Case-fatality rate of SARS-CoV-2 infection during the third and fifth epidemic waves in Spain: Impact of vaccination.

INTRODUCTION: During the first and second epidemic waves in Spain, the SARS-CoV-2 case-fatality rates (CFRs) showed significant differences between Autonomous Communities (ACs). Comparing CFRs in the third and fifth epidemic waves can provide information on the impact of the different vaccination coverages in the ACs. OBJECTIVE: To evaluate the impact of vaccination on COVID-19 CFRs in the third and fifth epidemic waves in Spain, according to sex, age, and AC. METHODS: This work is an observational, descriptive study which uses data on COVID-19 infections, deaths, and vaccinees published by the Spanish Ministry of Health and the regional Health Departments of the ACs. The third epidemic wave was defined as the period from 26th December 2020 to 19th April 2021, and the fifth wave, from 19th July to 19th September 2021. The CFRs (deaths per 1000 infected [‰]) were calculated according to sex, age group, and AC. The standardized case-fatality ratio (SCFR) was adjusted for age and sex for each wave. We estimated the correlation between CFRs and their change between the two epidemic waves with the vaccination coverages reached at the beginning of the fifth wave. RESULTS: The CFR in the fifth wave (5.7‰) was lower than in the third wave (16.5‰). In addition, the CFR in both waves was significantly higher in men than in women, and in older people than in younger ones. A decrease in the CFR between both waves was only observed in those older than 49. A strong direct and positive correlation (R2a=0.8399) was found between vaccination coverage by age group and decrease in CFR between both epidemic waves. Significant differences were seen between ACs in the two waves, as regards both CFRs and SCFRs. When comparing ACs, a direct correlation was observed between vaccination coverage and CFRs in the fifth wave, and also - although weak - between vaccination coverage and decrease in CFR between both waves. CONCLUSION: The CFR significantly decreased in Spain between the third and the fifth epidemic waves in population aged 50 or older, probably due to the high vaccination coverage in that age group. Differences were observed between CFRs and SCFRs between ACs that are not explained by the differences in vaccination coverage, suggesting the need for further research and evaluation.

Continuous cough monitoring with AI. Cases: treatment response, smoking cessation and COVID-19

Background: The potential of continuous cough monitoring is in an early stage, while almost every other clinical symptom has a way to be objectively monitored. Objective(s): Study if continuous cough monitoring is useful for early notice of an onset or worsening of respiratory conditions. Method(s): A free mobile application was used to detect and record cough sounds. Only 0.5s snippets of explosive sounds are sent to the server for AI to analyse. The 3 cases presented were identified within a study in Navarra, Spain. Result(s): Case 1: a 56-year-old was using the app with an average of 600 coughs/d, unknown cause. A trial with gabapentin was started, which within a month resulted in 150 coughs/d. With omeprazole added, coughing reduced to ~50 coughs/d. Case 2: a 70-year-old smoker was using the app with an average 52 coughs/day in over 2 months. She quit smoking and noticed improvements in cough, app showing 12 coughs/d. The next month, smoking relapsed, reaching 34 coughs/d. Data dynamics renewed her motivation to quit. Case 3: a 35-year-old was using the app at night, with an average of 4 coughs/hr (not self-perceived). Suddently, the patient felt general malaise and the app detected 12 coughs/hr (not self-perceived). Next day, she received a diagnosis of uncomplicated COVID-19. Conclusion(s): Cough patterns correlate with clinical progress and perceived improvement, accurately indicate signs of smoking cessation and relapse.

TWITTER, SOCIAL SERVICES AND COVID-19 . ANALYSIS OF THE COMMUNICATIVE INTERACTIONS OF THE COMMUNICATIVE INTERACTIONS OF THE MESSAGES EMITTED BY POLITICAL PARTIES, SOCIAL POLITICAL PARTIES, SOCIAL ENTITIES, AND CITIZENS

The state of alarm caused by Covid-19 has mobilised the digital social partici-pation of the population in social networks. Likewise, the relevance acquired by Social Services in the socio-health crisis has generated an unprecedented social debate on Twitter about the reality of these services. In the article, tweets about Social Services and Covid-19 published during the pandemic were analysed using Atlas.Ti software. The results show the precariousness of Social Services and the need for a change in the management and financing model of these services in order to guarantee social benefits. © GKA Ediciones, authors.

Treatment of COVID-19 pneumonia with low-dose radiotherapy plus standard of care versus standard of care alone in frail patients : The SEOR-GICOR IPACOVID comparative cohort trial.

PURPOSE: To assess the efficacy of lung low-dose radiotherapy (LD-RT) in the treatment of patients with COVID-19 pneumonia. MATERIALS AND METHODS: Ambispective study with two cohorts to compare treatment with standard of care (SoC) plus a single dose of 0.5 Gy to the whole thorax (experimental prospective cohort) with SoC alone (control retrospective cohort) for patients with COVID-19 pneumonia not candidates for admission to the intensive care unit (ICU) for mechanical ventilation. RESULTS: Fifty patients treated with LD-RT were compared with 50 matched controls. Mean age was 85 years in both groups. An increase in arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (PAFI) in the experimental LD-RT-treated group compared to the control group could not be found at 48 h after LD-RT, which was the primary endpoint of the study. However, PAFI values significantly improved after 1 month (473 vs. 302 mm Hg; p < 0.0001). Pulse oxymetric saturation/fraction of inspired oxygen (SAFI) values were also significantly higher in LD-RT-treated patients than in control patients at 1 week (405 vs. 334 mm Hg; p = 0.0157) and 1 month after LD-RT (462 vs. 326 mm Hg; p < 0.0001). All other timepoint measurements of the respiratory parameters were similar across groups. Patients in the experimental group were discharged from the hospital significantly earlier (23 vs. 31 days; p = 0.047). Fifteen and 26 patients died due to COVID-19 pneumonia in the experimental and control cohorts, respectively (30% vs. 48%; p = 0.1). LD-RT was associated with a decreased odds ratio (OR) for 1­month COVID-19 mortality (OR = 0.302 [0.106-0.859]; p = 0.025) when adjusted for potentially confounding factors. Overall survival was significantly prolonged in the LD-RT group compared to the control group (log-rank p = 0.027). No adverse events related to radiation treatment were observed. CONCLUSION: Treatment of frail patients with COVID-19 pneumonia with SoC plus single-dose LD-RT of 0.5 Gy improved respiratory parameters, reduced the period of hospitalization, decreased the rate of 1­month mortality, and prolonged actuarial overall survival compared to SoC alone.

Longitudinal immunological responses of COVID-19 vaccination in patients with solid tumors on active treatment: A pilot study

Background: Coronavirus disease 2019 (COVID-19), caused by betacoronavirus SARS-CoV-2, is associated with an increased risk of severe infection or death in cancer patients compared to the general population. The CANVAX trial recently demonstrated that short term immune responses to SARS-CoV-2 vaccines are modestly impaired in patients with cancer- particularly those who receive myelosuppressive chemotherapy. Because little is known regarding longitudinal antibody or T-cell responses in cancer patients who receive cytotoxic chemotherapy or non-myelosuppressive targeted systemic therapy, the aim of this longitudinal study is to assess immune B and T cell responses to SARS-CoV-2 over a 12-month period in solid tumor patients who receive chemotherapy or non-immunosuppressive therapy compared to healthy individuals without cancer. Methods: This is an ongoing prospective non-interventional clinical trial (NCT05238467). Approximately 100 patients will be enrolled into three different arms. Accrual began in May 2021 and 37 patients have been enrolled. Eligible patients must not have prior COVID-19 infection < 6 months from study enrollment and have a diagnosis of a solid tumor (breast, genitourinary, or gastrointestinal cancers), who either: received myelosuppressive chemotherapy within 60 days prior to initial or booster COVID vaccination, or who started on chemotherapy within 30 to 60 days after the initial or booster COVID vaccination (Arm A);or received non-immunosuppressive treatments (Arm B);or have no history of cancer or prior history of cancer but beyond 12 months from completion of curative cancer treatment (Arm C, control cohort). Whole blood will be collected in accordance with standard operating procedures. Blood samples analyzed for the presence of antibodies against the major antigenic components of SARS-CoV-2 including the spike glycoprotein (S), receptor binding domain (R) and nucleocapsid phosphoprotein (N). Antibody levels will be quantified utilizing quantitative ELISA. T-cell responses will also be quantified. The primary endpoint is seroprotection rate with an antibody titer protective (1:40) at any point: baseline, 2, 6, and 12 months. The secondary endpoint is to evaluate differences in longitudinal immunological responses to SARSCoV- 2 over a 12-month period. The difference of the seroprotection rate among 3 cohorts of participants will be examined using chi-square test. Moreover, the effect of treatment (chemotherapy, endocrine, TKIs) on seroprotection will be estimated using multivariable logistic regression controlling the effects of confounders, such as age, gender and cancer type. COVID antibody titers measured over time (baseline, 8 weeks, 6, 9, 12 months after the second vaccination) will be analyzed using mixedeffect models. .

Analysis of Facebook publications and comments about ivermectin during the COVID-19 pandemic in Peru

The purpose of the study was to analyze Facebook publications and perceptions of users, expressed in their comments, about the drug ivermectin during the COVID-19 pandemic in Peru. The publications and their comments were selected by manual search using the terms “ivermectin” and “#ivermectin” in July 2020. Interpretation of publications and their comments was performed by conventional qualitative content analysis with inductive processing and supported by scientific literature. A total 17 publications were retrieved from the period extending from 18 May to 7 July 2020. These were classified into five topics: rumors (58.8%), based on scientific evidence (11.8%), caution (11.8%), production of the drug (11.8%) and confrontation (5.9%). Paradoxically, 70.0% of the rumors were spread by mass media pages. Comments, on the other hand, were classified into four topics based on user perceptions: ivermectin as “effective cure” (64.8%), request for information about ivermectin (25.3%), against the use of ivermectin (6.3%) and other treatments (3.6%). As a conclusion, it was found that more than half of the information about ivermectin circulating in Facebook publications is classified as “rumors”, and most is spread by mass media pages. Analysis of the comments found that user perception considers ivermectin to be the “effective cure” against COVID-19. © 2022, Centro Nacional de Informacion de Ciencias Medicas. All rights reserved.

Hate speech: a systematic review of scientific production and educational considerations

Hate speech is a specific form of expression targeting certain vulnerable or minority groups. It is a social phenomenon which has gained strength in recent years due to its normalisation from the public sphere and escalation on social media, particularly in contexts of crisis such as the circumstances that have arisen around COVID-19. This paper presents a systematic review of the scientific literature produced over the past two decades in English, Portuguese and Spanish as a tool to examine, from social science, the landscape of studies around one of the main threats democratic societies face today. In addition to an evidence-based idea of the state of the art, the results show a substantial increase of research into hate speech over the past five years and how focal points and disciplines have evolved from those approaches and are gaining in importance, along with the analysis of regulations and laws, computational linguistics and discourse analysis. Furthermore, the dearth of research from the field of communication and education is confirmed, which would allow us to examine not only its management and analyse its impact, but rather its understanding from critical pedagogical perspectives committed to the deepening and extension of democracy.

[Case-fatality rates of SARS-CoV-2 infection according to Autonomous Communities during the second epidemic wave in Spain]. / Tasas de letalidad por SARS-CoV-2 según Comunidades Autónomas durante la segunda onda epidémica en España.

INTRODUCTION: In Spain, health systems are transferred to the Autonomous Communities (AC), constituting 19 health systems with differentiated management and resources. During the first epidemic wave of COVID-19, differences were observed in reporting systems and in case-fatality rates (FR) between the AC. The objective of this study was to analyze the FR according to AC. during the 2 nd epidemic wave (from July 20 to December 25, 2020), and its relationship with the prevalence of infection. MATERIAL AND METHODS: A descriptive observational study was carried out, extracting the information available on the number of deaths from COVID-19 registered in the Ministry of Health, the Health Councils and the Public Health Departments of the AC, and according to the excess mortality reported by the System Monitoring of Daily Mortality (MoMo). The prevalence of infection was estimated from the differences between the second and fourth rounds of the ENE-COVID study and their 95% confidence intervals. The global FR (deaths per thousand infected) were calculated according to sex, age groups (< 65 and ≥ 65 years) and AC. The age-Standardized Fatality Rates (SFR) of the AC were calculated using the FR of Spain for each age group. These estimates were made with officially declared deaths (FRo) and excess deaths estimated by MoMo (FRMo). The correlations between the prevalences of infection and the FRo and FRMo were estimated, weighting by population. RESULTS: For the whole of Spain, the FRo during the second epidemic wave was 7.6%, oscillating between 3.8% in the Balearic Islands and 16.4% in Asturias, and the TLMo was 10.1%, oscillating between 4.8% from Madrid and 21.7% in Asturias. Significant differences were observed between the FRo and the FRMo in the Canary Islands, Castilla la Mancha, Extremadura, the Valencian Community, Andalusia and the Autonomous Cities of Ceuta and Melilla. The FRo was significantly higher in men (8.2%) than in women (7.1%). The FRo and FRMo were significantly higher in the age group ≥ 65 years (55.4% and 72.2% respectively) than in the group <65 years (0.5% and 1.4% respectively). The Basque Country, Aragon, Andalusia and Castilla la Mancha presented SFR significantly higher than the global FR of Spain. The correlations between the prevalence of infection and the FRo were inverse. CONCLUSIONS: The case-fatality from COVID-19 during the second epidemic wave in Spain improved compared to the first wave. The case-fatality rates were higher in men and the elderly people, and varied significantly between AC. It is necessary to delve into the analysis of the causes of these differences.

Genomic testing on breast cancer core biopsy material is feasible and provides useful treatment information

Background: Genomic profiling assays for invasive breast cancer provide useful predictive and prognostic information and are performed most commonly on surgical resection specimens. Obtaining the molecular profile at the time of initial core needle biopsy is ideal because it could provide information that could significantly alter preoperative decision-making and avoid unnecessary treatments. In January 2020, the breast center began a 3 month pilot program that would reflexively send core biopsy material on all newly diagnosed patients for genomic testing using the MammaPrint (MPT) and BluePrint (BPT) assays regardless of receptor status. The goals were to determine feasibility and examine the impact to patient care. Methods: Breast core biopsy tissue was triaged by an attending pathologist as soon as slides were available. If invasive carcinoma with at least 3 mm in linear extent of tumor with 20% cellularity was identified, materials were immediately sent to Agendia for MPT/BPT testing even before ER/PR/HER2 testing was available to the pathologist. Clinicopathologic information, turn-around time (TAT) and adequacy data were tracked. The impact was discussed regularly at breast tumor board to determine if the results led to altered decision-making that could reduce unnecessary interventions and time to initial treatment. Results: 445 core biopsy specimens were sent for genomic testing. Of those 442, (97%) Syielded genomic results with an average TAT from biopsy to genomic result of 11 calendar days. MPT identified 233 (53%) cases that were low risk and 209 (47%) cases that were high risk. BPT showed that 60 (14%) cases were Basal, 18 (4%) cases were HER2, and 364 (82%) cases were Luminal. Further analysis of the Luminal subgroup demonstrated that 154 (42%) were Luminal A low risk, 78 (21%) were Luminal A Ultralow risk and 132 (36%) were Luminal B High Risk. Analysis by race demonstrated a significantly higher percentage of high risk tumors in African-American women including a higher percentage of basal cancers (26%) as compared to Caucasian women (10%). Of note, 51 patients in the pilot study had additional OncotypeDX (ODX) testing on subsequent surgical resection. There was fair correlation between the assays with the majority of the low risk MPT having low risk ODX scores (<=25) and the high risk MPT having high risk ODX scores (>25), though MPT identified more patients as being high risk. The COVID-19 pandemic altered plans to assess time to treat and treatment interventions as initially intended. However, the knowledge of genomic result enhanced the ability to triage patients, allowing those patients with low risk tumors to begin endocrine therapy and delay surgery. Use of preoperative hormone therapy was considered more often in place of neoadjuvant chemotherapy in patients with low genomic risk ER+/HER2-patients. Because of the continued feedback indicating positive impact, the pilot ultimately was extended to 11 months to allow time for formal implementation. Conclusions: Genomic testing using the MPT/BPT assay on core biopsy samples with at least 3 mm yields results 97% of the time with an average TAT of 11 days from biopsy date to result. The genomic information at the time of initial diagnosis impacted patient care most notably in the ER+ setting. The results led to the immediate implementation of direct reflex testing of all newly diagnosed ER+ and HER2-or IHC 2+ cancers by pathology after the initial pilot phase.

High-flow nasal therapy in severe respiratory failure due to SARS-CoV-2

The use of high-flow nasal therapy (HFNT) in patients with severe acute respiratory failure (SARF) due to COVID-19 pneu-monia (NCOVID-19) is debated. Given the lack of beds in Intensive Care Units in the Public Health System of the Province of Neuquén, their use was implemented in general wards. This restrospective multicenter study was carried out to describe the experience of using HNFT in patients with SARF due to NCOVID-19. The primary outcome was the frequency of successful weaning from HFNT and in-hospital mortality (IHM). Two hundred ninety-nine patients were analyzed;120 (40.1%) were successfully withdrawn from HFNT. This failed in 59.8% (179), 44.1% (132) required invasive mechanical ventilation (IMV), and 15.7% (47) was not candidates for intubation. A ROX index ≥ 5 at 6 h after initiation was associated with the success of HFNT (OR 0.26 [IC 95% 0.15-0.46] p<0.0001). The general IHM was 48.5% (145/299), 70.4% (93/132) in patients with IMV, 4.2% (5/120) died after successful weaning from HFNT and 100% (47/47) in the group not candidates for intubation. Patients with TNAFO had a statistically significant decrease in MIH and days of hospitalization. TNAFO in general wards achieved a decrease in the use of IMV, with a reduction in mortality and days of stay in hospitalized for NCOVID-19 with SARF.

Impact of SARS CoV2 on newborns weight from infected mothers

Introduction: During the present Sars cov-2 pandemic, pregnant women are considered high-risk group population due to a state of immune compromise. Previous knowledge regarding pregnant women and their newborns is rapidly changing as new covid discoveries are unraveled, paying special attention on newborns evolution during their first days of life. Objectives: To determine impact of Sars Cov2 infection on the expected birth weight of newborns of infected mothers. Methods: It is a descriptive, cross-sectional, observational and retrospective study involving the analysis of clinical records of patients from the infectiology service of the Hospital Español Mexico. The study includes newborns from mothers between the ages of 18 to 48 infected with Sars Cov2, confirmed by a PCR test. The study excludes patients with incomplete records. We evaluated the frequency and proportion of the qualitative variables;we obtained the arithmetic mean and the standard deviation for the quantitative variables with normal distribution. Results: Data included 36 patients from the infectology service between the months of March 2020 to April 2021, with positive PCR for sars cov 2, with a mean age of 34.28 ± 5.86 years, mainly presented the following comorbidities: : obesity in 27.8%, hypothyroidism 11.1%, diabetes 13.9%, gestational hypertension 13.9%. The principal symptoms presented by the mothers were respiratory in 19.4%, gastrointestinal 13.9%, asymptomatic presentation 47.2%. Newborns results were obtained with a mean gestational age of 37.3 ± 2.6, with a male predominance of 52.8%, with a mean birth weight of 2811.1 ± 616.7, height 47.64 ± 3.7. About 16.4% of the patients were premature, only 4 were admitted to the neonatal intensive care unit, due to sepsis, pediatric inflamatory multisystemic syndrome, and an intrauterine growth restriction. All the newborns had a negative PCR test despite the positive PCR of all the mothers Conclusion: Newborns from mothers infected with Sars cov 2, were born with appropriate weight for their gestational age. The immune system of newborn babies protects to have adequate nutrition during the gestational period, however, some presented inflammatory and vascular complications. Special emphasis should be done on maternal metabolic clinical history, such as obesity, metabolic syndrome, and hypothyroidism since these comorbidities can impact negatively in the prognosis of the infected mother and the newborn. It is very important to perform a nutritional screening during prenatal care for an adequate metabolic programming in early life in children.

INFLAMMATORY MARKERS AS PREDICTORS OF INTUBATION IN PATIENTS WITH COVID-19

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Common diseases such as hypertension and diabetes mellitus have been shown to increase the risk for mortality in patients with COVID-19. Several biomarkers such as Troponin, D-Dimer, and C-reactive protein (CRP) have been associated with increased mortality. There has been insufficient data to help predict the need for intubation in COVID-19. We aimed to assess the performance of common biomarkers of disease severity in COVID-19 with intubation risk and assess the prediction of early and late intubation in patients hospitalized with COVID-19. METHODS: We retrospectively reviewed consecutive patients hospitalized with COVID-19 in two medical centers in Washington, DC, from March to April 2020. Our primary outcome was time of intubation - early (occurring within 48 hours of admission) and late (occurring after 48 hours of admission). Secondary outcomes included overall intubation status. Our independent variables consisted of initial values for D-dimer, Troponin, and CRP. Covariates included demographics, comorbidities, and APACHE II score on admission. Descriptive analyses calculated median and IQR for continuous variables. For bivariate analyses, the median value was used to dichotomize continuous variables;the Mann-Whitney U test was used for skewed and Student T-Test for normally distributed variables. The Chi-Square test was used for categorical predictor and outcome variables. Logistic regression was used for multivariable analyses. All variables significant in bivariate analyses (P<0.05) were kept in the multivariable model. RESULTS: We identified 663 patients hospitalized with COVID-19. 125 patients were intubated with a median time to intubation of 43.4 hours. Initial Troponin (> 0.017 ng/ml) and D-dimer (> 1.175 μg/ml) levels were associated with overall subsequent intubation (p=0.0008;p=0.00061, respectively) during hospitalization. Only initial CRP level (> 92.2 mg/L) was associated with overall, early, and late intubation (p=0.003, p=0.03, p=0.0002, respectively). Comorbidities associated with increased mortality in COVID-19 were not predictors of intubation risk. CRP and APACHE II score at time of admission remained independently associated with intubation risk in multivariable modeling (OR=2.47 and p=0.0136;OR=4.82 and p<0.0001, respectively). CONCLUSIONS: In patients hospitalized with COVID-19, initial elevated CRP level identifies patients at increased risk for early and late intubation. Although predictive of intubations within 48 hours of admission, initial troponin, D-dimer, and APACHE II score were not associated with intubation occurring greater than 48 hours after admission. CLINICAL IMPLICATIONS: In patients admitted with COVID-19 who are not intubated within 48 hours of admission, the admission CRP value may help clinicians identify patients still at significant risk for respiratory decompensation and predict the need for intubation during hospitalization. DISCLOSURES: No relevant relationships by Sant Kumar, source=Web Response No relevant relationships by Alex Montero, source=Web Response No relevant relationships by Ilan Vavilin, source=Web Response

Could pulmonary low-dose radiation therapy be an alternative treatment for patients with COVID-19 pneumonia? Preliminary results of a multicenter SEOR-GICOR nonrandomized prospective trial (IPACOVID trial).

PURPOSE: To evaluate the efficacy and safety of lung low-dose radiation therapy (LD-RT) for pneumonia in patients with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: Inclusion criteria comprised patients with COVID-19-related moderate-severe pneumonia warranting hospitalization with supplemental O2 and not candidates for admission to the intensive care unit because of comorbidities or general status. All patients received single lung dose of 0.5 Gy. Respiratory and systemic inflammatory parameters were evaluated before irradiation, at 24 h and 1 week after LD-RT. Primary endpoint was increased in the ratio of arterial oxygen partial pressure (PaO2) or the pulse oximetry saturation (SpO2) to fractional inspired oxygen (FiO2) ratio of at least 20% at 24 h with respect to the preirradiation value. RESULTS: Between June and November 2020, 36 patients with COVID-19 pneumonia and a mean age of 84 years were enrolled. Seventeen were women and 19 were men and all of them had comorbidities. All patients had bilateral pulmonary infiltrates on chest X­ray. All patients received dexamethasone treatment. Mean SpO2 pretreatment value was 94.28% and the SpO2/FiO2 ratio varied from 255 mm Hg to 283 mm Hg at 24 h and to 381 mm Hg at 1 week, respectively. In those who survived (23/36, 64%), a significant improvement was observed in the percentage of lung involvement in the CT scan at 1 week after LD-RT. No adverse effects related to radiation treatment have been reported. CONCLUSIONS: LD-RT appears to be a feasible and safe option in a population with COVID-19 bilateral interstitial pneumonia in the presence of significant comorbidities.

Saving time in the radiotherapy procedures for COVID-19 pneumonia treatment. A single-institution experience.

BACKGROUND: The use of low dose radiotherapy (LD-RT) for the treatment of COVID-19 pneumonia is supported by biological rationale for its immunomodulatory effect. Some institutions have started to treat these patients showing encouraging results. To shorten procedure times is crucial for the comfort of symptomatic patients receiving respiratory support and to optimize institutional facilities. PATIENTS AND METHODS: At our institution, LD-RT is offered to hospitalized patients with COVID-19 pneumonia and signs of early cytokine-released syndrome on behalf of a multicenter study. We designed a coordinated process flow starting from the patient transfer to the simulation CT-scan (first-step), to the end of the LD-RT treatment (last step). The times spent on each step of the process flow were evaluated. RESULTS: Mean age of treated patients was 83 (72-91) years-old. The timing parameters of the first 10 consecutive patients were analyzed. Except for the first (dummy run), patients were managed from the first to the last step in a median of 38 min (25-58, SD 10.67). The most time-consuming sub-process was the contouring of the treatment volumes and dosimetry. CONCLUSIONS: LD-RT is not only an encouraging option for COVID-19 pneumonia patients, but a convenient and feasible procedure if performed in a coordinated way by reducing procedure times.

Elevated serum aminotransferase levels at presentation are associated with intensive care unit admission in patients with COVID-19

Background: Abnormal serum aminotransferase levels have been observed in up to 60% of patients with coronavirus disease 2019 (COVID-19) Higher serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels have been observed in hospitalized patients with severe disease However, the association between enzyme levels at the time of hospital admission and disease outcomes remains incompletely characterized Studies suggest that the mechanism of liver injury is multifactorial and may involve microvascular thrombosis We aimed to assess the prognostic value of abnormal AST and ALT on admission of patients with COVID-19 and their association with d-dimer in a large urban cohort in the U S Methods: Demographic and clinical data of 532 consecutive patient admissions for COVID-19 in two large, urban tertiary referral hospitals in Washington DC from March 13 to May 21, 2020 were analyzed Independent variables were initial AST and ALT values within 24 hours of presentation Primary outcomes were admission to intensive care unit (ICU) and inpatient mortality Presenting AST and ALT were examined as continuous and as dichotomized (≤2x and >2x upper limit of normal (ULN)) variables with outcomes Secondary analyses included general linear regression between AST/ALT and presenting d-dimer levels Statistical analysis was performed using RStudio (version 4 0 0) Results: Of 532 patients, 50 5% were male, 66 5% were Black, with a mean age of 60 3±16 4 years old Time from symptom onset to presentation was 6 (IQR = 3-8) days Chronic liver disease was observed in 20 patients (3 8%) (Table 1) Ninety-two patients (17 2%) expired and 164 (30 9%) required ICU care Abnormal AST and ALT levels were seen in 368 (70 4%) and 199 (38 0%) patients, respectively The mean presenting AST (95 1 vs 56 1 U/L, p= 0 017) and ALT (66 7 vs 43 9 U/L, p=0 008) levels were higher in patients who required ICU care compared to those who did not Patients with AST >2x ULN (>66 U/L) or ALT >2x ULN (>98 U/L) were more likely to require ICU care (OR 2 10, p=0 001 and OR 2 03, p=0 041, respectively) However, difference in mortality was not observed between those groups Lastly, AST was positively associated with presenting d-dimer (p=0 04) but not ALT (p=0 11) Conclusion: Liver function test should be obtained on admission and elevation in AST and/or ALT should be factored into patient risk stratification, especially when AST >66 U/L and/or ALT >98 U/L. Observed correlation between AST (but not ALT) and d-dimer supports the notion that AST level may reflect the ischemic burden of affected organs as a result of microvascular thrombosis, including but not limited to the liver. However, given the low specificity of d-dimer, its elevation may correlate more so with disease severity rather than true presence of microvascular thrombi within the liver (Table Presented).