ABSTRACT
Introduction: Patients with multiple myeloma (MM) have an inherently compromised humoral and cellular immunity predisposing to Covid-19 infection. Factors associated with increased risk of adverse COVID-19 outcome is unclear. The aim of our retrospective analysis was to evaluate COVID-19 infection outcome among our myeloma patients and to define the possible prognostic parameters. Patients And Methods: Between March 2020- February 2022, 10 myeloma patients were diagnosed with COVID infection confirmed by PCR test and computer tomography (CT). The severity of SARS-CoV-2 infection was classified according to WHO definition as: mild: symptomatic without pneumonia or hypoxia;moderate: with or without signs of pneumonia with SpO2 >90% on room air;severe disease: with symptoms of pneumonia and respiratory rate> 30/min, severe respiratory distress or SpO2 <90% on room air. Critical disease: with acute respiratory distress syndrome (ARDS), sepsis and septic shock. In addition, CALL (comorbidity-age-lymphocyte count-lactate dehydrogenase) score was used. All patients were given supportive care including heparin and 0.4 gr/kg/day intravenous immunoglobulin for those presenting with immunoparesis regardless of IgG treshold of 4.0 gr/L. Convalescent or monoclonal plasma was not used. All anti-myeloma treatments were discontinued until full recovery. Results: Baseline characteristics of our patients are summarized in Table 1. The median age at onset of COVID-19 was 62 years. Three patients were therapy naive, two newly diagnosed MM and one with smoldering MM. At the time point of COVID-19 diagnosis, eight patients were being followed without treatment. Twenty patients were followed out-patient without any treatment and with full recovery. Eighteen (16%) patients were admitted to ICU and 13 (12%) required invasive mechanic ventilation. Two patients received hydroxychloroquine, 68 received favipiravir, one patient received anakinra and two patients received tocilizumab. Full recovery from COVID-19 infection with regression of clinic symptoms and achievement of PCR negativity of COVID-19 was observed in 93 (84.5%) patients and 17 (15.5%) patients died due to severe COVID-19 pneumonia with respiratory and multi-organ failure. No death due to thromboembolic event was observed. As expected, high CALL risk score (HR:0.17 (95% CI: 0.06-0.48) and higher COVID severity grade (HR:0.26 (95% CI: 0.07- 0.97) were detrimental. Age did not have an impact. However response <VGPR (HR: 3.1 (95% CI: 1.0-9.6);p=0.04) or immunoparesis (HR: 6.59 (95% CI: 1.44-30.1);p=0.01) were correlated (Kappa CE: 0.212, p=0.03) and associated with worse COVID-19 outcome (Figure 1-2-3). In MVA with age, response, Call score, vaccine, immunoparesis entered in the model only immunoparesis was significant (HR: 6.5, p=0.016). Mortality prior to introduction of vaccines reduced to 3.6 % compared with 11.8 % at the pre-vaccine period. There was a trend to increase in Covid infection incidence recently due to the Omicron variant. Conclusion: Among 110 MM patients, the mortality rate is less than the one reported by IMS during the beginning of the pandemic. In our experience COVID-19 infection severity and mortality decreases with anti-Covid vaccination, response ≥VGPR or lack of immunoparesis. Importantly, MM patients with COVID-19 infection need close monitoring for severe COVID-19-related complications, and correction of humoral immunity may be life-saving. .
ABSTRACT
The COVID-19 pandemic is one of the most important problems affecting human health today and trying to find a solution. During the COVID-19 pandemic, people apply the means of protection methods specified by experts in order to continue their daily lives. One of these methods is the use of masks. There are a limited number of studies investigating different mask preferences and the effects of these masks during exercise. In this study, it was aimed to compare the effects of surgical mask and N95 mask on dyspnea and subjective perceptions during strength exercise. Thirty-two healthy male volunteers between the ages of 20 and 25 (20,28..1,76), who regularly going to fitness center three days a week, participated in the study. The comfortable/discomfort perception scale was used to determine the subjective perceptions of the participants in mask use, and the visual analog scale was used to determine the severity of dyspnea. Subjective perceptions in mask use and comparison of visual analog scale fatigue questioning according to mask types were determined with Mann Whitney U test, comparison of repeated measurements of visual analog scale fatigue questioning was determined with Friedman test, and Wilcoxon test was used to determine which group the difference originated from. As a result of the statistical analysis, it was determined that the visual analog scale fatigue query was statistically significantly higher in the N95 mask than in the use of surgical mask (p < 0.05). As a result, it can be said that the use of masks in exercise increases both subjective discomfort and dyspnea, and these problems are more common in the use of N95 masks. For this reason, it can be suggested that the use of masks in exercise is not correct and people who do not want to exercise without using a mask should prefer surgical masks.