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Introduction: The physiological changes in the respiratory and cardiovascular systems in the immunosuppressed state of pregnancy may exacerbate clinical features and deteriorate outcomes due to COVID-19 infection. We aimed to compare the maternal and neonatal adverse effects in the first and second COVID-19 waves. Methodology: This study was a prospective cohort study conducted in a tertiary care COVID-19-dedicated hospital. In total, 104 (group A) and 96 (group B) COVID-19-positive pregnant women admitted during the first and second waves, respectively, were included in the study. Data on baseline variables, associated comorbidities, clinical presentations, management strategies, and neonatal and maternal outcomes were collected and compared using parametric and nonparametric tests and analyzed. Result(s): Around 2.08% in group A and 6.72% in group B of COVID-19-infected pregnant women, respectively, had moderate-to-severe disease and required intensive care unit stay. Almost 1.04% in group A and 3.84% in group B had maternal mortality, 13.4% and 19.8% babies of groups A and B required admission in neonatal intensive care units, and 8.6% and 7.3% of newborns in groups A and B had COVID-19-positive reports by reverse transcriptase polymerase chain reaction (RT-PCR) at birth, respectively. Of them, 2.1% newborns in group B had RT-PCR positive on day 7 of life and beyond, whereas none had positive RT-PCR reports on 7 days and beyond in group A. Conclusion(s): Dreadful maternal outcomes like requirement of ICU and mechanical ventilator and persistence of neonatal infections were higher during the second wave.Copyright © The Author(s). 2023.
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Background: It is unknown whether individuals with neurological post-acute sequelae of COVID-19 (NeuroPASC) display altered levels of neuroimmune activity or neuronal injury. Method(s): Participants with new or worsened neurologic symptoms at least 3 months after laboratory-confirmed COVID-19 were enrolled in The COVID Mind Study at Yale. Never COVID controls (no history of COVID-19;nucleocapsid (N) antibody negative) were pre-pandemic or prospectively enrolled volunteers. CSF and plasma were assessed for neopterin and for IL-1beta, IL-1RA, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p40, IL-12p70, IL-13, MCP-1, TNFalpha by bead-based multiplex assay;and for anti-SARS-CoV-2 N antibodies by Luminex-based multiplex assay in technical replicate, normalized against bovine serum albumin conjugated beads. Plasma concentrations of D-dimer, C-reactive protein, neurofilament light chain (NFL), and glial fibrillary acid protein (GFAP) were measured using high-sensitivity immunoassays. Group comparisons used non-parametric tests. Result(s): NeuroPASC participants (n=38) were studied 329 (median) days (range 81-742) after first positive test for acute COVID-19. Cognitive impairment (84%) and fatigue (82%) were the most frequent post-COVID symptoms. NeuroPASC and controls (n=22) were median 49 vs 52 yrs old (p=0.9), 74% vs 32% female (p< 0.001), 76% vs 23% white race (p< 0.001), and 6% vs 57% smokers (p< 0.001). CSF white blood cells/mL, CSF protein, and serum:CSF albumin ratio were normal in both groups. CSF TNFalpha (0.66 vs 0.55 pg/ul) and plasma IL12p40 were higher (103.3 vs 42.7);and MCP-1 (503 vs 697 pg/ul) and IL-6 (1.32 vs 1.84 pg/ul;p < 0.05 for IL-6) were lower in NeuroPASC vs controls (p< 0.05);but none of these differences were significant after adjusting for multiple comparisons. Plasma GFAP was elevated in NeuroPASC vs controls (54.4 vs 42.3 pg/ml;adjusted p< 0.03). There were no differences in the other biomarkers tested. 10/31 and 7/31 NeuroPASC had anti-N antibodies in CSF and plasma, respectively. Conclusion(s): When comparing NeuroPASC to never COVID controls, we found no evidence of neuroinflammation (normal CSF cell count, inflammatory cytokines) or blood-brain barrier dysfunction (normal albumin ratio), and no support for ongoing neuronal damage (normal plasma NFL). Future studies should include better gender and race matched controls and should explore the significance of a persistent CNS humoral immune response to SARS-CoV-2 and elevated plasma GFAP after COVID-19. (Figure Presented).
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Introduction: IL-6 has been correlated as a prognostic biomarker for worsening sepsis and COVID-19 as well as positive fluid balance for duration of mechanical ventilation [1, 2]. Method(s): We performed a retrospective cohort study to analyze the correlation between high levels of serum IL-6 and positive fluid balances in the first 24 h of ICU arrival with mechanical ventilation days. We included adult patient records of critical COVID-19 during 2020 from the High Specialty Regional Hospital Bicentenario 2010, all patients were intubated, received treatment according to guidelines inforced in that time. We obtained mean and standard deviation for continuous variables and frequencies for categorical variables, calculated Kolmogorov-Smirnov for non-parametric test and Spearman correlation, OR for severe hypoxemia, RRT. Result(s): We analyzed 102 patient records, 72% were male, mean age 54.8 years (SD 19.4), tracheostomy was performed in 8.8% of cases, mean APACHE II 16.7 (SD 8.4), values of inflammatory markers were C-reactive protein 108 mg/dl (SD 95), IL-6 118 pg/ml (SD 240), mean paO2/FiO2 was 150 mmHg (SD 82), 93% were on vasopressors, fluid balance mean was 1542 ml (SD 839), severe hypoxemia was present on 62.7% (P/F below 150 mmHg), prono was used in 47.1%, with an overall mortality occurred in 69%. We found no correlation between serum IL-6 levels and positive fluid balance with mechanical ventilation days and outcomes (rs -0.11 p = 0.23, Fig. 1). Elevated serum IL-6 + positive fluid balance at 24 h ICU arrival was associated with severe hypoxemia (OR 2.82, CI 95% 1.14-6.97, x2 p = 0.022), OR for discharge was non-significant (0.48 CI 0.19-1.20 p = 0.11), RRT (1.09 CI 95% 0.27-4.37, p = 0.9). Conclusion(s): In our study no correlation was found between serum IL-6 levels, positive fluid balance and mechanical ventilation days, but there was a significant association with severe hypoxemia.
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Objective: To study the clinical characteristics of diabetes mellitus with Coronavirus disease 2019 (COVID-19) and explore the possible mechanism of diabetes predisposition. Method(s): A single center, retrospective and observational study was used to collect 48 inpatients diagnosed with COVID-19 who were admitted to the first ward of the third department of infection, Raytheon hospital, Wuhan from February 23, 2020 to March 30, 2020. Demographic data, symptoms, laboratory tests, comorbidities, treatments and clinical outcomes have been collected. The patients were divided into non-diabetic group and diabetic group according to the combination of diabetes. The clinical data and laboratory test results of the two groups were observed, and the t test, non-parametric test and Chi square test were used for comparison. Result(s): All the 5 patients with COVID-19 diabetes mellitus had fever and respiratory symptoms, chest CT was consistent with typical COVID-19 imaging features, and novel coronavirus nucleic acid test results were positive. There were no statistically significant differences in age, gender composition, co-existing diseases, clinical symptoms, clinical typing, disease course and treatment plan between the diabetic group and the non-diabetic group (P>0.05).There was a statistically significant difference in fasting blood glucose between the non-diabetic group and the diabetic group (P<0.05).The difference of fasting blood glucose at discharge from the diabetes group compared with that at admission was also statistically significant (P<0.05).There was no statistically significant difference between the two groups in other laboratory examination indexes (P>0.05). Conclusion(s): COVID-19 patients with diabetes are mainly manifested by fever and respiratory symptoms.Chest CT shows typical COVID-19 imaging features.Copyright © 2020 by the Chinese Medical Association.
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Introduction: The World Health Organization declared COVID-19 as a pandemic on 11th of March 2020. This pandemic of covid-19 had serious implications for public institutions especially due to lockdowns. As a result of lockdowns, E-learning has rapidly emerged as an alternative to traditional classroom-based education. The main concerns among medical students is the quality of medical education due to online classes. Objective(s): This study was conducted to assess perceptive of online teaching among medical students of new medical colleges of Jammu. Method(s): This was a Cross-sectional study conducted among 389 medical students of new government medical colleges of Jammu division of Jammu & Kashmir situated in North India. The survey questionnaire included questions asking about socio-demographic data such as sex, age, phase of study etc. and their attitude towards online classes. Data retrieved from the online survey was entered into Microsoft Excel and then analyzed using SPSS version 25.A univariate analysis was used to explore the associations between sample characteristics and the perception of online classes during the COVID19 epidemic. Result(s): Majority of students (70.5%) were of view that lockdown has affected their studies.64% were not comfortable with online teaching learning method. 64.5% were not satisfied with this form of teaching and 69.2% don't want this method to continue in future.61.2 % of students were not sure about overall effect of online teaching on studies while 23.9% were of opinion that online teaching has negatively effected their studies.On applying non parametric tests residence and college of students were found to be statistically significant relationship on the effect on studies. Conclusion(s): Despite the challenges posed by the covid pandemic, several resourceful initiatives like online learning techniques can be implemented to complete the curricula.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
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Background: The vast majority of studies indicate that asthma and allergic diseases are not risk factors, neither for COVID-19 susceptibility nor to cause a more severe course of disease. The study aimed to compare medical history, clinical characteristics, and outcome of COVID-19 in patients with allergic comorbidities and in general hospitalized population. Method(s): The study was a single-center retrospective analysis based on data of 632 COVID-19 patients admitted to the City Hospital No 4 (Dnipro) from August to October 2021. The patients' demographics, medical history, particularly the presence of allergic diseases, symptoms and lab tests on admission were collected from medical cards and analyzed. The methods of descriptive and non-parametric statistics were used to process the results. Result(s): Among 632 COVID-19 patients, 27 (4.3%) had the allergic diseases and reactions in medical history (Figure 1). Their median age was 60 (52;69) (p > 0.1), 21 (78%) were women (p = 0.072). The information concerning patients' demographics and clinical characteristics on admission is presented in Table 1. Conclusion(s): The hospitalized patients with COVID-19 and allergic diseases did not differ by from the general population with COVID-19. The Severity Index and lethality weren't higher in patients with allergies. At that time the frequency of saturation < 90% as key indicators of respiratory failure were lower in patients with allergic diseases. While there wasn't difference in need for supplemental oxygen support, interestingly, that there were less patients admitted to ICU in comparison with the general population. Thus, allergic diseases, at least, are not a risk factor for more severe COVID-19.
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The COVID-19 pandemic is accompanied by intensive attempts to build mathematical models to predict it. For this, various models are used, both traditional differential equations and machine learning models. Classical epidemiological compartment models contain parameters that are difficult to measure. Their results are used to model various scenarios, but it is difficult to obtain a reliable forecast with their help. Machine learning models, on the other hand, do not use prior assumptions, and their inferences are based only on training samples. This usually results in more reliable forecasts. In both the first and second cases, it is necessary not only to estimate the forecast error, but to compare the prediction accuracy of different models by checking the error homogeneity also. An additional factor complicating the problem is the small size of available samples in some cases. This forces one to resort to resampling methods. The article describes the Klyushin-Petunin test for testing the homogeneity of samples with ties in a multi-sample design and compares it with the traditional Anderson-Darling, Kruskal-Wallis and Friedman tests using the example of three methods for predicting the COVID-19 epidemic in the basis of epidemic data in Germany, Japan, South Korea and Ukraine. © 2022 IEEE.
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Aim: PR is an integral part of chronic respiratory disease (CRD) management. Evidence on the effectiveness, applicable components, and deliverable models have generated from high-income countries a different clinical context from low- and middle-income countries. Informed by global PR guidelines, a systematic review and stakeholder engagement, we adapted a PR programme to home-based (because of COVID) in a low-resource setting. This feasibility study tested the PR programme in Bangladesh. Method(s): Intervention was, assessment at the PR centre, twice-weekly tele-supervised sessions for 8 weeks at home. Primary outcomes were Endurance Shuttle Walk Test (ESWT) and COPD Assessment Test (CAT). Nonparametric tests were used to compare pre-and post- outcomes using SPSS version 26. Result(s): 51 participants (33 male;mean age 55yrs (SD 12)) were recruited with a range of CRDs. 40 completed the final assessment (COVID deterred eight follow-ups). Both ESWT and CAT improved by more than the minimum clinically important difference (MCID). Conclusion(s): Home-based PR is feasible in the Bangladesh context and associated with significant improvements in functional exercise capacity and health-related quality of life.
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Introduction: Increasing amount of data in the literature proves the predictive role of some biomarkers for severity and the outcome of the COVID 19 infection. Aim(s): To make assessment of the relationship between some laboratory parameters and in hospital outcomes in patients with COVID-19. Method(s): Data from 123 hospital patients for a 3-month period were analyzed, 71 men and 52 women, average age 68.1y +/-12.4. They were divided into two groups regarding the outcome - deceased (82, 66.7%) and discharged (41, 33.3%) and compared by demographic, hematological and biochemical indicators. In the analysis of the results the parametric tests were applied in: normal distribution for hypothesis testing: Student's t-test;Analysis of Variance (ANOVA) - LSD, Tukey HSD, Duncan, Scheffe, Bonferon, Student - Newman - Keuls. Non-parametric tests with a different than normal distribution to test hypotheses: chi2 Pearson test;Kruscal-Wallis test;Man Witney (Wilcoxon) W test. Result(s): There were no significant differences in terms of gender and age in the two groups p>0,05). We found significantly higher values of lactate dehydrogenase (LDH), p=0.0379, fibrinogen, p= 0.0209 and international normalized ratio (INR), p= 0.0151 in the group of the dead. The values of total protein and albumins in the same group were much lower - p=0.0203, p=0.0018 respectively. There was no significant difference between both groups regarding D-dimer, C-reactive protein, leucocytes, lymphocytes and thrombocytes. Conclusion(s): Deviations found in basic laboratory parameters are useful for assessing the risk of the outcome of COVID -19 infection in hospitalized patients.
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Background: The COVID-19 pandemic has induced fear and mental health problems in the community and among healthcare workers. Empathy with patients may be difficult in such situations due to urgent conditions. Objective(s): We aimed to evaluate medical students' empathy and fear toward COVID-19 patients during the pandemic. Method(s): This cross-sectional study recruited 107 medical students from Shiraz Medical School in 2021. A Persian version of the Jefferson Scale of Physician Empathy (JSPE) was used to assess the participants' empathy toward COVID-19 patients. The internal validity of the Persian version of JSPE was 0.78, and its test-retest reliability after 14 days was 0.92 in a previous study. The participants were requested to fill out a fear of COVID-19 scale (FCV-19S) previously developed to assess their fear of affliction with COVID-19. Since the normality of data distribution was not approved, we used nonparametric tests, namely, the Mann-Whitney U test and the Spearman correlation coefficient. Result(s): The mean empathy score based on the Persian version JSPE was 71.94 +/- 12.83 out of 140, which was higher in male students and those who resided in dormitories. The mean fear score was 24.93 +/- 6.16 out of 35. Participants living out of dormitories feared COVID-19 to a greater extent. No statistically significant association was found between the age of the participants and these two parameters. The Spearman correlation coefficient test showed that students with a history of COVID-19 had less fear and more empathy because of their experience with COVID-19 (r =-0.249, P-value = 0.02). Conclusion(s): This study highlights the impact of the pandemic on the interaction between medical students as healthcare professionals and patients by affecting medical students' fear and empathy. The study indicates ways to improve readiness for future pandemics. Our study showed that living far away from families in dormitories may influence students' fear and empathy. Moreover, empathy, unlike fear, was affected by gender. A reverse correlation existed between fear and empathy in students with a history of COVID-19, indicating that the more they had empathy, the less they experienced fear.Copyright © 2023, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
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Introduction: In developing countries, Post renal-transplant infections is the leading cause of mortality, morbidity and decreased allograft survival. Our aims and objectives was to determine the incidence and prevalence patterns of clinically or microbiologically confirmed infection in the post renal transplant patients of our population and profiling of infections in relation to time period from the Transplant and the induction agent, also to develop strategies to counter risk of post transplant infection. Method(s): This was a retrospective observational study. Time period: January 2020- April 2022. Post renal transplant recipients presenting with infections (with informed consent) was enrolled in this study. Recurrent episodes of infection by different organisms in a same patient treated as a separate event. Data was tabulated using MS excel and all results projected in bar graphs, pie charts, histograms. Differences of quantitative parameters between groups were assessed using the t test(for data that were normally distributed) or nonparametric test (for data that were not normally distributed). Differences of qualitative results were compared using chi2 test. Kaplan-meier was used for survival analysis. P < 0.05 was considered significant. Result(s): 213 incidents of post renal transplant infections were documented in 148 patients between the study period. Of the 85 patients who underwent renal transplant(57 living donor and 28 cadaveric) in this time period 33(38.8%) patients presented with 42 incidents of infections. Majority (74.3%) : Males. Mean age: 36.3+/-5.6 years. Most common cause of native kidney disease was chronic glomerulonephritis(30%). 121 (81.7%) had living donor transplant and 27(8.3%) patients had cadaveric transplant. Induction agent was basiliximab in 97 patients (65.5%) had 133 infections (62.4%) and ATG was used in 51 patients (34.5%) had 80(37.6%) infections. In recent transplant (last 2 yrs) cases-In Basiliximab group: infection rate 4.1 in 100 patient months and in ATG group infection rate was 5.7 in 100 patient months. (p=0.28). 37.5%cases had infections with graft dysfunction most commonly AKI. Immediate post transplant infections (<1 month) were 34 (15.9%), most commonly UTI (44.11%) followed by pneumonia (15.9%). 48(%) infections occurred between 1-6 months, most commonly pneumonia(27.08%) followed by UTI(22.9%) and superficial fungal infection. Pulmonary tuberculosis was in 14 (6.6%) cases. 3 cases had disseminated TB. Infectious diarrhea was in 18(8.4%) cases, most common organism isolated was EAEC and EPEC. CMV colitis found in 3 cases. 27 (18.2%) patients had NODAT/PTDM. ParvoB19 was in 11(5.16%), CMV in 5 and BKVN in 3 cases. 41(19.2%) cases had severe sepsis requiring intensive care support. New baseline s.cr was achieved in 29.1% cases. Infection related death was 24(16.2%). COVID 19 infection was in 41 cases, 31.7% developed graft dysfunction and 18 (43.9%) required hospital admission due to moderate or severe disease. 2 patients had mucormycosis, one of them died after admission. [Formula presented] Conclusion(s): Profiling of infection in our centre is essential to formulate future strategies for infection control especially as the DDKT & ABOi KT is on the rise. Proper survillence, screening protocol, vaccination and patient education are essential to reduce the burden of post transplant infection and for better graft and patient survival. No conflict of interestCopyright © 2023
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Introduction: Delta variant pandemic wave characterized by high lethality rate, hence the study aimed to examine the clinical features of hospitalized patients with severe COVID-19 during Delta surge. Method(s): Single-center retrospective analysis of patients' medical cards and Severity Index (SI)1 on admission to hospital during 08.2021-10.2021. Descriptive and nonparametric statistics were used. Result(s): 632 patients' medical cards were analyzed. 363(57.4%) of patients had critical clinical risk (SI>=8). Timeline of disease progression and patients' clinical characteristics are listed in Table 1, along with presenting of comorbidities in Figure 1. Conclusion(s): The study revealed the prevalence of elderly polymorbid females in critical patients group, who had the next key comorbidities: AH, CIHD, CF, DM, arrhythmias, stroke, atherosclerosis, GID and ACS/IM. It is necessary to highlight the part of critical patients without need in oxygen supply, thus respiratory failure is not the only criteria for hospital admission. (Figure Presented).
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The coronavirus epidemic has stimulated a surge of research in the field of forecasting the epidemic curve based on various mathematical models. To predict the time series that predicts the number of patients, different models are used, both differential and machine learning models. Differential models for predicting the epidemic curve depend on a number of unpredictable factors. This often results in inaccurate predictions. In contrast to these approaches, machine learning models that predict time series based on training samples show higher reliability. In both cases, the problem arises of testing the hypothesis about the homogeneity of errors on training samples. The paper describes the application of the Klyushin-Petunin test to test the homogeneity of two samples and compares its effectiveness with the widely used the Wilcoxon test and the Diebold-Mariano test and the using the example of three methods for predicting the COVID-19 epidemic curve based on data on the number of cases in a certain period in Germany, Japan, South Korea and Ukraine. The efficiency and usefulness of the proposed nonparametric approach is demonstrated. © 2022 Copyright for this paper by its authors. Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).
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PURPOSE: Lockdown guidelines during COVID-19 pandemic increased the e-learning methods and gadgets use, basically to undergo classes, recreation procedures and media news updates, which subsequently upsurgedasthenopic symptoms as digital eye strain (DES) epidemic amid COVID-19 lockdown. This is a descriptive cross-sectional questionnaire based study which is aimed to assess the prevalence, risk factors.Pattern of gadgets used, screen time and symptomatology of Digital eye strain among medical students, teaching doctor faculties and paramedical staff during COVID-19 lockdown at BBMCH, Balangir. METHODS: This e-filled self survey analysed 570 responses from medical students of online classes(200), teachers of online classes (38), paramedical staff (122) and general population(210) .Aprevalidated CVS-Q and OSDI questionnaire regarding screen time spent, was used to calculate the DES score. Median DES Score was compared by medians or non-parametric tests. Categorical variables were compared by Chi Square test and predictors of DES were found by binary logistic regression. SPSS Version 21.0 was used to interpret and analyse the collected data. RESULTS: Majority of survey participants(78%) had at least one symptom of digital eye stain;The reported symptoms during electronic device usage in decreasing frequency were Eye fatigue(65%), Eye strain(52%), Ocular discomfort(50%), headaches(48%), Burning eyes(42%), and Dry eyes(35%), watering(34%), shoulder pain(30%) DES symptoms were found to be more than that of dry eye symptoms. The prevalence of DES in students taking e-learning surpassed to those found with other health staff and general population. DES score was also observed to be on higher side for more screen time users, use of gadgets in dark, screen distance<25cm. Lens or spectacle users suffered worsening of vision and needed change of glasses. No association between DES and exacerbation of pre-existing dry eyes and eye diseases were appreciated due to exclusion of such participants from our survey. CONCLUSION:Eye care tips are needed at periodic intervals to create awareness and to reduce eye strain symptoms, closing of eyes on regular basic, maintaining reading distance between 25-30cm and reducing screen time by breaks can lessen the prevalence of DES. As because, use of gadgets were the major media for learning or communication, so ocular health, hygiene and practical precautions should be kept in mind.
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SESSION TITLE: Late Breaking Posters in Critical Care SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Respiratory failure is a life threatening emergency and the management of respiratory failure includes invasive or non-invasive ventilation based on the various clinical parameters. Hence the present study was conducted to assess the outcome of NIV in patients with respiratory failure and to determine the factors predicting the outcome. METHODS: This Prospective observational study had included a total of 104 subjects.The demographic details, clinical examination,vitals and arterial blood gas levels at 0,1, 4 and 24 hours were analyzed among study subjects. Descriptive analysis was carried out, that include mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Parametric statistics used were paired t test and ANOVA.Non parametric statistics used were Chisquare test.At 95% Confidence interval, p value of <0.05 was considered to be statistically significant. Multivariate Regression analysis was done to predict the factors determining outcome of NIV. The data was entered in excel sheet and analyzed using SPSS (Version 16). RESULTS: The mean age of the study population was 52.88±16.58 years.70.78% success rate was found among males and 29.23% success rate was found among females. The difference between gender and outcome was not statistically significant.There was no statistical significant association observed between BMI and outcome of NIV ( p value 0.84).Higher rate of success was seen among subjects with COPD (43.37%) followed by COVID 19 patients (18.07%), acute pulmonary edema and pneumonia (9.64% each), ARDS (8.43%).In our study, the difference between etiological diagnosis and outcome was found to be statistically significant in ARDS (P value 0.02), pneumonia (P value 0.04) and COPD (P value 0.007). Patients with GCS < 8, 12% were successful and GCS >8, 78.48% were successful. The difference between GCS and outcome was found to be statistically significant (P value <0.0001). All ABG parameters at 0, 1, 4 and 24 hours (except PaCo2 at 4 and 24 hours) were statistically significant to predict outcome of NIV. CONCLUSIONS: A successful outcome of 62.5% was observed in the subjects initiated on NIV for respiratory failure, COPD being the major etiological diagnosis and the factors determing NIV were based on etiological diagnosis, GCS and Arterial Blood gas parameters. CLINICAL IMPLICATIONS: Though studies on outcome of NIV are available involving multiple variables including sociodemographic data, clinical and ABG parameters, there are only limited Indian studies to determine NIV outcome based on etiological diagnosis, comorbidities, GCS and ABG parameters at different time intervals affecting outcome of NIV in respiratory failure.Thus, the present study was conducted to study the outcome of non-invasive ventilation in patients with respiratory failure and to determine the above factors that affect the outcome of non-invasive ventilation DISCLOSURES: No relevant relationships by Sahana K No relevant relationships by SURESH SAGADEVAN
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SESSION TITLE: Medications and Pulmonary Rehabilitation in COVID-19 Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: The use of inhaled epoprostenol (iEPO) has demonstrated improvement in outcomes for patients with pulmonary hypertension and right heart failure. iEPO has been used as a rescue therapy for acute respiratory distress syndrome (ARDS) and has been shown to improve oxygenation, reduce shunting, and decrease pulmonary artery pressures. However, pulmonary vasodilators do not improve mortality in patients with ARDS. Furthermore, there is currently little data on the efficacy of iEPO via high flow nasal cannula (HFNC) for ARDS patients. Here, we describe our experience with iEPO in our patients with COVID-19-related ARDS on HFNC in a Northern California county hospital. METHODS: From March 2020 to December 2021, 74 patients with COVID-19 infection and related ARDS were placed on HFNC and received iEPO, at a public tertiary care center. A positive response to iEPO was defined as an increase P/F ratio of 10%, increase in PaO2 of 20%, decrease in FiO2, or reduced flow rate within 24 hours of initiation of iEPO. Non-parametric statistics were used to compare groups. RESULTS: 21 women and 53 men with COVID ARDS ranging from 30-86 years of age (mean age 60.1 ± 13.9) received iEPO while on HFNC. The mean hospital length of stay was 36.3 ± 43 days. All patients received steroids and 83.8% received antibiotics. 55.4% of all patients in the study (n=41) progressed to mechanical ventilation and 58.1% (n=43) survived to discharge, mean age 57 ± 14 years. 20.3% (n=15) of patients showed a response to iEPO. Patients who responded to iEPO were significantly less likely to progress to mechanical ventilation (13% vs 66%, p=0.0003) and more likely to survive to discharge (93% vs 49%, p=0.0021). CONCLUSIONS: Among patients with COVID ARDS on HFNC, patients who respond to iEPO are less likely to progress to mechanical ventilation and more likely to survive to discharge. Our study is limited by small sample size and lack of randomization. Use of iEPO in the right subset COVID ARDS on HFNC may improve outcomes. CLINICAL IMPLICATIONS: Patients on HFNC selected for initiation of iEPO had a poor overall prognosis, with 41.9% not surviving to discharge and 55.4% requiring mechanical ventilation. iEPO response correlates with not requiring mechanical ventilation and with increased likelihood of survival to discharge. DISCLOSURES: No relevant relationships by Heng Duong No relevant relationships by Craig Ivie No relevant relationships by Neharika Khurana No relevant relationships by Connie Park No relevant relationships by Natasha Puri No relevant relationships by Adam Thompson No relevant relationships by John Wehner
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Background: Patients with chronic infammatory rheumatic diseases (CIRD) may be at increased risk of Corona Virus Disease 2019 (COVID-19).1 The quality of information obtained plays a crucial role for patients' decision to be vaccinated. Knowing patients' needs for information and which sources are used is important for the management of CIRD patients by rheumatologists and other physicians. Objectives: To identify main sources of information on SARS-CoV-2 used by patients with CIRD and to analyze their influence on opinions and willingness to be vaccinated. Methods: CIRD patients presenting to our tertiary rheumatology hospital were, after informed consent, consecutively included in the study once the vaccination campaign in Germany had started, to fll out a questionnaire. Next to sociode-mographic and disease-specifc data, vaccination willingness and knowledge regarding SARS-CoV-2 were assessed. Furthermore, patients' sources of information and their concerns about accuracy of information were evaluated. A numerical rating scale (NRS) ranging from 0 (completely disagree) to 10 (completely agree) was used. Values between ≥7 were taken as positive answer. Nonparametric tests and multivariate linear regression analyses were performed. Results: In early 2021, a total of 514 patients were interviewed (Table 1). The majority (63.9 %) reported to be well-informed (NRS ≥7), whereas 18% had doubts regarding information on SARS-CoV-2. The most often used source of information was television, and only 8.6% reported to have been informed by a rheumatologist (Figure 1). About 20% of patients were no longer interested in receiving any information on SARS-CoV-2 through media. Information from rheumatologists, general practitioners, public health authorities or health related web sites did not reach 30.5% of patients. Of interest, 16% of subjectively well-informed patients were hesitant towards vaccination. As many as 43.6% of patients with doubts regarding information about SARS-CoV-2 indicated that they were not willing to be vaccinated. No source of information showed a strong correlation with SARS-CoV-2 vaccination willingness or with knowledge on SARS-CoV-2. Weak positive correlations were found between age and education level on the one hand and information sources about SARS-CoV-2 on the other hand. A weak negative correlation was found between doubts about information and health authorities, whereas positive correlations were found with social networks, friends and family. Conclusion: Most CIRD patients think that they are well-informed about SARS-CoV-2. However, their information rarely comes from expert-based sources and rarely from rheumatologists. Thus, there is an unmet need for CIRD patients to receive appropriate and comprehensive information about SARS-CoV-2, its infu-ence on rheumatic diseases, and about vaccination of patients with CIRD.
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Background: The relevance of studying immune response after SARS-CoV-2 vaccination in patients with infammatory immune-mediated diseases (IMIDs) represents a deep concern regarding the risk estimation and management of patients with these diseases on immunomodulatory drugs. It is well known that certain treatments as anti CD20 therapies results in a diminished immunogenicity against common vaccines but it is a scarce data regarding the cellular protection obtained upon vaccination between patients with different IMID and between different treatments. Objectives: To compare a potential detriment on cellular and antibody-mediated protection upon SARS-CoV-2 vaccination in patients with IMIDs treated with immunosuppressive drugs. Methods: We recruited 73 patients with rheumatoid arthritis-RA-(n=49), spondy-larthritis-SpA-(n=19), infammatory bowel disease-IBD-(n=5), idiopathic juvenile arthritis-IJA-(n=2) and heterogenous group composed of sclerodermia, lupus, uveitis(n=6). They were treated mainly with rituximab (n=27), TNFi (n=37) or JAKi (n=3). We collected data of age,sex, csDMARDs, previous SARS-CoV-2 infection, last RTX infusion and prednisone use. After one month of vaccination, we assessed the humoral response performing the Thermo Scientific EliA SARS-CoV-2-Sp1 IgG Test (positivity cut-off >0.70 IU/ml) which was also compared with the data with of 35 healthy controls. In addition, in 40 patients who had serum antibody levels under 100UI/ml, we analysed the cellular response by the use of the QuantiFERON SARS-CoV-2 Starter Pack (Quiagen). A cut-off value of 0.15 IU/ml discriminate between positive or negative cell-mediated immune responses. We compared differences among the different IMIDs and between the different immu-nosuppressive treatments through non-parametric test (p<0.05) Results: Regarding demographic characteristics of patients, older patients (>56 years) and female sex were factors which were associated with low titles of serum antibodies. Anti-spike IgG antibodies were present in an 86% of the IMIDs patients and in 100% healthy controls with signifcant different IgG titre (median [IQR]): 51[11-184] vs 700[440-940];p<0.0001. The differences between (median [IQR]) serum antibody levels were statistically different between IMID type: 33[1-138] in RA vs 94[34-191] in SpA vs 204[187-204] in IBD vs 133[61-204] in IJA vs 13[1.5-31.8] in the rest;p=0.04. Remarkably, patients with IBD who had the highest antibodies titles were the youngest compared with the other patients. Target of the therapy played also an important role in serum antibody levels being these: 3.6 [0.7-51] in RTX patients vs 156 [45-204] in TNFi vs 40 [18-58] in JAKi patients;p<0.0001. In those patients who the last infusion of rituximab was, at least, one year before vaccination presented CD19+ B cells detected by fow cytometry and anti-spike IgG antibodies as well. Cell-mediated responses to SARS-CoV-2 were positive in 33% of IMIDs patients, indeterminated in 3% and negative in 65% of the patients. Strikingly, out of the 33% positive patients, 85% were treated with RTX. A 61% of the RTX patients had inducible cell-mediated responses vs 14% of the patients treated with TNFi;p<0.01. On the other hand, there were not differences in cell-mediated responses between positive and negative antibody patients. Conclusion: Titres of serum antibodies against spike protein of SARS-CoV-2 were lower in IMIDs patients than in controls. Patients with RTX had lower rates of positivity humoral response as well as lower serum titles than patients treated with other therapies regardless the patients 'age. Neverthless, in those patients in whom RTX infusion was delayed because of vaccination they conserved a humoral response. On the other hand, more patients treated with RTX had inducible cell-mediated responses compared with patients with TNFi.
ABSTRACT
Background: Mixed cryoglobulinaemic vasculitis (MCV) is an immune-complex-mediated systemic vasculitis characterized by heterogeneous clinical manifestations mainly involving skin, kidney and peripheral nervous system. Despite reassuring safety data from EULAR Coronavirus Vaccine (COVAX) physician-reported registry, a signifcant proportion of patients with autoimmune diseases reported unwillingness to get vaccinated against SARS-CoV-2 infection in the preliminary results of the COVAD study, due to concerns about the lack of longterm safety data, and fear of associated side effects and disease fare. Objectives: Aims of this multicentre Italian study were to investigate the prevalence of vaccination against SARS-CoV-2 in Italian population of MCV patients, to explore the reason for the missed vaccination, and to investigate short and long-term side effects of the vaccine, including vasculitis fare. Methods: All MCV patients referring to 12 Italian centres were investigated about vaccination and possible both short-(within 48 hours) and long-term (within 30 days) adverse events (AE), classifed according to FDA Toxicity Grading Scale for preventive vaccine clinical trials, and possible disease fares. Patients with MCV related to lymphoproliferative disorders or connective tissue diseases were excluded from the study. The baseline variables were expressed as percentages or mean±standard deviation. The differences between continuous variables were analysed using the Mann-Whitney nonparametric test. The chi-squared test, or Fischer's exact when appropriate, were used for categorical variables (absolute numbers and percentages) regarding baseline characteristics. Results: A total of 416 patients, 69.2% females and 30.8% males, with a mean age of 70.4±11.7 years, were included in the study. Only 7.7% of patients were not vaccinated, mainly for fear of adverse events (50%) or for medical decision (18.8%). Corminaty was the vaccine most frequently used (80.5%). Interestingly, 6 patients (1.44%) were with a heterologous vaccination (usually AstraZeneca-Corminaty). Considering ongoing treatment, not vaccinated subjects were more frequently treated with chronic glucocorticoid therapy and/or Rituximab (p=0.049 and p=0.043 respectively). AE were recorded in 31.7% of cases, mainly mild and self-limiting (grade 1). More severe adverse events, such as fare of vasculitis, were observed in 5.3% of cases. AE were not associated with the kind of vaccine used and with the clinical manifestations of vasculitis. Patients with active MCV showed a lower frequency of short-term (within 48 hours) adverse events, but patients affected by peripheral neuropathies or skin vasculitis frequently showed a fare of their symptoms, recorded in 40% and 25% of cases, respectively. Finally, patients under glucocorticoid treatment were more prone to develop a vasculitis fare within a month after vaccination. Conclusion: Vaccination in MCV patients has been performed in a high percentage of patients showing a good safety. Other than patients' fear, treatments with rituximab and glucocorticoids are the main reasons for delaying vaccination, and it should be considered by the physician before starting therapy. Vasculitis fares were observed in about 5% of cases, in line with that observed in other autoimmune diseases. Specific attention should be reserved to people with purpura or peripheral neuropathy, for the increased risk of exacerbation of their symptoms.
ABSTRACT
Background: The key link in the therapeutic drug monitoring of methotrexate (MTX) is the measurement of the concentrations of its most stable metabolites, as well as products of the early and late stages of MTX conversion (short-chain polyglutamates). Metabolic rate of MTX can depend on the clinical characteristics of patients and concomitant drug therapy. Objectives: To reveal the regularity of the distribution of various metabolites in patients who responded and did not respond to MTX therapy. To compare groups of patients with different responses to MTX according to clinical characteristics. Methods: The study included 79 RA diagnosis according to ACR/EULAR 2010 criteria, 65 (82%) women and 14 (18%) men, aged 53 ± 11 years, naiive to MTX. All patients had normal renal excretory function (GFR more than 60 ml/min). All patients were prescribed MTX of 10-15 mg/m2 of body surface. Achievement of therapy targets was established according to the EULAR therapy response criteria. The determination of MTX monoglutamate in erythrocytes (ER) and mono-nuclear cells (MO), as well as the main metabolites of MTX-polyglutamates with 2,3 and 4 glutamate residues (MTXPG 2-4), as well as 7-hydroxymethotrexate (7-OH-MTX) was measured by the tandem chromatomass spectrometry after 4, 12 and 24 weeks of therapy, the result was expressed in nmol/L. The calculation was performed using the statistical data analysis package Statistica 10 for Windows (StatSoft Inc., USA) using the methods of parametric and nonparametric statistics. Results: By the 24th week of therapy, 34 (43%) (group 1) patients achieved the targets of therapy, 36 (46%) did not achieve (group 2). MTX withdrawn in 5 (6%) patients-due to adverse reactions. 4 (5%) were unable to continue to participate due to SARS-CoV2 pandemic. After 4 weeks of treatment, the concentration of various MTX metabolites did not differ in the groups. After 12 weeks of therapy, signifcant differences were found in the content of 7-OH MTX in the ER: 28.19 [7.28;58.07] and 5.89 [0.79;20.03], respectively (p=0.002);the concentration of the remaining fractions did not differ. Group 1 showed a higher concentration of 7-OH-MTX in MO after 24 weeks of therapy-5.23 [1.39;12.52] and 1.05 [0.07;3.55], respectively (p = 0.006). No differences between the concentrations of other MTX metabolites were found. The groups were matched for age, body mass index, duration of RA, and disease activity at the baseline. In group 2, patients used statins more often (2 (6%) versus 6 (37%), p = 0.01), however, there were no statistically signifcant differences in the concentration of MTX metabolites in the groups of patients taking and not taking statins. Conclusion: The concentration of 7-OH-MTX after 12 and 24 weeks of therapy is statistically higher in the group of patients who responded to therapy. 7-OH-MTX appears to be a more persistent metabolite of MTX, therefore, it is more applicable for therapeutic drug monitoring of MTX. Patients taking statins may be potential nonresponders to MTX therapy.