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1.
Annals of the Rheumatic Diseases ; 81:961, 2022.
Article in English | EMBASE | ID: covidwho-2009057

ABSTRACT

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and its impact on disease outcome in patients with autoimmune rheumatic disease (ARD) are lacking. Also, whether patients with ARD receiving immunomodulators have different viral loads compared to the general population is unknown. Objectives: To compare the viral load of SARS-CoV-2 and its trending between patients without and with ARD. Methods: Retrospectively, patients with ARD infected with SARS-CoV-2 were matched by age and sex at a ratio of 1:2 to patients without ARD and not receiving immunosuppression or immunomodulator drugs. Viral load was determined by the cycle threshold (CT) value measured by a number of platforms: (a) Automated Platforms-the Roche Cobas 6800 system using the Cobas SARS-CoV-2 Test targeting the E and orf1a/b genes (Roche, Switzerland) and the Xpert Xpress SARS-CoV-2 targeting the E and N genes (Cepheid, USA);(b) Manual platforms-EZ1 (QIAGEN, USA), QIAsymphony (QIAGEN, USA), and Bioneer ExiPrepTM 96 Virus DNA/RNA kits Catalogue No K4614 (Bioneer, South Korea) extraction with thermal cycling using TaqPath™ PCR COVID-19 Combo Kit targeting the N, S and orf1a/b genes (Thermo Fisher Scientific, USA) on ABI 7500 thermal cyclers. Independent samples t-test was used to compare the mean CT values of the study groups at baseline and at 5 subsequent intervals (1-5.9, 6-11.9, 12-17.9, 18-23.9 and 24-30 days). Results: Mean age (SD) of 197 cases and 420 controls were 45.2 (11.8) and 44.1 (12.3) years, respectively. Females were predominant in both groups 60% vs. 52%, P=0.053. The most common ARD was rheumatoid arthritis in 82 cases (41.6%), followed by spondyloarthropathy in 33 (16.8%) and systemic lupus ery-thematosus in 31 (15.7%). Of the cases, 67% were on conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), 15.2% on biological DMARDs and 4.6% patients were on rituximab. The mean CT values was signifcantly lower in the ARD group at baseline and persisted till day 24. Conclusion: Compared to patients without ARD, the viral load of SARS-CoV-2 in patients with ARD is signifcantly higher at baseline testing and persists till day 24. This fnding may indicate that patients with ARD are at higher risk of severe SARS-CoV-2 infection and prolonged potential transmission. Clinical outcome correlation is needed.

2.
Open Forum Infectious Diseases ; 8(SUPPL 1):S356, 2021.
Article in English | EMBASE | ID: covidwho-1746489

ABSTRACT

Background. We investigated clinical outcomes of favipiravir in patients with COVID-19 pneumonia. Methods. Patients who between 23 May 2020 and 18 July 2020 received ≥24 hours of favipiravir were assigned to the favipiravir group, while those who did not formed the non-favipiravir group. The primary outcome was 28-day clinical improvement, defined as two-category improvement from baseline on an 8-point ordinal scale. Propensity scores (PS) for favipiravir therapy were used for 1:1 matching. Cox regression was used to examine associations with the primary endpoint. Results. The unmatched cohort included 1,493 patients, of which 51.7% were in the favipiravir group, and 48.3% were not receiving supplemental oxygen at baseline (table 1). Favipiravir was started within a median of 5 days from symptoms onset. Significant baseline differences between the two unmatched groups existed, but not between the PSmatched groups (N = 774) (table 1). After PS-matching, there were no significant differences between the two groups in the proportion with 28-day clinical improvement (93.3% versus 92.8%, P 0.780), or 28-day all-cause mortality (2.1% versus 3.1%, P 0.360) (Table 2). Favipiravir was associated with more viral clearance by day 28 (79.8% versus 64.1%, P < 0.001) (table 2). In the adjusted Cox proportional hazards model, favipiravir therapy was not associated 28-day clinical improvement (adjusted hazard ratio 0.978, 95% confidence interval 0.862 -1.109, P 0.726) (Table 3). Conclusion. Favipiravir therapy for COVID-19 pneumonia is well tolerated but is not associated with an increased likelihood of clinical improvement or reduced allcause mortality by 28 days.

3.
Open Forum Infectious Diseases ; 8(SUPPL 1):S383, 2021.
Article in English | EMBASE | ID: covidwho-1746436

ABSTRACT

Background. Tocilizumab is an interleukin-6 monoclonal antibody with widespread use in rheumatologic conditions. Observational studies have shown a promising role of Tocilizumab in severe COVID-19 patients with cytokine storm syndrome. Data about tocilizumab use in pregnant patients is limited. We report two outcomes of two pregnant patients with COVID-19 in the second trimester who received tocilizumab Methods. A 24-year-old 20 weeks pregnant lady with a history of asthma and gestational diabetes mellitus presented with three days history of fever, cough and shortness of breath (Figure 1). She was clinically stable but later developed ARDS and developed increased oxygen demand up to 10 liters/min. She received Tocilizumab on. Patient was observed in a high dependency unit but did not require mechanical ventilation. Patient was discharged home with full recovery and later delivered a healthy baby. Timeline of medicines used during hospital (Figure 2). Case 2: 39-year-old 23 weeks pregnant lady presented with seven days history of fever cough and shortness of breath (Figure 1). On presentation, she had progressive worsening hypoxic respiratory failure and was intubated. Patient had her nasopharyngeal swab for CODI-19 RT PCR was positive. The patient had severe ARDS requiring ECMO (extracorporeal membrane oxygenation) for respiratory support. Tocilizumab 400 mg was given on the presentation, along with other medications (Figure 3). Patient had regular monitoring of fetus;however, she had intrauterine fetal demise on day 14. Patient It is unclear if IUFD was due to using of tocilizumab or severity of COVID19 itself. The patient stayed in ICU for 20 days and was discharged after full recovery. Figure 1. Case 1 treatment timeline. Abberviations: Azithro: Azithromycin, HCQ: Hydroxychloroquine, CQ: Chloroquine, LPV/r: lopinavir/Ritonavir, Osel: Oseltamivir, MP: Methylprednisolone, Ampi-sulb: Ampicillin-sulbactam, TCZ: tocilizumab Figure 2. Case 2 treatment timeline Results. Learning points: Tocilizumab use in pregnant patients with severe COVID-19 pneumonia during the second trimester improved maternal outcomes in our cases. Tocilizumab use may be associated with worse fetal outcomes, including intrauterine fetal demise (IUFD). Conclusion. The pharmacological management of pregnant patients with severe COVID-19 pneumonia poses significant challenges. The use of Tocilizumab may improve maternal outcomes but may also increase the risk of worse fetal outcomes. Caution should be exercised in using this agent, and risks and benefits should be discussed with the patients.

4.
Journal of Emergency Medicine, Trauma and Acute Care ; 2021(2), 2021.
Article in English | EMBASE | ID: covidwho-1457538

ABSTRACT

Background: As of 26 June 2020, the global number of infections caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), had reached 11 million, with more than 500 thousand associated deaths1. Limited clinical information about COVID-19 on solid organ transplant (SOT) are available so far. We herein report our preliminary experience with COVID-19 in SOT recipients in the first few weeks of the outbreak in Qatar. Method: All SOT recipients with laboratory-confirmed COVID-19 up to 23 May 2020 were included. Baseline characteristics, antivirals and immunosuppressive management, complications, and outcomes were retrospectively extracted from the electronic health system. Categorical data are summarized as frequency and percentages, while continuous variables are presented as medians and ranges. Results: Twenty-four SOT patients with COVID-19 were included in this report (kidney: 16, liver: 6, heart: 1, and combined liver and kidney: 1). The median age was 57 years (range 24–72). Thanks to proactive screening, five (21%) asymptomatic cases were diagnosed (Table S1). Among the other 19 symptomatic patients, fever (15/19) and cough (13/19) were the most frequent presenting symptoms (Table S1). All patients were hospitalized;5 (21%) required invasive mechanical ventilation in the intensive care unit (ICU) (Table S2). Eleven (46%) patients developed acute kidney injury as a complication, including 3 in association with drug-drug interactions involving investigational COVID-19 therapies (Table S2). Maintenance of immunosuppressive therapy was changed in 18 (75%) patients, but systemic corticosteroids were not withdrawn in any. After a median follow up of 43 days (26–89), 18 (75%) patients had been discharged home, 3 (12.3%) were still hospitalized, 2 (8.3%) were still in ICU, and 1 (4.2%) had died (Table S2). Conclusion: Although higher mortality rates were observed in other reports,2,3 our results suggest that asymptomatic COVID-19 is possible in SOT recipients and that overall outcomes are not consistently worse than other immunocompetent patients. The results require validation in larger cohorts.

5.
J Hosp Infect ; 110: 165-171, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1120314

ABSTRACT

BACKGROUND: We investigated the clinical characteristics and risk factors for the isolation of multi-drug-resistant (MDR) Gram-negative bacteria (GNB) from critically ill COVID-19 patients. METHODS: We retrospectively matched (1:2) critical COVID-19 patients with one or more MDR GNB from any clinical specimen (cases), with those with no MDR GNB isolates (controls). RESULTS: Seventy-eight cases were identified (4.5 per 1000 intensive care unit (ICU) days, 95% confidence interval (CI) 3.6-5.7). Of 98 MDR GNB isolates, the most frequent species were Stenotrophomonas maltophilia (24, 24.5%), and Klebsiella pneumoniae (23, 23.5%). Two (8.7%) K. pneumoniae, and six (85.7%) Pseudomonas aeruginosa isolates were carbapenem resistant. A total of 24 (24.5%) isolates were not considered to be associated with active infection. Those with active infection received appropriate antimicrobial agents within a median of one day. The case group had significantly longer median central venous line days, mechanical ventilation days, and hospital length of stay (P<0.001 for each). All-cause mortality at 28 days was not significantly different between the two groups (P=0.19). Mechanical ventilation days (adjusted odds ratio 1.062, 95% CI 1.012-1.114; P=0.015), but not receipt of corticosteroids or tocilizumab, was independently associated with the isolation of MDR GNB. There was no association between MDR GNB and 28-day all-cause mortality (adjusted odds ratio 2.426, 95% CI 0.833-7.069; P= 0.104). CONCLUSION: In critically ill COVID-19 patients, prevention of MDR GNB colonization and infections requires minimizing the use of invasive devices, and to remove them as soon as their presence is no longer necessary.


Subject(s)
COVID-19/epidemiology , COVID-19/microbiology , COVID-19/physiopathology , Critical Illness , Drug Resistance, Multiple, Bacterial , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacterial Infections/epidemiology , Adult , Female , Humans , Incidence , Male , Middle Aged , Prevalence , Qatar/epidemiology , Retrospective Studies , Risk Factors , SARS-CoV-2
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