Coronavirus disease (COVID-19) associated delayed-onset fulminant myocarditis in patient with a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection

In this work, we discovered a new phenomenon—asymptomatic COVID-19 infection, or covert case, during the pandemic. All the 3 patients had a history of exposure, with no symptoms, and no abnormalities were found in computed tomography scan or lab tests. Except for case 2, the other patients’ severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) nucleic acid tests were negative. But their anti-SARS-COV-2 nucleocapsid antibody showed a dynamic trend, consistent with the process of virus infection and clearance. A growing number of asymptomatic or covert cases need more attention. Lack of surveillance may lead to another outbreak. We hope to demonstrate our cases to attract the attention of governments or health authorities that covert cases should be the focus as well.

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Eliciting History of Prior Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Diagnosing Interstitial Lung Disease during the Coronavirus Disease 2019 Pandemic

CHEST Journal ◽

10.1016/j.chest.2020.10.028 ◽

2021 ◽

Vol 159 (3) ◽

pp. 1306

Author(s):

Elena Stuewe ◽

Nicholas S. Hill ◽

Sucharita Kher

Keyword(s):

Interstitial Lung Disease ◽

Severe Acute Respiratory Syndrome ◽

Lung Disease ◽

History Of

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Conservation analysis of SARS-CoV-2 spike suggests complicated viral adaptation history from bat to human

Evolution Medicine and Public Health ◽

10.1093/emph/eoaa041 ◽

2020 ◽

Vol 2020 (1) ◽

pp. 290-303

Author(s):

Kuan Cheok Lei ◽

Xiaohua Douglas Zhang

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Mutation Analysis ◽

Evolutionary History ◽

Sequence Similarity ◽

Similarity Analysis ◽

Current Form ◽

Conservation Analysis ◽

Spike Sequences ◽

History Of ◽

Spike Sequence

Abstract Background The current coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome (SARS)-CoV-2, has become the most devastating public health emergency in the 21st century and one of the most influential plagues in history. Studies on the origin of SARS-CoV-2 have generally agreed that the virus probably comes from bat, closely related to a bat CoV named BCoV-RaTG13 taken from horseshoe bat (Rhinolophus affinis), with Malayan pangolin (Manis javanica) being a plausible intermediate host. However, due to the relatively low number of SARS-CoV-2-related strains available in public domain, the evolutionary history remains unclear. Methodology Nine hundred ninety-five coronavirus sequences from NCBI Genbank and GISAID were obtained and multiple sequence alignment was carried out to categorize SARS-CoV-2 related groups. Spike sequences were analyzed using similarity analysis and conservation analyses. Mutation analysis was used to identify variations within receptor-binding domain (RBD) in spike for SARS-CoV-2-related strains. Results We identified a family of SARS-CoV-2-related strains, including the closest relatives, bat CoV RaTG13 and pangolin CoV strains. Sequence similarity analysis and conservation analysis on spike sequence identified that N-terminal domain, RBD and S2 subunit display different degrees of conservation with several coronavirus strains. Mutation analysis on contact sites in SARS-CoV-2 RBD reveals that human-susceptibility probably emerges in pangolin. Conclusion and implication We conclude that the spike sequence of SARS-CoV-2 is the result of multiple recombination events during its transmission from bat to human, and we propose a framework of evolutionary history that resolve the relationship of BCoV-RaTG13 and pangolin coronaviruses with SARS-CoV-2. Lay Summary This study analyses whole-genome and spike sequences of coronavirus from NCBI using phylogenetic and conservation analyses to reconstruct the evolutionary history of severe acute respiratory syndrome (SARS)-CoV-2 and proposes an evolutionary history of spike in the progenitors of SARS-CoV-2 from bat to human through mammal hosts before they recombine into the current form.

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Carcinoembryonic Antigen Elevation in a Patient with SARS-CoV-2 and a History of Colon Cancer

Case Reports in Oncology ◽

10.1159/000515261 ◽

2021 ◽

pp. 802-805

Author(s):

Taha Alrifai ◽

Anita Sharko ◽

William T. Leslie

Keyword(s):

Health Care ◽

Colon Cancer ◽

Severe Acute Respiratory Syndrome ◽

Carcinoembryonic Antigen ◽

Health Care Delivery ◽

Care Delivery ◽

Prognostic Biomarkers ◽

Diagnosis And Treatment ◽

Routine Surveillance ◽

History Of

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic continues to affect millions of people and impact health-care delivery worldwide. New data and insights into the diagnosis and treatment of SARS-CoV-2 are emerging rapidly. Several prognostic biomarkers have been studied in patients with SARS-CoV-2. Among those biomarkers is the carcinoembryonic antigen (CEA). We report the case of a 46-year-old male with a history of colon cancer who was found to have an elevated CEA level during routine surveillance. Further workup confirmed a diagnosis of SARS-CoV-2 infection. The CEA level normalized with the resolution of the infection.

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EXPRESS: Risk factors for delayed-onset dementia after stroke or transient ischemic attack - A 5-year longitudinal cohort study

International Journal of Stroke ◽

10.1177/17474930211026519 ◽

2021 ◽

pp. 174749302110265

Author(s):

Moamina Ismail ◽

Vincent CT Mok ◽

Adrian Wong ◽

Lisa Au ◽

Brian Yiu ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Ischemic Stroke ◽

Recurrent Stroke ◽

Early Onset Dementia ◽

Delayed Onset ◽

Lower Baseline ◽

History Of ◽

Ischemic Attack ◽

Moca Score

Background Stroke not only substantially increases the risk of incident dementia early after stroke, the risk remains elevated years after. Aim We aimed to determine the risk factors of dementia onset more than 3-6 months after stroke or transient ischemic attack (TIA). Methods This is a single center prospective cohort study. We recruited consecutive subjects with stroke/TIA without early-onset dementia. We conducted an annual neuropsychological assessment for 5 years. We investigated the association between baseline demographic, clinical, genetic (APOEÎµ4 allele), and radiological factors, as well as incident recurrent stroke, with delayed-onset dementia using Cox proportional hazards models. Results 1,007 patients were recruited, of which 88 with early-onset dementia and 162 who lost to follow-ups were excluded. 49 (6.5%) out of 757 patients have incident delayed-onset dementia. The presence of â¥ 3 lacunes, history of ischemic heart disease (IHD), history of ischemic stroke and a lower baseline Hong Kong version of the Montreal Cognitive Assessment (MoCA) score, were significantly associated with delayed-onset dementia. APOEÎµ4 allele, medial temporal lobe atrophy, and recurrent stroke were not predictive. Conclusion The presence of â¥ 3 lacunes, history of IHD, history of ischemic stroke and a lower baseline MoCA score, are associated with delayed-onset dementia after stroke/TIA.

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Abstract 15365: Natural History of Immune Checkpoint Inhibitor Associated Myocarditis With Preserved Ejection Fraction

Circulation ◽

10.1161/circ.142.suppl_3.15365 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Joseph Nowatzke ◽

John R Power ◽

Wouter C Meijers ◽

Olusola Orimoloye ◽

Charlotte Fenioux ◽

...

Keyword(s):

Natural History ◽

Ejection Fraction ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitor ◽

Checkpoint Inhibitor ◽

Fulminant Myocarditis ◽

Circulatory Support ◽

Preserved Ejection Fraction ◽

History Of ◽

Electrical Pacing

Introduction: Immune Checkpoint Inhibitor (ICI)-associated myocarditis can be fatal, and is often characterized by arrhythmogenicity, although > 50% present with preserved ejection fraction (pEF). The natural history of ICI-myocarditis with pEF is unknown. Methods: We utilized a multicenter network of ICI-myocarditis cases spanning 12 countries to identify 83 cases of definite or probable myocarditis presenting with an EF above 50% on initial echocardiography. We further stratified patients based on continued pEF or worsening EF (rEF) during hospitalization. We compared independent variables, vital signs on presentation, and laboratory values between the two groups. Mortality was defined as those who died or were discharged to hospice within 90 days from admission. Fulminant myocarditis was defined as need for circulatory support, atrioventricular block requiring electrical pacing, ventricular tachycardia or fibrillation, or cardiac arrest while in the hospital. Results: Of the 83 patients, 15 developed a rEF; 68 maintained pEF during hospitalization. Although no significant change in heart rate was noted on presentation, systolic blood pressure was lower in the rEF group (111 vs 129, p=0.010). The rEF cohort were more prone to have a peak troponin elevation (432 vs 41, p=0.021), and to develop fulminant myocarditis (73% vs 26%, p=<0.001). Both in-hospital mortality (46% vs 17%, p=0.015) and 90-day all-cause mortality were significantly increased in those who develop a rEF (72% vs 29%, p=0.007). Overall, there was a 36.8% 90-day mortality rate for all those presenting with an initially normal EF. Conclusions: Patients with ICI-myocarditis can still have a fulminant course despite initial echocardiogram revealing EF>50%. In our database, 18% go on to develop new rEF and 73% die in the following 90 days. Decreased BP and troponin on presentation may identify patients at risk of subsequent rEF and fulminant course.

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Case series: COVID-19 infection causing new-onset diabetes mellitus?

Endocrinology&Metabolism International Journal ◽

10.15406/emij.2021.09.00302 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Rujuta Katkar ◽

Narasa Raju Madam

Keyword(s):

Diabetes Mellitus ◽

Severe Acute Respiratory Syndrome ◽

Cell Damage ◽

Small Sample Size ◽

Case Series ◽

Small Sample ◽

Onset Diabetes ◽

History Of ◽

New Onset Diabetes Mellitus ◽

New Onset

Objectives: This paper seeks to explore the hypothesis of the potential diabetogenic effect of SARS-COV-2 (Severe Acute respiratory syndrome coronavirus). Case series presentation: We present a case series of observation among 8 patients of age group ranging from 34 to 74 years with a BMI range of 26.61 to 53.21 Kilogram/square meters that developed new-onset diabetes after COVID-19 infection. Severe Acute Respiratory Syndrome Coronavirus (SARS-COV-2), commonly known as Coronavirus or COVID-19(Coronavirus infectious disease), gains entry into the cells by binding to the Angiotensin-converting enzyme-2(ACE-2) receptors located in essential metabolic tissues including the pancreas, adipose tissue, small intestine, and kidneys. The evidence reviewed from the scientific literature describes how ACE 2 receptors play a role in the pathogenesis of diabetes and the plausible interaction of SARS-COV-2 with ACE 2 receptors in metabolic organs and tissues. Conclusion: The 8 patients without a past medical history of diabetes admitted with COVID-19 infection developed new-onset diabetes mellitus due to plausible interaction of SARS-COV-2 with ACE 2 receptors. The resulting downregulation of ACE-2 and ACE-2 receptors expression caused islet-cell damage resulting into diabetes. The resulting observation has the potential to adversely impact significant number of the globally affected population. Screening patients with COVID-19 for diabetes routinely can help in early detection, significantly reducing morbidity and mortality associated with diabetes. Due to limitations of observational study with a small sample size will require further investigation in the form of Clinical trial.

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Covid-19 pandemic: What is the truth?

Surgical Neurology International ◽

10.25259/sni_1008_2021 ◽

2021 ◽

Vol 12 ◽

pp. 591

Author(s):

Russell L. Blaylock

Keyword(s):

United States ◽

Young People ◽

Severe Acute Respiratory Syndrome ◽

Early Treatment ◽

The United States ◽

Treatment Protocols ◽

Scientific Support ◽

Control And Prevention ◽

History Of ◽

Irreparable Damage

The ongoing “pandemic” involving the severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV-2) has several characteristics that make it unique in the history of pandemics. This entails not only the draconian measures that some countries and individual states within the United States and initiated and made policy, most of which are without precedent or scientific support, but also the completely unscientific way the infection has been handled. For the 1st time in medical history, major experts in virology, epidemiology, infectious diseases, and vaccinology have not only been ignored, but are also demonized, marginalized and in some instances, become the victim of legal measures that can only be characterized as totalitarian. Discussions involving various scientific opinions have been eliminated, top scientists have been frightened into silence by threats to their careers, physicians have lost their licenses, and the concept of early treatment has been virtually eliminated. Hundreds of thousands of people have died needlessly as a result of, in my opinion and the opinion of others, poorly designed treatment protocols, mostly stemming from the Center for Disease Control and Prevention, which have been rigidly enforced among all hospitals. The economic, psychological, and institutional damage caused by these unscientific policies is virtually unmeasurable. Whole generations of young people will suffer irreparable damage, both physical and psychological, possibly forever. The truth must be told.

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Respiratory Care in Corona

Psychology and Education Journal ◽

10.17762/pae.v58i2.1890 ◽

2021 ◽

Vol 58 (2) ◽

pp. 613-620

Author(s):

Mustafa Amdani, Dr. Swaroopa Chakole

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Human Life ◽

The Body ◽

Respiratory Care ◽

The Novel ◽

Specific Therapy ◽

History Of ◽

Novel Coronavirus ◽

Almost All ◽

The Impact

BACKGROUND The expanse of the coronavirus disease 2019 or COVID-19 is huge. The impact is multispectral and affected almost all aspects of human life. SUMMARY Respiratory impact of the COVID-19 is the most felt and widely reported impact. As the novel coronavirus maintained its history of affecting lungs as seen previously in severe acute respiratory syndrome (SARS) outbreak. Ventilators and oxygen support system are required mostly in comorbid patients particularly amongpatientsbearing illnesses like asthma, bronchial impairment and so on. CONCLUSION More study needs to be done in order to assess the impact on the respiratory functioning of the body. Respiratory care must be including proper instruments so that more efficient result can be obtained. Research is needed to promote the invention of specific therapy for targeted action for respiratory functioning improvement.

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Abstract 12563: Retrospective Analysis of Cardiovascular Events With the Use of Immune Checkpoint Inhibitors

Circulation ◽

10.1161/circ.142.suppl_3.12563 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Tushar Tarun ◽

Brian P Bostick ◽

Deepa Baswaraj ◽

Nishchayjit Basra ◽

Meeshal Khan ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Retrospective Analysis ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

Multiple Organ ◽

Fulminant Myocarditis ◽

Organ Systems ◽

History Of

Introduction: Immune checkpoint inhibitors have emerged as a promising, novel therapy for multiple malignancies. Immune-related adverse reactions pose a serious concern with use of these agents and reportedly involve multiple organ systems, notably cardiotoxicity. Early identification and management of these adverse events is essential in the prevention of morbidity and mortality. Hypothesis: Immune checkpoint inhibitors cause multiple cardiotoxic effects, and patients with prior cardiac history have a higher likelihood of cardiotoxicity. Methods: 1. A retrospective analysis of 150 patients was performed who had received immunotherapy with either the cytotoxic T lymphocyte associated antigen 4 inhibitors (CTLA4) or with the programmed cell death inhibitors (PD1) or programmed death-ligand 1 (PD-L1) inhibitors for a period of two years at a Tertiary health Care from 7/1/2016-6/30/2018. 2. Patients' cardiac diagnoses prior to the initiation of therapy were noted and included, including history of heart failure, coronary artery disease, atrial fibrillation, and sudden cardiac arrest. 3. Patients’ clinic visits and hospitalizations with admitting and discharge diagnosis, electrocardiogram, echocardiogram, troponin T, and NT-proBNP were reviewed. Results: 6% of patients had new onset heart failure (both preserved and reduced), 1.3% had evidence of myocardial infarction, 2% had new atrial fibrillation with rapid ventricular rate, and 0.6% had fulminant myocarditis. Of patients with new cardiac events, 60% had a history of cardiac disease, which was significantly higher than in patients without (p< 0.05). There were no age or sex differences between the groups with and without cardiotoxicity. Conclusion: Immunotherapy with immune checkpoint inhibitors have broadened the horizon for treatment of multiple solid and hematological malignancies. Nonetheless, new adverse effects on multiple organ systems, specifically cardiac involvement, occur with these therapies, which are important and potentially detrimental toxicities. Patients with a history of prior cardiovascular disease have higher likelihood to develop cardiotoxicity.

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