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Case report Background: Giant cell arteritis (GCA) is an immune-mediated vasculitis affecting large arteries. It has been hypothesized that pathogens including viruses may trigger inflammation within the vessel walls. Human leukocyte antigens' (HLA) genetic studies have previously reported HLA-DR4 (HLA-DRB1* 04 and HLA-DRB1* 01) as susceptibility, and HLA-DR2 (HLA-DRB1* 15 and HLA-DRB1* 16) as protective alleles for GCA. Here we report two cases of large vessel (LV) GCA diagnosed in patients previously suffered from mild coronavirus disese 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2). Case presentation: First case, a 69-year- old male, had a mild COVD-19 three months before the appearance of headache, malaise, and a febrile state associated with extremely increased inflammatory parameters (CRP 2847 mg/dl and IL-6 802.3 pg/ml). Computed tomography examination of the aorta (CTA) and the branches, performed in two occasions six months apart, showed an interesting picture of a migratory arteritis. HLA typing showed: HLA-A* 2,-A* 24;-B* 51,-B* 57;-DRB1* 15,-DRB1* 16;-DQB1* 05,-DQB1* 06;Second case, a 64-year- old female, was evaluated for LV-GCA two months after a mild COVID-19, when she presented with elevated CRP (183mg/dl) and systemic symptoms. Thickening of the ascending aorta and the aortic arch was seen on CTA. Typing of HLA revealed: HLA-A* 2,-A* 11;-B* 27,-B* 35;-DRB1* 14,-DRB1* 15;-DQB1* 05,-DQB1* 06;A whole-body 18F-FDG- PET/ CT performed in both cases revealed inflammation of the ascending, aortic arch, thoracic and abdominal aorta. The first patient had appearance of the inflammatory involvement of the iliac and femoral arteries, while the second patient had an additional pulmonary trunk inflammation. Corticosteroid treatment was introduced in both cases. Due to a progressive inflammatory course of LV-GCA in the first case, the IL-6 inhibitor (tocilizumab) was initiated, leading to a clinical and laboratory improvement. In conclusion, LV-GCA may be considered as an autoimmune disease triggered by SARS-CoV- 2, as one of the broad spectrum of manifestation within the post acute COVID-19. None of the previously known HLA susceptibility alleles for GCA were detected in our patients. In contrast, both patients had DRB1*15 allele, and one of them was DRB1*15/DRB1*16 carrier, suggesting a possibility of losing their protective effect in LV-GCA induced by COVID-19.
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Learning Objectives: Demonstrate the use of tele-medicine in remote proctorship when performing procedures during the COVID-19 pandemic. Background(s): Tumour ablation is a growing field within Interventional Radiology, providing a minimally invasive option in the treatment of renal, hepatic, lung and bone lesions. While the practice of tumour ablation is rapidly gaining acceptance, the expertise is still largely concentrated within specialist centres. Until recently, the few experienced practitioners could travel to support other clinicians in performing these procedures but the recent pandemic has halted this practice. We present our experience of remote proctorship in the expansion of our oncology services, offering our patients minimally invasive therapeutic options as part of their oncology care. Procedure Details: Seven ablation cases were performed over four days with virtual assistance via the Proximie platform. Cameras were used to relay the live operating field to the proctor. The intra-procedural CT images displayed in theatre were also directly linked and the addition of a tablet with an encrypted video link allowed the proctor to be seen by the operators. The proctor used integrated augmented reality tools to point, annotate and demonstrate on the screen in theatre in real time and a closed 2- way communication system was used between the operators and proctor to facilitate a dialogue throughout the procedure. Conclusion(s): The use of novel remote proctorship technology enables physicians to continue to be to able offer patients cutting edge technological advancements safely, at a time when on site presence is limited by the COVID-19 pandemic.
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Purpose: Hospitals worldwide face huge patient backlogs following the delays caused by the recent COVID-19 pandemic. Interventional Radiology (IR) is required to increase productivity to 120% in order to address the backlog and keep up with ongoing service demands. After a period of observation within the department, lack of recovery space was noted as a rate limiting step in patient and theatre turnover. Material(s) and Method(s): Data regarding a selection of day case procedures was obtained from patient tracking software. A total of 214 cases were reviewed. A literature review was also performed to determine the recommended recovery time for each procedure to develop new departmental guidelines. Result(s): The average recovery time for some procedures exceeded the recommendations in the literature. Results are listed as procedure: average recovery time;recommended time (hours:mins). The availability of a doctor to review and discharge patients was noted to be the cause of delay in some cases. A nurse-led discharge pathway, in another surgical speciality, has been reported in the literature to improve efficiency while maintaining safety. Conclusion(s): The recovery times for day case procedures far exceeds the reported recommendations, limiting our productivity. At present, a nurse-led discharge pathway does not exist within IR. We plan to explore this avenue as a means to increase patient turnover. Further work in training and creation of standard operating procedures is required before this can be implemented. (Table Presented).
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Purpose: The cyclic nature of active and recovery phases of the COVID-19 pandemic, has demanded fast adaptations and preparation for health care workers world-wide. We aimed to assess how interventional radiologists are handling the pandemic during active and recovery phases with regard to work and team structures, as well as mental health and how the pandemic could have increased the awareness of minimally-invasive therapies as alternatives to postponements of non-urgent procedures. Material and methods: 7125 CIRSE members were invited to participate. For this interim report, responses were collected between 23 November 2021 and 17 December 2021. Results: 114 responses were obtained for this preliminary report, of which 102 were complete. 94% (n=99) of respondents were interventional radiology specialists. Most respondents reported having established a routine to handle different waves of the pandemic (89.5%;n=102). Compared to active phases, fewer respondents indicated at least one pandemic-associated measure in their department during recovery phases (46%-71% vs 13%). 56% reported an increase in ambulatory care patients either during active and/or recovery phases. 54% reported more referrals during active and/or recovery phases. 25% reported increased hours at the hospital during recovery phases, 52% indicated increased sick leave, care leave, quarantine, and burn-out of team members and only 39% reported to get enough time to rest during recovery phases. Conclusion: While the COVID-19 pandemic is continuing to burden IR departments and the mental health of IRs, more than half of respondents reported an increase in referrals for minimally-invasive therapies and ambulatory care.
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Purpose: The purpose of the study is to highlight the relevance of reactance theory for modeling consumer responses to COVID restrictions. The study also aims to critically evaluate the appropriateness of the most established reactance model (the intertwined model) for studying reactance specifically in relation to freedom threats arising from measures aimed at combatting the spread of the pandemic. Design/methodology/approach: Following a conceptual analysis of the intertwined model of reactance, structural equation modeling is applied to Rain's (2013) meta-analytic data to compare the model to alternative model specifications. Findings: The analysis reveals both conceptual and statistical shortcomings of the intertwined model of reactance in its current/traditional form. It also draws attention to other model specifications that provide just as good statistical fit and offer promising alternative ways of modeling reactance in a COVID context. Originality/value: The study is the first attempt to explicitly discuss conceptual and statistical problems associated with the most widely accepted model of reactance, illustrate these issues with specific reference to consumer reactions to COVID restrictions, identify alternative promising model specifications and suggest a respecification of the intertwined model. © 2022, Michela Matarazzo and Adamantios Diamantopoulos.
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BACKGROUND: The COVID-19 pandemic had an unprecedented impact on clinical practice and healthcare professionals. We aimed to assess how interventional radiology services (IR services) were impacted by the pandemic and describe adaptations to services and working patterns across the first two waves. METHODS: An anonymous six-part survey created using an online service was distributed as a single-use web link to 7125 members of the Cardiovascular and Interventional Radiological Society of Europe via email. Out of 450 respondents, 327 who completed the survey at least partially including 278 who completed the full survey were included into the analysis. RESULTS: Interventional radiologists (IRs) reported that the overall workload decreased a lot (18%) or mildly (36%) or remained stable (29%), and research activities were often delayed (30% in most/all projects, 33% in some projects). Extreme concerns about the health of families, patients and general public were reported by 43%, 34% and 40%, respectively, and 29% reported having experienced significant stress (25% quite a bit; 23% somewhat). Compared to the first wave, significant differences were seen regarding changes to working patterns, effect on emergency work, outpatient and day-case services in the second wave. A total of 59% of respondents felt that their organisation was better prepared for a third wave. A total of 19% and 39% reported that the changes implemented would be continued or potentially continued on a long-term basis. CONCLUSION: While the COVID-19 pandemic has negatively affected IR services in terms of workload, research activity and emotional burden, IRs seem to have improved the own perception of adaptation and preparation for further waves of the pandemic.