BACKGROUND AND PURPOSE—Immune cells play a key role in the first 24h poststroke (acute phase), being associated with stroke outcome. We aimed to find genetic risk factors associated with leukocyte ...counts during the acute phase of stroke.
METHODS—Ischemic stroke patients with leukocyte counts data during the first 24h were included. Genome-wide association study and gene expression studies were performed.
RESULTS—Our genome-wide association study, which included 2064 (Discovery) and 407 (Replication) patients, revealed a new locus (14q24.3) associated with leukocyte counts. After Joint analysis (n=2471) 5 more polymorphisms reached genome-wide significance (P<5×10). The 14q24.3 locus was associated with acute stroke outcome (rs112809786, P=0.036) and with ACOT1 and PTGR2 gene expression. Previous polymorphisms associated with leukocyte counts in general-population did not show any significance in our study.
CONCLUSIONS—We have found the first locus associated with leukocyte counts in ischemic stroke, also associated with acute outcome. Genetic analysis of acute endophenotypes could be useful to find the genetic factors associated with stroke outcome. Our findings suggested a different modulation of immune cells in stroke compared with healthy conditions.
INTRODUCTIONIn 2014 the Consensus Document produced by the Spanish Paediatric Societies (SEIP-SERPE-SEOP) was published to help in the diagnosis and treatment of osteoarticular infections (OAI). In ...2015 the RIOPed was considered as a multidisciplinary national network for the investigation into OAI. The aim of this study was to assess the level of adaption to the recommendations established in the Consensus during one year of follow-up. MATERIAL AND METHODSA prospective, national multicentre study was carried out in 37 hospitals between September 2015 and September 2016. The study included patients >16years-old with a diagnosis of OAI, confirmed by microbiological isolation, or probable: septic arthritis (SA) with >40,000 white cells in synovial fluid, or osteomyelitis (OM)/spondylodiscitis (SD) with a compatible imaging test. The results were compared with those obtained in a retrospective study conducted between 2008 and 2012. RESULTSA total of 235 cases were included, of which 131 were OM, 79 SA, 30 OA, and 15 SD. As regards the complementary tests that the Consensus considered mandatory to perform, radiography was carried out on 87.8% of the cases, a blood culture on 91.6%, and culture of the synovial fluid in 99% of SA. A magnetic resonance (MR) was performed on 71% of the OM cases. The choice of intravenous empirical antibiotic treatment was adapted to the recommendations in 65.1% of cases, and in 62.3% for the oral treatment. Surgery was performed in 36.8% of SA cases (85.7% arthrotomy), with a significant decrease compared to the retrospective study (P=.014). Only 58.5% of cases followed the recommendations on the duration of the treatment; however, a lower duration of intravenous treatment was observed. CONCLUSIONSIn general, the level of adaptation to the recommendations that were set by the Expert Group, is good for the complementary tests, and acceptable as regards the choice of antibiotic treatment, although inadequate in almost 40% of cases. A decrease in hospital stay was achieved.
ABSTRACT
Background
The coronavirus disease (COVID) pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American ...Vascular Societies have proposed deferring the creation of an elective vascular access (VA) autologous or prosthetic arteriovenous fistula (AVF) or arteriovenous graft (AVG) in incident patients on haemodialysis (HD) in the era of the COVID pandemic. The aim of this study is to examine the impact of the COVID pandemic on VA creation and the central venous catheter (CVC)-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of three different regions.
Methods
We compared retrospectively two periods of time: the pre-COVID (1 January 2019–11 March 2020) and the COVID era (12 March 2020–30 June 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centres. The variables analysed were type of VA (CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD patients, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC HD sessions that did not reach the goal of Kt (>45) as a marker of HD adequacy.
Results
A total of 1791 VAs for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during the COVID period compared with pre-COVID period were significantly younger, with a significant decrease in surgical activity to create AVFs and AVGs in older HD patients (>75 and >85 years of age). There was a significant increase in CVC placement (from 59.7% to 69.5%; P < 0.001) from the pre-COVID to the COVID period. During the COVID pandemic, a significantly higher number of patients started HD through a CVC (80.3% versus 69.1%; P < 0.001). The percentage of CVC in prevalent HD patients has not decreased in the 19 months since the start of the pandemic 414 CVC/1058 prevalent patients (39.4%). No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In the COVID period, a significant increase in catheter replacement and the percentage of HD session that did not reach the HD dose objective (Kt > 45) was observed.
Conclusions
COVID has presented a public health system crisis that has influenced VA for HD, with an increase in CVCs relative to AVFs. A decrease in HD sessions that did not reach the HD dose objective was observed in the COVID period compared with a pre-COVID period.
Graphical Abstract
Graphical Abstract
Introduction
Coronavirus Disease 2019 (COVID19) has shown higher mortality in patients with comorbidities, including cancer. First reports from China, Italy, and US showed mortality comprised between ...20% and 40% in this specific population. However, the number of patients in these studies was limited and the percentage of hematological patients was underrepresented. In our study, we present a prospective evaluation of patients affected by solid and liquid tumors who were affected by COVID19 from the same geographical area and time period. Survival outcomes, prognostic risk factors, and effects of oncological treatments received were analyzed.
Methods
WAll consecutive oncological patients with age > 18 years old affected by COVID19 (confirmed by pharyngeal PCR test) who were hospitalized in 5 tertiary oncological referral centers in the Catalonia region were included in the study. The recruitment period started from 13/03/2020 to 24/04/2020.
Two-hundred thirty-one patients were recruited. Thirty-three percent had hematological malignancies and 67% had solid tumors. The median age was 65 years (range 58-75 years). Female patients were 41%. Twenty-six percent of patients were not considered candidates to intensive care treatments (tracheal intubation) due to their advanced oncological status. Of the hematological cohort, lymphoid malignancies represented 36% of the population, multiple myeloma 20%; acute leukemias 15%; chronic lymphoproliferative diseases 12% and other malignancies 17%. At the time of infection, 11% of patients were receiving steroids (more than 0.5mg/kg/24 hours >15 days), 4% were on active immunosuppressive therapy (calcineurin inhibitors, sirolimus or mycophenolate mofetil) and 5% had grade >3 neutropenia. Most importantly, 61% were on active oncological treatment, 18% were on follow-up, 10% had been diagnosed without having received any treatment.
Results
At COVID19 diagnosis, 75% of patients had a fraction of inspired oxygen (FiO2) < 24% and 63% had fever. Only 16% had cough,16 % had mucous secretion and 12% had dyspnea. All the other symptoms (myalgia, diarrhea, anosmia, ageusia, fatigue, headache) had an incidence < 10%. Chest X-ray was abnormal in 60% of cases. Regarding in-hospital treatments, 85% received antibiotics, 76% hydroxychloroquine, 12% tocilizumab, 30% corticoids, 70% prophylactic anticoagulation and 55% oxygen support.
The median duration of hospitalization was 9.00 days (range 5-16 days).
WThe overall mortality rate was 26% with a non-significant difference between hematological (32%) and oncological (23%) patients (p-value = 0.23, figure 1). A significant difference was observed between patients who were candidates to intensive care treatments (21.5%) and not candidates (42.6%)(p-value = 0.0038, figure 1).
The following risk factors were associated with decreased survival on multivariate analysis: having the oncological disease in progression (HR 3.33, 95%Confidence Interval (CI)= 1.73-6-41, p<0.001); use of steroids (>0.5mg/kg/24 hours) in the last 15 days (HR 3.76; 95%CI=1.69-8.40, p<0.001); age (continuous variable, HR 1.05, 95%CI= 1.01-1-08, p=0.005); grade 4 neutropenia. When considering COVID19 in-hospital treatments, only steroids were associated with a protective effect on survival (HR 0.51, 95%CI=0.27-0.94, p=0.032) while hydroxychloroquine and tocilizumab had no significant effect.
Severe respiratory insufficiency (defined as use of >50% FiO2 as oxygen support) was present or developed in 46% of patients. On multivariate analysis, the following factors were associated with a higher risk of developing severe respiratory insufficiency: use of steroids (>0.5mg/kg/24 hours) in the last 15 days (HR 2.36; 95%CI=1.12-4.97, p=0.023); age (HR 1.05, 95%CI= 1.01-1-08, p=0.009) and dyspnea at diagnosis (HR 3.95; 95%CI=1.77-8.78, p=0.001).
Conclusion
WCOVID19 is associated to increased mortality in patients affected by solid and liquid tumors. Being a candidate for intensive care treatments could improve survival while having progressive disease, older age and grade >3 neutropenia were considered negative factors. Interestingly, the use of steroids was associated to reduced survival if received within 15 days before COVID19 diagnosis, while it has protective effect when used as part of COVID19 therapy.
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Mussetti:Novartis, Gilead: Honoraria, Research Funding. Sureda Balari:Gilead/Kite: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; BMS: Speakers Bureau; Roche: Honoraria; Sanofi: Consultancy, Honoraria; Merck Sharpe and Dohme: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Celgene/Bristol-Myers Squibb: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Speakers Bureau; Incyte: Consultancy.
Tocilizumab for COVID19
ObjectiveTo assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain.SettingsThe initial flood of COVID-19 patients overwhelmed an unprepared ...healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied.ParticipantsThis was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020.InterventionsAn exploratory factorial analysis was performed to select the most relevant variables of the sample.Primary and secondary outcome measuresUnivariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection.ResultsSixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/105 people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade ≥3 (OR 2.5) and preoperative GCS 3–8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/105 people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated.ConclusionsPerioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/105 people/week) was a statistically independent predictor of mortality.Trial registration numberCEIM 20/217.
Background and Aims Childhood acute lymphoblastic leukemia (ALL) is the leading cause of childhood cancer-related deaths worldwide. Multiples studies have shown that ALL seems to be originated by an ...interaction between environmental and genetic susceptibility factors. The ARID5B polymorphisms are among the most reproducible ALL associated-risk alleles in different populations. The aim of the present study was to examine the contribution of ARID5B, CEBPE, and PIP4K2 risk alleles for the development of ALL in children from Mexico City and Yucatan, Mexico. Methods A study was conducted with a total of 761 unrelated subjects. Two hundred eighty five ALL cases (111 from Yucatan and 174 from Mexico City) and 476 healthy subjects. Genotyping included the rs7088318 ( PIP4K2A ), rs10821936 ( ARID5B ), rs7089424 ( ARID5B ) and rs2239633 ( CEBPE ) polymorphisms. Results Associations between ALL and rs10821936 and rs7089424 ARID5B SNPs were found (OR = 1.9, 95% CI (1.5–2.4) and OR = 2.0, 95% CI (1.6–2.5), respectively). Moreover, a higher risk was observed in the homozygous risk genotypes of carriers from Mexico City (OR = 3.1, 95% CI (2.0–4.9) and OR 3.1, CI 95% (2.0–4.8), respectively). Otherwise, the rs7088318 ( PIP4K2A ) and rs2239633 ( CEBPE ) polymorphisms were not associated with ALL risk. Conclusions Our analysis suggests that ARID5B confers risk for childhood ALL in a Mexican population.
La Sociedad Española de Neumología y Cirugía Torácica (SEPAR) ha elaborado este documento de recomendaciones sobre la vacuna para la COVID-19 en las enfermedades respiratorias, con el objetivo de ...ayudar al personal sanitario en la toma de decisiones sobre cómo actuar en la vacunación de estos pacientes.
Las recomendaciones han sido elaboradas por un grupo de expertos en la materia, tras la revisión de la literatura recopilada hasta el 7 de marzo del 2021, y de la información aportada por distintas sociedades científicas, agencias del medicamento y estrategias de organismos gubernamentales hasta esa fecha.
Podemos concluir que las vacunas para la COVID-19 no solo son seguras y eficaces, sino que, en aquellos pacientes vulnerables con enfermedades respiratorias crónicas, son prioritarias. Además, la implicación activa de los profesionales sanitarios que manejan estas patologías en la estrategia de vacunación es clave para lograr una buena adherencia y coberturas vacunales elevadas.
The Spanish Society of Pneumonology and Thoracic Surgery (SEPAR) has elaborated this document of recommendations for COVID-19 vaccination in patients with respiratory diseases aimed to help healthcare personnel make decisions about how to act in case of COVID-19 vaccination in these patients.
The recommendations have been developed by a group of experts in this field after reviewing the materials published up to March 7, 2021, the information provided by different scientific societies, drug agencies and the strategies of the governmental bodies up to this date.
We can conclude that COVID-19 vaccines are not only safe and effective, but also prior in vulnerable patients with chronic respiratory diseases. In addition, an active involvement of healthcare professionals, who manage these diseases, in the vaccination strategy is the key to achieve good adherence and high vaccination coverage.
Resumen: La Sociedad Española de Neumología y Cirugía Torácica (SEPAR) ha elaborado este documento de recomendaciones sobre la vacuna para la COVID-19 en las enfermedades respiratorias, con el ...objetivo de ayudar al personal sanitario en la toma de decisiones sobre cómo actuar en la vacunación de estos pacientes.Las recomendaciones han sido elaboradas por un grupo de expertos en la materia, tras la revisión de la literatura recopilada hasta el 7 de marzo del 2021, y de la información aportada por distintas sociedades científicas, agencias del medicamento y estrategias de organismos gubernamentales hasta esa fecha.Podemos concluir que las vacunas para la COVID-19 no solo son seguras y eficaces, sino que, en aquellos pacientes vulnerables con enfermedades respiratorias crónicas, son prioritarias. Además, la implicación activa de los profesionales sanitarios que manejan estas patologías en la estrategia de vacunación es clave para lograr una buena adherencia y coberturas vacunales elevadas. Abstract: The Spanish Society of Pneumonology and Thoracic Surgery (SEPAR) has elaborated this document of recommendations for COVID-19 vaccination in patients with respiratory diseases aimed to help healthcare personnel make decisions about how to act in case of COVID-19 vaccination in these patients.The recommendations have been developed by a group of experts in this field after reviewing the materials published up to March 7, 2021, the information provided by different scientific societies, drug agencies and the strategies of the governmental bodies up to this date.We can conclude that COVID-19 vaccines are not only safe and effective, but also prior in vulnerable patients with chronic respiratory diseases. In addition, an active involvement of healthcare professionals, who manage these diseases, in the vaccination strategy is the key to achieve good adherence and high vaccination coverage.
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