ABSTRACT
Objectives: To assess the impact of COVID-19 on disease activity and severity outcomes in patients with systemic vasculitis. Method(s): The Reuma-CoV Brazil is a longitudinal, multi-stage cohort study, designed to monitor patients with immune-mediated rheumatologic disease (IMRD) during the SARS-CoV-2 pandemic. Systemic vasculitis patients with COVID-19 were compared with those without COVID-19. Vasculitis activity was evaluated by the patient global assessment (PGA) and Birmingham Vasculitis Activity Score 3 (BVAS 3). The prognosis was assessed by the Five-Factor Score (FFS). Result(s): Between May 2020 and January 2021, 53 patients with vasculitis were included and followed for six months, 32 (60.3%) with COVID-19 and 21 (39.6%) in the control group. In total, 79.5% were female with a mean age (SD) of 49 (16.5) years. Both groups were homogeneous regarding sex, age, and comorbidities. Thirty-eight (71.8%) patients had at least one comorbidity. Thirty-two patients were classified as small vessels vasculitis (SVV), 10 as large vessels (LVV) and 11 as vasculitis of variable caliber. There was no difference in PGA, BVAS and FFS when comparing before and after SARSCoV-2 infection (Table 1). In the group of patients with LVV, two had clinical or laboratory worsening post infection. Compared to controls, patients with vasculitis and COVID-19 were at higher risk of intensive care unit (ICU) hospitalization [OR (IC95%) = 7.98 (3.78 - 16.8), p alpha 0.001], mechanical ventilation [OR (IC95%) = 7.45 (3.16 - 17.5), p = alpha0,001] and death [OR (IC95%) = 9.69 (3.87 - 24.3), p alpha 0,001]. Of the 7 patients who died, 40%were using high-dose prednisone (>20 mg/d) and 38.8% were using rituximab. Conclusion(s): In this sample of patients with systemic vasculitis, there was no worsening of disease activity after COVID-19, but there was a higher risk of poor outcomes, possibly related to immunosuppression.
ABSTRACT
Objectives: To describe the clinical characteristics and outcomes of SARSCoV-2 infection in patients with systemic vasculitis. Method(s): Observational, multicenter, cross-sectional analytical study in patients 18 or older diagnosed with systemic vasculitis with confirmed SARSCoV-2 infection (RT-PCR or serology) included in the SAR-COVID registry. Patients were evaluated from July 2020 to February 2022. Patients diagnosed with ANCA-associated vasculitis (AAV), other systemic vasculitides (Giant cell arteritis, Takayasu), and a control group of patients with other rheumatological diseases matched by age, sex, comorbidities, and date of SARS-CoV-2 infection. The survival curve of the groups was studied by Kaplan-Meier and compared through the Log-Rank Test. A Cox regression model will be performed to adjust survival for different variables (sex, age, treatments for underlying disease, treatments for viral infection, smoking, obesity, d-dimer level, and disease activity). Result(s): A total of 282 out of 2694 patients in the SAR-COVID registry were included, 57.4%women with a mean age of 55.7 years (SD 14.1). Fifty-four patients in the AAV group, 32 in the other vasculitis group, and 196 controls were studied. Hospitalization was required in 53.7% of the AAV group, 37.5% in other vasculitides, and 26.2% in the control group. 5.6% of patients in the control group presented acute respiratory distress syndrome (ARDS), 15.6% in the other vasculitis group, and 22.2% in the AAV group (p alpha 0.001). Complete recovery was observed in 82.3% of patients in the control group, 75%in the other vasculitis group, and 63%in the AAV group.We observed that 5.7% of the patients in the control group died from COVID-19, 9.4%from other vasculitides, and 27.8% in the AAV group (p alpha 0.001). We found a lower survival in the AAV group compared to the control group (p alpha 0.005). In the multivariate Cox regression model, older age (HR:1.05 IC95%1.01-1.09 p = 0.01), BMI > 40 (HR:13.2 IC95% 2.1-83.2 p = 0.01), and high activity of the underlying disease (HR:16 95% CI 3.7-69.4 p alpha 0.005) were associated with lower survival. Conclusion(s): In conclusion, patients diagnosed with AAV presented a worse disease course during SARS-CoV-2 infection with a more frequent requirement for invasive mechanical ventilation. Likewise, these patients showed lower survival compared to patients with other autoimmune diseases.
ABSTRACT
Introduction: In this study, we share the results of immunosuppressed patients who suffered from acute respiratory distress syndrome (ARDS) secondary to COVID-19 pneumonia managed in our ICU. Method(s): We tracked all patients admitted to ICU of a Tertiary Hospital diagnosed with severe SARS-COV2 pneumonia from March 1, 2020 to January 31, 2022. The definition of Immunocompromised patient is based on history of transplantation, active neoplasia, autoimmune diseases or HIV. Collected data includes: sex, age, type of immunosuppression, vaccination, mechanical ventilation, ECMO VV, incidence of superinfections and mortality. Result(s): From a cohort of 425 patients, 55 met the inclusion criteria. 33% were women and 67% male. The average age was 58 years for women and 62 years for men. Out of these patients, 27% had solid organ transplants. 40% suffered from neoplasic disease. 27% had autoimmune diseases and were under treatment with immunosuppressants. 3 had HIV. Only the 29% had received at least 1 dose of COVID 19 vaccine. 80% required orotracheal intubation. 3.64% (2) required Veno-Venous ECMO. 61% presented bacterial superinfection, with the most frequent germs being Pseudomonas aeruginosa and Enterococcus. 36% had viral superinfection, being cytomegalovirus the most frequent one. 32% had fungal superinfection, mainly by Aspergillus fumigatus. 27% did not suffer any superinfection. 40% of the total sample died. After logistic regression, in our model (AUC 83,4% (Se 57.1%, Sp 87.9%), we identified need of intubation as independent variable of mortality (OR 27,06 IC95% 1.76-415.55, p = 0.018). Conclusion(s): Immunocompromised patients with ARDS secondary to COVID-19 pneumonia present high mortality, with statistically significant difference when mechanical ventilation is needed. The most frequently isolated germs causing superinfection in this group of patients are bacterias. We believe that this group of patients require special care in our ICU units and an in-depth analysis and study to optimize their prognosis.
ABSTRACT
Introduccion: Se ha reportado que tanto la prevalencia como la incidencia de la enfermedad celiaca (EC) estan aumentando a nivel mundial. Este aumento podria ser atribuido a infecciones viricas como desencadenante de la EC, entre otros factores. La COVID-19 ha impactado de lleno en la realizacion del estudio de prevalencia del Plan Nacional de EC promovido por el CIBERHED. Se ha sugerido que SARS-CoV-2, que penetra por via digestiva, podria desencadenar brotes de EC. Objetivos: 1) Evaluar la prevalencia actual de EC en comparacion con la de la cohorte 2004-2009. 2) Evaluar el impacto de la COVID-19 en la prevalencia actual de EC. Metodos: Desde enero 2021 hasta la actualidad se han incluido 1886 individuos de entre 1 y 90 anos atendidos por cirugia menor en los 6 hospitales participantes (Hospitales Universitarios (HU) Mutua Terrassa- Sant Joan de Deu, HU Virgen del Rocio, HU Central de Asturias, HU Galdakao-Cruces y HU Fundacion Jimenez Diaz) (calculo muestral: 5.300). La inclusion se realiza ajustada por edad y sexo a la piramide poblacional. Se determinan Ac. antitransglutaminasa (tTGA) y en los casos positivos se confirma el diagnostico segun guias de consenso. Se reporta la prevalencia serologica (tTGA > 7 U/ml) mas los casos prevalentes previamente diagnosticados. La relacion entre COVID19, registrada mediante cuestionario, y los casos positivos (tTGA > 7 U/mL y tTGA zona gris 2-7 U/mL) se ha evaluado mediante prueba exacta de Fisher. Resultados: Se han detectado 11 sujetos con serologia positiva y 2 pacientes con diagnostico previo de EC;prevalencia 6,89 x 1.000, IC95% 3,68-11,76. En comparacion con la prevalencia de la cohorte (2004-2007), 5,67 x 1.000, no existen diferencias significativas. Se han detectado 3 casos con serologia tTGA positiva y COVID-19 sobre un total de 335 pacientes infectados y 8 casos con serologia tTGA positiva sin COVID-19 sobre un total de 1.547 individuos no infectados (p = 0,4247). Tampoco se ha encontrado relacion entre COVID-19 y valores de serologia en la zona gris. Conclusiones: No se detecta un incremento de la prevalencia de EC en las ultimas dos decadas en nuestro medio. La infeccion por COVID19 no ha tenido impacto en la aparicion de nuevos casos de la enfermedad.Copyright © 2023 Elsevier Espana, S.L.U. Todos los derechos reservados.
ABSTRACT
Purposes: Artificial Intelligence (AI) models are constantly developing to help clinicians in challenging tasks such as classification of images in radiological practice. The aim of this work was to compare the diagnostic performance of an AI classifier model developed in our hospital with the results obtained from the radiologists reading the CT images in discriminating different types of viral pneumonia. Material(s) and Method(s): Chest CT images of 1028 patients with positive swab for SARS-CoV-2 (n=646) and other respiratory viruses (n=382) were segmented automatically for lung extraction and Radiomic Features (RF) of first (n=18) and second (n=120) order were extracted using PyRadiomics tools. RF, together with patient age and sex, were used to develop a Multi-Layer Perceptron classifier to discriminate images of patients with COVID-19 and non-COVID-19 viral pneumonia. The model was trained with 808 CT images performing a LASSO regression (Least Absolute Shrinkage and Selection Operator), a hyper-parameter tuning and a final 4-fold cross validation. The remaining 220 CT images (n=151 COVID-19, n=69 non-COVID-19) were used as independent validation (IV) dataset. Four readers (three radiologists with >10 years of experience and one radiology resident with 3 years of experience) were recruited to blindly evaluate the IV dataset using the 5-points scale CO-RADS score. CT images with CO-RADS >=3 were considered "COVID-19". The same images were classified as "COVID-19" or "non-COVID-19" by applying the AI model with a threshold on the predicted values of 0.5. Diagnostic accuracy, specificity, sensibility and F1 score were calculated for human readers and AI model. Result(s): The AI model was trained using 24 relevant features while the Area under ROC curve values after 4-fold cross validation and its application to the IV dataset were, respectively, 0.89 and 0.85. Interreader agreement in assigning CO-RADS class, analyzed with Fleiss' kappa with ordinal weighting, was good (k=0.68;IC95% 0.63-0.72) and diagnostic performance were then averaged among readers. Diagnostic accuracy, specificity, sensibility and F1 score resulted 78.6%, 78.3%, 78.8% and 78.5% for AI model and 77.7%, 65.6%, 83.3% and 72.0% for human readers. The difference between specificity and sensitivity observed in human readers could be related to the higher rate of false positive due to the higher incidence of COVID-19 patients in comparison with other types of viral pneumonitis during the last 2 years. Conclusion(s): A model based on RF and artificial intelligence provides comparable results with human readers in terms of diagnostic performance in a classification task.Copyright © 2023 Southern Society for Clinical Investigation.
ABSTRACT
Background: COVID-19 is the most important health problem in the world nowadays. Since the publication of the first cases, the symptoms have become more numerous. Anosmia has been recently recognized as a frequent and relevant symptom for the detection of COVID-19, especially in pauci-symptomatic forms. Objective(s): To determine the prevalence of anosmia in health care workers affected by SARS-COV2 and to identify its associated factors. Method(s): This is a cross-sectional analytical study, carried out over a six-month period, which included all healthcare workers of Farhat Hached Academic Hospital of Sousse, Tunisia, affected by SARS-COV2 and confirmed by polymerase chain reaction or antigen rapid test. Result(s): A total of 474 healthcare workers were enrolled with a mean age of 41.02+/-10.67 years and a sex ratio of 0.2. The gynecology department was the most represented one (13.9%). Nurses were the most affected (31.4%). Hospitalization was required for 16 patients (3.4%). The average time of work was 17.04 +/- 11.6 days. Anosmia persisted for more than 90 days in 35 patients (7.4%). After multiple binary logistic regression, anosmia was statistically associated with female gender (p = 0.001;ORIC95%:2.46 [1.4-4.2]) and blue-collar occupational category (p = 0.002;ORIC95%:3.1 [1.5-6.5]). A significant association was also noted between the presence of anosmia and professional seniority (p = 0.019;OR IC95%: 0.97 [0.95-0.99]) and the duration of work (p = 0.03;OR IC95%: 0.97 [0.95-0.99]). Conclusion(s): Although anosmia seems to be frequent in COVID-19 patients, there is still not enough evidence to affirm that it is a strong predictor of the diagnosis of COVID-19.
ABSTRACT
Introduction: COVID-19 has been a challenge for healthcare, mainly in elderly patients in Nursing Homes (NHs) and Long-Term Care Facilities (LTCFs). We present a pioneering novel experience in addressing healthcare of elderly patients with COVID-19 in these facilities by a re-conversion of a NH in a medicalized NH. Method(s): All patients admitted to the center were included, recording clinical and epidemiological variables. We conducted a descriptive analysis and a multivariate analysis to identify variables linked to mortality and persistence of positive PCR test. Result(s): 84 patients were included (40% men), women presented more symptomatology. We found a positive correlation between the duration of symptoms and the days required to obtain a negative PCR test (r=0.512, P<0.001). We also found an independent and significant association between as-thenia (OR=2.58;IC95% 1.22-5.46) and mutism (OR=5.21;IC95% 1.58-17.15) and a longer time to achieve a negative PCR test. All patients, except contraindication, were treated with hydrox-ychloroquine and azithromycin, which was the recommended treatment during the period of the study. The early start of corticoid treatment (within the first 72 hours since the start of symptoms) was linked to a lower mortality in patients with moderate-severe symptoms. Mortality was lower than expected (which was higher than 20% in that period and group of age), reaching 14%, the main factors linked to mortality were the presence of mutism (OR=19;IC95% 3.4-108;P=0.001) and dyspnea (OR=12;IC95% 1.3-111;P=0.029). Conclusion(s): An alternative system was presented for the care of these patients through the recon-version of a basic NH in a medicalized one, which showed a significant reduction in the expected mortality.Copyright © 2021 Bentham Science Publishers.
ABSTRACT
Introduction: The HLA Class I genes codify crucial molecules in developing the immunological response against pathogenic agents such as SARS-CoV-2. We aimed to assess HLA-A alleles associated with COVID-19 subsequent pulmonary complications as interstitial lung manifestations (ILM). Material(s) and Method(s): 209 Mexican mestizo patients with a positive RT-PCR test for SARS-CoV-2 and confirmed clinical diagnosis of COVID-19 were included. The participants were monitored three months after the hospital discharge through tomography;They were divided into two groups, 1) patients who developed ILM post-COVID19 (n = 85) and 2) those patients without tomographic evidence of ILM (n = 124). The HLA-A locus was genotyped by endpoint PCR using Micro SSP Generic HLA Class I kits. The clinical and demographic variables were analyzed by SPSS software. The alleles and genotypes were analyzed by 2 x 2 contingency tables, the value of p was obtained by Yates' correction. Result(s): There is no significant difference in age, sex, BMI, hospitalization days, PAO2/FIO2, or invasive mechanical ventilation. The alleles HLA-A*02:01, *24:02, and *68:01 are the most frequent in both study groups, grouping more than 60% of the alleles identified. On the other hand, the frequency of the HLA-A*01:01 allele was decreased in the group with interstitial lung manifestations at 3 months of discharge, compared to the group without interstitial lung manifestations (p= 0.004, OR = 0.13, IC95% 0.03-0.58). There is no significant difference in the genotypic frequencies. Conclusion(s): Subjects carrying the HLA-A*01:01 allele have a lower risk of developing interstitial lung manifestations posterior from COVID-19.
ABSTRACT
INTRODUCTION: The COVID-19 vaccines have effectiveness above 90% for avoiding hospitalization. However, 5% of vaccinated patients require hospitalization with a mortality ratio between 15% to 24%, similar to the one reported for unvaccinated hospitalized patients. These vaccinated patients belong to the most sensitive groups with a high comorbidity burden. The similarity in the mortality ratio between vaccinated and unvaccinated patients has been used to make claims against the vaccine's efficacy. A thoughtful analysis, taking into account the comorbidities of each group, on how vaccination protects patients with moderate or severe illness, is missing. METHOD(S): We perform a multi-continental retrospective cohort study in 111 hospitals in Spain and 37 in Argentina. We included hospitalized patients who received oxygen therapy older than 18 years with COVID-19. To assess the relation between COVID-19 vaccine status and death, we performed a logistic regression adjusting by confounders. Also, as a sensitivity analysis, we perform a propensityscore matching. Additionally, we studied the Population Attributable Risk (PAR). RESULT(S): Between January 2020 and May 2022, we included 21,479 patients, 717 (3 3%) were vaccinated. Hospitalized vaccinated patients with oxygen therapy had a higher proportion of comorbidities. The overall mortality in vaccinated patients was 20 9%, and 19 5% in unvaccinated patients. The crude Odds Ratio was 1 07 (IC95% 0 89-1 29;p=0 41), while the adjusted was 0 73 (IC95% 0 56-0 95;p=0 02) in the complete case analysis (6,352 patients) and 0 77 (CI 95% 0 54-0 97;p=0 02) in the complete dataset after multiple imputations. These observations were robust to the sensitivity analysis. The adjusted PAR reduction was 4 3% (95%CI 1%-5%). Therefore, as the death proportion in unvaccinated patients was 19 6% (95%CI 19%-20 1%), if they were vaccinated the expected death proportion would have been 15 3% (95%CI 12 9%-18%;p< 0 01). CONCLUSION(S): Even with the high protection of the COVID-19 vaccine, patients with a high burden of comorbidities will be hospitalized in future pandemic waves. In this study, we observed that the COVID-19 vaccines significantly reduce the probability of death even when lung inflammation has already been initiated, with moderate or severe COVID-19 disease.
ABSTRACT
Objetivos: A manutencao dos estoques de sangue em niveis adequados para atender a demanda hospitalar requer dos hemocentros um trabalho sistematizado visando quais acoes torna possivel fidelizar o doador. Neste contexto, e necessario encontrar evidencias sobre a fidelizacao do doador de sangue para um direcionamento assertivo de recursos. Diante do exposto, este estudo teve como objetivo analisar fatores associados a fidelizacao do doador de sangue do Distrito Federal. Metodos: Realizou-se estudo de caso-controle com doadores de sangue em um hemocentro publico localizado no Distrito Federal, Brasil. Os "casos"foram definidos como aqueles que realizaram uma doacao em 2019, e pelo menos mais uma doacao nos 12 meses anteriores. Os "controles"foram doadores de primeira vez ou esporadicos, os quais realizaram apenas uma doacao de sangue no ano de 2019. Optou-se pelo ano supracitado por ser anterior a pandemia originada pelo Sars-CoV2, embora tenha sido considerada esta variavel como independente na analise. Excluiram-se os doadores convidados por fenotipagem, por aferese, doadores bloqueados para doacao ou que se recusaram a participar do estudo. Foi feita amostragem aleatoria simples dos doadores, com aplicacao de questionario estruturado por entrevistador que nao conhecia o status de caso ou controle dos participantes, via telefone. Foram abordadas variaveis socioeconomicas, relacionadas ao servico e ao ato de doacao. Realizou-se analise bivariada dos dados, com calculo da odds ratio (OR) e do seu intervalo de confianca (IC 95%). Este estudo foi apreciado e aprovado por um comite de etica em pesquisa (40370820.5.0000.5553). Resultados: Participaram deste estudo 153 doadores fidelizados e 133 controles doadores de primeira vez ou esporadicos, no periodo de janeiro a junho de 2021. Os doadores fidelizados tem mais chance de serem do sexo masculino (OR=1,79;IC95%=1,12-2,87), brancos (OR=1,68;IC95%=;1,01-2,8), da faixa etaria de 30 a 49 anos (OR=1,72;IC95%=1,17-2,55;referencia 16-29 anos), e com grau de escolaridade de ensino superior completo ou maior (OR=14,0;IC95%=5,65-34,68). Nao houve evidencia de diferenca entre os fidelizados e os nao-fidelizados em relacao a doacao de sangue estimulada por ajudar pessoas desconhecidas, por brindes/carteira do doador, ou por realizacao de exames laboratoriais. Ainda, acompanhar os estoques nas redes sociais/materias de TV nao se configurou como fator associado a fidelizacao. Tambem nao houve evidencia de alteracao da frequencia (aumento ou reducao) de doacao motivado pela pandemia da COVID-19. Discussao: Esta pesquisa evidenciou que sexo, raca/cor, faixa-etaria e escolaridade sao fatores associados a fidelizacao do doador de sangue. Nao houve diferenca entre os grupos para fatores relacionados ao ato de doar e a praticas do servico. Pesquisa semelhante aponta sobre a necessidade de ampliar as acoes para despertar o interesse dos individuos que nao se enquadram no perfil mais preponderante de doadores, como mulheres, casados, pertencentes a outras etnias, atingindo tambem individuos jovens e de baixa escolaridade.1 Conclusao: Doadores fidelizados tem mais chance de serem do sexo masculino, brancos, de alta escolaridade e adultos-jovens, com fatores individuais sendo associados a fidelizacao. Sugerem-se mais estudos sobre a tematica e estrategias institucionais que promovam a fidelizacao da doacao de sangue. Copyright © 2022
ABSTRACT
Introduction: Health student's mental health is considered a public health issue that dramatically increased with COVID 19's pandemic. However, very few studies assessed the prevalence of mental health in medical, pharmacist, and dental students. Objective(s): Our goal was to assess mental health in health students from the same university one year after pandemic's beginning and look at for associated factors. Method(s): An online survey was realized in Paris university which has the 3 specialties (medicine, pharmacy, and dental). We used the Hospitalization Anxiety and Depression scale, Composite International Diagnostic Interview - Short Form questionnaire, Maslach Burnout Inventory (with 2 versions (Student survey and Human Services Survey). We also asked for 12 months of suicidal ideation, humiliation, sexual harassment, and sexual aggression. We did multivariable logistic regression analyses to identify Major Depressive Episode (MDE) associated factors. Result(s): We included 1925 students: 95 dental, 233 pharmacists, 541 medical preclinic, 587 medical clinic and 469 residents. Overall prevalence of 7- days anxiety symptoms, 7- days depressive symptoms, 12-month MDE, 12-month suicidal ideation, humiliation, sexual harassment and sexual aggression were 55%, 23%, 26%, 19%, 19%, 22% and 6% respectively. There were significative differences between groups for anxiety and depressive symptoms and MDE (p<0.001 for all). Associated factors to MDE in multivariable logistic regression were humiliation (OR=1.71, IC95[1.28-2.28]), sexual harassment (OR=1.60, IC95[1.19-2.16]), sexual abuse (OR=1.65, IC95[1.04-2.60])) and moderate (OR=1.49, IC95 [1.17-1.90]) or important (OR=2.32, IC95[1.68-3.20]) subjective financial difficulties. Conclusion(s): Health student's prevalence of psychiatric symptoms is significant, but it seems possible to intervene on several risk factors.
ABSTRACT
Background: Vaccination during immunosuppression can result in impaired vaccine responses. In highly active patients requiring a rapid treatment initiation, vaccination can delay treatment onset. Natalizumab (NTZ) is a high-efficacy agent with potential low interference in vaccination responses, and could be a bridge therapy to achieve an adequate immunisation before starting another treatment. Objective(s): To assess the safety and immunogenicity of inactivated vaccines administered during NTZ treatment. Method(s): Self-controlled study based on an ongoing prospective cohort that included adult MS patients with complete immunisation schedules for hepatitis B vaccine (HBV), hepatitis A vaccine (HAV) and/or COVID-19 vaccine during NTZ treatment, between September 2016 and February 2022. Seroprotection rates were calculated for each vaccine. Demographic, clinical and radiological characteristics were collected the year before (pre-exposure period) and after vaccination (post-exposure period). Differences in annual relapse rate (ARR), contrast-enhancing lesions (CELs), new T2 lesions (NewT2) and changes in Expanded Disability Status Scale (EDSS) during pre and post exposure period were evaluated. Patients were also categorised according to time on NTZ exposure before vaccination (long-term exposure >1 year and short-exposure <=1 year) and according to JCV status. Result(s): From 248 patients treated with NTZ, 60 were vaccinated during NTZ exposure: 44 (73%) women, mean age 45 years, mean disease duration 17 (SD 8.7) years. Thirty (50%) patients bridged to anti-CD20 after immunisation, because of high titers of JC virus. Between the pre and post-exposure period, we observed a decrease in both the AAR (0.28 vs 0.01;p=0.004) and newT2 (0.8 vs 0.02;p=0.1) and no changes in disability accumulation (EDSS 3.5 vs 3.5 p=0.6). The global seroprotection rate was 93% (91.6% (IC95% 73-99) for HAV (n=24), 92.6% (IC95% 76- 99) for HBV (n=27), 100% (IC95% 84-100) for Covid-19 (n=23)). No differences were seen between short and long term NTZ exposure or between JCV positive or negative patients, in terms of safety and immunogenicity. Conclusion(s): Immunisation with inactivated vaccines during NTZ treatment is safe and effective, both for short and long term NTZ exposure. In highly active PwMS who need immunisation, NTZ could be a valuable strategy to avoid delays in the onset of high-efficacy DMD, even in JC virus positive in which it could be used as a bridge therapy strategy.
ABSTRACT
Background: The COVID-19 pandemic accelerated the use telemedicine for rheumatologic patients. Patient reported outcomes (PRO) can provide prioritization criteria for the form of face-to-face care in situations of social restriction, and optimization of early care by identifying high-risk patients. Objectives: Our aim was to demonstrate the main associated factors for a fall or fracture reported by rheumatoid arthritis (RA) patients in an electronic MDHAQ (Multidimensional Health Assessment Questionnaire) during this period. Methods: Patients with RA according to 2010 ACR/EULAR and access to digital platforms were enrolled in the study, from January to august 2021. A weblink was sent to MDHAQ in electronic platform. The study was approved by the ethics committee of Hospital de Clínicas de Porto Alegre-Brazil and all patients agreed with a Term of Informed Consent. Results: A total of 129 RA patients completed the electronic MDHAQ, mean age was 60 years (S.D. 14) and 83% were female. The mean DAS28, SDAI and HAQ were 3.8 (S.D. 1.6), 14.2 (S.D. 11.0) and 1. 2 (S.D. 0.7). Of those 129 patients, 14 reported a fall or fracture in the last 6 months of response and only 16 patients were physically active. Relevant symptoms known as factors associated with risk of fall and its prevalence in this study were: pain (82%), followed by articular pain (68%), fatigue (43%), muscle weakness (37%) and weight gain (22%). Among patients who reported a fall or fracture, 83% had a RADAI ≥ 16 and mean FAST3 (Fibromyalgia Assessment Screening Test) index of 19 (IC95 % 17-21). FAST3 based on MDHAQ and independent RADAI showed positively association with a reported fall or fracture for these patients, with a p value of 0.023 and 0.025, respectively. Other factors, such as high disease activity based on DAS28 or MDHAQ, obesity and age were not statistically signifcant with the reported episode. Conclusion: Maintaining PRO is aligned with patient-centered care, allowing relevant data source and identifcation of high-risk patients-in our study: patients in pain, sedentary and in major risk of fracture. Also, use of combined in like FAST3 or independent articular pain scores such as RADAI, might be helpful to identify those high-risk patients in need for orientation for reinforcement of physical activity, prioritization for in person visits and early clinical adjustments.
ABSTRACT
Background: High disease activity, treatment with glucocorticoids (GC) and rituximab (RTX), have been related to worse outcomes of COVID-19. Objectives: To assess the clinical characteristics and severity of the SARS-CoV-2 infection in patients with rheumatoid arthritis (RA) included in the SAR-COVID registry and to identify factors associated with poor outcomes. Methods: SAR-COVID is a national, longitudinal and observational registry. Patients of ≥18 years old, with diagnosis of RA (ACR-EULAR criteria 2010) who had confrmed SARS-CoV-2 infection (RT-PCR or positive serology) were included between 13-8-20 and 31-7-21. Sociodemographic and clinical data, comorbidities, disease activity and treatment at the moment of the SARS-CoV-2 infection were collected. Additionally, infection symptoms, complications, medical interventions and treatments for COVID-19 were registered. Infection severity was assessed using the WHO-ordinal scale (WHO-OS)1. A cut-off value of ≥5 identifed patients with severe COVID-19 and those who died. Statistical analysis: Descriptive statistics. Chi2 or Fischer test, Student T test or Mann-Whitney and Kruskal Wallis or ANOVA, as appropriate. Multiple logistic regression model. Results: A total of 801 patients were included, with a mean age of 53.1 ± 12.9 years, most of them were female (84.5%) and the median (m) disease duration was 8 years (IQR 4-14). One third were in remission and 46.4% had comor-bidities, being the most frequent, hypertension (26.9 %), dyslipidemia (13.5 %), obesity (13.4 %) and diabetes (8.9%). Moreover, 3.2% had interstitial lung disease (ILD) associated with RA. At SARS-CoV-2 diagnosis, 42.5% were receiving glucocorticoids (GC), 73.9% conventional (c) disease modifying antirheumatic drugs (DMARD), 24% biologic (b) DMARD and 9.1% targeted synthetic (ts) DMARD. Among bDMARD, the most frequently used were TNF inhibitors (17%), followed by abatacept (2.8%), IL-6 inhibitors (2.4%) and rituximab (RTX) (2.1%). During the SARS-CoV-2 infection, 95.8% had symptoms, 27% required hospital-ization, 7.9% presented complications and 4.4% died due to COVID-19. Severe disease and death (WHO-OS≥5) was present in 7.5% of the patients. They were older (62.9±12.5 vs 52.2±12.7, p<0.001), and they had more frequently ILD (18.5% vs 2%, p<0.001), comorbidities (82.5% vs 43.7%, p<0.001), ≥2 comor-bidities (60.3% vs 25.8%, p<0.001), treatment with GC (61% vs 40.7%, p=0.04) and RTX (8.3% vs 1.6%, p=0.007). Conversely, the use of cDMARD and TNF inhibitors was more frequent in patients with WHO-OS<5, nevertheless this difference was not signifcant. Disease activity was comparable between groups. In multivariable analysis, older age, the presence of diabetes, ILD, the use of GC and RTX were signifcantly associated with WHO-OS≥5 (Figure 1). Furthermore, older age (65.7±10.8 vs 52.4±12.8, p<0.001), the presence of comor-bidities (87.9% vs 44.7%, p<0.001), chronic obstructive pulmonary disease (21.9% vs 5.2%, p=0.002), diabetes (30.3% vs 7.9%, p<0.001), hypertension (57.6% vs 25.6%, p<0.001), cardiovascular disease (15.6% vs 3.2%, p=0.005), cancer (9.1% vs 1.3%, p=0.001), ILD (23.3% vs 2.4%, p<0.001) and the use of GC (61.8% vs 41.4%, p=0.02) were associated with mortality. Older age [OR 1.1 IC95% 1.06-1.13] and the use of GC 5-10 mg/day [OR 4.6 IC95% 1.8-11.6] remained signifcantly associated with death due to COVID-19. Conclusion: Treatment with RTX and GC, as well as older age, the presence of diabetes and ILD were associated with poor COVID-19 outcomes in this national cohort of patients with RA. Older patients and those taking GC had a higher mortality rate.
ABSTRACT
Background: In Argentina we have witnessed two COVID 19 waves between 2020 and 2021. The frst wave occurred during the spring of 2020 and it was related to the wild type of the virus, the second occurred during the fall/winter of 2021 when the gamma variant showed a clear predominance. During the frst wave, patient with rheumatic diseases showed a higher frequency of hospitaliza-tion and mortality (4% vs 0.26%) when compared to the general population1;at that time, however, vaccination was not yet available. Objectives: To compare sociodemographic and disease characteristics, course and outcomes of SARS-CoV-2 infection in patients with immune-mediated/auto-infammatory diseases (IMADs) during the frst and second waves in Argentina. Methods: SAR-COVID is a national, multicenter, longitudinal and observational registry, in which patients ≥18 years of age, with a diagnosis of a rheumatic disease who had confrmed SARS-CoV-2 infection (RT-PCR or positive serol-ogy) were consecutively included since August 2020. For the purpose of this report, only patients with IMADs who had SARS-CoV-2 infection during the frst wave (defned as cases occurred between March 2020 and March 2021) and the second wave (cases occurred between April and August 2021) were examined. Sociodemographic characteristics, disease diagnosis and activity, comorbidities, immunosuppressive treatment and COVID 19 clinical characteristics, complications and outcomes: hospitalization, intensive care unit (ICU) admission, use of mechanical ventilation and death were compared among groups. Descriptive statistical analysis was performed. Variables were compared with Chi squared test and Student T test or Mann Whitney test. Multivariable logistic regression models with forward and backward selection method, using hospitalization, ICU admission and death as dependent variables were carried out. Results: A total of 1777 patients were included, 1342 from the frst wave and 435 of the second one. Patients had a mean (SD) age of 50.7 (14.2) years and 81% were female. Both groups of patients were similar in terms of socio-de-mographic features, disease diagnosis, disease activity, the use of glucocorti-coids ≥ 10 mg/day and the immunosuppressive drugs (Table 1 below). Patients infected during the frst wave have higher frequency of comorbidities (49% vs 41%;p= 0.004). Hospitalizations due to COVID 19 (31% vs 20%;p <0.001) and ICU admissions (9% vs 5%;p= 0.009) were higher during the frst wave. No differences in the use of mechanical ventilation (16% vs 16%;p= 0.97) nor in the mortality rate (5% vs 4%;p= 0.41) were observed. In the multivariable analysis, after adjusting for demographics, clinical features and immunosup-pressive treatment, patients infected during the second wave were 40% less likely to be hospitalized (OR= 0.6, IC95% 0.4-0.8) and to be admitted to the ICU (OR= 0.6, IC95% 0.3-0.9). Conclusion: The impact of COVID 19 in Argentina, in terms of mortality in patients with IMADs was still higher compared to the general population during the second wave. However, the frequency of hospitalizations and ICU admissions was lower. These fndings could be explained by the introduction of the SARS COV 2 vaccination and, probably, by the cumulative knowledge and management improvement of this infection among physicians.
ABSTRACT
Introducción: La pandemia COVID-19 ha podido tener influencia en la incidencia de endocarditis infecciosa nosocomial (EIN). Objetivos: Describir la incidencia, características y evolución de la EIN durante la pandemia COVID-19. Material y métodos: Estudio retrospectivo unicéntrico incluyendo las EIN definidas, según los criterios de Duke, desde marzo 2020 hasta marzo 2021. Se dividieron a los pacientes en ingreso por COVID-19 (grupo COVID) o por otros motivos (grupo no COVID). Se comparó la incidencia de EIN con el mismo periodo de 2019-2020. Resultados: Durante el periodo de estudio se diagnosticaron 22 EIN, 7 (31,8%) en COVID, 15 (68,2%) en no COVID. La incidencia fue 9,7 casos/10.000 ingresos (22/22.596). La incidencia en el mismo periodo 2019-2020 fue 4,6/10.000 (10/21.668), siendo la diferencia significativa (OR 1,91, IC95% 1,03-3,96, p = 0,038). Durante el periodo 2020-2021, la incidencia de EIN en COVID fue 24,6/10.000 (7/2.846) frente a 7,5/10.000 (15/19.750) en no COVID, siendo la diferencia significativa (OR 3,23 IC95% 1,32-7,95, p < 0,001). La mediana de edad fue 75 años (RIQ 68-80), siendo varones 68,2%. La mediana de Índice de Charlson fue 5 (RIQ 4-6). Un 36,4% presentaban válvula protésica, mientras un 22,7% valvulopatías significativa no protésica. Los pacientes COVID habían recibido más frecuentemente inmunosupresores (71,4% vs. 13,3%, p = 0,014), sin otras diferencias entre grupos. El foco primario fue considerado vascular en 86,4% (19/22;10 por vía periférica (VP), 5 por catéter venoso central (CVC), 4 no se pudo diferenciar origen entre VP o CVC). 3 pacientes presentaron foco no vascular (1 genitourinario, 2 gastrointestinal). No hubo diferencias entre grupos. Las manifestaciones fueron: fiebre 95,5%;insuficiencia cardiaca 68,2%;embolismos 45,5%;ictus 40,9%;insuficiencia renal 40,9%;bacteriemia persistente 38,1%;y shock séptico 14,3%. Los pacientes no COVID presentaron con más frecuencia clínica subaguda (0 vs. 46,7%, p = 0,042), sin otras diferencias estadísticamente significativas. La etiología fue: estafilococos coagulasa negativo 6 (27,3%);Enterococcus faecalis 6 (27,3%);Staphylococcus aureus 4 (18,2%);Candida albicans 3 (13,6%). En 3 casos no hubo aislamiento microbiológico (13.6%). No hubo diferencias entre grupos. La mortalidad a 30 días fue 45,5%, siendo la EIN o sus complicaciones la causa en todos los casos salvo 1 (no COVID). No hubo diferencias de mortalidad entre grupos (28,6% vs. 53,3%, p = 0,381). Conclusiones: La incidencia de EIN ha aumentado durante la pandemia, especialmente en pacientes ingresados por COVID-19. El foco primario de las EIN fue predominantemente vascular. Afectaron frecuentemente a pacientes con comorbilidad y patología valvular previa. Las manifestaciones, etiología y evolución fueron similares en COVID y no COVID, destacando una elevada frecuencia de eventos embólicos, especialmente ictus. Las EIN asocian elevada morbimortalidad y es importante extremar las medidas de prevención.
ABSTRACT
Background and aims: This paper aims to evaluate the risk factors for hospitalizations for meningitis in Brazil and whether COVID-19 has an influence on this process. Methods: The patients' data is from the Notifiable Diseases Information System of Brazil's Ministry of Health. The lethality and odds ratio analyses were performed in the OpenEpi software using the Taylor Series with an IC95%. The temporal analysis is from January 2010 to November 2021, collected from the Hospitals' Information System of the Unified Health System. The statistical modelling used Gretl software and the US Census Bureau's X-13-ARIMASEATS tool (1.1). The adjustment statistics were calculated using MS Excel. We also checked the influence of COVID- 19 on the subject. Results: Aetiology, age, ethnicity, region and municipal income were considered statistically significant risk factors for unfavourable outcomes in meningitis. The sex category did not show a significant difference in meningitis lethality (Table 1). Regarding the temporal analysis, the best ARIMA models were (0,1,1,) x (0,0,0) for the North region and (0,1,1) x (0,1,1) for the others regions. All models proved to be more efficient than the naive prediction (MASE <1;Theil's U<1) and obtained R2 above 85% (Table 2). The trend of hospitalizations has been negative since 2020. Least squares regression showed that the COVID-19 was statistically significant in reducing hospitalization values in all Brazilian regions. Conclusion: It is possible that the measures against Sars- CoV-2 have contributed to reducing the hospitalizations by meningitis. (Figure Presented).
ABSTRACT
Background and aims: Anticoagulation on CVT is followed until 6 to 12 months according to guidelines. Longer periods of treatment are used in patients with high thrombotic risk. We describe the duration of treatment with OAC and what risk factors are related to longer treatment. Methods: We conducted a retrospective single centre study in a tertiary hospital in México City. Electronic medical files of consecutive patients with CVT were reviewed from January 2018 to June 2020. Clinical, radiological and laboratory variables were obtained. Patients were allocated according to the time of use of OAC (less or more than a year). Results: We collected data from 20 patients. 14 (70%) were female, with a mean age of 33.5 (26-50). 40% (n=8) were smokers, 20% (n=4) used hormonal contraceptives, 15% (n=3) were pregnant or in puerperium and 10% (n=2) referred vaccination for SARS-CoV-2. superior sagittal sinus was the most frequently affected (65%). The median time of AOC treatment was 13 months (6.7-16.7). In the bivariate analysis, the existence of a chronic cause (OR 14;IC95%, 1.25-156;p= 0.028), and prolonged hospitalization (OR 15.7;IC95% 1.7-141.4 p= 0.22) were associated with AOC treatment over a year. Initial NIHSS, mRS at discharge, D-dimer values or seizures al presentation showed no correlation. Conclusion: Use of OAC in a tertiary centre is related to chronic conditions with high thrombotic risk and with long hospital stay, according to the guideline's recommendations.
ABSTRACT
Introduction: At the beginning of the COVID-19 epidemic, the French Addictovigilance Network alerted on the need to facilitate access to methadone, while maintaining the safety of its use, to avoid the occurrence of overdoses and deaths. The impact of the lockdown on methadone-use related hospitalizations (MUH) has not been analyzed at the national level. The objectives of the study were to assess the impact of the lockdowns on the incidence of the MUHs and describe the characteristics of patients and hospitalizations. Material and methods: This retrospective study was conducted on patients hospitalized in France for methadone poisoning (ICD-10: T40.3) between January 2014 and December 2020, using the database of the Programme de Médicalisation des Systèmes d'Information. An interrupted time series using the Unobserved Components Model was performed to predict the monthly incidence of MUHs in 2020 on the basis of previous years data and confronted to MUHs really observed. The characteristics of the patients (age, sex, comorbidities) and hospitalizations (regions, duration of hospitalization, co-consumptions) were described over four time-periods: before lockdown, first lockdown, after-first lockdown, second lockdown. Results: Compared to the predictions, higher incidence of MUHs was found during the first month of lockdown (March) (66 cases vs. 51.3;IC95%: 34-65) and a large increase during the month following the end of the first lockdown (June) (79 cases vs. 61;IC95%: 46-75). Psychiatric comorbidities, psycho-social difficulties and co-consumptions (alcohol, cannabis, cocaine) were more observed during first lockdown, whereas patients aged over 30 years old and from Nouvelle-Aquitaine, Occitanie and Bretagne were more concerned after. The second lockdown did not present any particularity. Discussion/Conclusion: First lockdown had a significant impact on the incidence of MUHs. These results converge with the data from the reinforced national monitoring showing that methadone was the first substance involved in overdoses and deaths during and after the first lockdown [1].
ABSTRACT
Background and aims: Anticoagulation use on CVT is followed until 6 to 12 months according to guidelines. Longer periods of treatment are used in patients with high thrombotic risk. We describe the duration of treatment with OAC and what risk factors are related to longer treatment. Methods: We conducted a retrospective single centre study in a tertiary hospital in México City. Electronic medical files of consecutive patients with CVT were reviewed from January 2018 to June 2020. Clinical, radiological and laboratory variables were obtained. Patients were allocated according to the time of use of OAC (less or more than a year). Results: We collected data from 20 patients. 14 (70%) were female, with a mean age of 33.5 (26-50). 40% (n=8) were smokers, 20% (n=4) used hormonal contraceptives, 15% (n=3) were pregnant or in puerperium and 10% (n=2) referred vaccination for SARS-CoV-2. Superior sagittal sinus was the most frequently affected (65%). The median time of AOC treatment was 13 months (6.7-16.7). In the bivariate analysis, the existence of a chronic cause (OR 14;IC95%, 1.25 - 156;p= 0.028), and prolonged hospitalization (OR 15.7;IC95% 1.7 - 141.4 p= 0.22) were associated with AOC treatment over a year. Initial NIHSS, mRS at discharge, D-dimer values, or seizures at presentation showed no correlation. Conclusions: Use of OAC in a tertiary centre is related to chronic conditions with high thrombotic risk and with long hospital stay, according to the guideline's recommendations. (Table Presented).