Clinical Course Of COVID-19 Research Articles

Characteristic Features of the Novel Coronavirus Infection COVID-19 in Oncohematological Patients

Background. The novel coronavirus infection SARS-CoV-2 (COVID-19) is one of high-threat respiratory diseases, characterized by multiple organ disorders with primary respiratory failure and population mortality of 2–5 %. However, the mortality of oncohematological patients treated with chemotherapy is considerably higher.
 Aim. To analyze the COVID-19 treatment outcomes in hematological malignancy patients who received drug chemotherapy.
 Materials & Methods. The clinical course of COVID-19 was analyzed in 32 hematological malignancy patients aged 31–81 years (median 62 years). The disease onset was the date of the first positive COVID-19 PCR test. These patients were transferred to an infectious hospital specialized in the therapy of the novel coronavirus infection. Pneumonia was confirmed by standard radiography and CT. Blood oxygen saturation, body temperature, ECG, and respiratory rate were monitored. Moderate and severe COVID-19 was observed in 17 (53.1 %) of 32 patients. The condition of 15 (46.9 %) patients was described as good. For comparison, a control group was collected from 32- to 79-year-old (median 63 years) patients (n = 28) having hematological malignancies but no COVID-19.
 Results. Nine (28.1 %) of 32 patients under analysis died upon increasing respiratory and multiple organ insufficiency on Day 3–17 (mean 8,6 ± 4,6 days) from the first positive COVID-19 PCR test. Death was predominantly reported in multiple myeloma patients (n = 5) as well as in a patient with Waldenstrom’s macroglobulinemia. In the control group (n = 28) with similar hematological tumors but without COVID-19, three (10.7 %) patients died throughout the 12-month follow-up period. The present paper contains a case report illustrating the clinical features of coronavirus infection in a patient with Waldenstrom’s macroglobulinemia, a monoclonal gammopathy with primary bone marrow lesions.
 Conclusion. COVID-19 is a life-threatening viral disease with high mortality in patients with hematological malignancies, especially those with plasma cell dyscrasias.

Targeting yeast topoisomerase II by imidazo and triazoloacridinone derivatives resulting in their antifungal activity

Fungal pathogens are considered as serious factors for deadly diseases and are a case of medical concern. Invasive fungal infections also complicate the clinical course of COVID-19, leading to a significant increase in mortality. Furthermore, fungal strains' multidrug resistance has increased the demand for antifungals with a different mechanism of action. The present study aimed to identify antifungal compounds targeting yeast topoisomerase II (yTOPOII) derived from well-known human topoisomerase II (hTOPOII) poisons C-1305 and C-1311. Two sets of derivatives: triazoloacridinones (IKE1-8) and imidazoacridinones (IKE9-14) were synthetized and evaluated with a specific emphasis on the molecular mechanism of action. Our results indicated that their effectiveness as enzyme inhibitors was not solely due to intercalation ability but also as a result of influence on catalytic activity by the formation of covalent complexes between plasmid DNA and yTOPOII. Lysine conjunction increased the strength of the compound's interaction with DNA and improved penetration into the fungal cells. Triazoloacridinone derivatives in contrast to starting compound C-1305 exhibited moderate antifungal activity and at least twice lower cytotoxicity. Importantly, compounds (IKE5-8) were not substrates for multidrug ABC transporters whereas a derivative conjugated with lysine (IKE7), showed the ability to overcome C. glabrata fluconazole-resistance (MIC 32–64 µg mL−1).

Cardiovascular and mental symptoms of post-COVID-19 syndrome as a possible consequence of the bradykinin storm: A clinical case

IntroductionAlthough as of today, the hypothesis of bradykinin storm in COVID-19 cannot be directly confirmed, many theoretical assumptions and empirical data support its validity.AimThe purpose of this article is, using the example of a clinical case, to draw attention to the need for further study of the pathogenesis and clinical manifestations of COVID-19 and post-COVID-19 syndrome, considering the assessment of various theories, including bradykinin storm hypothesis.Case studyWe analysed the data from a young male patient with post-COVID-19 syndrome who referred to a consultant and expressed complaints of palpitation, blood pressure increase, muscle weakness, feeling of fear, hypochondria, sleep disturbances, and reduced working performance.Results and discussionWe found a high degree of autonomic dysregulation (predominantly sympathetic hyperactivation), anxiety, and sleep disorder. There was no hypertension, though ambulatory blood pressure monitoring allowed to determine the status of non-dipper. Patient's blood tests after COVID-19 revealed a decrease in the plasma level of aldosterone, a significant increase in both homocysteine blood level and free cortisol in urine, and mild transient isolated increase in free triiodothyronine. All abnormal blood test parameters turned to normal in 3 months after the onset of COVID-19. We assume that the clinical symptoms and changes in a number of laboratory parameters of the presented case may be associated with the effects of bradykinin storm.ConclusionsThis clinical case suggests continuing the discussion about the potential role of bradykinin storm in the clinical course of COVID-19 and post-COVID-19 syndrome.

Effect of nasal carriage of Bacillus species on COVID-19 severity: a cross-sectional study.

Intranasal sprays containing Bacillus species are being researched for treating viral respiratory tract infections. The aim of this study was to assess the relationship between the nasal carriage of Bacillus and COVID-19 severity. This was a cross-sectional study that collected nasopharyngeal samples from adults 18 years and above visiting two COVID-19 testing centers in Lagos, Nigeria, between September 2020 and September 2021. Bacillus species were cultured from the samples and confirmed using 16 s rRNA gene sequencing. The dependent variable was COVID-19 status classified as negative, asymptomatic, mild, or severe. The independent variable was the nasal carriage of Bacillus species. Multinomial regression analysis was done to determine the association between nasal carriage of Bacillus and COVID-19 severity after adjusting for age, sex, and co-morbidity status. A total of 388 participants were included in the study with mean (standard deviation) age of 40.05 (13.563) years. Sixty-one percent of the participants were male, 100 (25.8%) had severe COVID-19, 130 (33.5%) had pre-existing comorbidity, and 76 (19.6%) had Bacillus cultured from their nasopharyngeal specimen. Bacillus species presence was significantly associated with higher odds of severe COVID-19 compared to having a negative COVID-19 status (AOR = 3.347, 95% CI: 1.359, 8.243). However, the presence of Bacillus species was significantly associated with lower odds of severe COVID-19 compared to having a mild COVID-19 status. The study suggests that nasal carriage of Bacillus species is associated with the clinical course of COVID-19 and supports the exploration of Bacillus species in the management of viral respiratory tract infections.IMPORTANCEWith the introduction of intranasal spray containing Bacillus species for the treatment of viral respiratory tract infections, such as COVID-19 and respiratory syncytial virus, identifying the association between the nasal carriage of Bacillus species and COVID-19 susceptibility and severity will help further substantiate the investigation of these bacteria for COVID-19 prevention and treatment. This study evaluated the association between the carriage of Bacillus species in the nasopharyngeal tract and COVID-19 severity and found that the presence of Bacillus species in the nasopharynx may significantly impact the clinical course of COVID-19.

The clinical course of hospitalized COVID-19 patients and aggravation risk prediction models: a retrospective, multi-center Korean cohort study.

Understanding the clinical course and pivotal time points of COVID-19 aggravation is critical for enhancing patient monitoring. This retrospective, multi-center cohort study aims to identify these significant time points and associate them with potential risk factors, leveraging data from a sizable cohort with mild-to-moderate symptoms upon admission. This study included data from 1,696 COVID-19 patients with mild-to-moderate clinical severity upon admission across multiple hospitals in Daegu-Kyungpook Province (Daegu dataset) between February 18 and early March 2020 and 321 COVID-19 patients at Seoul Boramae Hospital (Boramae dataset) collected from February to July 2020. The approach involved: (1) identifying the optimal time point for aggravation using survival analyses with maximally selected rank statistics; (2) investigating the relationship between comorbidities and time to aggravation; and (3) developing prediction models through machine learning techniques. The models were validated internally among patients from the Daegu dataset and externally among patients from the Boramae dataset. The Daegu dataset showed a mean age of 51.0 ± 19.6 years, with 8 days for aggravation and day 5 being identified as the pivotal point for survival. Contrary to previous findings, specific comorbidities had no notable impact on aggravation patterns. Prediction models utilizing factors including age and chest X-ray infiltration demonstrated promising performance, with the top model achieving an AUC of 0.827 in external validation for 5 days aggravation prediction. Our study highlights the crucial significance of the initial 5 days period post-admission in managing COVID-19 patients. The identification of this pivotal time frame, combined with our robust predictive models, provides valuable insights for early intervention strategies. This research underscores the potential of proactive monitoring and timely interventions in enhancing patient outcomes, particularly for those at risk of rapid aggravation. Our findings offer a meaningful contribution to understanding the COVID-19 clinical course and supporting healthcare providers in optimizing patient care and resource allocation.

Clinical Course of Healthcare Workers Diagnosed as COVID-19 Suspects and Contacts during the Coronavirus Disease 2019 Pandemic: A Cross-sectional Study.

COVID-19 infection can present in various clinical forms. Anosmia has been significantly associated with a positive RT-PCR, but it usually appears after four days and has also been observed among COVID-19 negative patients. Knowledge on the clinical course of COVID-19 can guide decision-making on screening, diagnostic testing, and quarantine/isolation procedures. To describe the clinical course of healthcare workers (HCWs) with COVID-19-related exposure, symptoms, differential diagnoses, and time to return to work clearance. This was a cross-sectional study involving HCWs diagnosed as COVID-19 contacts/suspects between April 2020 and April 2021. Information on demographics, time elapsed between clinical events, outcomes, and final diagnoses were collected from hospital records. Categorical data was presented in frequencies and percentages, while numerical data were reported as range and median values. There were 4755 consultations for COVID-19-related symptoms or exposure that were included in the study. Symptoms developed at a median of one day post-exposure. Consultation was at two days following symptom onset or four days after exposure. RT-PCR was done on the day of consult. Symptoms resolved after a median of six days. Return to work (RTW) was seven days from consult. Common presenting symptoms were respiratory (56.71%) and systemic (34.04%). COVID-19 was positive in 13.79% of consults. Almost all HCWs recovered (99%) as outpatient (88%). Differential diagnoses were usually other respiratory infections (8.60%) and allergic rhinitis (2.37%). The clinical course for HCWs who consulted for COVID-19-related symptoms or exposure lasted for two weeks from symptom onset or exposure until clearance for work resumption. The most common symptoms were respiratory and systemic in nature. Recovery was noted after six days. The most common alternative diagnoses for COVID-19 negative cases were respiratory infection and allergic rhinitis.

ОСОБЕННОСТИ ГУМОРАЛЬНОГО ИММУННОГО ОТВЕТА У БОЛЬНЫХ С НАРУШЕНИЯМИ УГЛЕВОДНОГО ОБМЕНА В ПОСТКОВИДНОМ ПЕРИОДЕ

Intensive research is currently underway on the impact of the SARS-CoV-2 virus on the human body. One of the often-found consequences of such exposure is endocrine dysfunction. It has been previously shown that the detected hyperglycemia in patients infected with SARS-COV-2 is due to the consequences of direct damage by the SARS-CoV-2 virus, activation of the immune system and inflammation, as well as the consequences of the use of glucocorticosteroids. Changes in adaptive immunity are characteristic of both hyperglycemia and post-COVID syndrome. Of interest is the combination of these conditions, namely, the development of hyperglycemia in the post-COVID period and the resulting humoral immune response. This study is devoted to identifying the features of B-cell immunity in individuals with post-COVID syndrome and disorders of carbohydrate metabolism. The study included 72 people with carbohydrate metabolism disorders in the post-COVID period. In patients, the lymphocytic link of immunity was assessed: the relative and absolute number of B-lymphocytes (CD45+CD19+), B1-lymphocytes (CD45+CD5+CD19-CD27-), B2-lymphocytes (CD45+CD19+CD5-CD27-), general population Memory B cells (CD45+CD19+CD5-CD27+). In post-covid patients with type 2 diabetes mellitus, more significant changes in the B-cell link were revealed in comparison with patients with impaired glucose tolerance, including a statistically significant increase in the number of B-lymphocytes. Also, in the group of patients with type 2 diabetes mellitus, the number of B2-lymphocytes is significantly higher in the absence of differences in the levels of B1-lymphocytes, which is possibly characteristic of the autoimmune nature of the diseases, and is associated with the secretion of high-affinity antibodies, which presumably explains the more severe clinical course of COVID-19 in the study group. At the same time, in patients with type 2 diabetes mellitus, the number of B1- and B2-lymphocytes of memory cells is significantly lower compared to patients with impaired glucose tolerance in the post-COVID period, which suggests the ineffectiveness of the formed immune response, which confirms more frequent repeated cases. COVID-19 in this group of patients.

High production MBL2 polymorphisms protect against COVID-19 complications in critically ill patients: A retrospective cohort study

Mannose-binding lectin (MBL) binds to SARS-CoV-2, inhibits infection of susceptible cells, and activates the complement system via the lectin pathway. In this study, we investigated the association of MBL2 polymorphisms with the risk of hospitalization and clinical worsening in patients with COVID-19. A total of 550 patients with COVID-19 were included (94 non-hospitalized and 456 hospitalized). Polymorphisms in MBL2 exon 1 (codons 52, 54 and 57) and promoter region (−550, −221, and +4) were determined by real-time PCR. MBL and complement proteins were measured by Luminex. A higher frequency of the H/H genotype and the HYPA haplotype was observed in non-hospitalized patients when compared to hospitalized. In addition, critically ill patients carrying haplotypes associated with high MBL levels (HYPA/HYPA + HYPA/LYPA + HYPA/LYQA + LYPA/LYQA + LYPA/LYPA + LYQA/LYQA + LXPA/HYPA + LXPA/LYQA + LXPA/LYPA) were protected against lower oxygen saturation levels (P = 0.02), use of invasive ventilation use (P = 0.02, OR 0.38), and shock (P = 0.01, OR 0.40), independent of other potential confounders adjusted by multivariate analysis. Our results suggest that variants in MBL2 associated with high MBL levels may play a protective role in the clinical course of COVID-19.

Prediction of COVID-19 course in patients with stage 3 chronic kidney disease and type 2 diabetes mellitus

BACKGROUND. Patients with Diabetes Mellitus 2 (DM2) and Chronic Kidney Disease (CKD) are at a high risk for severe clinical course of COVID-19. The high mortality rate due to COVID-19 and widespread distribution of DM2 and CKD all over the world make it necessary to determine the predictors of adverse outcome of novel coronavirus infection (NCI).AIM. The identification of predictors of NCI adverse outcome in patients with DM2 and CKD stage 3 due to diabetic kidney disease.Patients and Methods. The patients with NCI and CKD stage 3 were included in observational retrospective uncontrolled study during the follow-up period from 04.01. to 10.30.2020. The study endpoints were the outcome of NCI (survivors/nonsurvivors). Data were collected from electronic versions of case records. Demographic, DM2-related, CKD-related and NCI-related baseline parameters/signs were studied as independent variables.RESULTS. 90 patients with DM2 and CKD stages 3 (Me GFR 43[37; 49] ml/ min/1,73m2) were included, mean age 70 [69; 78] y, females – 56 %, the mortality rate – 21 %. The independent predictors of NCI adverse outcome were detected using a single factor analysis (odds ratio). Among them are: initial prandial glycemia ≥ 10 mmol/l (ОR 11,8; 95 % CI 3,13–44,9; р <0,001), albuminemia at admission ≤ 35 g/l (ОR 5,52; 95 % CI 1,85–16,55; р = 0,012), initial proteinuria ≥ 1 g/л (ОR 6,69; 95 % CI 1,95–23,00; р = 0,002), News2 ≥ 5 at admission (ОR 14,7; 95 % CI 3,15–48,8; р <0,001), lung damage CT 3–4 at admission (ОR 31,7; 95 % CI 6,59–52,85; р = 0,04). A prognostic model was constructed to determine the risk of lethal outcome using logistic regression method. The detected risk factors were used as variables. The predictive value of the model was 93 % according to ROC-analyses data.CONCLUSION. The detected predictors of adverse outcome are the part of routine screening available in pre-hospital setting and at hospital admission. Early identification of predictors allows optimizing patient routing and selecting the best treatment strategy for each patient.

Does atrial fibrillation affect prognosis in hospitalised COVID-19 patients? A multicentre historical cohort study in the Netherlands

ObjectivesThe aim of this multicentre COVID-PREDICT study (a nationwide observational cohort study that aims to better understand clinical course of COVID-19 and to predict which COVID-19 patients should receive which...

Low Mortality from COVID-19 Infection in Patients with B-Cell Lymphoma after Bispecific CD20xCD3 Therapy

Introduction: Patients with hematological malignancies are at an increased risk of morbidity and mortality after COVID-19 infection.Especially patients treated with chimeric antigen receptor T-cell (CAR-T) therapy for B-cell malignancies have shown poor outcomes after COVID-19, resulting in reported COVID-19 attributable mortality rates between 41%-50%.Outcomes after COVID-19 infection in patients treated with CD20xCD3 bispecific antibodies have not been reported. We investigated the impact and clinical course of COVID-19 in 130 Danish patients with B-NHL who have received bispecific antibodies. Methods: Using clinical data from electronic health charts, the national Danish database of microbiology (MiBA), and the national drug- and vaccination registry (SharedMedicineCard), we collected data on date of positive COVID-19 test, quantitative PCR-determined COVID-19 variant, symptoms, reactivations, resolution of disease (either clinical, confirmed by negative PCR test or death), vaccination status and treatment. Disease duration was defined as the time from diagnosis of COVID-19 to clinical resolution. Results: A total of 130 patients who received bispecific CD20xCD3 antibodies (glofitamab or epcoritamab) as part of clinical trials in Denmark were assessed. Of the 130 patients, 109 were alive after March 8, 2020. We identified 43 patients infected with COVID-19, 34 of whom were during CD20xCD3 specific treatment or after end-of-treatment (Table 1). A total of 26 patients (79%) were in complete remission at the time of COVID-19 diagnosis, 5 patients (15%) had progressive disease, 2 patients (6%) had stable disease and 1 patient had no data on lymphoma status at COVID-19 diagnosis. With regards to COVID-19 symptom burden, 4 patients (12%) were asymptomatic during infection. The most common symptoms included fever (n=15), cough (n=12), and dyspnea (n=6). There were 16 patients (48%) admitted to the hospital for the treatment of COVID-19. Of these, 2 patients required oxygen support. Twelve patients (35%) received no specific treatment for COVID-19, while the most commonly prescribed treatments were sotrovimab in 13 patients (42%) and remdesivir in 9 patients (29%). At six months after COVID-19 infection, 3 patients had died, two before recovering from COVID-19. The two cases, where COVID-19 presumably was a cause of death, had a combination of multiple bacterial infections and progression of malignant disease. The 6-month cumulative incidence of death related to COVID-19 was 6.4% (95% CI 0% to 14.9%, Figure 1), while the cumulative incidence of death overall was 9.6% (95%CI 0% to 19.9 %). Of the 25 patients who were alive and had data available at 6 months follow-up after COVID-19 infection, 20 were in complete remission, while the rest (n=5) had refractory/relapsed lymphoma. Of the patients with COVID-19 during CD20xCD3 specific treatment or after end-of-treatment, 13 out of 34 had at least one reactivation. The mean number of COVID-19 reactivations was 1.2 (95%CI 0.44 to 2.03), ranging from 0 up to 9. An additional patient had a reactivation 20 days after first infection and 4 days after first treatment with bispecific antibodies. Only 9% (1 out of 11) of the patients who tested positive for SARS-CoV-2 before bispecific antibody treatment had a reactivation compared to 38% of those testing positive after or during bispecific antibody treatment. In an adjusted multivariable regression for age and sex only hospitalization during the first COVID-19 infection was significantly associated to reactivations (OR: 18.9, 95%CI 2.84-238, p=0.007). Conclusions: To our knowledge, this study presents the first data on COVID-19 incidence and severity in patients with relapsed/refractory lymphoma who have received CD3xCD20 bispecific antibodies. The COVID-19 attributable mortality after bispecific CD20xCD3 antibody therapy, when compared to CAR-T cell therapy, was much lower and comparable to the mortality reported in other cohorts of less heavily treated hematological malignancies infected with omicron variants. However, these patients present with considerable number of COVID-19 reactivations. In conclusion, it seems relatively safe to prescribe bispecific CD20xCD3 antibodies for lymphoma for patients who have been vaccinated for COVID-19 with the currently circulating virus variants.

Clinical particulars of acute coronary syndrome course in patients with COVID-19

Background: Cardiovascular complications of COVID-19 result in challenges for differential diagnosis, patients referral and treatment, which negatively affect the outcomes.
 Aim: To identify clinical particulars of various types acute coronary syndrome course in patients with COVID-19.
 Materials and methods: This retrospective cross-sectional study included 202 patients with COVID-19 and acute coronary syndrome (ACS) admitted to a primary vascular medicine center from September to December 2020. Their medical records were used for the analysis of ACS and COVID-19 clinical course, including physical and history data, laboratory and instrumental work-up. For the analysis, the patient sampling was divided into three study groups: 50 patients with unstable angina (UA), 107 patients with acute myocardial infarction with ST segment elevation (STEMI), and 45 patients with acute myocardial infarction without ST segment elevation (non-STEMI).
 Results: There were no differences in clinical manifestations of ACS in the study groups. As far as clinical manifestations of coronavirus infections are concerned, the patients differed significantly as per prevalence of fever and dry cough. Fever was present in 22 (44%) UA patients, 18 (17%) of STEMI patients and in 10 (22%) of non-STEMI patients (p 0.001 for comparison of 3 groups, Kruskall-Wallis test), whereas dry cough was present in 18 (36%), 19 (18%), and 14 (31%) patients, respectively (p = 0.029). Paired comparison (Mann-Whitney test with Bonferroni adjustment) showed significant differences between US and STEMI groups for both symptoms. The number of involved vessels (median [25%; 75%]) in UA patients was 0 [0; 2], in STEMI and non-STEMI patients 2 [1; 3] (p 0.001). A left coronary artery stenosis was detected in 2 (6%) of the UA patients, 13 (14%) of the STEMI and 4 (13%) of the non-STEMI patients (p = 0.452); left anterior descending artery stenosis, in 12 (36%), 67 (72%) and 23 (72%) patients, respectively (p 0.001). In the pairwise comparison, there were differences between UA and STEMI groups and between UA and non-STEMI groups. A left circumflex artery stenosis was found in 7 (21%) of the UA patients, 45 (48%) of the STEMI and 18 (56%) of the non-STEMI patients (p = 0.008); the pairwise comparisons showed the difference between UA and non-STEMI study groups. A right coronary artery stenosis was identified in 9 (27%), 64 (69%) and 18 (56%) of the study patients, respectively (p 0.001); in the pairwise comparison the difference was found between the UA and STEMI group. There were significant differences in the percentage of the right descendent and right coronary artery stenosis: the right descending artery stenosis was 70% [45; 80] in the UA patients, 90% [70; 100] in the STEMI and 95% [70; 100] in the non-STEMI patients (p = 0.013), whereas the right coronary artery stenosis was 50% [45; 80], 90% [70; 100], 90% [60; 100], respectively (p = 0.018). In the pairwise comparison, the differences were found between the UA and STEMI patients in both arteries. The STEMI patients had higher TIMI thrombus grade scores than those with non-STEMI: 3 [0; 5] vs 0 [0; 4] (p = 0.023). The rates of successful percutaneous coronary intervention and achievement of TIMI flow grade 3 between them was not significantly different (p = 0.170).
 Conclusion: The ACS patients with ACS and COVID-19 have high thrombotic load according to coronary angiography and TIMI score in the case of STEMI and more frequent absence of hemodynamically significant stenosis in those with UA and non-STEMI. The absence of any difference in clinical manifestations of ACS and viral infection between the study groups (except fever and dry cough difference between the UA and STEMI patients) indicates that specific characteristics of the ACS course in COVID-19 patients can be identified only by coronaroangiography.

COVID-19 among people living with HIV in Lebanon

Background: There are conflicting reports of the interaction between COVID-19 and HIV infection among coinfected individuals, and there is a particular dearth of evidence among populations in the Middle East. Aim: To determine if living with HIV and use of antiretroviral therapy increases susceptibility to, and severity of, COVID-19. Methods: This cross-sectional study was based on telephone survey of COVID-19 symptoms duration and clinical course among 200 people living with HIV (PLWHs) and a review of medical records in Beirut, Lebanon, during Spring 2021. Data were collected from consenting patients using standardized forms. The laboratory and medical characteristics of PLWHs with and without COVID-19 were compared and the outcomes of COVID-19 were described. A binary logistic regression model for contracting COVID-19 was constructed based on clinically relevant covariates consistently associated with COVID-19. Significance level was set at 0.05 and statistical analysis was performed using SPSS version 27.0. The Lebanese American University Institutional Review Board approved the study protocol. Results: Fifty-two of 200 PLWHs contracted COVID-19 but only 4 progressed to severe COVID-19. No significant differences were found with respect to gender, time since HIV diagnosis, most recent CD4 count, viral load, substance use, comorbidities, or use of antiretroviral therapy. Older PLWHs were at lower risk of contracting COVID-19; COVID-19 infection was significantly associated with younger age. Conclusions: COVID-19 infection was associated with younger age among PLWHs in Lebanon, possibly due to behavioural and socioeconomic factors.

Bariatric Surgery and COVID-19: a Change of Perspective in a New Phase of the Pandemic.

The protective role of bariatric surgery (BS) against COVID-19 has been reported by several studies, showing, in the first pandemic waves, better outcome of the infection in patients that had undergone BS. With the virus progressive endemicity, BS benefits on COVID-19 clinical course could appear less evident, while COVID-19 effects on BS outcomes must be investigated. In this national multicentric cross-sectional study, we compared COVID-19 incidence and clinical course between a cohort of patients that had undergone BS (OP) and a cohort of candidates to BS (WS); moreover, we analyzed BS outcomes based on SARS-CoV-2 positivity/negativity. From June to December 2021, 522 patients from five Italian referral centers were administered an 87-item telephonic questionnaire completing the analysis of electronic medical records. Demographics, COVID-19 "tested" incidence, suggestive symptoms and clinical outcome parameters of OP and WS were compared. BS outcomes parameters were compared between OP that developed the disease or not. COVID-19 incidence was the same in OP and WS, while symptoms and clinical course seemed milder in OP, with no data individually reaching statistical significance. OP who developed SARS-CoV-2 infection had higher excess weight loss than negative OP (66.8% ± 22.1 vs. 57.7% ± 22.8, p = 0.029). Positive OP had had gastric-bypass (RYGB/OAGB) more frequently than negative ones (38.4% vs. 18.2%, p = 0.025). With the disease becoming endemic, BS protective role against COVID-19 seems clinically less relevant. BS outcomes can be affected by COVID-19, thus imposing careful follow-up for positive patients, especially if undergoing gastric-bypass.

Better COVID-19 Outcomes in Children with Good Asthma Control

Factors associated with COVID-19 presentation in children with asthma are poorly defined. Our study aimed to assess the clinical course of COVID-19 in children with asthma, with particular attention to possible risk factors for severe disease and long-term sequelae in this group of patients. We assessed the occurrence of SARS-CoV-2 infection in children with asthma six months before their regular outpatient visit to the asthma clinic. Characteristics of patients presenting with signs of SARS-CoV-2 upper (URTI) or lower respiratory tract infection (LRTI) were compared. We focused on factors previously associated with COVID-19 severity. Twenty-seven percent of patients (57/210) reported exposure to SARS-CoV-2 infection. In the symptomatic group, 36% (15/42) reported symptoms of LRTI and 64% (27/42) of URTI. Poorer asthma control was observed in patients with LRTI compared to URTI (80% vs. 7%, p < 0.001). In addition, children with poorer asthma control had a higher risk of presenting with SARS-CoV-2 LRTI in a multiple logistic regression analysis. COVID-19 disease course was not associated with regular ICS use and asthma severity. However, patients on regular ICS had better asthma control (p = 0.026). We found no PFT deterioration post-COVID-19 in either group of patients. Our results suggest good asthma control and treatment adherence prior to infection are associated with better COVID-19 outcomes in children with asthma.

Pathomorphological Features of the Novel Coronavirus Disease in Patients with Systemic Amyloidosis.

Amyloidosis is one of the rare systemic illnesses characterized by the deposition of amyloid fibrils in various organs and tissues. There is a common point between COVID-19 and systemic amyloidosis regarding the multiorgan involvement in the pathological process which leads to a heightened risk for severe morbidity and mortality in amyloidosis patients who contracted COVID-19. We performed a pathomorphological analysis of the autopsy records of 22 patients who had COVID-19 and pre-existing systemic amyloidosis. The premortem diagnosis of systemic amyloidosis was established in 55% of patients, and in other 45% of cases, amyloidosis was found at autopsy. Based on the results of immunohistochemical amyloid typing, amyloid A (AA) amyloidosis was detected in 23%, amyloid light chain (AL) lambda in 32%, AL kappa-in 9%, and transthyretin (ATTR) amyloidosis-in 36% of observations. Immunohistochemical staining with an antibody against SARS-CoV-2 Spike (S) protein revealed positive immune reactions in type II alveolocytes in 59% of deceased persons. The analysis of autopsy findings indicates that patients with systemic amyloidosis are more likely to experience an aggressive clinical course of COVID-19 which leads to a multiorgan failure and a higher risk of fatal outcome.

Pulmonary mucormycosis diagnosed by ultrasound guided percutaneous biopsy: A case series

Pulmonary mucormycosis is a rare but highly lethal fungal infection, usually affecting immunocompromised patients. Pulmonary mucormycosis was also a critical problem that complicated the later part of the clinical course of COVID-19 in India. Early diagnosis of the disease, combined with aggressive treatment, is crucial for patient survival. Fibreoptic bronchoscopy is a useful procedure for diagnosis of pulmonary mucormycosis, but image-guided percutaneous biopsy efficiently samples lesions abutting the chest wall. Biopsy is more yielding than cultures and imaging guided biopsy is required for lesions that cannot be microbiologically confirmed by fibreoptic bronchoscopy. We present a case series of four patients of pulmonary mucormycosis in whom ultrasound guided biopsy clinched the diagnosis. All the four patients were poor surgical candidates and underwent medical management with antifungal agents, and had successful clinical recovery and radiological resolution. Our case series illustrates the utility of ultrasound guided percutaneous biopsy as a diagnostic tool for sampling cavitatory disease due to pulmonary mucormycosis, when fibreoptic bronchoscopy failed to yield a diagnosis and the beneficial role antifungal agents as salvage therapy in poor surgical candidates.

COVID-19-induced cardiovascular complexities

This study aimed to investigate the features of the clinical course of COVID-19 in combination with the pathology of the cardiovascular system (CVS). A prospective study was carried out. The main group (n=150) consisted of patients with changes in the cardiovascular system associated with COVID-19, i.e. newly diagnosed CV pathology, and patients with exacerbation of cardiac pathology against the background of COVID-19. The comparison group (n=154) included patients with COVID-19, but without any significant concomitant cardiac pathology. The average age of patients in the main group was 67.7 years (from 47 to 86 years), in the comparison group of 66.1 years (from 48 to 88 years). The study groups were representative and did not differ statistically in the nature of COVID-19 symptoms and the degree of lung involvement. Among the cardiac pathology, progressing or first occurring against the background of infection with COVID-19, in most cases, arterial hypertension of II-III degree (60.0%), coronary heart disease (48.7%), arrhythmias (23.3%) were diagnosed. Echocardiographic abnormalities included right ventricular dysfunction (22.7%), left ventricular contractility disorders (18.7%), with decreased ejection fraction (17.3%), diastolic dysfunction (14.0%), and toxic myocarditis (7.3%). The most significant risk factors were the presence of a burdened medical history (RR=10.39), elevated body mass index over 30 (RR=2.63) and diabetes mellitus (RR=1.55). In patients with COVID-19 in combination with CVS pathology, a relatively high incidence of acute onset (64.0% vs. 44.2%; p<0.001), respiratory failure (83.7% vs. 62.0%; p<0.001), admission to the intensive care unit (25.3% vs. 11.7%; p=0.004), development of acute respiratory distress syndrome (20.0% vs. 9.1%; p=0.012), hospital mortality (10.7% vs. 2.7%; p=0.006). Cardiac manifestations of COVID-19 included focal or global myocardial inflammation, ventricular dysfunction, heart failure, and arrhythmias. A high frequency of acute onset of the disease, respiratory failure and hospital mortality is determined.

COVID-19-induced cardiovascular complexities

This study aimed to investigate the features of the clinical course of COVID-19 in combination with the pathology of the cardiovascular system (CVS). A prospective study was carried out. The main group (n=150) consisted of patients with changes in the cardiovascular system associated with COVID-19, i.e. newly diagnosed CV pathology, and patients with exacerbation of cardiac pathology against the background of COVID-19. The comparison group (n=154) included patients with COVID-19, but without any significant concomitant cardiac pathology. The average age of patients in the main group was 67.7 years (from 47 to 86 years), in the comparison group of 66.1 years (from 48 to 88 years). The study groups were representative and did not differ statistically in the nature of COVID-19 symptoms and the degree of lung involvement. Among the cardiac pathology, progressing or first occurring against the background of infection with COVID-19, in most cases, arterial hypertension of II-III degree (60.0%), coronary heart disease (48.7%), arrhythmias (23.3%) were diagnosed. Echocardiographic abnormalities included right ventricular dysfunction (22.7%), left ventricular contractility disorders (18.7%), with decreased ejection fraction (17.3%), diastolic dysfunction (14.0%), and toxic myocarditis (7.3%). The most significant risk factors were the presence of a burdened medical history (RR=10.39), elevated body mass index over 30 (RR=2.63) and diabetes mellitus (RR=1.55). In patients with COVID-19 in combination with CVS pathology, a relatively high incidence of acute onset (64.0% vs. 44.2%; p<0.001), respiratory failure (83.7% vs. 62.0%; p<0.001), admission to the intensive care unit (25.3% vs. 11.7%; p=0.004), development of acute respiratory distress syndrome (20.0% vs. 9.1%; p=0.012), hospital mortality (10.7% vs. 2.7%; p=0.006). Cardiac manifestations of COVID-19 included focal or global myocardial inflammation, ventricular dysfunction, heart failure, and arrhythmias. A high frequency of acute onset of the disease, respiratory failure and hospital mortality is determined.

The clinical course of COVID-19 in pregnant and non-pregnant women

Aims: Pregnancy is a physiological condition that predisposes women to respiratory complications of viral infections thus, bringing the risk of developing more severe disease. The aim of this research was to elucidate the clinical course of COVID-19 in pregnant and non-pregnant women of childbearing age. Mortality rate, laboratory parameters, the occurence of cytokine storm in both groups and the response to treatment have been investigated.
 Methods: A total of 88 women of childbearing age with a diagnosis of COVID-19 disease has been retrospectively analyzed. Age, comorbidity, length of stay in the intensive care unit and treatment regimen of patients have been obtained from hospital database. Ferritin, IL-6, CRP, procalcitonin, D-dimer, urea, creatinine, GFR, ALT, AST, LDH, lymphocyte count, neutrophil count, white blood cell count were evaluated. Clinical response such as reduction in oxygen requirement and vasopressor utilization before and after treatment were examined
 Results: The rate of RT - PCR positive results were statistical significantly higher in pregnant women (p=0.003). The median WBC, lymphocyte and leukocyte values of the pregnant patients were higher (p=0.038, p=0.006 and p=0.035, respectively). The median hemoglobin, LDH and ferritin values of pregnant women were lower than those of non-pregnant individuals (p=0.032, p