Lactate Dehydrogenase is Associated with Hemorrhagic Stroke During Extracorporeal Membrane Oxygenation for COVID-19

Background: Hemorrhagic stroke (HS) is a devastating complication during extracorporeal membrane oxygenation (ECMO), but markers for risk stratification are unknown. Lactate dehydrogenase (LDH) is a readily available biomarker of global tissue injury and permeability. We sought to determine whether an elevated LDH at baseline is related to eventual HS during ECMO for COVID-19. Method(s): A multicenter, retrospective study was conducted. Adult patients with COVID-19 requiring ECMO between March 2020 and February 2022 were included. LDH values prior to ECMO were captured. Patients were categorized into high (>750 U/L) or low (<=750 U/L) LDH groups. Result(s): There were 520 patients (47+/-11 years old) that underwent ECMO placement in 17 centers and 384 had an available LDH. In this cohort, 122 (32%) had a high LDH. Forty (10%) patients required venoarterial ECMO, while the remaining 344 (90%) received venovenous support only. Twenty-one out of 122 (17%) patients with a high LDH had a HS in comparison to 21 out of 262 (8%) with a low LDH. At 100 days, the probability of a HS was 40% in the high LDH group and 23% in those with a low LDH, p=0.002. After adjustment for age, sex and antecedent cardiopulmonary resuscitation, high LDH was associated with subsequent HS (aHR: 2.73, 95% CI 1.46-5.12). Findings were similar when restricting to patients supported by venovenous ECMO only. Conclusion(s): Elevated LDH prior to ECMO is associated with a HS during device support. LDH can risk stratify cases for impending cerebral bleeding during ECMO.

Le syndrome post COVID-19 : un mythe ou une réalité ?

Le concept de post COVID-19 a été adopté par l'Organisation mondiale de la santé et d'autres sociétés savantes suite à la description de symptômes et de séquelles persistants pendant au moins deux mois, au-delà de 3 mois d'évolution après une COVID-19 aiguë. La prévalence, les caractéristiques cliniques et évolutives du Post COVID-19 méritent d'être étudiées. Nous avons mené une enquête monocentrique descriptive prospective à travers la mise en place d'un questionnaire en ligne où les patients ayant eu une infection COVID-19 confirmée par un test antigénique ou une PCR ont été sollicités pour renseigner cette fiche technique standardisée. Parmi 269 patients sollicités, 206 ont renseigné le questionnaire en ligne. Les patients étaient répartis en 106 femmes et 100 hommes dont 145 (70 %) avaient moins de 60 ans. 84 % des patients avaient des symptômes persistants au-delà de 4 semaines alors que 75 % des patients avaient un syndrome Post COVID-19 authentique. Les signes cliniques rapportés sont : l'asthénie (55,7 %), l'anxiété (25 %), les arthralgies (28 %), l'anosmie (27,5 %), l'agueusie (22,1 %), les céphalées (26 %), les vertiges (26,7 %), les acouphènes (9,2 %), hypoacousie, les troubles mnésiques (22 %), la toux (22,9 %), la dyspnée (22,1 %), les douleurs thoraciques (19,8 %), palpitations récurrentes (17,6 %), les troubles du sommeil (20,6 %), la vision flou (6,9 %), la dépression (19,1 %), l'alopécie (17,6 %), la sècheresse cutanée (9,9 %), la fièvre (17,6 %), les diarrhées (13,7 %), les nausées et vomissements (10,7 %) et les aphtes buccaux (6,1 %). Le retentissement sur la qualité de vie a été rapporté par 85 % des femmes, 66 % des hommes et 78 % des sujets de plus de 60 ans. L'asthénie, l'anxiété, les arthralgies, la dyspnée et les troubles mnésiques sont les symptômes les plus rapportés en Post COVID-19. Le retentissement du syndrome post COVID-19 sur la qualité de vie semble plus important chez les femmes et le sujet âgé. Les questionnaires dédiés au syndrome post COVID-19, à l'asthénie, l'anxiété et la dépression pourraient aider à mesurer et à mettre en évidence le syndrome post COVID-19. Une prise en charge multidisciplinaire est nécessaire pour améliorer la qualité de vie de ces patients, détecter des séquelles post COVID-19 relevant d'une prise en charge spécialisée et éliminer un diagnostic différentiel notamment une dyspnée d'origine cardiaque, post embolique ou une pneumopathie interstitielle d'une autre origine. (French) [ FROM AUTHOR] Copyright of Revue de Médecine Interne is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

National approaches to managing cancer care: Responses of countries in the MENA region to COVID-19 pandemic

Background: COVID-19 pandemic presented serious challenge to oncology care due to the associated risks form infection and from disruption of care delivery. Therefore, many professional societies published recommendations to help manage cancer care during the crisis. The objective of our study was to assess the national responses of MENA countries in terms of publishing relevant guidelines and analyse various components of these guidelines. Methods: A survey based on literature review regarding cancer care adaptation was developed then completed by senior oncologists representing the following countries: Algeria, Egypt, Iraq, Jordan, Kuwait, Lebanon, Morocco, Oman, Saudi Arabia, Syria, Tunisia, UAE and Yemen. The survey queried about instructions of the national recommendations regarding (1) general measures of COVID-19 prevention in oncology, (2) cancer care adaptations during the pandemic. Results: Analysis of the guidelines revealed 31 essential recommendations categorized into seven essential components with specific recommendations for each component. These components are patients’ management, health care workers (HCW) management, facility management, testing for COVID-19, measures to reduce hospital visits, measures to reduce complications, and site-specific recommendations. The table showed compliance of these guidelines with having the required components and relevant recommendations. [Formula presented] Conclusions: There is inconsistency in the components of the guidelines across the region, which may reflect the evolving nature of the pandemic and lack of clear evidence for many issues in question. There is a need from clear framework on essential components to be included in the guidelines to assure providing the best guidance to the oncology community. Editorial acknowledgement: On behalf of the International Research Network on COVID-19 Impact on Cancer Care (IRN-CICC). Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: M.A.M.A. AlNassar: Research grant/Funding (institution): Roche. A. Jazieh: Research grant/Funding (institution): MSD. All other authors have declared no conflicts of interest.