Disruptions in Health Care among Mwccs Participants during the Covid-19 Pandemic

Background: The COVID-19 pandemic resulted in disruptions to health care services. Vulnerable populations, including people living with HIV (PLHIV), may have experienced unique challenges when accessing medical care. The objective of this study was to evaluate the impact of social disruptions on health care visits among Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) participants. Method(s): A survey collecting data on missed health care visits and social disruptions (i.e., disruptions in employment, childcare, financial support, housing, and health insurance) during the pandemic was administered via telephone to MWCCS participants 1-3 times from March and September 2020. Logistic regression models adjusted for sociodemographics and HIV-status were used to test the association between social disruptions and three medical care interruption outcomes (i.e., missed healthcare appointment, interruption of mental health care, and interruption of substance use care). Result(s): Surveys (n=10,076) were conducted among 2238 PLHIV (61% women) and 1427 people living without HIV (PLWoH) (41% women). Overall, 42% of participants reported disruptions in health care with no significant difference by HIV status. Among participants receiving mental health care services and substance use treatment, 52% and 36% reported interruptions of care, respectively. Participants reporting >= 2 social disruptions were more likely to report missed health care appointments (adjusted odds ratio [aOR]: 1.81, 95% confidence interval [CI]: 1.54-2.13), and interruptions in mental health care [aOR: 2.42, 95%CI: 1.85-3.17) or substance use treatment (aOR: 1.97, 95%CI: 1.26-3.09), compared to those reporting no disruptions. Participants who were unemployed were more likely to miss health care appointments (aOR:1.46, 95% CI: 1.25-1.71) and report disruptions in mental health care (aOR: 2.02, 95% CI: 1.54-2.66) compared to those who were employed. PLHIV reporting >= 2 social disruptions were at increased risk for missed health care appointments (aOR 1.92, 95%CI: 1.56-2.36) and disruptions in mental health care (aOR: 2.54, 95%CI: 1.83-3.53 (Table 1). Conclusion(s): Social disruptions as a result of the COVID-19 pandemic have adversely impacted the receipt of health care among PLHIV and PLWoH, including the receipt of treatment for mental health and substance abuse. Providing childcare, financial support, housing, and health insurance may reduce disruptions in care and improve health outcomes.

Topical Platelet-Rich Plasma: A Novel Delivery Method for an Emerging Treatment of Olfactory Dysfunction

Introduction: Olfactory dysfunction (OD) affects more than 3 million US adults. The number of patients with post viral olfactory dysfunction (PVOD) is expected to increase secondary to the worldwide COVID-19 pandemic. Preliminary studies have demonstrated the efficacy of platelet-rich plasma (PRP) in restoration of smell in both animals and humans. To date, human studies have utilized injectable PRP only. We describe our pilot study investigating the use of topical PRP as a novel delivery method for smell restoration and contribute to existing literature demonstrating the promise of PRP as a therapeutic. Method(s): Pilot study from September 2020 to January 2022. Patients >18 years with hyposmia diagnosed via Brief Smell Identification Test (B-SIT) score <8 were included. PRPimpregnated Surgifoam was placed into bilateral olfactory clefts monthly for at least 3 months. Patients completed the B-SIT at baseline and 1 month after each treatment. Result(s): Eight patients underwent at least 3 treatments and completed the B-SIT at month 4. Average age was 56.3 years;mean smell loss duration was 19.3 months. Etiologies included PVOD, post-COVID (5), and idiopathic. Mean change in B-SIT after 3 treatments was +1.06. Of patients, 62.5% had achieved the minimal clinically significant difference of >1 on B-SIT after treatments 2 and 3. Patients with smell loss <12 months demonstrated greater B-SIT scores at 4 months (+1.6 vs +0.2). Two patients achieved B-SIT >8 after 3 treatments. Of patients who have returned thus far for a fourth treatment, 1 additional patient scored >8. Conclusion(s): We present the largest pilot study to date for the use of PRP in treatment of OD and the first study to develop methods for topical delivery in human subjects. Topical PRP may serve as a less invasive, efficacious therapy for patients. Further, randomized control trials are warranted to investigate the required number of topical PRP treatments for smell restoration.

Nuances in COVID-19-Related Olfactory Dysfunction: An Observational Study

Introduction: Almost 30% of olfactory dysfunction (OD) arises after a viral infection with increased incidence due to COVID-19. Hypothesized SARS-CoV-2 viral attachment to the olfactory epithelium differs from the traditional postviral OD (PVOD) mechanism. Hence, manifestations of OD may differ between the two etiologies. This study evaluates the difference in smell perception between post-COVID-19 OD and postviral or idiopathic etiologies. Method(s): This observational study, approved by the institutional review board, was conducted between September 2020 and January 2022 in adult patients with more than 6 months nontraumatic OD with no perceived improvement in smell even after 3 months of conservative treatment. OD in these patients was categorized as COVID-19 or non-COVID-19 related. Demographics, duration of OD, and Brief Smell Identification Test (B-SIT) scores were analyzed. Continuous variables were compared by t test, while categorical variables were compared by chi2 test using SPSS 27 (IBM Corp). Result(s): Of the 26 patients included in the study, 42.3% reported persistent OD following COVID-19 infection, while 57.7% had non-COVID-19-related OD. The mean B-SIT score in post-COVID-19 OD was 6.81+/-2.15 compared with 3.87+/-2.2 in the non-COVID-19 OD group, with the difference being statistically significant at 3.40 (P=.001). While race and gender ratios were similar between the groups, age (42 vs 54, P=.048) and duration of loss of smell (10 months vs 49 months, P<.001) had significant differences. Conclusion(s): This study shows that patients suffering from COVID-19-related OD may have normal scores on scratch and sniff smell tests, possibly because of the difference in the affected site of the olfactory pathway. Current hypotheses focus on olfactory epithelial damage in COVID-19 vs neuronal in PVOD. Differences seen in age and duration of smell loss between groups may be secondary to newfound worldwide attention to OD, while patients with OD etiologies predating COVID-19 may have newly sought treatment at this time. Olfactory threshold testing may be required for accurate assessment of post- COVID-19 OD. Larger studies are required to help delineate differences between these olfactory disturbance etiologies.

Emotional exhaustion, emotional intelligence and task performance of employees in educational institutions during COVID 19 global pandemic: a moderated-mediation model

Purpose: The objective of the present study is to investigate the relationship between emotional exhaustion and performance. During the present coronavirus disease (COVID-19) global pandemic, as the world has come to a standstill and more than 200 countries have been seriously affected, the level of emotional exhaustion experienced by people worldwide is beyond one's imagination. But how organizations were coping with emotional exhaustion and maintaining performance has remained an important question. To address this, the authors developed a conceptual model suggesting that organizational citizenship behavior (OCB) can act as a mediator, and leadership style and emotional intelligence (EI) can act as moderators in alleviating the dysfunctional consequences of emotional exhaustion. Design/methodology/approach: Using a structured survey instrument, data were collected from 384 respondents from the faculty and administrative personnel in the Mangalore Diocese educational institutions. The authors used stratified sampling and tested the psychometric properties of the instrument using Lisrel software. To test the hypotheses involving two-way and three-way interactions, the authors used Hayes (2018) PROCESS as a statistical technique. Findings: The results revealed that OCB mediated the relationship between emotional exhaustion and performance. To alleviate the dysfunctional consequences of emotional exhaustion, EI and transformational leadership interact to influence OCBs. The authors found that at lower and higher levels of EI, employees exhibited OCBs when leaders exhibited a greater level of transformational leadership. Furthermore, the transactional leadership style interacted with emotional exhaustion to reduce the adverse effects of later on performance. Research limitations/implications: As with any research based on self-report measures, the present study has inherent limitations of social desirability and common method bias. However, the authors have sufficient care to minimize, if not eliminate, these limitations. The research highlights the importance of EI, a contingency leadership style in organizations, to reduce the adverse effects of emotional exhaustion caused by the global pandemic. Practical implications: This study contributes to both organizations and literature on personnel psychology and organizational behavior. The study suggests that individuals need to invest resources in developing the skills of controlling and regulating their emotions and engaging in extra-role behaviors. In addition, leaders in organizations need to exercise transformational and transactional leadership styles to combat the present COVID-19 global pandemic situation. Originality/value: This study provides new insights into the importance of EI, leadership style, and OCBs in restoring the loss of resources because of emotional exhaustion. The conceptual model developed and tested is the first of its kind in India, to our knowledge, and contributes to both theory and practice. © 2022, Emerald Publishing Limited.

COVID-19 PNEUMONIA COMPLICATED BY CMV PNEUMONITIS FOLLOWING TREATMENT WITH AN IL-6 INHIBITOR

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: IL-6 inhibitors have emerged as a treatment option for moderate to severe COVID-19 infections. A hyperinflammatory state has been theorized to be the driving factor for acute respiratory distress syndrome in COVID-19. We discuss the case of a patient who received sarilumab for severe Covid infection and later developed CMV pneumonitis. IL- 6 inhibitors have been associated with secondary bacterial infections;however, the data on secondary viral and atypical infections are limited. CASE PRESENTATION: A 55-year-old male with no known past medical history presented to the hospital with complaints of worsening cough and shortness of breath. The patient was found to be COVID positive 3 days prior to presentation. CT chest on admission showed extensive peripheral ground-glass and consolidative lung opacities. Treatment with Decadron and Remdesivir was initiated.On hospital day 9, the patient had worsening respiratory status requiring up to 40 liters of vapotherm at 100% FiO2. After ruling out superimposed bacterial infection, he was treated with Sarilumab 400mg for worsening acute hypoxemic respiratory failure felt to be due to a hyperimmune syndrome from COVID-19. 10 days following treatment with Sarilumab, the patient's CRP normalized and his oxygen requirement decreased, he eventually weaned down to 5L nasal cannula.On hospital day 27, the patient again developed acute respiratory distress requiring intubation. A repeat chest CT showed evolving ground-glass and consolidative opacities with new basilar predominant traction bronchiectasis and architectural distortion. Additional lab testing revealed, CMV IgG >10 ( 0.00-0.59 U/ml) CMV IgM of 37.2 (0.0-29.9 AU/ml), CMV PCR DNA of 325000 ( not detected), and negative fungitell. Samples from bronchoalveolar lavage showed a CMV PCR of 46500 IU/ml ( not detected). Treatment with ganciclovir 5mg/kg q12h was initiated. Following treatment, the patient had progressive improvement in respiratory status, was weaned from the ventilator, and eventually discharged from the hospital. DISCUSSION: Cytokine storm is thought to play a key role in the lung injury seen in COVID 19 and IL-6 is essential in the propagation of cytokine Storm. There is an ongoing concern for bacterial infections in the setting of IL-6 inhibitors but the data on viral infections in this setting is limited. Van Duin et al describes a case of CMV reactivation in the setting of treatment with tocilizumab for rheumatoid arthritis. The patient developed fever and shortness of breath following the 2nd infusion of tocilizumab. A CT scan of the chest showed pneumonitis. Labs were significant for viremia on CMV PCR and positive CMV IgG. The patient had improvement after treatment with ganciclovir, similar to our case. CONCLUSIONS: The adverse effects of IL-6 inhibitors are not fully understood. Based on our limited experience we recommend checking CMV IgG before initiation of IL-6 inhibitors. REFERENCE #1: Han, Q., Guo, M., Zheng, Y., Zhang, Y., De, Y., & Xu, C. et al. (2020). Current Evidence of Interleukin-6 Signaling Inhibitors in Patients With COVID-19: A Systematic Review and Meta-Analysis. Frontiers In Pharmacology, 11. doi: 10.3389/fphar.2020.615972 REFERENCE #2: Tleyjeh, I., Kashour, Z., Damlaj, M., Riaz, M., Tlayjeh, H., & Altannir, M. et al. (2021). Efficacy and safety of tocilizumab in COVID-19 patients: a living systematic review and meta-analysis. Clinical Microbiology And Infection, 27(2), 215-227. doi: 10.1016/j.cmi.2020.10.036 REFERENCE #3: van Duin D, Miranda C, Husni E. Cytomegalovirus viremia, pneumonitis, and tocilizumab therapy. Emerg Infect Dis. 2011;17(4):754-756. doi:10.3201/eid1706.101057 DISCLOSURES: No relevant relationships by Gretel D'Souza, source=Web Response No relevant relationships by Elizabeth Pandian, source=Web Response

Sars-cov-2 testing & positivity among persons with & without hiv in 6 us cohorts

Background: It is not known if people with HIV (PWH) in the United States (US) have different access to SARS-CoV-2 RT-PCR (COVID-19) testing, or positivity proportions (among those tested), than people without HIV (PWOH). We describe COVID-19 testing and positivity proportions in 6 large geographically and demographically diverse cohorts of PWH and PWOH. Methods: The Corona-Infectious-Virus Epidemiology Team (CIVET) is comprised of five COVID-19 clinical cohorts within a health system (Kaiser Permanente Northern California, Oakland, CA;Kaiser Permanente Mid-Atlantic States, Rockville, MD;University of North Carolina Health, Chapel Hill, NC;Vanderbilt University Medical Center, Nashville, TN;Veterans Aging Cohort Study) and one established classical HIV cohort (MACS/WIHS Combined Cohort Study). Each participating cohort is restricted to individuals who were alive and “in-cohort” in 2020 (definitions of which were operationalized to fit the structure of each cohort). We calculated the percentage of patients in-cohort who were COVID-19 tested, and the proportion COVID-19 positive monthly, by HIV status, from March 1 to August 31, 2020. We report findings from the classical cohort separately because results are based on self-reported information. Results: In the 5 clinical cohorts, PWH ranged from N=2,515 to 31,040, and N=77,019 to 3,710,360 PWOH. Over the 6 month study period, the percentage of PWH who were tested for COVID-19 (13.5%-21.2%) was slightly higher than PWOH (10.8%-14.3%) in each of the cohorts (p-values in each cohort <0.001). However, among those tested, the percentage of patients with positive COVID-19 tests was similar regardless of HIV status (Figure). In the classical cohort that contributed self-reported testing and positive information (PWH N=2,222;PWOH N=1,417), the proportion tested was similar by HIV status (PWH 38.1% vs. PWOH 37.4%), but PWH had a greater positivity proportion (9.0%) compared with PWOH (5.3%, p-value=0.012). Conclusion: Although PWH had higher testing rates compared with PWOH, we did not find evidence of increased positivity among those tested in 5 clinical cohorts with large diverse populations across the US. We will continue to monitor testing, positivity, and COVID-19 related health outcomes in PWH and PWOH using our multiple data sources and leveraging the expertise of established longitudinal cohort studies in the CIVETS collaboration.

Post-COVID-19 respiratory management: expert panel report

This report is the first expert panel report on the management of post-COVID-19 patients from India. The report contains high risk groups, post-COVID-19 patient management at primary care level, general principles of medical management of post-COVID-19 in primary care settings, management of post-COVID-19 symptoms in primary care settings, recommendations for inclusion and exclusion into the Pulmonary Rehabilitation Programme, post-COVID-19 patient management at tertiary care level, post-COVID-19 complete assessment and management, and respiratory disease-specific conditions requiring expert opinion and further research.