Mild COVID-19 Disease Research Articles

Early Effectiveness of Four SARS-CoV-2 Vaccines in Preventing COVID-19 among Adults Aged ≥60 Years in Vojvodina, Serbia.

Real-world evidence of the vaccine effectiveness (VE) of different COVID-19 vaccines is needed in order to better shape vaccine recommendations and policies and increase vaccine acceptance, especially among vulnerable populations such as the elderly. We analyzed the early effectiveness of four COVID-19 vaccines, namely BNT162b2, BBIBP-CorV, Gam-COVID-Vac and ChAdOx1 nCoV-19 in population aged ≥60 years for symptomatic, mild and severe COVID-19, in the period January–April 2021 in Vojvodina, a northern province of Serbia. Incidence rates of SARS-CoV-2 infection were calculated using data from the provincial COVID-19 surveillance registry, and vaccination coverage data were obtained from the nationwide registry of administered COVID-19 vaccines. During the observation period, 134,535 subjects aged ≥60 years were fully vaccinated, of whom 87.7% received BBIBP-CorV, 7.1% BNT162b2 and 5.2% Gam-COVID-Vac vaccines. The estimated VE in fully vaccinated persons was 86.9% (95% CI, 86–87.7) for BBIBP-CorV, 95% (95% CI, 92.4–96.7) for Gam-COVID-Vac and 99% (95% CI, 97.8–99.5) for BNT162b2, while VE after the first dose of ChAdOx1 nCoV-19 was 88.6% (95% CI, 80.5–93.4). Estimates were similar when stratifying the analyses to severe and mild SARS-CoV-2 infections. Our analysis provides evidence of high early effectiveness of BNT162b2, BBIBP-CorV, Gam-COVID-Vac and ChAdOx1 nCoV-19 in elderly people in preventing symptomatic, severe and mild COVID-19 disease, particularly after being fully vaccinated.

Episcleritis and sub-conjunctival haemorrhage in Post- acute COVID-19 patients - A case series

The research on COVID-19 is mainly focused on the respiratory system for survival rate improvement. In recent days, the affect of the disease on other organs including eye has been reported.However, a lot of research and data is needed to understand the pathophysiology and develop effective treatment strategies.In the present study, we report a series of 8 patients who presented themselves in the hospital with complaints of redness in the eye. All these patients had a history of COVID-19 illness during preceding one month. Patients were diagnosed with epislecritis and/or sub-conjunctival haemorrhage using clinical evaluation. They were put on topical steriods and ganciclovir. All the patients improved/recovered within 10 days of presentation. Our study reports the ocular manifestations- episcleritis and sub-conjunctival haemorrhage as Post-acute COVID-19 symptom in cases of lab positive and symptomatic mild COVID-19 disease. These ocular manifestations have been otherwise reported during acute phase or as one of the early signs of infections. Mild cases of COVID-19 presented themselves with episcelritis and/or sub-conjunctival haemorrhage after acute phase (3- 4 weeks after commencement of infections). This highlights that SARS-COV-2 leads to hemorrhagic and inflammatory response in the eyes as a sequelae, well beyond the period when replication-competent SARS-CoV-2 have not been isolated.

Profiles and Characteristics of Patients with Mild to Moderate COVID -19 Disease Phenotypes in a Teaching Hospital in Kano, Northern Nigeria

Background and Introduction: COVID-19 has affected almost 180 million people around the world, causing the death of about 5 million persons, as of November 16, 2021. The disease presents with a plethora of pulmonary and extrapulmonary symptoms of varying severity. After an exhaustive review of the literature, we found no data on the mild and moderate COVID-19 disease phenotypes in Northern Nigeria. Our objective is to describe the clinical characteristics of non-severe COVID -19 disease phenotypes in Kano State. Methods: This is a retrospective cohort study at the COVID-19 Isolation Center of Muhammad Buhari Specialist Hospital Kano, Nigeria. We included all patients admitted from May 2020 to December 2020. Patients’ medical records were assessed and evaluated to describe the clinical characteristics at presentation. We explored time to discharge between patients aged ≤ 50 years old versus those >50. We applied the Kaplan-Meier product-limit estimator to generate cumulative probabilities of discharge over time and used the Log-rank test to determine differences between the two age groups. We applied Cox Proportional Hazards to identify predictors of time to discharge among the patients in the study. The study variables comprised of time of viral clearance and time to discharge as outcome variables, while main exposure variables included, age, sex, occupation, mode of exposure, presence of co-morbidity, and duration of hospitalization. Results: A total of 187 COVID-19 patients were reviewed. The commonest symptoms were fever, breathing difficulty, and dry cough. There was no recorded death. Contact with a confirmed COVID-19 positive person was the source of infection in 167(89.3%) of patients. We noted faster time to viral clearance in patients on lopinavir compared to those on chloroquine (Log-rank test p-value = 0.048). There were no significant differences in time to discharge between younger (< 50 years) versus older patients (≥ 50 years) [24 days vs. 26 days respectively; Log-rank test p-value = 0.082]. Age, sex, and source of infection did not appear to be predictors of infection phenotype. Conclusion and Implications for Translation: The findings of this study have a bearing on the surveillance and diagnosis of COVID-19 in Nigeria. While the plethora of clinical features may not be limited to infection with the SARS-CoV-2 virus, healthcare practitioners should consider these symptom clusters in addition to cognate contact and travel history when confronted with a suspected COVID-19 infection. Copyright © 2022 Maiyaki et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

P663 Mild COVID-19 disease and breakthrough cases among children with inflammatory bowel disease: An update from an international registry

BackgroundCoronavirus disease 2019 (COVID-19) tends to cause mild disease in children, although severe disease occurs rarely. Children with inflammatory bowel disease (IBD) often receive immunosuppressive medications that may increase risk of infectious complications. Little is known about the severity of breakthrough infection after COVID-19 vaccination in children with IBD. We describe COVID-19 outcomes among children with IBD, including those with breakthrough infection.MethodsThe Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is a database created to evaluate COVID-19 outcomes in IBD patients. We included children (age ≤18) from the SECURE-IBD database through November 17th, 2021. We used descriptive statistics to summarize demographic/disease characteristics of the study population, both overall and stratified by hospitalization status, and performed bivariate comparisons. We reported demographic and clinical details of patients requiring an intensive care unit stay and those with breakthrough infection (defined as ≥1 COVID-19 vaccination prior to infection), respectively.ResultsWe analyzed 606 pediatric IBD COVID-19 cases from 37 countries. The most common IBD medications were tumor necrosis factor (TNF) antagonist monotherapy (48%) and sulfasalazine/mesalamine (20%). Most patients (85%) had no non-IBD comorbidities. No patients died, and 28 children (5%) were hospitalized. Factors associated with hospitalization included non-IBD comorbid conditions (43% hospitalized vs 13% not; p <0.01), moderate/severe IBD disease activity (61% vs 15%; p <0.01 overall), gastrointestinal symptoms (68% vs 16%, p <0.01), and steroid use (29% vs 6%, p <0.01). TNF antagonist monotherapy was associated with a decreased likelihood of hospitalization (29% vs 49%; p value 0.03) (Table 1). Seven patients needed intensive care, and three (0.5%) required mechanical ventilation (Table 2). There were nine fully vaccinated and five partially vaccinated patients who developed breakthrough infection, of whom only one required hospitalization but did not need a ventilator (Table 3). The majority of patients with breakthrough infection (13/14) were on systemic immunosuppressants at the time of COVID-19 infection (10/14 on TNF antagonists). ConclusionWe found that children with IBD have a relatively low risk of severe COVID-19 outcomes. Among children with IBD who developed COVID-19 after vaccination, the majority were on immunosuppressants and had mild disease that did not require hospitalization. These data may reassure families and providers of children with IBD during the COVID-19 pandemic and support public health recommendations for COVID-19 vaccination among eligible children with IBD.

Prevalence of Long COVID-19 and its Impact on Quality of Life Among Outpatients With Mild COVID-19 Disease at Tertiary Care Center in North India.

Literature is lacking on the spectrum of symptoms of long COVID-19 (defined as symptoms persisting beyond 28 days of diagnosis) and its impact on quality of life. This single-center, cross-sectional study included mild COVID-19 cases as determined by a positive real-time reverse transcription polymerase chain reaction test. Patients were contacted at least 28 days after diagnosis and were interviewed telephonically using semi-structured questionnaires for duration of symptoms, fatigue using Fatigue Severity Scale (FSS) and quality of life using the World Health Organization Quality of Life: Brief Version (WHOQOL-BREF). A total of 251 COVID-19 patients were included; of which 169 (67.3%) were males. The mean age of the patients was 35.8 years (SD = 12.5). The prevalence of long COVID-19 was 28.2% (n = 71, 95% CI: 23.0–34.2). The most common symptoms involved the musculoskeletal system (12.7%), upper respiratory tract (7.6%), and fatigue among 17 (6.8%) patients. Patients with long COVID-19 had significantly higher FSS score and lower WHOQOL-BREF score compared to the patients without long COVID-19 (<28 days).

Profiling Cognitive Impairment in Mild COVID-19 Patients: A Case-Control Study at a Secondary Healthcare Centre in the Hilly Region of North India.

COVID-19 pandemic continues to be a serious threat to humanity even after the last 2.5 years and multiple reported waves. Post-COVID-19 cognitive impairment has a detrimental effect on the quality of life, education, occupation, psychosocial as well as adaptive functioning and independence. Profiling the cognitive impairment in the mild COVID-19 recovered patients. Interview-based case-control study. This study was conducted at a secondary healthcare center in a hilly region of north India. Group A included mild COVID-19 recovered patients and Group B included local non-COVID healthy individuals. Both groups of participants were interviewed using Montreal Cognitive Assessment (MoCA) to identify global and domain-wise cognitive impairment. Descriptive statistics were used to analyze the demographic and clinical variables. The Chi-square test was used to evaluate these results and statistical analysis was done using the Statistical Package for Social Sciences (version 23) program. A total of 284 individuals were enrolled in our study, equally split into Groups A (cases) and B (controls). No global cognitive decline was found in any participant. However, 40 cases scored low on MoCA. The decrease in domain-wise cognitive function was statistically significant for visuospatial skill/executive function and attention. Our results have demonstrated that there is domain-wise cognitive impairment associated with mild COVID-19 disease. We recommend lowering the threshold of the MoCA to identify the early cognitive impairment and the inclusion of detailed cognitive assessment in post-COVID-19 follow-ups to initiate early cognitive rehabilitation among these patients.

Role of methyle blue in the management of mild, moderate and severe COVID-19 disease.

Role of methyle blue in the management of mild, moderate and severe COVID-19 disease.

Retraction: Role of methyle blue in the management of mild, moderate and severe COVID-19 disease.

[This retracts the article on p. 812 in vol. 11, PMID: 35360806.].

Impact of mild COVID-19 infection on fetal growth during pregnancy

During pregnancy, certain viral infections are known to significantly affect fetal development. Data regarding the impact of COVID-19 viral infection in pregnancy, specifically in asymptomatic or mild cases, remains limited. This presents a challenge in providing prenatal counseling and antepartum surveillance in pregnancies complicated by COVID-19 infection. Placenta studies have demonstrated that vascular malperfusion patterns attributed to COVID appear to depend on the timing of infection. Given reported placenta changes, we aim to evaluate the impact of COVID-19 on fetal growth in pregnant patients with asymptomatic or mild disease, stratified by trimester of infection. We hypothesize that COVID-19 infection, especially early in pregnancy, increases the risk of fetal growth restriction (FGR). This is a single institution, retrospective cohort study of patients with asymptomatic or mild COVID-19 disease, and without disease. All patients age 16-55 years old with a singleton delivery between December 10, 2020, and April 19, 2021 were included. The number of patients diagnosed with and without FGR in each group were evaluated. Group differences were assessed using Chi-Square test with significance at p< 0.05. A total of 1971 patients were enrolled; 208 with COVID-19 and 1763 without. There was no difference in demographics and gestational age at delivery in both groups. There was no difference in the rate of FGR in patients with and without COVID-19, (3.4% vs 4.8%, p=0.36). Within the COVID-19 group, 7 patients met criteria for diagnosis of FGR (p=0.205), with distribution of 2, 1 and 4 patients within 1st, 2nd and 3rd trimester infection respectively. Mild COVID-19 infection in pregnancy, regardless of timing of infection, does not appear to be associated with FGR. Routine serial fetal growth assessment may not be warranted solely for history of COVID-19 infection.

The effects of SARS-CoV-2 on hearing thresholds in COVID-19 patients with non-hospitalized mild disease

IntroductionCOVID-19 may have many nonspecific symptoms, such as hearing loss, tinnitus and dizziness. This study aims to investigate the effects of SARS-CoV-2 on the hearing thresholds of patients with COVID-19. MethodsA total of 20 patients aged 20–55 years who were diagnosed with COVID-19 were included in this study. The relationship between the pure-tone thresholds of patients before and after COVID-19 was evaluated. ResultsThere was no statistically significant difference between bone conduction pure-tone thresholds in all frequencies before and after COVID-19. ConclusionSARS-CoV-2 has no effects on the hearing thresholds in patients with non-hospitalized mild COVID-19 disease. Further studies are needed to investigate the possible effects of SARS-CoV-2 on the auditory system.

LB10. Impact of SARS-CoV-2 Delta Variant on the Spectrum of Pediatric COVID-19 Disease in Arkansas

BackgroundPediatric SARS-CoV-2 infection is generally thought to be asymptomatic or result in mild COVID-19 disease, with a paucity of severe outcomes. However, SARS-CoV-2 variants, notably B.1.617.2 (WHO Delta), have changed the clinical landscape of COVID-19 in the United States. Delta became the dominant variant in Arkansas (AR) the 1st week of July 2021. Schools contributed to pediatric infections during the January 2021 surge in COVID-19 infections even with physical mitigation measures (PMM) that were removed in March 2021. We present preliminary data suggesting a shift in the clinical presentation of children with Delta variant infection. MethodsPediatric (ages ≤ 18 years) case records for the 3 months representing key inflection points of the COVID-19 Pandemic in AR were reviewed. Outcomes (hospitalizations, ICU admission, mechanical ventilation, death) were recorded by the Arkansas Department of Health (ADH) in a statewide database. Fisher’s Exact Test was used with p-values < 0.05 indicating statistical significance.ResultsDuring July 2020, 3,268 pediatric cases were reported to ADH with 55 hospitalizations, 6 ICU admissions, 2 mechanical ventilations, and no deaths. A second peak in January 2021 included 11,735 pediatric cases, a 259.1% increase. Increases were also seen in hospitalizations (n=74), ICU admissions (n= 11), and mechanical ventilations (n=2). No deaths reported. The beginning of an exponential growth in cases during July 2021, before the opening of schools, included 8,031 pediatric cases. Despite 31.6% fewer cases than the previous peak, hospitalizations increased 41.9% (n=105) (p < 0.0001) and included increases in ICU and ventilator use of 68.6% (n=18) (p 0.0016) and 300% (n=8) (p 0.0034), respectively. One pediatric death was reported. (Tbl 1)ConclusionIn the absence of PMM and despite the summer closure of schools, pediatric COVID-19 cases and severe outcomes increased significantly. Initial analysis of the AR July 2021 Delta variant surge indicates a statistically significant increase in pediatric COVID-19 disease and severity as indicated by a proportional increase in hospitalizations, ICU, and ventilator use. Further studies are warranted to better define Delta related childhood disease. Our findings also have implications for school PMM efforts.Disclosures All Authors: No reported disclosures

Abstract 10011: Oral Rivaroxaban versus Subcutaneous Enoxaparin in the Prophylaxis of Covid-19 Induced Coagulopathy in Mild to Moderate Sars Cov-2 Infection

Introduction: Preliminary data highlights the importance of anticoagulation therapy in the prevention and treatment of thromboembolism in SARS CoV-2 infection. There is insufficient data comparing the safety and efficacy of direct oral anticoagulants (DOACs) and subcutaneous enoxaparin in the prophylactic management of COVID-19 associated thromboembolic disease, particularly in mild to moderate cases of COVID-19 infection. Hypothesis: Oral rivaroxaban is superior to subcutaneous enoxaparin in the prophylaxis of COVID-19 induced coagulopathy in mild to moderate SARS CoV-2 infection. Methods: In this randomized, open-label, prospective, superiority trial involving hospitalized patients with confirmed mild or moderate COVID-19 disease, we began enrolment of 230 patients from 1 st August 2020 to receive either once-daily oral rivaroxaban (10mg or 15mg) or once-daily subcutaneous enoxaparin (40mg or 60mg) for duration of in-hospital stay (median: 8 days). Patients were randomised in a 1:1 ratio into groups by computer-generated allocation software. The primary outcome was a composite of all major, clinically relevant haemorrhagic and thrombotic events. An intention-to-treat analysis was carried out on the dataset. The trial was registered with Clinical Trials Registry of India (CTRI/2021/05/033871). Results: The primary efficacy outcome occurred in 4 of 115 patients in the rivaroxaban group (3.5%) versus 16 of 113 patients in the enoxaparin group (14.2%) (hazard ratio 0.207, 95% confidence interval [CI], 0.069 to 0.621, P=0.005). Adverse events developed in 4.3% of patients in the study group and 12.4% in the enoxaparin group (hazard ratio 0.328; 95% CI, 0.118 to 0.910; P=0.032). Major bleeding was seen in 1 patient (0.9%) in the rivaroxaban group and 3 patients (2.7%) in the enoxaparin group. Conclusions: Rivaroxaban alone was superior to enoxaparin for the prophylactic management of coagulopathy associated with mild to moderate SARS CoV-2 infection.

A Rare Case of Mild COVID-19 Disease Associated with Type 1 Cryoglobulinemia and Thrombotic Thrombocytopenic Purpura

Introduction:Type I cryoglobulinemia (Type I CG) usually develops in the setting of protein-secreting monoclonal gammopathies [1,2]. The estimated frequency of renal involvement is 30% in Type 1 CG. Thrombotic Thrombocytopenic Purpura (TTP) is a life-threatening disease in which there is a deficiency in ADAMTS13, a protease which normally functions to cleave von Willebrand factor (vWF). A deficiency leads to persistence of large vWF multimers and the formation of platelet-rich thrombi in the microvasculature. We present a case of 52 years old female with Type 1 CG and acquired autoimmune TTP secondary to mild Covid-19 disease.Case Report:A 52-year-old woman with medical history significant for CKD stage 2, with baseline creatinine (Cr) of 2.5, Diffuse Large B-Cell Gastric Lymphoma (DLBCL), in complete remission, and recent diagnosis with COVID-19 presented to the ED for evaluation of three days of a petechial rash on her bilateral extremities. Significant labs on arrival included hemoglobin (Hgb) 8.9, platelet count 65, Cr of 3.65, and K+ 6.6, meeting criteria for acute kidney injury (AKI). Peripheral blood smear showedthrombocytopenia and normochromic normocytic anemia with no schistocytes or microangiopathic changes. ADAMTS13 was 43% and there was no clinical suspicion for TTP. The patient's Cr continued to worsen up to 8.1 during admission, prompting renal biopsy. Renal biopsy showed Type 1 cryoglobulinemic glomerulonephritis with vasculitis and 30 to 40% fibrosis of glomeruli. The patient was started on systemic steroids, plasma exchange every 2-3 day (completed 6 sessions) and hemodialysis. Her platelet counts steadily increased to 212 but had a significant drop to 32 when rechecked seven days later, prompting further investigation. ADAMTS13 was rechecked and found to be 5% with presence of inhibitor, Hgb was 7.7, haptoglobin was <20, and a diagnosis of TTP was made. The patient was started on daily plasmapheresis, rituximab, Caplacizumab and high dose systemic steroid therapy. Our patient had prior history of DLBCL and was treated with radiation therapy. Restaging PET/CT and EGD with biopsy showed no evidence of recurrence. Bone marrow biopsy was negative for evidence of lymphoma. Several serologic tests were used to rule out other etiologies of Type I CG and came back negative including: SLE, HIV, hepatitis C, multiple myeloma, and Waldenstrom's macroglobulinemia. The patient had elevations in multiple immune markers including IgG, IgM, free kappa light chains, and free lambda light chains. She also had hypocomplementemia of both C3 and C4.Discussion:The relationship of Type I CG and COVID-19 is unclear, though viral infections can trigger autoimmune diseases [3]. Previously, all patients with Type I CG had either ahematologic malignancy, solid-organ malignancy, infection, or autoimmune syndromes. Interestingly, in our patient, several serologic tests were performed and negative, which ruled out these etiologies of Type I CG. Our patient's manifestation of Type I CG was petechial rash on extremities and acute on chronic renal disease. Specific treatment of CG can include plasma exchange, corticosteroids, rituximab, and hemodialysis, depending on underlying cause. Our patient was started on systemic steroids, plasma exchange every 2-3 days, and hemodialysis due to worsening renal functions. Despite cases of covid-19 and TTP being reported, the relationship between the disease processes remains unclear. COVID-19 infection can cause disproportionate activation of the complement system and lead to excessive coagulation and thrombotic events. Systemic infection can decrease ADAMTS-13 activity, and this has also been noted in COVID studies. ADAMTS-13 deficiency has no pathophysiologic relevance specific to Type 1 CG. Our patient developed anemia and thrombocytopenia, and ADAMTS13 activity testing was found to be 5% with presence of an inhibitor. Considered as high-risk disease, our patient was started on steroids, rituximab, Caplacizumab and daily plasmapheresis. Repeated weekly ADAMTS13 level was 26% and platelets were stabilized at 69k/microL.Conclusion:Suggests that Covid-19 virus has the capability to induce cryoglobulinemia through an unknown mechanism• There are two other case reports of an association between Covid-19 and TTP.• May be the first case indicating a possible association of Covid-19 with cryoglobulinemia. DisclosuresNo relevant conflicts of interest to declare.

Characterization of humoral and SARS-CoV-2 specific T cell responses in people living with HIV

There is an urgent need to understand the nature of immune responses against SARS-CoV-2, to inform risk-mitigation strategies for people living with HIV (PLWH). Here we show that the majority of PLWH with ART suppressed HIV viral load, mount a detectable adaptive immune response to SARS-CoV-2. Humoral and SARS-CoV-2-specific T cell responses are comparable between HIV-positive and negative subjects and persist 5-7 months following predominately mild COVID-19 disease. T cell responses against Spike, Membrane and Nucleoprotein are the most prominent, with SARS-CoV-2-specific CD4 T cells outnumbering CD8 T cells. We further show that the overall magnitude of SARS-CoV-2-specific T cell responses relates to the size of the naive CD4 T cell pool and the CD4:CD8 ratio in PLWH. These findings suggest that inadequate immune reconstitution on ART, could hinder immune responses to SARS-CoV-2 with implications for the individual management and vaccine effectiveness in PLWH.

Detection of SARS-CoV2 virus using the real-time reverse transcriptase polymerase chain reaction in semen and seminal plasma from men with active COVID-19 infection - A pilot study.

Introduction:SARS-CoV-2 has been detected in various body fluids. Its presence in semen has been tested with contradictory results. This study aimed to detect the presence of SARS-CoV-2 virus using the real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) in semen and seminal plasma from men with active COVID-19 infection.Methods:In a cross-sectional study at a COVID facility, men aged 20–45 years with active COVID-19 infection provided semen samples within 7 days of symptom onset or 5 days of nasopharyngeal rRT-PCR test positivity in asymptomatic men. Testing of SARS-CoV-2 was performed using rRT-PCR and semen analysis was done for sperm counts and motility as per the WHO (2010) standards.Results:A total of 37 men with a mean age of 32.2 ± 5.6 years were tested. SARS CoV-2 virus could not be isolated in any of the samples. Further, microscopic analysis done on 17 samples showed normal semen parameters during the active phase of disease.Conclusion:Men with mild COVID-19 disease or asymptomatic individuals do not shed virus in their semen, ruling out sexual contact as a mode of transmission in this subset of population.

VP31.07: Fetal neurosonographic assessment after maternal COVID‐19 infection during pregnancy

To assess the impact of COVID-19 during pregnancy in terms of fetal neurosonography (NSG) and its association with maternal severity and gestational age at infection. Multicentric prospective cohort study including singleton pregnant women with COVID-19 infection at 5 hospitals in Spain, from April 2020 to April 2021. Maternal infection was confirmed by clinical symptoms, nasopharyngeal PCR, or by serologic testing. Pregnancies were subdivided according to clinical severity of maternal COVID-19 disease according to NIH Classification. Fetal NSG was performed once COVID-19 symptoms ceased, at least 4 weeks after maternal infection. NSG was performed in 306 fetuses including 77 asymptomatic patients (26%), 195 mild COVID-19 disease (64%), and 32 moderate/severe COVID-19 disease (one critical, 10%). Maternal infection occurred in first trimester in 27% of cases, in second trimester in 53%, and in 19.4% during the third trimester. Gestational age at NSG was similar among groups [median 33 weeks (IQR: 32.2-35.1)]. No significant differences were observed in fetal corpus callosum or fetal cortical development, according to maternal severity of COVID-19 (table 1) or trimester at infection. Severity of maternal COVID-19 infection during pregnancy does not seem be associated with fetal neurosonographic abnormalities nor altered cortical brain development.

Timing of congenital cardiac surgery in children who turned COVID-19 positive.

We report a series of four patients with CHD who tested positive for COVID-19, got treated, and underwent cardiac surgery in the same sitting. All had an uneventful perioperative course similar to COVID-19-negative patients. We conclude that children with asymptomatic or mild COVID-19 disease may be subjected to surgery as early as within 1 week since COVID-19 negative.

Evaluation of Epidemiological, Demographic, Clinical Characteristics and Laboratory Findings of COVID-19 in the Pediatric Emergency Department.

ABSTRACTBackgroundThe aim of this study was to evaluate the epidemiological, demographic, clinical characteristics and laboratory findings of pediatric COVID-19 patients.MethodsPatients with a positive COVID-19 nasopharyngeal polymerase chain reaction (PCR) test between 11 March 2020 and 31 December 2020 were evaluated.ResultsDuring the study period, 3118 patients underwent PCR tests, and 621 of them (19.9%) were positive. Of the patients with a positive test result, 335 were male (53.9%), the median age was 11 years. There were 308 (49.6%) patients that had a history of household exposure. The mean time between the onset of the patients complaints and the diagnosis was 1.88 ± 1.16 days. The most common symptoms were: fever (n = 424), cough (n = 419) and nasal symptoms (n = 157); loss of smell (3.5%) and taste (4.3%) were other symptoms observed in only patients aged 10 years or older. The most common abnormal laboratory finding was lymphopenia (n = 29, 36.7%). Of the 621 patients, the vast majority (n = 546, 87.9%) were classified as mild COVID-19 disease. There was a significant relationship between disease severity and age and comorbidity (p = 0.01 and p < 0.001, respectively). Only 34 patients (5.5%) were admitted to hospital, and two patients were followed-up with a diagnosis of multisystem inflammatory syndrome in children. The mortality rate was 0.32%.ConclusionCOVID-19 can cause different symptoms in children. Although the disease generally causes a mild clinic presentation, it should be kept in mind that it may be more severe especially in children with comorbidities.

Evaluating the presence of SARS-CoV-2 in the intraocular fluid of COVID-19 patients.

Purpose:To detect the presence of SARS-CoV-2 in aqueous and vitreous humor of COVID-19 patients in a pilot study.Methods:Consecutive patients planned for emergency ophthalmic surgeries after ocular trauma were subjected to naso-oropharyngeal RT-PCR test for SARS-CoV-2. Laboratory-confirmed cases were enrolled for the study. During surgery, 0.1 mL aqueous and vitreous each was aspirated. The vitreous tap was collected on clinical suspicion of endophthalmitis. RT-PCR test was used to detect SARS-COV-2 nucleotide in the samples. Cycle threshold (Ct) for E gene of ≤35 along with confirmatory results on one of the two target genes (RdRp or ORF1b) was considered as positive.Results:One hundred and thirty two patients were found positive on naso-oropharyngeal RT-PCR test for SARS-CoV-2 preoperatively. Seven patients with ocular trauma were studied. The mean age was 31.8 years. There were six male and one female patient. Two patients had symptoms of mild COVID-19 disease and the rest were asymptomatic. The mean Ct value of the E gene on naso-oropharyngeal RT-PCR was 23.14 ± 4.7. Corneal and corneoscleral laceration repair was done in five patients, intracorneal wooden foreign body was removed in one patient, and injection of intravitreal antibiotics was done in one patient. Aqueous and vitreous tap was collected in 7 and 5 patients, respectively. None of the aqueous or vitreous samples was found positive for SARS-CoV-2.Conclusion:SARS-CoV-2 was not detected by RT-PCR in aqueous or vitreous humor in this pilot study. Future studies with a larger sample size are needed to further explore the presence of SARS-CoV-2 in intraocular fluids.

Clinical Characteristic of Thoracic Malignancy Patients with Coronavirus Disease 2019 Related to Mitigation Strategy in Dharmais National Cancer Center Hospital, Indonesia

Aim: To describe the clinical data and disease severity of thoracic malignancy patients with COVID-19 and its relation to the mitigation process at the Dharmais National Cancer Center, Indonesia.&#x0D; Methods: Total 5256 cancer patients registered from May 2020 to March 2021. There were 681 cancer patients diagnosed with COVID-19. Forty-five thoracic malignancy patients were enrolled. Data from medical records were obtained at the Dharmais Cancer Hospital, then analyzed using SPSS version 25. Comparative result was considered significant, as p-value &lt; 0.05.&#x0D; Results: There were 12.9% of total patients registered infected by COVID-19, which 6% with thoracic malignancy dominated by Non-small cell lung carcinoma (57.8%). Patients who have asymptomatic (31.1%), mild (13.3%), and moderate COVID-19 disease (8.9%) were alive. Patient with severe disease (46.7%) tend to deteriorate. Neutrophilia (mean 78.0%), lymphopenia (mean 13.0%), high neutrophil to lymphocyte ratio (mean 13.1), hyperuricemia (mean 31.6 mg/dL), high fibrinogen (mean 521.7 mg/dL), and high d-dimer (mean 3821.6 ng/mL) were significantly associated with disease severity (p-value &lt; 0.05).&#x0D; Conclusions: Only small number of cancer patients affected by COVID-19 and mostly do not progress to severe disease, showing the strict mitigation strategy was successful. Severe disease patients have a poor prognosis, with neutrophilia, lymphopenia, high neutrophil to lymphocyte ratio, hyperuricemia, high fibrinogen, and high d-dimer may be valuable for predicting poor prognosis.