Severe COVID-19 Illness Research Articles

Comparison of Some Biochemical Parameters in Covid-19 Patients and Vaccinated Individuals in Kirkuk/Iraq.

Corona virus2019(Covid-19) or severe Acute respiratory syndrome coronavirus-2 (SARS-Cov-2) has been reported by the World Health Organization (WHO) are global clinical biomarkers have been important in determining its severity, although its aspect have been well characterized, so the aim of this study is to investigate some common alteration in some biochemical parameters in serum of covid-19patients (hospitalized and non-hospitalized, vaccinated and control group. Study Design: The study conducted across sectional study in cohort of 167(40 hospitalized covid-19 whom paid a visit to Al-Shifaa-14 hospital, Kirkuk, from Iraq, 30 non-hospitalized covid-19, 67vaccinated individuals and 30 control healthy group), from december20,2021 till 20 March 2022. Their ages ranging from (20-75) years. The total 167 patients ,79 males and 88 were females. Age, comorbidities, and abnormalities in several clinical biomarkers have all been shown to be important in determining the severity of covid-19 illness in several investigations. Although the clinical aspects of COVID-19 have been well characterized, the assessment of changes in the most common biochemical indicators reported in COVID-19 patients is still lacking. So the study aimed to investigate common alterations in some biochemical parameters in the serum of COVID-19 patients (hospitalized and non-hospitalized), vaccinated individuals and control group. Sampling: Blood samples were collected from 167 individuals, then centrifuged to obtain serum for the biochemical tests that included B. urea and creatinine, Glutamic-pyruvic transaminase(GPT), Glutamic-oxaloacetic transaminase(GOT) and alkaline phosphatase (ALP). Nasopharyngeal swabs were collected from non-hospitalized of COVID-19 infection which was confirmed using real-time PCR technique. The study's findings revealed substantial variations in biochemical parameters between the examined groups in terms of creatinine (value >0.001) and urea (value >0.0001), as well as significant differences in GOT (value >0.0001) and ALP (value >0.0001). So this study can have concluded that patients infected with Covid-19 (hospitalized and infected outside the hospital- subsequently) have an increase in most biochemical parameters, however the effect was lower in the vaccinated group.

Antithrombin Activity Is Associated with Persistent Thromboinflammation and Mortality in Patients with Severe COVID-19 Illness

Introduction: Severe COVID-19 illness can lead to thrombotic complications, organ failure, and death. Antithrombin (AT) regulates thromboinflammation and is a key component of chemical thromboprophylaxis. Our goal was to examine the link between AT activity and responsiveness to thromboprophylaxis, markers of hypercoagulability, and inflammation among severe COVID-19 patients. Methods: This was a single-center, prospective observational study enrolling SARS-CoV-2-positive patients admitted to the intensive care unit on prophylactic enoxaparin. Blood was collected daily for 7 days to assess AT activity and anti-factor Xa levels. Patient demographics, outcomes, and hospital laboratory results were collected. Continuous variables were compared using Mann-Whitney tests, and categorical variables were compared using χ2 tests. Multivariable logistic regression was used to determine the association between AT activity and mortality. Results: In 36 patients, 3 thromboembolic events occurred, and 18 (50%) patients died. Patients who died had higher fibrinogen, D-dimer, and C-reactive protein (CRP) levels and lower AT activity. Reduced AT activity was independently associated with mortality and correlated with both markers of hypercoagulability (D-dimer) and inflammation (CRP). Conclusion: Low AT activity is associated with mortality and persistent hypercoagulable and proinflammatory states in severe COVID-19 patients. The anti-thromboinflammatory properties of AT make it an appealing therapeutic target for future studies.

COVID-19 and Other Underlying Causes of Cancer Deaths - United States, January 2018-July 2022.

Cancer survivors (persons who have received a diagnosis of cancer, from the time of diagnosis throughout their lifespan)* have increased risk for severe COVID-19 illness and mortality (1). This report describes characteristics of deaths reported to CDC's National Vital Statistics System (NVSS), for which cancer was listed as the underlying or a contributing cause (cancer deaths) during January 1, 2018-July 2, 2022. The underlying causes of death, including cancer and COVID-19, were examined by week, age, sex, race and ethnicity, and cancer type. Among an average of approximately 13,000 weekly cancer deaths, the percentage with cancer as the underlying cause was 90% in 2018 and 2019, 88% in 2020, and 87% in 2021. The percentage of cancer deaths with COVID-19 as the underlying cause differed by time (2.0% overall in 2020 and 2.4% in 2021, ranging from 0.2% to 7.2% by week), with higher percentages during peaks in the COVID-19 pandemic. The percentage of cancer deaths with COVID-19 as the underlying cause also differed by the characteristics examined, with higher percentages observed in 2021 among persons aged ≥65 years (2.4% among persons aged 65-74 years, 2.6% among persons aged 75-84 years, and 2.4% among persons aged ≥85 years); males (2.6%); persons categorized as non-Hispanic American Indian or Alaska Native (AI/AN) (3.4%), Hispanic or Latino (Hispanic) (3.2%), or non-Hispanic Black or African American (Black) (2.5%); and persons with hematologic cancers, including leukemia (7.4%), lymphoma (7.3%), and myeloma (5.8%). This report found differences by age, sex, race and ethnicity, and cancer type in the percentage of cancer deaths with COVID-19 as the underlying cause. These results might guide multicomponent COVID-19 prevention interventions and ongoing, cross-cutting efforts to reduce health disparities and address structural and social determinants of health among cancer survivors, which might help protect those at disproportionate and increased risk for death from COVID-19.

1072. SARS-CoV-2 Antibody Levels Associate with Neutrophil Activation

Abstract Background COVID-19 disease severity and outcomes have been linked to high antibody titers and a dysregulated neutrophil immune response. Here we query associations and connections between the endogenous SARS-CoV-2 antibody response and neutrophil activation in COVID-19. Methods Baseline serum or plasma samples from 57 patients hospitalized on oxygen with COVID-19 were used to perform; 1) quantitative measurements of SARS-CoV-2 specific antibodies using a luciferase-based immunoprecipitation system assay, 2) quantitative measurements of neutrophil specific biomarkers using Luminex technology, and 3) neutrophil extracellular traps (NETs) as measured by myeloperoxidase-DNA (MPO-DNA) complexes by ELISA. Absolute neutrophil count (ANC) and immature granulocyte count (IGC) were measured from complete blood counts (CBC). Antibody levels were compared by disease severity using Wilcoxon rank-sum test and correlations were generated between antibody levels and neutrophil activation markers using Spearman’s correlation (SC). Results In a cohort of hospitalized patients, severe/critical COVID-19 was associated with higher levels of nucleocapsid-IgA (p=0.011) as well as spike-IgG (p= 0.0007) compared to moderate disease, while spike-IgA and nucleocapsid-IgG showed similar associations, trending towards significance (Figure 1A). Levels of IgG-spike and IgG-nucleocapsid both had significant correlations with the ANC (SC 0.33, p = 0.029; SC 0.38 p = 0.012). All four antibody titers showed strong correlations with IGC, lactoferrin and lipocalin-2, evidence of emergency granulopoiesis. Further, S100A9, a component calprotectin correlated with spike-IgG and nucleocapsid-IgA levels (SC 0.29, p = 0.030, SC 0.29 p = 0.029). Lastly, we found circulating NETs correlated with spike IgA levels (SC 0.38 p = 0.006), and its correlations with IgG-spike and IgA-nucleocapsid additionally approached significance with NETs levels as well (Figure 1B). Antibody Levels Correlate with Disease Severity and Neutrophil Activation Markers Figure 1: A) Levels of anti-Spike and anti-Nucleocapsid IgA and IgG levels measured in the serum of 57 unvaccinated hospitalized COVID-19 patients. Moderate illness represents ordinal scale 5 requiring low flow oxygen, while severe/critical patients represent ordinal scale 6 and 7, requiring high flow oxygen, non-invasive or mechanical ventilation, respectively. P values are compared by a Wilcoxon ranked sum test. B) Heatmap showing Spearman correlations between levels of anti-Spike and anti-Nucleocapsid IgA and IgG and markers of neutrophil activation. P values for individual correlations are represented in parentheses. MPO (myeloperoxidase), ANC (absolute neutrophil count), S100A9 (S100 calcium binding protein A9). Conclusion Higher anti-spike and anti-nucleocapsid IgG and IgA levels associate with more severe COVID-19 illness. Further, endogenous SARS-CoV-2 specific antibody levels associate with markers of emergency granulopoiesis and neutrophil activation. Inhibiting antibody mediated neutrophil activation may improve outcomes in COVID-19. Disclosures All Authors: No reported disclosures.

Hypertension in Associated with COVID-19

The novel coronavirus infection (COVID-19), now a worldwide public health concern is associated with varied fatality. Patients with chronic underlying conditions like hypertension have shown worst outcomes. Hypertension is a multifactorial disease and a public health burden, as it is a risk factor for diseases like stroke, coronary artery disease, and heart failure. As one of the most important public health problems in the 21st century, hypertension affects more than one billion individuals worldwide. Hypertension is a common comorbidity in COVID-19 patients. However, the association of hypertension with the severity and fatality of COVID-19 remain unclear. Hypertension is a major risk factor regarding the severity and fatality of COVID-19, and the RAAS plays an important role in COVID-19 infection since SARS-CoV-2 can lead to a dysregulation of the system by reducing the ACE2 expression. Hypertension may also affect the prognosis of COVID-19 illness. The severity rate of COVID-19 in hypertensive patients was much higher than in non-hypertensive cases. A systematic literature search was conducted using several databases on studies that assess hypertension and outcome in COVID-19. Composite of poor outcome, comprising of mortality, severe COVID-19, acute respiratory distress syndrome (ARDS), need for intensive care unit (ICU) care and disease progression were the outcomes of interest. Authors independently reviewed some titles, abstracts and read full-texts of articles to identify potentially eligible studies to decide about final inclusions. This systematic review was conducted based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement. We used six different databases: Pubmed, Clinical Key, Science Direct, Cochrane Library, Springer Link and Oxford Academic. A total of 2731 articles from the databases were identified, we got three articles that fulfill the criteria. We excluded the other studies by reading the title, abstract, and full text assessment. Hypertension was associated with the severity and mortality of COVID-19 illness. Hypertension was also independently associated with a significantly increased risk of critical COVID-19 and inhospital mortality of COVID-19.

2298. Clinical and Demographic Characteristics of COVID-19 in Pediatric Patients in the United States

Abstract Background The percentage of children infected with COVID-19 has outpaced that of adults. As children >5 years are now eligible to receive vaccines, it is necessary to understand the effect of vaccination in the context of demographic characteristics, clinical factors, and variants on pediatric COVID-19 illness severity. Methods We conducted a descriptive study of patients ≤18 years from the Optum® COVID-19 electronic health record dataset. Patients were included if positive for COVID-19 by polymerase chain reaction or antigen testing for the first time from 3/12/2020 to 1/20/2022. We compare race and ethnicity, age, gender, US region of residence, vaccination status, body mass index (BMI), pediatric comorbidity index (PCI) (Sun, Am. J. Epidemiol. 2021), and predominant variant (by time and region) with 2-tailed t-test, multi-category chi-square test, and odds ratios (R version 4.1.2; α = 0.05). PCI is a validated comorbidity index predicting hospitalization in pediatric patients. Results Of all pediatric patients in our dataset, 165,468 (13.2%) tested positive for COVID-19. 3,087 (1.9%) were hospitalized, 1,417 (0.9%) were admitted to the ICU, 1545 (0.9%) received respiratory support, and 31 (0.02%) died, comparable to AAP-reported hospitalization and mortality rates in US children. Patients with severe outcomes were more likely to be younger, non-Caucasian, from the US South, unvaccinated, and have a higher PCI (Figure 1). Excluding non-severe outcomes, rates of death and ICU admission were higher in 0–4-year-olds compared to 5–11 or 12–18-year-olds (Figure 2). All patients receiving at least one dose of the vaccine survived. The odds ratio of a severe outcome is 0.11 (95% CI 0.07–0.16) in fully vaccinated patients compared to unvaccinated patients. The odds ratio of a severe outcome is 0.55 (95% CI 0.49–0.63) in partially vaccinated patients compared to unvaccinated patients. Demographic and clinical characteristics of pediatric patients with COVID-19 Relative proportion of clinically severe outcomes within age groups, excluding non-severe outcomes Conclusion In this large population, incidence rate of severe outcomes from COVID-19 in pediatric patients was higher among non-Caucasian patients, living in the South, with underlying comorbid illness, and those not yet eligible for vaccination. These findings reinforce the need for a vaccine for younger patients and targeted vaccine outreach to racial and ethnic minorities and children with chronic conditions. Disclosures Christoph U. Lehmann, MD, Celanese: Stocks/Bonds|Markel: Stocks/Bonds|Springer: Honoraria|UTSW: Employee.

Substance abuse and the risk of severe COVID-19: Mendelian randomization confirms the causal role of opioids but hints a negative causal effect for cannabinoids.

Since the start of the COVID-19 global pandemic, our understanding of the underlying disease mechanism and factors associated with the disease severity has dramatically increased. A recent study investigated the relationship between substance use disorders (SUD) and the risk of severe COVID-19 in the United States and concluded that the risk of hospitalization and death due to COVID-19 is directly correlated with substance abuse, including opioid use disorder (OUD) and cannabis use disorder (CUD). While we found this analysis fascinating, we believe this observation may be biased due to comorbidities (such as hypertension, diabetes, and cardiovascular disease) confounding the direct effect of SUD on severe COVID-19 illness. To answer this question, we sought to investigate the causal relationship between substance abuse and medication-taking history (as a proxy trait for comorbidities) with the risk of COVID-19 adverse outcomes. Our Mendelian randomization analysis confirms the causal relationship between OUD and severe COVID-19 illness but suggests an inverse causal effect for cannabinoids. Considering that COVID-19 mortality is largely attributed to disturbed immune regulation, the possible modulatory impact of cannabinoids in alleviating cytokine storms merits further investigation.

COVID-19 international experience in paediatric patients with congenital heart disease

ObjectiveAs COVID-19 continues to affect the global population, it is crucial to study the impact of the disease in vulnerable populations. This study of a diverse, international cohort aims to...

Study of Quality of life of family caregivers of hospitalized COVID-19 patients

Background: High morbidity and mortality due to this virus led to an international health crisis. Whereas frontline health workers, face problems due to increased work load, intense working schedule and increased chance of getting exposed to positive cases, the primary caregivers who are mostly family members and are indispensable in providing support to their member with illness in acute care settings, are also affected in various domains of their functioning. This affects their overall quality of life. Materials and Methods: This cross-sectional observational study was done at Sawai Man Singh and attached hospital, Jaipur. It included 45 caregivers of hospitalized COVID-19 patients. All subjects were evaluated by a general information sheet. WHOQOL-BREF was applied and statistical analysis done by SPSS 23. Results & Conclusion: Factors which were significantly associated with QOL and its domains were duration of illness, duration of hospitalization, severity of COVID-19 illness,occupation and marital status. Duration of illness and hospitalization can be reduced with early identification of illness and effective management which may improve QoL of caregivers. Also, there is need to rotate caregivers among family members and incorporating recreational activities for informal caregivers of Covid-19 patients to improve their QoL Keywords:QoL, COVID-19, caregiver

Ageing workers’ mental health during COVID-19: a multilevel observational study on the association with the work environment, perceived workplace safety and individual factors

ObjectivesThe stress and anxiety associated with the predisposition of ageing workers to severe COVID-19 illness, once occupationally infected, jeopardise their mental health. This study aimed to investigate the association between...

Trajectory of Functional Recovery from 6 to 12 Months in Persons Hospitalized for Severe SARS-CoV-2 Illness

<h3>Research Objectives</h3> To identify distinct post-acute COVID-19 phenotypes among adults hospitalized for severe SARS-CoV-2 infection and describe multidimensional outcomes and trajectories at 6 and 12 months post-hospitalization. <h3>Design</h3> Prospective, longitudinal data collection in functional, physical, cognitive, and psychological domains at 3, 6, and 12 months post-hospitalization. Retrospective data collection from the acute care and post-acute care settings. <h3>Setting</h3> Acute care and post-acute telephone follow-up. <h3>Participants</h3> English- and Spanish- speaking adults, with decision-making capacity, admitted for inpatient rehabilitation following inpatient rehabilitation for acute COVID-19 related illness (N = 61). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Physical, cognitive, and psychological symptoms; self-reported employment status and assistance with ADLs. <h3>Results</h3> Median age 60.8 years; 59% male; 72.1% white; 72.1% non-Hispanic; 26.2% preferred assessment in Spanish. 83% required mechanical ventilation in acute care. Comorbidities were common. We found a high prevalence of persistent symptoms at 6- and 12- months across physical, cognitive, and emotional health outcome domains. Three post-acute phenotypes were identified at 6 months; a "minimally symptomatic" subgroup with minimal symptom endorsement across all domains relative to other subjects (22.95%, n = 14), a "predominantly physical symptoms" subgroup (47.54%, n = 29), and a "globally symptomatic" subgroup (29.51%, n = 18). A similar pattern for phenotypes emerges at 12-months, with 67.21% of subjects falling into the same phenotype at both time points. In the Predominantly Physical Symptom phenotype, 31.0% declined into the Globally Symptomatic Phenotype and 10.3% improved. In the Globally Symptomatic phenotype, 11.1% of participants transitioned to the Minimally Symptomatic phenotype and 16.7% to the Predominantly Physical Symptom phenotype. Compared to premorbid level of employment (50.8%), 24.6% of participants were employed at 12-months. Phenotype at 6-months was a significant predictor of employment at 12-months (B = 2.26, p = .05, OR = 9.6). <h3>Conclusions</h3> Persons with severe COVID-19 illness experience persistent functional limitations and reduced employment up to 12 months post-hospitalization. Distinct recovery subgroups were found suggesting the need for comprehensive assessment and tailored treatment for recovery. <h3>Author(s) Disclosures</h3> The authors declare no relevant conflicts of interest.

Management and Implications of Severe COVID-19 in Pregnancy in the United Kingdom: Data From the UK OBSTETRIC Surveillance System National Cohort

(Acta Obstet Gynecol Scand. 2022;101:461–470. doi: 10.1111/aogs.14329) With the inauspicious rise to dominance of the Sars-CoV-2 Delta variant (B.1.617.2) in the United Kingdom in May 2021, the proportion of pregnant women experiencing severe disease proliferated significantly [35.8% during the Alpha variant duration vs. 45% in the Delta-dominant duration, adjusted odds ratio (aOR): 1.53]. A high proportion of pregnant women with COVID-19 deliver prematurely, are admitted to intensive care, and have neonates that also require intensive care. Most data thus far have come from single-center cohorts with small sample sizes, and present conflicting conclusions. There is an urgent need to investigate the risks and outcomes of severe COVID-19 illness in pregnant women to update guidelines for clinical management and prevention practices.

Rlip Protein: A Potential Target for COVID-19.

On January 30, 2020, the COVID-19 epidemic was declared an international public health emergency by the World Health Organization. Given the growing impact of the pandemic, there is great interest in finding potential targets for treating infected or hospitalized COVID-19 patients. Therapeutic studies have been conducted on pre-existing drugs, which vary by country, including anti-malarial agents, antiviral agents, and convalescent plasma. However, many of these agents are ineffective at reducing mortality or only shorten the severity or duration of COVID-19 illness in hospitalized patients. As such, other alternatives for treating COVID-19 are being investigated. One such target of interest has been clathrin-dependent endocytosis (CDE). Clathrin-dependent endocytosis is the most commonly observed mechanism of viral entry into cells. However, there have been no published studies to date on CDE inhibition strategies against COVID-19. One such target is Rlip or RLIP76 (human gene RALBP1, 18p11.22). Among its many functions, Rlip is a stress-protective, Ral-regulated ATPase of the mercapturic acid pathway that transports glutathione-electrophile conjugates of electrophilic toxins, which are precursors of mercapturic acid that precedes de-glutamylation by gamma-glutamyl transferase. Rlip is also regulated by several G-proteins that coordinate movement of cells, organelles, membranes, cytoskeleton, macromolecules, and other small molecules. Previous studies have link Rlip in the pathogenesis of several viral illness. In this paper, we want to propose that RLIP76 (Rlip or RALBP1) may be a novel target for treating SARS-CoV-2 viral infections.

Abstract 13505: COVID-19 and Cardiovascular Disease Patient Hearts Harbor Sympathetic Remodeling and Altered Angiotensin Converting Enzyme 2 Localization

Cardiac complications of COVID-19 have been well described and are associated with significant morbidity and mortality. Concomitantly, various pre-existing cardiovascular diseases (CVDs) are established risk factors for developing severe COVID-19 illness and death. The mechanisms of cardiac injury after COVID-19 remain incompletely understood. Further, whether and how SARS-CoV-2 directly infects the heart is unclear. In this study, we investigated cardiac sympathetic innervation and the cellular localization of angiotensin converting enzyme 2 (ACE2) to test the hypothesis that pre-existing or acute changes in these parameters could contribute to cardiac complications of COVID-19. We performed immunohistochemical (IHC) analysis on sections of left ventricular (LV) wall from twenty autopsied human hearts consisting of a control group, a CVD group, and COVID-19 ARDS and COVID-19 non-ARDS groups. Using tyrosine hydroxylase as a noradrenergic marker, we observed substantial sympathetic nerve loss in CVD LVs compared to the control group, which is consistent with previous work suggesting loss of sympathetic activity in severe heart failure. Additionally, we observed mild and heterogeneous nerve loss in both COVID-19 groups. Using an ACE2 antibody, we observed robust transmural staining localized to pericytes in the control group. The CVD hearts displayed significant loss of ACE2 in pericytes and increased ACE2 in cardiomyocytes. Both COVID-19 groups displayed a modest increase in cardiomyocyte ACE2 compared to controls, and pericyte ACE2 staining was generally maintained. We also performed IHC for PDGF receptor β, an established marker for pericytes, and confirmed ACE2 localization to pericytes. The observed sympathetic nerve remodeling could play a key role in arrhythmogenesis in acute or post-acute COVID-19 patients. Further, if SARS-CoV-2 does infect the heart, then our data demonstrate the primary target would be through microvasculature associated pericytes, not cardiomyocytes. Finally, the upregulation of cardiomyocyte ACE2 in both CVD and COVID-19 groups could play a contributing role in COVID-19 associated cardiac injury or a compensatory role in cardiac pathogenesis by attenuating the local effects of angiotensin II.

Molnupiravir Outpatient Treatment for Adults with COVID-19 in a Real-World Setting-A Single Center Experience.

Molnupiravir is approved for the treatment of adult patients with mild to moderate COVID-19. The main goal of the treatment is to reduce hospitalization and mortality rate. This study aimed at the all-cause hospitalization and all-cause death assessment in patients at high risk of severe COVID-19 treated with molnupiravir. This was a prospective, observational single center study. Non-hospitalized patients with SARS-CoV-2 infection, COVID-19 symptoms with the onset of up to 5 days, and at high risk of severe COVID-19 illness received molnupiravir based on attending physician decisions. In total, 107 patients were enrolled. Adverse events were reported in 28.0% of patients, with nausea and abdominal pain being the most commonly observed. No treatment-emergent AEs resulted in therapy discontinuation. Overall, 15 patients required hospitalization. During the observation, 2.8% (n = 3) of patients subsequently died. All deaths were considered to be related to COVID-19 complications. Age over 65 years, heart failure, and ischemic heart disease showed a significant correlation with the severe course of COVID-19. Molnupiravir may be perceived as an alternative treatment for patients with immunosuppression and advanced chronic kidney disease. Nevertheless, further studies are required to conclusively establish a role for molnupiravir in future COVID-19 treatment recommendations.

Sex differences in the prognostic value of troponin and D-dimer in COVID-19 illness

BackgroundMale sex, elevated troponin levels, and elevated D-dimer levels are associated with more complicated COVID-19 illness and greater mortality; however, while there are known sex differences in the prognostic value of troponin and D-dimer in other disease states, it is unknown whether they exist in the setting of COVID-19. ObjectiveWe assessed whether sex modified the relationship between troponin, D-dimer, and severe COVID-19 illness (defined as mechanical ventilation, ICU admission or transfer, discharge to hospice, or death). MethodsWe conducted a retrospective cohort study of patients hospitalized with COVID-19 at a large, academic health system. We used multivariable regression to assess associations between sex, troponin, D-dimer, and severe COVID-19 illness, adjusting for demographic, clinical, and laboratory covariates. To test whether sex modified the relationship between severe COVID-19 illness and troponin or D-dimer, models with interaction terms were utilized. ResultsAmong 4,574 patients hospitalized with COVID-19, male sex was associated with higher levels of troponin and greater odds of severe COVID-19 illness, but lower levels of initial D-dimer when compared with female sex. While sex did not modify the relationship between troponin level and severe COVID-19 illness, peak D-dimer level was more strongly associated with severe COVID-19 illness in male patients compared to female patients (males: OR=2.91, 95%CI=2.63-2.34, p<0.001; females: OR=2.31, 95%CI=2.04-2.63, p<0.001; p-interaction=0.005). ConclusionSex did not modify the association between troponin level and severe COVID-19 illness, but did modify the association between peak D-dimer and severe COVID-19 illness, suggesting greater prognostic value for D-dimer in males with COVID-19.

Acceptance Rate of COVID-19 Vaccine and Its Determinants Among Indian Pregnant Women: A Hospital-Based Cross-Sectional Analysis.

Background Vaccination is more widespread when the determinants and hesitancy of vaccination are identified, especially in vulnerable groups, such as pregnant women. Pregnant women if infected with COVID-19 are more likely to get severe COVID-19 illness and adverse neonatal outcomes as compared to non-pregnant women. The present study was designed with the aim to estimate the rate of COVID-19 vaccine acceptance and to identify the associated factors which influence the vaccine acceptance. Methods This study was a hospital-based cross-sectional study conducted in the Obstetrics Department of Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, from February 2022 to April 2022. Our study included 298 pregnant women above 18 years who were willing to participate in the study. Information was collected by face-to-face interview using a structured and pretested questionnaire. Binomial logistic regression (univariate and multivariate) was used to identify the associated factors on vaccination acceptance. Results Among 298 pregnant women, 234 expressed willingness to receive vaccine, giving an acceptance rate of 78.52%. The educational status, ethnicity, occupation of the woman and husband, and type of family showed no significant relationship with the vaccine acceptance. On multivariate logistic regression analysis, the determinants found to be significantly associated with COVID-19 vaccine acceptance among pregnant women were as follows: Muslim religion (aOR=0.27, CI: 0.12-0.61), gravida >2 (aOR=1.84, CI: 1.30-2.61), and awareness that COVID-19 vaccine has been approved by the government (aOR=3.03, CI: 1.45-6.36). Awareness that COVID-19 infection causes more severe complications in pregnant women than non-pregnant women (aOR=1.89, CI: 0.93-3.87) and hypertension (aOR=0.36, CI: 0.11-1.20) were non-significantly associated. Conclusion The acceptance of COVID-19 vaccination was high in this study and was well received especially by mothers who had knowledge about the importance of vaccination during pregnancy. Concerns about the side effects of vaccination and the possibility of harming the baby were the main reasons for refusal. During prenatal care, health care providers should reinforce the benefits of COVID-19 vaccination during pregnancy.

Characterization of autonomic symptom burden in long COVID: A global survey of 2,314 adults.

Autonomic dysfunction is a known complication of post-acute sequelae of SARS-CoV-2 (PASC)/long COVID, however prevalence and severity are unknown. To assess the frequency, severity, and risk factors of autonomic dysfunction in PASC, and to determine whether severity of acute SARS-CoV-2 infection is associated with severity of autonomic dysfunction. Cross-sectional online survey of adults with PASC recruited through long COVID support groups between October 2020 and August 2021. 2,413 adults ages 18-64 years with PASC including patients who had a confirmed positive test for COVID-19 (test-confirmed) and participants who were diagnosed with COVID-19 based on clinical symptoms alone. The main outcome measure was the Composite Autonomic Symptom 31 (COMPASS-31) total score, used to assess global autonomic dysfunction. Test-confirmed hospitalized vs. test-confirmed non-hospitalized participants were compared to determine if the severity of acute SARS-CoV-2 infection was associated with the severity autonomic dysfunction. Sixty-six percent of PASC patients had a COMPASS-31 score >20, suggestive of moderate to severe autonomic dysfunction. COMPASS-31 scores did not differ between test-confirmed hospitalized and test-confirmed non-hospitalized participants [28.95 (15.62, 46.60) vs. 26.4 (13.75, 42.10); p = 0.06]. Evidence of moderate to severe autonomic dysfunction was seen in 66% of PASC patients in our study, independent of hospitalization status, suggesting that autonomic dysfunction is highly prevalent in the PASC population and independent of the severity of acute COVID-19 illness.

Profiles of emerging adults’ resilience facing the negative impact of COVID-19 across six countries

Although emerging adults (i.e., individuals aged 18–29 years old) may be at a lesser risk of COVID-19 severe illness and mortality, studies have found that the negative impact of COVID-19 on mental health and well-being is higher among emerging adults when compared to other age groups. The current study aimed to identify profile(s) based on resilience resources, which could help emerging adults in managing the disruptions to their lives following the pandemic. A cross-national sample of 1,768 emerging adults from China, Italy, Lithuania, Portugal, Slovenia, and the US was utilized to identify profiles based on different resilience dimensions (ego-resiliency, positivity, religiosity, socioeconomic status, family support, peer support). Results of the Latent Profile Analysis suggest the presence of four different profiles: no resources, only peer, only family, and well-equipped. The association of these profiles with demographic variables, adulthood markers, self-perceived COVID-19 impact, present well-being, and future life perception was investigated. Implications for resilience theory as well as for future interventions are discussed.

SLEEP-DISORDERED BREATHING AND LONG-HAUL COVID-19: A CASE REPORT

SLEEP-DISORDERED BREATHING AND LONG-HAUL COVID-19: A CASE REPORT