Highlights Clinical performance of five different commercially available automated SARS-CoV-2 antibody tests. No overlap of “false” positive samples between different serology assays was observed. The ability to rule out acute SARS-CoV-2 infection at hospital admission with serology is limited.

While several studies have described the clinical course of patients with coronavirus disease 2019 (COVID-19), direct comparisons with patients with seasonal influenza are scarce. We compared 166 patients with COVID-19 diagnosed between February 27 and June 14, 2020, and 255 patients with seasonal influenza diagnosed during the 2017–18 season at the same hospital to describe common features and differences in clinical characteristics and course of disease. Patients with COVID-19 were younger (median age [IQR], 59 [45–71] vs 66 [52–77]; P < 0001) and had fewer comorbidities at baseline with a lower mean overall age-adjusted Charlson Comorbidity Index (mean [SD], 3.0 [2.6] vs 4.0 [2.7]; P < 0.001) than patients with seasonal influenza. COVID-19 patients had a longer duration of hospitalization (mean [SD], 25.9 days [26.6 days] vs 17.2 days [21.0 days]; P = 0.002), a more frequent need for oxygen therapy (101 [60.8%] vs 103 [40.4%]; P < 0.001) and invasive ventilation (52 [31.3%] vs 32 [12.5%]; P < 0.001) and were more frequently admitted to the intensive care unit (70 [42.2%] vs 51 [20.0%]; P < 0.001) than seasonal influenza patients. Among immunocompromised patients, those in the COVID-19 group had a higher hospital mortality compared to those in the seasonal influenza group (13 [33.3%] vs 8 [11.6%], P = 0.01). In conclusion, we show that COVID-19 patients were younger and had fewer baseline comorbidities than seasonal influenza patients but were at increased risk for severe illness. The high mortality observed in immunocompromised COVID-19 patients emphasizes the importance of protecting these patient groups from SARS-CoV-2 infection.

ObjectiveTo determine the effectiveness of digital telemedicine interventions designed to improve outcomes in patients with multimorbidity.DesignSystematic review and meta-analysis of available literature.Data sourcesMEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the Database of Abstracts of Reviews of Effectiveness and hand searching. The search included articles from inception to 19 April 2019 without language restrictions. The search was updated on 7 June 2020 without additional findings.Eligibility criteriaProspective interventional studies reporting multimorbid participants employing interventions with at least one digital telemedicine component were included. Primary outcomes were patient physical or mental health outcomes, health-related quality of life scores and the utilisation of health services.ResultsOut of 5865 studies initially identified, 7 articles, reporting on 6 studies were retained (total of 699 participants). Four of these studies reported interventions including integration with usual care, two studies had interventions with no links to usual patient care. Follow-up periods lasted between 2 and 6 months. Among the studies with links to usual care, the primary outcomes were systolic blood pressure (SBP) (three studies), haemoglobin A1c (HbA1c) (three studies), total cholesterol (two studies) and self-perceived health status (one study). The evidence ranged from very low to moderate certainty. Meta-analysis showed a moderate decrease in SBP (8 mm Hg (95% CI 4.6 to 11.4)), a small to moderate decrease in HbA1c (0.46 mg/dL (95% CI 0.25 to 0.67)) and moderate decrease in total cholesterol (cholesterol 16.5 mg/dL (95% CI 8.1 to 25.0)) in the intervention groups. There was an absence of evidence for self-perceived health status. Among the studies with no links to usual care, time to hospitalisation (median time to hospitalisation 113.4 days intervention and 104.7 days control group, absolute difference 12.7 days) and the Minnesota Living with Heart Failure Questionnaire (intervention group 35.2 score points, control group 23.9 points, absolute difference 11.3, 95% CI 5.5 to 17.1) showed small reductions. The Personal Health Questionnaire (PHQ-8) showed no evidence of improvement (intervention 7.6 points, control 8.6 points, difference 1.0 points, 95% CI −22.9% to 11.9%).ConclusionDigital telemedicine interventions provided moderate evidence of improvements in measures of disease control but little evidence and no demonstrated benefits on health status. Further research is needed with clear descriptions of conditions, interventions and outcomes based on patients’ and healthcare providers’ preferences.PROSPERO registration numberCRD42019134872.

In this study, we directly compared coronavirus disease 2019 (COVID-19) patients hospitalized during the first (27 February–28 July 2020) and second (29 July–31 December 2020) wave of the pandemic at a large tertiary center in northern Germany. Patients who presented during the first (n = 174) and second (n = 331) wave did not differ in age (median [IQR], 59 years [46, 71] vs. 58 years [42, 73]; p = 0.82) or age-adjusted Charlson Comorbidity Index (median [IQR], 2 [1, 4] vs. 2 [0, 4]; p = 0.50). During the second wave, a higher proportion of patients were treated as outpatients (11% [n = 20] vs. 20% [n = 67]), fewer patients were admitted to the intensive care unit (43% [n = 75] vs. 29% [n = 96]), and duration of hospitalization was significantly shorter (median days [IQR], 14 [8, 34] vs. 11 [5, 19]; p < 0.001). However, in-hospital mortality was high throughout the pandemic and did not differ between the two periods (16% [n = 27] vs. 16% [n = 54]; p = 0.89). While novel treatment strategies and increased knowledge about the clinical management of COVID-19 may have resulted in a less severe disease course in some patients, in-hospital mortality remained unaltered at a high level. These findings highlight the unabated need for efforts to hamper severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) transmission, to increase vaccination coverage, and to develop novel treatment strategies to prevent mortality and decrease morbidity.

Die saisonale Influenza ist eine akute, impfpräventable respiratorische Erkrankung, die durch das Influenzavirus (RNA, Orthomyxoviridae) verursacht wird [1]. Die Grippewelle der Saison 2017/2018 war die schwerste seit dem Jahr 2001 [2]. Etwa 65,0 % der nachgewiesenen Influenzainfektionen waren vom Influenza Typ B und gehörten fast ausschließlich der Yamagata-Linie an [2]. Die B-Komponente des während der Influenzasaison überwiegend genutzten, trivalenten Influenzaimpfstoffes basierte auf der Victoria-Linie und bot daher keinen hinreichenden Schutz vor einer Infektion mit der Yamagata-Linie. In der Influenzasaison 2017/2018 wurden in Deutschland etwa 9.000.000 zusätzliche influenzabedingte Arztkonsultationen und 45.000 Hospitalisierungen berichtet. Neben den Die Autoren C. Kraef und M. v. d. Meirschen habenzugleichenTeilenbeigetragen.

COVID-19 is a respiratory tract infection that can affect multiple organ systems. Predicting the severity and clinical outcome of individual patients is a major unmet clinical need that remains challenging due to intra- and inter-patient variability. Here, we longitudinally profiled and integrated more than 150 clinical, laboratory and immunological parameters of 173 patients with mild to fatal COVID-19. Using systems biology, we detected progressive dysregulation of multiple parameters indicative of organ damage that correlated with disease severity, particularly affecting kidneys, hepatobiliary system, and immune landscape. By performing unsupervised clustering and trajectory analysis, we identified T and B cell depletion as early indicators of a complicated disease course. In addition, markers of hepatobiliary damage emerged as robust predictor of lethal outcome in critically ill patients. This allowed us to propose a novel clinical CO VID-19 S everi T y (COST) score that distinguishes complicated disease trajectories and predicts lethal outcome in critically ill patients.

Der Morbus Mondor bezeichnet ursprünglich eine oberflächliche Venenthrombose einer gesunden Vene entlang der anterolateralen thorakalen Brustwand. Mittlerweile werden auch oberflächliche Venenthrombosen anderer spezifischer Lokalisationen, beispielsweise am Penis, darunter subsumiert. Im folgenden Fallbericht stellen wir einen jungen Patienten mit einem nach einer beidseitigen inguinalen Crossektomie aufgetretenen penilen Morbus Mondor vor. Der Klinische FallWir berichten über einen sonst gesunden 48-jährigen Patienten, der sich 3 Wochen nach beidseitiger inguinaler Crossektomie in unserer Klinik vorstellte. Er berichtete von Schmerzen und einem Druckgefühl im Penis sowohl im unerigierten als auch im erigierten Zustand. Die Eigen-und die Familienanamnese in Bezug auf thromboembolische Erkrankungen wurden verneint. Das präoperative Blutbild sowie die Gerinnung zeigten keine Auffälligkeiten. Körperliche UntersuchungKlinisch zeigte sich eine tastbare Verhärtung ohne umgebende Rötung im Verlauf der Vena dorsalis penis superficialis und einer Vene am lateralen rechten Hoden (▶ Abb. 1 und ▶ Abb. 2).▶ Abb. 1 Klinischer Befund des penilen Morbus Mondor. ▶ Abb. 2 Klinischer Befund der V. dorsalis penis superficialis.