Persistent Pneumonitis Post-COVID 19: description and risk factors

Background: Some patients present persistent ground glass opacities (GGO) and/or consolidations after an acute episode of SARS-CoV-2 pneumonia (COVID19). Risk factors for persistent pneumonitis (PPN) and potential response to corticosteroids remain unclear. Objective(s): To evaluate the clinical characteristics of patients with PPN, as well as to detect possible risk factors and the role of corticosteroids. Method(s): We conducted a prospective, controlled, multicenter analysis of patients hospitalized because of COVID19 with (n=152) or without (n=140) PPN. PPN was defined by the persistence of pulmonary opacities in a chest CT scan >14 days after admission. Characteristics of participants were obtained from their medical records. A CT score was used to quantify parenchymal abnormalities when PPN was suspected. Result(s): Compared to controls, patients with PPN were older and suffered more comorbidities, also D-dimer and Creactive protein levels were higher. The most frequent features observed in CT scans were GGO (97%), consolidation (95%), bronchial dilatation (93%) and reticular pattern (92%) with a CT score of 16.12+/-4.26. Multivariate logistic regression identified age and C-reactive protein levels on admission as independent risk factors for PPN. No significant differences were observed in thoracic CT scan one-month after discharge in patients treated with higher corticosteroids doses (>50 mg/day after discharge) compared to lower doses. Conclusion(s): Age and raised C-reactive protein levels on admission are significant risk factors of PPN after COVID19. Treatment with high doses of corticosteroids does not seem to add benefit.

Trends in treatments during COVID-19 pandemic in a university tertiary hospital

4CPS-004 Figure 1Conclusion and RelevanceThe use of drugs during the pandemic of COVID-19 has shown a clear evolution over months towards more standardised treatments, with remdesivir as antiviral and dexamethasone, tocilizumab and baricitinib standing out as anti-inflammatory drugs in our centre. Homogenisation and standardisation of COVID-19 treatments have been managed as a reflection of the scientific evidence accumulated throughout the pandemic.References and/or AcknowledgementsConflict of InterestNo conflict of interest

Antiviral drugs against SARS-CoV-2.

The use of antiviral drugs represents an important progress in the therapeutic management of COVID-19, leading to a substantial reduction of SARS-CoV-2-related complications and mortality. In immunocompetent host, peak viral replication occurs around the symptom's onset, and it prolongs for 5 to 7 days that is the window of opportunity for giving an antiviral. Accordingly, early and rapid diagnostic of the infection in the outpatient clinic is essential as well as the availability of oral agents that can be easily prescribe. Remdesivir has demonstrated its efficacy in hospitalized patients requiring oxygen support and in mild/moderate cases to avoid the hospitalization, however, the intravenous administration limits its use among outpatients. Molnupiravir and nirmatrelvir/ritonavir are potent oral antiviral agents. In the present review we discuss the potential targets against SARS-CoV-2, and an overview of the main characteristics and clinical results with the available antiviral agents for the treatment of SARS-CoV-2.

Fears during the Covid-19 pandemics and their influence on physical health: A cross-sectional study on the general population in Spain

BACKGROUND/OBJECTIVE: This study examines the paths through which Covid-19 can negatively impact health and lead to somatic symptoms. Based on the dual process theory, fears can impair health in two ways: through psychological distress, which is an automatic reaction to fear, and through a more conscious and deliberative rumination process. METHOD: Data from a representative sample of the Spanish population (N = 3083 subjects,18 years or older) were obtained from a Survey by the Sociological Research Center (CIS). The dual path model was tested, and a longer sequence was included where the two mediators act sequentially to produce an impact on somatic symptoms. RESULTS: The results showed how Covid-19 fears translate into somatic problems. Beyond the direct relations, and after comparing with other possible alternative models, our findings support a process where rumination mediates between fears and psychological distress, and psychological distress in turn leads to somatic problems. CONCLUSIONS: This process reveals a plausible mechanism that explains the somatization of health problems during the Covid-19 pandemic, and it provides theoretical and practical inputs to better understand the role of fears in health in crisis contexts.

Azolla Quantity Prediction using WSN and Machine Learning

Due to COVID-19 pandemic, the expenditures on pellets and feeds in broiler and fish industries increase every year, leading to price overshoots in various agricultural products. Azolla is an emerging protein source alternative for tilapia and other livestock breeders that is known for its fast reproduction. This study aims to enhance the yield production of Azolla ponds in Nevalga Farm, Brgy. Sala, City of Cabuyao, Laguna by employing wireless sensor network (WSN) technology and predictive machine-learning (ML) methods. LoRa-based WSN was designed to measure the parameters that affect the growth and reproduction of Azolla. Throughout the 24-day monitoring period, the average received signal strength indication (RSSI) and signal-to-noise ratio (SNR) of the packets from the three sensing nodes ranged from -50.86 dBm to -71.39 dBm and 8.92 dB to 9.81 dB, respectively. A total of 3582 data sets were obtained during the observation. Among the three regression ML models used, K-Nearest Neighbor algorithm outperformed Linear Regression and Support Vector Machine in predicting Azolla quantity parameters on both training and validation datasets by yielding the smallest values of root mean square error (RMSE) and absolute error on the seven quantity indicators and achieving squared correlation that varied from 0.935 to 0.997. © 2022 IEEE.

Anticoagulation strategies and risk of bleeding events in critically ill COVID-19 patients Estrategias de anticoagulación y riesgo de sangrado en pacientes ingresados en una Unidad de Cuidados Intensivos por COVID-19

Objective To evaluate the rate of thrombosis, bleeding and mortality comparing anticoagulant doses in critically ill COVID-19 patients. Design Retrospective observational and analytical cohort study. Setting COVID-19 patients admitted to the intensive care unit of a tertiary hospital between March and April 2020. Patients 201 critically ill COVID-19 patients were included. Patients were categorized into three groups according to the highest anticoagulant dose received during hospitalization: prophylactic, intermediate and therapeutic. Interventions The incidence of venous thromboembolism (VTE), bleeding and mortality was compared between groups. We performed two logistic multivariable regressions to test the association between VTE and bleeding and the anticoagulant regimen. Main variables of interest VTE, bleeding and mortality. Results 78 patients received prophylactic, 94 intermediate and 29 therapeutic doses. No differences in VTE and mortality were found, while bleeding events were more frequent in the therapeutic (31%) and intermediate (15%) dose group than in the prophylactic group (5%) (p < 0.001 and p < 0.05 respectively). The anticoagulant dose was the strongest determinant for bleeding (odds ratio 2.4, 95% confidence interval 1.26–4.58, p = 0.008) but had no impact on VTE. Conclusions Intermediate and therapeutic doses appear to have a higher risk of bleeding without a decrease of VTE events and mortality in critically ill COVID-19 patients.

Anticoagulation strategies and risk of bleeding events in critically ill COVID-19 patients

Objective To evaluate the rate of thrombosis, bleeding and mortality comparing anticoagulant doses in critically ill COVID-19 patients. Design Retrospective observational and analytical cohort study. Setting COVID-19 patients admitted to the intensive care unit of a tertiary hospital between March and April 2020. Patients 201 critically ill COVID-19 patients were included. Patients were categorized into three groups according to the highest anticoagulant dose received during hospitalization: prophylactic, intermediate and therapeutic. Interventions The incidence of venous thromboembolism (VTE), bleeding and mortality was compared between groups. We performed two logistic multivariable regressions to test the association between VTE and bleeding and the anticoagulant regimen. Main variables of interest VTE, bleeding and mortality. Results 78 patients received prophylactic, 94 intermediate and 29 therapeutic doses. No differences in VTE and mortality were found, while bleeding events were more frequent in the therapeutic (31%) and intermediate (15%) dose group than in the prophylactic group (5%) (p<0.001 and p<0.05 respectively). The anticoagulant dose was the strongest determinant for bleeding (odds ratio 2.4, 95% confidence interval 1.26–4.58, p=0.008) but had no impact on VTE. Conclusions Intermediate and therapeutic doses appear to have a higher risk of bleeding without a decrease of VTE events and mortality in critically ill COVID-19 patients. Resumen Objetivo Evaluar la incidencia de eventos trombóticos, sangrado y mortalidad comparando diferentes regímenes de anticoagulación en pacientes ingresados en unidades de Cuidados Intensivos (UCI) por COVID-19. Diseño Estudio de cohortes retrospectivo observacional y analítico. Ámbito Pacientes con COVID-19 ingresados en una UCI de un hospital terciario entre marzo y abril del 2020. Pacientes Se incluyó a un total de 201 pacientes de UCI ingresados por COVID-19. Los pacientes se categorizaron en 3 grupos en función de la dosis de anticoagulación más alta recibida durante el ingreso: profiláctica, intermedia y terapéutica. Intervenciones Se comparó la incidencia de eventos trombóticos, hemorragia y mortalidad entre los grupos. Se realizaron 2 regresiones logísticas multivariables para comprobar la asociación entre los eventos trombóticos y el sangrado con el régimen anticoagulante. Principales variables de interés Eventos trombóticos, sangrado y mortalidad. Resultados De los pacientes incluidos, 78 recibieron dosis profilácticas, 94 intermedias y 29 terapéuticas. No se encontraron diferencias en los eventos trombóticos y la mortalidad entre grupos, mientras que los sangrados fueron más frecuentes en el grupo de dosis terapéutica (31%) e intermedia (15%) que en el grupo de dosis profiláctica (5%) (p <0,001 y p <0,05, respectivamente). El régimen anticoagulante fue el mayor determinante de sangrado (odds ratio 2,4;, intervalo de confianza del 95%, 1,26-4,58;p=0,008) pero no tuvo ningún impacto en los eventos trombóticos. Conclusiones Las dosis intermedias y terapéuticas parecen tener un mayor riesgo de sangrado sin una disminución de los eventos trombóticos ni la mortalidad en pacientes de UCI con COVID-19.

Effects of Home-Based Respiratory Physiotherapy and Telephone- Based Psychological Support on Pulmonary and Mental Health Outcomes in Peru: A Feasibility Randomized Controlled Trial

Introduction: We sought to determine whether a 6-week integrated rehabilitation program improved pulmonary function, physical and mental health outcomes in patients discharged alive after surviving a severe COVID-19 pneumonia. Methods: Parallel, open-label, feasibility randomized controlled trial in participants aged 18-75 years who were discharged for severe COVID-19 pneumonia. The intervention consisted of 12 in-person home respiratory rehabilitation sessions and 6 telephonebased, emotion-centered problem-solving therapy psychological sessions. We measured the 6- minute walk test (6MWT), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), Patient Health Questionnaire (PHQ-9), General Anxiety Disorder (GAD-7), Impact of Event Scale- Revised (IES-R) and Short Form 36 health survey (SF-36). Following the recommendation by Cocks and Torgerson, we used a one-sided 80% confidence interval to determine if this feasibility trial should proceed to a phase III trial. Results: We randomized 103 participants (mean age, 48 years;71% men). There were no differences at baseline assessments of outcomes between the two groups. Intervention participants walked 15 and 45 meters more during a 6MWT at 7 and 12 weeks, respectively, than controls after accounting for baseline distance. In both instances, the onesided 80% lower bound was above 0. Intervention participants also had a greater improvement of lung function for week 7 (mean difference FEV1, 0.05 L;95% CI, -0.14 to 0.24;mean difference FVC, 0.10 L;95% CI, -0.12 to 0.31) and at week 12 (mean difference FEV1, 0.10 L;95% CI, -0.18 to 0.37;mean difference FVC, 0.15 L;95% CI, -0.17 to 0.47). Likewise, the prevalence of depression (percentage difference PHQ-9, 24.3%;95% CI, -4.3 to 44.3), anxiety (percentage difference GAD-7, 20.7%;95% CI, 0.8 to 40.6) and post-traumatic stress (percentage difference IES-R, 14.0%;95% CI, -5.7 to 33.7) were lower in the intervention group at week 2 after hospital discharge. At week 7, the intervention group had a greater improvement of physical (mean difference, 10.8;95% CI, -1.8 to 23.4) and social (mean difference, 6.43;95% CI, -0.65 to 13.5) function on the SF-36. Conclusion: We demonstrated that an integrated rehabilitation program administered over a 6-week after discharge in Lima, Peru was both feasible and acceptable, and had positive benefits on physical and pulmonary function and on mental health during the 12 weeks of follow-up. Measured improvements in the primary outcome of 6MWT distance recommend that we consider a phase III trial to test the efficacy of our integrated rehabilitation intervention in a larger sample.

Home Becomes the Most Common Place of Death for Cancer Patients During the COVID-19 Pandemic, A Descriptive Analysis in England

Background/aims: Despite increased numbers of deaths in England from COVID-19 and its co-lateral effect on acute services (569,700 in 2020 vs. 496,370 in 2019) the number of deaths from cancer was virtually unchanged (138,026 in 2020 vs. 137,851 in 2019). Deaths (all causes) at home have exceed the expected number every week since April 2020, (155,815 (27.4% of all deaths) in 2020 vs. 120,467 deaths (24.3%) in 2019. Cancer deaths accounted for 35.5% of all deaths at home in 2019. Aims: to investigate the contribution made by cancer patients to the increased deaths at home during the COVID-19 Pandemic in England. Methods: National Mortality data used to identify cancer deaths (underlying cause) and place of death in England in 2019 and 2020 and compared for place of death as a proportion of all cancer deaths. Results: Cancer increased as a % of all deaths in patients' own home in 2020 36.5% to 35.5%. The % of cancer deaths in hospital reduced significantly from 35% to 29% and increased in patient's home from 31% to 41%. Reductions in % cancer deaths occurred in Care Homes 15% to 13%), Hospice 8% to 15% but an increase in other places (relatives homes) 1.7% to 2.4%. Thus a 19% reduction in cancer deaths in hospital, 15% reduction in hospices but 33% increase in homes. Conclusions: In England, national strategy, improving choice of place to die achieved an 8-year 2011-19 small increase in cancer patients dying at home (28.9 to 31.1%). The COVID-19 pandemic caused a massive shift in the proportion of cancer patients (11%) and actual numbers (∼15,000) dying in their own or relatives private homes. It is not clear how much of this change was forced decisions (hospitals full of COVID-19, Hospice beds reduced) or personal choice influenced by severe visiting restrictions in hospital, care homes and hospices. The quality of care provided is also not known. If choice played a significant role, and the current increase is sustained, community palliative care needs to be increased to support more cancer patients to die at home.

Palliative Care Should be Part of a Public Health Pandemic Response - How Routine Data Analysis in the COVID-19 Pandemic in England Could Inform Level of Need and Deployment of Services

Background/aims: Palliative and End of Life Care (P&EOLC) services normally have a relatively fast turnover of patients, however, the monthly numbers in any setting/geography is usually predictable. In the COVID- 19 pandemic there was a seismic rise in the number dying (in England, 494,611 (2019), 568,070 (2020) and 321,474 (2021 January to July). Deaths peaked in the 1st and 2nd waves. Aims: To describe the temporal changes in demand for PEoLC services during the pandemic and geographical variation in impact on provision in different settings. Methods: Mortality data for England, January 2019 to July 2021was analysed by calendar month, place of death, and geographically for 106 clinical commissioning groups (CCGs) = health administrations. Comparisons were made for 2020 and 2021 with reference to 2019. For 2021 the data January to July was compared to these months in 2019. The variations across CCGs were described using interquartile range (IQR). Results: In 2020 deaths increased by 15% (73,459) vs. 2019 and 10% (29,652) more in 2021(Jan to July) c.f. 2019. 2020 saw increases in deaths of: 29% (35,342) at home, 21% (23,281) in care homes, 7% (15,970) in hospital but -12% (3,470) in hospice. April 2020 (peak of first wave) showed the greatest change by month: of: 194% (17,732) care home, 86% (8,428) home, 84% (15,629) hospital, but -6% (150) in hospice. Across 106 CCGs in 2020 variation in increase in deaths had IQR: care home (14% to 29%), home (23% to 34%), hospital (2% to 13%), hospice (-23% to -4%), In April 2020 across 106 CCGs the variation in deaths had an IQR: care home (137% to 275%), home (58% to 105%), hospital (46% to 96%), hospice (-27% to 17%). Conclusions: These results emphasise the importance of joint working in a pandemic between the public health response and P&EOLC services to use data to mobilise expert P&EOLC support to organisations and geographies with greatest need. Rapid P&EOLC redeployment is key and new ways of working (phone/video) to support/train non-specialists to support the dying.

QTc interval prolongation in paediatric patients admitted due to SARS-CoV-2 infection and their relationship with antiviral drugs

Introduction: Many antiviral agents such as hydroxychloroquine have been studied to treat COVID-19, without being broadly accepted. Multiple side effects have been described, with QTc interval prolongation being one of the most worrisome. Literature on electrocardiographic alterations in COVID-19 is scarce. There aren't large samples of paediatric patients receiving hydroxychloroquine beyond Covid-19 to establish its relationship with electrocardiographic abnormalities. This study aims to describe QTc prolongation in relation to hydroxychloroquine and its association with other antivirals: lopinavir/ritonavir, remdesivir and azithromycin. Methods: COVID-19 cases were detected by Polymerase Chain Reaction from nasopharyngeal aspirate and matched at a 1:2 ratio according to age and sex with controls not exposed to study drugs nor infected by COVID-19. Electrocardiograms, collected S62 Cardiology in the Young: Volume 32 Supplement 1 prospectively, were evaluated manually by the same person. QT intervals were calculated in 3 different beats and corrected with the Bazett formula. Electrocardiographic cut-off points were determined: before treatment, within 72 hours of the start and after more than 72 hours. Data were compared by using oneway ANOVA. Results: 11 out of 48 paediatric patients admitted due to COVID- 19 from March to July 2020, received antiviral therapy (22.9%) based on clinical evidence at the time;median age 9 years (IQR 10.5), 54.5% were male. Among the main underlying pathologies, congenital heart diseases (36.4%) and malignant haematological diseases (27.3%) stood out;5 had received treatments potentially causing QTc prolongation. 10 patients (90.9%) received hydroxychloroquine, mostly in association with azithromycin (80%). 3 patients received lopinavir/ritonavir and one remdesivir. The mean of the baseline QTc interval was 418.5ms (407.4-429.6, 95%CI), before 72 hours was 424.6ms (398.1-451.2). A prolongation occurred after 72 hours: 439.7ms (408.5-470.9) but was not significant (p=0.253). 2 patients had long QTc interval before starting the treatment, and 4 after 72 hours. No patient presented arrhythmias. Conclusions: A small proportion of patients received antiviral drugs. All had underlying diseases and a great proportion were taking drugs with an effect on QTc interval;this could contribute to QTc prolong. QTc prolongation occurred after 72 hours under treatment. Although only one patient had a QTc interval longer than 500ms (treatment was stopped afterwards) and none presented arrhythmias, QTc monitoring is advised.

Tracelet: Contact Tracing and Physical Distancing Device with Block-chain Technology for Pamantasan ng Cabuyao

In the Philippines, contact-tracing is done in the conventional method where people fill-up health-declaration forms. Proper physical distancing is not followed, especially in public places. This study is focused on concerns involving the conventional contact tracing and physical distancing in Pamantasan ng Cabuyao. Developed using modified incremental-prototyping methodology. The objective is to develop module device with ranging position, triggered when one-meter distance is compromised and physical distancing notification. Included a web-based application interface for contact-tracing where the administrator can update the status and registration of the users. Utilized block-chain technology as storage for the users' information. The device is developmentally-designed, implemented and evaluated. Based on the series of testing, the device provides notification through blinking light, and set-off to exchange identifications. Users' information is secured through the Block-chain. When a user is reported to be COVID-19 positive, all the users who have been in contact, will be alerted via text message. © 2021 IEEE.

Disinfectant Synthesizer using Electrolysis for Automatic Utilization of Sanitation Kiosk

Wearing facemasks, face shields and social distancing are some of health protocols that are being imposed to lessen the risk of viral transmission specifically COVID 19. All establishments here in the Philippines build their own sanitation booths to ensure virus prevention. This study aims to address the issues regarding the use of chemical disinfectants and manually placing them in sanitation booths, and the ineffective manual ways of sanitizing individuals. This study is a design project adopting the developmental type of research method. Hypochlorous acid (HOCL) has a lot of potential as a disinfectant. In an electrolysis chamber with dilute salt and distilled water, HOCL can be made. The researchers design a device to automate the manufacturing of HOCL, which will be use as disinfectant, and automatically sanitize individuals with a safer and non-toxic disinfectant. The researchers prepared questionnaires to assess the acceptability of the device. The statistical tool used in the interpretation of data is weighted arithmetic mean. The major finding of this study is the ability of the device to convert distilled water and salt into disinfectant solution with the electrolysis process utilized, the duration of the process that will optimally convert it is 40 minutes, with accurate reading of analog pH sensor and lessen the exposure to each individual through the automation of the sanitation booth. For that reason, the researchers conclude that this design project provides a way to ensure virus prevention using automatic sanitation booth with disinfectant (HOCL) solution that offers more benefits over traditional sanitation methods. The overall acceptability rating of the design project is 4.46, interpreted as Very Good which shows that the device has high satisfaction. © 2021 IEEE.

Clinical Outcomes of Hospitalized COVID-19 Patients Treated with Remdesivir-NEAT ID 909REM Study

Background. There are few real-world data on the use of remdesivir (RDV) looking at timing of initiation in relation to symptom onset and severity of presenting disease. Methods. We conducted multi-country retrospective study of clinical practice and use of RDV in COVID-19 patients. De-identified medical records data were entered into an e-CRF. Primary endpoints were all-cause mortality at day 28 and hospitalization duration. We assessed time from symptom onset to RDV start and re-admission. We included adults with PCR-confirmed symptomatic COVID-19 who were hospitalized after Aug 31, 2020 and received at least 1 dose of RDV. Descriptive analyses were conducted. Kaplan-Meier methods were used to calculate the mortality rate, LogRank test to compare groups defined by severity of disease. Competing risk regression with discharge and death as competing events was used to estimate duration of hospitalization, and Gray's test to compare the groups. Results. 448 patients in 5 countries (12 sites) were included. Demographics are summarized (table) by 3 disease severity groups at baseline: no supplemental oxygen (NSO), low flow oxygen ≤6 L/min (LFO), and high-flow oxygen > 6L/min (HFO). No demographic differences were found between groups except for the higher percentage of cancer/chemotherapy patients in NSO group. Corticosteroids use was HFO 73.6%, LFO 62.7%, NSO 58.0%. Mortality rate was significantly lower in NSO, and LFO groups compared with HFO (6.2%, 10.2%, 23.6%, respectively;Fig1). Median duration of hospitalization was 9 (95%CI 8-10), 9 (8-9), 13 (10-15) days, respectively (Fig2). Median time from first symptom to RDV start was 7 days in all 3 groups. Patients started RDV on day 1 of hospitalization in HFO and LFO and day 2 on NSO groups. And received a 5 day course (median). Readmission within 28-days of discharge was < 5% and similar across all 3 groups. Conclusion. In this real-world cohort of COVID-19 positive hospitalized patients, RDV use was consistent across countries. RDV was started within a median of 7 days from symptom within 2 days of admission and given for a median of 5 days. Higher mortality rate and duration of hospitalization was seen in the HFO group and similar rates seen in the LFO and NSO groups. Readmission was consistently low across all 3 groups.

Increased risk of ibd flare after sars-cov-2 infection. Whos the more guilty: Viral infection or therapy withdrawal?

Background: In the last year, the severe adult respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic has spread rapidly around the world. The interactions between SARS-CoV-2 and inflammatory bowel disease (IBD) are so far not fully understood. In particular, no studies evaluated the potential role of SARS-CoV-2 on IBD course. Indeed, it is known that viral infections can be act as triggers for IBD flare and it is reasonable that the possible drug discontinuation during SARS-CoV-2 infection could in turn lead to an IBD flare. Methods: This was a prospective, observational case-control study. From March 11th 2020 to June 30th 2020 we enrolled IBD patients with proven SARS-Cov-2 infection (cases) and IBD patients without SARS-CoV-2 infection matched for sex, age, diagnosis, therapy and clinical activity (controls). Cases and controls were followed-up at least for 6 months. Differences between case and control group were tested for significance using the Students t test and Fishers test, as appropriate. A two-tailed p value < 0.05 was indicative of statistical significance. Results: 219 IBD patients (127 UC, 58.0%) with SARS-CoV-2 infection and 219 IBD patients without SARS-CoV-2 infection were enrolled. Table 1 shows baseline features of the population. Among the 122 cases in clinical remission at the time of viral infection, 28 (22.9%) showed a disease flare;this percentage was significantly higher than that observed in controls: 12/137 (8.8%)(p=0.0018). Among patients with disease flare, there were no significant differences between cases and controls group in terms of age (42.3 ± 16.0 vs. 43.1 ± 15.4 years, p=0.44), gender (female 45.7% vs. 48.2%, p= 0.54), use of biologic therapies (p=0.83) and UC or CD diagnosis (p=0.06). Biologic therapy was temporary withdrawn more significantly in cases than in controls (68/202, 33.6% vs. 14/204, 6.9%) (p<0.001) and overall biologic therapy discontinuation was significantly associated with disease flare (OR 2.56, 95% CI 1.026.41, p=0.04). Conclusion: IBD patients with SARS-CoV-2 infection have an increased risk to have a clinical recurrence in short-term in comparison with IBD patients without SARS-CoV-2 infection. This increased risk could be due to the viral infection and/or to the temporary discontinuation of biologic therapies, because of infection.

COVID-19 in patients aged 80 years and over during the peaks of the first three pandemic waves at a Spanish tertiary hospital

INTRODUCTION COVID-19 disproportionately impacts patients aged >= 80 years, yet few studies have focused on this population. We aimed to investigate the clinical characteristics and outcomes of very elderly patients with COVID-19 across three consecutive waves in Spain. METHODS We retrospectively evaluated very elderly patients admitted with COVID-19 to a university hospital in Barcelona, Spain, across the three first waves. Main outcomes were ICU admission and 30-day mortality. RESULTS From March 2020 to February 2021, 3105 patients diagnosed with COVID-19 were admitted. Of these, 655 (21%) were very elderly patients, 50% were female and median age was 86 (83;89) years. ICU admission and ICU-mortality rates were 11% and 42%, respectively;male sex, respiratory rate >= 25 breaths/min, LDH >= 337.5 U/L and C-reactive protein >= 11.5 mg/dL were significantly associated with ICU admission in the multivariable analysis. Overall, 30-day mortality was 34%. The ICU admission rate was significantly higher during the first wave compared to the third wave (16% vs 8%;p=0.009), whereas no significant differences in 30-day mortality were found between waves (p=0.107). CONCLUSIONS We observed an increase in the percentage of very elderly patients admitted to the ICU during the three first pandemic peaks. ICU admission more likely occurs in very elderly male patients with higher respiratory rate, with elevate LDH and C-reactive protein. Overall, our 30-day mortality rate was lower compared to other series globally.

Anticoagulation strategies and risk of bleeding events in critically ill COVID-19 patients

Background : Previous reports describe high rates of venous thromboembolism (VTE) in critically ill COVID-19 patients. Consequently, intermediate and therapeutic doses anticoagulation have been used in clinical practice, potentially exposing patients to a higher risk of bleeding. Aims : To evaluate the rate of thrombosis, bleeding and mortality comparing prophylactic, intermediate or therapeutic doses in critically ill COVID-19 patients. Methods : All COVID-19 patients admitted to the intensive care unit of a tertiary hospital between March and April 2020 were included. Patients were categorized into three groups according to the highest anticoagulant dose received: prophylactic, intermediate and therapeutic. Incidence of VTE, bleeding and mortality were compared between groups. We performed two logistic multivariable regressions to test the association between VTE and bleeding with clinical characteristics and the anticoagulant regimen. Results : 201 patients were included. 78 (39%) received prophylactic, 94 (47%) intermediate and 29 (14%) therapeutic doses. There were no differences in VTE and mortality between groups. In contrast, bleeding events were more frequent in patients receiving therapeutic (31%) and intermediate (15%) doses than in those receiving prophylactic doses (5%) ( P < 0.001 and P < 0.05 respectively). Major bleedings were also more frequent in patients with anticoagulant doses ( P < 0.01). The anticoagulant dose was the strongest determinant for bleeding (odds ratio [OR] 2.4, 95% confidence interval (CI) 1.26-4.58, P = 0.008) but had no impact on VTE (OR 0.97, 95%CI 0.58-1.68, P = 0.92). Conclusions : Critically ill COVID-19 patients receiving intermediate or therapeutic doses of heparin appear to have a higher risk of bleeding without a decrease of VTE events and mortality.

Experience with the use of siltuximab in patients with SARS-CoV-2 infection.

OBJECTIVE: The study aims to describe characteristics and clinical outcome of patients with SARS-CoV-2 infection that received siltuximab according to a protocol that aimed to early block the activity of IL-6 to avoid the progression of the inflammatory flare. METHODS: Retrospective review of the first 31 patients with SARS-CoV-2 treated with siltuximab, in Hospital Clinic of Barcelona or Hospital Universitario Salamanca, from March to April 2020 with positive polymerase-chain reaction (PCR) from a nasopharyngeal swab. RESULTS: The cohort included 31 cases that received siltuximab with a median (IQR) age of 62 (56-71) and 71% were males. The most frequent comorbidity was hypertension (48%). The median dose of siltuximab was 800 mg ranging between 785 and 900 mg. 7 patients received siltuximab as a salvage therapy after one dose of tocilizumab. At the end of the study, a total of 26 (83.9) patients had been discharged alive and the mortality rate was 16.1% but only 1 out of 24 that received siltuximab as a first line option (4%). CONCLUSIONS: Siltuximab is a well-tolerated alternative to tocilizumab when administered as a first line option in patients with COVID-19 pneumonia within the first 10 days from symptoms onset and high C-reactive protein.