ABSTRACT
The COVID-19 pandemic produced unprecedented challenges to healthcare and medical device manufacturing (e.g. personal protective device and replacement part shortages). Additive manufacturing, 3D printing, and the maker community were uniquely positioned to respond to these needs by providing in-house design and manufacturing to meet the needs of clinicians and hospitals. This paper reviews the pandemic response of Children's Hospital of Philadelphia CHAMP 3D Lab, a point-ofcare3D printing team that supports clinical and research projects across the hospital network. The CHAMP team responded to a variety of COVID-19 healthcare needs including providing protective eyewear and ventilator components, creating a transport hook, and designing a novel transparent facemask. This case series details our response to these needs, describing challenges experienced and lessons learned in overcoming them so that others may learn from our experiences. Challenges to responding to the pandemic included the need to handle urgent pandemic related requests in addition to our standard fare. This required us to not only expand our capacity without additional resources, but also to develop a system of prioritization. Specific changes made included: streamlining workflows, identifying safety review processes, and developing/enlisting a network of collaborators. Further, we consider how to transition to a future, post-pandemic world without losing the cohesive drive of emergency-induced innovation. This paper aims to share what we have learned and to encourage both teams currently engaged in the printing community and those looking to join it © 2021 The Authors
ABSTRACT
Background and Aims: The burden of uploading diabetes device shifted from clinic staff to those living with T1D as a result of virtual encounters for COVID-19. Unfortunately, many patients were not familiar with the upload process, causing incomplete data availability. This study compared patients with device data available at the start of their routine virtual clinical visits vs. those that did not. Methods: Data was collected from individuals <23 years old, with T1D, who received virtual care at a network of tertiary pediatric diabetes clinics in the Midwest USA from 3/2020 to 11/ 2021. Successfully uploading any device data or having cloudconnected streaming data was defined as having engaged in data sharing. Results: Observations from 946 telehealth encounters were analyzed. Only 52.9% (n = 383) had device data uploaded before their visit. Mean HbA1c (9.5% vs 8.5%, p-value <0.001), and mean time in range (44.7% vs 35.7%, p-value <0.001) were lower in those that had uploaded/streamed their data before their clinic encounter. Those with a longer duration of diabetes, selfidentifying as Black or African American, and those with public insurance were less likely to have data available at the start of their visit. Conclusions: Data from diabetes devices are integral to routine, effective, and safe management of insulin therapy. Statistically significant differences in access to device data were noted in those with public insurance and those who self-identify as African American. HbA1c and TIR were also lower. This study highlights the importance of equitable access to diabetes devices and continued advancement in auto-data streaming technologies.
ABSTRACT
Introduction: Considerable research has addressed the impact and increased severity of coronavirus disease 2019 (COVID-19) in adult patients with type 2 diabetes (T2D). However, findings from older adult patients cannot be generalized to affected children and young adults. Objectives: In this retrospective cohort study, we examine whether race/ethnicity and other factors are associated with hospitalization in pediatric and young adult patients with T2D and COVID-19 infection. Methods: The de-identified COVID-19 patient cohort from the December 2020 release of Cerner Real-World Data™ includes longitudinal data for patients who received care at 87 US-based health systems between December 2019 and September 2020. A rigorous, multi-step algorithm was used to identify patients with T2D (n=229). Analysis was limited to patients <27 years old with a positive laboratory test or billing code consistent with COVID-19 infection. A generalized linear mixed model was used to evaluate race/ethnicity, gender, HbA1c, body mass index (BMI), mean blood glucose, age, payer, and Elixhauser comorbidity score as correlates of hospital admission. Results: In this cohort, 204 (89.1%) patients were 18-26 years old, and 133 (58.1%) were female. Fifty-two percent were Hispanic, 27.1% were non-Hispanic Black, and 12.2% were non-Hispanic White. Median BMI was 37.9 kg/m2 (IQR 32.3-45.1 kg/m2);median HbA1c was 9.25% (IQR 7.2-12.3%). Ninety-four patients (41.0%), including all 21 patients in diabetic ketoacidosis (DKA;9.2%) were hospitalized. Male gender (OR 2.46 [CI 1.23-4.91], p=0.011), HbA1c (OR 1.29 [CI 1.10-1.52], p=0.001), and BMI (OR 1.44 [CI 1.02-2.03], p=0.040) were associated with hospitalization. Conclusions: Male gender, increased HbA1c, and increased BMI are associated with hospitalization in youths and young adults with T2D and COVID-19 infection. Further study is needed to identify targeted interventions to prevent hospitalization in youths and young adults with T2D.
ABSTRACT
Objective: The pathophysiological mechanism of acute lung injury in COVID-19 includes a cascade of local and systemic responses with activation of several proinflammatory cytokines, including metalloproteinases. The aim of this study is investigate the role of matrix metalloproteinase-9 (MMP-9) in plasma from patients with severe COVID-19 hospitalized in a Brazilian ICU Design and method: The study was designed to analyze the MMP-9 plasmatic in COVID-19 severe infection. Epidemiological data and blood samples were obtained from 42 subjects hospitalized in the ICU with clinically SARS-CoV-2 infection con firmed by RT-PCR (COVID), and 15 healthy subjects (Control). Zymography methods obtained the MMP-9 plasma activity. Continuous variables are shown by mean±STDV and analyzed by the Mann-Whitney test. Categorical variables were compared by the Chi-squared test. The MMMP-9 activity is shown in the log of normalized and analyzed by unpaired T-test. Two-way ANOVA was used to analyze subgroups divided by gender, age greater or less than the median 60.4-year-old, hypertensive or normotensive, non-obese or obese Results: The COVID and Control groups did not differ signi ficantly by age (62.6±13vs.57.6±12.2 years old, p=0.097) and BMI (30.3±6.1vs.29.33±5.7 kg/m2, p=0.338). The COVID group has fewer women than the Control group (28.6%vs.80%, p=0.0008). The COVID subjects with hypertension were 42% vs.67% in the Control group (p=0,2), and diabetes was similar in both groups The hospital stay in the COVID group was 14.5±11.5 days and the hospitalization death rate was 32.5% The COVID-19 group has shown an increase in MMP-9 activity compared with the Control group (0.38±0.072 UA;95%CI=0.23-0.52,p<0.0001). The MMP-9 activity increasing was independent of gender (p=0.45), age (p=0.93), BMI (p=0.3) or hypertension (p=0.6) and dependent of the COVID-19 infection (p<0.0001). Therefore, our data are showing that the COVID-19 infection was responsible for MMP-9 improvement in plasma of severe COVID-19 infection (p<0.0001) while all different analyses consistently showed a signi ficant effect of COVID-19 infection (p<0.0001) Conclusions: There is a signi ficant increase in the MMP-9 plasmatic activity in severe COVID-19 patients independently of sex, age, obesity, and hypertension Therefore, MMP-9 may be a potential new target for acute lung injury therapy in patients with COVID-19.