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Family Medicine - Adult Infectious Diseases

Clinical presentation of COVID-19 cases due to Delta and Omicron variant (April 2022)


Symptoms of upper respiratory tract infection (URI) are the most common manifestations of nonsevere COVID-19, although the relative frequency of each symptom may vary by viral variant. In an observational study evaluating the reported clinical symptoms of over 63,000 confirmed COVID-19 cases between two time periods (during Delta variant predominance and Omicron variant predominance), nasal congestion, headache, sneezing, and sore throat were the most common presenting symptoms.5 Sore throat was more common and alteration or loss of smell was less common during the time period of Omicron predominance. As new variants emerge, the predominant URI symptoms of COVID-19 may continue to change.


Cardiovascular Medicine - Coronary Heart Disease, Acute

Troponin I after cardiac surgery and 30-day mortality (March 2022)


Patients with elevated troponin levels after coronary artery bypass grafting (CABG) have a worse prognosis than those with lower levels; however, the threshold of elevated troponin that identifies patients with periprocedural myocardial infarction or at risk for early postoperative mortality has been uncertain. In a study of nearly 14,000 cardiac surgery patients that examined the association between postoperative day 1 troponin I levels and 30-day mortality, the threshold troponin associated with a higher mortality risk was 5670 ng/L (or 218 times the upper reference limit) among patients undergoing CABG and 12,981 ng/L (499 times the upper reference limit) among those undergoing other cardiac surgeries.6 These troponin I levels that predict 30-day mortality are markedly higher than those demonstrated in prior studies, which may in part reflect differences in the troponin assays used in these studies.


Family Medicine - Immunizations

Second COVID-19 vaccine booster dose for selected individuals (April 2022)


In the United States, the FDA authorized a second booster dose of an mRNA COVID-19 vaccine for individuals who are >50 years old or are >= 12 years old and have certain immunocompromising conditions. The CDC also indicates that a second booster dose with an mRNA vaccine is an option for any individual who received Ad26.COV2.S (Janssen/Johnson & Johnson) for both the primary and booster doses.1,2 Vaccine effectiveness following a primary series and single booster dose appears to wane, and observational studies suggest that a second booster dose is associated with increased protection against severe COVID-19 and death.3,4 However, the absolute benefit may be very small and the duration of effect is uncertain. Among those eligible for a second booster dose, we individualize the decision based on patient preference, risk for severe disease, and risk of exposure; those at the highest risk are most likely to benefit.


1. Coronavirus (COVID-19) Update: FDA Authorizes Second Booster Dose of Two COVID-19 Vaccines for Older and Immunocompromised Individuals. (Accessed on March 30, 2022). [Context Link]


2. Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States. (Accessed on February 24, 2022). [Context Link]


3. Bar-On YM, Goldberg Y, Mandel M, et al Protection by a Fourth Dose of BNT162b2 against Omicron in Israel. N Engl J Med 2022. [Context Link]


4. Arbel R, Sergienko R, Friger M, et al Second Booster Vaccine and Covid-19 Mortality in Adults 60 to 100 Years Old. UNPUBLISHED. (Accessed on April 01, 2022). [Context Link]


5. Menni C, Valdes AM, Polidori L, et al Symptom prevalence, duration, and risk of hospital admission in individuals infected with SARS-CoV-2 during periods of omicron and delta variant dominance: a prospective observational study from the ZOE COVID Study. Lancet 2022. [Context Link]


6. Devereaux PJ, Lamy A, Chan MTV, et al High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality. N Engl J Med 2022; 386:827. [Context Link]


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