COMPARATIVE EFFECTS OF TOCILIZUMAB AND CYTOSORB ON BLOOD CYTOKIENE LEVELS IN PATIENTS WITH SARS-CoV-2 PNEUMONIA

Background/aims: SARS-CoV-2 is responsible of respiratory failure and also causes a massive release of inflammatory mediators such as IL-6, IL-1, CRP etc. This hyperinflammatory condition, often indicated as Cytokine Release Syndrome (CRS), could led to life-threatening events. The clinical course resembles septic shock and the elevated values of inflammatory mediators are associated with a higher viral load and reduced survival. The use of techniques aiming to contrast the surge of inflammatory mediators has been advocated in the treatment of this condition. Method(s): Four patients were retrospectively admitted in Intensive Care Unit with respiratory failure caused by SARS-CoV-2 infection. Two patients were treated with Tocilizumab (TCZ) alone, the others received TCZ in association with hemoadsorption (HA) treatment. The HA procedure was performed with CytoSorb responsible of removing hydrophobic molecules with a molecular weight of up to approximately 60 kDa including cytokines and other inflammatory mediators involved in CRS. Each procedure lasts 24 hours. Blood values of IL-6, C-reactive protein (CRP) and other biochemical variables were measured in two patients who received Tocilizumab (TCZ) alone and in other two in whom it was associated with hemoadsorption (TCZ- HA). All variables were measured before, during and after the treatment. The aim of the study is to assess the variations of IL-6 in patients with SARS-CoV-2 infection treated with TCZ alone or in association with hemoadsorption (HA). Result(s): All patients full-filled the criteria of severe SARS-CoV-2 infection. In all patients the administration of TCZ was followed by an increasing in IL-6 values. Its values remained elevated in patients given TCZ but sharply decreased in the following days in those treated also with HA. The percentage variations of IL-6 from the baseline between the two groups was +344% and +89% in the two patients treated with TCZ alone and - 56% and -15% in TCZ-HA group. Both TCZ and TCZ-HA were well tolerated. Conclusion(s): The increase of the IL-6 can be ascribed to its displacement from cellular and soluble receptors, whereas its decrease is likely due to the scavenging effect exerted by the HA. Although the association TCZ- HA could be valuable in the treatment of the Cytokine Release Storm (CRS) associated with SARS-CoV-2, the HA could be more effective as it neutralizes a wider panel of inflammatory mediators. More experience is needed to identify the best candidate for TCZ or TCZ-HA.

OFFICE BASED TRANSPERINEAL LASER ABLATION FOR BENIGN PROSTATIC HYPERPLASIA: 3 & 6 MONTHS OUTCOMES

INTRODUCTION AND OBJECTIVE: BPH affects tens of millions of men across the world. Most procedures require either general or regional anesthesia or a transurethral approach. Herein, we present the 3 & 6 months results of NCT04760483 is a phase I prospective, single center, interventional pilot study evaluating transperineal laser ablation (TPLA) of BPH tissues, carried in Office setting under local anesthesia. A detailed step by step video depiction of this procedure is available at the AUA video library. The objectives call for safety, feasibility, and impact in pertinent outcomes measures, such as Uroflowmetry, IPSS, Hematuria, Erectile function, and ejaculation METHODS: The study contemplated accrual of 20 men between 50 and 80 years with prostate volumes between 30 and 120 cc, IPSS scores >9, peak flows between 5 and 15 cc/s and void residuals under <250 ml. Any patient neurological conditions, history of any surgical intervention or urinary retention were excluded. IPSS assessments, Flow studies and prostate volume measures were conducted at 3 months. Herein we present the results. Bayesian analysis for continuous measurements were performed and non-parametric differences were evaluated using chi2 tests. RESULTS: Patients enrolled between December 2020 and February of 2021. The median (IQR) for age and BMI was 68 (58,73) and 29 (27,31), respectively. These parameters for room time, ablation time, watts and total joules were 29 (23,32), 9 minutes (7,12), 6 (5,7) watts and 3,400 (2,600, 3600) joules, respectively. 8(40%) were discharged with a Foley due to elevated residuals. 16 patients had erections and ejaculations before and 3 months after TPLA. 17/20 (85%) had significant improvement in their urinary profile after TPLA (See TABLE for details). One of the initial responders suffered from COVID- 19 infection and developed a CVA that hindered his urinary function. CONCLUSIONS: TPLA in the office setting is feasible and safe. Three month outcomes showed subjective and objective sustained improvement in over 80% of patients for at least 6 months. Furthermore, erections or ejaculations were not affected. This novel and promising approach demands further evaluation in phase II-III trials. (Figure Presented).

[The management of confirmed cases of Covid-19 infection in schools: the experience of the prevention Department of the Azienda Sanitaria Friuli occidentale in the Pordenone area]

The SARS-Cov-2 pandemic that exploded in 2020 resulted in an exceptional school closure involving at least 188 countries worldwide, leaving more than 90% of children at home. This event excluded children and teenagers from the opportunity to learn, socialize, experiment and increased early school leaving. In light of these premises, during the summer months of 2020 the Azienda sanitaria Friuli Occidentale (AsFO) decided to set up a working group to accompany schools in the prevention and containment of the spread of the SARS-CoV-2 infection in the course of the school year 2020-21, with the aim of guaranteeing the right to study and favoring teaching activities in presence in the highest conditions of health and safety. The school reality of the Pordenone area is made up of 40 Comprehensive Institutes for a total of about 206 school complexes of all levels (public, equal and private). In total, the local school population is about 33,000 pupils and 4,000 units of school staff (teachers, ATA, etc ...). The activities of the Schools Group were analyzed by monitoring all interventions with carrying out rapid antigen tests at school and by assessing the incidence of infections within schools. From September 2020 to June 2021, the AsFO Schools Group participated in about 35 teaching colleges and more than 10 dedicated meetings with the families of school pupils of all levels. In total, 170 interventions with rapid antigen tests were carried out at school, involving all the schools in the Pordenone area and a total of 206 classes. During the interventions at school, a total of 6,370 rapid antigen tests were carried out, of which 70% concerned pupils (4,458 total tests) and 30% concerned school staff (1,912 total tests). The antigen tests carried out at school found 173 total positivity (equal to 3% of all tests carried out at school). Out of 173 positives found, 121 are students (70% of the total) and 52 are school staff (30% of the total). During the observation period, the results of the interventions with rapid antigen tests carried out at school led to the continuation of the teaching activity in the presence (with respect to the hygiene and behavioral measures defined by the DP) in 69% of cases (118 interventions). In 9% of cases (15 interventions) the "cross" quarantine was carried out, while in 17% of cases (29 interventions) the quarantine was established for the entire class / section. In 7 circumstances, following the intervention at school, quarantine was established for several classes. Only in 4 circumstances was the institution of quarantine for all school staff, a situation that led to the interruption of all educational activities for the quarantine period.

Cholesterol and COVID-19: Findings from lipid profile of patients with SARS-COV-2 infection

Background and Aims: At the moment COVID-19 is the most relevant global health problem. It seems that during SARS-CoV-2 infection total cholesterol (TC), LDL-C, and HDL-C values decrease. In our clinical practice we frequently observed alterations of the lipid profile in patients with COVID-19. This study aims to evaluate whether SARS-CoV-2 infection could be actually involved in the determining of lipid profile alterations, and to study the possible correlation of TC, LDL-C, HDL-C lowering and disease severity and/or clinical outcome. Methods: We performed a retrospective analysis of the 118 patients who required hospitalization to Internal Medicine Unit of Chieti University Hospital (Italy) for COVID-19 between March and May 2020. We compared pre-infection lipid values collected from our laboratory exams software (53 of the 118 patients enrolled) to those measured on admission. Results: Preliminary Median values showed on admission for COVID-19 were: TC 136.89±42.73 mg/dl, LDL-C 81.53±30.35 mg/dl, HDL-C 32,36±15.13 mg/dl and triglycerides 115±40.45 mg/dl (p=0.001, p<0.001 respectively). Median values of pre-infection total cholesterol and HDL-C were significantly higher than those measured on admission. C-reactive protein negatively correlated with LDL-C and HDL-C (p=0.036). No significant influence of lipid alterations on clinical outcome was highlighted. Conclusions: Such results pointed out the impact of SARS-CoV-2 infection on TC and HDL-C, with the lowest values of LDL-C and HDL-C that are more likely to be detected at the highest inflammatory state in COVID-19 patients. It remains to better define a possible role for lipid metabolism and eventually for statins in the clinical and therapeutic approach to COVID-19.

Hospital length of stay among COVID-19-positive patients

Background and Aim: This study aims to determine COVID-19 patient demographics and comorbidities associated with their hospital length of stay (LOS). Methods: Design: Single-site, retrospective study. Setting : A suburban 700-bed community hospital in Newark, Delaware, USA. Patients: Patients admitted to the hospital from March 11, 2020, to August 11, 2020, with a positive COVID-19 status. We followed a time-to-event analysis approach and used Kaplan-Meir curves and log-rank tests for bivariate analyses, and an accelerated failure time model for a multivariable model of hospital LOS. Results: Six hundred and eighty-seven patients discharged alive (mean [SD] age, 60.94 [18.10] years;339 men [49.34%];307 Black/African-American [44.69%];and 267 White [38.86%]) were included in the investigation. Bivariate analysis using Kaplan-Meir curves showed that patients' age, sex, ethnicity, insurance type, comorbidity of fluid and electrolyte disorder, hypertension, renal failure, diabetes, coagulopathy, congestive heart failure, peripheral vascular disease, neurological disorder, coronary artery disease, and cardiac arrhythmias to be significantly associated with LOS (P<0.05). In the multivariable analysis, patients' age, sex, ethnicity, number of Elixhauser comorbidities, and number of weeks since onset of the pandemic was significantly associated with LOS (P<0.05). Fluid and electrolyte disorder is the only comorbidity independently associated with LOS after adjusting for patients' age, sex, race, ethnicity, number of Elixhauser comorbidities, and weeks since onset of pandemic. Conclusion: COVID-19 patients LOS vary based on multiple factors. Understanding these factors are crucial to improving the prediction accuracy of COVID-19 patient census in hospitals for resource planning and care delivery. Relevance for patients: Understanding of the factors associated with LOS of the COVID-19 patients may help the care providers and the patients to better anticipate the LOS, optimize the resources and processes, and prevent protracted stays.

Preventing transmission among operating room staff during COVID-19 pandemic: the role of the Aerosol Box and other personal protective equipment.

The COVID-19 pandemic is highly challenging for the operating room staff and healthcare workers in emergency departments. SARS-CoV-2 is a positive-sense single-stranded RNA beta-coronavirus that primarily targets the human respiratory system, with fever, cough, myalgia, and pneumonia as the most common manifestations. However, since SARS-CoV-2 RNA was detected in stool specimens much more attention has been paid to gastrointestinal symptoms such as loss of appetite, nausea, and diarrhea. Furthermore, the expression of ACE-2 receptors in absorptive enterocytes from ileum and colon suggests that these organs should also be considered as a potential high risk for SARS-CoV-2 infection. During aerosol-generating medical procedures (AGMP; e.g. intubating and extubating patients or any surgical procedures), the production of both airborne particles and droplets may increase the risk of infection. In this situation, the surgical staff is strongly recommended to wear personal protective equipment (PPE). A transparent plastic cube, the so-called "Aerosol Box" (AB), has been recently designed to lend further protection against droplets and aerosol exposure during the AGMP.