ABSTRACT
Background: COVID-19 is a worldwide emergency;hospitals are subjected to intense workloads, reduced compared to the previous waves, for advent of vaccination and use of immunomodulators Aim: to evaluate the clinical outcome of patients during the last wave in a Spoke hospital and compare the results with those of the end of 2020. Methods: In the period Dec. 21-Jan. 22 we treated 105 patients (62 men, average age 68.4 y, range 30-99, 51 polipathological), 56 of them with complete vaccination cycle ;the mean age of the vaccinated was lower (65.2+-15.1 vs 71.8+-15.7);in addition to therapy with EBPM and dexamethasone if indicated, 23 with risk factors were treated with casirivimab and indevimab 1200+1200 mg, 33 with remdesivir and 9 baricitinib;6 patients with combination therapies. The mean hospital stay was 7.9 days, range 3-24. Results: 10 patients died (5 unvaccinated) and 13 needed UTI (10 NIV support, 6 unvaccinated, and 3 IOT, 2 unvaccinated) but with a favorable evolution in over 2/3 of the cases;the other patients were discharged at home. Considering then other 75 hospitalized patients between Dec 20-Jan21, 53 men, average age 69.5 y, range 36-91, treated only with standard therapy (EBPM and steroid), the average stay had been 12.6 days and the previous outcome was 23 transferred UTI (8 intubated) and total of 17 deaths. Conclusions: With advent of vaccines, monoclonal antibodies, antivirals and immunomodulators, hospitalization times, the need for intensive care (13 vs 23) and deaths (10 vs 17) have been approximately halved.
ABSTRACT
Background: Remdesivir (REM) is authorized to cure COVID-19 pneumonia with low oxygen supplementation. We evaluated the effect of combination of REM and usual treatment with enoxaparin and dexamethasone on clinical outcome. Methods: A prospective open study with REM (200 mg first day and then 100 mg /day for four days) was performed in a medical unit with critical sector in the period of half november 2021 and half January 2022 . All COVID-19 patients requiring supplemental low O2 therapy were treated with enoxaparin (4000 unit/day for almost patients) and dexamethasone (6 mg);three patients were treated even with baricitinib for rapid pulmonary deterioration. The primary endpoint was the final outcome with discharge from Hospital. Results: 33 COVID-19 patients were enrolled, 20 men, mean age 66 y (range 41-87);14 patients with a complete vaccinal schedule;therapy was started 1-2 days after entering the hospital. The lenght of hospitalization was 7.5 days with a range of 7-25;mortality in two patients (one not vaccinated), need of intensive care in 10 patients with favorouble evolution (3 with oral intubation and seven with non invasive ventilation support);at the end, 31 patients were discharged or at home or at sub acute unit. We did not observe major side effects, cough, headache, moderate increase of transaminases Conclusions: REM treatment, associated with heparin, dexamethasone and oxigen supplement, especially if started early, is safety and associated with reduced length of hospitalization and reduction mortality.