Outcomes of patients with cancer infected with SARS-CoV-2: results from the Ion Chiricuta Oncology Institute series.

BACKGROUND: The evolution of COVID-19 is a controversial topic in cancer patients. They have been designated by international organizations as a vulnerable population at greater risk for contracting SARS-CoV-2 and having a more severe clinical outcome. PATIENTS AND METHODS: Active screening at our institution became routine early in the pandemic. We have examined the clinical data of 341 cancer patients, with a positive RT-PCR SARS-CoV-2 test between April 2020 and February 2021, in the prevaccination era. RESULTS: During the infection, 40.5% remained asymptomatic, 27.6% developed a mild form, 20.5% had a moderate form, and 11.4% a severe/critical form of COVID-19 that led to death in 7.6% of cases. Treatment was adapted to disease severity according to national guidelines. In our series, the incidence of COVID-19 infection was lower in cancer patients compared with the general population (P < 0.001), however, the mortality rate was higher in cancer patients in comparison with the general population (7.6% versus 2.9%, P < 0.001). The prognostic factors were assessed by three distinct univariate and multivariate analyses: (i) evolution to a moderate or severe/critical clinical manifestation, (ii) clinical worsening (severe/critical form or death), and (iii) overall survival. In the multivariate analysis, the prognostic factors associated with the evolution to a moderate or severe/critical clinical manifestation were: performance status (PS) (P < 0.0001) and no active treatment in the previous 3 months (P = 0.031). Factors associated with clinical worsening were: PS (P < 0.0001), peripheral arterial disease (P = 0.03), and chronic liver disease (P = 0.04). Factors associated with impaired overall survival were PS (P < 0.0001), ischemic cardiac disease (P = 0.0126), chronic liver disease (P = 0.001), and radiotherapy (P = 0.0027). CONCLUSION: Our series confirms a more severe evolution for COVID-19 infection in cancer patients, with PS as the most prominent prognostic factor in all three multivariate analyses. By active screening, efforts should be in place to keep cancer units as coronavirus-free sanctuaries.

[Meteorological risk factors of ischemic stroke]. / Meteorologicheskie faktory riska razvitiia ishemicheskogo insul'ta.

AIM: To study an impact of climate triggers on the seasonal incidence of ischemic stroke (IS). MATERIAL AND METHODS: Case histories of 1144 patients with IS were studied. The incidence rate was distributed over months and seasons. Indicators of circannual patterns are calculated as the arithmetic average of morbidity, data on meteorological measurements of temperature, atmospheric pressure and air humidity for the corresponding seasons of the year for the city of Orel. RESULTS: There was a weak correlation between the incidence rate and some meteorological indicators. The high direct correlations were found between the incidence, temperature, humidity (first set) and the incidence, pressure and humidity (second set) (0.701 and 0.764, respectively according to Cheddok). CONCLUSION: Meteorological triggers exert the effect on the incidence of IS. The procedure for calculating correlation indicators described in the study can be used to predict the morbidity in a particular hospital during a calendar year.

[Cognitive disorders and their correction in patients with ischemic stroke].

A study of the effectiveness of long-term (within a year) use cytoprotector neuropeptide nature of the drug cortexin (in the acute, early and late recovery periods) on the dynamics of the cognitive status of patients with ischemic stroke. The study involved 80 patients first ischemic stroke (IS). The patients of the main group (40 patients) received standard therapy cortexin + 10 mg once a day intramuscularly for 10 days with the same course again at 3, 6, 9 months during the year, the control group (40 people) - basic and vascular therapy for year. Four-time reception cortexin for a year at 10 mg once a day for 10 days promotes regression pronounced movement disorders, stabilize and restore cognitive function, and minimize the likelihood of post-stroke cognitive impairment during the recovery period.

[Efficacy of cereton in acute ischemic stroke: results of the trial SOLNTSE].

We studied 95 patients with acute (no later than 24h after onset) carotid ischemic stroke. Patients of the main group (50 patients) received cereton in dose 4 ml (1000 mg) intravenously during 10 days in the combination with traditional treatment; 45 patients of the control group received only traditional treatment. Neurological deficit on NIHSS and vigilance on The Glasgow Coma Scale were assessed at baseline and in 5th, 7th and 19-21th days. The Barthel index was used to measure functional independence of the patient at the discharge from a hospital (21th day). The "cost-effectiveness" ratio, the cost of one score on the NIHSS and Barthel scales were calculated. The reduction in neurological deficit (p<0.05) and higher extent of functional independence were seen in the main group compared to the controls. Based on the "cost-effectiveness" analysis, the use of cereton was shown to be more effective for treatment of patients with acute ischemic stroke: the cost of the achievement of positive effect in patients of the control group receiving only traditional treatment was significantly higher (p<0.05).

[The efficacy of work in the department for patients with acute disturbances of cerebral blood circulation].

The literature data revealed different, sometimes contradictory, views on the influence of the treatment in neurovascular departments of patients with stroke on mortality, fatal, short- and long-term outcomes, quality of life of patients and their need in secondary care. In Orel city (a population is about 331,300) patients with acute disturbances of cerebral blood circulation are admitted to neurovascular departments of the Region clinic (60 beds plus 6) and to the Semashko envergency hospital (40 beds plus 6 beds in the intensive therapy ward), where neurologists are able to use all methods of critical intensive therapy. The work of the latter hospital proved to be effective with an decrease of fatal outcomes and patients' disablement.

[An improvement of step-by-step medical care for patients with ischemic stroke in Orel region].

In Orel region, standardized mortality rates of cerebrovascular disorders (CVD) are one of the lowest in Russian Federation (RF)--200.1 per 100,000 population as compared to 316 per 100,000 in the country. According to the brain stroke register, CVD mortality in Orel city was evaluated as 79 per 100,000 population. The causes of such decrease are as follows: (1) people are well informed about the first signs of stroke and 60% of patients referred to medical services after the first signs; (2) Municipal Health Care department issued an instruction on the immediate hospitalization, with a small number of contra-indications, of all patients with acute lesions of brain blood circulation (ABBC)--as a result, 70% of patients were admitted within the first 6 hours from stroke development; (3) an efficient system of the first pre-hospital care performed by an emergency team, with delivering stroke patients to hospitals by the team that first diagnosed ABBC; (4) sufficient hospital facilities (100 beds for vascular neurological patients with 12 beds for intensive therapy per 331,300 population); (5) hospitalization of all patients with acute stroke to vascular neurological departments with intensive therapy wards and neurologists trained all the methods of critical care and intensive therapy; (6) a sufficient supply of all medications necessary for treatment of the acute stage of stroke. The scheme of therapeutic and diagnostic care for patients with ischemic stroke is proposed that could be recommended for organization of medical care to patients with ABBC in RF cities and towns.

[A comparative analysis of organization of care for patients with stroke in Russia, Europe and the United States]. / Sravnitel'nyi analiz organizatsii pomoshchi bol'nym s insul'tom v Rossii, Evrope i SShA.

Studies of the systems of medical care for patients with acute disorders of brain circulation indicate that well-organized "stroke" service promotes morbidity decrease, lowers neurological deficit expression and restriction of social and daily activities. At the same time, there are essential differences in the scope of the medical care, which a patient can receive in different countries and no consensus on the most optimal system of medical scope for patients with stroke at different stages. The recent statistical reviews confirm that a patient admitted to specialized stroke departments has a less chance to die or to be a handicap. The article analyzes current systems service for patients with acute disorders of brain blood circulation in the United States, Europe and Russia.