Reduction in the risk of progression of solid organ transplant recipients infected by SARS-CoV-2 treated with monoclonal antibodies.

Recipients of solid organ transplants (SOT) are at higher risk of infection by SARS-CoV-2 virus especially due to chronic immunosuppression therapy and frequent multiple comorbid conditions. COVID-19 is a potentially life-threatening disease in SOT recipients, with an increased likelihood of progressing to severe disease, with the need of hospitalization, admission to the intensive care unit (ICU) and mechanical ventilatory support. This article presents an updated review of different aspects related to the outcome of COVID-19 in SOT recipients. In nvaccinated SOT recipients, COVID-19 is associated with a high mortality rate, in-patient care and ICU admission, and impaired graft function or rejection in severe disease. In vaccinated SOT recipients even after full vaccination, there is a reduction of the risk of mortality, but the course of COVID-19 may continue to be severe, influenced by the time from transplant, the net state of immunosuppression and having suffered graft rejection or dysfunction. SOT recipients develop lower immunity from mRNA vaccines with suboptimal response. Treatment with mAbs provides favorable outcomes in non-hospitalized SOT recipients at high risk for severe disease, with lower rates of hospitalization, emergency department visits, ICU care, progression to severe disease, and death. However, broad vaccination and therapeutic options are required, particularly in light of the tendency of the SARS-CoV-2 virus to adapt and evade both natural and vaccine-induced immunity.

[Effect of antidiabetes treatment adjustment at discharge on 30-day outcomes of patients with diabetes mellitus presenting to an emergency department with hypoglycemia]. / Efecto del ajuste del tratamiento al alta en los resultados a 30 días en los pacientes diabéticos atendidos por hipoglucemia en un servicio de urgencias hospitalario.

BACKGROUND: To determine if antidiabetes treatment adjustment at discharge from an Emergency Department(ED) is associated with 30-day outcomes in patients with diabetes mellitus presenting to the ED with hypoglycemia. METHODS: Retrospective cohort observational study. Patients with diabetes mellitus presenting to the ED with hypoglycemia directly discharged from the ED between 2012-2014 were included. Primary outcome was a 30-day composite adverse event(mortality or revisiting). RESULTS: A total of 203 patients were included with a mean age of 69.7 (SD 18.9), mainly type 2 diabetics.Hypoglycemia was the primary diagnosis in 162(79%) of patients and antidiabetes treatment was adjusted at discharge in 98 (48%) of cases. Non-adjustment of antidiabetes treatment at ED discharge was an independent factor associated with a 30-day adverse event (OR=2.8; CI 95%=1.34-5.93; p=0.006). CONCLUSIONS: Non-adjustment of antidiabetes treatment at discharge in patients with diabetes mellitus presenting to the ED with hypoglycemia could be an independent factor of suffering a 30-day adverse event.

Efecto del ajuste del tratamiento al alta en los resultados a 30 días en los pacientes con diabetes mellitus atendidos por hipoglucemia en un servicio de urgencias hospitalario / Effect of antidiabetes treatment adjustment at discharge on 30-day outcomes of patients with diabetes mellitus presenting to an emergency department with hypoglycemia

Fundamento: Determinar si ajustar el tratamiento antidiabético al alta se relaciona con los resultados a 30 días en los pacientes con diabetes mellitus atendidos por hipoglucemia en un servicio de urgencias (SU). Método: Estudio observacional de cohorte retrospectivo. Se incluyeron todos los pacientes con diabetes mellitus con hipoglucemia dados del alta desde SU entre 2012-2014. La variable resultado fue un evento adverso por cualquier causa a los 30 días. Resultados: El estudio se realizó en 203 pacientes con edad media de 69,7(DE 18,9) mayoritariamente con diabetes mellitus tipo 2. El diagnóstico de hipoglucemia fue principal en 162 (79%) y se realizó ajuste terapéutico en 98 (48%) casos. El no ajuste de tratamiento fue un factor independiente asociado con un evento adverso a los 30 días (OR=2,82; IC 95%=1,34-5,93; p=0,006). Conclusiones: No ajustar el tratamiento antidiabético al alta del SU podría ser un factor independiente de sufrir un resultado adverso a los 30 días en los pacientes con diabetes mellitus que presentaron hipoglucemia en un SU (AU)

Background: To determine if antidiabetes treatment adjustment at discharge from an Emergency Department (ED) is associated with 30-day outcomes in patients with diabetes mellitus presenting to the ED with hypoglycemia. Methods: Retrospective cohort observational study. Patients with diabetes mellitus presenting to the ED with hypoglycemia directly discharged from the ED between 2012-2014 were included. Primary outcome was a 30-day composite adverse event (mortality or revisiting). Results: A total of 203 patients were included with a mean age of 69.7 (SD18.9), mainly type 2 diabetics. Hypoglycemia was the primary diagnosis in 162 (79%) of patients and antidiabetes treatment was adjusted at discharge in 98 (48%) of cases. Non-adjustment of antidiabetes treatment at ED discharge was an independent factor associated with a 30-day adverse event (OR=2.8; CI 95%=1.34-5.93; p=0.006). Conclusions: Non-adjustment of antidiabetes treatment at discharge in patients with diabetes mellitus presenting to the ED with hypoglycemia could be an independent factor of suffering a 30-day adverse event (AU)