Patients In Terms Of Symptoms Research Articles

Humoral response after breakthrough SARS-CoV-2 infection in type 2 diabetes mellitus patients

Abstract Type 2 diabetes mellitus (T2DM) remains an important public health problem in both developing and developed countries. In addition, the recent COVID-19 pandemic has revealed furthel risks for diabetes patients in terms of symptoms and disease progression. Higher mortality and morbidity are related to the complexity of the pathology of this chronic underlying disease, which negatively affects the immune response to the SARSCoV-2 virus. The humoral response plays an important role in the eradication of the virus; thus, it was analyzed in vaccinated diabetics who underwent COVID-19, as well as in the control group. The aim of this study was to assess the prevalence and level of IgG antibodies raised against the nucleocapsid protein (NCP), S1 subunit receptor binding domain (RBD) and subunit Spike 2 (S2) subunit of the virus’s S protein using the Microblot Array test. The results demonstrated significantly lower prevalence and titers of anti-SARS antibodies in diabetic patients compared to the control group. In addition, antibody titers were negatively related to the duration of this chronic disease, body mass index (BMI), comorbidities and HbA1c concentration. Further research is needed to develop the best strategy for specific prevention of SARS-CoV-2 infection in diabetic patients.

MO672: Covid-19 in Patients on Peritoneal Dialysis: A Case-Series

BACKGROUND AND AIMSA great amount of information has been divulged on the epidemiology and outcome of coronavirus disease 2019 (COVID-19) in patients with ESRD. The majority of the studies have been conducted in patients on maintenance hemodialysis (HD) and kidney transplant recipients. Unfortunately, few studies focused on the outcome of peritoneal dialysis (PD) patients. Information regarding this subset of the population has been extrapolated from aggregated data including a higher percentage of HD patients. As a result, the impact of COVID-19 is indefinite in patients receiving PD. We conducted a study to better understand how patients on PD have been affected by COVID-19.METHODWe conducted a single-center retrospective analysis of 141 PD patients followed at the University Hospital of Modena, Italy from 1 March 2020 to 31 December 2021. The diagnosis of COVID-19 was performed through nasopharyngeal swab RT–PCR testing. Duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding measured the time elapsed from diagnosis of COVID-19 to one or two (if available) negative nasopharyngeal PCR tests. Median and interquartile range or mean and standard deviation were used for continuous variables and percentage for categorical variables. A P-value <0.05 was considered statistically significant.RESULTSDuring the pandemic, 18 out of 141 (12.7%) patients receiving PD dialysis contracted COVID-19. Median age was 60 (50.2–66.5) years with a predominance of males (72.2%)The percentage of patients on APD accounted for 33.3%.The infection was symptomatic in out of 18 (94.4%) patients. Fever (94.4%) and cough (55.6%) were the most common symptoms. Viral shedding, traced with nasopharyngeal swabs lasted 26 (14.5–3.5) days. Two patients were inactive on the waiting list for kidney transplantation for a mean of 43 ± 1.4 days.COVID-19 caused hospital admission of seven (38.9%) patients. During hospitalization two (11.1%) patients switched from PD to HD for ultrafiltration failure and inadequate solute clearance and two (11.1%) died for septic shock with multiorgan failure. In our cohort of patients, excess death due to COVID-19 was 22.2%.Half of the patients contracted the infection before the availability of SARS-CoV-2 vaccine. There were no statistically significant differences between vaccinated and unvaccinated patients in terms of symptoms, viral shedding and hospital admission or (Table 1). We underline that COVID-19 was fatal only in two unvaccinated patients.Table 1.Demographic and clinical characteristics of patients on PD with COVID-19VariablesAllpatientsUnvaccinated patientsVaccinated patientsP-value(n. 18)(n. 9)(n. 9)Age, years60 (50.2–66.5)54 (52–65)62 (39–73)0.96Male, n. (%)13 (72.2)8 (88.8)5 (55.5)0.29Dialysis vintage, years0.9 (0.7–2.4)1.2 (0.5–2.9)0.94 (0.7–2)0.85CAPD, n. (%)6 (33.3)2 (33.3)4 (44.4)0.6Immunosuppressive therapy6 (33.3)1 (16.7)5 (55.5)0.13Etiology of ESRD0.59 Hypertensive nephropathy6 (33.3)4 (44.4)2 (22.2) Diabetic nephropathy3 (16.7)2 (22.2)1 (11.1) IgA nephropathy2 (11.1)1 (11.1)1 (11.1) Lupus nephritis2 (11.1)0 (0)2 (22.2) Others5 (27.8)2 (22.2)3 (33.3)Comorbidities Diabetes6 (33.3)3 (33.3)3 (33.3)1 CVD7 (38.9)4 (44.4)3 (33.3)1 Obesity5 (27.8)2 (22.2)3 (33.3)1 Cancer3 (16.7)2 (22.2)1 (11.1)1Symptoms Cough10 (55.6)7 (77.7)3 (33.3)0.15 Fever17(94.4)9 (100)8 (88.8)1 Dyspnea6 (33.3)3 (33.3)3 (33.3)1Asymptomatic, n. (%)1 (5.6)0 (0)1 (11.1)1Viral shedding, day26 (14.5–33.5)26 (15–35)27.5 (11.5–33)0.51Switch to HD2 (11.1)1 (11.1)1 (11.1)1Hospitalization, n. (%)7 (38.9)3 (33.3)4 (44.4)1Death, n. (%)2 (11.1)2 (22.2)0 (0)0.47CONCLUSIONThis study reports the monocentric experience of a large PD center during the COVID-19 pandemic. COVID-19 was symptomatic in the majority of patients and led to hospitalization of about 40% of the patients. The rate of symptoms, viral shedding and hospital admission was similar between vaccinated and unvaccinated patients. Two unvaccinated patients died for the severe consequence of COVID-19.

Impact of first COVID-19 lockdown on paediatric and adult haemophilia patients treated in a French Haemophilia Comprehensive Care Centre.

IntroductionThe coronavirus disease 2019 (COVID‐19) pandemic has created an unprecedented global health crisis.AimTo investigate the impact of the 1st COVID‐19 lockdown on haemophilia patients in terms of symptoms, management, medication adherence, mental health and lifestyle behaviours.MethodsA prospective cross‐sectional phone survey using a two‐part questionnaire was conducted in haemophilia patients (adults and children) followed‐up in a French Haemophilia Comprehensive Care Centre between May 5, 2020 and June 2, 2020 (CLEO CD study: NCT04390126).ResultsAmong 284 haemophilia A or B patients with FVIII or FIX < 40% contacted for the study, 239 (84%) including 183 adults and 56 children participated to the survey. In 81% of children and 78% of adults, bleeding episodes remained unchanged or decreased. Medication adherence was 82.0% in adults and 98.2% in children. Non‐adherence concerned haemostatic agents in six patients and analgesics in three. Overall, 67% of adults and 71% of children felt as good as before lockdown. In both adults and children, the three major changes in lifestyle behaviours were: increase in screen time (49% and 57%), decrease in physical activity (43% and 48%), and weight gain (32% and 27%), respectively.ConclusionsEncouraging results were observed in terms of haemophilia symptoms, medication adherence, and mental health. Conversely, a negative impact was observed on lifestyle behaviours in a cohort of French haemophilia patients during the 1st lockdown.

Triage and urgent dental care for COVID-19 patients in the Hospital District of Helsinki and Uusimaa

Objective This paper describes and reports the patient-specific characteristics of an urgent dental care clinic for COVID-19 infected, suspected, exposed or quarantined patients from March to December 2020 in the Hospital District of Helsinki and Uusimaa, Finland. Material and methods The triage and the treatment protocol were established based on the scientific data. Patient files were evaluated from the hospital district’s electronic medical record system. IBM SPSS software was used for statistical analysis. Results There were 1114 consultations and 257 visits at the clinic. Most of the patients were generally healthy with mean age of 35, had toothache and were suspected to be SARS-CoV-2 positive. Seventeen of the patients received positive tests for COVID-19 infection. The main treatment was tooth extraction, mostly due to caries. Statistically significant differences between COVID-19 infected and other patients occurred in age (45 vs 34 years-of-age, p = .009) and number of teeth (25 vs 28, p = .031). No SARS-CoV-2 infection transmission chains were traced to the clinic. Conclusion During the challenging pandemic time, patients were carefully screened by specialists in clinical dentistry and treated safely and effectively. Patient-specific characteristics revealed no differences between COVID-19 infected and other patients in terms of symptoms or treatment needs.

Evaluation of COVID-19 Thorax Computed Tomography Findings in Hemodialysis Patients

Aim: Coronavirus disease 2019 (COVID-19) is an unprecedented cause of pandemics affecting all segments of society. It is not known whether hemodialysis patients form a different patient group in terms of susceptibility to COVID-19 infection or severe disease. In this study, thorax computed tomography (CT) findings were evaluated in hemodialysis patients diagnosed with COVID-19 infection during the pandemic period.&#x0D; Material and Methods: CT findings of 32 hemodialysis patients diagnosed with COVID-19 with real-time polymerase chain reaction or thorax CT examination were evaluated retrospectively. Radiological findings were classified as ground glass, consolidation, mixed type involvement (ground glass and consolidation), crazy paving appearance, interlobular septal thickening, nodule, halo-reverse halo finding, air bronchogram finding, subpleural curvilinear opacities and tree-in-bud views.&#x0D; Results: A total of 32 patients were included in the study. Twenty-one (65.6%) of the patients were male and 11 (34.4%) were female. The mean age was 67.5±8.5 years. All patients had chronic kidney failure. Thorax CT examination revealed ground-glass opacities in 14 (43.8%) patients, consolidation in 3 (9.4%) patients, and mixed type involvement (ground-glass opacities and consolidation) in 15 (46.9%) patients. The accompanying CT findings were pleural effusion in 23 (71.9%) patients, subpleural curvilinear opacities in 13 (40.6%) patients, bronchial wall thickening in 11 (34.4%) patients, lymphadenopathy in 7 (21.9%) patients, bronchiectasis in 4 (12.5%) patients and pleural thickening in 4 (12.5%) patients.&#x0D; Conclusion: When hemodialysis patients are infected with COVID-19 infection, they differ significantly from other COVID-19 patients in terms of symptoms, clinical course, and prognosis, as well as imaging findings.

Recurrent Bell's palsy: outcomes and correlation with clinical comorbidities.

SUMMARYRecurrent Bell’s palsy (RBP) has been reported to range from 2.6 to 15.2% of primary Bell’s palsy (BP) and has been associated with systemic comorbidities such as diabetes and hypertension. A retrospective analysis of patients affected by BP and RBP were performed to define the signs and symptoms associated with recurrence and the outcomes. Clinical and subjective characteristics of 341 patients affected by facial palsy were analysed. Facial function was assessed via House-Brackmann and Sunnybrook grading system. Characteristics of the palsy and systemic comorbidities (diabetes, hypertension, herpetic infections, autoimmunity disorders, audio-vestibular symptoms) were analysed in BP and RBP patients applying Fisher exact and the Mann-Whitney U tests, while time to recovery was explored with univariate and multivariate analysis. Twenty-four patients presented two or more episodes of facial palsy, representing a recurrence rate of 7%. Associated symptoms (e.g. retroauricular pain, taste disorder, dry eye etc.) were similar between BP and RBP patients. RBP occurred at older age than primary episode (p = 0.03). Recurrence was a risk factor for delayed recovery (p = 0.02), although final facial function was similar between the two groups. In conclusion, no significant differences were found between primary BP patients and RBP patients in terms of symptoms, palsy severity and presence of comorbidities. Delayed facial nerve function recovery in RBP did not affect the final outcome. Treatment of facial nerve recurrences must be the same of the primary episode, although the presence of prodromal symptoms may alert the patient and early corticosteroid treatment may be commenced even before the onset of paresis.

Long-term benefit of ixekizumab treatment in Japanese patients in terms of symptoms and quality of life

Long-term benefit of ixekizumab treatment in Japanese patients in terms of symptoms and quality of life

Rate control in atrial fibrillation: looking beyond the average heart rate

The aim of this article is to provide a perspective on rate control in atrial fibrillation which emphasizes patient wellbeing (exercise tolerance, symptoms, quality of life) over attempts to reduce resting or exercise heart rate to an arbitrary range. Recent trials of rhythm versus rate control strategies of treatment in patients with atrial fibrillation suggest that rate control is a viable first line strategy in many patients. The adverse consequences of atrial fibrillation with rapid ventricular response are partly due to factors other than rate itself, such as irregularity of ventricular response, and variable changes in autonomic nervous system output. Digoxin, calcium channel blockers, and beta-blockers cause a similar reduction in resting heart rate. Beta blockers are the most potent at reducing exercise heart rate, followed by calcium channel blockers and digoxin. Exercise tolerance is occasionally improved by digoxin, sometimes improved by calcium channel blockers and not improved by (and sometimes decreased by) beta-blockers. Information about quality of life with different rate control regimens is sparse. Rate control in atrial fibrillation provides important benefits to patients in terms of symptoms, quality of life and prevention of late consequences of uncontrolled rate (such as tachycardia induced cardiomyopathy). Restricting treatment objectives to achievement of a specific heart rate range on resting or exercise electrocardiogram may result in lack of patient benefit or worsened symptoms. Understanding the nuances of rate control when treating individual patients and interpreting existing evidence allows patients to experience the most benefit from this treatment strategy.

Digoxin?Doubts to dampen enthusiasm

Dear Sir: Controversy concerning the use of digoxin in patients with heart failure in sinus rhythm has existed for almost the whole of the present century [1-4]. The debate is not finished. Several recent withdrawal studies [5-7] have revived enthusiasm for the use of digoxin, and the results of the large mortality study currently being undertaken by the National Institute of Health in America are awaited. The article by F.I. Marcus [8] in this journal puts forward an optimistic view. He believes that several clinical trials have shown unequivocally that digoxin decreases symptoms of cardiac failure and declares that the major unresolved question concerning digoxin is safety. I beg to differ. The first issue is to identify what are the key clinical questions concerning the use of digoxin. No physician doubts the value of digoxin in controlling the fast heart rate of patients with atrial fibrillation with or without heart failure. The question is not whether digoxin in patients with heart failure and in sinus rhythm is positively inotropic either acutely or chronically. Nor is the question whether digoxin in selected groups of patients under particular circumstances can be shown to be beneficial for heart failure. Such an argument could be used to justify the continual use of leaches. The key question for the clinician is whether, after a patient has received optimal t reatment with ACE inhibitors and a combination of diuretics, the addition of digoxin confers further advantage. The reason that this question is key is that the current initial t reatment for overt heart failure is the careful and thoughtful use of [9] an ACE inhibitor combined with a diuretic. The results from the study by Lee et al. in 1982 showed that patients with fluid overload and a third heart sound benefitted from the use of digoxin. That is to be expected, but exactly the same result might have been obtained by the propitious use of an ACE inhibitor and a diuretic. Indeed the clinical and hemodynamic benefit [10] in patients is probably related to change in total body weight [11]. There may be subgroups of patients in whom digoxin is particularly useful, but those subgroups need to be identified in carefully controlled clinical trials. Physicians may well have their own suspicions of who those particular groups might be. There have been a very large number of studies on the use of digoxin in the last century [3,4,12,13]. Most have been withdrawal or observational studies. Some included patients in atrial fibrillation. Very few of these studies would fulfill current criteria for a proper clinical trial. The historical data have been reviewed. One meta-analysis [4] and one overview have been published recently [3]. The meta-analysis found seven trials in the world literature that fulfill the criteria for a modern study but only six of these were included in the overview. The one additional study [5] was rejected from the overview because it was a withdrawal study and did not fulfill the appropriate criteria. The meta-analysis came to the conclusion that there was evidence that the number of patients in the control group who were withdrawn from studies was statistically different from those withdrawn in the group on digoxin. The overview was unable to show any benefit to patients in terms of symptoms or exercise capacity. The numbers are far too small to show any benefit in terms of mortality. These data do not lie easily with the claim by Dr. Marcus that digoxin unequivocally decreases symptoms of heart failure. Furthermore, withdrawal is not a rigorous or robust endpoint for a trial, nor does it answer the question as to whether the patients would be more appropriately treated with diuretics and ACE inhibitors. In one recent trial, withdrawal gave an advantage to patients because those patients were not then exposed to the risk of continuing with the drug [14]. Recently three withdrawal studies have been reported. One has been published as a full paper [5] and the other two as abstracts [6,7]. The problem with this approach is that it does not answer the clinical