COVID-19 Vaccine Failure in a Patient with Multiple Sclerosis on Ocrelizumab

Vaccines will play a key role in ending the COVID-19 pandemic. Vaccination against infections remains an important part of the management of patients with multiple sclerosis. However, there are limited data about the safety and efficacy of the currently available COVID-19 mRNA vaccines in patients with multiple sclerosis receiving concurrent immunosuppressive therapies. Patients on B cell depleting therapy such as ocrelizumab have an attenuated vaccine response. We report the first case of COVID-19 vaccine failure in a patient with relapsing-remitting multiple sclerosis on B cell depleting therapy, ocrelizumab. We offer suggestions to improve vaccine efficacy in these patients

Exploring the Causal Relationship Between Arterial and Venous Thromboembolism: A Case Series With Review of Literature

Venous thromboembolism (VTE) occurs due to venous stasis or low flow state within the blood vessels, resulting in subsequent fibrin and platelet aggregation leading to thrombosis. Arterial thrombosis affects various arteries including coronaries and is primarily due to platelet aggregation with little fibrin deposition leading to thrombosis. Although both arterial and venous thrombosis are considered as separate entities, some studies have suggested an association between them despite having distinctive causative factors. We retrospectively reviewed patients at our institution who were admitted with acute coronary syndrome (ACS) and underwent cardiac catheterization over a decade between 2009 and 2020 to look for patients who had both venous thromboembolic events and ACS. Here, we report a case series of three such patients who were found to have both VTE and coronary arterial thrombosis. However, it is unclear if having one of venous vs arterial clot increases the risk of having other vascular conditions, and further studies are needed to evaluate this hypothesis in the near future

Potential predictors of outcomes among hospitalized COVID-19 patients treated with convalescent plasma: a single-center study

Background: The coronavirus disease 2019 pandemic is a major international public health crisis, which has led to over 3 million deaths as of April 2021. Several therapeutics have been tried for this deadly illness including antivirals, immunosuppressive agents and convalescent plasma (CP). In this study, we present our inner-city safety net hospital experience with CP therapy. Methods: This was a retrospective chart review of hospitalized patients with confirmed COVID-19 who were treated with CP. Results: A total of 60 patients received CP during the study period. The mean age for patients in this study was 58.95 years. The most common presenting symptoms were shortness of breath (85%) and cough (73%). Hypertension (65%) and diabetes mellitus (55%) were the most common comorbidities in our patients. In our multivariate regression analysis, male sex, nausea and loss of appetite at presentation were associated with improvement in oxygenation after CP. Total survival time, history of obstructive airway disease, home use of angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers were associated with decreased survival, whereas Hispanic ethnicity showed a trend towards lower survival after CP therapy. Conclusions: Our study highlights several important characteristics of inner-city safety net hospital patient population who might benefit from CP therapy

Role of body mass index in outcomes of patients hospitalized with COVID‐19 illness

Abstract Background Since the start of coronavirus disease 2019 (COVID‐19) pandemic, several studies have linked obesity with severity of illness as well as mortality in patients with COVID‐19. Outcomes of patients with overweight or obesity, who develop critical illness, have been studied extensively over the past decade where the studies have shown conflicting results. In this study, we aimed to assess the association between the body mass index (BMI) classes and outcomes among hospitalized patients with COVID‐19. Methods This was a retrospective chart review of all adults admitted to our hospital with COVID‐19 illness between 1 March 2020 and 30 June 2020. Patients were divided into four groups based on their BMI range as follows: patients with underweight (BMI < 18.5 kg/m2), patients with normal weight (BMI 18.5–24.9 kg/m2), patients with overweight (BMI 25–29.9 kg/m2), and patients with obesity (BMI ≥ 30 kg/m2). Results 1274 patients were admitted during the study period. There were 24 (1.9%) patients with underweight, 268 (21%) patients with normal weight, 445 (34.9%) patients with overweight, and 537 (42.2%) patients with obesity. Patients with obesity were younger (p < 0.001) and there were more females among patients with underweight and patients with obesity (54% and 48% respectively, p < 0.001). There were no differences in subgroup with regards to presence of hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, and dyslipidemia. In a multivariate logistic regression model, patients with overweight and patients with obesity had higher odds of requiring mechanical ventilation. BMI class was not associated with difference in survival time in a multivariate analysis. Conclusions In our large single‐center study of hospitalized patients with COVID‐19, patients with overweight and obesity had higher need for mechanical ventilation but had similar mortality when compared to patients with normal weight and underweight

Impact of Prediabetes and Type-2 Diabetes on Outcomes in Patients with COVID-19

Introduction. The true impact of prediabetes and type-2 diabetes in patients with COVID-19 remains unknown, with studies thus far providing conflicting evidence. Methods. This is a single-center retrospective observational study involving 843 hospitalized patients with SARS-CoV-2 infection. Primary outcomes, mortality, and mechanical ventilation use were compared among the three groups: control, prediabetes, and type-2 diabetes. Binomial regression analysis was used to determine predictors of mortality and mechanical ventilation requirement. Results. Age was a significant predictor of mortality. On stratifying our patients based on their age, older patients aged 55 years and above had no difference in mortality or mechanical ventilation requirement among the three groups of control, prediabetes, and type-2 diabetes. However, among the younger population aged less than 55 years, patients with type-2 diabetes had significantly higher mortality as compared with patients in control and prediabetes groups (27% vs 12.5% vs 9%, p 0.025). Additionally, newly diagnosed type-2 diabetes patients demonstrated lower mortality rate in comparison to previously known type-2 diabetes patients (18% vs 40%, p 0.005). Outcomes in the prediabetes group were similar to that in the control group. Admission hyperglycemia was associated with higher mortality regardless of diabetes status. Conclusion. In older patients aged 55 years and above, status of type-2 diabetes does not influence their mortality. However, in younger patients aged less than 55 years, the presence of type-2 diabetes is an important driver of mortality. Newly diagnosed type-2 diabetes, in comparison with previously diagnosed type-2 diabetes, may have better survival. Presence of prediabetes did not affect outcomes in patients with COVID-19 infection

Extra-intestinal dissemination of SEE1.

<p>Bacterial burden of the liver (A) and spleen (B) from three experiments was taken and normalized with corresponding controls, and analyzed by Tukey’s post-test of one-way ANOVA, and significance of <i>p</i><0.05 is indicated by *. There were five mice per group in the first two experiments and four mice per group in the last experiment. Mice that received the same treatment in each of the three experiments were considered one group for final data analysis.</p

Gross pathological changes in mice.

<p>Overall changes in the mice internal organs from the third experiment were photographed and analyzed. Mice infected with SEE1 grown in egg yolk (B) appear to have greater outward pathology than the mice infected with SEE1 from LB broth (A) or from mouse feces (C). Major changes in gross pathology and organs of interest are indicated by the arrows and Roman numerals. I, The liver displaying marked paling, and prominent blood vessels. II, The small intestine showing signs of paling compared to the small intestine in A and C. III, The cecum that is emptied and shriveled. IV, The colon section of the large intestine that is extremely pale and empty. V, Fluid build-up in the visceral tissues. There were four mice in each experimental group and three mice in each control group.</p

Cytokine analysis of ceca of mice infected with SEE1 from three sources.

<p>Pro-inflammatory and anti-inflammatory cytokine profiles had been determined by ELISA for ceca of mice infected with SEE1 from egg yolk (four mice), LB broth (four mice), and passed through mice (four mice) as well as corresponding controls for each source used (three mice each). Results were normalized with corresponding controls and analyzed through one-way ANOVA and subsequent Tukey’s Pairwise Comparison Test. Significance of <i>p</i><0.05 is indicated by *.</p

Biometrics of the ceca.

<p>The overall size (A), weight (B), and pathology-driven morphological changes (C1-C3) were determined for the mice infected with SEE1 from the three sources. There were four mice in each experimental group and three mice in each control group. Measurements of the ceca from the last experiment were taken and normalized with corresponding controls, yielding the changes in size and weight. SEE1 grown in egg yolk appears to cause greater pathological changes in the ceca as compared to SEE1 grown in LB broth (C1) or passed through mice (C3). For A and B, significance was determined by one-way ANOVA Tukey’s pairwise comparison test, and significance was set at <i>p<</i>0.05; indicated by *.</p

Overall histopathology scores of ceca.

<p>The primary site of colonization for SE in mice is the cecum; so the histopathology of the ceca of three mice from each control group and four mice from each infection group was determined. Statistical significance was determined by one-way ANOVA Tukey’s pairwise comparison test, and significance was set at <i>p</i><0.05; indicated by *.</p