Real-life prospective study on tocilizumab in severe COVID-19 infection

The outcomes of tocilizumab (recombinant monoclonal antibody inhibiting IL-6) in SARS-CoV-2 infection have been variable, with REMAP-CAP and RECOVERY being the largest trials to show benefits. In this prospective, observational study we compared tocilizumab plus standard care (dexamethasone) vs standard care alone in patients with severe COVID-19 infection. Eligibility criteria included patients (age >18 years) with radiological evidence of COVID-19 Pneumonia, PO2/FiO2 (PF) ratio of <300 mmHg and an inflammatory phenotype defined by raised CRP, IL-6 and Ferritin. The primary outcome was a composite of mechanical ventilation and death. A total of 36 patients were included in this study, 27 in the treatment group and 9 in the standard care group. The treatment arm received tocilizumab 8mg/kg (maximum 800mg) as a single infusion within the first 24 hours of respiratory deterioration (identified as worsening RR and PF ratio). Results showed significantly lower mortality rate in the tocilizumab group compared to standard care group (3% vs 33% respectively, p=0.013). Patients who received tocilizumab were also less likely to progress to mechanical ventilation, with only 3.7% of the treatment group requiring mechanical ventilation vs 44% in the control group (p=0.002). Our findings support the use of tocilizumab in severe COVID-19 infection when given early in respiratory deterioration. The predominant variant at the time of this study was the Alpha variant, and so further investigation is required into its effectiveness in newer variants. Limitations include small sample size.

Quantitative assessment of early post injection stress-first tetrofosmin acquisition: Implications forlaboratory efficiency and potentially reducing patientand staff risk during the Covid-19 pandemic

Introduction: Recent Societal guidelines have recommended PET versus SPECT for myocardial perfusion imaging(MPI) if possible during the Covid-19 pandemic to reduce patient and staff interaction times. In this study, we testeda rapid stress-first stress-only if normal pharmacologic stress Tc-99m tetrofosmin (TETRO) SPECT protocol, withrest imaging if needed performed on a subsequent day. Methods: A total of 84 patients (47 male, BMI29+/-5 km/m2 , 52 stress only, 32 stress/rest, 67 regadenoson (REG),17 exercise (EX)) referred for MPI were examined as part of a quality improvement project. Patients were imagedupright and then supine on a Spectrum Dynamics, D-SPECT CZT system following injection of 15 mCi of TETRO atpeak stress and at rest (if needed). All had both early and late (standard) images acquired for 10 myocardial counts (approx. 2-5 minutes). Three regions of interest (ROIs;heart, blood pool, and liver) were examined in thereconstructed tomographic images and quantitative parameters were extracted using Radiant (Poznan Poland).Maximal heart counts were extracted from an elliptical ROI in a representative slice of the target organ. We alsoexamined lab efficiency: time of check-in, time in department, and time of study completion. Results: The average time delay between tracer injection and start of imaging was: 18 ± 3 min (early) and 52 ± 17mins (standard). Early and standard start times for REG were 17 ± 4 min and 67 ± 15 mins, and for EX were 14 ± 2min and 66 ± 11 mins respectively. All heart to liver ratios were statistically significant with p<0.005 except for theupright exercise ratio (p=0.064) (See Table 1). Ratios between other organs did not achieve statistical significance.Time between patient check-in to the department and end of stress imaging was reduced from 128 ± 45 to 69 ± 21minutes (p<10 ) for the stress only patients. Table 1: Summary H/L ratios. Numbers in Italics did not achieve p<0.005. Conclusions: Early post-stress imaging appears feasible with Tc-99m tetrofosmin and CZT instrumentation, with nodifference in heart/blood pool ratios between early and late acquisitions, and early heart/liver ratios well above 1.This protocol permits rapid acquisitions, reduces patient/staff interaction times, and almost halves the time a patientneeds to be in the lab. A blinded read of early and late acquisitions to determine image quality and diagnosticcertainty appears warranted.

Frailty, covid-19 disease severity and outcome among hospitalised older adults

Aim To examine the characteristics and outcomes of hospitalised older adults with COVID-19. Methods Retrospective, multi-centre, cohort observational study. Data from sixty-nine hospitalised patients aged over 70 years with reverse transcriptase polymerase chain reaction-confirmed COVID-19 at three Irish hospitals were collected from health records. Symptom profile, COVID-19 severity level based on Irish Thoracic Society guidelines, Clinical Frailty Scale (CFS), Cumulative Illness Rating Scale-Geriatric (CIRS-G) scores, laboratory and radiological data were reviewed. Results Patient mortality rate was 23.2% (n=16). Median survivor age was 81.5 years (IQR 76.5-86.5). Mean CFS and CIRS-G scores were 5;(SD1.6) and 8.19;(SD4.4). Most patients (n=56, 81.1%) were categorised as mild COVID-19 cases. Five patients (n=5, 7%) were asymptomatic. Atypical symptom presentation was 7%(n=5). Delirium was noted in almost one-third of patients (n=21, 30.4%). Seven patients (n=7,10.1%) required intubation and intensive care unit admission. Over 1/3 of delirious patients died (n=8, 38%). Frail patients were older (P= 0.005), more likely to have dementia (P=0.04) and required less ventilatory support than non-frail patients (P=0.001) but were categorised as mild COVID-19 on admission (P=0.004). Conclusion Despite mild COVID-19 symptoms, mortality and delirium rates remained high. Low co-morbidity burden & atypical symptom rates were recorded despite high frailty rates.

Irritant contact dermatitis in healthcare workers as a result of the COVID-19 pandemic

Healthcare providers at the forefront of the COVID-19 response are at constant risk of infection. International guidance recommends frequent handwashing and personal protective equipment (PPE) to help prevent contraction and transmission of the virus. However, evidence is emerging that these practices are causing adverse effects on the skin integrity of frontline healthcare workers (HCWs). This study aims to evaluate the degree of COVID-19-related dermatitis among frontline staff members from a large tertiary hospital in Ireland. A single-centre cross-sectional study of HCWs from a university hospital in Ireland was undertaken between 29 April and 13 May 2020. Approximately, 1000 online and paper surveys were distributed to hospital staff. Participants reported on the duration of PPE exposure, change in handwashing practices, symptoms of dermatitis and alleviating measures trialled. Data were collected in Microsoft Excel and the results were analysed using SPSS. Of the 270 participants in this study, 223 (82.6%) reported signs and symptoms of dermatitis. Hands were the most commonly affected site (76.5%) followed by the nose (13.7%) and cheeks (12.5%). The most frequently reported symptom was dry skin, with 75.4% of staff affected. Redness was described by 36.9% and 27.6% complained of itching. Virtually all (n = 268;99.2%) HCWs reported an increase in frequency of handwashing;however, 122 (45.2%) staff members denied using emollients or other topical treatment. Atopy was not related to the development of dermatitis, but a personal history of dermatitis contributed significantly, with 55 (24.7%) of the dermatitis group citing a history of dermatitis vs. 4.3% of unaffected staff (P < 0.001). The dermatitis group recorded wearing PPE for an average of 3.15 h in comparison with the nondermatitis group using continuous PPE for 1.97 h;however, this fell short of significance (P = 0.211). COVID-19 healthcare-related dermatitis is emerging as a significant problem. It is vital to promote awareness of this issue in order to provide appropriate prevention and timely treatment for our healthcare staff on the front line.

Irritant contact dermatitis in healthcare workers as a result of the COVID-19 pandemic: a cross-sectional study.

COVID-19 healthcare workers (HCWs) require frequent handwashing and use of personal protective equipment (PPE) to prevent infection. However, evidence is emerging that these practices are causing adverse effects on their skin integrity. A single-centre, cross-sectional study of HCWs from an Irish hospital was undertaken to evaluate the degree of COVID-19-related irritant contact dermatitis (ICD) between April and May 2020. Of 270 participants surveyed, 223 (82.6%) reported symptoms of ICD. The hands were the most commonly affected site (76.47%) and the most frequently reported symptom was dry skin (75.37%). Nearly all (268; 99.26%) HCWs had increased hand-washing frequency, but 122 (45.35%) did not use emollients. In the ICD group, 24.7% cited a history of dermatitis compared with 4.3% of unaffected staff (P < 0.001). The ICD group recorded PPE usage for an average of 3.15 h compared with the non-ICD group at 1.97 h (P = 0.21). Promoting awareness of COVID-19-related ICD is vital to highlight prevention and treatment for frontline staff.