Clinical presentation, disease course, and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease: a cohort study across 18 countries

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.

COVID-19 in cancer patients: clinical characteristics and outcome-an analysis of the LEOSS registry

Introduction

Since the early SARS-CoV-2 pandemic, cancer patients have been assumed to be at higher risk for severe COVID-19. Here, we present an analysis of cancer patients from the LEOSS (Lean European Open Survey on SARS-CoV-2 Infected Patients) registry to determine whether cancer patients are at higher risk.

Patients and methods

We retrospectively analyzed a cohort of 435 cancer patients and 2636 non-cancer patients with confirmed SARS-CoV-2 infection, enrolled between March 16 and August 31, 2020. Data on socio-demographics, comorbidities, cancer-related features and infection course were collected. Age-, sex- and comorbidity-adjusted analysis was performed. Primary endpoint was COVID-19-related mortality.

Results

In total, 435 cancer patients were included in our analysis. Commonest age category was 76–85 years (36.5%), and 40.5% were female. Solid tumors were seen in 59% and lymphoma and leukemia in 17.5% and 11% of patients. Of these, 54% had an active malignancy, and 22% had recently received anti-cancer treatments. At detection of SARS-CoV-2, the majority (62.5%) presented with mild symptoms. Progression to severe COVID-19 was seen in 55% and ICU admission in 27.5%. COVID-19-related mortality rate was 22.5%. Male sex, advanced age, and active malignancy were associated with higher death rates. Comparing cancer and non-cancer patients, age distribution and comorbidity differed significantly, as did mortality (14% vs 22.5%, p value < 0.001). After adjustments for other risk factors, mortality was comparable.

Conclusion

Comparing cancer and non-cancer patients, outcome of COVID-19 was comparable after adjusting for age, sex, and comorbidity. However, our results emphasize that cancer patients as a group are at higher risk due to advanced age and pre-existing conditions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00277-020-04328-4.

Healthcare burden of probable and proven invasive mucormycosis: a multi-centre cost-of-illness analysis of patients treated in tertiary care hospitals between 2003 and 2016

BACKGROUND

Invasive mucormycosis (IM) is a rare invasive fungal infection with a high mortality rate. However, data concerning the clinical and economic burden of IM are scarce.

AIM

To evaluate the direct treatment costs and additional expenditures of patients with IM.

METHODS

A retrospective cost-of-illness analysis of cases with IM extracted from FungiScope - Global Registry for Emerging Fungal Infections, accessible through the epidemiological research platform www.ClinicalSurveys.net, was undertaken. Results of patients with IM were compared with those of matched patients with similar underlying conditions based on the German Diagnosis Related Group (G-DRG) coding.

FINDINGS

Out of 46 patients with probable/proven IM, 31 (67%) patients were male and the median age was 53 years (range 11-88 years). Forty-two patients (92%) had haematological diseases as the most common risk factor. Analysis of cost factors identified antifungal treatment due to IM as the primary cost driver [€22,816, 95% confidence interval (CI) €15,036-32,346], with mean overall direct treatment costs of €53,261 (95% CI €39,660-68,825). Compared with matched patients, patients with IM were treated in hospital for 26.5 additional days (standard deviation 31.8 days; P < 0.001), resulting in mean additional costs of €32,991 (95% CI €21,558-46,613; P < 0.001). Probable IM, as well as absence of chemotherapy, surgical measures due to IM, and antifungal prophylaxis were associated with lower overall costs. Nineteen patients (41.3%) died during hospitalization.

CONCLUSION

This study demonstrates the considerable healthcare burden of IM. The choice of antifungal agent for treatment of IM had no impact on overall cost.

Echinococcus cysts affecting oromaxillofacial structures--a systematic review

OBJECTIVES

Cystic echinococcosis is a worldwide spread zoonosis and humans become accidental intermediate hosts. Any tissue can be affected. However, oromaxillofacial cystic echinococcosis is very uncommon and has never been studied systematically and no evidence-based treatment recommendations are available. Aim of this paper is to summarize the current knowledge and clinical experience with oromaxillofacial manifestations of cystic echinococcosis.

MATERIALS AND METHODS

PubMed database was accessed with a comprehensive, complex search strategy. Medical Subject Headings terms, wildcard search, truncated search terms and Boolean operators were used. No filters to restrict the results were set. Two evaluators jointly assessed the results in terms of defined criteria.

RESULTS

The search strategy retrieved 538 results in total. After evaluation 83 publications presenting 108 cases on oromaxillofacial cystic echinococcosis were included. Parotid gland, mandibular region and maxillary region were most commonly affected. Median patient age was 22 years (range 2.5 months to 81 years). Surgical treatment was performed in 97 cases.

CONCLUSIONS

In cases of oromaxillofacial cystic echinococcosis a thorough evaluation of the patients for further cysts is essential. Therapeutic treatment options are surgical or minimally invasive intervention and drug treatment with benzimidazoles. The diagnosis can be difficult and often require a multidisciplinary approach.

Synergistic extraction of Eu(III) with N-phosphorylated bis-ureas and chlorinated cobalt bis(dicarbollide) ion

Extraction of Eu(III) with a synergistic mixture of polydentate N-phosphorylated bis-ureas with the general formula (i-PrO)2P(O)NHC(O)NHXNHC(O)NHP(O)(Oi-Pr)2 (X = (CH2)7, (CH2)2O(CH2)2 and (CH2)2O(CH2)2O(CH2)2) and chlorinated cobalt bis(dicarbollide) ion (CCD−) with formula closo-[(1,2-C2B9H8Cl3)2-3-Co]− was studied using nitrobenzene as the solvent. Extraction of Eu(III) was very effective up to high concentrations of nitric acid. Eu(III) is most likely extracted into the organic phase as the [EuL2]3+ species whereas the positive charge of extracted complex is compensated by CCD and/or nitrate anions.

DNA-Based Vaccination with Polycistronic Expression Plasmids

DNA-based vaccination is a potent technique to prime cellular (T-cell mediated) immune responses (reviewed in 1). Many details of the priming of T-cell precursors by antigen translated from injected expression plasmid DNA are unknown. The relevant cell that is transfected in situ after DNA vaccination and that can process and present the protein in an immunogenic form has not yet been identified. Alternatively, the transfected cell may initiate 'cross-priming' in vivo by transferring processed antigen to a professional antigen-presenting cell (APC).

Separation of trivalent actinides and lanthanides from simulated high-level waste using cobalt bis(dicarbollide) ion derivate substituted with diphenyl-N-tert.octyl-carbamoylmethylphosphine oxide

A derivative with cobalt bis(dicarbollide)(1−) ion covalently bonded with diphenyl-N-tert.octyl-carbamoylmethylphosphine oxide with a formula [(8-Ph2P(O)-CH2C(O)N-t-C8H17-(CH2-CH2O)2-(1,2-C2B9H10)(1´,2´-C2B9H11)-3,3´-Co]− (CMPO-COSAN) has been evaluated for actinides(III)/lanthanides(III) separation from high level liquid waste (HLLW) from PUREX reprocessing. The procedures for HLLW treatment by CMPO-COSAN dissolved in low polar mixture of hexylmethylketone and hydrogenated tetrapropylene (HMK/TPH, 1:1) or polar mixture of nitrobenzene/bromoform (NB/BF, 9:1) were proposed. The good separation of Am(III)/Ln(III) from bulk of fission products was achieved. The trivalent radionuclides were effectively stripped from the loaded organic phase by using ammonium citrate or solution of ammonium citrate and ammonium diethylenetriamine pentaacetate (DTPA). The co-extraction of some undesirable elements as Zr, Mo, Pd was suppressed using oxalic acid and HEDTA in extraction and a scrub steps. However, co-extraction of Ag has to be solved, yet.

Vibrational relaxation and dephasing of Rb2 attached to helium nanodroplets

The vibrational wave-packet dynamics of diatomic rubidium molecules (Rb(2)) in triplet states formed on the surface of superfluid helium nanodroplets is investigated both experimentally and theoretically. Detailed comparison of experimental femtosecond pump-probe spectra with dissipative quantum dynamics simulations reveals that vibrational relaxation is the main source of dephasing. The rate constant for vibrational relaxation in the first excited triplet state 1(3)Σ(g)+ is found to be constant γ ≈ 0.5 ns(-1) for the lowest vibrational levels v ≲ 15 and to increase sharply when exciting to higher energies.

Banding pattern indicative of echinococcosis in a commercial cysticercosis Western blot

Objective

A commercial cysticercosis Western blot was evaluated for serological cross-reactivity of sera from patients with alveolar (AE) and cystic echinococcosis (CE).

Methods

A total of 161 sera were examined, including 31 sera from AE-patients, 11 sera from CE-patients, 9 sera from patients with other parasitic diseases and 109 sera from patients with unrelated medical conditions. All AE-and CE-sera were also examined by the echinococcosis Western blot.

Results

More sera from patients with AE than with CE showed cross-reactivity in the form of ladder-like patterns ("Mikado aspect") and untypical bands at 6-8 kDa (71% and 77.4% versus 27.3% and 45.5%, respectively). In contrast, triplets of bands in the area above 50 kDa and between 24 and 39-42 kDa were more frequent in CE than in AE sera. The fuzzy band at 50-55 kDa typical for cysticercosis was absent in all AE and CE sera.

Conclusions

Atypical banding patterns in the cysticercosis Western blot should raise the suspicion of a metacestode infection different from Taenia solium, i.e. Echinococcus multilocularis or E. granulosus, especially when the Mikado aspect and an altered 6-8 kDa band is visible in the absence of a fuzzy 50-55 kDa band.

Lanthanide and actinide extractions with anionic ligands based on cobalt bis(dicarbollide) ions with covalently bonded CMPO functions

Compounds were synthesized with the aim to develop efficient extraction agents for liquid-liquid extraction of polyvalent cations, i.e. lanthanides and actinides from high-level activity nuclear waste. Compounds of general formulation [(8-CMPO-(CH2-CH2O)2-1,2-C2B9H10)(1′,2′-C2B9H11)-3,3′-Co(III)]- with different phosphorus and nitrogen substitution (CMPO=2R,3R P(O)-(CH2) n C(O)N1R, 1R=t-octyl, H, Ph, 2R=Ph, n-octyl, 3R=Ph, n=1,2)-(4a to 4e), were prepared and characterized by combination of 11B NMR, 1H high field NMR, ESI-M.S., HPLC and other techniques. Molecular structure of the sodium complex of ligand 4a (1R=t-octyl, 2R=3R=Ph, n=1) was determined by single crystal X-ray diffraction analysis. Effect of several modifications in the structure of 4a–4e on the extraction properties was outlined. The study resulted in the definition of ionic ligand with enhanced extraction efficiency for 4a,b (t-octyl and H on the amidic nitrogen atom) and a better solubility of 4a and 4d (1R=t-octyl, 2R=n-Oct, 3R=Ph, n=1) in less polar solvents. Low polar mixtures of hydrogenated tetrapropylene (TPH) hexyl methyl ketone (HMK) can be applied as an auxiliary solvent for 4a, selected for detailed studies, replacing thus the polar and less environmentally friendly nitro-, fluoro- and chloro- solvents used in the current dicarbollide liquid-liquid extraction process. Results of the fission products separation from the simulated PUREX feed using 4a are presented inclusive procedures for Eu3+ stripping.

Autochthonous cystic echinococcosis in patients who grew up in Germany

Human cystic echinococcosis (CE) is a widespread zoonosis. Cases occurring in Germany are considered to result from imported infection and it is unclear if Echinococcus granulosus (sensu lato) is still transmitted in Germany. Therefore, exposure was investigated in 15 patients with cystic echinococcosis (7 female, 8 male; age-range 16-68, with a median of 48 years) who grew up in Germany. Fourteen patients had most likely acquired their infection in rural Germany, 11 from local dogs, one from an imported dog, two without obvious dog contacts. Taking into account multiple conceivable confounding factors might also account for some of infections: contacts with imported dogs or contact with dogs during travel in highly endemic regions, and ingestion of food contaminated by worm ova, whether in Germany or abroad. However, in at least two cases autochthonous transmission is beyond doubt, because these patients had never left Germany. The long pre-symptomatic development of cystic echinococcosis does not allow for a precise evaluation of the actual epidemiological situation. Compulsory notification of human cystic echinococcosis is an important instrument in the surveillance of the disease in humans. Regular inquiries at laboratories carrying out work in the field of veterinary medicine and at slaughterhouses, supervision of dogs at risk as well as genetic investigations on the strain or species of the causal agent of cystic echinococcosis are needed.

Long-term follow-up of metabolic activity in human alveolar echinococcosis using FDG-PET

AIM

[(18)F]fluoro-deoxyglucose positron-emission-tomography (FDG-PET) detects metabolic activity in alveolar echinococcosis (AE). The slow changes in metabolic and morphological characteristics require long-term follow-up of patients. This is the first study to evaluate metabolic activity over may years, hereby assessing the utility of FDG-PET for the evaluation of disease progression and response to treatment.

PATIENTS, METHODS

15 patients received a follow-up FDG-PET combined with computed tomography (integrated PET/CT) with a median of 6.5 years after the first PET in 1999. Number and location of enhanced metabolic activity in the area of AE lesions was determined. Quantification of intensity of metabolic activity was assessed by calculation of mean standardized uptake values.

RESULTS

AE lesions in 11/15 patients had been metabolically inactive initially, but only two showed permanent inactivity over the course of 81 months. Interestingly, in two patients metabolic activity was newly detected after 80 and 82 months. Benzimidazole treatment was intermittently discontinued in seven cases. Persisting activity at FDG-PET demanded continued benzimidazole treatment in four patients. Neither treatment duration, lesional size, calcifications nor regressive changes correlated with metabolic activity.

CONCLUSION

Treatment responses are heterogeneous and vary from progressive disease despite treatment to long-term inactive disease with discontinued treatment. Lack of metabolic activity indicates suppressed parasite activity and is not equivalent to parasite death. However, metabolic activity may remain suppressed for years, allowing for temporary treatment discontinuation. Relapses are reliably detected with PET and restarting benzimidazole treatment prevents parasite expansion.

A case of sporadic Echinococcus granulosus infection originating from Southern Germany

A 67-year-old woman with cystic echinococcosis (CE) is presented. She had complained of upper abdominal discomfort due to large hepatic cysts. These cysts showed no typical infrastructure characteristic for CE and she had never left the rural areas of southern Germany. Most remarkably, this area is highly endemic for alveolar echinococcosis, caused by Echinococcus multilocularis, but only sporadic cases of CE have been described. Due to the discrepancy between positive Echinococcus serology, atypical morphology and residency in an area non-endemic for Echinococcus granulosus, diagnostic puncture was performed with albendazole coverage. Puncture was complicated by anaphylaxis, from which the patient recovered without sequelae. The diagnosis of CE was highly likely due to the combination of positive serology with post puncture anaphylaxis, increasing antibody titers and eosinophilia. Retrospectively, the cysts had initially corresponded to the WHO stage CE 1. The patient was treated with albendazole for 15 weeks. Under treatment, the parasitic membrane detached from the cyst wall, revealing characteristic morphology for CE, now corresponding to the WHO stage CE 3. The patient remained asymptomatic during follow-up visits.

Unusual 9-->10 rearrangement of the substituted cage carbon in the ferratricarbollide series. Synthesis of the isomeric complexes [2-eta 5-(C5H5)-10-X-closo-2,1,7,10-FeC3B8H10] (where X = H2N, MeHN, Me2N, and ButHN)

Treatment of the zwitterionic amine tricarbollides of general formula 7-L-nido-7,8,9-C3B8H10 (1) (where L = Me2HN (1c) and ButH2N (1d)) with [(eta 5-C5H5)Fe(CO)2]2 in refluxing mesitylene resulted in the formation of a mixture of the known compounds [2-(eta 5-C5H5)-9-X-closo-2,1,7,9-FeC3B8H10] (2) (where X = H2N (2a), Me2N (2c), and ButHN (2d)) and a series of new, isomeric ferratricarbollylamines [2-(eta 5-C5H5)-10-X-closo-2,1,7,10-FeC3B8H10] (3) (where X = H2N (3a), Me2N (3c), and ButHN (3d)) in moderate yields. Complexes of type 3 (where X = H2N (3a), MeHN (3b), Me2N (3c), and ButHN (3d)) were also obtained readily by heating complexes of type 2 (where X = H2N (2a), MeHN (2b), Me2N (2c), ButHN (2d), and Bu(t)(Me)N (2e)) at ca. 300 degrees C for 10 min. All the complexes of type 3 contain reactive amine functions in meta positions with respect to the metal center. The observed 9-->10 rearrangement of the substituted cluster carbon is quite unexpected and is believed to result from higher thermodynamic stability of the 10-substituted isomers. The structures of all compounds of type 3 were established by high-field NMR spectroscopy and mass spectrometry, and that of 3d was determined by an X-ray diffraction study.

Polyvalent vaccination against hepatitis B surface and core antigen using a dicistronic expression plasmid

Genes encoding the small (S) surface antigen (HBsAg) or the core (C) antigen (HBcAg) of hepatitis B virus (HBV) were cloned into the monocistronic expression vectors pCMV-1 or pCMV-2 under HCMV-IE promoter control. Coding fragments of these vectors were fused to generate a dicistronic expression construct pCMV/C-S in which the antigens HBcAg and HBsAg are coexpressed. Transient in vitro transfection studies demonstrated that HBcAg and HBsAg are coexpressed from this construct. Vaccination of mice of different H-2 haplotypes with mono- or dicistronic expression plasmids induced humoral and cellular immune responses to HBsAg and the HBcAg. In particular, intramuscular injection of 'naked' dicistronic plasmid DNA into mice elicited polyvalent humoral and cytotoxic T lymphocyte responses to HBsAg and HBcAg. The studies demonstrate that dicistronic expression plasmids are a novel way to construct a polyvalent vaccine against HBV that comprises HBsAg and HBcAg as immunogens.

Dose-dependent disposition kinetics and tissue accumulation of boron after intravenous injections of sodium mercaptoundecahydrododecaborate in rabbits

Kinetics of boron disposition after single intravenous injections of two different doses (25 and 50 mg/kg) of mercaptoundecahydrododecaborate sodium (Na2B12H11SH; BSH) was studied in rabbits. Residual boron concentrations in various organs and tissues (heart, lungs, liver, spleen, kidney, adrenals, and brain) were also determined after seven daily injections of the same doses of BSH. Boron blood and tissue concentrations were measured by atomic emission spectrometry. In the majority of animals, the decline of boron blood concentrations after a single intravenous injection of either dose was biphasic, being consistent with a two-compartment model of boron disposition in the body. Although mean boron blood concentrations were roughly proportional to the BSH dose delivered, the mean total body clearance of boron from the body was 3 times lower (6.5 +/- 1.9 ml min-1 kg-1) after a dose of 50 mg/kg than after the injection of 25 mg/kg (22.4 +/- 7.9 ml min-1 kg-1), the difference between the means being statistically significant (P less than 0.05). Moreover, the mean terminal half-life of boron in blood was prolonged after the injection of 50 mg/kg (14.5 +/- 5.5 h) as compared with that found after the 25-mg/kg dose (3.5 +/- 0.9 h). On the other hand, the different BSH doses did not result in marked differences in the mean values obtained for the volume parameters - the volume of the central compartment (1.3 +/- 0.4 vs 1.3 +/- 0.5 l kg-1) and the volume of distribution at steady state (4.7 +/- 1.3 vs 6.0 +/- 4.0 l kg-1) - both of which were high, indicating extensive binding of the compound not only in the blood but also in tissues. Residual concentrations of boron found after seven daily injections of both doses of BSH were highest in the kidneys, the difference in the mean values being relatively small (33.6 +/- 6.1 vs 39.0 +/- 10.7 micrograms/g tissue). In the majority of other organs (heart, lung, liver, spleen, brain, adrenals), the residual concentrations after a dose of 50 mg/kg were disproportionately higher than those measured after the injection of 25 mg/kg, and the mean values corresponded to the reduced total body clearance rather than to the increased BSH dose. The saturability of BSH binding to blood and tissue proteins is suggested as a possible explanation for the dose dependency of the total clearance of boron from the body and the accumulation of BSH in organs and tissues.