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Objective: The Covid-19 pandemic necessitated a decrease in non-Covid-19 related diagnostic and therapeutic procedures in many countries. We explored the impact on hypertension care in the Excellence Center (EC) network of the European Society of Hypertension. Design and method: We conducted an electronic survey regarding 6 key procedures in hypertension care among our ECs. Results: Overall, 54 ECs from 18 European and 3 non-European countries participated. From 2019 to 2020, there was a significant decrease in the median number per center of ambulatory blood pressure monitorings (ABPMs;544 vs 289), duplex ultrasound investigations of renal arteries (DUS RA;88.5 vs 55), computed tomographic investigations of renal arteries (CT RA;66 vs 19.5), percutaneous renal artery angioplasties (PTA RA;5 vs 1), laboratory tests for catecholamines (2019: 116 vs 67.5) and for ennin/aldosterone (146 vs 83.5). All comparisons were statistically significant with p < 0.001, respectively (Figure). While the reduction in all diagnostic and therapeutic procedures was observed in all 3-months period comparisons between 2019 and 2020, the most profound decrease occurred from April to June 2020, which was the period of the first wave and the first lockdown in most countries. In this period, as compared to 2019, the median reduction in 2020 was 50.7% (ABPM), 47.1% (DUS RA), 50% (CT RA), 57.1% (PTA RA), 46.9% (catecholamines) and 41% ( ennin/aldosterone), respectively. Based on Friedman test, overall differences in reduction between 3 months time intervals were statistically highly significant. Conclusions: Diagnostic and therapeutic procedures related to hypertension were dramatically reduced during the first year of the Covid-19 pandemic, with the largest reduction during the first lockdown. The long-term consequences regarding blood pressure control and, ultimately, cardiovascular events remain to be investigated.
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BACKGROUND: Following the regional outbreak in China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world, presenting the healthcare systems with huge challenges worldwide. In Germany the coronavirus diseases 2019 (COVID-19) pandemic has resulted in a slowly growing demand for health care with a sudden occurrence of regional hotspots. This leads to an unpredictable situation for many hospitals, leaving the question of how many bed resources are needed to cope with the surge of COVID-19 patients. OBJECTIVE: In this study we created a simulation-based prognostic tool that provides the management of the University Hospital of Augsburg and the civil protection services with the necessary information to plan and guide the disaster response to the ongoing pandemic. Especially the number of beds needed on isolation wards and intensive care units (ICU) are the biggest concerns. The focus should lie not only on the confirmed cases as the patients with suspected COVID-19 are in need of the same resources. MATERIAL AND METHODS: For the input we used the latest information provided by governmental institutions about the spreading of the disease, with a special focus on the growth rate of the cumulative number of cases. Due to the dynamics of the current situation, these data can be highly variable. To minimize the influence of this variance, we designed distribution functions for the parameters growth rate, length of stay in hospital and the proportion of infected people who need to be hospitalized in our area of responsibility. Using this input, we started a Monte Carlo simulation with 10,000 runs to predict the range of the number of hospital beds needed within the coming days and compared it with the available resources. RESULTS: Since 2 February 2020 a total of 306 patients were treated with suspected or confirmed COVID-19â¯at this university hospital. Of these 84 needed treatment on the ICU. With the help of several simulation-based forecasts, the required ICU and normal bed capacity at Augsburg University Hospital and the Augsburg ambulance service in the period from 28 March 2020 to 8 June 2020 could be predicted with a high degree of reliability. Simulations that were run before the impact of the restrictions in daily life showed that we would have run out of ICU bed capacity within approximately 1 month. CONCLUSION: Our simulation-based prognosis of the health care capacities needed helps the management of the hospital and the civil protection service to make reasonable decisions and adapt the disaster response to the realistic needs. At the same time the forecasts create the possibility to plan the strategic response days and weeks in advance. The tool presented in this study is, as far as we know, the only one accounting not only for confirmed COVID-19 cases but also for suspected COVID-19 patients. Additionally, the few input parameters used are easy to access and can be easily adapted to other healthcare systems.
Subject(s)
Coronavirus Infections/therapy , Critical Care/organization & administration , Hospital Bed Capacity , Hospitals, University/organization & administration , Intensive Care Units/organization & administration , Pneumonia, Viral/therapy , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Critical Care/statistics & numerical data , Germany , Hospitals, University/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Pandemics , Pneumonia, Viral/epidemiology , Prognosis , SARS-CoV-2ABSTRACT
Introduction Peripheral T-cell lymphomas (PTCL) are a heterogeneous group of aggressive lymphomas, which usually carry a poor prognosis. Malignant T-cells may overexpress programmed death ligand 1 (PD-L1), which signals via programmed death-1 (PD-1) receptor, and provides an inhibitory signal on normal T-cells further suppressing antitumor immunity. They can also express PD1 which may act as a tumor suppressor on malignant T-cells (Wartewig et al, Nature 2017). Thus, blocking the PD1/PDL1 synapse in PTCL may lead to tumor regression or progression. The NIVEAU trial is an ongoing international, multicenter, randomized, open label, phase 3 study testing Nivolumab (Nivo) in combination with (Rituximab), Gemcitabine, Oxaliplatin ((R-)GemOx) for patients with aggressive (B and T-cell) Non-Hodgkin Lymphoma in first relapse or progression not eligible for High-Dose Chemotherapy (NCT03366272). Here, we performed a preliminary analysis of the experimental arm (Nivo-GemOx) of the PTCL cohort to assess the safety and efficacy of this regimen in this population. Methods Key eligibility criteria include: first relapse or progression of peripheral T-cell lymphoma (PTCL), ineligibility for high dose therapy (defined as >65 years of age or older than 18 years if HCT-CI score > 2), only one prior chemotherapy regimen including an anthracycline. Pts were planned to receive 8 cycles Nivolumab (3mg/kg) plus Gemcitabine and Oxaliplatin in 2-wk intervals followed by additional 18 Nivolumab (3mg/kg) biweekly as consolidation or until progression. Response was evaluated after 4 and 8 cycles of GemOx. Each progression/relapse of PTCL had to be reported as a SAE. Results The analysis (data cut-off 13-July-2020) included 12 PTCL pts enrolled in the experimental arm (Table 1): 4 (33%) PTCL NOS, 3 (25%) AITL, 1 (8%) PTCL TFH-type, 2 (17%) ALCL ALK-, 1 (8%) EATL, and 1 (8%) MEITL. Median age was 69.5 years (range, 53-80), 7 (58%) patients were male, 2 (17%) had received a prior autologous stem cell transplantation, and 5 (42%) were refractory to first line therapy. At enrollment, performance status was 0-1 in 9 (75%) pts and 2 in 3 (25%) pts, 11 (92%) had Ann Arbor stage III-IV, 2 (17%) had B-symptoms, 7 (58%) had more than one extra-nodal site and 4 (33%) had elevated LDH. PD1 and PD-L1 were expressed by the tumor cells in 6/10 (60%) and 2/11 (18%) patients, respectively (Table 1). Pts have received a median of 6 (1-8) cycles of GemOx and 7 (1-26) infusions of nivolumab. Treatment was prematurely discontinued in 9 pts (7 during induction and 2 during consolidation), due to lymphoma progression (n=6), toxicity (n=2) and an intercurrent disease (n=1). There were 26 SAE in 10 patients, including 8 progressive diseases. Nine (75%) patients achieved an objective response (4 CR and 5 PR). Two patients (pt 9: MEITL PD1-negative;and pt 12: PTCL-NOS strongly PD1-positive) experienced primary progression upon Nivo-GemOx (Table 1). Median PFS2 (time from randomisation to 2nd rel/prog/death) was 6.9 months (95% CI: 1.9-11.9) vs 7.7 months (95% CI: 7.2-8.2) for PFS1 (time from diagnosis to 1st rel/prog). PFS2 was superior to PFS1 in 2 out of 8 patients (25%), and not informative in 4 pts: 3 who are still on therapy (ongoing PFS) and 1 who died prematurely due to infection (pt 8) (Figure 1). Median OS was 24.8 months (95% CI: 0-49.8). After a median follow-up of 22.8 months, 7 patients have died (5 from lymphoma and 2 from infection (1 COVID-19 infection and 1 yeast septicemia)), and 5 remain alive. Conclusions Nivolumab in combination with GemOx was well tolerated in PTCL. The response rate and PFS2 (compared to PFS1) are encouraging. Marked differences in PFS2 might reflect heterogeneity of biology and susceptibility to PD-1 blockade in combination with GemOx chemotherapy. Furthermore, the translational research program of the study might help to identify markers which are predictive for efficacy of PD-1 blockade in PTCL. This phase 3 trial is actively enrolling patients and an update of these results will be presented at the meeting. Disclosure: ISR fin ncially supported by Bristol Myers Squibb. [Formula presented] Disclosures: Houot: Celgene: Honoraria;Janssen: Honoraria;Novartis: Honoraria;Roche: Honoraria;Kite: Honoraria;Gilead: Honoraria;MSD: Honoraria;Bristol-Myers Squibb: Honoraria. Poeschel: Roche: Other: Travel, Accommodations, Expenses;Amgen: Other: Travel, Accommodations, Expenses;Abbvie: Other: Travel, Accommodations, Expenses. André: Abbvie: Consultancy;Celgene: Other, Research Funding;Roche: Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding;Takeda: Consultancy;Bristol-Myers-Squibb: Consultancy, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company);Karyopharm: Consultancy;CHU UCL Namur, site Godinne, Yvoir, Belgium: Current Employment;Seattle Genetics: Consultancy;Gilead: Consultancy, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company);Johnson & Johnson: Research Funding;Novartis: Consultancy, Research Funding;Amgen: Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding. Dreyling: Beigene: Consultancy;Bayer: Consultancy, Speakers Bureau;Astra Zeneca: Consultancy;Abbvie: Research Funding;Roche: Consultancy, Research Funding, Speakers Bureau;Gilead: Consultancy, Research Funding, Speakers Bureau;Janssen: Consultancy, Research Funding, Speakers Bureau;Novartis: Consultancy;Celgene: Consultancy, Research Funding, Speakers Bureau. Tilly: BMS: Honoraria. Casasnovas: Gilead: Consultancy, Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding;Roche: Consultancy, Honoraria, Other: travel, accomodations, expenses, Research Funding;Abbvie: Consultancy, Honoraria;Takeda: Consultancy, Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding;Amgen: Consultancy, Honoraria;MSD: Consultancy, Honoraria. Le Gouill: Roche Genentech, Janssen-Cilag and Abbvie, Celgene, Jazz pharmaceutical, Gilead-kite, Loxo, Daiichi-Sankyo and Servier: Honoraria;Loxo Oncology at Lilly: Consultancy. Cartron: Celgene: Consultancy, Honoraria;Gilead: Honoraria;Abbvie: Honoraria;Jansen: Honoraria;Sanofi: Honoraria;F. Hoffmann-La Roche: Consultancy, Honoraria. Kerkhoff: BMS: Honoraria. De Leval: Lausanne University Hospital & Lausanne University Institute of Pathology: Current Employment;Lunaphore Technologies SA: Consultancy, Honoraria;Abbvie: Honoraria;Roche Diagnostics: Honoraria. Gaulard: takeda: Honoraria, Research Funding;innate pharma: Research Funding. Held: Roche: Consultancy, Other: travel grants, Research Funding;MSD: Consultancy;Acrotech, Spectrum: Research Funding;Amgen: Research Funding;BMS: Consultancy, Other: Travel Grants, Research Funding. OffLabel Disclosure: Nivolumab in peripheral T-cell lymphoma
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Research and development (R&D) collaborations are horizontal agreements among firms to join forces in their inventive activities. As in the context of the recent COVID-19 global pandemic, such collaborations are often promoted with an argument of increased R&D productivity. In numerous contexts, especially when marginal production costs are low, such as for medications or for software, the consumers' surplus depends critically on the best-performing product available on the market, for-all else equal-this product will tend to take a dominant position. Using a simple two-stage model of innovation and subsequent product commercialization on a market with heterogeneous consumers, we show that a noncollaborative patent race with patent protection (for the best product) provides strong innovation incentives, leading to better performing products than a regime of noncollaborative research without patent protection or of collaborative research (with profit sharing). © 2021 IEEE Computer Society. All rights reserved.
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Objective The objective of this work was to review papers that deal with nutritional therapy of inpatients with Covid-19 from the beginning of the pandemic. The survey covered the period until the month of September 2020. Methods This is a review of the indexed literature (Scopus, Pubmed and Lilacs), including area consensus. Results The review showed that the initial recommendations were based on generic assumptions and, as specific knowledge was being produced, the recommendations became more targeted. Conclusion In the health crisis generated by Covid-19, in the context of uncertainties related to nutritional care procedures, knowledge and action strategies were generated, coordinated by researchers and health professionals.
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BACKGROUND: Clinically, coronavirus disease 2019 (COVID-19) is associated with a wide range of symptoms, which can range from mild complaints of an upper respiratory infection to life-threatening hypoxic respiratory insufficiency and multiorgan failure. OBJECTIVE: The initially identified pulmonary damage patterns, such as diffuse alveolar damage in acute lung failure, are accompanied by new findings that draw a more complex scenario. These include microvascular involvement and a wide range of associated pathologies of multiple organ systems. A back-scaling of microstructural vascular changes is possible via targeted correlation of pathological autopsy results with radiological imaging. MATERIAL AND METHODS: Radiological and pathological correlation as well as microradiological imaging to investigate microvascular involvement in fatal COVID-19. RESULTS: The cases of two COVID-19 patients are presented. Patient 1 showed a relative hypoperfusion in lung regions that did not have typical COVID-19 infiltrates; the targeted post-mortem correlation also showed subtle signs of microvascular damage even in these lung sections. Patient 2 showed both radiologically and pathologically advanced typical COVID-19 destruction of lung structures and the case illustrates the damage patterns of the blood-air barrier. The perfusion deficit of the intestinal wall shown in computed tomography of patient 2 could not ultimately clearly be microscopically attributed to intestinal microvascular damage. CONCLUSION: In addition to microvascular thrombosis, our results indicate a functional pulmonary vasodysregulation as part of the pathophysiology during the vascular phase of COVID-19. The clinical relevance of autopsies and the integration of radiological imaging findings into histopathological injury patterns must be emphasized for a better understanding of COVID-19.