ABSTRACT
Objective: To identify risk factors for SARS-CoV-2 infection and for severe/critical COVID-19, and to assess the humoral response after COVID-19 in these patients. Methods: Nationwide study of adult patients with inflammatory RMDs prospectively followed in the Rheumatic Diseases Portuguese Register-Reuma.pt-during the first 6 months of the pandemic. We compared patients with COVID-19 with those who did not develop the disease and patients with mild/moderate disease with those exhibiting severe/critical COVID-19. IgG antibodies against SARS-CoV-2 were measured ≥3 months after infection and results were compared with matched controls. Results: 162 cases of COVID-19 were registered in a total of 6,363 appointments. Patients treated with TNF inhibitors (TNFi; OR = 0.160, 95% CI 0.099-0.260, P < 0.001) and tocilizumab (OR 0.147, 95% CI 0.053-0.408, P < 0.001) had reduced odds of infection. Further, TNFi tended to be protective of severe and critical disease. Older age, major comorbidities, and rituximab were associated with an increased risk of infection and worse prognosis. Most patients with inflammatory RMDs (86.2%) developed a robust antibody response. Seroconversion was associated with symptomatic disease (OR 13.46, 95% CI 2.21-81.85, P = 0.005) and tended to be blunted by TNFi (OR 0.17, 95% CI 0.03-1.05; P = 0.057). Conclusions: TNFi and tocilizumab reduced the risk of infection by SARS-CoV-2. Treatment with TNFi also tended to reduce rates of severe disease and seroconversion. Older age, general comorbidities and rituximab were associated with increased risk for infection and worse prognosis, in line with previous reports. Most patients with RMDs developed a proper antibody response after COVID-19, particularly if they had symptomatic disease.
ABSTRACT
Purpose: COVID-19 changed the dynamics of all healthcare system, leading to the restructuring of inpatient teams as well as the emergency department. Scheduled surgeries were suspended, operating rooms were closed, and anesthesiologists redistributed among the various intensive care units. At the Centro Hospitalar do Baixo Vouga the number of patients admitted to the emergency department decreased to approximately 8.000 during the period of lockdown which ranged from 18th March to 1st June 2020. The aim of this study was to compare the number of patients presenting with hip fractures during the first wave of the COVID-19 pandemic with the equivalent period in 2019 and to analyze postoperative outcomes. Methods: An observational retrospective study was conducted in two different periods. Patients over the age of 50 years admitted with hip fracture were included for analysis. The data was collected from the hospital database. A general descriptive analysis was performed. Results: There was an overall reduction in the number of admissions due to hip fractures in Period 2020 compared with homologous Period in 2019 (68 patients and 94 patients, respectively). No statistically significant differences were found regarding age, gender, ASA grade and pre-admission residence among patients admitted during these both periods. Nursing home patients in Period 2020 had a longer hospital stay (p=0.03), independently of the functional status (p=0.07). There were no statistically significant differences in the time it took the patient to go to the emergency department after the fall, place where the fracture had occurred, waiting time to perform the surgery, type of treatment performed, post-surgical complications and mortality. There was no relationship between mortality and the time it took the patient to access the emer- © 2021. All Rights Reserved.