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1.
Farmacia Hospitalaria ; 46(2):99, 2022.
Article in Spanish | EMBASE | ID: covidwho-1897114
2.
European Journal of Hospital Pharmacy. Science and Practice ; 29(Suppl 1):A6, 2022.
Article in English | ProQuest Central | ID: covidwho-1874574

ABSTRACT

Background and importanceHighly purified immunoglobulins (95%) are obtained from the purification of human plasma extracted from healthy donors. The mechanism of action consists of an antigen-specific activity, exerting immunomodulatory functions in addition to those of the natural immunoglobulins. The increase in demand, the dependence exclusively on plasma donations, and the pandemic situation have reduced the supply of immunoglobulins worldwide.Aim and objectivesTo elaborate a protocol at regional level (seven hospitals) to prioritise, rationalise and reduce the use of immunoglobulins in view of the worldwide supply problem.Material and methodsA multidisciplinary work team was created comprising professionals involved in the use of these therapies (immunologists, haematologists, internists, neurologists, paediatricians and pharmacists). The main pathologies involved were specified.Subsequently, the indications depicted in the technical data sheet and the available scientific evidence were reviewed, to define three priority groups:Priority 1: Necessary treatment, there is no other therapeutic alternative.Priority 2: Pathologies or clinical situations where the use of immunoglobulins is recommended.Priority 3: Clinical situations without sufficient scientific evidence.Finally, the indications and dose regimen of all patients under active treatment were reviewed.ResultsThe work team defined Priority 1 as follows:Chronic treatments: primary and secondary immunodeficiencies, CAR–T hypogammaglobulinaemia in paediatrics, pure motor chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy.Acute treatments: Kawasaki disease, primary immune thrombocytopenia (PIT) before undergoing urgent surgery or PIT with severe thrombopenia/large bleeding diathesis.Priority 2 included: Guillain-Barré syndrome, myasthenia gravis, PIT with high risk of bleeding, CIDP (excluding pure motor), severe neonatal sepsis, alloimmune haemolytic disease in neonates, alloimmune neonatal thrombocytopenia, haemophagocytic syndrome and paediatric multisystem inflammatory syndrome due to SARS-CoV-2.Pathologies not mentioned above were considered Priority 3, being evaluated by a multidisciplinary Experts Committee.After reviewing the active treatments, 21% of them were temporarily suspended. Since the protocol approval, eight new cases have been assessed as Priority 3, with only one of them being denied.Conclusion and relevanceThe creation of the protocol has made it possible to rationalise the use of immunoglobulins, reducing their consumption and promoting the use of therapeutic alternatives. Thus, completely necessary treatments are guaranteed through equitable and equal access throughout the region.References and/or acknowledgementsConflict of interestNo conflict of interest

4.
Stroke ; 53(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1724014

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) is a viral disease that has primarily been known to cause respiratory symptoms;however, there has also been an association of COVID-19 with neurological symptoms, including acute ischemic stroke (AIS). There is a lack of data on the characteristics of AIS patients with COVID-19 from the stroke belt. We aim to describe the characteristics of patients with COVID-19 and AIS and compare the characteristics of those who required intensive care unit (ICU) admission versus ward-only. Methods: Single center, retrospective cohort study of adult patients admitted in a tertiary academic center from March 1-December 31, 2020. The institutional COVID database was utilized for data collection. Demographic, clinical and laboratory data were collected. Primary outcome measure was mortality. Secondary outcomes included hospital length of stay (LOS) and discharge disposition. Results: Both COVID-19 and AIS were found in 2.4% (n=75) of patients out of 3,031 patients with COVID-19, during the study period. These patients were male (45, 60%), African American (43, 57%), 65±12 years old, with hypertension (69, 92%) and Diabetes Mellitus type 2 (50, 67%). We noted a 20% (n=15) overall in-patient mortality rate among patients with both COVID-19 and AIS. Among these patients, 23% (n=17) required ICU admission. Demographic, clinical and laboratory characteristics were comparable among ICU versus ward-only patients except for higher LDH (476.12±189.70 vs 276.17±88.35 U/L, p==0.0003);and lower relative lymphocytic count (3.57±3.56 vs 8.93±7.83 10 cells/μL, p=0.0160) among those admitted into the ICU. Mortality (13, 68% vs 6, 32%, p<0.001) was significantly higher among the ICU cohort while majority of the ward-only cohort were discharged home (21, 95%). Conclusion: We present the first description of characteristics and outcomes of patients with AIS and COVID-19 from Mississippi. Novel to this cohort is the comparison of those who were admitted into the ICU versus ward-only. Prospective studies analyzing larger datasets of COVID-19 and stroke in the stroke-belt are warranted to further study disparities of care and outcomes.

9.
9th International Conference on Technological Ecosystems for Enhancing Multiculturality, TEEM 2021 ; : 680-688, 2021.
Article in English | Scopus | ID: covidwho-1613101

ABSTRACT

The knowledge society has managed to address one of the biggest changes, in the last two years, which has had a total and partial confinement, of this issue that afflicts humanity, the health emergency caused by the COVID-19. The world could not be paralyzed in all scenarios, for this reason, it was necessary to act and get to incorporate information and communication technologies (ICT) into daily activities. The educational context was one which incorporates and uses of ICT is most reflected, which had to make a stop along the way, to think of how it would be implemented communication strategies to interact with students and be able to continue with education at home. In this way, ICTs began to be more relevant through Web tools and, to be incorporated, used, and adapted to keep the educational process active. In this way, individual work was also privileged, and even more collaborative one allowing Collective Intelligences to be empowered in education, by developing favorable spaces to home learning. This research project addressed the research question "How to promote the development of Collective Intelligence supported by web tools?"where the intervention and relevance of the web tools were understood in depth, as well as their incorporation, use, adaptation, and contribution to the development of the educational processes;whereas teachers, students and now family, they have played an active role facing this health emergency caused by COVID-19. The interactions and reflections made around these tools, allow to strengthen the competences, the collaborative and cooperative learning, which increases the group work team. One of the purposes was to interact with Web tools to strengthen the development of Collective Intelligences, the educational process conceived in a decentralized context allows to generate a technological transformation in education. This has allowed teachers, students, and parents to act in collective environments, in this sense, the expanded open classroom education that works collectively has taken a considerable enough of strength, where everyone acts, reflects and participates in active roles. The research was worked with the methodological approach of qualitative type, which allowed to know about the reality that surrounds the educational process, by observing to describe and explain the attitudes and academic developments of students in situations identified in a theoretical-practical context. One of the results was the interaction and the way who works emotional intelligence was addressed, when students and teachers are working as a team, in developing Collective Intelligences. The project has been advanced, thanks to the observation as an instrument that has made it possible to demonstrate the applicability of web tools to strengthen the development of Collective Intelligences in the educational process. © 2021 ACM.

11.
Research and Practice in Thrombosis and Haemostasis ; 5(SUPPL 2), 2021.
Article in English | EMBASE | ID: covidwho-1509107

ABSTRACT

Background : SARS-CoV-2 infection can trigger an important immune reaction, induce antiphospholipid antibodies, and is associated with a high-risk of venous thromboembolism (VTE), especially in patients with severe or critical disease. Hydroxychloroquine is an immunomodulator that had proven some efficacy in preventing thrombosis in antiphospholipid syndrome. Aims : To investigate if hydroxychloroquine prevents symptomatic VTE in patients with mild to moderate COVID-19. Methods : Ancillary study of HYCOVID trial, a prospective, multicenter, randomized, double-blind trial aiming to assess the efficacy of hydroxychloroquine with regard to the 14-day rate of death or invasive ventilation ( https://clini caltr ials.gov/ct2/show/NCT04 325893 ). COVID-19 patients were included, with their informed consent, if they had at least one of the following risk factors for worsening: need for supplemental oxygen, age ≥75 years, age between 60 -74 years and presence of at least one comorbidity. Eligible patients were randomized to receive either 800 mg hydroxychloroquine on Day 0 followed by 400 mg per day for 8 days, or a placebo. In the present study, we assessed the 28-day cumulative rate of symptomatic VTE. All suspected events were adjudicated by an independent committee, blinded to treatment allocation. Results : Two hundred and fifty patients were enrolled;124 and 123 patients received hydroxychloroquine or placebo and were included in the modified intention-to-treat analysis, respectively. Eightyseven percent of the patients received an anticoagulant treatment during hospitalization (104 [83.9%] and 111 [91.2%] in the hydroxychloroquine and the placebo group, respectively) (Table). Two patients in each group experienced VTE within the 28 days following inclusion. All events were pulmonary embolism (PE), including one fatal PE in the placebo group. The VTE rate was 1.61% (95%CI: 0.20 to 5.70) in the hydroxychloroquine group and 1.63% (95% confidence interval: 0.20 to 5.75) in the placebo group ( P = 1.00). Conclusions : In patients hospitalized for mild to moderate COVID-19, the rate of symptomatic VTE was low with no evidence of benefit of hydroxychloroquine.

12.
Research and Practice in Thrombosis and Haemostasis ; 5(SUPPL 2), 2021.
Article in English | EMBASE | ID: covidwho-1509032

ABSTRACT

Background : D-dimer is a safe tool to exclude pulmonary embolism (PE) but its specificity is decreased in COVID-19. Aims : Our aim was to derive a new algorithm with D-dimer threshold adjusted to CT extent of lung damage. Methods : We conducted a multicenter, retrospective cohort study among 774 COVID-19 patients with suspected PE. D-dimer threshold adjusted to CT extent of lung damage was derived in a patient set ( n = 337), and its safety assessed in an independent validation set ( n = 337). Results : According to ROC curves, D-dimer safely excluded PE, with one false negative when using a 900 ng/mL threshold when lung damage extent was <50% and 1700 ng/mL when lung damage extent was ≥50%. In the derivation set, the algorithm's sensitivity was 98.2% (95% CI: 94.7-100.0), and its specificity 28.4% (95% CI: 24.1-32.3). The negative likelihood ratio (NLR) was 0.06 (95% CI: 0.01-0.44) and the AUC was 0.63 (95% CI: 0.60-0.67). In the validation set, sensitivity and specificity were 96.7% (95% CI: 88.7-99.6) and 39.2% (95% CI: 32.2-46.1), respectively. The NLR was 0.08 (95% CI: 0.02-0.33), and the AUC did not differ from that of the derivation set (0.68 (95% CI: 0.64-0.72), P = 0.097). Using the Co-LEAD algorithm, 76/250 (30.4%) COVID-19 patients with suspected PE could have been managed without CT pulmonary angiography (CTPA). Conclusions : The Co-LEAD algorithm safely excludes PE, and allows reducing the use of CTPA in COVID-19 patients. Prospective management studies are necessary to validate this strategy.

13.
Research and Practice in Thrombosis and Haemostasis ; 5(SUPPL 2), 2021.
Article in English | EMBASE | ID: covidwho-1509009

ABSTRACT

Background : High rates of venous thromboembolic events associated to LMWH/heparin therapy lead to numerous heparin-induced thrombocytopenia (HIT) suspicion during COVID-19 outbreak. Aims : We aim to describe HIT-suspected patient's characteristics and prevalence between March 15 and April 15 of 2020. Methods : This is a multi-centric retrospective cohort study of HITsuspected patients referred to our center. 4T score has been realized by experienced hematologist and/or pharmacologist and allowed us to trigger specific HIT assays if score was >3 (IgG anti-PF4/H and 14C-serotonine release assay, SRA). We included all consecutive HIT-suspected patients during COVID-19 outbreak compared to the same period in 2019. Results : During 2019 and 2020-study periods we identified, respectively, 17 and 41 consecutive HIT-suspected patients. Among the 2020-group, 23 were COVID-19 and 18 were non-COVID-19 patients. Clinical and biological characteristics were not significantly different between the 2019, 2020 non-COVID-19 and COVID-19 HIT-suspected patients. During 2019-period study, 11 (64.7%) patients had a 4T score >3, 4 (36.3%) of them had positive anti-PF4/H antibodies and only one had a positive SRA assay. During 2020-period study, 8 (44.4%) non-COVID-19 and 10 (43.5%) COVID-19 patients had a 4T score >3. Among them, respectively, 3 (37.5%) and 3 (30.%) had positive anti-PF4/H antibodies. SRA assay was positive in 3 non-COVID-19 patients tested and in the only one COVID-19 tested patient. The 4T score was able to exclude HIT in 67% of COVID-19 patients suspected. In 2020-study period, when comparing COVID-19 and non-COVID-19 patients, the only significantly difference in term of HIT suspicion criteria was the mean duration of heparin exposition before suspicion: 9.9 days ±6.3 for non-COVID-19 patients versus 15.2 days ±8.8 for COVID-19 patients, P = 0.043). Conclusions : HIT suspicion in COVID-19 occurs after longer anticoagulation time than non-COVID-19. We did not observe more confirmed HIT in COVID-19 in contrast our two non-COVID-19 control groups.

14.
Research and Practice in Thrombosis and Haemostasis ; 5(SUPPL 2), 2021.
Article in English | EMBASE | ID: covidwho-1509008

ABSTRACT

Background : Antiphospholipid antibodies (APA) clinical relevance in COVID-19 is controversial. Aims : We aimed to investigate the prevalence and prognostic value of conventional and non-conventional APA in COVID-19 patients. Methods : This study was a multi-centric, prospective observational French cohort of patients hospitalized for COVID-19 suspicion. Results : 249 patients were hospitalized for suspected COVID-19, including 154 (61.8%) with confirmed COVID-19 and 95 (38.2%) not confirmed. We found a significant increase in lupus anticoagulant (LA) positivity among COVID-19 positive patients (60.9% versus 23.7% in non-COVID19 patients, P < 0.001), while prevalence of conventional (LA, IgG, IgM and IgA isotypes) and non-conventional APA (anti-phosphatidylserine/prothrombin IgG and IgM) were low in both groups. COVID-19 patients with LA positivity had higher levels of fibrinogen (6.0 g/L, IQR 5.0-7.0 versus 5.3 IQR 4.3-6.4, P = 0.028) and C-reactive protein (CRP, 115.5 IQR 66.0-204.8 versus 91.8 mg/L, IQR 27.0-155.1, P = 0.019). Univariate analysis did not show any association between LA positivity and higher risk of venous thromboembolism (VTE, OR 1.02, 95% CI 0.44-2.43, P = 0.95) or inhospital mortality (OR 1.80, 95% CI 0.70-5.05, P = 0.24). Unadjusted and adjusted (to CRP, age and sex) Kaplan-Meier survival curves according to LA positivity confirmed the absence of association with VTE or in-hospital mortality (unadjusted: P = 0.64 and P = 0.26, respectively;adjusted: hazard ratio = 1.13 95% CI 0.48-2.60 and 1.80 95% CI 0.67-5.01). Conclusions : COVID-19 patients have an increased prevalence of LA positivity associated with biological inflammation markers. However, positive LA at admission is not associated with VTE risk and/or inhospital mortality.

15.
International Journal of Gynecological Cancer ; 31(Suppl 3):A372-A373, 2021.
Article in English | ProQuest Central | ID: covidwho-1484050

ABSTRACT

Introduction/Background*COVID -19 pandemic has shown a huge impact in health-care systems. In the field of gynecology oncology, we had to postpone routinary tests and check-ups, as well as attend patients that had undergone an oncological process via telephone. Due to their vulnerability, the psychological impact on this patient has been even worse than on other users of the health system. The aim in this study is to evaluate the concerns, global health status and quality of life of patients with gynecological cancer during the pandemic.MethodologyThe GineonCoVID study is a multicenter Spanish study that collect data from a national survey. The anonymous survey consists of 23 questions regarding the personal experience of the patient and modifications in health care during follow up of patient with gynecological malignancies from April to May 2021. The survey has been divided into 3 sections. In this sub-analysis the results of the questions related to anxiety, concerns, quality of life and state of mind of the interviewed patients will be evaluated.Result(s)*376 patients responded to the survey. The median age was 58 years. 43% of the patients were diagnosed with endometrial cancer, 27.3% with ovarian cancer and 24.1% with cervical cancer. 39.6% and 33.6% of patients suffered anxiety and depression respectively during the pandemic. 81% of the patients report having a good quality of life during the last year. Results showed that 54.2% of the respondents are not concerns about viral infection and 67.9% consider that the risk of being infected during follow-up is low. 94% do not perceive changes in follow up, but if they do, 44% believe that clinical health care has experienced a change. 71.4% of the patients are concern about not being able to attend clinical visits.Conclusion*The pandemic could increase anxiety and depression, although it does not appear to worsen the quality of life in patients with gynecological cancer. More than half of the patients consider that they have a low risk of being infected during follow-up but are concerned about not being able to attend clinical visits due to the pandemic.

18.
Revista Medica de Chile ; 148(5):689-696, 2020.
Article in Spanish | GIM | ID: covidwho-1431447

ABSTRACT

Coronavirus infection (SARS-CoV-2), is a pandemic disease declared by the World Health Organization (WHO). This disease reports a high risk of contagion, especially by the transmission of aerosols in health care workers. In this scenario, aerosol exposure is increased in various procedures related to the airway, lungs, and pleural space. For this reason, it is important to have recommendations that reduce the risk of exposure and infection with COVID-19. In this document, a team of international specialists in interventional pulmonology elaborated a series of recommendations, based on the available evidence to define the risk stratification, diagnostic methods and technical considerations on procedures such as bronchoscopy, tracheostomy, and pleural procedures among others. As well as the precautions to reduce the risk of contagion when carrying out pulmonary interventions.

19.
Nephrology Dialysis Transplantation ; 36(SUPPL 1):i481, 2021.
Article in English | EMBASE | ID: covidwho-1402493

ABSTRACT

BACKGROUND AND AIMS: Hemodialysis patients are high-risk patients for severe forms of SARS-Cov 2. Extremadura has two provinces Badajoz(B) and Caceres(C) with one million of people. The incidence was small in the first part of the pandemic (2,6%) compared with the national incidence, and it was higher in C than in B (5,6% vs 1,1%) The aim of this study was to estimate the incidence of COVID-19 disease in the population of Extremadura's hemodialysis patients and to study the clinical evolution, treatment and mortality in patients with confirmed infection with Polymerase chain reaction(PCR) during the second wave. METHOD: Multicenter, retrospective, observational study of hemodialysis patients with COVID-19 disease between August and December of 2020. There were 683 hemodialysis patients in this period distributed in 5 hospital units and 7 out of hospital Units. RESULTS: Incidence: 6,8% (46 infected of SARS-Cov 2), with almost one patient in each center (the highest with 16,1%) and higher incidence in B than in C (8,1% vs 4,1%). Males (58,7%), media age, (69,3±11,9) and median renal replacement therapy time 29 months (RIC 47,4). The most frequent CKD was diabetic nephropathy (16%), but 35% of the patients have diabetes, 86% hypertension and 56% cardiovascular illness. Treatment with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers 40% and with vitamin D 62,8%. There were 42% patients who had contacted with positive people of hemodialysis unit and 37% with positive people outside. 67% have symptoms: the most frequent cough and fever (46%). Hospitalized patients: 41,6%, all of them with bilateral pneumonia. All had lymphocytopenia and high acute phase reactants: D-dimer 1195 ng/ml (RIC 1545), Ferritin 950,12ng/ml (RIC 533,6) IL-6 30,11pg/ml (RIC 41,13) C-reactive protein 28 mg/l (RIC 62,10) Procalcitonin 0,42 ng/ml (RIC 0,44), all increased in the hospitalized period without significant differences. Median hospitalized time was 10 days (RIC 11). Nine patients died (19,5%), 3 of them in intensive unit care with 15 days median. Most of them needed antibiotic therapy, steroids and anticoagulation, 5 convalescent plasma and 5 tocilizumab. We stopped isolated room dialysis when they had negative PCR (56%) or IgG positive (54%), median insulation 17 days (RIC 7). We haven't found differences in hospitalized vs no hospitalized patients in age, gender, renal replacement therapy time, etiology, DM, hypertension or cardiovascular illness and treatment, nor in relation with mortality. CONCLUSION: We have observed an increase in the incidence of infection in this period compared with the first period of the pandemic, parallel to the increases in the incidence of the general population in Extremadura (more in B than in C). The mortality is high but similar to other publications. We have to do screening due to the possibility of asymptomatic patients that could have contributed to expand the infection. The high number of hospitalized patients and the need of isolated rooms dialysis for infections patients is a challenge for the organization of hemodialysis units but having positive serologic reduce the isolation time.

20.
Journal of Investigative Medicine ; 69(2):507-508, 2021.
Article in English | EMBASE | ID: covidwho-1146992

ABSTRACT

Case Report Multi-System Inflammatory Syndrome in Children (MIS-C) is the presence of persistent fever with elevated inflammatory markers with evidence of organ dysfunction. Its presentation is highly variable and overlaps with Kawasaki disease. Ventricular dysfunction is the most common cardiac manifestation in MIS-C. In a study in Italy, only 2 out of 10 patients who had MISC did not test positive for either IgG or IgM. Considering the temporal relationship with the current SARS-CoV-2 pandemic high index of suspicion is indicated to capture and report unusual presentations of it even in seronegative cases. We present a rare case of an 8-month-old male child who was admitted for concerns of Kawasaki disease with continuous fever for two-weeks with diarrhea, cough, runny nose, edematous extremities, diffuse macular rash, bilateral erythematous conjunctiva, and oral mucosa. In a febrile event patient presented with supraventricular tachycardia (SVT) associated with desaturation that required transfer to the Pediatric Intensive Care Unit (PICU) for further care. Sinus rhythm was restored after 3 doses of adenosine and 1 synchronized cardioversion. Echocardiogram evidenced mild mitral regurgitation with small pericardial effusion without any coronary dilation or aneurysm. The patient met MIS-C criteria and he had exposure to SARS-CoV-2 infection in the past 3 wks. Multiple SARS-CoV-2 Protein Chain Reaction tests and antibody tests were negative. He was treated with immunoglobulin infusion and high dose aspirin. He did not require a second dose of immunoglobulin infusion or any second-line treatment. The patient recovered well and was discharged home with propranolol although no abnormal basal rhythm was identified. Supraventricular tachycardia is an unusual presentation for either Kawasaki Disease or SARS-CoV-2 related MIS-C. Although both entities overlap, they are not mutually exclusive and treatment is similar if not the same. As pediatricians, prompt initiation of treatment and a higher level of monitoring should be considered with suspected Kawasaki disease or suspected MIS-C since we are still learning about its presentation. In our patient, the lack of laboratory confirmation of SARS-CoV-2 does not rule in or rule out any of the conditions.

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