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Introduction: Mastocytosis encompasses a heterogeneous group of diseases characterized by an accumulation of clonal mast cells (MC) in the skin and/or internal organs, and symptoms of MC activation. This MC activation can be elucidated by several factors, including infections or vaccination. Objective(s): We present our experience with COVID infection and vaccination in a series of 133 patients with pediatric mastocytosis. Method(s): Between January 1998 and December 2022, 133 pediatric patients have been referred to our hospital owing to clinically suspected MC disorder, mainly with mastocytosis in the skin. The final diagnoses of mastocytosis were established by the presence of typical skin lesions together with an increase of MC numbers in a biopsy from lesional skin or activating KIT mutations in lesional skin tissue. Serum baseline tryptase and total immunoglobulin E levels were measured, and patients underwent a comprehensive allergy workup to confirm atopic status and history of anaphylaxis. Regarding vaccination, REMA's (Spanish Network on Mastocytosis) protocol was followed. Result(s): 13 patients with COVID infection were identified, of which 25 (56,8%) were female and 0% had symptoms of MC activation. All of them had an asymptomatic or mild course of COVID infection. None of the patients experimented MC activation symptoms during viral illness. Regarding COVID vaccination, all patients received premedication with antihistamine 60 minutes prior vaccination. No one experimented immediate reactions and only one patient (0,75%) referred worsening of MC activation symptoms (baseline pruritus, urtication and brain fog) only after the first doses, recovering without changes in his treatment (oral cromoglycate and antihistamine) in two months. Discussion(s): Although MC have been implicated in the pathogenesis of cytokine storm in COVID19, there is no clinical evidence of SARSCoV- 2-induced MC activation, perhaps related to the fact that bone marrow MC lack angiotensin-converting enzyme 2 receptors.
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Aim: The Cirujanos en Accion and Hernia International foundations carried out their own and collaborative surgical campaigns in developing countries. In 2020 and 2021 the programme had to be suspended due to Covid. In 2022 we restarted our actions, analysed the difficulties of reactivation and described the campaigns that had been carried out and those that had to be delayed. Material/ Methods: We describe the 9 campaigns of Surgeons in Action, our own and in collaboration with Hernia International and our own campaign to the region of Naborno Karabakh, planned for September and cancelled 24 hours before departure due to the resurgence of armed conflict. An analysis is made of volunteers, places, type (adults or children or mixed), collaborations with other foundations, patients operated and procedures done according to pathologies, integration with local staff with exchange of knowledge. Result(s): Made in 8 countries (Benin, Camerun, Gambia (2), Kenya, Liberia, Mozambique, Tanzania, Sierra Leone) and postponed in one country, the Naborno Karabakh region of Armenia. 85 volunteers (25 general and 10 paediatric surgeons, 19 anaesthetists, 3 intensivists, 23 nurses, 5 audiovisuals);local staff;1144 patients (473 children, 671 adults), 1325 procedures for various pathologies (hernias, goitres, hydroceles, undescendend testis, soft tissue tumours, etc.) Conclusion(s): 9 campaigns have been carried out successfully and new locations have been opened with a good projection for the coming years, and we have experienced difficulties with the cancellation of a mega-campaign in an area with geopolitical conflicts - to be taken into account in the future.
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Virtual, augmented, and immersive reality opens a world of possibilities in education by allowing students to recreate authentic situations, such as operating machinery, assembling a product, or training tool handling, to mention a few. In the TEC21 educational model, the core is the challenge: A project with a real-world challenge assigned by the training partner results in students offering solution proposals.The trigger that accelerated the development of virtual, augmented, and immersive reality activities in distance learning was COVID-19 confinement. During this, these technologies recreated the laboratory and its facilities' learning through augmented reality (AR) and virtual reality (VR) experiences.Using these technologies in the classroom allows students to achieve a great learning experience and develop skills for postgraduate studies and professional futures.Furthermore, now that we have returned to our physical facilities and laboratories, we can accelerate the learning obtained at the training partners' facilities, recreating processes and machinery through these immersive technologies and a hybrid experience for our students.The present research shows the activity learning design process and the statistical treatment of the data to provide continuous feedback during the activity;we examine the three transcendental variables in the educational process: The learning (academic rigor), the development of competencies, and the involvement or immersion of the students in the classroom. © 2023 IEEE.
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Background: The COVID-19 pandemic resulted in disruptions to health care services. Vulnerable populations, including people living with HIV (PLHIV), may have experienced unique challenges when accessing medical care. The objective of this study was to evaluate the impact of social disruptions on health care visits among Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) participants. Method(s): A survey collecting data on missed health care visits and social disruptions (i.e., disruptions in employment, childcare, financial support, housing, and health insurance) during the pandemic was administered via telephone to MWCCS participants 1-3 times from March and September 2020. Logistic regression models adjusted for sociodemographics and HIV-status were used to test the association between social disruptions and three medical care interruption outcomes (i.e., missed healthcare appointment, interruption of mental health care, and interruption of substance use care). Result(s): Surveys (n=10,076) were conducted among 2238 PLHIV (61% women) and 1427 people living without HIV (PLWoH) (41% women). Overall, 42% of participants reported disruptions in health care with no significant difference by HIV status. Among participants receiving mental health care services and substance use treatment, 52% and 36% reported interruptions of care, respectively. Participants reporting >= 2 social disruptions were more likely to report missed health care appointments (adjusted odds ratio [aOR]: 1.81, 95% confidence interval [CI]: 1.54-2.13), and interruptions in mental health care [aOR: 2.42, 95%CI: 1.85-3.17) or substance use treatment (aOR: 1.97, 95%CI: 1.26-3.09), compared to those reporting no disruptions. Participants who were unemployed were more likely to miss health care appointments (aOR:1.46, 95% CI: 1.25-1.71) and report disruptions in mental health care (aOR: 2.02, 95% CI: 1.54-2.66) compared to those who were employed. PLHIV reporting >= 2 social disruptions were at increased risk for missed health care appointments (aOR 1.92, 95%CI: 1.56-2.36) and disruptions in mental health care (aOR: 2.54, 95%CI: 1.83-3.53 (Table 1). Conclusion(s): Social disruptions as a result of the COVID-19 pandemic have adversely impacted the receipt of health care among PLHIV and PLWoH, including the receipt of treatment for mental health and substance abuse. Providing childcare, financial support, housing, and health insurance may reduce disruptions in care and improve health outcomes.
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In recent years, the excessive use of electronic cigarettes (e-cigarettes), and vaping, as a re-placement for traditional tobacco cigarettes, have highlighted potential health risks for users. One such risk is the development of "electronic cigarette (vaping) product use-associated lung injury" (EVALI). This type of lung injury has an unclear cause that may be related to the various components found in e-cigarette fluids. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection (coronavirus disease . 2019 or COVID-19) may worsen EVALI symptoms in individuals with both conditions. This could be due to the increased oxidative stress and inflammation caused by e-cigarette use, as re-search shows increased levels of reactive oxygen species (ROS) and decreased glutathione. In this paper, we present two critical cases of COVID-19 patients with a history of chronic e-cigarette smoking and describe their clinical progression during hospitalization. The findings suggest that their prolonged use of e-cigarettes may have sig-nificantly impacted the severity of the disease.Copyright © 2023, The Indonesian Foundation of Critical Care Medicine. All rights reserved.
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Objective: To determine the incidence of SARS-CoV-2 infection and its association with sociodemographic, clinical, and occupational characteristics in health workers (HCWs) in the COVID-19 risk area. Material(s) and Method(s): Longitudinal analytical study in a cohort of TS from the "Zafiro" area of patients with suspected or confirmed diagnosis of SARS-CoV-2 infection. The identification of positive cases of SARS-CoV-2 was carried out with the RT-PCR test. Result(s): The cohort was made up of 114 SWs, with an average age of 35.3+/-7.4 years, with positions as general practitioner (26.3%), nursing assistant (21.1%) and nurse (19.3%). The incidence rate of SARS-CoV-2 (31.6%) and reinfection (1.8%) during seven months. The factors jointly associated with SARS-CoV-2: cohabitation with people at high risk of contagion (HR=2.406, 95% CI: 1.225, 4.726, p=0.011), the lowest educational level (HR=2.241, 95% C: 1.051, 4.782, p=0.037) and a higher consumption of sleep medications (HR=4.680, 95% CI: 1.328,16.486, p=0.016). Conclusion(s): The contagion rate of SARS-CoV-2 during seven months of the pandemic, in health workers was high (one in three SW) associated with cohabitation with high-risk people, lower educational level and higher consumption of medications for to sleep. A situation of concern in the HCWs was the suspected cases of SARS-CoV-2 reinfection.Copyright © 2022 Asociacion Colombiana de Infectologia. All rights reserved.
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Background Since March 2020, Chile has been affected by the coronavirus disease 2019 (COVID-19) pandemic, which has caused disruptions throughout the world, greatly impacting health services and healthcare workers. Objective To describe the demographic characteristics related to the COVID-19 pandemic in orthopedic surgeons and orthopedic surgery residents in Chile. Methods We conducted an on-line survey requesting data on demographics, work, exposure to and infection by COVID-19, symptoms, and protection practices. Results A total of 567 surgeons answered the survey;37 (6.4%) had had COVID-19, without gender differences. Therewas a higher rate of infectionamong residents, 9 from73 (12.3%), than among surgeons, 28 from 494 (5.7%), as well as higher rates of infection among those working more than 60 hours (p<0.05). Among those infected, 31 (83.8%) were from the Metropolitan Region (MR), where the rate of infection was significantly higher compared with other regions (p< 0.05). Only 8 (21.6%) of those infected had medical history. Hospitalization was required by 3 (5.4%), 1 of them in the Intensive care Unit (ICU), and the remaining were handled at home. The most frequent location of infection was the workplace, with the common areas being the main suspected sites, followed by outpatient clinics and orthopedic surgery wards. In total, 40.5% (15) of the sample reported having infected other individuals. There was also an impact in the surgeon s income: 14.8% (84) reported a decrease lower than 20%, and 45% (256), a decrease higher than 50%. This decrease was higher among surgeons than among residents, and higher among those from the MR compared to other regions (p< 0.05). Conclusion Even though orthopedic surgery practice has been reduced by the pandemic, orthopedic surgeons have been exposed to the risk of infection by COVID-19. The workplace seems to be the site that poses the greatest risk, especially the common areas.Copyright © 2022 Georg Thieme Verlag. All rights reserved.
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The management and evaluation of projects is an art, teaching this art in educational projects is a challenge. Students are required to have a specific vision of the organizations to be able to define both the problem and with this, define the project that solves the problem, the visits and interaction with the organizations allow students to have the context to generate their project. Due to the confinement by Covid19, educational innovations were generated that allowed simulating the car manufacturing process, as well as the transactions carried out in the different entities of the organization through an online ERP simulator called VEP (Virtual Enterprise Planning) and the use of mixed reality lessons (virtual and augmented). In the simulation, it was possible to replicate problems that had to be solved with a project, which was designed and managed by the students. In this paper, we share the methodologies for the design of learning activities and the preparation of lessons in virtual and augmented reality, as well as the results obtained in their application in administration and project management courses. © 2022 by the authors. Licensee AEIPRO, Spain.
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Background: Racial and ethnic minorities have well-established disparities in cancer prevention, detection, treatment, and survival. A diverse oncology workforce improves the gap in cancer care for vulnerable populations. However, physicians, researchers, and others who are Underrepresented in Medicine (UIM) face unique challenges in obtaining mentorship and sponsorship, and there is a lack of safe spaces for them to thrive, forcing many to leave medicine entirely. To further efforts in improving the care of vulnerable populations and to create a welcoming environment for UIM medical trainees, the Florez Lab (formerly known as the Duma Lab) was founded by Dr. Narjust Florez in 2019 at the University of Wisconsin. Subsequently, Dr. Florez moved to Dana-Farber Cancer Institute and expanded the lab's reach. Here, we describe the history and legacy of our innovative group. Method(s): The Florez Lab is composed of 39 members, mostly UIM from different backgrounds and locations;members range from college students to faculty. It began as an allfemale team but now includes #HeforShe member allies. Several members joined as trainees, but are now junior faculty at NCI designated cancer centers and pay it forward by mentoring the next generation of the Florez Lab. We focus on social justice issues in medicine, including discrimination and gender bias in academic and clinical medicine, global oncology, and cancer health disparities, with a focus on thoracic oncology. Result(s): To date, the Florez Lab has secured research funding from several institutions and organizations, and has published 15 original articles, 11 editorials, 4 review articles, and 2 book chapters in addition to over 20 poster presentations at national and international conferences. Members have presented research findings at a wide array of national and international conferences, including the American Society of Clinical Oncology (ASCO) Annual Meeting and the World Conference on Lung Cancer, and the American Association for Cancer Research (AACR) Annual Meeting. The lab collaborates with multiple organizations, including the COVID-19 and Cancer Consortium (CCC19), ASCO Health Equity Committee, and the Lancet Commission: Women & Cancer. The lab is far-reaching;the #DumaLab and #FlorezLab hashtag is used on Twitter to amplify published work and advocacy efforts in improving the diversity of the oncology workforce and clinical trial enrollment. In 2021 the Florez Lab began a collaboration with Medscape and is the first lab to have a dedicated column, where we discuss issues related to social justice in medicine and cancer health disparities;the column has reached over 60,000 readers in less than one year. Conclusion(s): The success of the Florez Lab illustrates the importance of providing opportunities for, supporting, and amplifying the success of UIM trainees. Results indicate that the collaboration of UIM trainees is productive, meaningful, and necessary. Efforts should be made to continue supporting UIM trainees from all backgrounds and levels.
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OBJECTIVE: To determine the prevalence of CMV reactivation in a population admitted for severe COVID-19 to a general hospital. METHODS: Point prevalence study in all hospitalized patients with severe COVID-19 (admitted either to general wards or ICU). Determination of the presence of CMV DNA in circulating blood. COVID-19 was confirmed in patients with compatible clinical manifestations, usually with pneumonia and a positive nasopharyngeal PCR test. RESULTS: We included 140 hospitalized patients with COVID-19 who consented to participate. A total of 16 patients (11.42%), had circulating CMV-DNA in peripheral blood at the time of the study. Patients with positive CMV viral load were mainly ICU patients (11/37 -29,7%) and only 5/103 cases (4,85%) were hospitalized into general wards. The accumulated doses of corticosteroids (prednisone equivalents) in the study day were (median and IQR) 987.50 mg (396.87-2,454.68) and 187.50 mg (75.00-818.12) respectively in CMV positive and negative patients (p < 0.001). A significant proportion of CMV positive patients were discovered because of the study and were clinically unsuspected by their physicians. The coinfected COVID-CMV positive population had a higher risk of accumulated secondary nosocomially-acquired infections and a worse prognosis. CONCLUSIONS: CMV reactivation should be systematically searched in patients in COVID-19 cases admitted to the ICU.
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Introduction: Coronavirus disease 2019 (COVID-19) has been associated with high in-hospital mortality. Since the implementation of guidelines and improvement in the quality of cardiopulmonary resuscitation (CPR), the survival rate for non-COVID-19 patients has improved. There is, however, scarce data regarding in-hospital cardiac arrest outcomes in COVID-19 patients. This study aimed to investigate cardiac arrest outcomes in patients hospitalized for COVID-19. Method(s): Retrospective study of the data of 994 adult patients admitted to a single-center high acuity critical care COVID-19 unit between March 2020 and February 2022 with COVID-19 diagnosis. Patients who underwent CPR were identified. Resuscitation registers and demographic information were obtained. The primary outcome was survival to hospital discharge. Secondary assessments were the initial rhythm and duration of CPR. Descriptive statistics were utilized. Result(s): A total of 994 COVID-19 patients were included in the study. 129 (13%) had a cardiac arrest and underwent CPR. Two patients survived hospital discharge (1.6%). Of them, 91(70.5%) were male. Mean age was 68.6 (+/-13.5) years. Median BMI was 29.1 [25.8-35.7] Kg/m2. The most frequent comorbidity was hypertension in 59 patients (46.1%), followed by diabetes type 2 in 30 patients (23.4%), and there were 37 (28.9%) patients with no comorbidities. The median time from admission to cardiac arrest was 12[6-18.5] days, the most common rhythm at the time of cardiac arrest was asystole in 94 (72.9%) patients, followed by pulseless electrical activity in 25 (19.4%);Ventricular dysrhythmias occurred in 7 (5.5%)of the cases. Finally, the median duration of CPR was 20[13.7-29] minutes. Conclusion(s): Survival of COVID-19 patients after in-hospital cardiac arrest was dismal, despite the adequate implementation of resuscitation protocols. Many of these patients were overweight or obese with comorbid conditions. The most common presenting rhythm was a non-shockable rhythm.
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INTRODUCTION: Advanced age is frequently cited as a prognostic indicator in critically ill patients. This study aimed to assess the association between outcomes in three age subgroups of older adults with COVID 19 patients. METHOD(S): Retrospective analysis of 994 adult patients admitted to our hospital between March 2020 and February 2022 with COVID-19. Patients with ages on admission >= 65 years were included and classified as young-old (65- 74 years), middle old (75-84 years), and oldest old (>= 85 years). Primary endpoints were survival, hospital length of stay (LOS), and need for mechanical ventilation. Secondary assessments included code status, ICHIKADO score, and the highest value of IL-6. Descriptive statistics, Pearson Chisquare, and Mann-Whitney-U methods were used. A p value <= 0.05 was considered statistically significant. RESULT(S): 293 patients with age on admission >= 65 years were included in this analysis. 183 (68.5%) were young old patients, 81(27.6%) middle old patients, and 29(9.9%) oldest old patients. The median age for non-survivors was 73[69- 78.2] years vs 72[68-78] years for survivors. 56(30.6%) patients from young old group died, 28 (34.6%) died in middle old group and 10(34.5%) in the oldest old (X2(2) =0.491, p=0.78). 22(12%) of the young old group were do not resuscitate (DNR), 11(13.6%) in the middle old group, and 7(24%) in the oldest old group(X2(2) =3.118, p=0.21). LOS for young old patients was 9[4-15] days, 10[5-16] days for middle old, and 8[5-13] days for oldest-old (H(2)=1.070 p=0.58). A total of 25(13.7%) young old patients required mechanical ventilation, 11(13.6%) middle old patients and 5(17.2%) oldest old patients (X2(2) =0.282, p= 0.86). ICHIKADO score was 160[121-200] in the young old group, 150 [110-230] in the middle old and 145[119.2-176.2] in the oldest old group (H(2) =1.426,p= 0.49). Regarding inflammatory markers, IL-6 wasn't different between the groups. In the young old IL-6 was 40.9[8.9-176.5]pg/ mL, 74.45[12-374.3]pg/mL in the middle old and 51.85 [14.25-812.2]pg/mL in the oldest old group (H(2) =3.336, p=0.189). CONCLUSION(S): Oldest old patients were not found to have increased IL6, worse computed tomography findings, increased risk of death, length of stay, or need for mechanical ventilation than their younger counterparts.
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INTRODUCTION: Coronavirus disease 2019 (COVID-19) infection has been associated with the development of acute kidney injury (AKI) in some patients. The purpose of this study was to assess the mortality rates among different ethnicity of COVID-19 patients who developed AKI. METHOD(S): A retrospective study of adult patients admitted to our hospital with COVID-19 from March 2020 to February 2022 was performed. Patients were divided into three groups based increased creatinine levels compared to their baseline creatinine, according to the KDIGO Guidelines for AKI: Stage 1 (S1;1.5 -1.9 times baseline creatinine), Stage 2 (S2;2.0-2.9 times baseline creatinine), and Stage 3 (S3;>3.0 times baseline creatinine). Survival to hospital discharge was assessed for each individual. Descriptive statistics, Chisquare, and Mann-Whitney tests were utilized. A p value <= 0.05 was considered statistically significant. RESULT(S): 192 patients with AKI admitted to our hospital with COVID-19 were included in this study. The median age was 61 [18-95]. 75 (39.1%) were female.101 (52.6%) patients survived. 111 (57.8%) were Hispanic, 22 (11.5%) were African-American, 48 (25.0%) were Caucasian, and 8 (4.2%) had other ethnicities. 45 (23.4%) patients were classified in S1, 52 (27.1%) were in S2, and 95 (49.5%) were in S3. In S1, 15 (33.3%) patients died and 30 (66.7%) survived. In S2, 24 (46.2%) died and 28 (53.8%) survived. In S3, 52 (54.7%) died and 43 (45.3%) survived. There was no correlation between mortality and AKI staging. (chi2(2) = 5.655, p = 0.059). Of 48 Caucasians, 10 (20.8%) had S1 on admission, 14 (29.2%) S2, and 24 (50.0%) S3. Of 111 Hispanics, 25 (22.5%) had S1, 31 (27.9%) S2, and 55 (49.5%) S3. Of 22 African-Americans, 7 (31.8%) had S1, 5 (22.7%) had S2, and 10 (45.5%) S3. Of 8 in other ethnicities, 1 (12.5%) had S1, 2 (25.0%) S2, and 5 (62.5%) S3. There was no statistical significance between AKI staging on admission and race. (chi2(6) = 1.845, p = 0.933). CONCLUSION(S): The development of AKI is not associated with increased mortality for any specific ethnicity.
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INTRODUCTION: Elevated D-dimer levels are common in hospitalized COVID-19 patients. We aimed to investigate the correlation between D-dimer levels and survival, as well as ICHIKADO, APACHE II, and SOFA scores. METHOD(S): Retrospective study of adult patients with COVID-19 admitted to the hospital between March 2020 and February 2022. Patients were divided into three groups according to D-dimer levels: group 1 (G1) had levels less than 0.5 mg/L, group 2 (G2) had 0.5 to 3.99 mg/L and group 3 (G3) was above 4 mg/L. The primary outcome was survival to hospital discharge. Descriptive statistics, Chi-square, and Kruskal-Wallis tests were used. A p value <= 0.05 was considered statistically significant. RESULT(S): 830 patients were included in the study. 464 (55.9%) patients were men. Median age was 56 [45-66] years. There was a statistically significant association between D-dimer levels and survival rate. A total of 677 (81.6%) patients survived. 401 (89.3%), 235 (74.8%), and 41 (61.2%) patients survived in G1, G2, and G3 respectively, p < 0.001. There was also a statistically significant association between D-dimer levels and different severity scores. Median ICHIKADO scores across D-dimer levels;G1 had a median score of 140.00 [115-180]], G2 had a score of 157.50 [120-205], and G3 had a score of 200.00 [160- 245] (H (2) = 55.345, p < 0.001). APACHE II scores across the groups;G1 had a median score of 7.00 [5-11], G2 had a score of 10.50 [7-16], and G3 had a score of 12.00 [8-19] (H (2) = 76.817, p < 0.001). For SOFA scores, G1 had a median score of 2.00 [1-2], G2 had a score of 2.00 [1-3.25], and G3 had a score of 4.00 [2-6] (H(2)= 81.309, p < 0.001). CONCLUSION(S): In this cohort, elevation of D-dimer levels was associated with decreased survival rates as well as with increased ICHIKADO, APACHE II, and SOFA scores.
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INTRODUCTION: Increased mortality due to COVID-19 in the intensive care unit (ICU) raised questions about the best way and time to use invasive mechanical ventilation (IMV). The purpose of this study is to analyze effectiveness of IMV in COVID-19 patients. METHOD(S): We performed a retrospective analysis of adult patients admitted to our hospital with COVID-19 infection from May 2020 to December 2021. We reviewed the need of IMV in patients admitted to the ICU with APACHE II scores higher than 12.5. Outcomes from the IMV-receiving patients were compared to outcomes from patients on non-invasive mechanical ventilation (NIMV). The second analysis of IMV aimed to determine the best initiation time for IMV. Patients were divided into Group1: early intubation (IMV within the first 24hrs of admission) and Group2: late intubation (IMV later than 24hrs after admission). Primary outcomes included mortality and length of stay (LOS) in the ICU. Descriptive statistics, Mann-Whitney-U and Chi-square methods were used. RESULT(S): For the first part of the analysis, 82 patients were included. They were divided into 2 groups (IMV and NIMV) of 41 patients each. Median age in IMV group was 67 [51.5- 75.5] vs 64 [47.5-73.5]. 21 (51.2%) patients died in the IMV group vs 22 (53.7%) X2(1, N=82)=0.049, p=0.5. Median LOS in the IMV group was 10 [6-16] days vs 11 [5-19.5] days U(NIMV group=41, NNIMV group=41)=819, z=-0.2, p=0.84. For the second analysis, 68 patients were included. They were divided into 2 groups (Group1 and 2) of 34 patients each. Median age in group1 was 53.5 [25-90] vs 53.5 [37.75-65.25]. 19 (55.9%) patients in group1 were male vs. 26 (76.5%). The median APACHE II, SOFA and ICHIKADO scores on admission in group1 were 8 [6-10.5], 1.5 [1-2], 120 [110-165] points respectively vs 9.5 [6-16.5], 2 [1-4], 150 [132.5-200] points. 3 (8.8%) patients died in group1 vs 11 (32.4%) X2(1, N=68)=5.76,p=0.033. Median LOS in group1 was 4.5 [3-8.5] days vs 6 [3.75-10.5] days U(NGroup1=34, NGroup2=34)=450, z=-1.59, p=0.113. CONCLUSION(S): In COVID-19 patients admitted to the ICU with APACHE II score higher than 12.5, mortality and LOS were not significantly different in patients that received IMV vs those that received NIMV. Early intubation correlated with improved mortality, but not with length of ICU stay.
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INTRODUCTION: The antiviral efficacy of remdesivir is still controversial. We aimed to evaluate the impact of remdesivir use in patients admitted to our intensive care unit (ICU) with COVID-19. METHOD(S): A retrospective study of adult patients admitted to our hospital with COVID-19 infection from March 2020 to September 2021 was performed. Patients were divided into 2 groups;Group1 received remdesivir while Group2 did not. The primary outcomes studied were mortality rate, length of stay (LOS) in the ICU and the need of invasive mechanical ventilation (IMV). Additional outcomes assessed were highest APACHE II during stay and inflammatory markers (Ferritin, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)). Descriptive statistics, Mann-Whitney-U and Chisquare methods were used. RESULT(S): 227 patients were included, median age was 57 years [46-68]. 122 (53.7%) were male. 113 patients were in Group1 vs 114 in Group2. Median age in Group1 is 58 years [45.75-68] vs 57 years [46.5-68] in Group2. In Group1, 64 (56.1%) were male vs 58 (51.3%). The median APACHE II score on admission for group1 was 8 [5-12] vs 9 [6-12]. The median SOFA score on admission for group1 was 2 [2-3] vs 2 [1-2.75]. The median ICHIKADO score on admission for group1 was 160 [120-200] vs 140 [110-180]. 24 (21.1%) patients died in group1 vs 21 (18.6%) in group2 x2(1, 227) = 0.218, p = 0.74. The median LOS of group1 was 7 [4-10] vs 7 [5-11] U(NGroup1=114, NGroup2=113)=6400, z=- 0.083, p=0.934. 16 (14%) patients in group1 needed IMV vs 22 (19.5%) in group 2, x2(1, 227) = 0.273, p = 0.291. The median of the highest APACHE II score in group1 was 10 [6- 17.5] vs 11 [7-15] U(NGroup1=114, NGroup2=112)=6163, z=-0.45, p=0.652. In group1, median ferritin, CRP and ESR were 486.6 [246.75-1184.5] ng/ml, 90.35 [39.48-135] mg/L, 85 [60-106.5] mm/hr, respectively vs. 493.3 [174.6- 1025.5] ng/ml, 69.6 [35.25-116.75] mg/L, 77 [47.5-110] mm/hr, U(NGroup1=114, NGroup2=107)=5614.5, z=- 1.022, p=0.307, U(NGroup1=56, NGroup2=34)=854, z=- 0.816, p=0.415, U(NGroup1=113, NGroup2=110)=5644.5, z=-1.185, p=0.236, respectively. CONCLUSION(S): There is no difference in mortality, severity scales nor inflammatory markers in patients that were treated with remdesivir compared to those who were not.
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INTRODUCTION: Thrombocytopenia (TCP) can be caused by Epstein-Barr Virus (EBV), Cytomegalovirus (CMV), and Coronavirus Disease 2019 (COVID-19). This study aimed to evaluate the degree of TCP in COVID-19 patients with coinfection with EBV and/or CMV. METHOD(S): Retrospective study of adult patients admitted to our hospital with COVID-19 infection from March 2020 to February 2022 was conducted. Patients were divided into two groups. Group 1 (G1) had viral co-infection with EBV and/or CMV and group (G2) did not. These groups were analyzed based on the degree of TCP. Thrombocytopenia was classified into mild (100-150x103/uL), moderate (50- 99x103/uL), and severe (< 50x103/uL). Primary outcomes were mortality, need for ventilation (NFV), and length of stay (LOS). Descriptive statistics, crosstabulation, Chi-square, and Mann-Whitney tests were used. RESULT(S): Of 994 patients, 445 with a median age of 57 [45-68] years were tested for viral co-infection. 262 (58.9%) were male and 327 (73.5%) survived. There was a statistically significant association between co-infection and TCP, X2(3)= 22.335, p= <.001. Of 218 patients in G1, 98 (45.0%) had normal platelet count (NPC), 44 (20.2%) had mild TCP, 47 (21.6%) had moderate, and 29 (13.3%) had severe. Of 227 patients in G2, 132 (58.1%) had NPC, 59 (26.0%) had mild TCP, 26 (11.5%) had moderate, and 10 (4.4%) had severe. There was a statistically significant association between coinfection and mortality, X2(1)= 36.682, p= <.001. In G1, 86 (39.4%) died and 132 (60.6%) survived. In G2, 32 (14.1%) died and 195 (85.9%) survived. There was a significant difference in LOS between the groups, [U= 16935.50, p= <.001]. G1 had a median LOS of 12 [6-19] days and G2 had a median of 7 [4-11] days. There was no statistically significant association between co-infection and NFV, X2(1)= .033, p= .856. In G1, 34 (15.6%) patients were mechanically ventilated and 184 (84.4%) were not. In G2, 34 (15.0%) were ventilated and 193 (85.0%) were not. CONCLUSION(S): COVID-19 and viral co-infection with EBV and/or CMV is associated with the presence of thrombocytopenia, mortality, and longer LOS in hospitalized patients. The presence of co-infection is associated with moderate and severe TCP.