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Introduction: Patients on hemodialysis may mount impaired response to COVID-19 vaccination as seen against Influenza and HBV vaccination. Recently published data had shown that immunogenicity of COVID-19 vaccination in HD population is attenuated when compared to non-dialysis population. Medium and long term response to COVID-19 Vaccination in dialysis population of Pakistan is unknown. Method(s): CDC recommends SARS-Cov2 Vaccination in HD patients. The study was performed at dialysis unit of Jinnah hospital Lahore, Pakistan on patients who had completed 2 vaccine series of SARS-Cov-2. Anti-spike antibody titer with' Abbott-Alinity CI technique' was checked during the month of April, 2022.A comparative analysis of antibody titers was done between patients who completed two dose vaccine series less than 6 months ago and more than 6 months ago Results: Total of 101 dialysis patients were included in the study during the month of April, 2022. All patients had completed two dose series of COVID-19 vaccines. Females comprised 28.7% (29/101) of study population. About 40/101 (38.6%) of patient had diabetes and 75% patients had hypertension. About 19% patient had history of hepatitis C infection. Majority of patients (72.2%) had two doses of either Sinovac or Sinopharm vaccine administered. COVID 19 spike protein antibodies were measured for all participants. Mean COVID-19 spike antibody titers were 1892.4 BAU/mL and median titers were 971 BAU/ML. About 30% patients had their second COVID19 vaccine administered within 6 months of checking antibody titers, while 70% patients have had second dose of vaccine administered more than 6 months ago when their antibody titers were checked. Seropositivity was defined as BAU/mL of equal to or more than 7.1 as per manufacturer guidelines. Only 3 patients (2.9%) were seronegative in the whole sample. All patients who received 2nd COVID vaccines dose less than 6 months ago were seropositive. Meanwhile 65 out of 68 (95.5%) patients among subgroup who received 2nd COVID vaccine more than 6 months ago were seropositive. This small difference was not statistically significant (P value 0.55). A comparative analysis was done between patients who completed two dose vaccine series less than 6 months ago and more than 6 months ago when their antibody levels were measures (Table1). This reflects that there was no significant difference among two groups regarding antibody titers. Moreover, there was also no significant difference regarding antibody titers among subgroups defined by diabetes, hypertension, CAD or gender. Median age of the whole sample was 50 years. Sample was divided into two groups, 50 years or less (young) and >50 years of age (old). Surprisingly, older patients had significantly higher anti-spike antibody titers as compared to younger patients (2417.8 BAU/mL vs 1377.3 BAU/mL, P value 0.008) [Formula presented] Conclusion(s): Contrary to published data, hemodialysis Patients in our study had excellent antibody response to SARS-CoV 2 vaccination without any difference in medium and long term response. This is comparable to the antibody response in non-dialysis Pakistani population who has been vaccinated against Sinopharm & Sinovac. Surprisingly, Older populations had significantly higher anti-spike antibody titers as compared to younger population. This difference could be due to higher risk of SARS-CoV2 infection in older population. No conflict of interestCopyright © 2023
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Introduction: Retroperitoneal fibrosis (RPF) is a rare disease which can be primary (idiopathic) or secondary to drugs, tumors or infections. We are reporting the first case of RPF causing renal atrophy, renal artery stenosis and renovascular hypertension associated with SARS-CoV2. Method(s): A 37-year-old female nurse presented to her PCP with a new-onset of hypertension. She had recovered from severe SARS-CoV2 infection merely two months ago. Physical examination was remarkable for BP 170/110 mmHg, HR 88 beats/min, BMI of 31 alongside trace pitting edema. Initial lab data showed her creatinine to be 1.1mg/dl and ultrasound of her kidneys showed an atrophied right kidney with a size of 7.8 cm while the left kidney was 11.6 cm. An ultrasound KUB of that same time showed that the size of the right kidney was 10.4 cm and left 11.5 with normal renal parenchyma. She was started on amlodipine 10 mg and valsartan 160 mg per day. Two weeks later she was referred to a nephrologist when her creatinine was increased to 3.1 mg/dl. Renovascular hypertension secondary to right renal artery stenosis or thrombus was suspected. Autoimmune & hypercoagulable work up was negative. CT angiogram showed an ill-defined, poorly enhancing retroperitoneal soft tissue thickening draping the mid abdominal aorta, the origin of SMA, and bilateral renal arteries which terminated above the aortoiliac bifurcation. This, RPF, involved segment of 8.6 cm of the mid and lower abdominal aorta, causing moderate narrowing of proximal SMA, short segment narrowing of proximal left main and accessory renal artery, and diffuse long segmental narrowing of the right main renal artery. RPF encasement of right renal artery lead to poor right renal nephrogram and atrophic kidney. (Figure no A: Abdominal contrast-enhanced computed tomographic (CT) scan showing the encasement of the both renal arteries by the retroperitoneal fibrosis (RPF).Figure no B : Renal angiogram showing the renal artery stenosis on right side) Acute kidney injury (AKI) was initially thought to be due to angiotensin receptor blockade in the setting of bilateral renal artery stenosis. Valsartan was swapped for metoprolol and the serum creatinine levels decreased to 1.5 mg/dl in two weeks. Prednisone was started for RPF at a dose of 60 mg per day with a slow taper over 4 months. Over the next 8 weeks, creatinine became normal and blood pressure was controlled with amlodipine 2.5 mg/day. Subsequently at 4 months her creatinine was 1.0 mg/dl and she was off all anti-hypertensive drugs. A repeat CTA after 6 months showed that there was significant reduction in RPF. Atrophic right kidney was noted without any significant interval change. RPF, renal artery stenosis, renovascular hypertension and right renal atrophy was strongly suspected to be associated with SARS-Cov2 since none of these were identified prior to her suffering from SARS-CoV2. Result(s): [Formula presented] [Formula presented] Conclusion(s): To our knowledge, this is the first case of RPF associated with SARS-CoV-2 causing renovascular hypertension and renal atrophy. Local and systemic production of IL-6, TGF- beta and Th2 cytokines has been demonstrated in idiopathic RPF and pulmonary fibrosis due to SARS-CoV2. The presumptive pathogenesis could involve SARS-Cov2 induced release of IL-6 and other cytokines which can activate B cells and fibroblasts. No conflict of interestCopyright © 2023
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Background and Aims: Alcoholic hepatitis (AH) is associated with significant morbidity, mortality and healthcare expenditure. The global SARS-CoV-2 (COVID-19) pandemic and related lockdown measures have potentially contributed to an increase in alcohol misuse. This study examines frequency and patient outcomes of AH admissions to an Australian quaternary liver transplant referral centre. We aimed to ascertain the change in AH severity, ICU admission rates and healthcare utilisation costs over the last 5 years to identify temporal associations with the COVID-19 pandemic. Methods: A retrospective analysis of patients aged 18 years and older fulfilling National Institute on Alcohol Abuse and Alcoholism diagnostic criteria for AH between January 2016 and March 2021 was conducted. Data were collected from electronic medical records and analysed. Primary endpoints were the frequency of AH admissions, ICU admission rates and healthcare costs, which were evaluated with a divergence at the beginning of lockdown restrictions (March 2020 – March 2021 “COVID cohort”) versus the “historical cohort” (January 2016 - February 2020). Results: In total, 105 eligible AH admissions were identified. Overall, 90 day mortality was 18% (19/105). AH admission rate for the COVID cohort was significantly higher at 3.38 cases/month (n = 44) compared to the historical cohort at 1.22 cases/month (n = 61), p < 0.001. The COVID cohort had greater disease severity with a higher Glasgow Alcoholic Hepatitis Score during admission [8.5 (IQR 7-10) vs 7 (IQR 6-9), p = 0.04]. The AH COVID cohort trended towards a greater proportion requiring ICU admission, inotropic support and longer ICU length of stay. Whilst per-episode adjusted healthcare costs were similar across the study, monthly costs of the COVID cohort were higher compared to the historical cohort due to increased admission frequencies [mean (SD) ≥137,549 (54,058) vs ≥38,000 (27,448), p = 0.02 (Figure 1)]. No patients in this study were diagnosed with COVID-19. Conclusion: In this study, alcoholic hepatitis admission frequency and healthcare costs were found to have increased since the COVID-19 pandemic. These observations provide the impetus for future studies to understand how the COVID-19 pandemic has led to increased AH presentations and develop preventative strategies that reduce alcohol related admissions and associated costs (Figure Presented)
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INTRODUCTION: Following the initial COVID-19 surge in the UK, there was a national incentive for elective vascular surgery to be restricted to 'clean' sites to reduce perioperative cross-infection and subsequent mortality. We assessed the risk of dying from perioperatively acquired COVID-19 during the peak of the London outbreak. METHODS: Forty-three consecutive patients who had vascular (n=48) procedures in March and April 2020 at a regional hub serving five London hospitals were analysed. The patients were screened for COVID-19 in the 30-day postoperative period and the main outcome measure was mortality from COVID-19. A comparison was then made with patients who underwent minimally invasive procedures in our integrated interventional radiology department. Median follow-up was 41 days (interquartile range 8-58) overall. RESULTS: Three patients (7%) in the vascular group (median age 61 years, all diabetic, two male) died from COVID-19, all of whom tested positive postoperatively. Two others became positive but recovered. In comparison, two patients (2%) in the interventional radiology group died from COVID-19; however, one was positive prior to their procedure. CONCLUSION: Only urgent vascular cases should be performed during a COVID-19 surge. However, with growing waiting lists for elective surgery following the pandemic's second wave, further restrictions may not be a viable long-term solution. When prevalence of the disease is lower and if resources allow, resumption of care at 'hot' sites should be considered, if safety measures can be implemented. The advantages of minimally invasive surgery may also reduce risk.
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COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , Delivery of Health Care , Elective Surgical Procedures/methods , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures , Vascular Surgical ProceduresABSTRACT
Introduction: The number of patients on intensive care units (ICU) increased manifold during the initial COVID-19 surge and medical staff were relocated to help compensate. The need for central venous catheters (CVCs) increased accordingly and comprised a significant workload under challenging circumstances. Several models were proposed to manage the lines. We assigned a vascular team of vascular surgeons and interventional radiologists for CVCs in ICU. We report on the workload outcomes and lessons learned Method: 50 consecutive ventilated COVID-19 patients in ICU (median age 63 years, 80% male) who had a CVC inserted by the vascular team from March to May 2020 were assessed. Median follow up was 18 days (range 14- 29 days) after ICU admission Result: 166 CVCs (80 VasCaths) were inserted. Femoral access was preferred Each patient required a median of 3 lines (IQR 2-4). CVCs were exchanged after median 7 days (IQR 4-9) for thrombosis (35%), infection (24%) or prophylactically (41%). Our learning curve included the establishment of an online referral pathway, CVC teams of two operators extended disposable CVC kits and ICU based ultrasound scanners Additional staffing and retraining were avoided. There were no technical complications Conclusion: Ventilated COVID-19 patients require multiple CVCs which is a challenging workload during a pandemic. Vascular surgeons and interventional radiologists with endovascular skills are well positioned to perform central venous cannulation to alleviate the burden on critical care teams. Our lessons learned can help to provide a safe and efficient model amidst the ongoing national outbreaks Take-home Message: With the postponement of many elective vascular procedures during the pandemic crisis, the involvement of vascular surgeons in a dedicated Lines team is an important way that they can contribute given their proficiency with wires and cannulation equipment as well as familiarity in femoral triangle and jugular anatomy The retraining of staff and additional on-call rotas can then be avoided .
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Introduction: Following the initial COVID-19 surge in the United Kingdom, there was a national incentive for elective vascular surgery to be restricted to clean sites in order to reduce perioperative cross infection and subsequent mortality. We assessed the risk of dying from perioperatively acquired COVID-19 during the peak of the London outbreak Materials and Methods: 43 consecutive patients who had vascular (n=48) procedures in March and April 2020 at a regional hub serving five London hospitals were analysed. The patients were screened for COVID-19 in the 30-day postoperative period and the main outcome measure was mortality from COVID-19. A comparison was then made with patients who underwent minimally invasive procedures from our integrated interventional radiology department. Median follow-up was 41days (IQR 8-58 days) Result: Three patients (7%) in the vascular group (median age 61 years all diabetic, two male) died from COVID-19, all of whom tested positive postoperatively. Two others became positive but recovered. In comparison two patients (2%) in the interventional radiology group died from COVID-19, however one was positive prior to their procedure Conclusion: Only urgent vascular cases should be performed during a COVID-19 surge, with elective work delayed or continued at clean sites However, with growing waiting lists for elective surgery currently, further restrictions may not be a viable long-term solution. Resumption of care at hot sites should be considered, if resources allow for it and if safety measures can be implemented. The advantages of minimally invasive surgery may inherently reduce risk as well Take-home Message: Only urgent vascular cases should be performed during a peak outbreak of COVID-19, however we cannot continue to postpone elective procedures indefinitely or restrict all cases to solely clean sites. The resumption of care at hot sites encompasses a fine balance of risks versus benefits .
Subject(s)
COVID-19/therapy , Catheterization, Central Venous , Emergency Service, Hospital/organization & administration , Physician's Role , Surgeons/organization & administration , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Disease Outbreaks , Female , Humans , Male , Middle Aged , Respiration, Artificial , United Kingdom/epidemiology , WorkloadABSTRACT
The ongoing pandemic of Corona-Virus (COVID-19) induced by the coming forth category of SARS-CoV-2, has terrified the worldwide human health. Primarily, COVID-19 challenges can be categorized into (a) way of epidemic prevention and blocking transmission, (b) live monitoring of infected / suspected persons (c) FDA approved vaccine. Leading to said COVID-19 (a), (b) challenges, digit technologies such Artificial Intelligence, Big data analytics and Internet of Things (IoT), can play a vital role in epidemic prevention and blocking COVID-19 transmission. In this study, we have proposed a smart edge surveillance system that is effective in remote monitoring, advance warning and detection of a person's fever, heart beat rate, cardiac conditions and some of the radiological features to detect the infected (suspicious) person using wearable smart gadgets. The proposed framework provides a continually updated map/pattern of communication chain of COVID-19 infected persons that may span around in our national community. The health and societal impact of suggested research is to help public health authorities, researchers and clinicians contain and manage this disease through smart edge surveillance systems. The proposed model will help to detect and track the contagious person. Moreover, it will also keep the patient's data record for analysis and decision making using edge computing. © 2020 IEEE.
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The coronavirus disease (COVID-19), while mild in most cases, has nevertheless caused significant mortality. The measures adopted in most countries to contain it have led to colossal social and economic disruptions, which will impact the medium- and long-term health outcomes for many communities. In this paper, we deliberate on the reality and facts surrounding the disease. For comparison, we present data from past pandemics, some of which claimed more lives than COVID-19. Mortality data on road traffic crashes and other non-communicable diseases, which cause more deaths each year than COVID-19 has so far, is also provided. The indirect, serious health and social effects are briefly discussed. We also deliberate on how misinformation, confusion stemming from contrasting expert statements, and lack of international coordination may have influenced the public perception of the illness and increased fear and uncertainty. With pandemics and similar problems likely to re-occur, we call for evidence-based decisions, the restoration of responsible journalism and communication built on a solid scientific foundation.