Timing of convalescent plasma administration and 28-day mortality in COVID-19 pneumonia.

This is a multicenter cohort study including consecutive, hospitalized patients ≥18 years, with moderate to severe COVID-19, carried out to evaluate the relationship between the timing of convalescent plasma administration and 28-day mortality. Data were prospectively collected between May 14, 2020 and October 31, 2020. Patients were grouped according to the timing of administration of convalescent plasma as <3 days, between 3 and 7 days, and >7 days. The main outcome variable was 28-day mortality. Independent predictors of mortality were identified by logistic regression. Of 4719 patients receiving convalescent plasma, 3036 (64.3%) were in the general ward, 1171 (24.8%) in the intensive care unit (ICU), and 512 (10.8%) in the ICU on mechanical ventilation. Convalescent plasma was administered to 3113 (66%) patients within the first 3 days of hospital admission, to 1380 (29.2%) between 3 and 7 days, and to 226 after 7 days; 28-day mortality was, respectively, 18.1%, 30.4% and 38.9% (p<0.001). In the regression model, convalescent plasma administration within the first 3 days of admission was associated with reduced 28-day mortality, compared with the administration after 7 days (OR 0.40, 95% CI 0.30 to 0.53). Early convalescent plasma administration was associated to a significant decreased mortality in patients in the general ward (OR 0.45, 95% CI 0.29 to 0.69) and in the ICU (OR 0.35, 95% CI 0.19 to 0.64), but not in those requiring mechanical ventilation (OR 0.52, 95% CI 0.27 to 1.01). In conclusion, this study suggests that early administration of convalescent plasma to patients with COVID-19 pneumonia is critical to obtain therapeutic benefit.

Risk factors for COVID-19 mortality: The effect of convalescent plasma administration.

BACKGROUND: Convalescent plasma, widely utilized in viral infections that induce neutralizing antibodies, has been proposed for COVID-19, and preliminary evidence shows that it might have beneficial effect. Our objective was to determine the risk factors for 28-days mortality in patients who received convalescent plasma for COVID-19 compared to those who did not, who were admitted to hospitals in Buenos Aires Province, Argentina, throughout the pandemic. METHODS: This is a multicenter, retrospective cohort study of 2-month duration beginning on June 1, 2020, including unselected, consecutive adult patients with diagnosed COVID-19, admitted to 215 hospitals with pneumonia. Epidemiological and clinical variables were registered in the Provincial Hospital Bed Management System. Convalescent plasma was supplied as part of a centralized, expanded access program. RESULTS: We analyzed 3,529 patients with pneumonia, predominantly male, aged 62±17, with arterial hypertension and diabetes as main comorbidities; 51.4% were admitted to the ward, 27.1% to the Intensive Care Unit (ICU), and 21.7% to the ICU with mechanical ventilation requirement (ICU-MV). 28-day mortality was 34.9%; and was 26.3%, 30.1% and 61.4% for ward, ICU and ICU-MV patients. Convalescent plasma was administered to 868 patients (24.6%); their 28-day mortality was significantly lower (25.5% vs. 38.0%, p<0.001). No major adverse effects occurred. Logistic regression analysis identified age, ICU admission with and without MV requirement, diabetes, and preexistent cardiovascular disease as independent predictors of 28-day mortality, whereas convalescent plasma administration acted as a protective factor. CONCLUSIONS: Our study suggests that the administration of convalescent plasma in COVID-19 pneumonia admitted to the hospital might be associated with improved outcomes.

Prognostic impact of atrial fibrillation progression in a community study: AFBAR Study (Atrial Fibrillation in the Barbanza Area Study).

INTRODUCTION: The aim of the study is to describe the natural history of an unselected population of patients with atrial fibrillation (AF) currently attending primary care services in a single health-service area in Galicia, north-western Spain. METHODS: AFBAR is a transverse prospective study in which 35 general practitioners within one health-service area have enrolled patients diagnosed with AF who presented at their clinics during a three-month recruiting period. Primary endpoints are mortality or hospital admission. Here we report the results of the first 7-month follow-up period. RESULTS: 798 patients (421 male) were recruited; mean age of cohort was 75 years old. Hypertension was the most prevalent risk factor (77%). 87% of the patients were both overweight and obese. Permanent AF was diagnosed in 549 patients (69%). In the follow-up period, 16.4% of the patients underwent a primary endpoint and the overall survival was 98%. The following independent determinants of primary endpoint were identified: change in AF status (Hazard Ratio (HR) 2.89 (95% confidence interval (CI) 1.28-6.55); p=0.011); ischemic heart disease (IHD) (HR 2.78 (95% CI 1.51-5.13); p=0.001); pre-recruitment hospital admission (HR 2.22 (95% CI 1.18-4.19); p=0.013); left ventricular systolic dysfunction (HR 2.19 (95% CI 1.11-4.32); p=0.023); or AF-related complications (HR 1.98 (95% CI 1.10-3.56); p=0.022). CONCLUSIONS: In the first 7-month follow-up period of patients with AF in a primary care setting the study identified several independent risk factors for mortality or hospital admission, i.e. change in AF status, ischemic heart disease, left ventricular systolic dysfunction, previous AF-related complications and hospital admission.

Socially mediated alcohol preferences in adolescent rats following interactions with an intoxicated peer.

This study focuses on "passive social influences" (alcohol-related information acquired by an organism that interacts with an intoxicated counterpart) that can potentially affect alcohol preference in adolescent rats. Five experiments were conducted to investigate whether repeated social interactions with an intoxicated peer can generate alcohol-related memories that lead an animal to exhibit heightened alcohol olfactory preference patterns. Juvenile experiences with alcohol were operationalized as follows: interactions with an alcohol-intoxicated peer (Experiment 1), with an alcohol-scented cotton surrogate (Experiment 2) or with an anesthetized alcohol-intoxicated partner (Experiments 3-5). Periadolescents were then evaluated in a two-way location olfactory test where they had the opportunity to investigate a hole scented with alcohol odor or vanilla (an odorant naturally preferred by the strain of rats here utilized). Only juveniles that interacted with an alcohol-intoxicated peer were found to exhibit a significant change in alcohol odor preferences when compared to appropriate controls that interacted with a non-intoxicated peer. Alcohol odor exposure alone or interactions with an anesthetized alcohol-intoxicated peer were not sufficient to establish changes in preference for alcohol sensory cues. Results indicate that social interactions with an intoxicated peer determine heightened preference for alcohol cues in periadolescents. The establishment of this preference seems to require behavioral manifestations of the intoxicated counterpart, instead of just being dependent on an olfactory pre-exposure to alcohol cues.

Adolescent rats discriminate a mild state of ethanol intoxication likely to act as an appetitive unconditioned stimulus.

Practically no information is available in relation to the capability of the adolescent animal in terms of discriminating postabsorptive effects of ethanol. Three experiments were conducted to analyze whether young, genetically heterogeneous rats discriminate different stages of the process of intoxication exerted by a low dose (0.5 g/kg) of ethanol. An ethanol pharmacokinetic profile was first examined to select two stages within the process of ethanol intoxication that, as a function of the corresponding blood ethanol concentrations (BECs), could represent two potentially discriminable drug states. In a second experiment, sucrose was available when the BECs of rats peaked or were of a lesser magnitude (5 and 30 min postadministration time, respectively). When animals were tested under similar or different drug states relative to the training procedure, no behavioral evidence indicative of differential sucrose expectancy was obtained. In Experiment 3, rats discriminated each of the previously defined ethanol states from a non-drug state. Unexpectedly, it was also found that the pharmacological effects of the 0.5-g/kg dose of ethanol are likely to support appetitive associative learning that involves the taste of sucrose as a conditioned stimulus. The apparent positive affective components of the state of ethanol intoxication have rarely been observed in genetically heterogeneous rats with rather brief experiences with the drug's effects.