Risk Of COVID-19 Complications Research Articles

(070) Androgen Status in Men and Risk Of COVID-19 Complications: An Analysis of United States Claims Data

Abstract Introduction Biological males have had worse COVID-19 outcomes compared to females. Yet, the impact of hypogonadism (HG) on COVID complications remains unclear. Objective We sought to compare COVID complications in males with various androgen status (eugonadal, treated HG, untreated HG) to females to evaluate the effect of testosterone levels on COVID outcomes. Methods We used the IBM MarketScan database of commercial claims encounters to identify patients ages 18+ with a COVID diagnosis (n=756,855). We compared eugonadal males (no HG diagnosis), untreated HG males (HG diagnosis without therapy), treated HG males (HG diagnosis and testosterone prescription within 180 days before COVID diagnosis) to females. Rates of intensive care unit (ICU) admission co-occurring with initial COVID diagnosis were modeled using logistic regression. Acute respiratory distress syndrome (ARDS), acute respiratory failure (ARF), and use of critical care services (CCS) were modeled using Cox proportional hazards models. Outcomes were regressed against group, age, rurality, and Charlson Comorbidity Index. Results Eugonadal males (n=315,050) were at higher odds of ICU admission (OR: 1.611, 95% CI: 1.549-1.676), having ARDS (HR 1.766, CI: 1.670-1.868), having ARF (HR 1.609, CI: 1.575-1.644), and needing CCS (HR 1.696, CI: 1.652-1.742) compared to females. Treated HG males (n=2,343) and untreated HG males (n=22,614) were also more likely to experience all adverse outcomes compared to females. For untreated HG males the effect was less pronounced compared to eugonadal males and treated HG males for all outcomes (Figure 1). There were no differences in odds of all outcomes for castrate males (n=89) compared to females due to small sample size. Conclusions Eugonadal males, treated HG males, and untreated HG males were more likely to have adverse COVID outcomes compared to females. This effect was most pronounced for eugonadal and treated HG males compared to untreated HG males, suggesting normal androgen status is detrimental to COVID-19 outcomes. This is one of the largest studies to show a complex relationship between testosterone and COVID outcomes. Disclosure No.

COVID-19 exposure, mental health, and self-reported academic outcomes in undergraduates during the spring 2020 lockdown

The present study explores the effect of the COVID-19 pandemic on undergraduates, mental health distress, and changes in self-estimated grades during the start of the pandemic. A national sample of undergraduate students (N = 197) participated in an online survey during spring 2020. Undergraduate students were recruited for a survey during the initial lockdown in April-May 2020. Higher depressive symptoms, general anxiety, and academic distress were associated with significantly lower self-estimated grades. Perceived grade declines were also correlated with higher financial concerns and risk for COVID-19 complications or infection. These results suggest that COVID-19 and the resulting modifications to education impacted undergraduate achievement and mental health. It is imperative for colleges and universities to provide additional support for students and their mental health.

Assessing the coverage and timeliness of coronavirus vaccination among people experiencing homelessness in Wales, UK: a population-level data-linkage study

BackgroundPeople experiencing homelessness have elevated morbidity, increasing their risk of COVID-19 related complications and mortality. Achieving high vaccination coverage in a timely manner among homeless populations was therefore important during the mass vaccination programme in Wales to limit adverse outcomes. However, no systematic monitoring of vaccinations among people experiencing homelessness in Wales has been undertaken.MethodsRetrospective cohort analysis was conducted using de-identified administrative data. Study cohort members were adults (≥ 18 years old) living in Wales on the 2 December 2020 and who had recently experienced homelessness, defined as experiencing homelessness between 1 July 2020 and 2 December 2020. The outcome of interest was first coronavirus vaccine dose. Follow-up started on 2 December 2020, and ended if the participant died, had a break in address history > 30 days, reached the end of follow up (30 November 2021), or had the outcome of interest. Median-time-to-vaccination was used as a crude measure of ‘timeliness’ of vaccine uptake. To account for competing risk of death prior to vaccination, vaccine coverage was described using cumulative incidence at 350-days, and at 50-day increments over follow-up (2 December 2020 to 17 November 2021). As a benchmark, all time-to-event measures were generated for the adult population in Wales with similar baseline individual and residential characteristics as the study cohort.Results1,595 people with recent experiences of homelessness were identified and included in analysis. The study cohort were disproportionately male (68.8%) and concentrated in the most deprived areas in Wales. Median time-to-vaccination for the study cohort was 196 days (95% CI.: 184–209 days), compared to 141 days (95% CI.: 141–141 days) among the matched adult population in Wales. Cumulative incidence of vaccination after 350-days of follow-up was 60.4% (95% CI.: 57.8–62.8%) among the study cohort, compared to 81.4% (95% CI.: 81.3–81.5%) among the matched adult population. Visual analysis of cumulative incidence over time suggests that vaccine inequality, i.e., difference between study cohort and matched adult population, peaked after 200-days of follow-up, and declined slightly until last follow-up at 350-days.ConclusionsDespite being prioritised for vaccination, people experiencing homelessness in Wales appear to have been under-engaged, leading to lower vaccination coverage and greater time unvaccinated, potentially increasing their risk of COVID-19 complications and mortality.

SARS-CoV-2 infection in patients with melanoma: results of the Spanish Melanoma Group registry.

The Spanish Melanoma Group (GEM) developed a national registry of patients with melanoma infected by SARS-CoV-2 ("GRAVID"). The main objective was to describe the COVID-19 fatality rate in patients with melanoma throughout the pandemic, as well as to explore the effect of melanoma treatment and tumor stage on the risk of COVID-19 complications. These are the final data of the register, including cases from February 2020 to September 2021. One hundred-fifty cases were registered. Median age was 68years (range 6-95), 61 (40%) patients were females, and 63 (42%) patients had stage IV. Thirty-nine (26%) were on treatment with immunotherapy, and 17 (11%) with BRAF-MEK inhibitors. COVID-19 was resolved in 119 cases, including 85 (57%) patients cured, 15 (10%) that died due to melanoma, and 20 (13%) that died due to COVID-19. Only age over 60years, cardiovascular disorders, and diabetes mellitus increased the risk of death due to COVID-19, but not advanced melanoma stage nor melanoma systemic therapies. Three waves have been covered by the register: February-May 2020, August-November 2020, and December 2020-April 2021. The first wave had the highest number of registered cases and COVID-19 mortality. Tumor stage or melanoma treatments are non-significant prognostic factors for COVID-19 mortality. During the pandemic in Spain there was a downward trend in the number of patients registered across the waves, as well as in the severity of the infection. NCT04344002.

Outcomes of COVID-19 Infection in People Previously Vaccinated Against Influenza: Population-Based Cohort Study Using Primary Health Care Electronic Records.

A possible link between influenza immunization and susceptibility to the complications of COVID-19 infection has been previously suggested owing to a boost in the immunity against SARS-CoV-2. This study aimed to investigate whether individuals with COVID-19 could have benefited from vaccination against influenza. We hypothesized that the immunity resulting from the previous influenza vaccination would boost part of the immunity against SARS-CoV-2. We performed a population-based cohort study including all patients with COVID-19 with registered entries in the primary health care (PHC) electronic records during the first wave of the COVID-19 pandemic (March 1 to June 30, 2020) in Catalonia, Spain. We compared individuals who took an influenza vaccine before being infected with COVID-19, with those who had not taken one. Data were obtained from Information System for Research in Primary Care, capturing PHC information of 5.8 million people from Catalonia. The main outcomes assessed during follow-up were a diagnosis of pneumonia, hospital admission, and mortality. We included 309,039 individuals with COVID-19 and compared them on the basis of their influenza immunization status, with 114,181 (36.9%) having been vaccinated at least once and 194,858 (63.1%) having never been vaccinated. In total, 21,721 (19%) vaccinated individuals and 11,000 (5.7%) unvaccinated individuals had at least one of their outcomes assessed. Those vaccinated against influenza at any time (odds ratio [OR] 1.14, 95% CI 1.10-1.19), recently (OR 1.13, 95% CI 1.10-1.18), or recurrently (OR 1.10, 95% CI 1.05-1.15) before being infected with COVID-19 had a higher risk of presenting at least one of the outcomes than did unvaccinated individuals. When we excluded people living in long-term care facilities, the results were similar. We could not establish a protective role of the immunity conferred by the influenza vaccine on the outcomes of COVID-19 infection, as the risk of COVID-19 complications was higher in vaccinated than in unvaccinated individuals. Our results correspond to the first wave of the COVID-19 pandemic, where more complications and mortalities due to COVID-19 had occurred. Despite that, our study adds more evidence for the analysis of a possible link between the quality of immunity and COVID-19 outcomes, particularly in the PHC setting.

PSAT035 COVID-19 Infection Increases DKA and mortality- A Harbinger for Increased Acute Diabetes Emergencies in the Future?

Abstract DM patients infected with COVID-19 are at risk for developing severe complications including DKA and/or HHS, with a more severe disease course and higher mortality compared to those without DM or hyperglycemia. As COVID-19 is evolving into an endemic risk for the population, it is important to determine patients at risk for COVID-19 complications and outcomes. The Riverside University Health System Medical Center (RUHS-MC)-DKA Outcomes Group (RUDOG) initiated a study to characterize patients admitted for fatal DKA and/or HHS before and during the pandemic. This was a retrospective cohort study reviewing medical records of non-pregnant adults age 18 or older admitted to the RUHS-MC for DKA and/or HHS from Mar 2020 to Feb 2021 ("pandemic") compared to the 3 preceding years ("pre-pandemic"). The descriptive statistics were used to determine the clinical characteristics of hospitalized adult patients with DKA and/or HHS. Information of patient characteristics was extracted from chart reviews. Categorical data were compared using Fisher's Exact Test. Numerical variables were assessed using Mann-Whitney Test. The mortality rate during the pandemic was 8.4% (30/335) versus 1.7% (5/285) in the pre-pandemic period. Most of the deaths (24/30) were COVID infected. On average, the cases of deaths during pandemic had DM for a longer duration. There was no difference regarding age, race, HgbA1c on admission, insulin use history, and rate of micro- or macrovascular complications comparing these periods. More patients had HTN (80%) and HF (23%) during pandemic compared to pre-pandemic (69.2% and 7.7%, respectively). Infection was the cause of death for 63% and 31% of patients admitted for DKA and/or HHS during the pandemic versus pre-pandemic. There is a clear global concern that COVID-19 will be an endemic infectious disease placing people with pre-existing conditions such as DM at increased risk for morbidities and death. Our study has clearly demonstrated that contracting COVID is a risk for increased incidence of DKA and/or HHS and mortality compared to pre-pandemic levels. In addition, we have shown that certain pre-existing comorbidities are associated with the mortality of DKA and/or HHS including HTN and HF with COVID infection. The duration of DM was longer among patients that died during pandemic, regardless of age, race, or HgbA1c on admission. This finding is intriguing as we did not see increased DKA and/or HHS based on the number of micro- or macrovascular complications suggesting duration alone may be a new risk determinant. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Treatment with stimulants and the risk of COVID-19 complications in adults with ADHD

Adults with attention deficit hyperactivity disorder (ADHD) have shown higher infection rates and worse outcomes from COVID-19. Stimulant medications are prescribed as the first-line treatment for ADHD in adults and mitigate risk of negative ADHD-related health outcomes, but little is known about the association between stimulant medications and COVID-19 outcomes. The objective of this study was to assess the risks of severe COVID-19 outcomes among people with ADHD who were prescribed stimulant medications versus those who were not. This retrospective cohort study used electronic health records in the TriNetX research database. We assessed records of adults with ADHD diagnosed with COVID-19 between January 1, 2020 and June 30, 2021. The stimulant cohort consisted of 28,011 people with at least one stimulant prescription; the unmedicated cohort comprised 42,258 people without prescribed stimulants within 12 months prior to their COVID infection. Multiple logistic regression modeling was utilized to assess the presence of critical care services or death within 30 days after the onset of COVID diagnoses, controlling for patient demographics, and comorbid medical and mental health conditions. The stimulant cohort was less likely to utilize emergency department, hospital, and intensive care services than the unmedicated cohort, and had significantly lower 30-day mortality. Further research, including prospective studies, is needed to confirm and refine these findings.

Perceptions and patient care needs among hepatitis B patients during COVID-19

BackgroundThe novel coronavirus of 2019 (COVID-19) has been and continues to be a rapidly developing public health crisis, that has also disrupted routine and maintenance health care for people living with chronic conditions. Some of these chronic conditions also put individuals at increased risk of COVID-19 complications, particularly if the condition is not under control. For these reasons, the exploratory study reported here examined the needs and preparedness of patients at a community health organization that specifically provides hepatitis B virus (HBV) care for high-risk groups that had previously tested positive for HBV.MethodsCurrent study utilized exploratory analysis of qualitative COVID-19-related statements collected during calls to a total of 44 patients reached during April and May, 2020 in the Washington D.C. area. Researchers worked with a community based non-profit organization to reach current HBV + and HCV + patients to provide retention in care and assess patient needs in maintaining management of their condition adapted to include offering medication refills, telehealth, and other resources. We gathered emergent themes, using socio-ecological framework, regarding capacity and needs for managing their chronic condition in a vulnerable population during the initial, most interrupted, time period of a global public health crisis.ResultsFrom the notes of the calls, five thematic categories emerged: COVID-19 prevention awareness, assistance program access, medical resource access, access to knowledge and awareness about assistance programs, and needs and barriers. From these five themes, providers can develop strategies to better prepare their patients and provide care to patients with chronic conditions during major disruptions.ConclusionsFuture recommendations include increasing hepatitis and COVID-19 vaccine efforts, collaborating with community partners, and screening and understanding social determinants of health that affect racial and ethnic minorities.

Time trends in social contacts of individuals according to comorbidity and vaccination status, before and during the COVID-19 pandemic

BackgroundAs we are confronted with more transmissible/severe variants with immune escape and the waning of vaccine efficacy, it is particularly relevant to understand how the social contacts of individuals at greater risk of COVID-19 complications evolved over time. We described time trends in social contacts of individuals according to comorbidity and vaccination status before and during the first three waves of the COVID-19 pandemic in Quebec, Canada.MethodsWe used data from CONNECT, a repeated cross-sectional population-based survey of social contacts conducted before (2018/2019) and during the pandemic (April 2020 to July 2021). We recruited non-institutionalized adults from Quebec, Canada, by random digit dialling. We used a self-administered web-based questionnaire to measure the number of social contacts of participants (two-way conversation at a distance ≤2 m or a physical contact, irrespective of masking). We compared the mean number of contacts/day according to the comorbidity status of participants (pre-existing medical conditions with symptoms/medication in the past 12 months) and 1-dose vaccination status during the third wave. All analyses were performed using weighted generalized linear models with a Poisson distribution and robust variance.ResultsA total of 1441 and 5185 participants with and without comorbidities, respectively, were included in the analyses. Contacts significantly decreased from a mean of 6.1 (95%CI 4.9–7.3) before the pandemic to 3.2 (95%CI 2.5–3.9) during the first wave among individuals with comorbidities and from 8.1 (95%CI 7.3–9.0) to 2.7 (95%CI 2.2–3.2) among individuals without comorbidities. Individuals with comorbidities maintained fewer contacts than those without comorbidities in the second wave, with a significant difference before the Christmas 2020/2021 holidays (2.9 (95%CI 2.5–3.2) vs 3.9 (95%CI 3.5–4.3); P<0.001). During the third wave, contacts were similar for individuals with (4.1, 95%CI 3.4–4.7) and without comorbidities (4.5, 95%CI 4.1–4.9; P=0.27). This could be partly explained by individuals with comorbidities vaccinated with their first dose who increased their contacts to the level of those without comorbidities.ConclusionsIt will be important to closely monitor COVID-19-related outcomes and social contacts by comorbidity and vaccination status to inform targeted or population-based interventions (e.g., booster doses of the vaccine).

Associations among political voting preference, high-risk health status, and preventative behaviors for COVID-19

BackgroundWe investigate the relationships among political preferences, risk for COVID-19 complications, and complying with preventative behaviors, such as social distancing, quarantine, and vaccination, as they remain incompletely understood. Since those with underlying health conditions have the highest mortality risk, prevention strategies targeting them and their caretakers effectively can save lives. Understanding caretakers’ adherence is also crucial as their behavior affects the probability of transmission and quality of care, but is understudied. Examining the degree to which adherence to prevention measures within these populations is affected by their health status vs. voting preference, a key predictor of preventative behavior in the U. S, is imperative to improve targeted public health messaging. Knowledge of these associations could inform targeted COVID-19 campaigns to improve adherence for those at risk for severe consequences.MethodsWe conducted a nationally-representative online survey of U.S. adults between May–June 2020 assessing: 1) attempts to socially-distance; 2) willingness/ability to self-quarantine; and 3) intention of COVID-19 vaccination. We estimated the relationships between 1) political preferences 2) underlying health status, and 3) being a caretaker to someone with high-risk conditions and each dependent variable. Sensitivity analyses examined the associations between political preference and dependent variables among participants with high-risk conditions and/or obesity.ResultsAmong 908 participants, 75.2% engaged in social-distancing, 94.4% were willing/able to self-quarantine, and 60.1% intended to get vaccinated. Compared to participants intending to vote for Biden, participants who intended to vote for Trump were significantly less likely to have tried to socially-distance, self-quarantine, or intend to be vaccinated. We observed the same trends in analyses restricted to participants with underlying health conditions and their caretakers Underlying health status was independently associated with social distancing among individuals with obesity and another high-risk condition, but not other outcomes.ConclusionEngagement in preventative behavior is associated with political voting preference and not individual risk of severe COVID-19 or being a caretaker of a high-risk individual. Community based strategies and public health messaging should be tailored to individuals based on political preferences especially for those with obesity and other high-risk conditions. Efforts must be accompanied by broader public policy.

Feasibility and Considerations for Remote Interviewing of Persons Living With Dementia: Adaptations for COVID-19

The continuing COVID-19 pandemic has necessitated changes to research protocols and approaches to mitigate health risks to both study participants and researchers. This is particularly true of studies exploring the biopsychosocial well-being and personal perspectives of older adults and those at elevated risk of COVID-19 complications. While videoconferencing platforms have enabled remote work and social activities, reliance on them may potentially exclude some individuals (e.g., those without digital devices, access to high speed internet or proficiency with technology). Persons living with dementia (PLWD) may experience difficulties navigating videoconferencing systems and building rapport with interviewers, though the inclusion of PLWD in research is necessary to ensuring their equitable representation. This presentation disseminates promising practices and lessons learned from a longitudinal study conducting remote interviews on sensitive topics with PLWD and their care partners (CP). Findings are drawn from a case study of the Better Together Dementia Care Study, an 18-month longitudinal study of PLWD (N=8) and their CPs (N=13), which implemented remote interviewing in Summer 2020 to gather data on the quality-of-life, resilience, relationship quality, adverse childhood experiences, mistreatment, and health status of PLWD. Researchers were able to interview most enrolled PLWD (n=7) via videoconferencing. Paper surveys were mailed to phone-interviewed participants, enabling them to view questions and answer choices in concordance with verbal queries. Researchers also tested a protocol asking CPs to leave the room while PLWD answered questions on sensitive topics. Findings support the use of remote interviewing with PLWD and provide insights to guide replication of these approaches.

Impact of the COVID-19 Stay-at-Home Order on Diet and Health in Community-Dwelling Older Adults With Obesity

Profound restrictions were placed on previously free-living older adults due to mandatory stay-at-home orders for Covid-19. Recognizing the potential for worsening health and heightened risk of Covid-19 complications with older age and obesity, we conducted a survey to assess the impact of stay-at-home requirements on diet, health/social behaviors, and food security in 58 older adults (age=70.8±6.2, 55% Black, 93% female) who had participated in past obesity-reduction trials. A 71-item questionnaire was administered by phone and included demographics, health, lifestyle and dietary habits, food attitudes, and food security questions. Results showed indicators of heightened health risk, including health care appointments either delayed/cancelled (69%) and self-reported weight gain (62%). Of those with weight gain, 22% reported a gain of >10 pounds (33% gained 5-10 pounds and 7% < 5 pounds). Increased food intake was reported by 67% and 45% felt their eating patterns were less healthy due to increased snacking (71%) and consumption of sweets (41%). Food access and isolation were also an issue, as 51% were concerned about leaving the house for food and 81% reported eating alone. While some positive behaviors were reported (new ways to access food and health information, more reported cooking at home), the majority of findings indicated increased risk of obesity and its complications. The findings emphasize the need for effective lifestyle interventions that can be delivered remotely to high-risk older adults; this would benefit those presently self-restricted for Covid-19 concerns as well as other isolated older adults who need better access to individualized interventions.

Spatial Distribution of COVID-19 and Comorbidities in New England

The COVID-19 pandemic created new barriers and challenges to accessing primary care services, particularly among older adults who already faced barriers related to access to care, including transportation, health literacy, and self-management support. Nova Southeastern University South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) partnered with primary care clinics to conduct wellness calls to older adult patients identified through clinic EHR. The wellness calls’ objectives were to 1) discuss COVID-19 protective measures; 2) assess wellness needs and access to care barriers; and 3) screen for telehealth support. From September 2020 to February 2021, the team (including medical students, public health students, and SFGWEP staff) contacted 200 patients via telephone and conducted a comprehensive wellness survey developed by the study team, informed by validated surveys. Among the 200 patients called, 60% (n=34) were very concerned about the Covid-19 pandemic, 33% (n=34) reported often feeling isolated from others, and 20% (n=34) expressed difficulty getting medical care. A smaller subset of patients reported concern about limited COVID-19 testing (n=1), lack of knowledge about seeing their provider via telehealth (n=7), lack of face masks (n=1), and challenges with obtaining medication refills (n=1). Following wellness calls, the NSU SFGWEP team provided education, referred to clinical resources, and, for low-income patients with access to care challenges, provided Samsung Tablets (n=50) with peer training to enable telehealth.

Abstract 11803: Area Deprivation and COVID-19 Outcomes in Patients With and Without Cardiovascular Disease: The Curator Registry of Houston Methodist

Introduction: Individuals with CVD are at higher risk of COVID-19 complications. However, the impact of social disadvantage on COVID-19 outcomes has not been fully evaluated in people with CVD. We assessed Area Deprivation Index (ADI) associations with COVID-19 positivity, severity, and in-hospital mortality among patients with and without CVD. Methods: We used the Houston Methodist COVID-19 Surveillance and Outcomes Registry (CURATOR) of 152,850 consecutive adults tested for COVID-19 between March 6 and October 31, 2020. CVD status was obtained from electronic health records. We matched ZIP codes of patients’ residences to state-level ADI using the Neighborhood Atlas and Census Block information from the American Community Survey 2018. ADI was categorized into quintiles of increasingly higher social disadvantage. For reference, we also analyzed the data of patients without CVD. Results: The median ADI ranking of the total sample (mean age 51.3 years; 60% women) was 4 (IQR 1-6). Overall, 37,468 (24.5%) patients had CVD and their median ADI was higher than those without CVD. Of the total sample, 11.9% tested positive for COVID-19 (no CVD: 12.7%; CVD: 9.4%). COVID-19 patients with CVD (v. no CVD) were more likely to be hospitalized (68.4% v. 27.1%), receive intensive care (34.9% v. 16.4%), and die (16.2% v. 4.0%) during admission. Adjusting for demographics and comorbidities, the odds of COVID-19 positivity and hospitalization were at least 50% higher in the most (compared to the least) deprived groups, irrespective of CVD status (Figure). In contrast, associations were null between ADI, need for intensive care, and in-hospital mortality. Conclusions: Individuals from the most deprived neighborhoods were more likely to test positive and be hospitalized for COVID-19, irrespective of CVD status. However, once hospitalized, individuals from disadvantaged areas were not at increased risk of requiring intensive care or dying during admission.

Rapid Clinical Improvement and Negativization in Symptomatic Patient with Secondary Hypogammaglobulinemia and Sars-CoV-2 Respiratory Infection after COVID-19 Convalescent Plasma Transfusion

The novel coronavirus disease pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), represents a global public health issue. Neoplastic and immunosuppressed patients with haematological disorders are at high risk for COVID-19 complications. This patients are unable to develop neutralizing antibodies due to an underlying disease and persistent SARS-CoV-2 RNA shedding has been documented for long time. Convalescent plasma transfusion (CPT) should be usefull in patients who are unable to produce neutralizing antibodies, like patients whose immune systems have been compromised by an haematological or autoimmune underlying disease. We report the case of a 61-year-old man with chronic lymphocytic leukemia previously treated with chemotherapy and in current disease progression that undergoes periodic immunoglobulin infusions with long positivity to SARS-CoV-2. In this report we highlight how the administration of CPT has been determinant on the significant change in the course of our patient’s disease. In the case described, it is evident that the persistent positivity to SARS-CoV-2 over time has worsened the fragile clinical condition of our patient due to persistence of fever and worsening of interstitial lung involvement. The rapid clinical improvement is temporally correlated to the rapid viral clearance as well as the rapid improvement of the interstitial radiological picture. In our opinion, in patients with haematological disorders early treatment can have significant advantages and avoid a worsening of clinical conditions related to SARS CoV-2 infection.

Characteristics, clinical and laboratory data and outcomes of pregnant women with confirmed SARS-CoV-2 infection admitted to Al-Zahra tertiary referral maternity center in Iran: a case series of 24 patients

BackgroundPhysiological changes during pregnancy put pregnant women at higher risk for COVID-19 complications. The objective of this study was to evaluate clinical and laboratory characteristics and outcomes of 24 COVID-19 pregnant patients and their newborns referred to the Al-Zahra tertiary maternity hospital in Tabriz, Iran.MethodsClinical records of 24 COVID-19 confirmed pregnant patients were retrospectively reviewed from10 March 2020 to 15 April 2020. Vertical transition was assessed through neonatal pharyngeal swab samples. The study has been approved by the Tabriz University Medical Ethics Committee (IR.TBZMED.REC.1399.497).ResultsThere were 24 hospitalized cases with clinical symptoms and confirmed diagnosis of COVID-19. The mean age of cases was 26.5 years; most were nulliparous (54.2%), in their third trimester (62.5%) and were in the type A blood group. Clinical symptoms in order of prevalence were cough, fever, dyspnea, myalgia, anosmia, and diarrhea. Oxygen saturation (SpO2) in 70.8% cases was in the normal range (greater than 93%). The risk of premature labor or abortion in cases showed no increase. 12 cases were in ongoing normal status; on follow up, 11 cases had delivered their babies at term and one had ended in IUFD because of pregnancy-induced hypertension. All delivered babies were healthy. Caesarean section in all cases was performed under obstetric indications or maternal demand, and no relation was found between COVID-19 and Caesarean delivery. Neonatal outcomes according to gestational age in 8 cases out of 11 (72.72%) were desirable; neonatal morbidity and mortality resulted from pregnancy complications. Blood pH in 6 neonates was assessed due to immaturity and NICU admission, all of which were in normal ranges except one case related to HELLP syndrome. There was no evidence of vertical transmission.ConclusionsFindings suggest that clinical symptoms in pregnancy were similar to non-pregnant women, no rise in risk of premature labor or abortion was seen, and vertical transmission was not observed in none of cases. Lymphopenia was the leading laboratory change. Given asymptomatic cases despite severe forms of infection in pregnancies, we propose screening in all suspected cases. All placentas and newborns should be tested in the field for vertical transmission.

Severe, New-Onset Diabetes Mellitus Triggered by COVID-19 Infection Followed by Euglycemia Upon Recovery: A Case Report

Background: New-onset diabetes mellitus (DM) and severe metabolic complications in association with COVID-19 has been reported in the literature. Studies indicate a bidirectional relationship between COVID-19 and DM. Not only does severe DM lead to an increased risk for COVID-19 complications, but COVID-19 infection itself may precipitate new-onset DM. Clinical Case: A 45-year-old male with no known past medical history and normal body mass index presented after being found unresponsive at home. One week prior to admission, he tested positive for SARS-CoV-2 virus. On admission, laboratory evaluation showed: serum glucose 1090 mg/dl [70–109 mg/dL], anion gap 31 [<12], serum sodium 159 meq/L [133–145 meq/L], serum bicarbonate 18 meq/L [23–30 meq/L], creatinine 2.9 mg/dL [0.7–1.2 mg/dL], serum osmolality 438 mosm/k [280–295 mosm/k], venous pH 7.29 [7.32–7.42], venous bicarbonate 20 mmol/L [24–28 mmol/L], lactic acid 5.0 mmol/L [0.5–2.2 mmol/L], serum acetone positive 1+, urine ketone 20, hemoglobin 16.1 g/dL [14–18.0 g/dL] and HbA1c 13.5% [4.8–5.9%]. A diagnosis of diabetes with hyperosmolarity was made and he was admitted to the medical intensive care unit for treatment. Rapid resolution of hyperglycemia and hyperosmolarity was achieved with insulin infusion and intravenous fluids. He was transitioned to subcutaneous insulin on hospital day 2 and glycemic control was maintained using a basal/bolus insulin regimen. However, he experienced a prolonged two-month hospitalization due to complications including acute respiratory distress syndrome requiring mechanical ventilation and tracheostomy placement, pleural effusions with need for chest tube placement, and acute renal failure requiring short-term hemodialysis support. He was discharged to a rehabilitation facility on insulin glargine 15 units daily. Two-months after discharge, no weight changes were noted. Insulin was discontinued due to fasting serum glucose around 100 mg/dL and HbA1c 5.9%. Six-weeks later, a random serum glucose was 135 mg/dL and HbA1c 6.6%. He remains off glucose-lowering medications to date. Conclusion: We report an interesting case of new-onset diabetes with hyperosmolarity associated with COVID-19 infection with rapid achievement of euglycemia upon resolution of viral infection. Our case adds to growing evidence demonstrating a possible diabetogenic effect due to COVID-19 infection. There is also a complex interplay between SARS-CoV-2 virus and DM leading to a higher risk for complications. Questions remain regarding the long-term effects of COVID-19 on glucose metabolism. Patients with similar clinical presentations warrant close follow-up since it may be possible to de-escalate or discontinue hypoglycemic agents.

Implications of COVID-19 for patients with pre-existing digestive diseases: an update

Implications of COVID-19 for patients with pre-existing digestive diseases: an update

Quit Experiences among Primary Care Patients Enrolled in a Smoking Cessation Pilot RCT Early in the COVID-19 Pandemic.

The impact of the COVID-19 pandemic on US adults’ smoking and quitting behaviors is unclear. We explored the impact of COVID-19 on smoking behaviors, risk perceptions, and reactions to text messages during a statewide stay-at-home advisory among primary care patients who were trying to quit. From May–June 2020, we interviewed smokers enrolled in a 12-week, pilot cessation trial providing text messaging and mailed nicotine replacement medication (NCT04020718). Twenty-two individuals (82% white, mean age 55 years), representing 88% of trial participants during the stay-at-home advisory, completed exit interviews; four (18%) of them reported abstinence. Interviews were thematically analyzed by two coders. COVID-19-induced environmental changes had mixed effects, facilitating quitting for some and impeding quitting for others. While stress increased for many, those who quit found ways to cope with stress. Generally, participants felt at risk for COVID-19 complications but not at increased risk of becoming infected. Reactions to COVID-19 and quitting behaviors differed across age groups, older participants reported difficulties coping with isolation (e.g., feeling disappointed when a text message came from the study and not a live person). Findings suggest that cessation interventions addressing stress and boredom are needed during COVID-19, while smokers experiencing isolation may benefit from live-person supports.

Association Between Periodontal Disease and the Risk of COVID-19 Complications and Mortality: A Systematic Review.

ABSTRACTAim:The COVID-19 pandemic has strained the world’s healthcare systems. Studies have identified how the COVID-19 infections are linked to several co-morbidities such as hypertension, diabetes, cardiovascular disease, renal and pulmonary disease. It is known that periodontal disease (PD) shares the same risk factors. Moreover, both diseases are characterized by an exaggerated immune response. The aim of the study was to investigate the available evidence of a potential association between PD and the risk of COVID-19 complications and mortality.Materials and Methods:MEDLINE/PubMed, EMBASE, Scopus, and ProQuest were searched. Studies that assess the association between PD and the risk of COVID-19 complications and mortality were eligible for inclusion. Two independent reviewers performed the selection of articles and data extraction. The New Castle Ottawa Scale was used to assess the quality of the selected studies, and the GRADE system was used to evaluate the level of confidence to support the conclusions.Results:Only two studies met the eligibility criteria. One study had a low risk of bias, whereas the other had a high risk of bias.Conclusion:The level of confidence in the available evidence is very low. A close association between periodontitis and the risk of COVID-19 complications and mortality can neither be supported nor refuted.