the Cardiovascular Manifestations of COVID-19: A Review of the Literature and Institutional Experience

The cardiovascular health of those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) plays a major role in rates of hospitalization, mortality risk, and rates of mechanical ventilation. In patients with COVID-19, acute myocardial injury and history of cardiovascular disease are both independently established risk factors for poor patient prognosis. In addition to myocardial injury, numerous acute cardiovascular manifestations of COVID-19 disease have been identified. Previous work on this topic typically focused either upon a general description of the acute cardiovascular manifestations and sequalae of COVID-19, or upon broad-based clinical outcomes associated with COVID-19 in patients with history of cardiovascular and/or metabolic disease. However, the role of pre-existing cardiovascular and metabolic disease in predicting the development and severity of COVID-19-related cardiovascular complications remains unclear. We queried our institutional COVID-19 patient registry, extracting data on all patients who were tested for the presence of SARS-CoV-2 and myocardial injury from 3 March 2020 – 30 July 2020. We identified a total of 5,451 patients from our institutional COVID-19 registry who met our criteria, including 734 (13.5%) subjects ultimately confirmed to be COVID-19 positive, and 4,717 subjects confirmed to be COVID-19 negative. Those with a prior history of cardiovascular disease can have increased frequency of cardiovascular manifestations. Cardiovascular events in COVID-19 include acute myocardial injury, myocardial infarction, myocarditis, pericarditis, electrocardiogram abnormalities, acute thrombosis, and acute heart failure. Identifying underlying cardiovascular disease and evidence of myocardial injury may predict which patients should be prioritized or potentially require more aggressive management and treatment strategies

From pandemic response to portable population health: A formative evaluation of the Detroit mobile health unit program

This article describes our experience developing a novel mobile health unit (MHU) program in the Detroit, Michigan, metropolitan area. Our main objectives were to improve healthcare accessibility, quality and equity in our community during the novel coronavirus pandemic. While initially focused on SARS-CoV-2 testing, our program quickly evolved to include preventive health services. The MHU program began as a location-based SARS-CoV-2 testing strategy coordinated with local and state public health agencies. Community needs motivated further program expansion to include additional preventive healthcare and social services. MHU deployment was targeted to disease “hotspots” based on publicly available SARS-CoV-2 testing data and community-level information about social vulnerability. This formative evaluation explores whether our MHU deployment strategy enabled us to reach patients from communities with heightened social vulnerability as intended. From 3/20/20-3/24/21, the Detroit MHU program reached a total of 32,523 people. The proportion of patients who resided in communities with top quartile Centers for Disease Control and Prevention Social Vulnerability Index rankings increased from 25% during location-based “drive-through” SARS-CoV-2 testing (3/20/20-4/13/20) to 27% after pivoting to a mobile platform (4/13/20-to-8/31/20; p = 0.01). The adoption of a data-driven deployment strategy resulted in further improvement; 41% of the patients who sought MHU services from 9/1/20-to-3/24/21 lived in vulnerable communities (Cochrane Armitage test for trend, p\u3c0.001). Since 10/1/21, 1,837 people received social service referrals and, as of 3/15/21, 4,603 were administered at least one dose of COVID-19 vaccine. Our MHU program demonstrates the capacity to provide needed healthcare and social services to difficult-to-reach populations from areas with heightened social vulnerability. This model can be expanded to meet emerging pandemic needs, but it is also uniquely capable of improving health equity by addressing longstanding gaps in primary care and social services in vulnerable communities

Elevated Endogenous Erythropoietin Concentrations Are Associated with Increased Risk of Brain Damage in Extremely Preterm Neonates

Background We sought to determine, in very preterm infants, whether elevated perinatal erythropoietin (EPO) concentrations are associated with increased risks of indicators of brain damage, and whether this risk differs by the co-occurrence or absence of intermittent or sustained systemic inflammation (ISSI). Methods Protein concentrations were measured in blood collected from 786 infants born before the 28th week of gestation. EPO was measured on postnatal day 14, and 25 inflammation-related proteins were measured weekly during the first 2 postnatal weeks. We defined ISSI as a concentration in the top quartile of each of 25 inflammation-related proteins on two separate days a week apart. Hypererythropoietinemia (hyperEPO) was defined as the highest quartile for gestational age on postnatal day 14. Using logistic regression and multinomial logistic regression models, we compared risks of brain damage among neonates with hyperEPO only, ISSI only, and hyperEPO+ISSI, to those who had neither hyperEPO nor ISSI, adjusting for gestational age. Results Newborns with hyperEPO, regardless of ISSI, were more than twice as likely as those without to have very low (< 55) Mental (OR 2.3; 95% CI 1.5-3.5) and/or Psychomotor (OR 2.4; 95% CI 1.6-3.7) Development Indices (MDI, PDI), and microcephaly at age two years (OR 2.4; 95%CI 1.5-3.8). Newborns with both hyperEPO and ISSI had significantly increased risks of ventriculomegaly, hemiparetic cerebral palsy, microcephaly, and MDI and PDI < 55 (ORs ranged from 2.2-6.3), but not hypoechoic lesions or other forms of cerebral palsy, relative to newborns with neither hyperEPO nor ISSI. Conclusion hyperEPO, regardless of ISSI, is associated with elevated risks of very low MDI and PDI, and microcephaly, but not with any form of cerebral palsy. Children with both hyperEPO and ISSI are at higher risk than others of very low MDI and PDI, ventriculomegaly, hemiparetic cerebral palsy, and microcephaly

COVID-19 in multiple sclerosis patients and risk factors for severe infection

Multiple sclerosis (MS) patients have been considered a higher-risk population for COVID-19 due to the high prevalence of disability and disease-modifying therapy use; however, there is little data identifying clinical characteristics of MS associated with worse COVID-19 outcomes. Therefore, we conducted a multicenter prospective cohort study looking at the outcomes of 40 MS patients with confirmed COVID-19. Severity of COVID-19 infection was based on hospital course, where a mild course was defined as the patient not requiring hospital admission, moderate severity was defined as the patient requiring hospital admission to the general floor, and most severe was defined as requiring intensive care unit admission and/or death. 19/40(47.5%) had mild courses, 15/40(37.5%) had moderate courses, and 6/40(15%) had severe courses. Patients with moderate and severe courses were significantly older than those with a mild course (57[50-63] years old and 66[58.8-69.5] years old vs 48[40-51.5] years old, P = 0.0121, P = 0.0373). There was differing prevalence of progressive MS phenotype in those with more severe courses (severe:2/6[33.3%]primary-progressing and 0/6[0%]secondary-progressing, moderate:1/14[7.14%] and 5/14[35.7%] vs mild:0/19[0%] and 1/19[5.26%], P = 0.0075, 1 unknown). Significant disability was found in 1/19(5.26%) mild course-patients, but was in 9/15(60%, P = 0.00435) of moderate course-patients and 2/6(33.3%, P = 0.200) of severe course-patients. Disease-modifying therapy prevalence did not differ among courses (mild:17/19[89.5%], moderate:12/15[80%] and severe:3/6[50%], P = 0.123). MS patients with more severe COVID-19 courses tended to be older, were more likely to suffer from progressive phenotype, and had a higher degree of disability. However, disease-modifying therapy use was not different among courses

A Novel Molecular Microbiologic Technique for the Rapid Diagnosis of Microbial Invasion of the Amniotic Cavity and Intra‐Amniotic Infection in Preterm Labor with Intact Membranes

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106726/1/aji12189.pd

Prevalence and Clinical Significance of Sterile Intra‐amniotic Inflammation in Patients with Preterm Labor and Intact Membranes

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109340/1/aji12296.pd

Elevated protein concentrations in newborn blood and the risks of autism spectrum disorder, and of social impairment, at age 10 years among infants born before the 28th week of gestation

Among the 1 of 10 children who are born preterm annually in the United States, 6% are born before the third trimester. Among children who survive birth before the 28th week of gestation, the risks of autism spectrum disorder (ASD) and non-autistic social impairment are severalfold higher than in the general population. We examined the relationship between top quartile inflammation-related protein concentrations among children born extremely preterm and ASD or, separately, a high score on the Social Responsiveness Scale (SRS total score ≥65) among those who did not meet ASD criteria, using information only from the subset of children whose DAS-II verbal or non-verbal IQ was ≥70, who were assessed for ASD, and who had proteins measured in blood collected on ≥2 days (N = 763). ASD (N = 36) assessed at age 10 years is associated with recurrent top quartile concentrations of inflammation-related proteins during the first post-natal month (e.g., SAA odds ratio (OR); 95% confidence interval (CI): 2.5; 1.2–5.3) and IL-6 (OR; 95% CI: 2.6; 1.03–6.4)). Top quartile concentrations of neurotrophic proteins appear to moderate the increased risk of ASD associated with repeated top quartile concentrations of inflammation-related proteins. High (top quartile) concentrations of SAA are associated with elevated risk of ASD (2.8; 1.2–6.7) when Ang-1 concentrations are below the top quartile, but not when Ang-1 concentrations are high (1.3; 0.3–5.8). Similarly, high concentrations of TNF-α are associated with heightened risk of SRS-defined social impairment (N = 130) (2.0; 1.1–3.8) when ANG-1 concentrations are not high, but not when ANG-1 concentrations are elevated (0.5; 0.1–4.2)

Extremely low gestational age and very low birthweight for gestational age are risk factors for autism spectrum disorder in a large cohort study of 10-year-old children born at 23-27 weeks’ gestation

No prospective cohort study of high-risk children has used rigorous exposure assessment and optimal diagnostic procedures to examine the perinatal antecedents of autism spectrum disorder (ASD), separately among those with and without cognitive impairment

Elevated Endogenous Erythropoietin Concentrations Are Associated with Increased Risk of Brain Damage in Extremely Preterm Neonates

BackgroundWe sought to determine, in very preterm infants, whether elevated perinatal erythropoietin(EPO) concentrations are associated with increased risks of indicators of brain damage,and whether this risk differs by the co-occurrence or absence of intermittent or sustainedsystemic inflammation (ISSI).MethodsProtein concentrations were measured in blood collected from 786 infants born before the28th week of gestation. EPO was measured on postnatal day 14, and 25 inflammationrelated proteins were measured weekly during the first 2 postnatal weeks. We defined ISSIas a concentration in the top quartile of each of 25 inflammation-related proteins on two separate days a week apart. Hypererythropoietinemia (hyperEPO) was defined as the highestquartile for gestational age on postnatal day 14. Using logistic regression and multinomiallogistic regression models, we compared risks of brain damage among neonates with hyperEPO only, ISSI only, and hyperEPO+ISSI, to those who had neither hyperEPO norISSI, adjusting for gestational age.ResultsNewborns with hyperEPO, regardless of ISSI, were more than twice as likely as those without to have very low (&lt; 55) Mental (OR 2.3; 95% CI 1.5-3.5) and/or Psychomotor (OR 2.4;95% CI 1.6-3.7) Development Indices (MDI, PDI), and microcephaly at age two years (OR2.4; 95%CI 1.5-3.8). Newborns with both hyperEPO and ISSI had significantly increasedrisks of ventriculomegaly, hemiparetic cerebral palsy, microcephaly, and MDI and PDI &lt; 55(ORs ranged from 2.2-6.3), but not hypoechoic lesions or other forms of cerebral palsy, relative to newborns with neither hyperEPO nor ISSI.ConclusionhyperEPO, regardless of ISSI, is associated with elevated risks of very low MDI and PDI,and microcephaly, but not with any form of cerebral palsy. Children with both hyperEPOand ISSI are at higher risk than others of very low MDI and PDI, ventriculomegaly, hemiparetic cerebral palsy, and microcephaly

Executive and non-executive functions in low birthweight/preterm adolescents with differing temporal patterns of inattention.

ObjectiveThis study assesses whether low birthweight/preterm (LBW/PT) adolescents with persistent inattention (PIA) have neuropsychological deficits that distinguish them from adolescents with school age limited inattention (SAL) and those largely unaffected (UA).MethodThree latent classes (PIA, SAL, UA), derived from an earlier analysis of a LBW/PT birth cohort were compared on non-executive and executive functioning measures assessed at age 16.ResultsThe PIA class displayed the poorest performance on executive functioning, which was exaggerated in the context of lower IQ. The PIA and the SAL classes had poorer performance on non-executive functioning relative to the UA class. Both types of functioning mediated the relationship of class to school service use and grade retention.ConclusionNeuropsychological impairment characterizes children and adolescents with inattention problems. Problems in executive functioning characterize the subset whose inattention persists through adolescence. Subsequent research can examine the potential for remediating these deficits to address academic and social problems