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Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was detected in Wuhan, China, in December 2019. The disease (Covid-19) is mainly associated with lung injury, although neuromuscular symptoms including muscle weakness and myalgia are encountered in up to 10.7% of hospitalized patients affected by Covid-19. Nevertheless, the extent of muscular involvement in infected subjects has never been assessed with neurophysiological investigations. Method(s): Over a 3-week period, from April 30 through May 20, 2020, a total of 70 patients were hospitalized in the Internal Medicine Ward of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy. After excluding patients who underwent invasive ventilation and steroid treatment, 12 patients were evaluated. The Covid-19 diagnosis was confirmed by 2 positive nasopharyngeal swabs performed before and after our evaluation. All patients were asymptomatic for muscular involvement. Result(s): A total of 12 patients were included in this study. None of the patients exhibited neuromuscular symptoms during the disease course. All patients showed mild to moderate respiratory symptoms and chest X rays were suggestive for pneumonia. Mean age was 69 (SD 12.80) years, and 5 patients were men. The main comorbidity was hypertension. Neurological examination was unremarkable, and all the subjects obtained an MRC sum score of 60. None of the patients showed an elevation of the serum creatine-kinase (CK) or serum lactate dehydrogenase (LDH) levels performed before the neurophysiological assessment. No NCS abnormalities were found except the absence of bilateral sural sensory action potential (SAP) in patient 12, which was already reported in a previous evaluation and likely due to diabetes. Needle electromyography showed a myopathic pattern in 6 out of 12 subjects. Such alterations were prominent in a patchy fashion, in particular in proximal muscles such as trapezius (6), iliopsoas (4) and deltoid (1). The levels of fibrinogen, CK, D-dimer, C reactive protein did not show relevant differences between the two groups. When compared to non-myopathic subjects, patients with skeletal muscle injury exhibited more severe respiratory conditions according to the need for non-invasive mechanic ventilation (NIMV) Conclusion(s): Our data show that in SARS-CoV-2 infection muscular involvement may occur despite the absence of clinical signs or symptoms and should be considered part of the disease spectrum. The application of muscle biopsy to unravel the mechanisms of myofiber damage on tissue specimen could help to clarify the pathogenesis and the treatment response of coronavirus-mediated injury. Copyright © 2022
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The specific symptomatology of Covid-19 reveals discomfort with mild or moderate intensity depending on the body of each person. This article develops the design of an automatic device that encompasses an intelligent control and monitoring system for symptoms of covid-19, which allows determining and identifying an estimate of suspected cases of people who enter the Continental University-Peru, through a reading of patterns. The device was made covering three systems (mechanical, mechatronic and control), the integration of systems allowed an efficient design, dimensioned calculations in the mechanical, electrical, and electronic, and its integration of hardware-software for the graphical interface. The system presented allows real-Time monitoring of parameters captured by sensors with IOT technology, which has made it possible to deepen and estimate suspected cases of covid by comparing measured values with the ranges of values established by the American Medical Association. © 2022 IEEE.
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Background: Waldenström macroglobulinemia (WM) is a rare, indolent B-cell lymphoproliferative disorder. After the STiL-1 trial (Rummel MJ. Lancet. 2013;381(9873):1203-1210) demonstrated significant benefit in a subgroup analysis as well as reduced toxicity using bendamustine and rituximab (BR) compared to R-CHOP (N=41 enrolled WM patients), BR became the preferred immunochemotherapy (IC) regimen for all patients with symptomatic treatment naïve (TN) WM in British Columbia (BC) since 2014. Prior to the introduction of BR, the combination of rituximab, cyclophosphamide, vincristine, and prednisone (RCVP), was the standard of care in BC for this population since 2004, given its widespread use across a broad range of indolent B-cell lymphomas. We report a population-based analysis evaluating outcomes in TN-WM patients comparing BR with RCVP. Methods: The BC Cancer Centre for Lymphoid Cancer Database was used to identify TN-WM patients treated with BR or RCVP as their first systemic therapy between August 1, 2004 - August 1, 2020. A period of observation but no prior to systemic therapy was permitted. All patients had clinicopathologically confirmed lymphoplasmacytic lymphoma and measurable monoclonal IgM. Event-free survival (EFS) was defined as time from start of IC to progression, relapse, initiation of alternative therapy, histologic transformation, or death due to any cause. Early progression (POD24) was defined as relapse or progression, death from lymphoma, or treatment toxicity within 24 months of initiation of systemic therapy. Outcomes were compared with a historical cohort of patients treated with frontline RCVP. Responding patients were eligible to receive maintenance rituximab (MR) every 3 months for 2 years since 2006;however this was discontinued in 2020 when a subgroup analysis of the MAINTAIN trial (Rummel MJ. Blood 2019;134 (Supplement_1): 343), showed a lack of PFS benefit after BR, coupled with safety and vaccine response concerns during the COVID-19 pandemic. Results: A total of 111 patients with WM were identified;57 treated with BR, 54 treated with RCVP. Median age was 69 years (range 33-89) and baseline characteristics (Table 1), were well-balanced. A higher proportion of RCVP-treated patients received >4 cycles of chemotherapy (81% vs 65%, p=0.049). After IC, 75 (68%) received MR, with 36 (63%) and 39 (72%) in the BR and RCVP groups respectively (p=0.3). Median follow-up from diagnosis for all living patients was 5.9 years (range 0.8-19.2), with median 4.4y vs 9.8y for BR and RCVP respectively. EFS estimates at 4-years achieved with BR were 57% (95% CI 40-71%) compared to RCVP 60% (95% CI 45-72%), p=0.5 (Figure 1). Median EFS was established for RCVP due to longer duration of follow up at 6.3 years (95% CI 3.6-11.8y). Overall survival (OS) estimates at 4-years were 74% (95% CI 57-85%) and 81% (95% CI 67-89%) for BR and RCVP patients respectively, p=0.6. Worse performance status (≥2) was the only pre-treatment factor identified as significant for inferior EFS. A sub-analysis limited to patients that received >4 cycles of IC also showed no clear difference in outcomes between BR and RCVP. Median time to transformation was 6.5y (5.5-13y), with only 3 late biopsy-proven events. Early progression (POD24) has occurred in 19 (18%) patients, with inferior survival observed in patients that had an early event compared with a reference cohort (2-years event free), however this did not reach statistical significance (p=0.3) (Figure 1). Conclusion: This population-based analysis of TN-WM patients treated with upfront IC confirms the excellent outcomes that can be achieved with a finite course of therapy. In contrast to prior studies, similar outcomes were observed with RCVP and BR. Further, regardless of front-line therapy, POD24 may be associated with inferior outcome but larger studies are needed. To our knowledge, this study is the first to make a direct comparison between BR and RCVP, and one of the largest restricted to IC-treated TN-WM. This data supports RCVP as a viable option, and should ser e to inform clinicians, patients, and policy makers in decision-making when considering upfront therapeutic options, and when considering indefinite alternative regimens such as BTK inhibitors. [Formula presented] Disclosures: Gerrie: AbbVie: Honoraria, Research Funding;Janssen: Honoraria, Research Funding;Astrazeneca: Honoraria, Research Funding;Sandoz: Honoraria;Roche: Research Funding. Savage: Servier: Consultancy, Honoraria;Astra-Zeneca: Consultancy, Honoraria;BMS: Consultancy, Honoraria, Other: Institutional clinical trial funding;Seattle Genetics: Consultancy, Honoraria;Merck: Consultancy, Honoraria, Other: Institutional clinical trial funding;Takeda: Other: Institutional clinical trial funding;AbbVie: Consultancy, Honoraria;Roche: Research Funding;Beigene: Other: Institutional clinical trial funding;Genentech: Research Funding. Villa: Roche: Honoraria;Janssen: Honoraria;Lundbeck: Honoraria;Celgene: Honoraria;Seattle Genetics: Honoraria;AbbVie: Honoraria;AstraZeneca: Honoraria;Gilead: Honoraria;NanoString Technologies: Honoraria. Scott: BC Cancer: Patents & Royalties: Patent describing assigning DLBCL COO by gene expression profiling–licensed to NanoString Technologies. Patent describing measuring the proliferation signature in MCL using gene expression profiling.;Abbvie: Consultancy;Janssen: Consultancy, Research Funding;AstraZeneca: Consultancy;Rich/Genentech: Research Funding;Celgene: Consultancy;Incyte: Consultancy;NanoString Technologies: Patents & Royalties: Patent describing measuring the proliferation signature in MCL using gene expression profiling. Craig: Bayer: Consultancy. Slack: Seagen: Consultancy, Honoraria. Sehn: Debiopharm: Consultancy;Novartis: Consultancy;Genmab: Consultancy. Freeman: Amgen: Honoraria;Celgene: Honoraria;Sanofi: Honoraria, Speakers Bureau;Incyte: Honoraria;Abbvie: Honoraria;Teva: Research Funding;Roche: Research Funding;Bristol Myers Squibb: Honoraria, Speakers Bureau;Janssen: Honoraria, Speakers Bureau;Seattle Genetics: Honoraria.
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Background: Improving kidney transplant (KTx) outcomes remains a primary challenge and KTx ureter JJ stenting has been used to prevent urological complications. There is no consensus about EJJR timing, and literature regarding routine US imaging after EJJR to detect complications is lacking. Methods: We retrospectively analysed all routine KTx US done in our Unit from 2016-2020 by an experienced interventional nephrologist. US post EJJR findings were compared with previous US. KTx characteristics, treatment and outcomes were recorded. We aimed to define incidence of urological complications diagnosed, US utility and best time interval to perform it. Results: 345 KTx were done: 62.9% were male receptors, 81.7% had a first KTx and 91.5% of the organs were from a deceased donor. No routine US post EJJR was done in 20.9% due to COVID pandemic. Mean timing to elective JJ stent removal was 36.4 ± 25 days (SD). Mean time from EJJR to US was 16.3 ± 28.8 days (SD). Urinary tract ectasia was not considered pathological. Of those with an US, 45.1% (123) had a complication detected: 41.4% had a newly diagnosed collection and 21% had urinary tract dilatation (UTD): 10% grade I UTD. 6% grade II UTD. 5% grade III UTD. Of the 123 patients with a complication, 3 required a surgical approach, 2 had a drainage inserted, 2 nephrostomies, 11 required admission without surgical intervention and 51 had US follow up. Cumulative frequency analysis of complications post EJJR showed the highest diagnostic yield of US imaging was around day 10 post removal (figure 1). Conclusions: Routine US after EJJR allowed timely diagnosis and early treatment of urological complications, a key factor for successful transplantation. KTx US is an effective, cheap and reproducible test that provides crucial information to guide clinical decisions, being most effective when performed 10 days post stent removal. Interventional nephrologists could do this examination promptly.
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Background and aims: Coronavirus disease 2019 (COVID-19) is associated to neuromuscular symptoms in up to 10.7% of hospitalized patients. The prevalence and the characteristics of intensive care unit acquired weakness (ICUAW) in patients affected by COVID-19 have been extensively assessed, although no distinctive pattern was found. ICUAW has been described as a potential confounding factor during the identification of severe acute respiratory syndrome coronavirus 1-related myopathy. In order not to incur this potential bias, we focused on a subset of non-severe cases. Our aim was to precisely assess the extent of primary neuromuscular involvement with neurophysiological investigation in COVID-19 patients. Methods: From April through May 2020 a total of 70 patients were hospitalized in the Internal Medicine Ward of the Fondazione IRCCS Ospedale Maggiore Policlinico in Milan, Italy. After excluding patients who underwent invasive ventilation and steroid treatment, 12 patients were evaluated. Neurological examination, nerve conduction studies (NCS) and concentric-needle electromyography (EMG) were performed. Results: While nerve conduction studies were unremarkable, needle electromyography showed myopathic changes in 6 out of 12 subjects. All patients were asymptomatic for muscular involvement. Clinical features and laboratory findings did not show relevant differences between patients with and without myopathic changes. [Formula presented] [Formula presented] Conclusions: Our data show that in SARS-CoV-2 infection muscular involvement can occur despite the absence of clinical signs or symptoms and should be considered part of the disease spectrum. The application of muscle biopsy to unravel the mechanisms of myofiber damage on tissue specimens could help to clarify the pathogenesis and the treatment response of coronavirus-mediated injury.
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BACKGROUND: Among laboratory abnormalities described in the context of SARSCOV- 2 infection, hyponatremia seem to be the most common. The mechanism of this sodium disbalance is not well known. AIMS: Characterize the incidence, etiology and prognostic value of sodium disbalance in patients with COVID19. METHOD: Observational pilot study with 37 patients admitted to Hospital Ramon y Cajal in Madrid, Spain, between March and April 2020, with a confirmed diagnosis of COVID19. Patients were followed until discharge or death. Clinical and laboratory data were collected at admission and before the clinical outcome. Variables were analyzed comparing hyponatremic vs eunatremic patients. RESULTS: Distribution of patients according to their serum sodium was as follows: 16 patients with hyponatremia (44%), 19 with normal serum sodium (51%) and 2 with hypernatremia (5%). The average sodium level in hyponatremic patients was 130±3.2 mmol/l, median urine sodium was 36±3.2 mmol/l (only 6 urine sample available). Hyponatremia was associated with dyspnea at admission and with higher levels of LDH, neutrophil cells account and C reactive protein. However, no worse prognostic was associated with lower serum sodium. All patients recover sodium levels at discharge treated with salt supplementation and free water intake. CONCLUSION: mild hyponatremia is a common electrolyte disorder associated with COVID19. Sing as low urine sodium and recover with water and salt ingestion, point toward hydrosaline dehydration instead of SIADH as most common origin of hyponatremia.
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Objective: We aimed to realize a verification of the performance of the rapid serological tests used in Risaralda department. Methods: Analytical, cross-sectional study. Serum samples from health workers in Pereira city, who had a clinical and epidemiological suspicion for SARS-CoV-2 were included. The processing and validation of the tests was carried out at Universidad Tecnológica de Pereira. Sensitivity and specificity of rapid IgM / IgG serological tests were calculated using RT-PCR as the gold standard test. Results: 144 samples of health professionals were included. Rapid serological tests useful to identify or rule out the presence of IgM and IgG antibodies, especially in symptomatic patients, in whom the onset of symptoms is longer than 11 days. Discussion: The use of rapid tests is increasing, not only due to the speed of their results, but also due to the low associated costs and the need to identify non-susceptible patients, who must prioritize their return to work activities in the community as part of the economic reactivation of Colombia. It is necessary to confirm the adequate performance of the test to increase the probability of an adequate classification before proceeding with the routine use of this test. © 2021 Asociacion Colombiana de Infectologia. All rights reserved.