Impact of Atrial Fibrillation and Flutter on the in-Hospital Outcomes of Patients with Covid-19: A Nationwide Retrospective Cohort Study

Background: Atrial fibrillation and/or flutter is a common comorbidity in hospitalized patients with COVID-19. Objective(s): We aimed to assess the effect of atrial fibrillation and/or flutter on the outcomes of COVID-19 patients in a nationally representative sample. Method(s): We conducted a population-based analysis utilizing data from the national inpatient sample database. Hospitalized adults >= 18 years who were hospitalized with COVID-19 during the year 2020 were included. We used multivariate logistic regression models to investigate the outcomes in patients who had atrial fibrillation or flutter. Result(s): Among 1,018,115 (Nationally weighted sample) admissions with COVID-19, 154795 cases (15.2%) had atrial fibrillation and/or flutter. Patients with atrial fibrillation and/or flutter had significantly higher adjusted odds of all-cause in-hospital mortality (Odds Ratio [OR], 1.78 [confidence interval (CI), 1.75-1.80]), acute stroke (OR, 1.96 [CI, 1.85-2.07]), acute coronary syndrome (OR, 1.43 [CI, 1.37-1.48]), acute heart failure (OR, 4.24 [CI, 4.15-4.34]), cardiogenic shock (OR, 3.07 [CI, 2.85-3.30]), need for vasopressors (OR, 2.14 [CI, 2.06-2.22]), cardiac arrest (OR, 1.95 [CI, 1.89-2.02]), need for mechanical ventilation (OR, 1.79 [CI, 1.77-1.82]), acute kidney injury (OR, 1.25 [CI, 1.23-1.27]), major bleeding (OR, 1.82 [CI, 1.73-1.92]) compared to those patients without atrial fibrillation or flutter. On subgroup analysis, the risk for mortality was highest among atrial flutter (OR, 2.91), followed by atrial flutter and fibrillation group (OR, 2.38), followed by only atrial fibrillation group (OR, 1.71) (P value <0.001 for all) when compared to non-atrial fibrillation, non-atrial flutter in patients with COVID-19. Conclusion(s): Atrial fibrillation and flutter are associated with higher inpatient mortality and worse outcomes in COVID-19 patients. [Formula presented]Copyright © 2023

Practices of French and Francophones allergists in the management of allergic risks and complications of anti-SARS- COV- 2 vaccination

Background: The SARS-COV- 2 vaccination campaign has massively mobilized the allergists' community to screen patients deemed at risk for the SARS-COV- 2 vaccines. To describe data regarding the management of medical calls regarding the allergic risk for the SARS-COV- 2 vaccination, amongst French allergists. Method(s): A questionnaire-based survey was launched on the AdviceMedica platform (a platform of medical advice exchange between peers) between July and October 2021 (including two reminders). Result(s): Fifty-four allergists answered the survey. Three quarters of the responders were full-time allergists. Overall, 42% and 35% had an exclusive hospital or private practice, respectively. Allergists were mostly contacted by telephone (96.3%) and e-mail (79.6%), by general practitioners (92.6%) or physicians practicing in vaccination centers (88.8%) (median of vaccine related medical calls: 10 per week (Q25-Q75: 7-20, range (2-300). Allergists favored in-person visits rather than teleconsultations (85.2% vs. 61.1%). Allergy testing was prescribed for suspicions of allergy to polyethylene glycol (84.4%) or other vaccines and non-identified drugs (64.4%). Half of the responders (29, 53.7%) could perform vaccination and four (13.7%) declared reactions during vaccination. The responders used several tools in taking their clinical decision: exchanges with peers from the AdviceMedica platform (40.4%), advice from tertiary university hospital allergy units (25%), recommendations of the French Society of Allergy (17.3%). The three most frequent drawbacks that the allergists encountered were: having a hard time adding supplementary patient visits within optimal delays (three quarters of the responders), the reluctance expressed by the physicians requiring the advice and by the patients (two thirds) and the fact that the learnt society recommendations were deemed not to cover many on-field situations (one third). The major benefits from screening were estimated to be the lack of allergy contraindication to vaccination (88.7%) and the increased visibility of the allergist's role (69.8%). Conclusion(s): This survey put numbers on the management of screening patients deemed at risk for the SARS-COV- 2 vaccination amongst French allergists. Peer exchange was the most frequent tool in taking a clinical decision.

Effusive Constrictive Pericarditis in the Setting of Recurrent Covid-19 Infection in a Vaccinated Patient

Background Effusive constrictive pericarditis is one of the rare reported complications of COVID-19 infection. Case 58-yr-old female with history of COVID pneumonia 7 months ago presented with shortness of breath, cough and dizziness. She was tachycardic with soft BP. Transthoracic echocardiography was suggestive of effusive constrictive pericarditis and moderate pericardial effusion. COVID-19 test came back positive. She previously received 2 doses of COVID-19 vaccine. Decision-making Cardiac MRI showed thickened pericardium, multiple complex loculated pericardial fluid with septations and focal areas of pericardial hyper-enhancement suggestive of inflammation and fibrosis. There was no clear cause of constrictive pericarditis other than recurrent COVID-19 infection. Pericardial biopsy was negative for malignancy. Nuclear study was negative for cardiac amyloidosis. connective tissue disease markers were negative. The patient was planned to do right heart catheterization, however given her COVID infection, the decision was to hold on non-urgent interventions. Her infection was managed aggressively. Final plan was pericardiectomy after resolution of infection with urgent intervention in case of any hemodynamic instability. Conclusion Effusive constrictive pericarditis requiring pericardiectomy is a rare finding in patients with recurrent COVID 19 infection especially after vaccination. Early diagnosis and treatment is very important to prevent significant morbidity. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Réintroduction du vaccin COMIRNATY® chez une patiente présentant une allergie confirmée au PEG

Introduction (contexte de la recherche) Une allergie à l'un des composants du vaccin contre la Covid-19, comme le polyéthylène glycol (PEG), fait partie des contre-indications à la vaccination par COMIRNATY®. Un avis allergologique est nécessaire pour confirmer une éventuelle suspicion d'allergie au PEG. Objectif Présentation d'une proposition de prise en charge des patients ayant des antécédents de réaction allergique immédiate à l'un des composants du vaccin contre la Covid-19. Méthodes Nous présentons le cas d'une patiente travaillant dans le secteur médical, ayant présenté une réaction anaphylactique immédiate (nausée, vomissements, urticaire généralisée et céphalée) après avoir pris un laxatif contenant du PEG en tant que principe actif (MACROGOL®), 15 années auparavant, dans un contexte de constipation. Nous avons confirmé l'allergie au PEG par un test cutané (en prick) positif. Le prick test au vaccin COMIRNATY® était également positif. Après avoir évalué de façon stricte la balance bénéfice-risque individuelle de la vaccination, nous avons vacciné la patiente en hôpital de jour d'allergologie selon un protocole de réintroduction progressive et sous surveillance clinique rapprochée. Résultats La patiente a bénéficié de la réintroduction de ce vaccin (sans prémédication) selon un protocole en 4 étapes (dose totale 0,3 mL). Le protocole a été réalisé en milieu sécurisé dans le service d'allergologie et après avoir obtenu le consentement de la patiente. Une surveillance clinique classique d'un test de réintroduction à risque a été réalisée. Les résultats du test de réadministration du vaccin n'ont montré aucune réaction allergique après une surveillance prolongée (2 heures après la dernière dose). Conclusions En présence d'une balance bénéfice-risque favorable à la vaccination et avec une surveillance stricte, la réintroduction du vaccin COMIRNATY® chez les patients avec une allergie confirmée au PEG est possible, avec une bonne tolérance.

Enquête COMPac (Complications allergiques des vaccins de la Covid) : étude des pratiques des allergologues français et francophones

Déclaration de liens d’intérêts: Les auteurs n’ont pas précisé leurs éventuels liens d’intérêts.

THE ROLE OF TRUST AND SATISFACTION AS MEDIATORS ON USERS’ CONTINUOUS INTENTION TO USE MOBILE PAYMENTS: EMPIRICAL STUDY

During the period of Corona pandemic, many customers faced some difficulties due to the repeated closures of banks and government institutions, which necessitated them to search for other alternatives like mobile payments to pay their due bills. Consequently, more research is needed to study what factors are important to continue using of such technology. In response, this study used a sample of 880 respondents, then proposed a theoretical model and tested it empirically. Results highlighted the role of trust and satisfaction as mediators which significantly impacted users’ continuous intention to use mobile payments technology. © 2022 Little Lion Scientific