An epidemiological survey of COVID-19 serology and its association with clinical infection among older adults- does antibody titer matter?

BACKGROUND: Older adults are at increased risk of severe SARS-CoV-2 infection. In this study we assessed the response to COVID-19 vaccination and infection rates among nursing homes (NH) and assisted-living care home (ALCH) residents. METHODS: The study was conducted between August 2021 and January 2022, after widespread population vaccination with the third dose of Pfizer-BioNtech mRNA COVID-19 vaccine in Israel. Three groups were addressed: hospitalized older patients; NH and ALCH residents. Demographic data, COVID-19 serology (anti-spike IgG antibodies) and PCR test results were obtained to assess the dynamics of antibody titers and its correlation to infection rates. RESULTS: Two-hundred eighty-five individuals were evaluated; 92 hospitalized patients; 100 ALCH residents and 93 NH residents. In the latter two groups two serology surveys were conducted three months apart. Hospitalized patients were younger than ALCH and NH residents (mean age 80.4 ± 8 versus 82.6 ± 8 and 83.6 ± 5, respectively, p = 0.01), and had more comorbidities (p = 0.003). The degree of decline in the antibody level overtime was similar in ALCH and NH residents. Infection rates were higher among NH residents than ALCH residents [35/91 (38.4%) versus 11/100 (11%), p < 0.001]. Antibody level was lower among those infected [2113 (1271-3512) Au/ml versus 4113 (3364-5029) Au/ml, p < 0.001]. Adjusted analysis showed that NH residence, but not antibody levels, were significantly associated with infection. CONCLUSION: Among older adults, infection rates inversely correlated with antibody level. However, only nursing home residence was significantly associated with infection, suggesting that other factors such as crowding considerably contribute to the risk of infection.

Safety of oesophagogastroduodenoscopy in a nonagenarian population.

BACKGROUND: invasive gastrointestinal (GI) procedures are increasingly performed on much older patients but data regarding oesophagogastroduodenoscopy (OGD) in this population are limited. We compared the indications, safety and benefits of OGD for nonagenarians compared to octogenarians. METHODS: an observational retrospective review of patients who underwent OGD between 2013 and 2018 at a gastroenterology institute in one large hospital. Patients aged 90 and above 'nonagenarians' were compared to those aged 80-89 'octogenarians'. RESULTS: 472 patients (231 nonagenarians and 241 octogenarians), median age of 91 for nonagenarians (201 aged 90-94, 30 aged 95 and older) and 82 (174 aged 80-84, 67 aged 85-89) for octogenarians. GI bleeding was a more common and dyspepsia, a less common, indication for nonagenarians compared to octogenarians (55 and 7%, versus 43 and 18%). Significant findings and need for endoscopic treatments were both more commonly found in nonagenarians compared to octogenarians (25 and 24% versus 15 and 8%, respectively). General anaesthesia was more commonly given to nonagenarians (35 versus 10%). Immediate complications and 30-day mortality rate were similar between the groups: (2.6% of nonagenarians versus 1.6% of octogenarians). Of 30 patients aged 95 and older, 13% had late adverse events, compared to 1% of the overall cohort. CONCLUSIONS: OGD appears safe in nonagenarians. Pathological findings and endoscopic interventions are more common. Decisions regarding OGD should not be based on age alone.

[PROTEINURIA IN PATIENTS WITH ACUTE URINARY TRACT OBSTRUCTION].

AIMS: Urinary tract obstructions (UTO) induce tubular injury. The hypothesis explored in this study is that UTO can cause transient proteinuria. The aims of this study were to determine whether patients with UTO have a higher incidence/severity of proteinuria compared with catheterized patients without UTO and whether proteinuria resolves at short term follow-up. METHODS: This was a prospective, matched case control study that included 100 patients; 50 with acute UTO and 50 controls. Proteinuria was quantified using three consecutive 24-hour urinary collections during a week of hospitalization and its incidence, severity, and quantitative changes were compared between the study groups. RESULTS: Groups were similar by age (83.12±7.94 versus 84.48±9.39 (p=0.44)), major comorbidities, chronic medical treatment and causes of hospitalization. Abnormal proteinuria was observed in all patients with UTO and 94% of the control group. The degree of proteinuria was similar between the groups in the first, second and third 24-hour urine collections (638±419, 828±743, 728±944 vs. 620±639, 648±741, 732±841 mg/24 hours; p=0.88, 0.23 and 0.99, respectively). Proteinuria did not change significantly during a week of in-hospital follow-up in either study group (p=0.19 for trend). CONCLUSIONS: This study demonstrated a very high incidence of significant proteinuria in a cohort of hospitalized patients either with or without acute UTO. Proteinuria does not resolve in the early period after the relief of UTO. Future study with longer follow-up is needed to determine if this proteinuria resolves or persists following hospital discharge and if it has long-term prognostic significance.

[PREVALENCE OF AND POSSIBLE RISK FACTORS FOR PROLONGED HOSPITAL STAY IN DEPARTMENTS OF INTERNAL MEDICINE].

BACKGROUND: Prolonged hospitalization (PH) is associated with increasing rates of complications and cost. OBJECTIVES: To detect and quantify causes and predictors for PH in current practice. METHODS: PH was defined as higher than the 70th percentile of the mean hospitalization duration for each department (two medical departments and one acute geriatric ward). Demographic and clinical data were collected on admission in order to determine predictive factors for PH. Actual causes for PH were tested on the 4th day of hospitalization for all patients by: (1) questioning the patients' attending physicians using a structured questionnaire; (2) assessing the patients' charts using a validated tool. RESULTS: Data were collected during a 5-month study period for all 1092 consecutively admitted patients hospitalized in the three departments in the study of whom 337 (30%) had a PH. In the multivariate analysis we detected the following independent predictors for PH: (1) unmarried patients; (2) dependent-patients; (3) hospitalization in the geriatric versus medical department; (4) an expected high mortality rate according to a validated prediction score; (5) renal failure on admission; (6) prior admission in the previous 6 months. The disease leading to the current admissions was the reason for continued admission on day 4 in the patients with eventual PH in 85% of the cases, as compared to 93% in the control group with regular-duration of hospitalization (p=0.014). On day 4, non-medical reasons for prolonged duration were detected in 7% of those with eventual PH as compared to 1% in the control group (p=0.018). CONCLUSIONS: We already detected demographic and clinical predictors for PH on admission, some of which may be amenable to intervention.