Non-respiratory Complications Research Articles

ANÁLISE DO PERFIL CLÍNICO-EPIDEMIOLÓGICO DE PACIENTES COM EVENTOS VASCULARES DECORRENTES DA COVID-19 NO HOSPITAL REGIONAL DE PRESIDENTE PRUDENTE

The COVID-19 pandemic has highlighted weaknesses in health systems around the world. At the beginning of the pandemic, several authors observed non-respiratory complications in patients of different ages and races, which drew attention to the nature of the novel coronavirus infection, which was hardly restricted to the respiratory tract. Evidence has shown that the pathophysiology of the virus is closely related to coagulation disorders, which favors the emergence of thrombotic events. The aim of this article is to highlight the epidemiological experience of a tertiary public hospital during the first year of the pandemic and the vascular complications observed. The study found that complications were more frequent in older patients, but there was no significant difference between race or gender. We conclude that understanding the behavior of COVID-19, not just the respiratory behavior, is fundamental, as vascular complications are real and need to be understood through new and extensive studies.

Myocardial injury in COVID-19: A case series

The COVID-19 pandemic has affected nearly millions of populations worldwide. The range of symptomatology is vast, though predominantly respiratory, and ranges from mild flu-like symptoms to severe respiratory illness with acute respiratory distress syndrome. COVID-19 is associated with many non-respiratory complications affecting the heart, kidneys, gastrointestinal system, central nervous system, and blood vessels. Myocardial injury in COVID-19 patients has varied presentations ranging from arrhythmias, myocardial infarction, myocarditis, and cardiomyopathy to cardiogenic shock. It is usually associated with elevated levels of cardiac biomarkers, with or without any changes in electrocardiography or cardiac imaging. Diagnosis may be difficult based on clinical symptoms or electrocardiogram changes alone, and it can be made using 2D echocardiography, coronary angiogram, CT coronary angiogram, or cardiac magnetic resonance imaging, depending on clinical suspicion. COVID-19-associated cardiac injury increases overall morbidity and mortality. In this case series, five COVID-19 cases with different cardiac manifestations were reported with the intention of presenting the various manifestations of cardiac complications, the course of the disease, and the challenges associated with the complications. This case series showed that cardiac complications are common in the 2nd week during the cytokine storm phase, and timely case-specific specialized diagnostic and therapeutic cardiac interventions might improve the chances of patient survival.

Clinical impact of the suspension of the ERAS protocol on patients undergoing radical cystectomy during the COVID-19 pandemic

IntroductionDuring the beginning of the COVID-19 pandemic in our center, neither prehabilitation nor multimodal rehabilitation could be applied due to the excessive patient load on the health system and to reduce SARS-CoV-2 transmission. The objective of our study was to analyze the evolution, complications, and survival up to one year of patients who underwent radical cystectomy in our hospital from March 1st to May 31st, 2020 (period of the first wave COVID-19 pandemic in Spain). We also compared the results with cystectomized patients outside the pandemic period and with application of the ERAS (Enhanced Recovery After Surgery) protocol. Material and methodsSingle-center, retrospective cohort study of patients scheduled for radical cystectomy from March 1st, 2020 to May 31st, 2020. They were matched with previously operated patients using a 1:2 propensity matching score. The matching variables were demographic data, preoperative and intraoperative clinical conditions. ResultsA total of 23 radical cystectomies with urinary diversion were performed in the period described. In none of the cases the prehabilitation or the follow-up of our ERAS protocol could be applied, and this was the only difference we found between the 2 groups. Although the minimally invasive approach was more frequent in the pandemic group, the difference was not statistically significant. Three patients were diagnosed with COVID-19 during their admission, presenting severe respiratory complications and high in-hospital mortality. Apart from respiratory complications secondary to SARS-CoV-2, we also found statistically significant differences in other postoperative complications. The hospital stay increased by 3 days in the pandemic group. ConclusionsPatients who underwent radical cystectomy at our center during the first wave of the COVID-19 pandemic had a higher number and severity of respiratory and non-respiratory complications. Discontinuation of the ERAS protocol was the main difference in treatment between groups.

Impacto clínico de no aplicar el protocolo ERAS en los pacientes sometidos a cistectomía durante la pandemia COVID-19

IntroductionDuring the beginning of the COVID-19 pandemic in our center, neither prehabilitation nor multimodal rehabilitation could be applied due to the excessive patient load on the health system and to reduce SARS-CoV-2 transmission. The objective of our study was to analyze the evolution, complications, and survival up to one year of patients who underwent radical cystectomy in our hospital from March 1st to May 31st, 2020 (period of the first wave COVID-19 pandemic in Spain). We also compared the results with cystectomized patients outside the pandemic period and with application of the ERAS (Enhanced Recovery After Surgery) protocol. Material and methodsSingle-center, retrospective cohort study of patients scheduled for radical cystectomy from March 1st,2020 to May 31st, 2020. They were matched with previously operated patients using a 1:2 propensity matching score. The matching variables were demographic data, preoperative and intraoperative clinical conditions. ResultsA total of 23 radical cystectomies with urinary diversion were performed in the period described. In none of the cases the prehabilitation or the follow-up of our ERAS protocol could be applied, and this was the only difference we found between the 2 groups. Although the minimally invasive approach was more frequent in the pandemic group, the difference was not statistically significant. Three patients were diagnosed with COVID-19 during their admission, presenting severe respiratory complications and high in-hospital mortality. Apart from respiratory complications secondary to SARS-CoV-2, we also found statistically significant differences in other postoperative complications. The hospital stay increased by 3 days in the pandemic group. ConclusionsPatients who underwent radical cystectomy at our center during the first wave of the COVID-19 pandemic had a higher number and severity of respiratory and non-respiratory complications. Discontinuation of the ERAS protocol was the main difference in treatment between groups.

Influenza vaccines: an introduction

Seasonal influenza is a leading cause of severe respiratory infections and deaths. During an influenza infection, the immune system produces inflammatory mediators, which are largely responsible for the systemic symptoms and complications. Vaccines remain the most effective way to prevent influenza-related respiratory disease and non-respiratory complications despite antivirals. Numerous studies support the benefits of influenza vaccination, especially in high-risk groups. However, the effectiveness of the influenza vaccine varies markedly depending on the match between the circulating strains and those in the vaccine, and the recipient’s characteristics. Influenza vaccines are, in general, well-tolerated. Research could lead to more effective and, potentially, universal influenza vaccines.

Beyond the Lungs-Emerging Challenges in Adult Cystic Fibrosis Care.

Cystic fibrosis (CF) is a multisystem disease. This article provides an up-to-date review of many of the nonrespiratory complications of CF, including mental health issues, nutritional and gastrointestinal problems, fertility issues, diabetes mellitus, bone health and musculoskeletal problems, liver disease, renal problems, and risk of malignancy. It highlights the recent impact of new therapies, including CF transmembrane conductance regulator modulators, on the nonrespiratory complications of CF and provides insights into the potential challenges faced by an aging population of adults with CF and their caregivers, including the potential future risk for cardiovascular disease.

Influenza vaccines: an introduction

Seasonal influenza is a leading cause of severe respiratory infections and deaths. Type A influenza can cause severe respiratory disease, death and pandemics. Influenza B accounts for about a quarter of the annual number of seasonal flu cases, but does not cause pandemics. Influenza C viruses cause mild symptoms in humans. Evidence suggests Influenza D does not cause disease in humans. During an influenza infection, the immune system produces inflammatory mediators, which are largely responsible for the systemic symptoms and complications. Vaccines remain the most effective way to prevent influenza-related respiratory disease and non-respiratory complications despite antivirals. Numerous studies support the benefits of influenza vaccination, especially in high-risk groups. However, the effectiveness of the influenza vaccine varies markedly depending on the match between the circulating strains and those in the vaccine, and the recipient's characteristics. Influenza vaccines are, in general, well-tolerated. Research could lead to more effective and, potentially, universal influenza vaccines.

Pattern of Chest X-rays findings and clinical correlation with the severity in COVID-19 (RT-PCR positive) infected patients admitted in a COVID-19 dedicated hospital in Bangladesh

Objective: This study aims to analyze Chest X-ray findings in COVID 19(RT-PCR positive) patients, correlate between clinical and radiological findings and short-term outcomes of the patients with the view to enhance clinicians’ understanding of CXR findings in COVID 19 patients. Methods: This descriptive type of observational study included 277 reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed COVID-19 patients who were undergone CXRs, based on the clinician’s decision. Data were collected from May to September 2020 of Maternal and Child Health Training Institute (MCHTI)- a COVID-19 dedicated hospital, Lalkuthi, Mirpur-1, Dhaka and analyzed statistically through SPSS,Version 25. Each chest X-Ray is then scored using the Brixia score, a semi-quantitative scoring system rating lung involvement from 0 to 18 by a radiologist. The scores are then analyzed and compared with the characteristics of the patients, clinical presentation, and short-term outcome (in-hospital & after discharge) to correlate the severity and post covid-19 complications of COVID-19 infected patients. Results: A total of 277 RT-PCR-positive patients were performed chest x-ray P/A view, among them 58.12%(161) were male and 41.88%(116) were female. Age variation was from 6 to 95 years and the mean age was 42.48±15.53(S.D).Most of the patients(94.94%)were symptomatic and the majority(97.9%) of symptomatic patients had comorbidities(p-value 0.02).Among the x-ray performed patients(n=277), 39.35% (109) patients had positive findings suggestive of covid-19 infection. Comorbidities and sex had significant relation on positive x-ray findings(p-value 0.0001 and 0.001);males (70.6%) had more positive findings than females(29.4%).Positive x-ray findings were more common among the age group 41 to 60 years (p-value 0.0001 and Cramer’s V 0.59).Most of the patients (94.49%) had bilateral lungs involvement and consolidations were the commonest x-ray findings (43.1%).Clinical severity was assessed by symptoms and Spo2 level (<91%) and 20.2% were clinically severe (M-23.6%, F-15.5%). Age, comorbidities, and higher Brixia score (>8) had a significant relation to clinical severity (p-value 0.0001,0.0001&0.0001) and sex also influences clinical severity though statistically not significant (p-value 0.2).There was a significant relationship between positive X-Ray findings and decreased Spo2 level (p-value 0.0001, Cramer’s V 0.47).Regarding in-hospital outcome; 94.9% were recovered and 2.75%were death (only male)and following discharge; 42.60% (119) had post covid-19 complications and 0.72% (02) were dead. Comorbidities and age had an effect on short-term outcomes after hospital discharge though not statistically significant (p-value 0.16 and 0.16). The most common respiratory complications were SOB on exertion (23) and the most common non-respiratory complication was post covid fatigue syndrome (42). Comparison between Brixia score and post covid complications; more the Brixia score, the more the chance of post covid complications though statistically not significant (p-value 0.44). Conclusion: This study reveals bilateral lungs involvement and multifocal consolidations are the most common patterns of X-ray findings and clinical severity is associated with a higher Brixia score, male sex, increasing age, and presence of comorbidities. Bangladesh J Medicine 2022; 33: 280-292

Comparison of Severe Maternal Morbidities Associated With Delivery During Periods of Circulation of Specific SARS-CoV-2 Variants

Infection with SARS-CoV-2, which causes COVID-19, is associated with adverse maternal outcomes. While it is known that severity of COVID-19 varies by viral strain, the extent to which this variation is reflected in adverse maternal outcomes, including nonpulmonary maternal outcomes, is not well characterized. To evaluate the associations of SARS-CoV-2 infection with severe maternal morbidities (SMM) in pregnant patients delivering during 4 pandemic periods characterized by predominant viral strains. This retrospective cohort study included patients delivering in a multicenter, geographically diverse US health system between March 2020 and January 2022. Individuals with SARS-CoV-2 infection were propensity-matched with as many as 4 individuals without evidence of infection based on demographic and clinical variables during 4 time periods based on the dominant strain of SARS-CoV-2: March to December 2020 (wild type); January to June 2021 (Alpha [B.1.1.7]); July to November 2021 (Delta [B.1.617.2]); and December 2021 to January 2022 (Omicron [B.1.1.529]). Data were analyzed from October 2021 to June 2022. Positive SARS-CoV-2 nucleic acid amplification test result during the delivery encounter. The primary outcome was any SMM event, as defined by the US Centers for Disease Control and Prevention, during hospitalization for delivery. Secondary outcomes were number of SMM, respiratory SMM, nonrespiratory SMM, and nontransfusion SMM events. Over all time periods, there were 3129 patients with SARS-CoV-2, with a median (IQR) age of 29.1 (24.6-33.2) years. They were propensity matched with a total of 12 504 patients without SARS-CoV-2, with a median (IQR) age of 29.2 (24.7-33.2) years. Patients with SARS-CoV-2 infection had significantly higher rates of SMM events than those without in all time periods, except during Omicron. While the risk of any SMM associated with SARS-CoV-2 infection was increased for the wild-type strain (odds ratio [OR], 2.74 [95% CI, 1.85-4.03]) and Alpha variant (OR, 2.57 [95% CI, 1.69-4.01]), the risk during the Delta period was higher (OR, 7.69 [95% CI, 5.19-11.54]; P for trend < .001). The findings were similar for respiratory complications, nonrespiratory complications, and nontransfusion outcomes. For example, the risk of nonrespiratory SMM events for patients with vs without SARS-CoV-2 infection were similar for the wild-type strain (OR, 2.16 [95% CI, 1.40-3.27]) and Alpha variant (OR, 1.96 [95% CI, 1.20-3.12]), highest for the Delta variant (OR, 4.65 [95% CI, 2.97-7.29]), and not significantly higher in the Omicron period (OR, 1.21 [95% CI, 0.67-2.08]; P for trend < .001). This cohort study found that the SARS-CoV-2 Delta variant was associated with higher rates of SMM events compared with other strains. Given the potential of new strains, these findings underscore the importance of preventive measures.

Improving Bed Utilization in a Cohort of Bariatric Surgical Patients Using a Perioperative Obstructive Sleep Apnea Treatment and Bed Triage Protocol.

Postoperative bariatric management often includes high-intensity monitoring for respiratory complications since > 70% of patients have obstructive sleep apnea. Given the increasing number of bariatric surgeries, there is a need to determine safe and cost-effective processes for postoperative care.The objective of this study was to determine if a novel triage and perioperative management guideline reduces postoperative monitoring and costs following bariatric surgery. Using a pre-post design, this is a retrospective analysis of 501 patients who had bariatric surgery. Half the patients were managed with usual care, and the other half received obstructive sleep apnea screening and treatment of moderate/severe obstructive sleep apnea with perioperative continuous positive airway pressure. The intervention group was triaged preoperatively to a postoperative nursing location based on risk factors. There were no significant differences in demographics, comorbidities, frequency, or severity of OSA between groups. In the intervention group, there were fewer admissions to the intensive care unit (2.0% vs 9.1%; p < 0.01) and high acuity unit (9.6% vs 18.3%; p < 0.01). The length of stay was shorter in the intervention group (1.3 vs 2.3days; p < 0.01) with a 50% reduction in costs. There were no statistically significant differences in the incidence of postoperative respiratory and non-respiratory complications between the two groups. Most postoperative bariatric surgery patients can be safely managed on the surgical ward with monitoring of routine vitals alone if patients with moderate/severe obstructive sleep apnea receive perioperative continuous positive airway pressure.

Pulmonary Complications after COVID-19.

Coronavirus disease 2019 (COVID-19) is a threat to patients not only because of its acute course, but also because of various complications occurring in the following period, that is, more than 28 days after the onset of acute infection. The present study identified a total of 121 patients hospitalized 29 or more days after the first positive result of a PCR test for SARS-CoV-2, of whom 98 patients were included in the study. Patients were divided into two groups by the time interval between the positive COVID-19 test result and hospitalization date. The time intervals were week 5–11 in an ongoing-COVID group (57.1% of patients) and 12 or more weeks in a post-COVID-group (42.9%). The most frequent reason for hospitalization was respiratory tract infection (58.2%). Pneumonia accounted for 77.2% of these cases. Other reasons for hospitalization were interstitial lung disease (22.4%), pulmonary embolism (8.2%), and sarcoidosis (6.1%). The study group was further divided according to the causes of hospitalization into subgroups with infections and other causes. In the group with infectious diseases, there was a shorter time period between PCR positivity and hospitalization and there were significantly more frequent non-respiratory complications. In the entire sample, the in-hospital mortality was 5.1%.

Respiratory and nonrespiratory COVID-19 complications in patients with obesity: recent developments.

This narrative review summarizes recent reports to provide an updated understanding of the multiorgan effects of SARS-CoV-2 infection in obese individuals. A PubMed search of 528 primary articles was performed, with inclusion based on novelty, relevance and redundancy. Obesity confers an increased risk for hospitalization, intensive care unit admission, severe pneumonia, intubation and acute kidney injury in COVID-19 patients. Obesity is also associated with higher levels of inflammatory and thrombotic markers. However, the associations between obesity and mortality or cardiac injury in COVID-19 patients remain unclear. Obesity is a risk factor for several respiratory and nonrespiratory COVID-19 complications. Future work is needed to further explore these relationships and optimize the management of obese COVID-19 patients.

Nonrespiratory complications of nusinersen-treated spinal muscular atrophy type 1 patients.

Emergence of new treatments for spinal muscular atrophy type 1 (SMA1) has led to dramatic improvements in respiratory failure and survival. However, these "treated" patients sustain major problems in other organ systems, which may directly or indirectly affect their respiratory function. We observed three main nonrespiratory manifestations in these patients comprised of facial deformities, feeding problems, and spinal deformities. To investigate these three main sequelae in nusinersen-treated SMA1 patients. Data on nusinersen-treated SMA1 patients were prospectively collected throughout a 3-year period, with special focus upon nonrespiratory features of the disease. Twenty nusinersen-treated SMA1 patients were included (eight males, median age 13.5 months, interquartile range: 4-56.2 months), among whom 17 survived after 3 years of follow-up. At follow-up, 15 (88%) patients were diagnosed with facial weakness, hypoplasia, or deformity. All but one patient (94%) were fed invasively by percutaneous endoscopic gastrostomy or nasogastric tube feeding. Four patients (25%) had maintained oral feeding in parallel to gastrostomy feeding and had clinical and radiologic evidence of aspirations. Fifteen (88%) patients were diagnosed with scoliosis, of whom seven had undergone or were scheduled to undergo corrective surgery. Nusinersen-treated SMA1 patients may sustain facial deformities, feeding problems, and severe scoliosis, all of which affect their respiratory system. Strict surveillance of these complications is essential to avoid further respiratory morbidity.

POSA384 Identification of Complications Associated with COVID-19 Infection from Claims Data

Growing evidences suggest that COVID-19 infection should be considered as a systemic disease which involves multiple organ systems leading to numerous respiratory and non-respiratory complications. The current study evaluated all the potential complications associated with COVID-19 infections from administrative claims data. This retrospective, cross-over and observational study included patients diagnosed with COVID-19 infection between 1st April to 30th September 2020 with ICD-10 CM diagnosis recorded in the a large deidentified database of US health insurance claims. Only the patients having continuous eligibility between 4 months before (baseline period) to 1-month post (follow-up period) the first diagnosis of COVID-19 (index date) were included in study. Frequency of all ICD-10-CM diagnosis codes occurring during baseline period and during follow-up period were evaluated. For every ICD-10 CM diagnosis code, the risk estimates and odds ratios (ORs) of association with COVID-19 were evaluated. The study included 208,886 patients with a mean (SD) age of 53.65 (21.4) years, 44% males and 56% females. 486 out of 1,564 ICD codes evaluated found to be statistically significant with COVID-19 infection exposure. Notable disorders having higher odds and high absolute risk included viral pneumonia (OR: 90.09; CI:73.12-111.00; absolute risk: 16.12%), acute respiratory distress syndrome (OR: 46.92; CI:28.42-77.48; absolute risk: 1.5%), respiratory failure (OR: 17.44; CI:16.18-18.81; absolute risk: 10.74%), sepsis (OR: 7.94; CI:7.21-8.75; absolute risk: 5.25%), acute kidney failure (OR: 5.70; CI:5.33-6.09; absolute risk: 6.30%), essential hypertension (OR: 1.78; CI:1.74-1.82; absolute risk: 16.77%), Ischemic heart disease (OR: 1.97; CI:1.88-2.05; absolute risk: 4.46%) and heart failure (OR: 2.39; CI:2.27-2.51; absolute risk: 3.58%). Apart from respiratory system which is the primary site of infection for COVID-19, many other organs like cardiovascular, kidney and liver with varying degree are also involved in COVID-19 infection.

Lower cognitive scores among toddlers in birth cohorts with acute respiratory illnesses, fevers, and laboratory‐confirmed influenza

BackgroundWe established cohorts to assess associations between viral influenza and cognitive development to inform the value proposition of vaccination.MethodsFrom 2014 through 2017, we called women seeking care at four prenatal clinics in Panama and El Salvador to identify acute respiratory illnesses (ARIs). Within 2 weeks of childbirth, mothers were asked to enroll their neonates in the cognitive development study. Staff obtained nasopharyngeal swabs from children with febrile ARIs for real‐time reverse transcription polymerase chain reaction (rtPCR) detection of viral RNA. Toddlers were administered Bayley developmental tests at ages 12 and 18–24 months. We used multilevel linear regression to explore associations between Bayley scores, ARIs, fever, and laboratory‐confirmed influenza, controlling for maternal respiratory or Zika illnesses, infant influenza vaccination, birth during influenza epidemics, and the number of children in households.ResultsWe enrolled 1567 neonates of which 68% (n = 1062) underwent developmental testing once and 40% (n = 623) twice. Children with previous ARIs scored an average of 3 points lower on their cognitive scores than children without ARIs (p = 0.001). Children with previous fevers scored an average of 2.1 points lower on their cognitive scores than afebrile children (p = 0.02). In the second year, children with previous laboratory‐confirmed influenza scored 4 points lower on their cognitive scores than children without influenza (p = 0.04, after controlling for first Bayley cognitive scores).ConclusionsARIs and fever during infancy were associated with lower Bayley scores at 12 months, and laboratory‐confirmed influenza was associated with lower cognitive scores at 24 months suggesting the potential value of vaccination to prevent non‐respiratory complications of influenza.

COVID-19 in Children: Clinical Presentations and Outcomes in Fayoum Governorate, Egypt

Background: The number of children with coronavirus disease 2019 (COVID-19) significantly increased with limited data available about Egyptian children infected with COVID-19. Objectives: The study was performed early in the pandemic to address and record different clinical presentations of COVID-19 in Egyptian children in Fayoum Governorate and determine the percentage of children with complicated COVID-19 infection. The present article describes some epidemiological characteristics, along with the clinical patterns, laboratory and radiological findings, and outcomes of pediatric patients with COVID-19 in Fayoum Governorate. Methods: A total of 200 Egyptian children with COVID-19 in Fayoum Governorate were included in this study. This study was conducted from the beginning of June 2020 to the end of October 2020. In this study, 192 children (96%) had a history of contact with either suspected or confirmed COVID-19 cases in relatives. The age, gender, clinical symptoms, signs, and laboratory results were estimated. Results: About a tenth of the patients (n = 19; 9.5%) were asymptomatic. Fever and diarrhea were the most common symptoms at presentation, as it was identified in 81 children (40.5%). Lymphopenia was observed in 46.5% of the patients. The majority of the patients with respiratory symptoms had normal findings in chest X-rays (92.5%). Chest opacity was reported in 11 patients (5.5%). According to chest computed tomography, bilateral ground-glass opacity was identified in 16 patients (8.0%). Five hospitalized cases (2.5%) developed severe non-respiratory complications. One death was reported in this study. Conclusions: The COVID-19 can affect children at any age with variable presentations ranging from asymptomatic to severe symptomatic phenotypes requiring intensive care interventions.

Monoclonal Antibody Therapy for COVID-19 in Solid Organ Transplant Recipients.

BackgroundBamlanivimab and casirivimab-imdevimab are authorized for emergency use treatment of mild to moderate coronavirus disease 2019 (COVID-19) in patients at high risk for developing severe disease or hospitalization. Their safety and efficacy have not been specifically evaluated in solid organ transplant recipients.MethodsWe retrospectively reviewed solid organ transplant recipients who received monoclonal antibody infusion for COVID-19 at Mayo Clinic sites through January 23, 2021. Outcomes included emergency department visit, hospitalization, mortality, and allograft rejection.ResultsSeventy-three patients were treated, most commonly with bamlanivimab (75.3%). The median age was 59 years, 63% were male, and the median Charlson comorbidity index was 5. Transplant type included 41 kidney (56.2%), 13 liver (17.8%), 11 heart (15.1%), 4 kidney-pancreas (5.5%), 2 lung (2.7%), 1 heart-liver, and 1 pancreas. Eleven (15.1%) patients had an emergency department visit within 28 days of infusion, including 9 (12.3%) who were hospitalized for a median of 4 days. One patient required intensive care unit admission for a nonrespiratory complication. No patients required mechanical ventilation, died, or experienced rejection. Ten adverse events occurred, with 1 seeking medical evaluation. Hypertension was associated with hospital admission (P < .05), while other baseline characteristics were similar. The median time from symptom onset to antibody administration was 4 days in nonhospitalized patients compared with 6 days among hospitalized patients (P < .05).ConclusionsMonoclonal antibody treatment has favorable outcomes with minimal adverse effects in solid organ transplant recipients with mild to moderate COVID-19. Earlier administration of monoclonal antibody therapy appears to be more efficacious.

Radiological findings of COVID-19-related thromboembolic complications

BackgroundThe ongoing global pandemic of coronavirus disease 2019 (COVID-19) may cause, in addition to lung disease, a wide spectrum of non-respiratory complications. Among these are thromboembolic complications. The theories that explain the mechanism of thromboembolic complications of COVID-19 are accumulating rapidly, and in addition to the role of imaging for assessment of COVID-19 pneumonia, CT may be useful for identification of these complications, such as pulmonary embolism, ischaemic stroke, mesenteric ischaemia, and acro-ischaemia.ResultsThromboembolic manifestations were diagnosed in 10% of our patients (124 patients out of the total 1245 COVID-19 patients); 56 patients (45.2%) presented with pulmonary embolism, 32 patients (25.8%) presented with cerebrovascular manifestations, 17 patients (13.7%) presented with limb affection, and 19 patients (15.3%) presented with gastrointestinal thromboembolic complications.Most of our patients had significant comorbidities; diabetes was found in 72 patients (58%), dyslipidemia in 72 patients (58%), smoking in 71 patients (57.3%), hypertension in 63 patients (50.8%), and morbid obesity in 40 patients (32.2%).Thromboembolic events were diagnosed on admission in 41 patients (33.1%), during the first week in 61 patients (49.2%), and after the first week in 22 patients (17.7%).ConclusionsThe incidence of thromboembolic complications in COVID-19 patients is relatively high resulting in a multisystem thrombotic disease. In addition to the crucial role of imaging for assessment of COVID-19 pneumonia, CT is important for assessment of the thromboembolic complications, such as pulmonary embolism, ischaemic stroke, mesenteric ischaemia, and peripheral ischaemia, especially in patients with elevated d-dimer levels and those with sudden clinical deterioration.

The Weight of Obesity in Immunity from Influenza to COVID-19

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged in December 2019 and rapidly outspread worldwide endangering human health. The coronavirus disease 2019 (COVID-19) manifests itself through a wide spectrum of symptoms that can evolve to severe presentations as pneumonia and several non-respiratory complications. Increased susceptibility to COVID-19 hospitalization and mortality have been linked to associated comorbidities as diabetes, hypertension, cardiovascular diseases and, recently, to obesity. Similarly, individuals living with obesity are at greater risk to develop clinical complications and to have poor prognosis in severe influenza pneumonia. Immune and metabolic dysfunctions associated with the increased susceptibility to influenza infection are linked to obesity-associated low-grade inflammation, compromised immune and endocrine systems, and to high cardiovascular risk. These preexisting conditions may favor virological persistence, amplify immunopathological responses and worsen hemodynamic instability in severe COVID-19 as well. In this review we highlight the main factors and the current state of the art on obesity as risk factor for influenza and COVID-19 hospitalization, severe respiratory manifestations, extrapulmonary complications and even death. Finally, immunoregulatory mechanisms of severe influenza pneumonia in individuals with obesity are addressed as likely factors involved in COVID-19 pathophysiology.

Implications of SARS-CoV-2 infection for neurogastroenterology.

BackgroundCoronavirus disease 2019 (COVID‐19) is associated with gastrointestinal and hepatic manifestation in up to one fifth of patients. Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), the etiologic agent of COVID‐19, infects gastrointestinal epithelial cells expressing angiotensin‐converting enzyme 2 (ACE2) receptors triggering a cascade of events leading to mucosal and systemic inflammation. Symptomatic patients display changes in gut microbiota composition and function which may contribute to intestinal barrier dysfunction and immune activation. Evidence suggests that SARS‐CoV‐2 infection and related mucosal inflammation impact on the function of the enteric nervous system and the activation of sensory fibers conveying information to the central nervous system, which, may at least in part, contribute symptom generation such as vomiting and diarrhea described in COVID‐19. Liver and pancreas dysfunctions have also been described as non‐respiratory complications of COVID‐19 and add further emphasis to the common view of SARS‐CoV‐2 infection as a systemic disease with multiorgan involvement.PurposeThe aim of this review was to highlight the current knowledge on the pathophysiology of gastrointestinal SARS‐CoV‐2 infection, including the crosstalk with the gut microbiota, the fecal‐oral route of virus transmission, and the potential interaction of the virus with the enteric nervous system. We also review the current available data on gastrointestinal and liver manifestations, management, and outcomes of patients with COVID‐19.