COVID-19 Group Research Articles

Comparison of nailfold capillaroscopy findings in COVID-19 survivors with and without rheumatic disease: a case-control study

Purpose: The aim of this study was to evaluate the nailfold capillaroscopy (NFC) findings of patients with rheumatic disease and healthy controls (HCs) who survived coronavirus disease 2019 (COVID-19).
 Materials and Methods: This study included patients with axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), and rheumatoid arthritis (RA) who recovered from COVID-19 and HCs. NFC was performed for all participants. NFC findings of the three groups [patients with COVID-19 (group 1), HCs with COVID-19 (group 2), and HCs without COVID-19 (group 3)] were compared.
 Results: A total of 142 individuals (group 1, n = 42; group 2, n = 50; group 3, n = 50) were included in the study. Hospitalization and oxygen therapy were more common in group 1 than in group 2. The median time from a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive real-time polymerase chain reaction (RT-PCR) test to NFC was 10.3 (6.3–24.4) weeks in group 1 and 17.1 (6.1–44.9) weeks in group 2. All NFC findings did not differ among the groups except for capillary ramifications, which were higher in group 1 than in groups 2 and 3. Underlying rheumatic disease was the only predictor that was significantly associated with capillary ramifications.
 Conclusion: The NFC findings of COVID-19 survivors with and without rheumatic disease were substantially similar to those of HCs who did not have COVID-19. Capillary ramifications may result from an underlying rheumatic disease in patients with axSpA, PsA, and RA.

Immune Responses in Discharged COVID-19 Patients With and Without Long COVID Symptoms.

The immune mechanisms of long coronavirus disease 2019 (COVID) are not yet fully understood. We aimed to investigate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific memory immune responses in discharged COVID-19 patients with and without long COVID symptoms. In this cross-sectional study, we included 1041 hospitalized COVID-19 patients with the original virus strain in Wuhan (China) 12 months after initial infection. We simultaneously conducted a questionnaire survey and collected peripheral blood samples from the participants. Based on the presence or absence of long COVID symptoms during the follow-up period, we divided the patients into 2 groups: a long COVID group comprising 480 individuals and a convalescent group comprising 561 individuals. Both groups underwent virus-specific immunological analyses, including enzyme-linked immunosorbent assay, interferon-γ-enzyme-linked immune absorbent spot, and intracellular cytokine staining. At 12 months after infection, 98.5% (1026/1041) of the patients were found to be seropositive and 93.3% (70/75) had detectable SARS-CoV-2-specific memory T cells. The long COVID group had significantly higher levels of receptor binding domain (RBD)-immunoglobulin G (IgG) levels, presented as OD450 values, than the convalescent controls (0.40 ± 0.22 vs 0.37 ± 0.20; P = .022). The magnitude of SARS-CoV-2-specific T-cell responses did not differ significantly between groups, nor did the secretion function of the memory T cells. We did not observe a significant correlation between SARS-CoV-2-IgG and magnitude of memory T cells. This study revealed that long COVID patients had significantly higher levels of RBD-IgG antibodies when compared with convalescent controls. Nevertheless, we did not observe coordinated SARS-CoV-2-specific cellular immunity. As there may be multiple potential causes of long COVID, it is imperative to avoid adopting a "one-size-fits-all" approach to future treatment modalities.

TREATMENT, DISEASE CONTROL, QUALITY OF LIFE AND PSYCHOLOGICAL STATUS IN PATIENTS WITH ANKYLOSING SPONDYLITIS DURING THE COVID-19 PANDEMIC

Introduction. The coronavirus disease (COVID-19) pandemic has the potential to impact disease activity and psychological well-being in people with rheumatic diseases. This study aimed to compare ankylosing spondylitis (AS) patients with and without COVID-19 history in terms of treatment, disease control, quality of life and psychological status by providing a cross-sectional look at treatment, disease control, quality of life and psychological status in patients with AS during the COVID-19 pandemic.
 Methods. The study included 74 AS patients, in two groups based on COVID-19 history. Demographic data and clinical characteristics were recorded. Treatment, disease control, functional status, and quality of life were evaluated using Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index (BASFI), and impact of COVID-19 on quality-of-life scales. Psychological status was assessed using the Beck Depression Inventory, Beck Hopelessness Scale, and COVID-19 anxiety scale.
 Results. Of the 74 patients diagnosed with AS, 44 were female and 34 were male. The mean age was 47.3 years. In total, 35 patients (47.3%) had COVID-19. We found that the group without COVID-19 had significantly higher levels of hypothyroidism than the other group (p = 0.008). The BASFI value was significantly higher in the COVID-19 group (p = 0.031). The group with COVID-19 had a substantially higher rate of continuing non-anti-rheumatic drug use than the other group (p = 0.02).
 Conclusion. During COVID-19 pandemic period, the majority of patients continued their medication, so treatment and disease control were not negatively affected. Having COVID-19 did not cause a significant difference psychologically.

Dry eye symptoms are prevalent in moderate-severe COVID-19, while SARS-COV-2 presence is higher in mild COVID-19: Possible ocular transmission risk of COVID-19

PurposeTo evaluate the correlation between dry eye symptoms and coronavirus disease 2019 (COVID-19) infection and to assess the real-time reverse transcription–polymerase chain reaction (RT‒PCR) of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) from the conjunctival swab. MethodsA prospective observational case series study was conducted of all suspected and confirmed COVID-19 patients from Dr. Cipto Mangunkusumo Hospital (RSCM) and the Universitas Indonesia Hospital (RSUI). On the first day of the visit (day 0), systemic clinical symptoms and naso-oropharyngeal (NO) RT‒PCR results will classify all subjects as non-, suspected, or confirmed (mild, moderate, and severe) COVID-19. In all patients, we determined the dry eye symptoms based on the Ocular Surface Disease Index (OSDI) and followed up 7(day 7) and 14 days (day 14) after the first visit. When it was technically possible, we also examined the objective dry eye measurements: tear meniscus height (TMH), noninvasive Keratograph® break-up time (NIKBUT), and ocular redness. Additionally, we took conjunctival swab samples for SARS-CoV-2 RT-PCR in all patients. ResultsThe OSDI scores for 157 patients decreased across days 0, 7, and 14 (median (interquartile range): 2.3 (0–8), 0 (0–3), and 0 (0-0), p value < 0.0001 (D0 vs D14). The moderate-severe COVID-19 group had a higher OSDI score than the other groups at median D0 (15.6 vs 0–2.3), p value < 0.0001 and this pattern was consistently seen at follow-up D7 and D14. However, dry eye complaints were not correlated with the three objective dry eye measurements in mild-moderate COVID-19 patients. NO RT‒PCR results were positive in 32 (20.4%) patients, namely, 13 and 19 moderate-severe and mild COVID-19 patients, respectively. Positive RT‒PCR results were observed in 7/157 (4.5%) conjunctival swab samples from 1 in non-COVID-19 group and 6 in mild group. ConclusionIn the early phase of infection, COVID-19 patients experience dry eye symptoms, which have no correlation with objective dry eye measurements. SARS-CoV-2 in conjunctival swab samples can be detected in patients with normal-to-mild COVID-19, which shows the risk of ocular transmission.

Assessment of the emotional state of women in the early postpartum period during the COVID-19 pandemic

PurposeThe study aimed to assess the emotional state of women in the early postpartum period during the COVID-19 pandemic.MethodsThe study was carried out using the Perceived Stress Scale (PSS-10) and the Edinburgh Postnatal Depression Scales (EPDS). Sociodemographic data (e.g., age, marital status, education) and information concerning the women’s pregnancy and childbirth were collected using the authors’ own survey. That survey also included questions about childbirth-related fears, sources of knowledge about childbirth and infant care, physical activity and participation in childbirth classes. The study consisted of 224 postpartum women, of whom 124 were examined during the COVID-19 pandemic (between March and June 2021). The data obtained were compared with the results of the examinations carried out prior to the pandemic (100 women were examined between February 2019 and May 2019).ResultsIn both of the analysed groups, the mean stress was at an average level. However, in the COVID-19 group, a significantly higher level of perceived stress was noted. In this group, most women were experiencing high levels of stress.ConclusionsRegardless of the research results, providing women with comprehensive perinatal care is essential, irrespective of the existing epidemiological situation in a given country.

Safety of lung resection surgery after severe acute respiratory syndrome coronavirus 2 infection in the post-vaccination era.

To investigate the postoperative outcomes of lung resection in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and determine the optimal timing of surgery. This retrospective, single-centre cohort study included patients who underwent lung resection between June 2021 and June 2022. Patients were divided into the coronavirus disease 2019 (COVID-19) and non-COVID-19 groups based on their preoperative SARS-CoV-2 infection history, and postoperative outcomes were compared. Logistic regression analysis was conducted to identify the risk factors of complications after lung resection surgery. In total, 1194 patients were enrolled, of whom, 79 had a history of SARS-CoV-2 infection. In the COVID-19 group, 66 patients (90.4%) had received at least 1 vaccination dose. The average interval between infection and surgery was 67 days, with no significant impact on postoperative outcomes. Regarding postoperative outcomes, there were no significant differences in major complication rate (6.3% vs 5.4%, P = 0.613), respiratory complication rate (19.0% vs 12.2%, P = 0.079) or length of stays (4.9 ± 3.4 vs 5.0 ± 5.6, P = 0.992) between the 2 groups. Multivariate logistic regression analysis revealed that age, male sex, poor pulmonary function test, open surgery and extensive lung resection were risk factors for postoperative complications, while preoperative COVID-19 infection status was not a statistically significant risk factor. In the post-vaccination era, lung resection surgery can be safely performed shortly after SARS-CoV-2 infection, even within 4 weeks of infection.

Comparable Psychotropic Prescription Rates After Hospital Discharge Between Patients with COVID-19 and Those With Non-COVID-19-Related Respiratory Infection.

Whether psychiatric symptoms after recovery from coronavirus disease 2019 (COVID-19) are specific to this illness remains unclear. In this retrospective study, the Diagnosis Procedure Combination data and outpatient clinic data were used for patients who received inpatient treatment in Saiseikai-affiliated hospitals for COVID-19 or other respiratory tract infections (non-COVID) from 2020 to 2022. The primary outcome was new prescriptions of psychotropic drugs after discharge (i. e., prescriptions of psychotropics to patients who had not received them before or during their hospitalization). Values of interest were compared between groups using the chi-square test or Fisher's exact test. A COX proportional-hazards model was used to examine factors associated with psychotropic prescriptions after discharge in age- and sex-matched COVID-19 and non-COVID patients. Of 31,993 chart records, 19,613 were excluded due to a positive history with psychiatric disorders (n=2,445), prescriptions of psychotropics (n=744), and no follow-ups (n=16,424). Thus, 3,648 COVID-19 and 8,732 non-COVID patients were included (mean [range] duration of follow-up, days: 146.9 [1-727] and 239.2 [1-729], respectively). Two hundred and four (5.6%) of the 3,648 patients with COVID-19 received psychotropic prescriptions after discharge. No statistically significant differences were observed in the prescription rates of any psychotropic category between the COVID-19 and non-COVID groups. An increase in severity during hospitalization was significantly associated with more frequent psychotropic prescriptions (hazard ratio 1.83, p<0.001). The development of psychiatric symptoms should be closely observed, especially in patients who experienced increased severity during hospitalization, regardless of whether they suffered from COVID-19.

A pilot study to assess blood-brain barrier permeability in long COVID.

The etiology of brain fog associated with long COVID is not clear. Based on some preliminary work, disruption of the blood-brain barrier has been hypothesized, but has not been tested in patients with long COVID. In this case-control pilot study, we evaluated blood-brain barrier permeability in patients with long COVID and subjective memory loss or brain fog. We used 99m Technetium diethylenetriaminepentaacetic acid single-photon emission computed tomography (SPECT) to measure blood-brain barrier permeability and a telephone assessment (T-cog) to measure cognitive function. The blood-brain barrier permeability was quantified via SPECT standard uptake value (SUV). We assessed the blood-brain barrier permeability in 14 long COVID patients and 10 control participants without subjective cognitive impairment or brain fog. Participants in the two groups were similar in age. The long COVID group had more comorbidities compared to the control group. There was no difference in the SUVs in the long COVID (0.22 ± 0.12) vs the control (0.17 ± 0.04) group. There was no difference in the T-cog results in the two groups either. We found no evidence of a difference in blood-brain permeability in patients with long COVID when compared to controls without a known history of COVID-19 infection. Larger studies are needed to confirm these findings.

Monocyte-Mediated Thrombosis Linked to Circulating Tissue Factor and Immune Paralysis in COVID-19.

SARS-CoV-2 infections cause COVID-19 and are associated with inflammation, coagulopathy, and high incidence of thrombosis. Myeloid cells help coordinate the initial immune response in COVID-19. Although we appreciate that myeloid cells lie at the nexus of inflammation and thrombosis, the mechanisms that unite the two in COVID-19 remain largely unknown. In this study, we used systems biology approaches including proteomics, transcriptomics, and mass cytometry to define the circulating proteome and circulating immune cell phenotypes in subjects with COVID-19. In a cohort of subjects with COVID-19 (n=35), circulating markers of inflammation (CCL23 [C-C motif chemokine ligand 23] and IL [interleukin]-6) and vascular dysfunction (ACE2 [angiotensin-converting enzyme 2] and TF [tissue factor]) were elevated in subjects with severe compared with mild COVID-19. Additionally, although the total white blood cell counts were similar between COVID-19 groups, CD14+ (cluster of differentiation) monocytes from subjects with severe COVID-19 expressed more TF. At baseline, transcriptomics demonstrated increased IL-6, CCL3, ACOD1 (aconitate decarboxylase 1), C5AR1 (complement component 5a receptor), C5AR2, and TF in subjects with severe COVID-19 compared with controls. Using stress transcriptomics, we found that circulating immune cells from subjects with severe COVID-19 had evidence of profound immune paralysis with greatly reduced transcriptional activation and release of inflammatory markers in response to TLR (Toll-like receptor) activation. Finally, sera from subjects with severe (but not mild) COVID-19 activated human monocytes and induced TF expression. Taken together, these observations further elucidate the pathological mechanisms that underlie immune dysfunction and coagulation abnormalities in COVID-19, contributing to our growing understanding of SARS-CoV-2 infections that could also be leveraged to develop novel diagnostic and therapeutic strategies.

Comparison of mortality and outcomes of four respiratory viruses in the intensive care unit: a multicenter retrospective study

This retrospective study aimed to compare the mortality and burden of respiratory syncytial virus (RSV group), SARS-CoV-2 (COVID-19 group), non-H1N1 (Seasonal influenza group) and H1N1 influenza (H1N1 group) in adult patients admitted to intensive care unit (ICU) with respiratory failure. A total of 807 patients were included. Mortality was compared between the four following groups: RSV, COVID-19, seasonal influenza, and H1N1 groups. Patients in the RSV group had significantly more comorbidities than the other patients. At admission, patients in the COVID-19 group were significantly less severe than the others according to the simplified acute physiology score-2 (SAPS-II) and sepsis-related organ failure assessment (SOFA) scores. Using competing risk regression, COVID-19 (sHR = 1.61; 95% CI 1.10; 2.36) and H1N1 (sHR = 1.87; 95% CI 1.20; 2.93) were associated with a statistically significant higher mortality while seasonal influenza was not (sHR = 0.93; 95% CI 0.65; 1.31), when compared to RSV. Despite occurring in more severe patients, RSV and seasonal influenza group appear to be associated with a more favorable outcome than COVID-19 and H1N1 groups.

Thrombophilia genetic mutations and their relation to disease severity among patients with COVID-19.

Patients with COVID-19 infection appear to develop virus-induced hypercoagulability resulting in numerous thrombotic events. The aim of the present study was to determine the relationship between the thrombophilia genes mutations (prothrombin G20210A, factor V Leiden, and methyltetrahydrofolate reductase (MTHFR)) and the severity of COVID-19 patients. Prospective cross-sectional study. One hundred and forty patients (80 adults and 60 children) were included in the current study. They were divided into the severe COVID-19 group and the mild COVID-19 group, with each group comprising 40 adults and 30 children. The patients were assessed for FV R506Q, FV R2H1299R, MTHFR A1298C, MTHFR C677T, and prothrombin gene G20210A polymorphisms. CBC, D-dimer, renal and liver function tests, hs-CRP, ferritin, and LDH were also assessed. Thrombotic events were clinically and radiologically documented. Severe COVID-19 cases were significantly more frequent to have a heterozygous mutation for all the studied genes compared to mild COVID-19 cases (p<0.05 for all). Being mutant to gene FV R506Q carried the highest risk of developing a severe disease course (p<0.0001). Patients with abnormally high D-dimer levels were significantly more frequent to be heterozygous for FV R506Q, FV R2H1299R, and prothrombin gene G20210A (p = 0.006, 0.007, and 0.02, respectively). We concluded that there is an evident relationship between severe COVID-19 and inherited thrombophilia. In the current study, FV R506Q gene mutation carried the highest risk of developing a severe COVID-19 disease course.

Association of COVID-19 Infection with Subsequent Thyroid Dysfunction: An International Population-Based Propensity Score Matched Analysis.

Background: The COVID-19 pandemic's impact on thyroid function is a growing concern. Previous studies have produced inconclusive results, and there is a lack of comprehensive research into the long-term risks of thyroid dysfunction following COVID-19 infection. Methods: In this retrospective cohort study, we used data from the TriNetX international database, which includes electronic health records from a broad, diverse patient population. We compared patients with COVID-19 (cases) to those without (controls), matching for age, sex, race, and comorbidities using propensity score matching. The primary outcome was the diagnosis of thyroid dysfunction (thyrotoxicosis or hypothyroidism) within a 12-month period, analyzed using hazard ratios (HRs) and Kaplan-Meier curves, and stratified by age and sex. Results: Initially, the study included 1,379,311 COVID-19 patients and 6,896,814 non-COVID-19 patients from the TriNetX database. After matching, the cohorts were comparable in demographics and baseline characteristics. This study consistently demonstrated a significant increase in the risk of thyroid dysfunction, including thyrotoxicosis and hypothyroidism, among COVID-19 patients compared to non-COVID-19 patients. In the short term (3 months postexposure), the COVID-19 group exhibited a HR of 2.07 (95% confidence interval [CI] 2.01-2.12) for thyroid dysfunction, which included both thyrotoxicosis (HR 2.10, CI 1.92-2.29) and hypothyroidism (HR 2.08, CI 2.01-2.13). This heightened risk persisted over the long term (up to 12 months), with HRs indicating an ∼2.01-fold increased risk for overall thyroid dysfunction, a 1.8-fold increased risk for thyrotoxicosis, and a 2.04-fold increased risk for hypothyroidism. Subgroup analysis, stratified by age and sex, revealed a notably higher risk of thyroid dysfunction in patients aged 65 and above (HR 2.18, CI 2.11-2.25), compared to those in the under-65 age group (HR 1.97, CI 1.91-2.03). Both male and female patients were associated with an elevated risk, with females showing a slightly higher association with thyroid dysfunction (HR 2.12, CI 2.06-2.16) compared to males (HR 1.76, CI 1.69-1.82). Conclusions: COVID-19 infection was associated with an increased risk of thyroid dysfunction, including thyrotoxicosis and hypothyroidism, regardless of age or sex, during a 12-month follow-up period. Further research is required to validate these findings.

Optical Coherence Tomography Angiography Assessment of the Optic Nerve Head in Patients Hospitalized Due to COVID-19 Bilateral Pneumonia.

Background and objectives: We aimed to investigate changes in the radial peripapillary capillary (RPC) network using optical coherence tomography angiography (OCTA) in patients who recovered from coronavirus disease 2019 (COVID-19). Materials and Methods: This was a prospective study of patients hospitalized due to COVID-19 bilateral pneumonia between March and May 2021. The control group included healthy individuals matched for age and sex. Two months after discharge, the patients underwent ophthalmological examination, including optical coherence tomography (OCT) imaging. The RPC network and retinal nerve fiber layer (RNFL) of the optic disc (RNFL optic disc) were automatically evaluated and compared between the study groups. Additionally, the RPC parameters were compared between the men and women in the COVID-19 group, and correlations between the RPC and RNFL optic disc parameters were assessed. Results: A total of 63 patients (120 eyes) with bilateral pneumonia caused by severe acute respiratory syndrome coronavirus 2 infection were examined. No ophthalmic symptoms were reported by the patients. No significant differences were observed in the RPC parameters between the patients from the COVID-19 group and the 43 healthy controls. Moreover, the RPC parameters did not differ between the men and women in the COVID-19 group. A positive correlation was found between the RPC and RNFL optic disc parameters in the COVID-19 patients (p < 0.001). Conclusions: No changes in the RPC network were observed among the patients with COVID-19 bilateral pneumonia in the early period after hospital discharge. However, a longer follow-up is needed to monitor COVID-19-related changes in the microvasculature of the optic nerve head.

Abstract P123: Obesity-Related Inflammasome Activation in COVID-19 and Chronic Conditions: A Post-Mortem Lung Biopsies Study

Background: Obesity has been identified as an independent risk factor for severe COVID-19 outcomes. The association between viral infections and obesity, observed previously, suggests that obese individuals are more prone to severe complications. Several factors, such as increased ACE2 receptor expression, anatomical effects on lung function, and chronic inflammation contribute to this relationship yet the activation of the NLRP3 inflammasome pathway is a key element in understanding this mechanism. Objective: This study, conducted with post-mortem lung biopsies of obese individuals who died from COVID-19 (Group A) and from chronic conditions (Group B), focused on the involvement of the NLRP3 inflammasome pathway. Our primary goal was to determine whether chronic NLRP3 inflammasome activation in obese individuals is different in critical COVID-19 and in critical chronic conditions. Methodology: We conducted a retrospective analysis utilizing clinical data and post-mortem lung tissue samples from two distinct groups. Group A comprised 14 obese patients who succumbed to COVID-19, while Group B consisted of 9 obese individuals who passed away from causes unrelated to COVID-19, including thromboembolic events, metastatic neoplasms and acute myocardial infarction. The average age of the groups A and B is, respectively, 67 (ranging from 51 to 86) and 62.6 (ranging from 42 to 79) years. Immunohistochemical analysis was employed to assess the expression of twelve markers associated with inflammation (IL-6, IL-8, TNF-α, IL-18, IL-1β and HIF 1-α.) and the NLRP3 inflammasome pathway (NLRP3, ASC, CASP-1, CASP-9, gasdermin-D). Statistical analysis was performed using Mann-Whitney, Student’s t-test and Fischer’s exact test. Results: Group B showed significantly higher expression of IL-6 (p &lt;0.0001), NLRP3 (p = 0.0004), IL-18 (p = 0.002), HIF 1-α (p = 0.0327), CASP-9 (p &lt; 0.0001), and NF-Kb (p &lt; 0.0001). No significant differences were found for IL-8 (p = 0.8291), TNF-α (p = 0.2349), IL-1β (p = 0.5856), gasdermin-D (p = 0.3301), and ASC (p = 0.0572). CASP-1 expression was higher in Group A (p = 0.0142) marking pyroptosis in the COVID-19 group. Conclusion: While our study did not confirm chronic NLRP3 inflammasome activation was different between the two obese groups, it did reveal a distinctive pattern of cell death through pyroptosis, prevalent in obese individuals with COVID-19. Our findings underscore the necessity for additional research to unveil obesity as the underlying mechanism governing disease severity in infectious diseases.

Risk of Subclinical Atrial Fibrillation in Patients with Cardiac Implantable Electronic Devices after COVID-19 Infection: A Single-Center Study

Objective: To evaluate the risk of subclinical atrial fibrillation (SCAF) in patients with cardiac implantable electronic devices (CIEDs) after COVID-19 infection. Materials and Methods: The authors retrospectively enrolled patients receiving CIEDs with atrial leads at the device clinic between January 2022 and September 2023. Patients with 12-lead ECG documented atrial fibrillation, atrial flutter, or atrial tachycardia were excluded. The authors classified these patients as COVID-19 and non-COVID-19 groups. The outcome was the new onset and/or 20% increased episodes of the longest SCAF duration. The authors compared the outcome using a chi-square or Fisher’s exact test between both groups. Results: One hundred thirty-two patients were enrolled. Of the 132 patients, 44 patients were in COVID-19 group and 88 patients were in non-COVID-19 group. The average age was 67.6 years. About one-third of these patients were males. Most of these patients had hypertension and dyslipidemia. The average follow-up time was 9.3 months. Eighteen patients (40.9%) had the longest SCAF duration in the COVID-19 group, while 23 patients (26.1%) had the longest SCAF duration in the non-COVID-19 group. More patients in the COVID-19 group had the longest SCAF duration than those in non-COVID-19 group with no statistical significance (odds ratio 1.96, 95% confidence interval 0.91 to 4.21, p=0.13). Conclusion: Patients with a history of previous COVID-19 infection receiving CIEDs had no significantly increased risk of SCAF. Keywords: COVID-19; CIEDs; Subclinical atrial fibrillation; AHRE burden; Atrial high-rate episode

Urinary cadmium concentration is associated with the severity and clinical outcomes of COVID-19: a bicenter observational cohort study

BackgroundCadmium and nickel exposure can cause oxidative stress, induce inflammation, inhibit immune function, and therefore has significant impacts on the pathogenesis and severity of many diseases. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can also provoke oxidative stress and the dysregulation of inflammatory and immune responses. This study aimed to assess the potential associations of cadmium and nickel exposure with the severity and clinical outcomes of patients with coronavirus disease 2019 (COVID-19).MethodsWe performed a retrospective, observational, bicenter cohort analysis of patients with SARS-CoV-2 infection in Taiwan between June 2022 and July 2023. Cadmium and nickel concentrations in blood and urine were measured within 3 days of the diagnosis of acute SARS-CoV-2 infection, and the severity and clinical outcomes of patients with COVID-19 were analyzed.ResultsA total of 574 patients were analyzed and divided into a severe COVID-19 group (hospitalized patients) (n = 252; 43.9%), and non-severe COVID-19 group (n = 322; 56.1%). The overall in-hospital mortality rate was 11.8% (n = 68). The severe COVID-19 patients were older, had significantly more comorbidities, and significantly higher neutrophil/lymphocyte ratio, C-reactive protein, and interleukin-6 than the non-severe COVID-19 patients (all p < 0.05). Blood and urine cadmium and urine nickel concentrations were significantly higher in the severe COVID-19 patients than in the non-severe COVID-19 patients. Among the severe COVID-19 patients, those in higher urine cadmium/creatinine quartiles had a significantly higher risk of organ failure (i.e., higher APACHE II and SOFA scores), higher neutrophil/lymphocyte ratio, lower PaO2/FiO2 requiring higher invasive mechanical ventilation support, higher risk of acute respiratory distress syndrome, and higher 60-, 90-day, and all-cause hospital mortality (all p < 0.05). Multivariable logistic regression models revealed that urine cadmium/creatinine was independently associated with severe COVID-19 (adjusted OR 1.643 [95% CI 1.060–2.547], p = 0.026), and that a urine cadmium/creatinine value > 2.05 μg/g had the highest predictive value (adjusted OR 5.349, [95% CI 1.118–25.580], p = 0.036).ConclusionsUrine cadmium concentration in the early course of COVID-19 could predict the severity and clinical outcomes of patients and was independently associated with the risk of severe COVID-19.

The changing pattern of pediatric burns in a territory burn center before and during the COVID-19 pandemic in China: A retrospective study

BackgroundPediatric burn patients are an essential part of burn populations. However, there is limited publicly available data on the epidemiological impact of COVID-19 on pediatric burns in China. ObjectiveIn this paper, pediatric burn patients admitted to the Department of Burn Surgery of the First Hospital of Jilin University before and during COVID-19 were retrospectively investigated to determine the impact of COVID-19 on pediatric burn inpatients. MethodsThe information of inpatients from July 2017 to December 2019 (pre-COVID-19 group) and from January 2020 to June 2022 (COVID-19 group) in the Department of Burn Surgery at the First Hospital of Jilin University was retrospectively investigated. Demographic information of patients, length of hospital stay, total body surface area (TBSA) of burn injury, post-injury visit time, comorbidity, surgical methods, etc., were statistically analyzed. ResultsThe COVID-19 group included 154 (10.2%) patients, and the pre-COVID-19 group included 335 (19.4%) patients (P＜0.001). There were no differences in gender, age, length of hospital stay, or etiology of burns between the two groups. Compared to the pre-COVID-19 group, patients in the pre-COVID-19 group experienced a significant delay in presentation (P＜0.001), had a larger TBSA of burn wound (P ＜ 0.001), were more prone to sustaining major burns (P ＜ 0.001), a higher likelihood of undergoing operations (P = 0.03), higher cost (P＜0.001) and more complications (P＜0.001). Additionally, upper extremities were the most commonly part involved in both groups (P = 0.004), with the lower extremities showed a significant increase to be involved in burn injury during COVID-19 pandemic (P = 0.007). Furthermore, the majority of guardians did not take first aid measures in both groups following burn injury (P = 0.102). ConclusionsDuring the COVID-19 pandemic period, scalds remained the main reason for hospitalization. The number of hospitalized patients has decreased dramatically, while the severity of burns has significantly increased, with a notable delay in hospital visits and an increased occurrence of complications.

Does Postlong Coronavirus 2019 Disease Affect Renal Stiffness without any Chronic Systemic Disorders?

In the last few years, coronavirus disease 2019 (COVID-19) has changed human lifestyle, behavior, and perception of life. This disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). In the literature, there are limited studies about the late renal effects of COVID-19 that reflect the systemic involvement of this disease. In the present study, we aimed to compare sonoelastographic changes in both kidneys between patients who had totally recovered from COVID-19 and healthy individuals using strain wave elastography (SWE). This study was conducted between June 2021 and May 2022 in Kahramanmaraş City Hospital Department of Radiology. File and archive records were retrospectively evaluated. Basic demographic, laboratory, and renal ultrasonography (USG) and sonoelastographic findings were screened and noted. Two groups were defined to compare sonoelastographic findings. Post-long COVID-19 group had 92 post-long COVID-19 patients, and the comparator group had 9 healthy individuals". Both groups' demographic, laboratory, and ultrasound-elastographic findings were assessed. The post-long COVID-19 group had a higher renal elastographic value than the comparator group (1.52 [0.77-2.3] vs. 0.96 [0.54-1.54], p<0.001). There were no statistically significant differences between the two groups in terms of age (p=0.063), gender (p=0.654), or body mass index (BMI) (p=0.725), however, there was a significant difference observed between the two groups in the renal strain ratio (RSR). According to an ROC analysis, an RSR cutoff of >1.66 predicted post-long COVID-19 with 44.9% sensitivity and 81.9% specificity. (AUC=0.655, p<0.001). A separate ROC analysis was performed to predict post-long COVID-19 with a BMI cutoff of <33.52, kg/m2 sensitivity of 92.4% and specificity of 17% (AUC=0.655, p<0.001). We demonstrated that renal parenchymal stiffness increases with SWE in post-long COVID-19 patients.

Persistent increase of cardiovascular and cerebrovascular events in COVID-19 patients: a 3-year population-based analysis.

We evaluated the incidence and relative risk of major post-acute cardiovascular consequences of SARS-CoV-2 infection in a large real-world population from a primary care database in a region at moderate cardiovascular risk followed up in the period 2020-22. This is a retrospective cohort analysis using data from a cooperative of general practitioners in Italy. Individuals aged >18 affected by COVID-19 starting from January 2020 have been followed up for 3 years. Anonymized data from 228 266 patients in the period 2020-22 were considered for statistical analysis and included 31 764 subjects with a diagnosis of COVID-19. An equal group of subjects recorded in the same database in the period 2017-19 was used as propensity score-matched comparison as an unquestionable COVID-19-free population. Out of the 228 266 individuals included in the COMEGEN database during 2020-22, 31 764 (13.9%) were ascertained positive with SARS-CoV-2 infection by a molecular test reported to general practitioners. The proportion of individuals with a new diagnosis of major adverse cardiovascular and cerebrovascular events was higher in the 2020-22 COVID-19 group than in the 2017-19 COMEGEN propensity score-matched comparator, with an odds ratio of 1.73 (95% confidence interval: 1.53-1.94; P < 0.001). All major adverse cardiovascular and cerebrovascular events considered showed a significantly higher risk in COVID-19 individuals. Incidence calculated for each 6-month period after the diagnosis of COVID-19 in our population was the highest in the first year (1.39% and 1.45%, respectively), although it remained significantly higher than in the COVID-19-free patients throughout the 3 years. The increase of cardiovascular risk associated with COVID-19 might be extended for years and not limited to the acute phase of the infection. This should promote the planning of longer follow-up for COVID-19 patients to prevent and promptly manage the potential occurrence of major adverse cardiovascular and cerebrovascular events.

Post-COVID-19 Fetal Cardiac Morphology and Systolic Evaluation in Infected Pregnant Women by Fetal Heart Quantification Technology.

Due to the government's liberalization of epidemic control, the current 2019 novel coronavirus disease (COVID-19) has started to spread widely within China. This study aimed to use the fetal heart quantification (fetal HQ) technique to assess the cardiac function and morphology of the fetuses of pregnant women diagnosed with COVID-19 in the early stages of pregnancy. Exactly 86 pregnant women diagnosed with COVID-19 infection in early pregnancy (COVID-19 group) and 90 healthy pregnant women (control group) who underwent fetal echocardiography were prospectively included in this study. The fetal HQ technique was applied to compare the differences in the global sphericity index (GSI), global strain values (GS), fractional area change (FAC), and 24-segment fractional shortening (FS) of the left and right ventricles, between the COVID-19 group and the control group. Compared with the control group, the differences in GS and 24-segment FS of the left ventricle in the COVID-19 group were not statistically significant. However, the COVID-19 group showed lower GSI values compared with the control group (1.24 vs 1.28). FAC (48.12%) of the left ventricle and GS (-23.55%), FAC (41.74%) of the right ventricle in the COVID-19 group were reduced compared with FAC (50.50%) of the left ventricle and GS (-27.63%), FAC (46.01%) of the right ventricle in the control group. Segmental analysis revealed reduced FS in segments 20-24 in the COVID-19 group compared with the control group. Right ventricular GS was an independent predictor of adverse pregnancy outcome with an optimal cutoff value of -18.66%. The results suggest that COVID-19 infection in early pregnancy may have a negative impact on fetal cardiac morphology and function. Fetal HQ may offer a new assessment method for the early identification of fetal cardiac alterations in pregnant women infected with COVID-19.