Severe COVID pneumonia and undetectable B cells after vaccination in patients previously treated with rituximab: a case series

Efficacy, Immunogenicity, and Safety of COVID-19 Vaccines in Patients with Autoimmune Diseases: A Systematic Review and Meta-Analysis

Patients with autoimmune diseases are among the susceptible groups to COVID-19 infection because of the complexity of their conditions and the side effects of the immunosuppressive drugs used to treat them. They might show impaired immunogenicity to COVID-19 vaccines and have a higher risk of developing COVID-19. Using a systematic review and meta-analysis, this research sought to summarize the evidence on COVID-19 vaccine efficacy, immunogenicity, and safety in patients with autoimmune diseases following predefined eligibility criteria. Research articles were obtained from an initial search up to 26 September 2022 from PubMed, Embase, EBSCOhost, ProQuest, MedRxiv, bioRxiv, SSRN, EuroPMC, and the Cochrane Center of Randomized Controlled Trials (CCRCT). Of 76 eligible studies obtained, 29, 54, and 38 studies were included in systematic reviews of efficacy, immunogenicity, and safety, respectively, and 6, 18, and 4 studies were included in meta-analyses for efficacy, immunogenicity, and safety, respectively. From the meta-analyses, patients with autoimmune diseases showed more frequent breakthrough COVID-19 infections and lower total antibody (TAb) titers, IgG seroconversion, and neutralizing antibodies after inactivated COVID-19 vaccination compared with healthy controls. They also had more local and systemic adverse events after the first dose of inactivated vaccination compared with healthy controls. After COVID-19 mRNA vaccination, patients with autoimmune diseases had lower TAb titers and IgG seroconversion compared with healthy controls.

Cardiac auscultation predicts mortality in elderly patients admitted for COVID-19

INTRODUCTION

COVID-19 has had a great impact on the elderly population. All admitted patients underwent cardiac auscultation at the Emergency Department. However, to our knowledge, there is no literature that explains the implications of cardiac auscultation at the Emergency Department.

MATERIAL AND METHODS

Data collection from our hospital records. Our cohort consists of 300 admissions with a mean age of 81.6 years and 50.7% men.

RESULTS

Pathological cardiac auscultation at the Emergency Department was a risk factor for in-hospital mortality (RR = 1.9; 95% CI 1.3-2.8), heart failure (RR = 3.2; 95% CI = 1.8-5.6), respiratory failure (RR = 1.8; 95% CI = 1.3-2.5), acute kidney injury (RR = 2.6; 95% CI = 2-3.2), and ICU admission (RR = 3.3; 95% CI = 1.3-8.2). The findings in patients with pathological cardiac auscultation were that oxygen saturation in the Emergency Department, arterial pH, and HCO3^- were significantly lower, and the ALT/GPT, LDH, and lactate determinations were significantly higher, which is compatible and correlates with the fact that the main variable is indeed a risk factor for a more severe clinical course. Among the findings from pathological auscultation, arrhythmic tone/arrhythmia was the most frequent (50%) and a risk factor for in-hospital mortality (RR = 2.3; 95% CI = 1.6-3.4). Logistic regression was performed from a multivariate analysis that showed that the initial ex novo arrhythmia correlated with pathological cardiac auscultation is an independent risk factor for in-hospital mortality.

CONCLUSION

Continuous rhythm monitoring makes it possible to detect ex novo arrhythmias and act proactively, and to offer greater care and attention to these patients who have a higher risk of in-hospital mortality and a worse prognosis. Cardiac auscultation can alert us in order to perform more electrocardiograms in these patients and thus have better monitoring.

The deadliest lung lobe in COVID-19: a retrospective cohort study of elderly patients hospitalized for COVID-19

INTRODUCTION

The relationship between which lung lobe is affected on the chest X-ray (CXR) performed at the Emergency Department (ED) and mortality from COVID-19 has not been studied. With this in mind, the present study aimed to discern which lung lobe was the one with the highest associated mortality rate in the elderly population.

METHODS

Information was collected from the 2020 hospital admissions records of our hospital. Our cohort consists of 300 admissions.

RESULTS

The presence of the left lower lobe (RR = 1.6; 95% CI: 1.1-2.4) and right middle lobe involvement (RR =1.8; 95% CI: 1.2-2.7) on CXR at the ED were both predictive factors of in-hospital mortality. Right middle lobe involvement on CXR at the ED was the risk factor with the highest relative risk value (RR = 1.8). Furthermore, right middle lobe involvement on CXR at ED was a predictor for persistent organ failure (RR = 1.7; 95% CI: 1.2-2.3), respiratory failure (RR = 1.7; 95% CI: 1.2-2.4) and acute kidney injury (RR = 1.5; 95% CI: 1.2-2). The isolated right middle lobe involvement on CXR at ED was a risk factor for in-hospital mortality (RR = 2.6; 95% CI = 1.8 - 3.7). However, the affected right middle lobe along with another/other lobe/s was a null factor.

CONCLUSION

Right middle lobe involvement was an independent predictor of in-hospital mortality.