SARS-CoV2 Infection Research Articles

MR-Neurography and nerve ultrasound findings in a patient with chronic autoimmune-mediated neuropathy after SARS-CoV2 infection

MR-Neurography and nerve ultrasound findings in a patient with chronic autoimmune-mediated neuropathy after SARS-CoV2 infection

Spontaneous Coronary Artery Dissection and COVID-19: A Review of the Literature.

SARS-CoV-2 is responsible for the global coronavirus disease 2019 (COVID-19) pandemic. While the cardiovascular effects of COVID-19 have been thoroughly described, there are limited published studies in the literature establishing a connection between spontaneous coronary artery dissection (SCAD) and COVID-19. Cardiovascular manifestations include, among others, myocarditis, acute myocardial infraction, and thrombosis. In general, SCAD is an uncommon and underdiagnosed cause of acute myocardial infarction (AMI), particularly in younger women and in patients with underlying fibromuscular dysplasia (FMD). Many patients with SCAD often report significant emotional stress, especially in relation with job loss, during the week preceding their cardiac event. Moreover, the COVID-19 pandemic has led to societal stress and increased unemployment, factors that have been associated with cardiovascular morbidity. SCAD emerges as a rare manifestation of coronary artery disease, which a few recent case reports link to COVID-19. The aim of this article is to summarize the relevant data on the pathophysiology of COVID-19 and SCAD along with a review of the reported cases on acute coronary syndrome (ACS) following SARS-CoV2 infection and, thus, to provide insights about the relationship between COVID-19 and SCAD.

Correlation study of CBC derivatives and biochemical prognostic marker in covid-19 patients

: SARS-CoV2 infection induces inflammatory responses and acute lung injury in human beings. Infection causes certain haematological and biochemical changes in patients. This study aimed analyze the correlation between CBC derivatives and biochemical prognostic marker in COVID-19.: Total 80 individuals selected, 50 COVID-19 positive patients and 30 subjects negative for COVID-19 RT-PCR test. Blood collected was sent to NLR, RDW, assayed in Beckman Coulter DxH 800. Serum CRP estimated by Immuno-turbidimetric method, ferritin by CLIA. Plasma collected estimate for D-DIMER by CLIA. Unpaired T test & Pearson correlation (IBM SPSS 22.0) were used. : Elevated levels of NLR (p value <0.001), RDW (p value <0.001), FERRITIN (p value <0.001), D-D-DIMER (p value <0.001), CRP (p value <0.001) some research parameters like LHD and RSF show significant decrease. In current study the NLR positively correlate to CRP (r value=0.5, p value <0.001), NLR positively correlate to D-DIMER (r value=0.3, p value<0.05), RDW positively correlated to CRP (r value=, 0.3, p value <0.05), RDW negatively correlated to ferritin (r value=-0.439, p value <0.001)LHD negatively correlated ferritin (r value=-0.316, p value=<0.05), MAF negatively correlated to D-dimer (r value=-0.244 <0.05), MSCV positively correlated with CRP (r value=0.336, p value= <0.05).: The cytokine storm produced during covid-19 infection which inturn develop neutrophilia and lymphopenia, CRP production and also cause elevation of procoagulants &D-dimer. RDW and CRP are positively correlated they are elevated during inflammatory conditions.RDW and FERRITIN show negative correlation. Retrospective study have some limitation so future studies will reveal more information.

Elevated levels of cell-free NKG2D-ligands modulate NKG2D surface expression and compromise NK cell function in severe COVID-19 disease.

It is now clear that coronavirus disease 19 (COVID-19) severity is associated with a dysregulated immune response, but the relative contributions of different immune cells is still not fully understood. SARS CoV-2 infection triggers marked changes in NK cell populations, but there are contradictory reports as to whether these effector lymphocytes play a protective or pathogenic role in immunity to SARS-CoV-2. To address this question we have analysed differences in the phenotype and function of NK cells in SARS-CoV-2 infected individuals who developed either very mild, or life-threatening COVID-19 disease. Although NK cells from patients with severe disease appeared more activated and the frequency of adaptive NK cells was increased, they were less potent mediators of ADCC than NK cells from patients with mild disease. Further analysis of peripheral blood NK cells in these patients revealed that a population of NK cells that had lost expression of the activating receptor NKG2D were a feature of patients with severe disease and this correlated with elevated levels of cell free NKG2D ligands, especially ULBP2 and ULBP3 in the plasma of critically ill patients. In vitro, culture in NKG2DL containing patient sera reduced the ADCC function of healthy donor NK cells and this could be blocked by NKG2DL-specific antibodies. These observations of reduced NK function in severe disease are consistent with the hypothesis that defects in immune surveillance by NK cells permit higher levels of viral replication, rather than that aberrant NK cell function contributes to immune system dysregulation and immunopathogenicity.

Exploring the lived experiences and perspectives of individuals with communication and swallowing difficulties associated with Long-COVID

BACKGROUND: Long-COVID occurs in individuals with a history of probable or confirmed SARS CoV-2 infection. Long-COVID can affect individuals who experience both mild and severe acute COVID-19 and can involve and affect multiple body systems. Research thus far acknowledges swallowing and communication difficulties as a characteristic of Long-COVID, however, this research lacks detail and does not address the psychosocial impact of these problems. OBJECTIVES: To establish an understanding of the presence, severity, and trajectory of swallowing and communication difficulties as a symptom of Long-COVID among adults. To investigate the psychosocial impact of these characteristics and explore supports and barriers to recovery. METHODS: The objectives were addressed by utilizing a qualitative research design. Semi-structured interviews were carried out with participants using online Zoom sessions. The interviews were recorded and transcribed and reflexive thematic analysis was used to analyse the data. RESULTS: Seven participants from Ireland, Scotland and Australia were interviewed. Four main themes were identified including dysphagia-related issues, communication-related issues, psychosocial impact of dysphagia and communication disorders, and accessing Long-COVID related healthcare for dysphagia and communication disorders. The presentation of swallowing and communication problems was diverse and had significant psychosocial and mental health consequences. Furthermore, access to healthcare services to effectively treat these issues was challenging. CONCLUSIONS: The lack of recognition of swallowing and communication as a symptom of Long-COVID and its adverse effects is a pertinent issue which warrants further research and updated guidelines for individuals living with Long-COVID and healthcare professionals alike.

Abstract TP203: Effect of SARS-CoV2 Infection on Endovascular Thrombectomy Outcomes - Data From the Florida Stroke Registry

Introduction: The outcomes of endovascular thrombectomy (EVT) in SARS-CoV2 positive patients with acute ischemic stroke (AIS) are not well studied. In the large Florida Stroke Registry we compared in hospital and discharge outcomes of patients with target vessel occlusions treated endovascularly with versus without a SARS-CoV2 positive infection status during their hospitalization. Methods: Data from Get With the Guidelines-Stroke hospitals participating in the Florida Stroke Registry from March 2020 to December 2022 were reviewed. EVT patients with coding for SARS-CoV2 testing during their hospital stay were categorized into SARS-CoV2 positive or negative groups. Associations between SARS-CoV2 status and favorable EVT outcomes of good mRS (0-2) at discharge, discharge to home or to rehabilitation centre, and independent ambulation at discharge were examined using multivariate logistic regression modeling adjusting for demographics, vascular risk factors, and clinical characteristics with generalized estimating equations (GEE). Temporal analyses compared outcomes across the years 2020-2022. Results: A total of 8,778 patients underwent EVT, of these, 193 (2.25%) were SARS-CoV2 positive. The odds of mRS 0-2 and independent ambulation at discharge were OR 0.194 (CI 0.035,1.077) and OR 0.794 (CI 0.168,3.75) in SARS-CoV2 positive relative to negative EVT patients. Outcomes of mRS 0-2 (OR 0.194, CI 0.035,1.077) and ambulation at discharge (OR 0.794, CI 0.168,3.75) were shy of statistical significance. Accounting for baseline differences SARS-CoV2 positive patients were less likely to be discharged home or to a rehabilitation centre (OR 0.671, CI 0.488,0.921) in multivariable analysis with GEE. Temporal analysis of SARS-CoV2 positive patients showed no significant differences across the years studied. Conclusions: In this large muliticentre stroke registry the results suggest that favorable outcomes post thrombectomy may be negatively impacted by SARS-CoV2 infection. Temporal assessment showed similar results across the years studied. These findings provide novel insight from a large database to add to the emerging literature examining outcomes of concurrent SARS-CoV2 infection in the setting of EVT for target vessel occlusion AIS.

Pregnant individuals with uncomplicated pregnancies display pro-inflammatory immune changes when exposed to the COVID-19 pandemic.

The COVID-19 pandemic has been shown to have a detrimental impact on the mental health of pregnant individuals, and chronic stress can alter the immune profile. However, the effects of the COVID-19 pandemic on the immune system in pregnancy are still poorly understood. We aimed to evaluate the impact of pandemic exposure on the maternal immune profile in uncomplicated pregnancies. We collected blood and placenta samples from pregnant individuals exposed and unexposed to the pandemic to compare their immune and inflammatory profiles. We performed co-culture with circulating maternal immune cells and endothelial cells to assess endothelial activation. Statistical analysis was performed using unpaired t-test, Mann-Whitney, or Fisher's exact test as appropriate. In exposed individuals, we observed a decreased proportion of Th2 cells (p<.0001) and Treg/Th17 ratio (p<.05), as well as an increased Th1/Th2 ratio (p<.0001). Levels of IL-1β (p<.01) and IL-18 (p<.01) were increased in the circulation of exposed participants, whilst other mediators were significantly decreased (IFNγ, IL-8, MCP-1, amongst others). Furthermore, we observed increased production of ICAM, hallmark of endothelial activation, when we co-cultured endothelial cells with immune cells from exposed individuals. Vaccination status impacted the cellular profile with increased proportions of Th1 and B cells in vaccinated participants. Overall, we observed a pro-inflammatory bias in the circulation of pregnant individuals exposed to the COVID-19 pandemic, with otherwise uncomplicated pregnancies. Our work also supports an association between the increased risk of endothelial activation/hypertension and SARS-CoV2 infection, which might be driven in part by exposure to the pandemic and associated stressors.

Abstract 112: Assessing the Impact of the COVID-19 Pandemic on Childhood Arterial Ischemic Stroke: An Unanticipated Natural Experiment

Introduction: The Vascular effects of Infection in Pediatric Stroke (VIPS II) study aimed to confirm prior findings that viral infection can trigger childhood arterial ischemic stroke (AIS). The COVID-19 pandemic developed midway through VIPS II enrollment, creating an opportunity to assess its impact. Methods: At 22 North American sites, we enrolled 205 children (28 days-18 years) with AIS (12/2016 - 1/2022), collected serum samples up to 7 days post-stroke, and measured clinical infection via parental interview. We defined the COVID-19 pandemic epoch as 1/2020-1/2022. We collected serum samples on 40 stroke-free controls (median [IQR] age 13.2 years [6.4, 16.5]) during the pandemic. We measured SARS-CoV2 spike IgG antibodies (present after vaccination or infection) and nucleocapsid IgG total antibodies (present after infection only; elevated for months). Results: The sites saw 117 AIS cases in 2019 (51 enrolled), 122 (44) in 2020, and 109 (52) in 2021. Comparing the pre-pandemic (N=105) and pandemic (N=100) cohorts, pandemic cases were less likely to report a recent infection (Table). Evidence of SARS-CoV2 infection was seen in 4 (10%) of controls and 26 (25%) of 100 pandemic cases (p=0.065); 10 of the 26 COVID positive cases reported a recent infection, and 7 of the 10 had a clinical diagnosis of COVID. Median (IQR) nucleocapsid IgG titers were 18.8 (12.0, 101) in the positive controls and 50.1 (26.9, 95.3) in the positive cases (p=0.33). Conclusions: The COVID19 pandemic reduced the proportion of childhood AIS cases with preceding infection, likely reflecting decreased infectious exposures while “stay at home” and masking policies were in effect. A quarter of cases in the pandemic era had positive antibodies consistent with prior SARS-CoV2 infection. Like other childhood respiratory viruses, SARS-CoV2 may act as a trigger for childhood AIS, but further investigation is needed to establish a causal role.

Abstract B021: Influenza-induced inflammatory response reactivates and promotes dormant breast cancer cell outgrowth in lungs

Abstract Breast cancer is the most common form of cancer and the second cancer-causing death in females. Although remission rates are high if detected early, survival rates drop substantially when breast cancer becomes metastatic. Metastatic relapse can occur months to years after the initial diagnosis and treatment of the primary tumor. This relapse is mediated by awakening of dormant disseminated cancer cells (dDCCs). Studies have demonstrated that the relationship between the microenvironment and dDCCs is critical for maintaining both dormancy and for facilitating awakening to promote metastasis development. Prior studies have shown increased inflammation in the microenvironment can facilitate DCC awakening and outgrowth. Viral respiratory infections are also associated with massive inflammation and immune cell influx, typically in acute form. Respiratory infections affect millions of people worldwide, as is particularly evident in the ongoing SARS-CoV2 pandemic and variably severe annual influenza seasons. How the inflammatory response to viral respiratory infections impacts breast cancer metastasis remains unclear. Using FVB MMTV-erbB2/neu/HER2 mice as a model of breast dormancy in the lungs and influenza virus, we show that following influenza infection there is a significant increase in the number of disseminated cancer cells in the lungs of influenza infected mice with more than a 1000-fold expansion of carcinoma cells over a couple of weeks. Interestingly most of this expansion of DCCs takes place within 10 days following influenza infection. Strikingly, by 15 days post-infection, the lesions that expanded from solitary HER2+ DCCs almost homogeneously return to a quiescent state. Furthermore, we show interleukin-6 is required for the early phase of dormant cancer cells reawakening and proliferation and that CD4+ T cells are required for the maintenance of the expanded cancer cells post-infection at the late phase. Depletion of CD4 T cells (but not CD8 cells) during infection with influenza virus leads to the elimination of the expanded DCC population in the lung. Finally, single-cell RNA-seq analyses of DCC and microenvironmental cells in the lungs before and after infection reveals insight into underlying mechanisms for virus-induced awakening and reentry into dormancy. scRNA-seq analyses reveal that expanding DCC post-influenza infection reprogram CD4 and CD8 T-cells to a more immune suppressed state. These results support a model whereby pulmonary viral infections can increase the risk of metastatic relapse in the lungs for patients with a prior history of breast cancer. Thus, the immune response evolved to combat respiratory infections can be coopted and reprogrammed by dormant cancer cells to enable their expansion, thus increasing the odds of further metastatic cancer evolution. Ongoing work is currently being done to investigate this process in mouse models of SARS-CoV2 infection, as well as to examine clinical databases for epidemiological associations between respiratory viral infections and metastatic disease in the lung. Citation Format: Bryan J. Johnson, Shi Biao Chia, Vadym Zaberezhnyy, Varsha Sreekanth, Meher Boorgula, Michael Papanicolaou, James Costello, Andrew Goodspeed, Julio A. Aguirre-Ghiso, Mercedes Rincon, James V. DeGregori. Influenza-induced inflammatory response reactivates and promotes dormant breast cancer cell outgrowth in lungs [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Cancer Evolution and Data Science: The Next Frontier; 2023 Dec 3-6; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_2):Abstract nr B021.

Characteristics of Asymptomatic COVID-19 In SARS-COV-2 Vaccine Trial Screening Participants

Introduction We conducted a Phase I SARS-CoV-2 vaccine trial in March 2022. During the screening, we identified a significant number of asymptomatic COVID-19 cases among the candidate participants. We aimed to highlight the clinical characteristics among these asymptomatic individuals as compared to subjects negative for SARS-CoV-2. Methods This observational study was conducted during participant screening for a Phase I SARS-CoV-2 vaccine trial in Jepara and Mranggen districts in Central Java, Semarang, Indonesia. Participants who reported no symptoms associated with COVID-19, confirmed by physical examinations, were included. Data on laboratory markers were documented. An asymptomatic case was defined as showing no clinical symptoms and signs of SARS-CoV-2 infection with a positive SARS-CoV-2 RT-PCR result. Individuals who tested negative for SARS-CoV-2 were included for comparison. A chi-square test was employed to assess the differences between the two groups, with a p-value &lt;0.05 is considered significant. Results A total of 219 participants were screened and included. One hundred and six participants (48.4%) had positive SARS-CoV-2 RT-PCR results, with mean Ct values of 28.29 +/- 6.74 for the helicase gene. There was no significant difference in demographic characteristics, physical examination, and laboratory findings (p-value &gt;0.05) among individuals with positive and negative SARS-CoV-2. Conclusion In our vaccine trial screening phase, almost half were ineligible due to having asymptomatic SARS-CoV-2 infections. In addition, it is necessary that people with asymptomatic COVID-19 infection still need to be concerned because they have the same transmission potential.

Lipoprotein (a) as a cause of premature coronary artery disease; a case report of a 34-year-old male patient presenting with ST elevation myocardial infarction.

Background&#x0D; Premature coronary artery disease (PCAD) is considered when coronary artery disease (CAD) occurs in the younger population, less than 45 years old in males. Modifiable risk factors are present in about 80% of patients with PCAD such as smoking, diabetes, high blood pressure and obesity. High serum lipoprotein (a) level has recently emerged as a risk factor for PCAD. However, it is not routinely investigated in young patients presenting with acute coronary syndromes.&#x0D; Case Presentation&#x0D; A 34-year-old African man presented to our hospital with 2 hours of worsening left sided chest pain. He gave a history of long-standing chest pain in the past that was being managed as peptic ulcer disease. He also complained of a slow heart rate. He had no traditional cardiovascular risk factors. The only significant history was a recent recovery from COVID-19 infection two months prior. His physical examination was only significant for a bradycardia, ECG revealed a hyper acute inferior STEMI without right ventricular involvement. Echo showed a normal left ventricle with reduced ejection fraction (EF: 50%), wall motion abnormalities consistent of an inferior MI. He immediately received streptokinase with good clinical and ECG response. His coronary angiogram showed a severe lesion and plaque rupture in the mid-distal segment of a dominant right coronary artery. Percutaneous coronary intervention (PCI) was successfully done, and one drug eluting stent was implanted. He was placed on guideline directed medical therapy for secondary prevention. The only significant possible aetiology found was an elevated Lipoprotein (a) (137mg/dl). Subsequent serum Lipoprotein (a) remained persistently elevated despite therapy with high dose niacin. He was recommended for a PCSK9 receptor blocker, but this medication is not available in the country and the patient could not meet the costs. He remains stable to current medications with no recurrence of chest pain, two years after the index event, the Lipoprotein (a) levels are still high.&#x0D; Conclusions:&#x0D; Lipoprotein (a) appears to be an important overlooked cardiovascular risk factor for premature coronary artery disease especially in the absence of traditional risk factors. It should always be considered in the screening of premature coronary cardiovascular disease. The acute presentation in this patient was probably triggered by SARS COV-2 infection.

Association of IL-10–592 C > A /-1082 A > G and the TNFα -308 G > A with susceptibility to COVID-19 and clinical outcomes

BackgroundVariation in host immune responses to SARS-CoV-2 is regulated by multiple genes involved in innate viral response and cytokine storm emergence like IL-10 and TNFa gene polymorphisms. We hypothesize that IL-10; -592 C > A and − 1082 A > G and TNFa-308 G > A are associated with the risk of SARS-COV2 infections and clinical outcome.MethodsGenotyping, laboratory and radiological investigations were done to 110 COVID-19 patients and 110 healthy subjects, in Ismailia, Egypt.ResultsA significant association between the − 592 A allele, A containing genotypes under all models (p < 0.0001), and TNFa A allele with risk to infection was observed but not with the G allele of the − 1082. The − 592 /-1082 CG and the − 592 /-1082/ -308 CGG haplotypes showed higher odds in COVID-19 patients. Severe lung affection was negatively associated with − 592, while positive association was observed with − 1082. Higher D-dimer levels were strongly associated with the − 1082 GG genotype. Survival outcomes were strongly associated with the GA genotype of TNFa. -308 as well as AGG and AAA haplotypes.ConclusionIL-10 and TNFa polymorphisms should be considered for clinical and epidemiological evaluation of COVID-19 patients.

P448 The role of SARS-CoV2 infection in the clinical outcomes of patients with Inflammatory Bowel Disease

Abstract Background Immunosuppression has been identified as one of the main risk factors for complications and clinical outcomes in SARS-CoV2 infection, this takes special interest in patients with Inflammatory Bowel Disease (IBD), where there are a significant proportion of patients under immunosuppressant treatment such as biologics and steroids. On the other hand, SARS-CoV2 infection has been associated with recurrence or new onset of immune-mediated diseases like IBD. Methods This is a transversal, descriptive and observational study that included patients with IBD and history of SARS-CoV2 infection detected by laboratory tests and accepted to answer the questionary. Analyzed variables: sex, type of IBD (phenotype and localization), COVID-19 symptoms, treatment and severity, exacerbations, and its symptoms. Statics: we used SPSS software version 25 for the descriptive analysis and frequencies. Results We interviewed 186 patients, 105 women (56.5%) and 81 men (43.5%); 146 (78.5%) had Ulcerative Colitis (UC) and 40 (21.5%) Crohn´s disease (CD). Of the total of interviewed patients 82 (44.3%) had history of SARS-CoV2 infection, 16 (19.3%) were asymptomatic, 59 (71.1%) had a mild course of the infection, 8 (9.6%) moderate and no one had severe disease. The most common clinical manifestations were asthenia/adynamia (61.2%), cough (50.7%) headache (44.8%), rhinorrhea (44.8%) and fever (43.3%). Gastrointestinal manifestations were presented in less than 10%. For the infection treatment 69.1% patients used acetaminophen, 13.2% nonesteroideal anti inflammatory drugs (NSAIDs), 1.5% steroids and 4.4% antiviral therapy. Of the 82 patients who presented the infection, 24 (29.3%) had at least one clinical manifestation of disease flare. The most common one was diarrhea in 15 patients (62.5%),10 (41.6%) had abdominal pain, 7 (20.1%) patients had arthralgia and one patient (4.1%) required hospitalization due to disease flare. Of the 24 patients that had disease flare, only 10 (41.6%) received treatment optimization. Conclusion SARS-CoV2 infection prevalence in patients with IBD were 44.2% in this study. The most common clinical course of the infection was mild and moderate disease, no severe cases were reported. The infection caused mild to moderate exacerbation in 28% patients and one patient had severe exacerbation that required hospitalization.

P139 A potential protective rule of Mannose Binding lectin (MBL) against SARS-COV2 infection in IBD patients

Abstract Background Since the beginning of the COVID-19 pandemic, IBD patients have appeared to be less susceptible to a severe form of the disease, despite undergoing immunosuppressive treatments. Mannose binding lectin (MBL) is a humoral fluid-phase pattern recognition molecule (PRM) crucial for activating the lectin complement pathway. It is capable of binding to the spike protein and blocking SARS-CoV-2 infection. Low MBL expression has been linked to poor outcomes in both SARS and SARS- CoV-2 infections. In IBD patients, the role of MBL is controversial; low concentrations seem to predispose individuals to the development of IBD, while high concentrations have been observed in severe forms of Crohn's disease. Methods Since April 2020, 104 IBD patients have been enrolled, with 20% treated with mesalazine, 50% with Anti-TNFa, 20% with Vedolizumab, and 20% receiving no treatment. Additionally, 45 healthy controls (HC) from North Italy were included. Serum samples and colon biopsies from inflamed and non- inflamed mucosa were collected. Serum samples underwent an ELISA test to quantify circulating MBL concentration, and MBL gene expression in biopsies was analyzed using qPCR. Results Both Crohn's disease and Ulcerative Colitis patients exhibited significantly higher circulating MBL levels than HC (411.6 ± 45.5 ng/ml vs. 160.9 ± 35.3 ng/ml, p &amp;lt; 0.05). Patients treated with Anti-TNFa showed significantly higher circulating MBL levels compared to those not undergoing therapy (530.1 ± 76.5 ng/ml vs. 225.4 ± 61.6 ng/ml, p &amp;lt; 0.05) and patients receiving Vedolizumab (530.1 ± 76.5 ng/ml vs. 155.3 ± 32.1 ng/ml, p &amp;lt; 0.05). MBL intestinal gene expression is higher in IBD patients than HC (5.55 ± 0.9 vs. 2.36 ± 0.6; p=0.591) and tended to be elevated at similar levels in inflamed and non-inflamed mucosa (5.14 ± 1.4 vs. 5.79 ± 1.1; p=0.337), suggesting a prevalent genetic determination of MBL concentration regardless of the inflammatory background. Conclusion MBL appears to play a key role in SARS-CoV-2 infection. We demonstrate that IBD patients have, on average, higher circulating MBL levels than HC independently of their inflammatory status. The highest MBL levels were observed in patients treated with Anti-TNFa. These findings contribute to understanding the reported low mortality and hospitalization for COVID-19 among IBD patients treated with Anti-TNFa.

Neurological disorders throughout acute SARS-CoV2 infection: A comparative study between vaccinated and non-vaccinated patients

BackgroundThe role of vaccination on Covid-19 severity in neurological patients is still unknown. We aim at describing clinical characteristics and outcomes of breakthrough and unvaccinated Covid-19 patients hospitalized for neurological disorders. MethodsTwo hundred thirty-two Covid-19 patients were admitted to a neuro-Covid Unit form March 1st 2021 to February 28th 2022. Out of the total sample, 74 (32%) were full vaccinated. The prevalence, clinical characteristics, disease severity, expressed by Brescia-COVID Respiratory Severity Scale (BCRSS) and National Early Warning Score 2 (NEWS2), and final outcomes of neurological syndromes were compared between vaccinated and unvaccinated cases.Cox regression analysis was implemented in order to investigate the combined effect of predictors of mortality. ResultsBreakthrough vaccinated cases were older (years 72.4 ± 16.3 vs 67.0 ± 18.9 years, p = 0.029), showed higher pre-admission comorbidity score and Clinical Frailty scale score (4.46 ± 1.6 vs 3.75 ± 2.0, p = 0.008) with no differences in terms of disease progression or mortality rate (16.2% vs 15.2%), compared to full-dose vaccinated patients.Cox-regression analysis showed age and NEWS2 score as the variables with a significant relation to mortality between the two groups, independently from pre-morbid conditions and inflammatory response. ConclusionThis study on breakthrough COVID-19 infection could help identify vulnerable neurological patients with higher risk of poor outcomes.

Efficacy and safety of antiviral plus anti-spike monoclonal antibody combination therapy vs. monotherapy for high-risk immunocompromised patients with mild-to-moderate SARS-CoV2 infection during the Omicron era: A prospective cohort study

Antivirals and monoclonal antibodies lower the risk of progression in immunocompromised patients. However, combination therapy with both types of agents has not been studied. This was a single-centre, prospective, cohort study. All immunocompromised patients who received treatment for mild-to-moderate COVID-19 from 1 January 2022 to 30 October 2022 were enrolled. The primary endpoint was COVID-19 progression at 90 days, defined as hospital admission or death due to COVID-19 and/or seronegative persistent COVID-19. A total of 304 patients were included: 43 patients (14.1%) received sotrovimab plus a direct-acting antiviral, and 261 (85.9%) received monotherapy. Primary outcome occurred more frequently after monotherapy (4.6% vs. 0%, P=0.154). Among patients with anti-spike immunoglobulin G (anti-S IgG) titre <750 BAU/mL, COVID-19 progression was more common after monotherapy (23.9% vs. 0%, P=0.001), including more frequent COVID-related admission (15.2% vs. 0%, P=0.014) and seronegative persistent COVID-19 (10.9% vs. 0%, P=0.044). Combination therapy was associated with lower risk of progression (odds ratio [OR] 0.08, 95% confidence interval [95% CI] 0.01-0.64). Anti-S IgG titre <750 BAU/mL and previous anti-CD20 were associated with higher risk of progression (OR 13.70, 95% CI 2.77-67.68; and OR 3.05, 95% CI 1.20-10.94, respectively). In immunocompromised patients, combination therapy with sotrovimab plus an antiviral may be more effective than monotherapy for SARS-CoV2.

Association of respiratory infections and the impact of vaccinations on cardiovascular diseases.

Influenza, pneumococcal, severe acute respiratory syndrome coronavirus 2, and respiratory syncytial virus infections are important causes of high morbidity and mortality in the elderly. Beyond the burden of infectious diseases, they are also associated with several non-infectious complications like cardiovascular events. A growing body of evidence in prospective studies and meta-analyses has shown the impact of influenza and pneumococcal vaccines on types of cardiovascular outcomes in the general population. Influenza vaccination showed a potential benefit for primary and secondary prevention of cardiovascular diseases across all ages. A reduced risk of cardiovascular events for individuals aged 65 years and older was associated with pneumococcal vaccination. Despite scientific evidence on the effectiveness, safety, and benefits of the vaccines and recommendations to vaccinate elderly patients and those with risk factors, vaccination rates remain sub-optimal in this population. Doubts about vaccine necessity or efficacy and concerns about possible adverse events in patients and physicians refer to delayed acceptance. Vaccination campaigns targeting increasing professional recommendations and public perceptions should be implemented in the coming years. The aim of this review paper is to summarize the effect of vaccination in the field of cardiovascular disease to achieve a higher vaccination rate in this patient population.

Assessment of functional fitness impacted by hospital rehabilitation in post-stroke patients who additionally contracted COVID-19.

The aim of the study was to assess the effects of rehabilitation in post-stroke patients, or post-stroke patients with simultaneous COVID-19 infection, in relation to: improved locomotion efficiency, improved balance, reduced risk of falling as well as the patients' more effective performance in everyday activities. The study involved 60 patients in the early period (2-3 months) after a stroke. Group I consisted of 18 patients (30.0%) who, in addition to a stroke, also contracted COVID-19. Group II consisted of 42 patients (70%) post-stroke, with no SARS-CoV2 infection. The effects were assessed on the basis of: Tinetti test, Timed Up & Go test and Barthel scale. Both groups achieved a statistically significant improvement in their Barthel score after therapy (p < 0.001). The Tinetti test, assessing gait and balance, showed that participants in Group I improved their score by an average of 4.22 points. ±4.35, and in Group II, on average, by 3.48 points ± 3.45 points. In the Timed Up & Go test over a distance of 3 m, significant improvement was achieved in both groups, as well but the effect was higher in Group I (p < 0.001). Hospital rehabilitation in the early period after stroke improved locomotion efficiency and balance, and reduced the risk of falls in post-stroke patients, both with and without COVID-19 infection.

Epidemiological survey of elderly patients diagnosed with COVID-19 at mobile field hospitals.

During the COVID-19 pandemic, the mobile field hospital, a rapidly deployable healthcare facility for emergency care, was effective in ensuring rapid diagnosis and treatment of patients with mild or asymptomatic SARS-CoV2 infections, effectively preventing the spread of COVID-19. We conducted a survey to gain a thorough understanding of the epidemiological traits among the elderly who contracted the Omicron variant of the SARS-CoV-2 virus at a mobile field hospital set up at the National Exhibition and Convention Center (Shanghai). A cross-sectional study approach was employed to examine various factors such as demographic characteristics, clinical features, vaccination status, and nucleic acid testing. We utilized the DezhenTech Integrated Electronic Medical Record Platform (Municipal Isolation Hospital) to collect data and focused on elderly individuals infected with COVID-19 in the fifth isolation zone of the mobile field hospital set up at the National Exhibition and Convention Center (Shanghai). The patients were categorized into different age groups for analysis. Among the 3,183 elderly patients, 54.7% were males and 45.3% were females, with an average age of 65.32 ± 4.41years. Among them, 47.8% (1523/3183) were 60-64 years old, 34.0% (1082/3183) were 65-69 years old, 14.0% (444/3183) were 70-74 years old, 3.2% (103/3183) were 75-79 years old, and 1.0% (31/3183) were ⩾ 80 years old. The majority (95.7%) of the elderly patients with chronic conditions had hypertension, diabetes, and coronary heart disease. The first viral nucleic acid screening showed a higher positive rate in the community and hospital fever clinics. The cumulative positive rate of the nucleic acid test in the mobile field hospital was 38.7%. The average CT value of the COVID-19 ORF1ab gene was 34.56 ± 5.98, while the average CT value of the N gene was 33.10 ± 6.50. The patients took an average of 3.40 ± 0.45 days to test negative, with a positive rate of 15.4% and an average hospital stay of 7.45 ± 0.53 days. The overall rate of COVID-19 vaccine coverage was 68.0%, with an enhanced coverage rate of 40% and a non-coverage rate of 29.3%. The overall prognosis for elderly patients who experienced a mild or asymptomatic SARS-CoV-2 Omicron infection at the mobile field hospital was favorable, although the vaccination rate in general was not high. By effectively managing underlying health conditions, the duration of their hospital stay in the mobile field hospital was reduced.

Effects of the COVID-19 Pandemic in Patients with Systemic Autoinflammatory Diseases. An international survey

Background: Early in the COVID-19 pandemic it was recognized that individuals who had worse prognoses had hyperinflammatory reactions associated with SARS CoV-2. This was worrisome for patients with systemic autoinflammatory diseases (SAID) who already have episodic hyperinflammation at baseline. Aim: To assess the effects of the COVID-19 pandemic and SARS CoV-2 infection on patients with SAID. Methods: An anonymous survey developed on the Survey Monkey platform was distributed online through social media and support groups of patients with SAID between January 20th and May 17th of 2021. Results: We analyzed 484 surveys that conveyed data from 593 patients with SAID. Seventy-four percent of the surveys were answered in the United States, US territories, and Canada (n=360/484) and the rest from other countries. Sixty percent (n=330/547) of patients with SAID did not experience changes in the frequency of flares during the first year of the pandemic. Ten percent (n=52/545) of patients had presumed or confirmed COVID-19. Of those, 81% (n=42/52) had mild and moderate symptoms and 4 were hospitalized. Thirty-one percent (n=16/52) experienced flares during or after the infection and 40% (n=21/52) reported post-COVID manifestations. The individuals who had moderate symptoms or were hospitalized for COVID-19 were more likely to report post-COVID manifestations, OR 5.25 (95%CI 1.57-17.6, p=0.0072). Post-COVID integumentary manifestations occurred after asymptomatic and mild COVID-19 whereas neurologic manifestations occurred after acute COVID-19 with moderate symptoms or requiring hospitalization. Conclusion: During the COVID-19 pandemic, over half of patients with SAID did not experience changes in the frequency of flares despite a decreased exposure to environmental triggers. Few individuals with SAID required hospitalization for COVID-19. The presence and type of post-COVID manifestations were associated with the severity of acute COVID-19 in patients with SAID.