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1.
Topics in Antiviral Medicine ; 30(1 SUPPL):265, 2022.
Article in English | EMBASE | ID: covidwho-1880623

ABSTRACT

Background: Limited data are available on pregnancy and COVID-19 in sub-Saharan Africa (SSA). Methods: We conducted a retrospective cohort study of women ≥18 years old hospitalized at 23 health facilities in six SSA countries between March 1, 2020, and March 31, 2021. We assessed the impact of pregnancy on SARS-CoV-2 infection, and of SARS-CoV-2 on pregnant women, through comparisons of clinical outcomes among: 1) pregnant and non-pregnant women hospitalized with RT-PCR-confirmed SARS-CoV-2 infection, and 2) pregnant women confirmed to be positive or negative for SARS-CoV-2 infection by RT-PCR. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included need for oxygen supplementation or mechanical ventilation, pregnancy outcomes, and maternal or neonatal mortality. We performed negative log-binomial regression models to estimate the impact of pregnancy on SARS-CoV-2 among all women in the cohort, and the impact of SARS-CoV-2 on pregnancy outcomes. Factors associated with mortality were evaluated using competing-risk regression based on Fine and Gray's proportional hazards model. Results: We analyzed data on 1,315 hospitalized women: 510 pregnant women with SARS-CoV-2 infection;403 non-pregnant women with SARS-CoV-2 infection, and 402 pregnant women without SARS-CoV-2 infection. Among those with SARS-CoV-2 infection, pregnancy was associated with increased risk of ICU admission (adjusted rate ratio [aRR]= 1.86, 95% CI: 1.07-3.22, p=0.003) and oxygen supplementation (aRR= 1.48, 95% CI: 1.06-2.08, p=0.001). Among pregnant women, those with SARS-CoV-2 infection had increased risk of ICU admission (aRR = 2.0, 95% CI: 1.20-3.35, p=0.008), oxygen supplementation (aRR = 1.57, 95% CI: 1.17-2.11, p=0.002) and maternal mortality (aRR=3.08, 95% CI: 1.21-7.85, p=0.018) (Figure). Comparing SARS-CoV-2-infected vs. uninfected pregnant women, infected women were more likely to deliver by Caesarean section (59.3% vs 37.9%, RR = 1.56, 95% CI: 1.29-1.89, p<0.001);however, proportions of pre-term infants (32.4% vs. 31.1%, respectively, p = 0.870), infants with low birth weight (33.8% vs. 30.9%, respectively, p=0.711) and neonatal deaths [8/209 (3.8%) vs. 8/306 (2.6%) (RR=1.46, 95% CI: 0.56-3.84, p=0.436, respectively)] were similar. Conclusion: Among hospitalized pregnant women, SARS-CoV-2 infection increased morbidity and mortality. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women.

2.
Topics in Antiviral Medicine ; 30(1 SUPPL):114, 2022.
Article in English | EMBASE | ID: covidwho-1880598

ABSTRACT

Background: COVID-19 is characterized by a dysregulated inflammatory response associated with disease severity, poor prognosis and death. The aim of this study was to describe the real-life use of high-dose anakinra (ANK, a recombinant IL-1 receptor antagonist) among patients with COVID-19 who received remdesivir (REM). Methods: Cohort study including 277 patients with COVID-19 hospitalized at IRCCS San Raffaele Hospital between September 1st,2020 and February 28th, 2021;58 patients were treated with REM+ANK and 219 patients with REM only. ANK was administered intravenously at a dose of 5mg/kg every 12 hours. Patients were treated according to available local and international guidelines;corticosteroids and anticoagulation were administered when not contraindicated. Results are described by median (IQR) or frequency (%);P-values (P) were calculated by chi-square or Fishers' exact test and Wilcoxon rank-sum test, as appropriate. Survival estimates at 28 days were calculated using Kaplan-Meier curves. Results: At hospital admission (Table 1), patients treated with REM+ANK tended to be older [69 years (57-77) vs 62 years (53-75), P=0.06], had a significant lower PaO2/FiO2 [135 (91-220) vs 246 (172-299), P=0.0001], higher aspartate aminotransferase [51U/L (34-74) vs 40U/L (30-53), P=0.001], lactate dehydrogenase [405U/L (296-496) vs 334U/L (279-419), P=0.008], D-dimer [0.86mcg/mL (0.48-1.57) vs 0.67mcg/mL (0.39-1.17), P=0.048], ferritin [1167ng/mL (804-1983) vs 683ng/mL (391-1153), P<0.0001] and C-reactive protein [82mg/L (38-136) vs 58 mg/L (27-96), P=0.004), and were more frequently admitted to the Intensive Care Unit within the first 48 hours [3 (1.1%) vs 0, P=0.007). REM and ANK were started early within a median of 0 (0-2) and 1.5 days (0-3) since hospitalization, respectively. The Kaplan-Meier estimate of mortality at 28 days was 17.2% (95%CI 8.8-32.1%) in the REM+ANK group (8 deaths) and 21.4% (95%CI 13.3-33.3%) in the REM group (18 deaths;log-rank test P=0.797). Median time to death was 14 days (9-29) in the REM+ANK group vs 19 days (12-27) in the REM group (P=0.523). Conclusion: Real-life use of high-dose ANK in COVID-19 patients treated with REM was reserved for subjects with severe respiratory failure and a more pronounced inflammatory status. Nevertheless, mortality at 28 days was not significantly different among patients treated with or without ANK. Further analyses are warranted to verify the impact of ANK addition to REM in patients with a hyperinflammatory profile.

3.
Topics in Antiviral Medicine ; 30(1 SUPPL):303-304, 2022.
Article in English | EMBASE | ID: covidwho-1880596

ABSTRACT

Background: It is still unclear whether people with HIV (PWH) are more likely to have severe outcome of COVID-19. We aimed to assess this association using nation-wide register data. Methods: We included all adults hospitalized with a primary diagnosis of COVID-19 (ICD-10;U07.1, U07.2) in Sweden between Feb 1, 2020, and Aug 31, 2021, identified from the National Patient Register. The study population was linked to the National HIV Quality Register (n= 8 032), the Swedish Intensive Care Register, the Swedish Cause of Death Register, and the LISA database for labour market studies. Using multivariate logistic regression models, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for severe COVID-19 (intensive care admission or 90-day mortality), by HIV-status. Results: We included 121 PWH and 64 764 HIV-negative individuals hospitalized with COVID-19. PWH were younger (median age 57y vs. 65y, p<0.001) and more likely to be men (68% vs. 57%, p=0.015) compared to HIV-negative. There was no difference in level of education, level of income or number of comorbidities. Most hospitalized PWH had undetectable HIV-RNA (93%) and high CD4 counts (median 560, IQR 376-780). Severe COVID-19 was identified in 17 (14%) PWH and 14 648 (23%) HIV-negative. Ten (8%) PWH and 10 217 (16%) HIV-negative died within 90 days. HIV status was not associated with higher odds of severe COVID-19 (aOR 0.88, 95% CI 0.52-1.49). Higher age was associated with severe COVID-19 in PWH (aOR 1.08, 95% CI 1.02-1.15). PWH with one or more comorbidities were four times more likely to have severe COVID-19 (aOR 4.3, 95% CI 1.1-16.7, ref PWH with no comorbidity). Neither level of income nor level of education or migrant status was associated with severe COVID-19 in PWH. Level of HIV-RNA, current CD4, nadir CD4, and mode of HIV-transmission was not associated with severe COVID-19. PWH admitted to the ICU were six times more likely treated with tocilizumab compared to HIV-negative admitted to the ICU (aOR 6.1, 95% CI 1.5-24.5), even after adjusting for regional differences in early adoption of tocilizumab use. There was no difference in the number treated with steroids (aOR 0.9, 95% CI 0.2-3.1). Conclusion: This nation-wide cohort study, including the entire Swedish adult population hospitalized with COVID-19, indicates that PWH with well-treated HIV-infection have similar odds of severe COVID-19 as HIV-negative individuals. PWH admitted to the ICU were more likely treated with tocilizumab compared to HIV-negative.

4.
Topics in Antiviral Medicine ; 30(1 SUPPL):249, 2022.
Article in English | EMBASE | ID: covidwho-1880566

ABSTRACT

Background: The pathogenesis of neuropsychiatric symptoms persisting months after acute SARS-CoV-2 infection is poorly understood. We examined clinical and laboratory parameters in participants with post-acute COVID-19 neuropsychiatric symptom to assess for systemic and nervous system immune perturbations. Methods: Participants with a history of laboratory confirmed COVID-19 and ongoing neurologic symptoms were enrolled in an observational study that collected medical history;detailed post-COVID symptom survey;and paired cerebrospinal fluid (CSF) and blood. In addition to standard clinical labs, neopterin and anti-SARS-CoV-2 antibodies (anti-spike, RBD, and nucleocapsid) were measured by ELISA. Non-parametric tests were used to compare CSF and blood findings between the post-COVID participants and pre-COVID-19 era healthy controls. Results: Post-COVID participants (n=27) and controls (n=21) were similar in age (median 51 and 46 years), but there was a greater proportion of females (67% vs 24%;p=0.004) and white participants in the post-COVID cohort (63% vs 24%;p=0.04). The post-COVID study visit was a median of 264 days (IQR 59-332) after acute COVID-19 symptom onset. 35% were hospitalized during their acute illness;12% required intensive care. 33% had previously been treated with medications for mental health conditions. The most frequent neuropsychiatric symptoms were cognitive impairment (67%), mood symptoms (67%), headache (56%), and neuropathy (41%). Blood c-reactive protein, T cell count, and T cell subset frequency (CD4% and CD8%) were similar between groups, while D-dimer was higher in the post-COVID cohort (median 0.48 vs 0.27 mg/L;p = 0.019) (Figure). CSF WBC, protein, neopterin, and CSF/blood albumin ratio were similar between the groups;the frequency of CSF lymphocytes was lower in the post-COVID cohort (p = 0.05) (Figure 1). Antibodies against at least one SARS-CoV-2 antigen were detected in 7/10 CSF and 8/9 blood samples in the post-COVID CSF (antibody reactivity range 1.5 to 55-fold greater than to control antigens). Conclusion: In this small cohort of post-COVID participants with neurologic symptoms, we found limited differences in CSF and blood markers when compared to pre-pandemic healthy controls. Deeper immunophenotyping in a larger number of participants may provide greater insight into subtle differences. The presence of anti-SARS-CoV-2 antibodies in CSF months after acute infection warrants further investigation.

5.
Topics in Antiviral Medicine ; 30(1 SUPPL):303, 2022.
Article in English | EMBASE | ID: covidwho-1880553

ABSTRACT

Background: Four Coronavirus disease 2019 (COVID-19) epidemic waves occurred in France between March 2020 and September 2021. These 4 waves had different intensities and anti severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) therapies including the extensive use of corticosteroids, monoclonal antibodies, high-flow nasal oxygenotherapy, and generalization of vaccination. This single-center retrospective study compared patients' characteristics and outcomes during these four waves. Methods: We retrospectively analyzed the data of all consecutive inpatients with proven COVID-19 (based on polymerase chain reaction (PCR) testing of nasopharyngeal swab sampling) in a French tertiary care hospital from March 1 to July 31, 2020 (wave 1), August 1 to December 31 (wave 2), January 1 to June 30, 2021 (wave 3), and August 1 to September 30, 2021 (wave 4). Differences in baseline characteristics and outcomes i.e., intensive care unit (ICU) hospitalization and deaths were assessed. A patient with healthcare-associated COVID-19 was defined by a positive PCR 48 h after admission. Continuous variables were compared using the Kruskal-Wallis test and categorical data by the Chi-square test (SAS 9.4 software). Results: During wave 1, 1939 patients were hospitalized at the HCC for COVID-19 816 (42.1%), 463 (23.9%) during wave 2, 572 (29.5%) during wave 3, and 88 (4.5%) during wave 4. Table 1 summarizes the patients' main clinical characteristics, baseline biological results, and outcome according to COVID-19 waves Results are presented in table 1 in the form n (%) [95% confidence interval], percentages are calculated for non missing values only. Wave 1 patients were hospitalized later after COVID-19 symptom onset, had more serious disease at baseline (higher temperature, more frequent need for oxygen, higher C-reactive protein and lactate dehydrogenase levels, and lower lymphocytes), and were more frequently hospitalized in the ICU. Wave 4 patients were younger. The highest death rates were found during the first 2 waves;17% vs. 15% in wave 3 and 4% in wave 4. A higher percentage of healthcare-associated COVID-19 was found in wave 2. Although the month of October was not included in the results, there was a marked decrease of cases and the lowest death rate during wave 4. Conclusion: Wave 1 patients were had more serious disease at baseline with the highest death and ICU hospitalization rates. Deaths were reduced during wave 3 and 4 with a marked decrease in the number of patients hospitalized during wave 4.

6.
Topics in Antiviral Medicine ; 30(1 SUPPL):78, 2022.
Article in English | EMBASE | ID: covidwho-1880481

ABSTRACT

Background: The aim of this study was to identify the cause of lymphopenia, strongly predictive of survival in COVID-19. Methods: We recruited PCR-positive SARS-CoV-2-infected patients upon admission to Intensive Care Units (ICU, n = 29) and to the Infectious Diseases Department (non-ICU, n = 29) at Nîmes University Hospital, as well as age-and sex-matched healthy controls (HC). Their Angiotensin II plasma levels were measured by ELISA and their monocytic reactive oxygen species (ROS) production and T-cell apoptosis were measured by flow cytometry using dichloro-dihydro-fluorescein diacetate and fluorescent annexin V, respectively. DNA damage and double strand breaks were quantified in immunofluorescence using antibodies specific for-γ-H2AX and 53BP1, respectively. Results: The monocytes of certain COVID-19 patients spontaneously released ROS able to induce DNA damage and apoptosis in neighboring cells. High ROS production was predictive of death. Indeed, in most patients we observed the presence of DNA damage in up to 50% of their peripheral mononuclear blood cells, with double-strand DNA breaks, and T-cell apoptosis. The intensity of this DNA damage was linked to lymphopenia. SARS-CoV-2 is known to induce the internalization of its receptor, Angiotensin Converting Enzyme 2, a protease able to catabolize Angiotensin II. Accordingly, we observed high plasma levels of Angiotensin II in ROS-producing patients. In search of the stimulus responsible for their ability to release ROS, we unveiled that Angiotensin II triggers ROS production by monocytes via Angiotensin receptor I (AT1). ROS released by Angiotensin II-activated monocytes induced DNA damage and apoptosis in neighboring cells. Conclusion: Mononuclear cell apoptosis provoked via DNA damage due to the release of monocytic ROS could play a major role in COVID-19 pathogenesis, inasmuch as ROS are also known to trigger inflammatory cytokine production. Unveiling this new pathogenic pathway opens up new therapeutic possibilities for COVID-19 based on the early association of AT1 antagonists and antioxidants.

7.
Revista Cubana de Hematologia, Inmunologia y Hemoterapia ; 37, 2021.
Article in Spanish | EMBASE | ID: covidwho-1880384

ABSTRACT

Introduction: Intensive care nursing staff are exposed to different biological risk factors from the care of patients with COVID-19, therefore biosafety acquire special importance in these units. Objective: To evaluate the effectiveness of the nursing intervention in intensive care on biosafety for the care of patients with COVID-19. Methods: Descriptive and observational study, at the “Enrique Cabrera” General Teaching Hospital in Havana, between April 1 and June 30, 2020. The study population consisted of 60 nurses, to whom a questionnaire was applied and performance observation. Absolute and relative frequency distribution were used, in the case of quantitative variables the mean and standard deviation were used. To assess the results before and after the nursing intervention, Pearson's Chi-square test of independence was applied. Results: The female sex and the ages between 20 to 29 years prevailed. Once the overcoming actions were carried out, positive changes were evidenced in the level of knowledge about COVID-19 and biosafety standards. The most difficult aspects in the initial observation of performance were: use of personal protection equipment, hand washing, precautions in techniques and procedures, handling of biological waste. Conclusions: The nursing intervention was effective and responded to the learning needs about biosafety for the care of patients with COVID-19 in intensive care.

8.
Topics in Antiviral Medicine ; 30(1 SUPPL):177, 2022.
Article in English | EMBASE | ID: covidwho-1880382

ABSTRACT

Background: COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Vasoactive Intestinal Peptide (VIP) blocks replication of the SARS-CoV-2 virus in alveolar type II cells, inhibits cytokine synthesis, prevents cytopathy, and up regulates surfactant production. Synthetic VIP-aviptadil is a novel strategy to treat patients with COVID-19 and respiratory failure. Methods: This was a prospective, multicenter, randomized, placebo-controlled trial with 196 patients, nasal swab PCR+ for COVID-19 receiving intensive care at 10 U.S. hospitals (6 tertiary care and 4 regional hospitals) to determine if intravenous aviptadil is superior to placebo in achieving recovery from respiratory failure and survival at 60 days post treatment. The analysis was by modified intent to treat (ITT) using a pre-specified logistic regression model. The primary pre-specified endpoint was being alive with no respiratory failure at day 60. Results: There were 213 subjects screened, with 203 eligible and 196 randomized and treated. Baseline characteristics were comparable except for worse NIAID severity for aviptadil (Table 1). All subjects were followed up to 60 days. A favorable trend (OR 1.63;P=.14) was seen for the primary endpoint at 60 days with significance achieved after adjusting for hospital setting. Overall, there was 2.0-fold increased odds of survival (95% CI 1.05-3.88;P<.035) for aviptadil at Day 60 controlling for baseline NIAID score. Odds of survival increased to over 4-fold after adjusting for site of care (Tertiary care vs regional hospital, OR 4.35 (95% CI 1.91, 9.90;P<.035). Logistic regression indicated aviptadil treated patients were also significantly more likely to be discharged earlier than placebo-treated patients (p=0.01). The most common adverse events noted were diarrhea (32.8% vs. 1.5%) and hypotension (26% vs.21.5%) for aviptadil vs. placebo. Additional adverse events occurring more frequently in aviptadil treated patients included acute kidney injury (23.7% vs 20%), hyperkalemia (12.2% vs 6.2%), and atrial fibrillation (11.5% vs 4.6%). Multiple organ dysfunction syndrome (6.9% vs 13.8%) and respiratory failure (12.2% vs 13.8%) occurred more commonly in placebo-treated patients. Conclusion: Treatment with aviptadil demonstrates efficacy in improving the likelihood of recovering from respiratory failure, surviving to 60 days, and reducing hospital stay in critically ill patients with respiratory failure caused by COVID-19.

9.
Topics in Antiviral Medicine ; 30(1 SUPPL):18, 2022.
Article in English | EMBASE | ID: covidwho-1880294

ABSTRACT

Background: The Sisonke Phase IIIB open-label implementation study vaccinated health care workers (HCWs) with the single dose Ad26.COV2.S vaccine during two phases of the South African Covid-19 epidemic, dominated first by the Beta followed by the Delta variant of concern. Methods: HCWs were vaccinated over 3 months (17 February-17 May 2021). Safety was monitored by self-reporting, facility reporting and linkage to national databases. Vaccine effectiveness (VE) against Covid-19 related hospitalisation, hospitalisation requiring critical or intensive care and death, ascertained 28 days or more post vaccination was assessed up until 17 July 2021. Nested sub-cohorts (A and B) from two national medical schemes were evaluated to assess VE using a matched retrospective cohort design. Results: Over the 3-month period, 477234 HCWs were vaccinated in 122 vaccination sites across South Africa. VE derived from the sub-cohorts comprising 215 813 HCWs was 83% (95% CI 75-89) to prevent Covid-19 deaths, 75% (95% CI 69-82) to prevent hospital admissions requiring critical or intensive care and 67% (95% CI 62-71) to prevent Covid-19 related hospitalisations. The VE was maintained in older HCWs and those with comorbidities including HIV infection. VE remained consistent throughout the Beta and Delta dominant phases of the study. 10279 adverse events were reported and 139 (1.4%) were serious, including two cases of thrombosis with thrombocytopenia syndrome and four cases of Guillain-Barré syndrome who recovered. Conclusion: The single dose Ad26.COV2.S was safe and effective against severe Covid-19 disease and death post-vaccination, and against both Beta and Delta variants providing real-world evidence for its use globally.

10.
Topics in Antiviral Medicine ; 30(1 SUPPL):114-115, 2022.
Article in English | EMBASE | ID: covidwho-1880172

ABSTRACT

Background: Pulse glucocorticoid therapy (> 250 mg of prednisone equivalent per day for 1 or a few days) is used in many immuno-inflammatory diseases for its quick and strong anti-inflammatory effect in emergency situations. It was used during in Severe Acute Respiratory Syndrome epidemics with no consistent data regarding its benefits. The efficacy and safety of this therapy associated to dexamethasone in coronavirus disease 2019 (Covid-19) pneumonia are unclear. Methods: We conducted a double-blind, randomized, placebo-controlled trial in hospitalized patients with COVID19-pneumonia. The study population included patients hospitalized for recent-onset Covid-19 pneumonia requiring supplemental oxygen in any delivery mode, except invasive mechanical ventilation, with PaO2/FiO2 between 100 and 300, and a C-reactive protein greater than 5 mg/dl. Patients were randomly assigned to receive 1 gram of methylprednisolone for 3 consecutive days or placebo in addition to standard dexamethasone. The primary outcome was the duration of the patient hospitalization, calculated as the time interval between randomization and hospital discharge without the need of supplementary oxygen. All-cause mortality, survival free from invasive ventilation and safety were also evaluated. Written informed consent was obtained from each patient or from the patient's legally authorized representative if the patient was unable to provide consent. Results: A total of 304 patients underwent randomization in 19 Italian sites between December 21, 2020, and March 10, 2021. Three patients retired the consent to the study one day after randomization, leaving 301 patients eligible for intention to treat analyses. 112 of 151 (74.2%) patients in the pulse methylprednisolone arm and 111 of 150 (74.0%) patients in the placebo arm were discharged from hospital without oxygen (p = 0.528) within 28 days from randomization. We did not observe any significant differences between pulse methylprednisolone and placebo arms in terms of admission to Intensive Care Unit with orotracheal intubation or death (19.9% versus 16.0% respectively;hazard ratio, 1.27;95%CI, 0.74-2.16), or in terms of overall mortality (9.3% versus 11.3% respectively;hazard ratio, 0.82;95%CI, 0.40-1.66). Serious adverse events occurred in 9 patients (6.0%) in the methylprednisolone pulse group and in 12 patients (8.0%) in the placebo group. Conclusion: Methylprednisolone pulse therapy in addition to dexamethasone was not of benefit in patients with COVID-19 pneumonia.

11.
Topics in Antiviral Medicine ; 30(1 SUPPL):246-247, 2022.
Article in English | EMBASE | ID: covidwho-1880100

ABSTRACT

Background: Persistent COVID-19 symptoms have been reported up to six months (M6) after hospital discharge. Little is known on the frequency and the nature of persistent symptoms beyond M6. Here we assessed, in the longitudinal prospective French COVID-19 cohort, symptoms that persisted twelve months after admission for COVID-19. Methods: Hospitalized patients with a virologically-confirmed COVID-19 were enrolled. Follow-up was planned with a physician's visit at M3, M6 and M12 post-admission. At M12, manual assessment of muscle strength of each limb was assessed using the modified Medical Muscle Research council Scale for testing muscle strength (mMRC). Patients were also interviewed on health-related quality-of-life (SF-12) and on psychological distress (HADS). Associations between persistence of ≥ 3 symptoms at M12 and clinical characteristics at admission were assessed through bivariate and multivariate logistic regression. Results: By September 2021, M12 data were available for 737 patients enrolled between February 3rd and July 15th 2020. Median age was 61 years, 64% were men and 37% were admitted to intensive care unit during the acute phase. At M12 visit, 27% of participants had ≥ 3 symptoms, with no change between M6 and M12 globally. Fatigue (46%), dyspnea (33%) and joint pain (21%) were the 3 most frequently reported symptoms. Presence of ≥ 3 symptoms was associated with both anxiety and depression, an impaired quality of life and mMRC scale < 57. The mean percentage of predicted value of distance walked in 6 min (6MWT) was 88% (IQR 74-100) for the 163 patients who realised the 6MWT, this percentage was lower in patients who reported dyspnea (85% [IQR 71;99] vs 95% [IQR 76;101], p=0.04). Compared to men, women more often reported presence of ≥ 3 symptoms (39% vs 21%), depression and anxiety (respectively, 12% vs 6% and 21% vs 10%), an altered quality of life for the physical component only (54% vs 46%), and a slight or a moderate disability (respectively, 20% vs 14% and 6% vs 4%). Women had less often returned to work than men (34% vs 23%). Conclusion: A fourth of individuals admitted to hospital for COVID-19 still had ≥3 persistent symptoms at M12 post-discharge, with no improvement between M6 and M12. Also, 25% of those who initially had a professional occupation were not back to work at M12. Women reported more often ≥3 symptoms, suffered more from anxiety and depression, and had less often returned to work than men.

12.
US Oncology and Hematology Review ; 18(1):78-87, 2022.
Article in English | EMBASE | ID: covidwho-1879950

ABSTRACT

Introduction: Since the onset of the SARS-CoV-2 pandemic, haematological laboratory abnormalities and thrombotic complications have been observed among infected patients. We aimed to highlight key pathophysiological mechanisms of COVID-19-associated coagulopathy and to summarize incidence rates of venous and arterial thrombotic events, comorbidities conferring risk, and current treatment guidelines including data from ongoing clinical trials. Methods: A systematic review was performed according to PRISMA recommendations of case–control studies, cohort studies, observational studies and randomized clinical trials (RCTs) published between 1 December 2019 and 30 September 2021 within PubMed and Web of Science. Inclusion criteria were English language, adult patients and at least one coagulation parameter described. Results: 2,554 records were screened, from which 59 studies were included. Abnormalities in several laboratory parameters were associated with worse clinical outcomes including elevations in prothrombin time, activated partial thromboplastin time, D-dimer, fibrinogen, von Willebrand factor antigen/activity and lupus anticoagulant antibodies. Rates of venous and arterial thromboembolism varied significantly among studies performed early in the pandemic and across different nations. Pathophysiological mechanisms included vascular endotheliopathy, increased inflammation and macrophage activation, neutrophil extracellular traps, antiphospholipid antibody production and obesity/adipose tissue signalling. Current recommendations for management of COVID coagulopathy from various societies include the use and dosing of systemic anticoagulation to prevent thrombotic sequelae in the outpatient, inpatient and critical care settings. The optimal anticoagulant dose for thromboprophylaxis in the inpatient and critical care settings is currently not well established. Conclusions: SARS-CoV-2 infection can cause a distinct form of coagulopathy, with thromboembolic complications leading to significant morbidity and mortality. The optimal treatment requires further refinement pending the results from key ongoing RCTs.

13.
Topics in Antiviral Medicine ; 30(1 SUPPL):349, 2022.
Article in English | EMBASE | ID: covidwho-1879935

ABSTRACT

Background: Effective, safe, and affordable antivirals are needed for COVID-19. Several lines of reseach suggest that tenofovir may be effective against COVID-19 but no large-scale human studies with appropriate adjustment for comorbidities have been conducted. We describe the incidence, clinical severity and mortality of laboratory-confirmed SARS-CoV-2 infection by antiretroviral therapy (ART) among HIV-positive individuals with virological control adjusting for key potential confounders including hypertension, diabetes, chronic renal disease, cardiovascular disease, and treatment with immunosuppressants or corticosteroids. Methods: We studied HIV-positive individuals on ART in 2020 at 69 HIV clinics in Spain from February 1 to December 31. These 69 clinics serve approximately 44% of all persons on ART with virological suppression in Spain. We collected data on sociodemographics, ART, CD4-cell count, HIV-RNA viral load, comorbidities and the following outcomes: laboratory-confirmed SARS-CoV-2 infection, COVID-19 hospitalization, intensive care unit (ICU) admission and death. We compared 48-week risks, relative risks, relative differences and 95% confidence intervals (CI) for individuals receiving tenofovir disoproxyl fumarate (TDF)/emtricitabine (FTC), tenofovir alafenamide (TAF)/FTC, abacavir (ABC)/lamivudine (3TC), and other regimes. All estimates were adjusted for clinical and sociodemographic characteristics via inverse probability weighting. Results: Of 51,558 eligible individuals, 39.6% were on TAF/FTC, 11.9% on TDF/FTC, 26.6% on ABC/3TC, 21.8% on other regimes. There were 2,402 documented SARS-CoV-2 infections (425 hospitalizations, 45 ICU admissions, 37 deaths). Compared with TAF/FTC, the estimated risk ratios (RR) (95% CI) of hospitalization were 0.66 (0.43, 0.91) for TDF/FTC and 1.29 (1.02, 1.58) for ABC/3TC, the RRs of ICU admission were 0.28 (0.11, 0.90) for TDF/FTC and 1.39 (0.70, 2.80) for ABC/3TC, and the RRs of death were 0.37 (0.23, 1.90) for TDF/FTC and 2.02 (0.88-6.12) for ABC/3TC. The corresponding RRs of hospitalization for TDF/FTC were 0.49 (0.24, 0.81) in individuals ≥50 years and 1.15 (0.59, 1.93) in younger individuals. Conclusion: Our findings suggest that, compared with other antiretrovirals, TDF/FTC lowers COVID-19 severity among HIV-positive individuals with virological control. This protective effect may be restricted to individuals aged 50 years and older. Confirmatory randomized trials of TDF/FTC for the prophylaxis and early treatment of COVID-19 are warranted.

14.
Journal of Investigative Medicine ; 70(4):1066-1067, 2022.
Article in English | EMBASE | ID: covidwho-1866266

ABSTRACT

Purpose of Study Objective: To evaluate the short and midterm cardiac outcomes in children hospitalized with MIS-C in two pediatric intensive care units (PICU) in New Jersey. Methods Used Design/Methods: We conducted a retrospective review of children admitted to the PICU with a diagnosis of MIS-C between April 2020 through March 2021. Cardiac biomarkers and echocardiograms performed during hospitalization were analyzed. Follow-up echocardiograms were performed two to eight weeks post-discharge, with interval follow-up of up to one year. Shortening fraction (SF) was used to assess left ventricular systolic function using standard M-mode (SF < 28% considered abnormal). Summary of Results Results: Twenty-seven patients (18 male;median age 11 years) were included. The mean peak Troponin I in 25 patients was 2.10 +/- 5.0 ng/dL, and mean peak NTProBNP level in 26 patients was 1,606 +/- 1293 pg/dL. Most patients had normalization of cardiac biomarkers by time of discharge (table 1). Seven of the 23 patients who had an echocardiogram on admission had a SF less than 28%. Lowest SF and SF at the time of discharge were compared in 21 patients with a median improvement of 6% (p <0.001) (table 2). Nineteen patients had a follow-up echocardiogram two to ten weeks post discharge and 18 of those had normal left ventricular systolic function (p < 0.001). No patient had evidence of diastolic dysfunction at follow-up. Eight patients had midterm follow-up five to seven months post-discharge;one patient was followed for one-year post-discharge. Abnormalities that persist in these patients include low normal left ventricular systolic function. Three subjects had evidence of left coronary artery dilation (z score >2) during hospitalization and continued to have diffuse dilation at follow up, with one developing right coronary artery dilation. Conclusions Conclusion: In this cohort of patients, most children admitted to the PICU with MIS-C had abnormal cardiac biomarkers with normal to mildly decreased left ventricular systolic function that improved by time of discharge and continued to improve with midterm (5-7 months) follow-up. A very small subset of patients, however, continue to have cardiac complications including diffuse coronary artery dilation. (Table Presented).

15.
SAGE Open Med ; 10: 20503121221099359, 2022.
Article in English | MEDLINE | ID: covidwho-1872078

ABSTRACT

Objectives: Acute kidney injury is common among the critically ill. However, the incidence, medication use, and outcomes of acute kidney injury have been variably described. We conducted a single-center, retrospective cohort study to examine the risk factors and correlates associated with acute kidney injury in critically ill adults with a particular focus on medication class usage. Methods: We reviewed the electronic medical records of all adult patients admitted to an intensive care unit between 1 February and 30 August 2020. Acute kidney injury was defined by the 2012 Kidney Disease: Improving Global Outcomes guidelines. Data included were demographics, comorbidities, symptoms, laboratory parameters, interventions, and outcomes. The primary outcome was acute kidney injury incidence. A Least Absolute Shrinkage and Selection Operator regression model was used to determine risk factors associated with acute kidney injury. Secondary outcomes including acute kidney injury recovery and intensive care unit mortality were analyzed using a Cox regression model. Results: Among 226 admitted patients, 108 (47.8%) experienced acute kidney injury. 37 (34.3%), 39 (36.1%), and 32 patients (29.6%) were classified as acute kidney injury stages I-III, respectively. Among the recovery and mortality cohorts, analgesics/sedatives, anti-infectives, and intravenous fluids were significant (p-value < 0.05). The medication classes IV-fluid electrolytes nutrition (96.7%), gastrointestinal (90.2%), and anti-infectives (81.5%) were associated with an increased odds of developing acute kidney injury, odd ratios: 1.27, 1.71, and 1.70, respectively. Cox regression analyses revealed a significantly increased time-varying mortality risk for acute kidney injury-stage III, hazard ratio: 4.72 (95% confidence interval: 1-22.33). In the recovery cohort, time to acute kidney injury recovery was significantly faster in stage I, hazard ratio: 9.14 (95% confidence interval: 2.14-39.06) cohort when compared to the stage III cohort. Conclusion: Evaluation of vital signs, laboratory, and medication use data may be useful to determine acute kidney injury risk stratification. The influence of particular medication classes further impacts the risk of developing acute kidney injury, necessitating the importance of examining pharmacotherapeutic regimens for early recognition of renal impairment and prevention.

16.
Nurs Child Young People ; 2022 Jun 06.
Article in English | MEDLINE | ID: covidwho-1879636

ABSTRACT

This article explores the experiences of South Thames Retrieval Service (STRS) retrieval nurse practitioners in providing inter-hospital transfers of critically ill babies and children during the coronavirus disease 2019 (COVID-19) pandemic. As well as its usual cohort of patients, the STRS also transferred critically ill and ventilated adults. The authors present a comparative analysis of pre-pandemic and pandemic retrievals over two six-week periods, one year apart. In the first period, from December 2019 to the end of January 2020, STRS retrieval nurse practitioners transported 47 critically ill children. One year later, during the second wave of the COVID-19 pandemic, STRS retrieval nurse practitioners transported 50 critically ill children and 26 critically ill adults with COVID-19 and a premature baby who was a COVID-19 contact. The latter two groups are not usually transported by the service. All of the patients retrieved by the STRS team during the COVID-19 pandemic were safely transported. This initiative demonstrated how nurses worked flexibly during the pandemic within the limits of their professional competence.

17.
J Korean Med Sci ; 37(22): e78, 2022 Jun 06.
Article in English | MEDLINE | ID: covidwho-1879449

ABSTRACT

BACKGROUND: We analyzed the differences between clinical characteristics and computed tomography (CT) findings in patients with coronavirus disease 2019 (COVID-19) to establish potential relationships with mediastinal lymphadenopathy and clinical outcomes. METHODS: We compared the clinical characteristics and CT findings of COVID-19 patients from a nationwide multicenter cohort who were grouped based on the presence or absence of mediastinal lymphadenopathy. Differences between clinical characteristics and CT findings in these groups were analyzed. Univariate and multivariate analyses were performed to determine the impact of mediastinal lymphadenopathy on clinical outcomes. RESULTS: Of the 344 patients included in this study, 53 (15.4%) presented with mediastinal lymphadenopathy. The rate of diffuse alveolar damage pattern pneumonia and the visual CT scores were significantly higher in patients with mediastinal lymphadenopathy than in those without (P < 0.05). A positive correlation between the number of enlarged mediastinal lymph nodes and visual CT scores was noted in patients with mediastinal lymphadenopathy (Spearman's ρ = 0.334, P < 0.001). Multivariate analysis showed that mediastinal lymphadenopathy was independently associated with a higher risk of intensive care unit (ICU) admission (odds ratio, 95% confidence interval; 3.25, 1.06-9.95) but was not significantly associated with an increased risk of in-hospital death in patients with COVID-19. CONCLUSION: COVID-19 patients with mediastinal lymphadenopathy had a larger extent of pneumonia than those without. Multivariate analysis adjusted for clinical characteristics and CT findings revealed that the presence of mediastinal lymphadenopathy was significantly associated with ICU admission.


Subject(s)
COVID-19 , Lymphadenopathy , COVID-19/complications , Cohort Studies , Hospital Mortality , Humans , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/pathology , Retrospective Studies
18.
Noro-Psikyatri Arsivi ; 59(2):158-160, 2022.
Article in Turkish | ProQuest Central | ID: covidwho-1877399

ABSTRACT

Keywords: COVID-19, poliomyelitis, muscular weakness, intensive care unit, acute respiratory distress syndrome GÍRÍŞ Şiddetli akut solunum sıkıntısı sendromu koronavirüs 2'nin (SARS-CoV-2) neden olduǧu COVID-19, yoǧun bakım ünitesine (YBÜ) kabul gerektiren hayatı tehdit edici bir akut solunum sıkıntısına neden olabilir (1). Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: A systematic review and metaanalysis. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a singlecentered, retrospective, observational study.

19.
Pediatr Clin North Am ; 69(3): 425-440, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1878341

ABSTRACT

Neonatal and pediatric extracorporeal membrane oxygenation (ECMO) has evolved over the past 50 years. Advances in technology, expertise, and application have increased the number of centers providing ECMO with expanded indications for use. However, increasing the use of ECMO in recent years to more medically complex critically ill children has not changed overall survival despite increased experience and improvements in technology. This review focuses on ECMO history, circuits, indications and contraindications, management, complications, and outcome data. The authors highlight important areas of progress, including unintubated and awake patients on ECMO, application during the COVID-19 pandemic, and future directions.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , COVID-19/epidemiology , COVID-19/therapy , Child , Critical Illness/therapy , Humans , Infant, Newborn , Pandemics
20.
Eur Arch Otorhinolaryngol ; 2022 Jun 04.
Article in English | MEDLINE | ID: covidwho-1877831

ABSTRACT

PURPOSE: The COVID-19 outbreak has led to an increasing number of acute laryngotracheal complications in patients subjected to prolonged mechanical ventilation, but their incidence in the short and mid-term after ICU discharge is still unknown. The main objective of this study is to evaluate the incidence of these complications in a COVID-19 group of patients and to compare these aspects with non-COVID-19 matched controls. METHODS: In this cohort study, we retrospectively selected patients from November 1 to December 31, 2020, according to specific inclusion and exclusion criteria. The follow-up visits were planned after 6 months from discharge. All patients were subjected to an endoscopic evaluation and completed two questionnaires (VHI-10 score and MDADI score). RESULTS: Thirteen men and three women were enrolled in the COVID-19 group while nine men and seven women were included in the control group. The median age was 60 [56-66] years in the COVID-19 group and 64 [58-69] years in the control group. All the patients of the control group showed no laryngotracheal lesions, while five COVID-19 patients had different types of lesions, two located in the vocal folds and three in the trachea. No difference was identified between the two groups regarding the VHI-10 score, while the control group showed a significantly worse MDADI score. CONCLUSIONS: COVID-19 patients subjected to prolonged invasive ventilation are more likely to develop a laryngotracheal complication in the short and medium term. A rigorous clinical follow-up to allow early identification and management of these complications should be set up after discharge.

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