ABSTRACT
Background: Coronavirus Disease 2019 (COVID-19) is a highly contagious disease that resulted in 4533645 deaths until September first, 2021. Multiple Sclerosis (MS) patients receive immunosuppressive drugs. Thus, there is a concern that these drugs will reduce the patient's immune system resistance against COVID19. Objective(s): This study aimed to evaluate the epidemiology of COVID19 and its impact on MS patients in our university hospital in Tehran City, Iran. Material(s) and Method(s): A cross-sectional study was conducted based on hospital-based registry data from May 2020 to March 2021. Among more than 500 registered MS patients in Imam Khomeini Hospital in Tehran City, Iran, referring within our study period, 84 patients reported SARS-COV2 infection. The diagnosis of MS was confirmed by the McDonald criteria. Moreover, the diagnosis of COVID-19 in MS patients was established by the real-time-PCR technique and chest computed tomography. Result(s): Out of 84 MS patients with SARS-COV2 infection, 55(65.5%) were women, and their mean age was 37.48 years. The most commonly used medications by MS patients were Rituximab 20 (26.3%) and Dimethyl Fumarate 14(18.4%). Totally, 9(10.8%) of the patients needed to be hospitalized due to COVID-19, with a mean hospitalization duration of 5.88 days. A total of 1 (1.2%) death was reported. Conclusion(s): Compared to the healthy population, COVID-19 is not more serious in MS patients. Most MS patients with COVID-19 infection were not hospitalized and continued their medication during the infection.Copyright © 2022 The Authors. This is an open access article under the CC-By-NC license. All Rights Reserved.
ABSTRACT
Background: The national multiple sclerosis (MS) registry is aimed at monitoring and improving quality of care and providing feedback to improve health outcomes by systematic recording of data. In 2018, the nationwide MS registry of Iran (NMSRI) was initiated for collecting epidemiological data and information on health care provision for patients with MS. The aim of the current study was to introduce the role of implementing coronavirus disease 2019 (COVID-19) scale-up registry protocol in NMSRI and arrange the national MS generality with information obtained during the COVID-19 pandemic. Method(s): The NMSRI group set up a program with crucial elements to collect the data of patients with MS who developed COVID-19. All MS cases with confirmed diagnosis of COVID-19 were enrolled in this study. New elements were considered to be added into the dataset, including demographic characteristics, definite diagnosis of COVID-19 and its symptoms, history of comorbidities, history of medications and hospitalization, changes in magnetic resonance imaging (MRI), and infection outcomes. Result(s): The COVID-19 data collection program was designed in NMSRI to collect data of MS cases with COVID-19 infection. The data collection protocol was explained to neurologists through an online training workshop. To the date of the study, 21 centers from 17 provinces of Iran were involved in the COVID-19 databases promoting NMSRI and 612 participants were registered successfully. Conclusion(s): We extended an agreement on data collection and developed it in NMSRI with various contributors to discover a critical need for COVID-19 awareness and monitor clinical training in MS.Copyright © 2021 Iranian Neurological Association, and Tehran University of Medical Sciences Published by Tehran University of Medical Sciences.
ABSTRACT
Although it is a rare disease, the number of available therapeutic options for treating pulmonary arterial hypertension has increased since the late 1990s, with multiple drugs developed that are shown to be effective in phase 3 randomised controlled trials. Despite considerable advancements in pulmonary arterial hypertension treatment, prognosis remains poor. Existing therapies target pulmonary endothelial dysfunction with vasodilation and anti-proliferative effects. Novel therapies that target proliferative vascular remodelling and affect important outcomes are urgently needed. There is need for additional innovations in clinical trial design so that all emerging candidate therapies can be rigorously studied. Pulmonary arterial hypertension trial design has shifted from short-term submaximal exercise capacity as a primary endpoint, to larger clinical event-driven trial outcomes. Event-driven pulmonary arterial hypertension trials could face feasibility and efficiency issues in the future because increasing sample sizes and longer follow-up durations are needed, which would be problematic in such a rare disease. Enrichment strategies, innovative and alternative trial designs, and novel trial endpoints are potential solutions that could improve the efficiency of future pulmonary arterial hypertension trials while maintaining robustness and clinically meaningful evidence.Copyright © 2022 Elsevier Ltd
ABSTRACT
Background: Due to the COVID-19 pandemic, some planned medical activities have been postponed, for both national directives and out of concern of the patients who were afraid to go to hospitals.1 In our study we tried to evaluate if the pandemic has had any detrimental effect on melanoma diagnosis both in 2020 and 2021. Method(s): We collected all consecutive primary melanoma from the Pathology Registry of IDI-IRCCS of Rome (Breslow, ulceration and other main histological features). During year 2020 we divided the COVID-19 Italian pandemic into three phases: pre-lockdown (1 January- 9 March), lockdown (10 March-3 May), post-lockdown (4 May-6 June). We compared these data with the same period of year 2021. Result(s): In the year 2020 mean number of melanoma diagnoses per day were as follows: 2.3 in the pre-lockdown phase, 0.6 during the lockdown and 1.3 after the lockdown (in 20182019, we had 2.3/day). Mean Breslow thickness was 0.88 (95% CI, 0.501.26) pre-lockdown and 1.96 (95% CI, 1.162.76) post-lockdown. Proportion of ulceration was 5.9% (95% CI, 2.411.7%) pre-lockdown and 23.5% (95% CI 10.841.2%) post-lockdown. During the same period of year 2021 we observed a constant number of new melanoma cases, with a daily number similar to the 2020 pre-lockdown period. Overall, we observed a higher number of nodular melanoma and superficial spreading melanoma with nodule compared to 2020 pre-lockdown period. The proportion of in situ melanoma in 2021 (about 28%) is constant and it is very close to the observed values for 2018 (23.8%), 2019 (26.4%) and 2020 (25%). Conclusion(s): Our data support the hypothesis that during the COVID-19 lockdown period of year 2020, melanoma diagnoses may have been delayed. In 2020 a significant increase has been observed for men (from 0.96 to 2.70) but not for women (0.79 to 1.44), and in patients 50 years old or older. Regarding the year 2021, our data support the hypothesis that the number of new melanoma diagnoses returned to the pre-lockdown period, but the higher Breslow thickness and the largest number of thicker melanomas (nodular and superficial spreading with nodule) suggest it could be caused by the postponed prevention during the previous year. The constant proportion of in situ melanoma indicate that more health-conscious people were more likely to defy the 2020- 2021 lockdown limitations than people who might have been underestimating the severity of their lesions.
ABSTRACT
Introduction: Timely treatment of ST elevation myocardial infarction [STEMI] requires ongoing coordinated care between emergency departments, paramedics, and primary percutaneous coronary (PCI) intervention facilities. Method(s): To provide a current view and a national benchmark, we examined 121,576 patient records submitted by 648 hospitals participating the GWTG-CAD registry from Q2 2018 through Q3 2021 [median age 63, women 29%, Black 11%, Hispanic 8%, admission cardiac arrest 5%, shock 7%, heart failure 7%, Covid 0.2%, presentation EMS 47%, walk in 27%, transfer 22%] Results: Reperfusion method for all patients included primary PCI 87%, fibrinolysis 5%, and no reperfusion 8% [increasing from 7 to 9% during the study period]. Median time from symptom onset to reperfusion was shortest for EMS patients 148 minutes, followed by walk-in 195 minutes, ground transferred 238 minutes, and air transferred 247 minutes. Process times did not improve during the study period. First medical contact to device times increased by 5 minutes for EMS and ground transferred patients in Q2 2020 corresponding with the pandemic onset, and adjusted mortality was significantly higher in the final 3 quarters compared to Q2 2018 [OR, 95% CI 1.28(1.07-1.53);1.35(1.13-1.61);1.23(1.03-1.48)]. Patients treated within guideline goals had significantly lower mortality [Figure]. Conclusion(s): These data reaffirm the association between process times and lower mortality for STEMI patients. They also identify concerning trends and opportunities for improved care. Increasing delays in treatment, particularly for hospital transfer, greater numbers of untreated patients, and increased risk-adjusted in-hospital mortality all provide strong impetus for renewed focus on STEMI systems. Regional collaborative efforts led by coordinators and informed by a common data system have the potential to reverse these trends and improve survival.
ABSTRACT
Background. One of Singapore's national strategies for the COVID-19 pandemic was containment. Efforts included a fourteen-day quarantine of close contacts, were subjected to an entry and exit SARS-CoV-2 PCR test, the latter being done between 11-14 days post exposure. Additionally, symptomatic contacts were tested for SARS-CoV-2. We aim to determine the trend in COVID-19 incubation periods during three distinct pandemic waves corresponding to different SARS-CoV-2 variants. Incubation Period Incubation period of the prevalent SARS-CoV-2 variant in circulation Methods. This is an ecological study and information collected from the SingHealth COVID-19 Registry, a database of all inpatients admitted to any of the SingHealth hospitals. For patients under quarantine, the start date of the quarantine period was assumed to be the last date of exposure to the index case. Incubation period was determined by the duration between date of exposure and date of the first positive SARS-CoV-2 PCR test. The prevalent strain in circulation was identified from the Singapore database in the GISAID collection. Only variants of concern, as categorized by WHO, Alpha (23rd Jan 2020 - 1st Mar 2021), Delta (5th May 2021 - 31st Oct 2021) and Omicron (1st Jan 2022 - Present) were considered. For the Omicron variant, quarantine was discontinued, hence the last date of arrival from international travel was assumed to be the date of exposure. Results. From January 2020 to March 2022, there were 19,905 patients in the COVID-19 registry, of whom 11,235 were under quarantine and 8,612 had preceding international travel. Of the 11,235 patients under quarantine, 8,189 patients were infected when SARS-CoV-2 Alpha variant and 3,046 patients were infected when SARS-CoV-2 Delta variant were in circulation. Of the 8,612 patients with preceding travel, 6,503 patients were infected when SARS-CoV-2 Omicron variant was in circulation. The median incubation period for the Alpha variant was 11 days (IQR: 7-14 days) versus 3 days (IQR: 2-4 days) for the Delta variant versus 3 days (IQR: 0-5 days) for the Omicron variant. Pairwise comparisons between the variants were (p-value = < .001) Conclusion. The significant differences between incubation periods of the SARS-CoV-2 variants in circulation poses a challenge to containment efforts and has emphasize the importance of dynamic national strategies.
ABSTRACT
Background: Serum levels of aminotransferases ALT and AST are useful markers of hepatic injury. Serum levels of ALT and AST are elevated in most untreated Wilson Disease (WD) patients and during non-adherence to therapy. In some treated WD patients, ALT or AST may not normalize. We aimed to examine patterns of ALT and AST elevation, and hypothesize that there is a potential correlation with 24-hour urine copper excretion (UCE) in context of the current treatment regimen, and the trend of these values over the course of 3 years. Method(s): Patients at time of enrolment and up to year 3 in the WD Registry study with both ALT and AST and UCE available for analysis. Serum ALT and AST levels were classified as normal (10-35 IU), 1-2x the upper limit of normal (ULN), and 2-3x the ULN. Treatment regimens were included. Result(s): From enrolment to year 3 the number of adult patients was as follows: enrolment n=88, year 1 n= 61, year 2 n =42, year 3 n= 36. Average age was 41. The registry experienced a decrease in follow up related to the COVID-19 pandemic. Patients were on the following treatments: chelation therapy (Trientene or D-penicillamine) at time of enrolment n=56, year 1 n= 34, year 2 n=22, year 3 n= 15 zinc therapy, at enrolment n=30, year 1 n= 24, year 2 n=17, year 3 n= 17;and those on combination therapy at enrolment n=7, year 1 n= 4, year 2 n=3, year 3 n= 0. Average mean duration of treatment was 21 years at enrolment. When subdivided by the different treatment regimens and ALT and AST ranges, UCE fluctuated throughout the 3 years. Having normal to low 24-hour urine copper did not directly correlate directly with normalization of ALT and AST for the different treatment regimens (see Figure 1). Similarly, higher levels of UCE failed to show a linear correlation with ALT and AST. Conclusion(s): UCE and ALT and AST are laboratory measurements that have been used as a means for monitoring copper balance and therapeutic response for treating WD. The current data fails to support the hypothesis that UCE within target goals will exhibit direct correlation with normal ALT and AST values. Rather, the individual patient variability suggests that UCE cannot be used in isolation for treatment recommendations, supporting the need for better surrogate markers of copper balance. (Figure Presented).
ABSTRACT
Background: Post-traumatic stress disorder (PTSD) has been reported in up to 15% ofgeneral population during and after the first wave of the COVID-19 pandemic. The pandemic has acted as a catalyst for the application of telemedicine in neurology. Objective(s): to evaluate the presence of PTSD symptoms as effect of the lockdown measures in people with MS (PwMS) using an e-health application specifically built for remote management of PwMS, SMcare2.0 application. Method(s): Between March 4, 2020 and July 5, 2020 (T0) PwMS who were using (n=290) the app were asked to fill in the Impact of Event Scale - Revised (IES-R) questionnaire to evaluate the presence of PTSD symptoms. The IES-R has 3 subscales: intrusion, hyperarousal, avoidance. The total IES-R score ranges from 0 to 88. A cut-off value of 33 of the total score was used to define the presence of PTSD symptoms (PTSD+). Only those PwMS who filled-in the questionnaire the first time were asked to answer again it when the lockdown measures were abolished (T1). Clinical and demographic data were extracted from the Italian MS register application and linked to the IES-R results. Baseline clinical characteristics of PwMS (classified on the basis of IES-R score) and the proportion of PTSD+, the subscales and the total score at T0 and T1 were compared. Result(s): During the lockdown 90 PwMS (31% response rate) completed the IES-R (62 F;mean (SD) age 40.1(1.0) years;median (IQR) EDSS score 2.3 (1-8);mean disease duration (SD) 10.7 (0.7)). Mean (SD) baseline subscales values were: intrusion 15.9 (7.1), hyperarousal 10.7 (5.0), avoidance 15.4 (6.7). Mean (SD) total IES-R score was 42.0 (17.0), 63 (70%) patients scored above 33 and were identified as having recently developed PTSD symptoms. No significant difference were found between PTSD+ and PTSD- patients in terms of age, EDSS and disease duration. At T1, when the lockdown measures were removed, the IES-R scores were significantly reduced in comparison to T0 scores (intrusion 8.6 (8.9), hyperarousal 6.0 (5.8), avoidance 8.4 (8.5), total score 4.8 (1.9), p<0.0001). The number of patients classified as PTSD+ was significantly reduced in comparison to T0 (16 (17.8%), p<0.0001). Conclusion(s): Our study demonstrated that PwMS during and after lockdown manifested post-traumatic stress symptoms. Furthermore, our results show how e-data collected can be useful in remotely monitoring patients and can be easily linked to clinical data collected by disease registries.
ABSTRACT
Background and objective: The impact of COVID-19 infection and the effect of vaccinations on patients with demyelinating central nervous system disease in low middle income countries (LMIC's) have not been reported in detail earlier. We sought to identify risk factors associated with COVID-19 infection and the role of vaccinations in patients with MS and related disorders in order to develop management guidelines relevant to our patients. Method(s): A total of 621 patients (297 MS and 324 non MS disorders) from our registry were contacted. COVID-19 infection and vaccination status were queried. Patients who had infection were compared with noninfected patients to identify factors associated with susceptibility for COVID-19 infection. Univariate and multivariate analysis of potential risk factors included demographic and clinical features, body mass index (BMI), presence of comorbidities, absolute lymphocyte count, treatment types and vaccination status. Result(s): Sixty seven patients with MS and 27 with non MS disorders developed COVID-19 infection. Among them 13 patients were hospitalized, all of whom recovered. Vaccination status was known in 582 patients among whom 69.8% had completed or taken one dose of vaccine at the time of inquiry. Majority of treated patients (61.3%) were on nonspecific immunosuppressants. Multivariate analysis of all patients with MS and related disorders showed that higher mean body mass index(BMI [p - 0.002, OR- 0.86,95% CI - 0.78-0.94]), presence of >= 1 comorbidity ( p-0.005, OR- 3.57,95% CI- 1.46- 8.7) and concurrent treatment with disease modifying therapy(p- 0.004, OR- 2.80, 95% CI- 1.39- 5.6)were significantly associated with risk of COVID-19 infection. Vaccination against COVID-19 infection was strongly protective (p- 0.0001, OR- 0.10, 95% CI- 0.05- 0.20). In the unvaccinated group, patients on treatment ( 61% were on nonspecific immunosuppressants) were significantly at risk of Covid-19 infection (p- 0.001, OR- 10.1, 95% CI- 4.59- 22.22) when compared to untreated patients. Conclusion(s): Frequency and severity of COVID-19 infection was low among our patient cohort.Higher rate of infection in the treated group was significant among unvaccinated patients. Our preliminary results suggests that in LMIC's, where off label therapies with inexpensive immunosuppressives are the main disease modifying drugs, mRNA vaccinations appear safe and protective against severe COVID-19 infection.
ABSTRACT
Background: Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is a debilitating disease that can impact on a patient's quality of life. The aim of this study was to assess longitudinal quality of life among patients with AAV using the EQ-5D instrument. Method(s): 343 patients with AAV were recruited from the Irish Rare Kidney Disease Registry. The EQ-5D instrument was used to evaluate the domains of mobility, selfcare, usual activities, pain/discomfort, anxiety/depression and to generate an index score. Health was also rated using a visual analogue scale (0-100). Questionnaires were completed during nephrology clinics and through a patient support phone app. Data was screened for missing data and questionnaires with clear inconsistencies in responses were excluded. 2082 episodes and 283 patients were analysed. A random effects model was used to control for multiple entries relating to individual patients. Result(s): A poorer quality of life was seen amongst those with AAV (median index value 0.80, UK average 0.856). The mean visual analogue scale was 75.6 (UK average 82.8). Pain and discomfort levels were most affected while self-care was least affected. The index score decreased with increasing age with a 1.5% reduction in index score per decade. A 6% reduction in index score was seen during periods of disease activity compared to periods of remission. Patients requiring dialysis had a 5% reduction in index score. Covid-19 lockdown resulted in a 5.5% index score reduction. Using a median survival rate of 6.16 years for patients with small vessel vasculitis, we calculated the QALYs for this population as 4.9 years. Conclusion(s): We have defined for the first time the EQ-5D index value over the full disease course in patients with AAV. Other studies have demonstrated a reduction in quality of life during active disease using the AAV-PRO and the Medical Outcomes Study Short Form-36. A prior study among Japanese patients reported a mean index value of 0.72. This is lower than our observed index value however a smaller population (n=34) was examined. In conclusion, our research highlights the negative impact of AAV on patients' lives with a further reduction in quality of life seen during periods of increased disease activity, with increasing age and during the Covid-19 pandemic.
ABSTRACT
Background: Nephrotic Syndrome (NS) is a rare kidney disease diagnosed by the presence of proteinuria, oedema and hypoalbuminemia. The estimated global incidence of NS is 2-7 people per 100,000. The pathological processes that cause NS remain elusive. This novel multicentre longitudinal study aimed to identify the clinical and socio-demographic characteristics of a large NS cohort across Great Britain. Phenotypical analysis of such a large cohort will help understand the natural history and patterns of disease during a patient's lifetime. Method(s): A large multicentre longitudinal study was set up in January 2010 in 51 adult and paediatric sites across England, Scotland and Wales. Detailed prospective and retrospective clinical data was captured onto the Rare Renal Diseases Registry (RaDaR) over a period of 12 years from date of diagnosis until the cut-off point in January 2022. Patients were categorised by both their response to steroids and histological diagnoses to identify specific NS subgroups. Result(s): Over 12 years, a total of 1974 adult and paediatric NS patients were recruited. The results show that NS is a male predominant condition (56%) and more prevalent in South Asian (13%) and African ethnicities (4%). A large proportion of patients were steroid-sensitive (48%), and the main histological diagnosis was Minimal Change Disease (MCD) (50%). Those who reached end stage renal disease (16%) were mainly aged 0 - 17 years old. A high proportion of deaths were noted in 2020/1, and caused by cancer or COVID-19. Conclusion(s): It can be concluded that NS is dominant in males, and in South Asian and African ethnicities. A large proportion of patients were steroid-sensitive, and the main histological diagnosis was MCD. The data gathered in this study will help transform our understanding of NS. To better understand the implications of these results, future research including international collaboration will facilitate the development of translational research and evidence-based recommendations.
ABSTRACT
Introduction: Patients with inflammatory bowel disease (IBD) might be at risk of developing severe courses of respiratory tract infections including SARS-CoV-2 due to their immunotherapies. This risk could increases with the age of our patients. Aims & Methods: This study is focused on the question whether patients with IBD who receive immunotherapies are more vulnerable to respiratory tract infections, including SARS-CoV-2, in comparison to IBD patients without immunotherapies and to the general population. Further, we investigated, if age is a predictor for severe respiratory tract infections. We analysed data regarding respiratory tract infections that were collected in our IBD registry in 2020. We compared moderate respiratory symptoms (coughing, rhinitis or sore throat) to severe respiratory symptoms (fever, chills or anosmia) in 1091 IBD-patients with or without immunotherapies. We distinguished between the type of immunotherapy and the patients' age (younger than 50 years or older). Regarding SARS-CoV-2, we compared our data with corresponding published data from the healthy general population in the same city (Munich/ Germany) over the same time frame (April to June 2020). Patients were tested for SARS-CoV-2 immunoglobulins (Ig). For statistical analyses we applied the Shapiro-Wilk-test for Gaussian distribution, the t-test or the Mann-Whitney-U test, and for frequency distribution the Chi-square test or Fisher's exact test. For investigation of factors that could have an influence on the occurrence of symptoms we used logistic regression models. Result(s): Overall symptoms of respiratory tract infections occurred equally frequenty in patients with immunotherapies as compared to those without. Older age, TNF-inhibitor and ustekinumab treatment showed a significant protective role in preventing respiratory tract infections: Symptoms of respiratory tract infections in IBD patients occurred less frequently in patients treated with anti-TNF (p=0.03), infliximab (p=0.01), ustekinumab (p=0.03), but not vedolizumab, as compared to patients with no immunotherapy. Symptomatic, PCR-proven COVID-19 infections occurred in 0.45% of all IBD patients. SARS-CoV-2 IgG-testing showed a three times higher actual incidence of 1.8%. This is identical to the general population of Munich within the same timeframe. Whilst more than 3% of all COVID-19 subjects of the general population died during the first wave of the pandemic, none of our IBD-patients died, needed referral to the ICU or oxygen treatment. Conclusion(s): Contrary to our current assumption, older age and the treatment with TNF-inhibitors or ustekinumab showed a protective role in preventing respiratory tract infections in IBD patients. Moreover, IBD patients, predominantly treated with immunotherapies, are just as suscep tible to SARS-CoV-2 infection as the normal population. A reduced rate of COVID-19 deaths in IBD patients was observed, compared to the general population. Therefore, no evidence was found to suggest that IBD medication should be withheld, and adherence to medication should be encouraged to prevent flares at any age and in times of the SARS-CoV-2 pandemic.
ABSTRACT
Background and Aim: The considerable overlap in case definition and clinical features between patients with COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) and Kawasaki disease (KD) suggests shared pathogenesis. We sought to compare demographic, clinical presentation, management and outcomes of patients by COVID-19 status. Method(s): The International KD Registry (IKDR) began enrolling patients with clinical features of either acute MIS-C or KD or fever with hyperinflammation beginning in January 2020. The IKDR is unique regarding broad patient selection and includes sites from North, Central and South America, Europe, Asia and the Middle East. Patient groups stratified by COVID-19 status were compared. Result(s): As of October 6, 2021, 1330 patients were registered from 31 sites. COVID status was POSITIVE for 59% (confirmed household COVID-19 contact and/or positive SARS-CoV-2 PCR or serology), POSSIBLE for 4% (suggestive clinical features but some negative tests or absent exposure), NEGATIVE for 23%, and UNKNOWN (no known exposure and testing not com-pleted) for 14% (TABLE). Most of the UNKNOWN patients were from early in the COVID-19 pandemic before MIS-C was defined and before COVID-19 serologic testing was widely used. POSITIVE and POSSIBLE patients were older, had fewer KD clinical criteria, greater gastrointestinal symptoms, were more likely to present with shock and require ICU admission and inotropic support. POSSIBLE patients had greater days from symptom onset to first immune modulation treatment, with no differences between groups regarding days from admission to first treatment. Most patients in each group received intravenous immune globu-lin, with POSITIVE and POSSIBLE patients more likely to have received steroids and anakinra. NEGATIVE and UNKNOWN patients had higher maximal coronary artery Z scores, with a trend to having higher categories of aneurysm involvement. Conclusion(s): While there was considerable overlap in presentation, management and outcomes between COVID-19 POSITIVE/POSSIBLE (presumed MIS-C) and COVID NEGATIVE/UNKNOWN patients (presumed KD), COVID-19 POSITIVE/POSSIBLE patients had more severe presentations and required more intensive management, although coronary artery outcomes trended to be less severe. Patient recruitment con-tinues, and in-depth comparison of laboratory features and appli-cation of machine learning approaches to patient differentiation and prediction of optimal management pathways are forthcoming.
ABSTRACT
Background: SARS-CoV-2 vaccines offer the most effective way to reduce the risk of severe COVID-19. Recent data indicate sufficient immune response after vaccination in most patients with infammatory rheumatic diseases (IRD) on immunomodulatory treatments. Objectives: To investigate the clinical profile of SARS-CoV-2 breakthrough infections among double and triple vaccinated patients with IRD. Methods: Data from the German COVID-19-IRD registry, collected by treating rheumatologists between February 2021 and January 2022 were analysed. Patients double or triple vaccinated against COVID-19 ≥14 days prior to proven SARS-CoV-2 infection were identifed, and type of IRD, vaccine, immunomodulation, comorbidities and outcome of the infection were compared with 737 unvac-cinated IRD-patients with COVID-19. Results: In total, 271 cases of breakthrough infections were reported, 250 patients (91%) had received two doses of vaccines, 21 (9%) patients three. More than 70% of the patients received Pfzer/Biontech vaccine for the frst, second and third vaccination. The median time from second/third vaccine dose to infection was 148 days (range 14-302) days. Most of the patients were diagnosed with infamma-tory joint diseases (Table 1). Most of the patients were treated with methotrexate (Table 1). The use of Januskinase inhibitors(i) was more frequently reported in double vaccinated patients (10.4% vs 4.8%), whereas tumor necrosis (TNF)i were reported more often in triple vaccinated patients (33.3% vs. 22.8). Hospitalisation rate was higher in unvaccinated IRD-patients than in vaccinated ones, while fatality rate was similar in unvaccinated and double vaccinated patients. Although the rate of comorbidities and median age were higher in triple-vaccinated patients, infected patients showed a lower rate of hospitalisation, neither COVID-19 related complications, nor the need of oxygen treatment or death. Conclusion: In this cohort of triple-vaccinated IRD patients no fatal courses and no COVID-19 related complications were reported, although median age and rate of comorbidities were higher compared to double-vaccinated and unvacci-nated patients. These results support the general recommendations to reduce the risk of severe COVID-19 disease by administering three doses of vaccine, especially in patients with older age, presence of comorbidities, and on immuno-modulatory treatment.
ABSTRACT
CONTEXT: Access to real-time data that provide accurate and timely information about the status and extent of disease spread could assist management of the COVID-19 pandemic and inform decision-making. AIM: To demonstrate our experience with regard to implementation of technical and architectural infrastructure for a near real-time electronic health record-based surveillance system for COVID-19 in Iran. METHOD: This COVID-19 surveillance system was developed from hospital information and electronic health record (EHR) systems available in the study hospitals in conjunction with a set of open-source solutions; and designed to integrate data from multiple resources to provide near real-time access to COVID-19 patients' data, as well as a pool of health data for analytical and decision-making purposes. OUTCOMES: Using this surveillance system, we were able to monitor confirmed and suspected cases of COVID-19 in our population and to automatically notify stakeholders. Based on aggregated data collected, this surveillance system was able to facilitate many activities, such as resource allocation for hospitals, including managing bed allocations, providing and distributing equipment and funding, and setting up isolation centres. CONCLUSION: Electronic health record systems and an integrated data analytics infrastructure are effective tools to enable policymakers to make better decisions, and for epidemiologists to conduct improved analyses regarding COVID-19. IMPLICATIONS: Improved quality of clinical coding for better case finding, improved quality of health information in data sources, data-sharing agreements, and increased EHR coverage in the population can empower EHR-based COVID-19 surveillance systems.
ABSTRACT
Introduction: Interstitial lung disease (ILD) comprises a heterogeneous group of diseases affecting the lung interstitium often associated with significant morbidity and mortality. The Australasian Interstitial Lung Disease Registry (AILDR) launched in 2016 with the concurrent aims to: a) provide a valuable resource for high quality ILD research to further understanding of ILD and b) improve care for ILD patients across Australia and NZ. Consisting initially of four pilot sites, over time the registry has expanded to 21 sites across Australasia. Methods: Consecutive ILD patients attending any of the registered ILD centres across Australia and NZ are eligible to enrol in the AILDR following provision of informed consent. Comprehensive data including demographics, ILD diagnosis, objective functional markers (baseline and subsequent tests) and treatment parameters are collected and stored on a secure online platform. We report data from the AILDR since initiation in May 2016 to 30th September 2021 inclusive. Results: In total 2140 participants were enrolled from 16 sites at a mean rate of 43/month (mean age 65.8±13.3years;1185 (55.4%) male;982 (45.9%) ever-smokers;mean BMI 29.4±5.9kg/m2). Baseline functional parameters demonstrated mean FVC 85.6±21.7% predicted, mean DLCO 60.5±19.4%predicted, and mean six-minute walk test (6MWT) distance 434.3±126.5metres. ILD diagnoses included: idiopathic pulmonary fibrosis (IPF) n=545 (30.3%), connective tissue disease associated ILD (CTD-ILD) n=326 (18.1%), chronic hypersensitivity pneumonitis (CHP) n=155 (8.6%), sarcoidosis n=120 (6.7%) and unclassifiable ILD n=190 (10.6%). Patients with IPF were more likely to be male (n=403, 73.9%, p<0.001) and older (72.6±8.3years, p<0.001) compared to all other ILD subtypes. A female predominance was observed for CHP (n=92, 59%, p=0.001) and CTD-ILD (n=206, 63%, p<0.001). Baseline functional parameters were lowest for those with CHP (FVC 76.8±22.4% predicted, DLCO 54.1±16.9% predicted), significantly lower comparable to the IPF group (FVC 84.8±19.6%predicted, DLCO 58.7±17.8%predicted, p<0.001). The highest baseline functional parameters were observed in those with sarcoidosis. Conclusion: We demonstrate the feasibility of a bi-national ILD registry evidenced by steady recruitment despite the COVID-19 pandemic. In this study, lower functional baseline parameters were detected in the CHP group suggesting priority research should be afforded to this group. Through a routine approach across Australasia, the AILDR aims to improve standardisation of diagnosis and management of ILD patients.
ABSTRACT
Purpose: In the state of Wisconsin, breast cancer patients from African American (AAs) communities have lower survival rates compared to their Caucasian counterparts. Multiple inequities related to sociodemographic factors, delays in diagnosis, advanced disease stage at presentation and presence of comorbidities including higher body mass index (BMI) contribute to these disparities, many of which have only widened during the COVID-19 pandemic. This study examined specific factors related to prolonged hospital length of stay (LOS) for breast cancer patients admitted to inpatient units during the pandemic. Methods: This analysis includes initial CY20 LOS medical record data for hospitalized patients 18 years and older with a diagnosis of breast cancer from 1/1/2020-12/31/2020. Supplemental data included disease registry and diagnostic data, and SES data determined by patient zip code. Poisson regression models with robust standard errors were used to compare the LOS index (LOSi) between groups of patients based on race, SES group, primary payer, and BMI. Results: A total of 272 patients with breast cancer that were admitted to inpatient oncology units were identified. Demographics included White (72.4%), Black (22.4%), and others (5.1%). Other characteristics included: low SES (8.8%), medium-low (9.5%), medium (15.4%), medium-high (11.0%), high SES (4.4%), and others (non-SMilwaukee county) (50.7%), Medicaid (8.8%), Medicare (61.3%), Managed care (29.0%), and others (0.73%). Body mass varied among the patients;underweight (0.36%), overweight (30.8%), obese (41.5%). There were significant differences in LOSi: Black (LOSi=1.24, p=0.01), medium-low SES (LOSi=1.46, p=0.02), Medicaid (LOSi=1.40, p=0.00), underweight (LOSi=1.66, p=0.00), and overweight (LOSi=1.23, p = 0.01) patients had slightly longer LOSi, with LOSi ratio above 1. Conclusion: This study shows how patient-specific factors such as race, SES, primary payer, and BMI contribute to inpatient LOS for breast cancer patients. Healthcare systems may benefit by addressing indicators and patients' factors to reduce hospital LOS, and ultimately healthcare costs.
ABSTRACT
Background: The COVID-19 pandemic has had a large impact on regular healthcare provision in the Netherlands. During the first wave, healthcare in children was strongly reduced due to safety regulations and reduced hospital capacity for non-COVID care. This, and fear of COVID-19 could have led to delayed inflammatory bowel disease (IBD) healthcare, and delayed or even missed diagnoses. This has already been demonstrated in adult IBD patients in the Netherlands1, but not yet in the paediatric population. This is of importance, as in children, diagnostic delay is associated with higher rates of strictures, fistulising complications, and growth delay2. Therefore, this study aims to determine the impact of COVID-19 on IBD-related procedures and new IBD diagnoses in children in the Netherlands. Methods: In this nationwide retrospective cohort study, a search was conducted in the nationwide pseudonymized pathology registry of the Netherlands (PALGA), with complete national coverage. Using retrieval terms for ulcerative colitis, Crohn's disease, IBD unclassified and corresponding synonyms, all IBD related pathology reports (resection specimens or intestinal biopsies) from January 2018 to December 2020 in children age 1-18 were selected. Patients with a recognized diagnosis of IBD were eligible for inclusion, which was scored independently by two authors based on all reports. All IBD-related procedures (endoscopies and intestinal resections) were identified. Monthly frequencies of procedures and new IBD diagnoses during the COVID-19 pandemic in the Netherlands (March 11, 2020 - December 31, 2020) were compared to the average monthly frequencies of 2018-2019. Results: After exclusion of non-IBD related reports, 2161 IBD-related procedures were identified between January 2018 and December 2020. The average number of monthly IBD procedures in 2018-2019 was 59.8, whereas in 2020 this was 60.6 procedures per month, reflecting a 0.8% increase (Figure 1). In 2020, the number of new IBD diagnoses was 456, similar to the 458 new IBD diagnoses in 2018-2019. During the COVID-19 pandemic the weekly number of new diagnoses was 8.8, while between January 2018 and March 2020 this was 8.5 (Figure 2). A slight reduction in monthly IBD-related resections was observed (2.7 vs. 3.5). Conclusion: Despite the reduction in regular healthcare in children in the Netherlands due to the COVID-19 pandemic, no reduction was observed in IBD-related endoscopies and surgeries during the pandemic in the Netherlands. This reassuring evidence demonstrates that pediatric IBD healthcare remained unchanged, thus not delaying diagnosis of new IBD patients or treatment of severe disease flares.
ABSTRACT
Introduction: The COVID-19 pandemic has disproportionately affected low-income and racial/ethnic minority populations in the US. However, it remains unclear whether hospitalized COVID-19 patients who live in socially vulnerable neighborhoods are more likely to experience major adverse cardiovascular events and/or death. We evaluated the association between neighborhood social vulnerability and in-hospital outcomes in a national cohort of hospitalized COVID-19 patients. Hypothesis: Among patients hospitalized with COVID-19, residence in socially vulnerable neighborhoods is associated with worse in-hospital outcomes. Methods: The American Heart Association COVID-19 Cardiovascular Disease Registry includes patients hospitalized with COVID-19 across 107 hospitals in the US between January 14, 2020 to November 30, 2020. The Social Vulnerability Index (SVI), a composite measure of community vulnerability developed by Center for Disease Control was used to classify the social vulnerability of patients' place of residence defined by zip codes. We fit multivariable logistic regression models to evaluate the association between patient's SVI and in-hospital death or major adverse cardiovascular events (MACE, defined as composite of all-cause death, MI, stroke, new onset heart failure, or cardiogenic shock). Results: Among 20,925 hospitalized COVID-19 patients in the registry, 6083 (29.1%) resided in the most vulnerable communities (highest national quartile of SVI). Compared with those in lowest quartile of SVI, patients in the highest quartile were younger (mean age 59.8±17.7 versus 62.0±17.9), more likely to be women (47.1% vs. 43.2%), Black patients (36.1% vs. 13.3%), and less likely to have private insurance (29.0% vs. 39.1%). After adjusting for demographics (age, sex, race/ethnicity), insurance status, and comorbidities, the highest quartile of SVI (compared to lowest) was associated with higher likelihood of in-hospital MACE (OR [95% CI] 1.28 [1.12, 1.46], p<0.001) as well as in-hospital death (OR 1.37 [1.21, 1.54], p<0.001). Conclusion: Hospitalized patients with COVID-19 who reside in more socially vulnerable neighborhoods experience higher rates of in-hospital MACE and death, independent of race and ethnicity.
ABSTRACT
Introduction: The pathobiology of inflammation, thrombosis, and myocardial injury associated with SARS-CoV2 may be assessed by circulating biomarkers. However, their relative prognostic importance has been incompletely described. Methods: We analyzed data from pts hospitalized with COVID-19 in Jan to Nov, 2020 at 107 US hospitals in the AHA COVID-19 Cardiovascular (CV) Disease Registry who had biomarker data for D-Dimer, CRP, ferritin, natriuretic peptides [NP], or cTn at admission. We assessed the association between each biomarker by quintile [Q] and odds of in-hospital death and a composite of CV death, myocarditis, AMI, HF, or ischemic stroke. cTn quintiles were indexed to the assay-specific 99 %ile ref limits. Multivariable logistic regression determined the relative prognostic performance of each biomarker. Results: 17,829 (83% of total) had admission values reported for at least 1 of the 5 key biomarkers (n= 2422 with values for all). Each biomarker revealed a gradient of mortality risk from Q1 to Q5: Ddimer 17-35%, CRP 11-30%, ferritin 11-29%, cTn 13-42%, and NPs 7-35% (p for each <0.001;Panel A). After adjustment for all biomarkers, the highest values (Q5) of NP, CRP, and cTn independently identified pts at greater odds of death (Panel B) and the highest values of NP, CRP, cTn and D-dimer identified greater odds of the CV composite. After further adjustment for clinical variables, Q5 values for NPs (OR:4.07, 95% CI: 2.40 to 6.92) and CRP (OR: 2.43, 95% CI:1.62 to 3.66) retained the strongest prognostic value for death;NP (OR:6.79, 95% CI: 3.56 to 12.94) and cTn (OR:4.44, 95% CI:2.75 to 7.18) were associated with the greatest odds of the CV composite. Conclusions: Among pts hospitalized with COVID-19, high levels of NPs, CRP and hsTn at the time of admission were associated with the greatest risk of death, independent of other biomarkers and clinical variables, whereas D-dimer and ferritin did not offer independent prognostic information for mortality.