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INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic led to hospitals in the UK substituting face-to-face (FtF) clinics with virtual clinic (VC) appointments. We evaluated the use of virtual two-week wait (2-ww) lower gastrointestinal (LGI) clinic appointments, conducted using telephone calls at a district general hospital in England. METHODS: Patients undergoing index outpatient 2-ww LGI clinic assessment between 1 June 2019 and 31 October 2019 (FtF group) and 1 June 2020 and 31 October 2020 (VC group) were identified. Relevant data were obtained using electronic patient records. Compliance with national cancer waiting time targets was assessed. Environmental and financial impact analyses were performed. RESULTS: In total, 1,531 patients were analysed (median age=70, male=852, 55.6%). Of these, 757 (49.4%) were assessed virtually via telephone; the remainder were seen FtF (n=774, 50.6%). Ninety-two (6%, VC=44, FtF=48) patients had malignant pathology and 64 (4.2%) had colorectal cancer (CRC); of these, 46 (71.9%, VC=26, FtF=20) underwent treatment with curative intent. The median waiting times to index appointment, investigation and diagnosis were significantly lower following VC assessment (p<0.001). The cancer detection rates (p=0.749), treatments received (p=0.785) and median time to index treatment for CRC patients (p=0.156) were similar. A significantly higher proportion of patients were seen within two weeks of referral in the VC group (p<0.001). VC appointments saved patients a total of 9,288 miles, 0.7 metric tonnes of CO2 emissions and £7,482.97. Taxpayers saved £80,242.00 from VCs. No formal complaints were received from patients or staff in the VC group. CONCLUSION: Virtual 2-ww LGI clinics were effective, safe and were associated with tangible environmental and financial benefits.
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Objective: To analyze the most frequent radiographic abnormalities in COVID-19 patients. Methods: In this multicenter retrospective study, chest X-ray films and reports of COVID-19 patients admitted between March 2020 and June 2020 in three tertiary care hospitals of Lahore were analyzed for abnormalities. Patients of age > 18 years with positive COVID-19 RT-PCR, who underwent X-ray chest at presentation were enrolled. The study included pregnant patients as well. Results: Total 150 patients fulfilling inclusion criteria were enrolled. There was male predominance with mean age 50 years. Chest X-ray were abnormal in 127 (98%) patients. Predominant pattern of lung Involvement was bilateral lesions in 121(95%), left lower zone 89(70%), right lower zone 85(67%), right mid zone 57(45%), left mid zone 50(39%), and diffuse involvement in 36 (28%). GGOs was the most common lung lesion found in 53 (42%), followed by GGOs and consolidation combined. Peripheral distribution was noted in 36(28%), peripheral and peri hilar combined 58(45%), random 27(21%) and perihilar in 6(5%). Peri bronchial cuffing was seen in 23(18 %), reticulation 20(16%), nodular lesions 8(6%) pneumomediastinum (1.5%) and minimal pleural effusion 1(0.7%). Among 20 pregnant females, 15 (75%) had normal X- rays. All of abnormal CXR 5 (25%), had bilateral, mid and lower zone GGOs and consolidation. Distribution was random 3(60%), peripheral and perihilar combined 2(40%), patchy 1(20%) and confluent in 4(80%). Conclusion: The most predominant radiological features of COVID-19 in our population were bilateral, lower zone, patchy, pure GGOs or combined GGOs and consolidation with peripheral and perihilar distribution.
ABSTRACT
Purpose There is increasing evidence of adverse cardiovascular morbidity associated with SARS-CoV-2 (COVID-19). Pro-B-type natriuretic peptide (proBNP) is a biomarker of myocardial stress associated with outcomes in various respiratory and cardiac diseases. We hypothesized that proBNP level would be associated with mortality and clinical outcomes in hospitalized COVID-19 patients. Methods We performed a retrospective analysis of hospitalized COVID-19 patients (n=1232) using adjusted logistic and linear regression to assess the association of admission proBNP (analyzed by both categorical cutoff >125 pg/mL and continuous log transformed proBNP) with clinical outcomes. Covariates included age, sex, race, body mass index (BMI), hypertension, coronary artery disease (CAD), diabetes, smoking history, and chronic kidney disease stage (Model 1), with Troponin I added in Model 2. We performed survival analysis by a multivariate Cox proportional hazard model, incorporating log transformed proBNP. We additionally treated BMI, a strong potential confounder of both proBNP levels and COVID-19 outcomes, as an ordinal variable ordered across tertiles. Results Patients were mean age 62.9±17.6, 53.8% male, and 35.9% Black. Preadmission comorbidities were hypertension (57.1%), diabetes (31.6%), CAD (9.0%) and heart failure (HF, 10.6%). In Model 1 and 2, higher proBNP level was significantly associated with death, new HF, length of stay, ICU duration and need for ventilation among hospitalized COVID-19 patients. This significance persisted after ordinal compression of BMI across tertiles. The adjusted hazard ratio of death for log[proBNP] was 1.56 (95% CI: 1.23-1.97;P<0.0001). Conclusion Using a relatively large and racially diverse hospitalized COVID-19 patient cohort, we find that proBNP is associated with adverse clinical outcomes, including mortality and new HF in COVID-19. Further prospective investigation is warranted on the utility of proBNP for clinical prognostication in COVID-19.