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Karyakarte RP, Das R, Rajmane MV, Dudhate S, Agarasen J, Pillai P, Chandankhede PM, Labhshetwar RS, Gadiyal Y, Kulkarni PP, Nizarudeen S, Yanamandra S, Taji N, Joshi S, Potdar V. Appearance and Prevalence of JN.1 SARS-CoV-2 Variant in India and Its Clinical Profile in the State of Maharashtra. Cureus 2024; 16:e56718. [PMID: 38646375 PMCID: PMC11032724 DOI: 10.7759/cureus.56718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND In August 2023, the BA.2.86 SARS-CoV-2 variant, with over 30 spike protein mutations, emerged amidst the global dominance of XBB sub-lineages. It evolved into JN.1 by late 2023, spreading across 71 countries. JN.1, distinct for its L455S mutation, significantly dominated global sequences, raising concerns over its transmission and clinical impact. The study investigates JN.1's clinical severity and its effect on hospital admissions in Maharashtra, India. METHODOLOGY The present study involved 3,150 curated Indian SARS-CoV-2 whole genome sequences with collection dates between 1st August 2023 and 15th January 2024. Lineage and phylogenetic analysis of sequences was performed using Nextclade. Telephonic interviews were conducted to confirm the demographic details and obtain clinical information on the JN.1* (* indicates JN.1 and all its sub-lineages) cases. The obtained data were recorded and analyzed using Microsoft® Excel (Microsoft Corporation, Redmond, WA). RESULTS Out of 3,150 sequences analyzed, JN.1* was the most common lineage (2377/3150, 75.46%), followed by XBB.2.3* (281/3150, 8.92%) and XBB.1.16* (187/3150, 5.94%). In India, it was first identified on 6th October 2023, in Kerala. The highest proportion of JN.1* sequences originated from Maharashtra (628/2377, 26.42%), followed by West Bengal (320/2377, 13.46%), Andhra Pradesh (293/2377, 12.33%), Kerala (288/2377, 12.12%), and Karnataka (285/2377, 11.99%). In Maharashtra, the JN.1* variant was first identified on 23rd November 2023. A total of 279 JN.1* cases were included in the clinical study. Of these, 95.34% (266/279) had symptomatic disease with mild symptoms; cold (187/279, 67.03%) being the most common symptom, followed by fever (156/279, 55.91%), cough (114/279, 40.86%), and headache (28/279, 15.64%). Of all the cases, 13.26% (37/279) required institutional quarantine or hospitalization, and the rest were isolated at home. Among the hospitalized patients, 54.05% (20/37) cases were given conservative treatment while 45.95% (17/37) cases required supplemental oxygen therapy. Regarding the vaccination status, 94.26% (263/279) of cases received at least one dose of the COVID-19 vaccine, while 5.02% (14/279) were not vaccinated, of which most were children aged zero to nine years (5/14, 35.71%). The overall recovery rate among JN.1* cases was 98.57% (275/279), with 1.43% (4/279) cases succumbing to the disease. CONCLUSION The JN.1* variant, the dominant variant in India, exhibits clinical features similar to previous circulating variants in Maharashtra without increased severity. Its notable transmissibility underscores the importance of studying the ongoing viral evolution. The pressing necessity for swift identification and the clinical features of new variants is essential for effective public health response.
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Affiliation(s)
- Rajesh P Karyakarte
- Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, IND
- Microbiology, Byramjee Jeejeebhoy Government Medical College, Pune, IND
| | - Rashmita Das
- Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, IND
- Microbiology, Byramjee Jeejeebhoy Government Medical College, Pune, IND
| | - Mansi V Rajmane
- Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, IND
| | - Sonali Dudhate
- Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, IND
| | - Jeanne Agarasen
- Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, IND
| | - Praveena Pillai
- Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, IND
| | - Priyanka M Chandankhede
- Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, IND
| | - Rutika S Labhshetwar
- Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, IND
| | - Yogita Gadiyal
- Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, IND
| | - Preeti P Kulkarni
- Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, IND
| | - Safanah Nizarudeen
- Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, IND
| | - Sushma Yanamandra
- Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, IND
| | - Nyabom Taji
- Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, IND
| | - Suvarna Joshi
- Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, IND
| | - Varsha Potdar
- Infectious Diseases, Indian Council of Medical Research, National Institute of Virology, Pune, IND
- Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, IND
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2
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Tafreshi P, Pham J, Seetharam K, Mir T, Mir P. Lung Metastasis From Uterine Leiomyosarcoma: An Asymptomatic Presentation for a Rare Tumor. Cureus 2023; 15:e44671. [PMID: 37799237 PMCID: PMC10550340 DOI: 10.7759/cureus.44671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Uterine leiomyosarcoma (ULC) is an uncommon neoplasm characterized by poor prognosis, it can predispose to distant metastasis, causing various symptomatic presentations. We present a unique case of a large heterogeneous mass in the lung cavity arising from a ULC, with complete absence of pulmonary symptoms and with concurrent coronavirus disease 2019 (COVID-19) infection. A high degree of clinical suspicion is required for ULC with accompanying metastasis.
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Affiliation(s)
- Parsa Tafreshi
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
| | - Judy Pham
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
| | | | - Tanveer Mir
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
| | - Parvez Mir
- Pulmonary Critical Care and Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
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Shirozhan M, Mamode Khan NA, Bakouch HS. An INAR(1) Time Series Model via a Modified Discrete Burr–Hatke with Medical Applications. Iran J Sci Technol Trans A Sci 2022:1-16. [PMCID: PMC9742667 DOI: 10.1007/s40995-022-01387-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 11/10/2022] [Indexed: 12/14/2022]
Abstract
This paper introduces a flexible discrete transmuted record type discrete Burr–Hatke (TRT-DBH) model that seems suitable for handling over-dispersion and equi-dispersion in count data analysis. Further to the elegant properties of the TRT-DBH, we propose, in the time series context, a first-order integer-valued autoregressive process with TRT-DBH distributed innovations [TRBH-INAR(1)]. The moment properties and inferential procedures of this new INAR(1) process are studied. Some Monte Carlo simulation experiments are executed to assess the consistency of the parameters of the TRBH-INAR(1) model. To further motivate its purpose, the TRBH-INAR(1) is applied to analyze the series of the COVID-19 deaths in Netherlands and the series of infected cases due to the Tularaemia disease in Bavaria. The proposed TRBH-INAR(1) model yields superior fitting criteria than other established competitive INAR(1) models in the literature. Further diagnostics related to the residual analysis and forecasting based on the TRBH-INAR(1) model are also discussed. Based on modified Sieve bootstrap predictors, we provide integer forecasts of future death of COVID-19 and infected of Tularemia.
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Affiliation(s)
| | | | - Hassan S. Bakouch
- Department of Mathematics, College of Science, Qassim University, Buraydah, Saudi Arabia ,Department of Mathematics, Faculty of Science, Tanta University, Tanta, Egypt
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Caudron C, Ben Abdallah I, Détriché G, Cherkaoui R, Julia P, Alsac J, Mirault T, El Batti S. Aortic thrombosis as a dramatic vascular complication in COVID-19 disease. JMV-Journal de Médecine Vasculaire 2022. [DOI: 10.1016/j.jdmv.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 10/04/2022] [Indexed: 11/22/2022]
Abstract
Objective Methods Results Conclusion
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Paul S, Royal S, Lee M, Shin S, Chahine J, Rozeboom A, Ahn J, Dhani H, Yazigi N, Kaufman S, Khan K, Matsumoto C, Kroemer A, Fishbein T, Ekong UD. SARS-CoV-2 Infection in Pediatric Solid Organ Transplant Recipients: A Single Center Observation. J Pediatr Gastroenterol Nutr 2022; 75:276-285. [PMID: 35758426 PMCID: PMC9365074 DOI: 10.1097/mpg.0000000000003548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/31/2022] [Indexed: 12/10/2022]
Abstract
OBJECTIVES This is a descriptive study to characterize rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pediatric solid organ transplant (SOT) recipients during the early days of the pandemic. We hypothesized that asymptomatic infection may represent a large proportion of SARS-CoV-2 infection in pediatric SOT recipients. METHODS We queried Organ Transplant Tracking Record (OTTR) for all pediatric SOT recipients followed at our center and reviewed medical records to identify patients tested for SARS-CoV-2 between March 15, 2020 and June 30, 2021. Patients were tested by polymerase chain reaction (PCR): prior to planned procedures or because of symptoms; OR: tested by measurement of IgG to spike protein with their routine labs q 2-monthly. A positive PCR was called acute infection. A positive IgG with negative PCR was called convalescence. For immunologic studies, blood was obtained when the PCR or IgG was positive. Statistical comparisons were made between (1) acute infection versus convalescence; (2) acute infection versus SOT recipients without infection (called healthy controls); (3) liver transplant (LT) versus small bowel (SB)/multivisceral transplant (MVT); (4) positive versus negative test result. RESULTS Of 257 LT recipients, 99 were tested: 6 were PCR positive, 13 were antibody positive. Of 150 SB/MVT recipients, 55 were tested: 4 were PCR positive, 6 were antibody positive. Of 8 simultaneous liver, kidney transplant recipients, 3 were tested: 1 was PCR positive. Symptoms when present were mostly mild. Patients with a positive test result were younger (6.3 vs 10.0 years; P = 0.017). We observed a rapid decline in viral load within 96 hours without a change in immunosuppression. Antibody lasted >8 months beyond the time it was monitored. Acute infection was associated with increased CD4 and CD8 T EM cell frequency ( P = 0.04, P = 0.03, respectively), decreased interferon (IFN)-γ production from T-cells (2.8% vs 11.3%; P = 0.006), and decreased CD8 TEMRA frequency (4.56% vs 11.70%; P = 0.006). CONCLUSIONS Early in the pandemic, COVID-19 disease was mostly mild in pediatric SOT recipients with no rejection, patient death, or graft loss observed.
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Affiliation(s)
- Saikat Paul
- From the Medstar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC
| | - Scott Royal
- the Department of Pediatrics, Georgetown University School of Medicine, Washington, DC
| | - Margaret Lee
- the Georgetown University School of Medicine, Washington, DC
| | - Stephanie Shin
- the Georgetown University School of Medicine, Washington, DC
| | - Joeffrey Chahine
- the Department of Pathology & Laboratory Medicine, Medstar Georgetown University Hospital, Washington, DC
| | - Aaron Rozeboom
- the Georgetown University School of Medicine, Washington, DC
| | - Jaeil Ahn
- the Department of Biostatistics, Bioinformatics, & Biomathematics, Georgetown University, Washington, DC
| | - Harmeet Dhani
- From the Medstar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC
| | - Nada Yazigi
- From the Medstar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC
| | - Stuart Kaufman
- From the Medstar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC
| | - Khalid Khan
- From the Medstar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC
| | - Cal Matsumoto
- From the Medstar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC
| | - Alexander Kroemer
- From the Medstar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC
| | - Thomas Fishbein
- From the Medstar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC
| | - Udeme D. Ekong
- From the Medstar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC
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Vidula MK, Ambrose M, Glassberg H, Chokshi N, Chen T, Ferrari VA, Han Y. Myocarditis and Other Cardiovascular Complications of the mRNA-Based COVID-19 Vaccines. Cureus 2021; 13:e15576. [PMID: 34277198 PMCID: PMC8270057 DOI: 10.7759/cureus.15576] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/25/2022] Open
Abstract
Cardiovascular complications following the receipt of mRNA-based (Pfizer-BioNTech and Moderna) coronavirus disease 2019 (COVID-19) vaccines have not yet been described. In this case series, we describe two patients with clinically suspected myocarditis, one patient with stress cardiomyopathy, and two patients with pericarditis after receiving an mRNA-based COVID-19 vaccine. The two patients with clinically suspected myocarditis were otherwise healthy young men who presented with acute substernal chest pressure and/or dyspnea after receiving the second dose of the vaccine and were found to have diffuse ST elevations on electrocardiogram (ECG), elevated cardiac biomarkers and inflammatory markers, and mildly reduced left ventricular (LV) function on echocardiography. Both patients met the modified Lake Louise Criteria for acute myocarditis by cardiac magnetic resonance imaging. We subsequently discuss a case of a 60-year-old woman with known coronary artery disease (CAD) and previously normal LV function, who presented with new exertional symptoms, ECG changes, and apical akinesis following the second dose of the vaccine, and was diagnosed with a stress cardiomyopathy. Finally, we describe two patients with pericarditis who presented with chest pain, elevated inflammatory markers, and pericardial effusions after receiving the vaccine. Overall, this case series describes the first reported cases of myocarditis, stress cardiomyopathy, and pericarditis after receiving an mRNA-based COVID-19 vaccine.
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Affiliation(s)
- Mahesh K Vidula
- Medicine/Cardiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Marietta Ambrose
- Medicine/Cardiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Helene Glassberg
- Medicine/Cardiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Neel Chokshi
- Medicine/Cardiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Tiffany Chen
- Medicine/Cardiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Victor A Ferrari
- Medicine/Cardiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Yuchi Han
- Medicine/Cardiology, Hospital of the University of Pennsylvania, Philadelphia, USA
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Affiliation(s)
- Elena Roca
- COVID-19 Unit, Departmental Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
- Corresponding Author: Elena Roca MD, Covid-19 Unit, Head and Neck Department, Poliambulanza Fundation Hospital, Via Leonida Bissolati, 57, 25124 Brescia, Brescia (Italy), Phone: +39 3393667949, e-mail:
| | - Laura Ventura
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Costanza M Zattra
- COVID-19 Unit, Departmental Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Carlo Lombardi
- COVID-19 Unit & Departmental Unit of Pneumology & Allergology, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
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Hamid S, Alvares da Silva MR, Burak KW, Chen T, Drenth JP, Esmat G, Gaspar R, LaBrecque D, Lee A, Macedo G, McMahon B, Ning Q, Reau N, Sonderup M, van Leeuwen DJ, Armstrong D, Yurdaydin C. WGO Guidance for the Care of Patients With COVID-19 and Liver Disease. J Clin Gastroenterol 2021; 55:1-11. [PMID: 33230011 PMCID: PMC7713641 DOI: 10.1097/mcg.0000000000001459] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the least deadly but most infectious coronavirus strain transmitted from wild animals. It may affect many organ systems. Aim of the current guideline is to delineate the effects of SARS-CoV-2 on the liver. Asymptomatic aminotransferase elevations are common in coronavirus disease 2019 (COVID-19) disease. Its pathogenesis may be multifactorial. It may involve primary liver injury and indirect effects such as "bystander hepatitis," myositis, toxic liver injury, hypoxia, and preexisting liver disease. Higher aminotransferase elevations, lower albumin, and platelets have been reported in severe compared with mild COVID-19. Despite the dominance of respiratory disease, acute on chronic liver disease/acute hepatic decompensation have been reported in patients with COVID-19 and preexisting liver disease, in particular cirrhosis. Metabolic dysfunction-associated fatty liver disease (MAFLD) has a higher risk of respiratory disease progression than those without MAFLD. Alcohol-associated liver disease may be severely affected by COVID-19-such patients frequently have comorbidities including metabolic syndrome and smoking-induced chronic lung disease. World Gastroenterology Organization (WGO) recommends that interventional procedures such as endoscopy and endoscopic retrograde cholangiopancreatography should be performed in emergency cases or when they are considered strictly necessary such as high risk varices or cholangitis. Hepatocellular cancer surveillance may be postponed by 2 to 3 months. A short delay in treatment initiation and non-surgical approaches should be considered. Liver transplantation should be restricted to patients with high MELD scores, acute liver failure and hepatocellular cancer within Milan criteria. Donors and recipients should be tested for SARS-CoV-2 and if found positive donors should be excluded and liver transplantation postponed until recovery from infection.
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Affiliation(s)
- Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Kelly W. Burak
- Department of Medicine and Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Tao Chen
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Joost P.H. Drenth
- Department of Gastroenterology and Hepatology, Radboud UMC, Nijmegen, The Netherlands
| | - Gamal Esmat
- Endemic Medicine and Hepatogastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rui Gaspar
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Douglas LaBrecque
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Alice Lee
- Hepatitis Program, Concord Repatriation General Hospital, University of Sydney, Sydney, NSW, Australia
| | - Guilherme Macedo
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Brian McMahon
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK
| | - Qin Ning
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nancy Reau
- Section of Hepatology, Rush University Medical Center, Chicago, IL
| | - Mark Sonderup
- Department of Medicine, Division of Hepatology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Dirk J. van Leeuwen
- Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David Armstrong
- Division of Gastroenterology, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Cihan Yurdaydin
- Department of Gastroenterology & Hepatology, Koç University Medical School, Istanbul, Turkey
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Rubbi I, Pasquinelli G, Brighenti A, Fanelli M, Gualandi P, Nanni E, D'Antoni V, Fabbri C. Healthcare personnel exposure to COVID - 19: an observational study on quarantined positive workers. Acta Biomed 2020; 91:e2020012. [PMID: 33263344 PMCID: PMC8023106 DOI: 10.23750/abm.v91i12-s.10814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY COVID-19 is characterized by super spread events occurring in communities, e.g., hospitals. To limit virus diffusion among healthcare workers the use of personal protective equipment and screening tests are highly advised; also, isolation of virus positive professionals while monitoring their health condition is recommended. This study aims to assess, in a cohort of COVID-19 positive quarantined healthcare workers, the perceived source of infection and exposure risk as well as the clinical evolution of the disease through a surveillance interview. METHODS A retrospective observational study accounting 896 observations on 93 healthcare professionals tested positive for COVID-19. Data were collected from the Nursing and Technical Directorate of Romagna, Ravenna, Local Health Company, Italy. RESULTS 99.5% of the positive workers accepted phone interviews with management staff. 2.6% of workers were positive with increasing records in the specialist medical area. Nurses and social health professionals were mostly affected. Patient exposure at a distance <1 m and a contact time > 2 hours was the first cause of positivity. In COVID-19 and territorial emergency departments, the first cause was the contact with colleagues. At the time of the infection, most of the staff wore a surgical mask. Cough, asthenia, fever, anosmia, dysgeusia, and rhinitis were common symptoms. Asymptomatic percentage was about 10%. The self-perceived physical condition was high (>7) and improved during the observation period. CONCLUSIONS The diffusion rate of COVID-19 among healthcare workers is relatively low, probably due to the use of personal protective equipment. The distancing, also among colleagues, is a fundamental measure to reduce the possibility of infection. Symptoms are mild and can be controlled by surveillance measures. Constant contact with the organization is an essential strategy for promoting recovering of workers and reducing the spread of the virus within the healthcare organization.
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Affiliation(s)
- Ivan Rubbi
- Corso di Laurea in Infermieristica Università di Bologna - Faenza.
| | - Gianandrea Pasquinelli
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna,Italy.
| | | | | | | | | | | | - Cristina Fabbri
- Nursing and Technical Direction AUSL Romagna - Ravenna, Italy.
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Long SW, Olsen RJ, Christensen PA, Bernard DW, Davis JJ, Shukla M, Nguyen M, Saavedra MO, Yerramilli P, Pruitt L, Subedi S, Kuo HC, Hendrickson H, Eskandari G, Nguyen HAT, Long JH, Kumaraswami M, Goike J, Boutz D, Gollihar J, McLellan JS, Chou CW, Javanmardi K, Finkelstein IJ, Musser JM. Molecular Architecture of Early Dissemination and Massive Second Wave of the SARS-CoV-2 Virus in a Major Metropolitan Area. medRxiv 2020:2020.09.22.20199125. [PMID: 33024977 PMCID: PMC7536878 DOI: 10.1101/2020.09.22.20199125] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We sequenced the genomes of 5,085 SARS-CoV-2 strains causing two COVID-19 disease waves in metropolitan Houston, Texas, an ethnically diverse region with seven million residents. The genomes were from viruses recovered in the earliest recognized phase of the pandemic in Houston, and an ongoing massive second wave of infections. The virus was originally introduced into Houston many times independently. Virtually all strains in the second wave have a Gly614 amino acid replacement in the spike protein, a polymorphism that has been linked to increased transmission and infectivity. Patients infected with the Gly614 variant strains had significantly higher virus loads in the nasopharynx on initial diagnosis. We found little evidence of a significant relationship between virus genotypes and altered virulence, stressing the linkage between disease severity, underlying medical conditions, and host genetics. Some regions of the spike protein - the primary target of global vaccine efforts - are replete with amino acid replacements, perhaps indicating the action of selection. We exploited the genomic data to generate defined single amino acid replacements in the receptor binding domain of spike protein that, importantly, produced decreased recognition by the neutralizing monoclonal antibody CR30022. Our study is the first analysis of the molecular architecture of SARS-CoV-2 in two infection waves in a major metropolitan region. The findings will help us to understand the origin, composition, and trajectory of future infection waves, and the potential effect of the host immune response and therapeutic maneuvers on SARS-CoV-2 evolution.
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Affiliation(s)
- S. Wesley Long
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas 77030
- Departments of Pathology and Laboratory Medicine, and Microbiology and Immunology, Weill Cornell Medical College, 1300 York Avenue, New York, New York 10065
| | - Randall J. Olsen
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas 77030
- Departments of Pathology and Laboratory Medicine, and Microbiology and Immunology, Weill Cornell Medical College, 1300 York Avenue, New York, New York 10065
| | - Paul A. Christensen
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas 77030
| | - David W. Bernard
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas 77030
- Departments of Pathology and Laboratory Medicine, and Microbiology and Immunology, Weill Cornell Medical College, 1300 York Avenue, New York, New York 10065
| | - James J. Davis
- Consortium for Advanced Science and Engineering, University of Chicago, 5801 South Ellis Avenue, Chicago, Illinois, 60637
- Computing, Environment and Life Sciences, Argonne National Laboratory, 9700 South Cass Avenue, Lemont, Illinois 60439
| | - Maulik Shukla
- Consortium for Advanced Science and Engineering, University of Chicago, 5801 South Ellis Avenue, Chicago, Illinois, 60637
- Computing, Environment and Life Sciences, Argonne National Laboratory, 9700 South Cass Avenue, Lemont, Illinois 60439
| | - Marcus Nguyen
- Consortium for Advanced Science and Engineering, University of Chicago, 5801 South Ellis Avenue, Chicago, Illinois, 60637
- Computing, Environment and Life Sciences, Argonne National Laboratory, 9700 South Cass Avenue, Lemont, Illinois 60439
| | - Matthew Ojeda Saavedra
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas 77030
| | - Prasanti Yerramilli
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas 77030
| | - Layne Pruitt
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas 77030
| | - Sishir Subedi
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas 77030
| | - Hung-Che Kuo
- Department of Molecular Biosciences and Institute of Molecular Biosciences, The University of Texas at Austin, Austin, Texas 78712
| | - Heather Hendrickson
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas 77030
| | - Ghazaleh Eskandari
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas 77030
| | - Hoang A. T. Nguyen
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas 77030
| | - J. Hunter Long
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas 77030
| | - Muthiah Kumaraswami
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas 77030
| | - Jule Goike
- Department of Molecular Biosciences and Institute of Molecular Biosciences, The University of Texas at Austin, Austin, Texas 78712
| | - Daniel Boutz
- CCDC Army Research Laboratory-South, University of Texas, Austin, Texas 78712
| | - Jimmy Gollihar
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas 77030
- CCDC Army Research Laboratory-South, University of Texas, Austin, Texas 78712
| | - Jason S. McLellan
- Department of Molecular Biosciences and Institute of Molecular Biosciences, The University of Texas at Austin, Austin, Texas 78712
| | - Chia-Wei Chou
- Department of Molecular Biosciences and Institute of Molecular Biosciences, The University of Texas at Austin, Austin, Texas 78712
| | - Kamyab Javanmardi
- Department of Molecular Biosciences and Institute of Molecular Biosciences, The University of Texas at Austin, Austin, Texas 78712
| | - Ilya J. Finkelstein
- Department of Molecular Biosciences and Institute of Molecular Biosciences, The University of Texas at Austin, Austin, Texas 78712
- Center for Systems and Synthetic Biology, University of Texas at Austin, Austin, Texas 78712
| | - James M. Musser
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas 77030
- Departments of Pathology and Laboratory Medicine, and Microbiology and Immunology, Weill Cornell Medical College, 1300 York Avenue, New York, New York 10065
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11
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Malik FTN, Ishraquzzaman M, Kalimuddin M, Choudhury S, Ahmed N, Badiuzzaman M, Ahmed MN, Banik D, Huq TS, Al Mamun MA. Clinical Presentation, Management and In-Hospital Outcome of Healthcare Personnel With COVID-19 Disease. Cureus 2020; 12:e10004. [PMID: 32983701 PMCID: PMC7515093 DOI: 10.7759/cureus.10004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective Healthcare personnel (HCP) are undoubtedly one of the major frontline fighters in the coronavirus disease 2019 (COVID-19) pandemic. Therefore, it comes as no surprise that many HCP have become infected by COVID-19 globally. The infection of HCP has received great attention in social media and is frequently reported from different parts of the world. However, there are few scientific reports addressing this aspect of the COVID-19 pandemic. The aim of this study was to evaluate the characteristics of clinical presentation, treatment, and outcome of COVID-19 infection among the HCP of our setting. Methods This cross-sectional study was performed in the National Heart Foundation Hospital & Research Institute of Bangladesh from April 29 to July 20, 2020. HCP employed in this hospital who experienced fever or respiratory symptoms or came in close contact with COVID-19 patients at home or their workplace were included in this study. The presence of COVID-19 disease was confirmed by real-time reverse transcriptase-polymerase chain reaction on nasopharyngeal samples. A total of 394 HCP were sampled and 139 had a positive corona test. Structured interviews were conducted to document symptoms for all HCP with confirmed COVID-19. Data analysis was performed in July 2020. Results Out of 1,409 HCP, 139 subjects tested positive for COVID-19. Among the HCP, infection rate was 9.86%. The mean age of the study population was 34.08±11.11 years (range: 20-69 yrs), of whom 82 (59%) were female. Most of this cohort were nurses (56 [40.3%]) and physicians (25 [18%]), and the remaining 58 (41.7%) were other staff. The mean duration of onset of symptoms to test was 2.89±2.07 days. The most common symptoms were fever (84.2%), fatigue (56.1%), cough (54%), body ache (39.6%), headache, and anosmia (38.8%). Most subjects had mild disease (125 [93%]), three (2.1%) of the HCP had moderate disease and one (0.7%) had severe disease. Ten of the HCP (7.2%) were asymptomatic. Most of them were treated either by ivermectin plus azithromycin or ivermectin plus doxycycline. Only 20 (14.4%) of the HCP were hospitalized, while others were treated either in home isolation (59.7%) or in institutional isolation (25.9%). Recovery was almost uneventful except one healthcare worker who died. Conclusion Most HCP had mild symptoms and a few of them were asymptomatic also. HCP with mild COVID-19 symptoms may be treated in home or institutional isolation. As they are a vulnerable group for infection, providing adequate protection to HCP is absolutely mandatory to safeguard them from this pandemic.
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Affiliation(s)
| | - Mir Ishraquzzaman
- Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
| | - Md Kalimuddin
- Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
| | - Sohel Choudhury
- Department of Epidemiology and Research, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
| | - Nazir Ahmed
- Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
| | | | - Mir N Ahmed
- Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
| | - Dhiman Banik
- Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
| | - Tawfiq S Huq
- Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
| | - Mohammad Abdullah Al Mamun
- Department of Epidemiology and Research, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
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Abstract
The World Health Organization (WHO) declared COVID-19, a novel coronavirus infection, as a pandemic in March 2020. Since the origin of the disease in Wuhan, China, understanding the pathophysiology, clinical presentation, screening guidelines, and management of the disease has been ever-evolving. Though respiratory pathologies have been the major complications of a COVID-19 infection, other presentations like abdominal pain, deep venous thrombosis, cardiomyopathy, and even acute cerebrovascular ischemic attacks have been reported. We present a case of a young patient presenting with vertigo, possibly from COVID-19-induced acute vestibular neuritis. This is a 20-year-old Hispanic female patient presenting with intractable vertigo, nausea, and vomiting but without any typical symptoms like fever, cough, or shortness of breath. Initial examination and imaging ruled out an acute stroke. There was minimal improvement in her vestibular symptoms with the recommended COVID-19 treatment as of March 2020 (hydroxychloroquine and azithromycin) and symptomatic management. Her inflammatory markers were surprisingly normal all through the hospital course. She was then treated with oral prednisone and subsequently discharged home after a prolonged course of eight days. The pathophysiology of COVID-19-induced vestibular neuritis could be similar to any other viral infection. Clinicians should consider COVID-19 in the differential diagnosis for patients presenting with similar symptoms, especially in areas of a high prevalence of this disease. Early diagnosis of COVID-19 in such cases is important for proper isolation, to minimize exposure and avoid further unnecessary investigations. These symptoms will just resolve with symptomatic management like any other case of vestibular neuritis without any further management that is specific for a COVID-19 infection.
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Affiliation(s)
| | - Ambreen Raza
- Internal Medicine, Bayhealth Hospital, Dover, USA
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