Concurrent Coronavirus Disease 2019 Research Articles

SARS-Cov-2 Infection Uncovering Latent Mycobacterium Leprae Infection

Leprosy is a chronic granulomatous infection caused by the bacteria Mycobacterium leprae. It can remain dormant in a patient without any symptoms until triggered by a stressor on the body. During the coronavirus disease 2019 (COVID-19) pandemic, a significant amount of emotional and psychological stress was endured by patients. In addition, many patients experienced exacerbations of their preexisting conditions. Few reports have described cases of leprosy with concurrent COVID-19. This brief article presents a case of newly diagnosed leprosy in a middle-aged male following a COVID-19 infection. To our knowledge, this is the first reported case of its kind in the United States.

Ipsilateral Lymphadenopathy After COVID-19 Vaccination in Patients With Newly Diagnosed Breast Cancer.

This study aimed to evaluate the imaging and pathological findings in axillary lymph nodes in patients with breast cancer who received concurrent ipsilateral coronavirus disease 2019 (COVID-19) vaccination. Of the 19 women with breast cancer who received concurrent COVID-19 vaccination shot in the arm ipsilateral to breast cancer, axillary lymphadenopathy was observed in 84.2% (16 of 19) of patients on ultrasound (US) and 71.4% (10 of 14) of patients on magnetic resonance imaging (MRI), and 21.0% (4 of 19) of patients were diagnosed with metastasis. Abnormal US and MRI findings of cortical thickening, effacement of the fatty hilum, round shape, and asymmetry in the number or size relative to the contralateral side were noted in more than half of the non-metastatic and metastatic lymph nodes; however, statistical significance was not noted. Axillary lymphadenopathy is commonly observed in patients with breast cancer who receive concurrent ipsilateral COVID-19 vaccination without specific differential imaging features. Thus, understanding the limitations of axillary imaging and cautious interpretation is necessary to avoid overestimation or underestimation of the axillary disease burden.

Characteristics and Outcomes of a Series of COVID-Associated Mucormycosis Patients in Two Different Settings in Egypt Through the Third Pandemic Wave.

PurposeTo report on the underlying risk factors, clinical characteristics, presentation, and survival of coronavirus disease 2019 (COVID-19) associated mucormycosis (CAM) cases referred for ophthalmological consultation in two different Egyptian settings during the third viral pandemic wave (April to August of 2021).MethodsA multicentric, retrospective analysis involving one public and two private hospitals in metropolitan Cairo, and two university hospitals in upper Egypt (Aswan and Assuit). Cases that fulfilled the diagnostic criteria of mucormycosis, with a prior or concurrent COVID-19 infection, were included.ResultsOf the 26 patients included in the final analysis, 15 (57.7%) were from Cairo and 11 (42.3%) were from upper Egypt. Twenty-five patients (96.2%) had poorly controlled diabetes mellitus and 20 (76.9%) had received corticosteroid treatment for COVID-19, of which 30.8% had mild or moderate disease. The median duration from COVID-19 till the onset of CAM was 20.5 days. No visual function could be detected in the affected eye of 16 patients (61.6%) on presentation. The mortality rate was 46.2% despite surgical debridement in half of the cases that died.ConclusionCAM continues to be a concrete threat throughout Egypt, especially in patients with poorly controlled diabetes mellitus and those who inadvertently receive steroid therapy. It remains to be seen if increased vaccination coverage and early detection due to increased awareness would result in declining rates and adverse sequelae of CAM. A national registry would allow for better monitoring of the disease trends.

MASSIVE SPONTANEOUS PLEURAL EFFUSION IN END-STAGE RENAL DISEASE PATIENT WITH VANCOMYCIN RESISTANT ENTEROCOCCUS EMPYEMA AND COVID-19 INFECTION

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Pleural effusion is one of the most common complications seen in end-stage renal disease (ESRD) patients [1]. Here we report a case of massive spontaneous pleural effusion in an ESRD patient, who tested positive for coronavirus disease 2019 (COVID-19) on hospital admission, and later grew vancomycin resistant enterococcus (VRE) from the pleural space. CASE PRESENTATION: 79-year-old male with past medical history of ESRD on hemodialysis, hypertension, diabetes mellitus and history of prostate cancer presented with abdominal discomfort and progressive nausea and vomiting. COVID-19 test was positive on screening, although vital signs and review of systems were negative except as above. Labs were remarkable for leukocytosis, elevated blood urea nitrogen and creatinine. Chest X-ray showed nearly complete opacification of the left hemithorax associated with dense consolidation of the left lower lobe and the lingula. Computerized tomography scan showed a large complex fluid attenuating lesion involving the left hemithorax, which may represent a large loculated left-sided effusion versus a large left-sided empyema, resulting in mediastinal shift to the right and inferior displacement of the left hemidiaphragm. Pleural fluid was drained via pigtail catheter, and on analysis was found to be exudative with few leukocytes and no microorganisms. Due to septations of the hemithorax and development of hydropneumothorax, chest tube was placed and eventually video-assisted thoracoscopic surgery was performed for further drainage and decortication. Biopsy obtained during surgery showed no malignant cells; tissue culture and subsequent pleural fluid cultures were positive for VRE. DISCUSSION: Pleural effusion is a pathological finding that is often seen in ESRD patients with heart failure, pneumonia, pulmonary embolism, cancer and uremia [1]. Interestingly, our patient received regular hemodialysis, and presented with no signs of heart failure or fluid overload, making ESRD less likely to be a major or direct cause of the massive pleural effusion. Studies show VRE is prevalent in dialysis centers and frequently colonizes ESRD patients [2]. Rarely, VRE can cause empyema, as illustrated by Cotton in an asplenic patient with multiple co-morbidities who presented with pneumonia [3]. Our patient might have VRE colonized in his airway, so pleural cultures were positive after decortication. Additionally, COVID-19 infection has been associated with pleural effusion [4]. Hussein reported an acute accumulation of moderate exudative pleural effusion in a patient with no past medical history except for concurrent COVID-19 infection. As a result, the positive COVID-19 test in our patient might also contribute to his massive effusion. CONCLUSIONS: Factors like ESRD on hemodialysis, positive VRE in pleural tissue culture, as well as COVID-19 infection, may all contribute to the rare massive pleural effusion in our case. REFERENCE #1: Uzan, G. and H. Ikitimur, Pleural Effusion in End Stage Renal Failure Patients. Sisli Etfal Hastan Tip Bul, 2019. 53(1): p. 54-57. REFERENCE #2: Zacharioudakis, I.M., et al., Vancomycin-resistant enterococci colonization among dialysis patients: a meta-analysis of prevalence, risk factors, and significance. Am J Kidney Dis, 2015. 65(1): p. 88-97.Cotton, M.J. and C.D. Packer, Vancomycin-resistant Enterococcus faecium Empyema in an Asplenic Patient. Cureus, 2018. 10(8): p. e3227. REFERENCE #3: Hussein, M., et al., Pleural effusion as an isolated finding in COVID-19 infection. Respir Med Case Rep, 2020. 31: p. 101269. DISCLOSURES: No relevant relationships by Aram Hambardzumyan, source=Web Response No relevant relationships by Stephen Jesmajian, source=Web Response No relevant relationships by Liyun Liu, source=Web Response Speaker/Speaker's Bureau relationship with GSK Please note: approx 2016 to now Added 05/02/2021 by Michael Mandel, source=Web Response, value=Consulting fee No relevant relationships by Corina Nava, source=Web Response No relevant relationships by ABHISHEK NIMKAR, source=Web Response No relevant relationships by Carlos Romano, source=Web Response

Acyclovir as a Potential Adjuvant Therapy in COVID-19 Treatment Regimens

Introduction: There are successful reports of the concomitant management of herpes infection and coronavirus disease 2019 (COVID-19), using both acyclovir (ACV) and COVID-19 treatment regimens. Furthermore, ACV has been proposed to effectively treat COVID-19, through various mechanisms, such as inhibition of viral proteases, multiple viral gene expressions, and RNA-dependent RNA polymerase (RdRP). Therefore, this study aimed to review the reported cases of patients with concomitant herpes infection and COVID-19, receiving concurrent antiviral drugs for herpetic lesions. Methods: A search was done to find the relevant articles, published between December 2019 and December 2020, with no language limitations, in the PubMed database, using the Medical Subject Headings (MeSH) terms related to herpes simplex virus or herpes zoster (namely, shingles) combined with COVID-19. Accordingly, the reports of the concomitant herpes infection and COVID-19, receiving concurrent antiviral drugs for herpetic lesions were included. Results: Out of 90 articles, 11 records reporting the cases of herpes infection and concurrent laboratory-confirmed COVID-19, receiving antiherpetic therapies, were reviewed. There were 28 patients (age range of 7-82 years) with laboratory-confirmed COVID-19, concomitant with reactivation of herpes infection, receiving antiviral drugs alongside candidate COVID-19 treatment regimens, but no mortality. The mean (standard deviation [SD] range) age of these 28 patients during treatment was 56.4 (18.6 [7-82]) years, and the majority were male (n=18, 64.3%). A total number of 20 patients had also received ACV and eight cases had been administered with other two antiviral compounds, including seven cases with valacyclovir, and one case with famciclovir, with no mortality. Conclusion: The potential use of ACV, as an add-on therapy, along with candidate COVID-19 treatment regimens was proposed in this study. However, further clinical trials are recommended to test this hypothetical adjuvant therapy.

A rapid review of the overuse of antibiotics during the COVID-19 pandemic: lessons learned and recommendations for the future

The coronavirus disease 2019 (COVID-19) pandemic has had severe implications on healthcare systems and the patients affected by this infectious disease. To improve outcomes for patients with COVID-19 and limit future antimicrobial resistance, there is continued urgency to improve our understanding of the rates and causative agents of secondary bacterial infections in patients with COVID‑19, and recognise whether antibiotics are being overused in patients prior to and following COVID-19 diagnosis. This article presents the results of a rapid review comparing reported rates of secondary bacterial infections with rates of antibiotic use in patients with COVID-19 predominantly in a hospital setting, within the context of treatment guidelines and recommendations. The review revealed rates of antibiotic use in patients with COVID-19 of 37–100%, far outweighing rates of secondary bacterial infections which were typically below 20%. There was a lack of consistent reporting of causative microorganisms of secondary infections, and the distinction between bacterially- and virally-induced sepsis was rarely made. Early in the pandemic, healthcare agencies published treatment guidelines recognising the importance of antimicrobial stewardship. However, many are yet to provide updated guidance detailing the most appropriate antibiotics to treat patients with concurrent COVID-19 and secondary bacterial infections in a way which limits the emergence of drug-resistant infections and does not negatively impact patient outcomes. Without significant improvements to the testing and reporting of causative organisms and corresponding updates to antimicrobial treatment guidelines, there is a risk of worsened clinical outcomes and increased burden on healthcare systems from antimicrobial resistance during the remainder of the COVID-19 pandemic and beyond.

#52: Clinical Features and Management of Pediatric Patients Presenting with New Onset Acute Leukemia and Concomitant COVID-19

Abstract Background Infections represent a significant cause of morbidity and mortality in pediatric patients undergoing treatment for hematologic malignancies. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has led to a worldwide pandemic of coronavirus disease 2019 (COVID-19) and pediatric patients with cancer appear to be at higher risk of severe disease than reported in the general pediatric population. Data are limited on the optimal management of children infected with SARS-CoV-2 and a new diagnosis of leukemia. The objective of this study was to describe our experience of six children who presented with a new diagnosis of acute leukemia and concurrent COVID-19. Methods The study was IRB approved and children were enrolled following informed consent and assent as appropriate for age. The clinical presentations, serologic responses, treatments, and outcomes of patients who presented with acute leukemia and concurrent SARS-CoV-2 infection were abstracted. Residual blood was tested by ELISA for quantitative IgG to the SARS-CoV-2 spike protein receptor binding domain (RBD). Results From March 1, 2020 to Dec 31, 2020, 6 patients were identified with a new diagnosis of acute leukemia and SARS-CoV-2 infection including 3 with acute myeloid leukemia (AML) and 3 with acute lymphoblastic leukemia (ALL). The median age of our cohort was 9 years old (range 1 to 19 years old), 5 of 6 were male, and 4 of 6 patients were Hispanic. All 6 patients presented with symptoms that could be attributed to COVID-19 or acute leukemia, with fever being the most common. All 3 of the AML patients presented with hyperleukocytosis (white blood cell count > 50 x 109/L) and required oxygen therapy and intensive care. At the time of presentation, all patients with specimens available (n=5) had IgG antibodies to SARS-CoV-2 RBD. All patients received COVID-19 directed therapy, with remdesivir (n=5) and convalescent plasma (n=5) being the most common. Chemotherapy was modified or delayed in 5 of the 6 patients. The patient who received standard AML chemotherapy without awaiting COVID-19 directed treatment had delayed serologic response, delayed viral clearance from the nasopharynx, protracted respiratory failure, and ultimately died. For patients with a 12-week follow-up (n=5), 2 patients with AML had died, and the ALL patients were in remission and continuing their leukemia treatment. Conclusion COVID-19 may present concurrently in children with new onset leukemia resulting in severe morbidity and mortality. Our experience adds to growing evidence that children with AML and SARS-CoV-2 infection are at risk for severe COVID-19. Screening for SARS-CoV-2 infection with subsequent delay in chemotherapy and administration of COVID-19 directed therapies should be considered for pediatric patients with newly diagnosed acute leukemia and COVID-19.

Plasma exchange with COVID-19 convalescent plasma in a patient with severe ANCA-associated vasculitis and COVID-19 pneumonia after rituximab therapy.

ABSTRACTThe combination of coronavirus disease 2019 (COVID-19) pneumonia and pulmonary–renal syndrome due to ANCA‐associated vasculitis (AAV) poses diagnostic uncertainty and a therapeutic dilemma. According to current limited knowledge of COVID-19, the application of commonly used drugs in AAV, cyclophosphamide (CYC) and rituximab (RTX), must be weighed carefully in active COVID-19 infection. We report a case of a 52-year-old male patient with concurrent severe COVID-19 pneumonia and acute relapse of pulmonary–renal syndrome due to AAV after recent RTX maintenance dose. The patient presented with severe hypoxaemia, complete B-cell depletion and severe acute respiratory syndrome coronavirus 2 viraemia. He was successfully treated with therapeutic plasma exchange employing COVID-19 convalescent plasma.

Unilateral frosted branch angiitis in an human immunodeficiency virus-infected patient with concurrent COVID-19 infection: a case report

BackgroundFrosted branch angiitis (FBA) is an uncommon ocular sign with multiple causes. With the recent outbreak of coronavirus disease 2019 (COVID-19), many cases of ocular manifestation in association with this disease have been reported. However, as yet we have no complete understanding of this condition. We report here the first case of FBA in a human immunodeficiency virus-infected patient with coexisting cytomegalovirus (CMV) and COVID-19 infection.Case presentationA 33-year-old Malay man with underlying acquired immunodeficiency syndrome receiving highly active antiretroviral therapy was referred to the Opthalmology Department with complaints of blurry vision for the past 2 months. He had tested positive for and been diagnosed with COVID-19 1 month previously. Clinical examination of the fundus revealed extensive perivascular sheathing of both the artery and vein suggestive of FBA in the right eye. Laboratory testing of nasal swabs for COVID-19 polymerase chain reaction (PCR) and serum CMV antibody were positive. The patient was then admitted to the COVID-19 ward and treated with intravenous ganciclovir.ConclusionClinicians should be aware of and take the necessary standard precautions for possible coexistence of COVID-19 in an immunocompromised patient presenting with blurred vision, eye redness, dry eye and foreign body sensation despite the absence of clinical features suggestive of COVID-19. Whether FBA is one of the ocular signs of co-infection of COVID-19 and CMV remains unknown. Further studies are needed to provide more information on ocular signs presented in patients with concurrent COVID-19 and CMV infections.

International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19

BackgroundPublished data suggest worse outcomes in acute coronary syndrome (ACS) patients and concurrent coronavirus disease 2019 (COVID-19) infection. Mechanisms remain unclear. ObjectivesThe purpose of this study was to report the demographics, angiographic findings, and in-hospital outcomes of COVID-19 ACS patients and compare these with pre–COVID-19 cohorts. MethodsFrom March 1, 2020 to July 31, 2020, data from 55 international centers were entered into a prospective, COVID-ACS Registry. Patients were COVID-19 positive (or had a high index of clinical suspicion) and underwent invasive coronary angiography for suspected ACS. Outcomes were in-hospital major cardiovascular events (all-cause mortality, re–myocardial infarction, heart failure, stroke, unplanned revascularization, or stent thrombosis). Results were compared with national pre–COVID-19 databases (MINAP [Myocardial Ischaemia National Audit Project] 2019 and BCIS [British Cardiovascular Intervention Society] 2018 to 2019). ResultsIn 144 ST-segment elevation myocardial infarction (STEMI) and 121 non–ST-segment elevation acute coronary syndrome (NSTE-ACS) patients, symptom-to-admission times were significantly prolonged (COVID-STEMI vs. BCIS: median 339.0 min vs. 173.0 min; p < 0.001; COVID NSTE-ACS vs. MINAP: 417.0 min vs. 295.0 min; p = 0.012). Mortality in COVID-ACS patients was significantly higher than BCIS/MINAP control subjects in both subgroups (COVID-STEMI: 22.9% vs. 5.7%; p < 0.001; COVID NSTE-ACS: 6.6% vs. 1.2%; p < 0.001), which remained following multivariate propensity analysis adjusting for comorbidities (STEMI subgroup odds ratio: 3.33 [95% confidence interval: 2.04 to 5.42]). Cardiogenic shock occurred in 20.1% of COVID-STEMI patients versus 8.7% of BCIS patients (p < 0.001). ConclusionsIn this multicenter international registry, COVID-19–positive ACS patients presented later and had increased in-hospital mortality compared with a pre–COVID-19 ACS population. Excessive rates of and mortality from cardiogenic shock were major contributors to the worse outcomes in COVID-19 positive STEMI patients.

Myasthenia gravis and COVID-19: A case series and comparison with literature.

ObjectiveTo describe presenting symptoms, clinical outcomes, and therapeutic management of concurrent Coronavirus disease 2019 (COVID‐19) infections in patients with a pre‐existing myasthenia gravis (MG).MethodsWe conducted a retrospective study in patients with preexisting MG presenting with concurrent COVID‐19 between September 21st and November 4th, 2020 when attending the emergency department or routine neurology consultation at the National Institute Mongi Ben Hamida of Neurology of Tunis, Tunisia.ResultsFive patients were identified. The Myasthenia Gravis Foundation of America scores (MGFA) prior to COVID‐19 infection were class I in one patient, class II (IIa, IIb) in two patients, and class IIIb in one patient.Four patients had mild to moderate courses of COVID‐19 infection. One patient presented a critical infection with acute respiratory disease syndrome (ARDS) requiring mechanical ventilation. Two of them also demonstrated signs of MG exacerbation requiring the use of intravenous immunoglobulin in one case.We maintained immunosuppressant therapy to MG in all our patients. All our patients received Azithromycin (AZM) as a part of specific drug treatment of COVID‐19 infection. Outcome was favorable in 4 patients and rapidly fatal evolution was observed in the patient with ADRS.Discussions and conclusionThe results from our study suggest that prior MG activity could partially influence the subsequent clinical outcomes. It emerged also that ongoing long‐term immunosuppressive immunotherapy to MG should be maintained during the COVID‐19 pandemic and that AZM can be used safely in MG patients and concurrent COVID‐19 infection.

Leveraging pharmacists to maintain and extend buprenorphine supply for opioid use disorder amid COVID-19 pandemic.

PurposeStrategies for deploying clinical pharmacists to increase access to buprenorphine in inpatient, outpatient and transitional care, and community practice settings are described.SummaryAccess to medications for opioid use disorder (MOUD) is essential, but patients face many barriers when pursuing treatment and MOUD. The coronavirus disease 2019 (COVID-19) pandemic has compounded the opioid crisis and worsened outcomes by introducing new barriers to MOUD access. Many strategies to ensure continued access to MOUD have been described, but the role of leveraging pharmacists during the opioid/COVID-19 syndemic to improve medication access and outcomes remains underappreciated. Pharmacists, while both qualified and capable of liberalizing access to all forms of MOUD, may have the strongest impact by increasing access to buprenorphine. Herein, we present progressive strategies to maintain and extend buprenorphine access for patients with OUD through deployment of clinical pharmacists, particularly in the context of the COVID-19 pandemic, during which access may be further restricted.ConclusionLeveraging pharmacists to extend access to MOUD, particularly buprenorphine, remains an underutilized strategy that should be implemented, particularly during the concurrent COVID-19 global pandemic.

Worsening of heart failure by coronavirus disease 2019 is associated with high mortality.

AimsPatients with advanced heart failure (HF) with reduced left ventricular ejection fraction (HFrEF) and concurrent coronavirus disease 2019 (COVID‐19) might have a higher risk of severe events.Methods and resultsWe retrospectively studied 16 patients with advanced HFrEF who developed COVID‐19 between 1 March and 29 May 2020. Follow‐up lasted until 30 September. Ten patients previously hospitalized with decompensated HFrEF were infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) during hospitalization. Six patients undergoing ambulatory care at initiation of COVID‐19 symptoms were hospitalized because of advanced HFrEF. All patients who experienced worsening of HFrEF due to COVID‐19 required higher doses or introduction of additional inotropic drugs or intra‐aortic balloon pump in the intensive care unit. The mean intravenous dobutamine dose before SARS‐CoV‐2 infection in previously hospitalized patients (n = 10) and the median (inter‐quartile range) peak intravenous dobutamine dose during SARS‐CoV‐2 infection in all patients (n = 16) were 2 (0–7) μg/kg/min and 20 (14–20) (P < 0.001), respectively. During follow‐up, 56% underwent heart transplantation (n = 2) or died (n = 7). Four patients died during hospitalization from mixed shock consequent to severe acute respiratory syndrome with inflammatory storm syndrome associated with septic and cardiogenic shock during COVID‐19. After COVID‐19 recovery, two patients died from mixed septic and cardiogenic shock and one from sustained ventricular tachycardia and cardiogenic shock. Five patients were discharged from hospital to ambulatory care. Four were awaiting heart transplantation.ConclusionWorsening of advanced HF by COVID‐19 is associated with high mortality. This report highlights the importance of preventing COVID‐19 in patients with advanced HF.

Acyclovir As a Potential Add-On Treatment for COVID-19; A Narrative Review

Introduction: There are successful reports of the concomitant management of herpes infection and coronavirus disease 2019 (COVID-19), using both acyclovir (ACV) and COVID-19 treatment regimens. Furthermore, ACV has been proposed to effectively treat COVID-19, through various mechanisms, such as inhibition of viral proteases, multiple viral gene expressions, and RNA-dependent RNA polymerase (RdRP). Therefore, this study aimed to review the reported cases of patients with concomitant herpes infection and COVID-19, receiving concurrent antiviral drugs for herpetic lesions. Methods: A search was done to find the relevant articles, published between December 2019 and December 2020, with no language limitations, in the PubMed database, using the Medical Subject Headings (MeSH) terms related to herpes simplex virus or herpes zoster (namely, shingles) combined with COVID-19. Accordingly, the reports of the concomitant herpes infection and COVID-19, receiving concurrent antiviral drugs for herpetic lesions were included. Results: Out of 90 articles, 11 records reporting the cases of herpes infection and concurrent laboratory-confirmed COVID-19, receiving antiherpetic therapies, were reviewed. There were 28 patients (age range of 7-82 years) with laboratory-confirmed COVID-19, concomitant with reactivation of herpes infection, receiving antiviral drugs alongside candidate COVID-19 treatment regimens, but no mortality. The mean (standard deviation [SD] range) age of these 28 patients during treatment was 56.4 (18.6 [7-82]) years, and the majority were male (n=18, 64.3%). A total number of 20 patients had also received ACV and eight cases had been administered with other two antiviral compounds, including seven cases with valacyclovir, and one case with famciclovir, with no mortality. Conclusion: The potential use of ACV, as an add-on therapy, along with candidate COVID-19 treatment regimens was proposed in this study. However, further clinical trials are recommended to test this hypothetical adjuvant therapy.

Concurrent tuberculosis and COVID-19: reports of three cases

Coronavirus disease 2019 (COVID-19), the latest global pandemic is on the hunt and the incidence is sharply rising day by day. On the other hand, tuberculosis (TB) is the leading causes of death from infectious origin. Historically, coronaviral illness were reported with co-infection with TB; Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is not an exception. As both diseases have overlapping clinical features, sometimes it maybe very difficult to diagnose and long standing features of TB can easily be mistaken for post-acute COVID-19. This report emphasizes the importance of suspecting TB-COVID co-infection and its grave consequences.&#x0D; Birdem Med J 2020; 10, COVID Supplement: 111-114

Mortality of patients with COVID-19 who undergo an elective or emergency surgical procedure: a systematic review and meta-analysis.

There have been several reports that co-infection with the novel coronavirus severe acute respiratory syndrome coronavirus 2 at the time of surgery increases mortality. The aim of this study was to estimate the effect size of coronavirus disease 2019 (COVID-19) on post-operative mortality by performing a systematic review and meta-analysis of the literature. A systematic review and meta-analysis of the literature was performed. A search was undertaken using electronic bibliographic databases MEDLINE, EMBASE, PubMed and Cochrane Library to identify eligible studies published from 1 November 2019 until 21 August 2020. Eligible papers for meta-analysis were those that provided mortality rates following elective and emergency surgery in both COVID-19 positive and negative patients. Forest plots and estimates of odds of death related to having COVID-19 were formed using MedCalc version 9.6 software. Funnel plots to assess for publication bias and heterogeneity were formed in Meta-Essentials. There were 140 records screened for inclusion. Full texts of 39 articles were reviewed, and 36 articles were included in the qualitative synthesis. There were eight studies eligible for meta-analysis. There was a total of 193 operations performed on patients with a concurrent COVID-19 infection and 910 performed on patients who were COVID-19 negative. The odds ratio for mortality in patients who underwent a surgical procedure while COVID-19 positive was 7.9 (95% confidence interval: 3.2-19.4). This meta-analysis confirms that concurrent COVID-19 infection increases the risk of surgical mortality. The magnitude of this risk mandates that strategies are developed to mitigate the risk at both an individual and system level.

A narrative review of the challenges and countermeasures in hepatoblastoma management during COVID-19 epidemic.

An infectious disease named “coronavirus disease 2019” (COVID-19) currently has brought a threat to global health security and trends to be more and more severe in many countries. It also has introduced great challenges to the diagnosis and management of children with hepatoblastoma (HB). During the COVID-19 pandemic, pediatric surgeons should not only develop personalized treatment plans for HB therapy, but also emphasize the diagnosis, prevention, and treatment of this virus. Children with both HB and COVID-19 are recommended to undertake multidisciplinary assessment. Anti-SARS-CoV-2 therapy may be a preferred treatment for the infected without presenting a surgical emergency. However, emergent operation may be necessary for HB children with concurrent COVID-19 who developed a life-threatening surgical emergency condition. Otherwise, for children with negative virus examination results, treatment advice should be based on the impact of the epidemic and regional economic considerations. A “wait and see” strategy is recommended for children with resectable tumors after new adjuvant chemotherapy treatment (NACT). Assessment of liver transplantation is recommended for children with HB whose tumors cannot be resected after NACT. Children with HB with pulmonary metastasis may have abnormal findings on chest imaging due to COVID-19. Besides, the detailed therapeutic regimens may vary for children with HB with or without an emergency presentation. Based on previous consensus, current research, and the experiences of our hospital, we aim to offer available management plans for the above-mentioned concerns.

Excellent Outcomes of Patients of Middle Eastern Ethnic Origin with Autologous Haemopoietic Stem Cell Transplantation and COVID-19: Does a Dampened Immune System Protect Against Severe COVID-19?

IntroductionOutcomes of patients with hematological cancers and coronavirus disease 2019 (COVID-19) have been reported to be poor with high rates of hospitalization, mechanical ventilation with high case fatality rates, mortality being around 10% or higher. The mortality had been particularly higher among blacks and ethnic minority individuals. There is paucity of data on the outcomes of patients with autologous stem cell transplant and concurrent COVID-19 infections, especially from eastern mediterranean region, no similar studies have been reported so far.MethodsHere we describe outcomes of five consecutive patients of middle eastern ethnic origin who had a history of autologous stem cell transplant and developed COVID-19 infection, who were admitted at our tertiary care center between April and June 2020 with a minimum of 10 days follow-up.ResultsA total of five patients were identified who had undergone autologous stem cell transplantation and had developed COVID-19 infection. There were 3 males and 2 females and the median age was 43 years (range 18-59). Indications for transplant were myeloma (n=3), relapsed Hodgkin lymphoma (n=1), and relapsed diffuse large b cell lymphoma (n=1). Three of five patients had other comorbidities. Median time from transplant was 9 months (range 3-33 months). Four of five patients were on active treatment or maintenance at the time of infection. One patient was on brentuximab, and three were on lenalidomide based therapy. Only one of the five patients had active disease at the time of infection while the rest were in remission. None of the patients had severe disease and four were discharged to home isolation and made full recovery, and one needed admission requiring minimal oxygen and eventually made full recovery. At a median follow up of 70 days (range 12-90) all patients were doing well with no sequelae.ConclusionOur study, albeit small, shows excellent outcomes among patients of middle eastern ethnic origin with hematological cancers who had undergone autologous stem cell transplantation and had developed COVID-19 infection, unlike other studies that have shown high mortality among patients with hematological cancers. However, our cohort is relatively younger, most of them were in remission at the time of infection which may have had a protective effect. At the same time, the majority had transplant within the last nine months and four-fifths of the patients were on some sort of immunosuppressive therapy whilst developing COVID-19 infection. It is possible that a dampened immune system due to transplant and recent therapy might have had a protective effect against cytokine storm or severe COVID-19, in our view. More studies are needed to examine this aspect further, however, these results are encouraging.DisclosuresNo relevant conflicts of interest to declare.

Ischemic Stroke Occurs Less Frequently in Patients With COVID-19: A Multicenter Cross-Sectional Study.

The impact of coronavirus disease 2019 (COVID-19) on the occurrence of ischemic stroke has been the subject of increased speculation but has not been confirmed in large observational studies. We investigated the association between COVID-19 and stroke. We performed a cross-sectional study involving patients discharged from a healthcare system in New York State, from January to April 2020. A mixed-effects logistic regression analysis and a propensity score-weighted analysis were used to control for confounders and investigate the association of COVID-19 with ischemic stroke. Similar techniques were used to detect the impact of concurrent COVID-19 infection on unfavorable outcomes for patients with stroke. Among 24 808 discharges, 2513 (10.1%) were diagnosed with COVID-19, and 566 (0.2%) presented with acute ischemic stroke. Patients diagnosed with COVID-19 were at one-quarter the odds of stroke compared with other patients (odds ratio, 0.25 [95% CI, 0.16-0.40]). This association was consistent in all age groups. Our results were robust in sensitivity analyses, including propensity score-weighted regression models. In patients presenting with stroke, concurrent infection with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) was associated with higher case-fatality (odds ratio, 10.50 [95% CI, 3.54-31.18]) and a trend towards increased occurrence of discharge to rehabilitation (odds ratio, 2.45 [95% CI, 0.81-1.25]). Using a comprehensive cross-section of patients from a large NY-based healthcare system, we did not identify a positive association between ischemic stroke and COVID-19. However, patients with stroke with COVID-19 had worse outcomes compared with those without, with over a 9-fold increase in mortality. Although no definitive conclusions can be reached from our observational study, our data do not support the concerns for an epidemic of stroke in young adults with COVID-19.

TCT CONNECT-213 Clinical Characteristics and Outcomes of Patients With COVID-19 and STEMI Treated With Fibrinolytic Therapy

Background: The optimal management strategy for patients with concurrent coronavirus disease-2019 (COVID-19) infection and ST-segment elevation myocardial infarction (STEMI) is unknown This study describes the clinical characteristics and outcomes in patients with concurrent COVID-19 infection and STEMI treated with fibrinolytic therapy Methods: This is a multicenter retrospective chart review of patients admitted with concurrent COVID-19 infection and STEMI from February 1, 2020, to April 15, 2020 [Formula presented] Results: There were 59 patients treated with fibrinolytic therapy as first-line therapy (Table 1);50 (84 7%) had successful fibrinolysis Alteplase was used in 21 (35 6%) patients, and Tenecteplase in 38 (64 4%) Median peak troponin was 83 [58, 98] ng/ml and median left ventricular ejection fraction after revascularization was 43 5% [40%, 48%] Hemorrhagic stroke occurred in 5 patients (8 6%) Six (10 2%) required invasive mechanical ventilation;5 (8 6%) required cardiac resuscitation;and 4 (6 8%) died (Figure 1) [Formula presented] Conclusion: In this case series of COVID-19 patients presenting with STEMI treated with fibrinolytic therapy, there was a high rate of hemorrhagic stroke (8 6%) Further studies are needed to better understand this treatment approach in this patient population Categories: CORONARY: Acute Coronary Syndromes