The natural history of COVID-19 in vaccinated inflammatory bowel disease patients.

AIM: Assess the characteristics of break through COVID-19 in Inflammatory Bowel Disease (IBD) patients, despite complete vaccination. METHODS: Patients who reported a COVID-19 at least 3 weeks after complete vaccination were asked to answer an on-line anonymous questionnaire which included patient and disease characteristics, vaccination history, and the evolution of COVID-19. RESULTS: Among 3240 IBD patients who reported complete vaccination between 1st May 2021 and 30thJune 2022, 402 (12.4%) were infected by SARS Cov-2 [223 male, 216 Crohn's disease (CD), 186 Ulcerative Colitis (UC), mean (SD) age 42.3 (14.9) years, mean (SD) IBD duration 10.1 (9.7) years]. Three hundred and sixty-nine patients (91.8%) were infected once and 33 (8.2%) twice. The mean (SD) time between last vaccination and infection was 4.1 (1.6) months. Overall, 351 (87.3%) patients reported mild constitutional and/or respiratory symptoms, 34 (8.4%) were asymptomatic and only 17 patients (4.2%) required hospitalization. Of hospitalized patients, 2 UC patients died of COVID-19 pneumonia. The remaining hospitalized patients did not need high flow oxygen supply or ICU admission. CONCLUSIONS: A minority of completely vaccinated IBD patients developed COVID-19 which evolved with mild symptoms and a favorable outcome. These results reinforce the importance of vaccination especially in vulnerable populations.

Wearable blood pressure measurement devices and new approaches in hypertension management: the digital era.

Out-of-office blood pressure (BP) measurement is considered an integral component of the diagnostic algorithm and management of hypertension. In the era of digitalization, a great deal of wearable BP measuring devices has been developed. These digital blood pressure monitors allow frequent BP measurements with minimal annoyance to the patient while they do promise radical changes regarding the diagnostic accuracy, as the importance of making an accurate diagnosis of hypertension has become evident. By increasing the number of BP measurements in different conditions, these monitors allow accurate identification of different clinical phenotypes, such as masked hypertension and pathological BP variability, that seem to have a negative impact on cardiovascular prognosis. Frequent measurements of BP and the incorporation of new features in BP variability, both enable well-rounded interpretation of BP data in the context of real-life settings. This article is a review of all different technologies and wearable BP monitoring devices.

The Natural History of Covid-19 in Vaccinated Inflammatory Bowel Disease Patients

Introduction: Patients with Inflammatory Bowel Disease (IBD), especially those on immunosuppressives (IMS), should be vaccinated against SARSCoV- 2 to prevent hospitalization, mechanical ventilation, and death. However, IMS may adversely affect response to vaccination, raising concerns as to how vulnerable these patients are to break through COVID-19 infections. Thus, we aimed to assess the proportion of IBD patients who despite complete vaccination developed COVID-19, as well as the course of COVID-19 disease. Aims & Methods: This study was an initiative of the Hellenic IBD Study Group (EOMIFNE) and involved 12 IBD referral Centers. Patients attending these Centers who reported a COVID-19 infection at least 3 weeks after vaccination completion were asked to complete an on-line anonymous questionnaire which included patient demographics and IBD clinical and therapeutic data, a detailed vaccination history, and the course and outcome of COVID-19, especially the need for hospitalization, oxygen supply, and admission to ICU. In patients with a grave outcome information was sought by family members. Result(s): On estimate, 3240 patients reported full vaccination (vaccination scheme either with combined Vaxzevria- Comirnaty or onlyComirnaty vaccine) in the 12 centers. Between 1stMay 2021 and 20thApril 2022,351 (10.8%) fully vaccinated IBD patients reported COVID-19 infection [187 male, 212 CD, 139 UC, mean (SD) age 42.3 (14.9) years, mean (SD) IBD duration mean (SD), 10.1 (9.7) years]. Among them, 322 (91.7%) were infected once and 29 (8.3%) patients twice. Seventy-three patients were receiving 5-ASAs, 15 corticosteroids, 46 azathioprine/methotrexate, 117 anti-TNFs as monotherapy and 21 in combination with azathioprine/methotrexate, and 2 with corticosteroids, 43 vedolizumab, 25 ustekinumab, 5 tofacitinib and 1 rizakinzumab at the time of COVID-19 diagnosis. Three patients did not receive any treatment. IBD was in remission in 279/351 patients (79.5%). Comorbidities were reported by 112 patients (thyroid disease 66;diabetes mellitus 13;hypertension 12;coronary heart disease 11;prior cancer 4;psoriasis 2;spondyoartropathy 2;dyslipidemia 1;and PSC 1 patient). The mean (SD) time between last vaccination dose and infection was 4.1 (1.6) months. Overall, 308 (87.7%) patients reported mild constitutional and respiratory symptoms, 29 (8.6%) were asymptomatic and only 14 patients (3.9%) required hospitalization. Of those hospitalized, 2 patients, both with UC, died because of COVID pneumonia (one aged 67, on infliximab, with diabetes and the second one aged 80, on 5-ASA, with a history of laryngeal cancer);however, the remaining 12 patients did not need high flow oxygen supply or ICU admission, and none reported symptoms of long COVID. IBD medications were stopped in 145 patients (41.3%) during the COVID-19 infection. Conclusion(s): A minority of fully vaccinated IBD vaccinated patients developed COVID-19 which was relatively mild and uneventful. These results reinforce the importance of vaccination especially in vulnerable populations.

The natural history of COVID-19 in patients with IBD: A nationwide study by the hellenic society for the study of IBD

Introduction: COVID-19 has evolved into a global health crisis, variably affecting the management of patients with chronic illnesses. Patients with inflammatory bowel disease (IBD) may represent a vulnerable population due to the frequent administration of immune-modifying treatments. Aims & Methods: We aimed to depict the natural history of COVID-19 infection in Greek patients with IBD at a nationwide level via the unbiased reporting of all cases that were registered during the first and second waves of the pandemic. Following a national call from the Hellenic Society for the study of IBD, we enrolled all IBD patients with established diagnoses of COVID-19. Clinical and epidemiological data, including COVID-19 modifying factors and IBDassociated therapies, were analyzed against adverse outcomes (hospitalization, ICU admission, and death). Results: We identified 160 IBD patients who were diagnosed with COVID- 19 during the study period (male:56.9%;mean age=41.6 [SD=14.8] years;CD:64.4%). Adverse outcomes were reported in 34 patients (21.3%), including 3 ICU admissions (1.9%) and 2 deaths (1.3%). As shown in the table prognostic factor for adverse events due to COVID-19 in IBD patients were sought. Through multivariate logistic regression age (OR=1.04, 95% CI=1-1.08) and dyspnoea at presentation (OR=8.72, 95% CI=2.14-35.57) were identified as negative prognostic factors while there was also a tendency for fever at presentation (OR=3.23, 95% CI=0.91-11.43). In contrast, treatment with biologics, in particular anti-TNF agents, exerted a protective effect against an unfavorable course COVID-19 (OR=0.33, 95% CI=0.13-0.84). Patients on subcutaneous biologics were more likely to halt treatment due to the infection as compared to those on intravenous medications. Conclusion: IBD patients who developed COVID-19 had a benign course with adverse outcomes being scarce. Treatment with biologics had a beneficial effect, supporting the continuation of therapy during the pandemic. (Table Presented).