Gastrointestinal Manifestations and Their Association with Neurologic and Sleep Problems in Long COVID-19 Minority Patients: A Prospective Follow-Up Study.

BACKGROUND: Long-COVID is a condition post SARS-CoV-2 infection with persistent or recurring symptoms affecting multiple organs, and may involve viral persistence, changes to the microbiome, coagulopathies, and alterations to neuro-immune interactions. These factors can disrupt the Gut-Brain Axis, which is a complex system involving bidirectional communication between the central nervous system and the gastrointestinal (GI) system. As a result of these disruptions, individuals with long-COVID may develop post-infectious functional GI disorders, which can cause a range of symptoms affecting the digestive system. AIM: To understand frequency of GI manifestations of Long-COVID and to determine association with sleep or neurological symptoms in a predominantly minority population. METHODS: We included patients with positive SARS-CoV-2 PCR (n = 747) who were hospitalized from Feb. 2020 to May 2021 at Howard University Hospital and followed between 6 and 12 months from discharge. GI, sleep, and neurological symptoms (via the Montreal Cognitive Assessment (MoCA) scoring system) were assessed using a standardized questionnaire. Linear regression analysis, χ2 and Fisher's exact test were utilized to determine the statistical significance of correlations of GI/Neuro/COVID. RESULTS: The mean age of patients was 58, with 51.6% females and a predominant African American ethnicity (73.6%, n = 550). A total of 108 patients died during their initial hospital stay, with the remaining 639 patients followed-up. Three hundred fifty (350) patients responded to the questionnaire (57 patients died during the follow-up period). Overall, 39 (13.3%) patients reported GI-related symptoms, out of which 19 (6.4%) had persistent symptoms and 20 (6.8%) developed new onset GI symptoms. Nausea and vomiting were the most common 24/39 (61.5%), followed by abdominal pain 7/39 (18%), diarrhea 5/39 (12.8%), and others 3/39 (7.6%). Patients who presented with vomiting during acute SARS-CoV-2 infection were more likely to have Long-COVID GI manifestations (P = 0.023). Use of ACE inhibitors, abnormal lymphocyte count and elevated ferritin are other variables that showed significant associations with Long-COVID GI manifestations (P = 0.03, 0.006 and 0.03, respectively). During follow-up, a total of 28 (9.5%) patients reported difficulty with sleep and 79 (27%) patients had abnormal MoCA assessment. With further analysis, there was a trend between presentation of GI symptoms on admission with abnormal MoCA assessment, and an association between abnormal LFTs and history of liver disease during hospitalization with subsequent sleep problems. Baseline characteristics, clinical comorbidities, other laboratory values, hospital length of stay, mechanical ventilation, medications during hospitalization, re-admission and Flu or COVID-19 vaccination have not shown any association with Long-COVID GI symptoms in our cohort. CONCLUSION: Dyspeptic symptoms were common GI manifestations in the acute and post COVID periods. GI symptoms, abnormal LFTs and a history of liver disease during the acute infectious phase associates with abnormal MoCA and sleep problems during follow-up. Further large population studies are needed to determine if COVID-19 leads to a GI symptoms-associated Long-COVID phenotypes and other symptoms through the Gut-Brain-Axis.

The SLC36 transporter Pathetic is required for extreme dendrite growth in Drosophila sensory neurons.

Dendrites exhibit enormous diversity in form and can differ in size by several orders of magnitude even in a single animal. However, whether neurons with large dendrite arbors have specialized mechanisms to support their growth demands is unknown. To address this question, we conducted a genetic screen for mutations that differentially affected growth in neurons with different-sized dendrite arbors. From this screen, we identified a mutant that selectively affects dendrite growth in neurons with large dendrite arbors without affecting dendrite growth in neurons with small dendrite arbors or the animal overall. This mutant disrupts a putative amino acid transporter, Pathetic (Path), that localizes to the cell surface and endolysosomal compartments in neurons. Although Path is broadly expressed in neurons and nonneuronal cells, mutation of path impinges on nutrient responses and protein homeostasis specifically in neurons with large dendrite arbors but not in other cells. Altogether, our results demonstrate that specialized molecular mechanisms exist to support growth demands in neurons with large dendrite arbors and define Path as a founding member of this growth program.

Predictors of mortality in hospitalized African American COVID-19 patients with cancer.

Background: Coronavirus disease 2019 (COVID-19) manifest differently depending on patients' background and pre-existing conditions. It remains unclear how African Americans with cancer have been affected in comparison to those without. In this study, we aim to identify demographic, clinical, and laboratory markers associated with mortality in COVID-19 patients with cancer. Methods: We reviewed all COVID-19 hospitalized patients' records from Dec. 2019 to Oct. 2021 at Howard University Hospital. Patients having a history of, or active, cancer were reviewed. Clinical, treatment, lab test values, and pathological data were extracted. Univariable and multivariable analyses were conducted on the entire cohort as well as on cases and controls separately, using SPSS software. Results: Out of 512 COVID-19 infected patients, 49 had cancer, either active or history of cancer (cases) and 463 COVID-19 were cancer-free (controls), allowing for comparison. African American race was predominant in both cases and controls, 83.7% and 66.7% respectively. Cancer patients were older than non-cancer patients (mean age: 70.6 vs. 56.3 years) and had an increased length of hospital stay (mean 13.9 vs. 9.4 days). Mortality is significantly higher among cancer patients (n=10, 20.4%, P=0.03) compared to non-cancer COVID-19 patients (n=41, 8.9%). Among cancer patients, breast cancer was more prevalent in females and prostate cancer in males (54% and 52%, respectively). A comparison of patients with active vs. previous cancer showed no significant difference in the clinical outcome, death vs. discharge (P=0.34). A higher reduction in albumin level in cancer cases, from the time of admission to day 5, was significantly associated with death during the hospital stay compared to those discharged (n=24, 49.0%, P<0.001). In controls, lymphopenia (n=436, 94.2%, P=0.05), aspartate aminotransferase (AST) (n=59, 12.7%, P=0.008) and albumin (n=40, 8.6%, P=0.02) have shown an association with increased mortality. Conclusions: Albumin level has an inverse relationship with clinical outcomes among all COVID-19 infected cancer patients. Reduction in albumin level during the hospital stay, particularly in COVID-19 cancer patients should be considered as a predictor of mortality. Further research with a large cohort size is needed to verify and identify other predictors of outcomes in COVID-19 patients with cancer.

Split vs. Single Bolus CT Urography: Comparison of Scan Time, Image Quality and Radiation Dose.

The purpose of this study was to compare the scan time, image quality and radiation dose of CT urograms (CTU) using a split vs. single bolus contrast media injection technique. A total of 241 consecutive CTUs performed between August 2019-February 2020 were retrospectively reviewed. There were three study groups: Group 1, <50 years old, 50/80 cc split-bolus administered at 0 and 700 s post initiation of injection, with combined nephrographic and excretory phases; group 2, ≥50 years old, same split-bolus protocol; and group 3, ≥50 years old, 130 cc single bolus injection, with nephrographic and excretory phases acquired at 100 s and 460 s post injection initiation. The recorded data elements were scan time, number of excretory phases, imaging quality based on opacification of the urinary collecting system (<50%, 50-75%, 75-100%), and dose-length product (DLP). Associations between group and categorical variables were assessed (Chi-square); mean scan time and DLP were compared (one-way ANOVA). Following analysis, proportionally fewer CTUs required a repeat excretory phase in group 3 (32/112, 28.6%) than in groups 1 (25/48, 52.1%) and 2 (37/80, 46.3%) (p = 0.006). Mean scan time was significantly lower in group 3 (678 s) than in groups 1 (1046 s) and 2 (978 s) (p < 0.0001). There was no association between groups and image quality (p = 0.13). DLP was higher in group 3 (1422 ± 837 mGy·cm) than in groups 1 (1041 ± 531 mGy·cm) and 2 (1137 ± 646 mGy·cm) (p = 0.003). In conclusion, single bolus CTU resulted in significantly fewer repeat phases and faster scan time at the expense of a slightly higher radiation dose.

Learner drivers (and their parent-supervisors) benefit from an online hazard perception course incorporating evidence-based training strategies and extensive crash footage.

We previously found that a six-session online hazard perception training course, which incorporates evidence-based learning strategies and footage of over a hundred real crashes, improved hazard perception skill and reduced risk-taking intentions in novice drivers who had passed their on-road driving test within the previous three years. However, one issue with targeting crash-prevention training at individuals who are already driving unsupervised is that drivers are at their highest crash risk immediately after they pass their on-road driving test. That is, the training may arrive too late to protect drivers while they are at their most vulnerable. It is also possible that it may prove difficult to persuade drivers to complete an unsupervised training course if they are already licensed to drive independently. Given that learner drivers cannot drive unsupervised, and that they are typically supervised by a parent, one potential strategy is to target the training at learners and to ask their parents to provide one-on-one mentoring throughout the course. We therefore recruited learner driver/parent-supervisor dyads to participate in a randomized control study, with the objective of examining the effects of the hazard perception training course on aspects of driving behaviour associated with crash risk (as measured using validated computer-based tests). Outcome measures included two hazard perception skill assessments (a response time hazard perception test and a verbal response hazard prediction test), and three tests assessing aspects of risk-taking propensity in driving (speed choice, following distance, and gap acceptance). Learners who completed the course (N = 26) significantly improved their scores on both hazard perception skill measures, and also chose safer following distances, compared with a waitlist control group (N = 23). However, the training did not significantly reduce learners' speed choice or gap acceptance propensity. The hazard perception skill of parent-supervisors, who observed the course but did not complete it, also improved on both hazard perception measures, relative to controls. Additionally, both learners and their parent-supervisors reported a range of positive effects on the learners' real-world driving performance. These results suggest that this type of hazard perception training could be beneficial if deployed during the learner phase of driver licensing.

Environmental perceptions related to physical activity in high- and low-risk counties.

To identify whether perceptions about the physical activity environment were related to the prevalence of sedentary lifestyle, residents from high-risk (n = 153) or low-risk (n = 100) counties were interviewed. County risk status was determined by the prevalence of cardiovascular mortality, overweight, and sedentary lifestyle. Key public officials in the same counties were also interviewed. Residents in the low-risk county were more likely to report having sidewalks in their community and that these sidewalks were safe and well lit than residents living in the high-risk counties. Low-risk county residents also reported more indoor recreation facilities being available than the residents in the high-risk counties. Residents supported allocating tax dollars toward improving sidewalks, lighting, and so on. Thus a more conducive environment for physical activity was found in the low-risk county. Improving physical environments and individual perceptions could help increase physical activity behavior.