BIOLOGIC TREATMENT SUSPENSION AND ASSOCIATED FACTORS IN PATIENTS WITH RHEUMATIC DISEASES DURING THE COVID-19 PANDEMIC: DATA FROM MEXICAN ADVERSE REGISTRY (BIOBADAMEX)

BackgroundThe COVID-19 pandemic triggered serious challenges in the treatment of chronic diseases due to the lack of access to medical attention. Patients with rheumatic diseases (RD) must have adequate treatment compliance in order to reach and maintain remission or low activity of their diseases. Treatment suspension because of non-medical reasons might lead to disease activation and organ damage.ObjectivesIdentify the frequency of biologic treatment (bDMARD) suspension in patients with RD during the COVID-19 pandemic and determine the associated factors for suspension.MethodsIn this study we included all patients registered in the Mexican Biologics Adverse Events Registry (BIOBADAMEX), that started bDMARD before March 2019 and suspended treatment during the COVID-19 pandemic. We used descriptive statistic to analyze baseline characteristics and main treatment suspension causes. We used Chi[2] and Kruskal Wallis tests to analyze differences between groups.ResultsA total of 832 patients patients registered in BIOBADAMEX were included in this study, 143 (17%) suspended bDMARD during the COVID-19 pandemic. The main causes of suspension were inefficacy in 54 (38%) patients, followed by other motives in 49 (34%) patients from which 7 (5%) was loss of medical coverage. Adverse events and loss of patients to follow up were the motive in 16 (11%) and 15 (11%) patients respectively.When we compared the group that suspended bDMARD with the non-suspenders (Table 1), we found statistical differences in patient gender, with 125 (87%) female patients that suspended bDMARD, with a median age of 52 (42-60) years, and a treatment duration of 3.8 years.ConclusionIn our study we found that 17% of patients with RD suspended bDMARD treatment during the COVID-19 pandemic and that non-medical motives such as lack of patients follow up and loss of medical coverage due to unemployment were important motives. These results are related to the effect of the pandemic on other chronic diseases.Table 1.Patients baseline characteristicsPatients that did not suspended bDMARD during pandemic (n = 689)Patients that suspended bDMARD during pandemic (n = 143)pFemale gender, n(%)549 (79.7)125 (87.4)0.02Age, median (IQR)55 (45 – 63)52 (42 – 60)0.04Body mass index, median (IQR)26.4 (23 – 30.4)27.23 (24.2 – 30.46)0.13Social security, n(%)589 (85.5)128 (89.5)0.2Diagnosis0.7- Rheumatoid arthritis444 (64.4)97 (67.8)- Juvenil idiopathic athritis29 (4.2)2 (1.4)- Ankyosing sponylitis93 (13.5)19 (13.3)- Psoriasic arthritis43 (6.2)6 (4.2)- Systemic lupus erithematosus32 (4.6)9 (6.3)- Others48 (6.9)10 (6.9)Disease duration, median (IQR)11 (7 – 19.5)12 (6 - 18)0.95Comorbidities, n(%)305 (44.3)73 (51)0.08Previos biologic, n(%)249 (36.1)60 (42)0.1Treatment at pandemic iniciation, n(%)0.8 - Etanercept a34 (4.9)5 (3.5)- Infliximab a24 (3.5)5 (3.5)- Adalimumab130 (18.9)22 (15.4)- Rituximab a61 (8.9)25 (17.5)- Abatacept76 (11)20 (14)- Tocilizumab82 (11.9)18 (12.6)- Certolizumab92 (13.4)28 (19.6)- Rituximab b7 (1)0- Golimumab36 (5.2)5 (3.5)- Tofacitinib14 (2)1 (0.7)- Infliximab b4 (0.5)2 (1.4)- Etanercept b31 (4.5)6 (4.2)- Baricitinib12 (1.7)1 (0.7)- Belimumab5 (0.7)1 (0.7)- Secukinumb8 (1.2)3 (2.1)Steroids use, n(%):254 (36.9)57 (39.9)0.2Steroids dose (mg), median (IQR)6 (5 – 10)6 (5 – 10)0.47DMARD use, n(%):538 (78.1)118 (82.5)0.1Treatment duration, median (IQR)5.06 (4.04 – 5.78)3.82 (3.35 – 4.95)0.001Suspension motive, n(%)NA- Inefficacy-54 (37.8)- Adverse event-16 (11.2)- Pregnancy-2 (1.4)- Loss of patient-15 (10.5)- Remission-7 (4.9)- Others-49 (34.2)Adverse events, n(%):102 (14.8)24 (16.8)0.3- Severe, n(%)13 (1.9)5 (3.5)0.4a original, b biosimilarREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsVijaya Rivera Teran: None declared, Daniel Xavier Xibille Friedmann: None declared, David Vega-Morales: None declared, Sandra Sicsik: None declared, Angel Castillo Ortiz: None declared, Fedra Irazoque-Palazuelos: None declared, Dafhne Miranda: None declared, Iris Jazmin Colunga-Pedraza: None declared, Julio Cesar Casasola: None declared, Omar Elo Muñoz-Monroy: None declared, Sandra Carrilo: None declared, Angélica Peña: None declared, Sergio Duran Barragan: None declared, Luis Francisco Valdés Corona: None declared, Estefanía Torres Valdéz: None declared, Azucena Ramos: None declared, Aleni Paz: None declared, ERICK ADRIAN ZAMORA-TEHOZOL: None declared, Deshire Alpizar-Rodriguez Employee of: Scientific Advisor in GSK México.

Compromiso cardiologico y marcadores inflamatorios en ninos con Sindrome Inflamatorio Multisistemico relacionado a la infeccion por COVID-19

Coronavirus 2 (SARS-CoV-2) infection has spread rapidly. In pediatrics, a condition similar to shock is described named multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). The mechanisms of cardiological involvement are not clear. Objective: To describe cardiological in-volvement and inflammatory markers in hospitalized patients with MIS-C in a tertiary hospital. Patients and Method: Observational, retrospective study in children under 15 years of age with MIS-C. Demographic, clinical, and laboratory variables were collected from an electronic plat-form, including troponin, B-type natriuretic peptide (proBNP), ultrasound, and electrocardio-gram. Patients with / without cardiological involvement (CCC / SCC) were compared. GraphPad QuickCalcs (c) 2018 Software was used for statistical analysis, considering p < 0.05. Results: Thir-teen patients diagnosed with MIS-C, 9 males, median age 9.5 years. All presented with fever and abdominal pain, adding one or more of the following symptoms: vomiting, exanthema, diarrhea, altered mucous membranes and/or edema. Five patients had hemodynamic compromise, 9/13 were categorized as CCC. Troponins were elevated 4.1 times in CCC (p < 0.05), median ProBNP CCC 6940 pg/ml vs 921 pg/ml in SCC (p < 0.05), median Ferritin CCC 482 vs 154 ng/ml in SCC (p < 0.01), platelets CCC 106,000 vs SCC 207,000/mm3 (p < 0.05). Echocardiogram showed pe-ricardial effusion (N = 6), mild systolic dysfunction (N = 4), moderate dysfunction (N = 1) and coronary alterations (N = 3). In the ECG, 3 patients presented transient repolarization disturbance and 1 first-degree atrioventricular block. None required support with extracorporeal membrane oxygenation, with no deaths. Conclusion: cardiological involvement in hospitalized children with MIS-C is frequent. Our series showed nonspecific and transitory symptoms, and hemodynamic compromise which responded early to medical treatment, with a favorable evolution. The markers in CCC patients were troponin, ProBNP, ferritin, and thrombocytopenia. The most frequent ul-trasound finding was pericardial effusion. The importance of both clinical and laboratory cardio-logical evaluation in these patients is evident.

Epidemiological profile of SARS-COV-2 infection in pediatrics.

Objective: To describe the epidemiological and clinical profile of pediatric patients who were treated for suspected COVID-19 infecion, between March and October 2020, at the Hospital Universitario San Ignacio (HUSI), in Bogota, Colombia. Material(s) and Method(s): Cross-sectional design. Description of patients aged 1 month to 1 day before their 18th birthday, assessed between March and October 2020, who were approached by any pediatric care service of a university hospital for suspected COVID-infection. 19, according to current national and institutional protocols. Demographic variables and the reason for consultation of all individuals with suspected infection were recorded. Only when SARS-CoV-2 infection was confirmed were variables related to clinical aspects of the disease and its evolution recorded. Result(s): 920 medical records of pediatric patients with suspected SARS-CoV-2 infection were evaluated, of which there were 157 confirmed cases with COVID-19 infection. The main reason for consultation to suspect infection was fever in 50% of the cases. In patients with virological confirmation, 32.48% of the cases attended required hospital management. MIS-C was suspected in 5 patients who required intensive care unit management. In the evaluated period, there were no deaths associated with COVID-19 infection. Conclusion(s): SARS-CoV-2 infection is related in most cases to a spectrum of mild disease in the pediatric population. This study may be larger than pediatric patients presenting with gastrointestinal rather than respiratory symptoms, and the frequency of renal complications should be taken into account in patients in whom the systemic inflammatory syndrome associated with COVID-19 is suspected.Copyright © 2023 Asociacion Colombiana de Infectologia. All rights reserved.

Characteristics and outcomes of COVID-19 patients with COPD from the United States, South Korea, and Europe

Background: Characterization studies of COVID-19 patients with chronic obstructive pulmonary disease (COPD) are limited in size and scope. The aim of the study is to provide a large-scale characterization of COVID-19 patients with COPD. Methods: We included thirteen databases contributing data from January-June 2020 from North America (US), Europe and Asia. We defined two cohorts of patients with COVID-19 namely a ‘diagnosed' and ‘hospitalized' cohort. We followed patients from COVID-19 index date to 30 days or death. We performed descriptive analysis and reported the frequency of characteristics and outcomes among COPD patients with COVID-19. Results: The study included 934,778 patients in the diagnosed COVID-19 cohort and 177,201 in the hospitalized COVID-19 cohort. Observed COPD prevalence in the diagnosed cohort ranged from 3.8% (95%CI 3.5-4.1%) in French data to 22.7% (95%CI 22.4-23.0) in US data, and from 1.9% (95%CI 1.6-2.2) in South Korean to 44.0% (95%CI 43.1-45.0) in US data, in the hospitalized cohorts. COPD patients in the hospitalized cohort had greater comorbidity than those in the diagnosed cohort, including hypertension, heart disease, diabetes and obesity. Mortality was higher in COPD patients in the hospitalized cohort and ranged from 7.6% (95%CI 6.9-8.4) to 32.2% (95%CI 28.0-36.7) across databases. ARDS, acute renal failure, cardiac arrhythmia and sepsis were the most common outcomes among hospitalized COPD patients. Conclusion: COPD patients with COVID-19 have high levels of COVID-19-associated comorbidities and poor COVID-19 outcomes. Further research is required to identify patients with COPD at high risk of worse outcomes. Copyright: © 2023 Moreno-Martos D et al.

Cardiology compromise and inflammatory markers in children with Multisystemic Inflammatory Syndrome related to COVID-19 infection

Coronavirus 2 (SARS-CoV-2) infection has spread rapidly. In pediatrics, a condition similar to shock is described named multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). The mechanisms of cardiological involvement are not clear. Objective(s): To describe cardiological involvement and inflammatory markers in hospitalized patients with MIS-C in a tertiary hospital. Patients and Method: Observational, retrospective study in children under 15 years of age with MIS-C. Demographic, clinical, and laboratory variables were collected from an electronic plat-form, including troponin, B-type natriuretic peptide (proBNP), ultrasound, and electrocardio-gram. Patients with / without cardiological involvement (CCC / SCC) were compared. GraphPad QuickCalcs© 2018 Software was used for statistical analysis, considering p < 0.05. Result(s): Thir-teen patients diagnosed with MIS-C, 9 males, median age 9.5 years. All presented with fever and abdominal pain, adding one or more of the following symptoms: vomiting, exanthema, diarrhea, altered mucous membranes and/or edema. Five patients had hemodynamic compromise, 9/13 were categorized as CCC. Troponins were elevated 4.1 times in CCC (p < 0.05), median ProBNP CCC 6940 pg/ml vs 921 pg/ml in SCC (p < 0.05), median Ferritin CCC 482 vs 154 ng/ml in SCC (p < 0.01), platelets CCC 106,000 vs SCC 207,000/mm3 (p < 0.05). Echocardiogram showed pe-ricardial effusion (N = 6), mild systolic dysfunction (N = 4), moderate dysfunction (N = 1) and coronary alterations (N = 3). In the ECG, 3 patients presented transient repolarization disturbance and 1 first-degree atrioventricular block. None required support with extracorporeal membrane oxygenation, with no deaths. Conclusion(s): cardiological involvement in hospitalized children with MIS-C is frequent. Our series showed nonspecific and transitory symptoms, and hemodynamic compromise which responded early to medical treatment, with a favorable evolution. The markers in CCC patients were troponin, ProBNP, ferritin, and thrombocytopenia. The most frequent ultrasound finding was pericardial effusion. The importance of both clinical and laboratory cardio-logical evaluation in these patients is evident. Copyright © 2022, Sociedad Chilena de Pediatria. All rights reserved.

PNEUMOMEDIASTINUM AND PNEUMOTHORAX IN COVID-19 PNEUMONIA: A MATCHED CASE-CONTROL STUDY

SESSION TITLE: COVID-19 Infections: Issues During and After Hospitalization SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: Pneumothorax and pneumomediastinum (PTX/PM) has been associated with patients hospitalized with COVID-19 infections. The aim of our study was to assess the risk factors, hospital length of stay, and mortality of PTX/PM among hospitalized patients with COVID-19 infection in a matched case-controlled study. METHODS: Adult patients with confirmed COVID-19 infections who were hospitalized at 5 Mayo Clinic hospitals (Minnesota, Arizona, Florida, Wisconsin) between March 2020 and January 2022 were retrospectively screened. PTX and or PM in at least two consecutive imaging studies were included. They were matched to control patients based on age, gender, hospital admission period, severity on admission day and the day preceding the incident. Summary statistics, Mann Whitney-U, and chi-square tests were performed RESULTS: A total of 197 patients were included in the descriptive analyses.The median age was 61 years and the majority were men (70.8%). Patients with underlying pulmonary comorbidities was 2.27 (OR 1.42-3.62, p value < 0.001) times more likely to develop PTX/PM. Ten percent of the total cases had these complications present upon hospital admission.Patients who developed PTX/PM had a longer hospital length of stay compared to controls, 20 versus 12 days, OR 4.53 (p=0.002). On the day prior to developing PTX/PM, 42 (31%) of patients had been on high-flow nasal cannula only and 14 on non-invasive ventilation (10.4%). The highest recorded positive end-expiratory pressure, plateau, and driving pressures were recorded in our case group on the day before the complication and all were significantly higher than matched controls. In-hospital mortality in patients whose COVID-19 course was complicated by PTX/PM was 44.2% vs. those without, 21.1%, adjusted OR 2.71 (p=0.001). Sixty two percent were treated conservatively without any intervention. CONCLUSIONS: We have demonstrated in the largest study to date, that patients who were hospitalized with COVID-19 infection and had a PTX/PM had a longer hospital length of stay, were associated with higher mechanical ventilatory pressures, and had a higher in-hospital mortality, when compared with matched controls. CLINICAL IMPLICATIONS: Complications of PTX/PM in patients with COVID-19 infections can occur spontaneously and in barotrauma. Pre-existing lung disease is a risk factor for the development of these complications. Patients with PTX/PM have a longer hospital length of stay and higher in-hospital mortality which is in contrast with existing published data. DISCLOSURES: No relevant relationships by Natalya Azadeh No relevant relationships by Meghan Brown No relevant relationships by Rodrigo Cartin-Ceba No relevant relationships by Anusha Devarajan No relevant relationships by Juan Pablo Domecq No relevant relationships by Sandeep Khosa No relevant relationships by Amos Lal No relevant relationships by Shahraz Qamar No relevant relationships by Kenneth Sakata No relevant relationships by Mayank Sharma No relevant relationships by Nikhil Sharma No relevant relationships by Jamil Taji No relevant relationships by Fahimeh Talaei No relevant relationships by Aysun Tekin No relevant relationships by Diana Valencia Morales No relevant relationships by Stephanie Welle

Incorporation of a Filter Media by Cellulose Fibers in Biosafety from Sugarcane Bagasse by Alkaline Hydrolysis

The pandemic caused by COVID-19 has generated an increase in the consumption of personal protective equipment focused on reducing the risk of contagion and respiratory affectations, being the masks the fundamental article to combat the spread according to the World Health Organization, where the surgical mask is the most used worldwide, made entirely of polypropylene, taking 400 years to disintegrate being 90% of these masks end their useful life in streets, landfills or even in the ocean. To decrease contamination sugarcane bagasse due to its availability and percentage of cellulose has important characteristics to be used as a biodegradable filter media as the first step to incorporate it into a cloth mask. Three cellulose extraction methodologies were stipulated based on acid hydrolysis using H2SO4 and alkaline hydrolysis using NaOH, in acid routes there is a rupture of the β 1-4 glycosidic bonds generating glucose affecting the % of cellulose, giving reason to the use of alkaline hydrolysis at 5% w/v with a yield of 32.00 %, 80.39 % in its extraction and taking advantage of the black liquor generated in the alkaline hydrolysis towards cogeneration. Finally, as the filter media is an organic nonwoven, its disintegration time is shorter compared to the polypropylene nonwoven, evidenced in a qualitative study of vermicomposting by implementing Californian earthworm, governed by EN-13432, with 18°C, moisture above 50%, pH of roughly 9 and a C/N ratio of 25:1 are taken into account, resulting in a total disintegration of the filter media in 26 days compared with dry leaves, both sources of carbon. Copyright © 2022, AIDIC Servizi S.r.l.

First detection of SARS-CoV-2 variant B.1.1.529 (Omicron) in Ecuador.

The National Institute of Research and Public Health reported the first local record of the Omicron variant detected in Ecuador. A fully vaccinated subject returned from South Africa with a negative RT-PCR. We present the cumulative frequency of the variants in Ecuador and a phylogenetic analysis of this new Omicron.

Perspectives of nursing professionals regarding the care of patients with covid-19

Introduction: Currently the responsibilities and role of each nursing professional has been put to the test with the need to care for thousands of Covid-19 patients, whose demands for technical, cognitive and personal care have exceeded the capacities of many healthcare professionals. Aims & Objective: To know the perspectives of nursing professionals regarding the care of patients diagnosed with Covid-19. Material & Method: the qualitative method was applied with a phenomenological approach, with the consensual participation of 10 HANM professionals, for convenience. The information was collected through in-depth interviews and analyzed in the atlas ti software. V9, using 6 core categories and 11 subcategories with which the hermeneutical unit was built. Results: Nursing care in the time of Covid-19 has faced uncertainty and fear, not knowing accurately the procedures and treatments due to the lack of information in this regard, despite this they maintain the humanization in the treatment of the patient and the Family members, through emotional intelligence, manage their feelings and fears to provide support to their patients. Conclusions: Despite the limited accessibility to protection barriers and biosafety standards, mechanisms were established to provide comprehensive care, considering the needs of the patient and their families, and accompanying them throughout the disease process. The greatest impact for nursing professionals has been to be in constant contact with death, increasing their fear of catching it and bringing the disease to their family members.

Detection of SARS-CoV-2 in dialysis effluent on a peritoneal dialysis program in mexico city: four cases

Introduction: Since the rapid spread of the COVID 19 pandemic, it is crucial to identify possible sources of transmission of the SARS-COV-2 virus in order to perform procedures safely. There has been interest to identify the presence of SARS-CoV-2 in different compartments including peritoneal compartment. SARS-CoV-2 was detected by reverse transcriptase-polymerase chain reaction (RT-PCR) in dialysis effluent on a few single cases while other authors have reported negative results. Peritoneal membrane pores have a diameter of 20-40 nm while the SARS-CoV-2 virion diameter is between 60 to 140 nm, theoretically the virion could reach the peritoneal cavity by hematogenous diffusion or through the dialysis catheter after contact contamination. Case Description: We report dialysis effluent findings of four patients, two women and two men, with an age range of 35 to 64 years and different comorbidities including: diabetes mellitus, hypertension and obesity. They were diagnosed with COVID-19 using RT-PCR assay on nasopharyngeal samples or by tomography findings. RT-PCR samples of peritoneal effluent were obtained with a length of stay on peritoneal cavity of 6 hours, without centrifugation of the sample. Three patients were positive for presence of SARSCoV-2 on nasopharyngeal sample and dialysis effluent, while the fourth patient was negative in both samples despite having tomography findings suggestive of COVID-19 infection. It should be noted that in the 3 patients that had a positive RT-PCR on both nasopharyngeal and peritoneal effluent, samples were obtained within the first 7 days following the onset of symptoms associated with COVID-19 and on the fourth patient the peritoneal effluent sample was obtained 12 days after initial symptoms. All patients presented with acellular peritoneal fluid. No abdominal symptoms were reported. Discussion: Presence of SARS-CoV-2 on peritoneal fluid continues to be a subject of debate. Peritoneal effluent sample-drawing procedure has not been standardized, which may explain the inconsistent results noted by different authors. The positive results of the RT-PCR for SARS-CoV2 on peritoneal effluent must be confirmed on a larger sample. Although based on a small group, these findings should prompt to consider these fluids as potentially infective.

A Low-Cost Automated System for Manual Resuscitator for Emergency Covid-19 Care

The lack of mechanical ventilators during the COVID-19 pandemic and the time of import this medical equipment to Ecuador;we develop a low-cost clinical ventilator using the manual resuscitators AmbuBag. This prototype used the material that are easily buy in Ecuador, so it can be rapidly build and used by the medical person. The prototype was evaluate by three different medical groups that work in the intensive care unit (IUC) in three different hospitals. The evaluation was satisfactory and we show the building process of the equipment. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Mortality of COVID-19 in patients with rheumatic diseases: Comparison to the general population in méxico

Background: COVID-19 outcomes in Mexican patients with rheumatic diseases (RDs) in comparison to general population patients are unknown. Objectives: To compare mortality and hospitalization of COVID-19 patients with RDs and those without. Methods: We included for this study all the Mexican patients with RDs and COVID-19 registered from April 17th to October 30th, 2020 in the COVID-19 Global Rheumatology Alliance registry. We compare clinical and demographic characteristics of patients with RDs and COVID-19 to patients with COVID-19 that were selected randomly from the Mexican Epidemiology database (1:3). A logistic regression analysis was performed to adjust for confusion variables. Results: We included 322 patients with COVID-19 and RDs and 969 controls without RDs. Table 1 shows the demographic characteristics and comorbidities of both groups. Bivariate analysis showed that patients with RDs had higher mortality, were older, and were more frequently hospitalized. Comorbidities, such as diabetes, hypertension, cardiovascular and renal diseases were also more frequent in patients with RDs. In the multivariate analysis, having a RD was no longer associated with mortality (Figure 1). Conclusion: Patients with RDs had higher comorbidities, hospitalizations, and mortality than the general population in the bivariate analysis. However, adjusted multivariate analysis showed that the odds for mortality were not increased because of having a RD. These findings suggest that the increased mortality of Mexican patients with RDs may be explained by the higher frequency of comorbidities in this population.

Factors associated with mortality in patients with rheumatic diseases and COVID-19 in Mexico

Background: As of the 25th of January 2021, more than 150 thousand deaths as consequence of COVID-19 have been reported in Mexico [1]. Advanced age, male gender and comorbidities have been described as risk factors for severe disease and mortality in general population [2]. COVID-19 mortality in Mexican patients with rheumatic and musculoskeletal diseases (RMDs) is unknown. Objectives: To describe characteristics of Mexican patients with RMDs and COVID-19, and to analyse factors associated with mortality. Methods: The Global Rheumatology Alliance COVID-19 (GRA) physician reported registry, is an international effort to collect information on COVID19 in adult patients with RMDs. GRA is an observational registry. The first patient from Mexico was registered on April 17, 2020. All Mexican patients registered in GRA until October 30, 2020 were included in this analysis. The association of mortality with demographic and clinical variables was estimated using logistic regression analysis. Results: A total of 323 patients were registered, with a median age of 52 (IQR 41-61) years old, 166 (51.4%) patients lived in Mexico City. The most frequent RMDs were rheumatoid arthritis, 149 (46.1%) and systemic lupus erythematosus, 24 (19.8%). Over a third of patients with RMDs and COVID-19 (119 (36.8%)) were hospitalized, and 43 (13.3%) died. Table 1 shows clinical and demographic characteristics. In the univariable analysis, the absence of comorbidities was a protective factor, OR 0.3 (95% CI 0.1-0.6). Factors associated with mortality at COVID-19 diagnosis were age over 65 years old, having type 2 diabetes, chronic renal insufficiency, treatment at COVID-19 diagnosis with corticosteroids or with CD20 inhibitors. In the multivariable adjusted analysis, these factors remained independently associated with mortality. No associations with other treatments or comorbidities at COVID-19 diagnosis were found. Conclusion: Mexican patients with RMDs and COVID-19 in the GRA physician reported registry had a mortality of 13.3%. Factors associated with mortality were those described in the general population, such as older age and being on corticosteroids and CD20 inhibitors treatment at COVID-19 diagnosis.

Frequency and characteristics of alterations in liver function tests (LFT) in adult patients with COVID-19 (preliminary report)

Background and aim: Daily evidence arises from of other organs involvement in this new viral disease called COVID-19, several publications describe variable liver involvement, characterized by cholestasis and mild hyperbilirubinemia. The objective of the present work was to describe the frequency and characteristics of alterations in liver function tests (LFT) in patients diagnosed with SARS-COV2 in our hospital. Material and methods: Descriptive study type. Data obtained from database in COVID-19 unit. Hospitalized adult patients confirmed with SARS-COV2 diagnosis by using RNA through PCR were included, from April 7 to May 12, 2020. Demographic, biochemical variables were analyzed upon admission, as well as comorbidities and outcome. Results: 27 out of 113 patients, including those with suspicious diagnosis, were confirmed with SARS-COV2 which at the time of the cutoff were also included in the analysis. Average age 50.7 years (range 25-91 years). Male sex 74% (N = 20/27). 13 patients (48.1%) presented Liver Functions Tests (LFT) alterations, the cholestatic pattern predominated in 84.6% (N = 11). Ferritin value ≥ 1000 ng / mL and severe Acute Respiratory Distress Syndrome (ARDS) had a Predictive Positive Value (PPV) = 0.7%, Predictive Negative Value (PNV) 0.7%, S = 0.7%, E = 0.6% as a diagnostic marker. 20 patients have been discharged at the time of the cutoff, 4 remain hospitalized, and 3 deaths. 3/3 deaths had Liver Functions Tests (LFT) alterations. 55% (N = 11/20) of discharged patients had LFT alterations. None presented liver failure. Conclusions: Half of the patients affected with SARS-COV2 present LFT alteration, with predominance of cholestatic pattern in our sample. All deaths showed alteration at admission time, while 55% of discharged patients presented said alteration. The cause can be multifactorial, and involve hepatotoxicity due to drugs, deficient blood circulation, the effect of assisted ventilatory mechanics, among others, and not necessarily attributed exclusively to viral infection. Therefore, there is no evidence that suggests SARS-COV2 virus is directly hepatotropic. Serum ferritin could be useful in (ARDS) diagnosis secondary to SARS-COV2. Conflicts of interest: The authors have no conflicts of interest to declare.

SARS-CoV-2 nucleic acid shedding is variable for every person

INTRODUCTION: Considering the persistent positivity on RT-qPCR tests, the results of SARS-CoV-2 were monitored to evaluate the viral RNA shedding period. METHODS: Between March and June 2020, the sequential results of 29 healthcare workers' were monitored using RT-qPCR. RESULTS: More than 50% of the individuals remained RT-qPCR positive after 14 days. Furthermore, this is the first study to describe positive RT-qPCR for SARS-CoV-2 in a healthcare worker with mild symptoms 95 days after the first positive test. CONCLUSIONS: Sequential RT-qPCR results were heterogeneous, and the viral RNA shedding period is unique for each person.