scholarly journals POS1254 INCIDENCE AND OUTCOME OF COVID-19 IN ROUTINE RHEUMATOLOGY CARE: DATA FROM A SINGLE OUTPATIENT CENTER IN GERMANY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 910.2-911
Author(s):  
S. G. Werner ◽  
P. Höhenrieder ◽  
R. Chatelain ◽  
H. E. Langer
Keyword(s):  
Inflammatory Diseases ◽  
Virus Disease ◽  
Invasive Mechanical Ventilation ◽  
Signs And Symptoms ◽  
Published Data ◽  
Antibody Testing ◽  
University Center ◽  
Oxygen Administration ◽  
Outpatient Center ◽  
Rheumatology Outpatient

Background:Coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and its associated disease COVID-19 (Corona Virus Disease 2019) has become a worldwide pandemic since its first cases in December 2019 in Wuhan Province in China. Until now little is known about the incidence and the course of the disease in a routine setting of rheumatology outpatient care.Objectives:Aim of the study was to identify cases with COVID-19, to analyse course and outcome of the disease and the potential role of antirheumatic medication.Methods:On the occasion of a routine follow-up examination all consecutive patients of our rheumatology outpatient center were questioned about the history of established COVID-19, about typical symptoms or about contacts with patients in the period from March to the end of December 2020. Diagnostic work-up (results of PCR or antibody testing, imaging) was documented. Antibody ELISA-tests (IgG, IgA, IgM, Euroimmun) were performed in patients reporting typical signs and symptoms. Course and outcome of COVID-19 were divided in 5 groups (mild, moderate, severe, most severe, and lethal).Results:About 2.000 patients were screened. Positive findings for SARS-CoV-2 confirmed by PCR or serological testing were detected in n=33/2000 (1.65%) patients (n=14/33 (43%) rheumatoid arthritis (RA), n=8/33 (24%) psoriatic arthritis (PsA), n=7/33 (21%) spondyloarthritis (SpA), n=4/33 (12%) other diseases).No patient died and no patient required intensive care or invasive mechanical ventilation. N=2/33 patients (6%) suffered a severe course with hospitalization, one of these required intermittent oxygen administration. Both patients had no ongoing therapy with disease modifying antirheumatic drugs (DMARDs). One patient suffered from SpA, one patient from RA. Both patients had relevant comorbidities with chronic lung disease and breast cancer.Symptoms were absent or mild in n=21/33 (64%) patients, moderate in n=10/33 (30%). N=22/31 (71%) of patients with absent, mild or moderate symptoms were treated at least with one DMARD.Conclusion:For an at-risk population, the incidence of COVID-19 was unexpectedly low. Overall, patients had a mild course despite immunosuppressive therapy. This finding is consistent with published data from a single university center (1) and other university outpatient clinics (2). Possibly DMARD-therapy may protect against the occurrence of cytokine storm and vasculitic complications, which lead to severe courses and lethal outcomes in some of the patients. The data support the recommendation not to discontinue DMARDs for fear of COVID-19.References:[1]Simon D et al. Patients with immune-mediated inflammatory diseases receiving cytokine inhibitors have low prevalence of SARS-CoV-2 seroconversion. Nat Commun. 2020 Jul 24;11(1):3774. doi: 10.1038/s41467-020-17703-6. PMID: 32709909; PMCID: PMC7382482.[2]Gianfrancesco M et al. COVID-19 Global Rheumatology Alliance. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis. 2020 Jul;79(7):859-866. doi: 10.1136/annrheumdis-2020-217871. Epub 2020 May 29. PMID: 32471903; PMCID: PMC7299648.Disclosure of Interests:None declared

scholarly journals AB0702 PITFALLS IN THE DIAGNOSIS OF COVID-19 – EXPERIENCES FROM A RHEUMATOLOGY OUTPATIENT CLINIC

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1383.2-1383
Author(s):  
S. G. Werner ◽  
H. E. Langer ◽  
P. Höhenrieder ◽  
R. Chatelain
Keyword(s):  
Outpatient Clinic ◽  
Virus Disease ◽  
Disease Onset ◽  
Signs And Symptoms ◽  
Contact Tracing ◽  
Igg Antibodies ◽  
Antibody Testing ◽  
Antibody Titers ◽  
Rheumatology Outpatient

Background:PCR (Polymerase Chain Reaction) is generally considered the gold standard for confirming the diagnosis in the early stages of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection. However, in our rheumatology outpatient clinic we observed a significant discrepancy between clinical evidence of COVID-19 and PCR results.Objectives:Aim of this retrospective study was to analyze the significance of PCR and serologic tests in the diagnosis of COVID-19 (Corona Virus Disease 2019) in a cohort of patients with rheumatic diseases.Methods:Between March 2020 and January 2021, 35 patients with a history of established COVID-19 or typical signs and symptoms were identified on the occasion of a routine rheumatology follow-up examination in our institution. Previous diagnostic work-up in external facilities (results of PCR or antibody testing, imaging) was documented. Antibody ELISA-tests (IgG, IgA, IgM, Euroimmun) were performed in patients reporting typical signs and symptoms of COVID-19 in the past.Results:PCR diagnostics had been performed in 15/35 patients (43%), in 13/35 (39%) at the onset of the first symptoms, in 2 subjects only 2 months later. PCR was positive in 7/13 (54%) of those tested early, but negative in the two patients tested later. In 29/35 patients (83%) SARS-CoV-2-ELISA tests were performed on the occasion of the routine rheumatologic examination (interval between first symptoms and testing on average 98 days, median86, range 4-283 days). In two of the initially negative individuals the second PCR was positive. ELISA tests were positive in all patients. SARS-CoV-2 IgM antibodies were positive in only two patients (however 55 and 71 days after disease onset), n=8/29 (28%) IgG only, n=9/29 (31%) IgG and IgA, n=12/29 (41%) IgA only. In these subjects, IgG antibodies did not develop even in the further course. Antibody titers were in part very high, but in part also very low (only just above the normal value), so even low titers were diagnostic obviously. In all patients with negative PCR, ELISA was positive and retrospectively led to confirmation of the diagnosis. Only in 13/35 patients (37%) diagnosis had been made with the onset of the first symptoms or in the course of clinically manifest disease and had led to appropriate quarantine measures and contact tracing by the health authorities. In contrast, in the majority of patients (63%), the diagnosis of COVID-19 infection was only made retrospectively on the occasion of a routine rheumatologic follow-up. However, 5 of these 22 patients (23%) had quarantined themselves during the symptomatic phase. Titer histories were available from 12 patients. The titer became negative in 7 patients, after a mean of 188 days (median 202, min 51, max 296 days), and remained positive in 5 individuals (mean 190 days, median 191, min 122, max 260 days). The change of the titer was independent of disease severity or antirheumatic therapy.Conclusion:The results suggest that the importance of PCR in the diagnosis of COVID-19 may be overestimated. Therefore, antibody testing for SARS-CoV-2 should be performed in cases of clinical suspicion and negative PCR. In antibody diagnostics, special features were observed compared to other viruses, in particular, in some patients only low antibody titers or the absence of seroconversion with lack of development of IgG antibodies. Normalization of antibody titers in some patients supports the recommendation to vaccinate even after expired COVID-19 disease.Disclosure of Interests:None declared

The Role of Leukotrienes Inhibitors in the Management of Chronic Inflammatory Diseases

2020 ◽  
Vol 14 (1) ◽  
pp. 15-31
Author(s):  
Deepak Meshram ◽  
Khushbo Bhardwaj ◽  
Charulata Rathod ◽  
Gail B. Mahady ◽  
Kapil K. Soni
Keyword(s):  
Respiratory Diseases ◽  
Inflammatory Diseases ◽  
Leukotriene B4 ◽  
Published Data ◽  
Free Text ◽  
Plant Origin ◽  
Medical Subject Headings ◽  
Leukotriene Antagonists ◽  
Mesh Terms ◽  
Mediators Of Inflammation

Background: Leukotrienes are powerful mediators of inflammation and interact with specific receptors in target cell membrane to initiate an inflammatory response. Thus, Leukotrienes (LTs) are considered to be potent mediators of inflammatory diseases including allergic rhinitis, inflammatory bowel disease and asthma. Leukotriene B4 and the series of cysteinyl leukotrienes (C4, D4, and E4) are metabolites of arachidonic acid metabolism that cause inflammation. The cysteinyl LTs are known to increase vascular permeability, bronco-constriction and mucus secretion. Objectives: To review the published data for leukotriene inhibitors of plant origin and the recent patents for leukotriene inhibitors, as well as their role in the management of inflammatory diseases. Methods: Published data for leukotrienes antagonists of plant origin were searched from 1938 to 2019, without language restrictions using relevant keywords in both free text and Medical Subject Headings (MeSH terms) format. Literature and patent searches in the field of leukotriene inhibitors were carried out by using numerous scientific databases including Science Direct, PubMed, MEDLINE, Google Patents, US Patents, US Patent Applications, Abstract of Japan, German Patents, European Patents, WIPO and NAPRALERT. Finally, data from these information resources were analyzed and reported in the present study. Results: Currently, numerous anti-histaminic medicines are available including chloropheneremine, brompheniramine, cetirizine, and clementine. Furthermore, specific leukotriene antagonists from allopathic medicines are also available including zileuton, montelukast, pranlukast and zafirlukast and are considered effective and safe medicines as compared to the first generation medicines. The present study reports leukotrienes antagonistic agents of natural products and certain recent patents that could be an alternative medicine in the management of inflammation in respiratory diseases. Conclusion: The present study highlights recent updates on the pharmacology and patents on leukotriene antagonists in the management of inflammation respiratory diseases.

COVID-19: The Unprecedented Malady-A Holistic Review

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Viney Chawla ◽  
Pooja A Chawla
Keyword(s):  
Virus Disease ◽  
Drug Repurposing ◽  
Signs And Symptoms ◽  
Effective Vaccine ◽  
Runny Nose ◽  
Difficult Time ◽  
Holistic Review ◽  
The World ◽  
Spanish Flu ◽  
Corona Viruses

Background: Corona virus disease (COVID-19) is spreading rapidly at an unprecedented scale across continents and has emerged as the single biggest risk the world has faced in modern times. Some scientists are comparing it to Spanish flu that created havoc around a century ago. The fear of death by COVID-19 looms large at the world today. The disease has reached devastating proportions since its first reports in December 2019. Doctors are having a difficult time dealing with this challenge and the microbiologists are having sleepless nights to bring about an effective vaccine for this disease. Methods: A number of research and review articles have been exhaustively reviewed. The collected data was meticulously analysed and documented. Conclusion: This paper reviews the different types of corona viruses, the structure of SARS-CoV-2 responsible for COVID19, its transmission, virulence. Further, the article discusses the diagnosis, signs and symptoms like fever, breathlessness, cough, potential loss of taste or smell, sneezing, runny nose, fatigue, headache, sore throat and different treatment approaches including drug repurposing being tried by doctors around the globe that may come handy in the management of disease symptoms. The article describes the use of remdesivir, ribavarin, lopinavir, favipiravir, hydoxychloroquine, chloroquine, tocilizumab among others in treating COVID-19.

scholarly journals Enhancing Safety During a Pandemic Using Virtual Care Remote Monitoring Technologies and UML Modeling

2021 ◽  
Author(s):  
Elizabeth M. Borycki ◽  
Andre W. Kushniruk ◽  
Ryan Kletke ◽  
Vivian Vimarlund ◽  
Yalini Senathirajah ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Virus Disease ◽  
Grey Literature ◽  
Object Oriented ◽  
Signs And Symptoms ◽  
Use Cases ◽  
Virtual Care ◽  
The Future ◽  
Government Websites ◽  
Monitoring Technologies

Objectives: This paper describes a methodology for gathering requirements and early design of remote monitoring technology (RMT) for enhancing patient safety during pandemics using virtual care technologies. As pandemics such as COrona VIrus Disease (COVID-19) progress there is an increasing need for effective virtual care and RMT to support patient care while they are at home. Methods: The authors describe their work in conducting literature reviews by searching PubMed.gov and the grey literature for articles, and government websites with guidelines describing the signs and symptoms of COVID-19, as well as the progression of the disease. The reviews focused on identifying gaps where RMT could be applied in novel ways and formed the basis for the subsequent modelling of use cases for applying RMT described in this paper. Results: The work was conducted in the context of a new Home of the Future laboratory which has been set up at the University of Victoria. The literature review led to the development of a number of object-oriented models for deploying RMT. This modeling is being used for a number of purposes, including for education of students in health infomatics as well as testing of new use cases for RMT with industrial collaborators and projects within the smart home of the future laboratory. Conclusions: Object-oriented modeling, based on analysis of gaps in the literature, was found to be a useful approach for describing, communicating and teaching about potential new uses of RMT.

scholarly journals Immunogenetic Predictors of Severe COVID-19

Vaccines ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 211
Author(s):  
Anna Malkova ◽  
Dmitriy Kudlay ◽  
Igor Kudryavtsev ◽  
Anna Starshinova ◽  
Piotr Yablonskiy ◽  
...  
Keyword(s):  
Genetic Factors ◽  
Virus Disease ◽  
Analysis Data ◽  
Published Data ◽  
Diagnostic Significance ◽  
Life Threatening ◽  
Coronavirus Infection ◽  
Angiotension Converting Enzyme ◽  
Related Proteins

According to an analysis of published data, only 20% of patients with the new coronavirus infection develop severe life-threatening complications. Currently, there are no known biomarkers, the determination of which before the onset of the disease would allow assessing the likelihood of its severe course. The purpose of this literature review was to analyze possible genetic factors characterizing the immune response to the new coronavirus infection that could be associated with the expression of angiotension-converting enzyme 2 (ACE-2) and related proteins as predictors of severe Corona virus disease 2019 (COVID-19). We analyzed original articles published in Medline, PubMed and Scopus databases from December 2019 to November 2020. For searching articles, we used the following keywords: New coronavirus infection, Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), COVID-19, severe course, complications, thrombosis, cytokine storm, ACE-2, biomarkers. In total, 3714 publications were selected using the keywords, of which 8 were in congruence with all the criteria. The literature analysis of the association of immunogenic characteristics and the expression of ACE-2 and related proteins with the development of severe COVID-19 revealed following genetic factors: HLA-B*46:01 genotype, CXCR6 gene hypoexpression, CCR9 gene expression, TLR7, rs150892504 mutations in the ERAP2 gene, overexpression of wild-type ACE-2, TMPRSS2 and its different polymorphisms. Genes, associated with the severe course, are more common among men. According to the analysis data, it can be assumed that there are population differences. However, the diagnostic significance of the markers described must be confirmed with additional clinical studies.

scholarly journals Immersion Pulmonary Edema in Female Triathletes

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Eric A. Carter ◽  
Michael S. Koehle
Keyword(s):  
Pulmonary Edema ◽  
Water Immersion ◽  
Water Environment ◽  
Previous History ◽  
Signs And Symptoms ◽  
Contributing Factors ◽  
Long Distance ◽  
Oxygen Administration ◽  
Capillary Stress ◽  
Life Threatening

Pulmonary edema has been reported in SCUBA divers, apnea divers, and long-distance swimmers however, no instances of pulmonary edema in triathletes exist in the scientific literature. Pulmonary edema may cause seizures and loss of consciousness which in a water environment may become life threatening. This paper describes pulmonary edema in three female triathletes. Signs and symptoms including cough, fatigue, dyspnea, haemoptysis, and rales may occur within minutes of immersion. Contributing factors include hemodynamic changes due to water immersion, cold exposure, and exertion which elevate cardiac output, causing pulmonary capillary stress failure, resulting in extravasation of fluid into the airspace of the lung. Previous history is a major risk factor. Treatment involves immediate removal from immersion and in more serious cases, hospitalization, and oxygen administration. Immersion pulmonary edema is a critical environmental illness of which triathletes, race organizers, and medical staff, should be made aware.

Inflammatory and Infiltrative Diseases and Tumors

2015 ◽  
Author(s):  
Sharmila Dorbala ◽  
Katarina H. Nelson
Keyword(s):  
Radionuclide Imaging ◽  
Inflammatory Diseases ◽  
Imaging Techniques ◽  
Systemic Vasculitis ◽  
Vascular Inflammation ◽  
Image Interpretation ◽  
Response To Therapy ◽  
Published Data ◽  
The Novel ◽  
Clinical Scenarios

This chapter highlights some of the novel clinical radionuclide imaging strategies beyond perfusion imaging including inflammatory diseases, infiltrative diseases and tumors. Targeted molecular imaging techniques to evaluate cardiac amyloidosis as well as myocardial and vascular inflammation are addressed. Clinical 18F-FDG imaging of cardiac sarcoidosis, cardiovascular prosthetic valve and device infections, systemic vasculitis, and tumors are discussed in detail. For each of these pathologies, a concise overview of the disease pathophysiology and management pertinent to understanding of imaging techniques is provided followed by details of imaging including radiotracers, imaging techniques and image interpretation with a reference to societal guidelines. The published data on the utility of radionuclide imaging tests to assess diagnosis, prognosis and to monitor response to therapy are discussed. Clinical scenarios and available societal recommendations on the use of imaging are illustrated. The strengths and limitations of radionuclide techniques are discussed in the context of a comparison to echocardiography, cardiac magnetic resonance imaging, cardiac CT and endomyocardial biopsy. Future directions in imaging and ongoing clinical trials in these areas are listed at the end of each section.

Muddying the waters? A false positive case of autoimmune psychosis

2020 ◽  
pp. 103985622096504
Author(s):  
Sarangan Ketheesan ◽  
Georgia Bertram ◽  
Robert Adam ◽  
Anne Stark ◽  
James G Scott
Keyword(s):  
Psychotic Disorders ◽  
Signs And Symptoms ◽  
Psychosocial Problems ◽  
Antibody Testing ◽  
Laboratory Findings ◽  
Antineuronal Antibodies ◽  
Neurological Signs ◽  
Iatrogenic Harm ◽  
Treatment Refractory ◽  
Autoimmune Psychosis

Objective: To discuss challenges with the diagnosis of autoimmune psychosis (AP) in people with chronic psychotic disorders. Method: We present a case of a 23-year-old man with an exacerbation of treatment-refractory psychosis after receiving intravenous immunoglobulin (IVIG) for suspected AP, diagnosed 4 years after the onset of psychosis. We highlight the diagnostic and management challenges in such cases. Results: The diagnosis of AP in people with long-standing illness relies on the interpretation of non-specific clinical and laboratory findings in individuals with psychosocial problems and challenges of acceptance and adherence to complex medical investigations and treatments. Equivocal results from investigations undertaken without logical clinical reasoning can lead to inappropriate interventions that are costly and can cause iatrogenic harm. Conclusion: Psychiatrists should restrict screening for antineuronal antibodies in people with chronic psychosis to those with higher risk features such as persistent treatment refractory symptoms with concurrent neurological signs and symptoms. Further research informing the clinical circumstances for antineuronal antibody testing is needed.

scholarly journals Peripheral Neuronopathy Associated With Ebola Virus Infection in Rhesus Macaques: A Possible Cause of Neurological Signs and Symptoms in Human Ebola Patients

2020 ◽  
Vol 222 (10) ◽  
pp. 1745-1755
Author(s):  
David X Liu ◽  
Donna L Perry ◽  
Timothy K Cooper ◽  
Louis M Huzella ◽  
Randy J Hart ◽  
...  
Keyword(s):  
Ebola Virus ◽  
Neuronal Degeneration ◽  
Virus Disease ◽  
Rhesus Macaques ◽  
Signs And Symptoms ◽  
Ebola Virus Disease ◽  
Target Cells ◽  
Neurological Signs ◽  
Enteric Ganglia ◽  
Transmission Electron

Abstract Neurological signs and symptoms are the most common complications of Ebola virus disease. However, the mechanisms underlying the neurologic manifestations in Ebola patients are not known. In this study, peripheral ganglia were collected from 12 rhesus macaques that succumbed to Ebola virus (EBOV) disease from 5 to 8 days post exposure. Ganglionitis, characterized by neuronal degeneration, necrosis, and mononuclear leukocyte infiltrates, was observed in the dorsal root, autonomic, and enteric ganglia. By immunohistochemistry, RNAscope in situ hybridization, transmission electron microscopy, and confocal microscopy, we confirmed that CD68+ macrophages are the target cells for EBOV in affected ganglia. Further, we demonstrated that EBOV can induce satellite cell and neuronal apoptosis and microglial activation in infected ganglia. Our results demonstrate that EBOV can infect peripheral ganglia and results in ganglionopathy in rhesus macaques, which may contribute to the neurological signs and symptoms observed in acute and convalescent Ebola virus disease in human patients.

scholarly journals Postnatally Acquired Zika Virus Disease Among Children, United States, 2016–2017

2019 ◽  
Vol 70 (2) ◽  
pp. 227-231 ◽  
Author(s):  
Nicole P Lindsey ◽  
Charsey C Porse ◽  
Emily Potts ◽  
Judie Hyun ◽  
Kayleigh Sandhu ◽  
...  
Keyword(s):  
Zika Virus ◽  
Virus Disease ◽  
Healthcare Providers ◽  
Clinical Signs ◽  
Virus Transmission ◽  
Signs And Symptoms ◽  
Clinical Findings ◽  
Case Definition ◽  
Illness Onset ◽  
Clinical Signs And Symptoms

Abstract Background The clinical findings among children with postnatally acquired Zika virus disease are not well characterized. We describe and compare clinical signs and symptoms for children aged <18 years. Methods Zika virus disease cases were included if they met the national surveillance case definition, had illness onset in 2016 or 2017, resided in a participating state, and were reported to the Centers for Disease Control and Prevention. Pediatric cases were aged <18 years; congenital and perinatal infections were excluded. Pediatric cases were matched to adult cases (18‒49 years). Clinical information was compared between younger and older pediatric cases and between children and adults. Results A total of 141 pediatric Zika virus disease cases were identified; none experienced neurologic disease. Overall, 28 (20%) were treated in an emergency department, 1 (<1%) was hospitalized; none died. Of the 4 primary clinical signs and symptoms associated with Zika virus disease, 133 (94%) children had rash, 104 (74%) fever, 67 (48%) arthralgia, and 51 (36%) conjunctivitis. Fever, arthralgia, and myalgia were more common in older children (12‒17 years) than younger children (1‒11 years). Arthralgia, arthritis, edema, and myalgia were more common in adults compared to children. Conclusions This report supports previous findings that Zika virus disease is generally mild in children. The most common symptoms are similar to other childhood infections, and clinical findings and outcomes are similar to those in adults. Healthcare providers should consider a diagnosis of Zika virus infection in children with fever, rash, arthralgia, or conjunctivitis, who reside in or have traveled to an area where Zika virus transmission is occurring.

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