Recent Coronavirus Disease 2019 Research Articles

Guillain-Barré Syndrome Triggered by COVID-19: A Pediatric Case Report and Literature Review

Coronavirus disease 2019 (COVID-19) has been associated with a variety of neurologic manifestations, including Guillain-Barré syndrome (GBS), but few pediatric cases have been reported. We would like to present a pediatric case of GBS in association with a recent COVID-19 infection that presented with an isolated clinical facial nerve palsy.

COVID-19 Infection Is Associated With New Onset Erectile Dysfunction: Insights From a National Registry.

IntroductionThe short- and long-term effects of coronavirus disease 2019 (COVID-19) on erectile function and penile vasculature remains poorly understood and is of particular importance as the virus has been found to be present within the penile tissue.AimWe determined the association of COVID-19 infection and subsequent diagnoses of erectile dysfunction.MethodsWe assessed the risk of ED in men with COVID-19 in the United States (US) using the TriNetX Research Network, a federated electronic medical records network of over 42 healthcare organizations and 66 million patients from the US. We identified adult men (≥ 18 years) with a recorded COVID-19 infection (ICD-10-CM B34.2, U07.1, U07.2, J12.81, J12.82, B97.29) since January 1, 2020, and compared them to an equivalent number of adult men who did not have COVID-19 over the same timeframe. Men with prior history or diagnosis of ED before January 1, 2020 were excluded. We accounted for confounding variables through propensity score matching for age, race, body mass index (BMI), and history of the following comorbid medical conditions: diabetes mellitus (E11), hypertension (I10), ischemic heart disease (I20-25), or hyperlipidemia (E78).OutcomesWe assessed the association between COVID-19 and ED (N52) as a primary outcome through regression analysis with statistical significance assessed at P< .05.ResultsPrior to propensity score matching, men with COVID-19 were found to be older than men without COVID-19 (47.1 ± 21.4 vs 42.4 ± 24.3 years). Additionally, men with COVID-19 were noted to have increased prevalence of diabetes mellitus (DM) and hypertension (HTN) when compared to men without COVID-19 (13% DM and 27% HTN vs 7% DM and 22% HTN). After propensity score matching, we compared 230,517 men with COVID-19 to 232,645 men without COVID-19 and found that COVID-19 diagnosis was significantly associated with ED (odds ratio 1.20, 95% confidence interval 1.004–1.248, P= .04).Clinical ImplicationsOur findings indicate that clinicians should consider evaluating erectile dysfunction among men with recent COVID-19 diagnoses and counsel them regarding the risk of developing erectile dysfunction.Strengths and LimitationsStrengths include large sample size and adjustment for confounding variables. Limitations include reliance on a global federated dataset, retrospective study design, and lack of data regarding ED (mild vs moderate vs severe), COVID-19 infection severity, or history of prostate cancer and radiation,ConclusionThere is an increased chance of new onset erectile dysfunction post-COVID-19 infection.Chu KY, Nackeeran S, Horodyski L, et al. COVID-19 Infection Is Associated With New Onset Erectile Dysfunction: Insights From a National Registry. Sex Med 2022;10:100478.

Emergence of COVID-19 Infection and Healthcare Workers in Karachi, Pakistan

Background: The Healthcare workers (HCWs) are at the forefront of care-giving and hence understanding of the knowledge, attitudes and practices among HCWs is necessary to identify potential risk factors of COVID-19 dissemination. Objective: The objective of the study was to investigate the knowledge, attitude and practice (KAP) regarding novel coronavirus disease 2019 (COVID-19) among healthcare workers in Karachi Pakistan. Material and Methods: This was a cross-sectional study using a self-reported questionnaire which enrolled all the HCWs (doctors, nurses, pharmacists and technicians) in hospitals of Karachi from March to May 2020.Binary logistic regression analysis was performed to estimate the odds ratio with 95% confidence interval for KAP of HCWs regarding COVID-19. P-values less than 0.05 were considered statistically significant. Results: The total of 547 participants included in study. HCWs gross category and clinical setting were found to be statistically associated with overall KAP (P&lt;0.001 and P=0.048, respectively). Upon logistic regression analysis, KAP scores statistically differed across genders (? coefficient=2.115, SE =0.179 and P&lt;0.001), age groups (? coefficient=2.098, SE =0.138 and P&lt;0.001) and HCWs gross category (? coefficient=2.053, SE =0.135 and P&lt;0.001). The nurses and technicians were found less likely for good KAP with reference to COVID-19 as compared to doctors and pharmacists. These results were found to be statistically significant with P-value less than 0.05; the odds for nurses and technicians were 0.35 and 0.10, respectively. Conclusion: The study demonstrated that HCWs had good knowledge, optimistic attitude and decent practice towards recent COVID-19 pandemic. However, their source of information regarding COVID-19 is not reliable and can adversely influence the KAP.&#x0D; Keywords: KAP; COVID-19; Outbreak; Pandemic; Healthcare Workers&#x0D; &#x0D;

Personal Protective Equipment: Attitudes and Behaviors Among Nurses at a Single University Medical Center.

Introduction: Healthcare workers are at an increased risk of infectious disease transmission through occupational exposure. Despite this, rates of personal protective equipment (PPE) use vary among healthcare personnel. This cross-sectional study surveyed healthcare workers at a single academic center to determine how the coronavirus disease 2019 (COVID-19) pandemic affected the perceptions and behaviors of PPE usage.Methods: An anonymous online survey through the SurveyMonkey® tool (Zendesk Inc., San Francisco, California) was sent to the University of California, Irvine, Medical Center department listserv of nurses on March 20, 2021, and was closed on June 20, 2021.Results: Of 311 respondents, 23% admitted to suffering a splash injury to the face during a procedure. When compared to one year ago prior to the COVID-19 pandemic, PPE was more important (93% vs. 80%) and more frequently used (80% vs. 54%) by respondents. The recent COVID-19 pandemic had the strongest impact on increasing respondents’ perception of the importance of PPE (44%).Conclusion: The COVID-19 pandemic positively impacted rates of PPE usage and perceptions of the importance of PPE among healthcare workers at a single academic institution. Implementing clear and effective education and training programs, ensuring adequate access to protective gear, and promoting a positive safety climate can help improve adherence to safety protocols and appropriate use of PPE.

Neutralizing antibody responses over time in demographically and clinically diverse individuals recovered from SARS-CoV-2 infection in the United States and Peru: A cohort study.

BackgroundPeople infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) experience a wide range of clinical manifestations, from asymptomatic and mild illness to severe illness and death, influenced by age and a variety of comorbidities. Neutralizing antibodies (nAbs) are thought to be a primary immune defense against the virus. Large, diverse, well-characterized cohorts of convalescent individuals provide standardized values to benchmark nAb responses to past SARS-CoV-2 infection and define potentially protective levels of immunity.Methods and findingsThis analysis comprises an observational cohort of 329 HIV–seronegative adults in the United States (n = 167) and Peru (n = 162) convalescing from SARS-CoV-2 infection from May through October 2020. The mean age was 48 years (range 18 to 86), 54% of the cohort overall was Hispanic, and 34% identified as White. nAb titers were measured in serum by SARS-CoV-2.D614G Spike-pseudotyped virus infection of 293T/ACE2 cells. Multiple linear regression was applied to define associations between nAb titers and demographic variables, disease severity and time from infection or disease onset, and comorbidities within and across US and Peruvian cohorts over time. nAb titers peaked 28 to 42 days post-diagnosis and were higher in participants with a history of severe Coronavirus Disease 2019 (COVID-19) (p < 0.001). Diabetes, age >55 years, male sex assigned at birth, and, in some cases, body mass index were also independently associated with higher nAb titers, whereas hypertension was independently associated with lower nAb titers. nAb titers did not differ by race, underlying pulmonary disease or smoking. Two months post-enrollment, nAb ID50 (ID80) titers declined 3.5 (2.8)-fold overall. Study limitations in this observational, convalescent cohort include survivorship bias and missing early viral loads and acute immune responses to correlate with the convalescent responses we observed.ConclusionsIn summary, in our cohort, nAb titers after SARS-CoV-2 infection peaked approximately 1 month post-diagnosis and varied by age, sex assigned at birth, disease severity, and underlying comorbidities. Our data show great heterogeneity in nAb responses among people with recent COVID-19, highlighting the challenges of interpreting natural history studies and gauging responses to vaccines and therapeutics among people with recent infection. Our observations illuminate potential correlations of demographic and clinical characteristics with nAb responses, a key element for protection from COVID-19, thus informing development and implementation of preventative and therapeutic strategies globally.Trial registrationClinicalTrials.gov NCT04403880.

Emergence of Invasive Fungal Rhinosinusitis in Recently Recovered COVID-19 Patients.

The risk of invasive fungal rhinosinusitis is increased in Coronavirus disease 2019 (COVID-19) because of its direct impact in altering innate immunity and is further exacerbated by widespread use of steroids/antibiotics/monoclonal antibodies. The study aims to describe this recently increased clinical entity in association with COVID-19. A prospective, longitudinal study including patients diagnosed with acute invasive fungal rhinosinusitis (AIFRS) who recently recovered from COVID-19 infection or after an asymptomatic carrier state. A single-center, descriptive study investigating demographic details, clinical presentation, radio-pathological aspects, and advocated management. A total of 21 patients were included with a mean age of 49.62 years (SD: 14.24). Diabetes mellitus (DM) was the most common underlying disorder (90.48%), and 63.16% of all patients with DM had a recent onset DM, either diagnosed during or after COVID-19 infection. Nineteen patients (90.48%) had recently recovered from active COVID-19 infection, and all had a history of prior steroid treatment (oral/parenteral). Remaining 2 patients were asymptomatic COVID-19 carriers. Surprisingly, 2 patients had no underlying disorder, and 5 (23.81%) recently received the Covishield vaccine. Fungal analysis exhibited Mucor (95.24%) and Aspergillus species (14.29%). Most common sign/symptom was headache and facial/periorbital pain (85.71%), followed by facial/periorbital swelling (61.90%). Disease involvement: sinonasal (100%), orbital (47.62%), pterygopalatine fossa (28.58%), infratemporal fossa (14.29%), intracranial (23.81%), and skin (9.52%). Exclusive endoscopic debridement and combined approach were utilized in 61.90% and 38.10%, respectively. Both liposomal amphotericin B and posaconazole were given in all patients except one. A high suspicion of AIFRS should be kept in patients with recent COVID-19 infection who received steroids and presenting with headache, facial pain, and/or facial swelling. Asymptomatic COVID-19 carriers and COVID-19 vaccinated candidates are also observed to develop AIFRS, although the exact immuno-pathogenesis is still unknown. Prompt diagnosis and early management are vital for a favorable outcome.

Prevalence of cardiac involvement in home-based recovered coronavirus disease 2019 (COVID-19) patients: a retrospective observational study.

ObjectiveCoronavirus disease 2019 (COVID-19) has a risk of cardiac arrhythmia, acute coronary syndrome, heart failure and myocarditis, and the prognosis of COVID-19 has been associated with cardiovascular symptoms. However, there has not been enough information about cardiovascular involvement in patients who had recovered home-based mild symptoms of COVID-19 infection. Therefore, this study evaluates the prevalence of cardiac involvement and associated factors in home-based recovered COVİD-19 patients.Subject and methods.A total of 64 participants who applied to cardiology outpatient clinics with cardiac symptoms after recovering from COVID infection were recorded between April and December 2020. The patients were divided into two according to cardiovascular involvement in the cardiovascular magnetic resonance (CMR) imaging results.ResultsNo significant difference between the two groups regarding age and co‐morbidities. Patients with cardiac involvement had higher C-reactive protein compared to without cardiac involvement patients. A total of 46 patients who recently recovered from COVID-19 had abnormal CMR findings such as myocardial late gadolinium enhancement or pericardial enhancement. In addition, the left ventricular ejection fraction and stroke volume were significantly lower in the cardiac involvement patients.ConclusionWe demonstrate cardiac involvement in 46 patients (71%) with recent COVID-19, independent of pre-existing conditions. This indicates that there may be widespread cardiac involvement without high troponin values or severe clinical symptoms.

Did COVID-19 impact osteoarthritis - clinical perspective?

Purpose of reviewTo assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on patients with osteoarthritis (OA).Recent findingsThe COVID-19 pandemic negatively affected patients with OA irrespective of them contracting the infection. Patients with OA had a disruption in access to the healthcare system, which resulted in delays in joint replacement surgeries from cancellations of elective surgical procedures. On the other hand, the pandemic accelerated the drive towards telemedicine and telerehabilitation, with many nonurgent services being delivered remotely whenever possible. Cross-sectional studies showed that the majority of patients with OA were willing to accept the increased risks of contracting the COVID-19 infection and proceed with elective joint replacement surgeries.SummaryThe American College of Rheumatology and the European League Against Rheumatism issued guidelines for managing immune-mediated rheumatic diseases during the pandemic. However, these guidelines did not include recommendations for patients with OA.Healthcare providers, including physical therapists, should aim to schedule more frequent telemedicine follow-up appointments to maximize medical management while patients await elective joint procedures.

Precautions for breast ultrasound examination following COVID-19 vaccination

Background: Coronavirus disease 2019 (COVID-19) vaccine-induced lymphadenopathy is a critical side effect that should be a concern to clinicians, patients, radiologists, and oncologists. Vaccine-induced lymphadenopathy causes a diagnostic dilemma, especially for breast radiologists who examine both axillary regions during breast ultrasound examinations. Appropriate imaging guidelines are needed to manage vaccine-induced lymphadenopathy for patients undergoing screening examinations or symptomatic patients, including cancer patients.Current Concepts: For patients with axillary lymphadenopathy in the setting of recent ipsilateral vaccination, clinical follow-up is recommended. In other scenarios, short-term follow-up axillary ultrasound examinations are recommended if the clinical concerns persist for more than 6 weeks after vaccination. To mitigate the diagnostic dilemma of vaccine-induced lymphadenopathy, patients should schedule screening imaging examinations before the first vaccination or at least six weeks following the second vaccination. For clinicians and radiologists, documenting the patients’ vaccination status is critical to decreasing unnecessary follow-up imaging, biopsies, and patient’s anxiety.Discussion and Conclusion: Our proposal can help reduce patient anxiety, provider burden, and costs of unnecessary evaluation of enlarged lymph nodes in the setting of recent COVID-19 vaccination. Further, it can avoid delays in vaccination and breast cancer screening during the COVID-19 pandemic.

S3620 New Diagnosis of Crohn’s Disease After COVID-19

Introduction: Coronavirus disease 2019 (COVID-19) dysregulates the immune response and promotes overwhelming levels of inflammation. Data is scarce on the consequent effects of COVID-19 on the immune system and whether patients with COVID-19 are more prone to developing inflammatory bowel disease (IBD). We report two cases of previously healthy patients with a family history of IBD and recent COVID-19 diagnoses who were subsequently diagnosed with Crohn's disease. Case Description/Methods: Case 1: A previously healthy 17-year-old female presented with fever, bloody diarrhea, and weight loss. The patient had a diagnosis of COVID-19 from one month prior and a family history of Crohn's disease in her father. She underwent colonoscopy, which revealed ulcerations in terminal ileum and throughout the colon. Pathology demonstrated acute and chronic inflammation as well as chronic post-inflammatory changes throughout the colon and terminal ileum. She was diagnosed with Crohn's ileocolitis and treated with steroids followed by infliximab with a good clinical response. Case 2: A previously healthy 19-year-old male presented with recurrent abdominal pain and non-bloody diarrhea of two months. The patient had numerous first-degree relatives with Crohn's disease and a recent diagnosis of COVID-19 six months prior. Subsequent colonoscopy demonstrated a terminal ileum stricture with scarring and denuded mucosa. Pathology illustrated markedly active chronic ileitis. Magnetic resonance enterography (MRE) showed small bowel obstruction related to a long segment of active inflammation and stricturing within the terminal ileum. The patient was diagnosed with Crohn's disease and treated with steroids followed by adalimumab with marked improvement. Discussion: In our two cases, both patients were previously healthy aside from a recent COVID-19, and both had family history of Crohn's disease. IBD is thought to develop in patients with a genetic predisposition whose immune systems encounter an environmental trigger that promotes the inappropriate inflammation to normal intestine. New infections have been implicated as possible trigger events culminating in the pathogenesis seen in IBD. COVID-19 may represent one type of infection that drives new IBD development, especially given its known dysregulatory effects on the immune system. Whether our patients' new diagnoses of Crohn's disease were related to their recent COVID-19 infection remains unclear, and large epidemiological studies are required to investigate further.

SEVERE MULTISYSTEM INFLAMMATORY SYNDROME IN AN ADULT WITH MYOCARDITIS

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: There have been increasing reports of a rare hyperinflammatory syndrome seen in children following Coronavirus disease 2019 (COVID-19) with shared features of Kawasaki's Disease (KD). More recently, cases involving adolescents and young adults are emerging [1]. We present a case of severe multi-system inflammatory syndrome with myocarditis in a young adult. CASE PRESENTATION: A 20-year-old male with beta-thalassemia trait and a family history of Sjogren disease presented for screening after contact with a friend who tested positive for COVID-19. PCR testing confirmed COVID-19. He was asymptomatic at that time and was advised to quarantine at home.Five weeks later, he presented with a high-grade fever of 104 F, myalgias, difficulty breathing, chest pain, palpitations, hematuria, and hematochezia. Vital signs showed tachycardia (127 bpm) and hypotension (90/53 mmHg). Chest X-ray showed no infiltrates. Electrocardiogram (EKG) showed no ST abnormalities. Nasopharyngeal PCR was negative for COVID-19. Labs showed elevated C-reactive protein (CRP), creatinine phosphokinase (CPK), and lactate (8.0 mmol/L). Troponin T was elevated to 1.5 ng/L, and high sensitivity troponin was 12759 ng/L. Sequential Organ Failure Assessment (SOFA) score was 9. He was admitted to the intensive care unit (ICU) for cardiogenic vs distributive shock. Echocardiogram revealed new-onset reduced ejection fraction (EF) at 20%, with no wall motion abnormalities. He was anuric with rhabdomyolysis and acute tubular necrosis. He was treated with hemodialysis, intravenous N-acetylcysteine protocol, inotropic support, three doses of intravenous immunoglobulins (IVIG), corticosteroids, and aspirin. Serial blood cultures were negative. He had a high serum titer of COVID-19 antibody. Patient slowly improved following IVIG treatment and supportive care, with decreasing SOFA score. He was weaned off pressors and dialysis. Repeat echocardiogram showed recovered EF at 45%, and inflammatory markers improved to normal. After a 3-week hospital course, patient was near baseline with post-ICU deconditioning. DISCUSSION: Multisystem Inflammatory Syndrome in Adults (MIS-A) is a rare post-infectious sequela of COVID-19 with shared features of KD. Proposed mechanisms include direct hypoxic, ischemic injury, and post-viral immune-mediated vasculitis. Patients usually have limited respiratory involvement, evidence of recent COVID-19, and high antibody titers, which supports a post-infectious, immune-mediated etiology. Myocarditis is more common compared with Kawasaki disease, and both can have coronary artery aneurysms. Limited data from case series show good outcomes with IVIG, corticosteroids, and aspirin [2]. CONCLUSIONS: MIS is a rare extrapulmonary complication of COVID-19 with a wide spectrum of presentation. Initially described in children, more cases are emerging in young adults. A multidisciplinary approach is essential in severe cases. REFERENCE #1: Hékimian G, Kerneis M, Zeitouni M, et al. Coronavirus Disease 2019 Acute Myocarditis and Multisystem Inflammatory Syndrome in Adult Intensive and Cardiac Care Units. Chest. 2021;159(2):657-662. doi:10.1016 REFERENCE #2: Godfred-Cato S, Bryant B, Leung J, Oster ME, Conklin L, et al. California MIS-C Response Team. COVID-19-Associated Multisystem Inflammatory Syndrome in Childre, March-July 2020. MMWR Morb Mortal Wkly Rep. 2020 Aug 14;69(32):1074-1080. doi: 10.15585 DISCLOSURES: No relevant relationships by Mateus Fernandes, source=Web Response No relevant relationships by Ifediba Nwachukwu, source=Web Response

SINUS PAUSE SECONDARY TO ACUTE COVID-19 INFECTION

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Sinus pause/arrest most commonly occurs in medication toxicity, cardiac ischemia, infiltrative or fibrotic disease of SA node, structural heart disease, PE, sleep apnea, electrolyte disturbance (hyperkalemia), Lyme disease. We present to you a case of sinus pause/arrest in a patient with COVID-19 infection. CASE PRESENTATION: Patient is a 59 year male who presented to hospital with complaints of chest pain and dyspnea. Past medical history was significant for recent COVID-19 infection one week ago. Vital signs and physical examination on presentation were normal. Initial workup including CBC, INR, PTT, CMP, troponin and EKG were normal. Chest x-ray was remarkable for reticular nodular infiltrate in the right perihilar lung field. Patient was started on IV antibiotic for suspected pneumonia. On day 1, patient started experiencing skipped heartbeats. Cardiac telemetry demonstrated multiple sinus pauses with greatest pause duration of about 5 seconds. EKG showed normal sinus rhythm without any significant ST/T wave changes, Recent transthoracic echocardiogram was normal. Upon literature review, it was noted that there were cases of severe COVID-19 infection affecting the electrical system of the heart, resulting in sinus pauses. Hence, after ruling out some of the common differential diagnosis for sinus pauses including medications, ischemia, inflammatory, infiltrative or fibrotic disease of the SA node, structural heart disease, PE, OSA (obstructive sleep apnea), electrolyte disturbance (especially hyperkalemia), Lyme disease, patient's sinus pauses were attributed to underlying COVID-19 infection. Patient was discharged with 30 days cardiac event monitor which showed sinus rhythm with no significant pauses. DISCUSSION: SA nodal dysfunction typically results from either abnormality in impulse generation by the P cells or abnormalities in conduction across perinodal transitional (T cells). Hypoxemia, cytokine storm, direct viral infiltration, myocardial inflammation are thought to be responsible for sinus pause in COVID-19 disease, although exact mechanism is not known. Patients are symptomatic when longer episodes of sinus arrest occur resulting in dizziness, syncope, and death. Asymptomatic patients with SA nodal pauses or arrest often do not require treatment. Symptomatic patients are treated with a permanent pacemaker placement. CONCLUSIONS: Moderate to severe COVID-19 infection could be an uncommon cause of sinus pauses. However, before attributing COVID-19 as a cause of sinus pauses, common differential diagnosis for sinus pauses including medications toxicity (digoxin, antiarrhythmics-procainamide, quinidine), cardiac ischemia, infiltrative or fibrotic disease of SA node, structural heart disease, PE, sleep apnea, electrolyte disturbance and Lyme disease should be ruled out. REFERENCE #1: Peigh, Graham, et al. 'Novel Coronavirus 19 (COVID-19) Associated Sinus Node Dysfunction: A Case Series'. European Heart Journal - Case Reports, vol. 4, no. FI1, Oct. 2020, pp. 1–6. Silverchair, doi:10.1093/ehjcr/ytaa132. REFERENCE #2: Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, Jain SS, Burkhoff D, Kumaraiah D, Rabbani L, Schwartz A, Uriel N. Coronavirus disease 2019 (COVID-19) and cardiovascular disease. Circulation 2020;doi: 10.1161/CIRCULATIONAHA.120.046941 REFERENCE #3: Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020;17:259–260. DISCLOSURES: No relevant relationships by Luna Khanal, source=Web Response No relevant relationships by Adarsha Ojha, source=Web Response

Salivary detection of COVID-19: clinical performance of oral sponge sampling for SARS-CoV-2 testing.

BackgroundThe current diagnostic standard for coronavirus disease 2019 (COVID-19) is reverse transcriptase-polymerase chain reaction (RT-PCR) testing with nasopharyngeal (NP) swabs. The invasiveness and need for trained personnel make the NP technique unsuited for repeated community-based mass screening. We developed a technique to collect saliva in a simple and easy way with the sponges that are usually used for tamponade of epistaxis. This study was carried out to validate the clinical performance of oral sponge (OS) sampling for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing.MethodsOver a period of 22 weeks, we collected prospectively 409 paired NP and OS samples from consecutive subjects presenting to a public community-based free screening centre. Subjects were referred by their attending physician because of recent COVID-19 symptoms (n = 147) or by the contact tracing staff of the French public health insurance because they were considered as close contacts of a laboratory-confirmed COVID-19 case (n = 262).ResultsIn symptomatic subjects, RT-PCR SARS-CoV-2 testing with OS showed a 96.5% (95% CI: 89.6–94.8) concordance with NP testing, and a 93.2% (95% CI: 89.1–97.3) sensitivity when using the IdyllaTM platform and a sensitivity of 76.3% (95% CI: 69.4–83.2) on the Synlab Barla laboratory platform. In close contacts the NP-OS concordance (93.8%, 95% CI: 90.9–96.7) and OS sensitivity (71.9%, 95% CI: 66.5–77.3) were slightly lower.ConclusionThese results strongly suggest that OS testing is a straightforward, low-cost and high-throughput sampling method that can be used for frequent RT-PCR testing of COVID-19 patients and mass screening of populations.

A Multiplex Noninvasive Salivary Antibody Assay for SARS-CoV-2 Infection and Its Application in a Population-Based Survey by Mail.

ABSTRACTNoninvasive salivary antibody immunoassays can enable low-cost epidemiological surveillance of infections. This study involved developing and validating a multiplex suspension immunoassay on the Luminex platform to measure immunoglobulin G (IgG) responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid and spike (S) proteins, and the spike protein’s S1 and S2 subunits and receptor binding domain. Multiple versions of these recombinant proteins acquired from commercial and noncommercial sources were evaluated. Assay development and validation utilized saliva and serum samples from coronavirus disease 2019 (COVID-19) cases procured from commercial sources and negative controls from a prepandemic survey. Saliva was also collected in a demonstration survey by mail involving adult individuals in the United States who were diagnosed with SARS-CoV-2 infection 15 to 80 days prior to sample collection. The survey had an 83% valid sample return rate (192 samples from 38 states). Most COVID-19 cases (93%) reported mildly symptomatic or asymptomatic infections. The final salivary assay based on the best-performing spike and nucleocapsid proteins had a sensitivity of 87.1% (95% bootstrap confidence interval, 82.1 to 91.7%) and specificity of 98.5% (95.0 to 100%) using 227 and 285 saliva samples, respectively. The same assay had 95.9% (92.8 to 98.9%) sensitivity and 100% (98.4 to 100%) specificity in serum (174 and 285 serum samples, respectively). Salivary and serum antibody responses to spike and nucleocapsid proteins were strongly correlated in 22 paired samples (r = 0.88 and r = 0.80, respectively). Antibody responses peaked at approximately 50 days postonset; greater illness severity was associated with stronger responses. This study demonstrated that a salivary antibody assay can be used in large-scale population surveys by mail to better characterize public health impacts of COVID-19.IMPORTANCE Given the enormous impacts of the COVID-19 pandemic, developing tools for population surveillance of infection is of paramount importance. This article describes the development of a multiplex immunoassay on a Luminex platform to measure salivary immunoglobulin G responses to the spike protein, its two subunits and receptor binding domain, and the nucleocapsid protein of SARS-CoV-2. The assay validation utilized serum and saliva samples from prepandemic controls and recent COVID-19 cases. A survey by mail targeting recent COVID-19 cases across the United States also demonstrated the utility of safe, at-home self-collection of saliva. By incorporating multiple SARS-CoV-2 proteins, this assay may differentiate responses to natural SARS-CoV-2 infections from responses to most vaccines. Application of this noninvasive immunoassay in COVID-19 surveillance can help provide estimates of cumulative incidence rates of symptomatic and asymptomatic infections in various communities and subpopulations, temporal patterns of antibody responses, and risk factors for infection.

COVID-19 and Effect on Liver Transplant.

Purpose of reviewThe Coronavirus disease-2019 (COVID-19) pandemic has significantly impacted all aspects of liver transplantation. We reviewed the literature regarding COVID-19 clinical outcomes, treatment, and vaccination of liver transplant candidates and recipients.Recent findingsPatients with chronic liver disease, especially with cirrhosis, have higher morbidity and mortality from COVID-19 than patients without liver disease. Increased mortality has not been consistently seen in liver transplant recipients, in whom severe disease is more strongly associated advanced age and medical comorbidities, rather than with transplant-specific factors. While several targeted COVID-19 therapies have reported hepatotoxicity, these therapies may be safe and effective in patients with liver disease and liver transplant recipients. Questions remain regarding whether SARS-CoV-2 can be transmitted via the donor liver and whether transplant is safe in patients and/or donors with recent or active COVID-19.SummaryCOVID-19 has significantly affected the care of liver transplant candidates and recipients. Guidelines for the safe practice of liver transplantation are rapidly evolving, and current recommendations are discussed.

Persistent Endothelial Dysfunction in Post-Acute COVID-19 Syndrome: A Case-Control Study.

Background: Endothelial dysfunction has a key role in the pathogenesis of coronavirus disease 2019 (COVID-19) and its disabling complications. We designed a case-control study to assess the alterations of endothelium-dependent flow-mediated dilation (FMD) among convalescent COVID-19 patients. Methods: COVID-19 patients referred to a Pulmonary Rehabilitation Unit within 2 months from swab test negativization were consecutively evaluated for inclusion and compared to controls matched for age, gender, and cardiovascular risk factors. Results: A total of 133 convalescent COVID-19 patients (81.2% males, mean age 61.6 years) and 133 matched controls (80.5% males, mean age 60.4 years) were included. A significantly lower FMD was documented in convalescent COVID-19 patients as compared to controls (3.2% ± 2.6 vs. 6.4% ± 4.1 p < 0.001), confirmed when stratifying the study population according to age and major clinical variables. Among cases, females exhibited significantly higher FMD values as compared to males (6.1% ± 2.9 vs. 2.5% ± 1.9, p < 0.001). Thus, no significant difference was observed between cases and controls in the subgroup analysis on females (6.1% ± 2.9 vs. 5.3% ± 3.4, p = 0.362). Among convalescent COVID-19 patients, FMD showed a direct correlation with arterial oxygen tension (rho = 0.247, p = 0.004), forced expiratory volume in 1 s (rho = 0.436, p < 0.001), forced vital capacity (rho = 0.406, p < 0.001), and diffusing capacity for carbon monoxide (rho = 0.280, p = 0.008). Overall, after adjusting for major confounders, a recent COVID-19 was a major and independent predictor of FMD values (β = −0.427, p < 0.001). Conclusions: Post-acute COVID-19 syndrome is associated with a persistent and sex-biased endothelial dysfunction, directly correlated with the severity of pulmonary impairment.

The Cough Cold and Fever Clinic: A Model for the Safe Management of Ambulatory Patients With Suspected COVID-19.

When the coronavirus disease-2019 (COVID-19) pandemic swept through New York City, hospital systems became quickly overwhelmed and ambulatory strategies were needed. We designed and implemented an innovative program called the Cough Cold and Fever (CCF) Clinic to safely triage, evaluate, treat, and follow up patients with symptoms concerning for COVID-19. The CCF Clinic was launched on March 13, 2020, in the ambulatory internal medicine office of New York Presbyterian-Weill Cornell Medicine. Patients with symptoms suspicious for COVID-19 were first triaged via telemedicine to determine necessity of in-person evaluation. Clinic workspaces and workflows were fashioned to minimize risk of viral transmission and to conserve COVID-19 testing supplies and personal protective equipment. Protocols containing the most recent COVID-19 practice guidelines were created, updated regularly, and communicated through twice-daily huddles and as a shareable online document. Discharged patients were followed up for at least 7 days through telemedicine. Patient outcomes, including admission to the emergency department (ED), hospitalization, and death, were tracked to ensure clinical quality. We report on the first 620 patients seen at CCF between March 13, 2020, and June 19, 2020. Telemedicine follow-up was achieved for 500 (81%). We tested 347 (56%) patients for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with 119 (34%) testing positive. Forty-seven (8%) patients were sent to the ED directly from the CCF Clinic and 42 (89%) of these were admitted. Of the patients discharged home from CCF, 15 (3%) were later admitted to a hospital. Twelve (2%) patients in total died. The vast majority of patients, over 90%, seen in CCF were discharged home, with only a small percentage (3%) later requiring admission to a hospital. Of the patients sent directly to the ED from CCF, close to 90% were admitted, verifying the accuracy of our triage. Overall mortality was low (2%), especially when compared with mortality rates in New York City during the pandemic peak. Telemedicine was effective in identifying patients in need of in-person evaluation and in tracking and follow-up. Workflows and protocols were adaptable to reflect rapidly changing resources and clinical guidelines. Frequent communication through a diversity of methods was critical. Through these strategies, we were able to create a safe and effective outpatient program for patients with potential COVID-19.

Loss-of-function mutations in IFNAR2 in COVID-19 severe infection susceptibility

Recent COVID-19 (coronavirus disease 2019) host genetics studies suggest enrichment of mutations in genes involved in the regulation of type I and type III interferon (IFN) immunity in patients with severe COVID-19 infection. We performed whole-genome sequencing analysis of samples obtained from patients participating in the ongoing ODYSSEY phase 3 study of hospitalised patients with severe COVID-19 infection receiving supplemental oxygen support. We focused on burden testing of categories of rare and common loss-of-function (LOF) variants in all of the IFN pathway genes, specifically with MAF < 0.1% and MAF < 1%. In a model including LOF and missense variants (MAF < 1%), we report a significant signal in both INFAR1 and IFNAR2. We report carriers of rare variants in our COVID-19 cohort, including a stop-gain IFNAR2 (NM_000874:exon9:c.C966A:p.Y322X) amongst carriers of several other IFNAR rare nonsynonymous variants. Furthermore, we report an increased allelic frequency of common IFNAR2 variants in our data, reported also by the COVID-19 Host Genetics Initiative.

At a crossroads: coronavirus disease 2019 recovery and the risk of pulmonary vascular disease.

The coronavirus disease 2019 (COVID-19) pandemic has led to almost 3,000,000 deaths across 139 million people infected worldwide. Involvement of the pulmonary vasculature is considered a major driving force for morbidity and mortality. We set out to summarize current knowledge on the acute manifestations of pulmonary vascular disease (PVD) resulting from COVID-19 and prioritize long-term complications that may result in pulmonary hypertension (PH). Acute COVID-19 infection can result in widespread involvement of the pulmonary vasculature, myocardial injury, evidence of persistent lung disease, and venous thromboembolism. Post COVID-19 survivors frequently report ongoing symptoms and may be at risk for the spectrum of PH, including group 1 pulmonary arterial hypertension, group 2 PH due to left heart disease, group 3 PH due to lung disease and/or hypoxia, and group 4 chronic thromboembolic PH. The impact of COVID-19 on the pulmonary vasculature is central to determining disease severity. Although the long-term PVD manifestations of COVID-19 are currently uncertain, optimizing the care of risk factors for PH and monitoring for the development of PVD will be critical to reducing long-term morbidity and improving the health of survivors.

Cardio-Cerebral Infarction, Free-Floating Thrombosis and Hyperperfusion in COVID-19

Cardio-cerebral infarction, which refers to an acute ischemic stroke (AIS) and acute myocardial infarction (AMI) that occur concurrently, is an uncommon phenomenon with a grave prognosis. Intraluminal carotid thrombus (ICT) is an infrequently encountered cause of ischemic stroke and can be associated with an underlying hypercoagulable state. One severe yet prevalent complication of infection with Coronavirus Disease 2019 (COVID-19) is thrombosis from multi-pathway inflammatory responses. Here, we present a unique case of cardio-cerebral infarction, with a free-floating intraluminal thrombus in the left internal carotid artery, in the setting of recent COVID-19 infection, and with the etiology of both events attributed to a COVID-19 hypercoagulable state. CT perfusion imaging also showed an interesting imaging finding of hyperperfusion, which is believed to be a form of dysfunctional cerebral autoregulation.