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1.
Annals of the Rheumatic Diseases ; 81:163-164, 2022.
Article in English | EMBASE | ID: covidwho-2008909

ABSTRACT

Background: Some factors associated with severe COVID-19 outcomes have been identifed in patients with psoriasis (PsO) and infammatory/autoimmune rheumatic diseases, namely older age, male sex, comorbidity burden, higher disease activity, and certain medications such as rituximab. However, information about specifcities of patients with PsO, psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), including disease modifying anti-rheumatic drugs (DMARDs) specifcally licensed for these conditions, such as IL-17 inhibitors (IL-17i), IL-23/IL-12 + 23 inhibitors (IL-23/IL-12 + 23i), and apremilast, is lacking. Objectives: To determine characteristics associated with severe COVID-19 outcomes in people with PsO, PsA and axSpA. Methods: This study was a pooled analysis of data from two physician-reported registries: the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), comprising patients with PsO/PsA, and the COVID-19 Global Rheumatology Alliance (GRA) registry, comprising patients with PsA/axSpA. Data from the beginning of the pandemic up to 25 October, 2021 were included. An ordinal severity outcome was defned as: 1) not hospitalised, 2) hospitalised without death, and 3) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics (age, sex, time period of infection), comorbidities (hypertension, other cardiovascular disease [CVD], chronic obstructive lung disease [COPD], asthma, other chronic lung disease, chronic kidney disease, cancer, smoking, obesity, diabetes mellitus [DM]), rheumatic/skin disease (PsO, PsA, axSpA), physician-reported disease activity, and medication exposure (methotrexate, lefunomide, sulfasalazine, TNFi, IL17i, IL-23/IL-12 + 23i, Janus kinase inhibitors (JAKi), apremilast, glucocorticoids [GC] and NSAIDs). Age-adjustment was performed employing four-knot restricted cubic splines. Country-adjustment was performed using random effects. Results: A total of 5008 individuals with PsO (n=921), PsA (n=2263) and axSpA (n=1824) were included. Mean age was 50 years (SD 13.5) and 51.8% were male. Hospitalisation (without death) was observed in 14.6% of cases and 1.8% died. In the multivariable model, the following variables were associated with severe COVID-19 outcomes: older age (Figure 1), male sex (OR 1.53, 95%CI 1.29-1.82), CVD (hypertension alone: 1.26, 1.02-1.56;other CVD alone: 1.89, 1.22-2.94;vs no hypertension and no other CVD), COPD or asthma (1.75, 1.32-2.32), other lung disease (2.56, 1.66-3.97), chronic kidney disease (2.32, 1.50-3.59), obesity and DM (obesity alone: 1.36, 1.07-1.71;DM alone: 1.85, 1.39-2.47;obesity and DM: 1.89, 1.34-2.67;vs no obesity and no DM), higher disease activity and GC intake (remission/low disease activity and GC intake: 1.96, 1.36-2.82;moderate/severe disease activity and no GC intake: 1.35, 1.05-1.72;moderate/severe disease activity and GC intake 2.30, 1.41-3.74;vs remission/low disease activity and no GC intake). Conversely, the following variables were associated with less severe COVID-19 outcomes: time period after 15 June 2020 (16 June 2020-31 December 2020: 0.42, 0.34-0.51;1 January 2021 onwards: 0.52, 0.41-0.67;vs time period until 15 June 2020), a diagnosis of PsO (without arthritis) (0.49, 0.37-0.65;vs PsA), and exposure to TNFi (0.58, 0.45-0.75;vs no DMARDs), IL17i (0.63, 0.45-0.88;vs no DMARDs), IL-23/IL-12 + 23i (0.68, 0.46-0.997;vs no DMARDs) and NSAIDs (0.77, 0.60-0.98;vs no NSAIDs). Conclusion: More severe COVID-19 outcomes in PsO, PsA and axSpA are largely driven by demographic factors (age, sex), comorbidities, and active disease. None of the DMARDs typically used in PsO, PsA and axSpA, were associated with severe COVID-19 outcomes, including IL-17i, IL-23/IL-12 + 23i, JAKi and apremilast.

3.
Hong Kong Journal of Paediatrics ; 27(1):80, 2022.
Article in English | EMBASE | ID: covidwho-2003518

ABSTRACT

Introduction: Neuromuscular disorders (NMDs) are a group of diseases affecting the peripheral nervous system (1). Many NMDs cause disability or even premature death (2). We aim to design and establish a robust NMD patient registry in Hong Kong. Methods: By modelling international NMD patient registries, we designed patient-professional reported questionnaires to collect the demographic, clinical c haracteristics, genetic details, family history, investigation findings and specific treatment of NMD patients. Patients were recruited through Hong Kong West Cluster (DKCH, QMH) and Kowloon Central Cluster (HKCH). We also developed self-registration online platform. p<0.05 was considered statistically significant. Findings: Since June 2019, 125 NMD patients have been enrolled in the registry with 12 participants registered online. The registry recruited 13 types of NMDs, including spinal muscular atrophy (SMA) (n=31), Duchenne muscular dystrophy (DMD) (n=19) and congenital myopathy (n=18). The age range was 7 months to 63 years old. 65.6% of those enrolled were children (<18 years old). 63.2% were male. 64.8% of the patients had genetic diagnosis. The registry has contributed to two studies. The first one is a prospective study of clinical efficiency of Nusinersen in SMA patients (n=22). 14/16 SMA patients showed improvement in at least one of motor performance (CHOP intend/RULM/HINE/HFMSE) and health-related quality of life after 1st year of treatment. The second study is the reactogenicity and immunogenicity study of the COVID-19 vaccine in DMD patients (n=4). Data will be available in October. Conclusion: Hong Kong Patient registry has contributed to ongoing and new research study to optimise medical care.

4.
Journal of Cystic Fibrosis ; 21:S82, 2022.
Article in English | EMBASE | ID: covidwho-1996774

ABSTRACT

Objectives: To analyse characteristics of people with cystic fibrosis (PwCF) who were using home spirometry devices (HS) during 2020–2021 Methods: During the COVID-19 pandemic, the CF Foundation (CFF) partnered with a technology vendor, ZephyRx, to distribute MIR HS devices to eligible PwCF. During 04/2020–12/2021, 20,157 spirometers were shipped to PwCF. PwCF enrolled in the CFF patient Registry (CFFPR) provided an additional consent to have their HS values linked to their CFFPR data. An application programming interface (API) was built to allow transfers of HS data (FEV1, FVC, FEF25–75, sex, date of birth, height) from each device. Each record contained a CFFPR ID to enable its linkage to the CFFPR. This analysis uses CFFPR data to describe the HS cohort and the data obtained through API to characterise HS utilisation trends. Demographic and clinical characteristics between the HS cohort and the 2019–2020 CFFPR population ages 7 and older were also compared. Results: 272 (94.4%) CF programs participated in the HS program. Records of 1,537 patients, who had activated their device by January 10, 2021, or earlier were linked to CFFPR. The cohort was 69.8% adult, 89.5% Caucasian, 57.8% female, and had a mean age of 27.8, and mean FEV1 of 79.9% predicted. When compared to the CFFPR population, the HS cohort was older, contained more Caucasians and females, and had lower lung function. The median number of acceptable FEV1 measurements supplied per PwCF was 4 (IQR 2–8). 1065 (69%) PwCF in the HS cohort continued to use their device 6 months from activation. Conclusions: HS data has the potential to augment care and research databases like the CFFPR. Little is known about PwCF’s long-term usage of HS devices in a real-world setting. While the HS cohort is small and may be biased compared to the CFFPR population, we have established a reliable channel for collecting HS data and that PwCF’s usage patterns suggests that most are using the devices on a regular basis.

5.
Diabetologie und Stoffwechsel ; 2022.
Article in German | EMBASE | ID: covidwho-1937467

ABSTRACT

The present study gives an overview on the effects caused by the ongoing COVID-19 pandemic on the living and care situation of people with diabetes in Germany. For this purpose, a systematic search was conducted using the scoping review methodology. On the one hand, a systematic literature search was accomplished in scientific databases for empirical studies and in other search areas for other non-empirical publications. On the other hand, routinely collected electronic health data (routine data;e. g., health insurers administrative data, data from patient registers, medical billing, and drug care data from contractual physicians) were requested from health insurance companies, patient registries or other institutions to gain insight into the care situation of people with diabetes. The literature search identified a total of 53 publications (12 empirical studies and 41 other publications) which were included in the data extraction. Additionally, the methodological quality of the empirical studies was assessed. Due to the small number of empirical studies and their low methodological quality, the evidence gaps regarding the impact of the COVID-19 pandemic on care of people with diabetes are large. However, the empirical studies provide little evidence that the pandemic had a negative impact on the use of diabetes-specific services. The studies show fewer new and reenrolments in disease management programs for diabetes;fewer changes in prescriptions of blood glucose-lowering drugs;fewer diabetes diagnoses and a higher rate of diabetic ketoacidosis in children and adolescents. Additionally, the COVID-19 pandemic has encouraged the use of digital tools for the care of people with diabetes. The search for routine data remained without results. In summary, very limited reliable data on the effects of the COVID-19 pandemic on the care of people with diabetes in Germany was available.

6.
European Stroke Journal ; 7(1 SUPPL):455, 2022.
Article in English | EMBASE | ID: covidwho-1928075

ABSTRACT

Background and aims: National clinical quality registries facilitate reliable monitoring of stroke care by providing local hospital teams with data on their performance compared to national benchmarks. We aimed to assess changes in stroke care over time from public hospitals participating in the Australian Stroke Clinical Registry (AuSCR). Methods: AuSCR stroke quality care indicators were compared between 2017 and 2020, using a matched-hospital design. Analyses were limited to adults with stroke or transient ischaemic attack admitted to hospitals contributing ≥30 episodes each year during the study period. Descriptive statistics and linear tests for trend were used to assess changes in quality indicators across years. Results: Among 47 eligible hospitals, admissions increased from 13,508 (2017) to 18,139 (2020). Overall, half were aged ≥75 years, 45% were female, and 59% had a severe stroke (no differences by year). Between 2017 and 2020, improvements were observed for: endovascular retrieval (+8%;P<0.001), hyperacute antithrombotics (+6%;P<0.001), mobilisation during admission (+3%;P<0.001), swallow screen/assessment within 4 hours (+12%;P<0.001), discharge care planning (+11%;P<0.001), and discharge secondary prevention medications (+10%;P<0.001). However, delivery of thrombolysis remained unchanged (-1%;P=0.07), door-toneedle within 60 minutes decreased (-6%;P=0.008), and access to stroke unit care declined in 2020 (76% 2019 vs 72% 2020;P<0.001). Conclusion: Improvements in many indicators of quality stroke care have been observed within Australian hospitals participating in a national registry. Declines in timeliness to thrombolysis and access to stroke units in 2020 represent a likely consequence of the COVID-19 pandemic that requires national action.

7.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925352

ABSTRACT

Objective: To assess the long-term social and health impacts of the COVID-19 pandemic on people with muscular dystrophy (MD). Background: As the COVID-19 pandemic has continued, it has produced lasting impacts on daily life worldwide. People with muscular dystrophy are potentially at a higher risk for complications when infected with COVID-19, but little is known about the continued impact of COVID-19 on the muscular dystrophy population. Design/Methods: We modified our prior COVID-19 Impact Survey (K. Eichinger, et al) to assess impacts from the continuing pandemic using feedback from muscular dystrophy experts, patients, and advocacy group/registry representatives. The survey assessed COVID-19 medical history, and the effects of the pandemic on social aspects, muscle disease, and medical care. We also used the Perceived Stress Scale, a validated 10-item scale. The de-identified, electronic survey was distributed to adults with muscular dystrophy via international patient registries or advocacy group websites from February 8, 2021 to March 22, 2021. Results: Respondents (n=1243: 49% FSHD;43% DM, and 8% LGMD) were slightly more women and middle-aged (range 18-90). COVID-19 infection rates were 8%. Reported recovery times were typically less than 2 weeks with only 9% reporting recovery greater than 8 weeks, and 7% requiring hospitalization. Major challenges reported during the pandemic included stress management (27%) and wearing a mask (24%). The majority reported a slight worsening of their disease. Respondents reported moderate stress levels (average= 15.8;range= 0-39), with higher stress levels reported by women and those under age 30 years. Of the participants who had telemedicine visits, 70% reported satisfaction;however, most preferred in-person visits. Conclusions: People with muscular dystrophy reported moderate stress and challenges during the COVID-19 pandemic. COVID-19 infection rates and medical complications were similar to a general population. Telemedicine visits may have a more permanent role in care, though inperson visits are still preferred.

8.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925125

ABSTRACT

Objective: To investigate associations of COVID-19 illness severity in individuals who have developed objective or subjective neurologic findings after infection. Background: Following recovery from acute COVID-19 illness many patients report onset of new cognitive and neurological symptoms which can be disabling. Design/Methods: Early in the pandemic, in response to clinical experience and emerging research on post-acute neurological sequelae (PANS) of COVID-19, we created an IRB-approved patient registry in the Department of Neurology. Participants included are both retrospectively identified patients located through a search of all existing patients from Neurology outpatient practices at Columbia University Irving Medical Center with any COVID-19 related diagnosis, plus newly referred patients with PANS. Those included met CDC criteria of either suspected, probable, or confirmed COVID-19 (N=121). Information was obtained retrospectively through chart review and prospectively through symptom questionnaire and mini-MoCA. Analysis was performed with Chi-squared test and Pearson's correlation. Results: Our cohort was 72.7% women, mean age 47.9, 54.2% white, 16.7% Hispanic/Latino, 6.7% Black/African American, and 5% Asian. 55.45% had a prior neurological diagnosis, most commonly headache (23.1%). 68.8% had both clinical and lab definite COVID-19 infection, 23.1% required hospitalization, and 9.1% ICU care. 72.2% reported no worsening of prior neurological symptoms but 81.8% developed new neurological symptoms including general cognitive complaints (47.9%), attention difficulty (42.1%), word finding difficulty (36.4%), vestibular complaints (23.1%), and fatigue (19.8%). Mini-MoCAs were administered to 37 subjects (median score 12/15). Hospitalization for COVID-19 correlated with subjective “brain fog” (p= .009) and attention difficulty (p= .011). ICU requirement correlated with subjective word finding difficulty (p= .049), “brain fog” (p= .034), and attention difficulty (p= .020). There was a relationship between length of hospitalization and mini MoCA score (p= .006). Conclusions: In this patient sample, severity of infection assessed through surrogate measures of hospitalization and ICU requirement are associated with subjective and objective post COVID19 neurological dysfunction.

9.
Australian and New Zealand Journal of Psychiatry ; 56(SUPPL 1):253, 2022.
Article in English | EMBASE | ID: covidwho-1916630

ABSTRACT

Background: The challenges of the COVID-19 pandemic have dominated Australian healthcare. Counter-intuitively, despite baseline workforce, infrastructure and access problems, population mental health and mental health services have weathered the first two years of the pandemic. However, there remain especially vulnerable sub-populations. Objectives: To provide a clinical update for psychiatrists and trainees on specific aspects of population mental health and mental health service performance during the COVID-19 pandemic. Methods: We review the relevant research and policy data. Conclusions: COVID-19 pandemic population mental health policy research and analysis is essential to improve clinical care and will be needed for future pandemics. The establishment of clinical registries for population mental health data can help guide future pandemic mental health policy, planning and intervention.

10.
Basic and Clinical Pharmacology and Toxicology ; 130(SUPPL 2):48, 2022.
Article in English | EMBASE | ID: covidwho-1916038

ABSTRACT

Objective: To assess the quality of life perceived by patients after recovery from COVID-19 in a period of time between 6 and 12 months after hospital discharge. Material and/or methods: Prospective observational study, IDI-REM-2020 code and EUPAS34551 registration, non-interventional, telephone survey from 6 months after discharge date. Health questionnaire consisted of 13 questions covering 8 dimensions (physical functioning, bodily pain, general health, vitality, social functioning and emotional role). Results: Out of 250 patients included and hospitalized in the first wave of the pandemic, from March to April 2020, 161 patients were surveyed. As for the data recorded: at the beginning of the questionnaire general health was fair or poor in 39.8% of respondents and in the rest there was no impact. Social activities had no impact in 39% of the respondents, and only 26.3% had appreciable impact. As for bodily pain, although it did not hinder the usual work in 83.6% of the respondents, in the rest it was a major limitation. Emotional problems affected daily activity in 29.4% of cases. After suffering COVID infection, 50.3% of the participants indicated that their health worsened while in 45.9% it remained the same or even improved in 3.1% of the participants. Conclusions: The quality of life questionnaire is essential to complete a clinical data registry and to understand whether COVID-19 infection is affecting health in the months following infection. In this cohort of patients, a negative impact on health was seen in half of the patients followed.

11.
Clinical Toxicology ; 60(SUPPL 1):1, 2022.
Article in English | EMBASE | ID: covidwho-1915439

ABSTRACT

Objective: In response to the evolving threat of illicit drug use, combined with anticipated SARS-CoV-2 (COVID-19) pandemicrelated market volatility, we created a multi-institution network supplying high-quality data on illicit drug presentations to Victorian emergency departments (EDs). Primary objective: timely data provision to a state Early Warning System (EWS) utilising multiple intelligence sources (including syringe residue and wastewater analysis) to inform public health interventions. Methods: The Emerging Drugs Network of Australia VIC (EDNAV) project is a multi-site prospective observational study collating de-identified clinical and analytical information within an electronic clinical registry (Research Electronic Data Capture secure web-based software platform). Case inclusion criteria: individuals ≥16 years of age presenting with suspected illicit drug toxicity requiring venepuncture as part of standard care. Hospital ethics committee approved waiver of patient consent for inclusion of deidentified data. Nine metropolitan and one regional ED contributed blood samples for weekly toxicological analysis at the Victorian Institute of Forensic Medicine. Liquid chromatographytandem mass spectrometry (LC-MS/MS) screened for 327 pharmaceuticals and illicit substances, as well as 268 novel psychoactive substances. EDNAV data was reviewed weekly as a component of the state EWS. High-risk signals were disseminated to government and external stakeholders. Results: During September 2020 - March 2021, 320 cases were analysed (70% male, mean age 30 years, 72% ambulance arrival). Sedation (Glasgow Coma Score (GCS)<9, 35%) and agitation (33%) were the commonest reasons for presentation;33% of patients required parenteral sedation, and 18% were administered naloxone. In addition, 8% were intubated and 11% required critical care admission;85% had a Poisoning Severity Score of ≥2. There were two deaths. There were 815 separate detections (345 illicit substances, 470 pharmaceuticals). At least one illicit drug was detected in 87% of cases (> 1 illicit drug in 43%). Common illicit drugs included methylamphetamine (52% of cases), gamma-hydroxybutyrate (GHB), 3,4-methylenedioxymethamphetamine (MDMA), cocaine and opioids. Eight novel benzodiazepines, 7 cathinones, 5 hallucinogens, 3 synthetic cannabinoid receptor agonists (SCRAs) and one novel opioid (Beta-U10) were detected. In 90% of cases, reported exposure differed from analytical findings. During COVID-19 related lockdowns, there was evidence of substance substitution including benzodiazepines in products sold as heroin. Three public health warnings were released in association with EDNAV findings (Nethylpentylone in cocaine, 25B-NBOH sold as lysergic acid diethylamide (LSD), paramethoxymethamphetamine (PMMA) sold as MDMA). Conclusion: For the first time in Victoria, a network of healthcare institutions working together enabled timely detection of illicit drug related harm, facilitating early public health warnings and notification of peer-based harm reduction services.

12.
Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine ; 77(sup1):1-33, 2022.
Article in English | EMBASE | ID: covidwho-1886341
13.
European Urology ; 79:S1184-S1185, 2021.
Article in English | EMBASE | ID: covidwho-1747418

ABSTRACT

Introduction & Objectives: Men have a higher risk of death from COVID-19 than women and androgens facilitate entrance of the SARS-CoV-2 virus into respiratory epithelial cells. Thus, androgen deprivation therapy (ADT) may mitigate the course of COVID-19. The aim of the study was to estimate the impact of ADT on mortality from COVID-19 in men with prevalent prostate cancer by comparing all-cause mortality in the spring of 2020 to the same time period in previous years. Materials & Methods: All men with prevalent prostate cancer in Prostate Cancer data Base Sweden (PCBaSe) on March 1 each year in 2015-2020 were followed until June 30 the same year. Exposure to ADT was ascertained from filled prescriptions for bicalutamide, Gonadotropin Releasing Hormone agonists and antagonists (GnRH), and from The Patient Registry data on orchidectomy. The mortality rates by calendar day for each exposure group and calendar time period were calculated and plotted with locally weighted smoothing. Using Poisson regression, the rate of death was compared between 2020 and the average in previous years. Results: 9,822 men with Pca died in March-June in the years 2015-2020, of whom 5,034 men were on ADT. There was an excess mortality in 2020 vs previous years in men on GnRH, bicalutamide and men not on ADT (Figure). The crude relative mortality rate ratio in men on ADT in 2020 vs 2015-2019 was 0.86 (95% confidence interval 0.78 to 0.95). After multivariable adjustment this ratio was attenuated to 0.96 (95% CI 0.87 to 1.06). When restricting the analysis to regions with the highest incidence of COVID-19 and to the two months when mortality in 2020 was highest, the results were similar to those in the main analysis. Conclusions: We found little support for the hypothesis that androgen deprivation therapy mitigates the disease course of COVID-19. (Figure Presented)

14.
Blood ; 138:3034, 2021.
Article in English | EMBASE | ID: covidwho-1736304

ABSTRACT

Background: Persons with Sickle Cell Disease (SCD) infected with the SARS CoV-2 virus have significantly increased risks of hospitalization and death and are strongly recommended to be fully vaccinated. Vaccine hesitancy has previously been described in the SCD population and uptake of other recommended vaccines has been reported to be low in some studies. The goal of this study was to assess how vaccination rates amongst eligible pediatric and adult SCD patients in British Columbia (BC), Canada, compared to those of the general population and other “clinically extremely vulnerable” (CEV) groups. Methods: Persons age 12 and over with SCD in BC were identified as a CEV population and prioritized for immunization. A comprehensive process was undertaken to find and identify all CEV patients in BC and notify them of their priority status. Individuals diagnosed with SCD in the province were identified in the shared pediatric and adult patient registry (iCHIP), which tracks demographics, diagnoses and therapies, and added to the CEV patient list. SCD patients were notified of their priority status through standard mail from the provincial health officer, as well as emails and phone calls from the pediatric and adult SCD programs. Those aged 16+ were invited to register for immunization beginning in March 2021 while those 12-15 years were permitted to register starting in May 2021. Adult patients were eligible to receive mRNA vaccines from Pfizer and Moderna as well as the Astra-Zeneca (AZ) COVISHIELD vaccine, while those aged 12-17 were eligible only for Pfizer vaccines. The provincial immunization registry (PIR) was interrogated to confirm vaccine administration. The main outcome measure was the proportion of SCD patients who received 1st and 2nd dose COVID vaccines. Results: 138 individuals age 12+ with SCD were identified in the iCHIP database. 71.0% had Sickle Cell Anemia (SCA), 25.4% had Hemoglobin SC (Hb SC) and 3.6% had other genotypes. Participants ranged in age from 12-69 years with a median of 28 years. 67.4% were receiving disease-modifying therapy (76 were on hydroxyurea, 11 on regular red cell exchange, 1 was receiving crizanlizumab, and 5 with Hb SC were phlebotomized). None were treated with gene therapy or transplant. 7 individuals had a PCR-confirmed SARS CoV-2 infection prior, but none following immunization. As of July 30, 2021: 68.8% of persons with SCD received a 1st and 55.1% received a 2nd dose of COVID vaccine. Almost all doses were mRNA-based vaccines with the exception of a single 1st dose administration of AZ. Vaccination rates amongst different age ranges and genotypes are displayed in Table 1. Patients with SCA did not have significantly different vaccination rates compared to those with Hb SC/other genotypes: 64.3% versus 80.0% for 1st dose (p=0.0703) and 48.0% versus 62.5% (p =0.12114) for 2nd dose. Vaccination rates amongst the SCD group were compared to other age matched CEV populations as well as the general provincial population and are detailed in Tables 2 and 3. A higher proportion of persons with SCD under the age of 20 received 1st dose (70.8% versus 31.1%;p<0.00001) and 2nd dose (50.0 versus 15.3%;p <0.00001) of vaccines compared to the general population. However, a lower proportion age 20-49 and 50+ years old received a 1st dose as demonstrated in Table 2. In addition, lower proportions of persons with SCD of all age ranges were vaccinated in comparison to other CEV groups. As demonstrated in Table 3, SCD was not associated with receiving a 1st dose vaccine compared to the general BC population (OR 0.8, 0.56 to 1.16 95% CI, p=0.2481). In contrast, persons in other CEV groups were twice as likely to receive a first dose COVID immunization compared to the general BC population (p<0.0001). No severe vaccine-related complications including vaccine-induced immune thrombotic thrombocytopenia (VITT) were reported. There were 7 presentations to hospital for vaso-occlusive crises (VOC) within 21 days of immunization. Conclusion: Despite an active CEV process to find and invite perso s with SCD to be vaccinated, these data demonstrate that vaccination rates amongst persons with SCD in BC are below those of other CEV age-matched groups. Vaccination rates amongst adults are also lower than the general population, however there is a high vaccination rate in persons under 20 years old. A subsequent qualitative study exploring COVID vaccine hesitancy amongst persons with SCD in BC is being explored. [Formula presented] Disclosures: No relevant conflicts of interest to declare.

15.
Blood ; 138:5002, 2021.
Article in English | EMBASE | ID: covidwho-1582398

ABSTRACT

Introduction: COVID-19 has killed more than four million people worldwide and resulted in strained health resources globally(Dong Lancet ID 2020). There is a critical need for prognostic biomarkers to predict severity and outcomes in COVID-19 patients to allow more efficient resource allocation. Studies using pre-vaccination hospitalized patient data have demonstrated that elevated initial and peak immature platelet fraction (IPF), as well as related platelet indices, were associated with progression to severe COVID-19 outcomes (Welder Br J Haem 2021). This suggests the potential role of immature platelets as a cost-effective biomarker. The underlying pathophysiology of immature platelets in COVID-19 is unclear but these results support the hypothesis of higher inflammatory response, leading to thrombopoiesis mediated by pro-inflammatory cytokines and platelet hyper-reactivity in this population (Manne Blood 2021). It is unclear if this holds true in patients vaccinated against COVID-19. This study aims to assess the relationship between immature platelets in patients vaccinated against COVID-19 and hospitalized with acute COVID-19. Methods: This study used a COVID-19 patient registry established by the University of Texas Southwestern that comprises patients between May 2020 to July 2021. The database was approved by the Institutional Review Board. The study included 22 fully vaccinated adult patients with the mRNA COVID-19 vaccines hospitalized with acute COVID-19 and had IPF measurements during the hospitalization as well as 519 non-intensive care unit (ICU) patients admitted with acute COVID-19 prior to availability of a COVID-19 vaccine (pre-vaccination era). The study conducted non-parametric tests to compare hospital outcomes and covariates of interest between vaccinated patients and pre-vaccination era non-ICU patients. Covariates included for analysis are age, gender, race, length of hospital stay (LOS), dexamethasone use, platelet count, immature platelet count (IPC), IPF, thrombotic events and mortality. Results: All patients vaccinated against COVID-19 were alive without thrombotic events at the time of analysis. One out of 22 vaccinated patients required ICU admission and use of a ventilator. IPF and platelet counts at admission were similar between vaccinated patients and non-ICU patients from pre-vaccine era while IPC was significantly lower in the vaccinated group (Table 1). The vaccinated patient requiring ICU admission and mechanical ventilation was a heavy tobacco user with chronic obstructive pulmonary disease (IPF 6.1%, IPC 4x10 9/L, platelet count 66x10 9/L). There was a disproportionate number of Hispanic patients in the vaccinated cohort (44%, P = 0.02). The LOS was significantly shorter in vaccinated patients compared to pre-vaccination era non-ICU patients by a day and a half (P = 0.047). The admission IPF and IPC were not correlated with increased LOS (IPF Spearman ρ = 0.23, P = 0.31;IPC ρ = -0.34, P = 0.13), while platelet count at admission negatively correlated with LOS (ρ = -0.41, P = 0.06). Discussion: IPF, IPC, and platelet count have previously been demonstrated to be a predictor of increased ICU and hospital LOS, ventilator duration, and in-hospital mortality. To our knowledge, this is the first study assessing the relationship between IPF and platelet indices in hospitalized patients vaccinated against COVID-19. Due to the lack of severe COVID-19 outcomes in these vaccinated patients, LOS was the only variable able to be analyzed and lower platelet count was found to be associated with increased LOS. These preliminary results demonstrated similar initial IPF and platelet counts but lower IPC in a small cohort of vaccinated COVID-19 patients compared with the pre-vaccination era patients with no severe outcomes. This suggests that the predictive value of these biomarkers may also apply to the vaccinated patient population. As IPC in this current study is derived from IPF and platelet counts, independent measure of IPC is needed to confirm this finding in a larger cohort. This tudy also potentially suggests the protective benefits of COVID-19 vaccines as reported in prior randomized trials (Polack NEJM 2020). Further research is needed to confirm these findings in a larger vaccinated cohort assessing severe outcomes, hospitalization, and death, especially with future infection waves with contagious COVID-19 variants rapidly emerging. [Formula presented] Disclosures: No relevant conflicts of interest to declare.

16.
Blood ; 138:2090, 2021.
Article in English | EMBASE | ID: covidwho-1582213

ABSTRACT

[Formula presented] BACKGROUND AND AIMS Fear of receiving protective vaccinations against the COVID-19 virus is high among patients with immune thrombocytopenia (ITP), an autoimmune bleeding disorder, due to uncertainty around effects on platelet count (PC) reactivity. Decreases in PC have been previously reported, including decreases of >100,000/µL including a need for rescue treatment in a small fraction of patients. For ITP patients, a further reduction in PC could trigger bleeding symptoms that require hospitalization and additional treatments. Here, we report on differences in PC changes between not-splenectomized (NS) and (Spl) splenectomized adult ITP patients to explore if Spl ITP patients have a greater risk for PC decreases following COVID-19 vaccination. Methods Data were collected using the ITP COVID-19 web-based survey that is part of the Platelet Disorder Support Association's ITP Natural History Study Patient Registry. As of June 2021, 241 adults with ITP had received at least one vaccine dose, a post vaccine PC, and had disclosed their splenectomy status. Comparisons were made between Spl and NS groups focusing on quantitative differences in reported PC changes post-vaccination. Data was analyzed using descriptive statistics, chi-square analysis, and Fisher exact tests. Results Following Dose#1 (D1): For the Spl group (n=59), 2 (4%) experienced a PC increase from baseline, 38 (64%) reported their count remained unchanged, and 19 (32%) experienced a decrease. Within the NS group (n=182), 35 (19%) experienced an increased PC, for 89 (49%) the count remained unchanged, and 58 (32%) had a decrease. PC differences between the Spl and NS groups following D1 were significant (p =.018) using a Fisher exact test. Regarding large decreases in PC, 13 Spl patients (22%) experienced a decrease >50,000/µL and 6 (10%) a decrease >100,000/µL. Within the NS group, 15 (8%) experienced a PC decrease >50,000/µL and 5 (3%) a decrease >100,000/µL. Differences in large PC changes following D1 between both groups were significant (X 2 = 8.254;p =.004). Following Dose#2 (D2): For the Spl group (n=34), comparing their post-vaccination count to their typical baseline count, 1 (3%) experienced an increased PC, 26 (76%) reported their PC remained unchanged, and 7 (21%) experienced a decreased PC. Within the NS group (n=103) comparing their post-vaccination count to their typical baseline count, 17 (17%) experienced an increased PC, 56 (54%) reported their PC remained unchanged, and 30 (29%) experienced a decreased PC. These differences were not statistically significant. Within the Spl group, 3 out of 34 (9%) experienced a large PC decrease > 50,000/µL, all 3 >100,000/µL. Within the NS group, only 5 out of 103 (5%) experienced a PC decrease >50,000/µL with only 1 >100,000/µL. The Spl group experienced more PC decreases >100,000/µL compared to the NS group following D2;this difference was statistically significant (p =.047) using a Fisher exact test. Comparison of D1 and D2 Although more PC decreases were reported in both the Spl and NS group after receipt of D1 compared to D2, this difference was not statistically significant. Comparison between Spl and NS participants with the same PC result (increase, decrease, or no change) following both D1 and D2 (n=133) did not reveal a statistically significant difference;within the NS group (n=101), 73 (73%) reported the same result while for the Spl group (n=32) 25(78%) experienced the same result. Regardless of splenectomy status (n=133), 62 (72%) participants experienced the same PC result for D1 and D2. Conclusion Fear of a post-vaccination PC decrease, especially a large decrease, may influence an ITP patient's decision to accept or refuse vaccination. Spl participants were more likely than those NS to experience larger (>50,000/µL) albeit transient decreases in their PC following vaccination. However, the overall risk for large PC decreases is minimal among individuals with ITP, even among those who have had a splenectomy. Our results should provide reassurance to mo t ITP patients and reduce vaccine hesitancy, especially for those who have not undergone splenectomy;those who have can readily be vaccinated with close monitoring and planning with a hematologist familiar with ITP. Additional studies could focus on identifying more specific factors affecting PC changes post vaccination which in turn would lead to better understanding of platelet variability in ITP patients. Disclosures: MacWhirter - DiRaimo: JD has not personally received any payment personally, but PDSA has received grants and consultancy fees from Novartis, grant and honorarium from Amgen, grant and consultancy fees from Pfizer and UCB, and grants from Argenx, Principia, Rigel, and CSL Behr: Consultancy, Honoraria, Other. Kruse: CK has not personally received payment but reports that PDSA received grants and consultancy fees from Novartis, grant and honorarium from Amgen, grant and consultancy fees from Pfizer and UCB, and grants from Argenx, Principia, Rigel, and CSL Behring: Consultancy, Honoraria, Other. Bussel: CSL: Other: DSMB;Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees;UptoDate: Honoraria;Rigel: Consultancy, Membership on an entity's Board of Directors or advisory committees;UCB: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: DSMB;Argenx: Consultancy, Membership on an entity's Board of Directors or advisory committees;Dova/Sobi: Consultancy, Membership on an entity's Board of Directors or advisory committees;Principia/Sanofi: Consultancy, Membership on an entity's Board of Directors or advisory committees;Momenta/Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees;RallyBio: Consultancy, Membership on an entity's Board of Directors or advisory committees;Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees. Kruse: Alex has not personally received any payment but reports that PDSA received grants and consultancy fees from Novartis, grant and honorarium from Amgen, grant and consultancy fees from Pfizer and UCB, and grants from Argenx, Principia, Rigel, and CSL Behri: Consultancy, Honoraria, Other.

17.
Blood ; 138:3164, 2021.
Article in English | EMBASE | ID: covidwho-1582203

ABSTRACT

[Formula presented] BACKGROUND AND AIMS Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder causing low platelet counts (PC) and increased bleeding. COVID-19 vaccines are a major concern for ITP patients who fear vaccination might exacerbate their thrombocytopenia. To assess these concerns, PDSA developed a survey to explore how COVID-19 vaccinations impact individuals with ITP. Methods Data was collected using the ITP-COVID-19 web-based survey part of the Platelet Disorder Support Association's ITP Natural History Study. As of June 2021, 338 adult ITP patients had completed the survey. Data was analyzed with descriptive statistics and chi-squared tests. Results The majority of the 338 participants were female (78%) between 18-64 years of age (83%);118 (35%) participants reported they were in remission, and 79 (24%) reported they had undergone splenectomy. Viral Disease: Forty participants (12%) were diagnosed with COVID-19: 7 (18%) reported their PC increased from baseline, 20 (50%) reported their PC was unaffected, and 13 (32%) reported their PC decreased. Of the 20 participants who reported a PC change (increase or decrease) following a positive COVID-19 test, 13 (65%) reported their PC returned to baseline within four weeks following vaccination. Four patients (10%), all between the ages of 41-50 years, were hospitalized: 2 received dexamethasone, 1 received IVIG, and 1 required oxygen. Two of the 4 had been treated for ITP with corticosteroids within the last 6 months. Three out of 4 were female, and no additional autoimmune conditions were reported however, and 2 out of 4 reported co-morbid conditions including increased blood pressure, under-active thyroid, and allergies. No deaths occurred. Vaccination impacts: 267 (79%) participants reported receiving at least one vaccine dose at survey completion, and 137 (41%) of participants reported they were fully vaccinated: Pfizer (45%), Moderna (38%), other (17%). Following at least one vaccine dose, platelet increases were reported by 37 (15%), 127 (53%) reported no change, and decreases were reported by 77 (32%);26 did not answer. Of the 114 participants who reported a PC change following dose 1 (D1), 82 addressed the time for their PC to return to baseline;69 (84%) reported their PC returned to baseline within four weeks. Following dose two (D2), PC increases were reported by 18 (13%), 82 (60%) were unchanged, and 37 (27%) saw a decrease. Of 55 participants who reported a PC change following D2, 44 addressed the time for their PC to return to baseline with 31(71%) indicating their PC returned to their normal within four weeks. Changes in PC following receipt of D1 vs D2 were not statistically significantly (X 2=1.01, p=.31). Following at least D1, three participants reported bleeding symptoms including epistaxis, wet purpura, petechiae, bruising, and a gastrointestinal internal bleed in an asplenic 64-year-old female with alpha-gal allergy. Twenty-four (9%) participants of 262 who answered the question, reported adverse effects other than bleeding including chills and fever. Two women, aged 35 and 47, developed a blood clot after receiving the Pfizer vaccine, despite reporting no past personal or family history of hypercoagulability. Fourteen participants (13 females;1 male) reported platelet decreases >100,000/µL following vaccination, but only one received rescue treatment. Two had a pre-existing autoimmune disorder and eight a previous splenectomy. Eight received the Pfizer vaccine, five Moderna, and one AstraZeneca. Thirty (21%) participants reported a past change in platelets following a non-COVID vaccine;23/30 shared their experience following receipt of D1 of a COVID-19 vaccine including 11 (48%) who experienced a platelet decrease, 4(17%) an increase, and 8 (35%) reporting no change. Conclusion The results are very reassuring for ITP patients that the risks of aggravated thrombocytopenia due specifically to getting COVID-19 infection or vaccine are small. There were only three cases of bleeding and two of clotting;all were well-treate . Decreases in PC following viral infection and vaccine receipt did occur, but they were rarely substantial and most resolved within four weeks. These very positive findings should reduce vaccine hesitancy among ITP patients and encourage them to be vaccinated. Disclosures: MacWhirter - DiRaimo: JD has not personally received any payment personally, but PDSA has received grants and consultancy fees from Novartis, grant and honorarium from Amgen, grant and consultancy fees from Pfizer and UCB, and grants from Argenx, Principia, Rigel, and CSL Behr: Consultancy, Honoraria, Other. Kruse: CK has not personally received payment but reports that PDSA received grants and consultancy fees from Novartis, grant and honorarium from Amgen, grant and consultancy fees from Pfizer and UCB, and grants from Argenx, Principia, Rigel, and CSL Behring: Consultancy, Honoraria, Other. Bussel: UCB: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: DSMB;CSL: Other: DSMB;Momenta/Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees;Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees;Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees;Argenx: Consultancy, Membership on an entity's Board of Directors or advisory committees;UptoDate: Honoraria;Principia/Sanofi: Consultancy, Membership on an entity's Board of Directors or advisory committees;Rigel: Consultancy, Membership on an entity's Board of Directors or advisory committees;Dova/Sobi: Consultancy, Membership on an entity's Board of Directors or advisory committees;RallyBio: Consultancy, Membership on an entity's Board of Directors or advisory committees. Kruse: Alex has not personally received any payment but reports that PDSA received grants and consultancy fees from Novartis, grant and honorarium from Amgen, grant and consultancy fees from Pfizer and UCB, and grants from Argenx, Principia, Rigel, and CSL Behri: Consultancy, Honoraria, Other.

18.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):221, 2021.
Article in English | EMBASE | ID: covidwho-1570355

ABSTRACT

Background: Atopic Dermatitis (AD) can result in intolerable symptoms, psychological hardships, and stigmatization that affect patient quality of life. Allergic comorbidities may be overlooked by both healthcare providers and patients;emphasizing the importance of allergist referral. The Atopic Dermatitis Quality of Care (ADQoC) Initiative seeks to demonstrate the global imperative for quality AD care, by identifying primary challenges and reporting good practice intervention solutions. The COVID-19 pandemic highlights the positive impact of eHealth in the delivery of care, including allergy care, as a potential good practice intervention for AD. Method: A literature review was conducted to establish a foundation of challenges to AD care. In-depth site visits, performed at thirty-two select international centers, documented challenges to, and examples of, leading AD care. Results: eHealth is a reported good practice intervention to the challenges in AD care including allergy complications. eHealth, along with mHealth and teleHealth, provide opportunities to improve the quality and efficiency of AD care. eHealth provides greater access to care, specifically to patients who otherwise may not be able to access it due to obstacles such as travel distance or financial difficulties. eHealth also benefits dermatologists, allergists, and other AD care providers who can collaborate more easily due to the readily available resources within eHealth platforms. TeleHealth and information sharing through eHealth allows patients to benefit from care afforded by centers that incorporate multi-disciplinary care teams and patient education. Some centers use local databases and patient registries to restructure patient assessment and improve care delivery. Smartphone applications such as Zalf (UMC, Utrecht) and Virtual Nurse (McGill UHC) are designed to improve assessment, care delivery, AD outcomes, and education. Mobile imaging can also improve AD assessment and speed treatment. Conclusion: eHealth, mHealth, and teleHealth may be good practice interventions that improve AD assessment, better manage allergic complications, and provide better outcomes. The efficiency and convenience of eHealth delivers quicker service, reduces patient burden and simultaneously lessens time demands of healthcare providers. Such systems may be particularly useful during social distancing and additional demands on health care providers during COVID-19.

19.
Journal of Endourology ; 35(SUPPL 1):A9, 2021.
Article in English | EMBASE | ID: covidwho-1569535

ABSTRACT

Introduction & Objective: During the COVID-19 pandemic, limits on elective surgical care were instituted by hospitals to preserve resources. Additionally, patients' desire to limit health care contact may impact surgical decision making.We aimed to understand how institutional pressures and patient preference affected the delivery, choice and outcome of ambulatory surgical care for urinary stone disease during the COVID-19 pandemic. Methods: Reducing Operative Complications from Kidney Stones (ROCKS) is a quality improvement initiative from the Michigan Urological Surgery Improvement Collaborative (MUSIC) that maintains a prospective clinical registry of ureteroscopy (URS) and shockwave lithotripsy (SWL) cases. Using this registry, we categorized all cases by time frame, defining July 1st - December 31st 2019 as preCOVID (PC), March 16th - June 15th 2020 as duringCOVID (DC) and June 16th - September 15th 2020 as afterCOVID (AC). Patients in each cohort were characterized across a range of sociodemographic and clinical factors. We assessed changes in procedure choice (URS vs SWL), procedure acuity (elective vs emergent), and outcomes (ED visit and hospitalization within 30 days of surgery). Results: 6375 cases were identified, 4513 URS and 1862 SWL. PC consisted of 3310 cases (2238 URS and 1072 SWL), DC consisted of 1141 cases (888 URS and 253 SWL) and AC consisted of 1924 cases (1387 URS and 537 SWL). A higher proportion of URS cases were performed DC compared to PC and AC (77.8% vs 67.6% vs 72.1%, p < 0.001, respectively). A higher percentage of emergent cases in DC compared to PC and AC (21.8% vs 13.7% vs 15.3%, p < 0.001, respectively). Significantly more cases in DC compared to PC and AC were prestented, had positive UA/urine culture, ureteral stones, had hydronephrosis, were stented and had longer stent dwell time. ED visits and unplanned hospitalizations were not significantly different. Conclusions: The COVID-19 pandemic resulted in a lower overall stone treatment rates and higher proportions of URS compared to SWL. Significantly more emergent cases for ureteral stones with positive UA/urine cultures and evidence of obstruction were performed duringCOVID with higher stent placement rates and longer stent dwell times. These data pointing towards preference for higher intensity or acuity cases without differences in unplanned healthcare encounters. (Table Presented).

20.
Eur Heart J ; 43(11): 1104-1120, 2022 03 14.
Article in English | MEDLINE | ID: covidwho-1501068

ABSTRACT

AIMS: Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality. METHODS AND RESULTS: We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66-75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02-1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10-1.30; P < 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20-1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients. CONCLUSION: Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.


Subject(s)
COVID-19 , Heart Failure , Aged , COVID-19/complications , Cohort Studies , Comorbidity , Female , Heart Failure/epidemiology , Hospital Mortality , Hospitalization , Humans , Male , Risk Factors , SARS-CoV-2
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