Pulmonary function, muscular strength and quality of life according to mechanical ventilation use in post-Covid patients

Introduction: Mechanical ventilation (MV) is a known risk to impact in respiratory and functional capacity postCOVID-19 infection. Objective(s): Assess pulmonary function, muscular strength and quality of life in post-COVID-19 patients submitted or not to MV. Method(s): During March of 2020 and July 2021 we had 983 hospitalized COVID-19 patients and 527 patients were discharged and invited to be followed at the multidisciplinary assistance. From the total, 116 patients [57% male, 59(52-67) years] were evaluated 60 days after first symptoms appearance through pulmonary function testing, manovacuometry, handgrip test and Saint George's Respiratory Questionnaire (SGRQ). There were no vaccinated subjects. Result(s): 34% of the patients needed intensive care (n=39), of which, 51% needed MV (n=20). MV group showed statistically significant weaker handgrip strength [27(18-35) kgf vs 35(26-45) kgf;p=0,025] and maximum inspiratory pressure predicted percentile reduction (86+/-23,5% vs 101+/-27,6%;p=0,043) when compared to non-MV group. We did not observe SGRQ differences between the groups. However, females showed statistically significant higher impact in quality of life in all SGRQ domains compared to males. There were no differences in pulmonary function. Conclusion(s): MV submitted patients presented worsened respiratory and peripheral muscular strengths without difference in pulmonary function and quality of life. Women showed higher impact in quality of life regardless of MV use.

IMMUNOGENICITY and SAFETY of the CHADOX 1 COVID-19 VACCINE in PATIENTS with AUTOIMMUNE DISEASES and HEALTHY CONTROLS: DATA from SAFER STUDY

Background: Patients with autoimmune infammatory diseases (AID) have been prioritized for urgent vaccination to mitigate COVID-19 risk. However, few studies in the literature assessed the immunogenicity and safety of the COVID-19 vaccine in patients with AID. Objectives: In this context, the present study aims to evaluate the immunogenic-ity and safety of the vaccine against COVID-19 in patients with AID. Methods: These data are from 'Safety and efficacy on COVID-19 Vaccine in Rheumatic Disease'-SAFER study, a Brazilian multicentric prospective phase IV study to evaluate COVID-19 Vaccine in AID, in the real-life, in Brazil. Immunogenicity and adverse events (AE) from a single center were assessed, after 2 doses of ChAdOx1 (Oxford/AstraZeneca), 8 weeks of interval, in patients with AID and healthy controls (HC). Inclusion criteria were age ≥ 18 years and fulflling criteria according to international classifcation for AID. Exclusion criteria: pregnancy, previous severe AE to any vaccine, other immunosuppression causes. Stratifcation of post-vaccination AE was performed using a diary, flled out daily and returned at the end of 28 days for each dose. Participants were followed up through blood collection for measurement of IgG antibodies against SARS-CoV-2 spike receptor-binding domain by chemiluminescence (SARS-CoV-2 IgG II Quant assay, Abbott Laboratories, Abbott Park, IL, USA) at baseline and 28 days after the second dose. The seropositivity was defned for titers ≥50 AU/mL. Quantitative analyses were presented as observed frequency, percentage, central tendency, and variability measurements. The sample's normal distribution was verifed through the Shapiro-Wilk test. The Kruskal-Wallis test and the post-hoc Dwass-Steel-Critchlow-Fligner pairwise comparisons test were used to compare the IgG-S titers between the groups through the evaluation period. Categorical data were addressed using the Fisheŕs exact or Chi-squared (χ2) test. An alpha level of 5% signifcance was used in all analyses. Results: A total of 377 volunteers with AID and 50 HC were included in the study. Patients with spondyloarthritis (N=64), systemic lupus erythematosus (N=63), rheumatoid arthritis (N=61), primary Sjögren's syndrome (N=61), vasculitis (N=31), systemic sclerosis (N=14), inflammatory myopathy (N=9), Crohńs disease (N=49), ulcerative colitis (N=11) and other systemics AID (N=12) were evaluated. Both groups had female predominance (73.5% vs. 74.0%, p=0.937) and were homogeneous for age (43.5 vs. 41.7,p=0.308). The seroconversion among those not reactive (IgG-S negative at baseline) (46 HC and 191 AID), 28 days after second dose was 97.1% for spondyloar-thritis (p=0.425), systemic lupus erythematosus 88.2% (0.006), rheumatoid arthritis 93.5% (0.158), primary Sjögren's syndrome 92.6% (0.133), systemic sclerosis or inflammatory myopathy 47.1% (0.001), inflammatory bowel disease 100% (0.999) and vasculitis 80% (0.006), while in healthy control was 100%. In comparison with HC, there was a statistically significant difference in IgG-S titles only in systemic sclerosis or inflammatory myopathy (1.694 AU/ml vs. 3.719 AU/ml;p=0.006). Both groups only presented mild AE. Pain at the injection (85.7% vs. 78.4%, p=0.239), headache (67.3% vs. 53.8, p=0.074) and fatigue (59.2% Vs. 46.2%, p=0.089) were more common in HC than AID. Overall, reactions like arthralgia (52.6 vs. 22.4%, p<0.001), hematoma (14.1 vs. 4.1%, p=0.05), cutaneous rash (9.5 vs. 0%, p=0.024) were more frequent in AID. Most participants related that they felt safer after receiving a COVID-19 vaccination, and 52.4% did not reported a worse patient global assessment (PGA) index. Conclusion: In conclusion, our data indicated that ChAdOx1 vaccine is safe and induced high titers and seroconversion rate in AID. More severe AID, such as vasculitis, systemic lupus erythematosous, and systemic sclerosis and myositis showed a lower seroconversion rate. Further analysis will explore the association between immunossupressant and reactivity, and booster dose.

IMPROVING COLORECTAL CANCER SCREENING AND POLYP SURVEILLANCE DURING THE COVID-19 PANDEMIC

Introduction: Colorectal cancer screening and surveillance colonoscopy declined drastically during the initial surge of coronavirus infectious disease (COVID-19) cases in the United States. In August 2020, the state of Georgia (GA) had the highest per-capita circulating infection rate in the nation, with an average of more than 25 cases per 100,000 people and was the "most likely" state where someone may be exposed to COVID-19. Our ambulatory endoscopy unit at Emory Healthcare, which is a large, tertiary referral care center in GA had a precipitous drop in show rate for screening and surveillance colonoscopy even after elective procedures resumed. Patients cited fear of acquiring COVID-19 as the primary reason for previously cancelling their procedure. Therefore, we implemented a quality improvement project aimed at improving show rates for screening and surveillance colonoscopy by providing patients structured education via a telephone call regarding the safety of inperson colonoscopy and addressing concerns regarding COVID-19. Methods: We contacted patients between the ages of 40-75 who were due for screening or polyp surveillance colonoscopy in August via a telephone call. Patients were provided a comprehensive overview of public health guidelines regarding COVID-19, and safety precautions at Emory Healthcare to minimize risk of transmission of COVID-19 including pre-procedural testing for COVID-19, social distancing, enforcing a universal masking policy, limited visitor/escort policy, and vigorous surface disinfection. Patients who completed their procedures were asked to complete a survey to provide feedback about the impact of the study phone call using a dichotomous response of agree/disagree. Results: 161 patients were contacted, of which 49% were Caucasian, 48.4% were African-American and 1.9% were Asian. 95% of the patients who were contacted completed their colonoscopies. 91.8% agreed that they received information about COVID-19 that they were previously unaware of;81.4% agreed that they are now more likely to follow public health guidelines of social distancing, hand washing, and wearing a mask. 91.1% felt safer about procedures after the study phone call, and 90.9% agreed that they felt less anxious about the risk of acquiring COVID-19 while in our facility. 70.3% agreed that they may not have come in for their procedures if they did not receive the study phone call. 94.4% agreed that they were satisfied with the procedural protocol at our facility and would come back for another procedure if needed. Conclusions: Our study suggests that specific communication of pandemic related issues are key to reducing peri-procedural concerns about COVID-19. Failure of timely colorectal cancer screening and colonoscopy will lead to a large burden of missed polyps and colorectal cancers leading to increased morbidity and mortality from CRC.

Worsening of breast and cervical cancer stage at diagnosis due to COVID-19 pandemic

Background: The COVID-19 pandemic affected health services by overloading hospitals’ capacity, impacting cancer screening and treatment. Unfortunately, a late cancer diagnosis has a detrimental effect in prognosis. We aimed to assess the staging of breast cancer (BC) and cervical cancer (CC) patients (pts) during their first consultation, comparing the periods during and prior to the pandemic. Methods: Data were collected from pts who started follow-up and treatment in a cancer center in Brazil from Sep/20-Jan/21 and from Sep/19-Jan/20. These periods were selected considering the beginning and duration of the COVID-19 pandemic in Brazil, which started on Feb/20 and is still ongoing. We considered the period (Sep/20-Jan/21) to be representative of the pandemic impact on cancer diagnosis. The primary endpoint was BC and CC stages at diagnosis. CC staging was defined according to 2018 FIGO staging. Clinical or pathological (for those with upfront surgery) BC stage was defined according to the TNM anatomic stage from AJCC 8th edition. The comparison of cancer stages between the two periods was performed using Chi-Square test. Results: 268 BC pts and 44 CC pts had their first consult from Sep/20-Jan/21;457 and 60, respectively, occurred from Sep/19-Jan/20. Pts who attended their first consult during the pandemic period presented with higher BC (P<0.001) and CC (P=0.328) stages than those prior to the pandemic, although the difference was not statistically significant for cervical cancer. The proportion of CC pts diagnosed with locally advanced disease (stages III-IVA) was 56.8% (N=25) in Sep/20-Jan/21 compared to 43.3% (N=26) in Sep/19-Jan/20. Similarly, 37.3% (N=100) of BC pts had stage III disease in Sep/20-Jan/21 compared to 23.2% (N=106) in Sep/19-Jan/20. Fewer pts were diagnosed with stage I BC during the pandemic (9.3% vs 20.6%). Additionally, fewer BC pts were diagnosed due to screening tests during the pandemic (13.7%;N=36) than before it (25.5%;N=113) (P<0.001). Conclusions: BC and CC pts presented with a higher stage in their first consultation at a cancer center during the period of the COVID-19 pandemic compared to a similar period prior to the pandemic, confirming the long-term negative impact of the pandemic for oncologic pts. Thus, efforts should be made not to compromise essential cancer services. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: R.R.D.C.C. Bonadio: Financial Interests, Personal, Expert Testimony: Aché;Financial Interests, Personal, Funding, financial support for attending symposia: Roche;Financial Interests, Personal, Funding, financial support for educational program: AstraZeneca. All other authors have declared no conflicts of interest.