Nasopharyngeal Swab Polymerase Chain Reaction Research Articles

Chest Computed Tomography Radiomics for Determining Macrolide Resistance-Associated Gene Mutation Status in Children with Mycoplasma pneumoniae Pneumonia: A Two-Center Study

Rationale and ObjectivesThe mutations in the 23S ribosomal RNA (rRNA) gene are associated with an increase in resistance to macrolides in children with Mycoplasma pneumoniae pneumonia (MPP). This study aimed to develop and validate a chest computed tomography (CT) radiomics model for determining macrolide resistance-associated gene mutation status in MPP. Materials and MethodsA total of 258 MPP patients were retrospectively included from two institutions (training set: 194 patients from the first institution; external test set: 64 patients from the second). The 23S rRNA gene mutation status was tested by nasopharyngeal swab polymerase chain reaction. Radiomics features were extracted from chest CT images of pulmonary lesions segmented with semi-automatic delineation. Subsequently, radiomics feature reduction was applied to identify the most relevant features. Logistic regression and random forest algorithms were employed to establish the radiomics models, which were five-fold cross-validated in the training set and validated in the external test set. ResultsThe radiomics feature selection resulted in eight features. After five-fold cross-validation in the training set, the mean areas under the receiver operating characteristic curve (AUCs) of the logistic regression and random forest models were 0.868 (95% confidence interval (CI): 0.813-0.923) and 0.941 (95% CI: 0.907-0.975), respectively. In the external test set, the corresponding AUCs were 0.855 (95% CI: 0.758-0.952) and 0.815 (95% CI: 0.705-0.925). ConclusionChest CT radiomics is a promising diagnostic tool for determining macrolide resistance gene mutation status in MPP. Availability of data and materialThe datasets generated or analyzed during the study are available from the corresponding author on reasonable request.

Impact of the Covid-19 pandemic on the management of gynecologic cancer: a Spanish survey. Observational, multicenter study

BackgroundThe SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) pandemic changed the distribution of healthcare resources, leading in many cases to the suspension of all non-essential treatments and procedures and representing a challenge for medical professionals. The objective of this study was to evaluate whether clinical protocols in gynecologic oncology care were modified as a result of the pandemic and to assess surgeons’ perceptions regarding the management of gynecologic cancers".MethodsData were collected through an anonymous and voluntary survey sent via email to healthcare professionals in the field of gynecologic oncology in Spain.ResultsA total of 75 gynecologic oncologists completed the online survey. Of these, 93.2% (69) reported working in public hospitals and 62.5% (45) in tertiary care hospitals. 97.3% (71) were affiliated with hospitals treating patients infected with SARS-CoV-2. 85.1% (63) of the respondents expressed concern about the SARS-CoV-2 pandemic and 52.1% (38) indicated that the pandemic impacted the diagnostic and therapeutic quality of care for oncology patients. SARS-CoV-2 nasopharyngeal swab PCR (Polymerase Chain Reaction) testing was always performed before surgical interventions by 97.3% (71), being considered a best practice in triage by 94.4% (68). 87.5% (63) reported no change in the type of surgical approach during the pandemic. 62.5% (45) experienced limitations in accessing special personal protective equipment for SARS-CoV-2. An impact on the follow-up of patients with gynecologic cancers due to the pandemic was reported by 70.4% (50).ConclusionsMost of the Spanish gynecologic oncologists who responded to our survey reported that the SARS-CoV-2 pandemic had affected their clinical practice. The primary measures implemented were an increase in telemedicine, restricting outpatient visits to high-risk or symptomatic patients and the use of SARS-CoV-2 screening prior to surgery. No major changes in the surgical approach or management of the treatment of ovarian, endometrial or cervical cancer during the pandemic were reported.

A Prospective Cohort Study on Spectrum of Community Acquired Late Onset Neonatal Pneumonia: An Eye Opener for Neonatal Care

Background Acute lower respiratory tract infections (ALRTIs) are a leading cause of morbidity and mortality in infants in low- and middle-income countries. We emphasize the differences in presentation and outcome between viral and bacterial origin community acquired ALRTI in late neonatal period. Methods All consecutively admitted neonates, aged 7 days or older, with features of ALRTI were included in the study, other than babies referred with prior hospital stay, congenital airway malformations and heart disease. Relevant investigations including nasopharyngeal swab polymerase chain reaction (PCR) and blood culture were done for etiological diagnosis. The predisposing factors, presenting features and short-term outcomes were compared between viral and bacterial etiology cohorts. Results Half of the 89 babies had primary viral infections, respiratory syncytial virus (RSV) being predominant (n = 21, 23.6%); 27 (30.3%) had bacterial infections, while no organisms were identified in 18% cases. Ten babies (11.2%) had COVID-19 and 4 (4.5%) had pertussis. Small for date (n = 15, 55.5%, p < .001) and history of past sick neonatal care unit admission were significantly higher (n = 20, 74.1%, p = .009) in babies with bacterial isolates. Median age of presentation was day 10 (interquartile range [IQR] 8-12). Bacterial ALRTI was more severe with significantly high respiratory score ( p < .001), need for invasive ventilation ( p < .001), systemic complications, and mortality ( p = .012), while viral ALRTI group required longer respiratory support and hospital stay ( p < .001). Conclusions PCR based methods are important in etiological diagnosis of community acquired late onset neonatal pneumonia. Such ALRTI is mostly of viral origin, and this is less likely to be fatal but require longer hospital stay than bacterial pneumonia.

Development and validation of an electronic database-based frailty index to predict mortality and hospitalization in a population-based study of adults with SARS-CoV-2.

Electronic health databases are used to identify people at risk of poor outcomes. Using electronic regional health databases (e-RHD), we aimed to develop and validate a frailty index (FI), compare it with a clinically based FI, and assess its association with health outcomes in community-dwellers with SARS-CoV-2. Data retrieved from the Lombardy e-RHD were used to develop a 40-item FI (e-RHD-FI) in adults (i.e., aged ≥18 years) with a positive nasopharyngeal swab polymerase chain reaction test for SARS-CoV-2 by May 20, 2021. The considered deficits referred to the health status before SARS-CoV-2. The e-RHD-FI was validated against a clinically based FI (c-FI) obtained from a cohort of people hospitalized with COVID-19 and in-hospital mortality was evaluated. e-RHD-FI performance was evaluated to predict 30-day mortality, hospitalization, and 60-day COVID-19 WHO clinical progression scale, in Regional Health System beneficiaries with SARS-CoV-2. We calculated the e-RHD-FI in 689,197 adults (51.9% females, median age 52 years). On the clinical cohort, e-RHD-FI correlated with c-FI and was significantly associated with in-hospital mortality. In a multivariable Cox model, adjusted for confounders, each 0.1-point increment of e-RHD-FI was associated with increased 30-day mortality (Hazard Ratio, HR 1.45, 99% Confidence Intervals, CI: 1.42-1.47), 30-day hospitalization (HR per 0.1-point increment = 1.47, 99%CI: 1.46-1.49), and WHO clinical progression scale (Odds Ratio = 1.84 of deteriorating by one category, 99%CI 1.80-1.87). The e-RHD-FI can predict 30-day mortality, 30-day hospitalization, and WHO clinical progression scale in a large population of community-dwellers with SARS-CoV-2 test positivity. Our findings support the need to assess frailty with e-RHD.

The Evaluation of Hematological Parameters and Their Correlation with Disease Prognosis in COVID-19 Disease in Iran.

Background: Since 2019, Coronavirus has been a highly contagious disease. The COVID-19 outbreak was declared a pandemic by the World Health Organization in March 2020. Variable laboratory findings are reported in COVID-19 patients, among which elevated levels of D-dimer, lactate dehydrogenase, as well as lymphopenia, have been reported to be associated with increased severity of disease symptoms requiring ventilator support, intensive care unit admission, and mortality. Materials and Methods: In the current study, inclusion criteria were: patient age above 18 years and hospitalization in the Imam Khomeini hospital with COVID-19 disease confirmed with nasopharyngeal swab polymerase chain reaction tests. Levels of white blood cells, neutrophils, lymphocytes, hemoglobin, platelets, D-dimer, C-reactive protein, LDH, and ferritin were measured and their correlation with the final patients' outcome was evaluated. Results: A total of 208 patients were included in the present study. Higher neutrophil to lymphocyte ratio, (WBC count excluding lymphocyte)/lymphocyte, LDH, platelet to lymphocyte ratio, ferritin, and D-dimer were significantly related to O2 dependency. Neutrophil to lymphocyte ratio, (WBC count excluding lymphocyte)/lymphocyte and LDH were significantly related to higher rates of mortality. Higher Hb and lymphocyte count were significantly related to higher rates of survival. Conclusion: Hematological parameters including neutrophil to lymphocyte ratio, (WBC count excluding lymphocyte)/lymphocyte, LDH, platelet to lymphocyte ratio, ferritin, D-dimer, Hb, and lymphocyte count were significantly related to the prognosis of patients with COVID-19 disease. This could help decide which COVID-19 patients have priority for hospitalization and intensive medical care, particularly when the pandemic disease causes limitations in healthcare service.

The Association of Acute Motor Axonal Neuropathy (Guillain-Barre' Syndrome Variant) with Coronavirus (SARS-Cov-2) in a Child: A Case Report.

Various reports of neurological manifestations of SARS-COV-2 infection after the virus outbreak are available, including anosmia, seizures, acute flaccid myelitis, Guillain-Barré syndrome (GBS), and encephalitis. Most of the literature has focused on the respiratory manifestation of SARS-CoV-2 infection in adults, but recent evidence showed that it is not confined to the respiratory tract. This report is about a rare variant of GBS acute motor axonal neuropathy (AMAN) in a child due to COVID-19 infection An 11 years old boy was referred to the hospital with a history of three-day lasting mild fever, and gastroenteritis, two weeks before starting symptoms. He was presented with progressive ascending weakness, paresthesia, and areflexia in four limbs four days ago. Nasopharyngeal swab polymerase chain reaction (PCR) was positive for SARS-CoV-2. The electrodiagnostic finding was compatible with acute generalized axonal motor neuropathy, and imaging revealed thoracolumbar syrinx and nerve root enhancement in lumbosacral MRI. Other lab tests were normal. GBS and its variant are one of the manifestations of SARS-CoV-2 in children. Children with an unexplained neurological process should be tested for SARS-CoV-2.

Predictors of post-COVID-19 and the impact of persistent symptoms in non-hospitalized patients 12 months after COVID-19, with a focus on work ability.

BackgroundBetter knowledge of long-term symptoms following coronavirus disease 2019 (COVID-19), the so-called post-COVID-19, in non-hospitalized patients is needed. The aim of this study was to study persisent symptoms up to 12 months after COVID-19 in non-hospitalized patients and their impact on work ability. We also investigated predictors of persistent symptoms.MethodsThis study encompassed non-hospitalized adult subjects with a COVID-19 infection confirmed via positive nasopharyngeal swab polymerase chain reaction test during the first wave of the pandemic in Uppsala, Sweden. In total, 566 subjects were sent a survey via e-mail or post with an invitation to participate in the survey 12 months post-diagnosis. The majority of subjects were healthcare workers, as this group was prioritized for testing.ResultsA total of 366 subjects responded, with 47% reporting persistent symptoms 12 months after their COVID-19 diagnosis. The most commonly reported symptoms at this time were impaired sense of smell and/or taste and fatigue. Among the predictors of persistent symptoms were being born abroad, lower physical fitness compared with peers before COVID-19, body mass index >25 kg/m2, cooccurrence of hypertension and chronic pain, and having more than seven of the general COVID-19 symptoms at the onset. Respondents with symptoms after 12 months self-reported negatively about their general health and work ability.ConclusionsThis study indicated that many people who had mild COVID-19 might have a variety of long-term symptoms. It highlights the importance of considering work ability after mild COVID-19.

The Use of Therapeutic Plasma Exchange in the Treatment of a Pregnant Woman with COVID-19 Induced Acute Respiratory Distress Syndrome.

A 27-year-old woman at 17 weeks gestation was admitted to the intensive care unit (ICU) with a history of fever, dyspnea, and dry cough for 3 days. She was diagnosed with coronavirus disease 2019 (COVID-19) based on her nasopharyngeal swab polymerase chain reaction (PCR) that was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the ICU, the patient developed acute respiratory distress syndrome (ARDS) and increased levels of inflammatory markers. She was then intubated for mechanical ventilation and had a treatment for critical COVID-19 illness during pregnancy. She also received three cycles on alternating days of therapeutic plasma exchange (TPE) since she was failing to respond to conventional medical treatment. During hospitalization, the patient’s fetus was closely monitored by repetitive ultrasound. After 27 days of hospitalization and 10 days of mechanical ventilation weaning, the patient’s respiratory condition improved and her inflammatory biomarkers normalized. She was discharged from the hospital with an apparently healthy 20th week fetus. This case report highlights the role of TPE for treatment of ARDS due to cytokine storm in pregnant women with severe COVID-19 infection. This case emphasizes that careful evaluation of clinical and biological progression of the patient’s status is very important and when conventional therapies are failing, alternative therapies such as TPE should be considered.

The red half-moon nail sign in a COVID-19 patient

Sir, Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic. Several cutaneous manifestations associated with COVID-19 have been reported, including chilblains or chilblain-like lesions, erythematous rash, viral exanthem, urticaria, livedo reticularis, acral ischemia, palpable purpura, and erythema multiforme. These were thought to be useful in the early diagnosis and triage of COVID-19 patients and their risk stratification [1]. However, there are limited reports on the nail manifestations of COVID-19, including several cases of Beau lines, leukonychia, orange discoloration, and onychomadesis [2]. An exceptionally rarely reported manifestation of COVID-19 is the red half-moon-nail sign [3,4]. A 46-year-old male presented to our outpatient clinic with transversal red bands surrounding the distal margin of the nail’s lunula on all of the fingernails, which the patient noticed a week previously (Fig. 1). One month before, with symptoms of fever, shortness of breath, and coughing present for three days, he had been given the diagnosis of COVID-19 following a positive nasopharyngeal swab polymerase chain reaction test. Computed tomography of the lungs revealed generalized ground-glass opacities and paraseptal emphysema in the upper lobes, and the patient was hospitalized for one week and treated with favipiravir for five days and was on oxygen therapy. He was discharged from the hospital one week later with partial remission of the respiratory symptoms. He also had hypertension, atherosclerotic heart disease, and Behçet’s disease, and had been using metoprolol, amlodipine, edoxaban, irbesartan, hydrochlorothiazide, and colchicine. After two weeks of follow-up, the bands remained present and became wider (Fig. 2). The red-half-moon sign was first described by Neri et al. as half-moon-shaped transversal red bands after SARS-CoV-2 infection. The patient was a sixty-year-old female and the bands appeared two weeks after the onset of symptoms of COVID-19. The patient was hospitalized and received oxygen therapy and several other treatments, including hydroxychloroquine and lopinavir/ritonavir. As in our patient, the bands remained present and became wider after one month of follow-up [3]. Mendez-Flores et al. reported a case of the red half-moon nail sign in a 37-year-old female with COVID-19. The patient noticed the changes two days after the COVID-19 symptoms appeared, and these lasted for one week before gradually returning to normal. The patient was managed at home and required no oxygen therapy [4]. The pathogenesis of the red half-moon sign is unknown. Neri et al. proposed that localized microvascular injury secondary to an inflammatory immune response and procoagulant state may play a role. It is thought that, because of the location, the distal subungual arcade’s capillary network may be affected in these cases [2,3]. We also agree that the red half-moon sign could be associated with microvascular injury or a procoagulant state connected to an inflammatory immune response. Recently, Natalello et al. reported nailfold capillaroscopy abnormalities in COVID-19 patients, including microvascular alterations in the nailfold capillary bed ranging from microthrombosis to altered capillary structures, according to the COVID-19 phase supporting this theory [5]. We also think that the persistence of the bands might be related to the severity of the disease, as both our and Neri et al.’s patients were hospitalized and had a more severe disease course than Mendez-Florez et al.’s patient. We think that, similarly to skin findings, nail findings may be a clue in the diagnosis and prognosis of COVID-19 as well as the pathogenesis of the disease, and clinicians should search for nail findings in COVID-19 patients.

Neurovascular manifestations in patients with COVID-19: a case series

To describe cerebrovascular manifestations in patients hospitalized for treatment of severe COVID-19, highlighting the comorbidities observed, and those that may play a relevant role as risk factors for severe outcomes. This case series retrospective analyzed, from June to November, 2020, ten patients admitted to the emergency department, with positive nasopharyngeal swab polymerase chain reaction assay for SARS-CoV-2, presenting with neurological symptoms and positive findings at brain imaging studies. In this sample, the clinical severity of the symptoms varied from mild to critical. Ischemic stroke was observed in four patients, hemorrhagic events occurred in five cases. Three patients evolved with large parenchymal hemorrhage, and one presented petechial bleeding foci. In one case, we observed subarachnoid hemorrhage associated with bilateral hypodensity in both globus pallidus. Typical posterior reversible encephalopathy syndrome findings were observed in one patient on brain computed tomography. Patients with neurovascular complications related to COVID-19 had positive findings in brain imaging and neurological symptoms. The pathological entities observed drew attention to the neurological risk of patients with SARS-CoV-2 infection, including worse outcomes in individuals whose medical history includes clinical comorbidities, especially hypertension and obesity.

Low serum levels of zinc and 25-hydroxyvitmain D as potential risk factors for COVID-19 susceptibility: a pilot case-control study.

Background and aimsThis study aimed to evaluate serum 25-hydroxyvitmain D and zinc levels in coronavirus disease 2019 (COVID-19) patients in comparison to healthy subjects.MethodsThis was a single-center case-control study performed from March 20, 2020, to January 20, 2021, in Tehran, Iran. All patients diagnosed with COVID-19 based on a positive nasopharyngeal swab polymerase chain reaction (PCR) test were included in the case group. Controls were selected from patients referred for routine checkups who had a negative COVID-19 PCR test. Age, sex, marital and educational status, comorbidities, and serum 25-hydroxyvitmain D and zinc levels of patients were recorded.ResultsNinety patients in the case group and 95 subjects in the control group who were sex and age-matched were studied. 25-hydroxyvitmain D levels higher than 20 ng/ml were observed in 58 (64%) cases and 72 (76%) controls (P = 0.09). The median 25-hydroxyvitmain D level in the case group was significantly lower than controls (26 (interquartile range [IQR] = 24) ng/ml vs. 38 (IQR = 22) ng/ml, respectively, P < 0.01). The median zinc level in the case group was 56 (IQR = 23) mcg/dL, while it was 110 (IQR = 27) mcg/dL among the controls (P < 0.01). There was no significant difference in the level of 25-hydroxyvitmain D and zinc between cases with and without comorbidities (P > 0.05). Susceptibility to SARS-CoV-2 infection could be predicted by serum 25-hydroxyvitmain D levels below 25.2 ng/ml (81% sensitivity; 48% specificity) or zinc levels below 86.3 mcg/dL (93% sensitivity; 92% specificity).ConclusionsLow serum zinc and 25-hydroxyvitmain D levels appear to be risk factors for COVID-19 affliction; thus, the treatment of individuals with such deficiencies is recommended.

Discrepant serological findings in SARS-CoV-2 PCR-negative hospitalized patients with fever and acute respiratory symptoms during the pandemic.

Coronavirus Disease 2019 (COVID‐19) serology has an evolving role in the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. However, its use in hospitalized patients with acute respiratory symptoms remains unclear. Hospitalized patients with acute respiratory illness admitted to an isolation ward were recruited. All patients had negative nasopharyngeal swab polymerase chain reaction (PCR) for SARS‐CoV‐2. Serological studies using four separate assays (cPass: surrogate neutralizing enzyme‐linked immunosorbent assay [ELISA]; Elecsys: N‐antigen based chemiluminescent assay; SFB: S protein flow‐based; epitope peptide‐based ELISA) were performed on stored plasma collected from patients during the initial hospital stay, and a convalescent visit 4–12 weeks later. Of the 51 patients studied (aged 54, interquartile range 21–84; 62.7% male), no patients tested positive on the Elecsys or cPass assays. Out of 51 patients, 5 had antibodies detected on B‐cell Epitope Assay and 3/51 had antibodies detected on SFB assay. These 8 patients with positive serological test to COVID‐19 were more likely to have a high‐risk occupation (p = 0.039), bacterial infection (p = 0.028), and neutrophilia (p = 0.013) during their initial hospital admission. Discrepant COVID‐19 serological findings were observed among those with recent hospital admissions and bacterial infections. The positive serological findings within our cohort raise important questions about the interpretation of sero‐epidemiology during the current pandemic.

Bromhexine Hydrochloride Prophylaxis of COVID-19 for Medical Personnel: A Randomized Open-Label Study.

Background Bromhexine hydrochloride has been suggested as a TMPRSS2 protease blocker that precludes the penetration of SARS-CoV-2 into cells. We aimed to assess the preventive potential of regular bromhexine hydrochloride intake for COVID-19 risk reduction in medical staff actively involved in the evaluation and treatment of patients with confirmed or suspected SARS-CoV-2 infection. Methods In a single-centre randomized open-label study, medical staff managing patients with suspected and confirmed COVID-19 were enrolled and followed up for 8 weeks. The study began at the initiation of COVID-19 management in the clinic. The study was prematurely terminated after the enrollment of 50 participants without a history of SARS-CoV-2 infection: 25 were assigned to bromhexine hydrochloride treatment (8 mg 3 times per day), and 25 were controls. The composite primary endpoint was a positive nasopharyngeal swab polymerase chain reaction (PCR) test for SARS-CoV-2 or signs of clinical infection within 28 days and at week 8. Secondary endpoints included time from the first contact with a person with COVID-19 to the appearance of respiratory infection symptoms; the number of days before a first positive SARS-CoV-2 test; the number of asymptomatic participants with a positive nasopharyngeal swab test; the number of symptomatic COVID-19 cases; and adverse events. Results The rate of the combined primary endpoint did not differ significantly between the active treatment group (2/25 [8%]) and control group (7/25 [28%]); P=0.07. A fewer number of participants developed symptomatic COVID-19 in the treatment group compared to controls (0/25 vs. 5/25; P=0.02). Conclusion Although the study was underpowered, it showed that Bromhexine hydrochloride prophylaxis was associated with a reduced rate of symptomatic COVID-19. The prophylactic treatment was not associated with a lower combined primary endpoint rate, a positive swab PCR test, or COVID-19 (ClinicalTrials.gov number, NCT04405999).

Favipiravir Use in Kidney Transplant Recipients with COVID-19: A Single-Center Experience.

Kidney transplant recipients are among the high-risk groups for severe COVID-19. To date, no specific antiviral agent has proved uniformly effective against SARS-CoV-2. Favipiravir, the recommended drug by the Turkish Ministry of Health, was uniformly supplied to all patients diagnosed with COVID-19 by a positive nasopharyngeal swab polymerase chain reaction test. The aim of our study was to retrospectively compare our kidney transplant recipients treated with favipiravir who developed COVID-19 infection versus those not treated with favipiravir during the clinical course of the disease, with a special emphasis on the occurrence of side effects and adverse events. We included 37 consecutive kidney transplant recipients with a median age of 46 years (62.2% women). Recipients included 8 with deceased donors and 29 with living related donors; median posttransplant survival was 8.0 years (IQR, 5.5-12.5 years). Twenty-six patients (70.3%) received favipiravir, and 11 (29.7%) did not. There were no statistically significant differences between the groups for baseline demographic characteristics and clinical and laboratory data, except that the favipiravir-treated patients were older and had a higher requirement of oxygen treatment. There were no statistically significant differences between the 2 groups for the course and outcome of COVID-19 infection with regard to adverse side effects/events associated with favipiravir. Laboratory data at baseline, day 7, and day 30 were also comparable between the groups. Although the efficacy of favipiravir for treatment of COVID-19 infection remains controversial, favipiravir is safe for kidney transplant recipients.

Axonal Excitability Findings in Acute Inflammatory Demyelinating Polyneuropathy Related to SARS-CoV-2

Guillain–Barré syndrome (GBS) is a disorder of the peripheral nervous system characterized by acute-onset ascendance paresis. We present a patient who was diagnosed as having facial-onset acute inflammatory demyelinating polyneuropathy after being infected with SARS-CoV-2. A 51-year-old man presented to the emergency department with facial diplegia. He then developed bilateral ascendance paralysis. He had noticed that for 1 month, he had smell and taste disturbances. SARS-CoV-2 infection was suspected. Nasopharyngeal swab polymerase chain reaction test was negative, but anti-SARS-CoV-2 antibody was found to be positive. A nerve conduction study showed prolonged motor distal and F wave latencies with decreased motor and sensory compound muscle action potential amplitudes. Lumbar puncture revealed albuminocytologic dissociation. According to the neurologic examination and laboratory findings, the patient was diagnosed as having acute inflammatory demyelinating polyneuropathy. An axonal excitability study revealed fanning in pattern with prolonged refractoriness, which indicates nodal sodium channel disturbances. Facial-onset SARS-CoV-2–related GBS has been rarely reported; however, facial involvement seems to be one of the features of the neurologic findings.

Acute Severe Bilateral Visual Loss as Presenting Symptom of COVID-19 Infection

Introduction: Coronavirus disease 2019 (COVID-19) has emerged as a pandemic and is accompanied by extraordinary morbidity and mortality. Critically ill COVID-19 patients have frequent thrombotic problems and laboratory evidence of hypercoagulability. The spectrum of presentations and complications of COVID-19 is still evolving. We describe a patient with unusual visual symptoms as the presenting signs of COVID-19. Case Presentation: In this case report, we describe a patient who presented with acute severe bilateral visual loss and headache. On neurological examination, cranial nerves were normal. There was no motor and sensorial abnormality. While the patient was in the emergency room, he was tested positive for COVID-19 via nasopharyngeal swab polymerase chain reaction (PCR) as part of COVID-19 surveillance. An unenhanced brain CT scan showed infarction in the occipital cortex bilaterally due to ischemic stroke involving the Posterior Cerebral Artery (PCA). A few hours later, oxygen saturation was 42%, and a sudden decline of consciousness was observed, progressing to coma. The neurosurgery intervention failed to change the patient's status, and he was pronounced dead in the next few hours. Conclusions: This case illuminates a wide range of COVID-19-related symptomatology and highlights the need for clinicians to be aware of different clinical appearances associated with this infection.

COVID-19 AND NEUROMUSCULAR DISEASES: EP.19 Facial Onset Acute Inflammatory Demyelinating Polyneuropathy Related to SARS-CoV-2

Guillain–Barré is a disorder of the peripheral nervous system characterized by acute onset ascendance paresis. We present a case diagnosed with facial onset acute inflammatory demyelinating polyneuropathy after being infected with SARS-CoV-2. A 51-year-old man presented with facial diplegia to the emergency room. Then he developed bilateral ascending paralysis. He noticed that for one month he had smell and taste disturbances. SARS-CoV-2 infection was suspected. Nasopharyngeal swab polymerase chain reaction test was negative but anti-SARS-CoV-2 antibody found to be positive.

Fecal Microbiota Transplantation for Recurrent C difficile Infection During the COVID-19 Pandemic: Experience and Recommendations

ObjectiveTo report experience with fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (rCDI) and provide recommendations for management of rCDI and donor testing during the COVID-19 pandemic. MethodsA retrospective study of patients with rCDI who underwent FMT from May 26, 2020, to September 30, 2020, with stool from well-screened donors with health and infectious screening and a newly implemented strategy for COVID-19 screening with every 2-week bookend testing with stool quarantine. Patients were followed up for development of rCDI and COVID-19. ResultsOf the 57 patients who underwent FMT for rCDI, 29 were tested for COVID-19 via nasopharyngeal polymerase chain reaction (PCR) and 22 via serology. All results were negative, except for 1 positive serology. Donor testing every 2 weeks for COVID-19 via serology and nasopharyngeal swab PCR was negative, except for 2 donors at 1 center who were excluded. Three patients had rCDI after FMT, and 1 underwent repeat FMT. One patient developed respiratory symptoms suggestive of COVID-19 and tested negative via nasopharyngeal PCR. Eleven patients who underwent COVID-19 testing for elective procedures or hospitalizations tested negative. No SARS-CoV-2 transmission was noted. ConclusionsWith appropriate donor screening, FMT can be performed safely for rCDI during the COVID-19 pandemic. Development of a validated stool assay for SARS-CoV-2 will simplify this process further.

Circulating microRNA profiles predict the severity of COVID-19 in hospitalized patients

We aimed to examine the circulating microRNA (miRNA) profile of hospitalized COVID-19 patients and evaluate its potential as a source of biomarkers for the management of the disease. This was an observational and multicenter study that included 84 patients with a positive nasopharyngeal swab Polymerase chain reaction (PCR) test for SARS-CoV-2 recruited during the first pandemic wave in Spain (March-June 2020). Patients were stratified according to disease severity: hospitalized patients admitted to the clinical wards without requiring critical care and patients admitted to the intensive care unit (ICU). An additional study was completed including ICU nonsurvivors and survivors. Plasma miRNA profiling was performed using reverse transcription polymerase quantitative chain reaction (RT-qPCR). Predictive models were constructed using least absolute shrinkage and selection operator (LASSO) regression. Ten circulating miRNAs were dysregulated in ICU patients compared to ward patients. LASSO analysis identified a signature of three miRNAs (miR-148a-3p, miR-451a and miR-486-5p) that distinguishes between ICU and ward patients [AUC (95% CI) = 0.89 (0.81-0.97)]. Among critically ill patients, six miRNAs were downregulated between nonsurvivors and survivors. A signature based on two miRNAs (miR-192-5p and miR-323a-3p) differentiated ICU nonsurvivors from survivors [AUC (95% CI) = 0.80 (0.64–0.96)]. The discriminatory potential of the signature was higher than that observed for laboratory parameters such as leukocyte counts, C-reactive protein (CRP) or D-dimer [maximum AUC (95% CI) for these variables = 0.73 (0.55–0.92)]. miRNA levels were correlated with the duration of ICU stay. Specific circulating miRNA profiles are associated with the severity of COVID-19. Plasma miRNA signatures emerge as a novel tool to assist in the early prediction of vital status deterioration among ICU patients.

Demographics, clinical characteristics and outcomes among 197 patients with COVID-19 in the Gold Coast area.

BackgroundClinical characteristics and outcomes of coronavirus disease 2019 (COVID‐19) patients have been varied internationally but have not been studied in an Australian cohort.AimTo describe characteristics and outcomes of approximately the first 200 documented COVID‐19 cases during the first outbreak in the Gold Coast.MethodsRetrospective observational cohort study of COVID‐19 patients managed by Gold Coast Hospital and Health Service (GCHHS). Demographics, clinical characteristics and outcomes data were collected.ResultsOne hundred and ninety‐seven patients were included (mean age 45 years); 52.3% were female and 9.1% were healthcare workers. Most were overseas travellers (53.8%), contacts of a local confirmed case (25.4%) or cruise ship passengers (17.3%). The commonest comorbidities were hypertension (14.2%) and asthma (11.2%). The commonest symptoms were cough (74.1%), fever (58.9%), sore throat (48.7%), headache (48.7%) and rhinorrhoea (46.2%). Sixty‐three patients were hospitalised and the rest admitted to a ‘virtual ward’. Of 63 hospitalised patients, 5 (7.9%) required intensive care unit (ICU) admission and 3 (4.8%) required intubation. No patients died. Due to low numbers of accurate exposure dates, the incubation period could not be reliably calculated for a significant proportion of the cohort. Average duration of symptoms was 14 days, time from first symptom to hospitalisation was 5.3 days and time from first symptom to ICU admission was 11.6 days. The majority (88%) experienced mild disease and achieved complete symptom resolution (97%). Nasopharyngeal swab polymerase chain reaction was the main diagnostic method (99%). Twenty‐four patients received anti‐viral pharmacotherapy, with 87.5% getting hydroxychloroquine.ConclusionsThe present study provides characteristics and outcomes of the first 197 patients with COVID‐19 in the Gold Coast.