scholarly journals Severe COVID-19 is associated with sustained biochemical disturbances and prolonged symptomatology; A retrospective single-centre cohort study

Author(s):  
Marija Simjanoska ◽  
Zan Mitrev ◽  
Gianluca Villa ◽  
Daniel O. Griffin ◽  
Rodney A. Rosalia

AbstractIntroductionCoronavirus disease 2019 (COVID-19) is associated with significant acute clinical manifestations, and reports indicate that some patients experience prolonged symptomatology and morbidity. These late clinical manifestations have been termed Post-Acute Sequelae of COVID-19 (PASC) and hypothesised to be associated with clinical severity in the acute infection phase and biochemical abnormalities.AimEvaluate the incidence of PASC in previously hospitalised COVID-19 patients and compare the admission and follow-up levels of biochemical parameters stratified according to baseline clinical severity.MethodsN = 168 COVID-19 patients previously hospitalised at the Zan Mitrev Clinic in Skopje, North Macedonia, with matched laboratory data at baseline and follow-up clinical visit > 30 days post-discharge, were stratified according to National Institute of Health clinical severity guidelines as mild, moderate, severe or critical according to admission clinical presentation. We assessed the incidence of PASC and compared the biochemical profile.ResultsThe median hospitalisation and clinical follow-up period were 11 (9-20) and 53 (30-105) days. The overall incidence of PASC was 56.5% (95/168); most PASC cases were confined to the severe sub-group (61/101, 61.4%). Contrary to mild and moderate cases and a healthy “non-COVID-19” control cohort, we observed that severe COVID-19 cases experienced sustained biochemical disturbances, most notably elevated D-dimers and Ferritin of 600 ng/ml (283-1168) and 432 ng/ml (170-916), respectively.ConclusionsPreviously hospitalised severe COVID-19 patients are more likely to experience Post-Acute Sequelae of COVID-19 and prolonged biochemical disturbances, evident by abnormal values of D-dimers and Ferritin.

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249607
Author(s):  
David T. Arnold ◽  
Charmaine Donald ◽  
Max Lyon ◽  
Fergus W. Hamilton ◽  
Anna J. Morley ◽  
...  

Introduction Acute presentations of COVID-19 infection vary, ranging from asymptomatic carriage through to severe clinical manifestations including acute respiratory distress syndrome (ARDS). Longer term sequelae of COVID-19 infection includes lung fibrosis in a proportion of patients. Krebs von den Lungen 6 (KL-6) is a mucin like glycoprotein that has been proposed as a marker of pulmonary epithelial cell injury. We sought to determine whether KL-6 was a marker of 1) the severity of acute COVID-19 infection, or 2) the persistence of symptoms/radiological abnormalities at medium term follow up. Methods Prospective single centre observational study. Results Convalescent KL-6 levels were available for 93 patients (male 63%, mean age 55.8 years) who attended an 12-week follow up appointment after being admitted to hospital with COVID-19. For 67 patients a baseline KL-6 result was available for comparison. There was no significant correlations between baseline KL-6 and the admission CXR severity score or clinical severity NEWS score. Furthermore, there was no significant difference in the baseline KL-6 level and an initial requirement for oxygen on admission or the severity of acute infection as measured at 28 days. There was no significant difference in the 12-week KL-6 level and the presence or absence of subjective breathlessness but patients with abnormal CT scans at 12 weeks had significantly higher convalescent KL-6 levels compared to the remainder of the cohort (median 1101 IU/ml vs 409 IU/ml). Conclusions The association between high KL-6 levels at 12 weeks and persisting CT abnormalities (GGO/fibrosis), is a finding that requires further exploration. Whether KL-6 may help differentiate those patients with persisting dyspnoea due to complications rather than deconditioning or dysfunctional breathing alone, is an important future research question.


BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nilanka Wickramasinghe ◽  
Dhanushka Dasanayake ◽  
Neelika Malavige ◽  
Rajiva de Silva ◽  
Thashi Chang

Abstract Background Autoimmune encephalitis (AE) is now considered a main, potentially curable cause of encephalitis, but remains conspicuously underreported from South Asia. We studied the clinical characteristics in relation to their antibody status and outcomes of patients presenting with AE in Sri Lanka. Methods Patients admitting to government hospitals who were clinically suspected of AE by an on-site neurologist were prospectively recruited over a period of 12 months. Sera and cerebrospinal fluid were tested for NMDAR, AMPAR1, AMPAR2, LGI1, CASPR2, GABARB1/B2 antibodies (Ab) using commercial cell-based assays. Demographic, clinical and laboratory data were compiled into an investigator-administered proforma. Patients were reviewed at 1 year follow up either in person or via telephone. Results One-hundred and forty-two patients from 21 of 25 districts in Sri Lanka (median age = 20.5 years; range 1–86 years; females = 61.3%) were recruited. Of them, 65 (45.8%; median age = 19 years; range 1–86 years; females = 64.6%) fulfilled diagnostic criteria for probable NMDAR-antibody encephalitis (NMDARE) and 6 (4.2%; median age = 44 years; range 28–71 years; females = 83.3%) limbic encephalitis (LE). Abnormal behaviour (95.3%), seizures (81.5%) and movement disorders (69.2%) were the most frequent clinical manifestations of probable NMDARE. NMDAR-antibodies were detectable in 29 (44.6%) and not detectable in 36 in CSF of probable-NMDARE patients. Abnormal EEG was more frequent (p = 0.003) while a worse outcome (OR = 2.78; 95% CI = 0.88–9.09) and deaths (OR = 2.38; 95% CI = 0.67–8.33) were more likely in antibody-negative than antibody-positive probable-NMDARE. Most patients with LE had amnesia (50%) and/or confusion (100%) with agitation (83.3%) and seizures (100%) but none had detectable antibodies to any of the antigens tested. Conclusions NMDARE is the commonest type of AE among South Asians as is the case worldwide. Clinical presentations of NMDARAb-positive and NMDARAb-negative AE patients do not significantly differ but EEG may be a useful marker of an autoimmune basis for psychiatric symptoms.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1563.3-1563
Author(s):  
H. Tamaki ◽  
S. Fukui ◽  
T. Nakai ◽  
G. Kidoguchi ◽  
S. Kawaai ◽  
...  

Background:Currently it is hypothesized that many systemic autoimmune diseases occur due to environmental risk factors in addition to genetic risk factors. Anti-Neutrophil Cytoplasmic Antibody (ANCA) is mainly associated with three systemic autoimmune disease including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA). It is known that ANCA can be positive before clinical symptoms in patients with known diagnosis of GPA and ANCA titers rise before clinical manifestations appear. However, prevalence of ANCA among general population is not well known. It has not been described as well how many of people with positive ANCA eventually develop clinical manifestations of ANCA associated Vasculitis.Objectives:This study aims to estimate prevalence of ANCA in general population without ANCA associated Vasculitis. It also describes natural disease course of people with positive ANCA without ANCA associated Vasculitis. Risk factors for positive ANCA are also analyzed.Methods:This is a single center retrospective study at Center for Preventive Medicine of St. Luke’s International Hospital in Tokyo. ANCA was checked among the patients who wished to between 2018 and 2019. St. Luke’s Health Check-up Database (SLHCD) was utilized to collect the data. The patients whose serum was measured for ANCA were identified. The data for basic demographics, social habits, dietary habits and laboratory data were extracted. The charts of the patients with positive ANCA were reviewed.Results:Sera of total 1204 people were checked for ANCA. Of these 1204 people, 587 (48.8%) are male and the mean age was 55.8 years (32.6 to 79). There were total 11 patients with positive ANCA. Myeloperoxidase ANCA (MPO-ANCA) was positive for 3 patients and proteinase 3 ANCA (PR3-ANCA) was positive for 8 patients. Of these 11 patients, 5 were male (45.5%) and the mean age was 54.6 years. Two patients had history of autoimmune disease (primary biliary cirrhosis and ulcerative colitis). Five patients were evaluated by rheumatologists with the median follow-up period of 274 days. None of them developed clinical signs and symptoms of ANCA associated Vasculitis. Four out of five patients had ANCA checked later, two of which turned negative. The prevalence of ANCA in this cohort was 0.9% (95% confidence interval [95% CI]: 0.5% to 1.6%). Univariate analysis was performed to identify risk factors of positive ANCA. The variables analyzed include age, gender, body mass index (BMI), smoking habits, alcohol intake, dietary habits (fruits, fish, red meat), hypertension, dyslipidemia, and laboratory data. None of these variables demonstrated statistically significant differences except for positive rheumatoid factor (ANCA positive group: 33 % vs ANCA negative group: 9.1%, p value = 0.044).Conclusion:The prevalence of ANCA in this cohort was 0.9% (95% CI: 0.5% to 1.6%). None of them who had a follow-up developed ANCA associated Vasculitis during the follow-up period. Longer follow-up and more patients are necessary to determine natural course of people with positive ANCA.Disclosure of Interests:None declared


2020 ◽  
Author(s):  
Wenzhi ZHANG ◽  
Hui LI ◽  
Jingzhen LIU ◽  
Jiawei XU ◽  
Jinjin HAO ◽  
...  

Abstract The knowledge of clinical characteristics and prognosis of pediatric acute megakaryocytic leukemia (AMKL) with or without acquired +21 was limited. We reported 15 AMKL pediatric patients without Down Syndrome (four cases with acquired +21 and 11 cases without acquired +21) with the clinical manifestations, laboratory data, and prognosis. The clinical features and laboratory data between patients with acquired +21 and patients without acquired +21 are similar. As for prognosis, three of the 11 cases without acquired +21 obtained complete remission (CR) after 1st induction. The median follow-up time of the 11 cases was 9 months. Among four cases with acquired +21, one case gave up treatment during 1st induction, one obtained CR after 1st induction and was still alive after 49 months of follow-up. One case obtained CR after 2nd induction and was still alive for 15 months of follow-up after bone marrow transplantation, the other patient was planning for allogeneic hematopoietic stem cell transplantation (HSCT) without CR. The median follow-up time of the four cases was 12 months. None relapsed in our study. In conclusion, acquired trisomy 21 may not be an indicator for poor prognosis. Cytogenetics analysis can help us for diagnosis stratification, prognostic judgment and individualized treatment of AMKL.


Author(s):  
Damon Kamming

Seventy-five per cent of all elective surgery will soon be day surgery. Thirty to fifty per cent of the patients do not take post discharge analgesia around the clock regularly as instructed. Thirty per cent of the patients experience moderate to severe pain post discharge as a result of only taking analgesia as required after day surgery. Patient education in preassessment clinic (PAC) is vital to ensure that patients understand day surgery analgesia management. Proactive pre-emptive and multimodal analgesia utilizing regional anaesthesia reduce opioid-related side effects and enable discharge home. Post discharge regular multimodal analgesia is key to achieving goal of mild post discharge pain scores. Patient follow up is vital for audit and ensuring quality clinical care.


Phlebologie ◽  
2019 ◽  
Vol 48 (03) ◽  
pp. 177-181
Author(s):  
Martin Kiderlen ◽  
Nina Schäffer ◽  
Lisa Schuler ◽  
Athanasios Theodoridis ◽  
Iris Weingard ◽  
...  

Zusammenfassung Einleitung Die thermische Venenablation varikös veränderter Stammvenen der unteren Extremität ist in Deutschland aufgrund der guten Wirksamkeit, Anwendungssicherheit und hoher Patientenzufriedenheit eine anerkannte und häufig durchgeführte Behandlungsmöglichkeit. Zielsetzung der prospektiven Anwendungsbeobachtung (AWB) war die Untersuchung des Operationserfolges, der Patientenzufriedenheit und des Auftretens von Nebenwirkungen bei endovenöser Behandlung der varikös veränderten Vena saphena magna (VSM), Vena saphena parva (VSP) sowie bei Krossenrezidiven (KR) unter Verwendung der ETQ 360° FUSED Fiber™. Material und Methoden Insgesamt wurden 162 varikös veränderte Venen (VSM n = 76, VSP n = 65, KR n = 25) bei 144 Patienten behandelt und in die AWB eingeschlossen. Ein duplexsonographisches Follow-up erfolgte nach 10–14 Tagen sowie 3 Monaten. Die ETQ 360° FUSED Fiber™ hat eine Wellenlänge von 1470 nm bei einem beam angle von 60°. Für die endovenöse Therapie der VSM und von KR wurde eine Faser mit einem Faserkerndurchmesser von 600 µm bei einem Spitzendurchmesser von 1,8 mm und 8 Watt Behandlungsenergie eingesetzt. Zur Behandlung der VSP wurde ein Faserkerndurchmesser von 400 µm bei einem Spitzendurchmesser von 1,3 mm und 6 Watt Behandlungsenergie gewählt. Ergebnisse Alle thermisch behandelten VSM (n = 6) und VSP (n = 65) waren bei Visite 2 und Visite 3 vollständig verschlossen. In der KR Gruppe (n = 25) zeigten sich bei Visite 2 Verschlussraten von 96 % und Teilverschlussraten von 4 %. Bei Visite 3 konnten noch Verschlussraten von 80 % und Teilverschlussraten von 16 % nachgewiesen werden. In 4 % der Fälle kam es zu einer vollständigen Rekanalisierung. Tiefe Beinvenenthrombosen (TVT) oder Lungenembolien (LE) wurde in keiner der Kohorten diagnostiziert. 1,4 % der an der VSM behandelten Patienten gaben bei Visite 3 Sensibilitätsstörungen im Behandlungsareal an, in der VSP Gruppe waren es 6,15 %. Patienten der KR Kohorte gaben keinerlei Einschränkungen bezüglich der Sensibilität an. Die Patientenzufriedenheit war in allen Gruppen sehr hoch, in allen 3 Gruppen verbesserte sich der Venous Clinical Severity Score (VSCC) signifikant. Zusammenfassung Die Behandlung der VSM, VSP und von KR mit der ETQ 360° FUSED Fiber™ ist effizient, komplikationsarm und mit einer hohen Patientenzufriedenheit assoziiert.


2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yunfei Li ◽  
Xin Yuan ◽  
Ruimin Chen ◽  
Xiangquan Lin ◽  
Huakun Shangguan ◽  
...  

Abstract Objective Vitamin D-dependent rickets type IA (VDDR-IA) is a rare autosomal recessive disorder characterized by the early onset of severe rickets. The objectives of this study were twofold: (1) to analyze the clinical characteristics and therapy of two patients with VDDR-IA from two separate Chinese families, and (2) investigate the CYP27B1 gene mutations in two large pedigrees. Methods Medical history, clinical manifestations, physical examination, radiological findings and laboratory data were analyzed from two patients with VDDR-IA. Serum 1, 25-dihydroxyvitamin D [1, 25-(OH)2D3] of the two patients and their respective families were measured by ELISA and blood samples from both families was obtained for CYP27B1 gene sequence. Results Two patients had typical manifestations and radiological evidence of rickets. Laboratory data showed hypocalcaemia and hypophosphataemia, along with high levels of serum alkaline phosphatase, parathyroid hormone and 25-hydroxyvitamin D3. However, serum 1,25-(OH)2D3 level were low in the patients but normal in their family members. Genetic sequence identified two patients were homozygous for a duplication mutation in exon 8 of CYP27B1 gene (c.1319_1325dupCCCACCC, p.Phe443Profs * 24). After treating with calcitriol and calcium, there was biochemical improvement with normalization of serum calcium and phosphorus, and radiographic evidence of compensatory skeletal mineralization. One patient developed nephrocalcinosis during follow-up. Conclusions This study identified a recurrent seven-nucleotide insertion of CYP27B1 in two large pedigrees, and compared the clinical characteristics and individual therapy of two affected patients. Additionally, our experience further supports the notion that nephrocalcinosis can occur even on standard doses of calcitriol and oral calcium, and normal level of serum calcium, phosphorus, PTH and 25-(OH)D3.


2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S268-S269
Author(s):  
Mariawy Riollano ◽  
Christina L Marshall ◽  
shanna kowalsky ◽  
Michael Tosi ◽  
Roberto Posada ◽  
...  

Abstract Background MIS-C is a multi-system inflammatory syndrome which has been described in pediatric patients after COVID-19 since late April. Our objective is to describe the short-term outcomes of the first 15 cases with MIS-C, who presented for care to a tertiary pediatric referral center. Methods This is a retrospective chart review of patients who met MIS-C criteria based on the New York State Department of Health case definition and who were admitted to the Mount Sinai Hospital in New York City, between April 24 and May 14, 2020. We collected clinical and laboratory data during their hospital admission and subsequent outpatient follow up. Results The range of the length of hospital stay was 6–13 days (mean=7 days). One patient expired on day 9 of hospitalization. At the time of discharge, all patients had normalization of inflammatory markers. All patients were discharged on anticoagulation therapy for 14 days. One patient was readmitted with a subdural hematoma at day 13 post discharge and 3 patients had bruising at their follow up visit 7–12 days after hospital discharge. All patients had normalization of cardiac enzymes prior to hospital discharge. Abnormalities in coronary arteries and cardiac function which were observed during hospitalizations in 4 (27%) and 8 (53%) patients respectively, had resolved by day 6–35 post discharge (mean=20 days). Conclusion Although patients with MIS-C can present with severe multi-organ involvement and shock, the majority of the patients in our experience had resolution of symptoms and normalization of laboratory parameters within a few weeks of initial symptoms. Our findings underscore the need to carefully weigh the risk and benefits of anticoagulation therapy and to monitor this treatment closely. Further research is needed to determine long-term outcomes of these patients. Disclosures All Authors: No reported disclosures


2021 ◽  
Vol 31 (2) ◽  
pp. 189-196
Author(s):  
V. R. Makhmutova ◽  
T. E. Gembitskaya ◽  
A. G. Chermenskiy ◽  
O. N. Titova

March 11, 2020 WHO has declared the COVID-19 coronavirus pandemic. The European Society for Cystic Fibrosis (ECFS) has developed the ECFSCOVID- 19 surveillance program to collect information on the characteristics of COVID-19 in patients with cystic fibrosis (CF). CF centers in the Russian Federation also joined the ECFS study. The ECFS collected information only through national Registers. In our country, the national register of CF patients has existed since 2011, its data is included in the European Register. Тo analyze the prevalence and course of COVID-19 in adult CF patients in Saint-Petersburg and the Leningrad region.Methods. From 11.03.20 to 24.12.20, 10 cases of adult CF patients (4 women, 6 men) with COVID-19 were analyzed in Saint-Petersburg and the Leningrad region. At the beginning of the study, 56 adult CF patients lived in Saint-Petersburg and Leningrad Region. All patients were monitored remotely by telephone, in case of ARVI symptoms, disease exacerbation, a PCR smear was performed on SARS-CoV-2, therapy was prescribed remotely, and inpatient treatment was prescribed if indicated.Results. COVID-19 was diagnosed in 10 adult CF patients aged 21 to 43 years. Two patients (32-year-old male and 31-year-old female with severe mixed cystic fibrosis form) were hospitalized with polysegmental pneumonia. 8 people were treated on an outpatient basis. Only 1 outpatient patient aged 43 years had pronounced clinical manifestations of COVID-19, the condition was regarded as moderate, the remaining outpatient patients suffered from a mild ARI disease. All patients were treated with positive dynamics. During the period of this follow – up, 3 CF patients (2 men, 1 woman) died, the death cause was the respiratory failure progression. Clinical and radiological, repeated laboratory data for COVID-19 were not obtained. At the point of December 24, 2020 53 adult CF patients are alive.Conclusion. According to our data, the incidence of COVID-19 among adult CF patients in Saint-Petersburg and the Leningrad Region was 17.85%, which is a lower indicator than in the general population. The disease was rarely severe, and effective treatment was noted in outpatient settings. There were no deaths from COVID-19.


Author(s):  
Riccardo Cau ◽  
Pier Paolo Bassareo ◽  
Lorenzo Mannelli ◽  
Jasjit S. Suri ◽  
Luca Saba

AbstractSevere acute respiratory syndrome coronavirus 2 (SARS- CoV-2), previously named “2019 novel coronavirus” (2019-nCoV) is an emerging disease and a major public health issue. At the moment, little is known, except that its spread is on a steady upward trend. That is the reason why it was declared pandemic since March 11th, 2020. Respiratory symptoms dominate the clinical manifestations of the virus, but in a few patients also other organs are involved, such as their heart. This review article provides an overview of the existing literature regarding imaging of heart injury during COVID-19 acute infection and follow-up.


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