ABSTRACT
Background: there are few reported series n women with breast cancer (BC) and COVID-19, a better prognosis has been observed, with a lower rate of hospitalization and mortality than other neoplasms. Methods: We conducted a restrospective, non-experimental, observational, single center, study with a sample of 69 patients with BC who had presented COVID-19, in the period between March 2020 to August 2021. Clinicopathological characteristics of patients with BC were compared between severe and non-severe covid 19 groups, as well as hospitalized and non-hospitalized patients. An analysis of possible risk factors associated with severe disease and hospitalization was performed. Results: 69 cases were reported, median age 52y, mean BMI 25.2, ECOG 0-1: 97%. Smoking history in 24%, diabetes and hypertension were the most frequent comorbidities. The most frequent histology was ductal carcinoma in 80.6%, 73.8% showed ER + and 69.3% PR +, HER2 was overexpressed in 9.2%. The early stages predominated, I 22 (31.3%), II 25 (37.3%), III in 12 (17.9%) and IV in 6 (9%). The most frequents symptoms of COVID-19 were fatigue 70.1%, fever 65.7%, cough 59.7%, headache 56.7%, hyposmia 47.8%, dysgeusia 38.8%. A total of 53 (76.8%) mild cases, 14 (20.3) severe cases and 2 (2.9%) critical cases were registered. The 89.9% (62 patients) were treated as an outpatient basis, while 7 (10.1%) required hospitalization. Active treatment (< 45 days) at the time of COVID-19 was hormonal therapy 36 (50.7%), chemotherapy 11 (16.4%), anti-HER2 in 3 (4.5%), immunotherapy in 1.5%, targeted treatment in 4 (6.0%), surgery in 7 (10.4%) and radiotherapy in 1 (1.5%) patient. When comparing the severe and non-severe groups, as well as hospitalized versus nonhospitalized, we observed no difference between the clinicopathological characteristics. Then, we serch for possible risk factors, in wich, surgery in a period of less than 3 months increases the risk of severity OR 1,297 (95% CI 1,112-1,514), the risk of hospitalization increased in the triple negative subgroup OR 1,143 (95% CI, 1,035- 1,262), surgery less than 3 months OR 1,116 (1,014-1,229) and chemotherapy less than 45 days OR 1,217 (95% CI, 1,024-1,447). Conclusions: In patients with BC, the prevalence of severe or critical COVID-19 was 23% and the hospitalizacion rate 10%. No patient died from this infection. The clinical and pathological characteristics of BC do not appear to increase the risk of severe COVID-19 or the rate of hospitalization. Surgery performed in a period of less than 3 months is marginally associated with an increased risk of severe disease. Chemotherapy, targeted therapy, and immunotherapy do not modify the risk of severe disease;however, higher Ki 67, triple negative subgroup, surgery and chemotherapy showed a slight increase in risk of hospitalization.
ABSTRACT
Objective. Improve knowledge about a “home-made” CPAP system used during first COVID-19 outbreak and its effect on oxygenation and mortality. Materials and methods. Cohort study developed in a university hospital of 400 beds. All included patients had respiratory failure due to SARS-CoV-2 infection. 64 of them used a home-made CPAP system and 64 patients used a conventional high-concentration oxygen mask. The home-made CPAP system consists of an antistatic reservoir bag that receives oxygen at a flow of 15 litters per minute connected to an oronasal mask and to a PEEP valve. Mortality, respiratory support failure (death or change to IVM), and SpO2/FiO2 evolution were analyzed according to the type of respiratory support used. An analysis was carried out using regression methods and later a statistical adjustment taking into account the main differences between both groups. Results. Mortality was of 46.9% at the high-concentration oxygen mask group and 56.3% at the “home-made” CPAP system group (Adjusted OR 1.45, p= 0.573). Respiratory support failure was of 67.2% y 54.7% respectively (Adjusted OR 0.53, p= 0.329). SpO2/FiO2 evolution didn´t show a significative difference between both groups at adjusted analysis (-4, p= 0.876). Conclusions. The “home-made” CPAP system didn't show a negative impact on mortality, so it could be safe to consider its use. Even so, the “home-made” CPAP system didn´t show a positive impact on oxygenation or clinical evolution, so its use cannot be recommended.
ABSTRACT
During COVID-19 pandemic, intensive care and non-invasive ventilation (NIV) units have collapsed, forcing physicians to improvise alternative methods of respiratory support. One of these systems that had to be used in our hospital consists of an antistatic reservoir bag that receives oxygen at a flow of 15 litters per minute connected by a 'T' tube to an oronasal mask and to a PEEP valve. We developed a retrospective and descriptive study to improve knowledge of the effect of this dispositive. All patients (n=48) had severe respiratory failure due to bilateral pneumonia caused by SARS-cov-2 infection (confirmed by RT-PCR). The mean age was 66.3±12.9 years. Male was the most frequent sex (66.7%). Principal comorbidities were arterial hypertension (58.3%), mellitus diabetes (35.4%) and sleep apnea-hypopnea syndrome (20.8%). 26 patients (54.2%) had do-not-intubate (DNI) directives and they couldn't access to NIV either. Time from clinical onset to the dispositive use was 10.1±4.4 days. The 'home-made' CPAP was used during 3.4±2.8 days. During this time, most used pharmacological treatments were tocilizumab (60.4%) and systemic corticosteroids (56.3%). Main reasons for interrupting 'home-made' CPAP system were: dead (33.3%);good clinical course and change to conventional oxigenotherapy (27.1%);change to invasive mechanical ventilation (16.7%);change to NIV (14.6%). Overall mortality was 56.3%;73.5% at DNI group and 28.1% at the other group. Despite the use of this home-made CPAP, mortality rate remains high in the DNI group which suggests that the device may not be a proper respiratory support. However, in some cases it could be used as a respiratory support while other treatments become effective.