COVID-19 in adult acute myeloid leukemia patients: a long-term follow-up study from the European Hematology Association survey (EPICOVIDEHA)

COVID-19; Acute myeloid leukemia; SurveyCOVID-19; Leucemia mieloide aguda; EncuestaCOVID-19; Leucèmia mieloide aguda; EnquestaPatients with acute myeloid leukemia (AML) are at high risk of dying from coronavirus disease 2019 (COVID-19). The optimal management of AML patients with COVID-19 has not been established. Our multicenter study included 388 adult AML patients diagnosed with COVID-19 between February 2020 and October 2021. The vast majority were receiving or had received AML treatment in the preceding 3 months. COVID-19 was severe in 41.2% and critical in 21.1% of cases. The chemotherapeutic schedule was modified in 174 patients (44.8%), delayed in 68 and permanently discontinued in 106. After a median follow-up of 325 days, 180 patients (46.4%) had died; death was attributed to COVID-19 (43.3%), AML (26.1%) or to a combination of both (26.7%), whereas in 3.9% of cases the reason was unknown. Active disease, older age, and treatment discontinuation were associated with death, whereas AML treatment delay was protective. Seventy-nine patients had a simultaneous AML and COVID-19 diagnosis, with better survival when AML treatment could be delayed (80%; P<0.001). Overall survival in patients with a diagnosis of COVID-19 between January 2020 and August 2020 was significantly lower than that in patients diagnosed between September 2020 and February 2021 and between March 2021 and September 2021 (39.8% vs. 60% vs. 61.9%, respectively; P=0.006). COVID-19 in AML patients was associated with a high mortality rate and modifications of therapeutic algorithms. The best approach to improve survival was to delay AML treatment, whenever possible.EPICOVIDEHA has received funds from Optics COMMITTM (COVID-19 Unmet Medical Needs and Associated Research Extension) COVID-19 RFP program by Gilead Science, USA (Project 2020-8223). The funder of the study had no role in the study design, data analysis, interpretation, or writing of the report. All authors had full access to the data and had final responsibility for the decision to submit for publication

Outcome of infection with omicron SARS-CoV-2 variant in patients with hematological malignancies: An EPICOVIDEHA survey report

SARS-CoV-2; Hematological malignanciesSARS-CoV-2; Neoplasias hematológicasSARS-CoV-2; Neoplasies hematològiquesOptics COMMIT (COVID-19 Unmet Medical Needs and Associated Research Extension) COVID-19 RFP program by GILEAD Science, United States, Grant/Award Number: Project 2020-8223

Breakthrough COVID-19 in vaccinated patients with hematologic malignancies: results from EPICOVIDEHA survey

Limited data have been published on the epidemiology and outcomes of breakthrough COVID-19 in patients with hematological malignancy (HM) after anti-SARS-CoV-2 vaccination. Adult HM who received at least one dose of anti-SARS-CoV-2 vaccine and diagnosed with breakthrough COVID-19 between January 2021 and March 2022 and registered in EPICOVIDEHA were included in this analysis. A total of 1548 cases were included, mainly with lymphoid malignancies (1181 cases, 76%). After viral genome sequencing in 753 cases (49%), Omicron variant was prevalent (517, 68.7%). Most of the patients received at least two vaccine doses before COVID-19 (1419, 91%), mostly mRNA-based (1377, 89%). Overall, 906 patients (59%) received specific treatment for COVID-19. After 30-days follow-up from COVID-19 diagnosis, 143 patients (9%) died. The mortality rate in patients with Omicron variant was of 7.9%, comparable to that reported for the other variants. The 30-day mortality rate was significantly lower than in the pre-vaccine era (31%). In the univariable analysis, older age (p<0.001), active HM (p<0.001), severe and critical COVID-19 (p=0.007 and p<0.001, respectively) were associated with mortality. Conversely, patients receiving monoclonal antibodies, even for severe or critical COVID-19, had a lower mortality rate (p<0.001). In the multivariable model, older age, active disease, critical COVID-19 and at least 2-3 comorbidities were correlated with a higher mortality, whereas the administration of monoclonal antibodies, alone (p<0.001) or combined with antivirals (p=0.009), was observed protective. While mortality is significantly lower than in the pre-vaccination era, breakthrough COVID-19 in HM is still associated with considerable mortality. Death rate was lower in patients who received monoclonal antibodies, alone or in combination with antivirals. EPICOVIDEHA (www.clinicaltrials.gov; National Clinical Trials identifier NCT04733729) is an international open web-based registry for patients with HMs infected with SARS-CoV-2

Candida-Reactive T Cells for the Diagnosis of Invasive Candida Infection—A Prospective Pilot Study

Background: Blood or tissue culture or histology prove invasive Candida infection, but long time to result, limited feasibility and sensitivity call for new approaches. In this pilot project, we describe the diagnostic potential of quantitating Candida-reactive, CD4/CD69/CD154 positive lymphocytes in blood of patients with invasive Candida infection.Methods: We used flow cytometry quantitating Candida-reactive, CD4/CD69/CD154 positive lymphocytes from peripheral blood of patients with invasive Candida infection, from patients at risk and healthy volunteers as controls.Results: Elevated levels of Candida-reactive lymphocytes were measured in 13 patients with proven invasive Candida infection and in one patient with probable hepatosplenic candidiasis. Results of three candidemia patients were uninterpretable due to autofluorescence of samples. Twelve of 13 patients had Candida identified to species level by conventional methods, and T cell reactivity correctly identified Candida species in 10 of 12 patients. Nine hematological high-risk patients and 14 healthy donors had no elevated Candida-reactive T cell counts.Conclusions: This Candida-reactive lymphocyte assay correctly identified the majority of patients with invasive Candida infection and the respective species. Our assay has the potential to support diagnosis of invasive Candida infection to species level and to facilitate tailored treatment even when biopsies are contraindicated or cultures remain negative

Age, Successive Waves, Immunization, and Mortality in Elderly COVID-19 Haematological Patients: EPICOVIDEHA Findings

Introduction: elderly patients with haematologic malignancies face the highest risk of severe COVID-19 outcomes. The infection impact in different age groups remains unstudied in detail. Methods: We analysed elderly patients (age groups: 65-70, 71-75, 76-80 and &gt;80 years old) with hematologic malignancies included in the EPICOVIDEHA registry between January 2020 and July 2022. Univariable and multivariable Cox regression models were conducted to identify factors influencing death in COVID-19 patients with haematological malignancy. results: the study included data from 3,603 elderly patients (aged 65 or older) with haematological malignancy, with a majority being male (58.1%) and a significant proportion having comorbidities. The patients were divided into four age groups, and the analysis assessed COVID-19 outcomes, vaccination status, and other variables in relation to age and pandemic waves.tThe 90-day survival rate for patients with COVID-19 was 71.2%, with significant differences between groups. The pandemic waves had varying impacts, with the first wave affecting patients over 80 years old, the second being more severe in 65-70, and the third being the least severe in all age groups. factors contributing to 90-day mortality included age, comorbidities, lymphopenia, active malignancy, acute leukaemia, less than three vaccine doses, severe COVID-19, and using only corticosteroids as treatment. Conclusions: These data underscore the heterogeneity of elderly haematological patients, highlight the different impact of COVID waves and the pivotal importance of vaccination, and may help in planning future healthcare efforts

Predictors for prolonged hospital stay solely to complete intravenous antifungal treatment in patients with candidemia: Results from the ECMM candida III multinational European observational cohort study

Background To date, azoles represent the only viable option for oral treatment of invasive Candida infections, while rates of azole resistance among non-albicans Candida spp. continue to increase. The objective of this sub-analysis of the European multicenter observational cohort study Candida III was to describe demographical and clinical characteristics of the cohort requiring prolonged hospitalization solely to complete intravenous (iv) antifungal treatment (AF Tx). Methods Each participating hospital (number of eligible hospitals per country determined by population size) included the first ~ 10 blood culture proven adult candidemia cases occurring consecutively after July 1st, 2018, and treating physicians answered the question on whether hospital stay was prolonged only for completion of intravenous antifungal therapy. Descriptive analyses as well as binary logistic regression was used to assess for predictors of prolonged hospitalization solely to complete iv AF Tx. Findings Hospital stay was prolonged solely for the completion of iv AF Tx in 16% (100/621) of candidemia cases by a median of 16 days (IQR 8 – 28). In the multivariable model, initial echinocandin treatment was a positive predictor for prolonged hospitalization to complete iv AF Tx (aOR 2.87, 95% CI 1.55 – 5.32, p < 0.001), while (i) neutropenia, (ii) intensive care unit admission, (iii) catheter related candidemia, (iv) total parenteral nutrition, and (v) C. parapsilosis as causative pathogen were found to be negative predictors (aOR 0.22 – 0.45; p < 0.03). Interpretation Hospital stays were prolonged due to need of iv AF Tx in 16% of patients with candidemia. Those patients were more likely to receive echinocandins as initial treatment and were less severely ill and less likely infected with C. parapsilosis

Monkeypox diagnostic and treatment capacity at epidemic onset: A VACCELERATE online survey

We approached European tertiary care institutions to provide details regarding their management of the current human monkeypox outbreak. 73 out of 105 sites stated to have capacities to manage the outbreak adequately amid the ongoing coronavirus disease 2019 pandemic. There are effective protective measures to prevent nosocomial infections in place at nearly all institutions. Diagnostic and treatment capacities on the other hand have potential to be improved.(c) 2022 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. CC_BY_4.

MELHOR DESFECHO CLÍNICO DA COVID-19 EM PACIENTES COM MALIGNIDADE HEMATOLÓGICA QUE RECEBERAM UMA QUARTA DOSE DA VACINA ANTI-SARS-COV-2: EPICOVIDEHA (REGISTRO INTERNACIONAL ONLINE DE PACIENTES COM MALIGNIDADES HEMATOLÓGICAS, INFECTADOS POR SARS-COV-2)

Introdução: A falta de dados consolidados resultou em um ceticismo geral sobre a eficácia da quarta dose da vacina anti-SARS-CoV-2. Como consequência, poucos indivíduos receberam uma quarta dose, apesar de vários dados apoiarem a baixa imunogenicidade da vacina anti-SARS-CoV-2, em pacientes com neoplasias hematológicas. Métodos: Qualquer paciente incluído no registro EPICOVIDEHA era elegível, desde que atendesse aos seguintes critérios: a) malignidade hematológica (MH) HM ativa nos últimos cinco anos antes do diagnóstico de COVID-19, b) pacientes com idade ≥18 anos, c) diagnóstico laboratorial de infecção por SARS-CoV-2 e d) recebimento de uma quarta dose de anti-SARS-CoV-2 antes do diagnóstico de COVID-19. Resultados: Um total de 6867 pacientes com infecção por SARS-CoV-2 foi registrado no EPICOVIDEHA. Desses, 51 (0,7%) foram diagnosticados com COVID-19 após terem recebido uma quarta dose de vacina anti-COVID. A maioria deles (30/51; 58,8%) era do sexo masculino; a idade média foi de 71 anos (IQR 65-73), com apenas três pacientes com idade inferior a 50 anos. Doze pacientes (12/5; 23,5%) não apresentavam nenhuma condição subjacente de base além da MH. As neoplasias malignas linfo-proliferativas foram predominantes (47/51; 92%). A maioria dos pacientes apresentava uma MH controlada no momento do diagnóstico da COVID-19 (30; 58,8%). Os pacientes receberam a quarta dose da vacina em uma mediana de 32 dias (IQR 13-54) antes do diagnóstico da COVID-19, quase exclusivamente com base no mRNA (50/51; 98%). A COVID-19 permaneceu assintomática ou leve em quase todos os casos (49/51; 96%) com apenas um caso de infecção crítica (2%) que exigiu cuidados intensivos. A taxa de admissão hospitalar foi de 47,1%, com uma mediana de permanência hospitalar de 9 dias (IQR 5-14). Apenas 26 pacientes (51%) receberam tratamento específico para SARS-CoV-2, sendo que quase todos eles (18/26; 69,2%) receberam anticorpos monoclonais. Os pacientes foram acompanhados por uma mediana de 65 dias (IQR 26-86) e dois morreram (3,9%) devido à COVID-19. Conclusões: Apesar do número limitado de pacientes, nossos dados mostram que pacientes com MH que receberam uma quarta dose da vacina anti-SARS-CoV-2 apresentam formas menos graves de infecções por SARS-CoV2 e melhor desfecho evolutivo. Os dados sugerem que um segundo reforço da vacina pode ser de particular importância para proteger essa população de pacientes particularmente vulnerável da COVID-19 grave ou potencialmente fatal

Characterisation of the impact and features of trampoline park-related injuries

Introduction Numerous studies have described indoor trampoline park (ITP)-related injury patterns, but they have shown heterogeneous results. No such study has been performed in Germany to date. The aim of this study was to analyse the specific trampoline-related injury patterns found in our population. Methods This retrospective study included patients suffering from ITP-related injuries between 1 October 2016 and 30 April 2018. 258 patients were included in the analysis. Patients were categorised depending on different variables including age, sex, site of injury, diagnosis, length of admission and treatment using SPSS. Results In the 19-month study period, 258 patients with ITP-related injuries were recruited. Single ITP-related injuries were diagnosed in 250 (96.9 %) patients. The median age of this group was 22 years (IQR 15-28). 126 (50.4 %) injuries were suffered by men and 124 (49.6 %) by women. 168 (67.2 %) injuries occurred in the lower extremity. Sprains (n = 114, 45.6 %) and fractures without joint dislocation (n = 59, 23.6 %) were the most common diagnoses. Males suffered significantly more often from injuries of the upper extremity (26.2 vs. 9.7 %; p = 0.010), while females most commonly suffered from injuries of the lower extremity (79.8 vs. 54.8 %; p < 0.001). 45 (18 %) patients required hospital admission and twenty-five (10.0 %) patients required surgery. Eight (3.1 %) patients suffered from injuries in more than one anatomic location. Conclusions ITP-related injuries were more prevalent in adults compared with children. The lower limb was the most affected anatomic location in all ages. The pattern of the injuries was heterogeneous, and their respective treatment represents a major challenge for traumatology surgeons