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Buck AM, Deitchman AN, Takahashi S, Lu S, Goldberg SA, Bodansky A, Kung A, Hoh R, Williams MC, Kerbleski M, Maison DP, Deveau TM, Munter SE, Lombardo J, Wrin T, Petropoulos CJ, Durstenfeld MS, Hsue PY, Daniel Kelly J, Greenhouse B, Martin JN, Deeks SG, Peluso MJ, Henrich TJ. The breadth of the neutralizing antibody response to original SARS-CoV-2 infection is linked to the presence of Long COVID symptoms. J Med Virol 2023; 95:e29216. [PMID: 37988251 PMCID: PMC10754238 DOI: 10.1002/jmv.29216] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 11/23/2023]
Abstract
The associations between longitudinal dynamics and the breadth of SARS-CoV-2 neutralizing antibody (nAb) response with various Long COVID phenotypes before vaccination are not known. The capacity of antibodies to cross-neutralize a variety of viral variants may be associated with ongoing pathology and persistent symptoms. We measured longitudinal neutralizing and cross-neutralizing antibody responses to pre- and post-SARS-CoV-2 Omicron variants in participants infected early in the COVID-19 pandemic, before widespread rollout of SARS-CoV-2 vaccines. Cross-sectional regression models adjusted for clinical covariates and longitudinal mixed-effects models were used to determine the impact of the breadth and rate of decay of neutralizing responses on the development of Long COVID symptoms, as well as Long COVID phenotypes. We identified several novel relationships between SARS-CoV-2 antibody neutralization and the presence of Long COVID symptoms. Specifically, we show that, although nAb responses to the original, infecting strain of SARS-CoV-2 were not associated with Long COVID in cross-sectional analyses, cross-neutralization ID50 levels to the Omicron BA.5 variant approximately 4 months following acute infection was independently and significantly associated with greater odds of Long COVID and with persistent gastrointestinal and neurological symptoms. Longitudinal modeling demonstrated significant associations in the overall levels and rates of decay of neutralization capacity with Long COVID phenotypes. A higher proportion of participants had antibodies capable of neutralizing Omicron BA.5 compared with BA.1 or XBB.1.5 variants. Our findings suggest that relationships between various immune responses and Long COVID are likely complex but may involve the breadth of antibody neutralization responses.
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Affiliation(s)
- Amanda M. Buck
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Amelia N. Deitchman
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA, United States
| | - Saki Takahashi
- Division of HIV, ID and Global Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Scott Lu
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Sarah A. Goldberg
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Aaron Bodansky
- Division of Pediatric Critical Care Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Andrew Kung
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA, United States
| | - Rebecca Hoh
- Division of HIV, ID and Global Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Meghann C. Williams
- Division of HIV, ID and Global Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Marian Kerbleski
- Division of HIV, ID and Global Medicine, University of California San Francisco, San Francisco, CA, United States
| | - David P. Maison
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Tyler-Marie Deveau
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Sadie E. Munter
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, United States
| | - James Lombardo
- Division of HIV, ID and Global Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Terri Wrin
- Monogram Biosciences, South San Francisco, CA, United States
| | | | - Matthew S. Durstenfeld
- Division of Cardiology, University of California San Francisco, San Francisco, CA, United States
| | - Priscilla Y. Hsue
- Division of Cardiology, University of California San Francisco, San Francisco, CA, United States
| | - J. Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Bryan Greenhouse
- Division of HIV, ID and Global Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Jeffrey N. Martin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Steven G. Deeks
- Division of HIV, ID and Global Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Michael J. Peluso
- Division of HIV, ID and Global Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Timothy J. Henrich
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, United States
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Fessler SN, Liu L, Chang Y, Yip T, Johnston CS. Palmitoylethanolamide Reduces Proinflammatory Markers in Unvaccinated Adults Recently Diagnosed with COVID-19: A Randomized Controlled Trial. J Nutr 2022; 152:2218-2226. [PMID: 36084236 PMCID: PMC9494383 DOI: 10.1093/jn/nxac154] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/23/2022] [Accepted: 07/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Inflammation is at the core of many chronic conditions and exacerbates infectious conditions, including the severity of coronavirus disease 2019 (COVID-19) infections. OBJECTIVES This study aimed to examine the effects of a novel food supplement, palmitoylethanolamide (PEA), specifically Levagen+, as compared with a placebo on proinflammatory biomarkers in adults recently diagnosed with COVID-19 who were unvaccinated and nonhospitalized. METHODS This study was a double-blind randomized placebo-controlled trial conducted October 2020-March 2021 (clinicaltrials.gov: NCT04912921). Participants aged 19-53 y were unvaccinated and recently infected with COVID-19 as indicated by a positive test result per RT-PCR or antigen test, and they reported to the test site following diagnosis as allowed by the CDC's return-to-work policy. Participants were stratified by age, sex, and BMI and randomly assigned by coin toss to receive 600 mg Levagen+ twice daily (LEV) or placebo tablets twice daily (CON) for 4 wk. At baseline and week 4, participants completed health histories, 24-h dietary recalls, anthropometrics, and nonfasting blood sampling. The primary outcomes were the 4-wk change between groups for IL-6, C-reactive protein, ferritin, intercellular adhesion molecule 1, soluble P-selectin (sP-selectin), and neutrophil/lymphocyte ratio. Multiple linear regression models were utilized to assess treatment effects on outcomes, adjusting for covariates. RESULTS A total of 60 participants completed the study (LEV: n = 30; CON: n = 30). After 4 wk of supplementation, sP-selectin (β = -11.5; 95% CI: -19.8, -3.15; P = 0.0078), IL-1β (β = -22.9; 95% CI: -42.4, -3.40; P = 0.0222), and IL-2 (β = -1.73; 95% CI: -3.45, -0.065; P = 0.0492) concentrations were significantly reduced in the LEV group compared with the CON group. CONCLUSIONS Inflammatory mechanisms are crucial to optimal resolution of infectious conditions, yet unchecked secretion of inflammatory mediators can promote the dysregulated immune response implicated in COVID-19 complications. Overall, PEA supplementation produced anti-inflammatory effects in individuals recently diagnosed with COVID-19 who were nonhospitalized.
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Affiliation(s)
- Samantha N Fessler
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA,Address correspondence to SNF (E-mail: )
| | - Li Liu
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA,Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Yung Chang
- Biodesign Institute, Arizona State University, Tempe, AZ, USA,School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Theresa Yip
- Biodesign Institute, Arizona State University, Tempe, AZ, USA,School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Carol S Johnston
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
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Geldmaker LE, Hasse CH, Baird BA, Haehn DA, Anyane-Yeboah AN, Wieczorek MA, Ball CT, Dora CD, Lyon TD, Thiel DD. Impact of SARS-CoV-2 (COVID-19) on Fixed Operating Room Times in Urologic Surgeries. Mayo Clin Proc Innov Qual Outcomes 2022; 6:373-380. [PMID: 35765690 PMCID: PMC9222149 DOI: 10.1016/j.mayocpiqo.2022.06.002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the impact of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, on operating room (OR) efficiency for urologic procedures using the concept of fixed OR times. Patients and Methods Over a 24-month period, urology OR data were prospectively collected. Operations were divided into fixed and variable time points. The fixed OR times were in-roomw to anesthesia-release time, anesthesia-release to cut time, in-room to cut time, and close to wheels-out time. Data from January 1, 2019, to December 31, 2019, were pre-COVID-19 data, and data from April 1, 2020, to December 31, 2020, were post-COVID-19 data. Operations were grouped into endoscopic, implant, major open, and robotic-assisted cases. In the post-COVID-19 era, all patients had a negative polymerase chain reaction test result within 48 hours of operation. The Wilcoxon rank sum test was used to compare the fixed OR times between the pre- and post-COVID-19 eras. Results A total of 3189 procedures were evaluated: 2058 endoscopic operations (1124 in the pre-COVID-19 era and 934 in the post-COVID-19 era), 343 implant procedures (192 in the pre-COVID-19 era and 151 in the post-COVID-19 era), 222 major open procedures (119 in the pre-COVID-19 era and 103 in the post-COVID-19 era), and 566 robotic-assisted procedures (338 in the pre-COVID-19 era and 228 in the post-COVID-19 era). There were no fixed OR times in any of the examined groups that were negatively impacted by COVID-19. The percentage of the total OR time occupied by fixed OR variables in the pre-COVID-19 era was 40.6% for endoscopic operations, 41.1% for implant procedures, 29.8% for major open procedures, and 21.8% for robotic-assisted procedures. Conclusion A substantial portion of the total OR time includes fixed time points. Furthermore, COVID-19 did not have a negative impact on fixed OR times in a negative testing environment. Urologic OR efficiency should be maintained in the post-COVID-19 era.
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Affiliation(s)
| | | | - Bryce A Baird
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Mikolaj A Wieczorek
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Colleen T Ball
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | | | - Timothy D Lyon
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
| | - David D Thiel
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
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Tarin-Vicente EJ, Sendagorta Cudos E, Servera Negre G, Falces Romero I, Ballesteros Martín J, Martin-Gorgojo A, Comunión Artieda A, Salas Marquez C, Herranz Pinto P. Sexually Transmitted Infections During the First Wave of the COVID-19 Pandemic in Spain. Actas Dermosifiliogr 2021:S1578-2190(21)00328-0. [PMID: 34866637 PMCID: PMC8626349 DOI: 10.1016/j.adengl.2021.11.024] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/01/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe changes in sexually transmitted infection (STI) diagnoses during the first wave of the COVID-19 pandemic in Spain. MATERIAL AND METHODS We collected demographic, chronological, and clinical data for all patients seen for a possible STI at Hospital La Paz, Centro Sanitario Sandaval, and Centro de Diagnóstico Médico in Madrid and Hospital Costa del Sol in Malaga between March 14, 2020 and June 30, 2020. RESULTS We identified 674 STI diagnoses. The median age of the patients was 33 years. Most cases were observed among people aged 30 to 40 years and among men who have sex with men. The most common diagnoses were proctitis (36.5%), syphilis (16%), nongonococcal (13.3%) and gonococcal (11.3%) urethritis, genital herpes (8.8%), vulvovaginitis/cervicitis (8.3%), and genital warts (4.2%). A microbiologically confirmed diagnosis was on record for 77% of cases. The main microorganisms identified wereChlamydia trachomatis (35.7%), Neisseria gonorrhoeae (31.4%), and Treponema pallidum (17.2%). The number of STI diagnoses increased after the easing of lockdown restrictions, which resulted in greater freedom of movement and more consultations. On comparing the 2019 and 2020 STI registries from Centro Sanitario Sandoval and Hospital La Paz for the period March to June, we observed reductions (of up to 81%) in all STI diagnoses. CONCLUSIONS Physical distancing and movement restrictions appear to have resulted in a reduction in the incidence of STIs, although these measures did not completely eliminate sexual risk behaviors.
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Affiliation(s)
- E J Tarin-Vicente
- Servicio de Dermatología Medicoquirúrgica y Venereología, Hospital Universitario La Paz, Madrid, Spain
| | - E Sendagorta Cudos
- Servicio de Dermatología Medicoquirúrgica y Venereología, Hospital Universitario La Paz, Madrid, Spain
| | - G Servera Negre
- Servicio de Dermatología Medicoquirúrgica y Venereología, Hospital Universitario La Paz, Madrid, Spain
| | - I Falces Romero
- Servicio de Microbiología y Parasitología Clínicas, Hospital Universitario La Paz, Madrid, Spain
| | | | - A Martin-Gorgojo
- Servicio de ITS/Dermatología, Centro de Diagnóstico Médico, Ayuntamiento de Madrid, Madrid, Spain
| | - A Comunión Artieda
- Servicio de ITS/Dermatología, Centro de Diagnóstico Médico, Ayuntamiento de Madrid, Madrid, Spain
| | - C Salas Marquez
- Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - P Herranz Pinto
- Servicio de Dermatología Medicoquirúrgica y Venereología, Hospital Universitario La Paz, Madrid, Spain
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Alexander C, Vasefi M. Cannabidiol and the corticoraphe circuit in post-traumatic stress disorder. IBRO Neurosci Rep 2021; 11:88-102. [PMID: 34485973 PMCID: PMC8408530 DOI: 10.1016/j.ibneur.2021.08.001] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 01/06/2023] Open
Abstract
Post-Traumatic Stress Disorder (PTSD), characterized by re-experiencing, avoidance, negative affect, and impaired memory processing, may develop after traumatic events. PTSD is complicated by impaired plasticity and medial prefrontal cortex (mPFC) activity, hyperactivity of the amygdala, and impaired fear extinction. Cannabidiol (CBD) is a promising candidate for treatment due to its multimodal action that enhances plasticity and calms hyperexcitability. CBD’s mechanism in the mPFC of PTSD patients has been explored extensively, but literature on the mechanism in the dorsal raphe nucleus (DRN) is lacking. Following the PRISMA guidelines, we examined current literature regarding CBD in PTSD and overlapping symptomologies to propose a mechanism by which CBD treats PTSD via corticoraphe circuit. Acute CBD inhibits excess 5-HT release from DRN to amygdala and releases anandamide (AEA) onto amygdala inputs. By first reducing amygdala and DRN hyperactivity, CBD begins to ameliorate activity disparity between mPFC and amygdala. Chronic CBD recruits the mPFC, creating harmonious corticoraphe signaling. DRN releases enough 5-HT to ameliorate mPFC hypoactivity, while the mPFC continuously excites DRN 5-HT neurons via glutamate. Meanwhile, AEA regulates corticoraphe activity to stabilize signaling. AEA prevents DRN GABAergic interneurons from inhibiting 5-HT release so the DRN can assist the mPFC in overcoming its hypoactivity. DRN-mediated restoration of mPFC activity underlies CBD’s mechanism on fear extinction and learning of stress coping. CBD reduces PTSD symptoms via the DRN and corticoraphe circuit. Acute effects of CBD reduce DRN-amygdala excitatory signaling to lessen the activity disparity between amygdala and mPFC. Chronic CBD officially resolves mPFC hypoactivity by facilitating 5-HT release from DRN to mPFC. CBD-facilitated endocannabinoid signaling stabilizes DRN activity and restores mPFC inhibitory control. Chronically administered CBD acts via the corticoraphe circuit to favor fear extinction over fear memory reconsolidation.
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Key Words
- 2-AG, 2-arachidonoylglycerol
- 5-HT, Serotonin
- 5-HT1AR, 5-HT Receptor Type 1A
- 5-HT2AR, 5-HT Receptor Type 2 A
- AEA, Anandamide
- CB1R, Cannabinoid Receptor Type 1
- CB2R, Cannabinoid Receptor Type 2
- CBD, Cannabidiol
- COVID-19, SARS-CoV-2
- Cannabidiol
- DRN, Dorsal Raphe Nucleus
- ERK1/2, Extracellular Signal-Related Kinases Type 1 or Type 2
- FAAH, Fatty Acid Amide Hydrolase
- GABA, Gamma-Aminobutyric Acid
- GPCRs, G-Protein Coupled Receptors
- NMDAR, N-Methyl-D-aspartate Receptors
- PET, Positron Emission Tomography
- PFC, DRN and Raphe
- PFC, Prefrontal Cortex
- PTSD
- PTSD, Post-Traumatic Stress Disorder
- SSNRI, Selective Norepinephrine Reuptake Inhibitor
- SSRI, Selective Serotonin Reuptake Inhibitor
- Serotonin
- TRPV1, Transient Receptor Potential Vanilloid 1 Channels
- Traumatic Stress
- fMRI, Functional Magnetic Resonance Imaging
- mPFC, Medial Prefrontal Cortex
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Affiliation(s)
- Claire Alexander
- Department of Biology, Lamar University, Beaumont, TX 77710, USA
| | - Maryam Vasefi
- Department of Biology, Lamar University, Beaumont, TX 77710, USA
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Cohen SR, Kahn JS, Gao DX, Fiumara K, Lam A, Dumont N, Rosmarin D. Continuation and Discontinuation Rates of Biologics in Dermatology Patients During COVID-19 Pandemic. J Cutan Med Surg 2021; 25:646-647. [PMID: 34107794 DOI: 10.1177/12034754211024125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Stephanie R Cohen
- 1867 Department of Dermatology, Tufts Medical Center, Boston, MA, USA
| | - Jared S Kahn
- 1867 Department of Dermatology, Tufts Medical Center, Boston, MA, USA
| | - David X Gao
- 1867 Department of Dermatology, Tufts Medical Center, Boston, MA, USA
| | - Kristin Fiumara
- 12261 Department of Pharmacy, Tufts Medical Center, Boston, MA, USA
| | - Anh Lam
- 12261 Department of Pharmacy, Tufts Medical Center, Boston, MA, USA
| | - Nicole Dumont
- 1867 Department of Dermatology, Tufts Medical Center, Boston, MA, USA
| | - David Rosmarin
- 1867 Department of Dermatology, Tufts Medical Center, Boston, MA, USA
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Capaccione KM, Yang H, West E, Patel H, Ma H, Patel S, Fruauff A, Loeb G, Maddocks A, Borowski A, Lala S, Nguyen P, Lignelli A, D'souza B, Desperito E, Ruzal-Shapiro C, Salvatore MM. Pathophysiology and Imaging Findings of COVID-19 Infection: An Organ-system Based Review. Acad Radiol 2021; 28:595-607. [PMID: 33583712 PMCID: PMC7859715 DOI: 10.1016/j.acra.2021.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND COVID-19 commonly presents with upper respiratory symptoms; however, studies have shown that SARS-CoV-2 infection affects multiple organ systems. Here, we review the pathophysiology and imaging characteristics of SARS-CoV-2 infection in organ systems throughout the body and explore commonalities. OBJECTIVE Familiarity with the underlying pathophysiology and imaging characteristics is essential for the radiologist to recognize these findings in patients with COVID-19 infection. Though pulmonary findings are the most prevalent presentation, COVID-19 may have multiple manifestations and recognition of the extrapulmonary manifestations is especially important because of the potential serious and long-term effects of COVID-19 on multiple organ systems.
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Affiliation(s)
- K M Capaccione
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032.
| | - H Yang
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - E West
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - H Patel
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - H Ma
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - S Patel
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Fruauff
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - G Loeb
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Maddocks
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Borowski
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - S Lala
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - P Nguyen
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Lignelli
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - B D'souza
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - E Desperito
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - C Ruzal-Shapiro
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - M M Salvatore
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
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Sharma R, Seth S, Sharma R, Yadav S, Mishra P, Mukhopadhyay S. Perinatal outcome and possible vertical transmission of coronavirus disease 2019: experience from North India. Clin Exp Pediatr 2021; 64:239-246. [PMID: 33592686 PMCID: PMC8103039 DOI: 10.3345/cep.2020.01704] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The consequences of severe acute respiratory syndrome corona virus 2 on mother and fetus remain unknown due to a lack of robust evidence from prospective studies. PURPOSE This study evaluated the effect of coronavirus disease 2019 (COVID-19) on neonatal outcomes and the scope of vertical transmission. METHODS This ambispective observational study enrolled pregnant women with COVID-19 in North India from April 1 to August 31, 2020 to evaluate neonatal outcomes and the risk of vertical transmission. RESULTS A total of 44 neonates born to 41 COVID-19-positive mothers were evaluated. Among them, 28 patients (68.3%) (2 sets of twins) were delivered within 7 days of testing positive for COVID-19, 23 patients (56%) (2 sets of twins) were delivered by cesarean section; 13 newborns (29.5%) had low birth weight; 7 (15.9%) were preterm; and 6 (13.6%) required neonatal intensive care unit admission, reflecting an increased incidence of cesarean delivery and low birth weight but zero neonatal mortality. Samples of cord blood, placental membrane, vaginal fluid, amniotic fluid, peritoneal fluid (in case of cesarean section), and breast milk for COVID-19 reverse transcription-polymerase chain reaction tested negative in 22 prospective delivery cases. Nasopharyngeal swabs of 2 newborns tested positive for COVID-19: one at 24 hours and the other on day 4 of life. In the former case, biological samples were not collected as the mother was asymptomatic and her COVID-19 report was available postdelivery; hence, the source of infection remained inconclusive. In the latter case, all samples tested negative, ruling out the possibility of vertical transmission. All neonates remained asymptomatic on follow-up. CONCLUSION COVID-19 does not have direct adverse effects on the fetus per se. The possibility of vertical transmission is almost negligible, although results from larger trials are required to confirm our findings.
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Affiliation(s)
- Ritu Sharma
- Department of Obstetrics & Gynecology, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
| | - Shikha Seth
- Department of Obstetrics & Gynecology, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
| | - Rakhee Sharma
- Department of Obstetrics & Gynecology, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
| | - Sanju Yadav
- Department of Pediatrics, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
| | - Pinky Mishra
- Department of Obstetrics & Gynecology, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
| | - Sujaya Mukhopadhyay
- Department of Pediatrics, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
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Sperotto F, Friedman KG, Son MBF, VanderPluym CJ, Newburger JW, Dionne A. Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach. Eur J Pediatr 2021; 180:307-322. [PMID: 32803422 PMCID: PMC7429125 DOI: 10.1007/s00431-020-03766-6] [Citation(s) in RCA: 219] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/25/2020] [Accepted: 07/30/2020] [Indexed: 01/03/2023]
Abstract
Initial reports on COVID-19 described children as largely spared from severe manifestations, with only 2-6% of children requiring intensive care treatment. However, since mid-April 2020, clusters of pediatric cases of severe systemic hyperinflammation and shock epidemiologically linked with COVID-19 have been reported. This condition was named as SARS-Cov-2-associated multisystem inflammatory syndrome in children and showed similarities to Kawasaki disease. Here, we present a narrative review of cases reported in literature and we discuss the clinical acute and follow-up management of these patients. Patients with SARS-Cov-2-associated multisystem inflammatory syndrome frequently presented with persistent fever, gastrointestinal symptoms, polymorphic rash, conjunctivitis, and mucosal changes. Elevated inflammatory markers and evidence of cytokine storm were frequently observed. A subset of these patients also presented with hypotension and shock (20-100%) from either acute myocardial dysfunction or systemic hyperinflammation/vasodilation. Coronary artery dilation or aneurysms have been described in 6-24%, and arrhythmias in 7-60%. Cardiac support, immunomodulation, and anticoagulation are the key aspects for the management of the acute phase. Long-term structured follow-up of these patients is required due to the unclear prognosis and risk of progression of cardiac manifestations.Conclusion: Multisystem inflammatory syndrome is a novel syndrome related to SARS-CoV-2 infection. Evidence is still scarce but rapidly emerging in the literature. Cardiac manifestations are frequent, including myocardial and coronary involvement, and need to be carefully identified and monitored over time. What is Known: • Multisystem inflammatory syndrome in children (MIS-C) has been described associated with SARS-CoV-2. What is New: • Patients with MIS-C often present with fever, gastrointestinal symptoms, and shock. • Cardiac involvement is found in a high proportion of these patients, including ventricular dysfunction, coronary artery dilation or aneurysm, and arrhythmias. • Management is based on expert consensus and includes cardiac support, immunomodulatory agents, and anticoagulation. • Long-term follow-up is required due to the unclear prognosis and risk of progression of cardiac manifestation.
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Affiliation(s)
- Francesca Sperotto
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
- Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 USA
- Department of Women’s and Children’s Health, University of Padova, Via Giustiniani 2, Padua, Italy
| | - Kevin G. Friedman
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
- Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Mary Beth F. Son
- Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 USA
- Division of Immunology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Christina J. VanderPluym
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
- Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
- Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Audrey Dionne
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
- Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 USA
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10
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Chan SK, Du P, Ignacio C, Mehta S, Newton IG, Steinmetz NF. Biomimetic Virus-Like Particles as Severe Acute Respiratory Syndrome Coronavirus 2 Diagnostic Tools. ACS Nano 2021; 15:1259-1272. [PMID: 33237727 PMCID: PMC7724985 DOI: 10.1021/acsnano.0c08430] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/19/2020] [Indexed: 05/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a highly transmissible disease that has affected more than 90% of the countries worldwide. At least 17 million individuals have been infected, and some countries are still battling first or second waves of the pandemic. Nucleic acid tests, especially reverse transcription polymerase chain reaction (RT-PCR), have become the workhorse for early detection of COVID-19 infection. Positive controls for the molecular assays have been developed to validate each test and to provide high accuracy. However, most available positive controls require cold-chain distribution and cannot serve as full-process control. To overcome these shortcomings, we report the production of biomimetic virus-like particles (VLPs) as SARS-CoV-2 positive controls. A SARS-CoV-2 detection module for RT-PCR was encapsidated into VLPs from a bacteriophage and a plant virus. The chimeric VLPs were obtained either by in vivo reconstitution and coexpression of the target detection module and coat proteins or by in vitro assembly of purified detection module RNA sequences and coat proteins. These VLP-based positive controls mimic SARS-CoV-2 packaged ribonucleic acid (RNA) while being noninfectious. Most importantly, we demonstrated that the positive controls are scalable, stable, and can serve broadly as controls, from RNA extraction to PCR in clinical settings.
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Affiliation(s)
- Soo Khim Chan
- Department of NanoEngineering,
Department of Medicine,
Department of Radiology,
Department of Bioengineering,
Center for Nano-ImmunoEngineering,
Moores Cancer Center, Institute for
Materials Discovery and Design, and Veterans
Administration San Diego Healthcare System, University of
California San Diego, 9500 Gilman Drive, La Jolla,
California 92039, United States
| | - Pinyi Du
- Department of NanoEngineering,
Department of Medicine,
Department of Radiology,
Department of Bioengineering,
Center for Nano-ImmunoEngineering,
Moores Cancer Center, Institute for
Materials Discovery and Design, and Veterans
Administration San Diego Healthcare System, University of
California San Diego, 9500 Gilman Drive, La Jolla,
California 92039, United States
| | - Caroline Ignacio
- Department of NanoEngineering,
Department of Medicine,
Department of Radiology,
Department of Bioengineering,
Center for Nano-ImmunoEngineering,
Moores Cancer Center, Institute for
Materials Discovery and Design, and Veterans
Administration San Diego Healthcare System, University of
California San Diego, 9500 Gilman Drive, La Jolla,
California 92039, United States
| | - Sanjay Mehta
- Department of NanoEngineering,
Department of Medicine,
Department of Radiology,
Department of Bioengineering,
Center for Nano-ImmunoEngineering,
Moores Cancer Center, Institute for
Materials Discovery and Design, and Veterans
Administration San Diego Healthcare System, University of
California San Diego, 9500 Gilman Drive, La Jolla,
California 92039, United States
| | - Isabel G. Newton
- Department of NanoEngineering,
Department of Medicine,
Department of Radiology,
Department of Bioengineering,
Center for Nano-ImmunoEngineering,
Moores Cancer Center, Institute for
Materials Discovery and Design, and Veterans
Administration San Diego Healthcare System, University of
California San Diego, 9500 Gilman Drive, La Jolla,
California 92039, United States
| | - Nicole F. Steinmetz
- Department of NanoEngineering,
Department of Medicine,
Department of Radiology,
Department of Bioengineering,
Center for Nano-ImmunoEngineering,
Moores Cancer Center, Institute for
Materials Discovery and Design, and Veterans
Administration San Diego Healthcare System, University of
California San Diego, 9500 Gilman Drive, La Jolla,
California 92039, United States
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11
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Akuamoa-Boateng D, Wegen S, Ferdinandus J, Marksteder R, Baues C, Marnitz S. Managing patient flows in radiation oncology during the COVID-19 pandemic : Reworking existing treatment designs to prevent infections at a German hot spot area University Hospital. Strahlenther Onkol 2020; 196:1080-1085. [PMID: 33123776 PMCID: PMC7595566 DOI: 10.1007/s00066-020-01698-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/26/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE The described work aimed to avoid cancellations of indispensable treatments by implementing active patient flow management practices and optimizing infrastructure utilization in the radiation oncology department of a large university hospital and regional COVID-19 treatment center close to the first German SARS-CoV‑2 hotspot region Heinsberg in order to prevent nosocomial infections in patients and personnel during the pandemic. PATIENTS AND METHODS The study comprised year-to-date intervention analyses of in- and outpatient key procedures, machine occupancy, and no-show rates in calendar weeks 12 to 19 of 2019 and 2020 to evaluate effects of active patient flow management while monitoring nosocomial COVID-19 infections. RESULTS Active patient flow management helped to maintain first-visit appointment compliance above 85.5%. A slight appointment reduction of 10.3% daily (p = 0.004) could still significantly increase downstream planning CT scheduling (p = 0.00001) and performance (p = 0.0001), resulting in an absolute 20.1% (p = 0.009) increment of CT performance while avoiding overbooking practices. Daily treatment start was significantly increased by an absolute value of 18.5% (p = 0.026). Hypofractionation and acceleration were significantly increased (p = 0.0043). Integrating strict testing guidelines, a distancing regimen for staff and patients, hygiene regulations, and precise appointment scheduling, no SARS-CoV‑2 infection in 164 tested radiation oncology service inpatients was observed. CONCLUSION In times of reduced medical infrastructure capacities and resources, controlling infrastructural time per patient as well as optimizing facility utilization and personnel workload during treatment evaluation, planning, and irradiation can help to improve appointment compliance and quality management. Avoiding recurrent and preventable exposure to healthcare infrastructure has potential health benefits and might avert cross infections during the pandemic. Active patient flow management in high-risk COVID-19 regions can help Radiation Oncologists to continue and initiate treatments safely, instead of cancelling and deferring indicated therapies.
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Affiliation(s)
- Dennis Akuamoa-Boateng
- Department of Radiation Oncology, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany.
| | - Simone Wegen
- Department of Radiation Oncology, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Justin Ferdinandus
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Regina Marksteder
- Department of Hospital Pharmacy, University Hospital Cologne, Cologne, Germany
| | - Christian Baues
- Department of Radiation Oncology, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Simone Marnitz
- Department of Radiation Oncology, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany
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12
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Shauly O, Stone G, Gould D. The Public's Perception of the Severity and Global Impact at the Start of the SARS-CoV-2 Pandemic: A Crowdsourcing-Based Cross-Sectional Analysis. J Med Internet Res 2020; 22:e19768. [PMID: 33108314 PMCID: PMC7695545 DOI: 10.2196/19768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/14/2020] [Accepted: 08/11/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND COVID-19 is a rapidly developing threat to most people in the United States and abroad. The behaviors of the public are important to understand, as they may have a tremendous impact on the course of this novel coronavirus pandemic. OBJECTIVE This study intends to assess the US population's perception and knowledge of the virus as a threat and the behaviors of the general population in response. METHODS A prospective cross-sectional study was conducted with random volunteers recruited through Amazon Mechanical Turk, an internet crowdsourcing service, on March 24, 2020. RESULTS A total of 969 participants met the inclusion criteria. It was found that the perceived severity of the COVID-19 pandemic significantly differed between age groups (P<.001) and men and women (P<.001). A majority of study participants were actively adhering to the Centers for Disease Control and Prevention guidelines. CONCLUSIONS Though many participants identified COVID-19 as a threat, many failed to place themselves appropriately in the correct categories with respect to risk. This may indicate a need for additional public education for appropriately defining the risk of this novel pandemic.
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Affiliation(s)
- Orr Shauly
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Gregory Stone
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Daniel Gould
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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13
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Cavasotto CN, Di Filippo JI. In silico Drug Repurposing for COVID-19: Targeting SARS-CoV-2 Proteins through Docking and Consensus Ranking. Mol Inform 2020; 40:e2000115. [PMID: 32722864 DOI: 10.1002/minf.202000115] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/28/2020] [Indexed: 12/18/2022]
Abstract
In December 2019, an infectious disease caused by the coronavirus SARS-CoV-2 appeared in Wuhan, China. This disease (COVID-19) spread rapidly worldwide, and on March 2020 was declared a pandemic by the World Health Organization (WHO). Today, over 21 million people have been infected, with more than 750.000 casualties. Today, no vaccine or antiviral drug is available. While the development of a vaccine might take at least a year, and for a novel drug, even longer; finding a new use to an old drug (drug repurposing) could be the most effective strategy. We present a docking-based screening using a quantum mechanical scoring of a library built from approved drugs and compounds undergoing clinical trials, against three SARS-CoV-2 target proteins: the spike or S-protein, and two proteases, the main protease and the papain-like protease. The S-protein binds directly to the Angiotensin Converting Enzyme 2 receptor of the human host cell surface, while the two proteases process viral polyproteins. Following the analysis of our structure-based compound screening, we propose several structurally diverse compounds (either FDA-approved or in clinical trials) that could display antiviral activity against SARS-CoV-2. Clearly, these compounds should be further evaluated in experimental assays and clinical trials to confirm their actual activity against the disease. We hope that these findings may contribute to the rational drug design against COVID-19.
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Affiliation(s)
- Claudio N Cavasotto
- Computational Drug Design and Biomedical Informatics Laboratory, Translational Medicine Research Institute (IIMT), CONICET-Universidad Austral, Pilar, Buenos Aires, Argentina.,Facultad de Ciencias Biomédicas and Facultad de Ingeniería, Universidad Austral, Pilar, Buenos Aires, Argentina.,Austral Institute for Applied Artificial Intelligence, Pilar, Buenos Aires, Argentina
| | - Juan I Di Filippo
- Computational Drug Design and Biomedical Informatics Laboratory, Translational Medicine Research Institute (IIMT), CONICET-Universidad Austral, Pilar, Buenos Aires, Argentina
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