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Introduction: The COVID-19 pandemic revealed numerous barriers to effectively managing public health crises, including difficulties in using publicly available, community-level data to create learning systems in support of local public health decision responses. Early in the COVID-19 pandemic, a group of health care partners began meeting to learn from their collective experiences. We identified key tools and processes for using data and learning system structures to drive equitable public health decision making throughout different phases of the pandemic. Methods: In fall of 2021, the team developed an initial theory of change directed at achieving herd immunity for COVID-19. The theoretical drivers were explored qualitatively through a series of nine 45-min telephonic interviews conducted with 16 public health and community leaders across the United States. Interview responses were analyzed into key themes to inform potential future practices, tools, and systems. In addition to the interviews, partners in Dallas and Cincinnati reflected on their own COVID-19 experiences. Results: Interview responses fell broadly into four themes that contribute to effective, community driven responses to COVID-19: real-time, accessible data that are mindful of the tension between community transparency and individual privacy;a continued fostering of public trust;adaptable infrastructures and systems;and creating cohesive community coalitions with shared alignment and goals. These themes and partner experiences helped us revise our preliminary theory of change around the importance of community collaboration and trust building and also helped refine the development of the Community Protection Dashboard tool. Conclusions: There was broad agreement amongst public health and community leaders about the key elements of the data and learning systems required to manage public health responses to COVID-19. These findings may be informative for guiding the use of data and learning in the management of future public health crises or population health initiatives. © 2023 The Authors. Learning Health Systems published by Wiley Periodicals LLC on behalf of University of Michigan.
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Different health care strategies have been implemented worldwide due to the pandemic. We explore a new approach to guarantee the follow-up of severe asthmatic (SA) children. Method(s): A retrospective/prospective cohort study. All children (GINA guidelines) from the SA clinic at Garrahan Hospital were included. Clinic attendance (virtual [V] or face-to-face [FF]), asthma control (ACT), asthma exacerbations (AE) and hospitalizations (H) were evaluated in the same group during two periods: March 2019- March 2020 (FFP) and April 2020-April 2021 (VP). During VP children performed a validated electronic ACT that was sent monthly through an electronic APP, 48 hours after they were contacted via a phone call. Student's/Wilcoxon paired tests. P <0.05 Results: All SA patients (n 74) were seen every two months during FFP;47% male;median age 13 years (IQR 10- 15) and 68 (92%) of them during VP. In FFP, 393 visits were registered (5.3 visit/pat/year);246 ACT were performed (3.3 ACT/pat/year), 22% (n 54) were uncontrolled (ACT<20). During VP, 816 ACT were sent with 642 replies (79%), 9.4 ACT/pat/year;19% (n 120) <20. There were 46 (67%) patients with AE during FFP vs 31 (46%) in VP (p 0.0004);AE in FFP 135 vs 79 in VP (p 0.0031), (2 vs 1.1 AE/pat/year) with AE decrease of 41%;91 prescribed steroid courses in FFP (1.3 courses/pat/year) vs 49 in VP (0.72 courses/pat/year) (p 0.006), with a reduction of 46%. There were no differences in H (FFP 10, VP 6;p 0.39). In FFP 19% of patients were under biologics while 12% during VP. Conclusion(s): Virtual team clinics and electronic ACT at home were introduced easily and effectively during pandemic to manage SA children. Follow-up of almost all patients could be ensured.
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Vaccines have contributed to substantial improvements in health and social development outcomes for millions in recent decades. However, equitable access to immunization remains a critical challenge that has stalled progress toward improving several health indicators around the world. The COVID-19 pandemic has also negatively impacted routine immunization services around the world further threatening universal access to the benefits of lifesaving vaccines. To overcome these challenges, the Immunization Agenda 2030 (IA2030) focuses on increasing both commitment and demand for vaccines. There are three broad barriers that will need to be addressed in order to achieve national and subnational immunization targets: (1) shifting leadership priorities and resource constraints, (2) visibility of disease burden, and (3) social and behavioral drivers. IA2030 proposes a set of interventions to address these barriers. First, efforts to ensure government engagement on immunization financing, regulatory, and legislative frameworks. Next, those in subnational leadership positions and local community members need to be further engaged to ensure local commitment and demand. Governance structures and health agencies must accept responsibility and be held accountable for delivering inclusive, quality, and accessible services and for achieving national targets. Further, the availability of quality immunization services and commitment to adequate financing and resourcing must go hand-in-hand with public health programs to increase access to and demand for vaccination. Last, strengthening trust in immunization systems and improving individual and program resilience can help mitigate the risk of vaccine confidence crises. These interventions together can help ensure a world where everyone, everywhere has access to and uses vaccines for lifesaving vaccination.
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Introduction: Gradual enlargement of multinodular goiter (MNG) may compress surrounding structures which may progressively cause complications of tracheal stenosis and airway compromise. Surgical resection remains the gold standard treatment in MNG patients presenting with respiratory distress. In the current global COVID -19 pandemic, compressive goiter should be a differential diagnosis in patients with stable benign thyroid goiter presenting with dyspnea. We present a case of MNG with life threatening airway obstruction during an active COVID-19 infection. Case presentation: A 74-year-old female with a history of hyperthyroidism with multi-nodular goiter and recurrent atrial fibrillation status-post ablation, was transferred to the intensive care unit for treatment after being intubated for respiratory distress at a nearby hospital. She was diagnosed with hyperthyroidism about 40 years ago and managed with methimazole. Over the last two years, thyroid ultrasound and prior imaging showed MNG with patent but moderate tracheal narrowing;fine-needle aspiration (FNA) confirmed benign colloid nodules with cystic degeneration. She was pending cardiac clearance for surgery when symptoms acutely worsened two days before admission. On initial assessment, she was hemodynamically stable, afebrile, with oxygen saturation of 86% on room air. She was alert and able to follow commands. On physical examination, she had stridor and thyromegaly was evident with mild tenderness on palpation. Cardiopulmonary examination was remarkable for coarse breath sounds. Labs showed TSH 4.82 (Normal 0.3 - 4.5 ulU/mL), FT4 0.64 (Normal 0.5- 1.26 ng/dL). Respiratory panel test came back positive for SARS-CoV-2. Racemic epinephrine and albuterol nebulizers were administered to help with her symptoms. CT scan of the neck revealed a severe narrowing and mild rightward shift of the trachea by a large multinodular goiter, prompting the decision to intubate for airway protection. CT scan of the chest with contrast demonstrated the large MNG with tracheal stenosis. Her methimazole dose was adjusted. After cardiac clearance, she underwent thyroidectomy through a transcervical approach. Levothyroxine and calcium supplementation were started post-surgery. She was extubated two days after her thyroidectomy. Pathology results showed no evidence of malignancy. Discussion: Acute airway obstruction by large MNG requiring emergent airway protection is rare. Typically airway compromise from large otherwise stable benign goiters results from sudden hemorrhage into a cyst, upper respiratory tract infection leading to tracheal edema, or worseningcomorbid conditions. During the COVID-19 pandemic, acute respiratory failure and shortness of breath is typical of worsening disease course. This case highlights the importance of maintaining wider differentials of respiratory failure even and we need to consider worsening of tracheal narrowing with a large goiter due to tracheal edema from SARS- CoV-2 Infection. Thyroidectomy before SARS-CoV-2 infection may have reduced her need for emergent intubation for acute respiratory failure by improving pre existing airway compression.Presentation: No date and time listed
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A cross-sectional SARS-CoV-2 serosurvey was conducted after the Omicron surge in Jamaica using 1,540 samples collected during March - May 2022 from persons attending antenatal, STI and non-communicable diseases clinics in Kingston, Jamaica. SARS-CoV-2 spike receptor binding domain (RBD) and/or nucleocapsid IgG antibodies were detected for 88.4% of the study population, with 77.0% showing evidence of previous SARS-CoV-2 infection. Of persons previously infected with SARS-CoV-2 and/or with COVID-19 vaccination, 9.6% were negative for spike RBD IgG, most of which were unvaccinated previously infected persons. Amongst unvaccinated previously infected people, age was associated with testing spike RBD IgG negative. When considering all samples, median spike RBD IgG levels were 131.6 BAU/mL for unvaccinated persons with serological evidence of past infection, 90.3 BAU/mL for vaccinated persons without serological evidence of past infection, and 896.1 BAU/mL for vaccinated persons with serological evidence of past infection. Our study of the first reported SARS-CoV-2 serosurvey in Jamaica shows extensive SARS-CoV-2 population immunity, identifies a substantial portion of the population lacking spike RBD IgG, and provides additional evidence for increasing COVID-19 vaccine coverage in Jamaica.
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Background: Cancer and systemic anti-cancer treatment (SACT) have been identified as possible risk factors for infection and related severe illness associated with SARS-CoV-2 virus as a consequence of immune suppression. The Scottish COVID CAncer iMmunity Prevalence (SCCAMP) study aimed to characterise the incidence and outcomes of SARS-Cov-2 infection in patients undergoing active anticancer treatment during the COVID-19 pandemic and their antibody response following vaccination. Methods: Eligible patients were those attending secondary care for active anti-cancer treatment for a solid tumour. Blood samples were taken for total SARS-CoV-2 antibody assay (Siemens) at baseline and after 1.5, 3, 6 and 12 months. Data on COVID-19 infection, vaccination, cancer type, treatment and outcome (patient death) was obtained from routine electronic health records. Results: The study recruited 766 eligible participants between 28th May 2020 and 31st October 2021. During the study period there were 174 deaths (22%). The median age was 63 years, and 67% were female. Most received cytotoxic chemotherapy (79%), with the remaining 14% receiving immunotherapy and 7% receiving another form of anti-cancer therapy (radiotherapy, other systemic anti-cancer treatment). 48 (6.3%) tested positive for SARS-CoV-2 by PCR during the study period. The overall infection rate matched that of the local adult general population until May 2021, after which population levels appeared higher than the study population. Antibody testing detected additional evidence of infection prior to vaccination, taking the total number to 58 (7.6%). There was no significant difference in SARS-CoV-2 PCR positive test rates based on type of anti-cancer treatment. Mortality rates were similar between those who died within 90 days of a positive SARS-CoV-2 PCR and those with no positive PCR (10.4% vs 10.6%). Death from all causes was lowest among vaccinated patients, and of the patients who had a positive SARS-CoV-2 PCR at any time, all of those who died during the study period were unvaccinated. Multivariate analysis correcting for age, gender, socioeconomic status, Charlson co-morbidity score and number of previous medications revealed that vaccination was associated with a significantly lower infection rate regardless of treatment with chemotherapy or immunotherapy with hazard ratios of 0.307 (95% CI 0.144-0.6548) or 0.314 (95% CI 0.041-2.367) in vaccinated patients respectively. Where antibody data was available, 96.3% of patients successfully raised SARSCoV-2 antibodies at a time point after vaccination. This was unaffected by treatment type. Conclusions: SCCAMP provides real-world evidence that patients with cancer undergoing SACT have a high antibody response and protection from SARS-CoV-2 infection following COVID-19 vaccination.
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The pandemic caused by SARS-COV2, worldwide caused a sedentary lifestyle and damage to mental health in the general population, including university students, a sector that did not escape these adverse effects due to the pandemic. Therefore, the main aim of this research is to evaluate the levels of physical activity (PA) and mental health in university students during the COVID-19 coronavirus (SARS-COV2) pandemic. The DASS-21 scale, the Global Physical Activity Questionnaire (GPAQ) and the SF-36 Health Questionnaire were applied to 63 university students from the State of Veracruz, Mexico, aged 18 to 24 years. The data treatment was carried out in the statistical software SPSS v.25, the results showed that 76.2% of the sample was found in physically active levels, likewise the correlation coefficients made between physical activity (PA) and anxiety (r= -.41) physical activity (PA) and stress (r= -.42) showed negative correlations with moderate to intense magnitudes, respectively. Therefore, it is concluded that performing physical activity during the pandemic was shown to significantly reduce problems related to mental health in university students.
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Background It has recently been suggested that influenza vaccination may be a factor associated with decreased COVID-19 mortality. Methods An age-matched case–control study based on hospital cases. We included subjects aged 18 years and older with a diagnosis of moderate to severe COVID-19. Infection was corroborated by RT-PCR test for SARS-COV-2. Deceased subjects were considered cases, controls were patients discharged due to improvement of acute symptoms. We used bivariate analysis to determine factors associated with death from COVID-19, and calculated odds ratios and 95% confidence intervals. Results A total of 560 patients were included in the study, 214 (38.2%) were considered cases and 346 (61.7%) controls. A significant difference was observed with the presence of type 2 diabetes mellitus [54% vs. 39.3% between cases and controls, respectively (p = 0.04)] and having received influenza vaccination (p = 0.02). Type 2 diabetes mellitus was associated with higher COVID-19 mortality [OR 1.8 (95% CI 1.2–2.5) p = 0.01], whereas having been immunized against influenza in 2019 was associated with lower mortality in this group of patients [OR 0.6 (95% CI 0.4–0.9) p = 0.02]. Conclusions Influenza vaccination in the previous year appears to be associated with lower mortality from COVID-19;whereas type 2 diabetes mellitus is confirmed as a condition associated with higher mortality.
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COVID-19 , Vaccines , COVID-19/prevention & control , COVID-19 Vaccines , Humans , Immunization, SecondaryABSTRACT
Background: It has recently been suggested that influenza vaccination may be a factor associated with decreased COVID-19 mortality. Methods: An age-matched case-control study based on hospital cases. We included subjects aged 18 years and older with a diagnosis of moderate to severe COVID-19. Infection was corroborated by RT-PCR test for SARS-COV-2. Deceased subjects were considered cases, controls were patients discharged due to improvement of acute symptoms. We used bivariate analysis to determine factors associated with death from COVID-19, and calculated odds ratios and 95% confidence intervals. Results: A total of 560 patients were included in the study, 214 (38.2%) were considered cases and 346 (61.7%) controls. A significant difference was observed with the presence of type 2 diabetes mellitus [54% vs. 39.3% between cases and controls, respectively (p=.04)] and having received influenza vaccination (p= .02). Type 2 diabetes mellitus was associated with higher COVID-19 mortality [OR 1.8 (95% CI 1.2-2.5) p=.01], whereas having been immunised against influenza in 2019 was associated with lower mortality in this group of patients [OR .6 (95% CI .4-.9) p=.02]. Conclusions: Influenza vaccination in the previous year appears to be associated with lower mortality from COVID-19; whereas type 2 diabetes mellitus is confirmed as a condition associated with higher mortality.
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BACKGROUND: The neurologic assessment in neuro-oncology (NANO) scale was developed as a standardized metric to objectively measure neurologic function in patients with brain tumors and complement radiographic assessment in defining overall outcome. The scale has been incorporated in clinical trials. Early data is suggestive of feasibility and that NANO contributes to overall outcome assessment. However, real-world use of the NANO scale to drive clinical-decision making and the predictive value of the NANO scale to determine overall survival remains unclear in IDH-wt GBM. METHODS: We report on an ongoing study using the NANO scale to evaluate neurologic function in patients with IDH-wt GBM, seen at Dana-Farber Cancer Institute (DFCI). Patient demographics, tumor histology and molecular status, treatment history and progression dates are being captured. NANO score, as collected by a built-in scale in our institutional electronic medical record (EMR), functional status (Karnofsky performance status) and corticosteroid dose are collected at prespecified time points (prior to start of therapy, and during each subsequent MRI visit). Changes in the NANO score will be correlated to overall survival. Statistical analyses including descriptive data analysis and generalized linear models will be performed using R (version 3.4.3). RESULTS: Since June 2020, 50 patients have been enrolled in this study, including 42 (84%) with ≥2 follow up visits. Study accrual was initially impacted by the COVID-19 pandemic, but adaptation to a virtual platform for NANO allowed for improved recruitment and follow up of patients. Study results will be available for discussion at the 2021 SNO conference. CONCLUSIONS: Evaluation of neurologic function by NANO is feasible in a virtual framework in a prospective study in patients with GBM, aided by integration of the scale in our institutional EMR. NANO is able to objectively track neurologic function throughout disease course in IDH-wt GBM.
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In the growing pandemic of COVID-19, the reality many face includes insufficient testing, limited personal protective equipment (PPE), and high risk of infection to those on the front lines providing essential care. With a lack of effective treatment and no vaccine in sight, a high rate of morbidity and mortality looms. Osteopathic manipulative treatment (OMT) has been shown in numerous studies to support the body's own healing mechanisms, including beneficial effects on respiratory infections. Based on well-established osteopathic principles, the osteopathic self-treatment (OST) aims to promote optimal respiration, circulation (venous, arterial, and lymphatic), immune function, balance of the autonomic nervous system, reduced stress, and improved homeostasis. This OST provides exercises designed to remove obstacles to the body's own functions and therefore promote improved health. It is warranted for those at risk of infection or those already testing positive. There is particular utility in these approaches for patients that must self-isolate and socially distance such as during the 2020 COVID-19 pandemic. © 2020 American Academy of Osteopathy. All rights reserved.
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TOPIC: Diffuse Lung Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Sarcoidosis is a multisystem disorder of unknown etiology. Some cases are attributed to genetic factors, an inflammatory response by specific antigens including self-antigen, and autoimmune involvement. Ninety percent of patients with sarcoidosis have lung involvement, and a vast portion is asymptomatic. Most common initial symptoms are dry cough and dyspnea, however, manifestation can be unspecific and broad. Ocular manifestations like uveitis are a classical presentation. Cutaneous manifestations have also been associated with sarcoidosis but incidence is around 1.9 per 100,000 with a female predominance. Diagnosis can be performed from clinical, and radiological findings yet one of the most essential criteria is histopathological findings of non-caseating granulomas on a tissue biopsy. Here is a rare presentation of a Hispanic male with sarcoidosis after exposure to an unusual antigen. CASE PRESENTATION: A 32-year-old man came to the emergency department with dyspnea, dry cough, and bilateral eye redness of one week of evolution and ten days after the second dose of the SARS-CoV-2 vaccine. Before these symptoms, the patient experienced multiple desquamating tattoos and bilateral eye redness after the first dose of the vaccine, which presumed that resolved with tobramycin and dexamethasone eye drops. Physical examination was notable for tattoo peeling with surrounding erythematous papules and tenderness to palpation. Eye examination revealed an intact visual acuity bilaterally with hyperemia and conjunctival injection. Ophthalmology made the diagnosis of non-granulomatous bilateral anterior uveitis. Routine laboratories were unremarkable including angiotensin-converting enzyme levels except for erythrocyte sedimentation rate on 32mm/Hr and arterial blood gas with a partial pressure of oxygen of 72 mmHg. Chest radiograph revealed innumerable bilateral centrilobular nodules. Chest Computerized tomography showed bilateral centrilobular diffuse pulmonary nodules with associated mediastinal paratracheal and mediastinal lymphadenopathy. Skin biopsy revealed a nodular infiltrate of histiocytes with black foreign body deposits with non-caseating sarcoid granulomas. Treatment consisted of prednisone and azathioprine resulting in an improvement of symptoms the following days. DISCUSSION: The side effects of this novel ribonucleic acid vaccine are not well described yet, but our case raises the suspicion if the vaccine arouses or unmask autoimmune diseases like the one previously described. CONCLUSIONS: More studies and data are required on side effects to assess other possible complications, response to the vaccine, and which patients are at risk of developing autoimmune or serious health conditions. REFERENCE #1: Grunewald, J., Grutters, J. C., Arkema, E. V., Saketkoo, L. A., Moller, D. R., & Müller-Quernheim, J. (2019). Sarcoidosis. Nature Reviews Disease Primers, 5(1).doi:10.1038/s41572-019-0096-x REFERENCE #2: Greco FG, Spagnolo P, Muri M, et al. The value of chest radiograph and computed tomography in pulmonary sarcoidosis. Sarcoidosis, Vasculitis, and Diffuse Lung Diseases: Official Journal of WASOG. 2014 Jul;31(2):108-116. REFERENCE #3: Saygin, D., Karunamurthy, A., English, J., & Aggarwal, R. (2018). Tattoo reaction as a presenting manifestation of systemic sarcoidosis. Rheumatology. doi:10.1093/rheumatology/key316 DISCLOSURES: No relevant relationships by Jose Colon-Marquez, source=Admin input No relevant relationships by Ian Da Silva Lugo, source=Web Response No relevant relationships by Juan Feliciano-FIgueroa, source=Web Response No relevant relationships by Gabriela Negron-Ocasio, source=Web Response No relevant relationships by Stephanie Ortiz-Troche, source=Web Response No relevant relationships by Kimberly Padilla Rodriguez, source=Admin input No relevant relationships by Jerome Ramirez-Marquez, source=Web Response No relevant relationships by Juan Santiago, source=Web Response No relevant relationships by Luis Velazquez, source=Web Response