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1.
Ultrasound in Obstetrics & Gynecology ; n/a(n/a), 2022.
Article in English | Wiley | ID: covidwho-1819400

ABSTRACT

Objective Because pregnancy involves dynamic changes in the maternal immune system, the present work investigates whether gestational age is associated with in-hospital COVID-19 mortality and morbidity. Method Data of pregnant women with SARS-CoV-2 in different gestational age groups (subdivided in trimesters) were collected and analyzed from a Brazilian nationwide database. Multivariate logistic and Cox regression were used to identify in-hospital independent risk factors for in-hospital COVID-19 related mortality and morbidity, measured by time to recovery. Results A total of 7,461 cases were included in the study (9.3%, 28.4%, and 62.3% in 1st, 2nd, and 3rd trimester, respectively). After the adjustment for sociodemographic factors, epidemiologic and clinical characteristics, and intervention related variables, gestational age was not associated with mortality and morbidity. It is also suggested that obstetric centers and social organization healthcare can reduce the risk for mortality and morbidity, respectively. Conclusion Despite higher percentage of women admitted in the third trimester, we found no association between gestational age and COVID-19 mortality and morbidity. Therefore, the observed difference in the mortality and morbidity is explained by the different distribution of risk factors per gestational age. This article is protected by copyright. All rights reserved.

2.
Vaccines ; 10(3), 2022.
Article in English | EMBASE | ID: covidwho-1818229

ABSTRACT

Introduction: Onset of oral lichenoid lesions (OLL) or oral lichen planus (OLP) can be rare adverse reactions to vaccines. Recently, the first solitary cases were reported after COVID-19 vaccination. The aim of the present study was to assess if an increased frequency of OLL/OLP can be found after COVID-19 vaccination within a large real-world cohort. It was assumed that the incidence of OLL/OLP was significantly higher in subjects who received COVID-19 vaccine (cohort I) compared to individuals who were not vaccinated (cohort II). Patients and Methods: Initial cohorts of 274,481 vaccinated and 9,429,892 not vaccinated patients were retrieved from the TriNetX database (TriNetX, Cambridge, Massachusetts, USA), and matched for age, gender and the frequency of use of non-steroidal anti-inflammatory drugs, beta blockers, and angiotensin-converting enzyme inhibitors. Results: After matching each cohort, we accounted for 217,863 patients. Among cohort I, 146 individuals had developed OLL/OLP within 6 days after COVID-19 vaccination (88 and 58 subjects had received mRNA-and adenovirus vector-based vaccines), whereas in cohort II, 59 patients were newly diagnosed with OLL/OLP within 6 days after having visited the clinic for any other reason. The risk of developing OLL/OLP was calculated as 0.067% vs. 0.027%, for cohorts I and II, whereby the risk difference was highly significant (p < 0.001;log-rank test). RR and OR were 2.475 (95% CI = 1.829;3.348) and 2.476 (95% CI = 1.830;3.350), respectively. Discussion: The hypothesis was confirmed. Accordingly, the obtained results suggest that the onset of OLL/OLP is a rare adverse drug reaction to COVID-19 vaccines, especially to mRNA vaccines. Thus far, it remains unknown if specific components of the formulations cause a type IV hypersensitive reaction corresponding to OLL, or if the immune response post vaccination triggers a T cell-driven autoimmune reaction directed against the basal layer of keratinocytes of the oral mucosa in terms of OLP. Although OLL and OLP are both classified as premalignant lesions, spontaneous remission may be expected over time, at least in the case of OLL. Therefore, the presented findings should not place any limitation toward the use of COVID-19-vaccines in broad levels of the population.

3.
Canadian Journal of Infectious Diseases & Medical Microbiology ; : 1-9, 2022.
Article in English | Academic Search Complete | ID: covidwho-1816856

ABSTRACT

Background. Evidence from across the world suggests that the pediatric population shows different clinical manifestations and has a lower risk of severe presentation of SARS-CoV-2 infection compared to adults. However, Mexico has one of the highest mortality rates in the pediatric population due to SARS-CoV-2 infection. Therefore, our objective was to explore the epidemiological and clinical characteristics associated with a positive confirmatory test in the Mexican pediatric population admitted to a tertiary care hospital in Mexico City. Methods. Clinical, imaging and laboratory data were retrospectively collected from 121 children hospitalized during the period from March 4th, 2020, to August 8th, 2021. The patients were identified as suspicious cases according to the guidelines of the General Directorate of Epidemiology of Mexico. Real-time polymerase chain reaction (RT-PCR) tests were used to confirm SARS-CoV-2 infection. Categorical variables were compared using the Chi-square test, and propensity score matching was performed to determine univariate and multivariate odds ratios of the population regarding a positive vs. negative SARS-CoV-2 result. Results. Of the 121 children, 36 had laboratory-confirmed SARS-CoV-2 infection. The main risk for SARS-CoV-2-associated pediatric hospitalization was contact with a family member with SARS-CoV-2. It was also found that fever and fatigue were statistically significantly associated with a positive SARS-CoV-2 test in multivariate models. Clinical and laboratory data in this Mexican hospitalized pediatric cohort differ from other reports worldwide;the mortality rate (1.6%) of the population studied was higher than that seen in reports from other countries. Conclusion. Our study found that fever and fatigue at hospital presentation as well as an antecedent exposure to a family member with SARS-CoV-2 infection were important risk factors for SARS-CoV-2 positivity in children at hospital admission. [ FROM AUTHOR] Copyright of Canadian Journal of Infectious Diseases & Medical Microbiology is the property of Hindawi Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

4.
Journal of Environmental Psychology ; 79:6, 2022.
Article in English | Web of Science | ID: covidwho-1804526

ABSTRACT

The ongoing COVID-19 pandemic claimed millions of lives and caused unprecedented disruptions. Despite these negative impacts, there is optimism the pandemic may shift public opinion on other global crises by fostering a sense of collective efficacy. Using propensity score matching to compare New Zealanders assessed before (n = 12,304) and after (n = 12,370) nationwide lockdowns in 2020, we tested a preregistered mediation model with COVID-19 lockdown experience predicting increases in pro-environmental attitudes via enhanced socio-political efficacy. As hypothesized, socio-political efficacy increased after the successful nationwide lockdowns. In turn, socio-political efficacy amplified respondents' pro-environmental attitudes including climate beliefs and concern, as well as support for a government subsidy for public transport and opposition to government spending on new motorways. The pandemic also enhanced respondents' satisfaction with the quality of the natural environment, which was unmediated by socio-political efficacy. The crisis might offer an opportunity to foster collective pro-environmental actions.

5.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793854

ABSTRACT

Introduction: It's known that immunosuppressant agents such as pulse methylprednisolone (PMP), dexamethasone (DXM) and interleukin- blockers (IL-B) are used in COVID-19 [1-3]. The aim of this study is to investigate the effect of these immunosuppressant agents on secondary infections in patients with COVID-19 in intensive care units (ICU). Methods: This study was retrospectively designed and all data between March 2020 and October 2021 of six tertiary ICU was evaluated. All patients were divided by three groups as Group I (GI, no immunosuppressant or MP ≤ 1.0 mg/kg), Group II (GII, PMP and/or DXM) and Group III (GIII, only IL-B and PMP and/or DXM). Demographic data, PaO2/FiO2 (P/F) ratio, C-reactive protein (CRP) and procalcitonin, hemogram parameters, ferritin and d-dimer, culture results and outcomes were recorded. For comparison between GI-GII and GI-GIII, propensity score matching (PSM) was used by matching 14 parameters [age, gender, BMI, CCI, APACHE II, P/F ratio, CRP, procalcitonin, hemogram parameters, ferritin, d-dimer and invasive mechanical ventilation (IMV) requirements]. Results: 412 ICU patients were included in the study (GI = 118, GII = 184, GIII = 110). Mortality rates were 27.1%, 39.7% and 55.5% respectively. After PSM, in GII and GIII, the number of ( +) tracheal cultures, ( +) bloodstream cultures, detected different microorganisms during ICU period, neuropathy, tracheotomized patients, duration of IMV and length of ICU stay were significantly higher than GI. Mortality rate and ( +) CMV-DNA-PCR were similar in GI and GII whereas they were significantly higher in GIII than GI. Conclusions: The usage of immunosuppressant agents in COVID-19 causes increased secondary infections. Moreover, increased secondary infections appear as a reason for prolonged ICU stay and duration of IMV, and also, increased mortality.

6.
Kidney360 ; 3(2): 269-278, 2022 Feb 24.
Article in English | MEDLINE | ID: covidwho-1776878

ABSTRACT

Background: Remdesivir is not currently approved for patients with eGFR <30 ml/min per 1.73 m2. We aimed to determine the safety of remdesivir in patients with kidney failure. Methods: This study was a retrospective cohort study of patients with COVID-19 hospitalized between May 2020 and January 2021 with eGFR <30 ml/min per 1.73 m2 who received remdesivir and historical controls with COVID-19 hospitalized between March 1, 2020 and April 30, 2020 prior to the emergency use authorization of remdesivir within a large health care system. Patients were 1:1 matched by propensity scores accounting for factors associated with treatment assignment. Adverse events and hospital outcomes were recorded by manual chart review. Results: The overall cohort included 34 hospitalized patients who initiated remdesivir within 72 hours of hospital admission with eGFR<30 ml/min per 1.73 m2 and 217 COVID-19 controls with eGFR <30 ml/min per 1.73 m2. The propensity score-matched cohort included 31 remdesivir-treated patients and 31 nonremdesivir-treated controls. The mean age was 74.0 (SD=13.8) years, 57% were women, and 68% were white participants. A total of 26% had ESKD. Among patients who were not on dialysis prior to initiating remdesivir, one developed worsening kidney function (defined as ≥50% increase in creatinine or initiation of KRT) compared with three in the historical control group. There was no increased risk of cardiac arrythmia, cardiac arrest, altered mental status, or clinically significant anemia or liver function test abnormalities. There was a significantly increased risk of hyperglycemia, which may be partly explained by the increased use of dexamethasone in the remdesivir-treated population. Conclusions: In this propensity score-matched study, remdesivir was well tolerated in patients with eGFR <30 ml/min per 1.73 m2.


Subject(s)
COVID-19 , Renal Insufficiency , Adenosine Monophosphate/analogs & derivatives , Aged , Alanine/analogs & derivatives , Antiviral Agents/adverse effects , COVID-19/drug therapy , Female , Humans , Kidney , Propensity Score , Renal Dialysis , Renal Insufficiency/drug therapy , Retrospective Studies , SARS-CoV-2
7.
Front Public Health ; 9: 646494, 2021.
Article in English | MEDLINE | ID: covidwho-1760279

ABSTRACT

China has built a social medical insurance system that covers the entire population so as to reduce the impact of diseases on individuals and families. Although the decline in the incidence of catastrophic health expenditures (CHEs) in China is encouraging, this issue remains important. On the basis of considering selectivity bias and heterogeneity, we applied propensity score matching (PSM) to analyze the 2018 data from the China Family Panel Studies. We assigned CHE households and non-CHE households to the treatment group and the control group, respectively, and used non-random data to simulate a randomized trial to investigate the impact of CHE on household consumption in China. The results of this study indicate that, when the threshold is set at 40%, the consumption of households experiencing CHEs (CHE household) is significantly lower than that of households not experiencing CHEs (non-CHE households) and that CHEs have a significant negative impact on other household consumption and a significant impact on the household property and debt. This effect still exists when the threshold is set lower, with household essential consumption most affected. The occurrence of CHEs leads to a reduction in household consumption and a significantly worsening financial situation for the CHE households, impacting the basic quality of life of the families. Therefore, it is necessary to further reform the medical and health system to reduce the high medical expenses.


Subject(s)
Catastrophic Illness , Health Expenditures , Catastrophic Illness/economics , China , Humans , Quality of Life
8.
British Journal of Social Work ; : 20, 2021.
Article in English | Web of Science | ID: covidwho-1746946

ABSTRACT

Social work, like many other health and social care services has been overwhelmed by the COVID-19 pandemic. This article compares the differences of mental well-being and work-related quality of life (WRQoL) for UK social workers before and during the pandemic. Mental well-being and WRQoL were better during the COVID-19 pandemic in 2020 than prior to the pandemic in 2018. The findings of this study suggest that during the highpoint of the pandemic other factors such as increased support to changes in working practices may be responsible for this improvement. During the COVID-19 pandemic interest into its potential impact on mental well-being has intensified. Within the social care sector, the pandemic has increased job demands and prolonged stress taking a disproportionate toll on the workforce, particularly social workers. This article compares the mental well-being and quality of working life of social workers in the United Kingdom (UK) before and during the pandemic. Data were collected in 2018 (N = 1,195) and 2020 (N = 1,024) using two cross-sectional surveys. To account for the differences between the datasets, propensity score matching was employed prior to effect estimation, utilising demographic and work-related variables common to both datasets. The differences between the two time-points were estimated using multiple regressions. Both mental well-being and quality of working life were significantly higher during the COVID-19 pandemic in 2020 compared to 2018. This suggests that during the highpoint of the pandemic in the UK, increased support, and changes to working practices, such as reprioritisation of work and other initiatives, may be responsible for increased mental well-being and quality of working life. While acknowledging the known pressures on UK social workers during the COVID-19 pandemic this evidence suggests a mixed picture of the pandemic with lessons for managers and employers.

9.
Open Forum Infectious Diseases ; 8(SUPPL 1):S27-S28, 2021.
Article in English | EMBASE | ID: covidwho-1746801

ABSTRACT

Background. Remdesivir (RDV) reduced time to recovery and mortality in some subgroups of hospitalized patients in the NIAID ACTT-1 RCT compared to placebo. Comparative effectiveness data in clinical practice are limited. Methods. Using the Premier Healthcare Database, we compared survival for adult non-mechanically ventilated hospitalized COVID-19 patients between Aug-Nov 2020 and treated with RDV within 2 days of hospitalization vs. those who did not receive RDV. Preferential within-hospital propensity score matching with replacement was used. Patients were matched on baseline O2 and 2-month admission period and were excluded if discharged within 3 days of RDV initiation (to exclude anticipated discharges/transfers within 72 hrs consistent with ACTT-1 study). Time to 14- and 28-day mortality was examined separately for patients on high-flow/non-invasive ventilation (NIV), low-flow, and no supplemental O2 using Cox Proportional Hazards models. Results. RDV patients (n=27,559) were matched to unique non-RDV patients (n=15,617) (Fig 1). The two groups were balanced;median age 66 yrs and 73% white (RDV);68 yrs and 74% white (non-RDV), and 55% male. At baseline, 21% required high-flow O2, 50% low-flow O2, and 29% no O2, overall. Mortality in RDV patients was 9.6% and 13.8% on days 14 and 28, respectively. For non-RDV patients, mortality was 14.0% and 17.3% on days 14 and 28, respectively. Kaplan-Meier curves for time to mortality are shown in Fig 2. After adjusting for baseline and clinical covariates, RDV patients on no O2 and low-flow O2 had a significantly lower risk of death within 14 days (no O2, HR: 0.69, 95% CI: 0.57-0.83;low-flow, HR: 0.67, 95% CI: 0.59-0.77) and 28 days (no O2, HR: 0.80, 95% CI: 0.68-0.94;low-flow, HR: 0.76, 95% CI: 0.68-0.86). Additionally, RDV patients on high-flow O2/NIV had a significantly lower risk of death within 14 days (HR: 0.81, 95% CI: 0.70-0.93);but not at 28 days (Fig 3). Conclusion. In this large study of patients in clinical care hospitalized with COVID-19, we observed a significant reduction of mortality in RDV vs. non-RDV treated patients in those on no O2 or low-flow O2. Mortality reduction was also seen in patients on high-flow O2 at day 14, but not day 28. These data support the use of RDV early in the course of COVID-19 in hospitalized patients.

10.
Open Forum Infectious Diseases ; 8(SUPPL 1):S356, 2021.
Article in English | EMBASE | ID: covidwho-1746489

ABSTRACT

Background. We investigated clinical outcomes of favipiravir in patients with COVID-19 pneumonia. Methods. Patients who between 23 May 2020 and 18 July 2020 received ≥24 hours of favipiravir were assigned to the favipiravir group, while those who did not formed the non-favipiravir group. The primary outcome was 28-day clinical improvement, defined as two-category improvement from baseline on an 8-point ordinal scale. Propensity scores (PS) for favipiravir therapy were used for 1:1 matching. Cox regression was used to examine associations with the primary endpoint. Results. The unmatched cohort included 1,493 patients, of which 51.7% were in the favipiravir group, and 48.3% were not receiving supplemental oxygen at baseline (table 1). Favipiravir was started within a median of 5 days from symptoms onset. Significant baseline differences between the two unmatched groups existed, but not between the PSmatched groups (N = 774) (table 1). After PS-matching, there were no significant differences between the two groups in the proportion with 28-day clinical improvement (93.3% versus 92.8%, P 0.780), or 28-day all-cause mortality (2.1% versus 3.1%, P 0.360) (Table 2). Favipiravir was associated with more viral clearance by day 28 (79.8% versus 64.1%, P < 0.001) (table 2). In the adjusted Cox proportional hazards model, favipiravir therapy was not associated 28-day clinical improvement (adjusted hazard ratio 0.978, 95% confidence interval 0.862 -1.109, P 0.726) (Table 3). Conclusion. Favipiravir therapy for COVID-19 pneumonia is well tolerated but is not associated with an increased likelihood of clinical improvement or reduced allcause mortality by 28 days.

11.
Open Forum Infectious Diseases ; 8(SUPPL 1):S382, 2021.
Article in English | EMBASE | ID: covidwho-1746438

ABSTRACT

Background. Optimal dose of methylprednisolone in patients with moderate or severe COVID-19 is unclear. In our hospital, the use of 250-500 mg/day of methylprednisolone was frequent in the first wave of the pandemic. Lower dose were recommended in our protocol since September 2020. The aim was to evaluate the impact of methylprednisolone dose in the outcome of patients with moderate or severe COVID-19. Methods. This is a retrospective and observational study. Inclusion criteria: SARS-CoV-2 infection diagnosed by PCR, admission to our hospital between March 2020 and February 2021, SatO2 < 94% or SatO2/FiO2 < 447. Two treatment groups were compared: patients treated with 0.5-1.5 mg/kg/day (group 1) and patients treated with more than 1.5 mg/kg/day (group 2). The primary outcome analyzed was orotracheal intubation (OTI) or death from any cause at 28 days after admission. Differences in demographic, clinical and laboratory characteristics between treatment groups were analyzed. Variables with P < 0.1 were included in a binary logistic regression model, calculating a propensity score for assigning each patient to group 1 treatment. Bivariate analysis was performed to identify variables associated with worst outcome. Finally, Cox regression was performed including treatment group, propensity score as covariate and all the variables with P< 0.05 in the bivariate analysis. Results. 285 patients were included, 197 in group 1 and 88 in group 2. The median age was 73 years, 52,3% were male. Mortality or OTI at 28 days was 24,9%. There was a higher proportion of patients in group 1 with COPD (9,6% vs 1.1%, P< 0.01), dyspnea (60.4% vs 45.5%, P=0.01), sepsis (22.8% vs 13.6%, P=0.07). Patients in group 2 had more impaired consciousness (18.2% vs 8.6%, P=0.02). The median of lymphocytes count was lower in group 1 (900 vs 1025, P=0.01). There were no differences in the primary outcome between treatment groups (26.1% in the group 2 vs 24.4% in the group 1, P=0.7). Conclusion. The use of high dose of methylprednisolone compared with intermediate dose is not associated with a better outcome in patients with moderate or severe COVID-19.

12.
Clin Infect Dis ; 2022 Jan 17.
Article in English | MEDLINE | ID: covidwho-1740826

ABSTRACT

BACKGROUND: Several studies have investigated whether pregnancy is a risk factor for developing severe COVID-19; however, the results remain controversial. In addition, the information regarding risk factors for developing severe COVID-19 in pregnant women is limited. METHODS: A retrospective cohort study analyzing the data from the nationwide COVID-19 registry in Japan was conducted. Propensity score matched analysis was performed to compare COVID-19 severity between pregnant and nonpregnant women. Multivariate analysis was also conducted to evaluate risk factors for developing moderate-to-severe COVID-19 in pregnant women. RESULTS: During the study period, 254 pregnant and 3752 nonpregnant women of reproductive age were identified. After propensity score matching, 187 pregnant women and 935 nonpregnant women were selected. A composite outcome of moderate-to-severe COVID-19 was more frequently observed in pregnant women than that of nonpregnant women (n=18, 9.6% vs. n=46, 4.9%; P=0.0155). In multivariate analysis, the presence of underlying diseases and being in the second-to-third trimester of pregnancy were recognized as risk factors for moderate-to-severe COVID-19 in pregnant women (odds ratio [95% confidence interval]: 5.295 [1.21-23.069] and 3.871 [1.201-12.477], respectively). CONCLUSIONS: Pregnancy could be a risk factor for moderate-to-severe COVID-19 for women in Japan. In addition to the presence of comorbidities, advanced pregnancy stages may contribute to greater risks for developing moderate-to-severe COVID-19 in pregnant women.

13.
Clin Microbiol Rev ; : e0020021, 2022 Mar 09.
Article in English | MEDLINE | ID: covidwho-1736023

ABSTRACT

Convalescent plasma (CP) recurs as a frontline treatment in epidemics because it is available as soon as there are survivors. The COVID-19 pandemic represented the first large-scale opportunity to shed light on the mechanisms of action, safety, and efficacy of CP using modern evidence-based medicine approaches. Studies ranging from observational case series to randomized controlled trials (RCTs) have reported highly variable efficacy results for COVID-19 CP (CCP), resulting in uncertainty. We analyzed variables associated with efficacy, such as clinical settings, disease severity, CCP SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) antibody levels and function, dose, timing of administration (variously defined as time from onset of symptoms, molecular diagnosis, diagnosis of pneumonia, or hospitalization, or by serostatus), outcomes (defined as hospitalization, requirement for ventilation, clinical improvement, or mortality), CCP provenance and time for collection, and criteria for efficacy. The conflicting trial results, along with both recent WHO guidelines discouraging CCP usage and the recent expansion of the FDA emergency use authorization (EUA) to include outpatient use of CCP, create confusion for both clinicians and patients about the appropriate use of CCP. A review of 30 available RCTs demonstrated that signals of efficacy (including reductions in mortality) were more likely if the CCP neutralizing titer was >160 and the time to randomization was less than 9 days. The emergence of the Omicron variant also reminds us of the benefits of polyclonal antibody therapies, especially as a bridge to the development and availability of more specific therapies.

14.
Front Public Health ; 10: 848211, 2022.
Article in English | MEDLINE | ID: covidwho-1731873

ABSTRACT

The COVID-19 pandemic has caused great shocks on economic activities and carbon emissions. This paper aims to monitor the CO2 emission trajectory in China before and after the pandemic outbreak, and analyze the emission reduction effects by ETS and its market performances, which are important determinants underlying the trajectory and key drivers for emission reductions. We firstly find out a rather consistent trajectory of CO2 emissions in pre- and post-pandemic China over a 2-year time horizon, using the near-real-time datasets of daily CO2 emissions by Carbon Monitor and applying the Cox-Stuart trend test and mean equality test. We then examine the emission reduction effects by China's carbon ETS and its pilot market performances, using the methodologies of DID and PSM-DID as well as pre-pandemic region-level emission datasets by CEADs. Furthermore, it's found that the ETS pilot markets, which are immature with defects, have been performing more vulnerably in terms of liquidity and transaction continuity under pandemic shocks, thus undermining the emission reduction effects by ETS. These findings are providing insights into further mechanism design of the carbon ETS to the end of steady emission reductions even under shocks for post-pandemic China. It's of particular importance now that the nationwide market has been launched and needs to be enhanced based on lessons learned.


Subject(s)
COVID-19 , Carbon Dioxide , COVID-19/epidemiology , China/epidemiology , Humans , Industry , Pandemics , SARS-CoV-2
15.
Journal of Crohn's and Colitis ; 16:i533-i534, 2022.
Article in English | EMBASE | ID: covidwho-1722347

ABSTRACT

Background: Our objective is to evaluate the serologic response to the SARS-CoV-2 vaccine in patients with Inflammatory Bowel Disease (IBD). In addition to that, we want to analyze the influence of immunosuppressive drugs in that response, as well as describe the adverse events in this population. Methods: We included 266 patients in a unicentric prospective study. All patients signed informed consent. A serologic blood test was made days before the first dose and 2-4 weeks after the complete immunization. We used Siemens Atellica Anti-SARS-CoV-2 (N) and Vircell Virclia (S and N) electrochemiluminescence immunoassay to detect antibodies to SARS-CoV-2). If they were discordant, the results were considered as undetermined. The IBD treatment was stable along the study. The statistics analysis of data was done with Stata 16. Results: Basal characteristics are described in table 1. The patients were on treatment with: 15 (5.66%) had no treatment, 47 (17.7%) had mesalamine, 4 (1.51%) had corticosteroids, 41 (15.47%) had immunomodulator, 113 (42.64%) had biologic and 45 (16.98%) had combo. Amongst the biologic drugs: Infliximab 51 (32,3%), Adalimumab 50 (31,6%), Vedolizumab 19 (12,03%) y Ustekinumab 31 (19,6%). The vaccines were messenger RNA BNT162b2 (Pfizer-BioNTech) in 154 12 months are presented as a real world evidence (RWE) comparison of UST vs anti-TNF. Methods: After exclusion of other biologics than UST and anti-TNF and missing outcomes, the final sample consisted of 607 CD-patients. Clinical remission (HBI ≤ 4) was the predefined endpoint at month 12. Patients were analyzed on a modified intent-to-treat basis (mITT;switchers considered as outcome failure). To reduce the effect of confounders, propensity score (PS) adjustment with inverse probability of treatment weighting (IPTW) was implemented. A weighted logistic regression was used, and the results were reported as odds ratio (OR) and 95% confidence interval (CI). Results: 343 UST (naïve: 35) and 264 anti-TNF (naïve: 175) (ADA 61%, IFX 39%) CD-patients were included. PS removed systematic differences between both groups (mean of both groups: 15% perianal disease, 36% surgical resection, 41% EIM). Overall, the number of switches was lower in the UST group than in the anti- TNF group (Tab. 1). However, the number of switches within 12 months was significantly lower in the UST group only when compared to the IFX group (16.3% vs 27.2%;p=0.045) (Fig. 1). Clinical remission rates at 1 year (Tab. 2) were not statistically different for the overall UST vs. anti-TNF groups (65.8% vs 60.0%). Remission rates were similar for UST vs ADA, while these were significantly higher for UST vs. IFX (61.6% vs 41.8%;p=0.009). Looking at clinical remission in the week 16 responder group (Tab. 3), a statistically significantly higher remission rate was found in the overall group for UST (77.6%) vs anti-TNF (65.4%) (p=0.041), which was mainly driven by the higher UST remission rate in biologic-naïve CD patients (p=0.026). Conclusion: This 1-year maintenance phase RWE-comparison with UST vs anti-TNF showed remarkably high clinical remission rates in both groups. Also due to a more frequent switching within the IFX group, the clinical remission rate at 1 year was significantly higher with UST than with IFX and higher with UST vs anti-TNF in the biologic-naïve groups. These results support together with the known favorable safety profile consideration of UST as a first-line targeted therapy for CD.

16.
Journal of Crohn's and Colitis ; 16:i488, 2022.
Article in English | EMBASE | ID: covidwho-1722342

ABSTRACT

Background: Data regarding the long-term effects of COVID-19 on patients with Inflammatory bowel disease is scarce. Fecal calprotectin (FC) correlates with IBD clinical and endoscopic activity. We compared fecal calprotectin levels between patients with COVID-19 to a control group tested negative to SARS-CoV-2. Methods: We gathered data from a large health medical organization in Israel of insured individuals who underwent a SARS-COV-2 PCR test from March 1, 2020, to December 31, 2020. Among patients with IBD, data regarding fecal calprotectin taken 30-365 days before SARS-CoV-2 testing was gathered. We compared fecal calprotectin levels taken at least 30 days following COVID-19 infection to those who tested negative. Results: 1924 Crohn's disease (CD) patients and 949 Ulcerative Colitis (UC) patients were tested for SARS-CoV-2. 322 (16.7%) were tested positive in the CD group and 114 (13.7%) in the UC group. Pre-COVID-19 calprotectin levels did not show statistically significant differences between patients who ended up testing positive for SARS-CoV-2 and those who tested negative in CD (377 ±759.08 vs. 451.84±869, p-value = 0.4) and in UC (466.93±766.69 vs. 617.91 ±1243.99 p-value=0.37). Post-COVID-19 fecal calprotectin was higher among patients with CD who were tested positive than those who tested negative for SARS-CoV-2 (617.42±832.68 vs. 355.94±1207.46, p value=0.04). In a multivariate linear regression controlling for age, gender, BMI, smoking status, and pre-COVID-19 fecal calprotectin, SARS-CoV-2 positivity was associated with higher fecal calprotectin levels (p value=0.03). In contrast, there was no statistically significant change in fecal calprotectin levels among patients with UC and SARS-CoV-2 positivity (547.2±1089 vs.458.32± 689 p value=0.9). In a 2:1 propensity score-matched cohort (n=264), calprotectin levels were higher among patients with CD who suffered from COVID-19 compared to controls (657.64 vs. 384.94 p-value = 0.03) Conclusion: Patients with CD who had COVID-19 have higher FC levels compared to similar CD patients who did not have COVID-19. This finding was not found in patients with UC.

17.
J Diabetes Metab Disord ; 20(2): 1675-1683, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1694195

ABSTRACT

PURPOSE: Coronavirus increases mortality rate in people with underlying disease. The purpose of the present research was to compare the clinical outcomes in Covid-19 patients with and without underlying diabetes disease using propensity score matching. METHODS: A matched case-control study was conducted on 459 diabetic patients with Covid-19 (case group) and 459 non-diabetic patients with Covid-19 (control group). Matching in two groups was performed using propensity score matching method. The effect of covariates on the clinical outcome of the patients (recovery-death) was assessed using logistic regression and the associations of factors with the patients' survival were determined using Cox proportional hazards regression model. Data were analyzed using R software. RESULTS: The mean (standard deviation) age of patients in the case and control groups were 65.77 (12.2) and 65.8 (12.24), respectively. 196 patients (43%) in the case group, and 249 patients (54%) in the control group were male (with P-value < 0.05). The logistic regression model showed that the variables of age, level of blood oxygen (SpO2), ICU admission, length of hospitalization, cancer and diabetes affected patients' death. Furthermore, the resuts of the Cox regression showed that the variables of age, level of blood oxygen (SpO2), ICU admission,cancer and diabetes were related to survival of the patients. It was found that diabetes was significantly associated with mortality from COVID-19 with odds ratio of 2.88 (95% CI: 1.80-4.69; P < 0.01) and hazard ratio of 1.45 (95% CI: 1.01-2.03; P = 0.05). CONCLUSION: The underlying diabetes significantly increases the mortality among patients with Covid-19, so special care should be taken for this high risk group if they develop Covid-19.

18.
Clin Rheumatol ; 2022 Feb 16.
Article in English | MEDLINE | ID: covidwho-1694528

ABSTRACT

BACKGROUND: The clinical outcomes of patients with rheumatic diseases infected with COVID-19 were inconsistent characteristics across regions and time periods. We need to revisit and sort out the clinical characteristics of these patients at the beginning of the global COVID-19 epidemic. METHODS: We collected data from confirmed COVID-19 patients from two military-run field hospitals and classified them into the rheumatic disease group and no rheumatic disease groups, and the latter was further distinguished by ARD and non-ARD. We compared the primary outcome, which we defined as mortality, and the secondary outcome, which we defined as the ICU occupancy rate, the duration of hospitalization and the duration of viral clearance, between the patients with and without rheumatic diseases after PSM. A study-level meta-analysis of four studies was conducted on the mortality of the COVID-19 patients with and without rheumatic diseases. RESULTS: A total of 4353 COVID-19 patients were included in our cohort study; 91 had rheumatic diseases. The mean age of the entire cohort was 59.37, and 2281 (52.40%) patients were female. The mortalities after PSM were 1.11% and 3.46% in the rheumatic diseases and no rheumatic disease groups, respectively. The ICU occupancy rates after PSM were 2.22% and 4.61% in the rheumatic diseases and no rheumatic disease groups. The duration of hospitalization and viral clearance in the rheumatic disease group were 15.97 and 43.69, respectively; moreover, the same parameters in the no rheumatic diseases after PSM were 15.48 and 45.48. No significant differences were found in either the primary or secondary outcomes. After excluding the gout cases, the results were still similar. However, there was a significant difference between the two groups upon meta-analysis (RR = 1.70, 95% CI 1.35-2.13). CONCLUSIONS: Rheumatic diseases seemed to aggravate the course of COVID-19 infection. However, the poor outcomes of COVID-19 seemed to be unassociated with rheumatic diseases undergoing an adequate medical intervention. KEY POINTS: • We compared the outcomes and prognosis of COVID-19 patients in China at the beginning of the outbreak regarding the presence or absence of rheumatic disease patients and made some meaningful conclusions for future outbreaks of similar infectious diseases. • We compared similar recent studies from other countries and explored the changes and differences in patient outcomes associated with COVID-19 as it continued to spread worldwide during the year, providing clinical evidence to further explore the role rheumatic diseases play in COVID-19 patient outcomes. • We provided evidence for the treatment of relevant patients and made rationalized recommendations for treatment strategy.

19.
Critical Care Medicine ; 50(1 SUPPL):155, 2022.
Article in English | EMBASE | ID: covidwho-1691891

ABSTRACT

INTRODUCTION: Early reports from Wuhan, NYC and Detroit showed poor prognosis after in hospital cardiac arrest (IHCA) in COVID-19 patients. Factors leading to poor outcomes included overwhelmed healthcare systems, cardiac arrests on regular nursing floor instead of ICUs & shorter duration of resuscitation efforts. We aimed to assess whether there was a difference in resuscitation efforts in our healthcare system during the COVID-19 pandemic (22% survival - recently reported) when compared to our historic MICU IHCA (16% survival) resuscitation attempts. METHODS: In this retrospective study, we compared the duration of resuscitation between two cardiac arrest cohorts. Cohort one included COVID-19 IHCA patients who were admitted from 03/2020- 10/2020 in the ICU of the Cleveland Clinic Health System of NE Ohio. Cohort two included patients who were admitted to the medical ICU of Cleveland Clinic from 01/2014-12/2018. Study was approved by the IRB and data obtained through EMR and quality and patient safety registry. 2:1 propensity score matching was performed to derive two matched groups for outcome analysis. Wilcoxon test was used to compare the duration of resuscitation between two cohorts. Wilcoxon test was used to compare the duration. The statistical analysis was carried using R 4.0.3 and p< 0.05 was considered statistically significant. RESULTS: There were a total of 442 patients, 384 in non- COVID-19 cohort and 58 in COVID-19 cohort. The mean age of the study population was 61.3 (16.2) years and 44.5% were females. In 90.8% (n=385) patients, rhythm was nonshockable. After propensity score matching, there was no significant difference in the mean duration of resuscitation in COVID-19 (n=57) and non-COVID cohort (n=114) (13.1 (11.7) vs 11.4 (10.2), p=0.470). CONCLUSIONS: In this study, we found that there was no significant change in the duration of the resuscitation attempts in patients with COVID-19 when compared to the historic cohort of critically ill patients who had an IHCA. The favorable outcomes we noted in our patient cohort is related to the systems of care, the large ICU capacity, expansive restructuring of critical care resources and investment into critical care COVID 19 specific education.

20.
Vaccines (Basel) ; 10(2)2022 Feb 13.
Article in English | MEDLINE | ID: covidwho-1687068

ABSTRACT

This study aimed to observe adverse events following immunisation (AEFIs) that affected recovery within two weeks after COVID-19 vaccination and investigate their risks in propensity-score-matched populations. Data were collected from 447,346 reports from the VAERS between 1 January 2021 and 31 July 2021. Propensity-score-matched populations were constructed by adjusting for demographic characteristics and 11 underlying diseases in eligible subjects who received 1 of 3 COVID-19 vaccines: 19,462 Ad26.COV2.S, 120,580 mRNA-1273, and 100,752 BNT162b2. We observed that 88 suspected AEFIs (22 in Ad26.COV2.S, 62 in mRNA-1273, and 54 in BNT162b2) were associated with an increased risk of delayed recovery within 2 weeks after COVID-19 vaccinations. Nervous system, musculoskeletal and connective tissue, gastrointestinal, skin, and subcutaneous tissue disorders were the most common AEFIs after COVID-19 vaccination. Interestingly, four local and systemic reactions affected recovery in different vaccine recipients during our study period: asthenic conditions and febrile disorders in Ad26.COV2.S and mRNA-1273; general signs and symptoms in mRNA-1273 and BNT162b2; injection site reactions in Ad26.COV2.S and BNT162b2. Although it is necessary to confirm a causal relationship with COVID-19 vaccinations, some symptoms, including paralysis, allergic disorders, breathing abnormalities, and visual impairment, may hinder the recovery of these recipients.

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