Clinical Course Of COVID-19 Research Articles

Clinical case of severe COVID-19 in a child with morbid obesity

The pandemic of coronavirus infection is characterized by a low percentage of complications and severe forms in sick children compared to the adult population. However, there have been described cases of severe clinical course of COVID-19 in children with comorbidities among which is obesity. The aim of this study was to analyze the severe course of a new coronavirus infection paralleled with morbid obesity in a pediatric patient. Materials and methods. All accompanying patient medical documentation was examined. Results and discussion. From the anamnesis of life it is known that the patient was long time complained of intensively increased body weight, on which she repeatedly underwent examinations. In 2018, hypothalamic pubertal syndrome was diagnosed for the first time, for which the patient received hypoglycemic and antihypertensive drugs, hepatoprotectors on an ongoing basis. In the epidemiological anamnesis, the intrafamilial COVID-19 contact with mother was established. The main disease began acutely with a rise in body temperature up to 3939.5C, cough and weakness. During the first week of illness, the patient did not seek medical help and receive self-treatment, but the positive effect was not achieved. Saturation measurement showed low oxygen level (SpO2 71%). In this regard, the patient underwent chest computed tomography, which revealed a bilateral interstitial polysegmental lung lesion with signs of consolidation. After emergency hospitalization, the patient was prescribed empiric antibiotic therapy, anti-inflammatory and antithrombotic treatment, as well as respiratory support. A positive PCR result of a throat and nasal swab for SARS-CoV-2 was obtained in the hospital. Due to a poor response to therapy, the patient was transferred to a respiratory hospital. At the time of hospitalization, the condition was considered severe due to severe respiratory failure and premorbidity. The range of treatments included oxygenotherapy, antibacterial and anticoagulation therapy, as well as surfactant and the nucleoside analogue Remdesivir. During treatment, the clinical picture gained a positive trend, and after 6 days of hospitalization the patient no longer needed respiratory support. According to the results of repeated computed tomography, bilateral interstitial polysegmental pneumonia was diagnosed with damage to the lung tissue up to 95%. The patient remained stable and showed no signs of respiratory failure during the following days of hospitalization. On the 20th day of ilness, the patient was discharged from hospital with full clinical recovery. Conclusion. This clinical case demonstrates the role of premorbid background in aggravating the clinical picture of a new coronavirus infection in a child. Careful study of anamnestic characteristics is necessary in patients of any age, even with an uncomplicated disease course.

Toll-like Receptor 3 c.1377C/T and -7C/A Polymorphisms Associated with COVID-19 and COVID-19 Severity

Chinese officials have reported the novel coronavirus to the world health organization, which is called the SARS-CoV-2. Toll-like receptor 3 (TLR3) induces antiviral immune responses via the production of type I interferons and inflammatory cytokines. In this study, we aimed to examine TLR3 c.1377C/T and -7C/A polymorphisms in COVID-19 and the association between some clinical parameters. We investigated the frequencies of TLR3 (c.1377C/T and -7C/A) polymorphisms in 150 patients with COVID-19 and 171 healthy individuals as controls. We performed polymerase chain reaction (PCR) based on restriction fragment length polymorphism (RFLP). We also investigated whether TLR3 c.1377C/T and-7C/A were associated with the severity of COVID-19. In addition, CHAID tree-based classification algorithm was created to investigate the severity of the patients in our study. TLR3 c.1377C/T TT genotype frequencies were statistically significant between cases and controls (p= 0.02). For TLR3 -7C/A polymorphism, the findings showed a statistically significant difference in A allele frequencies (p= 0.03). There was a statistically significant difference in the distribution of TLR3 -7C/A CA genotype frequency (p= 0.04). Our findings suggest that TLR3 c.1377C/T and -7C/A polymorphisms may be important on susceptibility or clinical course of COVID-19.

Clinical Course and Severity of COVID-19 in 940 Infants with and without Comorbidities Hospitalized in 2020 and 2021: The Results of the National Multicenter Database SARSTer-PED.

This study aimed to analyze the differences in severity and clinical characteristics of COVID-19 in infants hospitalized in Poland in 2021, when the dominance of variants of concern (VOCs) alpha and delta was reported, compared to 2020, when original (wild) SARS-CoV-2 was dominant (III-IV vs. I-II waves of the pandemic, respectively). In addition, the influence of the presence of comorbidities on the clinical course of COVID-19 in infants was studied. This multicenter study, based on the pediatric part of the national SARSTer database (SARSTer-PED), included 940 infants with COVID-19 diagnosed between March 1, 2020, and December 31, 2021, from 13 Polish inpatient centers. An electronic questionnaire, which addressed epidemiological and clinical data, was used. The number of hospitalized infants was significantly higher in 2021 than in 2020 (651 vs. 289, respectively). The analysis showed similar lengths of infant hospitalization in 2020 and 2021, but significantly more children were hospitalized for more than 7 days in 2020 (p < 0.009). In both analyzed periods, the most common route of infection for infants was household contact. There was an increase in the percentage of comorbidities, especially prematurity, in children hospitalized in 2021 compared to 2020. Among the clinical manifestations, fever was predominant among children hospitalized in 2021 and 2020. Cough, runny nose, and loss of appetite were significantly more frequently observed in 2021 (p < 0.0001). Severe and critical conditions were significantly more common among children with comorbidities. More infants were hospitalized during the period of VOCs dominance, especially the delta variant, compared to the period of wild strain dominance, even though indications for hospitalization did not include asymptomatic patients during that period. The course of COVID-19 was mostly mild, characterized mainly by fever and respiratory symptoms. Comorbidities, particularly from the cardiovascular system and prematurity, were associated with a more severe course of the disease in infants.

Clinical implications of gut microbiota and cytokine responses in coronavirus disease prognosis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects gut luminal cells through the angiotensin-converting enzyme-2 receptor and disrupts the gut microbiome. We investigated whether the gut microbiome in the early stage of SARS-CoV-2 infection was associated with the prognosis of coronavirus disease (COVID-19). Thirty COVID-19 patients and 16 healthy controls were prospectively enrolled. Blood and stool samples and clinical details were collected on days 0 (enrollment), 7, 14, and 28. Participants were categorized into four groups by their clinical course. Gut microbiota composition varied during the clinical course of COVID-19 and was closely associated with cytokine levels (p=0.003). A high abundance of the genus Dialister (linear discriminant analysis [LDA] effect size: 3.97856, p=0.004), species Peptoniphilus lacrimalis (LDA effect size: 4.00551, p=0.020), and Anaerococcus prevotii (LDA effect size: 4.00885, p=0.007) was associated with a good prognosis. Starch, sucrose, and galactose metabolism was highly activated in the gut microbiota of the poor prognosis group. Glucose-lowering diets, including whole grains, were positively correlated with a good prognosis. Gut microbiota may mediate the prognosis of COVID-19 by regulating cytokine responses and controlling glucose metabolism, which is implicated in the host immune response to SARS-CoV-2.

Inflammasome genes polymorphisms are associated with progression to mechanical ventilation and death in a cohort of hospitalized COVID-19 patients in a reference hospital in Rio de Janeiro, Brazil

COVID-19 has a broad spectrum of clinical manifestations. We assessed the impact of single nucleotide polymorphisms (SNPs) of inflammasome genesas risk factors for progression toCOVID-19 critical outcomes, such as mechanical ventilation support (MVS) or death.The study included 451 hospitalized individuals followed up at the INI/FIOCRUZ, Rio de Janeiro, Brazil, from 06/2020 to 03/2021. SNPs genotyping was determined by Real-Time PCR. We analyzed risk factors for progression to MVS (n = 174[38.6 %]) or death (n = 175[38.8 %])as a result of COVID-19 by Cox proportional hazardmodels.Slower progression toMVSwas associated with allele G (aHR = 0.66;P = 0.005) or the genotype G/G (aHR = 0.391;P = 0.006) in the NLRP3 rs10754558 or the allele G (aHR = 0.309;P = 0.004) in the IL1βrs1143634, while C allele in the NLRP3 rs4612666 (aHR = 2.342;P = 0.006) or in the rs10754558 (aHR = 2.957;P = 0.005) were associated with faster progression to death. Slower progression to death was associated to allele G (aHR = 0.563;P = 0.006) or the genotype A/G (aHR = 0.537;P = 0.005) in the CARD8 rs6509365; the genotype A/C in the IFI16 rs1101996 (aHR = 0.569;P = 0.011); the genotype T/T (aHR = 0.394;P = 0.004) or allele T (aHR = 0.68;P = 0.006) in the NLRP3 rs4612666, and the genotype G/G (aHR = 0.326;P = 0.005) or allele G (aHR = 0,68;P = 0.014) in the NLRP3 rs10754558. Our results suggest that inflammasome genetic variations might influence the critical clinical course of COVID-19.

The Fallout of Catastrophic Technogenic Emissions of Toxic Gases Can Negatively Affect Covid-19 Clinical Course.

The coronavirus D-19 (Covid-19) pandemic has shaken almost every country in the world: as we stand, 6,3 million deaths from the infection have already been recorded, 167,000 and 380,000 of which are in Italy and the Russian Federation, respectively. In the first wave of the pandemic, Italy suffered an abnormally high death toll. A detailed analysis of available epidemiological data suggests that that rate was shockingly high in the Northern regions and in Lombardy, in particular, whilst in the southern region the situation was less dire. This inexplicably high mortality rate in conditions of a very well-developed health care system such as the one in Lombardy - recognized as one of the best in Italy - certainly cries for a convincing explanation. In 1976, the small city of Seveso, Lombardy, experienced a release of dioxin into the atmosphere after a massive technogenic accident. The immediate effects of the industrial disaster did not become apparent until a surge in the number of tumors in the affected population in the subsequent years. In this paper, we endeavor to prove our hypothesis that the release of dioxin was a negative cofactor that contributed to a worsening of the clinical course of COVID-19 in Lombardy.

Impact of plasmapheresis on severe COVID-19

The clinical course of COVID-19 may show severe presentation, potentially involving dynamic cytokine storms and T cell lymphopenia, which are leading causes of death in patients with SARS-CoV-2 infection. Plasma exchange therapy (PLEX) effectively removes pro-inflammatory factors, modulating and restoring innate and adaptive immune responses. This clinical trial aimed to evaluate the impact of PLEX on the survival of patients with severe SARS-CoV-2 and the effect on the cytokine release syndrome. Hospitalized patients diagnosed with SARS-CoV-2 infection and cytokine storm syndrome were selected to receive 2 sessions of PLEX or standard therapy. Primary outcome was all-cause 60-days mortality; secondary outcome was requirement of mechanical ventilation, SOFA, NEWs-2 scores modification, reduction of pro-inflammatory biomarkers and hospitalization time. Twenty patients received PLEX were compared against 40 patients receiving standard therapy. PLEX reduced 60-days mortality (50% vs 20%; OR 0.25, 95%CI 0.071–0.880; p = 0.029), and this effect was independent from demographic variables and drug therapies used. PLEX significantly decreased SOFA, NEWs-2, pro-inflammatory mediators and increased lymphocyte count, accompanied with a trend to reduce affected lung volume, without effect on SatO2/FiO2 indicator or mechanical ventilation requirement. PLEX therapy provided significant benefits of pro-inflammatory clearance and reduction of 60-days mortality in selected patients with COVID-19, without significant adverse events.

Variability in the Clinical Course of COVID-19 in a Retrospective Analysis of a Large Real-World Database.

The COVID-19 pandemic proceeds in waves, with variable characteristics of the clinical picture resulting from the evolution of the SARS-CoV-2 virus. This study aimed to compare the epidemiological characteristics, symptomatology, and outcomes of the disease in patients hospitalized for COVID-19 during periods of different variants dominance. Comparing the periods of dominance of variants preceding the Delta variant, the Delta period was characterized by a higher share of hospitalized females, less frequent comorbidities among patients, and a different age distribution. The lowest need for oxygen therapy and mechanical ventilation was observed under Omicron dominance. The triad of classic COVID-19 symptoms, cough, fever, dyspnoea, and fatigue, were most prevalent during the Delta period, and significantly less common under the Omicron dominance. During the Omicron period, nearly twice as many patients as in the previous periods could be discharged from the hospital within 7 days; the overall 28-day mortality was significantly lower compared to that of the Delta period. It also did not differ between periods that were dominated by the BA.1 and BA.2 subvariants. The study indicates that the Omicron SARS-CoV-2 variant that dominated between January and June 2022 caused a disease which resembled the common cold, and was caused by seasonal alpha and beta-coronaviruses with a low pathogenicity for humans. However, one should note that this effect may not only have been related to biological features of the Omicron lineage, but may additionally have been driven by the increased levels of immunization through natural infections and vaccinations, for which we could not account for due to a lack of sufficient data.

Outcomes of COVID-19 in peritoneal dialysis patients: A report by the European Renal Association COVID-19 Database

The clinical course of COVID-19 in peritoneal dialysis (PD) patients has so far only been analysed in relatively small, often single-centre case series. Therefore, we studied patient- and disease-related characteristics and outcomes of COVID-19 in a larger European cohort of PD patients. We used data from the European Renal Association COVID-19 Database (ERACODA) on PD and haemodialysis (HD) patients with COVID-19 (presentation between February 2020 and April 2021). Hazard ratios (HR) for mortality at 3 months were calculated using Cox proportional-hazards regression. In addition, we examined functional and mental health status among survivors at this time point as determined by their treating physician. Of 216 PD patients with COVID-19, 80 (37%) were not hospitalised and 136 (63%) were hospitalised, of whom 19 (8.8%) were admitted to an intensive care unit. Mortality at 3 months for these subgroups was 18%, 40%, and 37%, respectively (p = 0.0031). Compared with HD patients, PD patients had higher mortality (crude HR: 1.49; 95% CI: 1.33-1.66), even when adjusted for patient characteristics and disease severity (adjusted HR: 1.56; 95% CI: 1.39-1.75). Follow-up data on 67 of 146 patients who survived COVID-19 showed functional recovery to pre-COVID-19 levels in 52 (78%) and mental recovery in 58 patients (87%) at 3 months after the COVID-19 diagnosis. The mortality rate in the first 3 months after presentation with COVID-19 is high, especially among PD patients who were hospitalised. PD patients with COVID-19 had a higher mortality risk than HD patients. The majority of surviving patients recovered both functionally and mentally from COVID-19 within 3 months.

Impact of diabetes mellitus and co-morbidities on mortality in patients with COVID-19: A single-center retrospective study.

To describe the effect of diabetes mellitus (DM) on clinical outcomes of patients admitted with COVID-19 infection. We carried out a single center, observational, retrospective study. We included adult patients with laboratory-confirmed diagnosis of COVID-19 admitted to a tertiary hospital in Jeddah, Saudi Arabia, from April 2020 to December 2020. Electronic medical records were reviewed for demographics, clinical status, hospital course, and outcome; and they were compared between the patients with or without DM. Out of 198 patients included in the study, 86 (43.4%) were diabetic and 112 (56.5%) were non-diabetic. Majority of the patients were males 139 (70.2%) with a mean age of 54.14±14.89 years. In-hospital mortality rate was higher in diabetic patients than in non-diabetic patients (40 vs. 32; p=0.011). The most common comorbidity was hypertension (n=95, 48%) followed by ischemic heart disease (n=35, 17.7%), chronic kidney disease (n=17, 9.6%), and bronchial asthma (n=10, 5.1%). The risk of SARS-CoV-2 infection is higher among diabetic patients; particularly, those with preexisting co-morbidities or geriatric patients. Diabetic patients are prone to a severe clinical course of COVID-19 and a significantly higher mortality rate.

Monitoring the dynamics of the state of a 64-year-old man with covid-19 based on smart watch data

Introduction: The variability of the clinical course of COVID-19 and the variety of the “geography” of its complications actualize the issue of monitoring and assessing the dynamics of the patients’ condition for the most effective therapy and rehabilitation. Smart devices that track a number of physiological parameters allow you to monitor the health status and the course of the disease. Case description: We present a case of a past viral infection (COVID-19) in the aspect of assessing the dynamics of the patient’s condition and the effectiveness of treatment by resting heart rate and the total index of motor activity using smart watch. The patient was a 64-year-old man with a history of hypertension, atherosclerosis, type 2 diabetes mellitus and myocardial infarction. On certain days of viral infection, glucose levels, blood oxygen saturation, blood pressure and body temperature were measured. The patient was prescribed Ingavirin, Vitamins C and D, Doliprane, Azithromycin, Moxicin, Xarelto and Dexamethasone. Results and discussion: It was revealed that the dynamics of the clinical course showed the strongest correlation with resting heart rate and total index of motor activity. Resting heart rate demonstrated a very high sensitivity, also changing in response to stress factors. Thus modern smart devices are able to provide information about the COVID-19 clinical course and the effectiveness of therapy.

Potential application of Transcranial Electrical Stimulation (tES) techniques in the context of covid-19 clinical course: From theory to real-world application

Potential application of Transcranial Electrical Stimulation (tES) techniques in the context of covid-19 clinical course: From theory to real-world application

Polymorphisms in ACE1, TMPRSS2, IFIH1, IFNAR2, and TYK2 Genes Are Associated with Worse Clinical Outcomes in COVID-19.

Although advanced age, male sex, and some comorbidities impact the clinical course of COVID-19, these factors only partially explain the inter-individual variability in disease severity. Some studies have shown that genetic polymorphisms contribute to COVID-19 severity; however, the results are inconclusive. Thus, we investigated the association between polymorphisms in ACE1, ACE2, DPP9, IFIH1, IFNAR2, IFNL4, TLR3, TMPRSS2, and TYK2 and the clinical course of COVID-19. A total of 694 patients with COVID-19 were categorized as: (1) ward inpatients (moderate symptoms) or patients admitted at the intensive care unit (ICU; severe symptoms); and (2) survivors or non-survivors. In females, the rs1990760/IFIH1 T/T genotype was associated with risk of ICU admission and death. Moreover, the rs1799752/ACE1 Ins and rs12329760/TMPRSS2 T alleles were associated with risk of ICU admission. In non-white patients, the rs2236757/IFNAR2 A/A genotype was associated with risk of ICU admission, while the rs1799752/ACE1 Ins/Ins genotype, rs2236757/IFNAR2 A/A genotype, and rs12329760/TMPRSS2 T allele were associated with risk of death. Moreover, some of the analyzed polymorphisms interact in the risk of worse COVID-19 outcomes. In conclusion, this study shows an association of rs1799752/ACE1, rs1990760/IFIH1, rs2236757/IFNAR2, rs12329760/TMPRSS2, and rs2304256/TYK2 polymorphisms with worse COVID-19 outcomes, especially among female and non-white patients.

Prognosis of immune state following basic therapy and thymalin treatment in patients with severe COVID-19 infection

Significant changes in cellular and humoral immunity are observed in new coronavirus infection (COVID-19). The cytokine storm develops in cases of severe clinical course, being accompanied by significantly increased levels of pro-inflammatory cytokines, often associated with suppression of immune response. At the same time, the prediction of the immune status is an urgent task, thus allowing timely correction of current therapy. The aim of our research was to evaluate predictive capability for the immune system changes on the 6th day of COVID-19 disease when using standard therapy, or with addition of immunocorrector thymalin to the treatment regimen. A retrospective study was conducted in 87 patients with severe COVID-19. All patients were divided into 2 groups, i.e., (1) controls who received basic treatment; (2) basic treatment supplied with thymalin (10 mg, intramuscular injections daily for 5 days). Assessment of severity and clinical course of COVID-19, and basic treatment regimen for the patients corresponded to current version of the interim Guidelines from the Ministry of Health of the Russian Federation Prevention, diagnosis and treatment of a new coronavirus infection COVID-19. Laboratory studies included complete blood counts, immunogram parameters with the calculation of the ratio of certain types of leukocytes were performed on the 1st and 6th days of observation. Statistical evaluation was made using scripts of the specialized statistical analysis language R (http://cran.r-project.org) version 4.1.3. The blood parameters were evaluated using the binary classification method. The changes in parameters of cellular immunity were classified by means of ROC-analysis.&#x0D; We have found that the basic therapy of severely ill COVID-19 patients was not followed by recovery of immune status on the 6th day from the start of treatment. At marginal level, one can only suggest a probable prediction of increase in WBC and MON counts, a decrease in CD4+, NK and CD8+perNK, as well as the CD4+/CD8+ ratio. Addition of thymalin to the basic therapy is largely accompanied by the normalization of immunogram parameters. At the same time, it is possible to predict, with excellent rating, an increased number of T-LIM, including CD4+ and B-LIM, and, with good rating, an increase in the total numbers of LIM, as well as CD8+, HLA-CD3+DR+ and NK cells. The data obtained in severe cases of COVID-19 make it possible to predict changes in immune status, and, hence, the course of the disease, at a high degree of probability.

A “new” role of amantadines in COVID-19 in patients with Parkinson’s disease: results of own comparative study

Amantadine has begun to be used as a possible alternative in COVID-19 therapy to mitigate its effects. There is anecdotal evidence that patients with Parkinson's disease (PD) treated with amantadine and who test positive for COVID-19 often do not develop clinical manifestations of COVID-19. Objective : to compare the clinical course of COVID-19 in patients with PD who took or did not take amantadine sulfate. Patients and methods . A prospective continuous study included 142 patients with PD who were treated in Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy in Kazan from October 2021 to January 2022. Patients filled out a proprietary internally developed questionnaire. Results and discussion . Out of 142 individuals with PD COVID-19 occurred in 77 (54.2%), of which 52.0% had a mild course, 39.0% had a moderate course, 2.6% had a severe course, and in 6.5% the severity of the disease has not been established. Deterioration after COVID-19 infection was noted by 36% of patients: the appearance or increase in motor fluctuations (41%), increased tremor, stiffness or slowness (31%), the appearance of "exhaustion" of the effect of a single dose of levodopa (13%), the appearance or increased dyskinesia (21%), hallucinations (3.5%). Patients taking amantadine sulfate had PD much longer (11.5±5.62 years versus 5.12±3.24 years) and had a more pronounced (III–IV) stage of the disease. These patients were more likely to experience mild COVID-19 (in 60.87% of cases), in contrast to patients not receiving amantadine sulfate (only in 48.15% of cases). There was no correlation between the severity of COVID-19 and levodopa intake. Conclusion . The results of the study showed that patients with PD taking amantadine sulfate are more likely to have a mild course of COVID-19.

The Association of PLAUR Genotype and Soluble suPAR Serum Level with COVID-19-Related Lung Damage Severity.

Uncovering the risk factors for acute respiratory disease coronavirus 2019 (COVID-19) severity may help to provide a valuable tool for early patient stratification and proper treatment implementation, improving the patient outcome and lowering the burden on the healthcare system. Here we report the results of a single-center retrospective cohort study on 151 severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-infected symptomatic hospitalized adult patients. We assessed the association of several blood test measurements, soluble urokinase receptor (uPAR) serum level and specific single nucleotide polymorphisms of ACE (I/D), NOS3 (rs2070744, rs1799983), SERPINE1 (rs1799768), PLAU (rs2227564) and PLAUR (rs344781, rs2302524) genes, with the disease severity classified by the percentage of lung involvement on computerized tomography scans. Our findings reveal that the T/C genotype of PLAUR rs2302524 was independently associated with a less severe lung damage (odds ratio 0.258 [0.071-0.811]). Along with high C-reactive protein, fibrinogen and soluble uPAR serum levels turned out to be independently associated with more severe lung damage in COVID-19 patients. The identified factors may be further employed as predictors of a possibly severe COVID-19 clinical course.

1078. Vaccine-induced antibody level predicts the clinical course of breakthrough infection of COVID-19 caused by delta and omicron variants: a prospective observational cohort study

Abstract Background This study aimed to determine the effect of vaccine on clinical course of delta and omicron variant infection. Furthermore, we tried to evaluate the utility of antibody level against spike protein as a predictor of disease course of COVID-19 in vaccinated patients. Methods Between December 11, 2021 and February 10, 2022, we performed a prospective observational cohort study in an institution of South Korea. Among adult patients admitted due to COVID-19, individuals with confirmed delta and omicron variant infection were included. Multivariable logistic regression analysis was performed to determine the association between antibody level and clinical course of breakthrough infection in vaccinated patients. The relationship between antibody level and cycle threshold (Ct) values was confirmed using a generalized linear model. We used the antibody titers collected within 7 days of symptom onset or diagnosis and the Ct values tested on days 5-7 days after initial diagnosis. Figure 1.Study flow diagram. A, Study flow of enrollment. B, Severe acute respiratory syndrome coronavirus 2 diagnosis, antibody to spike protein test, variant type assay*Patients were diagnosed at a median of 2 days (interquartile range [IQR] 1–3) after symptom onset.¶Antibody tests were performed at a median of 4 days (IQR 2–6) after symptom onset or diagnosis, whichever was earlier.† Variant-type assays were conducted at a median of 4 days (IQR 3–5) after diagnosis. Results Of 161 patients with delta and omicron variant infection, 106 vaccinated patients (39 delta and 67 omicron) had available serum samples. The geometric mean titers of antibodies in patients who experienced the fever (≥37.5°C), hypoxia (≤94% of SpO2), pneumonia, C-reactive protein (CRP) elevation ( &amp;gt;8 mg/L) or lymphopenia (&amp;lt; 1,100 cells/μL) during hospitalization were 1201.5 U/mL, 98.8 U/mL, 774.1 U/mL, 1335.1 U/mL, and 1032.2 U/mL, respectively, which were lower compared with those who did not (p&amp;lt; 0.05 for all). Increase in antibody level of vaccinated patients with delta and omicron infection was associated with decrease in occurrence of fever (aOR, 0.23; 95% CI, 0.12-0.51), hypoxia (aOR, 0.23; 95% CI, 0.08-0.7), CRP elevation (aOR, 0.52; 95% CI, 0.29-0.0.94), and lymphopenia (aOR, 0.57; 95% CI, 0.33-0.98) during hospitalization, regardless of virus type or booster vaccination status. Data from 33 patients who had Ct values suitable for analysis showed a positive correlation between antibody levels and Ct values (p=0.02). Table 1.Association of antibody titres and variables with clinical courses during hospitalisation in vaccinated patients with breakthrough infections caused by delta and omicron variantsMultivariable logistic regression analysis was performed to determine the effect of antibody levels on the clinical course of breakthrough infections. Fever, hypoxia, pneumonia, CRP elevation, or lymphopenia were selected as variables representing the clinical course. Confounding factors were included in each multivariable model, as described below. Antibody titres were log10 transformed for analyses. Abbreviations: OR, odds ratio; CI, confidence interval; BT, body temperature; SpO2, percutaneous oxygen saturation; CRP, C-reactive protein; CCI, Charlson comorbidity index.a Multivariable analysis adjusted for age and sex.b Multivariable analysis adjusted for age, sex, immunocompromised status, and variant type.c Multivariable analysis adjusted for age, sex, immunocompromised status, CCI, and variant type‡d Multivariable analysis adjusted for sex‡ and variant type.f Multivariable analysis adjusted for sex, CCI, and variant type.†Presence of pneumonia was determined using chest radiography.‡ In addition to antibody titre, the omicron variant was associated with a decrease in the occurrence of pneumonia (OR, 0.150; 95% CI, 0.050-0.448); females were associated with a decrease in the occurrence of CRP elevation (OR, 0.431; 95% CI, 0.194-0.955).Figure 2.Comparison of antibody levels between vaccinated patients with or without specific signs during hospitalisation This analysis included 106 patients with delta and omicron variant infections whose serum samples were collected within 7 days of symptom onset or diagnosis. Antibody levels are described as box plots of medians with interquartile ranges. BT, body temperature; SpO2, percutaneous oxygen saturation; w/o, without; CRP, C-reactive protein Figure 3.Association of antibody titres and Ct valuesData from 33 patients, with Ct values measured 5–7 days after diagnosis, showed a positive correlation between antibody levels and Ct values (slope: 0.0004, p=0.022)Abbreviations: Ct, cycle threshold; PCR, polymerase chain reaction Conclusion Antibody levels are predictive of the clinical course of COVID-19 in vaccinated patients with delta and omicron variant infections. Our data highlight the need for concentrated efforts to monitor patients with SARS-CoV-2 infection who are at risk of low antibody levels. Disclosures All Authors: No reported disclosures.

COVID-19 Infection in Children with Down Syndrome and Hematologic Malignancies

INTRODUCTION: Since the onset of the COVID-19 pandemic, clinicians and researchers have sought to understand who is at risk of severe disease. Although children are more likely to have mild disease than adults, children with underlying health conditions (including cancer and Down syndrome [DS]) are at increased risk for severe infection. Children with cancer and COVID-19 have higher rates of hospitalization, ICU admission, and death when compared with children without cancer; they are also at risk of having their cancer therapy modified [Johnston...Wolfson; JCO 2021]. Children with DS and hematologic malignancies are a particularly vulnerable group in terms of cancer-related toxicities (infection-related mortality in particular). This has led to changes in treatment and supportive care protocols to decrease infection-related mortality for children with DS and hematologic malignancies. However, there are limited data regarding COVID-19 infections in this vulnerable group. We leveraged the Pediatric Oncology COVID-19 Case (POCC) Report registry to understand the clinical course of COVID-19 infection and optimize care in children with hematologic malignancies and DS. METHODS: POCC captures de-identified data from >100 sites (>50% of US pediatric oncology sites). Sites submit data regarding patients with a malignancy at age <40y and COVID-19 during cancer therapy or within 12 months of completing therapy. Sites submit sociodemographics, clinical and treatment details, known comorbidities, and the clinical course of COVID-19 within 12 weeks of infection (symptoms, support needed for COVID-19 infection and changes in cancer therapy). We constructed a cohort of children (≤21y at COVID-19 infection) with hematologic malignancies reported to POCC between 4/1/20 and 5/18/22. Primary outcomes of interest were hospitalization, ICU admission, and changes in cancer therapy. Multivariable logistic regression compared the odds of hospitalization, ICU admission, and changes in cancer therapy among DS and non-DS patients (adjusting for age at COVID-19 infection, sex, race/ethnicity, payor, cancer diagnosis, relapse status, blood or marrow transplant [BMT] status, absolute neutrophil count [ANC] at infection and comorbidities). RESULTS: Among 1,157 children with hematologic malignancies and COVID-19, 47 (4%) carried a DS diagnosis; 12-week follow-up data were complete in 98%. The median age at infection was similar in children with (10y, IQR: 5-16) and without (9y, IQR: 4-14.0; p=0.98) DS. Most children were publicly insured (DS=60%, non-DS=58%, p=0.98), while those with DS were more often Hispanic (DS=64%, non-DS=41%; p=0.03). The most common diagnosis was acute lymphoblastic leukemia ([ALL]: DS=94%, non-DS=74%; p=0.02). Few children had relapsed disease (DS=13%, non-DS=14%, p=0.78) or a history of BMT (DS=2%, non-DS=9%; p=0.18). Additional comorbidities were reported in 34% of DS and 22% of non-DS children (p=0.06). More children with DS (DS=13%, non-DS=10%; p=0.02) had an ANC <500 at the time of infection. No patients with DS died due to COVID-19. Hospitalization and ICU admissions: Children with DS were more likely to be hospitalized (DS=57%, non-DS=30%, p<0.01; OR=2.5, 95%CI 1.3-4.9) and admitted to the ICU (DS=19%, non-DS=7%, p<0.01; OR=4.6, 95%CI 1.9-10.8). Children with DS also more often required either respiratory (DS=28%, non-DS=8%; p<0.01 [supplemental oxygen: 13% vs. 6%; mechanical ventilation: 11% vs. 2%; BiPAP: 4% vs. 1%]) or other (DS=6%, non-DS=2%; p<0.01 [vasopressors, ECMO, dialysis]) support. [Fig1]Therapeutic Modifications: While half of DS patients (49%) had their cancer-directed therapy changed, there was no statistically significant difference between DS and non-DS patients (OR=1.2, 95%CI 0.6-2.3). DISCUSSION: Children with DS are a particularly vulnerable sub-population of children who face even greater risks than other children with hematologic malignancies when they develop COVID-19. These data can inform conversations with patients and families regarding the use of preventive measures that are pharmacologic (vaccines and pre/post-exposure prophylaxis) and non-pharmacologic (masking) as well as the risks and benefits of modifying chemotherapy and other therapeutic measures for patients who become infected (antivirals, monoclonal antibodies). Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Impact of Exercise on Covid-19 Patients in Saudi Arabia

BACKGROUND: The importance of exercise is improving the human body in different ways. Studies have shown that physical activity has a relationship with the enhancement of the immune system and maintains the body in a fit state, which explains the positive results of exposure to infection. Aim of the study: To measure the effectiveness of moderate exercise concerning symptoms, severity, and the recovery rate in COVID-19 patients METHODS: This is a cross-sectional study conducted in main cities in the Qassim region of Saudi Arabia. This investigation was undertaken during the pandemic of COVID-19, targeting individuals diagnosed with COVID-19. The final sample size was 385 individuals out of the 1,450,000 million Saudi Arabia population in Al-Qassim. The data was collected using a Self-administered online questionnaire and analyzed using statistical software SPSS. RESULTS: A total of 186 participants were included in this study. The majority of respondents were female (68.8%), most of the respondents (47.3%) were normal weight, and 35.5% were overweight. Regarding the medical history of COVID19 infection (75.8%), they are infected with COVID19. A statistically significant association was found between exercise practice and the disappearance of symptoms (p&lt;0.01). It disappeared early during exercise. In addition, normal-weight respondents resolved their symptoms faster than other respondents (p &lt;0.05). The results show that the most common and less common symptoms of COVID-19 were most frequently reported among normal weight respondents, and the most severe symptoms were most frequently reported among overweight respondents (p&lt;0.01). CONCLUSION: The present study results show that moderate exercise in patients with COVID-19 can be a valuable tool to improve symptoms, severity, and the recovery rate in COVID-19 patients. Moreover, our results showed that overweight patients were correlated with a severe clinical course of COVID-19.

Pathological Changes in the Lungs of Patients with a Lethal COVID-19 Clinical Course.

The novel coronavirus SARS-CoV-2 was identified in 2019 and quickly became the cause of the fifth worst pandemic in human history. Our goal for this research paper was to examine the morphology of the lungs in 88 patients that died from COVID-19 in Latvia, thus increasing the data available about the histological characteristics of SARS-CoV-2-induced disease. Lung tissue samples from 88 autopsies were visualized in hematoxylin-eosin and assessed by light microscopy. The male-to-female ratio was 56:32, and the mean age was 62 years ± 15.5 years (22-94 years). Clinically important laboratory data were assessed, including leucocyte count, CRP (C-reactive protein) and D-dimer levels. Signs of diffuse alveolar damage were found in 83/88 (94.3%; 95% CI 87.0-97.9) of patients, 38/88 (43.2%; 95% CI 33.3-53.6) in the exudative phase, and 45/88 (51.1%; 95% CI 40.8-61.3) in the proliferative phase. Vascular damage was identified in 70/88 (79.5%; 95% CI 69.9-86.7) of patients, and 83/88 (94.3%; 95% CI 87.0-97.9) had signs of thrombosis. A sparse inflammatory infiltrate of lymphocytes and macrophages was a common finding aside from cases with an identified coinfection. Eighty patients had significant co-morbidities, including coronary heart disease (49), primary arterial hypertension (41), and diabetes mellitus (34). Since our group's demographic profile and spectrum of co-morbidities were analogous to other reports, the histological findings of marked diffuse alveolar damage, widespread vascular lesions, and active thrombosis can be considered representative of severe COVID-19.