The peculiarities of patients with COVID-19 infection

Background: The surge demand and decreased availability of the health workers determined the designation of the Clinical Municipal Hospital of Phthisiopneumology (CMHP) into a hospital for the case-management of COVID-19 patients during the period of December 2020 – April 2021 for the treatment of the mild cases. The aim of the study was to assess the main peculiarities of the patients with COVID-19 through a cross-sectional study developed during the period February-April 2021 in the CMHP. Material and methods: A cross-sectional, analytical and prospective study was realized, which included 145 patients with COVID-19 hospitalized in the CMHP during February-April 2021. The inclusion criteria were: patient older 18 years, COVID-19 infection diagnosed by the pulmonologist with the positive polymerase chain reaction result for SARS-CoV-2 (COVID-19) and signed informed consent. Results: The peculiarities of patients with COVID-19 were dominated by the female sex, age over 60 years, residence in the urban districts of Chisinau and the infection acquired in the Republic of Moldova. Common clinical manifestations were: high temperature, profuse sweats, asthenia and headaches, productive cough, dyspnea, loss of smell or taste, and sore throat. The typical radiological findings such ground-glass pattern or consolidation with bilateral multifocal involvement were most frequent. Were cured most of the patients and the death rate was low. Conclusions: Peculiarities and clinical manifestations of the patients admitted in CMHP were typical for the COVID-19 infection. These findings did not show the real outcome of the standard case-management of the COVID-19 due to the restricted admission criteria.

Risk factors of deforming osteoarthritis in the family doctor practice

Osteoarthritis (OA) is the most common bone and joint pathology, affecting, according to the American College of Rheumatology ACR (2019), about 302 million people worldwide and is the leading cause of disability in the elderly.Objective. To investigate the role of additional risk factors in patients with OA in the practice of family physicians for secondary prevention.Material and methods. A retrospective analysis of 50 outpatient records and electronic medical records (EMC) of patients with OA for 2019-2020 was performed: 30 women, 20 men; aged 35-75 years. Concomitant risk factors were studied by epidemiological analysis: obesity / overweight, burdensome family history, traumatic factor, occupational exposure.Results. The respiratory and circulatory systems diseases dominate in the structure of the primary morbidity of the Northern Bukovina inhabitants in 2020. The incidence of bone and joint is 4.04% in the general structure, which does not differ significantly from the European average. The structure of the primary morbidity of the bone and joint sphere is dominated by arthrosis and deforming OA (DOA). The injuries and occupational factors dominated in structure of DOA risk factors at the age under 50, but after 50 years – obesity and burdened heredity prevailed, with a significant impact of the occupational factor. Absence of injuries in the anamnesis and occupational factors reduce the risk of DOA 8 and 3.5 times, respectively (p<0.05). Age over 60 years increases the relative risk of DOA 2.5 times as much (p=0.013), especially in women to almost 4 times.Conclusions. Additional risk factors should be considered in patients with DOA for secondary prevention.

Triple Post-Transplant Cyclophosphamide (PTCY) Based Gvhd Prophylaxis for HLA Matched or HLA Haploidentical Transplants

We report a retrospective analysis of 198 consecutive allogeneic stem cell transplant (HSCT) recipients, who received post transplant cyclophosphamide (PTCY), cyclosporine and mycophenolate mofetile as g raft-versus-host-disease (GVHD) prophylaxis. The donor was either HLA matched (n=78) (siblings -32- or unrelated -46) , or a haploidentical relative (HAPLO) (n=120). End points of the study were acute and chronic GVHD, transplant related mortality (TRM), relapse, disease free survival (DFS) and graft versus host and relapse free survival (GRFS). The two groups were comparable except for an older age (49 vs 56 years) in the haplo-HLA group. The diagnosis was mainly acute leukemia (57%), myelofibrosis (21%) or lymphoma (12%). Conditioning was myeloablative in 77% and 73% respectively (p=0.57). Acute GVHD grade II-IV developed in 10% of the HLA matched transplants vs 27% in the HAPLO group (p=0.005). The latter also had more moderate-to-severe cGVHD (4% vs 23%, p&lt;0.001). The cumulative incidence of transplant related mortality (TRM) at 1 year for the HLA matched vs HAPLO patients, was 10% vs 21% (p=0.04) (Fig.1) , with age over 60 years being the major negative predictor in multivariate analysis. Relapse at 1 year was 24% for HLA matched vs 10% for HAPLO transplants (p=0.051) (Fig.1). Disease free survival (DFS) at 1 year was 65% and 68% in matched and HAPLO patients, respectively (p=0.85) (Fig.1) and GRFS 55% vs 49% (p=0.18). In multivariate analysis, age over 60 years was the strongest predictor of DFS and GRFS (HR 1.73, p=0.03 and HR 1,65, p= 0.02). In conclusion: when using the same triple PTCY based GVHD prophylaxis, HLA matched grafts are associated with significantly less acute and chronic GvHD, if compared with HAPLO grafts. There is a trend for reduced TRM at 1 year, especially in chronic myelo-lymphoproliferative disorders, and a trend for increased relapse, resulting in identical disease free survival. Figure 1 Figure 1. Disclosures Laurenti: Gilead: Honoraria; Roche: Honoraria, Research Funding; AstraZeneca: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria; BeiGene: Honoraria. Sica: Pfizer: Honoraria.

Factors predicting readmission in patients with COVID-19

Objective COVID-19 has been introduced by the World Health Organization as a health emergency worldwide. Up to 9% of the patients with COVID-19 may be readmitted by 2 months after discharge. This study aimed to estimate the readmission rate and identify main risk factors for readmission in these patients. In this prospective study, 416 discharged COVID patients followed up with a minimum 1 month and the readmission rate was recorded. Evaluated characteristics included time of readmission, age and sex, main symptoms of disease, result of computed tomography scan, reverse transcription polymerase chain reaction test and treatment modalities. Results Regarding readmission, 51 patients of 416 discharged patients, was readmitted during the study period. The rate of readmission for 30 and 60 days after discharge was 7.6% and 8.1%, respectively. The median age of the readmitted patients was 67 years (IQR: 53–78). About 65% of readmitted patients had underlying disease. The most significant factor in readmission rate was related to the site of lung involvement (OR > 4). Age over 60 years, underlying disease especially diabetes (OR = 3.43), high creatinine level (≥ to 1.2 mg/dl) (OR = 2.15) were the most important predictors of readmission.

Factors related to adherence to pharmacological treatment of people with type 2 Diabetes Mellitus

Adherence is a key factor for the treatment of chronic conditions, especially if different drug administration routes are needed. This study aimed to analyze factors associated with adherence to pharmacological treatment in patients with type 2 diabetes. A cross-sectional study was carried out with 173 patients with type 2 diabetes, using a questionnaire with sociodemographic and clinical variables and the Morisky-Green Scale. Multivariate statistics were used. The results show that the female gender (69.4%), elderly (59.5%), low education (62.4%), and ten years or more years of diagnosis (67.1%) predominated in the sample. People over 60 years old were more likely to adhere to treatment than young adults (OR: 2.57). Those who performed physical activities were more likely to accept treatment than sedentary subjects (OR: 2.04). In conclusion, the study shows a significant association between adherence to pharmacological treatment and the variables age over 60 and physical activity practice.

Characteristics and Clinical Outcomes of 116,539 Patients Hospitalized with COVID-19—Poland, March–December 2020

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes Coronavirus Disease 2019 (COVID-19). This study aimed to characterize patients hospitalized with COVID-19 in Poland between March and December 2020, as well as to identify factors associated with COVID 19–related risk of in-hospital death. This retrospective analysis was based on data from the hospital discharge reports on COVID-19 patients hospitalized in Poland between March and December 2020. A total of 116,539 discharge reports on patients hospitalized with COVID-19 were analyzed. Among patients with COVID-19, 21,490 (18.4%) died during hospitalization. Patients over 60 years of age (OR = 7.74; 95%CI: 7.37–8.12; p < 0.001), men (OR = 1.42; 95%CI: 1.38–1.47; p < 0.001) as well as those with cardiovascular diseases (OR = 1.51; 95%CI: 1.46–1.56; p < 0.001) or disease of the genitourinary system (OR = 1.39; 95%CI: 1.31–1.47; p < 0.001) had much higher odds of COVID 19–related risk of in-hospital death. The presence of at least one comorbidity more than doubled the COVID 19–related risk of in-hospital death (OR = 2.23; 95%CI: 2.14–2.32; p < 0.01). The following predictors of admission to ICU were found in multivariable analysis: age over 60 years (OR: 2.03; 95%CI: 1.90–2.16), male sex (OR: 1.79; 95%CI: 1.69–1.89), presence of at least one cardiovascular disease (OR: 1.26; 95%CI: 1.19–1.34), presence of at least one endocrine, nutritional and metabolic disease (OR: 1.17; 95%CI: 1.07–1.28).

Asymptomatic morphometric vertebral fractures and its associated factors: A cross-sectional study among adults in a selected urban area in Selangor, Malaysia

Objective This study aimed to determine the prevalence of vertebral fractures (VF) in a selected urban population in Malaysia and to explore possible variables associated with VF in the study population. Methods A cross-sectional study involving community-living, healthy subjects aged between 45–90 years from the state of Selangor, Malaysia, were invited to attend a bone health check-up. Subjects with diseases known to affect bone metabolism or were on treatment for osteoporosis (OP) were excluded. Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry (DXA). Lateral and antero-posterior view lumbar spine x-rays were performed and VF was determined by the semi-quantitative Genant method. Results A total of 386 subjects were studied. Asymptomatic morphometric VF were found in 44 (11.4%) subjects. T12 was the most common vertebrae to be fractured. The prevalence of VF was significantly higher in menopausal women (12.4%) compared to non-menopausal women, in those above the age of 60 (18.5%), in those of Chinese ethnicity (16.5%), in those with a low body fat percentage (17.1%) and among those with OP (27.0%). The mean (standard deviation) 25-hydroxyvitamin D [25(OH)D] levels were significantly higher in those with VF compared to those without VF, 67.64 (23.50) and 57.47 (21.71) nmol/L, respectively. However, after multiple regression analysis, age over 60 years and OP on DXA BMD measurement were the only significant associated factors for VF. Conclusion Overall, 11.4% of a selected Malaysian urban population had asymptomatic morphometric VF. Age over 60 years and OP on DXA BMD measurement, but not 25(OH)D levels, were associated with VF.

The factors of the outcome of neurosurgical treatment in traumatic brain injury

The purpose of the research: to improve the results of neurosurgical treatment in patients with traumatic brain injury by detecting an optimal way of craniotomy. Material and methods. The study includes the analysis of 127 patients operated on in the Department of Neurosurgery. The examination sample consisted of 109 (85.8%) male and 18 (14.2%) female patients. Patients’ ages varied from 16 to 85 years. The average age of the patients was 43.8 ± 4.2 years. Results. Not depending on craniotomy method, there was not a statistically significant difference in outcome in patients with traumatic brain injury. Using of trephination, craniectomy and osteoplastic craniotomy revealed no significant differences in outcomes in patients with traumatic brain injury. Patients’ age over 60 years, consciousness degree 4-6 scores according to Glasgow Coma Scale, and dislocation syndrome are unfavorable prognostic factors. Resection craniotomy in traumatic brain injury may be effective even in deep coma consciousness level and dislocation syndrome, but in absence of intraoperative brain edema. Conclusion. During the planning of craniotomy method in traumatic brain injury, 4-9 score consciousness degree according to Glasgow Coma Scale, brain contusion foci, acute subdural and intracerebral hematomas, brain compression volume of 30-150 cm³, patient’ age and dislocation syndrome should be considered, which, in total, predicts an outcome.

Predictors of adverse COVID-19 outcomes in patients with oncohematological diseases

Material and methods. We performed a prospective cohort study including 66 patients with oncohematological pathology and confirmed COVID-19 infection who underwent treatment at the SI “Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology” from March to September 2020.Results. The overwhelming majority of patients with hematological pathology and COVID-19 infection were diagnosed with multiple myeloma (MM) — 25 (37.8 %). The highest mortality rate was recorded in patients with multiple myeloma and acute leukemia (21 % and 12 %, respectively). Stage 4–5 chronic kidney disease (p<0.05, Fisher’s exact test; 0.01) is a statistically significant factor of adverse outcomes in patients with oncohematological diseases. The presence of coronary artery disease, diabetes mellitus or other pathology did not affect the outcome. We found no effect of previous polychemotherapy performed within the time of less than a month (HR 1.15; 95 % CI 0.66–2.0) and less than 3 months (HR 0.94 %; 95% CI 0.53–1.65) on the risk of the fatal outcome of the infection in patients with neoplastic diseases of hematopoietic tissue. Age over 60 (HR 1.8; 95 % CI 1.01-3.28) and the stage of progression according to the underlying disease (HR 2.8; 95 % CI 1.9–4.0) were statistically significant factors of the fatal outcome in patients with oncohematological diseases.Conclusion. The presented study has determined the predictors of the fatal outcome in COVID-19 patients with oncohematological diseases: age over 60 and the stage of progression of the underlying disease. At the same time, the highest mortality rate in COVID-19 was recorded in patients with multiple myeloma and acute leukemia (21 % and 12 %, respectively). Among all the analyzed comorbidity factors, stage 4–5 chronic kidney disease had a statistical significance for adverse outcomes.

Costs per DALYs Averted of Quadrivalent Influenza Vaccine versus Trivalent Influenza Vaccine in Elderly Population in Thailand

Objective: Influenza is an infection of the respiratory system with a high annual incident rate. Influenza vaccinecan reduce the severity of influenza and prevent transmission of the virus. Influenza vaccines in Thailand are theTrivalent Influenza Vaccine (TIV) and the Quadrivalent Influenza Vaccine (QIV). The cost and the effectiveness ofthe QIV in preventing transmission of the virus are greater than the TIV. Until now, no studies have been conductedto compare the economic impact of using QIV or TIV. This study aimed to evaluate the economic effects of usingQIV versus TIV in Thai populations age 60 years and over.Materials and Methods: The study was carried out from a societal perspective for cost per DALYs averted. A decisiontree model was used to analyse the costs and DALYs averted of Thais after they received the vaccine.Results: In a period of one year, it was found that in Thais age 60 years and over, the total cost of TIV was 2,445.19baht with 0.0094 DALYs and total cost of the QIV was 2,629.28 baht with 0.0082 DALYs and the incremental costeffectivenessratio (ICER) of the QIV was 158,489.24 baht per DALYs averted. The acceptability curves demonstratedthat the probability of QIV being cost-effective was 95% of the willingness to pay, being 1.2 times the Thai grossnational income per capita.Conclusion: Therefore, in Thai people age over 60 years and over, QIV is more cost-effective than TIV. The resultsof this study can be used by policymakers to help inform their decisions about which influenza vaccine is morecost-effective.