Longitudinal lung function assessment of patients hospitalised with COVID-19 using 1H and 129Xe lung MRI

Introduction: The progression of pathophysiological pulmonary changes in patients following acute COVID-19 is not well established. Method(s): Patients hospitalised with COVID-19 pneumonia without signs of ILD, had MRI exams at a median of 6 (n=9), 12 (n=9), 25 (n=7), and 52 (n=3) weeks. MRI sequences included: dynamic contrast enhanced (DCE) lung perfusion,129 Xe diffusion weighted (DW-MRI), 129Xe ventilation and 129Xe 3D dissolved phase imaging. Result(s): 9 patients (age 56+/-9 years;7 male;1 required treatment in an ICU) were recruited. Median RBC:TP was abnormally low at all visits compared to reference age and sex matched data. An individual's RBC:TP was significantly and positively associated with an increase in their pulmonary blood volume (p=0.026). For patients with 52 week data available, one showed a continued increase in RBC:TP, 2 patients maintained a low RBC:TP (Figure 1). Ventilation defect percentage, and ventilation heterogeneity significantly decreased at 25 weeks compared to 6 129 129 129 weeks (p=0.010 and p=0.048). DW-MRI was normal at all visits. Dissolved phase xenon imaging showed RBC:TP significantly increased at 12 and 25 weeks compared to 6 weeks (p=0.048). Conclusion(s): In patients recovering after COVID-19, poor gas transfer is reflected by impaired xenon transfer, which improves alongside pulmonary blood volume.

Longitudinal 129xe and 1h Lung Mri Assessment of Lung Structure, Ventilation, Perfusion, and Gas Transfer Following Hospitalization with Covid-19

The long-term effects of coronavirus disease 2019 (COVID- 19) pneumonia on the lungs and pulmonary circulation require further characterization. We assessed progression of pathophysiological pulmonary changes during 1 year of follow-up of patients who had been hospitalized because of COVID-19. After discharge, recruited patients had up to four MRI examinations at a median of 6 (n=9), 12 (n=9), 25 (n=7) and 52 (n=3) weeks. Lung MRI examinations included: ultra-short echo time (UTE), dynamic contrastenhanced (DCE) lung perfusion, 129Xe diffusion weighted (DW-MRI), 129Xe ventilation and 129Xe 3D dissolved phase imaging. Nine patients (age 56 +/-9 years;six male) were recruited. Ventilation defect percentage and whole lung coefficient of variation of lung ventilation decreased significantly at 25 weeks (visit 3) compared with visit 1 at 6 weeks (p=0.010 and p=0.048). The UTE imaging indicated no evidence of lung scarring, and DW-MRI indicated normal lung microstructure across all visits. Dissolved phase xenon imaging showed that RBC:TP increased significantly at visits 2 and 3 compared with visit 1 (p=0.048). Median RBC:TP was abnormally low at all visits compared with reference age- and sex-matched data. An individual's RBC:TP was associated significantly and positively with an increase in their pulmonary blood volume (p=0.026). For patients with 52-week data available, one showed a continued improvement in RBC:TP;however, two of the patients maintained a low RBC:TP. In patients recovering from COVID-19, xenon gas transfer improves alongside pulmonary blood volume. Further work is needed to establish the proportion of post-COVID-19 patients who have longer-term impairment in xenon transfer and to correlate changes in lung MRI parameters with symptoms, lung function tests and other imaging modalities. Persistent impairment of xenon transfer might represent a physiological mechanism underlying ongoing symptoms in some patients and might indicate damage to the pulmonary microcirculation.

"When Can i Go Home?"-Unplanned Admissions following day case elective surgery

Aim: Day case surgeryisan effective and economical method tomanage patients while maintaining quality of care. During The COVID-19 pandemic and The reinstatement of non-cancerous elective surgery, efficient use of bed space capacity has been crucial. Strategies were implemented to reduce unplanned admission rates, including careful patient selection and preoperative assessment. We aimed to review rates of unplanned admissions (UA) following intended day case procedures and to identify methods of future prevention of UA. Method(s): A retrospective review was carried out of patients undergoing day case hernia repairs or laparoscopic cholecystectomy in a single district General hospital, between May 2021 and September 2021. Data was collated from an institutional data base with follow up data obtained from an electronic care record. Result(s):53patientsincluded,withamedianageof76years (range23-79), 56.6% male, 23 inguinal hernia repairs and 30 cholecystectomies. 30.2% were unexpectedly admitted post operatively (9 Cholecystectomies and 7 inguinal hernias). Of those admitted, median length of stay was 3.1 days (range2-10). Reason for admission included pain (43.8%), postoperative complications (18.8%) and urinary retention (18.8%). Patients requiring admission were significantly older (mean age 62 vs 49 years old), were more likely to be male (62.5% vs 37.5%) and had a significantly longer theatre time (1.46 vs 1.08 hours, p=0.0001). Conclusion(s): Our short review has identified older and male patient are more likely to require an overnight admission. Improvement in pain management, theatre planning and streamlining along with optimal discharge planning may reduce The volume of patient requiring UA.

Emergency presentations of colorectal cancer during the COVID 19 Era

Aims: COVID19 has reduced the ability to provide red flag investigations for colorectal patients. The aim of this study is to assess the number of emergency presentations of new colorectal malignancies during the COVID19 era and if there is an increase in palliative cases. Methods: A retrospective review of all patients presenting to unscheduled care with a new diagnosis of colorectal malignancy from 31st March 2020-25th January 2021 in a single UK Trust. An institutional data base and electronic care records were used to review patient demographics, management and curative intent. Data points for the same period in 2019-2020 were recorded for comparison. Results: 45 patients were diagnosed with new colorectal malignancy during an unscheduled admission to hospital within the study timeframe. 22% (10/45) presented in January 2021. 29 diagnosed during the same time interval 2019-2020. Median age at presentation was 77.5 and 79 respectively. 40% (18/45) of patients in 2020-2021 proceeded to emergency surgery, compared to 58% (17/29) in 2019-2020 (P = 0.12). 10.3% (3/29) of 2019-2020 patients were managed with colonic stenting. This increased in 2020-2021 to 17.8% (8/45) (P = 0.38). 77.8% (35/45) patients in 2020/2021 presented at a palliative stage of disease compared to 62.1% (18/29) in 2019-2020 (P = 0.15). Conclusions: Overall the data has not shown a statistically significant difference in patients presenting as an emergency with new colorectal malignancy. However, there was a rise in admissions noted in January 2021;should this trend continue, alongside the persistent pressures of COVID19, ongoing research is needed to assess the true impact.

Colonic stenting in colorectal malignancy-a single centre 3 year review

Aim/Background: Colonic stent insertion is a minimally invasive management option for patients requiring colonic decompression in colorectal malignancy (CRC). Acute colonic obstruction is a common presentation in patients with CRC, and approximately 20% present with distant metastases. Emergency primary resection carries increased morbidity and mortality and decreases likelihood of primary anastomosis. Our objective was to review the use of colorectal stents, examine survival in the palliative setting and determine interval time to surgery. Methods: A retrospective institutional review of all patients undergoing colonic stenting in a single centre between January 2018 and January 2021 was carried out. Data was retrieved from an institutional database search and patient follow up obtained from up to date regional care records. Results: A total of 58 patients were identified, 50 of which underwent attempted stenting for a colonic malignancy, with a 92% success rate. Median age 81.5years (54-95), 60.8% male and median follow up time 545 ± 353 days. Thirty three (64.8%) were performed in the emergency setting. Thirteen patients underwent stenting as a bridge to surgery, with median time interval 20 days (2018/2019) and 30.5 days (2020/2021). Thirty-three patients underwent stenting with palliative intent, with a median survival time of 96 days. There were no major stent related complications or mortality. Conclusion: Colonic stents offer an alternative management pathway in obstructed colorectal malignancies, in both the palliative and curative setting. Our study has illustrated high success rates, with no major complications seen. COVID-19 has expectedly impacted the length of time to surgery following stent insertion.

Transitioning to parenthood during the pandemic: COVID-19 related stressors and first-time expectant mothers’ mental health

The transition to parenthood represents a major life event for expectant parents, influencing personal and relational well-being. Unfortunately, the global coronavirus disease 2019 (COVID-19) pandemic may undermine first-time expectant mothers’ emotional health as elevated rates of depression, stress, and anxiety have been noted (Rajkumar, 2020). Thus, the current study was conducted to (a) describe the impact of the COVID-19 pandemic on first-time expectant mothers’ pregnancy, prenatal care, internal/dyadic and external experiences, (b) investigate the impact of pregnancy-related, internal/dyadic, and external COVID-19 changes on first-time mothers’ mental health (i.e., depression, stress, and anxiety symptoms), and (c) explore whether COVID-related internal/dyadic stressors predicted worse mental health among expectant mothers, above and beyond their general marital satisfaction. Forty-nine first-time, expectant U.S. mothers (Mage = 29.0 years, SD = 3.1) participated via Amazon MTurk between June and July 2020;each completed an online survey about their pandemic prenatal care, delivery plans, current mental health, and relationship. Most expectant mothers (82%) reported distress due to COVID-related prenatal care changes. Additionally, pandemic-related increases in alcohol use, intimate partner violence, and external demands (i.e., caring for someone infected with COVID-19), generally predicted worse mental health for first-time expectant mothers. The effects of increased alcohol use and intimate partner violence on maternal mental health remained, even after accounting for overall marital satisfaction. Conversely, having to isolate or quarantine due to exposure predicted reduced maternal stress. Results underscore the need to provide supports that promote the emotional health of first-time pregnant women and encourage healthy coping with the diverse pandemic-related experiences faced by expectant couples. (PsycInfo Database Record (c) 2021 APA, all rights reserved) © 2021 American Psychological Association

Can patients with acute appendicitis be ambulated safely?

Introduction: During the COVID-19 pandemic, surgical service and practice has been adjusted in order to reduce acute surgical admissions. Acute appendicitis accounts for a significant proportion surgical admissions in the UK. Intercollegiate general surgery guidance during the COVID-19 pandemic advised appendicitis should be managed conservatively, or with an open appendicectomy if indicated. Our aim was to determine the efficacy and safety of our ambulation service in the conservative management of acute uncomplicated appendicitis. Method: Data was collected prospectively from 30th March 2020 - 16th August 2020 on all patients presenting with suspected appendicitis. Stable patients with clinically suspected or CT-proven appendicitis were discharged with oral antibiotics as per trust guidance. Readmissions for ambulated patients were recorded. Results: 190 patients presented with suspected appendicitis (range 5- 71years). 49.4% patients were deemed suitable for ambulation on initial assessment, 22% of which had a CT confirmed diagnosis on discharge. 65% of the ambulated patients underwent a telephone review within a 72-hour window. 13.8% of patients represented within a 30-day period, 7.4% of which proceeded to appendicectomy. Conclusions: Patients with uncomplicated appendicitis can be safely managed with antibiotics out of hospital, with low representation rates.