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1.
JAAD Case Rep ; 30: 35-37, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2069299
2.
Journal of Pure and Applied Microbiology ; 16(3):1622-1627, 2022.
Article in English | EMBASE | ID: covidwho-2067515

ABSTRACT

Methicillin-resistant Staphylococcus aureus (MRSA) infections are a primary health concern. They are commonly differentiated as hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) and community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections, based on their epidemiology, susceptibility findings, and molecular typing patterns. Therefore, appropriate contact precautions and isolation measures should be implemented. CA-MRSA mostly causes skin and soft-tissue infections, but the probability and incidence of it causing sepsis and invasive infections have increased dramatically in recent years. In this study, we report a case of CA-MRSA pneumonia with pan-pneumonic effusion in a 59-year-old male diabetic patient with preexisting comorbidities such as diabetic ketoacidosis and non-ST elevated myocardial infarction. The early reporting of the organism's identity and its antimicrobial susceptibility, as well as timely initiation of antibiotic therapy, aided in the successful management and cure of the patient.

3.
Journal of Acute Disease ; 11(4):120-126, 2022.
Article in English | EMBASE | ID: covidwho-2066823

ABSTRACT

Unbalanced magnesium levels in the body, like other minerals, are a factor that is important in the severity and mortality of COVID-19. This study was designed to investigate the relationship between serum magnesium levels and clinical outcomes in COVID-19 patients. In this systematic review, a comprehensive search was performed in PubMed, Scopus, and Web of Science databases until September 2021 by using the keywords COVID-19, severe acute respiratory syndrome coronavirus 2, coronavirus disease, SARS- COV-infection 2, SARS-COV-2, COVID 19, and magnesium. End-Note X7 software was used to manage the studies. Articles that evaluated effect of magnesium on COVID-19 were included in the analysis. After reviewing several articles,12 studies were finally included in the ultimate analysis. The studies show that hypomagnesemia and hypermagnesemia are both factors that increase mortality in patients with COVID-19, even in one study, hypomagnesemia is the cause of doubling thedeaths in COVID-19 patients. Some studies have also found a negative correlation between magnesium deficiency and infectionseverity, while some others have reported no correlation between magnesium level and disease severity. According to the important role of magnesium in the body and its involvement in many physiological reactions, as well as differences in physical and physiological conditions of COVID-19 patients, in addition to the need for studies with larger sample sizes, monitoring and maintaining normal serum magnesium levels during the disease seems necessary as a therapeutic target, especially in patients admitted to the intensive care unit.

4.
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.

5.
Chest ; 162(4):A2478, 2022.
Article in English | EMBASE | ID: covidwho-2060950

ABSTRACT

SESSION TITLE: COVID-19 Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Pneumomediastinum is the presence of air or other gas in the mediastinum which can be due to trauma related to mechanical ventilation or spontaneous in preexisting lung diseases. Here, we present the case of Covid-19 pneumonia, who developed pneumomediastinum without any trauma or other risk factors. CASE PRESENTATION: A 56-year-old male COVID unvaccinated with a history of essential hypertension presented to the ED with shortness of breath and worsening cough for one week. He was living with his father, who was admitted to the ICU and receiving treatment for COVID pneumonia. The patient appeared to be in respiratory distress. His initial vital signs were temperature of 99.6 F, respiratory rate of 26 breaths per minute, blood pressure 125/71 mm Hg, heart rate 109 beats per minute with a regular rhythm, and oxygen saturation of 50% while he was breathing ambient air. Pulmonary examination revealed use of respiratory accessory muscle and widespread bilateral coarse rhonchi on auscultation. The rest of the physical examination was within normal limits. RT- PCR COVID -19 test was positive. The blood gas analysis reported respiratory alkalosis. Inflammatory markers were elevated: erythrocyte sedimentation rate (35.2 mg/L), C-Reactive Protein (17.70 mg/dL), Ferritin (1108.1 ng/mL), Lactate Dehydrogenase (813 U/L), Lactate (2.4 mg/dL), D-Dimer (35.20 mg/L) and Troponin High Sensitivity-236.6 ng/L. His CBC, electrolytes, and kidney function were normal. Chest X-ray showed Pneumomediastinum with dense basilar predominant consolidation. CT Angio Chest with contrast reported Pneumomediastinum likely from the left central airway source and bilateral dense ground glass consolidation. An echocardiogram showed an ejection fraction of 60-65%, no valvular abnormalities. He was placed on vapotherm(Oxygen 40L/min) with 100% FiO2. He was given Dexamethasone 6mg for ten days, Remdesivir, Barcitinib, and a 7-day course of Azithromycin and Ceftriaxone for community-acquired pneumonia. He was advised to practice prone positioning for 12 hours or more per day. Pulmonology, Infectious Disease, and Cardiology were consulted. Gradually, his oxygen requirement was weaned down and Pneumomediastinum resolved on serial chest x rays. He was discharged on home oxygen in a clinically stable condition. DISCUSSION: Pneumomediastinum in viral pneumonia is rare. The exact mechanism is unknown. Covid-19 pneumonia causes diffuse alveolar wall damage, which might cause air leakage into the mediastinum. The development of pneumomediastinum is an ominous sign in these patients. Fortunately, our patient did not worsen and was weaned off high flow oxygenation requirement. CONCLUSIONS: Few isolated reported cases of pneumomediastinum in a COVID-19 patient have been associated with life-threatening complications. It should be used as a prognostic marker, and close monitoring of these patients is advisable. Reference #1: Damous, S.H.B., dos Santos Junior, J.P., Pezzano, Á.V.A. et al. Pneumomediastinum complicating COVID-19: a case series. Eur J Med Res 26, 114 (2021) DISCLOSURES: No relevant relationships by Saad Ansari No relevant relationships by Akshit Chitkara No relevant relationships by Sudeshna Ghosh No relevant relationships by Femina Patel

6.
Chest ; 162(4):A1612, 2022.
Article in English | EMBASE | ID: covidwho-2060849

ABSTRACT

SESSION TITLE: Unusual Cancer Cases SESSION TYPE: Case Reports PRESENTED ON: 10/19/2022 09:15 am - 10:15 am INTRODUCTION: Cutaneous lesions may present as a clue to an internal malignancy and provide an easily accessible site for tissue confirmation. We present a case of an eyelid metastatic lesion presenting as an initial sign of primary pulmonary malignancy. CASE PRESENTATION: A 67-year-old woman with past medical history of SARS-COVID-2 pneumonia six months ago and reformed smoker (26 pack year) who quit 27 years ago, presented to the primary care physician's office with a chief complaint of a small right upper eyelid margin (base of eyelashes) lesion (Figure 1A), and ongoing nonproductive cough and fatigue since diagnosis of SARS-COVID-2 pneumonia. The eyelid lesion appeared two weeks prior and had quickly grown in size. The lesion was associated with mild itching, but without any associated pain, discharge, or bleeding. She also complained of left elbow and foot pain but denied fever, chills, rigors, hemoptysis, pleurisy, and weight loss. Physical examination was negative for lymphadenopathy. Chest x-ray revealed a hazy left upper lobe opacity. Urine antigen for blastomycoses and histoplasma were negative. Rheumatoid factor, erythrocyte sedimentation rate, C reactive protein, QuantiFERON TB gold and anti-nuclear and cyclic citrullinated peptide antibodies were negative. Computed tomography of chest revealed a left upper lobe 3.7 x 5.4 x 5.6 cm mass, numerous bilateral ground glass opacities, and scattered (less than 5 mm) nodules (Figure 1B). Simultaneously, the patient was evaluated by an ophthalmologist for excision of the eyelid lesion. Histopathological evaluation revealed malignancy compatible with metastatic lung adenocarcinoma (Figure 1C) DISCUSSION: While an uncommon presentation, this case highlights the importance of a through history and examination in a patient presenting with pulmonary symptoms with risk factors for a lung malignancy. While she did have imaging that demonstrated lung masses, the diagnosis of lung cancer came not from invasive sampling of these masses, but rather from excision and histopathological evaluation of an eyelid soft tissue mass. Lung cancer is prone to metastasis, however cutaneous manifestations of lung cancer are relatively rare and are more common in the advanced stages of disease, making cutaneous metastasis a poor prognostic factor. In terms of cutaneous metastases, ocular metastases are one of the rarest locations making this a unique presentation. In a patient presenting with pulmonary masses, any concurrent development of new and/or growing skin lesions should be evaluated to rule out metastasis and potentially yield diagnosis. CONCLUSIONS: In patients presenting with concern for a malignant lung process, a skin exam should be completed, and suspicious skin lesions should be biopsied. Although rare, lung malignancies do metastasize to ocular cutaneous tissues and are a marker of more advanced stage of the malignancy. Reference #1: Hidaka T, Ishii Y, Kitamura S. Clinical features of skin metastasis from lung cancer. Intern Med. 1996;35:459-462. Reference #2: Marcoval J, Penin RM, Llatjos R, Martinez-Ballarin, I. Cutaneous metastasis from lung cancer: retrospective analysis of 30 patients. Australas J Dermatol. 2012;53(4):288-290. Reference #3: Abdeen Y, Amireh S, Patel A, Al-Halawani M, Shaaban H, Miller R. Cutaneous metastasis as a first presentation for lung adenocarcinoma. N Am J Med Sci. 2016;8(5): 222-225. DISCLOSURES: No relevant relationships by Gregory Griepentrog No relevant relationships by Chinmay Jani No relevant relationships by Bailey Ray No relevant relationships by Harpreet Singh No relevant relationships by Amit Taneja No relevant relationships by Kara Young

7.
Chest ; 162(4):A960-A961, 2022.
Article in English | EMBASE | ID: covidwho-2060741

ABSTRACT

SESSION TITLE: Pulmonary Involvement in Critical Care Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Cryptogenic organizing pneumonia (COP), also known as bronchiolitis obliterans organizing pneumonia (BOOP), is one of the idiopathic interstitial lung diseases that affects the alveolar epithelium and surrounding interstitium. Its diagnosis is usually delayed due to similar clinical presentation as other illnesses (e.g. pneumonia) [1]. CASE PRESENTATION: A 65-year-old male presented with rapidly progressive respiratory failure. Computed tomography (CT) of chest showed multifocal ground glass opacities. He had suboptimal response to antibiotics and had to be intubated on day 9 due to worsening respiratory failure. Bronchoscopy with bronchoalveolar lavage was performed, cytology of which revealed severe acute inflammation and mononuclear infiltration. Decision was made to perform open lung biopsy which showed polypoid plugs of organizing fibroblasts and myofibroblasts in the distal airways and alveoli with focal hyaline membrane and alveolar damage, consistent with acute onset fulminant COP. As expected, the patient responded fairly well to high-dose corticosteroids and was extubated on day 9 of intubation. DISCUSSION: Even though it is very rare, COP should be kept in differentials especially when initial interventions fail (as in our patient). There is no single laboratory study or intervention to diagnose this condition. Hence it is imperative to rule out other causes of similar presentation like pneumonia (using cultures, urine antigen testing, and viral polymerase chain reaction tests). The clinical picture is combined with supportive evidence like elevated erythrocyte sedimentation rate, leukocytosis, imaging findings, and bronchoscopic and histopathology evaluation [2]. Once diagnosed, it is important to rule out any associated CTD, for it can change management and prevent additional complications. The majority of patients with COP exhibit rapid response to glucocorticoid treatment. For fulminant disease, intravenous glucocorticoids (e.g. methylprednisolone 125-250 mg every six hours) should be initiated based on the clinical experience and case reports [3]. CONCLUSIONS: Diagnoses of interstitial lung diseases should be pursued in a systemic fashion from more common to less common. However, anchoring to common diagnoses should be avoided to negate delay in diagnoses and allow timely management. If initial workup is unrevealing, bronchoscopy and open lung biopsies should be performed while the patient is stable enough to undergo the interventions to avoid antibiotic resistance, morbidity and mortality associated with rapidly progressive noninfectious illnesses like fulminant COP. Reference #1: Drakopanagiotakis F, Polychronopoulos V, Judson MA. Organizing pneumonia. The American journal of the medical sciences. 2008 Jan 1;335(1):34-9. Reference #2: Cordier JF. Cryptogenic organising pneumonia. European Respiratory Journal. 2006 Aug 1;28(2):422-46. Reference #3: Nizami IY, Kissner DG, Visscher DW, Dubaybo BA. Idiopathic bronchiolitis obliterans with organizing pneumonia: an acute and life-threatening syndrome. Chest. 1995 Jul 1;108(1):271-7 DISCLOSURES: No relevant relationships by Fareeha Abid No relevant relationships by Vipin Garg No relevant relationships by Qirat Jawed No relevant relationships by Asnia Latif No relevant relationships by Ahmed Mowafy No relevant relationships by Muniba Naqi No relevant relationships by Muhammad Atif Masood Noori No relevant relationships by Hasham Saeed

8.
Chest ; 162(4):A863-A864, 2022.
Article in English | EMBASE | ID: covidwho-2060713

ABSTRACT

SESSION TITLE: Biological Markers in Patients with COVID-19 Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Severe COVID19 patients present with low CD8(+) T cell counts. A reduced number of T-cells seems to be correlated with high serum IL-6 and IL-10 levels, and a marked inflammatory state. This study aimed to assess if low CD8(+) counts were associated with inflammation markers, length of stay, and Ichikado CT scores in COVID-19 patients. METHODS: A retrospective study of adult patients admitted to our hospital with COVID-19 infection from June 2021 to September 2021. CD8(+) count was obtained, and patients were divided into less than 150 cells/μl and more than 150 cells/μl. Ferritin, c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), troponin, Lactate dehydrogenase (LDH), and d-Dimer values were also recorded. Primary outcomes were hospital length of stay (LOS), Ichikado CT score, and correlation of CD8(+) count and inflammatory markers. Descriptive statistics, and Mann-Whitney-U methods were utilized. RESULTS: 264 patients were included, median age was 50 years [41-61]. 143 (54.2%) patients were male. There was a statistically significant difference when assessing hospital LOS in patients with CD8(+) counts <150 cells/μl vs > 150 cells/μl (9 days [5-16] vs 5 days [4-9], U=(134, 84)=3742, z=-4.174, p<0.01). The Ichikado CT score was significantly different between groups (190 [150-220] vs [130-190], U=(128,80)=3394, z=-4.094, p<0.01). IL-6 and IL-10 values were higher in those patients with CD8(+) less than 150 μl, when compared to higher CD8(+) counts. IL-10 value was (23.8pg/ml [13.6-43.3] vs (6.6pg/ml [9.4-29.2]), U=(131,78)=3711.5, z=-3.305, p<0.01), and for IL-6 (23.8pg/ml [7.6-88.3] vs (11.9 [4.1-32.1]), U=(125,75)=3473.5, z=-3.064, P<0.01). Ferritin was increased in patients with CD8(+) counts lower than 150 cells/μl compared to more than 150 cells/μl (845.3ng/ml [381.6-1600] vs 480ng/ml [232.6-988.7], U=(133,83)=3939.5, z=-3.550, p=<0.01). Similarly, CRP (83mg/L [46.3-136.7] vs 60.2 mg/L [33.25-100.72], U=(134-82)=4208, z=-2.885, p=<0.01), d-Dimer (1.76mg/L [0.53-7] vs 0.64 mg/L [0.35-1.72], U= (134,84)=3635.5, z=-4.396, p<0.01), and LDH (555IU/L [361-849.2] vs 375.5IU/L [273.2-531.2], U=(122,72)=2740,z=-4.373,p<0.01). Troponin and ESR were not significantly different, median troponin (0.022ng/ml [0.011-0.039] vs 0.012ng/ml [0.007-0.032], U=(111,70)=3218, z=-1.944,P=0.052) and median ESR (78mm/hr [57.2-105] vs 76.5 mm/hr [55-108.7], U=(134,84)=5603, z=-0.055,P=0.95). CONCLUSIONS: CD8(+) counts below 150 cells/μl are associated with increased inflammatory markers, a longer hospital stay, and higher Ichikado CT scores. CLINICAL IMPLICATIONS: CD8(+) count below 150 cells/μl is other indicator of disease severity in COVID-19 DISCLOSURES: No relevant relationships by David Akinwale No relevant relationships by Angelica Almaguer No relevant relationships by Sushen Bhalla No relevant relationships by Ailine Canete Cruz No relevant relationships by Ndiya Emeaba Speaker/Speaker's relationship with johnson and johnson Please note: approx year 2000 Added 03/31/2022 by Joseph Gathe, value=Honoraria clinical research relationship with gilead Please note: since 1990 Added 03/31/2022 by Joseph Gathe, value=Grant/Research clinical research relationship with ansun Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support clinical research relationship with regeneron Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support No relevant relationships by Jesus Salvador Gonzalez Lopez No relevant relationships by Najia Hussaini No relevant relationships by Claudia Ramirez No relevant relationships by Salim Surani No relevant relationships by Daryelle Varon No relevant relationships by Joseph Varon No relevant relationships by Mohamed Ziad

9.
Chest ; 162(4):A861-A862, 2022.
Article in English | EMBASE | ID: covidwho-2060712

ABSTRACT

SESSION TITLE: Biological Markers in Patients with COVID-19 Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Common markers of inflammation in COVID-19 include erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and ferritin. We aimed to find an association between creatine Phosphokinase (CPK) and other inflammatory markers and enzymes, and their effect on length of hospital stay, and the Ichikado CT scores. METHODS: Retrospective study of the data of 264 adult patients admitted to our hospital between June and September 2021, with COVID-19. Patients were divided into groups with CPK of greater or less than 200mg/dL. Each was assessed for its association with CRP, ESR, ferritin, and lactate dehydrogenase (LDH), length of hospital stay, and Ichikado CT score. Descriptive statistics, Mann Whitney-U were used to address statistical significance. RESULTS: 264 patients were included, median age was 51.95 years [41-63]. 143(53.2%) were male. The median highest CRP value in patients with CPK of <200 mg/dL was (55 mg/L [24-96.4] vs 97.4 mg/L [50.1-139]) in those with CPK of >200 mg/dL, (U=(131,118) =5097, z=-4.638, p<0.01). The median highest ESR with CPK of <200 mg/dL was (72 mm/hr [51.0-102.5] vs 89 mm/hr [60-109]) in those with CPK of >200 mg/dL, (U= (133,119) =6862.5, z=-1.820, p=0.069). The median highest ferritin value in those with CPK of <200 mg/dL was (388.5 ng/mL [187.1-804.4] vs 1046 ng/mL [462.1-1600]) in those with CPK of >200 mg/dL, (U=(132,118) =4156.5, z=6.3985, p<0.01). The median highest phosphate level in patients with CPK of <200 mg/dL was (3.6 mg/dL [3.3-4.2] vs 3.8 mg/dL [3.4-5.2]) in those with CPK of >200 mg/dL,(U=(133,119) =6487.5, z=-2.471, p=0.013). The median highest LDH level in patients with CPK of <200 mg/dL was (352 IU/L [271.5-459] vs 673.5 IU/L[411.7-980.2]) in those with CPK of >200 mg/dL, (U=(113,106) = 2201, z =-8.084, p<0.01). The median highest Ichikado CT score in patients with CPK of <200 mg/dL was (150[130-190] vs 190[140-222.5]) in those with CPK of >200 mg/dL,(U= (142,209) =5188, z=-4.482, p<0.01). The length of hospital stay in patients with CPK of<200 mg/dL was (5 days [3-8] vs 9 days [5-17]) in those with CPK of >200 mg/dL, (U=(144,120) = 5533, z =-5.049, p<0.01). CONCLUSIONS: CPK has a statistically significant association with CRP and ferritin levels but not ESR. Imaging disease severity at presentation (Ichikado CT score) was associated with higher CPK levels. CLINICAL IMPLICATIONS: CPK is another marker of disease severity in COVID-19. DISCLOSURES: No relevant relationships by David Akinwale No relevant relationships by Angelica Almaguer No relevant relationships by Sushen Bhalla No relevant relationships by Ailine Canete Cruz No relevant relationships by Ndiya Emeaba Speaker/Speaker's relationship with johnson and johnson Please note: approx year 2000 Added 03/31/2022 by Joseph Gathe, value=Honoraria clinical research relationship with gilead Please note: since 1990 Added 03/31/2022 by Joseph Gathe, value=Grant/Research clinical research relationship with ansun Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support clinical research relationship with regeneron Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support No relevant relationships by Jesus Salvador Gonzalez Lopez No relevant relationships by Najia Hussaini No relevant relationships by Claudia Ramirez No relevant relationships by Salim Surani No relevant relationships by Joseph Varon No relevant relationships by Daryelle Varon No relevant relationships by Mohamed Ziad

10.
Chest ; 162(4):A859-A860, 2022.
Article in English | EMBASE | ID: covidwho-2060711

ABSTRACT

SESSION TITLE: Biological Markers in Patients with COVID-19 Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: A significant reduction of CD4(+) cells and marked inflammatory activity in moderate and severe COVID-19 cases are seen, both associated with a poor prognosis. This study aimed to assess the association of low CD4(+) counts with inflammatory markers, length of stay, and ICKIKADO scores in COVID-19 patients. METHODS: A retrospective study of adult patients admitted to our hospital with COVID-19 infection from June 2021 to September 2021. CD4(+) count was obtained and patients were divided into two categories: less than 200 cells/μl and more than 200 cells/μl. Ferritin, c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), troponin, Lactate dehydrogenase (LDH), and d-Dimer values were also recorded. Primary outcomes were hospital length of stay (LOS), Ichikado CT scores, and correlation of CD4(+) count and inflammatory markers. Descriptive statistics, and Mann-Whitney-U methods were used. RESULTS: 264 patients were included, median age was 50 years [41-61]. 143(54.2%) were male. There was a statistically significant difference in LOS for patients with CD4(+) counts <200 cells/μl vs > 200 cells/μl CD4(+) (9 days [5-18]vs 6 days [4-9]), U=(111,107)=4330, z=-3.466, p <0.01). The Ichikado CT score was significantly different between groups (190[150-220]vs 160[128.7-192.5], U=(106,102)=3706.5, z=-3.923, p<0.01). IL-10 values and IL-6 values were higher in those patients with CD4(+) less than 200 cells/μl, as compared to higher CD4(+) counts. median IL-10 was (25.2 pg/ml [17-72.45 ] vs 15.7 pg/ml [9.4-26.8 ], U=(109,100)=3463, z=-4.550, p<0.01), and median IL-6 was (23 pg/ml [10.5-99] vs 12 pg/ml [3.77-39], U=(104, 96)=3444.5, z=-3.785, p<0.01). Ferritin was increased in patients with CD4(+) counts lower than 200 cells/μl when compared to counts more than 200 cells/μl (850.2 ng/mL [373.3-1600] vs 541.5 ng/mL [245.1-1034.6], U=(110,106) =4543.5, z=-2.813, p=<0.01). CRP had a similar pattern (82 mg/L[49.5-138.2] vs 60.8 mg/L[30-114.2]), U=(111,105)=4478, z=-2.940, p=<0.01), d-Dimer (2.2 mg/L[0.55-7.14] vs 0.7mg/L[0.37-1.75], U=(111,107)=3992.5, z=-4.180, p<0.01), LDH (630 IU/L[371-888] vs 381 IU/L[276-520.2], U=(102,92)=2631.5,z=-5.227, p<0.01) and troponin (0.024 ng/mL[0.012-0.048] vs 0.012 ng/mL[0.007-0.027], U=(91,90)=2925, z=-3.321,P<0.01). The only inflammatory marker that was not statistically significant different was ESR (86 mm/hr[60-110] vs 72 mm/hr[50-100], U(111-107)=5113, z=-1.773,P=0.076). CONCLUSIONS: CD4(+) counts below 200 cells/μl are associated with increased inflammatory markers, a longer hospital stay, and higher Ichikado CT scores. CLINICAL IMPLICATIONS: CD4(+) count below 200 cells/μl is other indicator of disease severity in COVID-19 DISCLOSURES: No relevant relationships by David Akinwale No relevant relationships by Angelica Almaguer No relevant relationships by Sushen Bhalla No relevant relationships by Ailine Canete Cruz No relevant relationships by Ndiya Emeaba Speaker/Speaker's relationship with johnson and johnson Please note: approx year 2000 Added 03/31/2022 by Joseph Gathe, value=Honoraria clinical research relationship with gilead Please note: since 1990 Added 03/31/2022 by Joseph Gathe, value=Grant/Research clinical research relationship with ansun Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support clinical research relationship with regeneron Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support No relevant relationships by Jesus Salvador Gonzalez Lopez No relevant relationships by Najia Hussaini No relevant relationships by Claudia Ramirez No relevant relationships by Salim Surani No relevant relationships by Daryelle Varon No relevant relationships by Joseph Varon No relevant relationships by Mohamed Ziad

11.
Chest ; 162(4):A858, 2022.
Article in English | EMBASE | ID: covidwho-2060710

ABSTRACT

SESSION TITLE: Management of COVID-19-Induced Complications SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Up to 17% of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been shown to develop pancreatic lesions (1). We present 2 cases of coronavirus disease 2019 (COVID-19) patients that presented with pancreatic lesions. CASE PRESENTATION: Case1 A 47-year-old lady with a history of type 2 diabetes mellitus present to the emergency department (ED) with complaints of flu-like symptoms for ten days. She tested positive for COVID-19 by rapid PCR. Computed tomography (CT) scan without contrast on admission shows an incidental finding of a pancreatic mass (see Figure 1). Abdominal CT with contrast shows a large, multiloculated cystic mass in the pancreatic tail (see Figure 2). Laboratory examination depicted lipase: 27 U/L, CA19-9: 72 U/mL, CEA: 6.5 ng/mL, CA125: 24 U/mL, erythrocyte sedimentation rate (ESR):2 mm/h, Total Bilirubin: 0.6 mg/dl, Direct Bilirubin: 0.1 mg/dl. Following treatment, the patient recovered fully and is discharged from the hospital 10 days later with home oxygen therapy. Case2 An 81-year old Caucasian lady presented to the outpatient clinic with complaints of fecal incontinence. She tested positive for COVID-19, four months before her visit. CT scan of the abdomen with oral contrast revealed multiple hypodense masses on the pancreas measuring 0.3cm in diameter (see Figure 3). Laboratory tests reveal CA19-9: 57 U/mL, CA125: 8 U/mL, CEA: 1.9 ng/mL, erythrocyte sedimentation rate (ESR):11 mm/h, C-reactive protein: 0.7 mg/L, Total Bilirubin: 1.5 mg/dl, Direct Bilirubin: 1.3 mg/dl. Following outpatient treatment and follow-up, the patient's symptoms were relieved. DISCUSSION: Pancreatic lesions in COVID-19 patients can be caused directly by the cytopathic effects of the viral infection, or indirectly by systemic responses to inflammation or respiratory failure. Several studies have shown that ACE2 is the functional receptor used by SARS-CoV-2 to gain access to target cells (2) and ACE-2 receptors are expressed in significant amounts in the pancreas (3). In the first case, an incidental finding of a multi-cystic pancreatic mass on admission was reported. There was no pancreatic ductal dilation on the CT scan, which may indicate a direct injury caused by cytopathic effects of the virus rather than inflammation resulting in exocrine secretions forming cysts. In the second case, multiple masses on the pancreas were found after recovering from COVID-19. These lesions could be remnants of a previous pancreatic injury during the acute phase of the infection. CONCLUSIONS: COVID-19 infection may trigger pancreatic injury in some patients. Reference #1: Yong, Shin Jie. Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infectious diseases. 2021 Oct;53(10): 737–754. Reference #2: Ma C, Cong Y, Zhang H. COVID-19, and the Digestive System. Vol. 115, American Journal of Gastroenterology. Wolters Kluwer Health;2020. p. 1003–6. Reference #3: Liu F, Long X, Zhang B, Zhang W, Chen X, Zhang Z. ACE2 Expression in Pancreatic Damage After SAERS-CoV-2 Infection. Gastroenterology. 2020 Aug 1;18(9): 2128 – 2130.e2. DISCLOSURES: No relevant relationships by Ailine Canete Cruz No relevant relationships by Claudia Ramirez No relevant relationships by Joseph Varon No relevant relationships by Mohamed Ziad

12.
NeuroQuantology ; 20(8):8837-8845, 2022.
Article in English | EMBASE | ID: covidwho-2044235

ABSTRACT

The World Health Organization (WHO) has declared the 2019–20 coronavirus outbreak a Public Health Emergency of International Concern (PHEIC). Covid-19infection is an ongoing pandemic with high morbidity and mortality, spread from one infected personto another through respiratory airway droplets.Covid-19circulatesin many organs, including the heart, kidneys, brain, etc.Ocular symptoms, along with other symptoms, may help diagnose COVID-19. Covid-19 ocular signs of dry eyes, weeping, itching, redness, eye discomfort, foreign body feeling, elevated CRP, Procalcitonin (PCT), and erythrocyte sedimentation rate (ESR) levels, indicating an immunologic response and disease severity. There was a positive correlation between high temperature and visual symptoms.

13.
Journal of Clinical and Diagnostic Research ; 16(9):OD01-OD03, 2022.
Article in English | EMBASE | ID: covidwho-2044184

ABSTRACT

Mucormycosis or zygomycosis is a life threatening invasive fungal infection, usually seen in patients with alteration of their immune system. It is a lethal and an aggressive fungal infection caused by the fungi of the order Mucorales. The angioinvasive property of mucormycosis can lead to fatal complications such as intracranial bleed. Acute pancreatitis refers to inflammation of the pancreas which presents mainly as acute pain in the abdomen and is a potentially fatal condition. The association of mucormycosis with acute pancreatitis is rare but dangerous. This case report highlights a case of 32-year-old male patient, with no co-morbidities, who was admitted to an rural central Indian hospital with four days of abdominal pain and two days of headache. Patient appeared to be in good health prior to this event. He was ultimately diagnosed with mucormycosis of paranasal sinus with acute pancreatitis. The patient was treated with intravenous antifungals, antibiotics and fluid therapy along with other supportive measures. Patient later developed intracranial bleed five days after admission, and ultimately succumbed on day seven of admission. After an extensive review of literature it was found that this is the first article to report mucormycosis, acute pancreatitis and intracranial bleed all occurring at once in an immunocompetent male.

14.
Frontiers in Medicine ; 9, 2022.
Article in English | EMBASE | ID: covidwho-2043475

ABSTRACT

Background and Aims: Adherence to the Mediterranean diet (MD) has been associated with a decreased risk of developing a variety of chronic diseases that are comorbidities in COVID-19 patients. However, its association to the severity and symptoms of COVID-19 are still unknown. This study aimed to examine the association between adherence to the MD pattern and COVID-19 severity and symptoms in Iranian hospitalized patients. Methods: In this cross-sectional study, 250 COVID-19 patients aged 18 to 65 were examined. We employed a food frequency questionnaire (FFQ) to obtain data on dietary intake of participants in the year prior to their COVID-19 diagnosis. COVID-19 severity was determined using the National Institutes of Health's Coronavirus Disease 2019 report. Additionally, symptoms associated with COVID-19, inflammatory markers, and other variables were evaluated. The scoring method proposed by Trichopoulou et al. was used to assess adherence to the MD. Results: The participants' mean age was 44.1 ± 12.1 years, and 46% of them had severe COVID-19. Patients who adhered more closely to the MD had lower serum C-reactive protein levels (7.80 vs. 37.36 mg/l) and erythrocyte sedimentation rate (14.08 vs. 42.65 mm/h). Those with the highest MD score were 77% less likely to have severe COVID-19 after controlling for confounding variables. The MD score was also found to be inversely associated with COVID-19 symptoms, including dyspnea, cough, fever, chills, weakness, myalgia, nausea and vomiting, and sore throat. Conclusion: Higher adherence to the MD was associated with a decreased likelihood of COVID-19 severity and symptoms, as well as a shorter duration of hospitalization and convalescence, and inflammatory biomarkers.

15.
Journal of Neuromuscular Diseases ; 9:S190-S191, 2022.
Article in English | EMBASE | ID: covidwho-2043376

ABSTRACT

Introduction: During Covid-19 pandemic periods, various studies have been revealed the coexistence of these two diseases, raising the question of whether SARS-CoV-2 has a role in triggering GBS or it's just co-incidentally. So far, 255 cases of this concurrence have been reported. In this study, we publish 45 patients' demographic, clinical, electro diagnostic study, response to treatment and prognostic features association of Covid- 19 and GBS during the 5 corona's epidemiologic peaks in Isfahan province. Methods: This cross-sectional, multi-central study was performed during covid-19 pandemic since 2020 February until 2021 October. In this period 5 epidemiologic peaks of corona virus occurred in Isfahan (one of providence of Islamic republic of Iran) and total of 417166 people became infected. 45 patient with definitive Covid-19 (based on positive nasopharynx Reverse transcription polymerase chain reaction (RT-PCR) or highly suggestion of Highresolution computed tomography (HRCT) for covid- 19) were referred to one of the 2 referral hospitals (Alzahra and Kashani hospital). All patients whom suspected of peripheral nerve symptoms referred to the neuromuscular fellowship for further examination and performing EDx. Demographic, clinical, therapeutic and prognostic features were collected according to Hospital records. Results & discussion: 45 patients (60% male, 40% female) were surveyed. The mean age was 54.66±10.021 (max: 84, min:14, range:80). The most EDx pattern was AIDP (57.8%, n=26).42.2%(n=19) of patients had axonal pattern. 8 of them were Acute motor axonal neuropathy(AMAN) and 11 patients were Acute motor-sensory axonal neuropathy(AMSAN). The most (91%) GBS phenotype was classic pattern which defined as acute-sub acute flaccid length dependent paralysis. 2 patients had pure para paretic pattern and 2 had miller-fisher pattern. The most common symptom of covid-19 was fever (89.7%), Other symptoms included dyspnea (48.7%), cough (46.2%), myalgia (28.2%), headache (28.2%), diarrhea (28.2%) and the less common was anosmia (12.8%). No significant difference was found between any of the covid-19 symptoms with EDx patterns. 7 patients had a history of GBS which were more than 1 year before the onset of new symptoms. 13.6% of patients had no any symptoms of covid-19 on the day of the onset of neurological symptoms, either the symptoms of covid-19 developed after the neurological symptoms or covid-19 was discovered accidentally. Mean distance between onset of covid-19 and neurological symptoms was 18.05±8.88 which was significantly lower in the axonal injury groups (12.00±800 pvalue: 0.013). Also There was also signifi cant difference between frequency of para/post infectious patient in axonal and demyelinating subtypes (p value: 0.045). So that Para infection was more associated with axonal injuries. Among other prognostic findings, include respiratory equipment (33% no equipment, 44% none-invasive and 22.2% mechanical ventilation), required to ICU admission (46.7%), length of ICU admission (16.66 ±12.03), length of intubation (12.10±6.24) , length of hospitalization( 23.66±14.13) and mortality(8.9%) no Significant differences were detected among each subgroups of EDx patterns and also between axonal/ demyelinating injuries. There was also significant difference among erythrocyte sedimentation rate and C-reactive protein among axonal patterns that means axonal patterns (AMAN and AMSAN) had more level of ESR and CRP at the first neurological symptom's day.

16.
JAMS Journal of Acupuncture and Meridian Studies ; 15(4):247-254, 2022.
Article in English | EMBASE | ID: covidwho-2033620

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a coronavirus (SARS-CoV-2) that can induce cytokine storm. To this point, no specific drug has been effective for curing COVID-19. Objectives: The aim of this study was to determine the effects of a combination of acupuncture intervention and pharmacologic treatment in hospitalized COVID-19 patients with mild-moderate symptoms. Methods: A single-blinded randomized controlled clinical trial of hospitalized COVID-19 patients confirmed by RT-PCR examination with mild-moderate symptoms was conducted from August to September 2020. Participants were assigned to the treatment group (receiving pharmacologic treatment and manual acupuncture intervention) or the control group (receiving only pharmacologic treatment). Laboratory outcomes, including complete blood count, C-reactive protein (CRP) and ferritin levels, and erythrocyte sedimentation rate (ESR), were measured before and after the intervention. For clinical outcomes, we evaluated the duration of the cough symptom. Results: We found that participants in the treatment group had a shorter duration of the cough symptom compared to the control group, and the difference was statistically significant. In the treatment group, we found an increase in the percentage of lymphocyte count and ESR, while in the control group, both parameters were decreased;however, the differences were not statistically significant. There was a decrease in the mean of CRP and ferritin levels in both groups, and the differences were not statistically significant. Conclusion: Our study has shown promising results for the effects of combined treatment of acupuncture and pharmacologic treatment on the duration of the cough symptom in hospitalized COVID-19 patients with mild-moderate symptoms. Further large-scale studies with rigorous design are needed to examine these preliminary results

17.
Journal of Xi'an Jiaotong University (Medical Sciences) ; 43(5):797-801, 2022.
Article in Chinese | EMBASE | ID: covidwho-2010485

ABSTRACT

Objective: To compare the clinical features of Omicron and Delta cases, so as to provide scientific basis for the prevention and treatment of COVID-19. Methods: The case-control study method was used to retrospectively analyze the clinical data of the Omicron cases admitted to the designated hospital for the treatment of COVID-19 in Xi'an from December 2021 to January 2022. and the Delta cases admitted during the same period were used as the control group. The demographic data, epidemiological history, vaccination status, clinical characteristics, laboratory tests, nucleic acid and antibody levels, and outcomes of patients in the two groups were collected and compared. Results: A total of 21 patients were included in the study, 5 were Omicron patients and 16 were Delta cases. The mean age of the patients in the two groups were (38.20±15.07) and (37.69±10.39) years, respectively.The time interval between the last vaccination and the diagnosis was (145.40±77.92) days and (159.00±99.74) days, respectively. For the initial symptoms, the patients with Omicron were mainly characterized by throat discomfort (3, 60%), cough and sputum (2, 40%), and the patients with Delta were mainly characterized by throat discomfort (5, 31.25%), fatigue (5, 31.25%), cough and sputum (4, 25%). On admission, laboratory tests showed that 60% of Omicron patients had low lymphocytes and elevated erythrocyte sedimentation rate, and 50% of patients in the delta group had elevated hemoglobin. The Ct values of ORFlab gene, N gene and E gene with Omicron were lower than those with Delta. And the difference of E gene between the two groups was statistically significant (t=-2.711, P=0.024). IgG antibody levels increased in both groups.The time for nucleic acid to turn negative with Omicron was (28.20±5.89) days, and it was (18.50±7.73) days with Delta, and the difference between the groups was statistically significant (t=2.565, P=0.019). The length of hospitalization with Omicron was (30.60±4.88) days, and that with Delta was (22.13±7.81) days, and the difference was statistically significant (t=2.270, P =0.035). Conclusions: The initial symptoms of Omicron patients are mainly throat discomfort, cough and sputum. The clinical manifestations are generally mild. The nucleic acid test Ct value is lower. The time for nucleic acid to turn negative and the time for hospitalization are longer, and the potential infectiousness is stronger. Those eligible for vaccination should complete the full course of vaccination and booster vaccination as soon as possible. At the same time, the management of "early detection, early reporting, early isolation, and early treatment" should be implemented.

18.
Annals of the Rheumatic Diseases ; 81:1028, 2022.
Article in English | EMBASE | ID: covidwho-2009194

ABSTRACT

Background: Vacuoles, E1 enzyme, X-linked, autoinfammatory, somatic (VEXAS) syndrome is a recently identifed disorder caused by somatic mutations in the UBA1 gene of myeloid cells. Various manifestations of pulmonary involvement have been reported, but a detailed description of lung involvement and radiologic fndings is lacking. Objectives: To describe lung involvement in VEXAS syndrome. Methods: A retrospective cohort study was conducted of all patients iden-tifed at the Mayo Clinic with VEXAS syndrome since October 2020. Clinical records and chest high resolution computed tomography (HRCT) scans were reviewed. Results: Our cohort comprised 22 white men with a median age of 69 years (IQR 62-74, range 57-84). Hematologic disorders including multiple myeloma, myelodysplastic syndrome and pancytopenia were present in 10 patients (45%), rheumatologic diseases including granulomatosis with poly-angiitis, IgG4-related disease, polyarteritis nodosa, relapsing polychondritis, and rheumatoid arthritis were found in 10 patients (45%), and 4 patients had dermatologic presentations including Sweet syndrome, Schnitzer-like syndrome or drug rash with eosinophilia skin syndrome (DRESS). VEXAS syndrome-related features included fever (18, 82%), skin lesions (20, 91%), lung infiltrates (12, 55%), chondritis (10, 45%), venous thromboembolism (12, 55%), macrocytic anemia (21, 96%), and bone marrow vacuoles (21, 96%). Other manifestations observed were arthritis, scleritis, hoarseness and hearing loss. Median erythrocyte sedimentation rate (ESR) was 69 mm/1st hour (IQR 34.3-118.8) and median C-reactive protein (CRP) of 55.5 mg/dL (IQR 11.4-98.8). The somatic mutations affecting methionine-41 (p.Met41) in UBA1 gene were: 11 (50%) p.Met41Thr, 7 (32%) p.Met41Val, 2 (9%) p.Met41Leu, and 2 (9%) in the splice site. All patients received glu-cocorticoids (GC) (median duration of treatment was 2.6 years);21 (96%) received conventional immunosuppressive agents (methotrexate, aza-thioprine, mycophenolate, leflunomide, cyclosporin, hydroxychloroquine, tofacitinib, ruxolitinib) and 9 (41%) received biologic agents (rituximab, tocilizumab, infliximab, etanercept, adalimumab, golimumab, abatacept). Respiratory symptoms included dyspnea and cough present in 21 (95%) and 12 (55%), respectively, and were documented prior to VEXAS diagnosis. Most of the patients were non-smokers (14, 64%) and obstructive sleep apnea (OSA) was present in 11 patients (50%). Seven patients (32%) used non-invasive ventilation, 6 used C-PAP, and 1 used Bi-PAP. Bronchoalveolar lavage (BAL) was available in 4 patients, and the findings were compatible with neutrophilic alveolitis in 3. Two patients had lung biopsies (2 transbronchial and 1 surgical) that showed ATTR amyloidosis and organizing pneumonia with lymphoid interstitial pneumonia, respectively. Pulmonary function tests were available in 9 (41%) patients and showed normal results in 5;3 patients had isolated reduction in DLCO and 1 with mild restriction. On chest HRCT, 16 patients (73%) had parenchymal changes including ground-glass opacities in 9, septal thickening in 4, and nodules in 3;pleural effusions were present in 3 patients, air-trapping in 3 patients and tracheomalacia in 1 patient. Follow-up chest HRCT was available for 8 patients (36%), the ground-glass opacities resolved in 5 patients, 3 patients manifested new or increased ground-glass opacities, and 1 patient had increased interlobular septal thickening. After 1 year of follow-up, 4 patients (17%) had died;3 due to pneumonia (2 COVID-19,1 bacterial) and 1 due to heart failure. VEXAS flares occurred in 18 patients (82%), the maximum number of relapses was 7, and they were mainly managed with GC and with changes in the immuno-suppressive regimen. Conclusion: Pulmonary involvement was documented by chest HRCT in most patients with VEXAS syndrome. Respiratory symptoms occurred in over one half of patients and about 20% had PFT abnormalities. The pulmonary manifestations of VEXAS are nonspecifc and characterized predominantly by infamma-tory parenchymal involvement.

19.
Annals of the Rheumatic Diseases ; 81:1706, 2022.
Article in English | EMBASE | ID: covidwho-2009178

ABSTRACT

Background: Patients with rheumatoid arthritis (RA) are considered a high-risk population to develop severe COVID-19 [1] and therefore vaccination is strongly recommended. Previous reports have shown a high hesitancy rate to receive a COVID-19 vaccine among RA. Objectives: This study aimed to evaluate the attitude of patients with RA to vaccination against SARS-CoV-2, explore the factors which may influence it, and assess adverse events of SARS-CoV-2 vaccines. Methods: This is a cross-sectional study including 106 patients with RA diagnosed according to the ACR/EULAR 2010 classification criteria and followed in the Rheumatology Department, over a period of 10 months from March to December 2021.Demographic and disease parameters were collected: age, gender, educational status, disease duration, erythrocyte sedimentation rate (ESR), disease activity score (DAS28), and treatments being used. All patients responded to a questionnaire on their perceptions and concerns about the covid-19 vaccine, and the adverse effects for those who got vaccinated. Results: Among the 106 patients, 90 (84,9%) were females and 16 (15,1%) were males. The mean age was 54 ±13 years old [23-77]. Sixty-four percent were from urban areas and 36 % were from rural areas. Thirty-three percent of patients were illiterate. The mean disease duration was 9.54 ±5.76 years [2-22]. The mean DAS28 ESR was 3,88 ±1.34 [1.2-7.58]. All of our patients were taking conventional synthetic DMARDs. Seventeen percent of patients were on biological DMARDs. The majority of the patients (90%) reported that they respected the preventive measures. Twenty-two percent of patients had stopped their treatment because they were afraid of the covid-19. Twenty-eight patients had contracted the SARS-CoV-2. Seventeen percent of the patients reported that they didn't get vaccinated against covid-19. The reasons given by these patients were: presumed adverse events (53,3%), presumed inef-fciency (25%), no recommendation from their doctor (46,7%), fear that the vaccine would make RA worse (64,7%). For the vaccinated patients, the vaccines administered were: 63,6 % Pfzer BioNTech, 6,8% Oxford/AstraZeneca, 5,7% Moderna, 4,5% Janssen/Johnson & Johnson, 2,3% Sinovac-Coro-naVac and 17% unspecifed. The majority of the patients (72,7 %) received two doses,14,8 % one dose and 12,5% 3 doses. After vaccination, 73,9% of patients reported adverse events, such as pain at the site of injection (88,1%), fatigue (35,8%), headache (14,9%), fever (13,4%) and muscle/joint pains (4,5%). Only 1 patient had experienced rheumatic disease fare. Hesitancy about the COVID-19 vaccination was associated with low intellectual level (p=0.004) and rural origin (p=0.001).RA disease duration, DAS28-ESR, and treatments have no influence on the attitude of patients towards COVID-19 Vaccination (p > 0,05). Conclusion: The acceptance of COVID-19 vaccination by RA patients in our study is quite promising. The majority of patients tolerated their vaccination well, with rare RA fares up. These results should reassure rheumatologists and patients. Education and outreach efforts need to be continued, especially for illiterate people and those who live in rural areas.

20.
Annals of the Rheumatic Diseases ; 81:123, 2022.
Article in English | EMBASE | ID: covidwho-2008934

ABSTRACT

Background: Even with the use of tocilizumab (TCZ), signifcant glucocorticoid exposure (usually ≥ 6 months) continues to be an important problem in giant cell arteritis (GCA). Objectives: We aimed to evaluate the efficacy and safety of tocilizumab (TCZ) in combination with 2 months of prednisone in a group of patients with GCA. Methods: We conducted a prospective, single arm, open-label study of TCZ in combination with 2 months of prednisone for new-onset and relapsing GCA patients with active disease (ClinicalTrials.gov Identifer NCT03726749). GCA diagnosis required confrmation by temporal artery biopsy or vascular imaging. Active disease was defned as presence of cranial or polymyalgia rheumat-ica symptoms necessitating treatment within 6 weeks of baseline. All patients received TCZ 162 mg subcutaneously every week for 12 months and an 8-week prednisone taper starting between 20 mg and 60 mg daily (Figure 1). The primary endpoint, sustained prednisone-free remission, was defned as absence of relapse from induction of remission up to week 52 while adhering to the prednisone taper. Relapse was defned as the recurrence of symptoms of GCA requiring treatment intensifcation regardless of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. Safety was also evaluated. 8-week prednisone taper starting between 20 mg and 60 mg Primary endpoint Prednisone-free remission at week 52 Figure 1. Clinical Trial Schema Results: Between 11/2018 and 11/2020 we enrolled 30 patients (mean age 74 years, 60% females, 50% new-onset disease, 77% temporal artery biopsy-proven, 47% imaging-proven). The mean ESR and CRP at screening were 45 mm/hour and 48 mg/L, respectively. The initial prednisone dose was 60 mg (n = 7), 50 mg (n = 1), 40 mg (n = 7), 30 mg (n = 6) and 20 mg (n = 9). All patients entered remission within 4 weeks of baseline. The primary endpoint was achieved by 23 (77%) patients (Table 1). The mean (SD) cumulative prednisone dose in these 23 patients was 1052 (390) mg. After a mean period of 16 weeks, 7 (23%) patients relapsed (Table 1). All relapses but one occurred after the completion of the study prednisone taper. Overall, 6 of the 7 patients with relapse received a second prednisone taper over 8 weeks. Of these 6 patients, 4 achieved and maintained remission for the remainder of the trial period, and 2 withdrew from the study after having a second relapse. One patient with relapse received a second prednisone taper over 26 weeks and stayed in remission until the end of the study. The mean (SD) cumulative prednisone dose in the 7 patients with relapse was 1883 (699) mg (Table 1). Overall, 4 (13%) participants developed a serious adverse event (Table 1). No cases of ischemia-related visual symptoms including permanent vision loss occurred during the study. Table 1. Efficacy and Safety Outcomes GCA patients (n = 30) Efficacy Sustained, prednisone-free remission by week 52 23.0 (76.7) Cumulative prednisone dose (mg) at week 52, mean (SD) 1051.5 (390.3) Relapse 70 (23.3) Time to relapse, weeks: mean (SD) 15.8 (14.7) Prednisone dose (mg/day) at relapse, mean (SD) 2.1 (5.2) Cumulative prednisone dose (mg), mean (SD) 1883.1 (699.2) Clinical manifestations at relapse Cranial symptoms 4 out of 7 patients schemic visual symptoms 0 out of 7 patients PMR symptoms 4 out of 7 patients Safety Serious adverse events 4.0 (13.3) Cellulitis 1 COVID-19 1 Fragility fracture 1 Cholecystitis 1 Values represent number and (%) unless otherwise specifed. SD, standard deviation;PMR, polymyalgia rheumatica Conclusion: These results suggest that 12 months of TCZ in combination with 8 weeks of prednisone could be efficacious for inducing and maintaining disease remission in patients with GCA. Confrmation of these fndings in a randomized controlled trial is required.

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