DOP40 Comorbidities and epidemiological risk factor but not immunosuppressive therapies increase the risk of COVID-19 in Inflammatory Bowel Disease (IBD): An ENEIDA-based, case-control study

Background The information regarding IBD patients with COVID-19 suggests that the factors related to bad outcome are older age and comorbidity whereas immunosuppressants do not have a significant impact worsening the disease evolution. To date, there is no information to assess if there are differences in epidemiological, demographical, and clinical characteristics between infected and non-infected IBD patients. Methods Case-control study in IBD patients with COVID-19 (cases) compared to IBD without COVID-19 (controls) in the period March-July/2020 within the ENEIDA registry (promoted by GETECCU and with more than 60.000 IBD patients included). Cases were matched 1:2 by age (±5y), type of disease (CD/UC), gender, and centre. All controls were selected from only one investigator blind to other clinical characteristics of the patients to avoid selection bias. Results 496 cases and 964 controls from 63 Spanish centres were included. No differences were found within the basal characteristics including CD location, CD behaviour, extraintestinal manifestations, family history of IBD or smoking habits. Cases had ≥ 1 comorbidities (cases:43%vs. controls:36%, p=0.01) and occupational risk (cases:27% vs. controls:10.6%, p<0.0001) in a higher proportion. Strict lockdown but not sick leave nor telecommuting was the only measure demonstrating protection against COVID-19 (cases:49% vs. controls:70%, p<0.0001). There were no differences in the use of systemic steroids (p=0.19), immunosuppressants (p=0.54) or biologics (p=0.25) between cases and controls. Cases were more often treated with aminosalicylates (45% vs.34%, p=0.022). Having ≥ 1 comorbidities (OR:1.4, 95%CI: 1–1.8), occupational risk (OR:2.05, 95%CI:1.5–2.9) and the use of aminosalicylates (OR:1.4, 95%CI: 1–1.8) were risk factors for COVID-19. On the other hand, the strict lockdown was a protective factor (OR:0.36, CI:0.27–0.48). Conclusion Comorbidities and epidemiological risk factors are the most relevant aspects for the risk of COVID-19 in IBD patients. This risk of COVID-19 seems to be increased by aminosalicylates but not by immunosuppressants or biologics. The attitude regarding treating IBD patients with aminosalicylates during the COVID-19 pandemic deserves a deeper analysis. Funded by the Carlos III Health Institute COV20/00227.

Differences in glycemic control between the treatment arms in cardiovascular outcome trials of type 2 diabetes medications do not explain cardiovascular benefits

Hyperglycemia is an undisputed epidemiological risk factor for microvascular complications in both type 1 and type 2 diabetes, integral in their causal pathways. Importantly, interventions that reduce the hyperglycemic burden in patients with either type of diabetes reduce the risk of microvascular complications (e.g., retinopathy, nephropathy, neuropathy). Hence, for microvascular risk, hyperglycemia is a proven risk factor and a proven treatment target, as reflected by treatment recommendations and guidelines across most scientific societies world-wide. However, although reducing the hyperglycemic burden to reduce microvascular risk remains a cornerstone of care for patients with type 2 diabetes, this therapeutic imperative does not apply to cardiovascular risk mitigation. This latter aspect is important in the context of interpreting therapeutic impact of treating hyperglycemia on risk for macrovascular complications in patients with type 2 diabetes. This letter, in response to a previous paper, discuss how modest differential glucose control contribute little if anything to the results observed of contemporary cardiovascular outcome trials in type 2 diabetes.

COVID-19 in children: A single center experience from Istanbul, Turkey

Objective: We aimed to evaluate the demographic, epidemiological, and clinical characteristics of children with coronavirus disease‐2019 (COVID-19), and to determine variations of the clinical presentation of the disease by age. Method: A total of 104 confirmed COVID-19 patients aged between 0-18 years were retrospectively analyzed. The study period was between March 15, 2020 and July 1, 2020. A confirmed COVID-19 was defined as a child who has positive real-time reverse transcription-polymerase chain reaction (rRT-PCR). The patients were analyzed in terms of demographic, epidemiological, clinical, laboratory and imaging features, and clinical outcomes. Results: The median age (inter-quartile range) of the patients was 11.8 (8.4) years, and 53 (51%) were male. Ninety-eight (94%) of the patients had an epidemiological risk factor. The most frequent symptoms were cough (62%), fever (42%), and fatigue (33%). Seven patients (7%) were asymptomatic, 84 (81%) were mild, 9 (9%) were moderate, and 4 (4%) were in severe or critical condition. Ninety-eight (94%) of the patients underwent a chest x-ray, and 12% had pneumonia. The patients younger than 5 years were more likely to have fever (p = 0.019), rhinorrhea (p = 0.041), and diarrhea (p = 0.035). Muscle/join pain (26%), loss of smell/taste (20%), and headache (19%) were striking extra-pulmonary symptoms in older patients. Only 8% of the patients were hospitalized, and 4% were admitted to the intensive care unit. No death occurred. Conclusion: The most of the pediatric COVID-19 cases have mild symptoms without pneumonia. They may not present with fever or cough which are considered characteristic symptoms of the disease and the frequency of signs and symptoms may vary by age. Children younger than 5 years old are more likely to have fever, rhinorrhea, and diarrhea. School-age children and adolescents may present with extra-pulmonary symptoms such as muscle/join pain, smell/taste loss, and headache.

Evaluating the Ecology and Distribution of Snail Hosts of Schistosoma at the Water Bodies in Ihitte-Uboma Area of Imo State

Intermediate snail host of Schistosoma species are known to exist and constitute public health problems in Imo state. Effects on this study were devoted to evaluate the ecology and distribution of the snail hosts of Schistosoma species at the water bodies of Ihitte Uboma local Government area and this was researched during the months of June and September, 2015. A total of 600 pulmonate or lunged snails were collected using scoop net technique from different water bodies in five villages, out of these, 345 (57.5%) were dissected and screened for cercariae of human Schistosomes 67 (19.4%) tested positive. The snail infected were Bulinus species 55 (82.1%) and Biomphalaria Pfeifferi (17.9%), out of the Bulinus species, Bulinus globosus recorded the widest ecological range, highest distribution and infection rate of 44.8% followed by Bulinus truncatus (22.4%). The other two genera Lymnaea spp and Melanoides spp encountered in the study did not test positive for cercariae. Environmental modifications such as water resources development schemes in the area are some of the ecological and epidemiological risk factor promoting the spread of the snails. Statistically, presence of urinary and intestinal Schistosomiasis becomes indicated in Ihitte Uboma L.G.A. Regular and timing mollusciciding, malacological and public health education are therefore recommended and imperative.

First Serological and Molecular Detection of Leptospira interrogans serovar canicola Bacteria in Dogs in Some Iraqi Governorates

The aim of present study was to serodetect of canine leptospirosis by using of indirect ELISA, and identification of Leptospira interrogans serovar canicola in serpositive dogs by application of PCR technique. For this purpose, 218 dogs from urban and rural regions related to three governorates were submitted for blood samples collection. The total results were revealed on 37/218 (16.97%) and 5/37 (13.51%) infected positive dogs by an indirect ELISA and PCR techniques, respectively. According to subjected study’s governorates, the positive results of indirect ELISA in Baghdad, Al-Qadisiyah and Dhi-Qar were 23/108 (21.3%), 10/79 (12.66%), and 4/31 (12.9%), respectively; while by PCR assay, the positive results {5/23 (21.74%)} had been detected in Baghdad only. Also, the relationship of positive dogs with some epidemiological risk factors has been discussed in this study. In association to inhabitant type, the rural and urban regions, respectively, were having 16/82 (19.51%) and 21/136 (15.44%) positive dogs by indirect ELISA; whereas, they have 4/16 (25%) and 1/21 (4.76%) positive dogs by PCR, respectively. In regarding to sex factor, the positive infected males and females, respectively, were amounted 13/67 (19.4%) and 24/151 (15.89%) by indirect ELISA; and 2/13 (15.38%) and 3/24 (12.5%) by PCR. In relation to age factor, >2years and £2 years groups have taken 36/149 (24.16%) and 1/69 (1.45%) positive dogs by indirect ELISA and 5/36 (13.89%) positive dogs for >2years group, only, by PCR assay. Statistically, the positive results were reported significant differences at level of P£0.05 between the study’s regions and between the groups related to each epidemiological risk factor.

OBJECTIVE COGNITIVE IMPAIRMENT AND PROGRESSION TO DEMENTIA IN WOMEN: THE PROSPECTIVE EPIDEMIOLOGICAL RISK FACTOR STUDY

Background: Identification of subjects with a progressive disease phenotype is an urgent need in the pharmaceutical industry where most of the recent clinical trials in Alzheimer’s disease have failed. Objectives: The objective of this study was to identify subgroups of individuals with objective cognitive impairment (OCI), who were most likely to progress to dementia and to identify the risk factors associated with progression. Design: Prospective cohort study. Setting: Population-based. Participants: 5,380 elderly women from Denmark. Measurements: The Short Blessed Test and a category fluency test with animal naming, was used to assess cognitive function, and to classify them into different groups of OCI. Results: OCI was identified in 852 subjects at baseline. The risk of dementia was elevated for OCI subjects as compared to subjects with normal cognition (HR 1.46[1.19-1.79]). The courses of OCI were studied in a sub-cohort who completed the cognitive assessment at both the baseline and the follow-up visit (n = 1,933). Of these subjects 203 had OCI at baseline. The multi-domain subtypes of OCI were associated with progressive OCI. Subjects most likely to progress were older, physically inactive, had a higher level of total cholesterol (>6.5 mmol/L) and had a history of depression as compared to subjects with a non-progressive course of OCI. Conclusions: In this cohort we identified a risk profile associated with progression from OCI in older women. The degree of impairment at baseline was an important predictor of conversion to dementia, additionally several modifiable risk factors were associated with progression.

Seroprevalence against Rickettsia and Borrelia Species in Patients with Uveitis: A Prospective Survey

Vector-borne diseases such as Lyme borreliosis and rickettsioses have been associated with ocular inflammation. Our aim was to study patients with diagnosed uveitis to evaluate serological signs of infection or exposure to these tick-borne agents. Forty-eight patients were prospectively examined with serology together with medical records and a questionnaire concerning previous exposure, diseases, and treatments. Seven patients (14.6%) showed seroconversion to Rickettsia spp. between acute and convalescent phase sera, which provides support for a positive Rickettsia diagnosis according to guidelines. The specificity was confirmed by Western blot. Additional 28 patients had stationary titres of which eight (16.6%) had 1 : 256 or higher titre in the first serum, and another 13 patients were seronegative. No epidemiological risk factor or marker could be identified. For Borrelia, only three patients showed moderate IgG titres. A control group of 100 blood donors, 60 patients with rheumatic disease, and 56 patients seeking medical care were tested of which 2.0–7.1% showed low anti-Rickettsia titres and 3.0–8.3% anti-Borrelia titres. The findings are indicative for an association between infection or exposure to Rickettsia spp. and uveitis with a seropositivity among patients with recurrent uveitis in concordance with the spread of rickettsial exposure in a tick-exposed population.