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1.
HemaSphere ; 5(SUPPL 2):378-379, 2021.
Article in English | EMBASE | ID: covidwho-1393418

ABSTRACT

Background: The COVID-19 pandemic had a high burden in Brazil. To date, data on mortality and prognostic factors of COVID-19 infection in Brazilian patients with hematological disorders are scarce. Aims: To describe the characteristics and outcomes of patients with hematological disorders admitted to the hematological COVID care unit of a reference center in Brazil;to analyze the impact of prognostic factors on in-hospital mortality. Methods: This prospective, single-center study,included 118 patients who have been admitted to the hematological COVID care unit of the Hospital das Clínicas da Faculdade de Medicina da USP, S.o Paulo, Brazil, from March to September 2020.All patients had >18 years,an underlying hematological disease and a moderate or severe COVID- 19 infection.For analyses, patients were grouped in:(1)benign or no oncological treatment(n=43),(2) intensive chemotherapy,including induction protocols for acute leukemia and stem cell transplantation conditioning(n=44) or(3) intermediate chemotherapy,including lymphoma regimens,myeloma triple treatment or continuous treatment( n=31).The primary outcome was in-hospital mortality;secondary outcome was overall survival after admission in the COVID-19 unit.Univariate analysis(UVA) used odds ratio(OR) for baseline characteristics and ROC curve analysis for laboratory tests collected at admission.Multivariate analyses(MVA) were adjusted by age and hematological disease status group.The median follow-up and survival time after COVID-19-unit admission were estimated by Kaplan- Meier method.All statistical tests were two-sided;p-values<0.05 were considered significant. Results: Median age was 58(19-90) years and 55% of patients were male. Most patients(83%)had hematological malignancies,- mainly non-Hodgkin lymphoma(29%) and multiple myeloma(19%). The most frequent benign disease was sickle cell disease(5%).12 patients had undergone hematopoietic stem cell transplantation (HSCT),4 allogeneic and 8 autologous.70% had at least one comorbidity, mostly arterial hypertension and diabetes mellitus. Thromboembolic events occurred in 9%. Median hospital stay in the COVID-19 unit was 12(1-63) days;54% needed intensive care and 41% mechanical ventilation.In-hospital mortality rate was 41%[95%CI 32-50];most deaths occurred in patients with malignancies. Median follow-up was 73(95%CI 61-81) and 54(95%CI 39-66) days after admission and discharge from the COVID-19 unit, respectively.UVA showed a risk of death increased by 25% every 10 years old.The risk of in-hospital death was 3-fold and 5-fold higher in groups 2 and 3 compared with group 1.MVA showed higher risk of death in patients from group 2(OR=11.1,95% CI 2.9- 54.8) or group 3(OR=9.7,95%CI 2.4-47.5]),who had lactate dehydrogenase( LDH)>440 U/L(OR=16.8,95%CI 4.9-71.8),C-reactive protein(CRP)>100 mg/L(OR=4.1,95%CI 1.4-13.6) or platelet count<150x10e9/L(OR=3.7,95%CI 1.3-11.7), regardless of age(OR=1.2,95%CI 1.0-1.5).79% of in-hospital deaths were from COVID-19;others were mainly due to hematological disease.The overall median survival time after admission was 92 days(95% CI 34-NA) and the 75-day survival probability was 51%(95%CI 41-60).25% of patients had hospital readmission,mostly due to other infections. Summary/Conclusion: In line with other reports,patients with hematological diseases are at higher risk of mortality from COVID-19 infection, particularly in low and middle income countries.In our cohort, prognostic factors were status of disease,platelets count,LDH and CRP. These findings might help risk stratification and prioritization of vaccines in this setting.

2.
Blood ; 136:26, 2020.
Article in English | EMBASE | ID: covidwho-1344063

ABSTRACT

Introduction: Hematopoietic Cell Transplant (HCT) is a potential curative treatment for hematological diseases. Patients undergoing HCT are usually immunosuppressed and require frequent outpatient visits. Patients actively enrolled at Hospital das Clínicas, School of Medicine, University of Sao Paulo (HCFMUSP) HCT Outpatient Clinic were already reached via Whatsapp (personal or family members’ cell phones) for clinic appointments and non-medical information before the COVID-19 pandemic. Since the onset of the pandemic, we have faced a challenge: providing medical care for HCT patients while preventing environmental exposure to SARS-CoV-2. Our HCT team started performing telehealth care using a HIPAA-compliant Google Meet-based institutional platform and telephone calls in March/2020. To evaluate this strategy as a permanent tool, we sent out a survey to patients in order to better understand their opinion on and early experience with telehealth. Methods: We sent out a questionnaire on Google Forms containing a few questions regarding barriers to commute to hospital, internet access, feelings about the use of telehealth at our outpatient clinic and their incipient experience with it. Participants were instructed to answer the questions from the patient's perspective, regardless if the survey was filled out by the patients themselves or caregivers. The questionnaire was anonymous, written in Portuguese, and remained open from August 3rd to 9th, 2020. Results: A survey invitation was sent out to 299 patients who had been seen in clinic over the last 12 months. During this period, all patients provided a contact number that could reached through Whatsapp, either on their own or a caregiver's smartphone. Of these, 133 patients answered the survey. The total time to go to and come back from hospital was <30 min for 5%, 30-60 min for 23%, 60-90 min for 20%, 90-120 min for 14% and >120 min for 38%. Total cost to commute to and from hospital (for both the patient and an eventual caregiver) was > US$ 10.00 for 42% (equivalent to 5% of the minimum wage per month). Thirty-two percent of participants reported any degree of mobility disability. Thirty-three and 29% of patients complained of long waiting times for in-person doctor and pharmacy appointments, respectively. In terms of technology, 97% had a personal cell phone or smartphone. Ninety-five percent of patients had access to internet on a smartphone, and 32% through a personal computer (some had both). Sixty-six percent reported no difficulty using a cell phone, 23% some difficulty and 9% significant difficulty. Ninety-five percent regularly used social media apps. Approximately half of the patients had at least one previous interaction via telehealth with our center during the COVID-19 pandemic, of whom 92% considered it a good or very good experience. When inquired if they would like to start receiving or continue to receive telehealth care, 83% answered yes, 10% expressed some interest and 7% declared no interest. When asked about their opinion on widening telehealth use at the HCFMUSP HCT Outpatient Clinic following the pandemic, 43% answered they would certainly use it, 45% thought it could be good, 5% had concerns, 4% were indifferent, and 3% did not approve the idea. Conclusions: In-person appointments seem to be both cost and time-consuming and represent a relevant burden on this limited-resource population. Despite being a public health institution from a middle-income country, most of our patients have personal cell phones with easy internet access. Among those who had an incipient experience with telehealth, the impression was overall positive. We cannot rule out selection bias towards participants who were more familiar with technology and thus more inclined to appreciate telehealth. Taken together, although not always fit for all clinical scenarios, our findings suggest telehealth may be efficient and complementary to in-person interactions with HCT patients, and prompt wider implementation of this health care modality. Disclosures: No relevant conflicts f interest to declare.

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