The strategy is effective in reducing unsafe abortions and their health consequences.
Background/objective This study aims to describe the course and to identify poor prognostic factors of SARS-CoV-2 infection in patients with rheumatic diseases. Methods Patients ≥ 18 years of age, with a rheumatic disease, who had confirmed SARS-CoV-2 infection were consecutively included by major rheumatology centers from Argentina, in the national, observational SAR-COVID registry between August 13, 2020 and July 31, 2021. Hospitalization, oxygen requirement, and death were considered poor COVID-19 outcomes. Results A total of 1915 patients were included. The most frequent rheumatic diseases were rheumatoid arthritis (42%) and systemic lupus erythematosus (16%). Comorbidities were reported in half of them (48%). Symptoms were reported by 95% of the patients, 28% were hospitalized, 8% were admitted to the intensive care unit (ICU), and 4% died due to COVID-19. During hospitalization, 9% required non-invasive mechanical ventilation (NIMV) or high flow oxygen devices and 17% invasive mechanical ventilation (IMV). In multivariate analysis models, using poor COVID-19 outcomes as dependent variables, older age, male gender, higher disease activity, treatment with glucocorticoids or rituximab, and the presence of at least one comorbidity and a greater number of them were associated with worse prognosis. In addition, patients with public health insurance and Mestizos were more likely to require hospitalization. Conclusions In addition to the known poor prognostic factors, in this cohort of patients with rheumatic diseases, high disease activity, and treatment with glucocorticoids and rituximab were associated with worse COVID-19 outcomes. Furthermore, patients with public health insurance and Mestizos were 44% and 39% more likely to be hospitalized, respectively. Study registration This study has been registered in ClinicalTrials.gov under the number NCT04568421. Key Points • High disease activity, and treatment with glucocorticoids and rituximab were associated with poor COVID-19 outcome in patients with rheumatic diseases. • Some socioeconomic factors related to social inequality, including non-Caucasian ethnicity and public health insurance, were associated with hospitalization due to COVID-19.
e13610 Background: In March 2020, a health emergency was decreed due to COVID-19 and this produced changes in the organization of health services. One of the objectives of the reorganization that took place was a reduction in face-to-face consultations (FTFC), and the promotion of telephone consultations (TC). Objective: Evaluate the effectiveness of TC and the level of satisfaction of patients attending the Mastology Unit using this method during the COVID health emergency. Methods: A prospective, cross-sectional study. A survey was used to assess the effectiveness of TC and the level of satisfaction with the method. Results: : Forty-two patients were surveyed, of which 69% were receiving adjuvant treatment and 14.2% palliative treatment. With regard to the effectiveness of TC, 76.1% of those surveyed had their appointment resolved by telephone; 78.6% of patients preferred to do the consultation by telephone; 97.6% believed that sufficient time was spent and that the timing of the appointment was appropriate. The responses showed a high degree of satisfaction with the care received. The medical care met the expectations of all patients, and 83.3% believed that once normalcy was restored, TC would be an option for their situation Conclusions: The TC method was evaluated with a high degree of satisfaction and allowed care to be maintained during the emergency. Although it is early to assess the healthcare impact of TC and the method's capacity to resolve issues, preliminary results show that it is a useful and valuable tool in clinical practice during periods of healthcare emergency.
e12502 Background: After the government declared a health emergency due to COVID-19 on March, 2020, the Mastology Teaching Unit (UDAM) providing care to breast cancer patients tried to ensure adequate oncological care, and to protect patients from the virus infection and serious complications due to a possible state of immunosuppression. Towards this objective, the Department of Clinical Oncology developed guidelines with some treatment modifications. Objective: To assess the health care activities of the UDAM during the period considered as the “peak” of the pandemic, since its beginning to June 30, 2020. Methods: This is an observational study that collected data from the electronic clinical record system called Oncology Electronic Health Record (HCEO) during the aforementioned period. Results: There werea total of 293 medical appointments (221 in person), through which 131 patients were attended to. The number of medical appointments decreased by 16.7% compared to the same period in 2019 (352 appointments). Of the patients who were attended to during the “peak” period, 109 (83.2%) were on systemic onco-specific treatment and 22 (16.8%) were attended to for disease control. The medical appointments were scheduled to evaluate the continuity of treatment and treatment modifications if necessary (95 patients; 72.5%), for disease control (17; 12.9%), for first-time consultation (12; 9.1%) and to assess paraclinical studies (7; 5.3%). The patients were on hormone therapy (HT) (81 patients; 74%), chemotherapy (CT) (21; 19%), and anti-HER2 therapies (9; 8%). A total of 20 treatments were initiated, 14 with HT and 6 with CT. Of the 21 patients on CT, 14 (66.6%) were on adjuvant/neoadjuvant therapy. Of these, 9 (64.3%) continued with the same regimen with the addition of prophylactic granulocyte colony stimulating factors (G-CSF), and 5 (35.7%), who were receiving weekly paclitaxel, continued the treatment with no changes. The remaining 7 of 21 patients (33.3%) were on palliative CT. Of these, 2 (28.5%) continued the treatment with the addition of G-CSF, 3 (42.8%) continued with weekly capecitabine or paclitaxel with no treatment changes, and 2 (28.5%) changed their treatment regimen (a less myelosuppressive regimen was selected for one of them and this decision was due to the progression of the disease in the other patient). The 90 patients who were receiving adjuvant, neoadjuvant, or palliative criteria HT and/or anti-HER2 therapies, continued the treatment with no changes Conclusions: Although these are preliminary results, the available evidence suggests that, although medical appointments decreased by approximately 17%, the UDAM was able to maintain its healthcare activities and continued most of the treatments. The most modified treatment was CT, with the addition of prophylactic G-CSF, to avoid myelosuppression and potential complications from COVID-19 infection.
Introducción: el lupus eritematoso sistémico (LES) es una enfermedad sistémica que se ha asociado a mayor severidad con la infección por SARS-CoV-2. Particularmente la alta actividad de la enfermedad y algunos inmunosupresores se han vinculado a peores desenlaces. Objetivos: describir las características por SARS-CoV-2 en pacientes con LES en Argentina del registro SAR-COVID y establecer los factores asociados a peor desenlace de la misma. Materiales y métodos: estudio observacional. Se incluyeron pacientes con diagnóstico de LES con infección confirmada por SARS-CoV-2 (RT-PCR y/o serología positiva) del registro SAR-COVID. Los datos se recolectaron desde agosto de 2020 hasta marzo de 2022. El desenlace de la infección se midió mediante la escala ordinal de la Organización Mundial de la Salud (EO-OMS). Se definió COVID-19 severo con un valor EO-OMS ≥5. Análisis descriptivo, test T de Student, U de Mann Whitney U, ANOVA, chi2 y Fisher. Regresión logística múltiple. Resultados: se incluyeron 399 pacientes, el 93% de sexo femenino, con una edad media de 40,9 años (DE 12,2). El 39,6% tenía al menos una comorbilidad. Al momento de la infección, el 54,9% recibía glucocorticoides, el 30,8% inmunosupresores y el 3,3% agentes biológicos. La infección por SARS-CoV-2 fue leve en la mayoría de los casos, mientras que un 4,6% tuvo curso severo y/o falleció. Estos últimos presentaban comorbilidades, usaban glucocorticoides y tenían síndrome antifosfolípido (SAF) con mayor frecuencia y mayor actividad de la enfermedad al momento de la infección. En el análisis multivariado, la hipertensión arterial, el diagnóstico de SAF y el uso de glucocorticoides se asociaron a hospitalización severa y/o muerte por COVID-19 (EO-OMS ≥5). Conclusiones: en esta cohorte de pacientes con LES con infección por SARS-CoV-2 confirmada, la mayoría cursó de manera sintomática, un 22,1% fue hospitalizado y un 5% requirió ventilación mecánica. La mortalidad fue cercana al 3%. El diagnóstico de SAF, tener hipertensión arterial y el uso de glucocorticoides se asociaron significativamente con COVID-19 severo.
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