infected children was found.

SARS-CoV-2 among liver transplant recipients: Clinical course and mutational analysis

BackgroundVery limited literature on the clinical course of COVID-19 among liver transplant recipients (LT) is available from India. The present study aimed to evaluate the clinical and mutational profile of SARS-CoV-2 among LT. MethodologyThis was a retrospective study including LT cases in whom SARS-CoV-2 RT-PCR testing was requested between April 2020 and December 2022. Detailed mutational analysis was performed by comparing LT COVID-19 positive study group i.e. LT-CoV(+) with two control groups. One including COVID-19 positive with underlying chronic liver disease (CLD) i.e. CLD-CoV(+) and other including COVID-19 positive outpatients without any underlying LD i.e. NLD-CoV(+) ResultsAmong 213 cases, 48 (22.5 %) were positive [LT-CoV(+)] and the remaining 165 (77.5 %) were negative [LT-CoV(-)] for SARS-CoV-2. Of these, 49 % had mild, 14 % moderate and 37 % had severe COVID-19. Mortality was recorded in 11 (23 %) cases, the majority being non-vaccinated. Severe COVID-19 with intensive care requirement was significantly higher among recipients with >5 years since transplant compared to recipients with ≤5 years (p = 0.02). Among 40 samples subjected to whole genome sequencing, 19 (47.5 %) were Delta, 15 (37.5 %) Omicron, and 6 (15 %) were other variants. COVID-19 severity was significantly higher in LT-CoV(+/D) with no significant difference in mortality (p = 0.122). No significant differences in mutational load and in fraction of deleterious mutations were observed between LT-/CLD-/NLD-CoV(+) groups for either Delta or Omicron. ConclusionAn overall fatality rate of 23 % was recorded among LT recipients. Longer duration since transplant was associated with severe clinical course. However, no significant difference in mutation load between studied groups was observed.

Adolescents and young adults (AYA) with cancer: the clinical course of COVID-19 infections

Abstract Adolescents and Young Adults (AYAs: 15-39 y) with cancer face unique vulnerabilities, yet remain under-represented on clinical trials, including adult registries of COVID-19 in cancer (AYAs: 8-12%). Thus, we leveraged the Pediatric Oncology COVID-19 Case Report (POCC) to examine the clinical course of COVID-19 among AYAs with cancer. POCC collects de-identified clinical and sociodemographic data regarding 0-39yo with cancer (AYAs = 37%) and COVID-19 from &amp;gt;100 institutions. Between 04/01/2020-11/28/2023, 191 older AYAs [22-39y] and 640 younger AYAs [15-21y] were captured. Older AYAs were less often hospitalized (p &amp;lt; .001), admitted to the intensive care unit (ICU, p = .02), and/or required respiratory support (p = .057). In multivariable analyses, older AYAs faced 80% lower odds of ICU admission but 2.3-times greater odds of changes to cancer-directed therapy. Unvaccinated patients had 5.4-times higher odds of ICU admission. Among AYAs with cancer, the COVID-19 course varies by age. These findings can inform pediatric/adult oncology teams surrounding COVID-19 management and prevention.

Assessment of the Impact of SARS-CoV-2 Infection on the Sexual Function of Women, Levels of Oxytocin and Prolactin: A Prospective Cohort Study.

(1) Background: There is a lack of direct evidence on whether SARS-CoV-2 affects women's sexual function through a biological-organic mechanism. Existing studies on the topic are few and have produced contradictory results. This study aims to explore the possible relationship between sex hormones and sexual function in patients who have been infected with SARS-CoV-2. Moreover, we aimed to determine whether these changes are related to the clinical course of COVID-19 and whether they are temporary or long-lasting. (2) Methods: A study was conducted on 104 women, including 64 women infected with COVID-19 and a control group of 40 healthy women, between January 2021 and August 2022. Blood samples were collected to measure prolactin and oxytocin levels, and a clinical assessment was performed 3 and 6 months later. Sexual function self-assessment was captured based on the FSFI scale. (3) Results: Our study found that patients with severe COVID-19 had better sexual satisfaction scores one month after recovery but no discernible difference after six months. High levels of serum prolactin were observed in patients with active COVID-19 but became similar to a control group after one month and remained stable over time. Higher prolactin levels were significantly associated with increased arousal and hydration. Individuals with severe COVID-19 had notably low levels of plasma oxytocin, but there was no correlation between oxytocin levels and sexual satisfaction. (4) Conclusions: The gynecologic symptoms, as well as disturbances in oxytocin and prolactin levels, might be observed in a short time after infection. However, SARS-CoV-2 infection has no lasting effect on sexual function, oxytocin, and prolactin levels among women.

COVID-19 Clinical Features and Outcome in Italian Patients Treated with Biological Drugs Targeting Type 2 Inflammation.

This is a multicentric investigation involving two Italian centers that examined the clinical course of COVID-19 in patients receiving biological therapy targeting type 2 inflammation and those not receiving biologicals. Since the beginning of the COVID-19 pandemic, the management of respiratory and allergic disorders and the potential impact of biological therapy in the most severe forms has been a point of uncertainty. Our multicentric investigation aimed to compare the clinical course of COVID-19 and the impact of vaccination in an Italian cohort of patients with atopic disorders caused by a type 2 inflammation, such as eosinophilic asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP), atopic dermatitis (AD), and chronic spontaneous urticaria (CSU). A questionnaire was given to patients coming to our outpatient clinic for the first evaluation or follow-up visit, asking for the clinical characteristics of the infection, the ongoing therapy during the infection, any relevant change, and the patient's vaccination status. We enrolled 132 atopic patients from two Italian centers; 62 patients were on biological therapy at the time of infection (omalizumab 31%, mepolizumab 26%, benralizumab 19%, and dupilumab 24%). The median age was 56 (IQR 22.8) for patients on biologicals and 48 (IQR 26.5) for those not on biologicals (p = 0.028). The two groups were comparable in terms of sex, body mass index (BMI), smoking history, and systemic oral corticosteroid use (OCS). There were no significant differences in non-biological therapy and comorbidity between the two groups. The patients not on biological therapy had a prevalence of 87% for asthma, 52% for CRSwNP, 10% for CSU, and 6% for AD. The patients on biologicals had a prevalence of 93% for asthma, 17% for CRSwNP, and 10% for CSU. In our work, we observed that mAbs targeting type 2 inflammation in patients with COVID-19 appeared to be safe, with no worsening of symptoms, prolongation of infection, or increase in hospitalizations. Between the two groups, there were no significant differences in the duration of swab positivity (p = 0.45) and duration of symptoms (p = 0.38). During COVID-19, patients on biologicals experienced a significant increase in common cold-like symptoms (p = 0.038), dyspnea (p = 0.016), and more, but not significant, asthma exacerbations, with no significant differences between the different biologicals. Regarding the vaccination status, we observed that there was an increased number of hospitalizations among unvaccinated patients in both groups, although the difference did not reach statistical significance. No patients on biologicals reported safety issues or adverse effects associated with the use of biological treatments during COVID-19. Our investigation showed that mAbs against type 2 inflammation given during Coronavirus Disease 2019 are safe and do not impact the clinical course or main outcomes. Therefore, we found no signals suggesting that anti-Th2 biological therapy should be discontinued during SARS-CoV-2 infection. Controlled studies and analysis, including data from registries and real-life studies, are required to draw firm conclusions regarding the safety or possible advantages that anti-type 2 mAbs could offer in particular clinical contexts, such as infections.

COVID-19 AND CLINICAL AND IMMUNOLOGICAL ASPECTS OF THE ORAL CAVITY IN WOMEN

The study included 254 Covid-19 positive patients, from which 105 eligible patients were selected. The aim of the study was to determine the damage to the oral cavity in various degrees of severity of coronovirus infection, for early prediction of the clinical course of COVID-19 by using modern methods for studying local immune and inflammatory responses of the oral mucosa. During the study, the state of the oral cavity, laboratory data, including the determination of the level of IgA and IL-17, were studied, as well as bacteriological culture was carried out. During the study, an oral manifest was determined, indicating a high expression of ACE-2 receptors in the oral cavity, an inverse correlation with the clinical course of the disease and the state of the oral cavity, a complete blood count is less informative compared to determining the level of IgA and IL-17.

Role of microbiota-derived corisin in coagulation activation during SARS-CoV-2 infection

BackgroundCoagulopathy is a major cause of morbidity and mortality in COVID-19 patients. Hypercoagulability in COVID-19 results in deep vein thrombosis, thromboembolic complications, and diffuse intravascular coagulation. Microbiome dysbiosis influences the clinical course of COVID-19. However, the role of dysbiosis in COVID-19-associated coagulopathy is not fully understood. ObjectivesThe present study tested the hypothesis that the microbiota-derived proapoptotic corisin is involved in the coagulation system activation during SARS-CoV-2 infection. MethodsThis cross-sectional study included 47 consecutive patients who consulted for symptoms of COVID-19. A mouse acute lung injury model was used to recapitulate the clinical findings. A549 alveolar epithelial, THP-1, and human umbilical vein endothelial cells were used to evaluate procoagulant and anticoagulant activity of corisin. ResultsCOVID-19 patients showed significantly high circulating levels of corisin, thrombin-antithrombin complex, D-dimer, tumor necrosis factor-α, and monocyte-chemoattractant protein-1 with reduced levels of free protein S compared with healthy subjects. The levels of thrombin-antithrombin complex, D-dimer, and corisin were significantly correlated. A monoclonal anticorisin-neutralizing antibody significantly inhibited the inflammatory response and coagulation system activation in a SARS-CoV-2 spike protein-associated acute lung injury mouse model, and the levels of corisin and thrombin-antithrombin complex were significantly correlated. In an in vitro experiment, corisin increased the tissue factor activity and decreased the anticoagulant activity of thrombomodulin in epithelial, endothelial, and monocytic cells. ConclusionThe microbiota-derived corisin is significantly increased and correlated with activation of the coagulation system during SARS-CoV-2 infection, and corisin may directly increase the procoagulant activity in epithelial, endothelial, and monocytic cells.