Subjective experience of patients in the time of the COVID-19 pandemic. A cross-sectional study in the department of medical oncology and hematology of the academic teaching hospital Fieldkirch

Introduction: It is well known, that oncological patients need acute support adapted to their situation of disease stress (diagnosis, start or change of therapy, side efects, critical point of disease) and life stress (drop of quality of life, reduction of wellbeing, fear of existence, family concerns). COVID-19 is likely to be an additional challenge. The aim of the present study was to fnd out whether and how the pandemic further infuences the subjective experience of oncological patients in correlation to a study by the University of Innsbruck. Method(s): Evaluation with a standardized procedure and open questions (online survey;patients, control group): SoMe (Schnell & Becker, 2007);SCS-K-D (Bertrams & Dickhauser, 2009);IE-4 (Kovaleva et al 2012);PANAS-SF (Tompson 2016);PHQ4 (Lowe et al 2010);ERQ (Abler & Kessler 2011);CMQ (Bruder et al 2013);IWAH (McFarland et al 2012);questions related to COVID-19 (fear of infection, information search and opportunities);questions about understanding the pandemic and personal conclusions to go on. Result(s): The result of all evaluated people (afected group N=91, 47% female, age 20 to 80 years, M=56.22, SD=14.81;control group N=800, 77% female, age 17 to 82 years, M=32.18, SD=12.85) showed, that all patients in ongoing treatment were searching for information about the pandemic: on TV 86% (cg 61%);in newspapers 53% (cg 42%);in the internet 61% (cg 89%): ofcial channels and online newspapers 34%, google 25%. 53% of cancer patients showed fear of SARS-CoV-2 (cg 13%). Only 11% of them couldnt handle their situation in a positive way respectively couldnt stop worrying thoughts and felt depressed, 18% were afraid of the future and 67% thought that they will survive well the coming months. 38% felt externally determined and 72% felt mistreated by fate. More than the half of all patients believe in conspiracy theories, but theres no correlation between fear of infection and conspiracy belief (r=.11;p=.25) (cg r=-.06;p=.04). This fear in correlation to depression and anxiety is signifcant (r=.37;p<.001) (cg r=.20;p<.001). Conclusion(s): Our surveys show that oncological patients need targeted information and acute support to counteract stressful thoughts and to minimize the fear of losing therapy during a pandemic. Overall, it means that self-regulation, control conviction and social conclusion are benef-cial characteristics, proven for all but especially for people burdened by life-threatening diseases.

Impact of the COVID-19 national lockdown on pharmacy students' productivity and their coping strategies in a developing country: An online survey in Nigerian universities

Background: The COVID-19 pandemic in Nigeria led to a national lockdown that resulted in the suspension of academic activities. Objective(s): To evaluate the impact of the COVID-19 national lockdown on pharmacy students' productivity and their coping strategies. Method(s): This study involved the cross-sectional collection of responses from undergraduate students of six Nigerian schools of pharmacy. Data was collected using a structured, validated questionnaire in the form of Google form. The data was entered into a statistical product and service solutions software (SPSS, version-25) for analysis. Result(s): A total of 808 students responded to the questionnaire. The majority of the students' responses (757, 93.7%) showed that their reading duration had decreased during the lockdown. The most missed variable during the closure by students was 'school life' (303, 37.5%). The use of social media (133, 16.5%) was the most common coping strategy. The majority of the students, 544 (67.3%), agreed to participate in the virtual mode of learning. The cost of data was the main challenge to online learning by the students (288, 36.0%). Conclusion(s): This study shows that the productivity of pharmacy students decreased during the COVID-19 lockdown. Social media and business activities were the most common coping mechanisms of pharmacy students. Pharmacy students were willing to accept virtual learning despite possible challenges. Copyright © 2020, International Pharmaceutical Federation. All rights reserved.

Thrombin generation test in COVID-19 related coagulopathy

Introduction: critically ill COVID-19 patients are known to have a coagulopathy characterized by increased levels of D-dimer (DD) associated to a thrombotic risk and a significant increase in mortality. However, it is not known whether the associated COVID-19 coagulopathy is due to a prothrombotic state or is caused by endothelial dysfunction and inflammation. Aim of our study, was to better characterize the hypercoagulability state of COVID-19 patients using Thrombin Generation analyser (ST Genesia, Diagnostica Stago, Asnieres, France). Method(s): a total of 46 non-critically ill hospitalized COVID-19 patients were compared to 19 critically ill COVID-19 patients utilizing calibrated automated thrombography and other biochemical, hematological and coagulation parameters. Result(s): critically ill patients had a significant increase in C reactive protein (CRP), interleukin-6 (IL-6), prothrombin time (PT), DD and a significant decrease in lymphocytes count. No significant differences in Thrombin Generation Test (TGT) parameters were observed between the two groups of patients with the only exception of the "Lag Time" parameter. Discussion(s): the obtained results confirmed increased levels of DD and PT in critically ill COVID-19 patients. Of note, disease severity did not cause an increase in Thrombin Generation when compared to non-critically COVID-19 patients. The significantly prolonged Lag Time in critically ill COVID-19 patients without decreased endogenous thrombin potential suggests an hypocoagulability state in these patients. The relevance of this finding is uncertain and may appear counterintuitive since these patients are expected to have a hypercoagulability status, and requires further research. Copyright © 2022 Biomedia. All rights reserved.

Use of Outpatient Intravenous Diuretic Therapy Among Patients With Heart Failure in the United States

Introduction: Select centers have published local experiences with outpatient (OP) intravenous (IV) diuretic clinics to treat worsening heart failure (HF) and prevent hospitalization. Little is known regarding widespread use of this care strategy in contemporary US practice, including the potential impact of the COVID-19 pandemic. Method(s): Inpatient (IP) and OP claims from Optum (April 2018-March 2021) were utilized to identify instances where patients with HF with reduced ejection fraction (HFrEF) received >=1 administration of IV diuretic. Episodes of care were categorized into hierarchical mutually exclusive groups defined by intensity of care setting, including IP hospitalization, critical care (without IP hospitalization), emergency department (without IP hospitalization), observation unit, nursing facility, and outpatient clinic. Analyses were stratified across pre-pandemic (4/2018-3/2019, 4/2019-3/2020) and COVID-19 pandemic periods (4/2020-3/2021). Result(s): Among 302,397 patients with HFrEF, 56,213 (19%) patients received IV diuretic therapy during the study period, accounting for 94,865 total IV diuretic episodes. Of patients receiving IV diuretics, 44% were female and 20% were Black. Among 85,827 (90%) IV diuretic episodes with available data on location of care, 14% were outpatient clinic visits, 60% were IP hospitalizations, and 21% were ED visits. Critical care, observation unit, and nursing facility locations each constituted ~1-2% of IV diuretic episodes. The proportion of outpatient IV diuretic visits and the overall distribution of IV diuretic episodes was similar over time, spanning the pre-pandemic and COVID-19 pandemic periods (Figure). Conclusion(s): In this cohort of US patients with HFrEF, approximately 1 in 7 care episodes involving IV diuretic therapy occurred in outpatient clinic. The relative proportion of outpatient IV diuretic visits did not meaningfully change during the first year of the COVID-19 pandemic. (Figure Presented).

Effect of an Intensive Nurse Home Visiting Program on Adverse Birth Outcomes in a Medicaid-Eligible Population: A Randomized Clinical Trial

Mortality, morbidity, and childhood developmental challenges can all result fromadverse birth outcomes. In regard to these outcomes, the United States exhibits significant racial and socioeconomic inequities, and effective interventions targeting lowincome pregnant people are necessary. A recommendation for expanding home visiting programs has been provided with the hope of improving newborn andmaternal outcomes, and substantial federal funding is granted to these programs via theMaternal, Infant, and Early Childhood Home Visiting program. The Nurse-Family Partnership program is a nurse home visiting service targeting nulliparous low-income families during pregnancy and early childhood. The state of South Carolina's preterm birth rate in 2016 was the sixth highest in the United States, which motivated the state to offer program services to Medicaid-eligible nulliparous women through aMedicaid waiver. This study's objective was to determine effects of intensive nurse home visiting programs on the composite outcome of small for gestational age, low birth weight, preterm birth, and perinatal mortality. This randomized clinical trial assigned participants in a 2:1 ratio to either a control group or an intervention group, which was offered access to the program. The control group was offered a list of community-based resources available to them, and all participants received usual care for South Carolina. Inclusion criteria were nulliparous pregnancy of less than 28 weeks' gestation, income-eligible for Medicaid during pregnancy, and residence in a program-served county. Self-referral, or referral through schools, clinicians, and Medicaid led patients to 1 of 9 program-implementing sites. The intervention, which consisted of a prenatal and early childhood home visiting program, was carried out by nurses conducting home visits with participants from pregnancy through the first 2 years of the child's life. The nurses used activities tailored to the clients' strengths, preferences, and risks via educational tools, motivational interviews, goal setting related to prenatal health, health assessments, maternal life course, and child health and development. Utilization of health care was encouraged when needed, coupled with referrals to health and social services. Ideal visits ranged from weekly 60- to 90-minute sessions for 4 weeks following enrollment and then every other week leading up to delivery. Nurse training encouraged flexible support of clients for more or fewer visits as necessary, with services provided in both Spanish and English, with other translation options. Enrollment for the study began on April 1, 2016, but concerns for the COVID-19 pandemic led to a recruitment halt on March 17, 2020. However, 95% of the target recruitment goal had already occurred, and the remaining home visits were conducted via telehealth. A total of 3319 patients were eligible and opted for enrollment. Upon time of enrollment, 18% of participants were younger than 19 years, with 54.8% of them between 19 and 24 years old. Self-reported race and ethnicity statistics were reported as 55.2% non-Hispanic Black, and 22.4% had not completed high school. Body mass index of greater than 30 kg/m2 was present in 34.5%, and smoking 3 months before pregnancy was reported in 25.8% of participants. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Spike in Critical Care Admissions for Severe Hyponatremia in Patients Receiving Paxlovid

INTRODUCTION: Paxlovid (nirmatrelvir-ritonavir) received Emergency Use Authorization (EUA) for mild to moderate COVID-19 among those at high risk for severe disease. Hyponatremia is not yet listed as an adverse reaction to either Paxlovid or ritonavir alone in UpToDate. The package insert lists hyponatremia if Paxlovid is administered with finerenone, due to the increased concentration of finerenone caused by a drug-drug interaction. The EUA lists one case of mild hyponatremia in a patient with 10 other adverse events, none of which thought to be related to Paxlovid. The Liverpool COVID-19 website allows review of concomitant medications for drug interaction prior to prescribing, although it is unclear how widespread its use is among prescribers. The objective of this case series is to review 4 cases of severe hyponatremia in patients receiving Paxlovid that required intensive care unit (ICU) admission. DESCRIPTION: During a 6-week period from June to July 2022, our community hospital treated 7 adult patients in the ICU for severe hyponatremia, defined as sodium (Na) less than 120 mEq/L. Of those 7, three patients did not have COVID-19. The remaining four patients had been prescribed and were taking Paxlovid for COVID-19, with Na levels upon admission ranging from 112 to 115 mEq/L. Weakness, nausea and dehydration were all common side effects upon presentation. Use of the Liverpool COVID-19 interaction checker revealed a potential weak interaction in only 1 of 4 patients that venlafaxine concentrations could potentially be increased and venlafaxine has been associated with hyponatremia. With cessation of the drug and conventional treatment measures for severe hyponatremia including hypertonic saline, the hyponatremia corrected appropriately in all four cases. DISCUSSION: COVID-19 itself has been associated with hyponatremia of unclear mechanism, however two large studies of 1099 & 5700 patients hospitalized for COVID-19 showed average Na levels of 138 & 136 mEq/L, respectively. We admitted 4 patients to the ICU in a 6-week period for severe hyponatremia while taking Paxlovid. Although the mechanism is unknown, this could be a signal that warrants further investigation. Vigilant review of concomitant medications when prescribing Paxlovid using the Liverpool interaction checker is needed.

Impact of Coronavirus Disease 2019 pandemic on healthcare-associated infections at intensive care unit in South Korea: Data from Korean National Healthcare-associated Infections Surveillance System (KONIS)

Background. Coronavirus Disease 2019 (COVID-19) pandemic has influenced hospital infection control practices. We evaluated the impact of the COVID-19 pandemic on healthcare-associated infections (HAIs) in the intensive care unit. Methods. We conducted a retrospective analysis using data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS). KONIS has conducted nationwide prospective surveillance of HAIs in intensive care units. Comparisons of incidence rates of bloodstream infection (BSI), central lineassociated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) before (Jan 2018-Dec 2019) and during the COVID-19 pandemic (Jan 2020-Jun 2021) were performed according to hospital size. The microorganism distributions in BSI, urinary tract infection, and pneumonia were compared between the period before and during the COVID-19 pandemic. Results. The incidence rate of BSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period (1.38 vs. 1.19 per 10,000 patient-days;P < 0.001) [Table 1]. Incidence rates of CLABSI (2.30 vs. 2.17 per 1,000 device-days;P = 0.03) and VAP (1.03 vs. 0.81 per 1,000 device-days;P < 0.001) decreased significantly during the COVID-19 pandemic than in the pre-COVID-19 period, whereas that rate of CAUTI was similar between the two periods. The annual trends of incidence rate of CLABSI and VAP also has decreased (Figure 1). According to the hospital size, the incidence rate per 1,000 device-days of CLABSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period in small to medium-sized hospitals (300-699 beds). The incidence rate per 1,000 device-days of VAP significantly decreased only in small-sized hospitals (200-449 beds). The microorganism distributions in HAIs did not change significantly. Conclusion. The incidence rates of CLABSI and VAP decreased during the COVID-19 pandemic than in the pre-COVID-19 period, which was attributable to the changes in small to medium-sized hospitals. (Figure Presented).

Breath Sample Collection from Individuals Infected with SARS-CoV-2: Biosafety Methodology

Background. Breath samples collected from patients infected with respiratory viruses are necessary for viral detection using breath analyzer devices. Given the highly transmissible nature of many of these illnesses, sample collection requires a multilayered approach to ensure the safety of the research staff responsible for obtaining and transporting these samples. Our team established a protocol to minimize exposure to and transmission of COVID-19 when collecting breath samples. Methods. We collected breath samples from 64 participants, of which 31 (48.4%) were positive for SARS-CoV-2 at the time of their visit. Before we started sample collection, biosafety inspection was conducted. We used a five-pronged approach to enhance safety and minimize transmission. First, we collected specimens in an outdoor space while the patients were seated in their vehicles. Second, we used a disposable mouthpiece and a one-way valve tofill a 1L TEDLAR bag. Third, patients were instructed to close the valve tightly before returning it to the staff. Fourth, we placed the bag in secondary containers which were placed in tertiary containers to minimize any contact with aerosols in the TEDLAR bag. In the last step, we placed a portable HEPAfilter near the indoor sample processing unit to minimize exposure and air contamination with the samples. Study staff donned all forms of necessary personal protective equipment, including gloves, gowns, N95 respirators, and protective eyewear, during sample collection and transportation. Results. A total of 64 breath samples were collected from 64 adult participants from February to March 2022. A total of 30 participants (46.9%) were within 7 days of their initial diagnosis. All participants were able to successfully collect samples without additional resources or attempts. All samples were able to be transported successfully into the lab. No staff contracted COVID-19 during the study period. Conclusion. Layered safety measures, including protective equipment, physical barriers, and well-ventilated environments mitigated the risks associated with breath sample collections from infected participants.

The impact of exposure to cigarette advertising and promotion on youth smoking behavior in Malang Regency (Indonesia) during the COVID-19 Pandemic

The prevalence of teen smokers has increased during the Covid-19 pandemic. Smoking behavior occurs due to exposure to advertising and the promotion of cigarettes. This quantitative research was conducted using cross-sectional approach. The purpose of the study was to analyze the relationship between advertising exposure and cigarette promotion on adolescent smoking behavior in Malang Regency during the pandemic using the chi-square test. Random sampling on students from several high schools or equal degree in the Kepanjen District was done with a total of 145 respondents. The results showed that there was no significant relationship between age, types of cigarette advertising media at the point of sale, outdoor media, social media, internet, and newspapers or magazines by adolescent smoking behavior during the Covid-19 pandemic (p-value > 0.05). Exposure to cigarette advertisements on television, total exposure to cigarette advertisements, cigarette promotion, and gender had a significant relationship with adolescent smoking behavior during the pandemic (p value < 0.05). Adolescents are quite highly exposed to the various types of advertisements and promotions of cigarettes that can influence increased smoking behavior during the pandemic. Copyright © the Author(s),2022.

Emergency Psychiatry before and during COVID-19 pandemia

Introduction: The COVID-19 pandemic had a significant impact worldwide. Consultations in the Emergency Service of the Hospital Clinic of Barcelona varied in terms of reasons for consultations, psychopathology, and other aspects, before and after the pandemic. Objective(s): To examine changes in the profile of patients admitted before and during the COVID-19 pandemic to our Psychiatric Emergency Service. Method(s): All children, adolescent and adult psychiatric inpatients admitted from December 4th 2019 to March 31st 2021 to the Psychiatric Emergency Service of Hospital Clinic of Barcelona, Spain, were retrospectively included for analysis and divided into two groups -groups 1 or 2- including the first one all patients who attended before lockdown and the second group those who attended during the pandemic. Result(s): A total of 1991 patients were included -1224 in the first group and 767 in the second group. The majority of patients were male (52.08%), with a mean age of 41.21 years (SD 16.53). A proportion significantly higher of men was found in the second group (p<0.05). The proportion of patients consulting with substance use disorders was significantly higher in the second group (p<0.05). Patients from the second group presented a significantly higher proportion of admissions in an acute psychiatric ward (p<0.05), and also a significantly higher proportion of consultations of patients with dementia (p<0.05). Conclusion(s): The COVID-19 pandemic lead to a significant reduction in the overall consultations, with a higher proportion of severe cases. The lack of availability of caregivers and telework might have influenced the increase in consultations of patients with dementia.

Mortality risk factors among hospitalised COVID-19 patients

Introduction: COVID-19 is an acute viral infection that mainly affects the respiratory system leading to mortality. Therefore, positive COVID-19 patients may require intensive care unit (ICU) admission in severe cases. Many factors are thought to exacerbate the symptoms of COVID-19 resulting in increased mortality, smoking, hypertension and type 2 diabetes mellitus (T2DM) are on the top of these factors. Objective(s): This study was designed to detect the strength of association between death rate among COVID-19 ICU admitted patients and being smokers, type 2 diabetes mellitus (T2DM), or hypertension. Material(s) and Method(s): A cross-sectional study was conducted. A sample of 302 patients included all COVID-19 patients admitted to the ICU of the central hospital in Amman, Jordan, in July 2021. Result(s) and Conclusion(s): Of the total 302 patients, 171 were smokers. the death rate among smokers (67.25%) was significantly higher than (53.43%) among non-smokers X2= 5.966, p=0.0145. We found that 118 cases had T2DM. the death rate among patient with T2DM (62.71%) was insignificantly higher than (60.32%) among non-diabetic patients X2= 0.172, p=0.67. Of the 130 COVID-19 patients with hypertension, the death rate was (70.76%) significantly higher than (54.1%) among those without hypertension X2= 8.70, p=0.0031. Moreover, by using the OR and 95% CI. Interestingly, we found that smokers were almost two times significantly more prone to death than nonsmokers (OR=1.79, 95%CI:1.12 - 2.86, p=0.015). Also, patients with hypertension were two times significantly more prone to death than normotensive patients, (OR=2.06, 95% CI: 1.27 - 3.33, p=0.0034). On the other hand, T2DM showed an insignificant risk factor (OR=1.11) for death. 95% CI: 0.687- 1.78, p=0.6780. Smoking and hypertension act as significant risk factors to increase mortality in COVID-19 patients.

Values of intensive care scores in predicting morbidity and mortality in patients treated for COVID-19 pneumonia

Some of the patients with COVID-19 pneumonia are followed up in intensive care units (ICU). This study aimed to determine the success of intensive care scores used in patients followed up in the ICU with the diagnosis of COVID-19 pneumonia in predicting morbidity and mortality. This retrospective study included patients treated for COVID-19 pneumonia in the ICUs of Samsun Training and Research Hospital. We used the patients' demographic characteristics, vital signs, arterial blood gas values, radiological imaging, and laboratory data by using the hospital database and patient files. Group I was composed of alive patients, while Group II was of dead ones. A total of 75 patients were included in the study, of which 34 (45.3%) were female and 41 (54.7%) were male. The median length of intensive care stay was 8 (5-15) days in Group I patients and 5 (2-8) days in Group II patients, which was higher in alive patients (p=0.004). Radiological involvement was present in 93.3% (n=70) of the patients, and involvement was observed in both lungs in 77.3% (n=58). We observed complications in 54.7% (n=41) of the patients, whereas the incidence of complications was 20% in Group I and 72% in Group II, which was statistically significant (p<0.001). APACHE II, PSI, SOFA, qSOFA, SMART-COP, CURB65, A-DROP and NEWS2 scores were statistically significantly higher in patients who died, whereas APACHE II, SOFA, qSOFA, and SMART-COP scores were more successful in predicting morbidity. It is vital to predict the mortality risk early in patients with COVID-19 pneumonia followed up in intensive care units. Among the scoring systems, APACHE II, PSI, SOFA, qSOFA, SMART-COP, CURB65, A-DROP, and NEWS2 can be used safely to predict mortality. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.

Two years follow up study of the psychological effect of COVID19 pandemic on neuromyelitis optica spectrum disorder patients, the dramatic effect of vaccination

Background: Coronavirus 2019 (COVID19) created a pandemic since early 2020. NMOSD patients are more affected by psychological effects of the pandemic such as anxiety and fear because they may be worried about suffering COVID19 infection. They often concern about their treatment protocol and disease relapses during the pandemic too. Aim(s): In this study we tried to show some psychological complications epidemic on NMOSD patients in Isfahan province, Iran. the first aim of the study was to evaluate the presence and the prevalence of anxiety among NMOSD patients during the first year from epidemic beginning and also in post vaccination phase after 24 months. The second goal was to see the level of respecting preventive measures among the same group. The follow up period is 2 year after declaring COVID19 epidemic in our country Iran, since late February 2020. Method(s): The objective of the study was to evaluate the anxiety due to COVID19 infection, 3, 12 and 24 months after beginning of epidemic. The study was done in NMOSD Clinic of Isfahan Kashani hospital. We first asked patients if they were anxious or afraid of the pandemic subjectively.To investigate the objective level of anxiety, we benefited Hospital Anxiety and Depression Scale(HADS-A) questionnaire. We asked them about respecting general health cautions to prevent infection. Result(s): Study included 120 patients(96 female) with mean age of 36.37+/-9.69 and mean duration of disease 8.49+/-5.35 years. 96 cases(80%) experienced anxiety during the first 3 months of pandemic and 66 patients(55%) were anxious after a year. The point is that their level of anxiety decreased significantly in post vaccination phase after 24 months and just 35 patients (29.16%) showed anxiety subjectively on the third survey. Based on HADS-A score, 92 patients (76.66%) were anxious on the third month while after one year of epidemic 70 cases(58.33%) and in post vaccination survey just 53(44.16%) were anxious. Respecting preventive measures increased in the first year but decreased after vaccination. Conclusion(s): Results showed that prevalence of anxiety was almost high in the first months of epidemic but it decreased gradually during a year and had a dramatic decline after vaccination. The level of alertness and attention seems to remain high and they respected the sanitary rules. We concluded that vaccination against COVID19 have positive impact on peoples mental health and reduced psychological distress.

Efficacy of a Recombinant Humanized Anti-IL-6 Receptor Monoclonal Antibody Compared to Hemoperfusion in Severe COVID-19 Pneumonia: Ambispective Cohort Study

Background: Coronavirus disease 2019 (COVID-19) is a newly emerging disease caused by the SARS-CoV-2 virus resulting in a global crisis. Activation of the cytokine cascades plays a crucial role in the pathophysiology of severe pneumonia caused by COVID-19. Several treatments targeting pro-inflammatory cytokines have been introduced, however, their efficacy remains controversial. We aimed to demonstrate the comparative efficacy between hemoperfusion and tocilizumab in the reduction of mortality from severe COVID-19 pneumonia. Method(s): A multicentered, ambispective study was conducted on adult patients who were diagnosed with COVID-19 pneumonia between January 1st, 2020, and December 31th, 2021. Clinical parameters including the specific therapy with hemoperfusion (Hemoadsorption cartridge, HA330 JACFRON) or tocilizumab were collected for analysis. Univariable and multivariable regression analyses were performed to determine the association between the specific therapy and the 28-day mortality. Result(s): A total of 92 patients with COVID-19 pneumonia were eligible for analyses (25 patients received hemoperfusion and 67 patients received tocilizumab). The 28-day mortality in the hemoperfusion and tocilizumab groups were 64.0% and 25.4% respectively (p=0.001). However, receiving Tocilizumab was not associated with mortality rate, compared to hemoperfusion in the multivariable analysis [OR 0.56 (95%CI 0.13 -2.39);p=0.428]. Receiving invasive mechanical ventilator (%), duration of hospitalization, and successful withdrawal of invasive mechanical ventilation was not different between the two groups. Inflammatory marker (CRP) was significantly reduced with hemoperfusion and tocilizumab -46.2 (-88.37, -24.9) (p=0.013) and -45.1 (-54.6, -26.15) (p=<0.001). Conclusion(s): The 28-day mortality of COVID-19 pneumonia patients receiving hemoperfusion and tocilizumab were comparable.

Outcome of COVID-19 Infections After Vaccination in Kidney Transplant Patients

Background: Kidney transplant recipients (KT) are a vulnerable population with a risk of death after COVID-19 infection (COV-I) four times higher than in the general population. mRNA COVID-19 vaccines changed the prognosis. Although KT have an impaired immunological response to mRNA vaccines, in March 2021 we started a vaccination campaign. Method(s): Among 1611 KT, 72 (4.2%) had COV-I (positive molecular nasopharyngeal swab) between 31 October 2021 and 15 January 2022 (3rd outbreak). Fourty-one (57%) were male and 58 (80.5%) had a deceased donor transplant, median age was 52 (43-60) years, median transplant vintage 57 (27-159) months, median serum creatinine 1.37 (1.0-1.7) mg/dL. KT were on calcineurin inhibitors, prednisone, mycophenolate (MMF) and mTOR inhibitors in 93-87-79% and 5.6% respectively. At COV-I 43 KT had received 3 doses of Comirnaty (BNT162b2), 21 two and 4 one, 4 were not vaccinated. DELTA variant was present in 36. Treatment included: increase of the daily steroid dosage (69%), MMF withdrawal (70%) or halving (5%) and monoclonal antibodies: Ronapreve or Xevudy (32%). Nine delta positive KT were hospitalized for severe respiratory distress: 2 died (6.6%). Result(s): The variables associated with an increased risk for hospitalization were older age and dyspnea (p=0.023, p<0.0001 respectively). At multivariate analysis, dyspnea (p <0.0001) and MMF (p=0.003) were independently associated with the risk for hospitalization. Combination of the two variables increased the significance (p<0.0001). Comparing this series to the 82/1503 (5.4%) KT infected during the previous waves, hospitalization, mortality and cumulative mortality rates dropped from 45%, 29.3% and 13.4% to 30%, 6.6% and 2.7% respectively, main difference being the absence of vaccination in the first group. Conclusion(s): Vaccinations did not reduce the incidence of COV-I among KT but provided certain protection associated with a significantly better outcome.

Serological Response to Third Dose of Sars-Cov-2 Mrna Vaccine in Patients Affected by Thymic Epithelial Tumors Who Did Not Achieve Seroconversion after the Second Dose

Background: Thymic epithelial tumors (TETs) are rare malignancies associated with dysregulation of the immune system with humoral and cell mediated immunity abnormalities. Anti-syndrome coronavirus type 2 (SARSCoV- 2) vaccine is effective at preventing COVID-19 morbidity and mortality. No published data are available regarding the post-vaccine immunization in TET patients (pts). The aim of our study was to evaluate the immunization in TET pts, who received the third mRNA vaccine dose and who did not achieve seroconversion after the previous two doses. Method(s): Starting from November 2021 to March 2022, 23 consecutive TET patients (pts) found to be serologically negative after two doses of SARS-Cov-2 mRNA vaccine (BNT162b2 by Pfizer-BioNTech) were enrolled at the Rare Tumors Coordinating Center of Campania Region (CRCTR-Naples, Italy). SARS-CoV-2 spike-binding IgG antibody serological levels were centrally analyzed by chemiluminescent immunoassay (CLIA) at two different time-points: T0 (before the third dose) and T1 (one month after the third dose). Cut-off for Ab titers positivity was >25 AU/mL. Result(s): Among the 23 enrolled pts, 10 (43,5%) were female and 13 (56,5%) males;17 pts had thymoma and 6 thymic carcinoma. Autoimmune disorders were detected in 20 TET pts (87%), of whom 3 (15%) suffered from Myasthenia Gravis, 8 (40%) from Good's Syndrome, 7 (35%) from both diseases, and 2 (10%) from other autoimmune disorders. By the time of third vaccine dose 2 pts had died, 2 pts were lost to follow up, 5 pts had suffered from SARS-CoV-2 infection. Of the remaining 14 pts, 7 achieved seroconversion whereas 7 maintained negative serological antibody titers. Two of these 7 pts had SARSCoV- 2 infection after the third dose. Interestingly, among these 7 pts who did not develop positive antibody titers, 6 had active cancer disease and only one was diseasefree. Moreover, 6 out of these 7 pts suffered from Good's Syndrome. On the other hand, among the 7 pts who developed positive antibody titers, only 3 had active disease. Conclusion(s): Our preliminary results showed that TET pts who did not achieve seroconversion even after the third SARS-Cov-2 vaccine dose in most cases had active cancer disease. If confirmed on larger cohorts of patients, these data may have important clinical implications and may help to better identify fragile pts who could benefit the most from prophylactic therapy with monoclonal antibodies.

Effect of Preadmission Proton Pump Inhibitor (Ppi) on the Clinical Outcome of Covid -19 Hospitalised Patients during the Pandemic at the James Cook University Hospital, Middlesbrough, Cleveland, United Kingdom

Introduction: The primary objective of this study was to assess whether proton pump inhibitor (PPI) use at pre-admission affected clinical outcomes among covid 19 hospitalised patients. Aims & Methods: Prospectively captured data was analysed to include patients (>18 year) at the hospital with covid 19 infection . PPI data was derived from hospital and primary care records and the study period is over between February 2020 and February 2021.Clinical outcomes of covid 19 patients who were on proton pump inhibitors preadmission were compared with that of covid 19 patients who were not on proton pump inhibitors at the same time. The primary endpoint of the study was 60-day mortality, intensive care unit admission, high dependency unit admission as well as the development of covid-19 complications. Additional endpoints included length of critical care admission. Result(s): A total of 305 patients were included in the study,158 were on proton pump inhibitors and 147 not on proton pump inhibitor at index admission. There were 101 males and 57 females with a mean age of 61.65 in the PPI group, and in the no-PPI group there were 92 males and 55 females with a mean age of 57.28. The mean length of stay was9.98 in the PPI group and 11.83 in the non-PPI group. There was a slightly increased mortality rate of 29.93% in the non-PPI group compared with 28.48 % in the PPI group. Intensive Care Unit (ITU) and High Dependency Unit (HDU) admissions were higher in the non-PPI group (64.62%,30.6% respectively) than in the PPI group (58.22%,27.21%). Complications were more common in the non-PPI group;84.3% had pulmonary complications,7.3% had thromboembolic complications. In the PPI group 72.15% had pulmonary complications which was over 10 % less than in the non-PPI group, 4.4% had thromboembolic complications which was 1.66 times less than the non-PPI group. Conclusion(s): In Our study PPI usage at index admission failed to show any worsening of outcomes in Covid 19 hospitalised patients, as opposed to recent published papers. This proposed causation needs further evaluation via well conducted prospective studies.