ABSTRACT
Background: Meta-analyses on venous thromboembolism (VTE) risk in admitted patients with COVID-19 have shown substantial heterogeneity among included studies. Aim(s): To explore sources of heterogeneity among studies estimating VTE risk in COVID-19 patients. Method(s): A systematic review using the databases PubMed and Embase was performed searching for studies reporting VTE risk in patients admitted to the ward or intensive care unit (ICU). Analysis was performed with studies from which a incidence proportion could be retrieved. The pooled incidence of VTE and heterogeneity (I2) were estimated in a random-effects model stratified by ICU or ward. Incidence estimates were logit-transformed. The effect of 12 pre-selected clinical and methodological variables were explored in a univariable linear meta-regression model. Because of limited degrees of freedom, a multivariable model was constructed in a stepwise fashion. The outcome measure was regression coefficient with a 95% confidence interval (CI). Result(s): Fifty-three and 26 studies reported on incidence of VTE at the ICU and ward respectively. The pooled incidence at the ICU was 20.3% (95% CI 16.4-24.8%, I2 95.4%) and at the ward was 4.7% (95% CI 3.0-7.3%, I2 96.2%). In studies concerning ICU patients, asian region, VTE-screening, standard error and date of publication were significantly associated with incidence of VTE in the univariable model. (Table Presented) Two multivariable models were fitted (Table 1). In the multivariable model only standard error remained significantly associated. In studies concerning ward patients, average age, VTE-screening, standard error were significantly associated in the univariable model. Two multivariable models were fitted (Table 2). Again, only standard error remained significantly associated. Conclusion(s): Studies with a high standard error yielded a higher VTE incidence in COVID-19, strongly suggesting publication bias. Remaining heterogeneity was not completely explained, but may be due to differences in setting/outcome definition and clinical practice.
ABSTRACT
Background: Registries are providing real-life, long-term data relevant to safety, efficacy and long-term outcomes in patients with various rheumatic diseases. The Romanian Registry of Rheumatic Diseases (RRBR) collects efficacy and safety data, for patients with infammatory rheumatic conditions treated with bio-logics and targeted synthetic DMARDs in the country. Infections are the most frequently adverse events associated with biologics exposure. Objectives: To analyze the distribution, severity class and outcome of infection with SARS-CoV-2 in infammatory arthritides during the last 2 years of COVID-19 pandemic. Methods: We collected data for the past 2 years (2020 and 2021) from the RRBR, for the three main infammatory rheumatic diseases (Rheumatoid Arthritis-RA, Spondyloarthritis-SpA and Psoriatic Arthritis-PsA): treatment exposure (drug class) at the time of COVID-19 diagnosis, severity class (mild, moderate, severe), the disease outcome (recovered, disabled, death). Finally, we compared those data to reported numbers of COVID-19 infections in the general population, aiming to observe if there is a signifcant difference between the two groups. Results: The study included 9469 patients with infammatory rheumatic disease, in 298 (3.14%) patients a history of COVID-19 infection was recorded: 160 (53.69%) were diagnosed with RA, 116 (38.92%) with SpA and 22 (7.28%) with PsA. At the moment of COVID-19 infection, 200 patients were receiving anti-TNF inhibitors (67.11%), 27 JAK inhibitors (9.06%), 24 tocilizumab (8.05%), 23 rituximab (7.71%), 9 anti-IL17A monoclonal antibodies (3.02%) and 4 abat-acept (1.34%). More than half of the cases were mild-59.39% (177), whereas moderate forms were noted in 26.17% (78) and severe in 14.09% (42) of the total infected patients. Out of the 42 severe COVID-19 cases, 11 (26.19%) were treated with rituximab, 18 (42.85%) with TNF inhibitors, 7 (16.66%) with JAK inhibitors, 4 (9.52%) with tocilizumab, 1 (2,38%) with secukinumab and 1 (2.38%) with abatacept. Almost all cases recovered: 286 (95.97%) patients, while 12 (4.02%) deaths were recorded. The patients who died were on treatment with rituximab (5), tofacitinib (3), etanercept (2), secukinumab (1) and tocilizumab (1). Data from the National Public Health Institute showed a rate of COVID-19 infection in the general population of 9.36%, out of which 96.7% had a favorable outcome, while 3.26% deaths were reported. Conclusion: This study confrms that patients receiving treatment with rituxi-mab are at risk for a worse COVID-19 outcome. The increased number of severe cases and deaths related to COVID19 in patients receiving TNF inhibitors may be explained by the large use of this therapeutic option. Surprisingly, we noted 4 severe cases and one death related to COVID19, in patients treated with tocilizumab. We observed no signifcant differences in death rates and the outcomes of COVID-19 in patients with rheumatic diseases treated with biological therapies and the general population. The low rate of SARS-CoV-2 reported infections in the registry, compared to the general population, is most probably due to the commonly found underreporting of adverse events in registries.
ABSTRACT
The uptick in malicious activity in cyberspace observed during the initial stage of the coronavirus pandemic highlighted once again the need for addressing cyberattacks. Health-related facilities were some of the main targets of cyber operations, several cyberattacks hitting even COVID-19 hospitals. Cyber operations grew in both intensity and numbers, both regarding cyberattacks and cybercrime. However, alleged state-sponsored cyberattacks are the main focus of this research. Malicious cyber operations set dangerous precedents during the pandemic, and it strengthens the need to adequately address these threats, but also broaden the research, especially in the field of International Relations. The discussion is centred on the most significant cyber incidents during the first year of the COVID-19 pandemic, beginning with the surge of cyberattacks and cybercrime during the first months of increased dependence on digital technologies for companies and state institutions. Therefore, this paper will start with a literature review regarding cyber operations and IR. Research on cyberspace in IR is not scarce, but it is still lagging behind new and dynamic evolutions. Further, I shall focus on the major state-sponsored cyber operations that occurred during this period, while also paying attention to the problem of attribution. All of these developments regarding cyber operations should stand as significant threats and warnings for governments, private companies, and citizens, and they must be addressed properly in order to prevent future considerable disruptions. Given the above, I shall summarise several general lessons and recommendations that emerged from studying the major state-sponsored cyberattacks during the COVID-19 pandemic.