This version of BIP! Finder aims to ease the exploration of COVID-19-related literature by enabling ranking articles based on various impact metrics.
Last Update: 18 - 01 - 2023 (628506 entries)
Popularity: Citation-based measure reflecting the current impact.
Influence: Citation-based measure reflecting the total impact.
Reader Attention: The current number of Mendeley readers.
Social Media Attention: The number of recent tweets related to this article.
*More details on these impact measures can be found here.
Exceptional score (in top 0.01%).
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| Title | Venue | Year | Impact | Source | |
|---|---|---|---|---|---|
| 3551 | Real-time social distance alerting and contact tracing using image processing Social distancing has been enforced by many government and health organizations as an imperative measure to stop the spread of the ongoing COVID-19 crisis. However, current surveillance systems do not have the ability to detect breaches in social distancing nor real-time contact tracing. This chapter aims to provide a novel solution to this problem with the help of image processing techniques. The proposed system will generate structured data involving social distancing breaches and face mask detection based on surveillance footages. In the case of a person testing positive for the virus, it will also project the susceptible victims who have been in contact with the person through contact tracing, An installation of this kind will decrease the spread substantially and enable real-time contact tracing. | Data Science for COVID-19 | 2021 | CORD-19 | |
| 3552 | Essentials of COVID-19 and treatment approaches The coronavirus family is as old as the 1930s when it first showed symptoms in chicken. The virus thereafter kept evolving and it has significantly taken over a large percentage of people worldwide in the form of this new pandemic. As of the present day, there is no treatment available for coronavirus disease 2019 (COVID-19) (caused by the severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]), although supportive therapy and preventive measures have shown a tremendous control rate among certain patients. Drugs like remdesivir, camostat, nafamostat, ritonavir/lopinavir, several monoclonal antibodies, and CPs are in their early phases of trials. There are approved by the WHO under an emergency use authorization program. Favipiravir has entered its phase 3 clinical trial and is supported by evidence to show no or less adverse effects in patients infected with SARS-CoV-2. Vaccine development is accelerating its pace, and vaccines will probably become available by the end of the year 2020. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3553 | Data interpretation leading to image processing: a hybrid perspective to a global pandemic, COVID-19 When coronavirus hit, it caught mankind at the disadvantage of ignorance to its influence, and before the knowledge was realized the world was hit with another pandemic. After having overcome epidemics unheard of, the challenge lies in facing yet an added virus that poses a threat to the human species, the coronavirus disease, also known as COVID-19 [World Health Organization]. From the first established case of coronavirus in China found in the city of Wuhan to the first recorded coronavirus death, everyone has been looking for ways to tackle it. So let us take a look at how to deal with something that has the advantage of confining people to their homes and promises to be there for another decade or so and how to use the data that it gives as an advantage. This chapter will be taking a walk through the build and shift of COVID-19, then statistically measure its movement using data analysis and processing, assess its guise via image processing, and then go over some effective perspectives to keep this virus in check. Now, there is so much of COVID-19 data around, surmounting the ability to fathom it, so let us try and manipulate this data to find methods to nip it at the bud. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3554 | Essentials of the COVID-19 coronavirus This chapter presents the essential characteristics of the coronavirus disease 2019 (COVID-19) coronavirus in terms of the physical, chemical, and biological attributes of the mutant strains causing the current global pandemic, with symptoms ranging from fever; dry cough; tiredness; loss of taste, smell, and speech; sore throat; and chest pain to difficulty in breathing and constituting a threat to the existence of humanity. Preliminary in silico studies of retrieved sequences for coronavirus isolates from some endemic countries, presented in this chapter, extensively revealed the true characteristics of the coronavirus isolates, ranging from molecular weight, total number of atoms, aliphatic index, instability index, extinction coefficient, theoretic isoelectric point, grand hydropathicity, total number of negatively and positively charged amino acids residues, secondary protein structure characteristics, variations in the tertiary protein 3D structures, and the guanine–cytosine content in the RNA sequence of the isolates. Preliminary in silico determination of genetic and thermal stability potentials of the isolates has also been revealed using the instability index, aliphatic index, guanine–cytosine content, hydropathicity, and half-life of the isolates in human reticulocytes in vitro. The scary characteristics of the coronaviruses were revealed in their ability to mutate at a faster rate producing many mutant copies of the virus that are not exact, thus conferring on it the ability to escape the host immune system. This probably is responsible for the resurgence of the viruses with varied characteristics and antigens that differ from the previous strains, thus giving room for the risk of a pandemic. This calls for a more concerted effort in studying the essentials and mutation rates of the viruses to be able to predict the future mutation rate and possible attributes with a view to finding a suitable therapy and drug design for the pandemic and for the biosecurity of humans against the virus in the future. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3555 | Role of big geospatial data in the COVID-19 crisis The outbreak of the 2019 novel coronavirus disease (COVID-19) has infected 4 million people worldwide and has caused more than 300,000 deaths worldwide. With infection and death rates on rise, COVID-19 poses a serious threat to social functioning, human health, economies, and geopolitics. Geographic information systems and big geospatial technologies have come to the forefront in this fight against COVID-19 by playing an important role by integrating multisourced data, enhanced and rapid analytics of mapping services, location analytics, and spatial tracking of confirmed, forecasting transmission trajectories, spatial clustering of risk on epidemiologic levels, public awareness on the elimination of panic spread and decision-making support for the government and research institutions for effective prevention and control of COVID-19 cases. Big geospatial data has turned itself as the major support system for governments in dealing with this global healthcare crisis because of its advanced and innovative technological capabilities from preparation of data to modeling the results with quick and large accessibility to every spatial scale. This robust data-driven system using the accurate and prediction geoanalysis is being widely used by governments and public health institutions interfaced with both health and nonhealth digital data repositories for mining the individual and regional datasets for breaking the transmission chain. Profiling of confirmed cases on the basis of location and temporality and then visualizing them effectively coupled with behavioral and critical geographic variables such as mobility patterns, demographic data, and population density enhance the predictive analytics of big geospatial data. With the intersection of artificial intelligence, geospatial data enables real-time visualization and syndromic surveillance of epidemic data based on spatiotemporal dynamics and the data are then accurately geopositioned. This chapter aims to reflect on the relevance of big geospatial data and health geoinformatics in containing and preventing the further spread of COVID-19 and how countries and research organizations around the world have used it as accurate, fast, and comprehensive dataset in their containing strategy and management of this public health crisis. China and Taiwan are used as case studies as in how these countries have applied the computational architecture of big geospatial data and location analytics surveillance techniques for prediction and monitoring of COVID-19-positive cases. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3556 | The effects of COVID-19 pandemic on Western Balkan financial markets At the end of 2019, the coronavirus disease 2019 (COVID-19) outbreak occurred in Wuhan, China, from where it spread to Europe and all over the world. Currently, this pandemic forced almost all countries of the world to shutter lives into their homes. The rapid rates of infection spread and the number of deaths in the world have caused a decrease in the financial markets. Increasing incidents and deaths have made instability in the financial market uncertain. This study investigated the effects of the COVID-19 epidemic on the stock markets in Balkan countries. As the Balkan region concerns, there are two countries, Kosovo and Albania, that have no stock exchanges. This study has covered the analysis of the countries of the Balkan region that already have a stock exchange. The study analyzed the daily stock market data between January 01, 2020, and March 31, 2020, and the daily COVID-19 cases and death rates. The data obtained for the specific dates have been examined on the basis of the movements and effects of COVID-19 and the Balkan stock exchange. The results revealed that the stock exchanges in the Balkan countries are affected at the same rate as the exchanges of other countries. These thoughts and insecurities occur according to the news and human deaths reported in the news. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3557 | Coronavirus epidemic and its social/mental dimensions: the Turkey case This chapter provides a general view on social and mental dimensions of the coronavirus epidemic by analyzing it in the context of Turkey. It is important that the appearance of the coronavirus has caused many occurrences of both social and mental effects, and these should be discussed in detail by looking at the past and the psychologic roots of humankind. The chapter gives a general view on the current as well as future insights by considering the observations in Turkey and blending them with the societal dynamics and the known directed order of the whole world. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3558 | COVID-19 diagnosis-myths and protocols Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) belonging to betacoronaviruses, on the basis of sequence analysis, mainly infects the lower respiratory tract in humans while symptoms remain milder than to those of severe acute respiratory syndrome and Middle East respiratory syndrome. The outbreak of coronavirus disease 2019 (COVID-19) has surprised the world with its rapid spread and potential virulence by compromising personal safety and economic perspectives. Its clinical diagnosis is mainly based on epidemiologic history, clinical manifestations, and auxiliary examinations including nucleic acid detection, computed tomographic scan, and immune identification technology. However, atypical signs and symptoms in patients and discrepancies in the identification techniques have also become the reason for the spread of the virus. Genetic mutations by the virus or sensitivity/specificity of diagnostic tests are becoming a major issue to report COVID-19. This chapter thus details the available diagnostic tests and their mechanisms and limitations, and finally, the approaches to identify COVID-19 with valid precision are discussed. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3559 | Application of big data in COVID-19 epidemic The scientific research centered on generating new data by performing basic experiments to answer specific questions related to any infectious diseases. The application of big data in the area of infectious diseases has introduced a number of changes in the information accumulation models using analytics. Therefore this chapter discusses the concept of big data for guaranteeing better expansion and research against coronavirus disease 2019 (COVID-19). The chapter examines how large-volume medical data can help clarify and elucidate COVID-19 disease patterns. Also, the chapter conveys the benefits of big data analytics during COVID-19. The hope of using big data in COVID-19 will have a great impact on the quality of outbreak care that can be delivered to patients across socioeconomic and geographic boundaries. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3560 | PwCOV in cluster-based web server: an assessment of service-oriented computing for COVID-19 disease processing system In this work, we are introducing a novel assessment methodology for evaluating a prototype web service–based system for COVID-19 disease processing system by using cluster-based web server. We call it as PwCOV. The service generates clinical instructions and process respective information for distributed disease data sets. It follows the business processes and principles of service-oriented computing for each end user request. The assessment methodology illustrates different aspects of service deployment for massive growth of service users. In this study, the PwCOV is observed to be stable up to the stress level of 1700 simultaneous users. The response time of 14.35 s, throughput of 8592 bytes/s, and central processing unit (CPU) utilization of 22.16% with a strong reliability of service execution is observed. However, the reliability of PwCOV execution degrades beyond that execution limit. For 1800 simultaneous users of the service, the response time, throughput and CPU utilization is recorded to be 25.28 s, 15,729 bytes/s, and 39.13%, respectively. During this stress, the service failure rate of 35% is observed. A moderate reliability of 70% of service period is observed for 1800 users. The propose study also discusses the impact of system metric, reliability, and their correlation over the service execution. The statistical analysis is carried out to study the viability, acceptability, applicability of such deployment for COVID-19 disease processing system. The limitation of PwCOV for processing geographically scattered data sets is also discussed. | Data Science for COVID-19 | 2021 | CORD-19 | |
| 3561 | Impact of COVID-19 and lockdown policies on farming, food security and agribusiness in West Africa The ongoing coronavirus disease 2019 (COVID-19) pandemic is having devastating impacts across the globe. Among the implemented policies to reduce the spread of the disease is lockdown. This might have serious impact on farming activities and the livelihoods of millions of people whose daily means of sustenance is tied to agricultural activities. We undertook this study in West Africa, one of the most fragile and vulnerable regions to the epidemic. Our aim was to understand (1) farmers' perception of the impact of COVID-19 and lockdown policies on their farm or business revenue, (2) farmers' preparedness for COVID-19 lockdown on their farm or business revenue, and (3) the impact of effectiveness of COVID-19 lockdown on their farm or business revenue. We combined online questionnaire, physical contact and administration, and social media (Facebook and WhatsApp) to get responses from 303 farmers in Nigeria and Ghana. Our findings show that COVID-19 and lockdown policies negatively affected the farmers. The impact of COVID-19 and lockdown policies on respondents' farm or business revenue was independent of either age or gender of respondents and the effectiveness of lockdown in both the countries. The status of lockdown in respondent places (locked down versus not locked down) and the level of preparedness of farmers to handle the situation with the current COVID-19 crisis in their farms were also independent in both the countries. However, we found that the impact of COVID-19 and lockdown policies on farm or business revenue depends on the level of preparedness of farmers to handle the situation in each country. We further found that the impact of COVID-19 and lockdown policies on farm or business revenue was independent of the status of lockdown but rather depended on the preparedness for the current COVID-19 crisis and differently across countries. Our findings suggest that building capacities of farmers and supporting them in preparedness for such occurrence, as well as establishing and implementing public policies in this direction, can mitigate the impact of the pandemic on their activities. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3562 | Sliding window time series forecasting with multilayer perceptron and multiregression of COVID-19 outbreak in Malaysia This study demonstrates a sliding window time series forecasting methods to predict future trends of pandemic coronavirus disease 2019 (COVID-19) reported in Malaysia using a multiple regression and single-layer feedforward artificial neural network. Data from Jan. 25 to Apr. 30 were obtained from the Malaysian Ministry of Health and Department of Statistics Malaysia website. The findings show that the Movement Control Order declared by the Malaysian government was effective in mitigating the risk for spreading COVID-19 diseases through home quarantine and isolation, and thus were able to flatten the curve. Sliding window time series forecasting with an artificial neural network performs better than multiple regression as a predictive model with a smaller residual error. | Data Science for COVID-19 | 2021 | CORD-19 | |
| 3563 | Identification of lead inhibitors of TMPRSS2 isoform 1 of SARS-CoV-2 target using neural network, random forest and molecular docking Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was responsible for over 4 million confirmed cases of severe acute respiratory syndrome, of which more than 300,000 cases were confirmed to be dead as of May 2020. The virulent endocytotic activities of SARS-CoV-2 have been associated with angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2). Previous studies on the viral activation of TMPRSS2 focused most often than not on the isoform 2 of TMPRSS2, but the isoform 1 (529 residues) has also been shown to be expressed in target cells and contribute to viral activation in host. The inhibition of TMPRSS2 has been reported to grossly reduce the pathogenic effects of SARS-CoV-2 endocytotic activities. In this study therefore, we developed two machine learning models using random forest classifier (RFC) and neural networks (NNs) based on 2251 serine protease inhibitors to screen a database of 21,000,000 virtual compounds. We screened the hit compounds using absorption, distribution, metabolism, and excretion (ADME) properties and finally docked the filtered compounds into the predicted binding site of TMPRSS2 isoform 1 homology model to determine their corresponding binding affinity and plausible molecular interactions. One (ASONN) and four (ASOIRFC1–4) lead compounds were obtained from the ADME-NN and RFC filtered hits, respectively, having better binding affinity and lead-likeness properties than those of camostat; this could be due to extensive hydrogen and hydrophobic interactions. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3564 | A review on epidemiology, genomic characteristics, spread and treatments of COVID-19 In December 2019, a new form of coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started spreading in Wuhan, China. According to the situation report-95 published by the World Health Organization (WHO), the coronavirus disease spread rapidly to 213 countries and territories by April 24, 2020, with the number of confirmed cases and deaths of 26,26,321 and 1,81,938, respectively. The WHO declared coronavirus disease 2019 (COVID-19) as a pandemic on March 11, 2020. People living in many countries are in lockdown and staying at home because of this deadly virus. Patients of COVID-19 are reported to have single or multiple symptoms, while some patients do not have any remarkable symptom at all. Patients have reported symptoms of dry cough, sore throat, fever, fatigue, breathing problem, and gastrointestinal infection. COVID-19 may become very dangerous especially for aged people and people with any other disease such as diabetes, kidney problem, etc. In that case, the virus can cause acute respiratory distress syndrome and cytokine storm. The whole world is in lockdown because of this deadly virus. Currently, there is no particular cure for this disease; however, researchers are trying to find appropriate antiviral and repurposed drugs. This chapter provides a review on the different aspects of COVID-19 including the epidemiology, genomic sequence, and clinical characteristics; current medical treatment options; and development of vaccines and drugs. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3565 | Control of antibiotic resistance and superinfections as a strategy to manage COVID-19 deaths According to the World Health Organization (WHO), viral infections continue to emerge and pose severe problems to public health. In mid-December 2019, coronavirus (coronavirus disease 2019 [COVID-19]) infection begun scattering from China. Globally, there are growing worries about community infections, in light of pandemic characterization for the outbreak by the WHO. Some studies have found that 1 out of 7 COVID-19 patients have acquired secondary bacterial infection, and half of the patients who have died had such infections. The challenge of antibiotic resistance could become an enormous force contributing to the rise in illness and death associated with COVID-19, as lower respiratory tract infections are among the leading causes of mortality in critically ill ventilated-patients with COVID-19. The increasing prevalence of resistance to penicillin and other drugs among pneumococci has considerably complicated the treatment of acquired pneumonia. Resistance to other classes of antibiotics, traditionally used as alternatives in the treatment of pneumococcal infections, has also increased markedly in the recent years. Although the search for new antibiotics remains a top priority, the pipeline for new antibiotics is not encouraging, making it essential to search for other alternative solutions. Researching promising antimicrobial agents that are effective against COVID-19 as well as Streptococcus pneumoniae, which is a major cause of pneumonia, should be encouraged to reduce mortality related to COVID-19 infections. In this chapter, the relation between secondary infections and antibiotic resistance as contributors to high death rate among COVID-19 patients will be traced and highlighted. The possibility of using antimicrobial agents of plant origin, either independently or in combination with nanostructures, as preventive and/or treatment strategies for infections associated with COVID-19 will be reviewed. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3566 | Study and impact analysis of COVID-19 pandemic clinical data on infection spreading In December 2019, a severe pneumonialike disease has occurred in the city of Wuhan, Hubei Province in China. Within a very short period the infection spread across the whole world, but there was no previous medical history about this virus and how, where, and when the disease infected the human body and mutated in humans is still unknown. Subsequently, the coronavirus disease 2019 (COVID-19) outbreak was declared as the world pandemic on March 2020 by the World Health Organization because of its harmfulness and super spreading nature. Till now, there is no specific medications and clinical treatment available to avoid this pandemic COVID-19 outbreak. For this, it is essential to have a detailed study and analysis through the recent technologies. The recent trends such as artificial intelligence and machine learning (ML) based models can learn from past patient medication data and can suggest improvement accordingly by analyzing the data to control the spread. In the present scenario, the correct decision could be the appropriate precaution to stop spreading as well as controlling such a pandemic disease by proposing predictive ML that analyzes past data and conclude some useful information for future control of the spread of COVID-19 infections using minimum resources. The ML-based approach can be helpful to design different models to give a predictive solution for controlling infection and spreading and taking precaution toward the COVID-19 outbreak. In this chapter, we study the basic information of COVID-19 and its effectiveness worldwide. We also state the fundamental steps of ML, discuss the ML mechanism to study the pandemic for research and academic purposes, and study the data analytics of clinical data of India through a case study. As the data is a time series data, we analyze the data from March 1, 2020 to April 15, 2020; the decision tree approach of ML is discussed through a case study. Finally, the chapter is concluded with certain future scope of work in this area of research. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3567 | Prioritization of health emergency research and disaster preparedness: a systematic assessment of the COVID-19 pandemic The spontaneous nature of health emergencies and disasters (HED) require research prioritization and preparedness from multidisciplinary sectors such as the current coronavirus disease 2019 (COVID-19) pandemic that has become a center of attention to the research community globally. This study aims at assessing global research evolution, precedence, and preparedness toward combating the COVID-19 pandemic via systematic analysis of published studies. We retrieved COVID-19 studies from Scopus and Web of Science databases from January 01, 2020, to March 23, 2020, according to the PRISMA guidelines using the search term “COVID-19 OR coronavir∗”. The dataset was analyzed for productivity indices, conceptual frameworks (CFs), discipline, and collaboration networks (CNs). Results revealed a total of 817 studies on COVID-19. The top two productive researchers include those by Wang Y. (3.55%) and Li Y. (2.94%). Among disciplines, virology (n = 40, 5 h-index), microbiology (n = 27, 2 h-index), immunology (n = 22), and infectious diseases (n = 21) were at the forefront. China (n = 181) and the United States (n = 69) ranked the first and second productive nations, respectively. Country CNs in COVID-19 can be clustered into four subnetworks. Also, four thematic areas evolved in COVID-19 research for the period, namely, epidemiologic studies of infectious bronchitis virus including coronavirus, elucidation of historical respiratory viral outbreaks, zoonoses and phylogenetic analysis, and influenza zoonosis; while the prevailing CFs of research prioritization ranged from comparative symptomatology of severe acute respiratory syndrome coronavirus (SARS-CoV)-2 and Middle East respiratory syndrome coronavirus (MERS-CoV), perceptivity studies from SARS-CoV-1,2 outbreaks, antigenic structural studies for vaccine production to antibody therapeutic target studies. In conclusion, the COVID-19 research has received progressive attention since the beginning of the pandemic; however, this study recommends that integrative and multidisciplinary research priority and preparation should be channelled toward HED from all experimental and nonexperimental biases of knowledge. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3568 | Artificial intelligence-based solutions for COVID-19 Witness the coronavirus disease 2019 (COVID-19) virus becoming more deadly. Artificial intelligence (AI) scientists are using social media, the web, and other knowledge machine learning techniques to look for subtle signs that the disease may spread elsewhere. AI is a weapon in the battle against the infectious pandemic that has had impacts on the whole planet since early 2020. It echoes the high hopes of data science to confront the coronavirus in the press and the scientific community. The AI approach is used in the battle for cure, prediction, and pandemic predictors. Improving AI is a good step toward growing such uncertainties, one of the essential data analytics tools built over the past decade or so. Data scientists have approached the task of motivation. The index is growing exponentially as work information surface, beyond the potential of humans to do it alone. AI describes large data models, and this chapter should clarify how this challenge has become one of the ace cards of humanity. Advances in AI software, such as natural language processing, expression understanding, data mining, etc., are used for diagnosis as well as traceability and production of vaccines. AI has supported and contributed to the control of the COVID-19 pandemic. We include an initial overview of the real and potential contribution of AI to the fight against COVID-19 and the existing constraints on these contributions. In this chapter, different technologic solutions using AI for COVID-19 have been discussed. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3569 | On privacy enhancement using u-indistinguishability to COVID-19 contact tracing approach in Korea South Korea's COVID-19 contact tracing is unique because detailed and personally sensitive information has been disclosed. As a result, privacy concerns and controversies have been raised. As long as the Korean format of contact information is to be shared, a more sophisticated technique is required to mitigate the risk of privacy breaches. To meet the requirement of minimum privacy infringement, technical solutions for privacy enhancement are needed. In this paper, a u-indistinguishability concept is proposed and its effectiveness is shown. By mixing at least u patients' quasi-identifiers into a cluster and their associated movement information into another cluster, linkability is weakened significantly. | Data Science for COVID-19 | 2021 | CORD-19 | |
| 3570 | Towards analyzing the impact of healthcare treatments in industry 4.0 environment-a self-care case study during COVID-19 outbreak Coronavirus infection is proceeding with its spread over the world, with more than 2.7 million affirmed instances of coronavirus now in 185 nations. In any event, 190,000 individuals have kicked the bucket. The United States has multiple occasions of the same number of affirmed cases as some other nation. The infection, which causes the respiratory disease coronavirus disease 2019 (COVID-19), was first identified in the city of Wuhan, China, in late 2019. It is spreading quickly in numerous nations and the number of passings is as yet climbing. The world is pretty upside down the present moment, as a result of the worldwide frenzy around coronavirus infection (COVID-19). In case you are feeling overpowered or worried about everything, then be consoled this is an extremely ordinary reaction. Notwithstanding, it is critical to back off of yourself and to set aside effort for self-care. We have assembled this rundown list (self-care dataset) of self-care exercises that you can do from home; this is the message the corresponding author got in morning wishes during his stay in China. In the fight against the pandemic, nations effectively utilized computerized innovations, for example, artificial intelligence , big data, cloud computing, blockchain, and 5G, which have adequately improved the proficiency of nations' endeavors in scourge checking, infection following, counteraction, control and treatment, and asset assignment. The chapter discusses a couple of the ways in which data innovations were successfully utilized toward impact of healthcare treatments in Internet of Things (IoT) environment for analyzing a self-care contextual investigation during the coronavirus outbreak. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3571 | Gut-lung cross talk in COVID-19 pathology and fatality rate Coronavirus disease 2019 (COVID-19) is the leading pandemic facing the world in 2019/2020; it is caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which necessitates clear understanding of the infectious agent. The virus manifests aggressive behavior with severe clinical presentation and high mortality rate, especially among the elderly and patients living with chronic diseases. In the recent years, the role of gut microbiota, in health and disease, has been progressively studied and highlighted. It is through gut microbiota-organ bidirectional pathways, such as gut-brain axis, gut-liver axis, and gut-lung axis, that the role of gut microbiota in prompting lung disease, among other diseases, has been proposed and accepted. It is also known that respiratory viral infections, such as COVID-19, induce alterations in the gut microbiota, which can influence immunity. Based on the fact that gut microbiota diversity is decreased in old age and in patients with certain chronic diseases, which constitute two of the primary fatality groups in COVID-19 infections, it can be assumed that the gut microbiota may play a role in COVID-19 pathology and fatality rate. Improving gut microbiota diversity through personalized nutrition and supplementation with prebiotics/probiotics will mend the immunity of the body and hence could be one of the prophylactic strategies by which the impact of COVID-19 can be minimized in the elderly and immunocompromised patients. In this chapter, the role of dysbiosis in COVID-19 will be clarified and the possibility of using co-supplementation of personalized prebiotics/probiotics with current therapies will be discussed. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3572 | Assessment of global research trends in the application of data science and deep and machine learning to the COVID-19 pandemic Researchers around the world have recently used data science and deep and machine learning to assess and combat the coronavirus disease 2019 (COVID-19). The results from this study have presented research on COVID-19 that applied data science, big data, machine learning, deep learning, artificial intelligence, and mathematic and statistical modeling between January 2020 and April 2020 by different researchers across disciplines from different countries of the world. It was noted that the prominent studies used various terms and keywords in COVID-19-related studies include 2019-nCoV, China, COVID-19, epidemic, remdesivir, SARS-CoV-2, coronavirus, epidemiology, infection 2019-nCoV, SARS coronavirus, angiotensin-converting enzyme 2, animal reservoir, cross-species transmission, and human-to-human transmission in COVID-19 studies between January and April 2020. The result reveals the relevance and percentage, as well as the distribution, of data science and modeling techniques used in COVID-19 research before 2020 and during the year 2020 (January to April 2020). More so, author keywords, both keywords, total articles, total citations, and h-index were identified. “Model” has the highest frequency with 19 papers, 11 total citations, and an h-index of 2; on the other hand, it appeared on number one on both keywords with 37 papers, 47 citations, and an h-index of 4. Bibliometrics generally applies Price's law to estimate authors' influence and output in a particular field of study, which can also determine the highest and lowest occurrence of important key terms. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3573 | The linkage between the epidemic of COVID-19 and oil prices: case of Saudi Arabia, January 22 to April 17 The prevalence of coronavirus disease 2019 (COVID-19) exacerbated investor fears, uncertainties, and increased volatility in financial markets. The reaction to oil prices gradually absorbed the epidemic until March 08, but the market situation changed soon with a sharp drop in prices until April 17. This study aims to verify the impact of COVID-19 cases on crude oil prices and the Saudi economy. A simple linear regression estimate shows that new daily outbreaks have a marginally negative impact on crude oil prices in the short term. However, COVID-19 also has an indirect effect on the recent volatility in crude oil prices. Solutions include proactive management, and we emphasize that special consideration must be given to the size of the supply to properly forecast oil prices. Volatility dominates in the short term. The relationship between the epidemic and oil prices reveals a root cause. Moreover, we investigate the interaction between the epidemic and oil prices, with the effective implementation of these solutions with the government's full support. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3574 | Telemedicine applications for pandemic diseases, with a focus on COVID-19 Dating back to the development of modern medicine, pandemic and epidemic diseases, such as bubonic plague, smallpox, the plague of Justinian, and the Antonine Plague, have caused massive damage to the human race. For instance, more than 200 million people are estimated to have died due to Black Death (bubonic plague) alone. This situation has not changed in near history either. Diseases such as influenza, HIV/AIDS, severe acute respiratory syndrome, Ebola, Middle East respiratory syndrome, and coronavirus disease 2019 (COVID-19), as today, have emerged and threatened the modern human life. The common feature of these diseases can be listed as having a high risk of infection and transmission, rapidly spreading to large areas, and having high mortality rates and causing permanent damage to the body because of the low immunity profile of the exposed population. If the number of cases increases rapidly for these diseases, the capacity of healthcare services can be exceeded and healthcare services can be threatened as well. These characteristics of pandemic diseases force the authorities to take extraordinary precautions such as isolation and quarantine to reduce the risk of infection. However, these applications can make it difficult to provide proper health services to patients. The development of information technologies provides patients an easy and remote access to healthcare services via telemedicine applications. Telemedicine is used for diagnosis and treatment of diseases by following the same practices used in clinics. It also provides care givers a real-time and remote monitoring of their patients, which can be beneficial in terms of reducing the risk of infections and maintaining healthcare services during a pandemic. Authorities can also use these telemedicine applications to track infected patients and get necessary precaution to minimize the infection risk. This chapter introduces the latest telemedicine applications for epidemic and pandemic diseases, especially for COVID-19. These potential applications could improve and transform the current practices for pandemic disease management. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3575 | Artificial intelligence and COVID-19: fighting pandemics Artificial intelligence (AI) is a computer-based technology that has the ability to learn and intelligently perform given tasks. AI-based services have already become a natural part of human life. As the significance of using these technologies is getting more recognized over time, they continuously give promising results to not only solve the current problems but also identify the possible problems of future. If these services can be used in this way, they may even surpass human solutions in different landscapes. Managing pandemic is one of them. At present, the new issues arising from the spread of coronavirus disease 2019 (COVID-19) in the world have become an important part of AI services for social good. These services have already shown promising results regarding healthcare in different landscapes such as early diagnosis, tracking the spread of virus, monitoring patients, relieving the overload on healthcare workers, identifying high-risk groups, and raising awareness about self-hygiene. However, most of the issues related to fighting against COVID-19 at a global level show that use of AI technologies in such disease prevention or public health management is still very limited. AI technologies could be more functional in the management of such crisis when they become part of intelligent healthcare systems and a requirement for the management systems of any potential pandemic in the future. The purpose of this chapter is to provide consistent knowledge to stakeholders regarding the critical issues and to analyze how AI-based solutions could be used for fighting against pandemics. Therefore using AI services in the management of COVID-19 pandemic is examined in four main phases: prevention, preparation, response, and recovery. Next, critical issues, ethical uses of those services, and the latest learned lessons were discussed. Then the existing gaps in fighting pandemics are presented together with the concluding remarks, where suggestions of relevant AI systems and how AI can help in fighting against pandemics are summarized. | Data Science for COVID-19 | 2022 | CORD-19 | |
| 3576 | Acute Circulatory Collapse and Advanced Therapies in Patients with COVID-19 Infection Introduction In the current COVID era, ICU-level patients typically develop respiratory failure and acute respiratory distress syndrome (ARDS). While less frequent, the management of concomitant acute circulatory collapse has its own challenges and nuances. Early identification of acute circulatory collapse requires appropriate imaging and precise diagnosis of cardiogenic shock. Escalation to mechanical circulatory support such as intra-aortic balloon pump (IABP), Impella and extracorporeal membrane oxygenation (ECMO) have been useful in patients with circulatory collapse from COVID. Case Report 42-year-old obese female presented with COVID bronchopneumonia 6 days after a positive outpatient COVID swab. In the ED, she was given 3L of fluid bolus for severe sepsis and developed flash pulmonary edema requiring emergent intubation. She also developed hemodynamic collapse, requiring inotrope and pressor support and a TTE demonstrated severely depressed left ventricular ejection fraction (LVEF) of < 10%. Peripheral VA ECMO was placed, and the patient was transferred to our tertiary care center for further management of fulminant COVID-myocarditis with cardiogenic shock. Patient did not have any significant obstructive coronary artery disease on catheterization. An Impella CP was placed for hemodynamic support. She was started on a high-dose steroid, one dose of tocilizumab for severe LV dysfunction, two rounds of IVIG, and CRRT for volume removal. On Day 11 she had improved hemodynamics and there were signs of LV recovery, after which she was decannulated. Impella support was continued until there was complete recovery. Patient was extubated on Day 17 and continues to recover at a long-term acute care facility. Summary Acute circulatory collapse in COVID-19 infection is a serious complication with high morbidity and mortality. Early recognition of depressed LV function and cardiogenic shock by echocardiography, cardiac MRI, and/or Swan-Ganz catheter assessment is critical. ICU management of hemodynamic function, fluid status, and blood pressure management remains standardized, but prompt medical management with inotropes and mechanical support maximizes patient outcomes. IABP, Impella, and ECMO all play a key role in managing acute circulatory collapse. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3577 | Challenges in Heart Transplantation During COVID-19 Pandemic in Brazil Purpose A recent UNOS analysis comparing COVID-19 to pre-COVID-19 era found an increased waitlist inactivation, decreased waitlist addition, and decreased in numbers of heart transplant (HT). In Brazil, a pronounced negative effect on transplant was anticipated but has not been measured so far. Our objective was to evaluate the impact of COVID-19 pandemic on heart donation and HT. Methods We performed a descriptive analysis of data related to patients registered in HT waitlist and numbers of HT performed from March 2018 to August 2019 (pre-COVID era) and March 2020 to August 2021 (COVID era), by reviewing medical records and data from State Transplant System. Results A total of 221 patients were included in HT waitlist from 2018 to 2021. Approximately the same number of patients were listed in pre-COVID and COVID era (111 vs 110, respectively). Mean age of patients were 48.7 in the pre COVID and 48.9 years in the COVID era (p=0.91). The majority were listed as top priority criteria, 94 (85.5%) in COVID vs 100 (90.1%) in pre-COVID era, p=0.293, mostly due to mechanical circulatory assist devices ECMO and Centrimag (10.9% vs 18%), and intra-aortic balloon pump (41.8 % vs 39.6%) respectively, p=0.496. There was no difference in the survival of patients in waitlist (p = 0.226). Regarding number of HT, we observed highest absolute number of surgeries in the pre-COVID era (78 vs 66), with no statistical significance (p=0.109). There was no difference between the deaths after HT, 17 (15.3%) in pre-COVID and 9 (8.2%) in COVID era, p=0.249. During the peak of number of COVID-19 cases in Brazil (may-july 2020 and february-april 2021) we observe a reduction in overall heart transplant procedures an inclusion in waitlist (figure). Conclusion To the best of our knowledge, this is the first report of the impact of COVID - 19 on solid organ donation and HT. There were no differences between number of patients included in HT waitlist and outcomes after HT before and during COVID. However, there was a decrease in number of HT and inclusion in HT waitlist during the peak of COVID-19. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3578 | Coronavirus 2019 in a Morbidly Obese Patient: ECMO or No ECMO? Introduction Coronavirus 2019 (COVID-19) can lead to Acute Respiratory Distress Syndrome (ARDS), necessitating prolonged mechanical ventilation and the use of extracorporeal membrane oxygenation (ECMO). A Body Mass Index (BMI) higher than 30 kg/m2 is associated with an increased risk of developing ARDS along with greater morbidity, length of stay, and duration of mechanical ventilation in the intensive care unit. There is limited data on utilizing ECMO support in the morbidly obese population. Case Report A 51-year-old female with a history of chronic obstructive pulmonary disease and extreme obesity with BMI of 54 kg/m2 presented with a complaint of worsening shortness of breath. She was afebrile with a temperature of 97F, tachypneic with a rate of 32, and hypoxic with oxygen saturation in the 80′s. Chest x-ray showed severe bilateral interstitial airspace opacities (figure 1). Transthoracic echocardiogram showed an ejection fraction of 55-60%. She tested positive for COVID-19 and was promptly started on dexamethasone and remdesivir. Her respiratory status continued to decline and she was intubated on day 6. Despite being on 100% Fio2, her hypoxemia persisted. We proceeded to cannulate veno-venous ECMO via the right internal jugular vein and right femoral vein. Over the next several days, her ARDS status continued to improve drastically along with oxygenation. On Day 13, she was successfully de-cannulated with no complications. The patient recovered well and was discharged to an acute rehabilitation facility. Summary ECMO has several advantages including direct pulmonary artery flow improving oxygenation and ventilation, early mobility once off the ventilator, and survival benefit. The use of veno-arterial ECMO should also be considered in the setting of severe respiratory failure accompanied by severe heart failure or right ventricular dysfunction. This case highlights the importance of considering ECMO as a feasible therapeutic option in the morbidly obese patient population with COVID-19 as it can be life-saving. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3579 | Characteristics and Outcome of COVID-19 Infection in Heart Transplantation Recipients in the Netherlands Purpose Immunocompromised patients are at high-risk for complicated COVID-19 infection. The aim of this study is to describe the characteristics and outcome of heart transplantation (HTx) recipients infected with COVID-19 in the Netherlands. Methods All HTx patients with a COVID-19 infection between February 2020 and June 2021, proven by positive polymerase chain reaction-test or positive serology in one of the three heart transplant centers in the Netherlands were retrospectively included. The primary endpoint of this study is all-cause mortality. Results COVID-19 was diagnosed in 54/665 (8%) HTx patients, mean time from HTx was 11±8 years, mean age 53±14 years and 39% were female. Immunosuppressive therapy was reduced in 37%, 21 (39%) patients required hospitalization and all-cause mortality was 6%. Severe COVID-19 disease (hospitalized with ICU admission or mortality) was seen in 7 (13%) patients. Compared to patients with mild (not hospitalized) or moderate (hospitalized, no ICU admission) COVID-19 infection, patients with severe COVID-19 infection were generally older (p=0.007) and had a history of ischemic heart failure (p=0.004) more frequently. Compared to patients with moderate COVID-19 infection, severe COVID-19 patients were transplanted earlier and had a significantly higher body mass index (30±3 vs 26±3; p=0.01). Myocardial infarction, cellular rejection and pulmonary embolism were observed once in three different HTx patients. Physical complaints post-infection persisted with a median of 30 days (IQR 30-83 days) in 16 (39%) cases. Conclusion HTx patients are at increased risk for complicated COVID-19 infection with frequent hospitalization, but mortality is substantially lower than previously described. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3580 | Outcomes of Critically Ill Lung Transplant Recipients with COVID-19 Purpose Critically ill patients with COVID-19 are at high risk of morbidity and mortality. This risk may be even higher among lung transplant recipients (LTxRs) as they are immunosuppressed and typically older with multiple co-morbidities. The aim of this study was to characterize the outcomes of critically ill LTxRs with COVID-19. Methods LTxRs with COVID-19 hospitalized in the ICU between 06/01/2020 and 02/28/2021 were included and classified as alive or deceased. Baseline clinical characteristics, laboratory results, and complications were reviewed. Death due to COVID-19 was the primary outcome. Descriptive statistics were used. Results Twenty-five LTxRs (13 men; 8 alive, 17 deceased) were included. Median (IQR) age, interval between LTx and COVID-19 diagnosis, and duration of ICU stay was 66 years (56, 71), 27 months (10, 51), and 19 days (10, 28), respectively. Pre-existing diabetes and chronic kidney disease were common (68%, 68%). Although statistical significance was not reached due to small sample size, survivors trended toward lower levels of CRP, ferritin, and D-Dimer at ICU admission. Fewer survivors had a stroke (0% vs 6%), hemorrhage requiring transfusion (14% vs 18%), new-onset heart failure (14% vs 29%), venous thromboemboli (24% vs 33%), and renal failure requiring dialysis (25% vs 53%). At a median of 8 days after COVID-19 diagnosis, 18 (72%) LTxRs required intubation. The need for mechanical ventilation increased the risk of death 4.327-fold (p=0.054) and lowered the probability of 60-day survival (16.7% vs 71.4%, p=0.035; Figure 1). The median survival of deceased subjects was 23 days (17, 34). Most LTxRs received corticosteroids, convalescent plasma, remdesevir, and reduced immunosuppression. Among LTxRs that survived to hospital discharge, 38% (3) were discharged home, 50% (4) required acute rehabilitation, and 75% (6) were supplemental oxygen dependent. Conclusion Critically ill LTxRs with COVID-19 have high morbidity and mortality. The need for mechanical ventilation portends a poor prognosis. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3581 | Too Much Too Soon? The Catch-22 of Catching COVID-19 Introduction Myocarditis has become a well-recognised cardiac complication of SARS-CoV-2 infection. Now, there are growing reports of rare incidences of myocarditis following receipt of mRNA COVID-19 vaccines. Case Report A previously healthy 35-year-old male tested positive for COVID-19 on 8/12/21. He never required hospitalisation and was thought to have cleared the infection by 9/5/21. Three weeks later he received the first dose of Pfizer-BioNTech BNTT162b2/Comirnaty mRNA COVID-19 vaccine. Five days later he presented to emergency with chest pain alongside myalgia, headache and cough. His troponin-T was below reference range (RR), electrocardiogram showed sinus rhythm with mild, diffuse T-wave flattening, and no evidence of pericardial effusion was seen on bedside transthoracic echocardiogram (TTE) so was discharged. Two days later he represented to hospital with fevers, vomiting, diarrhea and a maculopapular rash. His subsequent admission was complicated by rapid deterioration and his management reflected a diagnostic dilemma with wide differentials. On day 2 of admission he became haemodynamically unstable requiring vasopressor therapy with a high sensitivity (hs) troponin-I of 103ng/L (RR <26ng/L). On day 4 he developed atrial fibrillation, worsening respiratory distress, peak hs troponin-I of 1474ng/L and required intubation, direct-current cardioversion and venoarterial extracorporeal membrane oxygenation (ECMO) for intractable heart failure. TTE here showed severe global systolic impairment with a left ventricular ejection fraction of 15% and small pericardial effusion. His subsequent treatment targeted possible multiorgan sepsis with antibiotics, vaccine-induced myocarditis with immunosuppressive therapy including anakinra and parental corticosteroids, or delayed COVID-19 myocarditis with supportive care. He was later extubated and successfully decannulated from 5 days on ECMO on day 11. Cardiac magnetic resonance imaging on day 12 showed elevated T1 and T2 values consistent with ongoing myocardial edema, but normal ventricular volume, thickness and function. Summary This is a case of fulminant myocarditis whereby the aetiology is unclear considering recent COVID-19 infection and mRNA vaccination. This raises questions as to the ideal timing of vaccine, type of vaccine and requirement for cardiac screening prior to vaccination in patients who have recovered from COVID-19. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3582 | Lung Transplantation for post-COVID-19 End Stage Lung Failure: A Case Series from 3 Latin American Countries Purpose Lung transplantation has currently become a therapeutic option in severe cases of COVID-19, which present extensive and irreversible lung damage. We aim to assess demographic characteristics, and evolution of pre-transplant SARSCoV2 infection, complications, and post-transplant survival. Methods Retrospective case series from 4 Lung Transplant Centers of 3 Latin American countries: Chile, Brazil, and Mexico, including patients that underwent lung transplantation for post-COVID19 end stage lung failure. Results From January 2020 to September 2021, 13 bilateral lung transplants due to severe cases of post-COVID19 lung failure were performed. 69.2% in men, with an average age of 44 years (range 25 to 61 years). From symptoms onset, average intubation time was 12.9 days, and connection to ECMO was, on average, at 12.3 days, (range 2 to 28 days). Transplants were on average at 85.5 days from the connection to ECMO (range 52 to 167). Mean was BMI was 28.3 kg/m2 (range 24.4 to 35.5). One patient had previous comorbidity (arterial hypertension). Before transplantation, 100% were connected to ECMO, none of them were sedated, 11 achieved standing, 3 of which kept walking, and 53.8% maintained spontaneous ventilation. Transplant surgical approach used was Clamshell in 11 patients and median sternotomy 2. Intra-operative cannulation was performed in 100%, being veno-venous in 2 and veno-arterial in 10 of them. 61.5% of the cases (8 patients) remained on ECMO after surgery, for an average of 6.6 days (0 to 22).61.5% of the patients had complications, being bleeding, vascular stenosis, infections, and kidney failure are described. Overall survival was 53.8% (7 patients) with a median follow-up of 64 days. The 30-day survival rate was 75%. Average time to discharge was 44.6 days after transplantation, with total average time of hospitalization of 142 days (74 to 257). Conclusion Transplantation is considered as part of the therapeutic arsenal in those patients who have confirmed irreversibility of lung damage, despite medical support. However, the delay in transplantation and the consequent connection to prolonged ECMO is observed consistently in our countries, probably due to a low rate of organ donation. This exhibits the need for a better assessment on when to perform the transplant, considering the low donor rate of lung transplant programs in Latin American countries. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3583 | COVID-19 Has a High Mortality Rate in Lung Transplant Recipients: A Large Single-Center Experience Purpose Immunosuppressed patients, particularly solid organ transplant recipients, are at an increased risk of death from COVID-19. We report a large single-center experience with COVID-19 in lung transplant recipients (LTRs). Methods This is a retrospective cohort study of 91 LTRs diagnosed with COVID-19 between March 1, 2020 and August 31, 2021. Patients were classified as alive (n=61) or deceased (n=30). The Kruskal-Wallis and Chi-squared tests were used for data analysis. Results Mortality from COVID-19 was high (n=30, 33%). There was no difference in baseline clinical characteristics between alive and deceased patients; age, medical co-morbidities, body mass index, and lung function were similar (Table 1). The vast majority of patients were hospitalized (n=79, 86%), not only for severe illness but also to receive remdesivir, an infusion available only to inpatients. Patients that died were more commonly hypoxemic and admitted to the ICU, more likely to require mechanical ventilation, and had a longer hospital stay. Of the 24 intubated patients, only 4 survived (16.7%); 2 patients were placed on ECMO and both died. Deceased patients had higher peak levels of D-dimer, ferritin, procalcitonin, and lactate dehydrogenase. The vast majority of patients received corticosteroids; deceased patients were more likely to be treated with remdesivir and tocilizumab. Extrapulmonary complications were more common in deceased patients: 33% developed renal failure requiring hemodialysis and 19.2% developed multi-organ system dysfunction. The median time to death was 1.1 (0.63, 3.70) months; 3 patients survived the acute illness but died several months later of complications from post-adult respiratory distress syndrome-fibrosis. Conclusion The COVID-19 pandemic has had catastrophic consequences for lung transplant recipients. We hope that high vaccination rates, reduction of immunosuppression in the early disease period, and more effective antiviral therapies can reduce mortality. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3584 | Cardiogenic Shock in COVID-19 Fulminant Myocarditis Treated with V-A ECMO Introduction As COVID-19 pandemic spread, cases of involvement of the heart have been reported. Case Report A 47-year-old woman was admitted to the ICU of our hospital for severe cardiogenic shock. She was pyretic, hypoxemic, tachycardic and with reduction of voltages at ECG. TTE showed severe biventricular impairment with an EF of 20 %. Chest X-ray revealed interstitial edema (Fig.1). Invasive mechanical ventilation and inotropic support and empiric antibiotic therapy were set up. High levels of IL-6, lactate, TpnI, and pro-BNP and WBC emerged from laboratory exams (Fig.2).Testing for cardiotropic viruses came back negative, as well as hemocultures. BAL PCR resulted positive for SARS-CoV2. COVID-19 myocarditis was therefore diagnosed. Due to severe hypotension irresponsive to noradrenaline and adrenaline, IABP was placed. The following day, a pericardiocentesis was carried out for cardiac tamponade. Due to worsening of the general conditions, V-A ECMO was implanted. Corticosteroids were administered at high dosage. As cardiac function steadily improved and pro BNP and troponins decreased, vasopressor and inotrope were stopped, V-A ECMO was removed and IABP support was interrupted. Improvement of biventricular function was observed (EF 55 %), after 15 days the patient was transferred to the ward and after 25 days was discharged with heart failure therapy. Summary Currently, most of the ongoing research focuses on the respiratory complication of SARS-CoV2 and little is known about the management of COVID-19 myocarditis. In our experience, high dosage glucocorticoids, inotropes, and V-A ECMO improved the clinical conditions of the patient. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3585 | Gamma-Glutamyltransferase at the Time of Listing May Predict Irreversible Severe Cholangiopathy After Lung Transplantation for COVID-19-ARDS Purpose Lung transplantation (LTx) can be considered for selected patients suffering from COVID19 ARDS or fibrosis. Besides the lung, the virus also affects the liver and cholangiopathy with progressive biliary liver failure has been described in a substantial rate of COVID19 ARDS survivors. Despite an increasing number of LTx performed worldwide for post-COVID19 ARDS, rates of cholangiopathic liver dysfunction and factors predicting this detrimental late complication are unknown. Methods This retrospective analysis included all LTx performed for post-COVID ARDS or post-COVID fibrosis in our institution between May 2020 and October 2021. Clinical parameters available at the time of listing were compared between LTx recipients who developed irreversible cholangiopathy leading to death or consideration for liver transplantation (‘cholangiopathy’ group) and patients who had no or only transient liver dysfunction (‘control’ group). Severe elevation of LFPs was defined as greater than 5 times the upper limit of normal (ULN) of bilirubin, ASAT, ALAT, GGT and AP, respectively. Results A total of 23 patients were included in the analysis. While 14 (60.9%) showed no or only transient liver dysfunction post-transplant, 9 (39.1%) developed persistent cholangiopathy after LTx. In 4 of these cases, this ultimately led to death, while 2 patients had to be put on the liver transplant wait list. Median time between COVID disease onset and Tx listing (p=0.603) was similar in both study groups. Recipient BMI, previous comorbidities and SOFA score at Tx listing were comparable. Levels of AP, ASAT, ALAT and bilirubin were similar in both groups, however, GGT at the time of listing seemed to predict a later development of cholangiopathy (median 510 vs 211.5 U/L; p=0.062). Moreover, patients with a GGT > 5xULN had a 12 times higher likelihood for the development of post-transplant cholangiopathy compared to those with lower GGT values (OR 95% CI: 0.010 - 0.590). Conclusion Since severe cholangiopathy is associated with a high mortality after LTx, liver function should be thoroughly assessed in all post-COVID ARDS/fibrosis LTx candidates. In this preliminary observation, we found that GGT at the time of listing was the only parameter which appeared to predict this late complication. Further large-scale studies are required to confirm our findings. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3586 | Case Report of Donor Transmitted SARS-CoV-2 Infection During Lung Transplantation Introduction Avoiding SARS-CoV-2 infection in the peri-operative period is a challenge for lung transplantation during the COVID19 pandemic. Testing donor lung BAL samples for SARS-CoV-2 as part of pre-transplant workup may avoid donor-derived infections. Case Report A 36-year-old woman with interstitial lung disease secondary to desquamatous interstitial pneumonia during infancy underwent bilateral lung transplant. She was highly allosensitized (cPRA >89%, ccPRA 97%) prompting intra-operative plasmapheresis (PLEX) and rabbit thymoglobulin induction immunosuppression. Post-operatively, her immunosuppression consisted of institution-standard tacrolimus, mycophenolate, and methylprednisolone. For HLA desensitization belatacept, rituximab, intravenous immunoglobulin (IVIG), and carfilzomib regimens were added. She was extubated post-op day 2. Her course was complicated by worsening hypercarbia, hypoxia and respiratory secretions. Post-op day 11, she was reintubated with tracheostomy placement. Chest imaging showed bilateral heterogeneous pulmonary opacities. BAL sampling was positive for SARS-CoV-2 with concern for donor transmission given adherent hospital precautions. Pre-transplant donor and recipient nasopharyngeal (NP) SARS-CoV-2 screenings were negative. Donor transmission was confirmed by positive PCR testing of banked pre-operative donor lung BAL samples. Dexamethasone and remdesivir were started. Tacrolimus and mycophenolate were continued for immunosuppression. She developed acute antibody-mediated rejection (AMR) with new donor specific antigens (DSA) likely related to her SARS-CoV-2 infection. Her AMR was managed with IVIG and PLEX x 10 with PLEX followed by SARS-CoV-2 convalescent plasma. Her DSA's resolved and ventilatory support was weaned. She was discharged home post-op day 56 and was doing well on room air 6 months out. Summary This case emphasizes a potential to miss donor SARS-CoV-2 infection in standard pre-operative evaluation. Despite absence from the NP mucosa viable SARS-CoV-2 virions may be present in donor lung tissue, increasing risk of infection to recipients. Peri-transplant SARS-CoV-2 infection carries a high risk of morbidity. Of note, our case occurred prior to the UNOS mandate for donor lung SARS-CoV-2 screening by lower respiratory sampling. This mandate will decrease risk for similar cases in the future. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3587 | Lung Transplantation for COVID-19 induced Respiratory Failure: Single-Center Case Series Purpose Prior to the COVID-19 (C19) pandemic, adult respiratory distress syndrome (ARDS) was an unusual indication for lung transplant (LT); thus, short- and long-term outcomes data are lacking. As the pandemic continues, there is an increased need for post-LT data. Thus, we report our single-center experience transplanting 11 patients for C19 ARDS. Methods We conducted a chart review of LT recipients (LTRs) transplanted for C19 ARDS between 8/1/21 and 7/31/21. Descriptive statistics were used. Results Most LTRs were male (82%, n=9). The median age at LT, body mass index, and lung allocation score were 47 (43, 54) years, 28.9 (26, 30) kg/m2, and 84.5 (60, 88), respectively. The median interval from initial hospitalization to listing and listing to LT was 119 (97, 124) and 5 (4, 11) days, respectively. Pretransplant COVID-related morbidities included venous thromboembolism (55%, n=6), hemorrhage requiring transfusion (36%, n=4), pneumothorax (55%, n=6), bacterial pneumonia (82%, n=9), bacteremia (45%, n=5), fungemia (36%, n=4), renal failure requiring renal replacement therapy (RRT; 9%, n=1), cerebrovascular event (9%, n=1), and musculoskeletal weakness (100%, n=11). Most patients required mechanical ventilation (91%, n=10), and 55% (n=6) were intubated at the time of LT. Furthermore, most patients required ECMO support (73%, n=8) and 36% (n=4) were on ECMO at the time of LT. Intraoperatively, 64% (n=7) of patients required cardiopulmonary bypass, 73% (n=8) had severe intrathoracic adhesions, 73% (n=8) had delayed chest closure, and 18% (n=2) had an unexpected return to the operating room. Prevalence of primary graft dysfunction grade 2 or 3 at 72 hours was high (91%, n=10), median duration of mechanical ventilation after LT was 10 (6, 19) days, but no one required ECMO rescue. To date, 10 (91%) LTRs have been discharged, and 2 (20%) have been readmitted within 30 days; the median post-LT hospital stay was 18 (14, 24) days; all discharged LTRs required acute rehabilitation for a median of 17.5 (14, 23) days. Ten LTRs (91%) at a median of 208 (167, 245) days post-LT; 1 LTR died 344 days post-LT of treatment-refractory allograft failure due to aspiration and antibody-mediated rejection. Conclusion Despite pre-LT critical illness, intraoperative challenges, and prolonged post-LT recovery, LT appears feasible for carefully selected patients with irreversible C19 ARDS. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3588 | Peri-Operative Desensitization for Highly Sensitized Lung Transplant Recipients Following COVID-19 Acute Respiratory Distress Syndrome (ARDS)-Report of Two Cases Introduction Sensitized lung transplant (LTx) candidates have longer waiting times, decreased likelihood of transplant, and increased risk of death while on the waitlist. Patients with SARS-Cov-2 ARDS on ECMO support due to end-stage lung disease have a short window of opportunity for LTx. We report two cases in which the Toronto LTx peri-operative strategy was performed with good outcomes in highly sensitized Covid-19 patients. Case Report Case 1: 31-yo female patient with Covid-19 ARDS, transferred for LTx evaluation after 46 days on VV-ECMO. She was pregnant when she presented with Covid -19 acute respiratory failure, and underwent an urgent C-section due to fetal distress. She required blood transfusions during ICU stay. At LTx assessment: PRA class I: 95%; class II: 0%. A decision to proceed with LTx with perioperative desensitization was made considering the low probability of finding a suitable donor. After seven days on the waiting list, she underwent bilateral LTx. Virtual crossmatch (XM) positive (B35); CDC-XM negative. Desensitization protocol was performed with perioperative plasma exchange (PLEX) without basiliximab induction, followed by five sessions of PLEX and intravenous immunoglobulin 1 mg/kg. Due to postoperative acute cholecystitis with positive cultures after biliary drainage, anti thymocyte globulin (ATG) infusion (3 mg/kg) was held, and infusion postponed until four weeks post LTx. Tacrolimus, mycophenolate, and prednisone were used as maintenance immunosuppression. The patient was discharged home on PO day 53 with excellent graft function. Case 2: 35-yo female patient with Covid-19 ARDS, transferred for LTx after 69 days on VV-ECMO. History of 3 previous pregnancies and multiple blood transfusions due to transitory coagulopathy during her ICU stay. PRA class I: 83%; class II: 94%. VCM positive (B7, Cw7, DRB1*11:01, DR52, DQA1*05/DQB1*03). Desensitization protocol was performed, but ATG infusion was held due to C. albicans bloodstream infection and colonization with pan-resistant K. pneumoniae. DSAs at six weeks were negative. She remains hospitalized for mechanical ventilation withdrawal and inpatient rehabilitation. Summary In selected cases, peri-operative desensitization is feasible and can be safely implemented in highly sensitized patients with Covid-19 ARDS. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3589 | Fulminant Antibody-Mediated Rejection in a Stable Lung Transplant Recipient post-COVID-19 Vaccination Introduction Vaccination against COVID-19 in immunocompetent individuals has demonstrated high efficacy in disease prevention while significantly reducing severe infections and hospitalizations. COVID-19 vaccination is endorsed in immunosuppressed recipients of solid organ transplant. Trials have examined safety data in this population, with no published reports of increased risk of antibody-mediated rejection (AMR). We present a case of probable mRNA vaccine induced AMR in a previously stable lung transplant recipient. Case Report A 27-year-old bilateral lung transplant recipient for cystic fibrosis related lung had grade 2 rejection with class II antibodies 2 months post-transplant that was treated with methylprednisolone with good response. He was then event free for over two years. He developed acute onset of dyspnea, dry cough, non-pleuritic chest pain, and general malaise 24 hours after receiving his second dose of the Pfizer mRNA vaccine. Over the subsequent 3 weeks, he deteriorated with worsening exertional dyspnea and desaturation. He was admitted to hospital with rapidly progressive type 1 respiratory failure. A CT angiogram of the chest demonstrated findings consistent with organizing pneumonia versus opportunistic infection. Bronchoscopy was negative for infectious etiology. He was treated with a methylprednisolone pulse to treat the organizing pneumonia seen on imaging and potential AMR. He required intubation and mechanical ventilation on post admission day (PAD) 4. Human leukocyte antigen testing demonstrated de novo class II donor specific antibody (DR12) and possible weak class I reactivity. With declining status and refractory hypoxemia, 5 cycles plasma exchange (PLEX) alternating with thymoglobulin were administered. He became dependent on extracorporeal membrane oxygenation with poor lung compliance. Antibody levels decreased but remained elevated. Subsequent therapy included thymoglobulin (total dose 7mg/kg), 5 additional cycles of PLEX, and intravenous immunoglobulin and Dartinumab on PAD 38. He died PAD 47 when life sustaining measures were removed due complications from Clostridium difficile infection. Summary This case of probable AMR post mRNA vaccination in a lung transplant recipient raises clinical suspicion for a serious adverse event and contributes to safety data for this select population. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3590 | Use of High Dose Corticosteroids Reversed COVID-19 Associated ARDS in a Patient Listed for Lung Transplantation Introduction In acute respiratory distress syndrome (ARDS) patients with irreversible lung damage, lung transplantation from a ventilator and/or extracorporeal membrane oxygenation support (ECMO) is feasible. Recently, selection criteria for lung transplant candidates with a COVID-19 associated ARDS have been published. Here, we report the efficacy of high dose corticosteroids as ultimate salvage therapy, despite Meduri scheme attempts, in a patient listed for transplantation. Case Report A 50-year-old female with a medical history of Multiple Sclerosis (relapsing-remitting type under treatment with anti-alpha4 -integrin therapy), was tested positive for COVID-19. She deteriorated and was admitted to the hospital. High flow oxygen and dexamethasone (six milligram daily), were started but unfortunately, she developed a severe ARDS with need for mechanical ventilation and ECMO support. Corticosteroids according to the Meduri scheme and ciprofloxacin were started. Weaning trials were initiated but failed and CT-thorax showed consolidation and presumed fibrosis. After 37 days on ECMO, she was evaluated and listed for bilateral lung transplantation. A corticosteroid pulse therapy of 1000 mg of methylprednisolone IV for three days during antibiotic coverage with piperacillin/tazobactam was started and within three days the clinical condition of the patient improved and she could be weaned from ECMO (51 days of ECMO) and delisted from the lung transplantation waiting list. Nowadays, patient does not require oxygen, is at home and revalidating. Summary Here, we report the efficacy of a regimen with high dose corticosteroids as ultimate salvage therapy, despite Meduri scheme attempts, in a patient listed for transplantation. Corticosteroids are beneficial for immunomodulation and may reduce hyperinflammation. Our trial with administration of high dose corticosteroids pulse therapy in COVID-19 ARDS patients refractory to corticosteroids according to “classical schemes” has been successful and is informative. Further studies, will hopefully further elucidate responders and non-responders to high dose corticosteroid pulse therapy and preferably answer the question if prophylactic use of antibiotics and antifungals (in view of possible complications such as pulmonary aspergillosis and mucormycosis) is prudent in this vulnerable group. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3591 | Broad Decline in Viral Infections During COVID-19 Lockdown: Association with Lung Function in Lung Transplant Recipients Purpose In April 2020 COVID-19 lockdown measures were instigated leading to a dramatic drop in non-COVID respiratory virus infections (RVI). This provided a unique situation to assess the impact of RVI on annual FEV1 decline, episodes of temporary drop in lung function suggestive of infection (TDLF) and CLAD in lung transplant recipients (LTR). Methods All lung function tests (LFT) of LTR transplanted between 2009-April 2020 were used from post-transplant baseline onward. LFT were censored after COVID-19 infection. Weekly RVI counts from the virology department defined RVI pressure over time. TDLF was defined as sudden, reversible FEV1 drop compared to previous 4 values (any TDLF ≥10% and ≥200ml, severe TDLF ≥20% and ≥500ml). Annual FEV1 decline was estimated using linear mixed effects models with separate estimates for 2009/20 and 2020/21. Effect modification by TDLF frequency of individual LTR (two subgroups, split at median) and RVI pressure was tested. Rates of CLAD and TDLF were analyzed over time. Results 479 LTR (12,775 LFT) were included. Annual FEV1 change in 2009/20 was -114ml [95%CI -133; -94], while in 2020/21 this was significantly less: 5ml [-38; 48] (p<0.001). RVI pressure significantly affected FEV1 level (an increase in weekly RVI-count of 10 leading to a 7ml [-10; -5] lower FEV1 (p<0.001). FEV1 decline in 2009/20 was faster in frequent TDLF LTR vs. infrequent (-150ml [-181; -120] vs. -90ml [-115; -65] p=0.003 Fig A). 2020/21 showed significant decreases in number of any TDLF (OR 0.53 [0.33; 0.85], p=0.008) and severe TDLF (OR 0.34 [0.16; 0.71] p=0.005) and numerically lower CLAD (OR 0.53 [0.27; 1.02] p=0.060). Effect modification by RVI pressure (Figures B-D) indicated an association between the events and RVI. Conclusion During the lockdown year 2020/21 the broad decline in RVI coincided with substantially less FEV1 decline, TDLFs and possibly CLAD. All these outcomes were moderated by RVI pressure suggesting an important role for RVI in lung function decline in LTR. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3592 | Increased Drug Intoxications Seen in Heart Transplant Donors During COVID-19 Pandemic Purpose The majority of heart transplant centers decline heart donors with known or suspected COVID-19. In addition to impacting donor utilization, we hypothesize that the COVID pandemic is associated with increased number of drug intoxication in heart donors. Methods The COVID pandemic was declared on March 11th, 2020. The Scientific Registry of Transplant Recipient was analyzed during two 15-month eras: era 1 was defined as January 1st2019 - March 30th, 2020 and era 2 was defined as March 31th, 2020 - June 30th 2021. Donor populations are described by era and UNOS region. T-test was used for trend analysis. Results Era 1 identified 7,649 donor hearts and era 2 identified 8,475 donor hearts. There was a significant increase of 577 (45.2%) heart donors with drug intoxication identified as the cause of death from era 1 to era 2 (p<0.0001, Figure 1). There was an increase in heart donors from drug intoxication cross all UNOS regions, but the greatest increase was seen in UNOS region 5 (120.3%) followed by region 7 (69.1%) and region 4 (61.4%) (Figure 2). Conclusion More donor hearts were recovered for transplantation during the COVID-19 pandemic, with a notable increase in those who died from drug intoxication. This finding may reflect a psychosocial effect of the pandemic on the general population that has impacted the field of heart transplantation. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3593 | Long COVID-19 in Heart Transplant Recipients Purpose The goal of this study was to assess the frequency and common symptoms of post-acute COVID-19 syndrome (Long COVID-19) in heart transplant recipients (HTR). Methods After obtaining IRB approval, we conducted telephone surveys of HTR (n=30) who had tested positive for SARS-CoV-2 to evaluate their experience with acute COVID-19 illness and assess symptoms of Long COVID-19. Symptoms at onset and also beyond 6, 12, and 24 weeks of the initial diagnosis were recorded. Additionally, medical charts were reviewed for detailed information regarding transplant history, immunosuppression, COVID-19 management and hospitalization, and COVID-19 vaccination status. Results As noted in Table 1, among the 30 participants, 10 (33%) had symptoms consistent with Long COVID-19. Those with Long COVID-19 were more symptomatic during acute illness, with 40% of patients reporting cough, fevers or chills, and headaches, compared with 15%, 25%, and 20% respectively in those without Long COVID-19. Emergency department visits at initial illness (80% vs. 20%) and admission to the intensive care unit were more frequent (60% vs. 5%) in the Long COVID-19. Symptoms of Long COVID-19 lasted for a median of 9 weeks with 30% reporting ongoing symptoms at week 24. The most common persistent symptoms were depression, confusion, and difficulty concentrating. Conclusion This study is an early investigation of a complex syndrome of Long COVID-19 in transplant patients. Long COVID-19 is not well described in the transplant setting. HTR at our center with Long COVID-19 were sicker at their initial COVID-19 diagnosis and had more emergency room visits, hospital admissions, and longer hospital stays than those without subsequent Long COVID-19. Although, recall bias could affect participants’ ability to remember details and symptoms, this would have impacted both groups similarly as the time since COVID-19 diagnosis to study enrollment was similar between the two groups. These are preliminary findings and the study is currently ongoing. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3594 | Analysis of Humoral and Cellular Immunity of Lung Transplant Recipients Following SARS-CoV-2 Infection and BNT162b2 mRNA Vaccination Purpose Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in lung transplant recipients (LTxR) under immunosuppression carries higher risk with 14-39% mortality. Immune responses of LTxR under immunosuppression following SARS-CoV-2 infection or vaccination remains unknown. Our goal is to determine the humoral and cellular immunity to SARS-CoV-2 in LTxR with infection and following vaccination. Methods We performed a single center analysis to determine immune responses of LTxR with infection and following BNT162b2 mRNA vaccination. The results were compared with controls (non-transplant individuals). ELISA was developed to determine the antibody (Ab) concentration (IgG) to SARS-CoV-2 spike (CSP) and nucleocapsid (CNP) antigens. PBMCs from LTxR were isolated by ficoll-hypaque centrifugation to determining the frequency of cells secreting IFNγ and TNFα to CSP and CNP by ELISpot. Results Concentration of Abs developed and T-cell frequencies secreting TNFα and IFNγ against CSP and CNP in LTxR and controls are given in Table 1. Infected LTxR and controls developed Abs to both CSP and CNP. In contrast, vaccinated LTxR induced 10 fold less Abs to CSP in comparison to control. Frequencies of cells secreting TNFα for both CSP and CNP were significantly reduced in LTxR with infection. However, vaccination of both LTxR and control induced similar levels of TNFα secreting cells upon stimulation with both CSP and CNP. It is of interest that frequency of IFNγ producing cells against both CSP and CNP were significantly higher in LTxR in comparison to control. Conclusion Infection with SARS-CoV-2 in LTxR and controls produced comparable levels of Abs both against CSP and CNP. However, vaccinated LTxR didn`t induce significant levels of Abs against CSP. Frequency of T-cells, secreting IFNγ were significantly increased by vaccination in LTxR and in controls suggesting that T cell responses against SARS-CoV-2 has been induced in LTxR by mRNA vaccine. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3595 | COVID-19 Vaccine Triggered Rejection in Lung Transplant Recipients: A Case Series Purpose Anti-severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) vaccination is recommended by AST, ISHLT, and CDC in all transplant recipients. Lung transplant recipients (LTR) are at a higher risk of developing severe symptoms due to higher immunosuppression (IS) and baseline compromised graft function. Limited antibody response to messenger RNA (mRNA) vaccines has been reported in LTR, with the majority mounting a response after the 2nd dose. In this series, 3 patients developed new and significant respiratory compromise after their 2nd vaccine dose consistent with antibody mediated rejection (AMR). To our knowledge, this is the first published case series of vaccine induced rejection in LTR. Methods Retrospective chart review of our cohort showed 46% fully vaccinated and an additional 2.5% partially vaccinated patients. Three fully vaccinated patients with approved mRNA vaccines (2 Moderna, 1 Pfizer-BioNTech) were identified after developing severe respiratory compromise post 2nd vaccine dose. Evaluation revealed AMR as the underlying etiology. Results All patients were female, ages 50-70 years old, between 6 months and 2 years post-transplant. No previous rejection episodes. All were on standard IS as per institution protocols. Two were hospitalized with hypoxic respiratory failure within 2 weeks of their 2nd vaccine dose. The 3rd was seen at clinic for milder similar symptoms, later progressing and requiring supplemental oxygen (O2) and hospitalization. Imaging showed new lung infiltrates, infectious work up was negative. Biopsies did not show any cellular rejection. All developed new DSAs and received treatment for AMR with plasmapheresis, IVIg, and Rituximab. Two recovered their lung function and are off supplemental O2, the 3rd did not and is re-listed for transplant. Conclusion While LTR have a diminished response to SARS-CoV-2 vaccines making them more vulnerable to the disease, their immune system's response may not always be clear. We report three cases of patients developing severe AMR from new DSAs that appear to be triggered by the COVID-19 vaccine. This vaccine responses should be collected in a database where each case can be investigated to help better understand the mechanism behind them and hopefully identifying LTR at risk. This can then be used to modify vaccination strategies and aid in preventing adverse outcomes in this vulnerable group of patients. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3596 | Lung Transplant for Patients with COVID-19 Bridged with VV ECMO: Initial Experience Purpose During the COVID-19 pandemic, veno-venous Extracorporeal Membrane Oxygenation (VV ECMO) has been used extensively for respiratory failure refractory to conventional mechanical ventilation (MV) and rescue maneuvers. However, the worldwide experience with COVID-19 patients undergoing lung transplant (LTx) with pre-LTx VV ECMO support is limited. Therefore, we sought to report our institution's early experience with COVID-19 patients who underwent LTx after VV ECMO. Methods We retrospectively identified 5 COVID-19 patients who underwent LTx after VV ECMO support. Patients were required to have a negative nasopharyngeal swab and a negative bronchoalveolar lavage for COVID-19 prior to LTx listing. We analyzed preoperative and operative characteristics, details of VV ECMO support and early post-transplant outcomes. Results The mean age of our cohort was 50 years (range 39-57 years) and all patients were male. Mean recipient BMI was 30 (range 22-37). Mean duration of VV ECMO pre-Ltx was 60 days (range 44-72 days). At the time of the LTx operation, 60% (3/5) of patients were on VV ECMO, 20% (1/5) were on mechanical ventilation (MV), and 20% (1/5) were on supplemental oxygen only. Preoperatively, 80% (4/5) had acute kidney injury and 20% (2/5) were on dialysis. LTx was performed via clamshell approach with intraoperative venoaterial ECMO support in all cases. For 60% (3/5) patients, VV ECMO support was continued after LTx and discontinued on postoperative days 0, 1 and 6, respectively. All-cause mortality was 40% (2/5), related to sepsis and multi-organ failure, and both deaths occurred an average of 115 days post-LTx. Mean length of stay for surviving patients was 59 days (range 22-117). In the first 3 months postop-LTx, grade A2 acute cellular rejection was noted in 2 patients, A1 in 2 patients, and antibody-mediated rejection in 1 patient. Conclusion Our early experience with LTx for COVID-19 patients supported with VV ECMO support is notable for 1) prolonged VV-ECMO duration and significant morbidity pre-LTx, and 2) early mortalities related to sepsis and multiple organ failure. These data highlight a uniquely complex patient population that carries high risk of multi-organ failure and other comorbidities dictating careful selection for transplant. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3597 | Transplant Recipient Characteristics in COVID vs Non COVID Cause of Death Purpose The purpose of this study is to compare patient characteristics of those who died from Covid-19 compared to death from all other causes. Methods The UNOS registry was queried to compare transplant recipients who died of Covid (n=300) vs non-Covid causes (n=5,644) from 2018 to 2021. Patient characteristics including age, sex, ethnicity, smoking, medical comorbidities, and time of transplant hemodynamics were evaluated. Baseline characteristics were compared using the Mann Whitney U test and Chi square test as appropriate. Survival was compared using Kaplan-Meier survival analysis. Results The population who died from Covid was significantly older (56.6y vs 49.8y, p <0.001), had a higher percentage of males (79.3% vs 74.3%, p=0.049), had a higher incidence of diabetes (39.1% vs 27.8%, p<0.001), increased incidence of smoking (53.7% vs 42% p<0.001), and had a higher cardiac output (4.7L/min vs 4.5L/min, p=0.032). Causians had significantly lower incidence of death from Covid (62.7% vs 67.2%, p=0.031). Donor age, waiting times, baseline renal function, ischemic times, and cardiopulmonary support time did not differ significantly between the two populations. Conclusion Widely studied risk factors for Covid pneumonia mortality such as age, male sex, diabetes, and smoking were consistent in the post heart transplant population. Communities of color were disproportionately affected by Covid. Furthermore, Covid deaths were not associated with inferior cardiac characteristics at time of transplant. More investigation is warranted to investigate the effect of more widely available immunologic and pharmacological therapies on high-risk subpopulations following heart transplant. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3598 | Ambulation in Veno-Arterial-Venous (VAV) Cannulation for ECMO Support in COVID-19 Related ARDS with Right Ventricular Failure Purpose Physical functioning in patients undergoing extracorporeal membrane oxygenation (ECMO) related to strict bedrest requirements is debilitating. Physical therapy (PT) in these patients can be beneficial. However, the data in COVID-19 associated with acute respiratory distress syndrome (ARDS) is not well characterized. We present our experience with ambulation in patients receiving veno-arterial-venous (VAV) ECMO support. Methods Clinical charts of COVID-19 associated ARDS patients with VAV-ECMO support who received PT sessions between January 2021 and October 2021 were retrospectively reviewed and analyzed. Mobility functions were assessed. Episodes of oxygen saturation and hypotension were noted as primary outcomes. Results Eight patients were placed on VAV-ECMO for decompensated heart failure with right axillary artery cannulation via vascular graft and right internal jugular vein double lumen (Avalon) cannula. Mean age was 46.9 ± 10.3 years, and BMI was 30.6 ± 4.4 kg/m2 with five males. Mean duration of ECMO support was 53.6 ± 13.4 days. Average PT sessions per patient were 22.8 ± 12.2, with average days to PT initiation from ECMO insertion being 19.0 ± 8.1 days. The total average time per daily PT session was 27.2 ± 9.3 minutes. The ability to perform mobility functions with minimal, moderate, total, stand-by, contact-guard assistance for all patients is listed in the table. During PT sessions, a total of 14 episodes of oxygen desaturation and six episodes of hypotension in four patients were noted. There were no events of any cannula displacement. Of all, three are still in the hospital supported by ECMO, three transferred to the lung transplant center, one died in hospital, and one discharged home. Conclusion VAV ECMO support via right axillary and RIJ dual lumen cannulation provides a safe strategy for prolonging support and effective rehabilitation in severe COVID-19 related ARDS patients complicated with RV failure. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3599 | Successful Treatment of Fulminant Myocarditis with Intracardiac Thrombus in COVID-19 Introduction The treatment of pediatric patients with COVID-19 associated myocardial injury and prothrombotic coagulation derangements remains to be established. We cared for an adolescent with COVID-19 and fulminant myocarditis who required veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Her course was complicated by a large intracardiac thrombus, which was successfully treated with systemic tissue plasminogen activator (tPA). Case Report A 17 year old unvaccinated female presented with fever and chest pain 7 days after testing positive for COVID-19. She had a peak troponin of 21.48 ng/ml, elevated brain natriuretic peptide (629 pg/ml), and severely diminished left ventricular systolic function. She progressed to cardiogenic shock and was cannulated to VA-ECMO via the neck. On ECMO day 2 while therapeutic on unfractionated heparin (UFH), a large thrombus was noted in the left ventricular apex, extending toward the aortic valve (Figure 1). Prior to this, she had no evidence of a deep vein thrombosis. Given the concern for an impending stroke upon restoration of ventricular function, a continuous systemic high-dose tPA infusion (0.1mg/kg/hr) was initiated, while she was continued on UFH. A twenty-fold increase in D-dimer levels and serial echocardiograms indicated a thrombolytic effect. After 22 hours of thrombolysis, the patient developed bleeding complications and tPA was discontinued. By ECMO day 4, the thrombus completely resolved. Once her bleeding was controlled, she was transitioned to bivalirudin. Cardiac function recovered by day 11 allowing for separation from ECMO. 25 days later, she was discharged without any neurologic deficits. Summary The coagulopathic derangements associated with COVID -19 pose significant challenges to the management of fulminant myocarditis. There are no guidelines regarding management of an intracardiac thrombus on ECMO. However, with careful monitoring, systemic tPA can be used to provide life-saving therapies with excellent neurological outcomes. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3600 | Outcomes of COVID-19 in an Advanced Heart Failure Practice: A Single Center Study Purpose Patients with heart failure (HF) carry an increased risk of mortality and morbidity with COVID-19. The objective of this study is to compare the outcomes of HF (stage C or D), Left Ventricular Assist Device (LVAD) or Heart Transplant (HTx) patients who were diagnosed with COVID-19. Methods Out of 2635 patients followed in our program (HF=2234, LVAD=167, HTx=234), 96 patients diagnosed with COVID-19 infection between March 2020 to January 2021 were included in this study. Hospital length of stay (LOS), requirement for mechanical ventilation, and mortality rate were compared. Kaplan-Meier analysis was used to compare survival. Results The distribution of COVID among the 96 patients was: HTx = 15.8%, LVAD = 9.6% and HF = 1.9%. Table 1 outlines the clinical characteristics and outcomes of the 3 cohorts. A total of 49 patients were hospitalized: 18 (41.9%) HF, 8 (50%) LVAD, and 23 (62.2%) HTx. Of the hospitalized patients, 5 (27.8%) required ICU care in the HF, 2 (25%) LVAD, and 6 (26.1%) HTx groups. The median ICU LOS was significantly higher in HTx (24 days, p=0.04) when compared to HF (10 days) group. HTx patients had the highest 180-day mortality, followed by LVAD, and then HF patients (18.9%, 12.5% and 11.6%, respectively). All deaths occurred within 50 days from diagnosis. Among LVAD patients, COPD was the highest predictor of mortality (69% prevalence). Conclusion This report is among the first to describe the impact of COVID-19 on a comprehensive advanced heart failure (HF) practice. Our data highlights the risks of morbidity and mortality faced by HF and immunocompromised patients with COVID-19 infection. A mortality rate of 19% with HTx patients acquiring COVID is ominous (even if better than reported rates of 25%). Likewise, though not as high, mortality rates for COVID infected advanced HF and LVAD patients of 12% each represent substantial risk. Protecting these patients with all possible preventative and therapeutic options is an essential imperative. | J Heart Lung Transplant | 2022 | CORD-19 |
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