A young man, a recent coronavirus patient, was readmitted with hypoesthesia and dysarthria following a rapid deterioration of respiratory symptoms. The brain and lung CT scans revealed ischemia and cavitary lung lesions. Clinical suspicion for aspergillus leads to prompt treatment, confirmed by biopsy. Neurologic and pulmonary symptoms resolved ultimately.

Background: The Omicron (lineage B.1.1.529) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wales, UK on 3rd December 2021. The aim of the study was to describe the first 1000 cases of the Omicron variant by demographic, vaccination status, travel and severe outcome status and compare this to contemporaneous cases of the Delta variant. Methods: Testing, typing and contact tracing data were collected by Public Health Wales and analysis undertaken by the Communicable Disease Surveillance Centre (CDSC). Risk ratios for demographic factors and symptoms were calculated comparing Omicron cases to Delta cases identified over the same time period. Results: By 14th December 2021, 1000 cases of the Omicron variant had been identified in Wales. Of the first 1000, just 3% of cases had a prior history of travel revealing rapid community transmission. A higher proportion of Omicron cases were identified in individuals aged 20-39 and most cases were double vaccinated (65.9%) or boosted (15.7%). Age adjusted analysis also revealed that Omicron cases were less likely to be hospitalised (0.4%) or report symptoms (60.8%). Specifically a significant reduction was observed in the proportion of Omicron cases reporting anosmia (8.9%). Conclusion: Key findings include a lower risk of anosmia and a reduced risk of hospitalisation in the first 1000 Omicron cases compared to co-circulating Delta cases. We also identify that existing measures for travel restrictions to control importations of new variants identified outside the UK did not prevent the rapid ingress of Omicron within Wales.

Although sporadic Creutzfeldt Jakob disease is always fatal and no accepted treatment is currently available. Moreover, prevalence of COVID-19 in the same patient makes management protocol difficult and prognosis worse.

Lipschütz’s ulcers (LU) are rare entities, which occur mostly in non-sexually active young women. UL appear to be associated with infectious conditions such as Epstein-Barr virus or cytomegalovirus. We report a case that revealed that SARS-CoV-2 infection could be considered a trigger event for the appearance of acute vulvar ulceration.

To report two cases of suprachoroidal hemorrhage (SCH) during otherwise uncomplicated phacoemulsification, in whom COVID-19 was documented with PCR about one month before the surgery.

Immune-inflammatory proteome of elite ice hockey players before and after SARS-CoV-2 infection

A document by Joseph De Luca F. Click on the document to view its contents.

Background: Covid-19 can have remarkable effects on pregnancy, and pregnant women with this infection are at higher risk for developing ketoacidosis. In this case report, we report a 35-year-old pregnant woman infected with Covid-19 with early manifestations of ketoacidosis during term pregnancy.

Dynamic digital radiography (DDR) is a motion-detective technique with high temporal resolution. Flexible laryngoscopy is a common modality for observation of the larynx, but it is aerosol generating. DDR is an easy and less risky screening test for diagnosis of recurrent laryngeal nerve paralysis during the COVID-19 pandemic.

Objective: To evaluate for cardiac involvement in recovered COVID-19 patients using cardiac magnetic resonance imaging (MRI). Methods: A total of 30 subjects recently recovered from COVID-19 and abnormal left ventricular global longitudinal strain were enrolled. Routine investigations, inflammatory markers and cardiac MRI were done at baseline with follow-up scan at 6 months in individuals with abnormal baseline scan. Additionally, 20 age-and sex-matched individuals were enrolled as healthy controls (HCs). Results: All 30 enrolled subjects were symptomatic during active COVID-19 disease and were categorized as mild: 11 (36.7%), moderate: 6 (20%) and severe: 13 (43.3%). Of the 30 patients, 16 (53.3%) had abnormal CMR findings. Myocardial edema was reported in 12 (40%) patients while 10 (33.3%) had LGE. No difference was observed in terms of conventional LV parameters however, COVID-19 recovered patients had significantly lower right ventricular (RV) ejection fraction, RV stroke volume and RV cardiac index compared to HCs. Follow-up scan was abnormal in 4/16 (25%) with LGE persisting in 3 patients. Myocardial T1 (1284 + 43.8 ms vs 1147.6 + 68.4 ms; P<0.0001) and T2 values (50.8+16.7 ms vs 42.6+3.6 ms; P=0.04) were significantly higher in post COVID-19 subjects compared to HCs. Similarly, T1 and T2 values of severe COVID-19 patients were significantly higher compared to mild and moderate cases. Conclusions: An abnormal CMR was seen in half of recovered patients with persistent abnormality in one-fourth at six months. Our study suggests a need for closer follow-up among recovered subjects in order to evaluate for long term cardiovascular sequalae.

To our knowledge this is the first published case of NP associated with COVID-19 in an individual with CF and the first associated with Nocardia infection. We suspect the combination of cystic fibrosis, COVID-19 pneumonitis and co-infection with Nocardia farcinia caused this young man’s NP and ultimately his untimely death. We hope this case will highlight individuals with CF of all ages are at risk of severe COVID-19 infection.

Our patient is a 39-year-old male with normal baseline blood parameters who presented with COVID-19 infection, associated with neutropenia and then progressed to critical disease culminating into CSS. Based on risks and benefits evaluation, he was treated with Tocilizumab reinforced with G-CSF leading to full recovery including reversal of neutropenia.

Non covalent biliproteins are found in a growing number of living organisms and even in viruses, such as SARS-CoV-2. Unlike the well described covalent biliproteins, such as the phytochromes, they present a vast structural and functional diversity, and often with limited experimental information. A very important tool (and sometimes the only one available) to study these systems is the UV-Vis spectrum, which is modulated both by conformational changes of the biliverdin chromophore and specific interactions with the apoprotein. In this work we present a theoretical study of the microscopic determinants of the UV-Vis spectrum of these compounds through the use of hybrid QM(TD-DFT)/MM techniques and molecular dynamics simulations. Comparing our results with existing experimental data, we prove that it is possible to predict spectroscopic properties, such as relative position and intensity ratio of main bands, with affordable methods, and to provide a microscopic explanation of them. This systematic information can be very useful for the study of described biliproteins or for those yet unknown.

Purpose: Peripartum cardiomyopathy (PPCM) is a rare complication of pregnancy manifesting with acute cardiac failure. Coronavirus Disease 2019 (COVID-19) can be complicated by cardiomyopathy, which can be difficult to differentiate from PPCM. The aim of this publication is to investigate different outcomes of cases with cardiomyopathy during pregnancy. Methods: Here, we report 4 peripartum cases with COVID-19 and acute cardiac failure due to cardiomyopathy. Moreover, to find previous similar cases, a comprehensive review on PPCM and COVID-19 associated cardiomyopathy was conducted in PubMed, Scopus, Embase, and Google Scholar. Results: Out of 4 cases we had, two cases deceased and one became a candidate for heart transplant. Despite advanced diagnostic approaches, differentiating COVID-19 associated cardiomyopathy from PPCM was challenging. According to the literature review, 7 cases with similar conditions were found. Conclusion: Pregnant women with COVID-19 may develop acute cardiac failure associated with PPCM or COVID-19 associated cardiomyopathy or both. This condition may be deadly due to rapid disease progression, atypical manifestations, and limited treatment options.

Objective: To assess the utility of a test-based approach to shorten isolation of healthcare workers with COVID-19 in the setting of the highly transmissible omicron variant Methods: Between December 24th, 2021, to January 5th, 2022 HCWs who tested positive for SARS-CoV-2 were re-tested at least five days since onset of symptoms. Results: 46 sequential fully COVID-19 vaccinated HCWs who had tested positive for SARS-CoV-2 underwent follow up testing. All the isolates were confirmed as omicron variants and only 4 (8.7%) were negative 5 days or more since onset of symptoms., Conclusions: Implementation of a test-based strategy is logistically challenging, increases costs and did not lead to shorter isolation in our institution.

Anti-glutamic acid decarboxylase(Anti-GAD) are associated with various neurologic condition; but, no meningitis has been reported with it, so far. Evidence demonstrates the associated of autoimmune meningoencephalitis with Covid-19 infection. Here we report a 44-year-old female with progressive loss of consciousness with anti-GAD65 meningoencephalitis after Covid-19 infection.

Background Household studies are crucial for understanding the transmission of SARS-CoV-2 infection, which may be underestimated from PCR testing of respiratory samples alone. We aim to combine assessment of household mitigation measures; nasopharyngeal, saliva and stool PCR testing; along with mucosal and systemic SARS-CoV-2 specific antibodies, to comprehensively characterise SARS-CoV-2 infection and transmission in households. Methods Between March and September 2020, we obtained samples from 92 participants in 26 households in Melbourne, Australia, in a 4-week period following onset of infection with ancestral SARS-CoV-2 variants. Results The secondary attack rate was 36% (24/66) when using nasopharyngeal swab (NPS) PCR positivity alone. However, when respiratory and non-respiratory samples were combined with antibody responses in blood and saliva, the secondary attack rate was 76% (50/66). SARS-CoV-2 viral load of the index case and household isolation measures were key factors that determine secondary transmission. In 27% (7/26) of households, all family members tested positive by NPS for SARS-CoV-2 and were characterised by lower respiratory Ct-values than low transmission families (Median 22.62 vs 32.91; IQR 17.06 to 28.67 vs 30.37 to 34.24). High transmission families were associated with enhanced plasma antibody responses to multiple SARS-CoV-2 antigens and the presence of neutralising antibodies. Three distinguishing saliva SARS-CoV-2 antibody features were identified according to age (IgA1 to Spike 1, IgA1 to nucleocapsid protein (NP), suggesting that adults and children generate distinct mucosal antibody responses during the acute phase of infection. Conclusion Utilising respiratory and non-respiratory PCR testing, along with measurement of SARS-CoV-2 specific local and systemic antibodies, provides a more accurate assessment of infection within households and highlights some of the immunological differences in response between children and adults.

A document by Luise Erpenbeck. Click on the document to view its contents.

Objective. To compare the estimates of preterm birth (PTB; 22-36 weeks gestational age, GA) and stillbirth rates during COVID-19 pandemic in Italy with those recorded in the three previous years. Design. A population-based cohort study of liveborn and stillborn infants was conducted using data from Regional Health Systems and comparing the pandemic period (March 1st, 2020-March 31st, 2021, N= 362,129) to an historical period (January 2017- February 2020, N=1,117,172). The cohort covered 84.3% of the births in Italy. Methods. Logistic regressions were run in each Region and meta-analyses were performed centrally. We used an interrupted time series regression analysis to study the trend of preterm births from 2017 to 2021. Main Outcome Measures. The primary outcomes were PTB and stillbirths. Secondary outcomes were late PTB (32-36 weeks’ GA), very PTB (<32 weeks’ GA), and extreme PTB (<28 weeks’ GA), overall and stratified into singleton and multiples. Results. The pandemic period compared with the historical one was associated with a reduced risk for PTB (Odds Ratio: 0.90; 95% Confidence Interval, CI: 0.87, 0.93), late PTB (0.91; 0.87, 0.94), very PTB (0.87; 0.84, 0.91), and extreme PTB (0.88; 0.82, 0.94). In multiples, point estimates were not very different, but had wider CIs. No association was found for stillbirths (1.01; 0.90, 1.13). A linear decreasing trend in PTB rate was present in the historical period, with a further reduction after the lockdown. Conclusions We demonstrated a decrease in PTB rate after the introduction of COVID-19 restriction measures, without an increase in stillbirths.

During the COVID-19 pandemic, multiple skin manifestations have been described. These include an urticarial rash, morbilliform rash, maculopapular rash, vascular lesions, and varicella-like eruptions. A 30-year-old woman presented with a mild cough, then hives and pruritic rash for 3 days, followed by fever, dyspepsia, and throat pain for one day.

After a suspected allergic reactions to first dose of mRNA COVID-19 vaccine, given the PEG skin tests negativity and tolerance in vivo to PEG containing drugs, five patients were vaccinated with the second dose of Pfizer-Biontech undergoing a fractional protocol, with antihistamine premedication, without presenting immediate or delayed reactions.

A growing number of studies indicate a broad range of neurological manifestations, including seizures, occur in patients with COVID-19 infection. We report a 29-yers old female with status epilepticus and positive SARS-CoV-2 in the cerebrospinal fluid. Our findings support previous reports suggesting seizure as a possible symptom of COVID-19 infection.

Key Points 1. During the COVID-19 pandemic, NHS cancer referral guidance recommended a move from face-to-face clinics to telephone appointment. In this study, we reviewed the safety of telephone clinic for urgent 2-week wait cancer referrals. 2. In the 7 months study period during the COVID-19 pandemic, 1062 urgent 2-week wait cancer referrals were received in our regional head and neck specialist unit, reflecting a 7.3% decline compared to pre-pandemic data. 3. At 6-months follow-up, 98 (9.2%) patients received a new diagnosis of malignancy. 95 of them received their diagnoses promptly after their initial telephone clinic, whereas 3 patients received a delayed diagnosis. 4. There is a late diagnosis rate of 0.28% but we discussed in our cases that late diagnosis does not inevitably lead to worse clinical outcome or harm. 5. Telephone clinics will likely remain in some capacity after the pandemic, while telephone clinics are pragmatic means to maintain patient flow during the pandemic, they could result in risk of late diagnosis.

An 89-year-old male case was hospitalized in the COVID-19 department. His computerized chest tomography scan showed nodular opacities with glass halo including peripheral distribution. The patient showed active brucellosis.Finally, his respiratory symptoms and the radiologic images had got better and the second SARS-COV-2 test and the serologic tests were negative