ABSTRACT
Summary: Background. Due to similarities between the pathophysiological mechanisms of hereditary angioedema (HAE) and COVID-19, it has been hypothesized that SARS-CoV-2 infection may trigger HAE attacks or, alternatively, that HAE patients may experience different of COVID-19 disease severity. Furthermore, the potential for COVID-19 vaccination to trigger angioedema attacks in patients with HAE is still not completely defined. The objective is to characterize the exacerbations and clinical manifestations associated with COVID-19 infection and describe the adverse effects of COVID-19 vaccination in patients with HAE.Methods. Retrospective observational, descriptive, non-interventional, multicenter study conducted in four Allergy Units and Departments in Central Portugal between March 2020 and July 2022. HAE patient data were obtained from electronic medical records. Results. The study included 34 patients (67.6% female): 26 with HAE type 1, 5 with HAE type 2, and 3 with HAE with normal C1 inhibitor. Most patients with HAE type 1 and 2 were receiving long-term prophylaxis. Among the 32 patients who received COVID-19 vaccination, 86 doses, were administered with one angioedema attack (1.2%) associated with vaccination. A small increase in the average number of attacks was observed in the year following COVID vaccination (7.1 versus 6.2 in the previous year, p = 0.029), however, this difference is unlikely to be clinically significant, as the context of the COVID-19 pandemic likely introduced numerous confounders. During the study period, 16 HAE patients had COVID-19, all presenting with mild disease. Four out of 16 patients (25%) reported angioedema attacks during COVID-19, and 43.8% during the convalescence period (3 months after infection). Conclusions. Patients with HAE can safely receive COVID-19 vaccination. The severity of COVID-19 infection does not appear to be increased in HAE patients.
ABSTRACT
Introduction: Regional techniques are valuable tools in this specific pandemic context, inclusive in terms of patient and team safety. The authors report the ultrasound-guided selective trunk block (STB) of the brachial plexus with superficial cervical plexus (SCP) for proximal humeral fracture surgery. Case reports: Case 1: 52-year-old male proposed for open reduction and fixation (ORF) of the humerus. Case 2: 53-year-old male proposed for ORF of oblique fracture of the humeral shaft. Both patients were obese, had a hypertensive disease, and a positive test for SARS-COV2. The procedures were performed under ultrasound-guided STB and SCPB using 15 + 3 mL of 0.5% ropivacaine and 10 + 3 mL of lidocaine 1,5%. Intraoperatively, dexamethasone 4 mg, propofol IV perfusion titrated for BIS 60-70, and paracetamol 1g were administered. None of the patients experienced pain, desaturation, or any other complications. Postoperatively, there was no need for rescue analgesia. They had no complications on discharge and globally were satisfied with the technique. Discussion: When a patient with a positive test for SARS-COV2 needs surgery, regional anesthesia allows minimal aerosolization without airway manipulation, but also adds advantages in terms of hemodynamic stability, postoperative analgesia with decreased opioid consumption, and patient's recovery time. In these case reports, SCPB with Selective Trunk Block (upper trunk - C5 and C6, middle trunk - C7, and inferior trunk - C8-T1) allow the ideal target for a safe and effective block, avoiding unwanted side effects.