ABSTRACT
Background/Purpose The COVID-19 pandemic has impacted adolescents across multiple areas of health. While many factors influence outcomes following anterior cruciate ligament reconstruction (ACLR), the impact of the COVID-19 pandemic on early patient outcomes after ACLR is currently unknown in an adolescent population. The purpose of this study was to determine if short-term clinical outcomes were different in adolescents after ACLR for those who underwent surgery pre-COVID versus during the COVID-19 pandemic timeframe. Design Retrospective cohort Methods A retrospective review of records occurred for patients who underwent ACLR with a quadriceps tendon autograft. Two separate review timeframes were defined according to date of surgery (control: September 2017 - October 2019;COVID: March 2020 - May 2021). Patients were classified into pre-COVID (control) and COVID groups by surgical date and were then age- and sex-matched. Three-month postoperative outcomes were included for analysis, including normalized isometric quadriceps and hamstring peak torque, Anterior Cruciate Ligament - Return to Sport after Injury (ACL-RSI), and the Pedi International Knee Documentation Committee Form (Pedi-IKDC) scores. Results Sixty patients met the inclusion criteria (34 females, 56.7%). Follow-up testing occurred at 3.2 months (98.13 +/- 14.91 days) postoperative. A significant difference was found between groups for normalized quadriceps peak torque on the uninvolved limb, with the control group (2.03 +/- 0.47 Nm/kg) demonstrating decreased peak torque compared to the COVID group (2.49 +/- 0.61 Nm/kg) (p =0.002, effect size (d) = 0.84). For the involved limb, no difference in normalized quadriceps peak torque was observed between the control group (1.25 +/- 0.33 Nm/kg) and those who underwent surgery during the COVID-19 pandemic (1.49 +/- 0.70 Nm/kg) (p = 0.09). No differences were identified between groups for any of the other strength outcomes (p = 0.31 - 0.87). Similarly, no differences in patient reported outcomes were found for Pedi-IKDC or ACL-RSI between groups (p = 0.12 - 0.43). Conclusion At roughly three months after ACLR, normalized quadriceps peak torque on the uninvolved limb was reduced by 18.5% for adolescents who underwent surgery pre-COVID versus during the COVID-19 pandemic timeframe. No group differences were observed for other isometric strength outcomes, Pedi-IKDC, or ACL-RSI scores.
ABSTRACT
Background: Patients with inflammatory bowel disease (IBD) may be at risk for development of COVID-19 infection due to innate immune dysfunction and/or immunosuppressive medication use. We sought to 1) evaluate the incidence of COVID-19 infection in a large, U.S. cohort of patients with IBD and 2) evaluate associations between demographic, clinical, and treatment-related factors and the development of COVID-19 infection. Methods: Participants in 3 adult IBD studies sponsored by the Crohn's & Colitis Foundation, IBD Partners, IBD QORUS (Improving the Quality of Care for Adults with Inflammatory Bowel Disease), and SPARC IBD (Study of a Prospective Adult Research Cohort with IBD), were invited to participate in a prospective, direct-to-patient cohort study about COVID-19 from April 23, 2020 until August 30, 2021. Each cohort received online surveys with questions on comorbidities, medication utilization and development of laboratory confirmed COVID-19 at times 0, 2, 4, 6, 8 weeks and then every 6 months. We calculated the incidence rate of COVID-19 and performed bivariate and multivariate analyses to describe associations between age, immunosuppression use, obesity, and race on the development of COVID-19. Results: A total of 3953 patients with IBD were followed for a mean duration of 212 days (SD 157). Demographic, clinical and treatment factors are shown in Table 1. A total of 103 individuals developed COVID-19 during follow up (2.6%, rate of 45 per 1,000 person-years). Severity of infection was generally mild. Clinical characteristics were similar among those who developed COVID-19 as compared to not. African American race was associated with incident COVID-19 infection (OR 3.37, 95% CI 1.18-9.59). Immunosuppression use was not associated with development of COVID-19 (OR 1.19, 95% CI 0.72- 1.75), nor was age (OR 1.00, 95% CI 0.99-1.02), nor obesity (OR 1.01, 95% CI 0.61-1.66). Conclusion: The overall incidence of COVID-19 infection among this large U.S. cohort of IBD patients was relatively low. Immunosuppression use did not increase the risk of development of COVID-19. Therapeutic management of IBD should not be altered to prevent a risk of developing COVID-19.
ABSTRACT
Background. There is a significant and unmet need for pre-clinical models to predict responsiveness of immunotherapies to both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and respiratory syncytial virus (RSV) infection. Airway organoid models have been recently developed to study respiratory viruses;however, the current methods rely on invasive or biopsy derived samples to generate lung or airway organoids. Objective. To establish human nose organoids (HNOs) as a model to study SARS-CoV-2 and RSV pathogenesis and test therapeutics. Methods. We developed a non-invasive method to establish HNOs using stem cells isolated from nasal-wash and mid-turbinate samples. We made air liquid interface (ALI) cultures from undifferentiated 3-dimensional HNOs and differentiated for 21 days to form differentiated nasal epithelium. We inoculated the apical epithelium and assessed SARS-CoV-2 and RSV infection on the apical compartment using real time-polymerase chain reaction, plaque assays and immunofluorescence techniques. We then evaluated the feasibility of HNO-ALI model system to test the efficacy of serum antibodies to prevent SARS-CoV-2 infection and palivizumab monoclonal antibodies to prevent infection using palivizumab sensitive and resistant RSV strains. We introduced the antibodies in the basolateral compartment and monitored its neutralizing capacity on the apical side mimicking the neutralizing effects of antibodies in circulation. Results. Our HNO-ALI cultures consist of well-differentiated, pseudostratified, ciliated, and mucosal respiratory epithelial cells and are susceptible to SARS-CoV-2, RSV A and B infection. SARS-CoV-2 and RSV replicates in the apical ciliated cells of the HNO-ALI cultures, peaks at 4 days, and plateaus at 8 days post infection. Infected HNO-ALI recapitulates aspects of SARS-CoV-2 and RSV disease, including viral shedding, asynchronous cilia beating/ciliary damage, and mucus hyper-secretion. Our model effectively showed protection to infection in a concentration dependent manner of the antibodies used. Conclusion. We established a non-invasive method to generate HNO-ALI epithelial model as an authentic and an alternative model to 1-D cell culture systems. Our ex-vivo HNO-ALI infection model provides a novel approach for testing therapeutic interventions.