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1.
Clinical and Experimental Rheumatology ; 40(10):79, 2022.
Article in English | EMBASE | ID: covidwho-2067781

ABSTRACT

Background. Hearing dysfunction, caused by the involvement of the vestibulocochlear nerve or by direct damage on inner ear structures has been described in patients with Sjogren's Syndrome (SS). Previous studies evaluating the prevalence and incidence of hearing dysfunction in SS showed conflicting results, therefore, to date, the exact prevalence has not been extensively evaluated. Objectives. The aim of this study is to evaluate the prevalence of hearing involvement in patients with primary SS (pSS). Materials and methods. Patients with pSS (AECC criteria) with >=18 years of age attending a dedicated Sjogren's syndrome clinic were consecutively enrolled Auditory function was investigated by pure tone audiometry (PTA), It-Matrix test (Speech Reception Threshold in noise leading to 50% correct sentences-SRT) and the Hearing Handicap Inventory (HHI) during a baseline visit and at a follow up visit. A questionnaire of auto-evaluation of hearing loss impact on life was also administered to the patients. Results. Twenty-five patients with pSS (24 females) were enrolled in the study. The median age was 56.2 years (IQR 49-64) The mean disease duration was 3.7 years, 8 were treated with hydroxychloroquine (HCQ) and 1 with methotrexate. At baseline evaluation PTA revealed hearing loss in 17 patients (68%) with severity ranging from mild to severe. Fifteen patients (60%) presented mild hearing loss, 1(4%) moderate e 1 (4%) severe. The It-Matrix score ranged from -9.9 to 0.9 (median - 3.50). Median HHI score was 12.17 (min 0, max 68, SD 177.9). For Covid restrictions, a follow-up evaluation was available for 10 patients only. In these patients, a worsening of PTA and HHI was observed. Interestingly, the it-Matrix scores of patients with a stable disease showed an improvement. Conclusions. These preliminary findings suggest that hearing involvement is common in patients with SS and that it progresses over time. If confirmed on larger cohorts, these data will be useful for physicians in counseling patients about their disease and, in case of suspicious symptoms, an early evaluation by an otolaryngologist may prevent delay in diagnosis and allow an appropriate diagnostic evaluation and therapeutic intervention.

2.
Clinical and Experimental Rheumatology ; 40(10):84, 2022.
Article in English | EMBASE | ID: covidwho-2067776

ABSTRACT

Objectives. To investigate the safety and efficacy of SARS-Cov-2 vaccination in a large international cohort of patients with primary Sjogren syndrome due to scarcity of data in this population. Methods. By the first week of May 2021, all Big Data Sjogren Consortium centers had been contacted and asked for Registry patients to be included in the study if they had received at least one dose of any SARS-CoV-2 vaccine. The in-charge physician asked patients about local and systemic reactogenicity, using a pre-defined electronic questionnaire to collect epidemiologic data, COVID 19 vaccination data, and COVID 19 vaccination side effects. Adverse events were defined as those reported by the patient at the site of injection within 7 days from vaccination (reactogenicity) as local adverse events, systemic symptoms as systemic side effects, and postvaccination AEs of special interest related to SS as SS flares. Results. The vaccination data of 1237 patients (1170 women, with a mean age at diagnosis of primary SjS of 50.5 13.2) were received. A total of 835 patients (67 percent) reported any adverse event, including local (53 percent) and systemic (50 percent) AEs. Subjective symptoms (63%) were the most common local AEs, followed by objective signs at the injection site (16%) and general symptoms were the most commonly reported systemic AEs (46 percent), followed by musculoskeletal (25 percent), gastrointestinal (9 percent), cardiopulmonary (3 percent), and neurological (2 percent). People under 60 years old had a higher risk of developing AE after vaccination (OR 2.48, CI 95 1.89-3.27 percent), as did those with low systemic SS activity (OR 1.62, CI 95 1.22-2.15) and those who received mRNA vaccines, according to a multivariate analysis (OR 1.57, CI 95 percent 1.12- 2.18). The risk of developing systemic AEs was also higher in women (OR 2.85, CI 95 percent 1.60-5.2346), White people (OR 1.73, CI 95 1.14-2.65), and those who received a deficient vaccination regimen (OR 1.78, CI 95 1.12-2.88 percent). In addition to 141 (11%) patients who reported a significant worsening/exacerbation of their pre-vaccination sicca symptoms as a result of post-vaccination SS flares, 15 (1.2%) patients (13 women, mean age at vaccination 41.9 years) reported active involvement in the glandular (n=8), articular (n=7), cutaneous (n=6), pulmonary (n=2), and peripheral nervous system (n=1) domains as post-vaccination systemic flare. All side effects and flares subsided within 1-3 weeks, with no lasting effects or deaths. In terms of vaccination efficacy, breakthrough SARS-CoV-2 infection was confirmed after vaccination in three (0.24 percent) patients, all of whom recovered completely, and positive anti-SARS-Cov-2 antibodies were detected in approximately 95 percent of vaccinated SjS patients, according to data available. Conclusions. SARS-CoV-2 vaccination in patients with primary SjS, like other vaccines with adequate response and no safety signals, raised no concerns about the vaccine's efficacy or safety.

3.
Clinical and Experimental Rheumatology ; 40(10):82, 2022.
Article in English | EMBASE | ID: covidwho-2067775

ABSTRACT

Introduction. Vaccination against SARS-CoV2 is beneficial for patients with autoimmune disease. Therefore, we recommended basic immunization as soon as it has become available for our patients. We preferred mRNAbased vaccination based on the international recommendations. However, several patients received other types of vaccines at their own or their general practitioner's discretion. Based on the antibody levels against the SARSCoV2 spike protein measured at the Institute of Laboratory Medicine of our university, we were able to draw initial conclusions about the effectiveness of vaccination regarding our primary Sjogren's syndrome patients. Patients and methods. Antibodies to SARS-CoV2 spike protein were analyzed in the sera of 77 patients with primary Sjogren's syndrome after being vaccinated with two doses between 1st January and 30th April, 2021, at least 30 days after the second vaccination. Antibody responses were classified as high (above 250 U/ml), moderate (between 50 and 250 U/ml) and low (below 50 U/ml). Relying on the SPSS statistical program, we were seeking correlations between the serum levels and the EULAR Sjogren's syndrome disease activity index (ESSDAI) and the potential influence of the different immunosuppressive treatment modalities, respectively. For the statistical analysis, chi2 tests were performed. Result(s): Pfizer vaccine was given to 58 patients, and the rest of our cohort received Moderna (2 patients), Sinopharm (10 patients), Astra Zeneca (6 patients) and Sputnik vaccine (1 patient). High antibody levels were found in 54 subjects (70.1%), moderate levels in 11 subjects (14.3%), and low levels in 12 subjects (15.6%). After having received the Pfizer vaccine, 86.2% had high, and only 5.2% had low antibody levels. One patient vaccinated with Moderna had high, while the other had low antibody level. The majority (55%) of those vaccinated with Astra Zeneca achieved high titers, and 17% were classified as low responders. After immunization with Sinopharm vaccine, 20% of the patients were classified into moderate response category, while the rest (80%) presented low antibody levels. We also measured low value in the serum of the patient that received the Sputnik vaccine. Serum levels of specific antibodies in patients not receiving any specific therapy (14 subjects) did not differ significantly from those treated with antimalarials (18 subjects), methotrexate (19 subjects), azathioprine (6 subjects), or low-dose steroids (20 subjects). Based on our results, the type of immunosuppressive treatment had less effect on the protection developed than the type of vaccination. There was no significant correlation between Sjogren's syndrome disease activity and the degree of specific antibody response to the vaccine. Conclusions. Our initial results suggest that the use of COVID vaccines is safe and effective for Sjogren's syndrome patients, regardless of the treatment used or of the ESSDAI.

4.
Italian Journal of Gynaecology and Obstetrics ; 34(3):235-242, 2022.
Article in English | EMBASE | ID: covidwho-2067680

ABSTRACT

Objective. The lockdown due to COVID-19 has been associated with a reduction of physical activity and a change in eating behaviors, with consequent weight gain, in general and specific populations. The objective of this study was to assess whether women whose pregnancies encompassed the lockdown due to COVID-19 in 2020 had an excess gestational weight gain as compared with those who were pregnant in the same periods of previous years. Materials and Methods. This was a retrospective cohort study based on anony-mous data from the Birth Attendance Certificate (CedAP) information flow which is mandatorily collected in all Italian Regions. In the Autonomous Province of Trento, North-Eastern Italy, more information than those required as a minimum data set are collected, including maternal weight at the first gestational obstetric visit, initial body mass index (BMI), and maternal weight at delivery. We calculat-ed mean gestational weight gain for women whose pregnancy encompassed the 2-month lockdown in 2020 and for those who were pregnant in corresponding periods of the years 2016-2019. Linear and logistic regression models were built to assess the association between lockdown and weight gain or excess weight gain, respectively, adjusting for the potential confounding effect of gestational month at the beginning of lockdown or corresponding period and pre-pregnancy body mass index. Results. In 2020, mean gestational weight gain was not significantly different from the previous years, nor was the likelihood of gaining excess weight. Conclusions. Unlike other populations that increased weight during the COVID-19 lockdown, the Italian population of pregnant women described in this study has a gestational weight gain comparable with that of the previous years. Public health and environmental interventions, as well as dedicated programs taking care of women from conception to post-partum may have a role in the health of future mothers and should be promoted.

5.
Acta Medica Peruana ; 39(2):104-113, 2022.
Article in Spanish | EMBASE | ID: covidwho-2067675

ABSTRACT

Objective: To identify demographic, clinical, laboratory and treatment characteristics associated with mortality in hospitalized patients with SARS-CoV-2 pneumonia in a Level I Hospital of Peruvian Social Security, at La Libertad Network. Material(s) and Method(s): Retrospective cohort study. Cox proportional hazards model was used, calculating crude and adjusted hazard ratios (HR), and the Kaplan-Meier estimator was used to evaluate the overall survival curve and for each factor. Result(s): Of the 158 patients, the diagnosis was confirmed in 79.11%. Nearly 70% (68.99%) were men, the global median age was 65 years (IQR: 52-77), and it was higher in deceased subjects 69 years old (IQR: 61-80 years). Little more than half of this population (53.80%) had comorbidities, such as high blood pressure (27.85%), obesity (22.78%), and diabetes mellitus (13.92%). The median duration of symptoms prior to admission was 9 days (IQR: 6-11 days). HRs were determined for oxygen saturation less than 80% on admission with 0.21 FIO2, leukocytosis with associated lymphopenia, oxygen requirement at 0.80 FIO2 on admission, and moderate-severe ARDS. Such values were 1.54, 1.98, 2.07 and 2.91, respectively. Conclusion(s): The development of moderate-severe ARDS on admission, leukocytosis associated with lymphopenia, less than 80% hypoxemia on admission at 0.21 FIO2, and high-flow oxygen requirement since admission with 0.80 FIO2, were the only risk factors for mortality. Copyright © 2022 by Begell House, Inc.

6.
NeuroQuantology ; 20(10):7528-7533, 2022.
Article in English | EMBASE | ID: covidwho-2067316

ABSTRACT

Background: The coronavirus disease 19 (COVID-19) is a highly transmittable and pathogenic viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which emerged in Wuhan, China and spread around the world. Genomic analysis revealed that SARS-CoV-2 is phylogenetically related to severe acute respiratory syndrome-like (SARS-like) bat viruses, therefore bats could be the possible primary reservoir.The intermediate source of origin and transfer to humans is not known, however, the rapid human to human transfer has been confirmed widely. There is no clinically approved antiviral drug or vaccine available to be used against COVID-19. However, few broad-spectrum antiviral drugs have been evaluated against COVID-19 in clinical trials, resulted in clinical recovery.The liver, the largest internal organ in the body, is essential in keeping the body functioning properly. It removes or neutralizes poisons from the blood, produces immune agents to control infection, and removes germs and bacteria from the blood. It makes proteins that regulate blood clotting and produces bile to help absorb fats and fat-soluble vitamins. Several studies have shown a significant risk of mortality in patients with cirrhosis and in liver transplantation recipients.2, 3, 4 The severity of presentation and risk of mortality is more in patients with decompensated cirrhosis.5,6 COVID-19 had lead to a significant decrease in number of liver transplant surgeries being performed, which would lead to an increased wait list mortality in these patients.

7.
Journal of Clinical Outcomes Management ; 29(5):65-71, 2022.
Article in English | EMBASE | ID: covidwho-2067255

ABSTRACT

Objectives: The aim of this study was to describe the characteristics and in-hospital outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI) during the early COVID-19 pandemic at Piedmont Athens Regional (PAR), a 330-bed tertiary referral center in Northeast Georgia. Method(s): A retrospective study was conducted at PAR to evaluate patients with acute STEMI admitted over an 8-week period during the initial COVID-19 outbreak. This study group was compared to patients admitted during the corresponding period in 2019. The primary endpoint of this study was defined as a composite of sustained ventricular arrhythmia, congestive heart failure (CHF) with pulmonary congestion, and/or in-hospital mortality. Result(s): This study cohort was composed of 64 patients with acute STEMI;30 patients (46.9%) were hospitalized during the COVID-19 pandemic. Patients with STEMI in both the COVID-19 and control groups had similar comorbidities, Killip classification score, and clinical presentations. The median (interquartile range) time from symptom onset to reperfusion (total ischemic time) increased from 99.5 minutes (84.8-132) in 2019 to 149 minutes (96.3-231.8;P= .032) in 2020. Hospitalization during the COVID-19 period was associated with an increased risk for combined in-hospital outcome (odds ratio, 3.96;P= .046). Conclusion(s): Patients with STEMI admitted during the first wave of the COVID-19 outbreak experienced longer total ischemic time and increased risk for combined in-hospital outcomes compared to patients admitted during the corresponding period in 2019. Copyright © 2022 Turner White Communications Inc.. All rights reserved.

8.
Journal of Clinical and Diagnostic Research ; 16(9):OC21-OC24, 2022.
Article in English | EMBASE | ID: covidwho-2067195

ABSTRACT

Introduction: The clinical diagnosis of COVID-19 is supplemented by clinical severity indices. These indices are the National Early Warning Score (NEWS, which aids in risk stratification), CT severity score (radiological severity score), and Reverse Transcription-Polymerase Chain Reaction (RT-PCR) cycle threshold (Ct value, which provides a semi-quantitative measure of viral load). Aim(s): To assess the correlation between NEWS at admission, RT-PCR Ct value and CT severity score in mild and moderate COVID-19 patients. Methods and Materials: This prospective cohort study was conducted in Maulana Azad Medical College and Lok Nayak hospital, New Delhi, from January to June 2021. The study included 50 subjects (25 with mild COVID-19 and 25 with moderate COVID-19). NEWS was calculated at admission and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Ct value was estimated using real-time RT-PCR. CT severity score was calculated based on High Resolution Computed Tomography (HRCT) chest findings. The correlation among the parameters was determined using Pearson correlation formula. Result(s): The mean age of subjects in the mild and moderate COVID-19 groups were 49.52 years and 51.84 years, respectively. The mean RT-PCR Ct value of E gene was 24.48 and Rdrp gene was 24.56 in the mild COVID-19 group;while in the moderate group it was 23.72 for both E gene and Rdrp genes. The correlation between NEWS and Ct value of E gene (r-value=-0.06, p-value=0.68), Ct value of Rdrp gene (r-value=-0.03, p-value=0.79) and the correlation between CT severity score and Ct value of E gene (r-value=-0.05, p-value=0.73), Ct value of Rdrp gene (r-value=-0.06, p-value=0.68) was negative and insignificant. The mean CT severity score in mild COVID-19 group was 3.92, and in moderate COVID-19 group was 9.88. A significant positive correlation was found between the CT severity score and NEWS at admission. Conclusion(s): The clinical severity of COVID-19 as estimated by NEWS corroborates with CT severity score while the relationship between RT-PCR Ct value and clinicoradiological severity needs to be ascertained by further research. Copyright © 2022 Journal of Clinical and Diagnostic Research. All rights reserved.

9.
Acta Haematologica Polonica ; 53(4):273-276, 2022.
Article in English | EMBASE | ID: covidwho-2067065

ABSTRACT

Introduction: As more data is collected, hematologists will be able to gain more insight into the impact of coronavirus disease 2019 (COVID-19) on pediatric patients with hematological malignancies. Material(s) and Method(s): We analysed 21 cases of COVID-19 in pediatric patients with onco-hematological diseases treated in the Western Ukrainian Pediatric Medical Center from March 2020 through May 2021. The majority of patients (71.4%) were diagnosed with acute lymphoblastic leukemia. All patients from the analyzed cohort had an asymptomatic, mild or moderate course of coronavirus-19 infection. The most common symptoms of COVID-19 were fever, cough, gastrointestinal symptoms, and dermatitis. Severe severe acute respiratory syndrome coronavirus 2 increased the risk of liver toxicity and venous thrombosis. Result(s) and Conclusion(s): Our analysis showed that pediatric patients with hematological malignancies need the same treatment approach for COVID-19 as for other infective complications. Copyright © 2022.

10.
Colombian Journal of Anesthesiology ; 50(4) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2067057

ABSTRACT

Introduction: The ventilator-induced lung injury (VILI) depends on the amount of energy per minute transferred by the ventilator to the lung measured in Joules, which is called mechanical power. Mechanical power is a development variable probably associated with outcomes in ventilated patients. Objective(s): To describe the value of mechanical power in patients with SARS-CoV-2 infection and ventilated for other causes and its relationship between days of mechanical ventilation, length of stay in the intensive care unit (ICU), and mortality. Method(s): A multicenter, analytical, observational cohort study was conducted in patients with SARS-CoV-2 infection who required invasive mechanical ventilation and patients ventilated for other causes for more than 24 hours. Result(s): The cohort included 91 patients on mechanical ventilation in three tertiary care centers in the city of Pereira, Colombia. The average value of the mechanical power found was 22.7 +/- 1 Joules/min. In the subgroup of patients with SARS-CoV-2 infection, the value of mechanical power was higher 26.8 +/- 9 than in the subgroup of patients without a diagnosis of SARS-CoV-2 infection 18.2 +/- 1 (p <0.001). Conclusion(s): Mechanical power is an important variable to consider during the monitoring of mechanical ventilation. This study found an average value of mechanical power of 22.7 +/- 1 Joules/min, being higher in patients with SARS-CoV-2 infection related to longer days of mechanical ventilation and a longer stay in the ICU. Copyright © 2022 Lippincott Williams and Wilkins. All rights reserved.

11.
Indian Journal of Otology ; 28(2):130-134, 2022.
Article in English | EMBASE | ID: covidwho-2066877

ABSTRACT

Background: Long-term postsurgical follow-up in chronic otitis media (COM) is crucial in otologic practice for outcome assessment. Validated questionnaires for the same are robust alternatives when physical visits are not feasible such as the current COVID-19 pandemic and we present our findings of outcome assessment using COM outcome test (COMOT)-15 questionnaire through nonphysical mode. Material(s) and Method(s): A retrospective analysis of a cohort of 112 patients of COM who underwent surgery by the single senior otology surgeon between 2009 and 2019 was done using COMOT 15 questionnaire through telephonic methods to circumvent the need of office visits. Result(s): Fifty out of 112 patients could be contacted and consented for the assessment and their COMOT-15 scores were obtained. The numbers of patients with any otologic symptoms and their need for consultations, except hearing loss were significantly less. One-third of the patients had mild to moderate residual hearing loss and its quality of life impacts, although the same neither was statistically significant nor required increased numbers of consultations. Conclusion(s): Bothering symptoms and the need for a frequent visit to the doctor is significantly less with adequate clearance of disease and mastoid obliteration in cases of canal wall down procedures. The residual mild-to-moderate hearing loss are not significant and manageable with day-to-day activities. Successful outcome of COM surgery needs long-term follow-up and evaluation by all practicing otologic departments and surgeons which can well be done through nonphysical modes in unprecedented situations like the current times. Copyright © 2022 Indian Journal of Otology Published by Wolters Kluwer-Medknow.

12.
Open Access Macedonian Journal of Medical Sciences ; 10(E):1374-1379, 2022.
Article in English | EMBASE | ID: covidwho-2066700

ABSTRACT

BACKGROUND: The health care workers are considered as vulnerable people who had higher infecting dose of SARS-CoV-2 infection compared to other society. Among more than 500 deaths of Indonesians physicians, obstetrics and gynecologist (OBGYN) has become the most specialists who died in this pandemic. AIM: The objective of our study is to evaluate the antibodies of SARS-CoV-2 in serum OBGYN residents post-vaccination as well as the presence of infection 3 months after the vaccination. METHODS: A prospective cohort study was conducted in OBGYN residents Universitas Indonesia. Serum antibodies SARS-CoV-2 spike (S) protein receptor-binding domain (RBD) was measured using electrochemiluminescence immunoassay, 21 days after Sinovac vaccination, with basic characteristics being recorded. Within 3 months follow-up, the participants were monthly checked related to post-vaccination infection. RESULTS: The median antibodies SARS-CoV-2 for all participants were 50.72 (19.09–98.57) U/mL. There were 20 residents (24.1%) who had post-vaccination infection within 3 months and dominated by asymptomatic to mild symptoms. Body mass index (r = –0.221, p = 0.044) and sleep hours (r = –0.225, p = 0.041) were found to be inversely correlated with antibodies SARS-CoV-2 S RBD. CONCLUSION: Antibodies SARS-CoV-2 S RBD found to be correlated with BMI and sleep hours. The 3-month post-vaccine infection among OBGYN residents was almost similar to Jakarta’s positivity rate and the efficacy rate was higher than expected by National Agency of Drug and Food Control.

13.
Open Access Macedonian Journal of Medical Sciences ; 10:468-474, 2022.
Article in English | EMBASE | ID: covidwho-2066699

ABSTRACT

BACKGROUND: Coronavirus disease 19 (COVID-19) infection has been a global pandemic since late 2019. Even though most COVID-19 patients recover fully from the disease, approximately 5–10% experience prolonged symptoms for several months following the acute COVID-19 phase, defined as long COVID-19 syndrome. Most of the sequelae are respiratory sequelae. Rehabilitation therapy is needed to overcome their respiratory sequelae and to improve their functional capacity. AIM: This systematic review discusses rehabilitation therapy for long COVID-19 syndrome with respiratory sequelae. METHODS: Using PubMed and Cochrane library, a systematic review was conducted based on PRISMA guidelines. The subject of this research was long COVID syndrome with respiratory sequelae. For rehabilitation therapy for long COVID-19 patients with respiratory sequelae, inclusion criteria were studied. Exclusion criteria were letters to the editor, editorial or commentary reports, and studies not available in full-text and not in English or Bahasa. RESULTS: Nine studies are included in this systematic review comprising two consensus statements or recommendations, one cohort retrospective study, two case studies or case reports, one review, and three experimental studies. The recommended rehabilitation program pathway using a three-tier model depends on the severity of the disease. Several rehabilitation exercises for long COVID patients with respiratory sequelae include cardiorespiratory exercise, breathing exercise, therapeutic exercise, and even traditional Chinese fitness models such as Liuzijue exercise. CONCLUSION: Rehabilitation therapy exercise helps to improve the breathing effort, improving dyspnea, and respiratory muscle strength in long COVID patients with respiratory sequelae.

14.
Anti-Infective Agents ; 20(4):24-35, 2022.
Article in English | EMBASE | ID: covidwho-2065293

ABSTRACT

Background: Coronavirus disease 2019 (Covid-19) is caused by a novel coronavirus (SARS-CoV-2) infection, while influenza viruses cause the flu. SARS-CoV-2 and influenza virus co-infection seems to be a real and serious concern. Objective(s): This study aims to evaluate the clinical features, laboratory investigations, computed tomography scans, and interventions of Covid-19 patients during seasonal influenza. Method(s): This was a multi-center prospective cohort study that collected data from hospitals, clinics, and laboratories on measurements, treatments, and outcomes from Covid-19 patients admitted to temporary Covid-19 care centers. Result(s): A total of 480 individuals (female, 231 [48.12%];male, 249 [51.88%]) were recruited from March 31st to May 14th, 2021 at five hospitals/clinics in Uttar Pradesh, North India. The patients were divided into six groups based on their age (65+ years [25.41% of cases] being the most affected age) and five groups based on their conditions (asymptomatic 65 [13.54%], mild 94 [19.58%], moderate 206 [42.91%], severe 84 [17.50%] and critical 31 [6.45%]). Patients' outcomes were documented as death (19 [3.95%]), recovery (421 [87.71%]) and under-treatment (40 [8.34%]). Conclusion(s): The most common clinical symptoms reported were fever, sore throat, and dyspnea. The severity was linked to hypoxemia, lymphocytopenia, thrombocytopenia, elevated erythrocyte sedimentation rate (ESR), and high blood urea nitrogen (BUN). The vast majority of patients were given symptomatic treatment. Any onset of fever should be suspected and examined for the viral strain to distinguish between Covid-19 and the seasonal flu. Copyright © 2022 Bentham Science Publishers.

15.
American Journal of Transplantation ; 22(Supplement 3):776, 2022.
Article in English | EMBASE | ID: covidwho-2063545

ABSTRACT

Purpose: COVID-19 infection in kidney transplant (KT) recipients is characterized by an unpredictable course and can be life-threatening. Prompt adjustment of immunosuppression and hospitalization when decompensated are potential strategies to increase survival. Our objective is to determine if advanced practice nurse (APN)-driven COVID-19 monitoring would result in better health outcomes for KT recipients. Method(s): We performed a retrospective study on KT patients diagnosed with COVID-19 between 4/1/2020 and 11/30/2021. The patients were stratified into two groups: (1) a control group who initially presented to the emergency department (ED) with COVID-19 symptoms, (2) an intervention group where patients were diagnosed with COVID-19 outside of the ED and followed by the APN team. The APNs monitored this group daily via telephone and/or video call for symptom assessment, immunosuppression adjustment, health counseling, and emotional support. If the patients were distressed, the APNs arranged admission to the nearest hospital or transplant center. Data were analyzed using Pearson Chi-squared for comparisons and linear or logistic regression modeling with adjustment for age, ethnicity, diabetes, and obesity Results: In our cohort, there were 102 KT patients that were infected with the SARS-CoV-2 virus. The majority were Hispanic ethnicity and male gender who presented with fever and flu like symptoms. Fourty-four patients required oxygen therapy. Immunosuppression was adjusted earlier in the intervention group . When the APNs recommended hospitalization, those patients experienced less acute kidney injury (AKI), shorter duration of illness, lower readmission rates, and greater survival than the control group. Conclusion(s): In this single transplant center study, KT recipients diagnosed with COVID-19 had better clinical outcomes when intervention occurred in a timely manner by the APN team. Possible explanations include earlier withdrawal of antimetabolites, prompt triage for hospitalization, and enforcing of nursing practices (dietary educations, blood pressure/glucose management, emotional support). Interpretation and generalization of these findings should be cautious due to a small sample size. As more treatment options for COVID-19 emerge, earlier interventions and close monitoring as demonstrated in our APN-driven model has the potential to achieve better health outcomes.

16.
American Journal of Transplantation ; 22(Supplement 3):943, 2022.
Article in English | EMBASE | ID: covidwho-2063537

ABSTRACT

Purpose: To evaluate the efficacy and safety of a protocol increasing the net state of immunosuppression for adult kidney transplant recipients (KTR) with delayed graft function (DGF). Method(s): Single-center retrospective cohort of adult KTR with DGF transplanted from January 2017 to March 2021. Pre- vs post-DGF protocol implementation outcomes were evaluated. Protocol included cumulative 6 mg/kg rabbit antithymocyte globulin (rATG) induction, non-weight-based mycophenolate mofetil dosing (1000 mg bid), and higher goal tacrolimus trough (9-12 ng/mL). Pre-protocol patients received cumulative 4.5 mg/kg rATG. Efficacy outcomes were biopsy proven acute rejection (BPAR) and graft loss at 6 months. Safety outcomes were incidence of cytopenia, infection, and all-cause readmission at 6 months. Result(s): Eighty-nine DGF patients met inclusion criteria. Baseline characteristics were similar between groups, with median age (57+/-19) years and majority Hispanic (42.7%) males (61.8%) with a negative crossmatch (100%). Most post-protocol patients received 6 mg/kg cumulative rATG induction (71.4%) and mycophenolate mofetil 1,000 mg bid (80.3%) with therapeutic tacrolimus troughs by discharge (64.3%). Significantly less BPAR was observed post-protocol (7/56, 12.5% vs 10/33, 30.3%;p = 0.04). Of those with BPAR, significantly less post-protocol patients experienced T-cell mediated rejection (TCMR) than pre-protocol (2/7, 28.6% vs 9/10, 90.0%;p = 0.03). However, antibody-mediated (4/7, 57.1% vs 1/10, 10%) and mixed (1/7, 14.3% vs 0%) rejection were more frequent post-protocol (p = 0.10 and 0.41, respectively). Graft loss was similar post- vs pre-protocol (5/56, 8.9% vs 0;p = 0.16). All post-protocol graft losses were due to death (4 from COVID-19 and 1 unknown). Safety outcomes were similar between groups (Table 1). Conclusion(s): An increased net state of immunosuppression in DGF KTR significantly lowered the 6-month incidence of BPAR without significantly affecting safety. TCMR incidence was significantly decreased, but displaced by antibody-mediated and mixed rejection, implying need to conduct further prospective studies of larger sample sizes. Given majority of graft losses were due to COVID-19 pneumonia, studies are needed to evaluate the risk of COVID-19 infections in DGF KTR, especially with the availability of vaccines. (Table Presented).

17.
American Journal of Transplantation ; 22(Supplement 3):644-645, 2022.
Article in English | EMBASE | ID: covidwho-2063525

ABSTRACT

Purpose: Immunocompromised hosts are at risk for severe complications or death from SARS-CoV-2 infection. Few studies describe the clinical features, outcomes and treatment strategies in this population across multiple sites. Method(s): A multi-center retrospective analysis from academic medical centers in the Midwestern US was conducted for hospitalized patients with SARS-CoV-2 infection. Data was collected electronically using standardized intake and 28-day follow up case report forms. The centers included Northwestern University, University of Nebraska, Cleveland Clinic, University of Chicago, Indiana University and University of Kansas. Result(s): The cohort included 272 patients hospitalized from March 2020 to November 2021. Demographics are in Table 1. Mean admission was 6.84 +/- 6.42 days after symptom onset. The most commonly reported symptoms were cough (71.4%), dyspnea (59.6%), fatigue (55.3%), fever (54.9%), and diarrhea (43.9%). Admission CXR had pneumonia in 31.6%;63% with multifocal or patchy opacities. 87 patients had a chest CT;72 (82.7%) showed pneumonia. 97 patients (36.1%) required ICU admission. Treatments included remdesivir (58.5%), dexamethasone (54.4%), convalescent plasma (3.0%), IL-6 inhibitor (4.5%). Immunosuppression management included holding (44.2%) or decreasing (26.6%) the dose of antimetabolite. 76 patients (28.3%) had documented bacterial co-infection, in blood (34.1%), lung (30.6%) and urine (30.6%). 6 (2.2%) patients experienced rejection within 30 days and 8 patients (3.0%) developed CMV viremia. 26 patients (9.7%) died by day 28. Conclusion(s): This cohort had high rates of ICU admission (36.1%), bacterial coinfection (28.3%), rehospitalization (31.5%) and mortality (9.7%).

18.
American Journal of Transplantation ; 22(Supplement 3):1060, 2022.
Article in English | EMBASE | ID: covidwho-2063522

ABSTRACT

Purpose: Liver transplant (LT) recipients have a decreased response to 2 doses of SARS-CoV-2 vaccine compared to the general population, so we aimed to understand response to a third dose to inform vaccination strategies. Method(s): LT recipients in our observational cohort who received 3 homologous mRNA vaccines and available antibody levels pre- and post-dose 3 (D3) were identified. Those who reported a prior COVID-19 diagnosis or used belatacept were excluded. The peak anti-spike antibody level collected between the second (D2) and third dose (D3), was compared to the antibody level at 1 month post-D3. Samples were tested with Roche Elecsys Anti-Sars-CoV-2 enzyme immunoassay (EIA) (positive >=0.8 U/mL) or EUROIMMUN EIA (positive >=1.1 AU). Result(s): 146 participants completed 3 homologous doses of BNT162b2 (53%) or mRNA-1273 (47%) vaccines between 5/15/2021 - 11/8/2021. The median (IQR) time of peak pre-D3 antibody collection was 89 (31, 104) days post-D2. The median time of 1-month post-D3 antibody collection was 30 (23, 33) days. The median time between D2 and D3 was 168 (149-188) days. Overall, 125/146 (86%) were seropositive pre-D3, and 139/146 (95%) were seropositive post-D3 (Figure 1). There were no seroreversions post D3, and among the 21 seronegative recipients pre-D3, 14 (67%) seroconverted post-D3. Risk factors significantly associated with persistent seronegativity post-D3 were less time since LT (1.3 vs 6 years, p=0.042), mycophenolate use (100% vs 37%, p=0.001), BNT162b2 series (100% vs 50%, p=0.01), and pre-D3 seronegative status (86% vs 10%, p<0.001). Conclusion(s): Most LT recipients have excellent responses to a third homologous mRNA vaccine dose, greater than that seen in other transplant recipients. Persons seronegative after D2, however, show weaker response and may remain at high risk for SARS-CoV-2 infection despite D3.

19.
American Journal of Transplantation ; 22(Supplement 3):1091, 2022.
Article in English | EMBASE | ID: covidwho-2063516

ABSTRACT

Purpose: The new kidney allocation system has caused increased organ travel times and therefore increased cold ischemia time. Furthermore, the change in the priority to larger transplant centers has caused deprioritized centers to accept higher risk extended criteria donors. These factors lead to increased risk of delayed graft function (DGF). Method(s): To mitigate these risk factors of delayed graft function we have adopted an immunosuppression regimen of de novo belatacept with reduced dose tacrolimus with trough goal level of 5. We hypothesize that the use of belatacept will allow protection against rejection while allowing the renal allogaft to recover from ischemia reperfusion injury without concomitant calcineurin toxicity or vasoconstriction. The delayed addition of low dose tacrolimus can then aid in rejection prevention in addition to belatacept. Result(s): In a cohort of 83 patients we observed one graft loss, two episodes of rejection and three deaths. Of the 130 standard dose tacrolimus with no belatacept we observed no graft losses, seven rejections and one death. Two patients were converted from tacrolimus alone therapy to belatacept plus tacrolimus therapy after the diagnosis of rejection with concomitant tacrolimus toxicity. The belatacept group had a lower rate of rejection, but a higher rate of patient death with a P value <0.001 as calculated with the Z score test. The death in the tacrolimus group was due to covid. Two of the deaths in the belatacept group were cardiovascular, one was a cerebrovascular accident possible related to skull based osteomyelitis. The graft loss in the belatacept group was related to non-compliance. Conclusion(s): Despite initial reports of increased rates of rejection;we report decreased rejection with our belatacept for DGF regimen. We believe this regimen can be a useful tool to utilize more extended criteria donor kidneys in the new kidney allocation system.

20.
American Journal of Transplantation ; 22(Supplement 3):639, 2022.
Article in English | EMBASE | ID: covidwho-2063507

ABSTRACT

Purpose: Despite the large numbers of reports on patient risk factors for poor clinical outcomes with COVID-19, little is known about how these risks may differ for solid organ transplant (SOT) recipients versus non-SOT (NSOT) patients. Method(s): We reviewed demographic and comorbid conditions in a cohort of SOT (n=129) and NSOT patients (n=708) admitted to our center for COVID-19 between December 2019 and February 2021. Patient characteristics were compared between groups using the t-test or chi-square test. Univariable and multivariable (stepwise reduced) logistic regression models were constructed for our outcomes of interest. Result(s): Patient age and sex were similar between SOT and NSOT cohorts. However, SOT patients were more likely to be of Hispanic ethnicity (64% v. 39%, p<0.001). Both SOT and NSOT had similar incidence of neurologic conditions (23% and 21%, p=0.476), but SOT patients were more likely to have comorbid conditions including diabetes mellitus, cardiovascular condition, or lung disease (all p<0.001). Several clinical factors were associated with ICU admission in NSOT patients, including patient age, diabetes, cardiac disease, neurologic disease, obesity, and hepatobiliary disease (all p < 0.05). In contrast, only cardiac disease was associated with ICU admission for SOT patients (p=0.010). Multivariable analysis of factors associated with increased mortality revealed that neurologic condition (OR 3.0, 95% CI 0.8-11.4) and lung disease (OR 3.5, 95% CI 0.7-18.2) were significant for SOT patients in a model including age, sex, and other comorbid conditions. In contrast, for NSOT patients, history of a neurologic condition (OR 2.3, 95% CI 1.3-4.0) and age >65 (OR 4.2, 95% CI 2.1-8.7) were significantly associated with death in a multivariate analysis. Conclusion(s): It has been previously unclear whether risk factors associated with poor outcomes in NSOT patients with COVID-19 will be similarly important in SOT recipients. Our analysis demonstrated different risk associations in contemporaneous patient cohorts at a single academic center. This observation suggests that SOT-specific approaches for risk stratification would be beneficial for patient evaluation and triage.

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