Implementing the Yorkshire Cancer Research funded Prehabilitation Radiotherapy Exercise smoking Habit cessation And Balanced diet Study (PREHABS): a therapeutic radiographer's perspective

Introduction: Lung cancer patients often have a number of comorbidities which impacts patient mortality and morbidity rates. Lifestyle changes for this group of patients have the potential to positively impact both quality of life and longevity. The Yorkshire Cancer Research funded Prehabilitation Radiotherapy Exercise smoking Habit cessation And Balanced diet Study (PREHABS) was designed to determine if it is feasible to embed interventions promoting a healthier lifestyle into the radical lung radiotherapy pathway. Method(s): The PREHABS study was led by therapeutic radiographers trained in smoking cessation provision, motivational interviewing, informed consent and good clinical practice and a dietitian. Radiographers screened and consented study participants, delivered the exercise intervention and up to 12-weeks of smoking cessation support, whilst dietary advice was provided by the dietitian. Patients diagnosed with chronic obstructive pulmonary disease (COPD), were referred to a community based pulmonary rehabilitation service rather than the PREHABS exercise intervention. Ethical and regulatory approvals were secured in September 2021. Result(s): 61 patients were recruited between September 2021 and October 2022. The majority were female (n=42), mean age 73.1 years (SD 9.36 years). Discussion(s): In addition to the training requirements detailed above and the challenges of COVID-19, the radiographers had to become adept in a number of study-specific aspects including writing the study standard operating procedures (SOPs), creating a study organisational workflow and patient recruitment. The PREHABS study has broadened the radiographer's perspective beyond the radiotherapy department, by further understanding the complex comorbidities that lung cancer patients present with, how to motivate patients to positively change their lifestyle, and how the side effects caused by cancer treatment can affect a patient's ability to change their lifestyle. Conclusion(s): Therapeutic radiographers, after appropriate training, are capable of delivering lifestyle intervention support within a radical lung cancer radiotherapy pathway. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

Unsupervised Clustering and Binary Classification Analysis for Predicting COVID Syndrome (LONG COVID) in US Adults

Objectives: This study investigated the risk factors of developing COVID Syndrome and identified potential disease profiles that may exist among those who have contracted COVID-19. Method(s): Data on 13,953 adults who had experienced COVID-19 at any time were analyzed from the 2022 US National Health and Wellness Survey. XGBoost binary classification with 10-fold cross-validation was used to predict long COVID among those who reported experiencing COVID-19 and to extract feature importance. Synthetic minority oversampling technique (SMOTE) was used to address class imbalance in the outcome variable. Variable selection was conducted based on SHAP values. Fifty variables including demographic characteristics, COVID-19 symptoms, comorbidities, and health characteristics were used in the final model. Parameters were tuned using AUC. Among the 2,665 respondents who were diagnosed with long COVID, k-medoids clustering with t-SNE dimensionality reduction was implemented to determine whether distinct symptom profiles exist. Average silhouette score was used to determine the optimal number of clusters. Result(s): The XGBoost binary classification for predicting long COVID among those with COVID-19 had an AUC of 0.9145, accuracy of 0.9072, sensitivity of 0.9630, specificity of 0.8328, and Brier score of 0.0928. The most important features in predicting long COVID were age, smoking habits, COVID-19 vaccination status, certain COVID-19 symptoms experienced, and certain comorbidities. Among those diagnosed with long COVID, the clustering analysis found nine unique clusters of symptoms. The cluster that experienced the most severe symptoms was older, female, lower income, lower vaccination rate, and had more comorbidities like asthma, chronic bronchitis, and allergies. Conclusion(s): In a broadly representative US adult population, XGBoost model identified a selection of risk factors for developing long COVID. K-medoids clustering identified clusters of patients that were at risk for developing severe symptoms.Copyright © 2023

Anti-hepatitis B surface antigen as a biomarker for immunity acquisition against SARS-CoV-2

Background: More than a year has passed since the first coronavirus vaccines were widely used. However, some healthcare workers are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) despite full vaccination. The immune effect of SARSCoV- 2 vaccines attenuates in a few months in contrast to other universal vaccines, such as the hepatitis B vaccine, which have an immune effect that lasts for a longer time. In addition, the neutralizing antibody (Ab) titers can be measured only in limited medical institutions. In this study, we aimed to investigate the factors that predict SARS-CoV-2 infection in healthcare workers after vaccination. Method(s): In this study, we enrolled one thousand one hundred and thirty-three healthcare workers (826 women, 307 men) after second inoculation of the BNT162b2 vaccine (Pfizer /BioNTech) in February- April 2021. Medical checkups and self-reported questionnaires were used to collect medical histories and demographic characteristics. The Alinity SARS-CoV-2 IgG II Quant (Abbott) quantitative IgG spike protein serology assay was examined in a cohort of participants 1, 4, 6 months after the second vaccination, and 1 month after the third vaccination of the BNT162b vaccine. Lower Ab titers were defined under median at each time point. The relationships between SARS-CoV-2 infection and these factors were analyzed. Result(s): The mean observation period was four hundred and fortyeight days. The median titers at 1, 4, 6 months after the second vaccination were 9293 U/mL (interquartile range [IQR], 5840-14392 U/mL), 1658 U/mL (IQR, 999-2676) and 832 U/mL (IQR, 523-1300), respectively. The risk factors for lower Ab titers were age (60 years older, odds ratio [OR], 2.08), presence of current illness (OR 1.52), smoking habit (OR 2.36), and no fever after the second vaccination (OR 2.44). The median titers at 1 month after the third vaccination was 13780 U/mL (IQR, 9085-22722), and the risk factor for lower Ab titers was hepatitis B surface Ab (HBsAb) negative (OR 1.38). The total 1-year cumulative infection rate was 4.9%. The median infection period was three hundred and twenty days (IQR, 298-365) after the second vaccination. The risk factors of infection were age (30 s and 40 s), and HBsAb negative. The 1-year cumulative infection rate of 30-40 s and other ages were 6.6% and 3.7%, respectively (p<0.01). The 1-year cumulative infection rate of HBsAb negative participants with 30-40 s and other age were 7.7% and 4.9%, respectively (p = 0.064), while that of HBsAb positive participants with 30-40 s and other age were 6.7% and 1.7%, respectively (p<0.01). Conclusion(s): HBsAb and age can become prognostic factors to be infected with SARS-CoV-2 after vaccination. Especially, HBsAb negative people under 50 years old should pay attention to SARSCoV- 2 infection even after second vaccination.

Prevalence of asthmatic patients and clinical trend among hospitalized for Sars-Cov2 infection during the first pandemic wave in North-West Italy

Background: In first pandemic wave, SARS-CoV2 infection was hypothesized to be more frequent and severe in asthmatic patients with reduced anti-viral immune response and typical disease flares during viral respiratory infections. Despite this, the studies performed to date have not confirmed these data. The purpose of our research is to evaluate the prevalence and clinical trend in patients with bronchial asthma among hospitalized for COVID-19 in North-West Italy. Method(s): In our multicentre retrospective study, we enrolled all patients hospitalized for COVID-19 from February to July 2020 at four leading hospitals: City of Health and Science of Turin (Molinette-unit), Umberto I Hospital (Turin), Umberto Parini Hospital (Aosta) and Santa Croce and Carle Hospital (Cuneo). We inclueded all patients with SARS-CoV- 2 positive nasopharyngeal swab and/or serology and/or clinical features highly suggestive of SARS-CoV- 2 infection and a hospital stay for COVID-19 of more than 48 hours. We excluded patients with exacerbation of disease not related to SARS-CoV- 2 and fewer than 48 hours of hospital stay;for each patient were collected demographic and clinical data before and during admission. Result(s): We evalueted 1016 patients: 110 (10.8%) had obstructive airway disease [71 COPD (6.9%) and 39 bronchial asthma (6.9%)]. The majority of patients with asthma took an inhaled corticosteroids (ICS) with or without Short or Long Acting Beta-Agonists (SABA, LABA) at home (56.4%);only two cases had severe asthma, both in therapy with biologics. A comparison of clinical trend and outcomes in patients with asthma, COPD and no history of obstructive lung disease is in Table 1. Conclusion(s): The prevalence of asthma among hospitalized for COVID-19 was lower than the prevalence data reported in the general population (3.8 vs 6.6% reported by ISTAT), in Piedmont and Val d'Aosta1 (3.8 vs 5.7%) and in recent meta-analysis2 (3.8 vs 8.08%). There were no significant differences between asthmatics and non-asthmatics in gender, age, smoking habits, associated comorbidities, length of hospital stay, development of disease complications, invasive and/or non-invasive ventilation, treatment with hydroxychloroquine, antivirals or biologics or mortality.

Impact of SARS-CoV2 infection in asthmatic patients at the Hospital La Paz in Madrid

Background: COVID-19 is an infectious disease caused by the SARS-CoV- 2 virus. It presents a wide clinical spectrum from asymptomatic cases to severe pneumonia and even death. Since the report of its first cases in 2019, risk factors for mortality or clinical failure have been described. Asthma, as a respiratory disease, could be a risk factor for developing severe COVID-19 disease. Thus, the aim of this study was to evaluate the impact of COVID-19 disease in asthmatic patients Method: 173 electronic medical records (DXC-HCIS- Healthcare Information System) of asthmatic patients were individually reviewed and demographic and clinical data were extracted: sex, age, smoking habit, comorbidities (obesity, rhinosinusitis, nasal polyps, COPD and T2 or non T2-asthma), previous asthma treatment (inhaled therapy, oral corticosteroids (OCS), biological therapy, azithromycin and anti-leukotriene use), number of previous exacerbations, blood eosinophils and serum Total-IgE levels. Severity of infection was registered according to the presence of pneumonia, need for hospitalization, intensive care unit (ICU) admission and mortality. Result(s): Higher risk of pneumonia was found in males (p = 0.004), smokers (p = 0.025) and previous treatment with inhaled corticosteroids (ICS) + long-acting s-agonist (LABA) (p = 0.001). We did not find higher risk of pneumonia for obesity, COPD, T2 asthma, OCS treatment, or previously elevated number of exacerbations or eosinophils (> 250/mcl). Higher risk of hospitalization was found among males (p = 0.048), smokers (p < 0.001) or patients with previous ICS+LABA treatment (p = 0.003) and lower risk of hospitalization in T2 asthmatic patients (p = 0.002) and those previously treated with ICS (p = 0.005). Although there were non-significant associations, there was a relation between obese patients and hospitalization risk (p = 0.064). There was no increased risk of death or ICU admission in asthmatic patients adjusted for gender, smoking, obesity, T2 asthma, type of previous treatment and number of exacerbations Conclusion(s): Asthmatic patients present a higher risk of pneumonia and hospitalization if they are male, smokers or undergoing ICS+ LABA treatment. Asthmatics with T2 asthma and previous treatment with ICS alone have a lower risk of hospitalization. Further studies with a higher number of patients are needed to explore deeply the impact of COVID-19 on asthma outcomes.

Evaluation of Incidence and Complications during COVID-19 Desease in Patients with Asthma

Background: COVID-19 is presented by a wide clinical spectrum from asymptomatic cases to severe pneumonia and even death. Since the report of its first cases in 2019, risk factors for mortality or clinical failure have been described. Asthma, as a respiratory disease, could be a risk factor for developing severe COVID-19 disease. Thus, the aim of this study was to evaluate the impact of COVID-19 disease in asthmatic patients. Method(s): 173 electronic medical records (DXC-HCIS- Healthcare Information System) of asthmatic patients were reviewed and demographic and clinical data were extracted: sex, age, smoking habit, comorbidities (obesity, rhinosinusitis, nasal polyps, COPD and T2 or non T2-asthma), previous asthma treatment (inhaled therapy, oral corticosteroids, biological therapy, azithromycin and anti-leukotriene use), previous exacerbations, blood eosinophils and serum Total-IgE levels. Severity of infection was registered according to the presence of pneumonia, need for hospitalization, intensive care unit (ICU) admission and mortality. Result(s): Higher risk of pneumonia was found in males (p=0.004), smokers (p=0.025) and previous treatment with inhaled corticosteroids (ICS) + long-acting s-agonist (LABA) (p=0.001). Higher risk of hospitalization was found among males (p=0.048), smokers (p<0.001) or patients with previous ICS+LABA treatment (p=0.003) and lower risk of hospitalization in T2 asthmatic patients (p=0.002) and those previously treated with ICS (p=0.005). Conclusion(s): Asthmatic patients present a higher risk of pneumonia and hospitalization if they are male, smokers or undergoing ICS+LABA treatment. Asthma T2 and previous treatment with ICS are related with a lower risk of hospitalization.

Smoking habits during the COVID pandemic: data from Greek healthcare professionals' population

Background: Although smoking is associated with more severe outcomes of COVID-19, little is known about smoking habits during the COVID pandemic. Healthcare professionals (HCPs) are significant role models for the society and their smoking habits are critical concerning the general public attitudes. Aim(s): to determine the smoking levels of HCPs, to assess the effect of the pandemic on their smoking attitude and to evaluate possible associations with their psychological status. Method(s): An anonymous online survey was conducted among HCPs of Northern Greece in 2020 by emails delivered from the local medical and nursing stuff associations including basic information (age, gender, marriage, education level, etc.), smoking status (Heaviness of Smoking Index (HSI)) contact with COVID-19 patients, quarantine status, current physical condition, Sleep Condition Indicator (SCI), DAR-5 (anger), PHQ-4(depression and anxiety), Loneliness scale (LS). Result(s): 1057 HCPs answered (males 45.3%) 79% doctors with mean age 45.2+/- 11.7years and HIS 2.4+/-1.7. 32% of HCPs smoked: 24.9% smoked more cigarettes during the pandemic, 14.2% smoked less, 7% stopped smoking and 54% did not change their smoking habits. There was an association between alcohol use and smoking (p=0.002). A weak but significant correlation was found between LS and HIS (r=0.22, p=0.02) and especially with 'how soon after you wake up do you have your first cigarette' (r=0.28, p=0.001). SCI, LS and PHQ-4 of HCPs that smoked more were significantly higher compared with the other groups. Conclusion(s): During the pandemic, most of the HCPs that smoked continued their smoking habits as before, 25% increased their cigarettes and only 7% stopped.

Evolution of asthmatic patients at 6 and 12 months after acute COVID-19 recovery

Nowadays, beyond the acute phase of COVID-19, there is a growing interest in the clinical manifestations that appear after the recovery of this phase, giving the potential repercussions that this could have in the recovered population. Asthma is a prevalent disease, and it is possible that its pathogenic basis could affect the postCOVID-19 course. Objective(s): evaluate the evolution of asthmatic patients at 6 and 12 months after the recovery of COVID-19. Method(s): Data was collected through manual revision of electronic clinical histories. There were included as demographic features the age and sex, and comorbidities such as smoking habit, COPD, obesity (BMI > 30 Kg/m2), obstructive sleep apnea, gastroesophagic reflux, rinosinusitis, nasal poliposis, anxiety and depression. Patients were classified according to whether they had T2 asthma or not. There were considered previous pneumonia, need of conventional hospitalization or ICU. Symptoms (chest pain, cough, sputum production and dyspnoea) and the development of further complications were also recorded. Result(s): After analyzing the variables at 6 months after recovery, we found statistical significance in the presence of chest pain in patients with previous COVID-19 pneumonia (p=0.009). In the same period, lower eosinophil blood levels were found in patients that had dyspnoea (p=0.043). Additionally, there was a significant association between smoking habit and pulmonary embolism at 12 months after recovery (p=0.025). Conclusion(s): Developing COVID-19 associated pneumonia in asthmatic patients is related to the presence of chest pain at 6 months after recovery. Also, the smoking habit seems to be associated with thromboembolic disease in postCOVD-19 period.

Tobacco smoking and severity of COVID-19: Experience from ICU department in a referral hospital during the third pandemic wave

Aim: To investigate the association between tobacco smoking habits and severity and mortality of COVID-19 disease among ICU hospitalized patients. Material: Baseline sociodemographic, co-morbidities and clinical characteristics of 222 adult (70 women) COVID-19 hospitalized patients, aged 69+/-8yrs, mean ICU length of stay 35+/-12 days, were retrospectively collected and analyzed from 01/08/2020-01/08/2021. Also, information about caregivers' tobacco smoking behaviors were obtained. Result(s): 57 patients were current smokers (35+/-4 pack/yrs) and 61 ex-smokers(28+/-9pack/yrs). E-cigarette users were 18 patients (2 ex-smokers), dual users 22 (all current smokers). 37 continued to smoke up to hospital admission. Arterial hypertension (47/35) diabetes (44/24), betamuI>30 (22/34), coronary disease (40/22) and COPD (41/28) noted as main comorbidities in current smokers and ex-smokers. CT findings of pulmonary emphysema were detected in 31% of current and ex-smokers. 51% (113) of total patients died, aged 71+/-4 yrs, and ICU length of stay 40+/-15 days. Current smokers and ex-smokers were hospitalized in ICU for a longer period 29+/-7 days (p=0.001). APACHE II (48+/-8) and SOFA score (11+/-3) were higher in current smokers and ex-smokers (p=0.003). 53% of ICU patients had a family member that smoked, and 35% of them were willing to undergo a Tobacco Prevention and Cessation Program. 90% of current smokers after ICU discharge quitted smoking. Conclusion(s): Tobacco smoking is a serious comorbidity in ICU patients hospitalized for covid 19 disease, with both current smokers and ex-smokers reveal more severe rates of mortality and morbidity.

Identification of Multi Drug Resistant Bacteria from Drinking Water Samples - A Microbial Survey

Antimicrobial resistance may result from rising resistance patterns of commercially available antibiotics, which is one of the most serious threats to global health and should not be overlooked while the world is focused on the COVID-19 disaster. Waterborne resistant bacteria have been shown to be capable of spreading to people in a lot of circumstances, particularly crowded places in urban living environment with heavy human behavior, such as drinking in public systems and swimming pools. Four hundred drinking water samples were collected from different zones in district Lahore, Pakistan. Multidrug resistance bacterial strains of waterborne pathogens have been isolated and characterized on the basis of colony characteristics, microscopic visuality and biochemical tests. The outcomes of this project revealed that Staphylococcus aureus was (26%), Escheria coli was (45%), Salmonella typhi (15%), Shigella dysenteriae (10%) and Enterococcus faecalis (4%) in district Lahore, Pakistan. These multidrug resistance bacteria showed high resistant patterns against amoxicillin, penicillin, streptomycin, tetracycline, erythromycin, gentamycin, amikacin whereas susceptible for chloramphenicol, cefixime, ofloxacin and ciprofloxacin. The prevalence of associated risk factors such as polluted drinking water (32%), children<5year age (22%), adults >45year age (18%), excessive use of antibiotics (8%), health status of individual (5%), smoking habits (6%), and emotional variables (6%) were observed in this research. These investigations have demonstrated infectious bacterial contamination in surface and groundwater, which caused significant bowel syndrome.Copyright © 2022 Indian Veterinary Assocaition. All rights reserved.

Underdiagnosis of chronic obstructive pulmonary disease: a problem that persists

Introduction and objective: Chronic obstructive pulmonary disease (COPD) is a public health problem of the first order and underdiagnosis of this disease is a universal phenomenon. The objective of our study is to determine the prevalence of COPD and to analyze the clinical, radiological and functional characteristics of patients without a previous diagnosis of COPD and diagnosed with this disease in the post-COVID follow-up consultation, and to compare them with patients without COPD. Methods and materials: A study was carried out of the patients referred to the post-COVID consultation who were diagnosed with COPD in said consultation between the months of June 2020 and February 2021. The variables included were: sex, age, smoking habit, pack-year index (IPA), degree of dyspnea according to the mMRC scale, function and characteristics in chest CT. Result(s): Of the 371 patients evaluated in the post-COVID follow-up consultation, 23 of them, 11%, were diagnosed with COPD. 61% were men with a mean age of 60 +/- 11 years, 17% being active smokers, 56% ex-smokers with a mean IPA of 26 +/- 15. The rest of the variables are shown in Table 1. Significant differences were found between patients with and without COPD in terms of smoking (p<0.001) and lung function (p=0.002). No significant differences were found in the rest of the variables. 21% of COPD patients had emphysema on chest CT. Conclusion(s): The diagnosis of COPD was established in 11% of the patients evaluated in the post-COVID consultation.

Impact of the COVID-19 pandemic on alcohol use and smoking habits

Background: It is very important to monitor changes in substance use during the pandemic period, as individuals dealing with substance use may be at greater risk for COVID-19, and stress factors and changes resulting from the pandemic may cause alterations in substance use models. Method(s): In this review, the existing literature on how COVID-19 affected people's alcohol consumption, smoking, and vaping use in different societies was evaluated. Articles that are relevant to the subject were searched using PubMed, ScienceDirect and Google Scholar and reviewed. Result(s): It was observed that due to COVID-19, there may be no alterations in these substance use types or it may result in a decrease of consumption of substances or a quit attempt due to health concerns about COVID-19 or it may cause an increase in the alcohol, or cigarette consumption. Conclusion(s): With this review we hope to present detailed information on the impact of the pandemic on alcohol consumption, and cigarette or e-cigarette use from various studies conducted in different societies all around the world and highlight the importance and necessity of new studies on this subject. Copyright © 2023 Taylor & Francis Group, LLC.

Association Between Smoking and SARS-CoV-2 Infection: Cross-sectional Study of the EPICOVID19 Internet-Based Survey.

BACKGROUND: Several studies have reported a low prevalence of current smoking among hospitalized COVID-19 cases; however, no definitive conclusions can be drawn. OBJECTIVE: We investigated the association of tobacco smoke exposure with nasopharyngeal swab (NPS) test results for SARS-CoV-2 infection and disease severity accounting for possible confounders. METHODS: The nationwide, self-administered, cross-sectional web-based Italian National Epidemiological Survey on COVID-19 (EPICOVID19) was administered to an Italian population of 198,822 adult volunteers who filled in an online questionnaire between April 13 and June 2, 2020. For this study, we analyzed 6857 individuals with known NPS test results. The associations of smoking status and the dose-response relationship with a positive NPS test result and infection severity were calculated as odds ratios (ORs) with 95% CIs by means of logistic and multinomial regression models adjusting for sociodemographic, clinical, and behavioral characteristics. RESULTS: Out of the 6857 individuals (mean age 47.9 years, SD 14.1; 4516/6857, 65.9% female), 63.2% (4334/6857) had never smoked, 21.3% (1463/6857) were former smokers, and 15.5% (1060/6857) were current smokers. Compared to nonsmokers, current smokers were younger, were more educated, were less affected by chronic diseases, reported COVID-19-like symptoms less frequently, were less frequently hospitalized, and less frequently tested positive for COVID-19. In multivariate analysis, current smokers had almost half the odds of a positive NPS test result (OR 0.54, 95% CI 0.45-0.65) compared to nonsmokers. We also found a dose-dependent relationship with tobacco smoke: mild smokers (adjusted OR [aOR] 0.76, 95% CI 0.55-1.05), moderate smokers (aOR 0.56, 95% CI 0.42-0.73), and heavy smokers (aOR 0.38, 95% CI 0.27-0.53). This inverse association also persisted when considering the severity of the infection. Current smokers had a statistically significantly lower probability of having asymptomatic (aOR 0.50, 95% CI 0.27-0.92), mild (aOR 0.65, 95% CI 0.53-0.81), and severe infections (aOR 0.27, 95% CI 0.17-0.42) compared to those who never smoked. CONCLUSIONS: Current smoking was negatively associated with SARS-CoV-2 infection with a dose-dependent relationship. Ad hoc experimental studies are needed to elucidate the mechanisms underlying this association. TRIAL REGISTRATION: ClinicalTrials.gov NCT04471701; https://clinicaltrials.gov/ct2/show/NCT04471701.

The impact of COVID-19 on adults with vision and/or hearing impairment in California

Purpose : To explore associations between sensory impairment (vision and/or hearing) and Coronavirus disease 2019 (COVID-19) in the adult 2020 California Health Interview Survey (CHIS) population. Methods : A cross-sectional study was conducted using the 2020 CHIS, the nation's largest state health survey with a sample representative of the population of California. The exposure of interest was having sensory impairment, defined as answering “Yes” to the question, “Are you blind or deaf, or do you have a severe vision or hearing problem?” The outcome of interest was whether a health professional suspected the respondent had COVID-19, assessed among those adults who had or thought they had COVID-19 and contacted a health professional. Logistic regression models were constructed to determine the odds of suspected COVID-19 by sensory impairment status, controlling for the following covariates: age, sex, race/ethnicity, self-reported general health status, current smoking habits, overweight/obese body mass index, and current health insurance status. All analyses were weighted according to the CHIS sampling design. Results : A total of 21,949 sampled participants were included, representing a weighted estimate of 29,684,882 individuals. The weighted prevalence of sensory impairment was 5.9% (95% confidence interval [CI] 5.4-6.4%). Approximately 10.9% (95% CI: 10.3-11.6%) of all participants had or thought they had COVID-19, 4.9% (95% CI: 4.5-5.3%) contacted a health professional about COVID-19 concerns, and 1.7% (95% CI: 1.4-2.0%) were suspected of having COVID-19 by a health professional. Regression analyses were performed in a subgroup of 988 participants representing 1,431,690 individuals who had or thought they had COVID-19 and contacted a health professional. Those with sensory impairment had 2.12 times the unadjusted odds of suspected COVID-19 compared to those without sensory impairment (odds ratio [OR]: 2.12, 95% CI: 0.98-4.63). Those with sensory impairment had 2.51 times the adjusted odds of suspected COVID-19 compared to those without sensory impairment (adjusted OR: 2.51, 95% CI: 1.03-6.10). Conclusions : In the 2020 CHIS adult population, individuals with vision and/or hearing impairment had greater odds of having COVID-19 suspected by a health professional. Additional studies are necessary to triangulate these findings and further explore this possible increased risk for COVID-19 in this vulnerable population.

THE COURSE of COVID-19 in A COHORT of SPONDYLOARTHRITIS PATIENTS: A CASE-CONTROL PROSPECTIVE STUDY

Background: With the outbreak of the SARS-CoV-2 pandemic, the rheumatol-ogists' attention was directed at understanding whether infected patients could have a less favorable outcome. Available data seem to indicate that the course in rheumatic patients is not dissimilar from that in the general population. However, data on the outcome of COVID-19 in patients with spondyloarthritis (SpA) are scant. Objectives: To describe the outcome of COVID-19 in patients with SpA in terms of hospitalization, need of oxygen therapy, and symptoms compared to a control group. The variation in disease activity before and after COVID-19 was also assessed. Methods: We enrolled adult patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS) classifed according to standard criteria, that received a diagnosis of COVID-19 through molecular or rapid antigen swab tests between September 2020 and January 2022. Demographic and clinical data, including age, body mass index (BMI), smoking habit, comorbidities, rheumatic treatment at diagnosis of COVID-19, date of COVID-19 diagnosis, symptoms and additional therapy during the infection and vaccination status were collected through a questionnaire and recorded on an electronic database. Disease activity, assessed by DAPSA in PsA patients and by BASDAI and ASDAS in AS patients, was evaluated before and at the frst visit after the infection. As controls, individuals with COVID-19 but with no known diagnosis of rheumatic/autoimmune disease were recruited using the 'best friend' system. Results: Sixty-two patients were enrolled [43 with PsA and 19 with AS;F:M=40:22;median age 51 years, 25th-75th percentile 39.5-61;median BMI 25.5, 25th-75th percentile 21.75-28;median disease duration 90 months, 25th-75th per-centile 36-192;6 (9.7%) smokers, 37 (59.7%) non-smokers, 19 (30.6%) past smokers;15 (24.2%) only treated with one conventional DMARD, 27 (43.5%) with bDMARDs and 20 (32.3%) with both;44 (71%) had received no vaccine, 18 (29%) one or more doses of vaccine]. Forty-eight controls were also recruited [F:M=29:19;median age 48 years, 25th-75th percentile 41.5-57;median BMI 23.86, 25th-75th percentile 20.69-28.03;10 (20.83%) smokers, 28 (58.33%) non-smokers, 10 (20.83%) past smokers;43 (89.6%) had received no vaccine, 5 (10.4%) one or more doses of vaccine]. Among patients, 10 (16.1%) were hospitalized, of whom 8 (80%) required noninvasive oxygen therapy. Among controls, 7 (14.5%) were hospitalized, of whom 5 (71.4%) required noninvasive oxygen therapy. No differences were observed compared to the control group in terms of hospitalization and need for oxygen support. Likewise, the two groups did not bear any statistically signifcant difference in terms of symptoms (fever, dys-geusia, dyspnoea) and cardiovascular and respiratory comorbidities. BMI and smoking habit did not influence the outcome of COVID-19 in SpA patients, while a BMI of 25 or above was associated with hospitalization in the control group (p=0.0004, RR 3.417). Baseline treatment with immunosuppressants did not influence the disease outcome. DAPSA, ASDAS, and BASDAI did not signif-cantly change after the infection (Table 1). We did not record any COVID-19-re-lated death in either group. Conclusion: Our data show that patients with SpA do not face a worse prognosis of COVID-19 than subjects without rheumatic/autoimmune diseases and that demographic and clinical features did not influence the course of the disease.

REMOTE MONITORING TOOLS in RA PATIENTS: FACIT-FATIGUE and HAQ

Background: The need to avoid the transmission of COVID19 infection has forced to promote teleconsultations for rheumatic diseases follow-up. However, remote monitoring for rheumatic diseases which require clinical examination, as rheumatoid arthritis (RA), may affect to the evaluation of clinical activity, including the biological therapies follow-up. Due to that, count on tools as Patient Reported Outcomes (PROs) could help the remote monitoring of patients when it is not advisable their physical presence in health centers, being a great help in RA control. Objectives: We aim to assess the association among the tiredness, disability and pain perception with the clinical activity in RA patients. Methods: We performed a prospective observational study of three months of follow-up in RA patients (ACR/EULAR 2010) who are newly on biological or anti-JAK therapy. A basal visit and 1, 3 months follow-up visits were conducted. We analyzed changes during follow-up in the PROs parameters reported by patients through FACIT-fatigue and HAQ questionnaires, as well as pain VAS (0-10). Moreover we measured clinical activity through Das28, Das28-CRP, SDAI and CDAI index. Results: We included 60 patients (83.3% female), with a mean age of 55 (13) and mean disease evolution of 13 (11) years. At the basal visit, 55% of them exhibited increased levels of CRP and the 48.3% of ESR, showing moderate or high clinical activity the 83.3% of the total patients. 39 patients started anti-JAK therapy and 21 with TNF-α inhibitors. The 33.34% of patients were under monotherapy, and the 46.67% previously have been treated with biological therapy. The 77.36% of the total number of patients was on the biological therapy at 6 months of follow-up, while the 22.64% discontinued at 6 months of follow-up (9 due to inefficacy and 3 due to adverse effects). 48 patients continued the treatment in the 6 months after, and 12 patients discontinued due to ineffectiveness or drug intolerance. Clinical activity, fatigue, disability and pain perception are shown in Table 1. Using a mixed linear regression model the association among the fatigue, disability and pain perception with clinical activity was conducted, corrected by age, smoking habits, time of disease evolution, BMI, previous biological/anti-JAK therapy administration and current dose of steroids. We observed a signifcant association among clinical activity and fatigue (P<0.001), disability (P<0.001) and pain perception (P<0.001). The statistical analyses showed a signifcant association where a high fatigue is increased in cases with high pain perception (P>0.001) and high number of swollen joints (P=0.002), but not in high levels of CRP and ESR. Fatigue was higher in those cases whom discontinued treatment (P=0.044) regardless of which therapy was chosen. No effect of age, time of disease evolution, steroid dose, BMI or previous therapy and smoking habits in the PROs values was observed. Conclusion: PROs would be helpful in the disease control in those cases where a remote monitoring is needed, since HAQ or FACIT-FATIGUE index showed a signif-cant association with clinical activity index in RA. Because of its ease for shipping and handling by the health professional, PROs could be a useful tool in the disease control. Its implementation in the remote monitoring of RA patient, as has been the case of Covid19 pandemic, results in an improvement of the clinic evaluation of RA patient, due to required information to clinical management is reported, avoiding presence consultation in those situations when it is required.

IMPACT OF ENVIRONMENTAL CHANGES FORCED BY PANDEMIC RESTRICTIVE MEASURES ON THE DEVELOPMENT AND COURSE OF IRRITABLE BOWEL SYNDROME

Background and aim: Irritable Bowel Syndrome (IBS) is a highly prevalent disorder that greatly affects patients’ quality of life, causing a significant burden to healthcare systems worldwide. Its pathophysiology is incompletely understood but symptoms seem to be the result of an interplay between environmental and patientrelated factors. This study aimed to analyse the influence of lockdown-forced changes in lifestyle habits and COVID-19 pandemic stress on the development of IBS manifestations. Materials and methods: An online survey was sent to groups of people representative of the general population. It contained questions regarding sociodemographic data, dietary habits, alcohol consumption, smoking habits, physical activity, sleeping hours, working activities, stress level and GI symptoms, related to both the pre-pandemic and lockdown period. A P-value<0.05 was considered statistically significant. Uni and Multivariate Cox methods and Wald test were used to evaluate the association between exposure variables and IBS occurrence/resolution. Results: From April 1st to 30th, 2020, 2735 participants completed the survey(mean age:39.7±16.1 years, F:M=2:1). During lockdown 122 IBS patients (46.2%) reported improvement of symptoms while 118 negative subjects (4.8%) developed IBS. Age,gender,BMI,employ ment,teleworking and smoking were not associated with IBS incidence or resolution. Reduced general stress(OR=2.23,95%CI 1.09- 4.56,P=0.029), increased fibers intake(OR=2.83,95%CI 1.60- 5.02,P<0.001) and increased hours of sleep(OR=2.00,95%CI 1.07-3.76,P=0.031) were associated with a high probability of resolution of IBS, while increased intake of anxiolytic pills(OR=0.14,95%CI 0.04-0.46,P=0.001) showed a low probability of resolution of IBS. Reduced physical activity(OR=2.04,95%CI 1.30-3.19,P=0.002), increased anti-inflammatory (OR=2.38,95%CI 1.39-4.10,P=0.002), anxiolytic pills intake(OR=3.52,95%CI 2.08-5.95,P<0.001) and increased work related stress(OR=1.81,95%CI 1.16-2.83,P=0.009) were risk factors for IBS occurrence. Finally, the resolution of IBS did not affect the onset of upper GI functional symptoms(OR=0.18,95%CI 0.11-0.31,P<0.001). (Figure Presented) Conclusions: Lifestyle changes forced by COVID-19 lockdown resulted in a beneficial effect in almost half of IBS patients, whereas they favoured the development of IBS in 5% of healthy subjects, thus confirming that environmental factors play a pivotal role in the pathophysiology of IBS. In particular, stress, fibres and alcohol intake seem to be able to influence IBS occurrence or resolution.

Periodontal disease and clinical association with COVID-19 infection

SARS-CoV-2 infection can cause long-standing damage to the immune system characterized by increased inflammatory cytokine activation. Maintaining periodontal health may reduce host susceptibility to COVID-19 and prevent COVID-19 aggravation in infected patients. There is sufficient evidence in the literature to warrant an association between the presence of PDs and the development and course of respiratory illnesses. Optimum oral health, maintaining good systemic health, and elimination of smoking habits may be beneficial for the prevention and management of COVID-19 infections. Future studies on the periodontal status of patients with COVID-19, including from mild to severe forms, could allow the opportune identification of people at risk of severe illness and generate relevant recommendations. The connection, if any, between the oral microbiome and COVID-19 complications is urgently required to establish the importance of oral hygiene and pre-existing oral disease in the severity and mortality risk of COVID-19.

COVID-19 pandemia impact on patients included in heart rehabilitation programme

Background/Introduction: COVID-19 PANDEMIA has significant cardiovascular implications. Patients with acute or latent infection may present with myocardial injury, endothelial dysfunction and thrombotic complications. Health systems in many places have been overwhelmed and prevention has been pushed aside in favor of urgent care. In many cases, the usual activity of heart rehabilitation programmes is affected. Some programmes have stopped, some have managed to perfom e-rehailitation. Our programme stopped during confinement and restarted on face-to-face mode in June 2020 with adjustments (reduction of capacity, reduction of sessions, hygienic measures) Purpose: Our objective is to analyze the main characterisitcs and main results of the patients included on heart rehabilitation programmes inmediately before and inmediately after the beginning of COVID-19 pandemia and check if the changes made to the programme affected the results of the patients Methods: Retrospective descriptive cohort of consecutive patients admitted to cardiac rehabilitation in the second half of 2019 compared with patients who started inmediately after the pandemia beginning in our city (second half of 2020), The selection criteria are: 1) patients who have started rehabilitation within the established periods. 2) complete cardiac rehabilitation programme. Baseline, ergometric and echocardiographic characteristic are analyzed. Results: 131 patients werw included, 59 in second half 2019 group (2019 group) and 72 in the second half 2020 group (2020 group). The mean age of the 2020 group was lower, without reaching statistical significance (65 +/-13 vs 62 +/-10 p=ns). In the “2019 group” 52(88%) males were included vs 58 males (81%) included in the “2020 group”. The initial burden of cardiovascular risk factors (hypertension, diabetes, dyslipemia, smoking habit) was similar ( see Table 1). The main reason for inclusion in cardiac rehabilitation programme was ischemic heart disease in both groups (49 (83%) VS 57 (79%), p= ns), and the number of vessel affected was similar ( see Table 1). Patients with ventricular ejection fraction less than 50% were similar, too. Initial functional capacity (initial METS) and final functional capacity ( final METS) showed no differences, neither mean BMI. The initial and final lab test parameters analyzed here (LDL-choleterol and HDL-cholesterol) showed no differences between the 2 groups. Conclusion(s): Our group opted to maintain a face-to-face cardiac rehabilitation programme with adaptations (reduction of capacity, reduction of sessions, hygienic measures among others. Despite this adaptation, the baseline characteristics of the patients included, the reason for inclusion on the programme and the main results showed no differences between both groups. (Figure Presented).

Managing complexity: the experience of the Internal Medicine unit of Cesena (AUSL Romagna-Italy) during the SARS-CoV-2 pandemic

Aim of the study: The impact of COVID-19 pandemic put the Italian health system to the test. A retrospective analysis of an Internal Medicine ward experience in north of Italy is described. Materials and Methods: Between september 2020 and june 2021, the Internal Medicine unit of the M. Bufalini Hospital of Cesena managed 954 COVID-19 patients;339 of the totals were hospitalized in sub-intensive area, treated with high flow nasal cannula (25,5%) and non-invasive ventilation support (28,8%). To allow the management of these patients, compared to pre-pandemic, 47 beds and 24 to ordinary and sub-intensive area respectively were added. Results: Patients had an average age of 66 years and 62% of the total was female;prevalent comorbidities were arterial hypertension (53%), smoking habit (28,7%), obesity (27.9%), uncomplicated (10%) and complicated diabetes (9%). Hospitalization lasted about 7 days in the ordinary ward and 13 in the sub-intensive area. The overall mortality rate was 11%. In the considered period, the mean percentage of deaths compared to hospitalizations in Italy was equal to 22.21%. Conclusions: Our organizational model included different areas of intensity care in the same ward, various specialist skills as the pre-existing ability to manage non-invasive ventilation and bedside ultrasound knowledge, as well as an unitary organization and additional nursing assistance well trained. This allowed management of the “complex” COVID patient and even the mortality rate may be the result of this model. These features mark what modern internal medicine should be like.