VACCINATION AGAINST COVID-19 IN PARAGUAYAN PATIENTS WITH RHEUMATOID ARTHRITIS

BackgroundIn February 2021, the first doses of COVID-19 vaccines were received in Paraguay, and rheumatic patients were the preferred population to get these vaccines. Up to December 2022 the vaccination coverage in Paraguay was 59.4%, with at least one vaccine dose. 52.4% accessed the primary scheme (two doses), while 28.6% had at least one booster dose. Only 7.1% completed the COVID-19 immunization scheme.ObjectivesTo describe vaccination against COVID-19 in Paraguayan patients with Rheumatoid Arthritis (RA).MethodsDescriptive, cross sectional, observational study, in a Paraguayan cohort of RA patients meeting ACR/EULAR2010 criteria, under follow-up in two Rheumatology reference centers, from October to December 2022. A standardized questionnaire according to the variables included (clinical, vaccination, vaccine type, number of doses) was made. Quantitative variables were presented as means and qualitative as frequencies.Results568 patients with RA were included, 84.1% were female, mean age 55.48±13.94 years old. 23.9% patients were from Hospital de Clínicas and 76.1% from Hospital Central del Instituto de Previsión Social. The average number of received vaccinations doses was 2.54±1.19. 88.7% of patients acquired at least one dose of COVID-19 vaccine, 85% obtained two doses;and, while 60.9% of patients received the first booster, 21.2% had the second one.ConclusionIn this series of Paraguayan RA patients, vaccination against COVID-19 is higher than the general population, perhaps due to priority of patients with rheumatic diseases receiving immunization, and frequent access to medical care with physician's prompt to receive vaccinations. While over 80% of patients have a complete primary schedule, and more than 60% received the first booster;only 21% have a complete immunization schedule, which is still much higher than the general population in Paraguay.Table 1.Vaccines in Paraguayan patients with Reumatoid ArthritisVaccines against COVID-19First Dose n: 504Second Dose n: 483First booster n: 344Second booster n: 122Sputnik V(Gam--COVID-Vac) n (%)149 (26.2)137 (24.1)10 (1.8)0Astrazeneca (ChAdOx1 nCoV-19) n (%)172 (30.3)171 (30.1)110 (19.4)36 (29.5)Pfizer n (BNT162b2) (%)81 (14.3)80 (14.1)198 (34.9)68 (55.7)Moderna (mRNA-1273) n (%)41 (7.2)38 (6.7)22 (3.9)18 (14.8)Hayat Vax n (%)29 (5.1)28 (4.9)1 (0.2)0Sinopharm BBIBP n (%)2 (0.4)1 (0.2)00Covaxin n (%)28 (4.9)26 (4.6)3 (0.5)0CoronaVac n (%)2 (0.4)2 (0.4)00REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Covid 19 in Patients with Rheumatic Diseases

Objectives: BIOBADAGUAY is the Paraguayan/Uruguayan registry of adverse events in patients with inflammatory rheumatic conditions under biologic therapy (BT). Three years have elapsed from the first case of coronavirus and data about South American patients with COVID are still scarce. In this study we analyzed the frequency and clinical outcomes of COVID-19 in a cohort of patients with rheumatic diseases from Paraguay. Method(s): A cross sectional study of Paraguayan patients with rheumatic diseases from BIOBADAGUAY and controls without BT. Clinical, epidemiological, and COVID-19 data were analyzed. Only cases confirmed by SARSCoV-2 positive PCR test were included. Descriptive analysis were performed for this study. Result(s): 832 patients were included (696 under BT and 136 controls). 116 (13.9%) had COVID-19. 22 had a second infection and 9 a third reinfection. Table 1 shows characteristic of COVID-19 patients. The most frequent diagnosis was rheumatoid arthritis (n = 93, 80.2%) followed by ankylosing spondylitis (n = 6, 5.2%), undifferentiated spondylarthritis (n = 5, 4.3%), psoriatic arthritis (n = 4, 3.4%), juvenile onset arthritis (n = 2, 1.7%), vasculitis (n = 2, 1.7%). Only 1 case (0.8%) were registered for Still's disease, enteropathic spondylarthritis, systemic sclerosis and seronegative polyarthritis, respectively. When comorbidities were analyzed, 46 (39.6%) patients had at least one (Table 1). Of the total treatments received: 65 (56.0%) had methotrexate, 53 (45.7%) leflunomide, 3 (2.5%) sulfasalazine, 15 (12.9%) hydroxychloroquine, 25 (21.5%) glucocorticoid, 52 (44.8%) anti-TNF and 20 (17.2%) non-anti-TNF. COVID-19 severity outcomes were: 101(87%) non severe, 31 (26.7%) severe and 1 fatal(0.8%). 189 (90.9%) patients received vaccination and the mean number of doses were 2.5 doses. 55 (26.4%) had COVID prior to vaccination Conclusion(s): In this study we examined the frequency of COVID-19 in Paraguayan patients with rheumatic diseases. In this cohort of rheumatologic patients, COVID 19 severity was similar to the one in the general population.

Immunization against Covid-19 in a Population of Patients with Rheumatoid Arthritis

Objectives: Immunization against COVID-19 in Paraguay began in February 2021, and patients with rheumatic diseases were the preferred population to get vaccinated. Up to December 2022 the immunization coverage in Paraguay was 59.4%, with at least one vaccine dose. 52.4% accessed the primary immunization schedule (two doses), while 28.6% had at least one booster dose. Only 7.1% received the complete schedule. The aim of this study was to describe the frequency of vaccination, the number of doses, and the type of vaccines against COVID-19 in Paraguayan patients with Rheumatoid Arthritis (RA). Method(s): Descriptive, cross sectional, observational study, in a Paraguayan cohort of RA patients meeting the 2010 ACR/EULAR criteria, under follow-up in two Rheumatology reference centers, from October to December 2022. A standardized questionnaire according to the variables included (clinical, vaccination, vaccine type, number of doses)was made. Quantitative variables were presented as means and qualitative as frequencies. Result(s): 568 patients with RA were included, 84.1% were female, mean age 55.48 +/- 13.94 years. The average number vaccinations doses received was 2.54 +/- 1.19. 88.7% of patients acquired at least one dose of COVID-19 vaccine, 85%obtained two doses;and, while 60.9% of patients received the first booster, 21.2% had the second one. The table describes the characteristics of the received vaccines. Conclusion(s): In this series of Paraguayan RA patients, vaccination against COVID-19 was higher than the general population, perhaps due to priority of patients with rheumatic diseases receiving immunization, and frequent access to medical care with physician's prompting them to receive the vaccine. While over 80% of patients have a complete primary schedule, and more than 60% received the first booster;only 21% have a complete immunization schedule, which is still much higher than the general population of Paraguay.

Zero COVID 19 Occurrence among 206 of 1023 Migrants of War from Syria at the Czech Border (Rapid Research Note)

Recent war conflicts in Europe and Middle East generate new refugee wawes and possible dissemination of Covid I9 variants from countries with low vaccination activity due to armed events.Therefore we have tested all migrants of war(206) coming via Hungarian Slovak Czech Border,within one week among 1023 refugees of war..who had symptoms of respiratory infection.None of tested symptomatic individuals was pos- itive by rapid antigen test.Therefore the the risk ofCOVID I9 dissemination was not been confirmed.

Deadly Synergy: between Postcovid & Posttrauma Stress Syndrome in Areas of Armed Conflicts in COVID-I9 Era (Note)

Postcovid syndrome affects 5-20% of all patients with symp-tomatic Covid-I9 infection, resulting in temporary or perma-nent disability for next weeks or months. The commonest syn-dromes after long Covid-I9, (or chronic fatigue syndrome after Covid, or as synonymum postcovid syndrome) are psychic or psychosomatic disorders known under the name Depression and Anxiety Syndrome. After the unrest and armed conflicts during the Covid era, clients or patients, mainly migrants of war, are also exposed to chronic post trauma syndrome related to previous or recent de-struction of infrastructure, temporary homelesness and escape from affected regions/country. Cumulation of those 2 syndro-mes may have devastating consequences to both, individual health and economic losses due to permanent working and eco-nomy disabilities and consumption of health and social funds. After the unrest and armed conflicts during Covid era,clients or patients, mainly migrants of war, are also exposed to chronic post trauma syndrome related to previous or recent destruction of infrastructure, temporary homelesness and escape from af-fected regions/country.

Low stroke incidence in the TEMPiS telestroke network during COVID-19 pandemic: Effect of lockdown on thrombolysis and thrombectomy.

BACKGROUND: During the COVID-19 pandemic emergency departments have noted a significant decrease in stroke patients. We performed a timely analysis of the Bavarian telestroke TEMPiS "working diagnosis" database. METHODS: Twelve hospitals from the TEMPiS network were selected. Data collected for January through April in years 2017 through 2020 were extracted and analyzed for presumed and definite ischemic stroke (IS), amongst other disorders. In addition, recommendations for intravenous thrombolysis (rtPA) and endovascular thrombectomy (EVT) were noted and mobility data of the region analyzed. If statistically valid, group-comparison was tested with Fisher's exact test considering unpaired observations and ap-value < 0.05 was considered significant. RESULTS: Upon lockdown in mid-March 2020, we observed a significant reduction in recommendations for rtPA compared to the preceding three years (14.7% [2017-2019] vs. 9.2% [2020], p = 0.0232). Recommendations for EVT were significantly higher in January to mid-March 2020 compared to 2017-2019 (5.4% [2017-2019] vs. 9.3% [2020], p = 0.0013) reflecting its increasing importance. Following the COVID-19 lockdown mid-March 2020 the number of EVT decreased back to levels in 2017-2019 (7.4% [2017-2019] vs. 7.6% [2020], p = 0.1719). Absolute numbers of IS decreased in parallel to mobility data. CONCLUSIONS: The reduced stroke incidence during the COVID-19 pandemic may in part be explained by patient avoidance to seek emergency stroke care and may have an association to population mobility. Increasing mobility may induce a rebound effect and may conflict with a potential second COVID-19 wave. Telemedical networks may be ideal databases to study such effects in near-real time.

CAPTAÇÃO DE DOADORES EM UM HOSPITAL DE TRAUMA DE PORTO ALEGRE/RS DURANTE A PANDEMIA

Objetivos: Desenvolvimento e implementação de reforço do processo de captação ativa de doadores de sangue, a fim de suprir as demandas do Hospital Cristo Redentor (HCR), especializado no atendimento às vítimas de trauma na cidade de Porto Alegre/RS, tendo início em setembro de 2020. Material e métodos: Elaboração e implementação de um fluxo de abordagem humanizada, educativa e transparente dos usuários e familiares para captação/ sensibilização quanto à importância da doação de sangue. O fluxo tem início na entrada do paciente no hospital, adotando estratégia mais abrangente com todos os familiares dos pacientes internados. A solicitação de doadores varia conforme o tipo de cirurgia a ser realizado. As abordagens ocorrem com os pacientes ambulatoriais que internam para realizar cirurgias eletivas, durante a consulta médica e de enfermagem e na marcação cirúrgica. Os pacientes internados vindos da emergência têm seus familiares abordados pela equipe do Serviço Social, de forma a esclarecer as dúvidas referentes à doação e entendimento da importância quanto à necessidade de manter os estoques de hemocomponentes para atender as demandas da hemoterapia. Resultados: A partir da implementação do fluxograma de captação/sensibilização de doadores ocorreu aumento do número de doações direcionadas ao HCR recebidas no Banco de Sangue do Hospital Nossa Senhora da Conceição, que abastece a demanda de estoques de hemocomponentes do serviço. A Agência Transfusional do HCR realiza em média 250 transfusões mensais (período da pandemia), dessas 174 são de Concentrado de Hemácias (CH). O cálculo do percentual de doadores reposição é realizado de acordo com a equação: número de doadores aptos/número total de transfusões de CH. O percentual de reposição foi de 54% (1° semestre 2020) para 111% (2° semestre 2020) e 140% (1° semestre 2021). Discussão: Considerando a drástica diminuição de doações de sangue durante o período da pandemia de COVID-19 e a necessidade de manter um estoque adequado para atendimento de vítimas de trauma, foi necessário o desenvolvimento de estratégias que possibilitassem um incremento do número de doações, a fim de suprir as demandas da Agência Transfusional do HCR. Após a implementação de uma abordagem mais ativa sobre a importância da doação de sangue, observamos uma maior mobilização de amigos e familiares de pacientes internados e consequentemente aumento no número de doações para o HCR, mesmo em nome de pacientes que não necessitaram efetivamente de transfusão. Conclusão: O trabalho de captação de doadores é uma tarefa contínua e integrada que requer participação de todos profissionais da saúde. Diante das adversidades enfrentadas na pandemia, diminuição da capacidade de atendimento de doadores no Banco de Sangue, doações com horário marcado e o isolamento social foi necessário criar métodos para continuar atendendo a demanda de transfusões. O esclarecimento quanto à segurança da doação e da importância da mesma para familiares dos pacientes foi fundamental para o engajamento no processo de captação de doadores. Esse esforço resultou em um salto na média de doadores de reposição de 54% no primeiro semestre de 2020 para 140% no primeiro semestre de 2021. Um aumento considerável no número de doadores de sangue mesmo em um período complicado por tantas restrições.

Safety, Pharmacokinetics, and Activity of High Dose Ivermectin and Chloroquine against the Liver Stage of Plasmodium cynomolgi Infection in Rhesus Macaques

Previously, ivermectin (1 to 10 mg/kg of body weight) was shown to inhibit the liver-stage development of Plasmodium berghei in orally dosed mice. Here, ivermectin showed inhibition of the in vitro development of Plasmodium cynomolgi schizonts (50% inhibitory concentration [IC50], 10.42 micro M) and hypnozoites (IC50, 29.24 micro M) in primary macaque hepatocytes when administered as a high dose prophylactically but not when administered in radical cure mode. The safety, pharmacokinetics, and efficacy of oral ivermectin (0.3, 0.6, and 1.2 mg/kg) with and without chloroquine (10 mg/kg) administered for 7 consecutive days were evaluated for prophylaxis or radical cure of P. cynomolgi liver stages in rhesus macaques. No inhibition or delay to blood-stage P. cynomolgi parasitemia was observed at any ivermectin dose (0.3, 0.6, and 1.2 mg/kg). Ivermectin (0.6 and 1.2 mg/kg) and chloroquine (10 mg/kg) in combination were well-tolerated with no adverse events and no significant pharmacokinetic drug-drug interactions observed. Repeated daily ivermectin administration for 7 days did not inhibit ivermectin bioavailability. It was recently demonstrated that both ivermectin and chloroquine inhibit replication of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro. Further ivermectin and chloroquine trials in humans are warranted to evaluate their role in Plasmodium vivax control and as adjunctive therapies against COVID-19 infections.

VPipe: an Automated Bioinformatics Platform for Assembly and Management of Viral Next-Generation Sequencing Data.

Next-generation sequencing (NGS) is a powerful tool for detecting and investigating viral pathogens; however, analysis and management of the enormous amounts of data generated from these technologies remains a challenge. Here, we present VPipe (the Viral NGS Analysis Pipeline and Data Management System), an automated bioinformatics pipeline optimized for whole-genome assembly of viral sequences and identification of diverse species. VPipe automates the data quality control, assembly, and contig identification steps typically performed when analyzing NGS data. Users access the pipeline through a secure web-based portal, which provides an easy-to-use interface with advanced search capabilities for reviewing results. In addition, VPipe provides a centralized system for storing and analyzing NGS data, eliminating common bottlenecks in bioinformatics analyses for public health laboratories with limited on-site computational infrastructure. The performance of VPipe was validated through the analysis of publicly available NGS data sets for viral pathogens, generating high-quality assemblies for 12 data sets. VPipe also generated assemblies with greater contiguity than similar pipelines for 41 human respiratory syncytial virus isolates and 23 SARS-CoV-2 specimens. IMPORTANCE Computational infrastructure and bioinformatics analysis are bottlenecks in the application of NGS to viral pathogens. As of September 2021, VPipe has been used by the U.S. Centers for Disease Control and Prevention (CDC) and 12 state public health laboratories to characterize >17,500 and 1,500 clinical specimens and isolates, respectively. VPipe automates genome assembly for a wide range of viruses, including high-consequence pathogens such as SARS-CoV-2. Such automated functionality expedites public health responses to viral outbreaks and pathogen surveillance.

Unexpected Low Mortality on Covid-19 in Homeless During Spring Wave 2021

Introduction: COVID-19 virus disease specific mortality variant throughout all continents between 3 and 15 percent, depending on virus subtype and age, social and health status of the affected population. Groups at risk were seniors after 70, low socioeconomic groups, unvaccinated and groups with no access to health care, elderly and mental facilities residents, homeless and orphan facilities. Method and results: We have analyzed three cohorts of 702 homeless from clients from, Slovakia, Poland, Czech republic, Ukraine, Moldova, Serbia and found unexpectedly low specific mortality, probably due to isolation of those full-board centers from neighboring large towns in to life islands and few social contacts of this risk population during 2 wave because of church and social daycare centers closure. Conclusion: In conclusion, life island quarantine model powered by vaccination may decrease even more COVID-19 related mortality in expected winter or spring waves. © 2021. All Rights Reserved.

Relative Low Incidence of Post-Covid Syndrome in Homeless Infected During Second Wave in Spring 2021 During Covid-19

Chronic post-covid syndrome is long lasting however not life-threatening consequence of acute Covid 19 disease specially in those undergoing severe clinical course. A case report presents multidisciplinar approach and minireview occurrence of chronic postcovid syndrome in a cohort of homeless from three sister cities. © 2021. All Rights Reserved.

Health and Wellbeing Benefits from Nature Experiences in Tropical Settings Depend on Strength of Connection to Nature.

A growing number of policies and programmes in cities aim to increase the time people spend in nature for the health and wellbeing benefits delivered by such interactions. Yet, there is little research investigating the extent to which, and for whom, nature experiences deliver such benefits outside Europe, North America, and Australia. Here, we assessed the relationships between nature dose (frequency, duration, and intensity) and three mental wellbeing (depression, stress, and anxiety) and two physical health (high blood pressure, diabetes) outcomes in Singapore, an intensely urbanised tropical city. Our analyses accounted for individual factors, including socio-economic status, nature connection (nature relatedness), and whether people with poor health are prevented by their condition from visiting green spaces. Our results show that the association between nature dose (specifically duration) and mental wellbeing is moderated by a nature connection. Specifically, people with a stronger nature connection were less likely to be depressed, stressed, and anxious, regardless of the duration of their nature dose. For those with a weaker connection to nature, spending longer in nature was associated with being more depressed, stressed, and anxious. We did not find a relationship between nature dose and high blood pressure or diabetes. Our results highlight that the relationship between nature dose and wellbeing might vary substantially among cities.

Early-onset cytokine release syndrome following allogeneic haploidentical peripheral blood stem cell transplantation might decrease overall survival

Background: Haploidentical HLA stem cell transplantation (haplo- HSCT) is increasingly being used as part of the treatment of hematological malignancies lacking a suitable HLA-matched donor. Cytokine release syndrome (CRS) is a systemic inflammatory response with aberrant immune activation and hyperstimulation which has been described in a number of clinical settings, including haplo-HSCT. However, clinical impact of CRS on these patients is controversial. During COVID-19 pandemic, graft cryopreservation in haplo-HSCT has increased in our centre. As a result, we clinically noticed a change in CRS onset in these patients. Aims: To identify novel CRS features that might have a prognostic impact on haplo-HSCT, as well as to determine if graft cryopreservation might influence any of those features. Methods: A cohort of154 patients undergoing allogeneic stem cell transplantation in2019 and2020 in our centre, from which 51 patients receiving peripheral blood haplo-HSCT from1st February2019 to31st December2020 were selected. Two of them were excluded for the CRS analysis due to relevant microbiological isolation close to the infusion date and impossibility to distinguish between infectious and CRS fever. CRS was graded according to the ASBMT consensus. Results: The median age was 51 years (range17-72), 59% were male. Median follow-up was359 days for alive patients. Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) was low risk in 45%, intermediate risk in22% and high risk in33%. Most patients (71%) had an intermediate Disease Risk Index (DRI). Conditioning regimen was myeloablative in12 (24%). 84% of the patients presented with CRS after haplo-HSCT (71% of them occurred in the first 48 hours after infusion). CRS was mild in most patients (grade1 in29 (71%) and grade2 in12 (29%);no grade3 CRS or further occurred. Graft cryopreservation accounted for13 (25%) patients. Early-onset CRS (<48h since stem cell infusion) was associated with lower overall survival (Figure1, p=0,01), as well as lower event free survival (relapse or death, p=0,03) when compared with the remaining patients in a univariate analysis. Non-myeloablative conditioning was associated with a higher proportion of early-onset CRS (74% vs 9%, p<0,001) as well as age >60 years (80% vs 45% p=0,014). It should be noted that age >60 years did not impact on overall survival in the first year following haplo-HSCT in our patients (p=0,485). We also found an interesting trend between graft cryopreservation and early- onset CRS (only38% of patients with graft cryopreservation presented early-onset CRS, whereas 67% of patients with fresh graft did so, p=0,075). Cryopreservation was related to less proportion of CRS grade ≥2 (0% vs33%, p=0,014) and it did not impact on engraftment, overall survival nor graft versus receptor disease rate or severity in our patients. Patients with refractory disease prior to transplantation presented higher rates of CRS grade ≥2 (75% vs20%, p=0,041). Moreover, a trend was observed for mononucleated cell count >8 x108 (37% vs14%, p=0,067). However, CRS grade ≥2 did not impact on overall survival in our patients (p=0,251) Summary/Conclusion: Early-onset CRS is associated with less overall survival and less event-free survival following the first year after haplo- HSCT. Cryopreservation is associated with less CRS grade =2 probability and might also reduce the chance of developing early-onset CRS.

Evaluation of the impact of the covid-19 pandemic in the diagnosis and treatment of breast cancer patients treated at clínica alemana de santiago

Introduction: Due to SARS-CoV-2 pandemic there has been a delay in oncological diagnosis and treatments potentially increasing mortality. Aim: To evaluate the effects of the pandemic in patients treated in Clinica Alemana with recent diagnosis of breast cancer, comparing the reason of consultation, stage and treatment to a similar time frame in 2019. Materials and Method: This is a retrospective, descriptive and quantitative study. Analyzing patients registry from April 1st to July 31st, 2020 compared with same time frame of 2019. Retrospective analysis of our database searching for reason of consultation, stage and treatment. Data analysis using STATA, T student test and Fisher exact test, considering significant a p < 0.05. Results: N156, 70 (44.87%) consultations in the 2020-time frame versus 86 (55.13%) in 2019 (p = 0.1). Mean age 55 years versus 58 (p = 0.38). Palpable tumor 25 versus 29 (p = 0.86). There was a difference in patients consulting due to personal breast oncological background, 0 versus 6 (p = 0.033) or familiar breast oncological background 0 versus 6 (p = 0.033). Breast images control 39 versus 53 (p = 0.5). In Pandemic more Her 2 tumors were diagnosed 11 versus 2 (p = 0.006). No differences in stages were observed. Upfront surgical treatment in 49 versus 71 patients (p = 0.85) and neoadjuvant hormonal treatment 7 versus 1 (p = 0.058). Conclusions: In the pandemic time frame there were less consultations due to breast cancer. The majority of the patients came because of a palpable tumor or breast image control without a significant difference compared with a similar time frame in previous year. There were less surgeries and more neoadjuvant hormonal treatments. © 2021, Sociedad de Cirujanos de Chile. All rights reserved.

Cerebrovascular events and outcomes in hospitalized patients with COVID-19: the society of vascular and interventional neurology multinational registry

Background: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aims: To summarize the findings of a multinational observational cohort of patients with SARS-CoV- 2 and cerebrovascular disease. Methods: Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in 4 countries (2/1/2020 - 06/16/2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST). Results: Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort;1130/100,000 patients, 95%CI 970- 1320/100,000), 68/171 (40.5%) of whom were female and 96/172 (55.8%) were between the ages 60-79 years. Of these, 156 had acute ischemic stroke (1.08%;1080/100,000 95%CI 920- 1260/100,000), 28 ICH (0.19%;190/100,000 95%CI 130 - 280/100,000) and 3 with CVST (0.02%;20/100,000, 95%CI 4-60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline strokeseverity, and all predictors of in-hospital mortality found in univariate regression (p<0.1: male sex,tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, andintracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63-15.44, p<0.01), olderage (aOR 1.78, 95%CI 1.07-2.94, p=0.03), and lower lymphocyte count on admission (aOR 0.58,95%CI 0.34-0.98 p=0.04) were the only independent predictors of mortality among patients withstroke and COVID-19. Conclusions: COVID-19 is associated with a small but significant risk of clinically relevantcerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19associated cerebrovascular complications, therefore aggressive monitoring and early interventionshould be pursued to mitigate poor outcomes.

One Month or Real Life in a Single Clinic near the Slum Area in Mukuru Urban setting in the Time after COVID-19 Epidemic in Kenya

The Muruku Clinic of Mary Immaculate is the oldest project of Slovak Doctors in Africa founded in 1999 by Sr. Mary Killeen and Prof. L. Soltes, working on an active survey of HIV especially in pregnant women, as well as OPD for basic diseases for two neighboring slums - Mukuru and St. Catherine. The aim of this research note is to describe the change of the spectrum of diseases just after Covid-19 pandemics in Kenya after first wave in 2020 just 20 years after founding of the clinic. When before 2000, malaria HIV, TB and STDs were the commonest diseases followed by multiple parasitic related anemia, after active screening and education against HIV the situation changed.

Stroke Care during the COVID-19 Pandemic: International Expert Panel Review.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has placed a tremendous strain on healthcare services. This study, prepared by a large international panel of stroke experts, assesses the rapidly growing research and personal experience with COVID-19 stroke and offers recommendations for stroke management in this challenging new setting: modifications needed for prehospital emergency rescue and hyperacute care; inpatient intensive or stroke units; posthospitalization rehabilitation; follow-up including at-risk family and community; and multispecialty departmental developments in the allied professions. SUMMARY: The severe acute respiratory syndrome coronavirus 2 uses spike proteins binding to tissue angiotensin-converting enzyme (ACE)-2 receptors, most often through the respiratory system by virus inhalation and thence to other susceptible organ systems, leading to COVID-19. Clinicians facing the many etiologies for stroke have been sobered by the unusual incidence of combined etiologies and presentations, prominent among them are vasculitis, cardiomyopathy, hypercoagulable state, and endothelial dysfunction. International standards of acute stroke management remain in force, but COVID-19 adds the burdens of personal protections for the patient, rescue, and hospital staff and for some even into the postdischarge phase. For pending COVID-19 determination and also for those shown to be COVID-19 affected, strict infection control is needed at all times to reduce spread of infection and to protect healthcare staff, using the wealth of well-described methods. For COVID-19 patients with stroke, thrombolysis and thrombectomy should be continued, and the usual early management of hypertension applies, save that recent work suggests continuing ACE inhibitors and ARBs. Prothrombotic states, some acute and severe, encourage prophylactic LMWH unless bleeding risk is high. COVID-19-related cardiomyopathy adds risk of cardioembolic stroke, where heparin or warfarin may be preferable, with experience accumulating with DOACs. As ever, arteritis can prove a difficult diagnosis, especially if not obvious on the acute angiogram done for clot extraction. This field is under rapid development and may generate management recommendations which are as yet unsettled, even undiscovered. Beyond the acute management phase, COVID-19-related stroke also forces rehabilitation services to use protective precautions. As with all stroke patients, health workers should be aware of symptoms of depression, anxiety, insomnia, and/or distress developing in their patients and caregivers. Postdischarge outpatient care currently includes continued secondary prevention measures. Although hoping a COVID-19 stroke patient can be considered cured of the virus, those concerned for contact safety can take comfort in the increasing use of telemedicine, which is itself a growing source of patient-physician contacts. Many online resources are available to patients and physicians. Like prior challenges, stroke care teams will also overcome this one. Key Messages: Evidence-based stroke management should continue to be provided throughout the patient care journey, while strict infection control measures are enforced.

Decline and Recurrence of Stroke Consultations during the COVID-19 Pandemic Lockdown Parallels Population Activity Levels.

BACKGROUND: The COVID-19 pandemic lockdown (CPL) lead to a significant decrease in emergency admissions worldwide. We performed a timely analysis of ischemic stroke (IS) and related consultations using the telestroke TEMPiS "working diagnosis" database prior (PL), within (WL), and after easing (EL) of CPL. METHODS: Twelve hospitals were selected and data analyzed regarding IS (including intravenous thrombolysis [intravenous recombinant tissue plasminogen; IV rtPA] and endovascular thrombectomy [EVT]) and related events from February 1 to June 15 during 2017-2020. In addition, we aimed to correlate events to various mobile phone mobility data. RESULTS: Following the significant reduction of IS, IV rtPA, and EVT cases during WL compared to PL in 2020 longitudinally (p values <0.048), we observed increasing numbers of consultations, IS, recommendations for EVT, and IV rtPA with the network in EL over WL not reaching PL levels yet. Absolute numbers of all consultations paralleled best to mobility data of public transportation over walking and driving mobility. CONCLUSIONS: While the decrease in emergency admissions including stroke during CPL can only be in part attributed by patients not seeking medical attention, stroke awareness in the pandemic, and direct COVID-19 triggered stroke remains of high importance. The number of consultations in TEMPiS during the lockdown parallels best with mobility of public transportation. As a consequence, exposure to common viruses, well-known triggers for acute cerebrovascular events and other diseases, are reduced and may add to the decline in stroke consultations. Further studies comparing national responses toward the course of the COVID-19 pandemic and stroke incidences are needed.

CT-152: Application of Web-Scraping Techniques for Autonomous Massive Retrieval of Hematologic Patients' Information During SARS-CoV2 Pandemic

Context: Data collection involving a large number of patients is usually known as a tedious and time-consuming task by healthcare professionals. Current patient load makes collecting clinical data almost impossible even though we need that information more than ever. Objective: We wanted to deploy a system that automatically and autonomously retrieves clinical data from our patients suffering from SARS-CoV2 that arrive at hospital admission to collect that information for further analysis. Design: We designed a daemon in PHP programming language connected to a MySQL MariaDB database that continuously searches for new patients consulting at hospital. We collected medical history, disease records, regular medication, physical exploration, vital signs, blood chemistry and count, and finally, microbiology testing of SARS-CoV2 (both PCR and ELISA antibody testing). As we don't have access to any API service (out-of-the-box connection to the data mainframe), we took advantage of web-scraping (brute-force data extraction from webpages using HTTP protocol) applied to our hospital web interface. Setting: Monitoring was made between 1st March, 2020 and 15th April, 2020 (during worst Coronavirus outbreak phase of the country), using only one computer connected to the hospital network. The number of patients identified was 259, each one with 344 clinical and testing variables. Results: Using this technique, we collected data of 259 hematologic patients without human intervention and more than 300 variables have been analyzed. Nowadays, manual revision of certain aspects of the database (e.g., comorbidities) is needed and some data needs to be manually entered due to the lack of proper codification. In the future, with the development of semantic-matching technologies, fully autonomous building of the databases will be possible. In the meantime, our technique can solve the capture of enormous amount of clinical information without effort. With that information, observational studies, even a prognosis score using machine learning, have been developed in our center. Conclusions: Data collection for further analysis is usually a vital, but time-consuming, task in order to answer clinical questions. We developed a technique that helped our center retrieve patients' clinical information autonomously during the SARS-Cov-2 pandemic.