Swab Polymerase Chain Reaction Research Articles

The Use of Therapeutic Plasma Exchange in the Treatment of a Pregnant Woman with COVID-19 Induced Acute Respiratory Distress Syndrome.

A 27-year-old woman at 17 weeks gestation was admitted to the intensive care unit (ICU) with a history of fever, dyspnea, and dry cough for 3 days. She was diagnosed with coronavirus disease 2019 (COVID-19) based on her nasopharyngeal swab polymerase chain reaction (PCR) that was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the ICU, the patient developed acute respiratory distress syndrome (ARDS) and increased levels of inflammatory markers. She was then intubated for mechanical ventilation and had a treatment for critical COVID-19 illness during pregnancy. She also received three cycles on alternating days of therapeutic plasma exchange (TPE) since she was failing to respond to conventional medical treatment. During hospitalization, the patient’s fetus was closely monitored by repetitive ultrasound. After 27 days of hospitalization and 10 days of mechanical ventilation weaning, the patient’s respiratory condition improved and her inflammatory biomarkers normalized. She was discharged from the hospital with an apparently healthy 20th week fetus. This case report highlights the role of TPE for treatment of ARDS due to cytokine storm in pregnant women with severe COVID-19 infection. This case emphasizes that careful evaluation of clinical and biological progression of the patient’s status is very important and when conventional therapies are failing, alternative therapies such as TPE should be considered.

Discord between presence of follicular conjunctivitis and Chlamydia trachomatis infection in a single Torres Strait Island community: a cross‐sectional survey

ObjectiveRecent surveys identified trachomatous inflammation – follicular (TF) at endemic levels in the Torres Strait Islands; however, local health staff do not report trachomatous trichiasis (TT) in adults. We undertook a cross‐sectional survey involving eye examination and microbiological testing to better understand this disconnect. MethodsWe examined 169 of 207 (82%) residents and collected ocular swabs for polymerase chain reaction (PCR) testing for Chlamydia trachomatis. Other viral PCR tests and bacterial culture were also performed. ResultsTF prevalence in children aged 5–9 years was 23% (7/30). No ocular C. trachomatis was identified by PCR. For the 72 participants (43%) with follicles, bacterial culture was positive for 11 (15%) individuals. No individual had trachomatous trichiasis. ConclusionsFollicular conjunctivitis consistent with TF was prevalent but ocular C. trachomatis and cicatricial trachoma were absent. Non‐chlamydial infections or environmental causes of follicular conjunctivitis may be causing TF in this community. Implications for public healthIn similar settings, reliance on simplified clinical assessment alone may lead to an overestimation of the public health problem posed by trachoma. Consideration should be given to incorporating C. trachomatis PCR, and in certain settings, a detailed clinical exam could be performed by an experienced ophthalmologist during prevalence surveys.

The red half-moon nail sign in a COVID-19 patient

Sir, Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic. Several cutaneous manifestations associated with COVID-19 have been reported, including chilblains or chilblain-like lesions, erythematous rash, viral exanthem, urticaria, livedo reticularis, acral ischemia, palpable purpura, and erythema multiforme. These were thought to be useful in the early diagnosis and triage of COVID-19 patients and their risk stratification [1]. However, there are limited reports on the nail manifestations of COVID-19, including several cases of Beau lines, leukonychia, orange discoloration, and onychomadesis [2]. An exceptionally rarely reported manifestation of COVID-19 is the red half-moon-nail sign [3,4]. A 46-year-old male presented to our outpatient clinic with transversal red bands surrounding the distal margin of the nail’s lunula on all of the fingernails, which the patient noticed a week previously (Fig. 1). One month before, with symptoms of fever, shortness of breath, and coughing present for three days, he had been given the diagnosis of COVID-19 following a positive nasopharyngeal swab polymerase chain reaction test. Computed tomography of the lungs revealed generalized ground-glass opacities and paraseptal emphysema in the upper lobes, and the patient was hospitalized for one week and treated with favipiravir for five days and was on oxygen therapy. He was discharged from the hospital one week later with partial remission of the respiratory symptoms. He also had hypertension, atherosclerotic heart disease, and Behçet’s disease, and had been using metoprolol, amlodipine, edoxaban, irbesartan, hydrochlorothiazide, and colchicine. After two weeks of follow-up, the bands remained present and became wider (Fig. 2). The red-half-moon sign was first described by Neri et al. as half-moon-shaped transversal red bands after SARS-CoV-2 infection. The patient was a sixty-year-old female and the bands appeared two weeks after the onset of symptoms of COVID-19. The patient was hospitalized and received oxygen therapy and several other treatments, including hydroxychloroquine and lopinavir/ritonavir. As in our patient, the bands remained present and became wider after one month of follow-up [3]. Mendez-Flores et al. reported a case of the red half-moon nail sign in a 37-year-old female with COVID-19. The patient noticed the changes two days after the COVID-19 symptoms appeared, and these lasted for one week before gradually returning to normal. The patient was managed at home and required no oxygen therapy [4]. The pathogenesis of the red half-moon sign is unknown. Neri et al. proposed that localized microvascular injury secondary to an inflammatory immune response and procoagulant state may play a role. It is thought that, because of the location, the distal subungual arcade’s capillary network may be affected in these cases [2,3]. We also agree that the red half-moon sign could be associated with microvascular injury or a procoagulant state connected to an inflammatory immune response. Recently, Natalello et al. reported nailfold capillaroscopy abnormalities in COVID-19 patients, including microvascular alterations in the nailfold capillary bed ranging from microthrombosis to altered capillary structures, according to the COVID-19 phase supporting this theory [5]. We also think that the persistence of the bands might be related to the severity of the disease, as both our and Neri et al.’s patients were hospitalized and had a more severe disease course than Mendez-Florez et al.’s patient. We think that, similarly to skin findings, nail findings may be a clue in the diagnosis and prognosis of COVID-19 as well as the pathogenesis of the disease, and clinicians should search for nail findings in COVID-19 patients.

Multisystem screening reveals SARS-CoV-2 in neurons of the myenteric plexus and in megakaryocytes.

SARS‐CoV‐2, the causative agent of COVID‐19, typically manifests as a respiratory illness, although extrapulmonary involvement, such as in the gastrointestinal tract and nervous system, as well as frequent thrombotic events, are increasingly recognised. How this maps onto SARS‐CoV‐2 organ tropism at the histological level, however, remains unclear. Here, we perform a comprehensive validation of a monoclonal antibody against the SARS‐CoV‐2 nucleocapsid protein (NP) followed by systematic multisystem organ immunohistochemistry analysis of the viral cellular tropism in tissue from 36 patients, 16 postmortem cases and 16 biopsies with polymerase chain reaction (PCR)‐confirmed SARS‐CoV‐2 status from the peaks of the pandemic in 2020 and four pre‐COVID postmortem controls. SARS‐CoV‐2 anti‐NP staining in the postmortem cases revealed broad multiorgan involvement of the respiratory, digestive, haematopoietic, genitourinary and nervous systems, with a typical pattern of staining characterised by punctate paranuclear and apical cytoplasmic labelling. The average time from symptom onset to time of death was shorter in positively versus negatively stained postmortem cases (mean = 10.3 days versus mean = 20.3 days, p = 0.0416, with no cases showing definitive staining if the interval exceeded 15 days). One striking finding was the widespread presence of SARS‐CoV‐2 NP in neurons of the myenteric plexus, a site of high ACE2 expression, the entry receptor for SARS‐CoV‐2, and one of the earliest affected cells in Parkinson's disease. In the bone marrow, we observed viral SARS‐CoV‐2 NP within megakaryocytes, key cells in platelet production and thrombus formation. In 15 tracheal biopsies performed in patients requiring ventilation, there was a near complete concordance between immunohistochemistry and PCR swab results. Going forward, our findings have relevance to correlating clinical symptoms with the organ tropism of SARS‐CoV‐2 in contemporary cases as well as providing insights into potential long‐term complications of COVID‐19. © 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Neurovascular manifestations in patients with COVID-19: a case series

To describe cerebrovascular manifestations in patients hospitalized for treatment of severe COVID-19, highlighting the comorbidities observed, and those that may play a relevant role as risk factors for severe outcomes. This case series retrospective analyzed, from June to November, 2020, ten patients admitted to the emergency department, with positive nasopharyngeal swab polymerase chain reaction assay for SARS-CoV-2, presenting with neurological symptoms and positive findings at brain imaging studies. In this sample, the clinical severity of the symptoms varied from mild to critical. Ischemic stroke was observed in four patients, hemorrhagic events occurred in five cases. Three patients evolved with large parenchymal hemorrhage, and one presented petechial bleeding foci. In one case, we observed subarachnoid hemorrhage associated with bilateral hypodensity in both globus pallidus. Typical posterior reversible encephalopathy syndrome findings were observed in one patient on brain computed tomography. Patients with neurovascular complications related to COVID-19 had positive findings in brain imaging and neurological symptoms. The pathological entities observed drew attention to the neurological risk of patients with SARS-CoV-2 infection, including worse outcomes in individuals whose medical history includes clinical comorbidities, especially hypertension and obesity.

Low serum levels of zinc and 25-hydroxyvitmain D as potential risk factors for COVID-19 susceptibility: a pilot case-control study.

Background and aimsThis study aimed to evaluate serum 25-hydroxyvitmain D and zinc levels in coronavirus disease 2019 (COVID-19) patients in comparison to healthy subjects.MethodsThis was a single-center case-control study performed from March 20, 2020, to January 20, 2021, in Tehran, Iran. All patients diagnosed with COVID-19 based on a positive nasopharyngeal swab polymerase chain reaction (PCR) test were included in the case group. Controls were selected from patients referred for routine checkups who had a negative COVID-19 PCR test. Age, sex, marital and educational status, comorbidities, and serum 25-hydroxyvitmain D and zinc levels of patients were recorded.ResultsNinety patients in the case group and 95 subjects in the control group who were sex and age-matched were studied. 25-hydroxyvitmain D levels higher than 20 ng/ml were observed in 58 (64%) cases and 72 (76%) controls (P = 0.09). The median 25-hydroxyvitmain D level in the case group was significantly lower than controls (26 (interquartile range [IQR] = 24) ng/ml vs. 38 (IQR = 22) ng/ml, respectively, P < 0.01). The median zinc level in the case group was 56 (IQR = 23) mcg/dL, while it was 110 (IQR = 27) mcg/dL among the controls (P < 0.01). There was no significant difference in the level of 25-hydroxyvitmain D and zinc between cases with and without comorbidities (P > 0.05). Susceptibility to SARS-CoV-2 infection could be predicted by serum 25-hydroxyvitmain D levels below 25.2 ng/ml (81% sensitivity; 48% specificity) or zinc levels below 86.3 mcg/dL (93% sensitivity; 92% specificity).ConclusionsLow serum zinc and 25-hydroxyvitmain D levels appear to be risk factors for COVID-19 affliction; thus, the treatment of individuals with such deficiencies is recommended.

Discrepant serological findings in SARS-CoV-2 PCR-negative hospitalized patients with fever and acute respiratory symptoms during the pandemic.

Coronavirus Disease 2019 (COVID‐19) serology has an evolving role in the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. However, its use in hospitalized patients with acute respiratory symptoms remains unclear. Hospitalized patients with acute respiratory illness admitted to an isolation ward were recruited. All patients had negative nasopharyngeal swab polymerase chain reaction (PCR) for SARS‐CoV‐2. Serological studies using four separate assays (cPass: surrogate neutralizing enzyme‐linked immunosorbent assay [ELISA]; Elecsys: N‐antigen based chemiluminescent assay; SFB: S protein flow‐based; epitope peptide‐based ELISA) were performed on stored plasma collected from patients during the initial hospital stay, and a convalescent visit 4–12 weeks later. Of the 51 patients studied (aged 54, interquartile range 21–84; 62.7% male), no patients tested positive on the Elecsys or cPass assays. Out of 51 patients, 5 had antibodies detected on B‐cell Epitope Assay and 3/51 had antibodies detected on SFB assay. These 8 patients with positive serological test to COVID‐19 were more likely to have a high‐risk occupation (p = 0.039), bacterial infection (p = 0.028), and neutrophilia (p = 0.013) during their initial hospital admission. Discrepant COVID‐19 serological findings were observed among those with recent hospital admissions and bacterial infections. The positive serological findings within our cohort raise important questions about the interpretation of sero‐epidemiology during the current pandemic.

MRSA nasal swab PCR to de-escalate antibiotics in the emergency department

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) nasal swab polymerase chain reaction (PCR) assay has a 96.1–99.2% negative predictive value (NPV) in pneumonia and may be used for early de-escalation of MRSA-active antibiotic agents. Xu (2018), File (2010) [1,2]. ObjectiveThe objective of our study was to determine if a negative MRSA PCR nasal swab collected in the emergency department (ED) improves early MRSA-active antibiotic de-escalation. MethodsA single center observational cohort study used ICD-10 codes to identify records for adults admitted to the ED with a hospital discharge diagnosis of pneumonia. The primary outcome was proportion of patients with early de-escalation on an MRSA-active agent (≤ 1 dose). Secondary outcomes included rate of acute kidney injury (AKI), positive MRSA cultures (blood culture, respiratory sputum, tracheal aspirate), hospital length of stay (LOS), in-hospital mortality, and 30-day readmission rates. ResultsA total of 341 patients were included in the study. Of the patients with an MRSA PCR swab, 35.2% of patients with a negative swab received >1 dose of MRSA-active agent compared to 52% of patients without an MRSA nasal swab (p < 0.01). There were no significant differences in secondary outcomes except readmission rate of 1.6% of patients that did not have an MRSA swab in the ED vs 6.6% of patients that received an MRSA swab in the ED. Conclusion and relevanceMRSA PCR nasal swabs in the ED may serve as a useful tool for early MRSA-active antibiotic de-escalation when treating pneumonia.

Detection of SARS-CoV-2 infection by exhaled breath spectral analysis: Introducing a ready-to-use point-of-care mass screening method.

SummaryBackgroundThe current SARS-CoV-2 pandemic created an urgent need for rapid, infection screening applied to large numbers of asymptomatic individuals. To date, nasal/throat swab polymerase chain reaction (PCR) is considered the “gold standard”. However, this is inconducive to mass, point-of-care (POC) testing due to person discomfort during sampling and a prolonged result turnaround. Breath testing for disease specific organic compounds potentially offers a practical, rapid, non-invasive, POC solution. The study compares the Breath of Health, Ltd. (BOH) breath analysis system to PCR's ability to screen asymptomatic individuals for SARS-CoV-2 infection. The BOH system is mobile and combines Fourier-transform infrared (FTIR) spectroscopy with artificial intelligence (AI) to generate results within 2 min and 15 s. In contrast to prior SARS-CoV-2 breath analysis research, this study focuses on diagnosing SARS-CoV-2 via disease specific spectrometric profiles rather than through identifying the disease specific molecules.MethodsAsymptomatic emergency room patients with suspected SARS-CoV-2 exposure in two leading Israeli hospitals were selected between February through April 2021. All were tested via nasal/throat-swab PCR and BOH breath analysis. In total, 297 patients were sampled (mean age 57·08 SD 18·86, 156 males, 139 females, 2 unknowns). Of these, 96 were PCR-positive (44 males, 50 females, 2 unknowns), 201 were PCR-negative (112 males, 89 females). One hundred samples were used for AI identification of SARS-CoV-2 distinguishing spectroscopic wave-number patterns and diagnostic algorithm creation. Algorithm validation was tested in 100 proof-of-concept samples (34 PCR-positive, 66 PCR-negative) by comparing PCR with AI algorithm-based breath-test results determined by a blinded medical expert. One hundred additional samples (12 true PCR-positive, 85 true PCR-negative, 3 confounder false PCR-positive [not included in the 297 total samples]) were evaluated by two blinded medical experts for further algorithm validation and inter-expert correlation.FindingsThe BOH system identified three distinguishing wave numbers for SARS-CoV-2 infection. In the first phase, the single expert identified the first 100 samples correctly, yielding a 1:1 FTIR/AI:PCR correlation. The two-expert second-phase also yielded 1:1 FTIR/AI:PCR correlation for 97 non-confounders and null correlation for the 3 confounders. Inter-expert correlation was 1:1 for all results. In total, the FTIR/AI algorithm demonstrated 100% sensitivity and specificity for SARS-CoV-2 detection when compared with PCR.InterpretationThe SARS-CoV-2 method of breath analysis via FTIR with AI-based algorithm demonstrated high PCR correlation in screening for asymptomatic individuals. This is the first practical, rapid, POC breath analysis solution with such high PCR correlation in asymptomatic individuals. Further validation is required with a larger sample size.FundingBreath of Health Ltd, Rehovot, Israel provided study funding.

Bromhexine Hydrochloride Prophylaxis of COVID-19 for Medical Personnel: A Randomized Open-Label Study.

Background Bromhexine hydrochloride has been suggested as a TMPRSS2 protease blocker that precludes the penetration of SARS-CoV-2 into cells. We aimed to assess the preventive potential of regular bromhexine hydrochloride intake for COVID-19 risk reduction in medical staff actively involved in the evaluation and treatment of patients with confirmed or suspected SARS-CoV-2 infection. Methods In a single-centre randomized open-label study, medical staff managing patients with suspected and confirmed COVID-19 were enrolled and followed up for 8 weeks. The study began at the initiation of COVID-19 management in the clinic. The study was prematurely terminated after the enrollment of 50 participants without a history of SARS-CoV-2 infection: 25 were assigned to bromhexine hydrochloride treatment (8 mg 3 times per day), and 25 were controls. The composite primary endpoint was a positive nasopharyngeal swab polymerase chain reaction (PCR) test for SARS-CoV-2 or signs of clinical infection within 28 days and at week 8. Secondary endpoints included time from the first contact with a person with COVID-19 to the appearance of respiratory infection symptoms; the number of days before a first positive SARS-CoV-2 test; the number of asymptomatic participants with a positive nasopharyngeal swab test; the number of symptomatic COVID-19 cases; and adverse events. Results The rate of the combined primary endpoint did not differ significantly between the active treatment group (2/25 [8%]) and control group (7/25 [28%]); P=0.07. A fewer number of participants developed symptomatic COVID-19 in the treatment group compared to controls (0/25 vs. 5/25; P=0.02). Conclusion Although the study was underpowered, it showed that Bromhexine hydrochloride prophylaxis was associated with a reduced rate of symptomatic COVID-19. The prophylactic treatment was not associated with a lower combined primary endpoint rate, a positive swab PCR test, or COVID-19 (ClinicalTrials.gov number, NCT04405999).

Favipiravir Use in Kidney Transplant Recipients with COVID-19: A Single-Center Experience.

Kidney transplant recipients are among the high-risk groups for severe COVID-19. To date, no specific antiviral agent has proved uniformly effective against SARS-CoV-2. Favipiravir, the recommended drug by the Turkish Ministry of Health, was uniformly supplied to all patients diagnosed with COVID-19 by a positive nasopharyngeal swab polymerase chain reaction test. The aim of our study was to retrospectively compare our kidney transplant recipients treated with favipiravir who developed COVID-19 infection versus those not treated with favipiravir during the clinical course of the disease, with a special emphasis on the occurrence of side effects and adverse events. We included 37 consecutive kidney transplant recipients with a median age of 46 years (62.2% women). Recipients included 8 with deceased donors and 29 with living related donors; median posttransplant survival was 8.0 years (IQR, 5.5-12.5 years). Twenty-six patients (70.3%) received favipiravir, and 11 (29.7%) did not. There were no statistically significant differences between the groups for baseline demographic characteristics and clinical and laboratory data, except that the favipiravir-treated patients were older and had a higher requirement of oxygen treatment. There were no statistically significant differences between the 2 groups for the course and outcome of COVID-19 infection with regard to adverse side effects/events associated with favipiravir. Laboratory data at baseline, day 7, and day 30 were also comparable between the groups. Although the efficacy of favipiravir for treatment of COVID-19 infection remains controversial, favipiravir is safe for kidney transplant recipients.

Manifestation of Neurological Symptoms in Patients with Severe Covid-19 in the Intensive Room

Abstract Background: In addition to causing respiratory problems, patients with COVID-19 infection also present with neurological symptoms. We report neurological symptoms in a patient with severe COVID-19 infection admitted to the intensive care unit. Patients and Methods: We conducted a descriptive observational study from the patients treated in the intensive care unit (ICU) from October 2020 to September 2021 with neurological symptoms. Inclusion criteria for participants were patients who were confirmed positive for COVID-19 from the results of the nasopharyngeal polymerase chain reaction (PCR) swab, with neurological symptoms that appeared less ≤5 days before the results of the COVID-19 PCR swab were confirmed. Exclusion criteria were patients with negative PCR swab results, patients presenting with neurological symptoms &gt;5 days before confirmed PCR, and patients with previously known neurological disorder. Results: A total of 160 COVID-19 patients were admitted to the ICU with neurological symptoms, consisting of 99 males (61.9%) and 61 females (38.1%). A total of 35 patients (21.9%) complained of headache, nine patients (5.6%) complained of vestibular disturbances, 23 patients (14.4%) with seizures, 88 patients (55%) with decreased consciousness (encephalopathy), nine patients with intracranial infection, 67 patients (41.9%) with stroke, and nine patients (5.6%) with movement disorders. Conclusion: The most common neurological symptom in severe COVID-19 patients treated in our ICU was decreased consciousness, followed by stroke and headache. Neurological symptoms found in patients with severe COVID-19 infection can be caused by direct viral infection or indirectly through the mechanism of severe hypoxia due to respiratory failure.

Co-Infection in COVID-19 Pneumonia: Discussion Continues.

Sixty-six patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 and pneumonia on chest computer tomography were prospectively recruited. A combined respiratory swab for polymerase chain reaction (PCR), urine sample for pneumococcal and Legionella antigen, and sputum or endotracheal aspirate were collected. Urinary antigen and blood culture tests were negative in all cases as well as the PCR tests for other respiratory viruses and atypical bacterial pathogens. In total, 5 patients (7.5%) had co-infection. By PCR a high prevalence of colonization with bacterial pathogens was found. In conclusion, co-infection is rare in coronavirus disease 2019 patients, and additional examination to identify other pathogens should be performed only in selected cases.

Axonal Excitability Findings in Acute Inflammatory Demyelinating Polyneuropathy Related to SARS-CoV-2

Guillain–Barré syndrome (GBS) is a disorder of the peripheral nervous system characterized by acute-onset ascendance paresis. We present a patient who was diagnosed as having facial-onset acute inflammatory demyelinating polyneuropathy after being infected with SARS-CoV-2. A 51-year-old man presented to the emergency department with facial diplegia. He then developed bilateral ascendance paralysis. He had noticed that for 1 month, he had smell and taste disturbances. SARS-CoV-2 infection was suspected. Nasopharyngeal swab polymerase chain reaction test was negative, but anti-SARS-CoV-2 antibody was found to be positive. A nerve conduction study showed prolonged motor distal and F wave latencies with decreased motor and sensory compound muscle action potential amplitudes. Lumbar puncture revealed albuminocytologic dissociation. According to the neurologic examination and laboratory findings, the patient was diagnosed as having acute inflammatory demyelinating polyneuropathy. An axonal excitability study revealed fanning in pattern with prolonged refractoriness, which indicates nodal sodium channel disturbances. Facial-onset SARS-CoV-2–related GBS has been rarely reported; however, facial involvement seems to be one of the features of the neurologic findings.

A Case of Postpartum Maternal Death with COVID-19 in the West of Iran

Introduction:: There are a limited number of studies about COVID-19 during delivery and postpartum. Case presentation:: A 38 -years- old G3p2 woman at 35 weeks and 4 days of gestation was referred with the chief complaints of dyspnea, cough, headache, and fever. Pharyngeal swab polymerase chain reaction (PCR) was negative for COVID-19; however, in chest Computed Tomography (CT) angiography, ground glass was observed in the basal lobe of the left lung. The infant was born via cesarean section with a gestational age of 36 weeks and an Apgar score of 8/9. No infant document was found about COVID-19 and other infections in several days after delivery. The patient died eight days after the onset of symptoms due to cardiovascular collapse. Discussion:: we reported the first death of a postpartum maternal with COVID-19 and a healthy baby with no evidence of COVID-19 and a gestational age of 36 weeks. Conclusion:: Physicians should be aware that pregnant women with symptoms of respiratory infection and pulse negative PCR test should be followed for infected with COVID-19. This infection may be led to maternal death.

An Outbreak of Severe Kawasaki-Like Disease at the Italian Epicentre of the SARS-CoV-2 Epidemic: An Observational Cohort Study

An outbreak of Kawasaki disease was noted in 2020 in Italy during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The authors’ objectives in which to evaluate the incidence and features of patients with Kawasaki-like disease diagnosed during the SARS-CoV-2 epidemic. They looked at cases of hemodynamic instability during the acute phase of the disease (Kawasaki disease shock syndrome [KDSS]) and those that might fulfill the criteria of macrophage activation syndrome (MAS).All patients diagnosed with Kawasaki or Kawasaki-like disease who presented over the past 5 years (January 1, 2015, and April 20, 2020) before the COVID pandemic at this institution (Bergamo, Italy) were reviewed and compared with those who were diagnosed after the onset of the pandemic (February 18 to April 20, 2020).Patients with Kawasaki-like presentations were defined according to the 2017 criteria of the American Heart Association, including both classic type and incomplete types. KDSS was defined as Kawasaki disease accompanied by systolic arterial hypotension, a decrease from baseline systolic blood pressure of at least 20%, or the appearance of peripheral hypoperfusion. MAS was defined by using the Pediatric Rheumatology International Trials Organization criteria used in systemic juvenile idiopathic arthritis and commonly used for other systemic autoinflammatory diseases (Kawasaki disease and pediatric systemic lupus erythematosus). Data reviewed from medical records included demographic data, presenting symptoms and treatments, contact with confirmed or suspected cases of coronavirus disease 2019, vital signs, laboratory data (white blood cell count, lymphocyte count, erythrocyte sedimentation rate, C-reactive protein, procalcitonin, ferritin, fibrinogen, pro B-type natriuretic peptide, troponin I, natural killer activity, and interleukin 6 concentrations), electrocardiogram, and echocardiogram data. Current or previous infection with SARS-CoV-2 was obtained by reverse-transcriptase quantitative polymerase chain reaction in nasopharyngeal and oropharyngeal swabs and by serological testing for SARS-CoV-2 immunoglobulin M and immunoglobulin G. Patients were treated with 2 g/kg of intravenous immunoglobulin and aspirin dosed on the basis of Kobayashi score with 2-week methylprednisolone taper.Group 1 (pre–coronavirus disease) comprised 19 patients (7 boys and 12 girls; mean age: 3 years old) and group 2 (during coronavirus disease) included 10 patients (7 boys and 3 girls; mean age: 7.5 years old). A total 8 of 10 patients in group 2 were positive for SARS-CoV-2 immunoglobulin G or immunoglobulin M or both. A total of 5 presented with classic Kawasaki, and 5 presented with incomplete form. Comparing the 2 groups (group 1 versus group 2), there was a significant difference in disease incidence (0.3 patients per month versus 10 patients per month), mean age (3.0 vs 7.5 years), cardiac involvement (2 of 19 vs 6 of 10), KDSS (0 of 19 vs 5 of 10), MAS (0 of 19 vs 5 of 10), and need for adjunctive steroid treatment (3 of 19 vs 8 of 10; all P < .01).A 30-fold increased incidence of Kawasaki-like disease was seen at this institution. Children diagnosed with Kawasaki disease after the SARS-CoV-2 epidemic onset showed evidence of an immune response to the virus, were older, had a higher rate of cardiac involvement, had respiratory and gastrointestinal symptoms, were more resistant to intravenous immunoglobulin treatment, had more severe disease, and had features of MAS.Within the past year, multisystem inflammatory syndrome in children has been diagnosed around the world. Some of these children will fulfill criteria for complete and incomplete Kawasaki. Affected children tend to be older, and there is disproportionate number of Hispanic and African American children. They present with fever, gastrointestinal symptoms, rash, conjunctivitis, mucous membrane involvement, neurocognitive symptoms, lymphadenopathy, and respiratory symptoms. Clinicians should be aware of this syndrome to ensure proper care of patients.

Children and Adolescents’ Behavioral Patterns in Response to Escalating COVID-19 Restriction Reveal Sex and Age Differences

PurposeThe COVID-19 pandemic affects students in a myriad of different ways. Our prospective, longitudinal study in a cohort of students in Hannover, Germany explores behavioral patterns during escalating COVID-19 restrictions. MethodsIn total, 777 students between the age of 9 and 20 were assessed for their activity engagement, travel patterns, and self-assessed compliance with protective recommendations at six time points between June 2020 and June 2021 (3,564 observations) and were monitored for severe acute respiratory syndrome coronavirus 2 infection by nasal swab polymerase chain reaction and serum antibody titers. ResultsActivity engagement decreased, but self-assessed compliance with measures such as mask wearing and social distancing was stable during escalating restrictions. Although we found no sex difference during the summer break, when incidence was lowest, females engaged in a higher variety of activities than males for all other time points. Older students engaged in more activities and self-assigned themselves lower compliance values than younger ones. Greater involvement in different activities was seen in households which traveled more frequently. Infection rate in our cohort was low (0.03% acute infections, 1.94% positive seroprevalence). DiscussionOur study supports the view that, overall, students show high compliance with COVID-19 recommendations and restrictions. The identification of subsets, such as female and older students, with higher risk behavioral patterns should be considered when implementing public information campaigns. In light of the low infection rate in our cohort, we conclude that in-person learning can occur safely if extensive protective measures are in place and the incidence in the general population remains moderate.

Evaluating Polish nurses' working conditions and patient safety during the COVID-19 pandemic.

AimTo study the relationship between Polish nurses' working conditions and their attitudes towards patient safety during the COVID‐19 pandemic.BackgroundFacing the COVID‐19 pandemic, caused by the SARS‐CoV‐2 virus, healthcare worldwide has been reorganised. How these changes affected patient safety for hospitalised persons is not well understood.IntroductionDifficult working conditions related to the outbreak of the COVID‐19 pandemic may affect the provision of safe and effective care by healthcare staff.MethodsThis observational research was performed on the group of 577 nurses working during the COVID‐19 pandemic in isolation infection wards (n = 201) and non‐infectious diseases wards (n = 376) in Polish hospitals. The evaluation of working conditions was performed with an author's questionnaire, while the evaluation of factors influencing attitudes towards safety of the hospitalised patients was performed using Safety Attitudes Questionnaire. The STROBE checklist was used to report this study.ResultsThe procedures developed by management in advance for COVID‐19 patient treatment had a statistically significant influence on nurses' ‘evaluation of teamwork climate, safety climate, job satisfaction, perception of management and work conditions’. Providing management with the ability to perform a swab polymerase chain reaction SARS‐CoV‐2 test for hospital staff in the workplace, and psychological support from professionals and employers were statistically significant for higher ratings of ‘teamwork climate, safety climate, job satisfaction, stress recognition, perception of management and work conditions’ by the Polish nurses. Hospital workload during the COVID‐19 pandemic was significantly correlated with lower evaluation of work conditions.DiscussionOur study reinforces the existing literature on many fronts and demonstrates how even when operating under the COVID‐19 pandemic conditions, some factors remain critical for fostering a culture of patient safety. Reinforcing patient safety practices is a imperative under these conditions.Conclusions and implications for nursingWorking conditions influence nurses' attitudes towards safety of the hospitalised patients. These are largely modifiable factors related to the workplace and include prior preparation of procedures, restrictions to extending daily work hours and psychological counselling for the staff.

Happy hypoxic: Unaware young man with DVTs and pulmonary emboli

Introduction: COVID-19 is a multi-systemic disease announced to be a pandemic by the WHO within three months of the first reported case. It was initially characterized as a respiratory virus; however, hypercoagulability and development of strokes and deep vein thrombosis (DVTs) have been seen. We present a case of a young patient with no past medical history who developed minimally symptomatic bilateral DVTs and pulmonary emboli (PE). Case Report: A 26-year-old male with no past medical history presented with complaints of cough, fever, and diarrhea. Symptoms started two weeks prior to presentation, and he tested negative on COVID-19 nasal swab within that time frame. His cough was improving; however, he developed inability to keep food down along with bilateral calf pain with ambulation for three days prior to admission. Admission vitals were notable for fever and oxygen saturation of 91% on room air. A duplex ultrasound of the lower extremities showed bilateral thrombosis. Pulmonary computed tomography angiography (CTA) showed bilateral pulmonary emboli with numerous filling defects in the pulmonary arteries, along with peripheral interstitial densities. His COVID-19 nasal swab polymerase chain reaction (PCR) was negative, but the IgG serum antibody was positive. He was treated with steroids and anticoagulation. Conclusion: Studies have documented that patients with COVID-19 pneumonia have increased risk of lower limb DVT, despite proper prophylactic treatment. Clinicians must maintain high index of suspicion and a low threshold to order key tests in setting of unexplained hypoxia. We recommend obtaining serologic studies in late presenting patients with negative PCR swabs.

HIV-1 Nucleic Acids Identify Rectal HIV Exposures in Self-Collected Rectal Swabs, Whereas Y-Chromosome Single Tandem Repeat Mixtures Are Not Reliable Biomarkers of Condomless Receptive Anal Intercourse.

To focus interventions, biomarkers of HIV-1 exposure could help in identifying subpopulations at highest risk of acquisition. We assessed whether Y-chromosome single tandem repeat (YSTR) mixtures obtained from rectal swabs could serve as a biomarker of condomless receptive anal intercourse (CRAI) among men who have sex with men and transgender women and evaluated the feasibility of detecting HIV-1 virions to assess exposures. Twenty-nine sexually active HIV-seronegative men who have sex with men and one transgender woman from New York City answered on-site and mobile app sexual behavior questionnaires. They were randomized to collecting self-administered rectal swabs every morning or after receptive anal intercourse (RAI). YSTR profiles were assessed from blood sample and swabs; HIV-1 exposure was measured by conducting quantitative polymerase chain reaction in swabs. After 2 months, the daily mobile survey had 135%-201% more instances of anal sex acts and 170%-193% more RAI than on-site surveys. Daily mobile reporting had 11%-35% less CRAI events than those reported on-site (Pdaily = 0.001; Pper-sex = 0.047). The daily swabbing arm reported less RAI (P < 0.001) and CRAI (P < 0.038) and had 2.95 lower odds of detecting YSTR mixtures (P = 0.021) than the per-sex-event arm. Surprisingly, YSTR detection was not significantly modified by report of bowel movements and lubricant, enema, or condom use. No participant became HIV-1 infected, yet HIV-1 total nucleic acids were detected in 6 independent episodes of CRAI in 2 participants taking pre-exposure prophylaxis. YSTR mixtures demonstrated 80% specificity but only 30% sensitivity as a biomarker of CRAI in self-collected rectal swabs. However, detection of HIV-1 exposures in self-collected swabs may help in identifying those needing further HIV risk reduction strategies.