Setting Of Coronavirus Disease 2019 Infection Research Articles

Bowel Necrosis in the Setting of COVID-19 Infection, Report of 2 Cases

Severe respiratory syndrome coronavirus 2 (SARS-CoV-2) is well known for causing respiratory and other extrapulmonary manifestations. Patients infected with coronavirus disease 2019 (COVID-19) may demonstrate atypical presentations with gastrointestinal symptoms. Clinicians managing these patients should reserve a high index of suspicion for the rare complication of acute mesenteric ischemia (AMI). It is a challenging diagnosis that is often missed when presenting symptoms are subtle and nonspecific like nausea, emesis, or diarrhea. Outcomes are typically catastrophic and fatal as bowel ischemia progresses to necrosis but may be averted with timely diagnostic and therapeutic methods to swiftly restore blood flow.

Outcome of COVID-19 in Egyptian living-donor kidney transplant recipients and relation to maintenance immunosuppressive drugs: a pilot study

Coronavirus disease 2019 (COVID-19) in kidney transplant recipients is a subject of much debate and became of interest to nephrologists amidst the pandemic. The main concerns are the influence of the chronic use of immunosuppressive drugs, the viral-related risk of acute rejection, and the long-term outcome of allograft function. This single-center prospective study included kidney transplant recipients with COVID-19 infection. Patients were maintained on immunosuppressive regimens. The severity of disease was defined as oxygen saturation < 94%, the need for hospitalization and/or hemodialysis, the occurrence of acute kidney injury (AKI), and mortality. Seventeen patients (54.8%) required hospital admission, four patients needed hemodialysis (12.9%), twelve patients (38.7%) had AKI, and three patients died (9.7%). Oxygen saturation < 94% showed a positive correlation with the presence of diabetes (p value 0.031) and a negative correlation with the maintenance steroid dose (p value 0.046). A negative correlation existed between the need for hemodialysis and average Cyclosporin level (p value 0.019) and between the need for hospitalization and average Tacrolimus level (p value 0.046). Severity of disease was associated with the presence of lymphopenia (p value 0.042), the cumulative steroid dose (p value 0.001), increased serum levels of LDH (p value 0.010), Ferritin (p value 0.020), AST (p value 0.047), and ALT (p value 0.006) and D-dimer levels more than 0.5 mg/L (p value 0.038). This study highlighted that the immunocompromised state of renal transplant recipients may not be regarded as a disadvantage in the setting of COVID-19 infection. Studies on a larger scale are needed to validate these results.

The Exacerbation of Lutembatcher Syndrome in The Setting of COVID-19 infection: A Rare Case Report

Lutembatcher syndrome is a rare cardiac condition characterized by a combination of the atrial septal defect (ASD; congenital or iatrogenic) and mitral stenosis (MS; congenital or acquired). Patients with Lutembatcher syndrome and adults with congenital heart disease (ACHD) in general may be at high risk when accompanied by coronavirus disease 2019 (COVID-19). Since there is no published study on the impact of COVID-19 on ACHD, little is known about management strategies in this subset of patients. Herein, we report a young adult female presented with abdominal discomfort, swollen legs, fever, cough, and dyspnea. The patient had developed palpitation and exercise intolerance five years ago but paid it no attention. Echocardiography revealed large secundum type ASD with severe MS (Wilkins score of eight) and a nasopharyngeal swab confirmed SARS-COV-2 infection. The patient was diagnosed with Lutembacher syndrome and COVID-19. Intensive treatment was given to relieve symptoms due to heart failure and to treat COVID-19 pneumonia. Patients with Lutembatcher syndrome are at a higher risk of being infected with COVID-19 and manifest into severe infections. Therefore, determining the risk of infection and the severity of COVID-19 in ACHD patients are required during the pandemic.

Failure of Therapeutic Anticoagulation in COVID-19 Patients With Acute Ischemic Stroke. A Retrospective Multicenter Study.

BackgroundAcute ischemic stroke (AIS) is a possible complication of coronavirus disease 2019 (COVID-19) infection. Although peculiar clinical features and underlying specific mechanisms of thrombogenesis have been suggested so far, there is no consensus on the appropriate vascular preventive drug regimen in patients with COVID-19.Aim and MethodsFrom a larger clinical series of consecutive acute ischemic strokes related to COVID-19 admitted to three cerebrovascular units in Northern Italy, herein, we describe the clinical features of a subgroup of patients in whom stroke occurred despite therapeutic anticoagulation.ResultsA total of seventeen/80 AIS related to COVID-19 (21.2%) occurred in anticoagulated patients. Although no blood level was available for Direct Oral AntiCoagulant, the drug dosage was appropriate according to guidelines. Their National Institute of Health Stroke Scale (NIHSS) at admission was 12.0 (SD = 7.4) and 58.8% of them had evidence of large vessel occlusion. The case fatality rate was as high as 64.7%.Discussion and ConclusionsThe occurrence of an anticoagulation failure seems to be increased in the setting of COVID-19 infection, with worse clinical outcomes if compared to non-COVID-19 related ischemic strokes. We discuss the diagnostic and therapeutic implications of such evidence, suggesting that some arterial thrombotic complications might be either resistant to or independent of the anticoagulation effect.

COVID-19 Aortitis: A Review of Published Cases.

Coronavirus disease 2019 (COVID-19) has a myriad of different presentations and various complications. Aortitis is one of the less explored pathologies associated with COVID-19 infections. In this review, we searched PubMed/Medline, Web of Science, Google Scholar, and Scopus for case series and case reports involving adults patients who presented with aortitis and COVID-19. We found and reviewed four published case reports of aortitis in a setting of COVID-19 infection. The mean age of the four adult patients was 69 ± 1.732 years (range = 63-71 years), and all patients were males. Most of the patients (75%) did not have any preexisting comorbidities. All patients were treated conservatively and recovered with excellent outcomes.

A rare case report of transient pancytopenia in a patient with coronavirus disease 2019

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for coronavirus disease 2019 (COVID-19) infection. The ongoing pandemic of COVID?19 has sought the attention of clinicians and researchers to investigate and describe its various pathological aspects. Infection with SARS-CoV-2 and the resulting COVID-19 can affect virtually any organ of the human body, including the bone marrow which, in turn, causes pancytopenia. Diagnosing pancytopenia in the setting of COVID-19 infection is challenging and requires ruling out all other potential causes of pancytopenia. Herein, we report a rare case of severe pancytopenia secondary to COVID-19 infection that developed severe transient pancytopenia which improved with conservative management.

Coronavirus Disease 2019 and Pituitary Apoplexy: A Single-Center Case Series and Review of the Literature

BackgroundPituitary apoplexy (PA) is a rare, but life-threatening, condition characterized by pituitary infarction and hemorrhage, most often in the setting of a preexisting adenoma. The risk factors and mechanisms associated with PA are poorly understood. Although neurovascular manifestations of coronavirus disease 2019 (COVID-19) infection have been documented, its association with PA has not yet been determined.MethodsFrom a prospectively collected database of patients treated at a tertiary care center for pituitary adenoma, we conducted a retrospective medical record review of PA cases during the COVID-19 pandemic from March 2020 to December 2020. We also conducted a literature review to identify other reported cases.ResultsWe identified 3 consecutive cases of PA and concomitant COVID-19 infection. The most common symptoms at presentation were headache and vision changes. The included patients were successfully treated with surgical decompression and medical management of the associated endocrinopathy, ultimately experiencing improvement in their visual symptoms at the latest follow-up examination. COVID-19 infection in the perioperative period was corroborated by polymerase chain reaction test results in all the patients.ConclusionsWith the addition of our series to the literature, 10 cases of PA in the setting of COVID-19 infection have been confirmed. The present series was limited in its ability to draw conclusions about the relationship between these 2 entities. However, COVID-19 infection might represent a risk factor for the development of PA. Further studies are required.

Deep vein thrombosis and pulmonary embolism among hospitalized coronavirus disease 2019–positive patients predicted for higher mortality and prolonged intensive care unit and hospital stays in a multisite healthcare system

ObjectiveWe assessed the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in hospitalized patients with coronavirus disease 2019 (COVID-19) compared with that in a matched cohort with similar cardiovascular risk factors and the effects of DVT and PE on the hospital course. MethodsWe performed a retrospective review of prospectively collected data from COVID-19 patients who had been hospitalized from March 11, 2020 to September 4, 2020. The patients were randomly matched in a 1:1 ratio by age, sex, hospital of admission, smoking history, diabetes mellitus, and coronary artery disease with a cohort of patients without COVID-19. The primary end point was the incidence of DVT/PE and the odds of developing DVT/PE using a conditional logistic regression model. The secondary end point was the hospitalization outcomes for COVID-19 patients with and without DVT/PE, including mortality, intensive care unit (ICU) admission, ICU stay, and length of hospitalization (LOH). Multivariable regression analysis was performed to identify the variables associated with mortality, ICU admission, discharge disposition, ICU duration, and LOH. ResultsA total of 13,310 patients had tested positive for COVID-19, 915 of whom (6.9%) had been hospitalized across our multisite health care system. The mean age of the hospitalized patients was 60.8 ± 17.0 years, and 396 (43.3%) were women. Of the 915 patients, 82 (9.0%) had had a diagnosis of DVT/PE confirmed by ultrasound examination of the extremities and/or computed tomography angiography of the chest. The odds of presenting with DVT/PE in the setting of COVID-19 infection was greater than that without COVID-19 infection (0.6% [5 of 915] vs 9.0% [82 of 915]; odds ratio [OR], 18; 95% confidence interval [CI], 8.0-51.2; P < .001). The vascular risk factors were not different between the COVID-19 patients with and without DVT/PE. Mortality (P = .02), the need for ICU stay (P < .001), duration of ICU stay (P < .001), and LOH (P < .001) were greater in the DVT/PE cohort than in the cohort without DVT/PE. On multivariable logistic regression analysis, the hemoglobin (OR, 0.71; 95% CI, 0.46-0.95; P = .04) and D-dimer (OR, 1.0; 95% CI, 0.33-1.56; P = .03) levels were associated with higher mortality. Higher activated partial thromboplastin times (OR, 1.1; 95% CI, 1.00-1.12; P = .03) and higher interleukin-6 (IL-6) levels (OR, 1.0; 95% CI, 1.01-1.07; P = .05) were associated with a greater risk of ICU admission. IL-6 (OR, 1.0; 95% CI, 1.00-1.02; P = .05) was associated with a greater risk of rehabilitation placement after discharge. On multivariable gamma regression analysis, hemoglobin (coefficient, −3.0; 95% CI, 0.03-0.08; P = .005) was associated with a prolonged ICU stay, and the activated partial thromboplastin time (coefficient, 2.0; 95% CI, 0.003-0.006; P = .05), international normalized ratio (coefficient, −3.2; 95% CI, 0.06-0.19; P = .002) and IL-6 (coefficient, 2.4; 95% CI, 0.0011-0.0027; P = .02) were associated with a prolonged LOH. ConclusionsA significantly greater incidence of DVT/PE occurred in hospitalized COVID-19–positive patients compared with a non–COVID-19 cohort matched for cardiovascular risk factors. Patients affected by DVT/PE were more likely to experience greater mortality, to require ICU admission, and experience prolonged ICU stays and LOH compared with COVID-19–positive patients without DVT/PE. Advancements in DVT/PE prevention are needed for patients hospitalized for COVID-19 infection.

Difficult Airway Management in Adult Coronavirus Disease 2019 Patients: Statement by the Society of Airway Management.

The coronavirus disease 2019 (COVID-19) disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), often results in severe hypoxemia requiring airway management. Because SARS-CoV-2 virus is spread via respiratory droplets, bag-mask ventilation, intubation, and extubation may place health care workers (HCW) at risk. While existing recommendations address airway management in patients with COVID-19, no guidance exists specifically for difficult airway management. Some strategies normally recommended for difficult airway management may not be ideal in the setting of COVID-19 infection. To address this issue, the Society for Airway Management (SAM) created a task force to review existing literature and current practice guidelines for difficult airway management by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. The SAM task force created recommendations for the management of known or suspected difficult airway in the setting of known or suspected COVID-19 infection. The goal of the task force was to optimize successful airway management while minimizing exposure risk. Each member conducted a literature review on specific clinical practice section utilizing standard search engines (PubMed, Ovid, Google Scholar). Existing recommendations and evidence for difficult airway management in the COVID-19 context were developed. Each specific recommendation was discussed among task force members and modified until unanimously approved by all task force members. Elements of Appraisal of Guidelines Research and Evaluation (AGREE) Reporting Checklist for dissemination of clinical practice guidelines were utilized to develop this statement. Airway management in the COVID-19 patient increases HCW exposure risk. Difficult airway management often takes longer and may involve multiple procedures with aerosolization potential, and strict adherence to personal protective equipment (PPE) protocols is mandatory to reduce risk to providers. When a patient's airway risk assessment suggests that awake tracheal intubation is an appropriate choice of technique, and procedures that may cause increased aerosolization of secretions should be avoided. Optimal preoxygenation before induction with a tight seal facemask may be performed to reduce the risk of hypoxemia. Unless the patient is experiencing oxygen desaturation, positive pressure bag-mask ventilation after induction may be avoided to reduce aerosolization. For optimal intubating conditions, patients should be anesthetized with full muscle relaxation. Videolaryngoscopy is recommended as a first-line strategy for airway management. If emergent invasive airway access is indicated, then we recommend a surgical technique such as scalpel-bougie-tube, rather than an aerosolizing generating procedure, such as transtracheal jet ventilation. This statement represents recommendations by the SAM task force for the difficult airway management of adults with COVID-19 with the goal to optimize successful airway management while minimizing the risk of clinician exposure.

Outcomes of COVID-19 Infection in Patients with Hematologic Malignancies

The coronavirus disease 2019 (COVID-19) outbreak, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic on March 11, 2020. This novel virus can cause a rapid progression from cough to acute respiratory distress syndrome and death. Cancer patients infected with COVID-19 were reported to have a 39% incidence of severe events, including admission to intensive care unit (ICU), mechanical ventilation, or death. Patients with hematologic malignancies, especially those undergoing treatment, are a particularly at-risk population due to disease-related impairment of the immune system and chemotherapy-induced neutropenia. The goal of this study is to analyze outcomes of COVID-19 infected patients with hematologic malignancies in order to better understand the impact of SARS-CoV-2 on this vulnerable population.MethodsWe performed a retrospective analysis on 26 COVID-19 positive patients with hematologic malignancies identified at our center. On July 22, 2020, there were 264 COVID-19 positive patients with hematologic malignancies (including our center's 26 patients) reported to the American Society of Hematology Research Collaborative COVID-19 Registry (ASH RC), a global public reference tool. We extracted our patient's data from each category reported to the ASH RC and compared hospitalization, ICU admissions, and mortality rates between our cohort and the remaining 238 cases. Chi-square test was used for analyses. We also performed a subgroup analysis comparing demographics; type and status of hematologic malignancy, as well as COVID-19 directed treatments between our center's patients and the patients reported to the ASH RC.ResultsBetween March and June 2020, a total of 1265 COVID-19 positive patients were hospitalized at our institution. A significantly higher percentage of COVID-19 patients with hematologic malignancies were hospitalized at our institution compared to the ASH RC (61.5% versus 35.3%, P=. 009). There was no difference in ICU admission rate at our center compared to the ASH RC (23.1% versus 30.2%, P=.45). Significantly less COVID-19 directed therapies were administered at our center compared to the ASH RC (46.2% versus 66.4%, P=.041). Our patients received: 7.7% Remdesivir, 11.5% Tocilizumab, 15.4% hydroxychloroquine, 11.5% azithromycin, 0% convalescent plasma, compared to the ASH RC: 1.7% Remdesivir, 5.5% Tocilizumab, 30.3% hydroxychloroquine, 25.6% azithromycin, 4.6% convalescent plasma. Lastly, our institution had a significantly decreased mortality rate compared to the ASH RC (11.5% versus 29.8%, P=.049). Demographics as well as type and status of hematologic malignancy comparing the two cohorts are shown in Table 1.ConclusionsIn our comparative analysis, we found that our center’s patients were hospitalized significantly more than the ASH RC cohort yet had lower mortality rates. These differences were seen despite similar distribution of malignancy types between the two groups. It should be noted that more patients in our cohort were in remission and none presented at initial cancer diagnosis at the time of infection, which may have contributed to better outcomes. The difference in mortality rates may also be attributed to variance in provider experience, higher percentage of patients >80 years of age reported to the ASH RC, and closer patient monitoring at our center due to a higher hospitalization rate. Differences in ICU admissions were not significant, suggesting a similar rate of severe COVID-19 infection between the two cohorts. Our demographics reflect the urban population we serve with more African Americans and Hispanics compared to the ASH RC. The greater number of COVID-19 directed therapies in the ASH RC cohort compared to ours is likely attributed to the use of convalescent plasma, which was not commonly used as COVID-19 directed treatment at our institution. Limitations of our study include a restricted time frame, small sample size, and the possibility of incomplete datasets within the ASH RC, as stated on the registry’s website. In conclusion, we recommend close monitoring and a lower threshold for hospitalizing patients with hematologic malignancies in the setting of COVID-19 infection; however, additional prospective studies are needed to confirm our findings, and further investigate the complications and outcomes of SARS-CoV-2 on this at-risk population.DisclosuresUstun:Kadmon: Honoraria. Shammo:Celgene: Consultancy, Research Funding, Speakers Bureau; BMS: Consultancy, Research Funding, Speakers Bureau; Onconova: Research Funding; Incyte: Consultancy, Research Funding, Speakers Bureau; Apellis: Consultancy; Regeneron: Consultancy; Novartis: Consultancy; Agios: Consultancy; Sanofi: Speakers Bureau; Abbive: Current equity holder in publicly-traded company; Baxter: Current equity holder in publicly-traded company; Takeda: Current equity holder in publicly-traded company; Alexion: Consultancy, Research Funding, Speakers Bureau.

S3306 H2-Blocker Use Is Associated With Acute Kidney Injury Among COVID-19 Patients

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) has infected over 6.5 million people worldwide, claiming nearly 400,000 lives as of June 2020. Among those hospitalized, acute kidney injury (AKI) occurs in approximately 20–40% of patients. Proton pump inhibitors (PPIs) and H2-blockers (H2Bs) are commonly used medications and have been linked to acute and chronic interstitial nephritis. We assessed the association between PPI or H2B use prior to admission and AKI among patients admitted with COVID-19 infections. METHODS: This was a single center retrospective cohort study. Adult patients with confirmed COVID-19 infection admitted from March to April 2020 were identified. Patients with end-stage renal disease were excluded. Charts were reviewed for patient demographics, outpatient medication list, creatinine at baseline and upon admission, and hospital course. The primary outcome was any association between PPI or H2B use with development of AKI. RESULTS: We reviewed 100 consecutive patients admitted with COVID-19 and 93 patients were included. The mean age of this cohort was 58.9 years and 36.5% were female (Table 1). Sixteen patients were prescribed a PPI prior to admission and 6 patients were on H2B. Of the 93 patients, 84 did not have known chronic kidney disease (CKD). Among patients without CKD, PPI use was not associated with AKI (P = 0.857) but patients taking H2Bs were more likely to develop AKI on admission (P = 0.032) (Figure 1). There were no differences in average BUN-to-creatinine ratios (P = 0.172) or rates of systemic inflammatory response syndrome (P = 0.904) between those who were on H2Bs versus those who were not. CONCLUSION: Among non-CKD patients who were admitted for COVID-19 infection, H2B use was associated with development of AKI whereas PPI use was not. In vitro studies have shown cimetidine to raise serum creatinine theoretically by competitive tubular secretion for creatinine. In the setting of COVID-19 infection and systemic inflammation, reduced renal blood flow adds insult to the kidneys and may synergistically raise serum creatinine with famotidine use. Increased awareness of the relationship between medications and COVID-19 infection may be helpful in providing comprehensive care for critically ill patients.Table 1.: Demographics and clinical characteristicsFigure 1.: Incidence of acute kidney injury (AKI) on admission among patients without chronic kidney disease (CKD).

Progressive Hypoxia: A Pivotal Pathophysiologic Mechanism of COVID-19 Pneumonia

Progressive Hypoxia: A Pivotal Pathophysiologic Mechanism of COVID-19 Pneumonia

Acute Fulminant Myocarditis in a Pediatric Patient With COVID-19 Infection.

The majority of patients with coronavirus disease 2019 (COVID-19) display pulmonary disease; however, a significant portion of patients have cardiac injury as well, with a high incidence of myocarditis documented in the adult population. Pediatric disease from COVID-19 has been relatively rare, and no cases of virus-related cardiac disease have been published. We present a case of an adolescent girl with fulminant myocarditis with complete heart block, elevated troponin I levels, and severely depressed systolic function in the setting of COVID-19 infection.

COVID-19 in Kidney Transplantation: Outcomes, Immunosuppression Management, and Operational Challenges.

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2, has led to the death of hundreds of thousands of people worldwide. If infected, older individuals and those with diabetes, hypertension, cardiovascular disease, and compromised immune systems are at higher risk for unfavorable outcomes. These comorbidities are prevalent in patients with kidney disease, hence the significant burden of COVID-19 on kidney transplant programs. Multiple case series of kidney transplant recipients with COVID-19 have shown increased mortality compared to nontransplant patients. To date, we do not have high-level evidence to inform immunosuppression minimization strategies in infected transplant recipients. Most centers however have adopted early antimetabolite withdrawal in addition to other interventions. This review summarizes the published COVID-19 literature as it relates to outcomes and immunosuppression management in kidney transplant recipients. It also discusses challenges pertaining to pretransplant evaluation and wait-listed patients.

Clinical course of asthma in 4 cases of coronavirus disease 2019 infection

Clinical course of asthma in 4 cases of coronavirus disease 2019 infection

MANAGEMENT OF COVID-19 IN PERSPECTIVE OF CARDIOLOGISTS

MANAGEMENT OF COVID-19 IN PERSPECTIVE OF CARDIOLOGISTS