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Article ; Online: "Role of Cardiac Inflammation in the Pathology of COVID-19; relationship to the current definition of myocarditis".

Fox, Sharon E / Heide, R S Vander

Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology

2022 Volume 59, Page(s) 107429

MeSH term(s)	Arrhythmias, Cardiac ; COVID-19 ; Humans ; Inflammation/pathology ; Myocarditis/pathology ; Myocardium/pathology ; SARS-CoV-2
Language	English
Publishing date	2022-05-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	1134600-0
ISSN	1879-1336 ; 1054-8807
ISSN (online)	1879-1336
ISSN	1054-8807
DOI	10.1016/j.carpath.2022.107429
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Article ; Online: Acute neutrophilic vasculitis (leukocytoclasia) in 36 COVID-19 autopsy brains.

Rhodes, Roy H / Love, Gordon L / Da Silva Lameira, Fernanda / Sadough Shahmirzadi, Maryam / Fox, Sharon E / Vander Heide, Richard S

Diagnostic pathology

2024 Volume 19, Issue 1, Page(s) 33

Abstract: Background: Hypercytokinemia, the renin-angiotensin system, hypoxia, immune dysregulation, and vasculopathy with evidence of immune-related damage are implicated in brain morbidity in COVID-19 along with a wide variety of genomic and environmental ... ...

Abstract	Background: Hypercytokinemia, the renin-angiotensin system, hypoxia, immune dysregulation, and vasculopathy with evidence of immune-related damage are implicated in brain morbidity in COVID-19 along with a wide variety of genomic and environmental influences. There is relatively little evidence of direct SARS-CoV-2 brain infection in COVID-19 patients. Methods: Brain histopathology of 36 consecutive autopsies of patients who were RT-PCR positive for SARS-CoV-2 was studied along with findings from contemporary and pre-pandemic historical control groups. Immunostaining for serum and blood cell proteins and for complement components was employed. Microcirculatory wall complement deposition in the COVID-19 cohort was compared to historical control cases. Comparisons also included other relevant clinicopathological and microcirculatory findings in the COVID-19 cohort and control groups. Results: The COVID-19 cohort and both the contemporary and historical control groups had the same rate of hypertension, diabetes mellitus, and obesity. The COVID-19 cohort had varying amounts of acute neutrophilic vasculitis with leukocytoclasia in the microcirculation of the brain in all cases. Prominent vascular neutrophilic transmural migration was found in several cases and 25 cases had acute perivasculitis. Paravascular microhemorrhages and petechial hemorrhages (small brain parenchymal hemorrhages) had a slight tendency to be more numerous in cohort cases that displayed less acute neutrophilic vasculitis. Tissue burden of acute neutrophilic vasculitis with leukocytoclasia was the same in control cases as a group, while it was significantly higher in COVID-19 cases. Both the tissue burden of acute neutrophilic vasculitis and the activation of complement components, including membrane attack complex, were significantly higher in microcirculatory channels in COVID-19 cohort brains than in historical controls. Conclusions: Acute neutrophilic vasculitis with leukocytoclasia, acute perivasculitis, and associated paravascular blood extravasation into brain parenchyma constitute the first phase of an immune-related, acute small-vessel inflammatory condition often termed type 3 hypersensitivity vasculitis or leukocytoclastic vasculitis. There is a higher tissue burden of acute neutrophilic vasculitis and an increased level of activated complement components in microcirculatory walls in COVID-19 cases than in pre-pandemic control cases. These findings are consistent with a more extensive small-vessel immune-related vasculitis in COVID-19 cases than in control cases. The pathway(s) and mechanism for these findings are speculative.
MeSH term(s)	Humans ; Vasculitis, Leukocytoclastic, Cutaneous/metabolism ; Vasculitis, Leukocytoclastic, Cutaneous/pathology ; COVID-19 ; Microcirculation ; SARS-CoV-2 ; Vasculitis/pathology ; Brain/metabolism ; Brain/pathology ; Autopsy ; Hemorrhage
Language	English
Publishing date	2024-02-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2210518-9
ISSN	1746-1596 ; 1746-1596
ISSN (online)	1746-1596
ISSN	1746-1596
DOI	10.1186/s13000-024-01445-w
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Article ; Online: COVID-19: The Heart of the Matter-Pathological Changes and a Proposed Mechanism.

Fox, Sharon E / Heide, Richard S Vander

Journal of cardiovascular pharmacology and therapeutics

2021 Volume 26, Issue 3, Page(s) 217–224

Abstract: The SARS-CoV-2 virus has resulted in over 88 million cases worldwide of COVID-19 as of January 2021. The heart is one of the most commonly affected organs in COVID-19, but the nature and extent of the cardiac pathology has remained controversial. It has ... ...

Abstract	The SARS-CoV-2 virus has resulted in over 88 million cases worldwide of COVID-19 as of January 2021. The heart is one of the most commonly affected organs in COVID-19, but the nature and extent of the cardiac pathology has remained controversial. It has been shown that patients infected with SARS-CoV-2 can sustain type 1 myocardial infarction in the absence of significant atherosclerotic coronary artery disease. However, many patients present with small elevations of troponin enzymes of unclear etiology which correlate with overall COVID-19 disease outcome. Early autopsy reports indicated variable levels of typical lymphocytic myocarditis, while radiology reports have indicated that myocarditis can be a persistent problem after recovery from acute illness, raising concern about participation in college athletics. In this communication, we review the literature to date regarding the gross and microscopic findings of COVID-19 cardiac involvement, present the findings from over 40 cases from our academic medical center, and propose mechanisms by which patients develop small elevations in troponin. .
MeSH term(s)	Angiotensin-Converting Enzyme 2/metabolism ; COVID-19/pathology ; Comorbidity ; Diagnostic Imaging ; Heart/physiopathology ; Humans ; Inflammation Mediators/metabolism ; Myocardial Infarction/pathology ; Myocarditis/pathology ; SARS-CoV-2 ; Troponin/biosynthesis
Chemical Substances	Inflammation Mediators ; Troponin ; Angiotensin-Converting Enzyme 2 (EC 3.4.17.23)
Language	English
Publishing date	2021-03-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1329372-2
ISSN	1940-4034 ; 1074-2484
ISSN (online)	1940-4034
ISSN	1074-2484
DOI	10.1177/1074248421995356
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Article ; Online: COVID-19 myocarditis: quantitative analysis of the inflammatory infiltrate and a proposed mechanism.

Fox, Sharon E / Falgout, Lacey / Vander Heide, Richard S

Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology

2021 Volume 54, Page(s) 107361

Abstract: COVID-19 has a significant effect upon the cardiovascular system. While a number of different cardiovascular histopathologies have been described at post-mortem examination, the incidence of typical viral myocarditis in COVID-19 positive patients appears ...

Abstract	COVID-19 has a significant effect upon the cardiovascular system. While a number of different cardiovascular histopathologies have been described at post-mortem examination, the incidence of typical viral myocarditis in COVID-19 positive patients appears very low [1-3]. In this study, we further characterize and quantify the inflammatory cell infiltrate in a COVID-19 study cohort and compare the findings to both an age and disease matched control cohort and a cohort of patients diagnosed with typical inflammatory myocarditis. All study and control cohorts had 1 or more of the comorbidities most commonly associated with severe disease (hypertension, type II diabetes, obesity, or known cardiovascular disease). The results demonstrate a skewed distribution of the number of CD68+ cells in COVID-19 hearts, with upper quantiles showing a significant increase as compared to both matched control hearts, and those with myocarditis. In contrast, hearts from typical inflammatory myocarditis contained increased numbers of CD4+, and CD8+ cells compared to both COVID-19 and control cohorts. In conclusion, the presence of an increased number of CD68+ cells suggests that COVID-19 may incite a form of myocarditis different from typical viral myocarditis, and associated with diffusely infiltrative cells of monocytes/macrophage lineage.
MeSH term(s)	Adult ; Aged ; Antigens, CD/analysis ; Antigens, Differentiation, Myelomonocytic/analysis ; Autopsy ; Biomarkers/analysis ; COVID-19/immunology ; COVID-19/mortality ; COVID-19/pathology ; COVID-19/virology ; Case-Control Studies ; Female ; Host-Pathogen Interactions ; Humans ; Immunohistochemistry ; Macrophages/immunology ; Macrophages/virology ; Male ; Middle Aged ; Myocarditis/immunology ; Myocarditis/mortality ; Myocarditis/pathology ; Myocarditis/virology ; Myocardium/immunology ; Myocardium/pathology ; SARS-CoV-2/immunology ; SARS-CoV-2/pathogenicity
Chemical Substances	Antigens, CD ; Antigens, Differentiation, Myelomonocytic ; Biomarkers ; CD68 antigen, human
Language	English
Publishing date	2021-06-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	1134600-0
ISSN	1879-1336 ; 1054-8807
ISSN (online)	1879-1336
ISSN	1054-8807
DOI	10.1016/j.carpath.2021.107361
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Article ; Online: Effectiveness of a

Taverno Ross, Sharon E / Liang, Hai-Wei / Cheng, Jessica / Fox, Andrea / Documet, Patricia I

Health education & behavior : the official publication of the Society for Public Health Education

2022 Volume 49, Issue 3, Page(s) 455–467

Abstract: Background: Latinos living in emerging communities (i.e., nontraditional destinations with a small ...

Abstract	Background: Latinos living in emerging communities (i.e., nontraditional destinations with a small but growing population) face obstacles to their mental and physical health. This study evaluated the effectiveness of a 6-month, Method: Participants ( Results: There was a marginally significant improvement in dietary practices in the intervention group at follow-up, and no change in access to care. Both groups experienced an improvement in social support. There was a significant intervention-by-time interaction such that the intervention group increased physical activity by 259 minutes/week compared with the control group. Conclusion: This study demonstrates the potential effectiveness of a
MeSH term(s)	Diet ; Exercise ; Hispanic or Latino ; Humans ; Pennsylvania ; Social Support
Language	English
Publishing date	2022-04-26
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1362906-2
ISSN	1552-6127 ; 1090-1981
ISSN (online)	1552-6127
ISSN	1090-1981
DOI	10.1177/10901981221090161
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Article ; Online: Inequities in Treatments and Outcomes Among Patients Hospitalized With Hypertrophic Cardiomyopathy in the United States.

Johnson, Daniel Y / Waken, R J / Fox, Daniel K / Hammond, Gmerice / Joynt Maddox, Karen E / Cresci, Sharon

Journal of the American Heart Association

2023 Volume 12, Issue 11, Page(s) e029930

Abstract: Background Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiac disease. In small studies, sociodemographic factors have been associated with disparities in septal reduction therapy, but little is known about the association of ... ...

Abstract	Background Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiac disease. In small studies, sociodemographic factors have been associated with disparities in septal reduction therapy, but little is known about the association of sociodemographic factors with HCM treatments and outcomes more broadly. Methods and Results Using the National Inpatient Survey from 2012 to 2018, HCM diagnoses and procedures were identified by
MeSH term(s)	Humans ; Female ; United States/epidemiology ; Male ; Hospital Mortality ; Cardiomyopathy, Hypertrophic/diagnosis ; Cardiomyopathy, Hypertrophic/epidemiology ; Cardiomyopathy, Hypertrophic/therapy ; Risk Factors ; Defibrillators, Implantable ; Comorbidity
Language	English
Publishing date	2023-05-26
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.122.029930
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Article ; Online: Evaluation of behavioral economic strategies to raise influenza vaccination rates across a health system: Results from a randomized clinical trial.

Szilagyi, Peter G / Casillas, Alejandra / Duru, O Kenrik / Ong, Michael K / Vangala, Sitaram / Tseng, Chi-Hong / Albertin, Christina / Humiston, Sharon G / Ross, Mindy K / Friedman, Sarah R / Evans, Sharon / Sloyan, Michael / Bogard, Jonathan E / Fox, Craig R / Lerner, Carlos

Preventive medicine

2023 Volume 170, Page(s) 107474

Abstract: Influenza vaccination rates are low. Working with a large US health system, we evaluated three health system-wide interventions using the electronic health record's patient portal to improve influenza vaccination rates. We performed a two-arm RCT with a ... ...

Abstract	Influenza vaccination rates are low. Working with a large US health system, we evaluated three health system-wide interventions using the electronic health record's patient portal to improve influenza vaccination rates. We performed a two-arm RCT with a nested factorial design within the treatment arm, randomizing patients to usual-care control (no portal interventions) or to one or more portal interventions. We included all patients within this health system during the 2020-2021 influenza vaccination season, which overlapped with the COVID-19 pandemic. Through the patient portal, we simultaneously tested: pre-commitment messages (sent September 2020, asking patients to commit to a vaccination); monthly portal reminders (October - December 2020), direct appointment scheduling (patients could self-schedule influenza vaccination at multiple sites); and pre-appointment reminder messages (sent before scheduled primary care appointments, reminding patients about influenza vaccination). The main outcome measure was receipt of influenza vaccine (10/01/2020-03/31/2021). We randomized 213,773 patients (196,070 adults ≥18 years, 17,703 children). Influenza vaccination rates overall were low (39.0%). Vaccination rates for study arms did not differ: Control (38.9%), pre-commitment vs no pre-commitment (39.2%/38.9%), direct appointment scheduling yes/no (39.1%/39.1%), pre-appointment reminders yes/no (39.1%/39.1%); p > 0.017 for all comparisons (p value cut-off adjusted for multiple comparisons). After adjusting for age, gender, insurance, race, ethnicity, and prior influenza vaccination, none of the interventions increased vaccination rates. We conclude that patient portal interventions to remind patients to receive influenza vaccine during the COVID-19 pandemic did not raise influenza immunization rates. More intensive or tailored interventions are needed beyond portal innovations to increase influenza vaccination.
MeSH term(s)	Adult ; Child ; Humans ; Influenza Vaccines ; Influenza, Human/prevention & control ; Economics, Behavioral ; Pandemics ; Reminder Systems ; COVID-19/prevention & control ; Vaccination
Chemical Substances	Influenza Vaccines
Language	English
Publishing date	2023-03-02
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	184600-0
ISSN	1096-0260 ; 0091-7435
ISSN (online)	1096-0260
ISSN	0091-7435
DOI	10.1016/j.ypmed.2023.107474
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Article ; Online: Cardiac Endotheliitis and Multisystem Inflammatory Syndrome After COVID-19.

Fox, Sharon E / Lameira, Fernanda S / Rinker, Elizabeth B / Vander Heide, Richard S

Annals of internal medicine

2020 Volume 173, Issue 12, Page(s) 1025–1027

MeSH term(s)	Adult ; Biopsy ; COVID-19/complications ; COVID-19/epidemiology ; Coronary Vessels/pathology ; Endothelium, Vascular/pathology ; Female ; Humans ; Myocarditis/diagnosis ; Myocarditis/etiology ; Myocardium/pathology ; SARS-CoV-2 ; Systemic Inflammatory Response Syndrome/diagnosis ; Systemic Inflammatory Response Syndrome/etiology
Keywords	covid19
Language	English
Publishing date	2020-07-29
Publishing country	United States
Document type	Case Reports ; Letter
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/L20-0882
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Article: Nailfold Videocapillaroscopic Alterations as Markers of Microangiopathy in COVID-19 Patients.

Gualtierotti, Roberta / Fox, Sharon E / Da Silva Lameira, Fernanda / Giachi, Andrea / Valenti, Luca / Borghi, Maria Orietta / Meroni, Pier Luigi / Cugno, Massimo / Peyvandi, Flora / On Behalf Of The Capcovid Study Group

Journal of clinical medicine

2023 Volume 12, Issue 11

Abstract: Nailfold videocapillaroscopic alterations have been described in COVID-19, but their correlations with biomarkers of inflammation, coagulation and endothelial perturbation are still unclear, and no information is available on nailfold histopathology. ... ...

Abstract	Nailfold videocapillaroscopic alterations have been described in COVID-19, but their correlations with biomarkers of inflammation, coagulation and endothelial perturbation are still unclear, and no information is available on nailfold histopathology. Nailfold videocapillaroscopy was performed on fifteen patients with COVID-19 in Milan, Italy and the signs of microangiopathy were correlated with plasma biomarkers of inflammation (C reactive protein [CRP], ferritin), coagulation (D-dimer, fibrinogen), endothelial perturbation (Von Willebrand factor [VWF]) and angiogenesis (vascular endothelial growth factor [VEGF]) along with genetic drivers of COVID-19 susceptibility. Histopathological analysis of autoptic nailfold excisions was performed on fifteen patients who died for COVID-19 in New Orleans, United States. All COVID-19 patients studied with videocapillaroscopy showed alterations rarely seen in healthy individuals consistent with microangiopathy, such as hemosiderin deposits (sign of microthrombosis and microhemorrhages) and enlarged loops (sign of endotheliopathy). The number of hemosiderin deposits correlated both with ferritin and CRP levels (r = 0.67,
Language	English
Publishing date	2023-05-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12113727
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Article ; Online: How social media images of sexualized young women elicit appearance commentary from their peers and reinforce objectification.

Vendemia, Megan A / Fox, Jesse

Body image

2024 Volume 49, Page(s) 101683

Abstract: ... including photographs of oneself (e.g., selfies). In a 3 × 2 between-subjects online experiment ... Social media platforms like Instagram enable users to share, view, and provide feedback on images ...

Abstract	Social media platforms like Instagram enable users to share, view, and provide feedback on images, including photographs of oneself (e.g., selfies). In a 3 × 2 between-subjects online experiment, we investigated how women evaluate and react to photographs of their peers on social media and the role that feedback might play in both objectification of others and oneself. U.S. adult young women (N = 256; M
Language	English
Publishing date	2024-03-06
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2211449-X
ISSN	1873-6807 ; 1740-1445
ISSN (online)	1873-6807
ISSN	1740-1445
DOI	10.1016/j.bodyim.2024.101683
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