ABSTRACT
Background and Objective: This study describes the prevalence, characteristics, and outcomes of COVID-19 infection among patients with autoimmune rheumatic diseases (AIRD) seen in a tertiary hospital in Manila, Philippines. Method(s): This cross sectional study included patients diagnosed with AIRD seen over a 24-month period from March 2020 to February 2022 confirmed with COVID-19 infection. We collected data from patients' electronic records, clinic and hospital charts and analyzed underlying AIRD characteristics including disease activity, medications, severity, and outcomes including hospitalization and mortality. Result(s): Of the 565 patients with AIRD, 67 patients reported to be positive for COVID-19. The most common underlying AIRD was systemic lupus erythematosus (SLE) in 53 patients followed by rheumatoid arthritis and dermatomyositis. Cough, fever, dyspnea, diarrhea, anosmia, ageusia and sore throat were the common presenting symptoms. Three were asymptomatic, 52 had mild symptoms, 3 patients had moderate and 9 had severe COVID-19 infection. Nineteen patients (28%) were subjected to hospitalization and admission and 48 (72%) were confined at home or in an isolation facility. Use of methotrexate, mycophenolate mofetil, prednisone <10 mg/day and hydroxychloroquine did not affect the risk for moderate to severe COVID-19 infection, hospitalization and mortality. However, the use of azathioprine increases the risk for moderate to severe COVID-19 infection but not for hospitalization and mortality. Four (6%) patients died of severe COVID-19 pneumonia: an elderly rheumatoid arthritis patient with co-morbidity of asthma, a lupus nephritis patient with end stage renal disease on hemodialysis, another lupus nephritis patient with malignancy who underwent radiotherapy and lastly, a patient with overlap dermatomyositis and SLE with restrictive lung disease due to severe dextroscoliosis. Conclusion(s): This single-center experience on AIRD patients with COVID-19 infection showed that patients with active disease, co-morbidities, especially lung diseases, and use of high dose glucocorticoid had higher risk for moderate to severe COVID-19 infection, hospitalization and mortality.
ABSTRACT
Background: People with systemic lupus erythematosus (SLE) are at greater risk of developing infections, including COVID-19. This study describes the characteristics and outcomes of COVID-19 infection among patients with SLE seen in a tertiary hospital in Manila, Philippines. Method(s): This cross-sectional study included patients with diagnosed SLE seen over 24 months from March 2020 to February 2022, who were confirmed with COVID-19 infection. We collected data from patients' electronic records and clinic charts and analyzed underlying SLE characteristics including disease activity and medications, COVID-19 involvement, vaccination status and outcomes including hospitalization and mortality. Result(s): Of the 507 patients with SLE, 53 patients reported positive for COVID-19. Cough, fever, dyspnea, diarrhea, anosmia, ageusia, and sore throat were the common presenting complaints. Three were asymptomatic, 41 had mild symptoms, 2 had moderate, and 7 had severe COVID-19 infection. Sixteen patients (30%) were hospitalized, and 37 (70%) were confined at home or an isolation facility. More than half of patients were unvaccinated during the time of COVID-19 infection (28, 54%), 3 (6%) were partially vaccinated and 21 (40%) were fully vaccinated. Use of methotrexate, mycophenolate mofetil, prednisone <10 mg/day, and hydroxychloroquine did not affect the risk for moderate to severe COVID-19 infection. Patients in low disease activity or remission tended to have asymptomatic to mild COVID-19 infection. Two (4%) died with severe COVID 19 infection: a lupus nephritis patient with end-stage renal disease on hemodialysis and a lupus nephritis patient with concomitant double gynecologic malignancy (vulval and cervical) who underwent 35 cycles of radiotherapy prior to COVID-19 infection. Conclusion(s): This study on SLE patients with COVID-19 infection showed that patients with high disease activity, co-morbidity especially ESRD and the use of high dose glucocorticoid had higher risk for moderate to severe COVID-19 infection and hospitalization. Use of immunosuppressants and prednisone <10 mg/day did not appear to contribute to increased severity of COVID-19 infection, hospitalization and mortality.
ABSTRACT
Objective: We report the complicated and challenging case of a lupus nephritis patient on treatment for multi-drug resistant disseminated tuberculosis who developed severe COVID-19 infection. Case: A 24-year-old female diagnosed with SLE nephritis maintained on mycophenolate mofetil (MMF), hydroxychloroquine (HCQ) and a calcineurin inhibitor (CNI) developed disseminated multidrug resistant tuberculosis (MDR-TB) involving the lungs, liver and lymph nodes. She was started on anti-TB regimen in addition to high dose prednisone, whereas MMF and CNI were discontinued. In the course of anti-TB treatment, adverse drug reactions to MDR-TB included QT prolongation also prompting the discontinuation of HCQ. On the 10th month of treatment with clofazimine, cycloserine, paminosalicylic acid, and delamanid, she developed fever, dyspnea, chest pain, disorientation accompanied by progressive oxygen desaturation. Nasopharyngeal swab for SARS-CoV-2 RT-PCR test was positive, high resolution chest CT (HRCT) showed new peripheral ground-glass opacities consistent with COVID-19 pneumonia. Oxygen support with high-flow nasal cannula at 60% FiO2, low molecular weight heparin, meropenem, remdesivir, and dexamethasone were given;MDR-TB treatment was temporarily withheld. The patient recovered after 3 weeks hospitalization and MDR-TB treatment was resumed following hospital discharge. Conclusion: This case illustrates the management challenges in a lupus nephritis patient with disseminated TB who developed and eventually recovered from severe COVID-19 infection.
ABSTRACT
Background and Objective: People with systemic autoimmune diseases (AID) are at greater risk of developing infections including COVID-19. This study describes the characteristics and outcomes of COVID-19 Infection among patients with AID seen in a tertiary hospital in Manila, Philippines. Methods: This cross sectional study included patients with diagnosed AID seen over a 12-month period from April 2020 to March 2021, who were confirmed with COVID-19 infection. We collected data from patients' electronic records, clinic and hospital charts and analyzed underlying AID characteristics including disease activity and medications, COVID-19 involvement and outcomes including hospitalization and mortality. Results: Of the 565 patients with AID, 26 patients reported positive for COVID-19. The most common underlying AID was systemic lupus erythematosus (SLE) in 22 patients. Cough, fever, dyspnea, diarrhea, anosmia, ageusia and sore throat were the common presenting complaints. Two were asymptomatic, 16 had mild symptoms, 3 patients had moderate and 5 had severe COVID-19 infection. Nine patients were hospitalized and 17 were confined at home or isolation facility. Use of methotrexate, mycophenolate mofetil, prednisone <10 mg/day and hydroxychloroquine did not affect the risk for moderate to severe COVID-19 infection. Patients in low disease activity or remission tended to have asymptomatic to mild COVID-19 infection. Three patients died of severe COVID-19 pneumonia: an elderly rheumatoid arthritis patient with history of asthma, another lupus nephritis with end stage renal disease on hemodialysis, and the third patient with overlap dermatomyositis and SLE with restrictive lung due to severe dextroscoliosis. Conclusion: This single-center experience on AID patients with COVID-19 infection showed that patients with active disease or comorbidities had higher risk for hospitalization and mortality. Use of immunosuppressants and prednisone <10mg/day did not appear to contribute to increased severity of COVID 19 infection.
ABSTRACT
Spain’s public universities agreed recently to contribute to the 2030 Agenda of Sustainable Development Goals. The University of La Laguna (ULL) endorsed this agreement and launched INGENIA, which is a competitive funding program for projects conceptualised and performed by high school and undergraduate students, utilising a Project-oriented Problem Based Learning (PoPBL) strategy. This program addresses needs of the society in the Canary Islands;it supports participating students’ development of knowledge and skills regarding: (1) relevance of the problem each student team identifies, and the (2) viability, (3) impact, and (4) endurance of each team’s proposed solution. Forty-seven students were anticipated to participate in the program;these students would be supported by 13 academic staff alongside 11 postgraduate students who would participate in a student-facilitators subprogram. INGENIA formally launched at ULL on 31 January 2020, but was interrupted in mid-March when Coronavirus resulted in the closure of all Spanish universities. To date, academic staff have served as mentors, advising student teams in choosing significant local SDG-related problems and writing proposals to address the four aspects listed above. Student-facilitators would support these mentors to help keep undergraduate students on track and motivated during their project work. INGENIA accomplished almost two of three stages and started its third stage which has been restructured to be performed online after COVID-19 lockdown: (1) informative and training actions for getting academic staff and students interested in participating;(2) training of the student-facilitators;and (3) project development and presentation. In the first two months, students worked on project proposal. In the subsequent three months the selected teams were to develop and conduct their proposals, then report and present results. The final presentations would allow students to pitch solutions to local companies and public institutions to help secure additional funding after the end of the grant-funded INGENIA period. This paper provides details of the program, identifies methodological and pedagogical fundamentals upon which it is grounded, reports results of completed phases, and identifies implications that may be of relevance to other programs and in future iterations of INGENIA. The report may be of use to others wishing to conduct PoPBL and/or hands-on sustainability projects. © The authors, 2020.