Nasopharyngeal RT-PCR Research Articles

Long COVID at 3 and 6 months after covid-19 infection in Thailand.

"Long COVID", which describes a diverse set of symptoms or conditions that persist or develop after four weeks from the onset of initial SARS-CoV-2 infection has been introduced. However, the true prevalence varies worldwide. This study aimed to determine the point prevalence and clinical characteristics of long COVID at three and six months after acute COVID-19 infection in Thailand. Methods All adult patients who were diagnosed with COVID-19 by positive nasopharyngeal RT-PCR for SARS-CoV-2 at Thammasat University Hospital between October and December 2021 were recruited and followed for long COVID symptoms by telephone interviews at 3 and 6 months after an acute infection. Among 1,400 eligible COVID-19 cases, interviews were complete for 1,129 and 932 individuals at 3 and 6 months, respectively. Of those, 431 and 314 reported at least one symptom consistent with long COVID. The point prevalence was 38.2% (95% confidence interval: 35.3-41.1%) and 33.7% (95% confidence interval: 30.7-36.7%) respectively. Female gender, disease severity, and symptomatic acute infection were identified as independent risk factors. Conclusion Based on the reported symptoms, long COVID is commonly observed either at 3 or 6 months in our study.

Diagnostic Value of Saliva RT-PCR Test within Suspected SARS-CoV-2 Cases in Indonesia

Introduction: The ongoing SARS-CoV-2 pandemic has profoundly emphasized the pressing need for accurate and reliable diagnostic procedures. Given the potential health risks associated with nasopharyngeal swabs, there has been growing interest in seeking alternative diagnostic mediums. In this context, our study delved into evaluating saliva as a potential diagnostic tool, simultaneously assessing its efficiency in relation to patient demographics and their exhibited clinical symptoms. Methods: Spanning from May to December 2020, we conducted a comprehensive cross-sectional analysis. We meticulously examined medical records to gather insights on patient characteristics, existing health conditions, onset of symptoms, clinical manifestations, and compared the results obtained from both salivary and nasopharyngeal RT-PCR tests for SARS-CoV-2. Results: Among the individuals suspected of SARS-CoV-2 infection, the mean age stood at 52.4 years, with males representing 60.3% of this group. Interestingly, a significant 76.9% reported underlying health conditions, predominantly hypertension and diabetes. The most commonly reported symptoms encompassed respiratory challenges, notably coughing and shortness of breath, succeeded by symptoms like nausea, fever, and a general sense of fatigue. The performance of saliva tests, in terms of accuracy, appeared to be significantly influenced by the timing of symptom emergence. Conclusion: The RT-PCR tests utilizing saliva samples demonstrated considerable promise, especially during the early stages of symptom manifestation, providing a reliable alternative to traditional nasopharyngeal swabs. The findings suggest a superior diagnostic sensitivity when utilizing saliva during the initial phases of a SARS-CoV-2 infection.

Maternal and neonatal outcomes of French prospective multicenter cohort study COVIPREG during the first two COVID-19 waves

BackgroundSARS-CoV-2 infection on pregnant women was the subject of many questions since the COVID-19 pandemic. MethodsWe aim to assess maternal and neonatal outcomes of SARS-CoV-2 infection contracted during 2nd and 3rd trimesters of pregnancy during the first two COVID-19 waves across a prospective French multicenter cohort study. Patients were included between April 2020 and January 2021 in 10 maternity hospitals in Paris area with two groups (i) pregnant women with a positive SARS-CoV-2 nasopharyngeal RT-PCR between [14WG; 37WG[(symptomatic infection), (ii) pregnant women with a negative serology (or equivocal) at delivery and without a positive SARS-CoV-2 nasopharyngeal RT-PCR at any time during pregnancy (G2 group) Main findings2410 pregnant women were included, of whom 310 had a positive SARS-CoV-2 nasopharyngeal RT-PCR and 217 between [14WG; 37WG[. Most infections occurred between 28 and 37 weeks of gestation (56 %). Most patients could be managed as outpatients, while 23 % had to be hospitalized. Among women with a positive RT-PCR, multiparous women were over-represented (OR = 2.45[1.52;3.87]); were more likely to deliver before 37 weeks of gestation (OR = 2.19[1.44;3.24]) and overall cesarean deliveries were significantly increased (OR = 1.53[1.09;2.13]). ConclusionsThis study highlights the maternal, obstetrical, and neonatal burden associated with SARS-CoV-2 infections during the first two pandemic waves before availability of vaccines. Trial registrationNCT04355234 (registration date: 21/04/2020)

Liver damage and hepatomegaly in COVID-19 patients.

The aim of this study was to evaluate the patients with high liver function test results detected at admission to the hospital diagnosed with COVID-19. Patients diagnosed with COVID-19 by a nasopharyngeal RT-PCR (+) test in the emergency department were included in the study. CRP, liver function tests, and abdominal ultrasonography (US) findings of the patients were recorded. A total of 367 COVID-19 patients, 254 (69.2%) males and 113 (30.8%) females, with a mean age of 60.39 (16.81) years, were included in the study. It was seen that 236 (68.7%) patients were treated without complications, 131 (35.7%) patients needed intensive care, and 81 (22.1%) patients died. The frequency of hepatomegaly was significantly higher in patients with severe course and mortality (p < 0.001). When COVID-19 patients who developed mortality were compared with other patients with a diagnosis of COVID-19, no additional risk factors affecting mortality were detected, except LDH [OR: 1.009, (1.006-1.012); p < 0.001] and high CK [OR: 1.001 CI: 95%, (1.000-1.001); p = 0.032]. Patients who need to be hospitalized with COVID-19 and who do not have acute and/or chronic liver disease, elevated liver function test results, and an increase in liver sizes at presentation, it was seen that these did not have an effect on the clinical outcome. However, in addition to the presence of advanced age and comorbidity, the presence of hepatomegaly measured by CT at admission, and high LDH and CK levels were associated with poor clinical outcomes.

Gender disparities in symptomology of COVID-19 among adults in Arkansas

Only a few studies and reports assessing the natural history and symptomatology for COVID-19 by gender have been reported in literature to date. Thus, the objective of this study was to examine patterns in symptomology of COVID-19 by gender among a diverse adult population in Arkansas. Data on COVID-19 symptoms was collected at day of testing, 7th day and 14th day among participants at UAMS mobile testing units throughout the state of Arkansas. Diagnosis for SARS-CoV-2 infection was confirmed via nasopharyngeal swab and RT-PCR methods. Data analysis was conducted using Chi-square test and Poisson regression to assess the differences in characteristics by gender. A total of 60,648 community members and patients of Arkansas received RT-PCR testing. Among adults testing positive, we observed a statistically significant difference for fever (p < 0.001) and chills (p = 0.04). Males were more likely to report having a fever (22.6% vs. 17.1%; p < 0.001) and chills (14.9% vs. 12.6%; p = 0.04) compared to females. Among adults testing negative, females were more likely to report each symptom than males. To conclude, we observed a greater prevalence of certain symptoms such as fever and chills among men testing positive for COVID-19, compared to women during the time of testing. These differences elucidate the important issue of rapidly emerging health disparities during the COVID-19 pandemic.

Impact of variants of SARS-CoV-2 on obstetrical and neonatal outcomes.

SARS-CoV-2 can lead to several types of complications during pregnancy. Variant surges are associated with different severities of disease. Few studies have compared the clinical consequences of specific variants on obstetrical and neonatal outcomes. Our goal was to evaluate and compare disease severity in pregnant women and obstetrical or neonatal complications between variants of SARS-CoV-2 that have circulated in France over a two-year period (2020-2022). This retrospective cohort study included all pregnant women with a confirmed SARS-CoV-2 infection (positive naso-pharyngeal RT-PCR test) from March 12, 2020 to January 31, 2022, in three tertiary maternal referral obstetric units in the Paris metropolitan area, France. We collected clinical and laboratory data for mothers and newborns from patients' medical records. Variant identification was either available following sequencing or extrapolated from epidemiological data. There were 234/501 (47%) Wild Type (WT), 127/501 (25%) Alpha, 98/501 (20%) Delta, and 42/501 (8%) Omicron. No significative difference was found regarding two composite adverse outcomes. There were significantly more hospitalizations for severe pneumopathy in Delta variant than WT, Alpha and Omicron respectively (63% vs 26%, 35% and 6%, p<0.001), more frequent oxygen administration (23% vs 12%, 10% and 5%, p=0,001) and more symptomatic patients at the time of testing with Delta and WT (75% and 71%) versus Alpha and Omicron variants (55% and 66% respectively, p<0.01). Stillbirth tended to be associated with variants (p=0.06): WT 1/231 (<1%) vs 4/126 (3%), 3/94 (3%), and 1/35 (3%) in Alpha, Delta and Omicron cases respectively. No other difference was found. Although the Delta variant was associated with more severe disease in pregnant women, we found no difference regarding neonatal and obstetrical outcomes. Neonatal and obstetrical specific severity may be due to mechanisms other than maternal ventilatory and general infection.

STUDY OF ADVERSE NEONATAL OUTCOMES BORN TO SARS-CoV-2 POSITIVE MOTHERS.

Retrospective review of hospital records of 42 mother baby dyads at or above 34 completed weeks of gestation and tested SARS-CoV-2 positive by antigen or RTPCR within 14 days preceding delivery from 1st August 2020 till 6th February 2022 and the nasopharyngeal RTPCR reports of 43 neonates born to such mothers within 24- 48 hours were reviewed. Demographic and clinical features of neonates were studied. Of the 42 motherbaby dyad and 43 newborns(1 DCDA) one newborn tested positive (2.32%).No maternal ICU or maternal mortality was observed.Thirty newborns (69.76%) were delivered via cesarean of which 3(6.97%) were late-preterm while 3 (6.97%)were post dated deliveries.No gender discordance and meconium stained liquor noted in 4 deliveries(9.30%).7 were SGA(16.27%) while rest were AGA.2 babies(4.65%) required resusciation at birth and 3(6.97%) required NICU admission (Respiratory distress was the most common cause) with 2(4.64%)having mild requiring oxygen while 1 (2.32%) had severe distress requiring invasive ventilation.38 (88.37%)were asymptomatic while 5(11.62%) had adverse outcomes in the form of TTNB(4.65%),fever(2.32%),probable sepsis(2.32%),stillbirth(2.32%),PPHN(2.32%),poor feeding and lethargy(2.32%).1 (2.32%)neonate succumbed to PPHN on day 2.TTNB (4.65%)was the most common postnatal adverse outcome.Neonates have an overall favorable prognosis.We propose that a professional should always be present at the time of delivery for the possible need of resuscitation considering the higher incidence of respiratory distress 6.97% and birth asphyxia 2.32% in our study

Effects of post COVID-19 on lungs in tertiary care hospital, Peshawar

Background: A severe acute respiratory virus that started lethal lung infections in Wuhan, China in Dec 2019 swiftly evolved into an epidemic in March 2020. Millions of fatalities have been attributed to COVID-19 globally, and people who survived the acute type often experience major mortality. Objective: The purpose of this research was to describe a number of patients who had experienced pulmonary problems following COVID-19. Methods: From December 2021 to June 2022, a retrospective research was done in Hayatabad Medical Complex, Peshawar. Patients with a record of a COVID-19 diagnosis verified by nasopharyngeal RT-PCR and who had been hospitalized to or visited an outpatient department were included. Results: This research included a total of 50 COVID-19 infected individuals. patients most frequently reported shortness of breath (n=29; 58%), fever (n=7; 14%), cough (n=5; 10%), and hemoptysis (n=9; 18%). Major surgical treatments were carried out on them, including bullectomies, lobectomies, and decortications and the most successful treatment for empyema is open decortication. Thirteen patients (26%) were admitted to the ICU after operations, nine cases (18%) acquired mucormycosis, and two deaths were reported.

SARS-CoV-2 Breakthrough Infections in Health Care Workers: An Italian Retrospective Cohort Study on Characteristics, Clinical Course and Outcomes.

The aim of this study was to determine the characteristics, clinical course and outcomes of COVID-19 breakthrough infections (BIs) among healthcare workers (HCWs) of an Italian University Hospital. A retrospective observational study was conducted on 6111 HCWs, from January 2021 to February 2022. The study population was offered the full vaccination with BNT162b2 mRNA COVID-19 vaccine. To allow return to work after BI, the protocol required one negative nasopharyngeal RT-PCR swab followed by a medical examination to assess the HCW's health status. Laboratory tests, instrumental tests and specialist evaluations were carried out if necessary. The cases of BIs observed numbered 582 (9.7%). The frequency of BIs was significantly higher in females than in males (67% vs. 33%; p = 0.03), and in nurses than in all other professional categories (p = 0.001). A total of 88% of the HCWs affected by BI were still symptomatic after the negative swab. None of the instrumental tests carried out showed any new findings of pathological significance. All cases showed progressive disappearance of symptoms, such that no cases of long COVID and no hospitalization or deaths were recorded. Our results confirm that SARS-CoV-2 infections occur even after a full vaccination course; however, the clinical course is favorable and severe outcomes are reduced.

Utilization of COVID-19 allografts without transmission to recipients in liver transplantation

Background: The utilization of COVID-19 positive donors has expanded the donor pool for liver and kidney transplantation in the United States since initiation of COVID allograft utilization protocols in 2020 and 2021. Utilization of these allografts has been demonstrated to be a safe practice and to reduce waitlist mortality; however, the transmission rate of COVID-19 from these allografts has not been well documented. Methods: In August 2021, an institutional COVID-19 positive serology donor protocol was implemented for liver and kidney transplants. Post-reperfusion liver biopsies were obtained intra-operatively to evaluate for COVID-19 RNA in the donor allografts. Post-operative management of recipients and immunosuppression were similar to standard protocols. All recipients were vaccinated per institutional protocol. Primary endpoint evaluated was transmission of COVID-19 to donors via nasopharyngeal RT-PCR swab on post-operative day 7. Results: 38 vaccinated recipients underwent transplantation with 17 livers, 3 liver-kidneys (SLK), and 18 kidneys from 33 COVID-19 positive deceased donors between August 2021 and April 2022. 90.9% of donors were asymptomatic at time of donation. On post-reperfusion allograft biopsies, COVID-19 RNA was found in only 10% (2/20) of samples. All recipients were COVID-19 negative on post-operative day 7 nasopharyngeal RT-PCR, showing a 0% transmission rate of COVID-19 from the positive allografts. Respiratory complications were noted in 13% of the recipients; however, none were related to COVID-19. Conclusion: The safety of using COVID-19 allografts has been demonstrated in the literature and is again supported by this study which demonstrates no cases of clinically relevant or PCR-detectable transmission of COVID-19 from the positive allografts to recipients, despite 10% of allografts having COVID-19 RNA present on post-reperfusion biopsy. Further use of this underutilized donor source can continue to expand the donor pool in the US and decrease waitlist mortality.

1920. Lack of SARS-CoV-2 transmission from a Healthcare Worker to a Cohort of Immunosuppressed Patients during the Omicron Surge, California, 2022

Abstract Background The Omicron surge caused a significant strain on the healthcare system, particularly as it relates to healthcare worker (HCW) infections. Occult infection transmission from HCWs to patients is an important area upon which infection control programs can continue to improve. Methods We conducted a retrospective chart review of 9 patients on the immunocompromised solid organ transplant service who were exposed to a highly infectious vaccinated and boosted healthcare worker across 2 days during the Omicron surge in January 2022. Results The index healthcare worker began to show symptoms shortly after rounds on the second day of clinical service. Nasopharyngeal rtPCR testing for SARS CoV 2 was positive, Ct value 15.9; a routine screening Covid19 test the day prior using an anterior nares swab had been negative. All 9 patients who were exposed and received follow-up testing on days 3-5 since exposure were negative for SARS CoV 2. One additional healthcare worker who was also exposed tested negative on follow-up testing despite several hours of close contact across 2 days. Both HCWs wore N95 respirators during all patient care and in breakrooms. Patient exposures were less than 15 minutes in duration, but also less than 6 feet in distance. Conclusion The index healthcare worker did not transmit SARS CoV 2 to a cohort of immunocompromised patients or to a fellow HCW despite being very infectious. The index HCW wore an N95 respirator during all patient encounters which could have reduced the chance for transmission. Disclosures All Authors: No reported disclosures.

Comparison of Nasopharyngeal and Saliva Swab Nucleic Acid Amplification and Rapid Antigen Testing To Detect Omicron SARS-CoV-2 Variant of Concern: a Prospective Clinical Trial (OMICRON).

In November 2021, the World Health Organization declared the Omicron variant (B.1.1.519) a variant of concern. Since then, worries have been expressed regarding the ability of usual diagnostic tests to detect the Omicron variant. In addition, some recently published data suggested that the salivary reverse transcription (RT)-PCR might perform better than the current gold standard, nasopharyngeal (NP) RT-PCR. In this study, we aimed to compare the sensitivities of nasopharyngeal and saliva RT-PCR and assess the diagnostic performances of rapid antigen testing (RAT) in nasopharyngeal and saliva samples. We conducted a prospective clinical study among symptomatic health care professionals consulting the occupational health service of our hospital for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening and hospitalized patients in internal medicine/intensive care wards screened for SARS-CoV-2 with COVID-19-compatible symptoms. A composite outcome considering NP PCR and/or saliva PCR was used as a reference standard to define COVID-19 cases. A total of 475 paired NP/saliva specimens have been collected with a positivity rate of 40% (n = 192). NP and salivary RT-PCR exhibited sensitivities of 98% (95% CI, 94 to 99%) and 87% (95% CI, 81 to 91%), respectively, for outpatients (n = 453) and 94% (95% CI, 72 to 99%) and 69% (95% CI, 44 to 86%), respectively, for hospitalized patients (n = 22). Nasopharyngeal rapid antigen testing exhibited much lower diagnostic performances (sensitivity of 66% and 31% for outpatients and inpatients, respectively), while saliva RAT showed a sensitivity of less than 5% in both groups. Nasopharyngeal RT-PCR testing remains the gold standard for SARS-CoV-2 Omicron variant screening. Salivary RT-PCR can be used as an alternative in case of contraindication to perform NP sampling. The use of RAT should be limited to settings where access to molecular diagnostic methods is lacking. IMPORTANCE The Omicron variant of concern spread rapidly since it was first reported in November 2021 and currently accounts for the vast majority of new infections worldwide. Recent reports suggest that saliva sampling might outweigh nasopharyngeal sampling for the diagnosis of the Omicron variant. Nevertheless, data investigating the best diagnostic strategy specifically for the Omicron variant of concern remain scarce. This study fills this gap in current knowledge and elucidates the question of which strategy to use in which patient. It provides a new basis for further improving COVID-19 screening programs and managing patients suspected to have COVID-19.

MYASTHENIA GRAVIS PRECIPITATED BY ASYMPTOMATIC COVID-19 INFECTION, VACCINE, OR BOTH? HOW GENETIC PREDISPOSITION AND IMMUNE RESPONSES PLAY A ROLE IN THE NEUROMUSCULAR JUNCTION

MYASTHENIA GRAVIS PRECIPITATED BY ASYMPTOMATIC COVID-19 INFECTION, VACCINE, OR BOTH? HOW GENETIC PREDISPOSITION AND IMMUNE RESPONSES PLAY A ROLE IN THE NEUROMUSCULAR JUNCTION

Nasopharyngeal microbiota profiling of pregnant women with SARS-CoV-2 infection

We aimed to analyze the nasopharyngeal microbiota profiles in pregnant women with and without SARS-CoV-2 infection, considered a vulnerable population during COVID-19 pandemic. Pregnant women were enrolled from a multicenter prospective population-based cohort during the first SARS-CoV-2 wave in Spain (March-June 2020 in Barcelona, Spain) in which the status of SARS-CoV-2 infection was determined by nasopharyngeal RT–PCR and antibodies in peripheral blood. Women were randomly selected for this cross-sectional study on microbiota. DNA was extracted from nasopharyngeal swab samples, and the V3-V4 region of the 16S rRNA of bacteria was amplified using region-specific primers. The differential abundance of taxa was tested, and alpha/beta diversity was evaluated. Among 76 women, 38 were classified as positive and 38 as negative for SARS-CoV-2 infection. All positive women were diagnosed by SARS-CoV-2 IgG and IgM/IgA antibodies, and 14 (37%) also had a positive RT–PCR. The overall composition of the nasopharyngeal microbiota differ in pregnant women with SARS-CoV-2 infection (positive SARS-CoV-2 antibodies), compared to those without the infection (negative SARS-CoV-2 antibodies) (p = 0.001), with a higher relative abundance of the Tenericutes and Bacteroidetes phyla and a higher abundance of the Prevotellaceae family. Infected women presented a different pattern of microbiota profiling due to beta diversity and higher richness (observed ASV < 0.001) and evenness (Shannon index < 0.001) at alpha diversity. These changes were also present in women after acute infection, as revealed by negative RT–PCR but positive SARS-CoV-2 antibodies, suggesting a potential association between SARS-CoV-2 infection and long-lasting shift in the nasopharyngeal microbiota. No significant differences were reported in mild vs. severe cases. This is the first study on nasopharyngeal microbiota during pregnancy. Pregnant women with SARS-CoV-2 infection had a different nasopharyngeal microbiota profile compared to negative cases.

SARS-CoV-2 antibody response after BNT162b2 mRNA vaccine in healthcare workers: Nine-month of follow-up

We collected sequential serum samples (0, 4, 12 weeks, 9 months) for the determination of S-RDB IgG levels from 103 vaccinated healthy subjects (age 45 ± 13 years; 60 women), in order to evaluate neutralizing antibody response against SARS-CoV-2 in healthy healthcare workers (HCWs) after the administration of two doses of BNT162b2 SARS-CoV-2 mRNA vaccine. Every subject received two doses of mRNA vaccine BNT162b2 (Pfizer-BioNTech), 21 days apart (January-February 2021). Furthermore, antibody titer of 14 subjects who were hospitalized for symptomatic COVID-19 was evaluated. Antibody response was (median, interquartile range) 35 U/mL (10–104) at baseline, 1960 (1241–3221) at 4 weeks, 791 (388–1179) at 12 weeks and 524 (273–931) at 6 months. Antibody response was inversely correlated with age at all timepoints (p < 0.001) while gender and Body Mass Index had no significant effect. At multivariate analysis, post-baseline values were significantly higher than baseline (p < 0.001) with a reduction at 12 weeks and 9 months (p < 0.001). Antibody response of hospitalized subjects who did not receive vaccination, symptomatic for COVID 19 infection, was 103 (25–557) U/mL, significantly higher than baseline (p = 0.007) of study population but lower than all post-baseline determinations (p < 0.001). Younger subjects showed a stronger response and a lower decrease of antibody titers compared to the classes of older subjects. SARS-CoV2 infection was excluded by performing 1017 nasopharyngeal RT-PCR swabs on the study cohort. The second dose of mRNA vaccine resulted in an antibody response effective in preventing infection in a population of healthcare professionals. The antibody level was stable through week 12, showing a reduction in the following six months.

Diagnostic accuracy of non-invasive detection of SARS-CoV-2 infection by canine olfaction.

BackgroundThroughout the COVID-19 pandemic, testing individuals remains a key action. One approach to rapid testing is to consider the olfactory capacities of trained detection dogs.MethodsProspective cohort study in two community COVID-19 screening centers. Two nasopharyngeal swabs (NPS), one saliva and one sweat samples were simultaneously collected. The dog handlers (and the dogs…) were blinded with regards to the Covid status. The diagnostic accuracy of non-invasive detection of SARS-CoV-2 infection by canine olfaction was assessed as compared to nasopharyngeal RT-PCR as the reference standard, saliva RT-PCR and nasopharyngeal antigen testing.Results335 ambulatory adults (143 symptomatic and 192 asymptomatic) were included. Overall, 109/335 participants tested positive on nasopharyngeal RT-PCR either in symptomatic (78/143) or in asymptomatic participants (31/192). The overall sensitivity of canine detection was 97% (95% CI, 92 to 99) and even reached 100% (95% CI, 89 to 100) in asymptomatic individuals compared to NPS RT-PCR. The specificity was 91% (95% CI, 72 to 91), reaching 94% (95% CI, 90 to 97) for asymptomatic individuals. The sensitivity of canine detection was higher than that of nasopharyngeal antigen testing (97% CI: 91 to 99 versus 84% CI: 74 to 90, p = 0.006), but the specificity was lower (90% CI: 84 to 95 versus 97% CI: 93 to 99, p = 0.016).ConclusionsNon-invasive detection of SARS-CoV-2 infection by canine olfaction could be one alternative to NPS RT-PCR when it is necessary to obtain a result very quickly according to the same indications as antigenic tests in the context of mass screening.

SYSTEMIC STEROIDS IN COVID-19 PNEUMONIA: A RETROSPECTIVE ANALYSIS

TYPE: Abstract TOPIC: Critical Care PURPOSE: The objective of study is to assess correlation of P:F ratio in SARS-CoV-2 patients receiving systemic steroids. METHODS: We conducted retrospective analysis in local hospital in California. Patient population included 250 patients who were adults above 18 years old who tested positive via nasopharyngeal RT-PCR assays between 03,2020 to 06,2020. P:F ratio of patients were measured on days 1-7 and day 14 following steroid injection. Patient mortality is indicated by lower PaO2 to FiO2 ratio over time, on average. The time series plots of all patients are averaged over time using local polynomial regression of the ratio in the log scale. RESULTS: Our study showed patients who received first dose of steroid injection with lower initial P:F ratio had worse outcomes compared to patients with higher P:F ratio. 23.6% of patients (59/250) died despite receiving intravenous steroids. Our study showed patients with P:F ratio lower than 230 on average had worse outcomes. Limitations for this study included smaller sample size and skewness in distribution. Because of skewness in distribution, time series plots of all patients are averaged using local polynomial regression. CONCLUSIONS: P:F ratio correlates clinically with severity of respiratory failure and prognosis. Systemic steroids may result in slowing the disease progression and halt the inflammatory cytokine storm. Steroids administered during early hospitalization resulted in improved outcomes in our patient population. CLINICAL IMPLICATIONS: We recommend initiating systemic steroids in patients earlier in their clinical course despite a high P:F ratio as it may improve clinical outcomes and disease progression. DISCLOSURE: Nothing to declare. KEYWORD: COVID-19

Racial disparities in symptomatology and outcomes of COVID-19 among adults of Arkansas

Few reports have suggested that non-Hispanic (NH) blacks may present with different symptoms for COVID-19 than NH-whites. The objective of this study was to investigate patterns in symptomatology and COVID-19 outcomes by race/ethnicity among adults in Arkansas. Data on COVID-19 symptoms were collected on day of testing, 7th and 14th day among participants at UAMS mobile testing units throughout the state of Arkansas. Diagnosis for SARS-CoV-2 infection was confirmed via nasopharyngeal swab and RT-PCR methods. Data analysis was conducted using Chi-square test and Poisson regression to assess the differences in characteristics by race/ethnicity. A total of 60,648 individuals were RT-PCR tested from March 29, 2020 through October 7, 2020. Among adults testing positive, except shortness of breath, Hispanics were more likely to report all symptoms than NH-whites or NH-blacks. NH-whites were more likely to report fever (19.6% vs. 16.6%), cough (27.5% vs. 26.1%), shortness of breath (13.6% vs. 9.6%), sore throat (16.7% vs. 10.7%), chills (12.5% vs. 11.8%), muscle pain (15.6% vs. 12.4%), and headache (20.3% vs. 17.8%). NH-blacks were more likely to report loss of taste/smell (10.9% vs. 10.6%). To conclude, we found differences in COVID-19 symptoms by race/ethnicity, with NH-blacks and Hispanics more often affected with specific or all symptoms, compared to NH-whites. Due to the cross-sectional study design, these findings do not necessarily reflect biological differences by race/ethnicity; however, they suggest that certain race/ethnicities may have underlying differences in health status that impact COVID-19 outcomes.

Successful kidney transplantation from a deceased donor with severe COVID-19 respiratory illness with undetectable SARS-CoV-2 in donor kidney and aorta

To the Editor: Kidney transplantation (KT) from coronavirus disease 2019 (COVID-19) donors were avoided due to concerns for donor-derived transmission.1Kates OS Fisher CE Rakita RM Reyes JD Limaye AP. Use of SARS-CoV-2-infected deceased organ donors: should we always "just say no?".Am J Transplant. 2020; 20 (doi:10.1111/ajt.16000): 1787-1794Crossref PubMed Scopus (0) Google Scholar,2Shah MB Lynch RJ El-Haddad H Doby B Brockmeier D Goldberg DS. Utilization of deceased donors during a pandemic: argument against using SARS-CoV-2-positive donors.Am J Transplant. 2020; 20 (doi:10.1111/ajt.15969): 1795-1799Crossref PubMed Scopus (43) Google Scholar There have been no data on the long-term safety, and sensitive molecular testing for SARS-CoV-2 in donor kidney is not routinely performed. We report a successful KT from a deceased donor who died with severe COVID-19 respiratory failure with a detailed investigation of the donor kidney and aorta tissue for SARS-CoV-2. A 30-year-old female was admitted to a hospital due to severe COVID-19 pneumonia with a positive nasopharyngeal RT-PCR for SARS-CoV-2. With clinical worsening, she was placed on extracorporeal membrane oxygenation, but developed hypoxic brain injury and progressed to brain death. Renal function was stable during her hospital course with a serum creatinine concentration of 0.7 mg/dl. SARS-CoV-2 PCR for bronchoalveolar lavage and nasopharyngeal swab re-tested 3 days prior to donation was negative. A 55-year-old male recipient with an end-stage renal disease secondary to hypertension underwent a transplant with the left kidney from this donor. The donor kidney was studied using pre-implantation surgical biopsy samples to investigate the presence of SARS-CoV-2 RNA using in situ hybridization (ISH) and quantitative RT-PCR (qRT-PCR). Aorta tissue dissected with the kidney during the organ procurement was also studied given high expression of angiotensin-converting enzyme 2 receptors in vasculature. Kidney hematoxylin and eosin staining showed acute tubular injury without any glomerular damage or inflammation (Figure 1A). ISH analyses lacked a positive signal for SARS-CoV-2 RNA in the donor kidney sample (Figure 1B) compared to the SARS-CoV-2 positive lung control (Figure 1C). All samples for qRT-PCR were negative for SARS-CoV-2. We found no evidence of SARS-CoV-2 in donor tissues. The recipient has tested negative for SARS-CoV-2 by nasopharyngeal swab RT-PCR on days 20, 30, and 90 following transplantation, and there have been no signs or symptoms of COVID-19. After an initial period of delayed graft function requiring hemodialysis, the recipient now has excellent renal recovery over 9 months following the transplant, and the most recent creatinine is 1.3 mg/dl. Evidence supporting the use of deceased donors who died due to catastrophic COVID-19-related respiratory illness is limited, and these cases do not fit in any categories of the most up-to-date guideline for COVID-19 donors.3Summary of current evidence and information–donor SARS-CoV-2 testing & organ recovery from donors with a history of COVID-19. https://optn.transplant.hrsa.gov/media/kkhnlwah/sars-cov-2-summary-of-evidence.pdf. Published September 22, 2021. Accessed December 20, 2021.Google Scholar As such, the decision of whether to accept nonlung organs from those donors has been decided on a case-by-case basis. Based on recent observations of successful KT outcomes from mild or asymptomatic SARS-CoV-2 positive donors,4Koval CE Poggio ED Lin YC Kerr H Eltemamy M Wee A. Early success transplanting kidneys from donors with new SARS-CoV-2 RNA positivity: a report of 10 cases.Am J Transplant. 2021; 21 (doi:10.1111/ajt.16765): 3743-3749Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar and a short-term safety report of KT from a donor similar to this case,5Meshram HS Kute VB Patel H Desai S Chauhan S Dave RB. A case report of successful kidney transplantation from a deceased donor with terminal COVID-19-related lung damage: ongoing dilemma between discarding and accepting organs in COVID-19 era!.Transpl Infect Dis. 2021; 23 (doi:10.1111/tid.13683)Crossref Scopus (10) Google Scholar the transmission risk of SARS-CoV-2 through KT is likely very low. In conclusion, the use of deceased donors who died after severe COVID-19 can be individually considered for KT, and these organs should not be routinely discarded. We acknowledge that our case may not be representative of many possible COVID-19 donors since the donor was negative for SARS-CoV-2 PCR at the time of transplantation. Larger scale studies are warranted to confirm our findings, and long-term graft outcomes from COVID-19 donors should be studied. We thank all the JH kidney transplant and COVID-19 research team members.

Impact of Corona Virus Disease in Pregnancy and Newborn

Background: The novel corona virus has made the world standstill. In India COVID first and second wave has created dramatic fear among the pregnant mothers and the treating obstetricians. Objectives: To study the impact of COVID-19 in pregnancy, newborn and to compare the maternal and neonatal outcome among COVID-19 negative and COVID-19 positive pregnant women during the first and second COVID wave. Materials and Method: This was a prospective study done over one year from July 2020 to July 2021 in a tertiary care hospital in South India. 400 pregnant women attending antenatal outpatient department during COVID willing to participate in the study were included. Nasopharyngeal RT-PCR was done. Socio-demographic profile, maternal and neonatal outcome were compared between non COVID and COVID positive pregnant women. Results: A total of 400 pregnant women were screened for corona virus. 75 pregnant mothers turned positive for COVID-19 and 325 were negative. Among them, 10 were positive during first wave and 65 during second wave. Of them, 20 (26.7%) were asymptomatic and 55 (73.3%) were symptomatic. During the second COVID wave, there was a rise in missed miscarriage (21.5%), intrauterine growth restriction (46.15%), oligohydramnios (53.8%) and intrauterine demise (4.6%). The rate of caesarean and neonatal intensive care unit admission also increased to 70.3% and 59.5% respectively. Conclusion: This study has found increased maternal and neonatal adverse effects associated with COVID second wave. Hence vaccine should be recommended for all pregnant women.