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1.
Open Forum Infectious Diseases ; 8(SUPPL 1):S296, 2021.
Article in English | EMBASE | ID: covidwho-1746606

ABSTRACT

Background. Patients with severe SARS-CoV-2 infection are at high risk of complications due to the intensive care unit stay. Hospital-acquired infections (HAI) are one of the most common complication and cause of death in this group of patients, it is important to know the epidemiology and microbiology of this hospital-acquired infections in order to begin to the patients a proper empirical treatment. We describe the epidemiologic and microbiologic characteristics of HAI in patients with COVID-19 hospitalized at intensive care unit (ICU) in a tertiary level private hospital in Mexico City. Methods. From April to December 2020, data from all HAIs in patients with severe pneumonia due to SARS-CoV-2 infection with mechanical ventilation at ICU were obtained. The type of infection, microorganisms and antimicrobial susceptibility patterns were determined. Results. A total of 61 episodes of HAIs were obtained, the most common was ventilator associated pneumonia (VAP) in 52.4% (n=32) followed by urinary tract infection (UTI) 34.4%(n=21) and bloodstream infection (BSI) 9.84% (n=6). Only two episodes corresponded to C. difficile associated diarrhea. We identified 82 different microorganisms, the most frequent cause of VAP was P. aeruginosa 22% (10/45) followed by K. pneumoniae 20% (9/45);for UTI, E. coli 28.5% (6/21), and S. marcescens 19% (4/21);for BSI the most frequent microorganism was S. aureus 28.5 (2/7). Regarding the antimicrobial susceptibility patters the most common were Extended Spectrum Beta-Lactamase (ESBL) Gram-negative rods followed by Methicillinresistant Staphylococcus aureus. Conclusion. In patients with severe COVID-19 hospitalized in the ICU the most frequent HAIs were VAP and UTI caused by P. aeruginosa and E. coli respectively. ESBL enterobacteriaceae was the most common resistant pattern identifed in the bacterial isolations in our series.

2.
Movement Disorders ; 36:S118-S118, 2021.
Article in English | Web of Science | ID: covidwho-1436883
3.
Annals of Oncology ; 32:S1155-S1156, 2021.
Article in English | EMBASE | ID: covidwho-1432914

ABSTRACT

Background: The onset of COVID-19 pandemic forced lockdown and halted breast cancer screening programs. We aimed to investigate the impact of COVID-19 on the new diagnosis and staging of breast cancer. Methods: In this cohort study, we included all patient with new diagnosis of breast cancer who were admitted to our Hospital (Hospital Pedro Hispano, Matosinhos, Portugal), between March 2019 and March 2021. We collected data on baseline clinical conditions such as age, stage at diagnosis and treatment. We created two different groups were created: 1st group- before COVID-19 pandemia (March 1, 2019 to March 16, 2020);2nd group - COVID-19 pandemia (March 17, 2020 to March 31, 2021). A comparative assessment between groups was carried out. Results: Were included 483 patients;n=289 in the 1st group and n= 194 in the 2nd group. The median age was 60 years old in the 1st group and 59 years old in the 2nd group. In the 1st group, 13% patients were diagnosis with ductal in situ carcinoma (DCIS), 51% in stage I, 24% in stage II, 9.5% in stage III and 3% in stage IV. In 2nd group, 9% had DCIS, 30% were in stage I, 40% in stage II, 11% in stage III and 10% in stage IV. Stage at diagnosis was significantly higher in the 2nd group (p< 0.001) This situation was mainly due to tumour size (T). In the 1st group, most patients (n=91;38%) had tumour size between 10 e 20mm (T1c in TNM classification). One the other hand, 40% (n=78) of patients included in the 2nd group had tumour size between 20 e 50mm (T2), with significant differences between them (p=0.004). No difference was found between groups in nodular involvement (p=0.189), with the majority of patients (∼50% in both groups) presenting without nodular involvement (N0 in TMN classification). 10% of patients in 2nd group and 3% in 1st group had metastatic disease at diagnosis, with differences between them (p=0.006). 49% (n=119) of patients in 1st group and 52% (n=100) in the 2nd group were treated with chemotherapy, without differences between those groups. Conclusions: Our results show that during one year after COVID-19 pandemia the incidence of breast cancer decreased, and patients were diagnosis in more advanced stages. This situation could have been related to patient referral to non COVID-19 Hospitals or correspond to a true sub-diagnosis. Legal entity responsible for the study: M. Vilaça. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

4.
EClinicalMedicine ; 37: 100962, 2021 07.
Article in English | MEDLINE | ID: covidwho-1275283

ABSTRACT

Background: Angiotensin receptor blockers (ARBs), such as telmisartan, have been postulated to treat Covid-19-induced lung inflammation. Methods: This is a parallel-group, randomized, two-arm, open-label, adaptive, multicenter superiority trial with 1:1 allocation ratio. Participants included patients from 18 years of age hospitalized with Covid-19 with 4 or fewer days since symptom onset enrolled at a university and a community hospital in Buenos Aires, Argentina. Exclusion criteria included prior intensive care unit (ICU) admission and use of ARBs/angiotensin converting enzyme inhibitors at randomization. Control arm received standard care alone and treatment arm telmisartan 80 mg twice daily for 14 days. Primary outcomes were C-reactive protein (CRP) plasma levels at day 5 and 8 after randomization. Secondary outcomes included time to discharge within 15 days, admission to ICU and death at 15- and 30-days. NCT04355936 (Completed). Findings: A pragmatic decision to end the study before the third interim analysis was made on Oct. 30th due to sharp reduction in recruitment. A total of 162 patients were randomized. 158 patients enrolled between May 14 and October 30 2020, were included in the analysis, 80 in the standard care and 78 in the telmisartan added to standard care group. Baseline absolute CRP serum levels were 5.53 ± 6.19 mg/dL (95% CI 6.91 to 4.15, n = 80) and 9.04 ± 7.69 (95% CI 9.04 to 10.82, n = 74) in the standard care and telmisartan added to standard care groups, respectively. Day 5 control-group CRP levels were 6.06 ± 6.95 mg/dL (95% CI 7.79-4.35, n = 66) while telmisartan group were 3.83 ± 5.08 mg/dL (95% CI 5.08-2.59, n = 66, p = 0.038). Day 8 CRP levels were 6.30 ± 8.19 mg/dL (95% CI 8.79-3.81, n = 44) and 2.37 ± 3.47 mg/dL (95% CI 3.44-1.30, n = 43, p = 0.0098) in the control and telmisartan groups, respectively (all values expressed as mean ± SD). Kaplan-Meier analysis showed that telmisartan-treated patients had a lower median time-to-discharge (control=15 days; telmisartan=9 days). Death by day 30 was reduced in the telmisartan-treated group (control 22.54%, 16/71; telmisartan 4.29%, 3/70 participants; p = 0.0023). Composite ICU, mechanical ventilation or death was reduced by telmisartan treatment at days 15 and 30. No adverse events were reported. Interpretation: Our study suggests that the ARB telmisartan, a widely used antihypertensive drug, is safe and could reduce morbidity and mortality in hospitalized patients infected with SARS -CoV-2 by anti-inflammatory effects. Further studies employing telmisartan are needed for confirmation of our results and to define its true therapeutic value as a tool against Covid-19.

5.
Rev Clin Esp (Barc) ; 2021 Jun 12.
Article in English | MEDLINE | ID: covidwho-1267901

ABSTRACT

BACKGROUND: A high incidence of pulmonary embolism has been described during the coronavirus pandemic. METHODS: This work is a single-center retrospective study which reviewed computed tomography pulmonary angiograms ordered due to suspected pulmonary embolism during two periods: from March 1, 2020 to May 31, 2020 (pandemic) and during the same interval in 2019 (control). RESULTS: Twenty-two pulmonary embolisms were diagnosed during the control period and 99 in the pandemic, 74 of which were associated with COVID-19. Of all patients hospitalized with COVID-19, 5.3% had a pulmonary embolism, with a delay between the two diagnoses of 9.1 ± 8.4 days. During the pandemic, patients with pulmonary embolism had fewer predisposing conditions (previous pulmonary embolism 5.1 vs. 18.2%, p = .05; previous surgery 2 vs. 35.4%, p = .0001; deep vein thrombosis 11.1 vs. 45.5%, p = .0001); peripheral pulmonary embolisms were the most frequent (73.5 vs. 50%, p = . 029). CONCLUSIONS: There is an increased risk of having a pulmonary embolism during the SARS-CoV-2 pandemic, which affects patients with a different clinical profile and more often causes distal pulmonary embolisms.

6.
Front Pharmacol ; 12: 603736, 2021.
Article in English | MEDLINE | ID: covidwho-1186854

ABSTRACT

COVID-19 pandemic demands a swift response to find therapeutic tools that effectively reduce morbidity and mortality. Despite initial fears, evidence from retrospective observational studies supports the inhibition of the renin-angiotensin system as an emerging pathway to delay or moderate angiotensin II-driven lung inflammation. This has triggered several prospective clinical trials. In this commentary we provide an overview and analysis of current ongoing clinical trials aimed at evaluating the therapeutic efficacy of angiotensin receptor blocker (ARB) use in COVID-19. The relevance of the results of these trials will have to be interpreted depending on the stage and severity of the disease and in light of the start time of their prescription related to the time of diagnosis of COVID-19 as well as the administered doses.

7.
Rev Clin Esp ; 2021 Jan 16.
Article in Spanish | MEDLINE | ID: covidwho-1047800

ABSTRACT

BACKGROUND: A high incidence of pulmonary embolism has been described during the coronavirus pandemic. METHODS: This work is a single-center retrospective study which reviewed computed tomography pulmonary angiograms ordered due to suspected pulmonary embolism during two periods: from March 1, 2020 to May 31, 2020 (pandemic) and during the same interval in 2019 (control). RESULTS: Twenty-two pulmonary embolism were diagnosed during the control period and 99 in the pandemic, 74 of which were associated with COVID-19. Of all patients hospitalized with COVID-19, 5.3% had a pulmonary embolism, with a delay between the two diagnoses of 9.1+/-8.4 days. During the pandemic, patients with pulmonary embolism had fewer predisposing conditions (previous pulmonary embolism 5.1% vs. 18.2%, p = .05; previous surgery 2% vs. 35.4%, p = .0001; deep vein thrombosis 11.1% vs. 45.5%, p=.0001); peripheral pulmonary embolisms were the most frequent (73.5% vs. 50%, p =. 029). CONCLUSIONS: There is an increased risk of having a pulmonary embolism during the SARS-CoV-2 pandemic, which affects patients with a different clinical profile and more often causes distal pulmonary embolisms.

8.
Annals of Oncology ; 31:S1028, 2020.
Article in English | EMBASE | ID: covidwho-806289

ABSTRACT

Background: On March 11, 2020, COVID-19 was declared a global pandemic. Caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), this infection may remain asymptomatic. The European Society of Medical Oncology and the Portuguese Health Authority recommended both a symptomatic survey and laboratory testing in all cancer patients (pts) undergoing immunosuppressive treatment (IT). The impact of this measure is still unknown. We report our experience in a Portuguese center. Methods: Since March 2020, a symptomatic survey has been performed at our institution before each hospital visit. From April 6 through May 8, 2020, reverse-transcriptase polymerase chain reaction (RT-PCR) SARS-CoV-2 testing was added on cancer pts before undergoing IT. The impact of this intervention was evaluated comparing the hospitalization rate of cancer pts due to COVID-19, before and after the introduction of RT-PCR testing. Retrospective analysis of clinical data was performed. Results: 444 tests were carried out on 244 pts and laboratory SARS-CoV-2 infection was confirmed in 11 (5%);5 were male, with a median age of 65 years [34-76]. Breast and colorectal cancer were prevalent;2 pts had lung cancer;6 advanced disease. Ongoing IT in these pts was temporarily suspended: 9 pts under chemotherapy, 1 atezolizumab and 1 rituximab. Only 1 patient was symptomatic (9%) and previously hospitalized. No admission due to COVID-19 was registered in this group. Since March 7, 179 pts were admitted due to COVID-19 at our center: 12 were active cancer pts (6.7%) of which 4 were under IT. 6 of the oncological pts passed away, all of them had advanced diseases, 1 was under IT. Of the dead pts, lung and breast tumors were prevalent. Among all COVID-19 hospitalizations, the prevalence of pts under IT was similar before and after the implementation of the RT-PCR testing (2.2% vs. 2.4%). Conclusions: We found a significant percentage of active cancer pts diagnosed with asymptomatic COVID-19. Due to the small sample size of COVID-19 pts under IT, it is difficult to evaluate the impact of RT-PCR testing. However, on a long-term analysis, this intervention may reduce the risk of severe complications related to COVID-19 in cancer pts. Health education and dynamic organization are also important measures. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

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