Hospital Epidemics Tracker (HEpiTracker): Description and pilot study of a mobile app to track COVID-19 in hospital workers

Background: Hospital workers have been the most frequently and severely affected professional group during the COVID-19 pandemic, and have a big impact on transmission. In this context, innovative tools are required to measure the symptoms compatible with COVID-19, the spread of infection, and testing capabilities within hospitals in real time. Objective: We aimed to develop and test an effective and user-friendly tool to identify and track symptoms compatible with COVID-19 in hospital workers. Methods: We developed and pilot tested Hospital Epidemics Tracker (HEpiTracker), a newly designed app to track the spread of COVID-19 among hospital workers. Hospital staff in 9 hospital centers across 5 Spanish regions (Andalusia, Balearics, Catalonia, Galicia, and Madrid) were invited to download the app on their phones and to register their daily body temperature, COVID-19-compatible symptoms, and general health score, as well as any polymerase chain reaction and serological test results. Results: A total of 477 hospital staff participated in the study between April 8 and June 2, 2020. Of note, both health-related (n=329) and non-health-related (n=148) professionals participated in the study; over two-thirds of participants (68.8%) were health workers (43.4% physicians and 25.4% nurses), while the proportion of non-health-related workers by center ranged from 40% to 85%. Most participants were female (n=323, 67.5%), with a mean age of 45.4 years (SD 10.6). Regarding smoking habits, 13.0% and 34.2% of participants were current or former smokers, respectively. The daily reporting of symptoms was highly variable across participating hospitals; although we observed a decline in adherence after an initial participation peak in some hospitals, other sites were characterized by low participation rates throughout the study period. Conclusions: HEpiTracker is an already available tool to monitor COVID-19 and other infectious diseases in hospital workers. This tool has already been tested in real conditions. HEpiTracker is available in Spanish, Portuguese, and English. It has the potential to become a customized asset to be used in future COVID-19 pandemic waves and other environments

EAACI Biologicals Guidelines-Recommendations for severe asthma

Severe asthma imposes a significant burden on patients, families and healthcare systems. Management is difficult, due to disease heterogeneity, co-morbidities, complexity in care pathways and differences between national or regional healthcare systems. Better understanding of the mechanisms has enabled a stratified approach to the management of severe asthma, supporting the use of targeted treatments with biologicals. However, there are still many issues that require further clarification. These include selection of a certain biological (as they all target overlapping disease phenotypes), the definition of response, strategies to enhance the responder rate, the duration of treatment and its regimen (in the clinic or home-based) and its cost-effectiveness. The EAACI Guidelines on the use of biologicals in severe asthma follow the GRADE approach in formulating recommendations for each biological and each outcome. In addition, a management algorithm for the use of biologicals in the clinic is proposed, together with future approaches and research priorities.Peer reviewe

Efficacy and Safety of Reslizumab in Patients with Severe Asthma with Inadequate Response to Omalizumab: A Multicenter, Open-Label Pilot Study

[Background] Patients with severe allergic and eosinophilic asthma could qualify for different biologic therapies.[Objective] To evaluate the efficacy and safety of weight-based intravenous reslizumab dosing in patients who have previously failed therapy with omalizumab.[Methods] We carried out a 24-week prospective, multicenter, open-label, single-group, self-controlled study in patients with severe eosinophilic asthma who had previously failed to respond to omalizumab. The main objective was to determine whether treatment with reslizumab significantly improved asthma symptoms assessed by the Asthma Control Test (ACT) at week 24. Secondary objectives were to evaluate symptoms at weeks 4 and 12, change in FEV1 at week 24, and the incidence of severe exacerbations over the study period.[Results] Twenty-nine patients (62.1% women, median age, 50.8 years) were included in the study. The median ACT score significantly increased from 13.0 (interquartile range, 8.0-18.0) at baseline to 21.0 (interquartile range, 14.0-24.0) at 24 weeks (P = .002). Only 2 of 29 patients developed at least 1 severe exacerbation during follow-up and none of them required hospitalization. Overall, 15 of 25 patients (60%) were considered as being controlled (ACT score of ≥20 and no exacerbations) at week 24. The percentage of patients who were receiving daily systemic corticosteroids significantly decreased from 72.4% to 52.0% (P = .019). Adverse events were mostly moderate and within the range of previously reported side effects with reslizumab.[Conclusion] Reslizumab is an effective and safe option for patients with severe eosinophilic asthma and a history of omalizumab failure

Estudio multicéntrico, prospectivo, de comparación del tratamiento de la tromboembolia pulmonar submasiva con enoxaparina y heparina no fraccionada

Objetivo: Evaluar la eficacia y seguridad del tratamiento de la tromboembolia pulmonar submasiva (TEP) con enoxaparina en comparación con heparina no fraccionada. Pacientes y métodos: Se incluyó en el estudio, de forma prospectiva, a 56 pacientes con TEP que no precisaron tratamiento fibrinolítico. Se asignaron de forma aleatoria a dos grupos de tratamiento: el grupo A, que recibió enoxaprina (1 mg/kg cada 12 h) y el grupo B, al que se le administraron dosis ajustadas de heparina no fraccionada. La anticoagulación oral se inició una vez que el diagnóstico se comprobó y se mantuvo durante 6 meses. Se evaluó la incidencia de recurrencia tromboembólica y de hemorragia mayor al cabo de ese tiempo. Resultados: Seis pacientes fueron excluidos del estudio. De los 50 finalmente incluidos, 29 fueron asignados al grupo A (enoxaparina) y 21 al grupo B (heparina no fraccionada). Tres pacientes del grupo A (10,7%) fueron diagnosticados de recurrencia tromboembólica, mientras que dicha complicación se constató en dos pacientes del grupo B (9,5%). No se encontraron diferencias significativas. Dos pacientes fallecieron, siendo una de las muertes achacada a hemorragia secundaria a la anticoagulación oral (grupo A) y la otra a un proceso independiente a la enfermedad tromboembólica. Conclusiones: El empleo de enoxaparina en el tratamiento inicial del TEP parece ser tan efectivo y seguro como el uso de heparina no fraccionad

Obesity-hypoventilation syndrome: increased risk of death over sleep apnea syndrome.

AIM:To study whether mortality and cardiovascular morbidity differ in non-invasive ventilation (NIV)-treated patients with severe obesity-hypoventilation syndrome (OHS) as compared with CPAP-treated patients with obstructive sleep apnea syndrome (OSAS), and to identify independent predictors of mortality in OHS. MATERIAL AND METHODS:Two retrospective cohorts of OHS and OSAS were matched 1:2 according to sex, age (± 10 year) and length of time since initiation of CPAP/NIV therapy (± 6 months). RESULTS:Three hundred and thirty subjects (110 patients with OHS and 220 patients with OSAS) were studied. Mean follow-up time was 7 ± 4 years. The five year mortality rates were 15.5% in OHS cohort and 4.5% in OSAS cohort (p< 0.05). Patients with OHS had a 2-fold increase (OR 2; 95% CI: 1.11-3.60) in the risk of mortality and 1.86 fold (OR 1.86; 95% CI: 1.14-3.04) increased risk of having a cardiovascular event. Diabetes, baseline diurnal SaO2 < 83%, EPAP < 7 cmH2O after titration and adherence to NIV < 4 hours independently predicted mortality in OHS. CONCLUSION:Mortality of severe OHS is high and substantially worse than that of OSAS. Severe OHS should be considered a systemic disease that encompasses respiratory, metabolic and cardiovascular components that require a multimodal therapeutic approach

Univariate analysis of risk factors related to mortality in OHS patients.

<p>SaO2: oxygen saturation; NIV: non invasisve ventilation; CPAP: continuous positive airway pressure; EPAP: expiratory positive airway pressure; IPAP: inspiratory positive airway pressure; BIPAP: bilevel positive airway pressure; CVE: cardiovascular events; HF: heart failure.</p><p>Univariate analysis of risk factors related to mortality in OHS patients.</p

Kaplan Meier curves for time to first cardiovascular event.

<p>Kaplan Meier curves for time to first cardiovascular event.</p

Independent predictors of mortality on Multivariate Analysis for OHS patients.

<p>Independent predictors of mortality on Multivariate Analysis for OHS patients.</p

Epworth sleepiness scale, basal arterial blood gas results, sleep study findings and therapeutic intervention for the 2 cohorts.

<p>Values are expressed as mean ± SD or No. of patients (%). PaO2: arterial oxygen pressure; PaCO2: arterial carbon dioxide pressure; AHI: apnea-hypopnea index; DI4: nocturnal desaturation ≥ 4% index; CT90%: cumulative percentages of sleep time with SaO₂ <90%; CPAP: continuous positive airway pressure; NIV: non invasive ventilation; IPAP: inspiratory positive airway pressure; EPAP: expiratory positive airway pressure.</p><p>Epworth sleepiness scale, basal arterial blood gas results, sleep study findings and therapeutic intervention for the 2 cohorts.</p