SARS-CoV-2 vaccination and COVID-19 infections in people with multiple sclerosis treated with ocrelizumab in the prospective, multicenter, noninterventional MuSicalE and CONFIDENCE studies

Background: Understanding outcomes of Coronavirus Disease 2019 (COVID-19) and the impact of COVID-19 vaccination deserve significant consideration for people with multiple sclerosis (MS) treated with ocrelizumab (OCR). Aim(s): To report the number, characteristics and outcomes of COVID-19 cases in all OCR-treated patients and in those with COVID-19 vaccination (i.e. breakthrough cases) in two realworld cohort studies. Method(s): We analysed data from OCR-treated patients enrolled in ongoing, prospective, noninterventional studies conducted in Germany (CONFIDENCE, EUPAS22951) and in 25 other countries (MuSicalE, NCT03593590). COVID-19 seriousness was assessed per ICH guidelines. Outcomes were captured as recovered, recovered with sequelae, recovering, not recovered or fatal. Vaccine breakthroughs were cases with COVID-19 onset >=14 days after completion of the primary immunisation schedule recommended for each COVID-19 vaccine platform. 'Unvaccinated' included patients without COVID-19 vaccination recorded (including the prevaccination era) or with incomplete immunisation scheme. Result(s): Analyses included 1,702 OCR-treated patients from MuSicalE (73.1% relapsing-remitting MS, 21.2% primary progressive MS [PPMS], 5.6% relapsing secondary progressive MS) and 2,784 from CONFIDENCE (81.7% relapsing MS, 18.3% PPMS). As of March 2022 (preliminary data), completion of primary immunisation schedule was recorded for 542 (31.8%) and 710 (25.5%) patients in each study, mainly with mRNA vaccines (72.3% and 93.8%). COVID-19 infection was reported in 189 and 122 patients in MuSicalE and CONFIDENCE (11.1% and 4.4% among all patients), mostly reported as nonserious (85.2% and 83.6%), including 71 and 31 vaccine breakthroughs (13.1% and 4.4% among fully vaccinated patients). The following rates were reported in vaccinated and unvaccinated patients in MuSicalE and CONFIDENCE, respectively: (a) hospitalisations, 8.5% (6/71) vs 16.0% (19/118) and 9.7% (3/31) vs 14.3% (13/91);(b) serious cases, 8.5% (6/71) vs 17.8% (21/118) and 9.7% (3/31) vs 18.7% (17/91);(c) fatalities, 1.4% (1/71) vs 2.5% (3/118) and 0 deaths vs 2.2% (2/91). In both studies, the majority of patients had fully recovered (79.9% and 74.6%) or were recovering (11.1% and 7.4%) at last follow-up. Updated vaccination rates will be presented. Conclusion(s): Most COVID-19 cases were nonserious in these OCR-treated patient cohorts. Initial data suggest more favourable clinical outcomes associated with COVID-19 vaccination.

Telephone consultation for two-week-wait ENT and head and neck cancer referrals: initial evaluation including patient satisfaction.

OBJECTIVE: To analyse the outcomes of telephone consultation, including patient satisfaction, for two-week-wait head and neck cancer referrals. METHODS: Analysis of the data of this prospective study was centred on outcomes of the consultation, patient satisfaction and preference for telephone consultation. RESULTS: Patient satisfaction and preference for telephone consultation were influenced by patient awareness of cancer referral. When comparing the three most common presenting symptoms, patients with sore throat were more satisfied than those with neck mass. Regarding telephone consultation outcomes, patients with neck mass were less likely to be discharged and more likely to require investigations than those with sore throat or hoarseness. Patients with hoarseness more often required a face-to-face appointment. CONCLUSION: Telephone consultation might be a valid initial encounter for the majority of two-week-wait head and neck cancer referrals, especially when the referral symptoms are considered. This work shows the validity and safety of telephone consultation for two-week-wait head and neck cancer referrals.

Epileptic seizures in the emergency room: clinical and electroencephalographic findings associated with brain perfusion patterns on computed tomography.

BACKGROUND: Diagnosis of epileptic seizures, particularly regarding status epilepticus (SE), may be challenging in an emergency room setting. The aim of the study was to study the diagnostic yield of perfusion computed tomography (pCT) in patients with single epileptic seizures and SE. METHODS: We retrospectively reviewed the records of patients who followed an acute ischemic stroke pathway during a 9-month period and who were finally diagnosed with a single epileptic seizure or SE. Perfusion maps were visually analyzed for the presence of hyperperfusion and hypoperfusion. Clinical data, EEG patterns, and neuroimaging findings were compared. RESULTS: We included 47 patients: 20 (42.5%) with SE and 27 (57.5%) with single epileptic seizure. Of 18 patients who showed hyperperfusion on pCT, 12 were ultimately diagnosed with SE and eight had EEG findings compatible with an SE pattern. Focal hyperperfusion on pCT had a sensitivity of 60% (95% CI 36.4-80.2) and a specificity of 77.8% (95% CI 57.2-90.6) for predicting a final diagnosis of SE. The presence of cerebral cortical and thalamic hyperperfusion had a high specificity for predicting SE presence. Of note, 96% of patients without hyperperfusion on pCT did not show an SE pattern on early EEG. CONCLUSIONS: In acute settings, detection by visual analysis of focal cerebral cortical hyperperfusion on pCT in patients with epileptic seizures, especially if accompanied by the highly specific feature of thalamic hyperperfusion, is suggestive of a diagnosis of SE and requires clinical and EEG confirmation. The absence of focal hyperperfusion makes a diagnosis of SE unlikely.

Treatment setting, symptomatology, clinical course, severity degree and case-fatality rate in 536 adults over 50 years with laboratory-confirmed COVID-19 in Tarragona, Spain, March-June 2020

Background: Population-based clinical data on COVID-19 is scarce. This study analyzed distinct clinical characteristics of COVID-19 and relationships with lethality among adults.

Treatment setting, symptomatology, clinical course, severity degree and case-fatality rate in 536 adults over 50 years with laboratory-confirmed COVID-19 in Tarragona, Spain, March-June 2020.

OBJECTIVE: Population-based clinical data on COVID-19 is scarce. This study analyzed distinct clinical characteristics of COVID-19 and relationships with lethality among adults. METHODS: Retrospective cohort that included all population >=50 years with a laboratory-confirmed COVID-19 in Tarragona, Spain, during 01/03/2020-30/06/2020. Treatment setting (outpatient/hospital/nursing-home), pre-existing comorbidities, signs/symptoms, clinical course, severity and lethality (death from any cause in-hospital or within the first 30-day after the diagnosis) were determined. Chi squared and Fisher's test were used to compare percentages. RESULTS: Of the 536 overall cases (mean age: 74 years;43.8% male), 150 (28%) were outpatient, 179 (33.4%) were hospitalised and 207 (38.6%) happened in nursing-home/social-health centres. The most prevalent symptoms were fever (57.9%), cough (49.8%), dyspnea (41.5%), general discomfort (36.2%), fatigue (24.4%), diarrhea (19.6%), myalgias (17.3%), headache (14.6%), confusion/lethargy (14.6%), thoracic pain (10%), anosmia (9.8%), disgeusia/ageusia (8.1%) and sore throat (7.7%). Global lethality was 23.1% (1.7% in 50-64 years vs 25.5% in 65-79 years vs 38.7% in >=80 years, p<0.001;26.8% in men vs 20.3% in women, p=0.075;3.3% in outpatient vs 29.6% in hospitalised vs 31.9% in nursing-home/social-health centres, p<0.001). By symptomatology, maximum lethality was observed among patients with confusion/lethargy (77.6%) and minimum among those with ageusia/disgeusia (4.8%), anosmia (3.9%) or myalgias (1.1%). By pre-existing comorbidities, greater lethality happened among patients with neurologic (36.7%), renal (35.4%) and cardiac disease (35.3%). CONCLUSIONS: There was a relatively great lethality of COVID-19 among the general population >=50 years across the first epidemic wave in the study setting. Increasing age, male sex, nursing-home residence and several signs/symptoms and comorbidities were associated with higher mortality.

[Extrathoracic manifestations of COVID-19 in adults and presentation of the disease in children]. / Manifestaciones extratorácicas de la COVID-19 en adultos y presentación de la enfermedad en niños.

In March 2020, the World Health Organization declared a global pandemic of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); epidemic conditions continue in nearly all countries today. Although the symptoms and imaging manifestations of COVID-19 predominantly involve the respiratory system, it is fundamental to know the manifestations of the disease and its possible complications in other organs to help in diagnosis and orient the prognosis. To improve the diagnostic process without increasing the risk of contagion unnecessarily, it is crucial to know when extrathoracic imaging tests are indicated and which tests are best in each situation. This paper aims to provide answers to these questions. To this end, we describe and illustrate the extrathoracic imaging manifestations of COVID-19 in adults as well as the entire spectrum of imaging findings in children.

Culinary and Gastronomic Practices During the COVID-19 confinement in the Alicante province

Introduction: The confinement generated by the state of alarm decreed by the COVID-19, forced citizens to stay in their homes except for justified cause and limited access to collective catering services. These restrictions led to a change in the habits and routines of the population, which translated into more culinary activity at home. The objective of this study is to know the impact of confinement on eating behavior, studying the changes in culinary and gastronomic practices experienced by the Alicante population. Material and methods: Observational cross-sectional, although with a diachronic approach based on the perception and experiences of the interviewees: before/during confinement, and non probabilistic convenience sampling of the population aged 18-69 years recruited electronically between 28 April and 10 May 2020 (weeks 7-8 of confinement) in the province of Alicante (n = 679). Univariate, bivariate, and multivariate statistical analysis of the data using the SPSS statistical package. Use of nonparametric tests by assuming the condition of paired samples for the responses before (sample 1) and during confinement (sample 2). Results: 70% cooked more often and spent more time cooking. More than 35% expanded their culinary knowledge, with an increase in web browsing and social networking. During the confinement, traditional Valencian cuisine predominated and desserts were the preferred preparations. Group cooking increased by more than 11 percentage points, as did eating in company, although the use of audio-visual devices during the act of eating persisted. 84% changed their perception about some aspect related to food. The differences between the behavior prior to the pandemic and the one that developed during confinement have been shown to be statistically significant in most of the variables tested. Conclusions: During the confinement, the increase in culinary activity translated into a commitment to traditional cuisine to the detriment of pre-cooked dishes, more conviviality in the act of eating, and a greater commitment to trade and consumption of local foods and the sustainability of the food system.

Managing the pandemic from the radiology department's point of view. / Gestión de la pandemia. Visión del radiólogo.

The COVID-19 pandemic is forcing our entire society to adopt numerous changes, at least until an effective treatment and/or vaccine becomes widely available. Because COVID-19 is a new disease that has required us to make complex decisions based on scant evidence, the pandemic is having an enormous impact on our health system. Radiology departments play a fundamental role in the management of COVID-19, both in the diagnosis of the disease and in the posterior management of patients. To ensure the safety of patients and healthcare professionals, it is essential to understand the infection so that safe circuits can be implemented. This article summarizes the pathophysiology of COVID-19 infection and explains the measures that radiology departments need to adopt during the pandemic.

[Evaluation of incidence and risk profile for suffering Covid-19 infection by underlying conditions among middle-aged and older adults in Tarragona.]

OBJECTIVE: Population-based data on the current Covid-19 pandemic is scarce. This study investigated incidence and risk to suffer Covid-19 by baseline underlying conditions in people ≥50 years in Tarragona region across march-april 2020. METHODS: Population-based retrospective cohort study involving 79,071 adults ≥50 years-old in Tarragona region (Southern Catalonia, Spain). Cohort characteristics (age, sex, residence, vaccinations history and comorbidities) were established at baseline, and Covid-19 cases occurring between 01/03/2020-30/04/2020 were registered. Cox regression analysis calculating Hazard ratios (HRs) adjusted by age, sex and comorbidities was used to estimate risk for Covid-19. RESULTS: Across study period, 1,547 cohort members were PCR tested (22.6% positive) and 367 were presumptive cases without PCR tested. Considering PCR-confirmed Covid-19, incidence (per 100,000 persons-period) was 441 overall (248, 141, 424, 1,303 and 3,135 in 50-59, 60-69, 70-79, 80-89 and ≥90 years-old, respectively;380 in men and 497 in women;259 in community-dwelling and 10,571 in nursing-home). By comorbidities, maximum incidence emerged among persons with neurological disease (2,723), atrial fibrillation (1,348), chronic renal failure (1,050), cardiac disease (856), respiratory disease (798) and diabetes (706). Lower incidence appeared in rheumatic diseases (230) and smokers (180). In multivariable analysis focused on community-dwelling individuals (N=77,671), only cardiac disease (HR: 1.47;95% CI: 1.01-2.15;p=0.045) and respiratory disease (HR: 1.75;95% CI: 1.00-3.02;p=0.051) were associated with an increased risk, whereas smoking (HR:0.43;95% CI: 0.25-0.74;p=0.002) and influenza vaccinated (HR: 0.63;95% CI: 0.43-0.92;p=0.015) appeared associated with a decreased risk. CONCLUSIONS: Apart of increasing age and nursing-home residence, chronic respiratory and cardiac disease appear at increased risk for suffering covid19. This study investigated population-based incidence of Covid-19 infection by underlying conditions among adults ≥50 years in Tarragona (Southern Catalonia, Spain) across two first months pandemic period.