Objectives: Few data are available regarding follow up of patients with coronavirus disease 2019 (COVID-19) after their discharge. We aim to describe the long-term outcomes of survivors of hospitalization for COVID-19 followed up first at an outpatient facility and subsequently by telephone. Methods: Observational prospective study conducted at a tertiary general hospital. Clinical and radiological progression was assessed and data were recorded on a standardized reporting form. Patients were divided into three groups according to PaO 2 /FiO 2 at hospitalization: PaO 2 /FiO 2 >300, PaO 2 /FiO 2 300e200 and PaO 2 /FiO 2 <200. A logistic multivariate regression model was performed to identify factors associated with persistence of symptoms. Results: For facility follow up, 302 individuals were enrolled. Median follow up was 45 days after discharge; 78% (228/294) of patients had COVID-19-related symptoms (53% asthenia, 56% respiratory symptoms) and 40% (122/302) had residual pulmonary radiographic lesions. PaO 2 /FiO 2 <200 was an independent predictor of persistent dyspnoea (OR 1.87, 95% CI 1.38e2.52, p < 0.0001). PaO 2 /FiO 2 >300 was associated with resolution of chest radiographic lesions (OR 0.56, 95% CI 0.42e0.74, p < 0.0001). Fifty per cent of patients required specific medical follow up after the first consultation and were transferred to another physician. A total of 294 patients were contacted for telephone follow up after a median followup time of 7 months. Fifty per cent of patients (147/294) still presented symptoms and 49% (145/294) had psychological disorders. Asthenia was identified in 27% (78/294) and dyspnoea in 10% (28/294) of patients independently of PaO 2 /FiO 2 . Conclusions: Patients with COVID-19 require long-term follow up because of the persistence of symptoms; patients with low PaO 2 /FiO 2 during the acute illness require special attention.

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Introduction Tocilizumab is an interleukin 6 receptor antagonist which has been used for the treatment of severe SARS-CoV-2 pneumonia (SSP), aiming to ameliorate the cytokine release syndrome (CRS) -induced acute respiratory distress syndrome (ARDS). However, there is no data about the best moment for its administration along the course of the disease. Methods We provided tocilizumab on a compassionate-use basis to patients with SSP hospitalized (excluding intensive care and intubated cases) who required oxygen support to have a saturation >93%. Primary endpoint was intubation or death after 24 hours of its administration. Patients received at least one dose of 400 mg intravenous tocilizumab during March 8-2020, through April 20-2020. Findings A total of 207 patients were studied and 186 analysed. The mean age was 65 years and 68% were male. A co-existing condition was present in 68 % of cases. At baseline, 114 (61%) required oxygen support with FiO2 >0.5 % and 72 (39%) <0.5%. Early administration of tocilizumab, when the need of oxygen support was still below FiO2 <0.5%, was significantly more effective than given it in advanced stages (FiO2 >0.5 %), achieving lower rates of intubation or death (13% vs 37% repectively, p<0.001). Interpretation The benefit of tocilizumab in severe SARS-Cov-2 pneumonia is only expected when it is administrated before the need of high oxygen support.

Background/Objective: Immune-mediated necrotizing myopathy (IMNM) is a subtype of myositis that is associated with a refractory phenotype and poorer prognosis. The aim of the study was to provide single large center experience of outcomes of intravenous immunoglobulin (IVIg) for patients with IMNM using longitudinally collected data.Methods: This case series longitudinally evaluated 4 of the 6 myositis core set measures at baseline and at 3 and 6 months after IVIg on 20 adult IMNM patients from 2014 to 2019 at the University of Pittsburgh. We assessed patients for improvement in core set measures, prednisone dose, adverse effects, and by the "limited" ACR/EULAR 2016 myositis response criteria. The mean differences in CK and manual muscle testing (MMT-8) were compared using a paired t test. A clinically significant response was defined as a >10% absolute improvement in the MMT-8 and a >50% absolute reduction in serum CK at 6 months of IVIg.Results: Intravenous immunoglobulin treatment was associated with marked improvement in IMNM patients, with 85% of patient meeting clinically significant response. The median (interquartile range) relative percent improvement in CK level was 96% (85%-98%) and in MMT was 29% (14%-36%) at 6 months.There was a significant reduction in the mean (SD) dose of prednisone at 6 months and had minimal adverse effects. In addition, with IVIg, most (13/14) patients had at least minimal improvement as per ACR/ EULAR 2016 myositis response criteria.Conclusions: Based on objective, meaningful improvement in MMT-8 and CK as well as marked reduction in prednisone doses with acceptable tolerability, early implementation of IVIg should be considered in adult IMNM.

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Introduction The severe acute respiratory syndrome-coronavirus-2 (SARS-Cov2) pandemic has been overcome after more than 3 years1. Several patients were affected by neurosurgery-related complications during SARS-CoV-2 infection 2,3. The aim of the present study was to assess the incidence of SARS-Cov2-associated intracranial hemorrhage (ICH), the reasons therefore and to identify predictors of outcome. Methods We retrospectively analyzed data of patients with SARS-CoV-2 infection admitted to the intensive care unit (ICU) of our hospital in the period of 2 years. We included all patients who acquired a SARS-CoV-2 infection and required intensive care treatment. All patients were followed up until death or discharge from ICU. The primary outcome was the incidence of mortality during ICU stay and occurrence of ICH. We compared survivors and non-survivors with ICH during their ICU stay and patients who developed intracerebral hemorrhage with those who did not. Results Four hundred and sixty-seven patients with a mean age of 64.33 (± 14.76) years with confirmed SARS-CoV2-infection were registered. The mortality rate during ICU stay was 32.11%. Within the two years period, 18 out of 467 patients (3,85%) with spontaneous SARS-Cov2-associated ICH were treated in our department. In the multivariate analysis, ICH was not identified as an independent risk factor for mortality. ECMO treatment (OR 5.130, 95%: 1.739-15.133, p=0.003) was the only independent risk factor of the occurrence of ICH. Conclusion SARS-Cov2-associated ICH itself did not result in increased mortality in patients with SARS-CoV-2 infection treated on the ICU. We hypothesize, that increased mortality in patients with ICH is caused by other comorbidities such as renal failure requiring dialysis, age over 65, the use of ECMO and mechanical ventilation. The use of ECMO was found to be the strongest independent risk factor associated with the occurrence of ICH.