ABSTRACT
Introduction: Pulmonary hypertension (PH) patients may be vulnerable to SARS-CoV-2 infection, but large analytic studies on morbidity and mortality risks are limited. Aim(s): Assessment of the incidence and course of COVID-19 among patients (pts) diagnosed with PH, treated under the NFZ program, registered in the national BNP-PL database with the assessment of the impact of the SARS-CoV-2 pandemic on the care of patients with pulmonary hypertension in Poland. Method(s): We analyzed the records of the complete population of Polish pts treated under the National Drug Program of PH (PAH and CTEPH), registered in the national database of BNP-PL, and updated on an ongoing basis by all PH centers. The frequency of SARS-CoV-2 infections, clinical severity of COVID-19 course and mortality were reviewed. Clinical characteristics of infected and deceased patients were compared to the remaining patients registered in the BNP-PL database. The rate of increase of new diagnoses ended with inclusion in the Drug Program between 01 March 2020 and 31 August 2021, compared to the pre-pandemic year 2019, and the change in the treatment profile were reviewed. Result(s): The analysis included 1923 pts (PAH 1292, CTEPH 631). The incidence of SARS-CoV-2 infections was 7.4% (n=143) and similar to general population (7.6%), with a slight preponderance in PAH 8.1% (n=105) vs. CTEPH 6.0% (n=38) (p=0.099). 47 patients (33%) required hospitalization. Mortality rate was 24% (34/143) vs. 2.6% for general population - including 19/34 outside of hospital. Those who died due to COVID-19 were older (mean age 56+/-17.6 vs. 70.5+/-12.8 yrs;p<0.0001) and had more cardiovascular comorbidities (1.35 vs. 1.97;p=0.01). Systemic arterial hypertension was the strongest unique risk factor for mortality, present in 71% decedents vs. 45% of survivors, and the only independent risk factor in multivariate logistic regression analysis (OR 2.94, 95% CI 1.28-6.73). Moreover, there was a trend towards a higher incidence of diabetes and coronary artery disease in the group of non-survivors (Table 1). The number of new diagnoses of PH decreased during the pandemic compared to 2019 (new diagnoses rate in 2019 was 28.2/month vs. 19.2/month during COVID). A significant increase in total mortality was also observed in the PH group (11.1/month in 2019 vs. 13.7/month during COVID). Escalation of specific PH therapy also reduced (rate of specific therapy escalation in 2019 was 30.4/month vs. 20.5/month during COVID). Conclusion(s): The COVID-19 pandemic has deeply affected the care of patients with pulmonary hypertension by reducing the number of new diagnoses, escalation of therapy, and increasing overall mortality in this population, and this impact continues into second year of pandemics. Pulmonary hypertension is associated with a more severe course and higher mortality in COVID-19. (Figure Presented).
ABSTRACT
Introduction: The subject of our study was the role of age, fear of COVID-19 infection and insomnia as predictors of cyberchondria in a Polish sample. We were also interested in whether insomnia mediated the relationship between fear of COVID-19 infection and cyberchondria in the entire sample. Material(s) and Method(s): The study sample consisted of 504 people, including 420 women and 84 men, aged 18 to 76 years (M +/-SD 30.49 +/-10.28), who were recruited through an online platform. Cyberchondria was assessed using the Polish version of the Cyberchondria Severity Scale. An 11-point numerical rating scale was used to measure the intensity of fear of COVID-19 infection for oneself. Insomnia symptoms were measured using the Polish version of the Athenian Insomnia Scale. Result(s): The correlation coefficients indicated positive relationships between the fear of COVID-19 infection and insomnia and cyberchondria, while age correlated negatively with cyberchondria. The hierarchical multivariate linear regression analysis revealed that COVID-19-related fear was the best predictor of cyberchondria. Insomnia and age were also cyberchondria predictors, but to a lesser extent. The mediation analysis revealed a significant indirect relationship between COVID-19-related fear and cyberchondria through insomnia symptoms. Conclusion(s): We observed that COVID-19-related fear and, to a lesser extent, age and insomnia were cyberchondria predictors. We also found both direct and indirect relationships between COVID-19-related fear and cyberchondria through insomnia.Copyright © 2022 Termedia Publishing House Ltd.. All rights reserved.
ABSTRACT
Introduction: The level of post-traumatic stress symptoms (PTSS) associated with the early stages of the COVID-19 outbreak, stress, anxiety, and depressive symptoms was assessed. Risk factors for mental health in the Polish population have been identified. Material and methods: Nine hundred and twenty-six respondents completed a set of questionnaires consisting of questions concerning COVID-19, PTSS related to the COVID-19 outbreak (Impact of Event Scale-Revised, IES-R), and their mental health status (Depression, Anxiety and Stress Scale, DASS-21). Results: Most respondents reported severe PTSS related to the COVID-19 outbreak (44.06%), the normal intensity of depressive symptoms (52.38%), anxiety symptoms (56.05%), and stress (56.48%). Almost 20% of Polish respondents were characterized by a severe or extremely severe level of stress, anxiety, or depressive symptoms. Every seventh respondent reported an extremely severe level of depressive symptoms. Female gender, parental status, having a relationship, at least a two-person household were associated with higher PTSS or DASS-21 subscales. A few physical symptoms, a medical visit, quarantine, negative health evaluation, chronic diseases, knowledge about the increase in the number of infected people or deaths were associated with higher levels of PTSS. Some of the precautions and the need for additional information on COVID-19, the certainty of a high COVID-19 contracting probability or of a low survival rate, and concerns about the loved ones were associated with higher PTSS. Conclusions: The indicated risk factors can be used for developing psychological interventions to improve mental health. It is necessary to conduct qualitative research on the psychological reasons for the occurrence of mental symptoms during the pandemic.
ABSTRACT
The guidelines describe the basic principles of outpatient care for children during the COVID-19 pandemic caused by the SARS-CoV-2 virus. The presented recommendation developed based on the literature reviews, websites of scientific societies and international proposals. The guidelines concern outpatient care for sick children, children with documented SARS-CoV-2 infection COVID-19 confirmed in the mothers, vaccinations, preventive visits for healthy children, as well as monitoring of the child's safety and mental health. Copyright © 2020, Wydawnictwo Czelej Sp. z o.o.. All rights reserved.
ABSTRACT
Background: The introduction of venetoclax into clinical practice has improved the outcome of patients with relapsed/refractory chronic lymphocytic leukemia (RR-CLL). The results of the MURANO trial published in March 2018 showed significantly longer progression-free survival (PFS) and overall survival (OS) in RR-CLL patients treated with venetoclax and rituximab (VEN-R) comparing to bendamustine and rituximab (BR) and resulted in the approval of VEN-R in the therapy of RR-CLL in the European Union and the United States. It should be noted that the results of registration studies often do not correspond with the data from real-life observations. Aims: To study the clinical efficacy and safety profile of VEN-R treatment in RR-CLL patients outside clinical trials. Methods: We performed retrospective analysis of RR-CLL patients treated with VEN-R in hematology centers of the Polish Adult Leukemia Study Group (PALG) from 2019 to 2021. Results: Clinical data of 117 RR-CLL patients treated with VEN-R were collected. Median patient age upon initiation of VEN-R therapy was 67 years (range 33 - 84 years). Seventy-two patients (61.5%) were men. Median Cumulative Illness Rating Scale (CIRS) was 6 (range 2 -16). Patients were treated with a median of 2 (range 1-9) previous lines of therapy, whereas 32 patients (27.4%) had relapsed following the first line of treatment. Overall, 25 patients (21.4%) had 17p deletion, whereas TP53 mutation was identified in 13 patients (11.1%). The median follow-up was 9.96 months (range 0.27 -29.13). The overall response rate (ORR) was 95.2%. Seventeen patients (14.5%) achieved complete remission (CR), 83 (70.9%) partial remission (PR), while in 5 patients (4.3%) disease progression was noted. In the patients with 17p deletion (n=22) or TP53 mutation (n=11), CR and PR were observed in 4 (12.1%) and 29 (87.9%) patients, respectively. The median PFS in the whole cohort was 20.8 (95% CI 18.43 -not reached) months and the median OS was not reached. In our study none of the analyzed clinico-pathological factors had significant impact on ORR, PFS and OS. During the follow-up time four (3.4%) cases of Richter transformation were diagnosed. There were 18 deaths recorded during the course of observation;3 (16.7%) due to disease progression and 7 (38.9%) due to COVID-19 infection. The others were due to infections other than SARS-CoV-2 (n=3, 16.7%) and the cause of death could not be specified in five cases (27.8%). Eighty-three patients (70.9%) remain on treatment, while treatment was discontinued in thirty-four cases (29.1%). Reasons for therapy discontinuation included patient's death (52.9%), treatment-related cytopenias (17.6%), disease progression (14.7%), Richter's transformation (11.8%), autoimmune hemolytic anemia (5.9%), diarrhea (2.9%) and infections (8.8%). In one case treatment discontinuation was due to consent withdrawal and one patient was lost to follow-up. The following adverse events of VEN-R treatment were reported during the study: all grade neutropenia (71.8% with grade 3/4 in 55.6%), anemia (51.3%), thrombocytopenia (47%), pneumonia (9.4%), neutropenic fever (6.8%), autoimmune hemolytic anemia (4.3%), immune thrombocytopenic purpura (1.7%), diarrhea (4.3%) and in one case exacerbation of heart failure was observed. Summary/Conclusion: In this retrospective analysis the outcomes of treatment with the VEN-R regimen in real-life setting were worse than those reported in the MURANO trial.
ABSTRACT
Introduction: COVID-19 has had a significant impact on all aspects of pulmonary arterial hypertension (PAH), from diagnosis and management to an increased risk of death in patients with PAH. Pandemic made it necessary to revisit the manner in which patients receive care to decrease risk of contracting the virus. Methods: Eight Tertiary Paediatric Centres participating in the paediatric arm of the registry Database of Pulmonary Hypertension in the Polish Population (BNP-PL) took part in this multi-centre cross-sectional observational study. Eligible children were diagnosed with PAH before March 20, 2020, the day the pandemic was officially announced by the Polish government. All parents of children with PAH in the BNP-PL were invited to take part in an anonymous electronic questionnaire. It comprised of several question panels: demographic data, fear of COVID-19 and other pandemic related problems, standard anxiety scale (GAD-7), presence of alarming symptoms, which had appeared or exacerbated since March 20, 2020. Data collection was seized on the September 09, 2020. Results: We have received 62 responses (response rate 77%), 4 were incomplete. The remaining 58 were further analysed. Ninety-five percent of the responders were women (n=55) at a median age of 41 years. Ninety-five percent of the parents were afraid of possible negative consequences of the SARS-CoV-2 on their children's health including death in 77%. Sixty to 71% of the parents were also afraid of various potential problems resulting from re-organising health-care system. As a result, 72% of parents had symptoms of anxiety as assessed by GAD-7, noticeably 34% in moderate-tosevere degree. No cases of COVID-19 were reported in the studied group of children. Conclusions: The impact of COVID-19 on health care delivery and on society at large is going to be felt for years to come. This information is vital to provide prognostic information on cardiac health after COVID-19, to inform long-term clinical care pathways, and to guide lifestyle recommendations. COVID-19 pandemic had an overall negative impact on children with PAH and their families. Several risk factors for poor outcome were identified. Long-term strategies should be validated and implemented to deliver quality care for children with PAH, with emphasis on psychosocial well-being.
ABSTRACT
Introduction: The severe acute respiratory syndrome coronavirus (SARS-CoV-2) has become the cause of a worldwide pandemic. The clinical course of COVID-19 was reported to be more severe in patients with cancer, especially with hematological malignancies. Due to the impairment of the immune system, infections are the leading cause of death in patients with chronic lymphocytic leukemia (CLL). Methods: We performed an observational, retrospective study in polish hematological centers within the Polish Adult Leukemia Study Group analyzing the clinical course of SARSCoV- 2 infection in patients with CLL. Results and conclusions: The study group included 188 patients. The median age of the patients was 67.9 years (range 36-87) and 70 (37.2%) were men. The Median Eastern Cooperative Study Group (ECOG) score was 1 (range 0-4). At the time of SARS-CoV-2 infection, 29 (15.4%) patients were treatment-naïve, 41 (21.8%) have ended the treatment, whereas 118 (62.8%) were during the active phase of CLL therapy. The median number of lines of previous treatment regimens was 1 (range 0-7), whereas 24 (12.8%) patients received four or more treatment regimens. At the time of infection 51 patients (27.1%) were treated with Bruton's tyrosine kinase inhibitor (iBTK), 46 (24.5%) with anti-CD20 antibodies while 37 patients (19.7%) were during venetoclax therapy. In the analyzed cohort 111 patients (59.0%) required hospitalization and 50 patients (26.5%) died due to COVID- 19. Patients with poor performance status (ECOG >1), advanced age (≥65 years), low platelet count (<100 G/l), low hemoglobin levels (<10 g/dl), and elevated lactate dehydrogenase (LDH) were at increased risk of death due to SARSCoV- 2 infection. Poor performance status, low platelet count and hemoglobin levels, elevated LDH and advanced Binet stage at diagnosis were associated with the need for hospitalization for the purpose of COVID-19 treatment. Multivariate analysis revealed that independent factors associated with risk of hospitalization due to SARS-CoV-2 infection and its complications were presence of 17p deletion (p = 0.042), anti- CD20 antibody treatment (p = 0.01), low hemoglobin (p = 0.008) and platelet (p = 0.004) levels and elevated LDH (p = 0.0023). Interestingly, the CLL treatment status (treatment naïve vs. treated) or type of administered treatment (BTKi, anti-CD20, or venetoclax) had no impact on SARS-CoV-2 related risk of death. Univariate survival analysis showed that poor performance status (p = 0.02), advanced age (p = 0.04), low platelet count (p = 0.0012), low hemoglobin level (p = 0.0017) and elevated lactate dehydrogenase (p = 0.008) were associated with significantly shorter overall survival. Multivariate Cox regression analysis showed that only the low platelet count (p < 0.0001) and advanced age (p = 0.019) were associated with patients' shorter overall survival. Considering the abovementioned data, SARS-CoV-2 infection in patients with CLL is associated with the poor outcome regardless of administered CLL-directed treatment.
ABSTRACT
INTRODUCTION COVID-19 pandemic and following restrictions have impacted every life domain. Students are an especially affected group where social distancing, numerous quarantine periods and e-learning changed lifestyle as we knew. It is well documented that physical activity (PA) has a crucial impact on cardiovascular diseases prevention and is a healthy lifestyle habit. Aim of the study is assessment of physical activity among Polish university students during the normal week in the pandemic period (since 20th March 2020 to 20th March 2021). MATERIAL AND METHODS An online based survey distributed via different social media channels (e.g.: Facebook and e-mail newsletters). Data were collected from 1491 Polish undergraduates and 1200 met all study conditions (80.48%;77.25% were females;0.5% didn't specify gender;49.75% were medical university students). The questionnaire included IPAQ-Short Form and one authorès question. Respondents declared body mass index (BMI) and the amount of weekly physical activity (number of active days/week, active type and time every day, sitting hours and summary question in -5-0-+5 scale which compared activity changes with times before restrictions). Finally, we calculated total MET-min/week. RESULTS 33.17% (n = 398) of students were in a low physical activity group, 41.42% (n = 497) in a medium and 25.41% (n = 305) in a high. Average BMI was 22.26 kg/m2 (13.62-48.29 kg/m2). 11.5% (n = 138) participants were underweight (BMI <18.5), 14.67% (n = 176) overweight (BMI ≥25.0) and 3.92% (n = 47) obese (BMI ≥30.0). However correlations between higher BMI (r = -0.00369;P = 0.898) or gender (P = 0.145) with, respectively, lower MET-min/week or lower PA level werenèt statistically significant. 71.92% (n = 863) reported that pandemic negatively influenced their physical activity level, 8.25% (n = 99) didnèt notice any changes and 19.83% (n = 238) observed positive impact. CONCLUSIONS High number of Polish students didnèt meet physical activity requirements to be described as medium or highly active people. Moreover most students declared a negative impact on their PA due to COVID-19 pandemic. It is important to be aware by public health workers and physicians to encourage undergraduates to stay physically active even during restrictions (while taking all appropriate precautions) because of its numerous possible positive outcomes on cardiovascular health.
ABSTRACT
Introduction: COVID-19 pandemic has caused not only an increase in overall and cardiovascular mortality, but also hindered access to health care, diagnosis and treatment of diseases other than coronavirus infection. Aim: Assessment of the impact of the SARS-CoV-2 pandemic on the rate of diagnosis and therapy of pulmonary hypertension (PH) in Poland, along with an analysis of the incidence and course of COVID-19 among patients (pts) diagnosed with PH, treated under the National Health Fund program, registered in the national BNP-PL database. Methods: The records of the complete population of Polish pts treated under the National Drug Program of PH (PAH and CTEPH), registered in the national database of BNP-PL, updated on an ongoing basis by all PH centers, were analyzed. The frequency of SARS-CoV-2 infections, the clinical severity of their course and the mortality were reviewed, taking into account the specific therapies used. The basic clinical characteristics of the group of sick and deceased patients were compared to the remaining patients registered in the BNP-PL database. The rate of increase of new diagnoses ended with inclusion in the Drug Program between March and December 2020, compared to the corresponding periods of the previous year, and the change in the treatment profile were compared. Results: The analysis included 1704 pts (PAH 1134, CTEPH 570). The incidence of SARS-CoV-2 infections was 3.8% (n=65), including PAH 2.7% (n=46) and CTEPH 3,2% (n=18). 32 patients (49%) required hospitalization. Mortality rate was 28% (18/65) - including 7/18 outside of hospital. Those who died due to COVID-19 were older (mean age 68.4±l15.8 vs. 50.8±l18.8 yrs;p<0,001), had higher WHO class and more cardiovascular comorbidities (4±l2,06 vs. 2,66±l1,8;p=0,01) (Table 1). During the pandemic the number of new diagnoses of PH markedly decreased compared to the corresponding period in 2019 (total 150 vs. 203, PAH 90 vs. 123, CTEPH 60 vs. 80, respectively). A significant increase in total mortality was also observed in the PH group (9,72 vs. 5,85%). Moreover, escalation of specific PH therapy decreased significantly (14,7% vs. 21,6%). Incidence of COVID-19 study group was lower than estimated for general Polish adult population (3,8% vs. 6,5%). Conclusions: COVID-19 pandemic deeply influenced the diagnostic and therapeutic process of pulmonary hypertension by reducing the number of new diagnoses, escalation therapy and increased overall mortality in this population. This may be due in part to the conversion of some PAH centers into hospitals treating patients infected with SARS-CoV-2, as well as to patients' fear of admitting to hospital despite clinical deterioration. Pulmonary hypertension is linked to markedly increased mortality in COVID-19, similarly for PAH and CTEPH. Intriguing finding of lower infection rate may be linked to protective lifestyle or specific therapies.