ABSTRACT
Ultrasound-guided fine-needle aspiration cytology (FNAC) is a commonly performed procedure and often the first line of diagnostic testing for patients presenting with a head and neck swelling. This technique yields a high accuracy rate and is recommended by NICE guidance. The head and neck ultrasound waiting list, consequently, has always highlighted capacity issues and this became more pronounced during Covid-19 due to the temporary cancellation of clinics. The aim of training a sonographer was to reduce the ultrasound waiting list and allow the radiologists more time in other areas, such as reporting cross-sectional imaging. The aim of this study was to document how training was undertaken, and whether FNAC success rates were comparable to those performed by radiologists. In-house training was undertaken over a 12-month period by three consultants in an acute and outpatient setting. A retrospective audit was performed of FNAC outcomes, comparing sonographer and radiologist non-diagnostic rates over an 18-month period. Statistics of the ultrasound waiting list were also analysed over this period. 250 FNAs performed by a sonographer were analysed. Results showed a 71% conclusive rate. This was compared to a previous 4-year audit, undertaken by radiologists within the department. The comparison study analysed 1222 FNAC samples and demonstrated a non-diagnostic sample of 27.2%. This was compared with the RCR live audit, which expects a 70% diagnostic rate for FNAC samples of the thyroid. This study demonstrated comparable FNAC results between a sonographer and consultant radiologist. Statistics also showed a decrease in the ultrasound waiting list, from 310 patients to 114 patients in the past 18 months. It is possible to train a sonographer to become proficient in head and neck scanning with FNAC and for cytology rates to be comparable to that of a radiologist. The study showed a positive impact on the ultrasound waiting list.
ABSTRACT
Introduction: The offer of immediate breast reconstruction (IBR) was temporarily withdrawn for women requiring mastectomy during the COVID-19 pandemic to allow prioritisation of emergency care. Many women are now awaiting delayed breast reconstruction (DBR) surgery. This survey aimed to explore the current provision of DBR in the UK and how this had been impacted by COVID-19. Method(s): An online survey was distributed to UK breast units via the ABS/Mammary Fold newsletters and social media feeds between 10/2021 and 04/2022. Simple descriptive statistics were used to summarise the results. Result(s): Of the 42 UK breast units that completed the survey, most units reported that COVID-19 had led to increased waits for DBR. Before the pandemic over three quarters of units reported waits of less than 1 year (29% <6 months, 45% 6-12 months) whereas currently waits of 12-24 months are common with a third of units reporting waits of 24-36 months. A small number of units reported waits of >3 years or that DBR had not yet restarted (14%). Key identified challenges for DBR services included limited availability of theatre time and consultant and/or theatre/nursing staff, and a lack of in-patient capacity for post-operative recovery. Conclusion(s): Waiting times for DBR have been negatively impacted by COVID-19. As reconstruction is an integral part of women's breast cancer treatment, there is an urgent need to develop a recovery plan to address this issue, support patients and allow women to access reconstructive surgery in a timely manner.Copyright © 2023
ABSTRACT
BACKGROUND: We have previously shown that iatrogenic dehydration is associated with a shift to organic osmolyte production in the general ICU population. The aim of the present investigation was to determine the validity of the physiological response to dehydration known as aestivation and its relevance for long-term disease outcome in COVID-19. METHODS: The study includes 374 COVID-19 patients from the Pronmed cohort admitted to the ICU at Uppsala University Hospital. Dehydration data was available for 165 of these patients and used for the primary analysis. Validation was performed in Biobanque Québécoise de la COVID-19 (BQC19) using 1052 patients with dehydration data. Dehydration was assessed through estimated osmolality (eOSM = 2Na + 2 K + glucose + urea), and correlated to important endpoints including death, invasive mechanical ventilation, acute kidney injury, and long COVID-19 symptom score grouped by physical or mental. RESULTS: Increasing eOSM was correlated with increasing role of organic osmolytes for eOSM, while the proportion of sodium and potassium of eOSM were inversely correlated to eOSM. Acute outcomes were associated with pronounced dehydration, and physical long-COVID was more strongly associated with dehydration than mental long-COVID after adjustment for age, sex, and disease severity. Metabolomic analysis showed enrichment of amino acids among metabolites that showed an aestivating pattern. CONCLUSIONS: Dehydration during acute COVID-19 infection causes an aestivation response that is associated with protein degradation and physical long-COVID. TRIAL REGISTRATION: The study was registered à priori (clinicaltrials.gov: NCT04316884 registered on 2020-03-13 and NCT04474249 registered on 2020-06-29).
Subject(s)
COVID-19 , Humans , SARS-CoV-2 , Dehydration/etiology , Sodium , Urea , Potassium , Amino Acids , Glucose , Post-Acute COVID-19 SyndromeABSTRACT
Coronavirus disease (COVID-19) caused by novel coronavirus (SARS-CoV-2) infection is still incompletely understood in transplantation, and there have been a few reports of multisystem inflammatory syndrome in adults (MIS-A) like illness in transplant patients. Herein, we report a case of MIS-A in a renal transplant that ultimately was successfully managed. The case was a 32-year-old man, transplanted 3 years ago, with chronic graft dysfunction and no other comorbidities. He presented with a 3-day history of fever and abdominal pain with no respiratory complaints. The patient had multi-organ involvement in the form of acute pancreatitis, severe diarrhea, acute kidney injury, and shock. Inflammatory markers including D-dimer and C-reactive protein were elevated. Chest radiology showed bilateral haziness on admission. The patient had two consecutive SARS CoV 2 reverse transcription-polymerase chain reaction (RT PCR) tests negative initially but eventually SARS CoV 2 antibody test came positive. The patient was managed initially with broad-spectrum antibiotics, and after confirmation of MIS-A, steroids, intravenous immunoglobulin, and anticoagulation were administered. The patient survived and was discharged on the 29 th day of admission. Our reports highlight that MIS-A should be suspected in atypical cases irrespective of COVID-19 tests and should be confirmed with repeated RT-PCR and SARS-CoV-2 antibody tests. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
Transplant in COVID era is a challenging task given a paucity of data and limited experience worldwide. A 35-year-old male patient with chronic kidney disease on dialysis for the past 9 months underwent successful living-related donor transplant with his father (aged 64 years) as donor at our center. In this case, donor was diagnosed with reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 during evaluation, and he was managed with supportive care and comprehensive social distancing at home. Donor was asymptomatic throughout this period. Interval from positive to negative RT-PCR for nasopharyngeal swab test was 37 days. Interval from negative RT-PCR to kidney transplant was 33 days. Later, recipient and donor were discharged with negative RT-PCR posttransplant. At 71 days of follow-up, both recipient and donor have stable kidney function with normal urinalysis. Hence, prospective donor with a history of COVID-19 infection can be taken for transplant after thorough pretransplant evaluation and having two negative RT-PCR reports after infection, normal imaging, and additional preprocedural negative RT-PCR testing. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
The role of intellectual property in the pharmaceutical industry has been controversial for decades. On one hand, evidence suggests that patents and monopolies on drug sales for limited periods are necessary to fund costly R&D required to produce life-saving therapies. On the other, there is concern that patent rights have gone too far in favour of innovation, limiting access to lower-income populations who cannot afford exorbitant drug prices. This tension plays out at a grander scale in the international context, as drug prices can vary drastically between countries, as has happened in the COVID-19 pandemic. In 2017, the United States Supreme Court held in Lexmark that a patentee's rights are exhausted after international sale. This decision has immense implications for the U.S. pharmaceutical industry and the affordability of medicines worldwide. Legislators such as Senator Bernie Sanders have proposed bills in light of the decision to lower American drug prices by permitting importation from countries like Canada. Though FDA and other regulatory barriers may still be present, American innovator companies can no longer sue reimports on the grounds of patent infringement. However, while the results may be favourable to U.S. consumers, international impacts remain to be seen. Some suggest that prices in countries like India could increase to reduce opportunities for arbitrage. In this article, we suggest methods for branded pharmaceutical companies to address issues arising from Lexmark while simultaneously providing affordable access-from voluntary licensing to avoid the risk of compulsory licenses and creative forms of contracting. Finally, we conclude regarding India's newfound consumer protection laws to note that American pharmaceutical players may not simply be able to lower product standards to prevent parallel importation back to the US. © 2021 Chair on Consumer law and practice, National Law School of India University.
ABSTRACT
Background: Coronavirus disease 19 (COVID-19) caused by a severe acute respiratory syndrome coronavirus-2 belonging to the Coronaviridae family has caused a global pandemic. As it has emerged as a newer disease, there is a lack of information in many aspects of it. Materials and Methods: We tried to study the progression in the COVID-19 patients in terms of their clinical, laboratory, and X-rays as a radiological modality, for that, we did a single-centered retrospective observational study in 159 laboratory-confirmed COVID-19 positive patients with sample size being duration dependent. Results: We found statistically significant correlation between clinical parameters and lung involvement based on chest X-ray (CXR) scoring and also temporal variation as the disease progression occurs. Conclusion: Along with clinical and laboratory parameters, CXRs can be used as a useful bedside, inexpensive, and easily available radiological tool for assessment in resource-poor settings where high-resolution computed tomography scans are not feasible.
ABSTRACT
The UK COVID vaccination programme has progressed at an astonishing rate since the first patients received their doses in December 2020. It is well known that other vaccines including influenza and human papilloma virus (HPV) can result in reactive lymphadenopathy in the axilla and/or neck. Patients are now presenting via the two week wait neck lump clinic with supraclavicular fossa and low neck lymphadenopathy related to COVID vaccination, and to similar one stop breast clinics with axillary lymph nodes. In an audit of 80 patients seen over a period of one month, we found COVID vaccine-related low neck lymphadenopathy in four cases (5%), with an additional rectal cancer patient thought to have metastatic disease who presented with a Virchow type node. COVID vaccine-related lymphadenopathy should be considered in the differential diagnosis of low-neck nodes if they occurred shortly after vaccination, but it is important to exclude sinister disease using ultrasound and other investigations as necessary.
Subject(s)
COVID-19 , Lymphadenopathy , COVID-19 Vaccines , Follow-Up Studies , Humans , Lymph Nodes/diagnostic imaging , Lymphadenopathy/etiology , SARS-CoV-2 , Vaccination/adverse effectsABSTRACT
Background: Outpatient antibiotic stewardship is an emerging area of interest. The COVID-19 pandemic has led to unique restrictions such as social distancing and an increase in telemedicine visits. The effects on outpatient antimicrobial prescription needs further exploration. Methods: We investigated the outpatient antimicrobial prescription trend pre (January 5 to March 14 2020) and post (March 15 to May 31 2020) COVID-19 restrictions at the Veteran's Affairs Maryland Health Care System. We compared prescribing characteristics pre and post restrictions using Chi-squared and Mann Whitney U tests. Segmented regression analysis was used to compare antimicrobial prescriptions per 1000 encounters, with a control group from the same weeks in 2019. Results: There were 3,881 total antibiotics prescribed for 382501 encounters during the 16 weeks in 2020. Post-restrictions, there was a significant decrease in encounters and antibiotics per week with mean difference of -15241 and -147, for encounters and antibiotics, respectively. The mean antibiotics per 1000 encounters was slightly higher in the post-restriction group, but without statistical significance by this analysis (10.1 vs 10.4, p-value 0.48). Other notable changes post-prescription described in the Table was a decrease in macrolide and an increase in trimethoprim-sulfamethoxazole;urgent care prescriptions decreased, while primary care prescription increased;and refill prescriptions were less common, while mail prescriptions were more common. On regression analysis, we found a significant level change of +2.7 antibiotics per 1000 encounters (p=0.02) immediately after restrictions were placed, without any significant change in trend (Figure). This translates to an additional 243 antibiotics prescribed during the post-restriction weeks. This was in comparison to data from 2019 which had no significant level or trend change during the same weeks. Table 1. Characteristics of antibiotics prescribed and comparison between pre and post COVID-19 restrictions in 2020, with 2019 control. Conclusion: We found an immediate increase in antibiotics relative to encounters post COVID-19 restrictions though antibiotics and encounters were all generally decreased with azithromycin showing the most appreciable decrease. Further investigation is needed to understand these findings and the implications on the population.
ABSTRACT
The first COVID-19 vaccination was given in December 2020 and there is an effort to vaccinate the international population on a massive scale. Common side effects from the vaccine include headache and tiredness. Regional lymphadenopathy has been described in relation to other vaccines. We describe two cases of supraclavicular reactive lymphadenopathy presenting in patients who had the COVID vaccination in the ipsilateral arm. Awareness of this diagnosis is important for patients presenting to the neck lump clinic.