Clinical and immunological features of COVID-19 in patients with anti-MDA5 dermatomyositis during the omicron wave in Chongqing, China

Patients with anti-melanoma differentiation-associated gene 5 (anti-MDA5) dermatomyositis (DM) have a higher risk of coronavirus disease 2019 (COVID-19) infection. In this longitudinal observational study, we aimed to investigate the clinical and immunological features of these patients after COVID-19 infection. A total of 73 patients with anti-MDA5 DM were recruited from the Second Affiliated Hospital of Chongqing Medical University during the Omicron wave epidemic. Clinical data were collected by questionnaire survey and electronic medical records. Blood samples were used to determine the immunity responses. From December 9, 2022 to March 31, 2023, 67 patients were eligible for final analysis; 68.7% of them were infected with COVID-19. The most common symptoms observed in COVID-19 were upper respiratory symptoms, most cases were mild or moderate (97.8%). The clinical laboratory indexes were relativity stable in patients after infection (all p > 0.05). Vaccination is not a protective factor against the Omicron infection (odds ratio: 2.69, 95% confidence interval: 0.81-8.93, p = 0.105). Both wildtype (WT) neutralizing antibodies titer and BA.5-specific immunoglobulin G titer were significantly enhanced after infection (all p < 0.01), which was as high as healthy controls (HCs). The memory B-cell responses were similar between the patients with anti-MDA5 DM and HCs (p > 0.05). However, both the WT-specific CD8+ T cells and CD4+ T cells were reduced in patients with anti-MDA5 DM (all p < 0.05). In conclusion, patients with anti-MDA5 DM did not deteriorate the COVID-19, in turn, COVID-19 infection did not increase the risk of anti-MDA5 DM exacerbation. The humoral responses were robust but the cellular responses were weakened after COVID-19 infection.

Population Older than 69 Had Similar Fatality Rates Independently If They Were Admitted in Nursing Homes or Lived in the Community: A Retrospective Observational Study during COVID-19 First Wave

The aim of this study is to assess the influence of living in nursing homes on COVID-19-related mortality, and to calculate the real specific mortality rate caused by COVID-19 among people older than 20 years of age in the Balaguer Primary Care Centre Health Area during the first wave of the pandemic. We conducted an observational study based on a database generated between March and May 2020, analysing COVID-19-related mortality as a dependent variable, and including different independent variables, such as living in a nursing home or in the community (outside nursing homes), age, sex, symptoms, pre-existing conditions, and hospital admission. To evaluate the associations between the independent variables and mortality, we calculated the absolute and relative frequencies, and performed a chi-square test. To avoid the impact of the age variable on mortality and to assess the influence of the "living in a nursing home" variable, we established comparisons between infected population groups over 69 years of age (in nursing homes and outside nursing homes). Living in a nursing home was associated with a higher incidence of COVID-19 infection, but not with higher mortality in patients over 69 years of age (p = 0.614). The real specific mortality rate caused by COVID-19 was 2.27⁰/₀₀. In the study of the entire sample, all the comorbidities studied were associated with higher mortality; however, the comorbidities were not associated with higher mortality in the infected nursing home patients group, nor in the infected community patients over 69 years of age group (except for neoplasm history in this last group). Finally, hospital admission was not associated with lower mortality in nursing home patients, nor in community patients over 69 years of age.

Influence of the COVID-19 pandemic on labor and childbirth care practices in Brazil: a cross-sectional study

BACKGROUND

It has been hypothesized that the coronavirus disease 2019 (COVID-19) pandemic may have changed the conduct of obstetric practices at the time of labor, delivery, and birth. In Brazil, many practices lacking scientific evidence are implemented in this care, which is charcaterized by excessive use of unnecessary interventions. This scenario may have been worsened by the pandemic. Thus, we analyzed the effects of the pandemic on care during prenatal care and delivery by comparing the results of two surveys (one was administered before the pandemic and the other during the pandemic) in public hospitals in Belo Horizonte - Minas Gerais (MG), Brazil.

METHODS

This cross-sectional and comparative study analyzed preliminary data from the study "Childbirth and breastfeeding in children of mothers infected with SARS-CoV-2", which was conducted in three referral maternity hospitals in Belo Horizonte - MG during the pandemic in the first half of 2020 in Brazil. The final sample consisted of 1532 eligible women. These results were compared with data from 390 puerperae who gave birth in the three public hospitals in the study "Birth in Belo Horizonte: labor and birth survey", conducted before the pandemic to investigate the changes in practices of labor and delivery care for the mother and her newborn, with or without COVID-19 infection, before and during the pandemic. In this research, "Birth in Belo Horizonte: labor and birth survey", data collection was performed between November 2011 and March 2013 by previously trained nurses. Between study comparisons were performed using Pearson's chi-square test, with a confidence level of 95%, and using Stata statistical program.

RESULTS

We found a significant increase in practices recommended by the World Health Organization during the pandemic including the following: diet offering (48.90 to 98.65%), non-pharmacological pain relief (43.84 to 67.57%), and breastfeeding in the newborn´s first hour of life (60.31 to 77.98%) (p < 0.001). We found a significant reduction of non-recommended interventions, such as routine use of episiotomy (15.73 to 2.09%), the Kristeller maneuver (16.55 to 0.94%), oxytocin infusion misused (45.55 to 28.07%), amniotomy (30.81 to 15.08%), and lithotomy position during labor (71.23 to 6.54%) (p < 0.001).

CONCLUSION

Our study revealed a statistically significant increase in the proportion of use of recommended practices and a reduction in non-recommended practices during labor and delivery. However, despite advances in the establishment of World Health Organization recommended practices in labor, delivery, and birth, the predominance of interventionist and medicalized practices persists, which is worsened by events, such as the pandemic.

Predicting the response to methylprednisolone pulses in patients with SARS-COV-2 infection

INTRODUCTION

Treating systemic inflammation caused by SARS-COV 2 (COVID-19) has become a challenge for the clinician. Corticosteroids have been the turning point in the treatment of this disease. Preliminary data from Recovery clinical trial raises hope by showing that treatment with dexamethasone at doses of 6 mg/day shows a reduction on morbidity in patients requiring added oxygen therapy. However, both the start day or what kind of corticosteroid, are still questions to be clarified. Since the pandemic beginning, we have observed large differences in the type of corticosteroid, dose and initiation of treatment.Our objective is to assess the predictive capacity of the characteristics of patients treated with methylprednisolone pulses to predict hospital discharge.

MATERIALS AND METHODS

We presented a one-center observational study of a retrospective cohort. We included all patients admitted between 03/06/2020 and 05/15/2020 because of COVID-19. We have a total number of 1469 patients, of whom 322 received pulses of methylprednisolone. Previous analytical, radiographic, previous disease data were analyzed on these patients. The univariant analysis was performed using Chi-squared and the T test of Student according to the qualitative or quantitative nature of the variables respectively. For multivariate analysis, we have used binary logistic regression and ROC curves.

RESULTS

The analysis resulted statistically significant in dyspnea, high blood pressure, dyslipidemia, stroke, ischemic heart disease, cognitive impairment, solid tumor, C-reactive protein (CRP), lymphopenia and d-dimer within 5 days of admission. Radiological progression and FIO₂ input are factors that are associated with a worst prognosis in COVID-19 that receive pulses of methylprednisolone. Multivariate analysis shows that age, dyspnea and C-reactive protein are markers of hospital discharge with an area below the curve of 0.816.

CONCLUSIONS

In patients with methylprednisolone pulses, the capacity of the predictive model for hospital discharge including variables collected at 5 days was (area under the curve) 0.816.

Predicting the response to methylprednisolone pulses in patients with SARS-COV-2 infection

INTRODUCTION

Treating systemic inflammation caused by SARS-COV 2 (COVID-19) has become a challenge for the clinician. Corticosteroids have been the turning point in the treatment of this disease. Preliminary data from Recovery clinical trial raises hope by showing that treatment with dexamethasone at doses of 6mg/day shows a reduction on morbidity in patients requiring added oxygen therapy. However, both the start day or what kind of corticosteroid, are still questions to be clarified. Since the pandemic beginning, we have observed large differences in the type of corticosteroid, dose and initiation of treatment. Our objective is to assess the predictive capacity of the characteristics of patients treated with methylprednisolone pulses to predict hospital discharge.

MATERIALS AND METHODS

We presented a one-center observational study of a retrospective cohort. We included all patients admitted between 03/06/2020 and 05/15/2020 because of COVID-19. We have a total number of 1469 patients, of whom 322 received pulses of methylprednisolone. Previous analytical, radiographic, previous disease data were analyzed on these patients. The univariant analysis was performed using Chi-squared and the T test of Student according to the qualitative or quantitative nature of the variables respectively. For multivariate analysis, we have used binary logistic regression and ROC curves.

RESULTS

The analysis resulted statistically significant in dyspnea, high blood pressure, dyslipidemia, stroke, ischemic heart disease, cognitive impairment, solid tumor, C-reactive protein (CRP), lymphopenia and d-dimer within 5 days of admission. Radiological progression and FIO₂ input are factors that are associated with a worst prognosis in COVID-19 that receive pulses of methylprednisolone. Multivariate analysis shows that age, dyspnea and C-reactive protein are markers of hospital discharge with an area below the curve of 0.816.

CONCLUSIONS

In patients with methylprednisolone pulses, the capacity of the predictive model for hospital discharge including variables collected at 5 days was (area under the curve) 0.816.

Persistent Symptoms among Frontline Health Workers Post-Acute COVID-19 Infection

Growing evidence shows that a significant number of patients with COVID-19 experience persistent symptoms, also known as long COVID-19. We sought to identify persistent symptoms of COVID-19 in frontline workers at Right to Care South Africa, who are past the acute phase of illness, using a cross-sectional survey. We analysed data from 207 eligible COVID-19 positive frontline workers who participated in a two-month post-COVID-19 online self-administered survey. The survey response rate was 30%; of the 62 respondents with a median age of 33.5 years (IQR= 30–44 years), 47 (76%) were females. The majority (n = 55; 88.7%) self-isolated and 7 (11.3%) were admitted to hospital at the time of diagnosis. The most common comorbid condition reported was hypertension, particularly among workers aged 45–55 years. The most reported persistent symptoms were characterised by fatigue, anxiety, difficulty sleeping, chest pain, muscle pain, and brain fog. Long COVID-19 is a serious phenomenon, of which much is still unknown, including its causes, how common it is especially in non-hospitalised healthcare workers, and how to treat it. Given the rise in COVID-19 cases, the prevalence of long COVID-19 is likely to be substantial; thus, the need for rehabilitation programs targeted at each persistent COVID-19 symptom is critical.

Surveillance for Pressure Injuries on Admission to Inpatient Rehabilitation Hospitals During the COVID-19 Pandemic

Objective

To determine if the incidence of pressure injuries (PIs) on admission to an inpatient rehabilitation hospital (IRH) system of care was increased during the early coronavirus disease 2019 (COVID-19) pandemic period.

Design

Retrospective survey chart review of consecutive cohorts. Admissions to 4 acute IRHs within 1 system of care over the first consecutive 6-week period of admitting patients positive for COVID-19 during the initial peak of the COVID-19 pandemic, April 1-May 9, 2020. A comparison was made with the pre–COVID-19 period, January 1-February 19, 2020.

Setting

Four acute IRHs with admissions on a referral basis from acute care hospitals.

Participants

A consecutive sample (N=1125) of pre–COVID-19 admissions (n=768) and COVID-19 period admissions (n=357), including persons who were COVID-19–positive (n=161) and COVID-19–negative (n=196).

Main Outcome Measures

Incidence of PIs on admission to IRH.

Results

Prevalence of PIs on admission during the COVID-19 pandemic was increased when compared with the pre–COVID-19 period by 14.9% (P<.001). There was no difference in the prevalence of PIs in the COVID-19 period between patients who were COVID-19–positive and COVID-19–negative (35.4% vs 35.7%). The severity of PIs, measured by the wound stage of the most severe PI the patient presented with, worsened during the COVID-19 period compared with pre–COVID-19 (χ² 32.04%, P<.001). The length of stay in the acute care hospital before transfer to the IRH during COVID-19 was greater than pre–COVID-19 by 10.9% (P<.001).

Conclusions

During the early part of the COVID-19 pandemic time frame, there was an increase in the prevalence and severity of PIs noted on admission to our IRHs. This may represent the significant burden placed on the health care system by the pandemic, affecting all patients regardless of COVID-19 status. This information is important to help all facilities remain vigilant to prevent PIs as the pandemic continues and potential future pandemics that place strain on medical resources.

The Effect of COVID-19 Pandemic on the Lifestyle Behaviors of Individuals

The study was planned and administered as a descriptive study to determine how COVID-19 pandemic affected the lifestyle behaviors of individuals. The study was administered from 30 June to 30 September by including 615 adult individuals who had been exposed to the COVID-19 pandemic. Of the healthy lifestyle behaviors scale II, the total mean score was found to be 126.37 ± 18.58. The health responsibility (p = .032) and nutrition (p = .004) subscale mean scores of women were found to be significantly higher than men, while the spiritual development subscale mean scores of men (p = .047) were found to be significantly higher than that of women. It was found in this study that individuals did not regularly maintain healthy lifestyle behaviors in general during the pandemic period according to the subscales of health responsibility, physical activity, nutrition, spiritual development, interpersonal relationships, and stress management.

The clinical impact of the COVID-19 pandemic on daily urological practice: first 3-month multicenter results from İstanbul

BACKGROUND/AIM

The aim of this paper was to determine the general tendencies of urology patients and effect of COVID-19 pandemic on daily urological practice at tertiary centers located in the most affected area in Turkey.

MATERIALS AND METHODS

We retrospectively analyzed the data of 39,677 patients (group 1) that applied to 6 different large-volume tertiary centers in İstanbul for outpatient consultation, surgery, or other procedures in the 3-month period between March 16 and June 14, 2020. The distribution of the number of patients who applied to subspecialty sections of urology outpatient clinics and inpatient services were recorded by weeks. That data was compared to data obtained from 145,247 patients that applied to the same centers in the same period of the previous year (group 2). The reflection of worldwide and Turkish COVID-19 case distribution on the daily urological practice was analyzed.

RESULTS

There was a decrease in the number of patients in all subspecialty sections the in group 1 compared to group 2; however, there was a significant proportional increase in urooncology and general urology admissions. A decrease of approximately 75% was observed in the total number of surgeries (p < 0.001). We detected a negative correlation between the numbers of admission to all outpatient clinics and COVID-19 cases or deaths in Turkey (p < 0.05). The same negative correlation was present for all surgical procedures and consultations (p < 0.05). The multivariate linear regression analysis revealed that the number of cases in Turkey, and the number of deaths worldwide affect the number of outpatient clinic admissions (R2 = 0.38, p = 0.028) and urological surgery (R2 = 0.33, p = 0.020) in Turkey negatively.

CONCLUSION

This novel pandemic has implications even for urology practice. Urological surgical procedures were more affected by COVID-19-related deaths in Turkey and worldwide. Outpatient admissions and urological surgeries decreased significantly by increasing COVID-19 case numbers in Turkey and worldwide deaths.

Acute pancreatitis in children hospitalized with COVID-19

BACKGROUND

Limited data exists on the association or prevalence of pancreatitis in children with COVID-19.

METHODS

This is a retrospective study of pediatric patients admitted to a large health system in New York (Northwell Health System) from March 1, 2020-June 1, 2020 during the COVID-19 pandemic.

RESULTS

8159 pediatric patients were admitted to our healthcare system during the study period, of which 112 were diagnosed with COVID-19 (1.37%). Thirteen were diagnosed with pancreatitis for a point prevalence of 0.16% (13/8159) for all patients admitted. Of the thirteen patients admitted with pancreatitis, two patients were COVID-19 positive for a point prevalence of 1.8% (2/112) among COVID-19 patients compared to 0.14% (11/8047) in the non-COVID-19 population.

CONCLUSIONS

This study shows that pancreatitis can occur in pediatric patients with COVID-19 and may be more common in the COVID-19 population.

Prolongation of QT interval due to hydroxychloroquine overdose used in COVID-19 treatment

Hydroxychloroquine is one of the most commonly used drugs in COVID-19 treatment. In this case report, we aimed to present a young patient whose QT interval was prolonged due to hydroxychloroquine overdose which was given for COVID-19 treatment. This is the first reported case of QT interval prolongation at a low dose of 1.600 mg in the literature. A 28-year-old male patient was admitted to the emergency department with the complaints of nausea, diarrhea, and weakness. The patient was diagnosed with COVID-19 a day prior and home isolation was recommended with hydroxychloroquine and oseltamivir P. O. treatment. His complaints started 6 h after accidentally taking 1.600 mg of hydroxychloroquine P. O. at the same time. On physical examination, the Glasgow Coma Scale was 15, and neurological, respiratory, and abdominal examinations were normal. His pulse was 54 beats/min, oxygen saturation was 99%, arterial blood pressure was 122/82 mmHg, and fever was 36.5°C. Electrocardiography (ECG) showed sinus bradycardia and corrected QT interval was calculated as 510 ms. The QT interval prolongation and bradycardia persisted, and the patient was hospitalized for follow-up and treatment. He was discharged on the 3rd day of his hospitalization after the corrected QT interval was detected to be 420 ms and his bradycardia improved. Due to the potential cardiac side effects, patients who are sent to home isolation with treatment should be educated about the use, dosage, and possible side effects of this medicine, and serial ECG monitoring should be provided to patients who are hospitalized.