Prior COVID-19 infection among newly diagnosed tuberculosis patients in a tertiary care center in Tehran: A case-control study.

OBJECTIVE: To assess the risk of developing pulmonary tuberculosis (TB) in accordance with prior history of COVID-19 infection. BACKGROUND: Since the advent of the COVID-19 pandemic much discussion has been had on the possible role it might play on global efforts to combat TB; most, focusing on the pandemic's impact on health care systems' capabilities to manage TB cases. Mechanisms have also been proposed by which the COVID-19 infection may directly affect individuals' chance of developing TB infection. Cases have been reported with a history of COVID-19 infection preceding a diagnosis of TB, evidencing its possible role as a risk factor for the disease. METHODS: A case-control study was conducted enrolling patients diagnosed with pulmonary TB in the absence of major risk factors previous history of TB, (HIV) human immunodeficiency virus infection), end-stage renal disease, organ transplants, and use of immunosuppressive agents) for developing TB. Each patient was age and sex matched with one healthy control. Data regarding prior COVID-19 infection, diabetes, and smoking status as well as the use of corticosteroids and Tocilizumab for the treatment of COVID-19 infection was obtained. Bivariate analysis was conducted and variables with a likely association with TB status were entered in a multivariate model. RESULTS: Bivariate analysis demonstrated a significant relationship between prior COVID-19 infection and TB (95% confidence interval = 1.1-22.8, odds ratio [OR] = 5). Among other variables the severity of COVID-19 infection was found to have a likely association with TB status (p = .125). In a multivariate model, prior COVID-19 infection per se, was not found to be significantly associated with TB (p = .12, OR = 4.5). CONCLUSIONS: There seems to be an association between prior history of COVID-19 and a future diagnosis of TB partially linked to the severity of disease. The findings of the current study may serve as a basis for further studies to determine the need for and efficacy of measures to follow-up COVID-19 patients at an increased risk for developing TB.

Managing Hepatotoxicity Caused by Anti-tuberculosis Drugs: A Comparative Study of Approaches.

BACKGROUND: Tuberculosis (TB) is one of the oldest and most well-known diseases that has been associated with humans for many years and remains a global health challenge today. Timely diagnosis and proper treatment are crucial for controlling and preventing the spread of the disease. While anti-TB drugs offer many benefits, inadequate monitoring can lead to a range of side effects, including hepatotoxicity, which is a major concern and can cause treatment discontinuation. The aim of this study was to determine the approach to the hepatotoxicity of anti-TB drugs and to investigate potential relationships between demographic factors, underlying medical conditions, and successful retreatment outcomes for hepatotoxicity induced by anti-TB drugs. METHODS: For this study, we reviewed the medical records of patients who experienced hepatotoxicity due to anti-TB treatment and were admitted to the infectious ward of Imam Khomeini Hospital between April 2015 and February 2019. The data were collected using a questionnaire. RESULTS: The findings indicated that the female gender, weight loss at the beginning of hospitalization, hepatitis C virus, hepatitis B virus (HBV), heart disease, and high levels of aspartate aminotransferase (AST) and alanine transaminase (ALT) at the beginning of hepatotoxicity are risk factors for failure to the retreatment of hepatotoxicity. There were two different approaches to the anti-TB retreatment regimen. The first approach involved gradually starting the drugs in full dose, while the second approach encompassed starting the drugs in the minimum dose and then increasing to the maximum dose. The results demonstrated no significant difference between the two approaches to managing hepatotoxicity induced by anti-TB drugs. CONCLUSION: Drug-induced hepatotoxicity is a common occurrence that often results in treatment discontinuation. Understanding the prevalence of this complication and identifying appropriate methods of rechallenge treatment is crucial to reducing complications and mortality rates.

Effect of high-dose Spirulina supplementation on hospitalized adults with COVID-19: a randomized controlled trial.

Objective: Spirulina (arthrospira platensis) is a cyanobacterium proven to have anti-inflammatory, antiviral, and antioxidant effects. However, the effect of high-dose Spirulina supplementation on hospitalized adults with COVID-19 is currently unclear. This study aimed to evaluate the efficacy and safety of high-dose Spirulina platensis for SARS-CoV-2 infection. Study Design: We conducted a randomized, controlled, open-label trial involving 189 patients with COVID-19 who were randomly assigned in a 1:1 ratio to an experimental group that received 15.2g of Spirulina supplement plus standard treatment (44 non-intensive care unit (non-ICU) and 47 ICU), or to a control group that received standard treatment alone (46 non-ICU and 52 ICU). The study was conducted over six days. Immune mediators were monitored on days 1, 3, 5, and 7. The primary outcome of this study was mortality or hospital discharge within seven days, while the overall discharge or mortality was considered the secondary outcome. Results: Within seven days, there were no deaths in the Spirulina group, while 15 deaths (15.3%) occurred in the control group. Moreover, within seven days, there was a greater number of patients discharged in the Spirulina group (97.7%) in non-ICU compared to the control group (39.1%) (HR, 6.52; 95% CI, 3.50 to 12.17). Overall mortality was higher in the control group (8.7% non-ICU, 28.8% ICU) compared to the Spirulina group (non-ICU HR, 0.13; 95% CI, 0.02 to 0.97; ICU, HR, 0.16; 95% CI, 0.05 to 0.48). In non-ICU, patients who received Spirulina showed a significant reduction in the levels of IL-6, TNF-α, IL-10, and IP-10 as intervention time increased. Furthermore, in ICU, patients who received Spirulina showed a significant decrease in the levels of MIP-1α and IL-6. IFN-γ levels were significantly higher in the intervention group in both ICU and non-ICU subgroups as intervention time increased. No side effects related to Spirulina supplements were observed during the trial. Conclusion: High-dose Spirulina supplements coupled with the standard treatment of COVID-19 may improve recovery and remarkably reduce mortality in hospitalized patients with COVID-19. Clinical Trial Registration: https://irct.ir/trial/54375, Iranian Registry of Clinical Trials number (IRCT20210216050373N1).

Comparison of Omicron and Delta Variants of SARS-CoV-2: A Systematic Review of Current Evidence.

INTRODUCTION: Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) caused the outbreak of coronavirus disease 2019 (COVID-19) in late 2019 in Wuhan, China. In early 2020, the disease spread rapidly around the world. Since the pandemic, SARS-CoV-2 has evolved dramatically into a wide variety of variants endowed with devastating properties. As of March 6, 2022, five SARS-CoV-2 variants of concern, including Alpha, Beta, Gamma, Delta, and Omicron strains have been identified. Due to the crucial importance of understanding the differences between the Omicron and Delta variants, this systematic review was conducted. METHODS: This systematic review investigated new variants of Omicron SARS-CoV-2 based on cur-rent studies. Online databases were searched for English articles as of January 03, 2023. Selection of publications was a two-step process of title/abstract and full-text assessment against eligibility crite-ria. The relevant data from the included articles were systematically collected and organized in a designed table for analysis. To ensure the quality of the review, the PRISMA checklist and Newcas-tle-Ottawa Scale (NOS) of quality assessment were utilized. RESULTS: The data extracted from 58 articles were analyzed, including 10003 pieces of evidence. Lower risk of hospitalization, ICU admission, and mortality after vaccination were reported in the Omicron variant compared to the Delta variant. Additionally, the Delta variant led to more severe clinical symptoms in comparison to the Omicron variant. CONCLUSION: The Omicron variant of SARS-CoV-2 results in less severe disease outcomes as com-pared to Delta. Nevertheless, it remains crucial to maintain ongoing monitoring, implement contain-ment measures, and adapt vaccination protocols to effectively address the evolving variants.

Preparation, characterization and in vitro evaluation of insulin-PHBV nanoparticles / alginate hydrogel composite system for prolonged delivery of insulin.

PURPOSE: In the present study, biodegradable poly (3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) nanoparticles (NPs) containing insulin were loaded in sodium alginate/jeffamine (ALG/jeff) hydrogel for prolonged delivery of insulin. The main aim of this work was to fabricate an efficient insulin delivery system to improve patient adherence by decreasing the repetition of injections. METHODS: Swelling and morphological properties and crosslinking efficiency of ALG/jeff hydrogel were assessed. The composite hydrogel was prepared by adding PHBV NPs to ALG/jeff hydrogel concurrently with crosslinking process. The morphology and loading capacity of composite hydrogel were analyzed. RESULTS: Circular dichroism measurement demonstrated that insulin remains stable following fabrication process. The release profile exhibited 54.6% insulin release from composite hydrogel within 31 days with minor initial burst release equated to nanoparticles and hydrogels. MTT cell viability analysis was performed by applying L-929 cell line and no cytotoxic effect was observed. CONCLUSIONS: Favorable results clearly introduced fabricated composite hydrogel as an excellent candidate for drug delivery systems and also paves the route for prolonged delivery systems of other proteins.

Ocular manifestations of COVID-19: A systematic review of current evidence.

Introduction: COVID-19 caused by SARS-CoV-2, commonly presents with symptoms such as fever and shortness of breath but can also affect other organs. There is growing evidence pointing to potential eye complications. In this article, we aim to systematically review the ocular manifestations of COVID-19. Methods: We conducted a systematic review to explore the ocular manifestations of COVID-19. We searched online databases including PubMed, Embase, Scopus, and Web of Science up to September 4, 2023. After a two-stage screening process and applying inclusion/exclusion criteria, eligible articles were advanced to the data extraction phase. The PRISMA checklist and Newcastle-Ottawa Scale (NOS) were used for quality and bias risk assessments. Results: We selected and extracted data from 42 articles. Most of the studies were cross-sectional (n = 33), with the highest number conducted in Turkey (n = 10). The most frequent ocular manifestation was conjunctivitis, reported in 24 articles, followed by photophobia, burning, chemosis, itching, and ocular pain. Most studies reported complete recovery from these manifestations; however, one study mentioned visual loss in two patients. Conclusion: In general, ocular manifestations of COVID-19 appear to resolve either spontaneously or with supportive treatments. For more severe cases, both medical treatment and surgery have been employed, with the outcomes suggesting that complete recoveries are attainable.

The effect of macronutrient and micronutrient supplements on COVID-19: an umbrella review.

BACKGROUND AND AIMS: A healthy diet play an important role in the prevention and even treatment of various diseases. Proper nutrition plays an important role in boosting of immune system. These include the consumption of macronutrients such as proteins, lipids, carbohydrates, and also micronutrients including vitamins. Here, we aimed to systematically review the effects of macronutrients and micronutrients on the prevention and treatment of COVID-19. METHODS: We searched the databases of PubMed, Scopus, Embase, and Web of Science on December 23, 2023. The records were downloaded into an EndNote file, the duplicates were removed, and the studies underwent a two-phase screening process based on their title/abstracts and full texts. The included articles were screened and underwent inclusion and exclusion criteria. We included the English systematic reviews and meta-analyses that concurred with the aim of our study. The selected articles were assessed by Cochrane's Risk of Bias in Systematic Reviews for the quality check. The data of the eligible studies were extracted in a pre-designed word table and were used for the qualitative synthesis. RESULTS: A total of 28 reviews were included in this study. Most studies have shown that micronutrients are effective in morbidity and mortality controlling in viral respiratory infections such as COVID-19 but some studies have shown that micronutrients are sometimes not effective in controlling severity. On the other hand, calcifediol was by far the most successful agent in reducing intensive care needs and mortality between studies. CONCLUSION: Individuals without malnutrition had a reduced risk of SARS-CoV-2 infection and severe disease. The administration of Vitamin D is effective in reducing the morbidity and mortality of COVID-19 patients. Patients with vitamin D deficiency were more prone to experience severe infection, and they were at higher risk of morbidities and mortality. Other micronutrients such as Vitamin A, Vitamin B, and Zinc also showed some benefits in patients with COVID-19. Vitamin C showed no efficacy in COVID-19 management even in intravenous form or in high doses.

Estimating the Size of the Hidden Population of COVID-19.

INTRODUCTION: An asymptomatic population has the same infection as symptomatic individuals, so these individuals can unknowingly spread the virus. It is not possible to predict the rate of epidemic growth by considering only the identified isolated or hospitalized population. In this study, we want to estimate the size of the COVID-19 population, based on information derived from patients visiting medical centers. So, individuals who do not receive a formal diagnosis in those medical centers can be considered as hidden. METHODOLOGY: To estimate the Bayesian size of the hidden population of COVID-19 a respondentdriven sampling (RDS) method was used. Twenty-three people infected with COVID-19 seeds and who had positive PCR test results were selected as seeds. These participants were asked whether any of their friends and acquaintances who had COVID-19 did not visit a medical center or hid their illness. Access to other patients was gained through friendship and kinship, hence allowing the sampling process to proceed. RESULTS: Out of 23 selected seeds, only 15 seeds remained in the sample and the rest were excluded due to not participating in the further sampling process. After 5 waves, 50 people with COVID-19 who had hidden their disease and were not registered in the official statistics were included in the sample. It was estimated that 12,198 people were infected with COVID-19 in Khalkhal city in 2022. This estimate was much higher than recorded in the official COVID-19 statistics. CONCLUSIONS: The study findings indicate that the estimated 'true' numbers of COVID-19 patients in one town in Iran were significantly higher compared to the official numbers. The RDS method can help capture the potential size of infections in further pandemics or outbreaks globally.

Prevalence of Erectile Dysfunction (ED) among People Living with HIV in Tehran, Iran.

BACKGROUND: Sexual problems are rarely addressed in human immunodeficiency virus (HIV) management, even though overt sexual dysfunctions are more prevalent in people living with HIV. This study aimed to ascertain the prevalence of erectile dysfunction (ED) among HIVinfected men in a stable clinical state, examine the relationship between antiretroviral therapy (ART) exposure and sexual dysfunction, and identify the associated risk factors. METHOD: This cross-sectional study recruited HIV-positive males who visited the Voluntary Counseling and Testing (VCT) center of Imam Khomeini Hospital (Tehran) in 2020. The International Index of Erectile Function (IIEF) questionnaire was used to evaluate the ED in participants. Sociodemographic and clinical data were also collected. RESULTS: Of 65 patients who participated in this study, 27.7% had ED. The mean age of participants with and without ED was 39.4±11.5 and 40.4±7.6 years old, respectively. No significant difference was observed between patients with and without ED concerning the sociodemographic status and the use of ART drugs. CONCLUSION: The prevalence of ED is relatively high among men living with HIV. Future research is recommended among HIV-positive males to identify the underlying causes and explore the potential impact that associated psychological distress could have on sexual dysfunction.

Serum C-reactive protein greater than 75 mg/dL as an early available laboratory predictor of severe COVID-19: A systematic review.

INTRODUCTION: Severe COVID-19 management is still challenging. Having a laboratory factor to predict the severity of a patient's condition can be very useful in how to approach each patient. There have been studies concentrating on the correlation between serum C-reactive protein (CRP) level and COVID-19 severity but we aim to reach a threshold for CRP in disease severity determination. METHODS: We conducted a thorough search on PubMed, Web of Science and Google Scholar databases from early 2019 to October 2021, and 323 studies were assessed for eligibility in three phases. We used the Newcastle-Ottawa Scale to examine the validity of the studies. The t-test was applied for the CRP level cutoffs. RESULTS: Eventually, 11 articles and 1615 patients were included in this systematic review. Our analysis evaluated combined mean, median, and standard deviation of severe patients' CRP to be respectively 73.37, 53.80, and 47.936. Based on the combined mean, 75 mg/dL was suggested as an initial threshold for baseline CRP in hospitalized patients for developing severe conditions. CONCLUSION: This study recommends that COVID-19 patients with on-admission serum CRP levels of 75 mg/dL and more are likely associated with severe conditions. Thus, anti-inflammatory agents and further following may be helpful in these patients.

Social stigma during COVID-19: A systematic review.

Objectives: Stigmatization was reported throughout the COVID pandemic for COVID-19 patients and close contacts. The aim of this systematic review was to comprehensively examine the prevalence and impact of stigmatization during COVID-19 pandemic. Methods: English articles were searched using online databases that included PubMed, Scopus, Embase, and Web of Science up to 24 August 2022. A two-step screening and selection process was followed utilizing an inclusion and exclusion criteria and then data was extracted from eligible articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed, and the risk of bias was assessed using the Newcastle-Ottawa Scale. Results: Seventy-six studies were eligible for inclusion. Twenty-two studies reported the prevalence of social stigma due to COVID-19 infection with social isolation being the most commonly reported stigma. There were 20 studies that reported the majority of participants experienced stigma due to COVID-19 infection, which was as high as 100% of participants in two studies. Participants in 16 studies reported blaming from others as the second most common type of stigma, with various other types reported such as psychological pressure, verbal violence, avoidance, and labeling. The most common effect of the stigma was anxiety followed by depression, and then reduction of socialization. Conclusion: Findings from the present review have identified that COVID-19-related stigma studies have generally focused on its prevalence, type, and outcome. Greater awareness of this topic may assist with improving public education during pandemics such as COVID-19 as well as access to support services for individuals impacted by stigmatization.

Current ART, determinants for virologic failure and implications for HIV drug resistance: an umbrella review.

OBJECTIVE: The purpose of this study is to investigate the incidence of determinants for virologic failure and to identify predisposing factors to enhance treatment efficacy. Tackling this global public health issue is the key to reducing the rate of virological failure and increasing the success of treatment for those living with HIV. METHODS: This umbrella review delves into various aspects of current anti-retroviral therapy (ART) which is the primary treatment for human immunodeficiency virus (HIV) infection. Comprehensive searches were conducted in online databases including PubMed, Embase, Scopus, and Web of Science, up to May 26, 2023. Following the screening and selection of relevant articles, eligible articles were included in the data extraction. This study adhered to the PRISMA guideline to report the results and employed the NIH quality and bias risk assessment tool to ensure the quality of included studies. RESULTS: In total, 40 review studies published from 2015 to 2023 were included. The bulk of these studies concurred on several major factors contributing to HIV drug resistance and virological failure. Key among these were medication adherence, baseline and therapeutic CD4 levels, the presence of co-infections, and the advanced clinical stage of the infection. CONCLUSION: The resistance to HIV drugs and instances of determinants for virologic failure have a profound impact on the life quality of those infected with HIV. Primary contributors to this scenario include insufficient adherence to treatment, decreased CD4 T-cell count, elevated viral levels, and certain treatment regimens. Implementing appropriate interventions could address these issues. Sub-Saharan Africa exhibits elevated rates of determinants for virologic failure, attributed to the delay in HIV testing and diagnosis, and late initiation of antiretroviral therapy (ART). It is essential to undertake further research aimed at enhancing the detection of resistance in HIV patients and mitigating viral failure by addressing these underlying causes.

The relationship of hip fracture and thyroid disorders: a systematic review.

Introduction: Bone density regulation is considered one of the systems affected by thyroid hormones, leading to low bone density that can result in pathologic fractures, including hip fractures. This review aimed to update clinicians and researchers about the current data regarding the relationship between hip fractures and thyroid disorders. Methods: English papers were thoroughly searched in four main online databases of Scopus, Web of Science, PubMed, and Embase. Data extraction was done following two steps of screening/selection using distinct inclusion/exclusion criteria. This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist and the Newcastle-Ottawa Scale (NOS) as bias assessment. Results: In total, 19 articles were included in the research. The risk of hip fractures in women with differentiated thyroid cancer (DTC) is higher than hip fractures caused by osteoporosis. Men with hyperthyroidism and subclinical hyperthyroidism are at higher risk for hip fracture. Also, a decrease in serum thyroid stimulating hormone (TSH) may be associated with an increased risk of hip fracture. Conclusion: Reaching a consensus conclusion regarding the association between subclinical thyroid dysfunction and hip fracture is not feasible due to the heterogenicity of evidence; however, there may be a higher risk of fracture in individuals with subclinical hyperthyroidism.

The possible role of viral infections in acute pancreatitis: a review of literature.

Acute pancreatitis, a potentially fatal disease, with symptoms including nausea and/or vomiting, indigestion, and abdominal pain, is known to range from a mild self-limiting state up to a more severe and lethal form. This review aims to provide a clearer picture to improve understanding the role of viral agents in the development of acute pancreatitis. Common databases including PubMed, Google Scholar, and Scopus were used for the literature search. In this review search terms including virus, viral, infection, and specific descriptive terms for a virus were considered in different combinations. Various causative agents are recognized in the development of acute pancreatitis as one of the most frequent gastrointestinal diseases, such as gallstones, alcoholism, and hypertriglyceridemia. Microbial pathogens with about 10% of acute pancreatitis cases, mainly viruses, among other factors, are thought to play a role in this regard. Once the pancreatitis diagnosis has been made, depending on the causative agent, the management approach and specific interventions affect the final outcome. Virus-induced acute pancreatitis in patients should be considered. Advanced diagnostic tests such as PCR, in situ hybridization, and biopsy can help for a better understanding of the role of viruses in causing acute pancreatitis. Improvement in the tests will lead to timely diagnosis, treatment, and better management of pancreatitis.

Prevalence of hepatitis B infection in the Gambian population: A narrative review of recent developments.

Hepatitis B is a "silent epidemic", fifty to a hundred (50-100) times more infectious than HIV, a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). HBV can cause acute and chronic infection and subsequently results in a high risk of death from cirrhosis and liver cancer. Despite the availability of a safe and effective vaccine, HBV continues to be a global burden including in The Gambia. This study reviewed the recent trends in the epidemiological characteristics of HBV in the Gambia. The researchers conducted an online literature search for primary studies on HBV prevalence published in the past two decades from Jan 1992 to Feb 2022 inclusive on Google Scholar, PubMed, and Scopus. All retrieved studies were assessed for eligibility according to specific inclusion/exclusion criteria, data completeness, and methodological coherence. We found that HBV infection prevalence is above 8% in The Gambia. Moreover, HBV is the most common cause of hepatocellular carcinoma (HCC) in Gambia. Liver cirrhosis and HCC have the highest mortality contribution among hepatitis patients, with occult HBV carriers as major culprits. Also, vaccination coverage has declined from 91% to 88% according to reports from current literature. To achieve the WHO goal of eliminating HBV by 2030, policies targeting infection transmission control among risk groups, community awareness programs, research, price reduction of drugs, mass vaccinations, and diagnostics should be urgently instituted.

The Effectiveness of Face Masks in Preventing COVID-19 Transmission: A Systematic Review.

INTRODUCTION: Since the beginning of the COVID-19 pandemic, face masks have been among the cornerstones of COVID-19 prevention. Therefore, evaluating their preventive effects against COVID-19 is crucial. This review aimed to systematically search for the systematic review articles that explored the role of various types of face masks in preventing COVID-19. METHODS: We browsed the keywords of this study in the online databases of Scopus, Web of Science, PubMed, and Cochrane on 10th January 2023 and retrieved all the relevant systematic review articles. The records were downloaded into an Endnote file, and the duplicates were removed. A two-step screening process consisting of title/abstract and full-text screenings was conducted to select the most relevant articles. To ensure the validity and reliability of the results, this study adhered to the PRISMA protocol. RESULTS: A total of 28 systematic reviews were included in this review. Most studies found that face masks are beneficial against viral respiratory infections, such as COVID-19. Different types of masks were evaluated in included studies. It appeared that mask efficacy depends on the material, layers, fitting on the face and user compliance. N 95 respirator had maximum efficacy, especially when used continuously. CONCLUSION: Face masks have a beneficial effect against COVID-19. Home masks are less protective than surgical masks or N95 personal breathing masks. Besides, the use of masks may elicit a false sense of security in people, which may lead to poor hand hygiene and violation of social distancing. Therefore, the necessary training should be provided to the public to increase awareness and encourage the right practice of using the mask, emphasizing the preventive effects of washing hands, social distancing, and using a face mask against COVID-19.

Prevalence and complication of COVID-19 in patients with ankylosing spondylitis (AS) and its relationship with TNF-a inhibitors.

INTRODUCTION: Ankylosing spondylitis (AS) is a condition that is treated with nonsteroidal anti-inflammatory drugs and biological drugs such as anti tumor necrosis factor alpha (TNF-α). This study examined the prevalence of COVID-19 among individuals with AS and compare it between those receiving and not receiving TNF-α inhibitors. METHODS: A cross-sectional study was conducted at the rheumatology clinic of Imam Khomeini Hospital in Tehran, Iran. The study included patients with AS who sought treatment at the clinic. Demographic information, laboratory and radiographic findings, and disease activity were recorded through interviews and examinations using a questionnaire. RESULTS: A total of 40 patients were studied over the course of 1 year. Among them, 31 patients were administered anti-TNF-α drugs, with 15 patients (48.3%) receiving subcutaneous Altebrel (Etanercept), 3 patients (9.6%) receiving intravenous Infliximab, and 13 patients (41.9%) receiving subcutaneous Cinnora (Adalimumab). Of the total, 7 patients (17.5%) tested positive for COVID-19, 1 of whom was confirmed through both CT scan and polymerase chain reaction (PCR) testing, while the remaining 6 patients were confirmed only through PCR testing. All patients tested positive for COVID-19 were male, and 6 of them had received Altebrel. Among the 9 AS patients who did not receive TNF inhibitors, 1 patient contracted SARS-CoV-2. The clinical symptoms experienced by these patients were mild, and hospitalization was not required. However, 1 patient who had insulin-dependent type 1 diabetes and was receiving Infliximab required hospitalization. This patient exhibited more severe COVID-19 symptoms, including high fever, pulmonary involvement, dyspnea, and decreased oxygen saturation. No cases of COVID-19 were reported in the Cinnora treatment group. The use of any of the drugs did not demonstrate a significant relationship with the occurrence of COVID-19 in patients. CONCLUSIONS: The use of the TNF-α inhibitors in patients with AS, may be associated with reduced hospitalization and death rate in COVID-19 cases.

Physical and functional evaluations in oncological patients elective to medium and large operations.

PURPOSE: To evaluate the risk of sarcopenia on the length of hospital stay and deaths in preoperative cancer patients as well its relation to physical and functional capacity. METHODS: Preoperative patients admitted to the Cancer Hospital of Mato Grosso comprised the sample. Sociodemographic data, lifestyle data, and a questionnaire for sarcopenia screening were collected. Subsequently, total body mass, height, muscle strength, muscle mass, and physical performance were evaluated. The primary, secondary and tertiary outcomes were sarcopenia, length of stay and death, respectively. The data were tabulated and analyzed using the statistical software SPSS (25.0). The significance level was 5%. RESULTS: We observed 12 (7.4%) patients with low muscle strength, 20 (12.3%) patients with low muscle mass, 11 (6.8%) patients with low physical performance, and 18 (11.1%) patients with scores for possible sarcopenia. When the risk of sarcopenia was observed, 44 (27.2%) patients had at least one risk related to muscle disorder. When analyzing the prevalence and association of sarcopenia with sociodemographic variables, we observed that education level was associated with sarcopenia (p = 0.031). In addition, there was an association between preoperative sarcopenia and postoperative death (p = 0.006). Finally, there were important correlations between muscle strength and physical performance (p < 0.05), between muscle strength and the sarcopenia questionnaire (p < 0.001), and between physical performance and the sarcopenia questionnaire (p < 0.05). CONCLUSION: The results suggest the need for counseling and the need to evaluate patients for risk of sarcopenia, since early intervention, such as dietary supplementation and physical exercise, may favor a better postoperative prognosis, possibly corresponding to shorter hospital stays and longer survival and quality of life for patients, especially those who will undergo surgical procedures.